Health inspection·March 28, 2025

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some residents are asked if they have an advance directive or would like to form one. SW stated there was no documentation that an advance directive was offered or discussed for Resident's 89 and 195. During an interview on 3/28/2025 at 12:13 p.m. with the Director of Nursing (DON), the DON stated all residents should be offered to formulate an advance directive for their protection, choices, and rights. The DON stated the advance directive is important to have so the staff are aware of what the resident's wishes are or who would make the decision for their care if they were unable to do so for themselves. During a review of the facility policy and procedure (P&P) titled, Advance Directives, dated 7/2018, the P&P indicated, In compliance with the Patient Self-Determination Act, all adult patients admitted to the medical center as inpatients, or their surrogates/family members, will be given specific information concerning Advance Directives unless they specifically state they do not need or want information on the topic. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 2 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0583 Keep residents' personal and medical records private and confidential. 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 ensure Resident 196's medical information was kept private from unintended public view, affecting one of five residents observed during survey task observations. Residents Affected - Few This deficient practice had the potential for anyone to access Resident 196 medical records that are confidential. Findings: During a review of Resident 196's admission Record, undated, the admission Record indicated, Resident 196 was admitted to the facility on [DATE]. During a review of Resident 196's Minimum Data Set (MDS - a resident assessment tool), undated, the MDS indicated diagnoses that included but not limited to, hypertension (HTN - high blood pressure) and seizure [a sudden, uncontrolled electrical disturbance in the brain which can cause uncontrolled jerking, blank stares, and loss of consciousness] disorder or epilepsy. During an observation on 3/25/2025 at 2:05 p.m. in the facility's floor hallway near the nurses' Station 2, the computer screen was unattended and open on a mobile workstation showing Resident 196's medical information. There was no facility nurse near the computer screen. The computer screen indicated, but not limited to, Resident 196's name, date of birth , age, medical record number, code status, and medication administration record (MAR). The MAR indicated medications such as hydralazine (a medication used to treat HTN) tablet 50 milligrams ([mg] a unit of measurement for mass) three times daily along with doses given versus what was due, lamotrigine (a medication used to treat seizures) tablet 50 mg two times daily along with doses given versus what was due, and levetiracetam (a medication used to treat seizures) tablet 1000 mg two times daily. During a concurrent observation and interview on 3/25/2025 at 2:16 p.m. with the Unit Coordinator (UC) at Nurses' Station 2, the computer screen with Resident 196's medical information was reviewed. The UC stated the computer screen should be always locked to protect resident privacy. During an interview on 3/27/2025 at 3:58 p.m. with the Director of Nursing (DON), the DON stated, it is never okay to keep the patient information visible for public view because that can compromise patient privacy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 3 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. 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 ensure one of four sampled residents (Resident 20) had side rails (bars or rails attached to the sides of a bed) were in up position. Residents Affected - Few This failure had the potential to put Resident 20 at risk for injuries such as falls, strangulation and death. Findings: During a review of Resident 20's admission Record, the admission Record indicated the resident was admitted on [DATE] to the facility. During a review of Resident 20's History and Physical (H&P) dated 2/26/2025, the H&P indicated the resident had history of recurrent falls, hypertension (HTN- high blood pressure), and left clavicular fracture ( a break in theft left collarbone) after a fall at home. During a review of Resident 20's Minimum Data Set ( MDS- a resident assessment tool ) dated 3/4/2025, the MDS indicated the resident had severely impaired cognitive skills( a person has a significant difficulty in thinking, learning, remembering , using judgement, and making decisions affecting daily activities) and was dependent (helper does all the effort) on the staff with dressing, toileting hygiene, and bathing. The MDS indicated the resident required partial/moderate assistance (helper does less than half the effort) with bed mobility and transfer to and from a bed to chair. During an observation on 3/25/2025, at 11:10 a.m. in Resident 20's room, Resident 20 had bed side rails up times four. Bruises were observed in both arms. During an interview on 3/27/2025, at 9:30 a.m. and at 3:12 p.m. with Certified Nursing Assistant (CNA 1), CNA1 stated Resident 20 should have three side rails in up position because four side rails up is a form of restraint and required a physician's order. CNA1 stated she had seen the resident when he came back from physical therapy and all the four side rails were in up position on 3/25/2025. CNA 1 stated she should have placed the other side rail down to ensure Resident 20's movement will not be restricted. During a concurrent observation and interview on 3/25/2025, at 11:27 a.m. in Resident 20's room and subsequent interview on 3/27/2025, at 9:19 a.m. with Registered Nurse (RN 1), RN 1 stated Resident 20 stated Resident 20's had four bed rails in up position because the resident was a high risk for fall. Observed Resident 20 tries to climb out of bed. RN 1 stated four bed rails up was considered a restraint ( any manual method, physical or mechanical device, equipment, or material that limits a resident's freedom of movement and cannot be removed by the resident) because it limits the mobility of a resident and could lead to injury. RN 1 stated four side rails in up position required a consent and a physician order. RN 1 stated the Physical Therapist (health care professional who helps people improve their movement and function through exercises) might have placed all four side rails up because he did not see the resident when he came back from physical therapy (healthcare profession that focuses on helping people with conditions or injuries that limit their ability to move and do physical activities). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 4 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 3/27/2025 at 2:26p.m., with Physical Therapist (PT 1), PT 1 stated Resident 20 was taken out of bed around 9 a.m. on 3/25/2025 and upon return to Resident 20's room at around 11:00 a.m., the resident was left sitting on the side of the bed because the resident wanted to use the restroom. PT 1stated he handed off Resident 20 with the nursing staff who was present in the room before he left. During an interview on 3/28/2025 at 11:45 a.m., with the Director of Nursing (DON), DON stated four side rails up was considered a restraint and can have a negative outcome. The DON stated the resident could get climb out of the bed and this would lead to fall and injury. During a review of the facility's policy and procedure (P&P) titled, TCC/TCU: Bedrails last revised 3/2020, the P&P indicated, Bed rails will not be used when a resident cannot raise and lower them easily, thereby meeting the definition of a physical restraint. During a review of the facility's P&P titled, Restraint for Non-Violent /Non-Self-Destructive Behavior revised on 5/2022, the P&P indicated all patients have the right to be free from any form of restraint that are imposed as a means of coercion, discipline, convenience, or retaliation by staff. The P&P indicated the facility will protect and preserve the rights , dignity , safety of the residents and eliminate inappropriate use of restraints. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 5 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 observation, interview, and record review, the facility failed to ensure Registered Nurse (RN) 2 crushed and administered each oral medication separately for one of five sampled residents (Resident 94) during medication administration observation. Residents Affected - Few This failure had the potential to place Resident 94 at risk for drug interactions (occur when two or more drugs taken simultaneously affect each other's actions in the body) or intolerability to one or more medications without possibly knowing which medication caused intolerability. Findings: During a review of Resident 94's admission Record (a document containing demographic and diagnostic information), dated 3/27/2025, Resident 94 was admitted to the facility on [DATE] with diagnoses including, but not limited to, swallowing impairment and gastroesophageal reflux disease ([GERD] a condition where stomach contents flow back up to esophagus causing irritation). During a review of Resident 94's Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 3/13/2025, the MDS indicated Resident 94's cognition was moderately impaired. The MDS indicated, Resident 94 needed supervision level assistance from facility staff for Activities of Daily Living (ADLs) such as for eating and oral hygiene, moderate assistance for personal hygiene, maximal assistance for upper body dressing, dependent for lower body dressing, putting on/taking off footwear and showering, and toileting hygiene not attempted due to medical condition or safety concerns. During a concurrent observation and interview on 3/26/2025 at 9:10 a.m. with RN 2, RN 2 prepared the following five medications to be administered to Resident 94. RN 2 stated she would need to crush Resident 94's four medications and administer docusate sodium (a medication used to treat constipation) oral liquid with a thickening agent. 1. One tablet of amlodipine (a medication used to treat high blood pressure) 5 milligrams ([mg] a unit of measure for mass) 2. One tablet of ferrous gluconate (a medication used to treat low level of iron) 324 mg 3. One tablet of bisoprolol (a medication used to treat high blood pressure and heart complications) 5 mg 4. One tablet of multivitamin with iron 5. 10 milliliters ([mL] a unit of measure for volume) of docusate sodium oral liquid 50 mg per 5 mL RN 2 placed four medications (amlodipine, ferrous gluconate, bisoprolol, multivitamin with iron) in a clear bag and crushed them together using a crushing device before pouring the powder mixture into a paper cup. RN 2 stated she would administer the powder mixture of four medications to Resident 94 with apple sauce. RN 2 stated if it was a gastrostomy tube (g-tube - a surgically placed tube used to administer medications or food directly into the stomach) then she should have crushed each medication separately and administered each medication separately. RN 2 stated because the medications were to be administered orally to Resident 94 it was okay to crush all medications together and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 6 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 administer altogether by mouth with apple sauce. RN 2 did not ask Resident 94 if she preferred to take crushed medications together before administering medications to the resident. During a review of Resident 94's Order Summary Report (a document containing a summary of all active current physician orders), dated 3/27/2025, the document did not indicate a physician order to crush oral medications. During a concurrent interview on 3/27/2025 at 3:27 p.m. with the Director of Nursing (DON) and pharmacist (RPH) 3, DON stated if medications were to be crushed and given by mouth, then facility nurse should have crushed one medication at a time, then mix with apple sauce and administer one medication at a time .second medication same way, crush it, mix it and give it. DON stated each medication should have been crushed separately and mixed with apple sauce one by one. DON and RPH 3 stated it was important to administer each crushed medication separately to be able to determine which medication caused an allergic reaction if the resident was allergic to a medication or had absorption issues with a certain medication. During a review of the facility's policy and procedure (P&P), titled, Oral drug administration, dated 5/20/2024, the P&P indicated, cardiovascular agents, antibiotics .are the most common drugs that cause drug interactions. The P&P indicated, Verify that you're administering the medication at the proper time by the correct route .errors. Administer the medication to the patient .as needed, to aid in swallowing, minimize adverse effects and promote absorption. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 7 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure Certified Nursing Assistant's (CNA's) annual skills competencies were completed for CNA 2 and CNA 3 . These failures had the potential to put the resident's safety at risk during care. Findings: During a concurrent interview and record review on [DATE] at 10:45 a.m. with the Director of Staff Development (DSD), CNA 2 and CNA 3's Education & Professional Practice Competency Checklists. The DSD stated CNA 2 was hired on [DATE] and her last competency was done on [DATE]. The DSD stated CNA 3 was hired [DATE] and that her last skills competency was done on [DATE]. The DSD stated competencies are done annually. DSD stated we need to make sure that the staff are still preforming their skills appropriately. DSD stated CNA's can develop wrong habits and residents could receive poor care and be re-hospitalized if the CNAs are not providing good quality care. During an interview on [DATE] at 12:17 p.m. with the Director of Nursing (DON). The DON stated the DSD is responsible for education in the facility and that the CNAs should have annual skills competencies to ensure that the staff are performing their skills accurately and not missing anything . The DON stated there is a risk for the residents to develop an infection when not providing proper care. During a review of the facility's policy and procedure (P&P) titled Transitional Care Center Scope of Service - Education. Dated 7/2024, the P&P indicated, in keeping with the mission and core values of St. [NAME] Health Services Transitional Care, it is the policy of the facility to provide quality care for residents/customer satisfaction by individualizing, teaching, and coordination with other health services to assure continuity of care and to provide safe delivery of patient care to a culturally diverse young adult to geriatric community. A. The education department/ staff development assess and maintain the educational needs of the nursing staff and the interdisciplinary health team of Providence Little Company of [NAME] Transitional Care Center. B. Provides educational programs, in-services in accordance with the requirement of the federal and state regulations of Title XXII and TJC (The joint commission) C. Develops coordinates and implements competency based educational programs which are in compliance with the applicable standards and regulations. D. Maintains updated licenses, CPR certificates & health/physical exams. Validates and maintains competencies required for the nursing staff and other members of the health care team as required. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 8 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure one of four sampled residents (Resident 95) received appropriate services to meet resident's behavioral health care needs by failing to: 1.Ensure the psychiatric services( type of mental health care that focuses on diagnosing and treating mental illness) were provided to Resident 95 who was prescribed Ativan (Lorazepam- drug used to treat anxiety) and Seroquel ( Quetiapine- drug to treat depression) after manifesting confusion, anxiety and climbing out of bed. Resident 95 had diagnoses of anxiety and depression and was on Prozac(Fluoxetinedrug used to treat depression), Ambien ( drug used treat insomnia) and Valium ( medicine used to treat anxiety disorder). 