Health inspection·November 20, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few License Vocational Nurse (LVN) 1, Resident 1's Morse Fall Scale, (a simple tool used by healthcare professionals to quickly assess a patient's risk of falling) dated 9/11/2025 was reviewed. The Morse Fall Scale indicated Resident 1's score was 65.0, indicating high risk for falls. LVN 1 stated that she was notified of Resident 1's fall by a registry nurse, on 11/7/2025 at approximately 5:00 p.m., but she was unable to recall the individual's name. LVN 1 stated that for residents identified as high-risk for falls, the facility implements the Falling Star Program. LVN 1 stated that the program includes placing the resident's bed in a low position, use of floor mats, and use of a bed alarm if needed, and frequent monitoring, particularly for residents who demonstrate unsafe behaviors such as attempting to get out of bed or exhibiting aggressive behavior. LVN 1 stated that prior to Resident 1's fall, the resident had been confused, striking out at staff, and was attempting to get out of bed without assistance. LVN 1 stated that these behaviors increased the resident's fall risk and contributed to the need for additional safety interventions. LVN 1 stated that the physician was not notified about Resident 1's behavior. LVN 1 stated the only fall precaution that was in place prior to Resident 1's fall was the bed was in a low position. LVN 1 stated that she informed Resident 1's representative that the facility was unable to obtain a sitter or a bed alarm for Resident 1 because a physician order was required. LVN 1 stated that she offered to provide floor mats as an intervention; however, she was unable to obtain the floor mats at that time. LVN 1 stated that she did not contact the physician at the time to try to obtain a sitter or bed alarm and reported that she did not have a reason for why the physician was not contacted. LVN 1 acknowledged that the physician should have been notified to obtain the necessary orders for additional safety interventions. LVN 1 stated that a potential outcome of not having these interventions in place is that the resident could fall and get injured because staff may not know right away that the resident is getting out of bed. During a telephone interview on 11/18/2025 at 11:06 a.m. with Registered Nurse Supervisor (RNS), the RNS stated that her role is to oversee residents that are at high risk for falls, which includes implementing fall-prevention precautions and carrying out the facility's Falling Star Program. The RNS stated that this program includes ensuring that the residents' bed is in the lowest position, floor mats are in place, bed alarms are used if needed, and frequent monitoring. RNS stated that prior to Resident 1 falling, that the resident was yelling, attempting to hit staff, and repeatedly attempting to get out of bed. RNS acknowledged that these behaviors represented a change in condition ([COC] a sudden, clinically important deviation from a patient's baseline in physical, cognitive (ability to think, understand, learn, and remember) behavioral, or functional status which without immediate intervention, may result in complications or death, and that the physician should be notified of such changes so that the resident's care plan can be revised and updated. The RNS stated that she did not notify the physician of the resident's change in condition prior to the fall, and she did not complete a change in condition assessment after the resident began exhibiting increased confusion. The RNS stated that failure to notify the physicians could result in the residents not receiving timely medical interventions, which may lead to further decline, increased risk of injury, or additional adverse events. The RNS acknowledged that this could negatively impact the residents' overall safety and well-being. The RNS validated that Resident 1 did not have floor mats at the time of her fall. RNS stated that she did not think about the resident not having floor mats. The RNS stated that Resident 1 should have floor mats in place, as floor mats are part of the Falling Star Program for residents identified as high risk for falls. The RNS acknowledged that the absence of floor mats could increase the risk of injury if the resident attempted to get out of bed or fall, as the mats provide an added safety measure to reduce potential harm. During a concurrent interview and record review on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete 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 11/20/2025 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 - Minimal harm or potential for actual harm Residents Affected - Few 11/18/2025 at 12:54 p.m. with the Assistant Director of Nursing (ADON), Resident 1's Care Plan dated September 2025 was reviewed. The Care Plan indicated, Resident is high risk for fall but the facility's Falling Star Program interventions were not initiated until 11/10/2025. The ADON stated the Falling Star Program was not initiated for Resident 1 upon admission in September 2025, despite the resident being identified as a fall risk on the care plan. The ADON stated the failure to implement the program could have resulted in a negative outcome, as Resident 1 sustained two falls on 11/7/2025 and 11/8/2025. The ADON stated she did not know why the Falling Star Program was not initiated at the time of Resident 1's admission. The ADON stated upon admission and readmission, all residents should be assessed for their fall risk by utilizing the Morse Fall Scale. The ADON stated the facility's fall-prevention policy for confused residents includes frequent visual monitoring, rounding every two hours and as needed, and bed alarms if indicated, to ensure resident safety and to identify any changes in condition promptly. The ADON stated that based on Resident 1's behaviors prior to the falls, such as confusion and attempts to get out of bed, that a bed alarm should have been attempted as an intervention for Resident 1. The ADON stated the physician should have been informed of Resident 1's behavior prior to the fall to determine whether additional safety interventions, including a bed alarm. The ADON stated Resident 1's care plans and interventions were not revised following the first fall. The ADON stated that she is not sure why this was not completed. The ADON stated it is important for care plans to be reviewed and updated after a fall to ensure that resident goals and interventions are met and to maintain resident safety. The ADON stated all staff are responsible for ensuring that fall precaution interventions are in place. During a concurrent on 11/20/2025 at 12:51 p.m. with Certified Nurse Assistant (CNA) 2, Resident 1's Tasks section of the electronic health record (EHR-collection of a resident's health information that is stored electronically) was reviewed. Review of the documentation from 10/31/2025 through 11/7/2025 showed no evidence that floor mats were documented as being in place during this period. CNA 2 stated there was no documentation indicating that floor mats were present for Resident 1 on the dates reviewed. During a concurrent interview and record review on 11/20/2025 at 1:44 p.m. with the Director of Nursing (DON), the facility's policy titled Falling Star Program was reviewed, the P&P indicated, Provide floor mats at the bedside and utilize chair and bed alarms for residents with unsafe behaviors, as appropriated. The DON stated staff reported to her that Resident 1 was exhibiting unsafe behaviors, including attempting to get out of bed, being confused, striking out at staff, and removing clothing. The DON stated these behaviors were not documented or reported to the physician. The DON stated Resident 1 should have been assessed for fall-prevention interventions such as bed alarms and floor mats, in alignment with policy expectations. The DON acknowledged that a bed alarm was not ordered, and floor mats were not provided at the time of Resident 1's first or second fall. The DON stated that the resident's care plan and interventions should have been reviewed and updated after the first fall to reflect the increased risk. The DON stated that failure to follow established interventions can result in unwitnessed falls, delayed staff response, head injuries, fractures, hospitalization, or other serious harm. The DON stated that the lack of a bed alarm or floor mats may have contributed to Resident 1 experiencing two falls on 11/7/2025 and 11/8/2025. During a review of the facility's policy and procedure (P&P) titled, Alarms (Personal), dated 2024, the P&P indicated, the purpose of this procedure is to decrease the incidents of fall and to intervene as soon as possible when a fall occurs.During a review of the facility's policy and procedure (P&P) titled, Falling Star Program, dated 2024, the P&P indicated to utilize chair and bed alarms for residents with unsafe behaviors, as appropriate.During a review of the facility's policy and procedure (P&P) titled, Safety and Supervision of Residents, dated 2017, (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 11/20/2025 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 the P&P indicated, the care team shall target interventions to reduce individual risks related to hazards in the environment, including adequate supervision and assistive devices. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056488 If continuation sheet Page 4 of 4