Inspection·September 10, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 8/21/2025 and timed at 7:10 a.m., the Nurses Notes indicated Resident 1's family called 911 because Resident 1 was not feeling well. The Nurses Notes indicated paramedics transferred Resident 1 to a General Acute Care Hospital (GACH). During a review of the GACH's Face Sheet, the Face Sheet indicated Resident 1 was admitted to GACH on 8/21/2025 at 11:14 a.m., with diagnoses including pneumonia (an infection/inflammation of the lungs), secondary to the Covid 19 virus (a potentially severe respiratory illness caused by a coronavirus and characterized by fever, coughing, and shortness of breath) and hypoxia (low levels of oxygen in your body tissue causing symptoms like, restlessness and difficulty breathing). During an interview on 9/8/2025 at 10:30 a.m., Resident 1 stated on 8/20/2025 shortly after 12 a.m., he was feeling short of breath (SOB) and was afraid to lie down in bed because he was afraid that he might choke. Resident 1 stated he asked LVN 1 to call his physician to inform him that he (Resident 1) was having difficulty breathing and was SOB. Resident 1 stated for the majority of the 11 p.m. - 7 a.m. shift on 8/20/2025, he sat up on the edge of his bed or in a wheelchair because it helped him breathe. Resident 1 stated LVN 1 gave him pain medicine for his headache and cough drops for his throat which really didn't help. Resident 1 stated he felt increasingly anxious and nervous and thought the nursing staff did not believe he was having difficulty breathing. Resident 1 stated his family called 911 on 8/21/2025 and he was transferred to the GACH on 8/21/2025 at approximately 7 a.m. During a telephone interview on 9/9/2025 at 12:10 a.m., LVN 1 stated on 8/20/2025 at approximately 12 a.m., she observed Resident 1 with a cough and congestion, he was restless and agitated but did not appear to be SOB. LVN 1 stated Resident 1 did not want to lay in bed because he thought he might choke. LVN 1 stated this was the first time she observed Resident 1 in this condition, so she initiated a COC by texting Resident 1's physician's via the nurse supervisor's cell phone to notify him that Resident 1 had a cough and congestion but stated she did not notify Resident 1's physician that Resident 1 felt like he was choking. LVN 1 stated Resident 1's physician did not respond during her shift (11 p.m. - 7 a.m.) so she endorsed Resident 1's care to the oncoming nurse (7 a.m. - 3 p.m.). LVN 1 stated she should have followed up with Resident 1's physician when he did not respond to the text messages, notified the Medical Director and/or the Director of Nursing (DON). During an interview on 9/10/2025 at 1 p.m., Resident 1's physician stated he received text messages from the facility nursing staff at approximately 12:30 a.m., and 3:30 a.m., on 8/20/2025 regarding Resident 1's cough and congestion but he was not informed that Resident 1 felt like he was choking. Resident 1's physician stated he did not know why he did not respond to the text messages until almost 9 a.m. Resident 1's physician stated if the nursing staff had reported that Resident 1 felt like he was going to choke he would have ordered different interventions, such as an Xray and/or transferred Resident 1 to the GACH. During an interview on 9/10/2025 at 2:20 p.m., the DON stated physicians should be available to respond to calls or text messages from the nursing staff 24 hours a day to meet the needs of the residents. The DON stated when LVN 1 did not receive a response from Resident 1's physician she should have called her (DON) or the Medical Director. During a review of the facility's Policy, and Procedure, (P/P), titled, Change of Condition Notification dated 10/1/2023, the P/P indicated the purpose of the policy is to ensure residents, family, legal representative and physicians are informed of changes in the resident's condition in a timely manner. The P/P indicated the attending physician will be notified in a timely with a resident's change in condition, the notification to the attending physician will include a summary of the condition change and an assessment of the resident's vital signs and system review focusing on the condition and or signs and symptoms for which the notification is required, in emergency situations (resident is experiencing unexpected shortness of breath, intense pain, unexpected bleeding, serious abnormal labs or x-ray), the Licensed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056425 If continuation sheet Page 2 of 7 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 056425 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Studebaker Healthcare Center 13226 Studebaker Rd Norwalk, CA 90650 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 Nurse will immediately call the attending physician, if the LVN is unable to reach the attending physician or the physician on call during emergency situations, she will notify the facility's medical director. The P/P indicated the licensed nurse will document the time the attending physician was contacted, the method by which he/she was contacted, response time and whether orders were received. