Health inspection·December 12, 2025

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete baseline care plans were created over 48 hours after admission (on 11/16/2025). The TN stated Resident 1 did not have baseline care plans to address her activities of daily living and her medications, conditions, and pain monitoring within 48 hours of admission. The TN stated that there was a risk of Resident 1's nursing staff being unaware of Resident 1's needs, which could result in those needs not being met.During a concurrent interview and record review on 12/4/2025 at 3:53 p.m., with Registered Nurse 1 (RN 1), Resident 1's MDS, dated [DATE], was reviewed. RN 1 stated Resident 1 needed moderate to maximal assistance with toileting, bathing, and moving from a sitting to standing position. RN 1 stated Resident 1's care and level of assistance should have been care planned to inform the care team about Resident 1's needs and provide appropriate care.During a review of the facility's P&P titled Care Plan - Baseline, dated 8/25/2021, the P&P indicated a baseline care plan that included instructions needed to provide effective and person-centered care of the resident should be developed for each resident by the Interdisciplinary Team ([IDT] group of healthcare professionals, including physician, nurses, resident/ resident representative, working together to develop a plan of care for the residents) within 48 hours of a resident's admission. Event ID: Facility ID: 555004 If continuation sheet Page 2 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure care was provided in accordance with professional standards of practice and the resident's comprehensive person-centered care plan for one of three residents (Resident 1) who was admitted to the facility with a left hip surgical incision/wound received treatment. The facility failed to ensure:1). Resident 1's left hip surgical site/ wound was monitored for signs of infections like pustules (a small blister or pimple on the skin containing pus) and inflammation (a condition in which a part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection) as indicated in Resident 1's care plan titled, Resident has skin breakdown related to surgical site.2). The Baseline Care Plan (a care plan developed within 48 hours of admission, which would address resident-specific health and safety concerns and instructions to prevent decline) was created timely, to ensure staff received the necessary interventions and instructions in the care and assessment of Resident 1's left hip surgical site. 3). Resident 1's follow up appointment to the surgeon (the doctor who performed surgery) was scheduled timely, as ordered on 11/13/2025. 4). The physician, physician assistant (PA) and licensed nurses, assessed Resident 1's left hip surgical site, for any signs of wound complications (such as redness, pain, discharges, and dehiscence) after admission to the facility on [DATE].5). Resident 1 was assessed thoroughly, when the resident presented pain on 11/16/2025, 11/17/2025, 11/20/2025, 11/21/2025, 11/22/2025, and 11/23/2025.These failures had the potential to result in delayed assessment for signs of infections and in providing the care and services necessary to promote wound healing. Findings:During a record review of Resident 1's Inter-Facility Transfer Report (essential documentation accompanying a patient being transferred from one healthcare facility to another to receive a different level of care), dated 11/11/2025, the Inter-Facility Transfer Report indicated Resident 1 had left hip hemiarthroplasty (partial joint replacement surgery) on 11/9/2025.During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted on [DATE], with diagnoses including history of left femur (leg bone) fracture (broken bone) and for aftercare following joint replacement surgery.During a review of Resident 1's History and Physical (H&P), dated 11/12/2025, the H&P indicated Resident 1 had the capacity to understand and make decisions.During a review of Resident 1's Body Check, dated 11/12/2025, the Body Check indicated Resident 1 had a left trochanter (hip) surgical site (the specific location where an incision (cut) was made to perform an operation), measuring 15 centimeters (cm- a metric unit of length) with 23 staples (wound closure devices). Resident 1's Body Check indicated the left trochanter surgical site had some hematuria (bloody urine), no signs or symptoms of infection, and no dehiscence (a surgical incision or wound split open).During a review of Resident 1's care plan titled Resident has skin breakdown related to surgical site., dated 11/12/2025, the goal indicated the facility would manage wound odor (smell) and exudate (discharge). The interventions indicated to observe for signs and symptoms (s/s) of skin breakdown such as redness, cracking (split on the skin's surface), blistering (small bubbles on the skin filled with serum [fluid] and caused by friction, burning, or other damage), and skin that does not blanche (turn white when pressed) easily and to evaluate for localized skin problems such as dryness, redness, pustules, and inflammation.During a review of Resident 1's Physician Orders, dated 11/13/2025, the Physician Orders indicated staff to monitor Resident 1's left trochanter surgical site for skin breakdown every dayshift (7:00 a.m.