Health inspection·September 11, 2025

F 0557 Level of Harm - Minimal harm or potential for actual harm wheelchair. During a review of the facility's P&P titled, Residents' Personal Property, dated 12/2016, the P&P indicated any personal clothing or possessions retained by the facility for the resident during his or her stay should be identified and inventoried upon admission and the copy of inventory provided to the resident. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 2 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report the Ombudsman's (Patient advocate) allegation of neglect (failure of the facility to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress, which occurs when the facility is aware of, or should have been aware of goods or services that a resident[s] requires but the facility fails to provide them to the resident[s], resulting in, or may result in, physical harm, pain, mental anguish, or emotional distress) to the California Department of Public Health (CDPH), for one out of four sampled residents (Resident 1), alleging staff did not provide basic services such as bathing, shaving and offering urinal.This deficient practice resulted in delayed investigation by the CDPH and placed Resident 1 and other residents at risk for further neglect. Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including hypertension (high blood pressure), benign prostatic hyperplasia with lower urinary tract symptoms (BPH with LUTS, condition where the prostate gland [walnut-shaped gland located in the male reproductive system, just below the bladder] enlarges, which can put pressure on the urethra [tubular structure that carries urine from the bladder to the outside of the body] and cause frequent urination and urgency), and Intractable with status epilepticus severe, life-threatening condition where continuous or very frequent seizures [temporary disruption in brain function caused by abnormal electrical activity in the brain, causing unconsciousness and uncontrolled muscle movements] that have not responded to two or more standard anti-seizure medications persist). During a review of Resident 1's History and Physical (H&P) dated 8/11/2025, the H&P indicated Resident 1 had fluctuating capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 8/17/2025, the MDS indicated Resident 1 was able to understand and be understood by others. The MDS indicated Resident 1 required supervision for eating. The MDS indicated Resident 1 required moderate assistance (Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort) for oral hygiene and personal hygiene. The MDS indicated Resident 1 was dependent (helper does all the effort) for toileting hygiene, shower/bathe self, lower dressing, and putting on/taking off footwear and required maximal assistance (helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) with upper body dressing. The MDS indicated Resident 1 required maximal assistance with rolling from left to right and was dependent on sitting to lying, lying to sitting on side of the bed and dependent on chair/bed to chair transfer, tub/shower transfer. The MDS indicated Resident 1 was always incontinent with urine and bowel. MDS indicated Resident 1 had an unhealed pressure ulcer (localized areas of skin damage that develop due to prolonged pressure on the body). During a review of Resident 1's care plan titled, The resident has an ADL self-care performance deficit related to (r/t) limited mobility, dated 8/14/2025, the care plan interventions indicated to provide assistance with Activities of Daily Living (ADL) as needed and to provide sponge bath when a full bath or shower cannot be tolerated. During an interview on 9/9/2025 at 10:01 a.m. with the Ombudsman, the Ombudsman stated when she visited the facility on 9/8/2025 between 11:00 a.m. and 12 p.m., Resident 1 reported that he had not showered since the resident was admitted to the facility on [DATE]. The Ombudsman stated Resident 1 wanted to be showered, shaved and provided with a urinal. The Ombudsman stated Resident 1 stated he was afraid of the geriatric lift (hoyer lift, a specialized device designed to assist elderly individuals in safely transferring from one position to another). The Ombudsman stated Resident 1 reported that staff would take away (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 3 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few his urinal and not bring it back. The Ombudsman stated Resident 1 did not have a urinal for several days (days not specified). The Ombudsman stated Resident 1 did not have a urinal at the bedside during her visit to the facility on 9/8/2025. The Ombudsman stated to assist Resident 1, the resident was instructed to press the call light to get assistance from the staff, but no one answered the call light. The Ombudsman stated she had to step out of the room, went to the hallway to call for assistance. The Ombudsman stated she observed Certified Nurse Assistant (CNA 1) leaning on the desk at the nurse's station with clear visibility to the call light being on and did not answer. The Ombudsman stated CNA 1 entered Resident 1's room and while telling CNA 1 Resident 1 needed to be showered, shaved and provided with a urinal, CNA 1 responded to the Ombudsman that it was not her job, and she was on her way to get her lunch. The Ombudsman stated that CNA 1 dismissed Resident 1's needs and stated that Resident 1 had dementia and he did not know what he