Health inspection·May 9, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few to the facility on [DATE] and readmitted on [DATE] with diagnoses including anxiety disorder (a mental health condition characterized by excessive worry and fear that significantly interferes with daily life) and unspecified signs and symptoms (s/s) involving cognitive function decline (changes in thinking, memory, or attention that are not clearly categorized as a specific type of cognitive deficit) following a cerebral infarction ([stroke] loss of blood flow to a part of the brain)). During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool), dated 2/23/2025, the MDS indicated Resident 1's cognition was intact (able to make independent and reasonable decisions), and she could walk 150 feet. During a review of Resident 2's admission Record, (Face Sheet), the Face Sheet indicated Resident 2 was originally admitted to the facility on [DATE] and readmitted [DATE] with diagnoses including mild cognitive impairment (a brain condition that causes noticeable but mild memory and thinking problems) unspecified dementia (a progressive state of decline in mental abilities without behavioral disturbance, psychotic disturbance (a state where a person's thinking, perception, and behavior are significantly altered, leading to a loss in contact with reality), mood disturbance (a serious mental illness that causes persistent and intense changes in a person's mood, energy, and behavior), and anxiety. During a review of Resident 2's MDS, dated [DATE], the MDS indicated Resident 2's cognition was intact. During a review Resident 3's admission record (Face sheet), the Face Sheet indicated Resident 3 was admitted to the facility on [DATE], with diagnoses including hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and hemiparesis (weakness or inability to move on one side of the body) following a cerebral infarction affecting Resident 3's left non dominant side. During a review of Resident 3's MDS, dated [DATE], the MDS indicated Resident 3 's cognition was intact. The MDS indicated Resident 3 used a walker (a device used to assist with walking) for mobility. During a review of Resident 3's H&P dated 2/19/2025, the H&P indicated Resident 3 was alert and able to make decisions regarding routine medical decisions and her immediate needs. During a review of Resident 1's Progress Note, dated 2/24/2025, the Progress Note indicated Resident 2 reported that Resident 1 hit her with a cane on her left arm. During a review of Resident 1's Change in Condition (COC) Evaluation, dated 2/24/2025, the COC indicated at 10:43 p.m., Resident 2 reported that Resident 1 struck her with a stick. During a review the facility's Investigation of Resident 2's allegation dated 2/24/2025, the Investigation indicated the cane/stick was not located and there were no witnesses who saw the cane/stick. During a review of Resident 3's Nurses Progress Note, dated 4/20/2025, the Nurse Progress Note indicated Resident 3 reported that Resident 1 pushed her down and hit her with a stick multiple times on 4/19/2025. The Nurses Progress Note indicated three Certified Nursing Assistants (CNA 2, 3 and 4) reported seeing Resident 1 walking away from Resident 3's bed with a stick wrapped in a white sheet. The Nurses Progress Note indicated Resident 1 reported that Resident 3 always disrespected her and would always close the sliding door in the room and the room was always hot. The Nurses Progress Note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 2 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0600 indicated Resident 1 reported today (4/19/2025) she (Resident 3) closed the sliding door, and she (Resident 1) opened it. Level of Harm - Actual harm Residents Affected - Few During a review of Resident 1's Nurses Progress Note, dated 4/21/2025 and timed at 10:06 a.m., the Nurses Progress Note indicated Resident 3 requested an X-ray (a procedure used to generate images of tissue and structures inside the body) of her right shoulder and back. A subsequent Nurses Progress Note dated 4/21/2025 timed at 12 p.m., indicated the Nurse Practitioner (NP) ordered a STAT (immediately) X-ray for Resident 3. During a review of Resident 3's X-ray results dated 4/21/2025, the X-ray results indicated an acute fracture of the mid sacrum. During a review of Resident 3's Physician's Order, dated 4/22/2025, the Physician's Order indicated to transfer Resident 3 to the GACH for an X-ray of her lumbar spine (lower portion of the back) and sacrum. During a review of Resident 3's Nurses Progress Note, dated 4/22/2025 and timed at 2:40 p.m., the Nurses Progress Note indicated Resident 3 was transported to a GACH for evaluation due to an X-ray result that indicated a fracture of the mid sacrum. During a review of the GACH's Face Sheet, the Face Sheet indicated Resident 3 was admitted to the GACH on 4/22/2025. During a