- 3:00 p.m.). The Physician Orders indicated to schedule Resident 1's follow-up appointment with Medical Doctor 2 (MD 2- Surgeon).During a review of Resident 1's care plan titled, Baseline Care Plan: Resident is newly admitted to the facility, dated 11/16/2025, the care plan Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555004 If continuation sheet Page 3 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few interventions indicated, alteration in skin integrity (skin's overall health) (Actual or Potential): monitor skin and report red/ discolored or broken skin; alteration in skin integrity: skin assessment per protocol; at risk for orthopedic complications: observe for s/s of infection at surgical site; at risk for pain/ discomfort: assess pain level as needed, give meds as ordered and observe for pain and provide comfort measures as needed.During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated 11/17/2025, the MDS indicated Resident 1 was cognitively intact and did not reject care. The MDS indicated Resident 1 required moderate assistance (helper does less than half the effort) to roll left and right on the bed (the ability to roll from lying on back to left and right side, and return to lying on back on the bed), moving from sitting to lying (the ability to move from sitting on side of bed to lying flat on the bed), and move from a sitting to standing (the ability to come to a standing position from sitting). The MDS indicated Resident 1 had a surgical wound and a history of surgery.During a review of Resident 1's Medical Doctor's Progress Notes, dated 11/17/2025, the progress notes indicated a plan for wound care and pain management for Resident 1.During a review of Resident 1's Follow-Up Progress Notes written by the PA 1, dated 11/19/2025, 11/21/2025, and 11/25/2025, the progress notes indicated Resident 1's left hip surgical wound dressing was clean, dry, and intact.During a review of Resident 1's Nurses Progress Note, dated 11/20/2025, the note indicated Resident 1's follow-up appointment with MD 2 was scheduled for 12/3/2025 at 1:45 p.m.During a review of Resident 1's Change of Condition (a communication tool used by healthcare workers when there is a change of condition [COC-a clinical deviation from a resident's baseline] among the residents), dated 11/26/2025 at 3:45 p.m., the COC indicated Resident 1's left trochanter surgical incision had 2 cm. of wound dehiscence. The COC indicated Resident 1's left trochanter surgical incision had some (unspecified) drainage and moisture. The COC indicated Resident 1's left trochanter surgical site dehiscence started in the morning. The COC indicated Resident 1's Medical Doctor 1 (MD 1) was notified about Resident 1's change in condition at 3:30 p.m.During a review of Resident 1's Progress Notes, dated 11/26/2025 at 6:30 p.m., the Progress Notes indicated paramedics arrived at the facility because Resident 1 called 911 for assistance with her left hip wound.During a review of Resident 1's General Acute Care Hospital (GACH) Emergency Department (ED) Provider Notes, dated 11/26/2025, the notes indicated Resident 1 called 911 for herself after an unnamed wound nurse informed her that her sutures (wound closure devices) were not effective. Resident 1 presented to the GACH ED with increased hip pain with erythema (redness of the skin) and scant clear discharge of the left hip surgical site.During a review of Resident 1's Treatment Administration Record (TAR -daily documentation by a licensed nurse for treatments given to a resident), for the month of 11/2025, the TAR did not indicate Resident 1's left trochanter surgical site was monitored for signs and symptoms of infection.During a review of Resident 1's Medication Administration Record (MAR - daily documentation by a licensed nurse for medications given to a resident), for the month of 11/2025, the MAR indicated Resident 1 reported numerical pain levels (a pain scale used in a facility with 0 no pain, 1-3 mild pain, 4-6 moderate pain, 7-8 severe pain, 9-10 worst pain possible) as follows:1). 8/10 pain on 11/16/2025 at 4:46 p.m.,2). 8/10 pain on 11/17/2025 at 6:56 p.m. 3). 7/10 pain on 11/21/2025 at 7:39 p.m.,4). 7/10 pain on 11/22/2025 at 10:52 a.m.,5). 7/10 pain on 11/23/2025 at 3:29 a.m., and6). 8/10 pain of ten on 11/23/2025 at 9:57 a.m.The MAR did not indicate the location or quality of the pain.During a concurrent interview and record review on 12/2/2025 at 2:25 p.m., with the Treatment Nurse (TN), Resident 1's Body Check, dated 11/12/2025, Resident 1's TAR, for the month of 11/2025, Resident 1's COC, dated 11/26/2025, and the facility's P&P titled Skin Integrity Management, dated 5/26/2025, were reviewed. The TN stated the Body Check indicated Resident 1 was admitted on [DATE], (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555004 If continuation sheet Page 4 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with no dehiscence, no signs or symptoms, and some hematuria on the left hip surgical site. The TN stated she believed hematuria meant bloody discharge. The TN stated the wound assessment was incorrect because of hematuria which is of the urine and not from a wound. The TN stated Resident 1's monitoring documentation in the TAR did not indicate if Resident 1's left hip surgical site had skin breakdown based on the check marks documented in the TAR. The TN stated the P&P indicated Resident 1's left hip surgical site should have been measured and assessed weekly but was not. The TN stated the P&P indicated skin integrity status, the need for prevention, intervention and treatment were dependent on all assessment information. The TN stated that because Resident 1's left hip surgical site was not assessed and measured, staff were not able to plan and update wound interventions. The TN stated Resident 1's left hip surgical site was not assessed by the wound MD. The TN stated Resident 1 had no