Health inspection·December 2, 2025

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to 11.7 fl. d. Hemoglobin A1C (HgbA1C) of 6.6 percent, with a normal range between 4.6 to 5.6 percent. e. Digoxin level of 0.4 nanograms per deciliter (Ng/dl) with a normal range between 0.8 Ng/dl to 2.0 Ng/dl. f. Triglycerides (the main type of fat in the body) of 203 milligrams ([mg] a metric unit of measurement, used for medication dosage and/or amount)/per deciliter (mg/ dl) with a normal range of less than 150 mg/dl. g. High Density Cholesterol ([HDL] also known as good cholesterol) of 19 mg/dl, with a normal range of less than 40 mg/dl. h. Neutrophils (the most common type of white blood cell) Absolute (the actual number of disease fighting white blood cells) of 8.3 per mcl, with a normal range between 2.0 to 8.1 per mcl. i. Lymphocytes (a white blood cell that destroys bacteria and viruses) of 8.0 per mcl with a normal range between 14.0 to 52.0 per mcl. j. Monocytes (a white blood cell that destroys germs and eliminate infected cells in the body) of 12.0%, with a normal range between 1.0% to 11.0%. k. Monocytes Absolute of 1.3 thou/mcl, with a normal range between 0.0 thou/ul to 0.8 thou/ul. l. Sodium ([Na] an electrolyte that regulates fluid levels, transmits nerve signals in the body and contract muscles) level of 158 millimoles/liter (mmol/l) with a normal range between 136 mmol/l to 145 mmol/l. m. Chloride ([Cl] an electrolyte that maintains the fluid balance, blood pressure and acid-base balance in the body) level of 112 mmol/l, with a normal range between 98 mmol/l - 107 mmol/l. n. Electrolyte Balance (a state of the body when there is the right amount of minerals) of 15 mmol/l, with a normal range between 2 mmol/l to 12 mmol/l. o. Glucose (blood sugar [b/s]) level of 358 mg/dl with normal range between 85 mg/dl to 125 mg/dl. p. Blood Urea Nitrogen ([BUN] a test that reveals the function of the kidneys) of 150 mg/dl, with a normal range between 7 mg/dl to 25 mg/dl. q. Creatinine (a waste product produced by muscle breakdown, which higher levels may indicate impaired kidney function) of 3.7 mg/dl, with normal range between 0.7 mg/dl to 1.3 mg/dl. r. Glomerular Filtration Rate ([eGFR] a measurement of how well the kidneys filter waste from the blood) of 17 ml/minute/1.73 square meters (sq/m), with a normal range of more than or equal to 60 ml/minute/1.73 sq/m. s. Albumin (a protein in the blood that maintains fluid balance in the body) of 4.0 grams (g)/dl, with a normal range between 4.2 g/dl to 5.5 g/dl. t. Aspartate Amino Transferase ([AST] a test used for monitoring the liver health overtime) of 201 u/l, with a normal range between 13 u/l to 39 u/l. u. Alanine Aminotransferase ([ALT] a test done to identify potential liver problem) of 228 u/l, with a normal range between 7 u/l to 52 u/l. During a review of Resident 1's clinal record (Nursing Notes, Laboratory Results, Physician Progress Notes), the clinical record indicated there was no documentation indicating Resident 1's physician was notified of Resident 1's Lab Results. During a review of Resident 1's Change of Condition (COC) Evaluation dated 9/10/2025 and timed at 9:19 a.m., the COC indicated Resident 1 had abnormal lab results and Resident 1's physician ordered Resident 1 to be transferred to a GACH. During a review of Resident 1's Order Summary (Physician Orders) dated 9/10/2025, the Physician's Order indicated to transfer Resident 1 to the GACH at 12 p.m., for further evaluation due to abnormal lab results. During a review of Resident 1's Transfer Form dated 9/10/2025 and timed at 9:22 a.m., the Transfer Form indicated Resident 1 had an unplanned transfer to a GACH due to abnormal kidney function. During a review of the GACH's Emergency Note dated 9/10/2025 and timed at 12:56 p.m., the Emergency Note indicated Resident 1 was assessed with dry mucous membranes (a thin, wet, tissue layer that lines body cavities and passages that open to the outside, such as the mouth, nose, digestive tract, and respiratory tract) and was sleepy with a blood pressure ([BP] of 91/61 (with a normal range of less than 120/80 millimeters of mercury (mmHg), and a heart rate (HR) of 44 beats per minute (bpm) (with a normal range between 60 to 100 bpm. The Emergency Note indicated Resident 1 had the following abnormal laboratory results in the GACH: 1. WBC - 11.1 uL 2. Sodium- 157 mg/dl 3. Potassium - 5.7 mg/dl 4. Chloride- 114 mg/dl 5. BUN- 174 mg/dl 6. Creatinine (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056425 If continuation sheet Page 2 of 6 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 12/02/2025 