wanted. The Ombudsman stated she reported this to the Assistant Administrator (AADM), and the AADM told her he was going to suspend CNA 1 and will complete a Report of Suspected Dependent Adult/Elder Abuse (SOC 341- documentation of information given by the reporting party on the suspected incident of abuse or neglect of an elder or dependent adult). During an interview on 9/9/2025 at 1:22 p.m., with Resident 1, Resident 1 stated CNA 1 told him he did not need a urinal, that he could just urinate in his diaper and they would change him. Resident 1 stated CNA 1 also told him she was the sergeant (military official), and Resident 1 was supposed to do whatever she told him after he (Resident 1) shared he had been in the military. Resident 1 stated staff does not respond to his call light when he needed assistance. Resident 1 stated he just wanted to be treated like a human being. Resident 1 stated the Ombudsman was there to advocate for him, but CNA 1 started yelling at the Ombudsman. Resident 1 stated CNA 1 did not want to help him and did not care. During an interview on 9/9/2025 at 4:00 p.m., with the AADM, the AADM stated that the Ombudsman reported to him (date not specified) that the Ombudsman pressed the call light in Resident 1's room while the CNA 1 was about to go to her break. The AADM stated the Ombudsman requested a wheelchair and medication for Resident 1. The AADM stated the Ombudsman told him (AADM) CNA 1 was being neglectful (CNA not responding to the Ombudsman) towards her (Ombudsman). The AADM stated he had suspended CNA 1 because of unprofessionalism. The ADM stated CNA 1 continued being unprofessional and did not want to leave even after being asked to. The AADM stated if the Ombudsman had told him Resident 1 was neglected and was not provided with basic needs, he would have reported it as indicated in their policy, but the Ombudsman did not tell him about neglect and that was the reason why he did not report anything. During a concurrent interview on 9/9/2025 at 4:10 p.m., with the AADM and Resident 1, Resident 1 stated he told the AADM and the Ombudsman on 9/8/2025 regarding CNA 1 told Resident 1 she was a sergeant and Resident 1 should do whatever CNA 1 would tell him to do. Resident 1 stated when the Ombudsman visited him, he got his urinal and got cleaned. The AADM stated he could not remember Resident 1 stated such (do whatever CNA 1 would tell him to do). The AADM stated he remembered Resident 1 told AADM CNA 1 told Resident 1 she was a sergeant. During a phone interview on 9/10/2025 at 3:06 p.m., with CNA 1, CNA 1 stated she was on her way to her break and the Ombudsman had come out of Resident 1's room asking loudly who was caring for Resident 1. CNA 1 stated Resident 1 was an attention seeker (a person who consistently acts in ways designed to gain notice, validation, and admiration from others, often through excessive, dramatic, or disruptive behaviors) and was a difficult resident. CNA 1 stated Resident 1 had been asking for all kinds of things (unspecified) all day. CNA 1 stated the Ombudsman asked about Resident 1's medication and told Ombudsman she (CNA 1) did not help with that. CNA 1 stated the Ombudsman asked about shaving him, but she (CNA 1) did not want to use Resident 1's own razor because the facility needed to use the facility(continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 4 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete provided razor for safety. CNA 1 stated the Ombudsman told her Resident 1 was being neglected. CNA 1 stated the Ombudsman asked her (CNA 1) about why Resident 1 was not being showered. CNA 1 stated she told Ombudsman it was because Resident 1 was afraid to get in the Hoyer Lift (mechanical device, also called a patient lift, used to safely lift and transfer individuals with limited mobility). CNA 1 stated Resident 1 received bed-baths on Tuesday and Fridays, but the Ombudsman kept insisting Resident 1 was neglected. CNA 1 stated that Ombudsman was on the phone with someone (unidentified) screaming it was resident neglect. CNA 1 stated the AADM told her the Ombudsman reported her for neglect. CNA 1 stated the AADM told her (CNA 1) that the AADM did not think she (CNA 1) did any neglect. CNA 1 stated that she (CNA 1) had to be suspended until he spoke with Department of Public Health (DPH). CNA 1 stated she was not suspended for neglect; she was suspended for customer service. CNA 1 stated the AADM told her, she could return to work today (9/10/2025) but then called back and told her she could not go back to work until the investigation was complete. During a review of the facility's Policies and Procedures (P&P) titled Abuse and Neglect Prohibition Policy, dated 6/2022, the P&P indicated upon receiving information concerning a report of suspected neglect, the Administrator or designee should report all alleged violations immediately, but not later than 2 hours if the alleged violation involves abuse, using the SOC 341, to the Licensing and Certification Program District Office. Event ID: Facility ID: 056435 If continuation sheet Page 5 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to implement its policy and procedure (P&P) titled, Pharmaceutical Services Policy and Procedure Manual, by failing to ensure one of three sampled residents' (Resident 1) medications ordered by the physician, were administered within 60 minutes of scheduled time.This deficient practice resulted in the delay for Resident 