wound MD consultation order until after the wound dehisced on 11/26/2025.During a concurrent interview and record review on 12/4/2025 at 3:53 p.m., with Registered Nurse 1 (RN 1), the TAR for the month of 11/2025, were reviewed. RN 1 stated Resident 1's left hip surgical site should have been assessed and measured at least weekly to identify any infections and to intervene as soon as signs of the infections occurred. RN 1 stated the left hip surgical site was not assessed and measured on 11/19/2025 and 11/26/2025. RN 1 stated Resident 1's left hip surgical site's wound healing should have been closely monitored to identify early signs of infection. RN 1 stated that Resident 1's severe infection and subsequent surgical wash-out (irrigation, lavage or flushing the surgical site with fluid (like sterile saline or soapy water) to remove blood, debris, dead tissue, bacteria, and other contaminants, preventing infection and promoting healing) could have been avoided if the wound was assessed weekly and monitored for signs of infections daily.During a concurrent interview and record review with Medical Doctor 1 (MD 1) on 12/9/2025 at 12:48 p.m., Resident 1's Orthopedic Note, dated 11/27/2025, Resident 1's GACH Surgical Notes, dated 11/28/2025, were reviewed. MD 1 stated she did not incision check Resident 1's left hip surgical site under the wound dressing at all while Resident 1 was at the facility. MD 1 stated she thought the facility's wound specialist MD and nurses were assessing and monitoring the wound for signs of infection. MD 1 stated she was notified on 11/26/2025, in the afternoon (time not specified), that Resident 1's left hip surgical wound was red, dehisced and had purulent discharge. MD 1 stated an underlying infection could have caused Resident 1's left hip surgical wound dehiscence. MD 1 stated that because of Resident 1's left hip surgical wound infection, Resident 1 was admitted to GACH 1, requiring surgical wound washout.During an interview on 12/11/2025 at 8:30 a.m., with Resident 1, Resident 1 stated she reported pain at the left hip incision site to the TN on 11/26/2025 around 3:00 p.m. Resident 1 stated the TN gasped and left the room when she saw Resident 1's left hip wound. Resident 1 stated she became very worried and concerned when the TN did not return. Resident 1 stated she called 911 (paramedics, emergency services) on 11/26/2025 around 5:30 p.m. because she was worried about her left hip incision.During a concurrent interview and record review on 12/11/2025 at 9:40 a.m., with PA 1, Resident 1's Follow-Up Progress Notes written by PA 1, dated 11/19/2025, 11/21/2025 and 11/25/2025 were reviewed. PA 1 stated she only looked at Resident 1's left hip surgical dressing during her resident visits and assessments and did not check Resident 1's left hip surgical incision site. PA 1 stated she did not check/ assess the resident's surgical site on the left hip because she thought the wound care MD and TN assessed and monitored the left hip surgical site for signs of infection.During a concurrent interview and record review on 12/12/2025 at 11:30 a.m. with the Director of Nursing (DON), Resident 1's MAR and progress notes, for the month of 11/2025, were reviewed. The DON stated there is no indication in Resident 1's progress notes that nurses assessed Resident 1's left hip surgical site when Resident 1 reported pain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555004 If continuation sheet Page 5 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on 11/16/2025, 11/17/2025, 11/21/2025, 11/22/2025, and 11/23/2025. The DON stated Resident 1's MAR did not indicate the licensed nurses assessed Resident 1's pain location, quality, and aggravating factors (situation that made pain worse) every time Resident 1 reported pain. The DON stated pain on Resident 1's left hip surgical site could be a sign of infection or wound complication. The DON stated the licensed nurse assessing the pain did not assess Resident 1's left hip surgical wound for changes in condition and for signs of infection. The DON stated the licensed nurse should not assess the left hip surgical wound's dressing only.During an interview on 12/12/2025 at 1:15 p.m., with PA 1, PA 1 stated she trusted the facility's nurses to assess Resident 1's left hip wound. PA 1 stated Resident 1's pain on 11/17/2025, 11/20/2025, 11/21/2025, 11/22/2025, and 11/23/2025 could have been symptoms of infection and the wound should have been assessed each time the pain was reported. PA 1 stated she was not notified about Resident 1's pain and did not have time to review Resident 1's pattern of pain.During a concurrent interview and record review on 12/11/2025 at 2:00 p.m. with the TN, Resident 1's care plan titled Resident has skin breakdown related to surgical site.,, dated 11/12/2025, TAR, for the month of 11/2025, and care plan titled Baseline Care Plan: Resident is newly admitted to the facility, dated 11/16/2025, were reviewed. The TN stated the baseline care plan was not specific and should have identified focus as actual alteration in skin integrity. The TN stated, in Resident 1's baseline care plan interventions indicating at risk for orthopedic (branch of medicine dealing with conditions affecting the bones or muscles) complications: observe for s/s of infection at surgical site, the intervention was not performed. The TN stated the signs and symptoms of infection was not the same as signs of skin breakdown. The TN stated she did not document or monitor for signs of symptoms of infection in Resident 1's wound after Resident 1 was admitted . The TN stated the intervention