review of GACH's Radiology (the science dealing with X-rays for the diagnosis and treatment of disease) Results, dated 4/22/2025, the Radiology Results indicated Resident 3 sustained a non-displaced fracture (a broken bone where he bone fragments remain in their correct alignment after the break) of the mid sacrum. During a review of the GACH's Assessment and Plan, dated 4/22/2025, the Assessment and Plan indicated Resident 3 was given Percocet (no dosage indicated) and a Lidocaine patch (no dosage indicated) for pain management. During a review of Resident 1's IDT Conference Record, dated 4/23/2025, the IDT Conference Record indicated Resident 1 had poor impulse control and was easily angered. The IDT Conference Record indicated there was no reference to the Dowel Resident 1 used to strike Resident 3 or interventions to prevent access to the Dowel During an interview on 5/5/2025, at 3:40 p.m., Resident 3 stated, approximately two Saturdays ago (unsure of the date), Resident 1 was upset because the patio door, that was located near her (Resident 3) bed, was closed and locked. Resident 3 stated Licensed Vocational Nurse (LVN) 1 explained to Resident 1 that the door had to remain closed at 7 a.m., because it was cold. Resident 3 stated Resident 1 argued with LVN 1 about the door being closed but thought she finally accepted what LVN 1 said. Resident 3 stated she was lying in bed watching television (4/19/2025) when Resident 1 called her names using expletives (a swear word). Resident 3 stated, Resident 1 had a pole in her hand and walked over to her (Resident 3) bed and hit her (Resident 3) on her right arm, right shoulder, and the pole grazed the right side of her face. Resident 3 stated she stood up because she was afraid of what Resident 1 would do next. Resident 3 stated she screamed for help and that was when Resident 1 turned and pushed her and she (Resident 3) fell backwards, hitting a wheelchair and bedside table on her way to the floor. Resident 3 stated Resident 1 tried to hide the pole in a sheet, but a CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 3 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0600 (unknown) saw the pole and took it away from Resident 1. Resident 3 stated she does not feel safe; she can't sleep and is afraid Resident 1 will find her and harm her. Level of Harm - Actual harm During an interview on 5/5/2025, at 3:55 p.m., Resident 1 refused to speak about the alleged incident. Residents Affected - Few During an interview on 5/5/2025, at 4:10 p.m., CNA 2, stated on 4/19/2025 she heard yelling and screaming coming from a room (Resident 1 and Resident 3's shared room) and when she entered the room, she saw Resident 3 on the floor against the wall and Resident 1 was standing over Resident 3 holding a pole in her hand and calling Resident 3 expletives. Resident 3 stated the pole that Resident 1 used to hit Resident 3 with, was approximately two to three feet long, wrapped in a sheet. During an interview on 5/6/2025, at 2:32 p.m., CNA 3, stated, around 10 p.m., (4/19/2025) she heard loud yelling coming from Resident 1's room. CNA 3 stated she, CNA 2, and CNA 4, who also heard the yelling, ran to Resident 1's room. CNA 3 stated when she arrived at the room, she saw Resident 1 holding a pole that was approximately three feet long, wrapped in a sheet, Resident 1 was standing over Resident 3 who was lying on the floor between the bed and the patio door in a fetal position (lying on one's side with knees pulled up towards the chest). During an interview on 5/6/2025, at 3:37 p.m., Registered Nurse Supervisor (RNS) 1 stated, a few months ago Resident 2, Resident 1's former roommate, accused Resident 1 of hitting her (Resident 2) with a stick. RNS 1 stated she looked everywhere for the stick but couldn't find it. During an interview on 5/7/2025, at 11:15 a.m., the Director of Rehabilitation (DOR) stated, when staff from the Rehab Department were not in the Rehab room, they close the door, but they don't lock it. The DOR stated, when the Rehab staff leave the facility, between 5 p.m. and 7 p.m., they (Rehab staff) lock the door. The DOR stated there were a total of 10 weighted dowels hanging on the wall in the Rehab room, and one of them was used by Resident 1 to hit Resident 3. The DOR stated the Dowel weighed two pounds. During an observation on 5/7/2025 (18 days after Resident 1 struck Resident 3 with the Dowel that was identified coming from the Rehab room), at 2:20 p.m., with the ADM and the DON present, in the rehabilitation room, Dowels and free weights of different weight and sizes were observed hanging unsecured on a wall in the Rehab room. During a concurrent observation and interview on 5/7/2025, at 2:57 p.m., the DOR showed the Dowel to Resident 2, Resident 2 confirmed that the Dowel looked like the object that Resident 1 hit her with on 2/24/2025. During a review of the facility's P/P, titled Prevention, Reporting and Correction of Inappropriate Conduct, Including Abuse Neglect and Mistreatment of Residents and Investigations of Injuries of Unknown Origin dated 7/2023, the P/P indicated It is the policy of the facility that each resident will be free from abuse. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 4 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the facility's Rehabilitation (Rehab) room equipment was not readily accessible for unauthorized use by residents and/or visitors or used as a weapon to hit for one of four sampled residents (Resident 1). The facility failed to: 1. Ensure the Rehab room and equipment located in the Rehab room was secured and supervised at all times to prevent unauthorized access by residents and/or visitors. 2. Ensure Resident 1 did not gain access to a Dowel (a pole or rod used in rehabilitation to improve shoulder mobility and strength) from the facility's Rehab room without staff knowledge. 3. Ensure Resident 1 did not use a Dowel to physically assault Resident 2 and Resident 3. 4. Ensure staff followed the facility Policy and Procedure (P&P) titled, Safety and Supervision of Residents dated 7/2017, which indicated, the facility has individualized resident centered approach to safety, addresses safety and accident hazards for individual residents. The interdisciplinary care team ([IDT] a group of health care professionals with various areas of expertise who work together toward the goals of the residents) shall analyze information obtained from assessments and observations to identify any specific accident hazards or risks for individual residents. The care team shall target interventions to reduce individual risks related to hazards in the environment. These deficient practices resulted in Resident 1 obtaining a Dowel (used to improve range of motion ([ROM] the direction a joint can move to its full potential), strength, and coordination, particularly for upper body movements like the shoulder and the hand) from the facility's Rehab room without staff knowledge or consent and using the Dowel to hit Resident 2 on her left arm on 2/24/2025 and Resident 3 on her right arm, right shoulder, and face then pushing Resident 3 to the floor on 4/19/2025. Resident 3 sustained a fracture (a break in a bone) to the mid sacrum (a triangular bone located at the base of the spine [back]) and was transferred to a General Acute Care Hospital (GACH) on 4/22/2025. These deficient practices placed residents' and/or visitors at risk for serious harm and death. On 5/8/2025, at 5:27 p.m., an Immediate Jeopardy ([IJ]) a situation in which the facility's noncompliance with one or more requirements of participation caused, or was likely to cause, serious injury, harm, impairment, or death to a resident) was called in the presence of the facility's Administrator (ADM) and Director of Nursing (DON) due to the facility's failure to keep the Rehab room equipment secured at all times and not accessible to Resident 1 or any other resident without supervision. On 5/9/2025, the facility submitted an acceptable IJ Removal Plan ([IJRP] an intervention to immediately correct the deficient practices). After onsite verification of the facility's IJRP implementation through observation, interview, and record review, the IJ was removed on 5/9/2025 at 5:23 p.m., in the presence of the facility's ADM and DON. The IJRP included the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 5 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 1. Corrective and appropriate actions to be implemented for the affected residents identified in the deficiencies. a. Immediate Action: On 4/19/2025, Resident 1 and Resident 3's incident was reported to the California Department of Public Health (CDPH) with final investigation of the report completed on 4/25/2025 and submitted. Following the resident-to-resident incident on 4/19/2025, Resident 1 and Resident 3 were immediately separated from each other on 4/19/2025. b. Immediate action: Resident 3 was transferred to another room in a different wing of the building with ongoing monitoring by staff of Resident 3's psychosocial wellbeing. Resident 3 was transferred to the hospital on 4/22/2025 for additional assessment related to an acute fracture of the mid sacrum and was returned to the facility on the same day with no new orders. Resident 3's care plan was updated by the assigned licensed nurse on 4/22/2025 to include a resident-to-resident altercation. c. Immediate action: Resident 1's care plan for behaviors was reviewed and updated on 4/19/2025 to include physical aggressive behavior. On 4/22/2025, Resident 1 was referred to a psychiatric mental health Nurse Practitioner (NP) but refused to meet with a mid-level practitioner (NP). On 4/23/2025 the Interdisciplinary Team ([IDT] a group of health care professionals with various areas of expertise who work together toward the