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056425 If continuation sheet Page 3 of 7 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 056425 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Studebaker Healthcare Center 13226 Studebaker Rd Norwalk, CA 90650 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide the results of multiple grievances filed by one of three sampled resident's (Resident 1) and/or their responsible party (RP). This deficient practice resulted in Resident 1 and/or his RP not being aware of the outcome/resolution of the grievances filed by him and his RP, which led to distrust toward the facility. This deficient practice had the potential to delay the delivery of care and services to Resident 1 and could negatively impact Resident 1's mental health and emotional well-being.Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including amyotrophic lateral sclerosis ([ALS] a progressive disease that leads to muscle weakness and eventual loss of the ability to move, speak, swallow, or breathe), diabetes type 2 ([DM] a disorder characterized by difficulty in blood sugar control and poor wound healing), and major depressive disorder ([MDD] a mood disorder that causes a persistent feeling of sadness and loss of interest) During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool), dated 8/8/2025, the MDS indicated Resident 1 was cognitively intact (no impairment in the ability to think, learn, remember, use judgement, and make decisions) and had the ability to understand and be understood by others. During a review of Resident 1's Resident Grievance/Complaint Investigation reports dated 8/6/2025, 8/8/2025, 8/10/2025, 8/20/2025, 8/26/2025 and 9/3/2025, the Resident Grievance/Complaint Investigation reports indicated the grievances were investigated by the facility, but documentation on the reports did not indicate that Resident 1 and/or Resident 1's RP were notified regarding the results/resolution of the facility's investigation. During an interview on 9/8/2025 at 10:30 a.m., Resident 1 stated he had filed multiple grievances since his admission to the facility in 4/2025, regarding what he believed were violations of resident rights and substandard quality of care. Resident 1 stated he made his complaints known to the licensed nurses, the Social Services Director (SSD), the Director of Nursing (DON) and the Administrator, verbally and in writing. Resident 1 stated his family also filed grievances on his behalf. Resident 1 stated he had not been provided an update on the status of his grievances and was unsure if the facility investigated his concerns and whether there had been any resolutions. Resident 1 stated he felt stressed, helpless and frustrated at the lack of communication regarding his grievances, so he escalated the complaints to the California Department of Public Health (CDPH). Resident 1 stated he feels hopeless and was scared that in few months his disease would progress and prevent him from speaking and he wanted to know that he could trust the facility to address his concerns while he could still speak. Resident 1 stated, he had asked repeatedly for the status of his grievances to be given to him in writing, but his request fell on deaf ears. During an interview on 9/9/2025 at 2:42 p.m., the SSD stated Resident 1's Resident Grievance/Complaint Investigation reports dated 8/6/2025, 8/8/2025, 8/10/2025, 8/20/2025, 8/26/2025 and 9/3/2025, were discussed with him, however, the status/update of those grievances were not provided to him in writing because she thought it was sufficient to discuss the outcomes in person. The SSD stated Resident 1 should have received the status/outcome of his grievances in writing, per his request, and not doing so could contribute to his distrust toward facility staff. During an interview on 9/11/2025 at 2:20 p.m., the DON stated, residents have the right to be updated timely on the status of their grievances. The DON stated failure to provide timely updates to Resident 1 could cause mistrust toward the facility and potentially delay the delivery of care and services to Resident 1. During a review of the facility's Policy and Procedure (P/P) titled, Grievances and complaints, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056425 If continuation sheet Page 4 of 7 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 056425 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Studebaker Healthcare Center 13226 Studebaker Rd Norwalk, CA 90650 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete dated 10/1/2023, the P&P the purpose of the policy is to ensure that residents, family members and representatives know about the procedure for filing grievances and complaints . The P/P indicated upon receiving a resident grievance/complaint