to evaluate any localize skin problems was not performed because licensed nurses only monitored for skin breakdown and did not assess signs of infection such as pustules, inflammation, purulent discharges, and fever. The TN stated the care plan's goal to manage wound odor and exudate indicate a goal to manage signs of infection.During an interview on 12/16/2025 at 2:39 p.m., with MD 4, MD 4 stated that doctors and licensed nurses must look under wound dressings to completely assess Resident 1's left hip surgical site/ wound. MD 4 stated looking at the outside wound dressing was not adequate to assess the resident's left hip surgical site/ wound and could lead to missed signs of infection that should have been caught earlier. During a review of the LVN Job Description, dated 5/2022, the job description indicated LVNs must provide nursing services to residents in accordance with facility policies and professional standards of care. The job description indicated that LVNs must possess the ability to plan, develop, implement, and interpret the goals and objectives to provide quality care.During a review of the facility's policy and procedure (P&P) titled Skin Integrity Management, dated 5/26/2021, the P&P indicated to identify a resident's skin integrity status and need for treatment modalities (a specific method, technique, or approach used by healthcare professionals to promote healing). The P&P indicated, staff should perform skin inspection weekly and document in TAR or in Point Click Care (PCC- a computer program used for documentation). The P&P indicated to perform wound observations and measurements weekly, and with anticipated decline of wound. The P&P indicated to perform daily monitoring of wounds or dressings for presence of complications or declines and document if indicated. The P&P indicated facility should follow specific orders from the surgeon for surgical wounds.During a review of the facility's document titled Surgery-Related (Pre-and Postoperative) Management- Clinical Protocol, dated 10/2010, the document indicated, after readmission postoperatively (after surgery), the physician and facility staff should maintain appropriate communication with the surgeon to ensure the resident received adequate postoperative care. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555004 If continuation sheet Page 6 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete document indicated the staff should assess the resident for pain and continue to monitor the resident for changes in the level of pain. The document indicated that the staff, and physician should monitor for and address postoperative risks and complications such as infection and failure of surgical wounds to heal.During a review of the facility's P&P titled Care Plan- baseline, dated 8/25/2021, the P&P indicated baseline care plan should be developed and implemented by the Interdisciplinary Team ([IDT] group of healthcare professionals, including physician, nurses, resident/ resident representative, working together to develop a plan of care for the residents), for each resident that include instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. The P&P indicated the baseline care plan includes the minimum healthcare information necessary to properly care for a resident. Event ID: Facility ID: 555004 If continuation sheet Page 7 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on an interview and record review, the facility failed to implement the physician's order for pain management for one of four sampled residents (Resident 1).This failure had the potential to result in Resident 1 becoming dependent on pain medication.This failure had the potential for Resident 1 to reduce her capacity to manage and cope with her pain.Findings:During a review of Resident 1's Resident 1's Inter-Facility Transfer Report, dated 11/11/2025, the Inter-Facility Transfer Report indicated Resident 1 had left hip hemiarthroplasty (partial joint replacement surgery) on 11/9/2025.During a review of Resident 1's admission Record, Resident 1 was admitted on [DATE]. The admission Record indicated that Resident 1 had a history of fracture of left femur (leg bone), generalized anxiety (a mental condition characterized by excessive or a mental condition characterized by excessive worry) disorder, and polyneuropathy (disease or dysfunction of one or more nerves, typically causing numbness or weakness in the hands and feet). The admission Record indicated Resident 1 was admitted for aftercare following joint replacement surgery.During a review of Resident 1's History and Physical (H&P), dated 11/12/2025, the H&P indicated Resident 1 had the capacity to understand and make decisions. The H&P indicated Resident 1 had a diagnosis including [NAME] Syndrome (painful inflammatory condition causing swelling and tenderness in the cartilage where ribs meet the breastbone).During a review of Resident 1's Body Check, dated 11/12/2025, the Body Check indicated Resident 1 had a left trochanter (hip) surgical site (the specific location where an incision (cut) was made to perform an operation) measuring 15 centimeters (cm- a metric unit of length) with 23 staples (wound closure devices). Resident 1's Body Check indicated the left trochanter surgical site had some hematuria (bloody urine), no signs or symptoms of infection, and no dehiscence (a surgical incision or wound split open).During a review of Resident 1's Physician Orders, dated 11/12/2025, the Physician Orders indicated staff must document non-pharmacological interventions such as heat, repositioning, relaxation breathing, flood/fluid, massage, exercise, immobilization