2. Ensure Interdisciplinary Team (IDT group of healthcare professionals from different disciplines who collaborate to provide comprehensive and coordinated care for a patient) addressed resident's behavioral problems and the use of psychotropic medicines (a drug or other substance that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behavior). These failures had the potential to put Resident 95 at risk for increased pharmacological treatment for resident's behavioral symptoms and lack or inappropriate treatment or management of Resident 95 's mental and psychosocial needs. Findings: 1.During a review of Resident 95's admission Record, the admission Record indicated the resident was admitted on [DATE] to the facility. During a review of Resident 95's History and Physical (H&P) dated 3/6/2025, the H &P indicated the resident had a history of multiple sclerosis ( disorder in which body's immune system attacks the protective covering of the nerve cells in the brain and spinal cord ), possible status epilepticus (a prolonged or continuous seizure activity that can be life threatening) and femur fracture ( a break in the thigh bone)surgery after a fall in the hospital. During a review of Resident 95's Minimum Data Set (MDS- a resident assessment tool) dated 3/12/2025, the MDS indicated the resident had an intact cognition(thought process) and had no potential indicators of psychosis( a severe mental condition in which thought, emotions are so affected that contact is lost with reality) such as hallucinations(perceptual experiences in the absence of real external sensory stimuli) and delusions (having false or unrealistic beliefs). The MDS indicated the resident required partial/moderate assistance (helper does less than half the effort) with bed mobility, oral hygiene and personal hygiene. The MDS indicated the resident had diagnoses that included anxiety disorder, seizure disorder or epilepsy( disorder of the brain characterized by repeated seizures) and hip fracture. During a review of Resident 95's Medication Administration Record (MAR-MAR - a daily documentation record used by a licensed nurse to document medications and treatments given to a resident) 3/2025, the MAR indicated the resident was on Valium ( a medicine of the benzodiazepine family that acts as an anxiolytic) 10 milligrams( mgs.- unit of measurement) every 8 hours as needed for anxiety. The MAR indicated the Valium was ordered 3/8/2025 and was reordered on 3/29/2025. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 9 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of Resident 95's MAR, the MAR indicated Prozac (can treat depression, obsessive-compulsive disorder (OCD), bulimia nervosa, and panic disorder)60 mgs. daily was ordered 3/6/2025. During a review of Resident 95's MAR, the MAR indicated Seroquel 25 mgs. every 12 hours as needed for agitation was ordered on 3/5/29025. The MAR indicated Seroquel's physician order was changed to 25 mgs. nightly on 3/13/2025. During a review of Resident 95's MAR, the MAR indicated Zolpidem (Ambien) 5 mgs. nightly prn (as needed) for insomnia was ordered on 3/5/2025 and was reordered on 3/19/2025. During a review of Resident 95's Nursing Progress Note dated 3/17/2025 timed at 6:22 p.m., the Nursing Progress Note indicated the resident was confused, restless, agitated and had a feeling of sadness. The Nursing Progress Note indicated the resident was confused and forgetful to situation and time and the resident tend to say, help me, help me. During a review of Resident 95's Nursing Progress Note dated 3/17/2025, timed at 3:36 a.m., the Progress Notes indicated the resident was anxious, confused, and was climbing out of bed. The Nursing Progress Notes indicated the resident was awake, with episode of inability to relax manifested by calling out from time to time and received pain medication for the complaint of right forearm pain. The Progress Notes indicated on 3/17/2025, at 3:40 a.m. the resident woke up and requesting for anti- anxiety medicine again and medication was provided. During a review of Resident 95's Informed Consent (voluntary agreement to accept treatment after receiving education regarding risks, benefits and alternatives offered) dated 3/16/2025 timed at 7:30 p.m., the Informed Consent indicated a signed consent for the use of Ativan 1 mg. twice a day for anxiety. During a review of Resident 95's Informed Consent dated 3/17/2025 timed at 7:30 p.m., the Informed Consent indicated a signed consent for the use of Seroquel 50 mgs. nightly for psychosis. During a concurrent observation and interview on 3/27/2025, at 8:39 a.m. with Resident 95, Resident 95 was lying in bed. Resident 95 stated she was sleepy and not that awake yet. Resident 95 stated she could not remember the names of her medications that help her relax and there was no psychiatrist seeing her with her anxiety. During a concurrent interview and record review of Resident 95's electronic chart on 3/27/2025, at 10:43 a.m. with Registered Nurse (RN 2), RN 2 stated the psychotropic medicines were given to Resident 95 's anxiety. RN 2 stated the resident had psychosis, depression and anxiety and confirmed there was no psychiatrist evaluating resident's behavioral problems and psychotropic medicines RN 2 stated the resident should be seen by a psychiatrist so his behavioral needs and mental health will be addressed and reassessed. RN 2 stated Resident 95 could get sleepier, and her mental health could get worse if resident's psychotropic medicines were not reassessed for appropriateness of use. During a concurrent interview and record review of Resident 95's electronic chart on 3/27/2025, at 3:25 p.m. with RN 3, RN 3 confirmed the resident had no diagnosis for psychosis .RN 3 stated Resident 95 could be at risk for unnecessary medicines and could be at risk for adverse effects (undesired and unwanted harmful effects that can occur after taking a medication) of the psychotropic medicines if the medications are not properly monitored for its use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 10 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and record review of Resident 95's electronic chart on 3/28/2025, at 9:07 a.m. with Assistant Nurse Manager(ANM), ANM verified the resident was on Valium, Prozac, Ativan, Seroquel and Ambien. ANM stated on 3/17/2025, the resident had a change in condition (COC-significant change in someone's health, functioning, or circumstances that requires attention or intervention) when the resident was manifesting more anxiety. ANM stated the neurologist( medical doctor who specializes in the diagnosis, treatment, and management of disorders affecting the brain, spinal cord, and nervous system) ordered Ativan 1 mg. twice a day and increased the dose of Seroquel to 50 mgs. due to resident's agitation. ANM stated there was no psychiatrist involved in the resident's case. ANM stated the facility should have consulted a psychiatrist because the resident was manifesting more anxiety. ANM stated the resident's behavioral change should have been addressed properly so the resident can have a better quality of life. ASM stated using Seroquel and Ativan could act as a chemical restraint and could be also an unnecessary medicine. 2. During a review of Resident 95's IDT Care Conference( structured meeting where the care team , resident, and family members discuss the resident's care plan, progress, and any concerns to ensure a collaborative approach to care) dated 3/20/2025, the IDT Care Conference indicated psychotropic medicines usage and change in condition of the resident were not addressed during the meeting. During a concurrent interview and record review of Resident 95's electronic chart on 3/28/2025, at 9:07 a.m. with ANM, ANM confirmed the IDT Care Conference conducted on 3/20/2025 did not address the resident's change in condition regarding her increased anxiety on 3/17/2025. ANM stated the IDT Care Conference is performed twice a week and the facility should have addressed the behavior during IDT meeting. During an interview on 3/28/20245, at 11:45 a.m. with Director of Nursing (DON), DON stated the facility conducted IDT Meeting on all residents to ensure residents' goals are met, plan of care and residents' progress are discussed. DON stated psychiatric consultation should be expected to ensure Resident 95's behavior was addressed. DON stated Resident 95's increased anxiety was a change in condition with two psychotropic medicines added and should be discussed during IDT Care Meeting to reach resident's goals. During a review of facility's policy and procedure (P&P) titled Transitional Care Center: Interdisciplinary Team Conference, revised 11/2024, the P&P indicated resident's needs are assessed and the plan of care is established from admission through discharge by utilizing an interdisciplinary team approach composed of Physicians, Director of Nursing or designee, Activity Coordinator, Physical therapist, Speech Therapist, Social Services, and other members as is appropriate in caring for the resident. During a review of facility's P&P titled Psychotropic Drug Management for Long Term Care Facilities, revised 3/2022, the P&P indicated psychoactive medications (anti-psychotics, anti-depressants, anti-anxiety, hypnotics) must only be prescribed by a person authorize to prescribe medications, when a medication is necessary to treat a specific condition as diagnosed and documented in the medical record. The P&P indicated it is the responsibility of the physician or provider who prescribes psychoactive