goals of the residents) met with Resident 1 and her family member who agreed to intervene to assist Resident 1 to be seen by a psychiatrist. Resident 1 was sent out to General Acute Care Hospital (GACH) on 4/28/2025 for in-patient psychiatric evaluation related to physical aggression. Resident 1 returned on 4/29/2025 with a diagnosis of a urinary tract infection ([UTI] an infection in the bladder/urinary tract) and an order for antibiotics. Resident 1's care plan and IDT note was updated on 5/09/25 to address Resident 1's use of a dowel during the episode of aggressive behavior on 4/19/2025. d. Immediate Action: Effective 5/8/2025 a tracking system was implemented requiring Rehab staff to sign weighted dowels, free weights, and ankle weights in and out, noting their location and assigned user. If any item is found missing, staff must immediately notify the Rehab Manager and complete an incident log to initiate a prompt search and resolution process. e. Immediate Action: On 5/7/2025, the Executive Director was assigned to the Rehab Manager to ensure that weighted dowels, free weights, and ankle weights were properly locked and secured at the end of each treatment day. A log was created on 5/8/2025 to document and verify daily compliance with this security measure. f. Immediate action: On 5/8/2025, the Executive Director designated the Rehab Manager to ensure that access to the Rehab room is secured when staff were not present to supervise the gym. A log was created on 5/8/2025 to document daily compliance and serve as evidence of adherence to this protocol with rehab staff assigned with responsibility of documenting the time the room was secured and verification that no residents remain inside, to prevent unauthorized and unsupervised access. 2. Governing Body -Quality Assurance Performance Improvement (QAPI) committee a. Immediate Action: The IDT was in-serviced on 5/8/2025 by the Senior Nurse Executive (SNE) to review how to conduct an IDT meeting when reviewing resident to resident incidents. b. Immediate Action: An ad hoc (created or done for a particular purpose as necessary) QAPI Committee meeting was scheduled for 5/9/2025 to conduct a root cause analysis (RCA) to determine key issues (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 6 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few stemming from the recent resident to resident altercation to determine process breakdowns, including communication breakdowns, inconsistent documentation, and training gaps in high-risk monitoring protocols/interventions. c. The Executive Director (ED) will oversee corrective actions initiated on 5/8/2025 and monthly thereafter during QAPI meetings which were based on the results of the RCA and plan of corrections for the findings during the survey. Any corrective actions not meeting the 100% compliance benchmark, as determined by medical record audits, such as IDT, care plan and change of condition audits as well as safety equipment monitoring of rehab equipment random audits will be reviewed and revised with the QAPI Committee for revision, further evaluation, and recommendations, with a designated IDT member assigned to each corrective action. d. Any new issues found during medical record audits on resident to resident altercation will be presented to the IDT members for immediate action. The Chief Clinical Officer (CCO) will monitor the immediate actions for implementation of monitoring/audit needs at least monthly for the next 3 months or until compliance is 100% or is achieved. 3. Specific staff involved in implementing the corrective actions. a. Team Members: Medical Director, Executive Director, Chief Clinical Officer, Director of Staff Education, and Regulatory Compliance Nurse. Each member will perform: i. Medical Director: Through the QAPI committee, the Medical Director will monitor the system, recommend changes, and oversee corrective action plans. This role includes identifying and implementing medical interventions related to injuries resulting from resident-to-resident altercation. ii. Executive Director (ED): The ED will oversee all corrective actions initiated on 5/8/2025 and continue monthly reviews during QAPI meetings. iii. Chief Clinical Officer: Leading the IDT, the Chief Clinical Officer will regularly review at-risk residents who have physical aggression behaviors and assess intervention effectiveness and adjust care plans as needed. This role also ensures that abuse prevention practices are standardized, monitors staff compliance, coordinates equipment maintenance, educates staff, oversees data analysis, and conducts reviews to recommend preventive measures. iv. Regulatory Compliance Nurse/ Designee: This role entails staying updated on regulatory changes, collaborating with the interdisciplinary team to update policies, and ensuring staff adherence to these policies. It includes participating in quality improvement initiatives, analyzing compliance data, assisting with corrective actions, identifying risks, and investigating incidents to prevent recurrence. v. Director of Staff Education: This role involves educating staff on care planning, documentation, and protocols for abuse prevention and management, covering incident reporting, preventive measures, and emergency responses. Responsibilities include training new hires on resident safety, conducting competency assessments, and ensuring accurate documentation related to resident-to-resident altercation. 