1 to receive scheduled medications and had the potential for the medications to be ineffective.This deficient practice also had the potential to administer hypertension [HTN], high blood pressure) medications ordered twice a day, close to the next dose, causing the blood pressure to drop lower, resulting in hospitalization and death.Findings:During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including hypertension, benign prostatic hyperplasia with lower urinary tract symptoms (BPH with LUTS, condition where the prostate gland [walnut-shaped gland located in the male reproductive system, just below the bladder] enlarges, which can put pressure on the urethra [tubular structure that carries urine from the bladder to the outside of the body] and cause frequent urination and urgency), and Intractable with status epilepticus severe, life-threatening condition where continuous or very frequent seizures [temporary disruption in brain function caused by abnormal electrical activity in the brain, causing unconsciousness and uncontrolled muscle movements] that have not responded to two or more standard anti-seizure medications persist).During a review of Resident 1's History and Physical (H&P) dated 8/11/2025, H&P indicated Resident 1 had fluctuating Capacity to understand and make decisions.During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 8/17/2025, the MDS indicated Resident 1 was able to understand and be understood by others. The MDS indicated Resident 1 required supervision for eating. MDS indicated Resident 1 required moderate assistance (helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort) for oral hygiene and personal hygiene. The MDS indicated Resident 1 was dependent (helper does all the effort) for toileting hygiene, shower/bathe self, lower dressing, and putting on/taking off footwear and required maximal assistance (helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) with upper body dressing. The MDS indicated Resident 1 required maximal assistance with rolling from left to right and was dependent on sitting to lying, lying to sitting on side of the bed and dependent on chair/bed to chair transfer, tub/shower transfer. The MDS indicated Resident 1 was always incontinent with urine and bowel. MDS indicated Resident 1 had an unhealed pressure ulcer (localized areas of skin damage that develop due to prolonged pressure on the body). During a review of Resident 1's care plan titled, Hypertension, dated 8/11/2025, the care plan interventions indicated to administer antihypertensive and diuretic medications as ordered.During a review of Resident 1's care plan titled, Metformin, dated 8/11/2025, the care plan interventions indicated to administer Metformin with meals as prescribed to reduce stomach upset.During a review of Resident 1's care plan titled, Keppra, dated 8/11/2025, the care plan interventions indicated to administer Keppra as prescribed. During a review of Resident 1's care plan titled, Tamsulosin, dated 8/11/2025, the care plan interventions indicated to administer tamsulosin ideally 30 minutes after the same meal each day.During a review of Resident 1's Prescriber Order dated 8/29/2025, the orders indicated the following:1. Bimatoprost Solution 0.03 percent ([%] medication for glaucoma [eye diseases that damage the optic nerve, which carries visual information from the eye to the brain]), instill (place) 1 drop in both eyes in the evening.2. Clonidine Hydrochloride ([HCl] medication for HT), 0.1 milligram (mg, unit of measurement), give 1 tablet by mouth three times a day for HTN. Hold for systolic Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 6 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few blood pressure (SBP, the pressure in the arteries when your heart beats and pumps blood throughout body) < (less than)110 or heart rate (HR) <603. Coreg oral tablet 25 mg (Carvedilol) give 1 tablet by mouth two times a day for HTN. Hold for SBP<110 or HR<60, give with food.4. Hydralazine HCL oral tablet 100 mg give 1 by tablet by mouth three times a day for HTN. Hold for SBP<110 or HR <60.5. Keppra (medicine for epilepsy [a neurological condition characterized by recurrent, unprovoked seizures]) 100 mg. oral tablet, to give by mouth two times a day.6. Metformin HCL (medication for diabetes [DM], abnormal blood sugar levels), 500 mg. oral tablet, to give 1 tablet by mouth two times a day with food.7. Tamsulosin HCL capsule 0.4 mg give two capsules by mouth one time a day for BPH.During an interview on 9/9/2025 at 10:01 a.m. with the Ombudsman, the Ombudsman stated during her visit on 9/8/2025 around 11 a.m., Resident 1 stated he did not get his morning medications yet (names not specified). The Ombudsman stated she did not know exactly what time Resident 1 received his morning medications on 9/8/2025.During an interview on 9/9/2025 at 1:22 p.m. with Resident 1, Resident 1 stated he always received his medications (names unspecified) late by several Licensed Vocational Nurses (did not remember other nurses' names). Resident 2 stated LVN 2 usually gave his medications late (names not specified). Resident 1 stated LVN 2 would tell him that he (LVN 2) needed to go to lunch (time unspecified) and would administer Resident 1's medications when LVN 2 returned from lunch. Resident 1 stated that he had HTN and should take his medications on time. Resident 1 stated he had three strokes (occurs when blood flow to the brain is interrupted, leading