Health inspection·July 24, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete review on 7/24/2025 at 10:24 a.m. with the Treatment Nurse (TN 1), Resident 1's Change of Condition (COC), dated July 2025 was reviewed. The COC indicated, on 7/2/2025, Resident was noted by TX Nurse with an open wound to the left hip. Wound Measurement 3.0 centimeter (cm-unit of measurement) by 4.0 cm. Light serious drainage noted, No mal odor, no signs and symptoms of infection. TN 1 stated Resident 1 was dependent on care for repositioning, toileting and hygiene care. TN 1 stated Resident 1 had a healed pressure ulcer on his left buttock upon admission on [DATE]. TN 1 stated the reopening of the left buttock pressure ulcer was identified on 7/2/2025 by the TN 2. TN 1 stated incontinence management (the management and treatment of involuntary loss of bladder or bowel control) was important in order to maintain resident's dignity and prevent health complications. TN 1 stated that incontinence management helps to prevent pressure ulcers, prevent worsening of current pressure ulcers, and to prevent a reopening of a healed pressure ulcer. TN 1 stated towels were not a standard of practice at the facility, and should not be used as a diaper, because they are rough and can cause friction. TN 1 stated using towels on Resident 1's perineal area could have caused his healed pressure ulcer to reopen. TN 1 stated he had received training on neglect and that not cleaning Resident 1 in a timely manner would be considered neglect. TN 1 stated if residents are not cleaned in a timely manner the residents could develop skin breakdowns such as pressure ulcers and could cause a healed pressure ulcer to reopen. TN 1 stated that residents being left soiled with urine and feces could also cause the residents to develop a urinary tract infection (UTI) due to the bacteria.During an interview on 7/24/2025 at 11:55 a.m. with the Director of Nursing (DON), the DON stated that the facility's practice was to check and change residents every two hours and as needed. The DON stated that towels should not be used as a diaper for the residents' perineal area because residents could feel less dignified, and towels could lead to skin breakdown due to increased moisture. The DON stated that all staff were responsible for ensuring that residents were cleaned in a timely manner. The DON stated she does round twice a day and spot checks to ensure that all staff were following incontinence management. The DON stated residents that have a higher risk for skin breakdown may require frequent monitoring for incontinence management. The DON stated Resident 1 probably felt uncared for and neglected by being left uncleaned by the staff.During a review of Resident 1's Care Plan, dated 11/2024, the goal Care Plan indicated resident will be clean, dry and odor-free daily through review date. The Care Plan interventions indicated to provide resident with absorbent incontinence briefs, clean peri-area with each incontinence episode.During a review of Resident 1's Care Plan, dated 12/2024, the Care Plan goal indicated to help reduce the risk of a skin impairment by the review date. The Care Plan interventions indicated to keep skin clean and dry. During a review of the facility's policy and procedure (P&P) titled, Wound Care Suggestions and Documentation, dated 2024, the P&P indicted, Cleanse skin, removing any incontinence, moisture, etc. in a timely manner, with soap and water or a commercial product of choice per manufacturer recommendations.During a review of the facility's policy and procedure (P&P) titled, Incontinence Care, dated 2024, the P&P indicated, It is the policy of this facility to promote skin hygiene, minimize risk of infection, and facilitate skin integrity by providing incontinent care as needed to residents.Cross reference F686. Event ID: Facility ID: 056488 If continuation sheet Page 2 of 4 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 07/24/2025 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 provide necessary treatment and services for one of two sampled residents (Resident 1), when Resident 1, who had an existing pressure ulcer (injury to skin and underlying tissue resulting from prolonged pressure on the skin), was left in urine and feces for an extended period of time.This failure had the potential for worsening of pressure ulcers and placed Resident 1 at risk for further skin breakdown, infection, and delayed wound healing.Findings:During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was originally admitted to the facility on [DATE] and was readmitted on [DATE] with diagnoses including cerebral infarction (blockage of blood flow to the brain, leading to tissue damage or death), malignant neoplasm of rectum (cells in the rectal lining grow uncontrollably and abnormally), and vascular dementia (conditions that damage blood vessels in the brain). During a review of Resident 1's History and Physical (H& P) dated 10/18/2024, the H&P indicated Resident 1 did not have the capacity to make decisions.During a review of Resident 1's Minimum Data Set ([MDS] resident assessment tool) dated 4/26/2025, indicated Resident 1 was dependent (helper does all of the effort, resident does none of the effort to complete the activity or the assistance of two or more helpers is required for the resident to complete the activity) on toileting hygiene, shower/bath, and personal hygiene. The MDS indicated Resident 1 was always incontinent with urine and bowel movements and was at risk of developing pressure ulcers/injuries. During a concurrent observation and interview on 7/24/2025 at 8:20 a.m. with Certified Nurse Assistant (CNA 1), observed Resident 1 lying in bed on his right side, towel positioned on Resident 1's perineal area (skin between your [genitals]- external and internal reproductive organs), saturated