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 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few level= 3.42 mg/dl 7. Random blood sugar- 226 mg/dl 8. International Normalized Ratio ([INR] a measurement used to measure how long it takes a person's blood to clot) of 1.7 INR, with a normal range between 0.8 INR to 1.2 INR 9. AST of 202 U/L 10. ALT of 267 U/L 11. Total Bilirubin (a test to check for liver damage or disease) 1.9 mg/dl, with a normal range of 0.2 mg/dl to 1.2 mg/dl. During a review of the GACH's History and Physical (H&P) dated 9/10/2025 and timed at 4 p.m., the H&P indicated Resident 1 was restless, unable to follow commands and dehydrated. The H&P indicated Resident 1 was admitted for further medical treatment due to severe dehydration, hypernatremia, hypotension and non-traumatic acute kidney injury. The H&P indicated, Resident 1 was given an intravenous ([IV] within or through the vein) bolus (a single, concentrated dose of medication or fluid given over a short period to achieve a rapid therapeutic effect to quickly raise the substance's concentration in the blood stream to an effective level) for hydration (the process of supplying water to the body, either by drinking fluids, eating water-rich foods or by medical means to ensure it has enough fluid to function properly), and (IV) fluid maintenance at 150 milliliters (ml)/per hour. During a telephone interview on 9/25/2025 at 12:33 p.m., Registered Nurse Supervisor (RNS) 3 stated on 9/9/2025 during the 3 p.m. to 11 p.m. shift, she did not recall receiving any endorsement from the outgoing (7 a.m. to 3 p.m.) nurse related to Resident 1's lab results. RNS 3 stated it was the responsibility of the licensed nurses to report abnormal lab results to Resident 1's physician during the shift that the lab results were reported to the facility. During an interview on 9/25/2025 at 2:03 p.m., RNS 1 stated on 9/9/2025 during the 7 a.m. to 3 p.m. shift, Resident 1's lab results were still pending (not available) through the end of the shift. RNS 1 stated she should have documented in Resident 1's progress notes that she followed up on Resident 1's lab results. RNS 1 stated when she came back to work the next day (9/10/2025) at 7 a.m., she reviewed the lab results from the previous day (9/9/2025) and found Resident 1's physician had not given any instructions related to Resident 1's abnormal lab results. RNS 1 stated she immediately called Resident 1's physician and received orders to transfer Resident 1 to the GACH for evaluation and treatment because of the abnormal lab results received on 9/9/2025. During a telephone interview on 9/25/2025 at 3 p.m., Licensed Vocational Nurse (LVN) 1 stated on 9/9/2025 during the 3 p.m. to 11 p.m. shift, she printed Resident 1's lab results, took photos of the results and texted the photos to Resident 1's physician. LVN 1 stated she did not call Resident 1's physician despite the abnormal lab results because Resident 1's physician responded with a text message ‘Ok, meaning the physician acknowledged receipt of the lab results. LVN 1 stated she communicated the results to RNS 3 as well. LVN 1 stated it was not necessary to document the lab results in Resident 1's progress notes because texting Resident 1's physician was enough, and texting the results of the labs was the only documentation the licensed nurses used to relay residents' lab results. During an interview on 9/25/2025 at 3:25 p.m., LVN 3 stated when she came to work on 9/9/2025 at 11 p.m., she was not given a report by the outgoing shift (3 p.m. to 11 p.m.) nurse to follow up with Resident 1's physician regarding pending lab results and there was no endorsements noted in the communication board (a digital display often integrated with the electronic health record, that provides real-time, patient specific information for patients, families and care teams) section of the facility's electronic medical record. During a telephone interview on 9/25/2025 at 3:40 p.m., Resident 1's physician stated the facility's licensed nurses know she does not want residents' lab results sent to her via text message. Resident 1's physician stated during the evening on 9/9/2025 she received Resident 1's lab results from the facility via a text message. Resident 1's physician stated she acknowledged she received the lab results on 9/9/2025, by saying OK but stated she was not able to review the lab results at that time. Resident 1's physician stated the facility's licensed nurses (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056425 If continuation sheet Page 3 of 6 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 12/02/2025 