to brain damage), and did not want to have another one. Resident 1 stated that he needed eye drops because he had bad glaucoma and did not want to lose his eyesight. Resident 1 stated that he also took seizure medication and was afraid he was going to get another seizure, if he did not get his medication on time. Resident 1 stated he also took medication for his prostate because it was difficult to urinate at times. Resident 1 stated that he wanted to take all his medications on time.During a concurrent interview and record review on 9/11/2025 at 12:17 p.m. with Director of Nursing (DON), Resident 1's random (undated) Administration Details Record was reviewed. The Administration Details Record indicated the following:1. On 8/28/2025, Keppra 100 mg scheduled for 9:00 a.m. was administered at 12:03 p.m. and the 9:00 p.m. Keppra was administered at 12:03 a.m.On 8/30/2025, Keppra 100 mg scheduled for 9:00 a.m. was documented given at 12:00 p.m., On 9/1/2025, Keppra 100 mg scheduled for 9:00 a.m. was given at 11:19 a.m.On 9/6/2025, Keppra 100 mg scheduled for 9:00 a.m. was given at 11:56 a.m.On 9/8/2025, Keppra 100 mg scheduled for 9:00 a.m. was given at 11:11 a.m. 2. On 9/6/2025, Clonidine scheduled for 9:00 a.m. was documented given at 11:55 a.m., Clonidine scheduled for 1:00 p.m. was documented given at 2:25 p.m., and Clonidine scheduled for 5:00 p.m. was documented given at 4:40 p.m.On 9/7/2025, the Clonidine scheduled for 9:00 a.m. was given at 12:58 p.m. Clonidine scheduled for 1:00 p.m. was documented given at 3:05 p.m., and Clonidine scheduled for 5:00 p.m. was documented given at 5:27 p.m.On 9/8/2025, the Clonidine scheduled for 9:00 a.m. was given at 11:17 a.m. Clonidine scheduled for 1:00 p.m. was documented given at 2:55 p.m., and Clonidine scheduled for 5:00 p.m. was documented given at 5:27 p.m. 3. On 9/6/2025, the Hydralazine scheduled for 9:00 a.m. was documented as administered at 11:56 a.m., Hydralazine scheduled for 1:00 p.m. was documented given at 2:25 p.m., and Hydralazine scheduled for 5:00 p.m. was documented given at 4:40 p.m.4. On 9/7/2025, the Hydralazine scheduled for 9:00 a.m. was documented as administered at 12:58 p.m., Hydralazine scheduled for 1:00 p.m. was documented given at 3:05 p.m., and Hydralazine scheduled for 5:00 p.m. was documented given at 5:27 p.m.5. On 9/8/2025, the Hydralazine scheduled for 9:00 a.m. was documented as administered at 11:19 a.m., Hydralazine scheduled for 1:00 p.m. was documented given at 2:56 p.m., and Hydralazine scheduled for 5:00 p.m. was documented given at 5:27 p.m.4. On 8/30/2025, the Coreg scheduled 5:00 p.m., was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 7 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete documented given at 7:28 p.m.5. On 8/28/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 12:03 p.m.On 8/30/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 12:01 p.m.On 9/1/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 11:21 a.m.On 9/6/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 11:55 a.m.On 9/8/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 11:10 a.m.6. On 8/30/2025, the Metformin scheduled for 5:00 p.m., was documented given at 7:25 p.m.,On 9/1/2025, the Metformin scheduled for 7 a.m., was documented given at 11:21 a.m.7. On 8/30/2025, the Bimatoprost scheduled for 5:00 p.m. was documented given at 7:26 p.m.The DON stated Resident 1's Administration Details Record indicated the medications (Keppra, Clonidine, Hydralazine, Coreg, Tamsulosin and Metformin) were all given late. The DON stated it was important to administer all of Resident 1's medications on time because, if not, the medications will not be effective. The DON stated that not giving Resident 1 his BPH medicine on time could lead to difficulty in urination and discomfort. The DON stated HTN medications scheduled more than twice a day should be given as scheduled, because when given late and close to the next dose, could lead to double dosing causing the blood pressure to drop low and possibly lead to hospitalization. The DON stated it was very important to administer the seizure medication on time to prevent additional seizures, which could lead to hospitalizations.During a review of the facility's P&P titled Pharmaceutical Services Policy and Procedure Manual, dated 3/2022, the P&P indicated medications should be administered in accordance with good nursing principles and practices. The P&P indicated medications should be administered in accordance with written orders of the attending physician and should be administered within 60 minutes of scheduled time. Event ID: Facility ID: 056435 If continuation sheet Page 8 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to implement its Policy and Procedure (P&P) titled, Scope of Infection Control Program, which indicated standard precaution (the basic level of infection prevention and control practices used in healthcare settings to minimize the transmission of infections) and hand hygiene should be followed to prevent the spread of infections to 1 of 3 sampled residents, (Resident 1) during wound care procedure.This failure had the potential to result in cross contamination and spread of bacteria and other microorganisms causing wound infections and other complications of infections leading to hospitalization.Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including hypertension (HTNhigh blood pressure), benign prostatic hyperplasia with lower urinary tract symptoms (BPH with LUTS, a condition where the prostate gland [walnut-shaped gland located in the male reproductive system, just below the bladder] enlarges, which can put pressure on the urethra [tubular structure that carries urine from the bladder to the outside of the body] and cause frequent urination and urgency), and intractable with status epilepticus severe, life-threatening condition where continuous or very frequent seizures [temporary disruption in brain function caused by abnormal electrical activity in the brain, causing unconsciousness and uncontrolled muscle movements] that have not responded to two or more standard anti-seizure medications persist). During a review of Resident 1's History and Physical (H&P) dated 8/11/2025, the H&P indicated Resident 1 had fluctuating Capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 8/17/2025, the MDS indicated Resident 1 was able to understand and be understood by others. The MDS indicated Resident 1 required supervision for eating. The MDS indicated Resident 1 required moderate assistance (Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort) for oral hygiene and personal hygiene. The MDS indicated Resident 1 was dependent (helper does all the effort) for toileting hygiene, shower/bathe self, lower dressing, and putting on/taking off footwear and required maximal assistance (helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) with upper body dressing. The MDS indicated Resident 1 required maximum assistance with rolling from left to right and was dependent on sitting to lying, lying to sitting on side of the bed and dependent for chair/bed to chair transfer, tub/shower transfer. The MDS indicated Resident 1 was always incontinent with urine and bowel. The MDS indicated Resident 1 had an unhealed pressure ulcer (localized areas of skin damage that develop due to prolonged pressure on the body). During a review of Resident 1's care plan titled, Resident 1 is at risk for infection related to sacral wound and compromised skin integrity, dated 8/12/2025, the care plan interventions indicated to perform wound care as ordered using aseptic technique (a collection of medical practices and procedures used to prevent contamination from pathogens during medical procedures, involving strict protocols to ensure that the environment remains free of germs, thereby protecting patients from infections, especially in procedures involving open wounds or invasive treatments) and ensure hand hygiene before and after care. During a review of Resident 1's Prescriber Order dated 8/29/2025, the order indicated to cleanse left buttock pressure injury (localized areas of skin damage and underlying tissue that develop due to prolonged pressure or shear forces) with normal saline (NS- cleansing solution), pat dry, apply Santyl (ointment used to remove dead tissue from a wound and promote healing) ointment to wound bed and cover with dressing every day shift for 14 days. During a review of Resident 1's Prescriber Order dated 9/6/2025, the order indicated to cleanse right buttock pressure injury with NS, pat dry, apply Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 9 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Medihoney (medical grade honey used to treat wounds) to wound bed and cover with dressing every day shift for 14 days. During an observation on 9/10/2025 at 10:25 a.m. with Treatment Nurse (TN) for Resident 1's wound care, Resident 1's bedside table was observed (while standing from the foot of the bed as requested by Resident 1) had two (2) water cups, 2 open straws, tissues, an open box of cereal, remote control and cell phone, opened clean dressing, gloves, wet gauze inside a clear plastic cup, ointment (unidentified) in a clear plastic cup and a white spray bottle (contents not identified). The TN was observed came in to the room and put on a pair of gloves. The TN asked the Certified Nurse Assistant (CNA) 4 to get a trash bag. CNA 4 left the room and returned with a trash bag, put on her pair of gloves and turn Resident 1 to his left side. The TN removed Resident 1's dirty dressings on the buttocks area (sites not visible) and threw the dirty dressing into the trash bag that was hung on Resident 1's left side rail. The TN cleansed the buttocks area using the white spray bottle (contents not identified) that was on the table. The TN pat dried the buttocks (site not visible), applied ointment that was in the clear plastic cup (name of ointment unidentified), and applied the dressing. TN and CNA 4 repositioned Resident 1 flat the bed. CNA 4 handed the TN the trash bag containing dirty wound dressing supplies and placed the trash bag on Resident 1's bedside table. The TN covered Resident 1 with his blanket and then removed her gloves and threw them into the trash bag. The TN removed the trash bag from the bedside table and threw the trash bag inside the trash can. The TN moved the bedside table in front of Resident 1 and left the room without cleaning the bedside table. During an interview on 9/10/2025 at 11:00 a.m. with TN, the TN stated wound treatment should be done using clean technique (basic wound care hygiene and proper handwashing). The TN stated prior to the wound care, she should have introduced herself to the resident, got a bedside table and cleaned it, removed all personal items, draped the table then place the clean wound care supplies. The TN stated she did not remove Resident 