4. Identification of other residents who may need to be included (who may have been affected by the deficient practice: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 7 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0689 a. All residents were identified as potentially affected by the deficient practice. Level of Harm - Immediate jeopardy to resident health or safety b. There are 4 independent residents who can walk 10 to 50 feet. Out of these 4 residents, 3 can walk 150 ft and above. Out of these residents 1 resident with physical aggression - Resident 1. 5. Systemic Changes and Measures: Residents Affected - Few a. Immediate Action: The Interdisciplinary Team (IDT) in-service on 5/8/2025 by the Senior Nurse Executive (SNE) to review how to conduct an interdisciplinary team meeting when reviewing resident to resident incidents. b. System Change: A log was created on 5/08/2025 to document and verify daily compliance with securing weighted dowels, free weights, and ankle weights and locking the rehab room when no staff were present to supervise. Beginning 5/09/2025, the Activity Director and/or designee will use a monitoring tool to document compliance of logs created by the Rehab Department. Audits will be conducted daily for three days, then weekly for two weeks, and monthly thereafter. The issues found will be referred to the ED for further review and revision of the action plan and/or to determine any further training needed for staff involved. c. System Change: Starting 5/9/2025, the Medical Records Department will use a monitoring tool to audit the documented IDT and care plan for change of conditions related to any resident-to-resident altercations. Audits will be conducted daily for three days, then weekly for two weeks, and monthly thereafter. Any issues found will be referred to the Chief Clinical Officer (CCO) immediately for further review and revision of the action plan and/or to determine any further training needed for staff involved. 6. Training and Education Started on 5/08/2025 by Senior Nurse Executive and/or Designee. a. Immediate action: Inservice training for staff license nurses was started on 5/8/2025 on updating comprehensive care plans for residents that have been identified with physical aggression. A total of 16 nurses have been trained. The facility will continue training until all staff nurses have attended by 5/10/2025. b. Immediate action: Inservice training for IDT was started on 5/8/2025 on updating comprehensive care plan and interdisciplinary team investigation and documentation for residents that have been identified with physical aggression and those with resident-to-resident altercations. A total of 4 IDT members have been trained and will continue training until all IDT members have attended by 5/10/2025. c. Immediate action: Inservice training for rehab staff was started on 4/25/2025 on how to secure weighted dowels, free weights, and ankle weights and the rehab room door when no staff are present in the gym to supervise, as well as additional in-service initiated on 5/09/2025 on how to track and sign equipment in and out, noting its location and assigned user. A total of 10 rehab staff have been trained and will continue training until all Rehab staff have attended by 5/10/2025. Findings: During a review of Resident 1's Face Sheet (the front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated Resident 1 was originally admitted (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 8 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few to the facility on [DATE] and readmitted on [DATE] with diagnoses including anxiety disorder (a mental health condition characterized by excessive worry and fear that significantly interferes with daily life) and unspecified signs and symptoms (s/s) involving cognitive function decline (changes in thinking, memory, or attention that are not clearly categorized as a specific type of cognitive deficit) following a cerebral infarction ([stroke] loss of blood flow to a part of the brain)). During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool), dated 2/23/2025, the MDS indicated Resident 1's cognition was intact (able to make independent and reasonable decisions), and she could walk 150 feet. During a review of Resident 2's admission Record, (Face Sheet), the Face Sheet indicated