of joint, and other as needed and to document the results. The orders indicated Tramadol (a synthetic [man-made] opioid medication to treat pain) 50 milligrams (mg- a unit of measurement), two tablets, by mouth every six hours as needed for moderate to severe pain rated five (5) to 10 out of 10.During a review of Resident 1's Progress Notes, dated 11/12/2025, the notes indicated Resident 1 was alert with periods of confusion.During a review of Resident 1's care plan titled Baseline Care Plan: Resident is newly admitted to the facility, dated 11/16/2025, the care plan indicated an intervention of at risk for pain or discomfort: observed for pain and provide comfort measures as needed and At risk for pain or discomfort: give pain meds as ordered.During a review of Resident 1's Physician Orders, dated 11/17/2025, the Physician Orders indicated an order placed on11/12/2025 for pain monitoring every shift and to document non-pharmacological interventions(s) such as heat, repositioning, relaxation, breathing, food/fluid, massage, exercise, immobilization of join. The physician's orders indicated to write in progress notes as needed and document results of non-pharmacological interventions. During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated 11/17/2025, the MDS indicated Resident 1 was cognitively intact and did not reject care. The MDS indicated Resident 1 required moderate assistance (helper does less than half the effort) in rolling left and right, moving from sitting to lying position, and to a standing position from sitting. The MDS indicated Resident 1 had a surgical wound and a history of surgery. The MDS indicated Resident 1 occasionally experienced moderate pain and did not receive non-medication interventions for pain within the past five days.During a review of Resident 1's Medication Administration Record (MAR - a daily documentation record used by a licensed nurse to document medications and Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555004 If continuation sheet Page 8 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete treatments given to a resident), for the month of 11/2025, the MAR did not indicate Resident 1 was offered or provided any non-pharmacological interventions on the following dates as indicated in the physician's orders:1). For 8/10 pain on 11/16/2025 at 4:46 p.m.2). For 7/10 pain on 11/21/2025 at 7:39 p.m.3). For 7/10 pain on 11/22/2025 at 10:52 a.m.4). For 7/10 pain on 11/23/2025 at 3:29 a.m.5). For 8/10 pain on 11/23/2025 at 9:57 a.m. The MAR indicated Resident 1 received Tramadol 50 mg 2 tablets for the following:1). 0/10 pain on 11/18/2025 at 1:14 pm.2). 0/10 pain on 11/21/2025 at 1:54 p.m.3). 0/10 pain on 11/26/2025 at 12:31 p.m. During a concurrent interview and record review on 12/4/2025 at 9:22 a.m. with Registered Nurse 15 (RN 15), Resident 1's MAR, for the month of 11/2025, and Progress Notes, for the month of 11/2025, were reviewed. RN 15 stated Resident 1 should have been offered non-pharmacological pain management interventions on 11/16/2025, 11/21/2025, 11/22/2025 and 11/23/2025 when she complained of pain and every time, she would report pain and discomfort and should be documented in the progress notes and MAR. RN 15 stated Resident 1 should not have been given Tramadol 50 mg 2 tablets on 11/18/2025, 11/21/2025 and on 11/26/2025 because Resident 1 reported 0/10 pain. RN 15 stated the Tramadol 50 mg 2 tablets administered on 11/18/2025, 11/21/2025, and 11/26/2025 did not meet these parameters and did not have any physician's orders. During a concurrent interview and record review on 12/4/2025 at 3:53 p.m., with RN 1, Resident 1's Progress Notes, for the month of 11/2025, and Resident 1's MAR, for the month of 11/2025, were reviewed. RN 1 stated Resident 1's diagnoses, surgical history, and left hip wound made her vulnerable to pain in many areas of her body. RN 1 stated Resident 1's pain could be a sign of surgical complications, wound infection, and wound dehiscence. RN 1 stated nursing staff should have assessed Resident 1's pain location, quality, frequency, alleviating factors (measures to reduce pain), and aggravating factors (circumstances that increases the severity) every time she reported and documented in the MAR or progress notes to ensure all shifts and members of the care team can monitor and plan Resident 1's care and provide appropriate interventions. RN 1 stated Resident 1's MAR only indicated the pain scale that Resident 1 reported. RN 1 stated Resident 1's MAR and progress notes did not indicate Resident 1's pain location, quality, frequency, alleviating factors, or aggravating factors. RN 1 stated all residents must be offered non-pharmacological pain management interventions any time they report pain. RN 1 stated only providing pharmacological pain interventions and incorrectly administering pain medication had the potential to result in Resident 1 becoming dependent on pain medication and unable to cope with her pain.During an interview on 12/10/2025 at 12:48 p.m., with Resident 1's Medical Doctor 1 (MD 1), MD 1 stated that PRN (given as needed or requested) pain medication can only be administered after the prescribed order parameters are met. MD 1 stated licensed nurses are only allowed to give pain medication to residents who report zero out of ten pain if the order parameters allow it.During an interview on 12/11/2025 at 8:30 a.m. with Resident 1, Resident 1 stated nursing staff did not offer heat, repositioning, relaxation breathing, food/fluid, massage, exercise, or immobilization when she reported pain and discomfort