1's personal items on the bedside table because Resident 1 did not want his personal items removed. The TN stated her dirty gloves were not removed throughout the wound care treatment because she had forgotten. The TN stated the bedside table was not cleaned after the dirty trash bag was removed on the bedside table because she forgot. The TN stated not following clean technique could lead to cross contamination, spread of germs leading to infections. During an interview on 9/10/2025 at 12:01 p.m. with CNA 4, CNA 4 stated she did not sanitize her hands prior to entering Resident 1's room and prior to turning Resident 1. CNA 4 stated she should have sanitized her hands to prevent the spread of germs. During a review of the facility's P&P titled, Clean Dressing Change, dated 4/2015, the P&P indicated licensed nurses should apply dressing using clean technique to promote wound healing and prevent cross-contamination among and between residents and caregivers. The P&P indicated to clean the work surface, wash hands, put on gloves, remove soiled dressing and gloves, place in bag for disposal, wash hands, put on clean gloves, clean wound as ordered, carefully dry wound, remove gloves, wash hands, put on clean gloves, apply dressing, remove gloves place in bag for disposal, wash hands, return resident to comfortable position with call button in reach and follow standard precautions at all times. During a review of the facility's P&P titled, Scope of Infection Control Program, dated 6/29/2022, the P&P indicated standard precaution should be followed to prevent the spread of infections. The P&P indicated hand hygiene procedures should be followed by staff involved in direct resident contact. Event ID: Facility ID: 056435 If continuation sheet Page 10 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, for three (3) of 3 sampled residents (Residents 1, 3 and 4), the facility failed to:1). Ensure Resident 3's call light was in working condition.2). Ensure Residents 1 and 4's call lights were placed within reach.3). Ensure Resident 4, who needed staff assistance and whose call light was turned on, was answered in a timely manner. These deficient practices had the potential that the needs of the residents will not be attended to timely.These deficient practices had the potential to result in falls and injuries, and other severe complications in cases of an emergency situation.This deficient practice resulted in Resident 4's needs not assisted timely and had the potential to affect the resident's psychosocial well-being causing the resident's feeling of desperation (despair) and neglect. Findings: 1). During a review of Resident 3's admission Record, the admission Record indicated Resident 3 was admitted to the facility on [DATE] with diagnoses including muscle wasting and muscle atrophy (the gradual loss of muscle tissue, size, and strength, resulting from the breakdown of muscle), and benign prostatic hyperplasia with lower urinary tract symptoms (BPH with LUTS, condition where the prostate gland [walnut-shaped gland located in the male reproductive system, just below the bladder] enlarges, which can put pressure on the urethra [tubular structure that carries urine from the bladder to the outside of the body] and cause frequent urination and urgency). During a review of Resident 3's History and Physical (H&P) dated 5/30/2025, the H&P indicated Resident 3 had the capacity to understand and make decisions. During a review of Resident 3's Minimum Data Set (MDS - a resident assessment tool) dated 8/17/2025, the MDS indicated Resident 3 was able to understand and be understood by others. The MDS indicated Resident 3 required supervision for eating. MDS indicated Resident 3 required moderate assistance (helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort) for eating, oral hygiene and upper body dressing. The MDS indicated Resident 3 required maximal assistance (helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) with toileting hygiene, shower/bathing self, lower body dressing, putting-on/ taking off footwear, personal hygiene. The MDS indicated Resident 3 required maximal assistance with rolling from left to right and was dependent on sitting to lying, lying to sitting on side of the bed and dependent on chair/bed to chair transfer, toilette transfer and tub/shower transfer. The MDS indicated Resident 3 was always incontinent with urine and bowel. During a review of Resident 3's care plan titled, The resident has an ADL (Activities of Daily Living) self-care performance deficit, dated 8/29/2025, one of the interventions indicated to cue resident to request staff assistance as needed, and reinforce use of call light before attempting mobility or toileting. During an interview on 9/9/2025 at 11:40 a.m. with Resident 3, Resident 3 stated most of the staff in all shifts, does not answer call light when he needed help. Resident 3 stated he was frequently left in feces for long periods of time. Resident 3 was observed tearful. Resident 3 stated he felt awful because he felt the staff did not care about his wellbeing. During a concurrent observation and interview on 9/9/2025 at 12:16 p.m. with Resident 3, Resident 3 pressed the call light. Several staff members (unidentified) were observed walking by Resident 3's room and staff at the nurse's station walked away and did not respond to the call light. During a concurrent observation and interview on 9/9/2025 at 12:25 p.m. with Resident 