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 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete should have called her with Resident 1's abnormal lab results and she would have instructed the staff to transfer Resident 1 to the GACH immediately for evaluation and treatment. Resident 1's physician stated Resident 1's care was delayed when he was transferred to the GACH on 9/10/2025, the day after the abnormal lab results were received on 9/9/2025. Resident 1's physician stated the delay in transferring Resident 1 to the GACH could have had life threatening consequences. During an interview on 9/25/2025 at 3:45 p.m., the Director of Nursing (DON) stated Resident 1's physician prefers to be called and LVN 1 should have called Resident 1's physician to notify her of Resident 1's abnormal lab results in a timely manner and obtain instructions for care on 9/9/2025, when the abnormal lab results were received to prevent a delay in care and to prevent possible complications. During an interview on 9/25/2025 at 5:01 p.m., the Administrator (ADM) stated all licensed nurses at the facility were expected to call any abnormal lab results to the residents' physician to ensure there was no delay in residents receiving care. During a review of the facility's Policy and Procedure (P/P) titled, Laboratory, Diagnostic and Radiology Services dated 10/1/2023, the P/P indicated the primary care physician will be notified of results that fall outside of the clinical reference or expected normal ranges. Event ID: Facility ID: 056425 If continuation sheet Page 4 of 6 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 12/02/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure Licensed Vocational Nurse (LVN) 1 documented one of three sampled residents (Resident 1) laboratory (lab) results and communication of those lab results in Resident 1's medical record. This deficient practice resulted in an incomplete/inaccurate depiction of Resident 1's general well-being and had the potential for non-continuity of care. Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with diagnosis including acute kidney failure (a condition when the kidneys lose their ability to remove waste and help balance fluids and electrolytes in the body), cerebral infarction (a condition where blood flow to the brain Is interrupted, causing brain tissue damage) and congestive heart failure ([CHF] a heart disorder which causes the heart not to pump the blood efficiently, sometimes resulting in leg swelling). During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool) dated 9/9/2025, the MDS indicated Resident 1 was unable to make decisions that were reasonable and consistent. During a review of Resident 1's Physician Order dated 9/6/2025, the Physician Order indicated to obtain a Complete Blood Count ([CBC] a common blood test that counts and examines the types and numbers of blood cells to check for health problems), a Comprehensive Metabolic Panel ([CMP] a blood test that measures the overall health including metabolism, liver and kidney functions and electrolyte levels), a Hemoglobin A1C (a blood test that shows the average sugar level in the body for the past three months), a Keppra level (a blood test that measures the amount of an anti-seizure medication in the body), a digoxin level (a blood test that measure the amount of medication digoxin in the body) and a lipid panel (a blood test that measure different types of fats in the blood) for Resident 1 on 9/9/2025. During a review of the Resident 1's Lab Results, dated 9/9/2025, drawn at 5:06 a.m., and reported to the facility at 1:32 p.m. (9/9/2025), the Lab Results indicated the following abnormal results: a. [NAME] Blood Cell Count ([WBC] a blood cell that helps attack infection or injury in the body) 10.7 cells per microliter (cells/mcl) with a normal range between 4.0 cell/ul to 10.5 cells/ul b. Red Cell Distribution Width ([RDW] a test that measures the size of the red blood cells) of 15.3%, with a normal range between 11.6% to 14.4%. c. Mean Platelet Volume ([MPV] a test that measures the average size of the blood cells that stop bleeding) of 12.0 femtoliters (fl) with a normal range between 7.2 fl to 11.7 fl. d. Hemoglobin A1C (HgbA1C) of 6.6 percent, with a normal range between 4.6 to 5.6 percent. e. Digoxin level of 0.4 nanograms per deciliter (Ng/dl) with a normal range between 0.8 Ng/dl to 2.0 Ng/dl. f. Triglycerides (the main type of fat in the body) of 203 milligrams ([mg] a metric unit of measurement, used for medication dosage and/or amount)/per deciliter (mg/ dl) with a normal range of less than 150 mg/dl. g. High Density Cholesterol ([HDL] also