Health inspection·July 30, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 1's Resident Representative Notification section of the Change of Condition Note, dated 7/25/2025, was reviewed. The Resident Representative Notification section indicated RP 1 was notified of the incident on 7/25/2025 at 3:16 p.m. The Resident Representative Notification section indicated RN 1 signed the completion of the section. RN 1 stated after a change of condition occurred, it was important to notify the resident's RP because it was the RP's right to be aware of any changes that occurred in the resident. RN 1 stated if RP 1 was not successfully contacted, then a voicemail should be left and a follow-up call should occur to ensure the RP was notified. RN 1 stated she recalled, on 7/25/2025, she helped Licensed Vocational Nurse (LVN) 1 with documenting after the incident. RN 1 stated she signed the notification section of the Change of Condition Note because she thought LVN 1 was able to successfully notify RP 1 of the incident. RN 1 stated if LVN 1 was unable to speak to RP 1, then a voicemail should have been left and documented, or LVN 1 should have followed up or endorsed a need for a follow-up for the next shift. RN 1 stated there was no documentation to indicate LVN 1 left a voicemail or followed up. During an interview on 7/30/2025 at 12:21 p.m. with LVN 1, LVN 1 stated the normal process was to notify the resident's RP of any changes of condition. LVN 1 stated she called RP 1's number but was not able to speak with RP 1. LVN 1 stated she left a voicemail, but did not document that a voicemail was left. LVN 1 stated she did not document or follow up to ensure RP 1 was informed of Resident 1's change of condition because the shift was chaotic and that she was very busy. During a concurrent record review and interview on 7/30/2025 12:34 p.m. with the Director of Nursing (DON), Resident 1's Resident Representative Notification section of the Change of Condition Note, dated 7/25/2025, was reviewed. The Resident Representative Notification section indicated RP 1 was notified of the incident on 7/25/2025 at 3:16 p.m. There was no documentation to indicate a voicemail was left or follow-up attempts were made. The DON stated the normal expectation for any change of condition was to document the notification to the physician and RP. The DON stated if RP 1 did not answer her phone, LVN 1 should have continued to follow up or endorse to the following shift to follow up. The DON stated LVN 1 should have left a voicemail and documented that a voicemail was left. The DON stated RP 1 had the right to be made aware of any change of conditions that occurred with Resident 1 and the licensed nursing staff had the responsibility to ensure RP 1 was made aware of Resident 1's physical altercation. The DON stated the lack of documentation and follow-up led to a delay in RP 1's notification of Resident 1's involvement in a physical altercation. 2. During a review of Resident 1's Progress Notes, dated 7/25, 7/26, 7/27, 7/28, 7/29, and 7/30/2025, the Progress Notes did not indicate RP 1 was made aware of Resident 1's Interdisciplinary Team (IDT) conference held on 7/28/2025. During a review of Resident 1's IDT Conference Note, dated 7/28/2025, the IDT Conference Note indicated RP 1 was notified of the IDT conference. During an interview on 7/30/2025 at 11:41 a.m. with RP 1, RP 1 stated she never received notification of an IDT conference. During a concurrent record review and interview on 7/30/2025 at 11:48 a.m. with the Program Director (PD), Resident 1's IDT Conference Note, dated 7/28/2025, was reviewed. The IDT Conference Note indicated RP 1 was notified of the IDT conference. The PD stated the purpose of an IDT was to follow up on an incident to try to see what we can do to make sure it does not happen again and to formulate a plan of care. The PD stated it was important the RP was involved or notified of the IDT conference because the RP [had] the power and the facility had to consult with the RP to ensure he or she was in agreeance with the plan of care. The PD stated he completed and signed the IDT Conference Note that indicated RP 1 was notified of the IDT conference meeting on 7/28/2025. The PD stated he did not personally call and ensure RP 1 was made aware of the IDT conference meeting (on 7/28/2025) or the incident (on 7/25/2025) because he assumed LVN 1 successfully notified RP 1 based on her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056417 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 056417 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE View Heights Conv Hosp 12619 S. Avalon Blvd Los Angeles, CA 90061 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete documentation. The PD stated it was not his practice to call the RP before an IDT conference was scheduled because he relied on the RP to call and follow up with the facility, especially if there was a major injury. The PD stated RP 1 should have been aware of the IDT conference because she is the one that has the power and had the right to be informed of what is happening with the client. During a concurrent interview and record review on 7/30/2025 at 12:34 p.m. with the DON, Resident 1's IDT Conference Note, dated 7/28/2025, was reviewed. The IDT Conference Note indicated RP 1 was notified of the IDT conference. The DON stated an IDT conference was designed to ensure a treatment plan was developed through the involvement of the department heads, the resident, and the RP. The DON stated the RP was usually notified ahead of time so that the RP can meet with the facility staff at a scheduled time and can be a part of the resident's treatment plan. The DON stated RP 1 should have been made aware and notified of the IDT meeting, so RP 1 could have had an opportunity to be a part of the treatment plan. The DON stated the form was inaccurately completed if the PD indicated RP 1 was notified of the IDT meeting based on the notification documentation in Resident 1's Change of Condition Note. During a review of the facility's P&P titled, Resident-Resident Abuse Policy, dated 2023, the P&P indicated the facility was to notify each resident's legal representative should the resident be observed in a physical altercation with another resident.During a review of the facility's Policy and Procedure (P&P) titled, Change in a Resident's Condition, dated 12/2024, the P&P indicated the facility shall promptly notify the resident's Conservator/ Los Angeles Public Guardian of changes in the resident's medical/mental condition. The P&P indicated the nurse supervisor/ charge nurses would notify the resident's representative with the exception of those residents that are conserved in which the conservator would be notified when the resident is involved in any accident or incident that results in an injury including injuries of an unknown source. The P&P indicated notification would be made within the assigned shift of a change occurring in the resident's medical/ mental condition or status. During a review of the facility's P&P titled, Careplan Guidelines, dated 12/2024, indicated the Interdisciplinary Team would work in coordination with private or public guardians, and appropriate family members to develop and maintain a comprehensive care plan for each resident. Event ID: Facility ID: 056417 If continuation sheet Page 3 of 3