3, Certified Nurse Assistant (CNA 2) was observed walking by Resident 3's room. Resident 3 stated staff do not respond to the call light every day. This Surveyor stepped out to call CNA 2 into the room while Resident 3 was seated at the edge of the bed. CNA 2 went into the room, pressed the cable to the outlet on the wall and after wabbling the cord, the call light turned on for few seconds Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 11 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and then turned back off. CNA 2 stated the call light was not working. CNA 2 stated he did not know how long the call light had not been working. CNA 2 stated the call light was working around 9:00 a.m. CNA 2 stated it was dangerous not to have a working call light for Resident 3 because if he needed help, he would not be able to call for assistance. CNA 2 stated Resident 3 could fall, get injured or die because they could not get help right away. CNA 2 stated that Resident 3 could have feelings of being ignored by the call light not being answered in a timely manner. 2). During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including hypertension (high blood pressure), benign prostatic hyperplasia with lower urinary tract symptoms (BPH with LUTS, condition where the prostate gland [walnut-shaped gland located in the male reproductive system, just below the bladder] enlarges, which can put pressure on the urethra [tubular structure that carries urine from the bladder to the outside of the body] and cause frequent urination and urgency), and Intractable with status epilepticus severe, life-threatening condition where continuous or very frequent seizures [temporary disruption in brain function caused by abnormal electrical activity in the brain, causing unconsciousness and uncontrolled muscle movements] that have not responded to two or more standard anti-seizure medications persist).During a review of Resident 1's History and Physical (H&P) dated 8/11/2025, H&P indicated Resident 1 had fluctuating Capacity to understand and make decisions.During a review of Resident 1's care plan titled, Ambien (sleeping medication) 10 milligram (mg unit of measurement) once daily at bedtime, dated 8/11/2025, the care plan interventions indicated to maintain call light within reach.During a review of Resident 1's care plan titled, Risk for self-care deficit, dated 8/14/2025, the care plan interventions indicated to provide Resident 1 assistance with Activities of Daily Living (ADL) as needed. During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 8/17/2025, the MDS indicated Resident 1 was able to understand and be understood by others. The MDS indicated Resident 1 required supervision for eating. The MDS indicated Resident 1 required moderate assistance (helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort) for oral hygiene and personal hygiene. The MDS indicated Resident 1 was dependent (helper does all the effort) for toileting hygiene, shower/bathe self, lower dressing, and putting on/taking off footwear and required maximal assistance (helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) with upper body dressing. The MDS indicated Resident 1 required maximal assistance with rolling from left to right and was dependent on sitting to lying, lying to sitting on side of the bed and dependent on chair/bed to chair transfer, tub/shower transfer. The MDS indicated Resident 1 was always incontinent with urine and bowel. MDS indicated Resident 1 had an unhealed pressure ulcer (localized areas of skin damage that develop due to prolonged pressure on the body). During an interview on 9/9/2025 at 10:01 a.m. with the Ombudsman, the Ombudsman stated when she visited the facility on 9/8/2025 around 11:00 a.m., Resident 1 reported that he had not showered since 9/8/2025, that he wanted to be showered and shaved and provided with a urinal. The Ombudsman instructed Resident 1 to press the call light to get assistance, but no one answered the call light. The Ombudsman stated she stepped out of the room and went to the hallway to call for assistance and observed CNA 1 leaning on the desk at the nurse's station with clear visibility to the call light being on. The Ombudsman stated CNA 1 entered Resident 1's room and while telling CNA 1 Resident 1 needed to be showered, shaved and provided with a urinal, CNA 1 responded to the Ombudsman that it was not her job, and she was on her way to get lunch. During a concurrent observation and interview on 9/9/2025 at 1:22 p.m. with Resident 1, Resident 1's call light was observed behind his right shoulder, under his pillow. Resident 1 stated he could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 12 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not reach his call light and staff never answer call lights on time. Resident 1 stated staff hide their call lights sometimes. Resident 1 stated he was left wet or dirty for hours (dates not specified) and no one would come to assist him. Resident 1 stated there were times when he peed out of his diaper and the urine would get on his bed (dates not specified). Resident 1 stated he wished the staff would treat him like a human being, with some respect and dignity. Resident 1 stated he was paralyzed from his left side and could not do things on his own. Resident 1 stated he felt so powerless because of the lack of care. 3). During a review of Resident 4's admission Record, the admission Record indicated