Health inspection·October 6, 2023

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to provide privacy for one of 15 sampled residents (Resident 38) by discussing care and treatment of Resident 38 at the nurse's station in the presence of staff and other residents. Residents Affected - Few This deficient practice had the potential to result in embarrassment and reveal private information for Resident 38. Findings: During a review of Resident 38's Face Sheet, the Face Sheet indicated, Resident 38 had diagnoses of but not limited to malignant (spreads fast) neoplasm (a type of abnormal and excessive growth of tissue) of the mouth, major depressive disorder (a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of pleasure in normally enjoyable activities), muscle wasting (a condition where muscles lose mass and strength) and atrophy (decrease in size or wasting away of a body part or tissue). During a review of Resident 38's History and Physical (H&P), dated 2/14/2023, the H&P indicated, Resident 38 had the mental capacity to understand and make decisions. During a review of Resident 38's Minimum Data Set (MDS) a standardized assessment and care planning tool, dated 8/21/2023, the MDS indicated, Resident 38 was able to understand and had the ability to express ideas and wants. The MDS indicated Resident 38 required supervision for bed mobility, transferring, walking, locomotion on and off the unit, dressing, eating, toilet use, and personal hygiene. During an interview on 10/3/2023 at 11:57 am, with Resident 38, Resident 38 stated he went to the nurses' station because he wanted to speak with his doctor about receiving an alternative medication. Resident 38 stated he had to explain his issues about the alternative medication at the nurses' station in front of staff and residents. Resident 38 stated, he knows the facility has a room where doctors can speak to residents privately. During an interview on 10/4/2023 at 9:00 am with Resident 38, Resident 38 stated when speaking to the doctor, the doctor talks to him about his care in front of the nurses' station where other staff and residents could hear the conversation. During an interview on 10/5/2023 at 2:26 pm with Licensed Vocational Nurse (LVN 1), LVN 1 stated she saw Resident 38 at the nurses' station speaking with doctors while nurses were at the station charting. LVN 1 stated that speaking with the doctor at the nurses' station does not maintain privacy Page 1 of 16 555010 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few for Resident 38. LVN 1 stated the facility does have a room where residents and doctors can go to speak privately. During an interview on 10/6/2023 at 2:26 pm with the Director of Nursing (DON), the DON stated she had noticed Resident 38 at the nurses' station speaking to the doctor, discussing medications. The DON stated nurses are working at the nurses' station when residents are speaking with the doctors. The DON stated if doctors are talking about resident care there should not be anybody there, it is a Health Insurance Portability Accountability Act, (HIPPA a law designed to provide privacy standards to protect patient's medical records and other health information) violation. The DON stated the facility has a room that doctors can use to speak to residents privately. During a review of the facility's policy and procedure (P&P) titled, Resident Right's to Dignity and Privacy, revised 9/2017, the P&P indicated, Communication such as shift reports shall be conducted outside of the hearing range of residents and the public. 555010 Page 2 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to initiate a person-centered care plan for one of three sampled residents (Resident 41) for missing teeth. This deficient practice had the potential for Resident 41 to not be monitored for adverse outcomes of missing teeth such as choking due to trying to swallow unchewed food. Findings: During a review of Resident 41's admission record, the admission record indicated Resident 41 was admitted to the facility on [DATE] with diagnoses including dysphagia (swallowing difficulties) and functional dyspepsia (recurring symptoms of an upset stomach that have no obvious cause). During a review of Resident 41's Minimum Data Set (MDS, a standardized assessment and care screening tool) dated 9/5/2023, the MDS indicated Resident 41 had the ability to makes self-understood and was able to understand others. During a review of Resident 41's Oral/ Dental Care plan (CP) initiated on 5/31/2023 and last revised on 9/2023, the CP indicated Resident 41 had a potential for the inability to do oral care because of behaviors. The CP goals for Resident 41 were his mouth and teeth would be clean daily as manifested by no visible debris in mouth and interventions that included diet as ordered, encouraging resident to report difficulty in chewing food and staff monitoring for signs and symptoms of chewing difficulty. The CP did not indicate Resident 41 was missing teeth, had the potential for choking and did not have goals related to no choking episodes. During a review of Resident 41's admission Nutritional Assessment (ANA) dated 6/2/2023, Resident 41 was edentulous (without teeth). During an observation on 10/3/2023 12:24 p.m., Resident 41 was eating his lunch and had no teeth. Resident 41 was eating a regular consistency (food that requires teeth and jaw strength to chew) diet. During an interview and concurrent record review on 10/5/2023 at 2:20 p.m., licensed vocational nurse (LVN) 3 confirmed Resident 41 did not have a CP that indicated he did not have any teeth or was a choking risk. LVN 3 stated it was important to have accurate information in the CPs so the facility can implement appropriate interventions and the residents can receive appropriate care. During an interview on 10/5/2023 at 3:31 p.m., the director of nursing (DON) stated if a resident had missing teeth, it needed to be care planned. The DON stated the CPs are important because it details the individualized care for each resident, and it is the communication between nurses as to what care the residents need. During a review of the facility's policy and procedure (P/P) titled Comprehensive Care Planning dated 1/2017, the P/P indicated the plan of care is driven not only by identified resident issues and/ or conditions but also by the resident's unique characteristics, strengths and needs, goals, life history and preferences and discharge planning. 