in the facility.During a review of the facility's policy and procedures (P&P) titled Pain Management, dated 8/25/2025, the P&P indicated staff should document non-pharmacological interventions.During a review of the facility's P&P titled Administering Medications, dated 4/2019, the P&P indicated medications should be administered in a safe and timely manner, in accordance with prescriber orders. Event ID: Facility ID: 555004 If continuation sheet Page 9 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pork sausage patty in the breakfast tray, for two of four sampled residents (Residents 2 and 3), as indicated on the menu and meal tickets (the diet order that matched the dietitian approved menu, honoring resident food preferences).This failure resulted in Resident 2 and Resident 3 not receiving the adequate protein and calories, potentially worsening their protein and calorie malnutrition (undernutrition).Findings:1.) During a review of Resident 2's admission Record, the admission Record indicated Resident 2 was originally admitted on [DATE] and readmitted on [DATE]. Resident 2's diagnoses included generalized muscle weakness, anemia (a condition where the body does not have enough healthy red blood cells), and chronic kidney disease (long-term impaired kidney function).During a review of Resident 2's History and Physical (H&P), dated 10/28/2025, the H&P indicated Resident 2 had the capacity to understand and make decisions.During a review of Resident 2's Dietary Profile, dated 10/28/2025, the Dietary Profile indicated Resident 2 did not have any religious or cultural preferences and did not dislike any meat products.During a review of Resident 2's Minimum Data Set (MDS - a resident assessment tool), dated 12/4/2025, the MDS indicated Resident 2 was cognitively intact, was able to understand others and express ideas and wants.During a review of Resident 2's Nutrition Assessment, dated 12/4/2025, the assessment indicated Resident 2 weighed 126.6 pounds (in low normal range for Resident 2's height and age). The assessment indicated Resident 2 received supplementation for her iron deficiency. The assessment indicated a goal for Resident 2 to maintain optimal oral intake to avoid significant weight change.During a review of Resident 2's Breakfast Meal Ticket, dated 12/4/2025, Resident 2's Meal Ticket indicated a regular texture, regular diet. The Meal Ticket indicated Resident 2's breakfast tray should include one sausage patty.During a concurrent observation and interview on 12/4/2025 at 8:11 a.m., with Resident 2 in Resident 2's room, Resident 2's breakfast tray did not have a sausage patty. Resident 2 stated she was saddened by the lack of sausage patty.During a concurrent interview and record review on 12/4/2025 at 10:20 a.m., with the Dietary District Manager (DDM), Resident 2's Meal Ticket, dated 12/4/2025, was reviewed. The DDM stated Resident 2 did not have an allergy or dislike to pork or sausage or sodium intake restriction. The DDM stated the kitchen cooks, dietary aides, and nursing staff check each tray composition to ensure residents receive the correct diet and food items according to their meal tickets. The DDM stated Resident 2 should have received every item listed on the Meal Ticket, including the sausage patty. The DDM stated the cooks, aides, and nursing staff should have noticed Resident 2's tray did not include each item from the menu and meal ticket, returned the tray to the kitchen, and added the sausage patty to the tray before Resident 2 received the tray.During a concurrent interview and record review on 12/4/2025 at 3:15 p.m., with the Registered Dietitian (RD 1), Resident 2's Meal Ticket, dated 12/4/2025, Resident 2's Nutrition Assessment, dated 12/4/2025, the facility's menu, dated 12/4/2025, and the facility's recipe titled Sausage Patty, dated Fall 2025, were reviewed. RD 1 stated the menu, recipe, and Resident 2's Meal Ticket indicated Resident 2 should have one sausage patty with breakfast. RD 1 stated this failure had the potential to result in Resident 2 experiencing weight loss, worsened iron deficiency, and compromised protein intake. 2.) During a review of Resident 3's admission Record, the admission Record indicated Resident 3 was originally admitted to the facility on [DATE] and readmitted on [DATE]. The admission Record indicated Resident 3 had diagnoses including muscle weakness, acute (short-term) and chronic (long-term) respiratory failure (impairment of the lungs), and chronic obstructive pulmonary disease (COPD-a chronic lung disease causing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555004 If continuation sheet Page 10 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete difficulty in breathing).During a review of Resident 3's H&P, dated 8/20/2025, the H&P indicated Resident 3 had the capacity to understand and make decisions.During a review of Resident 3's Interdisciplinary Care Conference ([IDT] group of healthcare professionals, including physician, nurses, resident/ resident representative, working together to develop a plan of care for the residents), dated 8/21/2025, the conference indicated admission goals to improve nutritional status and tolerate a high protein diet. During a review of Resident 3's care plan titled At risk for malnutrition related to inadequate protein-calorie intake , dated 8/22/2025, the care plan indicated staff must provide diet as ordered.During a review of Resident 3's Dietary Profile, dated 11/21/2025, the profile indicated Resident 3 liked all meats, had no food allergies or intolerances, and tolerated her regular texture diet.During a review