Resident 4 was admitted to the facility on [DATE] with diagnoses including muscle wasting and muscle atrophy (the gradual loss of muscle tissue, size, and strength, resulting from the breakdown of muscle), and urge of incontinence (loss of urine that happens after a sudden, strong, and overwhelming need to urinate that is difficult to control).During a review of Resident 4's H&P dated 8/23/2025, the H&P indicated Resident 4 had the capacity to understand and make medical decisions. During a review of Resident 4's care plan titled, Functional decline with ADLs, dated 8/25/2025, the interventions indicated to cue resident to request staff assistance as needed and reinforce use of call light before attempting mobility or toileting. During a review of Resident 4's MDS dated [DATE], the MDS indicated Resident 4 was able to understand and be understood by others. The MDS indicated Resident 4 required supervision for eating. MDS indicated Resident 4 required for eating, oral hygiene, toileting hygiene, shower/bathe self, upper body dressing, and personal hygiene. The MDS indicated Resident 4 was for lower body dressing and putting-on/taking off footwear. The MDS indicated Resident 4 was dependent with rolling from left to right for sitting to lying, lying to sitting on side of the bed, sit to stand, and for chair/bed to chair transfer. The MDS indicated Resident 4 was always incontinent with urine and bowel. During a concurrent observation and interview on 9/9/2025 at 1:30 p.m. with Resident 4, Resident 4 was sitting up on his wheelchair by the foot of his bed, facing the wall. Resident 4's bedside table was behind him. Resident 4's call light was observed on the nightstand on the right side of his bed. Resident 4 stated he's aware his call light was not near him at this time and could not call for help. Resident 4 stated the staff never answer the call light even if you press it. Resident 4 stated he had to yell loudly to get help. At 1:47 p.m., Resident 4 requested that his roommate (Resident 2) press his call light for assistance and observed the Director of Staff Development (DSD) walked by at 1:49 p.m. and did not answer the call light. During a concurrent observation and interview on 9/9/2025 at 1:56 p.m. with CNA 3, CNA 3 walked into Resident 4's room, removed Resident 4's call light from behind the pillow and placed it over the rail. CNA 3 went to Resident 4 and stated she did not know who removed Resident 4's call light or where Resident 4's call light was. CNA 3 saw Resident 4's call light was on the nightstand and not within Resident 4's reach. CNA 3 stated not having the call light within the resident's reach could lead to dangerous situations in case of an emergency. CNA 3 stated the call light should be accessible to the residents so it could not delay care. CNA 3 stated if the residents are dirty, the residents could call for help right away. CNA 3 stated residents could feel ignored and sad if they were not able to get the assistance they need. CNA 3 stated not attending to residents' basic needs is considered neglect (fail to care for properly). During a concurrent observation and interview on 9/10/2025 at 3:24 p.m. with Resident 4 in Resident 4's room, Resident 4's call light was turned on. Resident 4 stated he had been waiting for a while for a staff to answer the call light, but no one had come in. During the observation, several staff members had walked/ passed by the room, and no one answered the call light in Resident 4's room. Resident 4 stated he wished staff cared more about the residents' needs. Resident 4 stated he felt neglected and unimportant to the staff. Resident 4 stated he had feelings of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056435 If continuation sheet Page 13 of 14 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 056435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hyde Park Healthcare Center 6520 West Blvd. Los Angeles, CA 90043 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete desperation because he could not get assistance in a timely manner. Resident 4 stated he was very thirsty and wanted something to drink. At 3:46 p.m. Resident 4 stated he could not wait any longer and he needed someone right away. CNA 5 was observed walking by Resident 4's room and was called for assistance. CNA 5 was in a rush. CNA 5 was directed to ask what assistance Resident 4 needed. After CNA 5 asked Resident 4 what he needed, CNA 5 walked out of the room in a rush, came back and rushed to leave Resident 4's room. CNA 5 stated he was trying to get the charge nurse and did not notice the call light. CNA 5 stated all call lights should be answered even if they were not their assigned rooms in case the situation was urgent. CNA 5 stated Resident 4 could have fallen attempting to get the attention of someone for assistance. During a review of the facility's Policy and Procedure (P&P) titled, Answering Call Lights, dated 8/2017, the P&P indicated residents' call lights should be answered as soon as possible, The P&P indicated staff should identify self when answering call light as needed and listen to the request. Requests should be fulfilled, if request cannot be fulfilled at the time of call light being answered, consider reporting and asking the charge nurse or supervisor or department manager for assistance. The P&P indicated staff should report all defective call lights. Event ID: Facility ID: 056435 If continuation sheet Page 14 of 14