medications to include the specific condition and target behavior documented in the medical record. The P&P indicated if the physician wishes to write a new order for a prn antipsychotic, the physician should evaluate the patient to determine appropriateness of the order, evaluation and rationale must be documented in the medical order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 11 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure Resident 20's physician orders for losartan (a medication used to treat hypertension [HTN - high blood pressure]) and hydrochlorothiazide (a medication used to treat HTN) indicated hold parameters for medications based on resident's blood pressure readings, affecting one of five sampled residents reviewed for medication administration. This deficient practice had the potential to result in medication errors, blood pressure abnormalities and heart complications for Resident 20. Findings: During a review of Resident 20's admission Record, dated 3/26/2025, the admission Record indicated, Resident 20 was admitted to the facility on [DATE]. During a review of Resident 20's Minimum Data Set (MDS - a resident assessment tool), dated 3/4/2025, the MDS indicated, Resident 20's cognition (ability to think, understand, learn, and remember) was severely impaired. The MDS indicated, Resident 20 needed supervision level assistance from facility staff for Activities of Daily Living (ADLs) such as eating, oral hygiene and personal hygiene, moderate assistance for upper body dressing, and dependent for toileting hygiene, showering, lower body dressing and putting on/taking off footwear. During a concurrent observation and interview on 3/26/2025 between 8:46 a.m. and 8:57 a.m. with the Registered Nurse (RN) 2, RN 2 prepared five medications to be administered to Resident 20 that included, but not limited to, the following: 1. One tablet of losartan 50 milligrams ([mg] a unit of measurement for mass) 2. One-half tablet of hydrochlorothiazide 25 mg (12.5 mg dose) RN 2 then conducted blood pressure check for Resident 20 using an automatic blood pressure monitor. RN 2 stated Resident 20's systolic blood pressure ([SBP] the pressure with which the heart pumps blood into the arteries) was 114 millimeters of mercury ([mmHg] a unit of measurement for blood pressure) and diastolic blood pressure ([DBP] the pressure in arteries when the heart is relaxed between beats) was 44 mmHg. RN 2 stated, the bottom BP reading (DBP) was low so she would recheck resident's blood pressure. During a concurrent observation and interview on 3/26/2025 at 8:57 a.m. with RN 2, RN 2 conducted blood pressure check again for Resident 20. RN 2 stated Resident 20's BP reading was 117(SBP) mmHg / 44 (DBP) mmHg. RN 2 stated she would hold losartan and hydrochlorothiazide and would determine later if able to administer them after rechecking Resident 20's blood pressure after his rehabilitation therapy. RN 2 stated she did not have physician orders or hold parameters to hold the losartan and hydrochlorothiazide but in her judgement, she would hold them because the DBP was lower than 50 mmHg. During a review of medication reconciliation and review of Resident 20's Physician Order Summary Report, dated 3/26/2025, the Physician Order Summary Report indicated, but not limited to, the following medications: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 12 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0755 1. Hydrochlorothiazide 12.5 mg, take one tablet by mouth daily, order date 2/25/2025, start date 2/26/2025. Level of Harm - Minimal harm or potential for actual harm 2. Losartan tablet 50 mg, take one tablet by mouth daily, order date 2/25/2025, start date 2/26/2025 Residents Affected - Some During a review of Resident 20's Nursing Progress Notes, signed date 3/26/2025 timed at 3:21 p.m., the RN 2's Nursing Progress Notes indicated, BP was checked at 8:55 a.m., 114/44 mmHg and medication was held .BP rechecked at 11:00 a.m., and medication was given, BP at the time was 130/56 . During a review of Resident 20's Nursing Progress Notes, edited date 3/26/2025 4:06 p.m., RN 2's Nursing Progress Notes indicated, parameter for losartan 50 mg and hydrochlorothiazide 12.5 mg, hold for DBP less than 50, hold for SBP less than 100, put it in MAR. During a concurrent interview and record review on 3/27/2025 at 10:44 a.m. with the Assistant Nurse Manager (ANM) and the Registered Nurse (RN) 6, the order audit trail for Resident 20's hydrochlorothiazide 12.5 mg and losartan 50 mg were reviewed. The initial order details (after action #3, after action #2 and after action #1) for hydrochlorothiazide 12.5 mg and losartan 50 mg did not indicate hold parameters. Order details after action #4 which was a modified order, indicated the hold parameters for hydrochlorothiazide 12.5 mg daily and losartan 50 mg indicating to hold if SBP less than 100 or DBP less than 50. ANM stated if there was a hold parameter for resident's high blood pressure medications from the physician's order, then the nurse should follow that. ANM stated if the nurse did not feel comfortable administering the medication because of low blood pressure, she should have escalated the situation by calling the physician to ask if he/she could hold the blood pressure medication. ANM stated she did not have a facility specific protocol to show for blood pressure monitoring. ANM stated the facility nurse should have called the physician to get an order of 'hold parameters' when she decided to hold the medications due to low blood pressure. During an interview on 3/26/2025 at 1:45 p.m. with RN 2, RN 2 stated she knew she would need physician orders for medications before they can be administered or held if needed. RN 2 stated, in the past, doctor was okay with the medications being held if the nurse thought of doing so in her clinical judgement. RN 2 stated she did not contact the physician before holding administration of Resident 20's blood pressure medications. RN 2 stated if physician orders were not followed for blood pressure medications, it could have caused abnormal blood pressure. RN 2 stated she did not see any parameters for Resident 20's blood pressure medications. RN 2 stated she could not describe or explain if there was a facility protocol or guidelines that she was following but usually saw parameters such as hold if BP less than 110. During a review of the facility's policy and procedure (P&P) titled, Medication Management, applicability includes TCC, dated 7/2023, the P&P indicated, Medication Orders: medication may only be administered by an RN and LVN on the order of a licensed physician The P&P indicated, Protocol orders are performed only on order of the physician as a patient's condition warrants. Titrate orders include specific limits and guidelines for dosage adjustment and frequency of patient assessment. Taper orders include specific dosage adjustments and frequency of change. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 13 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure two of four sampled Residents (Resident 95 and Resident 293) were free of unnecessary psychotropic medications (any drug that affects the brain activities associated with mental processes and behavior) by failing to: A. Assess appropriateness of Resident 95's psychotropic medications and reevaluated when Resident 95's had increased anxiety (emotion characterized by feelings of tension, worried thoughts) on 3/17/2025. B. Document indication for the use of Seroquel (medication that treats several kinds of mental health conditions including schizophrenia [a mental illness that is characterized by disturbances in thought]) and Ativan (medication to treat anxiety) for Resident 95 and Resident 293. These failures had the potential to put Resident 95 and Resident 293 at risk for unnecessary psychotropic medicines and increased adverse effects (unwanted and harmful result that can occur after taking a medication) associated with the prescribed medications. A. During a review of Resident 95's admission Record, the admission Record indicated Resident 95 was admitted to the facility on [DATE]. During a review of Resident 95's History and Physical (H&P) dated 3/6/2025, the H&P indicated Resident 95 had a history of multiple sclerosis ( disorder in which body's immune system attacks the protective covering of the nerve cells in the brain and spinal cord ), possible status epilepticus (a prolonged or continuous seizure activity that can be life threatening) and femur fracture ( a break in the thigh bone)surgery after a fall in the hospital and anxiety (emotion characterized by feelings of tension, worried