form, the Grievance official or designee begins an investigation into the allegations. the facility will inform the resident or his or her representative of the finding of the investigation and any corrective actions recommended in a timely manner, if the resident is not satisfied with the result of the investigation or recommended actions, he may file a written complaint to local Long Term Ombudsman office or to the Department of Public Health. During a review of the facility's policy, and procedure (P/P) titled, Grievances and complaints, dated October 1, 2023, the P&P the purpose of the policy is to ensure that residents, family members and representatives know about the procedure for filing grievances and complaint, any resident, representative, family member or appointed advocate may file a grievance or complaint concerning treatment, medical care, behavior of other residents, theft of property without fear of threat or reprisal In any form. The P/P indicated upon receiving a resident grievance/complaint form, the Grievance official or designee begins an investigation into the allegations. The Grievance official will take immediate action to prevent further potential violations of resident right while the alleged violation is being investigated. The P/P further indicated the facility will inform the resident or his or her representative of the finding of the investigation and any corrective actions recommended in a timely manner, if the resident is not satisfied with the result of the investigation or recommended actions, he may file a written complaint to local Long Term Ombudsman office or to the department of public health. Event ID: Facility ID: 056425 If continuation sheet Page 5 of 7 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 056425 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Studebaker Healthcare Center 13226 Studebaker Rd Norwalk, CA 90650 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 0713 Provide or arrange emergency care by a doctor 24 hours a day. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Cross referenced to F580Based on interview and record review, the facility failed to ensure a physician responded to one of three sampled resident's (Resident 1) change of condition in a timely manner when Resident 1's physician (MD 1) did not respond to Licensed Vocational Nurse (LVN 1) text messages on 8/20/2025 for greater than eight hours. This deficient practice resulted in Resident 1 experiencing increased anxiety (persistent an excessive worry which interferes with daily activities) and potential delay in needed care and services, including transfer to the General Acute Care Hospital (GACH). Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including amyotrophic lateral sclerosis ([ALS] a progressive disease that leads to muscle weakness and eventual loss of the ability to move, speak, swallow, or breathe), diabetes type 2 ([DM] a disorder characterized by difficulty in blood sugar control and poor wound healing), and major depressive disorder ([MDD] a mood disorder that causes a persistent feeling of sadness and loss of interest) During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool), dated 8/8/2025, the MDS indicated Resident 1 was cognitively intact (no impairment in the ability to think, learn, remember, use judgement, and make decisions) and had the ability to understand and be understood by others. During a review of Resident 1's Nurses Notes , dated 8/20/2025 and timed at 12:45 a.m., the Nurses Notes documented indicated at the beginning of the shift Resident 1 complained of a headache and requested to have his blood pressure ([B/P] 117/86, normal B/P 120/80) checked, Resident 1 then complained of a cough and congestion. The Nurses Note indicated Resident 1 was administered Ibuprofen (Tylenol) at 12:11 a.m., for a headache, and at 2:15 a.m., Cepacol (a medication used to treat a sore throat) was administered to Resident 1 for a sore throat. The Nurses Note indicated Resident 1 wanted to lie down but voiced fear of choking and wished to remain sitting for the remainder of shift. The Nurses Note indicated Resident 1's physician was notified of Resident 1's complaints of congestion and cough (via text message at 12:22 a.m. and 3:40 a.m.), only, and not that he felt he might choke or his B/P. During a review of Resident 1's Change of Condition (COC), dated 8/20/2025 and timed at 3:41 a.m., the COC indicated Resident 1 had a cough and congestion. During a review of the Charge Nurse Cell Phone Log dated 8/20/2025, the Charge Nurse Cell Phone Log indicated LVN 1 sent text messages to Resident 1's physician related to Resident 1's symptoms of a cough and congestion on 8/20/2025 at 12:22 a.m. and again at 3:40 a.m. The Charge Nurse Cell Phone Log indicated Resident 1's physician responded via text message on 8/20/2025 at 8:56 a.m. (over eight hours after the first text message was sent to him). During a review of Resident 1's Nurses Notes dated 8/21/2025 