Resident 2 was originally admitted to the facility on [DATE] and readmitted [DATE] with diagnoses including mild cognitive impairment (a brain condition that causes noticeable but mild memory and thinking problems) unspecified dementia (a progressive state of decline in mental abilities without behavioral disturbance, psychotic disturbance (a state where a person's thinking, perception, and behavior are significantly altered, leading to a loss in contact with reality), mood disturbance (a serious mental illness that causes persistent and intense changes in a person's mood, energy, and behavior), and anxiety. During a review of Resident 2's MDS, dated [DATE], the MDS indicated Resident 2's cognition was intact. During a review Resident 3's admission record (Face sheet), the Face Sheet indicated Resident 3 was admitted to the facility on [DATE], with diagnoses including hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and hemiparesis (weakness or inability to move on one side of the body) following a cerebral infarction affecting Resident 3's left non dominant side. During a review of Resident 3's MDS, dated [DATE], the MDS indicated Resident 3 's cognition was intact. The MDS indicated Resident 3 used a walker (a device used to assist with walking) for mobility. During a review of Resident 3's H&P dated 2/19/2025, the H&P indicated Resident 3 was alert and able to make decisions regarding routine medical decisions and her immediate needs. During a review of Resident 1's Progress Note, dated 2/24/2025, the Progress Note indicated Resident 2 reported that Resident 1 hit her with a cane on her left arm. During a review of Resident 1's Change in Condition (COC) Evaluation, dated 2/24/2025, the COC indicated at 10:43 p.m., Resident 2 reported that Resident 1 struck her with a stick. During a review the facility's Investigation of Resident 2's allegation dated 2/24/2025, the Investigation indicated the cane/stick was not located and there were no witnesses who saw the cane/stick. During a review of Resident 3's Nurses Progress Note, dated 4/20/2025, the Nurse Progress Note indicated Resident 3 reported that Resident 1 pushed her down and hit her with a stick multiple times on 4/19/2025. The Nurses Progress Note indicated three Certified Nursing Assistants (CNA 2, 3 and 4) reported seeing Resident 1 walking away from Resident 3's bed with a stick wrapped in a white sheet. The Nurses Progress Note indicated Resident 1 reported that Resident 3 always disrespected her and would always close the sliding door in the room and the room was always hot. The Nurses Progress Note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 9 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few indicated Resident 1 reported today (4/19/2025) she (Resident 3) closed the sliding door, and she (Resident 1) opened it. During a review of Resident 1's Nurses Progress Note, dated 4/21/2025 and timed at 10:06 a.m., the Nurses Progress Note indicated Resident 3 requested an X-ray (a procedure used to generate images of tissue and structures inside the body) of her right shoulder and back. A subsequent Nurses Progress Note dated 4/21/2025 timed at 12 p.m., indicated the Nurse Practitioner (NP) ordered a STAT (immediately) X-ray for Resident 3. During a review of Resident 3's X-ray results dated 4/21/2025, the X-ray results indicated an acute fracture of the mid sacrum. During a review of Resident 3's Physician's Order, dated 4/22/2025, the Physician's Order indicated to transfer Resident 3 to the GACH for an X-ray of her lumbar spine (lower portion of the back) and sacrum. During a review of Resident 3's Nurses Progress Note, dated 4/22/2025 and timed at 2:40 p.m., the Nurses Progress Note indicated Resident 3 was transported to a GACH for evaluation due to an X-ray result that indicated a fracture of the mid sacrum. During a review of the GACH's Face Sheet, the Face Sheet indicated Resident 3 was admitted to the GACH on 4/22/2025. During a review of GACH's Radiology (the science dealing with X-rays for the diagnosis and treatment of disease) Results, dated 4/22/2025, the Radiology Results indicated Resident 3 sustained a non-displaced fracture (a broken bone where he bone fragments remain in their correct alignment after the break) of the mid sacrum. During a review of the GACH's Assessment and Plan, dated 4/22/2025, the Assessment and Plan indicated Resident 3 was given Percocet (no dosage indicated) and a Lidocaine patch (no dosage indicated) for pain management. During a review of Resident 1's IDT Conference Record, dated 4/23/2025, the IDT Conference Record indicated Resident 1 had poor impulse control and was easily angered. The IDT Conference Record indicated there was no reference to the Dowel Resident 1 used to strike Resident 3 or interventions to prevent access to the Dowel During an interview on 5/5/2025, at 3:40 p.m., Resident 3 stated, approximately