thoughts ). During a review of Resident 95's Minimum Data Set (MDS- a resident assessment tool) dated 3/12/2025, the MDS indicated Resident 95 had an intact cognition (ability to think, understand, learn, and remember) and had no potential indicators of psychosis( a severe mental condition in which thought, emotions are so affected that contact is lost with reality) such as hallucinations(perceptual experiences in the absence of real external sensory stimuli) and delusions (having false or unrealistic beliefs). The MDS indicated Resident 95 required partial/moderate assistance (helper does less than half the effort) with bed mobility, oral hygiene and personal hygiene. The MDS indicated the resident had diagnoses that included anxiety disorder, seizure disorder (a sudden, uncontrolled electrical disturbance in the brain which can cause uncontrolled jerking, blank stares, and loss of consciousness) or epilepsy (disorder of the brain characterized by repeated seizures) and hip fracture. During a review of Resident 95's Medication Administration Record (MAR), the MAR indicated Prozac (medication used to treat depression [ a mood disorder that causes a persistent feeling of sadness and loss of interest]) 60 milligrams (mgs. - unit of measurement) daily by mouth ordered on 3/6/2025.The MAR indicated Prozac had no indication for its use. During a review of Resident 95's MAR, the MAR indicated Seroquel (medication used to treat depression) 25 mgs. every 12 hours as needed for agitation ordered on 3/5/2025. The MAR indicated Seroquel's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 14 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0758 physician order was changed to 25 mgs. nightly on 3/13/2025. Level of Harm - Minimal harm or potential for actual harm During a review of Resident 95's Physician Order Report, dated 3/17/2025 timed at 5:14 p.m. the Physician Order Report indicated an order of Seroquel 50 mgs. by mouth nightly and was started on 3/17/2025, at 11:15 p.m. Residents Affected - Few During a review of Resident 95's MAR, the MAR indicated Zolpidem (Ambien) 5 mgs. nightly as needed (prn) for insomnia (difficulty falling asleep) was ordered on 3/5/2025 and was reordered on 3/19/2025. During a review of Resident 95's Nursing Progress Note dated 3/17/2025 timed at 6:22 p.m., the Nursing Progress Note indicated Resident 95 was confused, restless, agitated and had a feeling of sadness. The Nursing Progress Note indicated Resident 95 was confused and forgetful to situation and time and the resident tend to say, help me, help me. During a review of Resident 95's Nursing Progress Note dated 3/17/2025, timed at 3:36 a.m., the Nursing Progress Notes indicated Resident 95 was anxious, confused, and was climbing out of bed. The Nursing Progress Notes indicated Resident 95 was awake, with episode of inability to relax manifested by calling out from time to time. The Nursing Progress Notes indicated Resident 95 received pain medication for complaint of right forearm pain. The Nursing Progress Notes indicated on 3/17/2025, at 3:40 a.m. Resident 95 woke up requested anti- anxiety medication and was provided to Resident 95. During a review of Resident 95's Physician Order Report, dated 3/16/2025, timed at 7:30 p.m. an order of Ativan 1 milligram (mg.- unit of measurement) by mouth 2 times a day without indication and was started on 3/17/2025 at 8:00 a.m. During a review of Resident 95's Informed Consent (voluntary agreement to accept treatment after receiving education regarding risks, benefits and alternatives offered) dated 3/16/2025 timed at 7:30 p.m., the Informed Consent indicated a signed consent for the use of Ativan 1 mg. twice a day for anxiety. During a review of Resident 95's Informed Consent dated 3/17/2025 timed at 7:30 p.m., the Informed Consent indicated a signed consent for the use of Seroquel 50 mgs. nightly for psychosis. During a review of Resident 95' Neurology Transitional Care Unit Follow up Note dated 3/17/2025, the Neurology Transitional Care Follow Up Note indicated Resident 95 was still having depression and aphasia (disorder that makes it difficult to speak) was improving. The Neurology Transitional Care Unit Follow Up Note indicated Resident 95 continued to have mood changes and would treat depression/anxiety aggressively, reevaluate, increased the dose of Seroquel to 50 mgs. nightly for rage episodes as described by the resident's family member and would start Ativan (medicine to treat anxiety) 1 mg. twice a day. During a review of Resident 95's Care Plan titled Psychotropic Drug Use and Risk for related side effects initiated 3/6/2025, the Care Plan indicated Resident 9. were on psychotropic medicines such as Seroquel for psychosis manifested by hallucinations (sensory experiences that occur without external stimulus), Ambien for hypnotics manifested by insomnia, Fluoxetine for depression manifested by worthlessness/helpless/hopeless and Diazepam for anxiety manifested by inability to relax. The Care Plan's goals indicated the resident will have than less than two episodes of hallucinations, inability to relax, inability to sleep and feeling of worthlessness. The Care Plan's interventions included (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 15 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0758 administration of medication as ordered and monitoring of resident's behavior. Level of Harm - Minimal harm or potential for actual harm During a concurrent observation and interview on 3/27/2025, at 8:39 a.m. with Resident 95, Resident 95 was lying in bed. Resident 95 stated she was sleepy. Observed Resident 95 not fully awake. Resident 95 stated she could not remember the names of her medications that help her relax. Residents Affected - Few During a concurrent interview and record review of Resident 95's electronic chart on 3/27/2025, at 10:43 a.m. with Registered Nurse (RN 2), RN 2 stated the psychotropic medicines were given to Resident 95 's anxiety. RN 2 stated Resident 95 had psychosis, depression and anxiety and confirmed there was no psychiatrist evaluating resident's behavioral problems and psychotropic medication. RN 2 stated the Valium, Prozac and Ambien were resident home medications that were continued in the facility and no documented diagnosis of psychosis (a severe mental condition in which thought, and emotions are so affected that contact is lost with reality) was found in the electronic health record. RN 2 stated Resident 95 might become sleepier due to the use if these psychotropic medications. RN 2 stated Resident 95's mental health could get worse if resident's psychotropic medications were not reevaluated or monitored for appropriateness of use. During a concurrent interview and record review on 3/27/2025, at 12:22 p.m. with RN 3, reviewed Resident 95's electronic health record. RN3 stated there was no diagnosis of psychosis in Resident 95's electronic health the chart. RN 3 stated psychotropic medicines from home will be verified by licensed nurse with the physician who will reconcile the medications from home. RN 3 stated not reassessing the appropriateness of psychotropic medicines could put Resident 95 at risk for unnecessary medication and adverse effects. During a concurrent interview and record review on 3/28/2025, at 10:37 a.m. with RPH1 reviewed Resident 95's electronic health record. RPH 1 stated the physician's order for Ativan had no indication for its use and Seroquel was ordered for agitation. RPH 1 stated if he had seen the order for Ativan without indication, he would have clarified the order with Resident 95's physician. RPH 1 stated Resident 95 could be at risk for side effects like sedation (stated of calmness, relaxation, or sleepiness caused by a drug) and would not be able to participate in activities of daily living. RPH 1 stated psychotropic medication could act as a chemical restraint (medication given primarily to control a person's behavior, used for discipline or convenience and not required to treat medical symptoms) and could cause adverse effects if they are given without proper indication and monitoring for their appropriateness. During a concurrent interview and record review on 3/28/2025, at 9:07 a.m. with Assistant Nurse Manager (ANM), reviewed Resident 95's electronic health record. ANM stated Resident 95 took Valium, Prozac, Ambien at home prior to admission to the facility. ANM stated Seroquel and Ativan were started in the facility. ANM stated the physician order of Ativan 1 mg. twice a day had no indication for its use. ANM stated there should be an indication when ordering a psychotropic medication like Ativan. ANM stated Resident 95 had a change in condition (COC- any significant alteration in a patient's physical, mental, or emotional stays that requires attention and intervention) on 3/17/2025 for increased anxiety. ANM stated the neurologist (medical doctor who specializes in diagnosing and treating diseases of the brain, spinal cord, and nerves) ordered the Ativan and increased the dose of Seroquel 50 mgs nightly for psychosis. ANM stated the facility should have ordered psychiatric consultation, to ensure the use of psychotropic medication was addressed and Resident 95's increased anxiety. ANM stated the use of too many psychotropic medications could lead to unnecessary medication and could affect resident's activities of daily living (ADL- activities such as bathing, dressing and toileting a person performs daily). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 16 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0758 Level of Harm - Minimal harm or potential for actual harm During an interview on 3/28/2025, at 11:45 a.m., with the Director of Nursing (DON), the DON stated the facility should know why the psychotropic medications were prescribed and why the resident would need the medications. The DON stated Resident 95 should have gotten a psychiatric consult to address the change in condition of increased anxiety on 3/7/2025 and Seroquel and Ativan were ordered for the increased anxiety. Residents Affected - Few B. During a review of Resident 293's admission Record, the admission Record indicated Resident 293 was admitted on [DATE]. During a review of Resident 293's Hospitalist Progress Note dated 3/24/2025, the Hospitalist Progress Note indicated Resident 293 was oriented to person. During a review of Resident 293's History & Physical (H&P) dated 3/22/2025, the H&P indicated Resident 293 had diagnoses of anxiety (intense, excessive, and persistent worry and fear about everyday situations), cirrhosis (chronic liver damage from a variety of causes leading to scarring and liver failure), and rhabdomyolysis (a breakdown of muscle tissue that releases a damaging protein into the blood). During a review of Resident 293's Active Medication Orders dated 3/28/2025 indicated Resident 293 was prescribed lorazepam (medication to treat anxiety) 0.5 mg every eight hours as needed for anxiety, insomnia (trouble falling asleep or staying asleep). The active medication orders also indicated that Resident 293 was taking Seroquel 25 mg nightly with no indication of its use. During a review of Resident 293's Completed Medication Administration Record (MAR) dated 3/28/25, the MAR indicated Resident 293 was given lorazepam 0.5mg on 3/24/25 at 1:44 p.m., and on 3/25/25 at 6:09 p.m. The MAR also indicated Resident 293 was given Seroquel 25 mg nightly on 3/24/2025 at 8:26 p.m., 3/25/2025 at 8:56 p.m., 3/26/2025 at 8:56 p.m., and 3/27/2025 at 8:22 p.m. During a review of Resident 293's Informed Consent for Psychotropic Medications, dated 3/21/2025, the Informed Consent indicated Resident 293 was taking Ativan 0.5 mg every eight hours as needed for anxiety as manifested by impatience, inability to relax and insomnia. During a review of Resident 293's Informed Consent for Psychotropic Medications, dated 3/24/2025, the Informed Consent indicated Resident 293 was taking Seroquel 25 mg nightly for agitation as manifested by persistent crying out. During an interview on 3/28/25 at 9:55 a.m. with ANM, the ANM stated agitation was not a diagnosis for giving Seroquel it was a manifestation of a behavior. The ANM stated that insomnia was not an appropriate manifestation to give lorazepam during the day. The ANM stated lorazepam should be given for insomnia at night. The ANM stated facility pharmacist should have caught this. The AMN stated that the use of too much psychotropic medication would be deemed unnecessary. During an interview on 3/28/25 at 11:45 a.m. with the DON, the DON stated we need to know the reasons why psychotropic medications were prescribed and if they were appropriate for Resident 293 to take. The DON stated to much psychotropic medication can cause respiratory depression, constipation and depression. During a review of facility's policy and procedure (P&P) titled Psychotropic Drug Management for Long Term Care Facilities, revised 3/2022, the P&P indicated Psychoactive medications (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 17 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete (anti-psychotics, anti-depressants, anti-anxiety, hypnotics) must only be prescribed by a person authorized to prescribe medications, when a medication is necessary to treat a specific condition as diagnosed and documented in the medical record and to use the lowest effective dose to optimize treatment and reduce adverse effects. The P&P indicated it is the responsibility of the physician or provider who prescribes psychoactive medications to include the specific condition and target behavior documented in the medical record. The P&P indicated if the physician wishes to write a new order for a prn antipsychotic, the physician should evaluate the patient to determine appropriateness of the order, evaluation and rationale must be documented in the medical order. Event ID: Facility ID: 056499 If continuation sheet Page 18 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0759 Ensure medication error rates are not 5 percent or greater. 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 maintain a medication error rate of less than 5 percent (%) during medication pass for two of five reviewed residents for medication errors (Residents 95 and 296) by failing to: Residents Affected - Some a. Administer Resident 95's Vimpat ([generic name - lacosamide] a medication used to treat seizures [a sudden, uncontrolled electrical disturbance in the brain which can cause uncontrolled jerking, blank stares, and loss of consciousness]), gabapentin (a medication used to treat nerve pain and seizures), levetiracetam (a medication used to treat seizures) and metoprolol tartrate (a medication used to treat high blood pressure), within one hour before or after the scheduled administration time of 9:00 a.m., per facility's policy and procedure (P&P) titled, Medication Management, dated 7/2023. b. Administer Resident 296's furosemide (a medication used to treat fluid retention and high blood pressure), amlodipine (a medication used to treat high blood pressure), metoprolol tartrate and amiodarone (a medication used to treat heart complications), within one hour before or after the scheduled administration time of 9:00 a.m., per facility's P&P titled, Medication Management, dated 7/2023. These deficient practices of medication error rate of 26.67 percent (%) exceeded the five (5) % threshold and placed Residents 95 and 296 at risk for adverse medical consequences such as seizures, high blood pressure and cardiac complications. Findings: a. During a review of Resident 95's admission Record, the admission Record indicated, Resident 95 was admitted to facility on 3/5/2025. During a review of Resident 95's History and Physical (H&P), dated 3/5/2025, the H&P indicated Resident 95's diagnoses including to, history of multiple sclerosis ([MS]- a chronic, progressive disease involving damage to the nerve cells in the brain and spinal cord), possible status epilepticus (seizure), hypertension ([HTN] high blood pressure), history of depression and anxiety, and deep venous thrombosis ([DVT] a medical condition characterized by blood clots in deep vein, in the leg) risk. During a review of Resident 95's Minimum Data Set (MDS -resident assessment tool), dated 3/12/2025, the MDS indicated, Resident 95's cognition (ability to think, understand, learn, and remember) was intact. The MDS indicated, Resident 95 needed maximal assistance from facility staff for activities of daily living (ADLs) such as eating and upper body dressing, moderate assistance for oral hygiene and personal hygiene, and activities such as toileting, showering, and lower body dressing. During an observation on 3/26/2025 at 8:32 a.m. with Registered Nurse (RN) 2, RN 2 prepared and administered one tablet of lorazepam (a medication used to treat anxiety) 1 milligrams ([mg] a unit of measurement for mass) to Resident 95 before moving on to the next resident during medication administration. During the process of medication reconciliation and review of Resident 95's Physician Order Summary Report, dated 3/27/2025, the Physician Order Summary Report indicated, the following medications were also scheduled to be administered starting at 9:00 a.m. daily, in addition to Lorazepam administered during medication administration observation: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 19 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0759 1. Gabapentin capsule 300 mg, take 1 capsule by mouth three times daily, order date 3/5/2025, start date 3/5/2025. Level of Harm - Minimal harm or potential for actual harm 2. Lacosamide 200 mg, take 1 tablet by mouth two times daily, order date 3/5/2025, start date 3/5/2025. Residents Affected - Some 3. Levetiracetam 1000 mg, take 1 tablet by mouth two times daily, order date 3/5/2025, start date 3/5/2025. 