known as good cholesterol) of 19 mg/dl, with a normal range of less than 40 mg/dl. h. Neutrophils (the most common type of white blood cell) Absolute (the actual number of disease fighting white blood cells) of 8.3 per mcl, with a normal range between 2.0 to 8.1 per mcl. i. Lymphocytes (a white blood cell that destroys bacteria and viruses) of 8.0 per mcl with a normal range between 14.0 to 52.0 per mcl. j. Monocytes (a white blood cell that destroys germs and eliminate infected cells in the body) of 12.0%, with a normal range between 1.0% to 11.0%. k. Monocytes Absolute of 1.3 thou/mcl, with a normal range between 0.0 thous/ul to 0.8 thou/ul. l. Sodium ([Na] an electrolyte that regulates fluid levels, transmits nerve signals in the body and contract muscles) level of 158 millimoles/liter (mmol/l) with a normal range between 136 mmol/l to 145 mmol/l. m. Chloride ([Cl] an electrolyte that maintains the fluid balance, blood pressure and acid-base balance in the body) level of 112 mmol/l, with a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056425 If continuation sheet Page 5 of 6 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 12/02/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete normal range between 98 mmol/l - 107 mmol/l. n. Electrolyte Balance (a state of the body when there is the right amount of minerals) of 15 mmol/l, with a normal range between 2 mmol/l to 12 mmol/l. o. Glucose (blood sugar [b/s]) level of 358 mg/dl with normal range between 85 mg/dl to 125 mg/dl. p. Blood Urea Nitrogen ([BUN] a test that reveals the function of the kidneys) of 150 mg/dl, with a normal range between 7 mg/dl to 25 mg/dl. q. Creatinine (a waste product produced by muscle breakdown, which higher levels may indicate impaired kidney function) of 3.7 mg/dl, with normal range between 0.7 mg/dl to 1.3 mg/dl. r. Glomerular Filtration Rate ([eGFR] a measurement of how well the kidneys filter waste from the blood) of 17 ml/minute/1.73 square meters (sq/m), with a normal range of more than or equal to 60 ml/minute/1.73 sq/m. s. Albumin (a protein in the blood that maintains fluid balance in the body) of 4.0 grams (g)/dl, with a normal range between 4.2 g/dl to 5.5 g/dl. t. Aspartate Amino Transferase ([AST] a test used for monitoring the liver health overtime) of 201 u/l, with a normal range between 13 u/l to 39 u/l. u. Alanine Aminotransferase ([ALT] a test done to identify potential liver problem) of 228 u/l, with a normal range between 7 u/l to 52 u/l. During a review of Resident 1's Nursing Progress Notes, dated 9/9/2025, the Nursing Progress Notes indicated there was no documentation to reflect Resident 1's lab test results were communicated to Resident 1's physician on 9/9/2025 when the lab results were transmitted to the facility. During a review of Resident 1's Change of Condition (COC) Evaluation dated 9/10/2025 and timed at 9:19 a.m., the COC indicated Resident 1 had abnormal lab results and Resident 1's physician ordered Resident 1 to be transferred to a GACH. During a telephone interview on 9/25/2025 at 3 p.m., Licensed Vocational Nurse (LVN) 1 stated on 9/9/2025 during the 3 p.m. to 11 p.m. shift, she printed Resident 1's lab results, took photos of the results and texted the photos to Resident 1's physician. LVN 1 stated it was not necessary to document the lab results in Resident 1's progress notes because texting Resident 1's physician was enough, and texting the results of the labs was the only documentation the licensed nurses used to relay residents' lab results. During an interview on 9/25/2025 at 3:45 p.m., the Director of Nursing (DON) stated it was the responsibility of all licensed nurses to document all care provided in the resident's medical record to reflect the status of the resident. During a review of the facility's Policy and Procedure (P/P) titled, Documentation-Nursing dated 10/1/2023, the P/P indicated the facility shall ensure documentation of the residents' status and care given by nursing staff is concise, clear, pertinent and accurate and should reflect the following, but not limited to: a. any communication with the residents' family and/or responsible parties or physician; and b. all laboratory data dated, timed and initiated when received and reviewed by the licensed nurse and the disposition of that information shall be in the nursing progress notes. During a review of the facility's P/P titled, General Provisions Medical Records Manual-General dated 10/1/2023, the P/P indicated the facility shall ensure accurate documentation and maintenance of the residents' medical records. Event ID: Facility ID: 056425 If continuation sheet Page 6 of 6