two Saturdays ago (unsure of the date), Resident 1 was upset because the patio door, that was located near her (Resident 3) bed, was closed and locked. Resident 3 stated Licensed Vocational Nurse (LVN) 1 explained to Resident 1 that the door had to remain closed at 7 a.m., because it was cold. Resident 3 stated Resident 1 argued with LVN 1 about the door being closed but thought she finally accepted what LVN 1 said. Resident 3 stated she was lying in bed watching television (4/19/2025) when Resident 1 called her names using expletives (a swear word). Resident 3 stated, Resident 1 had a pole in her hand and walked over to her (Resident 3) bed and hit her (Resident 3) on her right arm, right shoulder, and the pole grazed the right side of her face. Resident 3 stated she stood up because she was afraid of what Resident 1 would do next. Resident 3 stated she screamed for help and that was when Resident 1 turned and pushed her and she (Resident 3) fell backwards, hitting a wheelchair and bedside table on her way to the floor. Resident 3 stated Resident 1 tried to hide the pole in a sheet, but a CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 10 of 11 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 056488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunnyside Nursing Center 22617 S. Vermont Ave Torrance, CA 90502 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few (unknown) saw the pole and took it away from Resident 1. Resident 3 stated she does not feel safe; she can't sleep and is afraid Resident 1 will find her and harm her. During an interview on 5/5/2025, at 3:55 p.m., Resident 1 refused to speak about the alleged incident. During an interview on 5/5/2025, at 4:10 p.m., CNA 2, stated on 4/19/2025 she heard yelling and screaming coming from a room (Resident 1 and Resident 3's shared room) and when she entered the room, she saw Resident 3 on the floor against the wall and Resident 1 was standing over Resident 3 holding a pole in her hand and calling Resident 3 expletives. Resident 3 stated the pole that Resident 1 used to hit Resident 3 with, was approximately two to three feet long, wrapped in a sheet. During an interview on 5/6/2025, at 2:32 p.m., CNA 3, stated, around 10 p.m., (4/19/2025) she heard loud yelling coming from Resident 1's room. CNA 3 stated she, CNA 2, and CNA 4, who also heard the yelling, ran to Resident 1's room. CNA 3 stated when she arrived at the room, she saw Resident 1 holding a pole that was approximately three feet long, wrapped in a sheet, Resident 1 was standing over Resident 3 who was lying on the floor between the bed and the patio door in a fetal position (lying on one's side with knees pulled up towards the chest). During an interview on 5/6/2025, at 3:37 p.m., Registered Nurse Supervisor (RNS) 1 stated, a few months ago Resident 2, Resident 1's former roommate, accused Resident 1 of hitting her (Resident 2) with a stick. RNS 1 stated she looked everywhere for the stick but couldn't find it. During an interview on 5/7/2025, at 11:15 a.m., the Director of Rehabilitation (DOR) stated, when staff from the Rehab Department were not in the Rehab room, they close the door, but they don't lock it. The DOR stated, when the Rehab staff leave the facility, between 5 p.m. and 7 p.m., they (Rehab staff) lock the door. The DOR stated there were a total of 10 weighted dowels hanging on the wall in the Rehab room, and one of them was used by Resident 1 to hit Resident 3. The DOR stated the Dowel weighed two pounds. During an observation on 5/7/2025 (18 days after Resident 1 struck Resident 3 with the Dowel that was identified coming from the Rehab room), at 2:20 p.m., with the ADM and the DON present, in the rehabilitation room, Dowels and free weights of different weight and sizes were observed hanging unsecured on a wall in the Rehab room. During a concurrent observation and interview on 5/7/2025, at 2:57 p.m., the DOR showed the Dowel to Resident 2, Resident 2 confirmed that the Dowel looked like the object that Resident 1 hit her with on 2/24/2025. During a review of the facility's Policy and Procedure (P&P), titled, Safety and Supervision of Residents dated 7/2017, the P&P indicated, our individualized resident centered approach to safety addresses safety and accident hazards for individual residents. The interdisciplinary care team shall analyze information obtained from assessments and observations to identify any specific accident hazards or risks for individual residents. The care team shall target interventions to reduce individual risks related to hazards in the environment. The P&P indicated Resident supervision is a core component of the systems approach to safety. The type and frequency of resident supervision is determined by the individual resident's assessed needs and identified hazards in the environment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 11 of 11