Health inspection·January 13, 2026

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to administered medication Lyrica (a medication that treats nerve pain) as ordered for neuropathy (disease or dysfunction of one or more nerves, typically causing numbness, tingling, burning pain in the hands and feet) for one of two sampled residents (Resident 1) as ordered by the attending physician. This deficient practice resulted in the resident missing the medication as scheduled and could result in increased discomfort. During a record review of Resident 1's admission Record (AR), dated 12/20/2025, the AR indicated Resident 1was admitted to the facility on [DATE] with medical diagnoses that included Diabetes Mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), ESRD (End Stage Renal Disease-irreversible kidney failure) with hemodialysis (a treatment to cleanse the blood of wastes and extra fluids artificially through a machine when the kidney(s) have failed). During a record review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 12/25/2025, the MDS indicated that Resident 1's cognitive skills (related to thinking, reasoning, decision making and problem solving) were cognitively intact. The MDS further indicated Resident 1 required substantial/maximal assistance on staff for shower/bathe self and putting on and off footwear. Partial/moderate assistance for lower body dressing, upper body dressing, and toileting hygiene. During a record review of Resident 1's Order Summary Report dated 12/20/2025, the report indicated a physician order for Lyrica 150 mg milligrams (mg- metric unit of measurement, used for medication dosage and/or amount) give 1 capsule by mouth three times a day for neuropathy (disease or dysfunction of one or more nerves, typically causing numbness or weakness in the hands and feet). During a concurrent interview and record review on 1/13/2026 of Resident 1's Order Summary Report dated 1/2/2026, the report indicated transfer of care from Physician 1 to Physician 2. The Director of Nursing (DON) stated the attending physician (Physician 1) was not responding to the facility and pharmacy staff calls for the care of Resident 1. The DON stated this was communicated to the Medical Director (Physician 2) who took over the care of Resident 1. During a concurrent interview and record review on 1/13/2026 at 12:10 PM with the Director of Nurses (DON), the Medication Administration Record (MAR), dated 12/01/2025 - 12/31/2025, and 1/1/2026 - 1/31/2026 was reviewed. The MAR indicated that Lyrica was not administered due to it being unavailable from the pharmacy. The DON stated that the facility's pharmacy had faxed a Request for New/Continuance of Schedule II-V Medication Therapy authorization to the facility and to the physician, but the attending physician did not respond to the pharmacy or the facility. The DON stated that the physician was not responding and could not provide services to Resident 1. The facility's medical director was then made aware and took over the care of Resident 1. During an interview with the Registered Pharmacist (RP) on 1/14/2026 at 10:27 AM the RP stated that on 12/22/2025 the pharmacy faxed a Request for New/Continuance of Schedule II-V Medication Therapy authorization for approval to the facility and to the physician. The authorization was not received by the physician. On 1/2/2026 the Request for New/Continuance of Schedule II-V Medication Therapy authorization approval was re-sent to the facility and the attending physician but was not received. RP stated that the pharmacy was not made aware of Resident 1's change of physician on 1/2/2026. RP stated on 1/8/2026 the pharmacy finally received the authorization approval for Lyrica from the physician. During an interview on 1/13/2026 at 4:11 PM with the Director of Nursing (DON), stated that it is important to administer medications as ordered by the physician to prevent relapse of conditions or withdrawal symptoms depending on the medication. During a review of the facility's policy and procedure (P&P) titled, Medication Therapy, dated 12/2017, The P&P indicated, shortly after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056413 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 056413 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/13/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Temple City Healthcare 5101 Tyler Avenue Temple City, CA 91780 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm admission of a resident the staff and the practitioner assisted by the consultant pharmacist will review the current medication regimen. During a review of the facility's policy and procedure (P&P) titled, Physician Services, dated 6/2022, the P&P indicated, the facility must ensure that the medical care of each resident is supervised by a physician and to ensure that another physician supervises the medical care of residents when their attending physician is unavailable. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056413 If continuation sheet Page 3 of 3