of Resident 3's Nutrition Assessment, dated 12/4/2025, the Nutrition Assessment indicated Resident 3's needs were not met because a regular diet may not be enough calories and protein to meet Resident 3's needs. The assessment indicated Resident 3 had low visceral protein (proteins found in the blood and other body fluids used as markers for nutritional status) status and moderate protein-calorie malnutrition. The assessment indicated a goal to gain weight and improve visceral protein status.During a review of Resident 3's Breakfast Meal Ticket, dated 12/4/2025, the Meal Ticket indicated Resident 3's tray should include one sausage patty. The Meal Ticket did not indicate a dislike of sausage, meat, or pork. The Meal Ticket did not indicate an allergy or dislike of sausage, meat, or pork.During an observation on 12/4/2025 at 8:09 a.m., the Director of Nursing (DON) delivered Resident 3's breakfast tray to Resident 3 in Resident 3's room.During a concurrent observation and interview on 12/4/2025 at 8:12 a.m., with Resident 3 in Resident 3's room, Resident 3 removed the plate cover. The tray did not contain sausage patty. Resident 3 stated she felt disheartened that she did not receive all the menu and meal ticket items.During a concurrent observation and interview on 12/4/2025 at 8:14 a.m., with CNA 11 in Resident 3's room, Resident 3's breakfast tray did not have a sausage patty. CNA 11 stated the sausage patty was ground into the gravy on the plate.During a concurrent interview and record review on 12/4/2025 at 10:20 a.m., with the DDM, Resident 3's Meal Ticket, dated 12/4/2025, and the facility's menu, dated 12/4/2025, were reviewed. The DDM stated Resident 3 did not have an allergy or dislike to pork or sausage or sodium intake restriction. The DDM stated the kitchen cooks, dietary aides, and nursing staff each check tray composition to ensure residents receive the correct diet and food items according to their meal tickets. The DDM stated Resident 3 should have received every item listed on the Meal Ticket, including the sausage patty. The DDM stated the cooks, aides, and nursing staff should have noticed Resident 3's tray did not include each item from the menu and meal ticket, returned the tray to the kitchen, and added the sausage patty to the tray before Resident 3 received the tray. The DDM stated the sausage patty was not ground into the gravy for regular texture diets. The DDM stated the CNA should have notified the kitchen after learning that Resident 3 did not have a sausage patty.During a concurrent interview and record review on 12/4/2025 at 3:15 p.m., with the RD 1, Resident 3's Meal Ticket, dated 12/4/2025, Resident 3's Nutrition Assessment, dated 12/4/2025, the facility's menu, dated 12/4/2025, and the facility's recipe titled Sausage Patty, dated Fall 2025, were reviewed. RD 1 stated the menu, recipe, and Resident 3's Meal Ticket indicated Resident 3 should have received one, whole sausage patty with breakfast. RD 1 stated this failure had the potential to result in Resident 3 experiencing worsened protein-calorie malnutrition, weight loss, and increased muscle weakness. Event ID: Facility ID: 555004 If continuation sheet Page 11 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **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 2) was not served in her breakfast tray, orange juice and hot cereal as indicated in the resident's meal ticket.This failure resulted in a violation in Resident 2's rights, which caused her to feel angry and distressed.Findings:During a review of Resident 2's admission Record, the admission Record indicated Resident 2 was originally admitted to the facility on [DATE] and readmitted on [DATE]. Resident 2's diagnoses included generalized muscle weakness, anemia (a condition where the body does not have enough healthy red blood cells), and chronic kidney disease (long-term impaired kidney function).During a review of Resident 2's history and physical (H&P), dated 10/28/2025, the H&P indicated Resident 2 had the capacity to understand and make decisions.During a review of Resident 2's Minimum Data Set (MDS - a resident assessment tool), dated 12/4/2025, the MDS indicated Resident 2 was cognitively intact, understood others and was able to express her ideas and wants.During a review of Resident 2's physician orders, dated 12/12/2025, the physician's order indicated a regular texture, regular diet.During a review of Resident 2's Dietary Profile, dated 10/28/2025, the Dietary Profile indicated Resident 2 disliked orange juice, hot cereal, tomatoes, and bell peppers.During a concurrent observation and interview on 12/4/2025 at 8:11 a.m., with Resident 2 in Resident 2's room, Resident 2's breakfast tray included orange juice and hot cereal. Resident 2 stated she did not like orange juice and hot cereal. Resident 2's Meal Ticket indicated Resident 2 disliked orange juice and hot cereal.During an observation on 12/4/2025 at 8:18 a.m., Certified Nursing Assistant (CNA) 10 was in Resident 2's room. Resident 2 informed CNA 10 about the presence of her disliked food (orange juice and hot cereal) on her breakfast tray. CNA 10 removed the orange juice and told Resident 2 that she should not have received her disliked food items. CNA 10 left the hot cereal on Resident 2's tray.During a concurrent observation and interview on 12/4/2025 at 8:29 a.m., with the Dietary Services Supervisor (DSS) in Resident 2's room, Resident 2's breakfast tray that included hot cereal was observed. The DSS stated Resident 2's tray should not have included any items on her dislike list (orange juice and hot cereal). During a