4. Lorazepam 1 mg, take 1 tablet by mouth two times daily, 0800 (8:00 a.m.) & 1800 (6:00 p.m.), order date 3/16/2025, start date 3/17/2025. 5. Metoprolol tartrate 12.5 mg, take 1 tablet by mouth two times daily, hold if systolic blood pressure ([SBP] the pressure with which the heart pumps blood into the arteries) less than 105 or heart rate (HR) less than 65, order date 3/6/2025, start date 3/6/2025 During a review of Resident 95's Medication Administration Record (MAR), dated 3/26/2025, the MAR indicated the following medications were administered at 10:36 a.m. which was one hour and 36 minutes after the scheduled medication administration time of 9:00 a.m.: 1. One capsule of gabapentin 300 mg (300 mg dose) administered on 3/26/2025 at 10:36 a.m. 2. Four tablets of lacosamide 50 mg (200 mg dose) administered on 3/26/2025 at 10:36 a.m. 3. Two tablets of levetiracetam 500 mg (1000 mg dose) administered on 3/26/2025 at 10:36 a.m. 4. One-half tablet of metoprolol tartrate 25 mg (12.5 mg dose) administered on 3/26/2025 at 10:36 a.m. b. During a review of Resident 296's admission Record, the admission Record indicated Resident 296 was admitted to the facility on [DATE]. During a review of Resident 296's H&P dated 3/24/2025, the H&P indicated Resident 296's diagnoses including chronic kidney disease (CKD a gradual, progressive loss of kidney function) and non-ST elevation myocardial infarction (MI - heart attack). During a concurrent observation and interview on 3/26/2025 at 10:22 a.m. with RN 4, RN 4 removed the following five medications from automated dispensing machine to be administered to Resident 296. 1. One tablet of furosemide 20 mg 2. One tablet of amlodipine 2.5 mg 3. One tablet of metoprolol tartrate 25 mg, but dose of one-half tablet (12.5 mg) to be given 4. One tablet of amiodarone 200 mg 5. One tablet of aspirin 81 mg chewable tablet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 20 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some RN 4 stated Resident 296 left for his therapy upon reaching Resident 296's room to administer medications. RN 4 stated she would need to return to administer medications to Resident 296 after he returned from therapy. RN 4 stated Resident 296's medications were scheduled for 9:00 a.m. and were supposed to be given latest by 10:00 a.m. RN 4 stated it was important to administer medications on time to ensure stable blood concentrations. RN 4 stated Resident 296 was on a few blood pressure medications as listed above, so Resident 296 was at risk for high blood pressure, and could get symptoms of headache. RN 4 stated high blood pressure could place Resident 296 at risk for stroke (loss of blood flow to a part of the brain) and hospitalization. RN 4 stated, sometimes medications could be administered late because there were a lot of activities during medication administration task and all residents have therapy. During an observation on 3/26/2025 at 10:59 a.m., RN 4 administered Resident 296's medications after checking his blood pressure. During a review of Resident 296's Physician Order Summary Report, dated 3/26/2025, the Physician Order Summary Report, indicated the following medications scheduled to be administered starting at 9:00 a.m. daily, unless specified otherwise: 1. Amiodarone 200 mg, take 1 tablet by mouth two times daily, order date 3/24/2025, start date 3/25/2025. 2. Amlodipine 2.5 mg, take 1 tablet by mouth daily for radial artery spasm prevention, order date 3/24/2025, start date 3/25/2025. 3. Aspirin chewable tablet 81 mg, take 1 tablet by mouth daily, initiate within 6 hours of arrival in the intensive care unit, if aspirin was not administered preoperatively. If unable to take by mouth tablet, may give rectal aspirin, if ordered, order date 3/24/2025, start date 3/25/2025. 4. Furosemide 20 mg, take 1 tablet by mouth daily, order date 3/24/2025, start date 3/25/2025. 5. Metoprolol tartrate 12.5 mg, take 1 tablet by mouth daily, hold for HR less than 60, SBP less than 100, order date 3/24/2025, start date 3/25/2025. During a review of Resident 296's MAR, dated 3/26/2025, the document indicated the following medications were administered at least two hours after the scheduled medication administration time of 9:00 a.m.: 1. One tablet of amiodarone 200 mg (200 mg dose) administered on 3/26/2025 at 11:07 a.m. 2. One tablet of amlodipine 2.5 mg (2.5 mg dose) administered on 3/26/2025 at 11:08 a.m. 3. One tablet of aspirin chewable tablet 81 mg (81 mg dose) administered on 3/26/2025 at 11:08 a.m. 4. One tablet of furosemide 20 mg (20 mg dose) administered on 3/26/2025 at 11:06 a.m. 5. One-half tablet of metoprolol tartrate 25 mg (12.5 mg dose) administered on 3/26/2025 at 11:08 a.m. During a concurrent interview and record review on 3/27/2025 at 11:23 a.m. with Assistant Nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 21 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Manager (ANM), Resident 95's MAR for 9:00 a.m. was reviewed. ANM stated, Resident 95's gabapentin, lacosamide, levetiracetam and metoprolol tartrate were due at 9:00 a.m. and should have been administered within one hour time frame from scheduled administration time. ANM stated Resident 95's medications were administered on 3/26/2025 at 10:36 a.m., which was late by at least 35 minutes. ANM stated it was important that facility nurses gave Resident 95's medications on time to be able to manage pain and seizures. ANM stated if the medications were not administered on time, there was a risk of hospitalization due to seizures, high blood pressure and stroke. During a concurrent interview and record review on 3/27/2025 at 11:37 a.m. with ANM, Resident 296's MAR for 9:00 a.m. was reviewed. ANM stated, Resident 296's aspirin, amlodipine, metoprolol tartrate, amiodarone and furosemide were due at 9:00 a.m. and were administered late after 11:00 a.m. which was beyond the allowed one hour after scheduled administration time of 9:00 a.m. ANM stated facility nurse was supposed to follow the policy to administer medications within one hour before and one hour after the scheduled time of administration. ANM stated facility nurse should have called the physician by 10 a.m. to get authorization whether to administer medications late. During a concurrent interview and record review on 3/27/2025 at 11:23 a.m. with the Director of Risk and Regulatory (DRR), the facility's P&P, titled, Medication Management was reviewed. The DRR stated, medications due at 9 a.m., could be given as early as 8 a.m. and as late as 10 a.m. The DRR stated, there was an addendum to the Medication Management policy titled, 'Addendum B Missed Dose and 1st Dose Home Medication Decision Guide - Post-EPIC,' that supposed to act as a guide for facility staff for retiming of missed doses - If a medication was missed daily for 9 a.m. dose, then could give dose now (then) and resume at 9 a.m. tomorrow (next day). The DRR stated, by policy, it was considered a missed dose, and then the policy gave instructions on when it could be safely given and resumed. The DRR stated, this addendum was followed for all skilled nursing facility medications as well as for hospital medications. During a concurrent interview and record review on 3/27/2025 at 12:29 p.m. with ANM, Resident 296's physical therapy schedule and notes were reviewed. ANM stated Resident 296's physical therapy start time on 3/26/2025 was at 10:21 a.m. During an interview on 3/27/2025 at 2:27 p.m. with RN 2, RN 2 stated, she thought that it was okay to administer 9:00 a.m. medications until 10 a.m. to 10:30 a.m. RN 2 then stated she could have administered Resident 95's medications on 3/26/2025 along with her lorazepam, to prevent their late administration at 10:36 a.m. RN 2 stated there was a risk for Resident 95 to experience seizures, nerve pain and high blood pressure because she received her medications late. During an interview on 3/27/2025 at 4:48 p.m. with the Director of Nursing (DON), the DON stated, the medications scheduled for 9:00 a.m. administration and given at 10:36 a.m. and 11:00 a.m. would be considered late administration. The DON stated, licensed nurse should follow one hour before and one hour after the scheduled administration time window. The DON stated if medications like amiodarone and others such as those for high blood pressure and seizures were given later than scheduled time, it would place residents at increased risk for seizures, high blood pressure, stroke and hospitalization. During a review of the facility's P&P, titled, Medication Management, applicability includes TCC, dated 7/2023, the P&P indicated, Medication Administration Procedures: Refer to Lippincott's Nursing Procedures and Skills for Medication Administration Procedures and Safe Medication Practices. For Non- Time-Critical Scheduled Medications - medication prescribed with a minimum frequency of every (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 22 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0759 four (4) hours and not greater than every 24 hours, the goals for timely administration - within one (1) hour before or after the scheduled time. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 23 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure safe, secured, and limited access to Resident 20's, Resident 94's and Resident 296's prepared medication that was left at the bedside and Resident 95's gabapentin (a medication used to treat nerve pain), affecting four of five residents sampled during medication administration. This deficient practice increased the risk of unintended access to medications, potential for misuse and medication errors for Residents 20, 94, 95 and 296. Findings: a. During a concurrent observation and interview on 3/26/2025 at 8:46 a.m. with Registered Nurse (RN) 2, RN 2 prepared five medications to be administered for Resident 20. RN 2 stepped away, stating she needed to find a pill-cutter and left the following medications unattended at her mobile computer station. 1. One tablet of losartan 50 milligram ([mg] a unit of measurement for mass) 2. Two tablets of vitamin D 25 microgram ([mcg] a unit of measurement for mass) 3. One tablet of vitamin C 500 mg 4. One-half tablet of hydrochlorothiazide 25 mg 5. One tablet of Thera-vite (multivitamin with iron) RN 2 performed blood pressure check for Resident 20 and based on blood pressure reading, RN 2 stated she would administer medications except for losartan 50 mg and hydrochlorothiazide 25 mg. RN 2 left Resident 20's room to ask a question to Certified Nurse Assistant (CNA), leaving behind the losartan 20 mg and hydrochlorothiazide 25 mg unattended in Resident 20's room. b. During a concurrent observation and interview on 3/26/2025 at 9:20 a.m. with RN 2, RN 2 prepared five medications to be administered for Resident 94. RN 2 crushed the tablet form of following medications to be administered with apple sauce. RN 2 stated she needed to find a spoon and left the mixture of medications and docusate oral liquid on the bedside table unattended when she left Resident 94's room. 1. One tablet of amlodipine 5 mg 2. One tablet of ferrous gluconate 324 mg 3. One tablet of bisoprolol 5 mg 4. One tablet of multivitamin with iron 5. 10 milliliters ([mL] a unit of measurement for volume) of docusate sodium oral liquid 50 mg per (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 24 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 0761 5 mL Level of Harm - Minimal harm or potential for actual harm c. During a concurrent observation and interview on 3/26/2025 at 10:22 a.m. with RN 4, RN 4 initially prepared five medications to be administered for Resident 296 and then returned them to automated dispensing storage when Resident 296 was not found to be in his room. On 3/26/2025 at 10:59 a.m., RN 4 stated she saw Resident 296 returned from therapy and so she was ready to retrieve medications and administer them. RN 4 stated she needed to bring the blood pressure monitor and left the following medications unattended on mobile computer station in resident's room. Residents Affected - Few 1. One tablet of furosemide 20 mg 2. One tablet of amlodipine 2.5 mg 3. One tablet of aspirin 81 mg chewable 4. One-half tablet of metoprolol tartrate 25 mg 5. One tablet of amiodarone 200 mg d. During a concurrent observation and interview on 3/26/2025 at 2:07 p.m. with RN 2, RN 2 prepared one capsule of gabapentin 300 mg to be administered for Resident 95. RN 2 stated she needed to get apple sauce from the kitchen and left the gabapentin at Resident 95's bedside unattended. RN 2 stated she forgot the meds on the cart unattended. RN 2 stated medications should not be left unattended because that would increase the risk that residents could grab the medication and take them without supervision. During an interview on 3/27/2025 at 4:58 p.m. with the Director of Nursing (DON), DON stated no medications should be left unattended. DON stated if there was a reason for a facility nurses to step away, they should move the medications to medication room to prevent medication errors, prevent medications storage at unsafe temperatures, and to prevent unintended access to medications. During a review of the facility's policy and procedure (P&P) titled, Pyxis MedStation Nursing Use of Policy So Bay Community, applicability includes TCC, dated 3/2023, the P&P indicated, Custody of the medication is the responsibility of the nurse removing the medication (e.g., the nurse removing the medication must be the one administering the medication - except .above). During a review of the facility's P&P titled, Labeling of Medications, applicability includes TCC, dated 5/2024, the P&P indicated, Drugs dispensed from Pyxis or floorstock and immediately administered to the patient do not require additional labeling. This includes unit dose administration. An immediately administered medication is one that an authorized staff member prepares or obtains, takes directly to a patient, and administers to that patient without any break in the process. During a review of the facility's P&P titled, Medication Management, applicability includes TCC dated 7/2023, the P&P indicated, Medication Administration Procedures .Note: Do not leave the medication at the bedside. Facility did not provide any specific policy focused only on medication storage. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 25 of 26 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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 Based on observation, interview and record review, the facility failed to observe infection control measures by not ensuring staff perform hand hygiene when food server (FSW) failed to wash her hands when entering leaving the kitchen area. Residents Affected - Few This failure had the potential to result in cross contamination (the physical movement or transfer of harmful bacteria from one person, object, or place to another) and place the residents at risk for the spread of infection. Findings: During tray line observation on 03/26/2025 at 11:03 a.m., in the kitchen, FSW walk in the kitchen, from outside holding a used surgical mask on her right hand. FSW walked towards her co-worker who was preparing food in the kitchen. FSW left the kitchen again without washing her hands. During a concurrent observation and interview on 03/26/2025 at 11::46 a.m., with FSW, FSW stated she should wash her hands when entering and leaving the kitchen area. FSW stated she was in a hurry to ask another kitchen staff about something and don't want to forget. FS 1 stated that not washing her hands can cause cross contamination (the physical movement or transfer of harmful bacteria from one person, object, or place to another) and infection control issues. During an interview on 3/28/25 at 09:07 am, with the Kitchen Director Manager (KDM), KDM stated he does in-service once a month about handwashing and different area, and daily huddles, for all shift, KDM stated staff should wash their hands prior to entering the kitchen area and prior to leaving the kitchen area. During an interview on 03/28/25 at 09:14 a.m., with Kitchen Assistants Director (KAD), KAD stated it was important for staff to wash their hands prevent to cross contamination. KAD stated all kitchen staff including the cook, should wash their hands when entering the kitchen area and prior to leaving the kitchen area and must wear a hair net. During a review of the facility's policy and procedure (P&P) revised 10/22, titled Hand Hygiene, the P&P indicated, In the food &Nutrition Services Department: Hands are washed with soap and water at the following Times: After taking a break/when returning to kitchen, After touching hair, skin, beard or clothing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056499 If continuation sheet Page 26 of 26