with urine and feces. Resident 1 had dried feces on his buttocks and thighs. The odor of urine and feces was noticeable upon entering the room. CNA 1 stated that Resident 1 was dependent of care, and he had a pressure ulcer (injury to skin and underlying tissue resulting from prolonged pressure on the skin) on his left buttock and left thigh. CNA 1 stated residents should be checked every two hours and as needed to avoid them being left soiled for long periods of time, which could cause skin breakdown. CNA 1 stated neglect (the ongoing failure to meet a person's basic needs) would be not changing the residents in a timely matter, delaying care, and withholding care. CNA 1 stated if a resident goes for a long time without being change it could cause pressure ulcers, or they could develop a urinary tract infection ([UTI]- an infection in any part of the urinary system) due to the bacteria ( germs that cause infection) from the feces and urine. CNA 1 stated that it was not the facility's practice to use towels for residents' perineal area. CNA 1 stated that Resident 1 should not have a towel placed in his perineal area, because that could cause skin problems because the towel was rough on the skin. CNA 1 stated Resident 1 could have felt neglected due to being left lying in feces and urine. CNA 1 validated the feces observed on Resident 1 was dry which indicates that he had not been cleaned in a timely manner and that would be considered neglect.During a concurrent interview and record review on 7/24/2025 at 10:24 a.m. with the Treatment Nurse (TN 1), Resident 1's Change of Condition (COC), dated July 2025 was reviewed. The COC indicated, on 7/2/2025, Resident was noted by TX Nurse with an open wound to the left hip. Wound Measurement 3.0 centimeter (cm-unit of measurement) by 4.0 cm. Light serious drainage noted, No mal odor, no signs and symptoms of infection. TN 1 stated Resident 1 was dependent on care for repositioning, toileting and hygiene care. TN 1 stated Resident 1 had a healed pressure ulcer on his left buttock upon admission on [DATE]. TN 1 stated the reopening of the left buttock pressure ulcer was identified on 7/2/2025 by the TN 2. TN 1 stated incontinence management (the management and treatment of involuntary loss of bladder or bowel Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 3 of 4 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 07/24/2025 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete control) was important in order to maintain resident's dignity and prevent health complications. TN 1 stated that incontinence management helps to prevent pressure ulcers, prevent worsening of current pressure ulcers, and to prevent a reopening of a healed pressure ulcer. TN 1 stated towels were not a standard of practice at the facility, and should not be used as a diaper, because they are rough and can cause friction. TN 1 stated using towels on Resident 1's perineal area could have caused his healed pressure ulcer to reopen. TN 1 stated he had received training on neglect and that not cleaning Resident 1 in a timely manner would be considered neglect. TN 1 stated if residents are not cleaned in a timely manner the residents could develop skin breakdowns such as pressure ulcers and could cause a healed pressure ulcer to reopen. TN 1 stated that residents being left soiled with urine and feces could also cause the residents to develop a urinary tract infection (UTI) due to the bacteria.During a review of Resident 1's Order Summary Report, dated 7/2025, the Order Summary Report indicated, Clarification of Orders: Left hip open wound reclassified to left buttock reopen pressure injury (injury to skin and underlying tissue resulting from prolonged pressure on the skin).During an interview on 7/24/2025 at 11:55 a.m. with the Director of Nursing (DON), the DON stated that the facility's practice was to check and change residents every two hours and as needed. The DON stated that towels should not be used as a diaper for the residents' perineal area because residents could feel less dignified, and towels could lead to skin breakdown due to increased moisture. The DON stated that all staff were responsible for ensuring that residents were cleaned in a timely manner. The DON stated she does round twice a day and spot checks to ensure that all staff were following incontinence management. The DON stated residents that have a higher risk for skin breakdown may require frequent monitoring for incontinence management. The DON stated Resident 1 probably felt uncared for and neglected by being left uncleaned by the staff.During a review of Resident 1's Braden Scale (a widely used tool in healthcare to assess a patient's risk of developing pressure ulcers) for Predicting Pressure Sore Risk, dated 4/2025, the Braden Scale for Predicting Pressure Sore Risk indicated, Resident 1's Braden Score 12 (score of 10-12 is considered high risk for developing pressure ulcer).During a review of Resident 1's Care Plan, dated 12/2024, the Care Plan goal indicated to help reduce the risk of a skin impairment by the review date. The Care Plan interventions indicated to keep skin clean and dry. During a review of the facility's policy and procedure (P&P) titled, Wound Care Suggestions and Documentation, dated 2024, the P&P indicted, Cleanse skin, removing any incontinence, moisture, etc. in a timely manner, with soap and water or a commercial product of choice per manufacturer recommendations.During a review of the facility's policy and procedure (P&P) titled, Incontinence Care, dated 2024, the P&P indicated, It is the policy of this facility to promote skin hygiene, minimize risk of infection, and facilitate skin integrity by providing incontinent care as needed to residents.Cross reference

F600. Event ID: Facility ID: 056488 If continuation sheet Page 4 of 4