concurrent interview and record review on 12/4/2025 at 3:15 p.m., with the Registered Dietitian (RD 1), Resident 2's Meal Ticket, dated 12/4/2025, and the facility's policy and procedure (P&P) titled Dining and Food Preferences, dated 9/2017, were reviewed. RD 1 stated Resident 2's Meal Ticket indicated Resident 2 should not have orange juice and hot cereal. RD 1 stated the P&P was not followed because Resident 2 should not have received any food that she disliked. RD 1 stated this failure had the potential to result in Resident 2 experiencing weight loss, losing her sense of control, and feeling dissatisfied. RD 1 stated residents had the potential to be exposed to allergens and could develop allergic reactions because dietary and nursing staff did not ensure residents' food trays match the foods listed on their Meal Tickets.During a review of the facility's P&P titled Dining and Food Preferences, dated 9/2017, the P&P indicated that upon meal service, any resident with expressed refusal of food and/or beverage should be offered an alternate selection of comparable nutritive value. Event ID: Facility ID: 555004 If continuation sheet Page 12 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure accurate documentation was maintained for one of four resident's (Resident 1).This failure had the potential for miscommunication and inaccurate clinical decision-making and could result in delayed identification of condition changes and providing care.Findings:During a record review of Resident 1's Inter-Facility Transfer Report (essential documentation accompanying a patient being transferred from one healthcare facility to another to receive a different level of care), dated 11/11/2025, the Inter-Facility Transfer Report indicated Resident 1 had left hip hemiarthroplasty (partial joint replacement surgery) on 11/9/2025.During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted on [DATE], with diagnoses including history of left femur (leg bone) fracture (broken bone) and for aftercare following joint replacement surgery.During a review of Resident 1's History and Physical (H&P), dated 11/12/2025, the H&P indicated Resident 1 had the capacity to understand and make decisions.During a review of Resident 1's Body Check, dated 11/12/2025, the Body Check indicated Resident 1 had a left trochanter (hip) surgical site (the specific location where an incision (cut) was made to perform an operation), measuring 15 centimeters (cm- a metric unit of length) with 23 staples (wound closure devices). Resident 1's Body Check indicated the left trochanter surgical site had some hematuria (bloody urine), no signs or symptoms of infection, and no dehiscence (a surgical incision or wound split open).During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated 11/17/2025, the MDS indicated Resident 1 was cognitively intact and did not reject care. The MDS indicated Resident 1 had a surgical wound and a history of surgery.During a review of Resident 1's Change of Condition (COC- a communication tool used by healthcare workers when there is a clinical deviation from a resident's baseline), dated 11/26/2025 at 3:45 p.m., the COC indicated Resident 1's left trochanter surgical incision had 2 cm. of wound dehiscence (split open skin). The COC indicated Resident 1's left trochanter surgical incision had some (unspecified) drainage and moisture. The COC indicated Resident 1's wound dehiscence started in the morning (time not specified). During a review of Resident 1's Daily Body Check, dated 11/26/2025 for the 3:00 p.m. to 11:30 p.m. shift, the body check indicated Resident 1 had skin treatment on the right hip. During a concurrent interview and record review on 12/2/2025 at 2:25 p.m., with the Treatment Nurse (TN), Resident 1's Body Check, dated 11/12/2025, was reviewed. The TN stated Resident 1's Body Check indicated Resident 1 was admitted on [DATE], with a surgical site on the left hip with some hematuria on the left hip surgical site. The TN stated she incorrectly believed hematuria meant bloody discharge. The TN stated the wound assessment was incorrect because hematuria, which is of the urine, and was not coming out of Resident 1's lift hip wound. During a concurrent interview and record review on 12/12/2025 at 11:30 a.m., with the Director of Nursing (DON), Resident 1's Body Check, dated 11/12/2025, and Daily Body Check, dated 11/26/2025, were reviewed. The DON stated Resident 1 had a surgical incision and wound treatment on her left hip, not the right hip as indicated in the Daily Body Check dated 11/26/2025 for the 3:00 p.m. to 11:30 p.m. shift.During a concurrent interview and record review on 12/12/2025 at 11:45 a.m., with the TN, Resident 1's COC, dated 11/26/2025, was reviewed. The TN stated Resident 1's wound dehiscence indicated in the COC was identified on 11/26/2025, in the afternoon (time not specified), not in the morning. The TN stated the documentation of her assessment was incorrect because Resident 1's wound dehiscence was not discovered in the morning.During a review of the facility's policy and procedure (P&P) titled Nursing Documentation, dated 6/27/2022, the P&P indicated nursing documentation should be accurate and based on the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555004 If continuation sheet Page 13 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Playa Del Rey Center 7716 Manchester Avenue Playa Del Rey, CA 90293 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 0842 condition to communicate a resident's status. 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: 555004 If continuation sheet Page 14 of 14