and timed at 7:10 a.m., the Nurses Notes indicated Resident 1's family called 911 because Resident 1 was not feeling good. The Nurses Note indicated paramedics transferred Resident 1 to a General Acute Care Hospital (GACH). During a review of the GACH's Face Sheet, the Face Sheet indicated Resident 1 was admitted to GACH on 8/21/2025 at 11:14 a.m., with diagnoses including pneumonia (an infection/inflammation of the lungs), secondary to the Covid 19 virus (a potentially severe respiratory illness caused by a coronavirus and characterized by fever, coughing, and shortness of breath) and hypoxia (low levels of oxygen in your body tissue causing symptoms like, restlessness and difficulty breathing). During an interview on 9/8/2025 at 10:30 a.m., Resident 1 stated on 8/20/2025 shortly after 12 a.m., he was feeling short of breath (SOB) and was afraid to lie down in bed because he was afraid that he might choke. Resident 1 stated he asked LVN 1 to call his physician to inform him that he (Resident 1) was having difficulty breathing and was SOB. Resident 1 stated for the majority of the 11 p.m. - 7 a.m. shift on 8/20/2025, he sat up on the edge of his bed Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056425 If continuation sheet Page 6 of 7 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 056425 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Studebaker Healthcare Center 13226 Studebaker Rd Norwalk, CA 90650 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 0713 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete or in a wheelchair because it helped him breathe. Resident 1 stated LVN 1 gave him pain medicine for his headache and cough drops for his throat which really didn't help. Resident 1 stated he felt increasingly anxious and nervous and thought the nursing staff did not believe he was having difficulty breathing. Resident 1 stated his family called 911 on 8/21/2025 and he was transferred to the GACH on 8/21/2025 at approximately 7 a.m. During a telephone interview on 9/9/2025 at 12:10 a.m., LVN 1 stated on 8/20/2025 at approximately 12 a.m., she observed Resident 1 with a cough and congestion, he was restless and agitated but did not appear to be SOB. LVN 1 stated Resident 1 did not want to lay in bed because he thought he might choke. LVN 1 stated this was the first time she observed Resident 1 in this condition, so she initiated a COC by texting Resident 1's physician's via the nurse supervisor's cell phone to notify him that Resident 1 had a cough and congestion but stated she did not notify Resident 1's physician that Resident 1 felt like he was choking. LVN 1 stated Resident 1's physician did not respond during her shift (11 p.m. - 7 a.m.) so she endorsed Resident 1's care to the oncoming nurse (7 a.m. - 3 p.m.). LVN 1 stated she should have followed up with Resident 1's physician when he did not respond to the text messages, notified the Medical Director and/or the Director of Nursing (DON). During an interview on 9/10/2025 at 1 p.m., Resident 1's physician stated he received text messages from the facility nursing staff at approximately 12:30 a.m., and 3:30 a.m., on 8/20/2025 regarding Resident 1's cough and congestion but he was not informed that Resident 1 felt like he was choking. Resident 1's physician stated he did not know why he did not respond to the text messages until almost 9 a.m. Resident 1's physician stated if the nursing staff had reported that Resident 1 felt like he was going to choke he would have ordered different interventions, such as an Xray and/or transferred Resident 1 to the GACH. During an interview on 9/10/2025 at 2:20 p.m., the DON stated physicians should be available to respond to calls or text messages from the nursing staff 24 hours a day to meet the needs of the residents. The DON stated when LVN 1 did not receive a response from Resident 1's physician she should have called her (DON) or the Medical Director. During a review of the facility's policy, and procedure (P/P) titled, Physician Services and Visits dated 10/1/2023, the P/P indicated the purpose of the policy is to ensure that the facility provides residents with care under an Attending Physician. The P/P indicated physician services include .providing consultation or treatment when called by the facility and provision for alternate physician coverage in the event the Attending physician is not available. During a review of the facility's P/P titled, Change of Condition Notification, dated 10/1/2023, the P/P indicated. the Licensed Nurse will immediately call the attending physician, if the LVN is unable to reach the attending physician or the physician on call during emergency situations, she will notify the facility's medical director. The P/P indicated the licensed nurse will document the time the attending physician was contacted, the method by which he/she was contacted, response time and whether orders were received Event ID: Facility ID: 056425 If continuation sheet Page 7 of 7