555010 Page 3 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0685 Assist a resident in gaining access to vision and hearing services. 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 two of 15 sampled residents (Resident 38 and Resident 53) optometrist (a healthcare professional who provides vision care) recommendations to arrange for Resident 38's new glasses, to be adjusted (to improve his sight) and to obtain new glasses for Resident 53 were followed. Residents Affected - Few This failure resulted in a diminished quality of life for Resident 38 not being able to read fine print, and Resident 53 not having new glasses to maintain vision. Findings: a. During a review of Resident 38's Face Sheet, the Face Sheet indicated, Resident 38 had diagnoses of but not limited to malignant (spreads fast) neoplasm (a type of abnormal and excessive growth of tissue) of the mouth, major depressive disorder (a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of pleasure in normally enjoyable activities), muscle wasting (a condition where muscles lose mass and strength) and atrophy (decrease in size or wasting away of a body part or tissue). During a review of Resident 38's History and Physical (H&P), dated 2/14/2023, the H&P indicated, Resident 38 had the mental capacity to understand and make decisions. During a review of Resident 38's Minimum Data Set (MDS) a standardized assessment and care planning tool, dated 8/21/2023, the MDS indicated, Resident 38 was able to understand and had the ability to express ideas and wants. The MDS indicated Resident 38 required supervision for bed mobility, transferring, walking, locomotion on and off the unit, dressing, eating, toilet use, and personal hygiene. During an interview on 10/3/2023 at 11:57 am with Resident 38, Resident 38 stated it had been four months since the optometrist had given him a prescription for glasses that do not work. Resident 38 stated he talked to the nurses at the facility several time and about two months ago was told he would get a new pair of glasses and has not heard anything about the glasses since. Resident 38 stated it is hard for him to read fine print. During an interview on 10/5/2023 at 10:22 am with Licensed Vocational Nurse (LVN) 1, LVN 1 stated Resident 38 was admitted to the facility with glasses and the Social Services is responsible for getting residents glasses, calling the optometrist or ophthalmologist (eye doctor) and make vision appointments and transportation to the appointments. During a concurrent interview and record review on 10/5/2023 at 2:15 pm with the Director of Social Services (DSS), Resident 38's Ophthalmology Consultation report, dated 7/2/2023 was reviewed. The Ophthalmology Consultation report indicated, a recommendation to obtain an appointment to adjust Resident 38's new glasses. The DSS stated residents will have problems seeing if ophthalmology recommendations for them, are not carried out. b. During a review of Resident 53's Face Sheet, the Face Sheet indicated, Resident 53 was admitted to the facility on [DATE] with diagnoses including but not limited to benign (not harmful) prostatic (prostate [a gland of the male reproductive system] enlargement) hyperplasia (abnormal enalrgment), 555010 Page 4 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0685 kidney disease (a gradual loss of kidney function), and bradycardia (an abnormally slow heart rate). Level of Harm - Minimal harm or potential for actual harm During a review of Resident 53's H&P, dated 5/24/2023, the H&P indicated, Resident 53 had the mental capacity to understand and make decisions. Residents Affected - Few During a review of resident 53's Optometric Consultation report dated 8/16/2023, the report indicated a recommendation for new reading glasses. During a review of Resident 53's Minimum Data Set (MDS) a standardized assessment and care planning tool, dated 8/28/2023, the MDS indicated, Resident 53 used glasses. The MDS indicated, Resident 53 was able to understand and had make himself understood. The MDS indicated, Resident 53 required limited assistance with bed mobility, transferring, walking, locomotion on and off the unit, dressing, toilet use, and hygiene. During an interview on 10/6/2023 at 10:41 am with the DSS, the DSS stated she was not able to find proof that any of the residents with recommendations for new glasses, had received them. The DSS stated she did not follow up on any recommendations from ophthalmology and missed the recommendation because her system to track residents with recommendations does not work and will follow up on the recommendations now. The DSS stated negative outcomes for residents with ophthalmology recommendation that are not being followed would be problems with activities of daily living and not being able to see. During an interview on 10/6/2023 at 2:34pm with the Director of Nursing (DON), the DON stated the negative outcome for a resident whose recommendation by the eye doctor are not followed is not being able to see properly. During a review of the facility's policy and procedure (P&P) titled, Social Service Department, undated, the P&P indicated, Social Services staff will coordinate Dental, Optometry, and Audiology evaluations for Residents. Social Services will maintain a system to monitor the Dental, Optometry, and Audiology evaluations. 555010 Page 5 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

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 observation, interview and record review, the facility failed to monitor and reassess pain level on one of five sampled residents (Resident 9) in accordance with the standard practice of care. Residents Affected - Few This deficient practice resulted in facility staff not reassessing Resident 9's pain level in a timely manner and placing Resident 9 at risk for unnecessary pain. Findings: During a review of Resident 9's admission Record (AR), the AR indicated the resident was admitted on [DATE] to the facility with diagnoses that included diabetes (high blood sugar), chronic pain syndrome (pain that lasts for over three months and can interfere with daily activities), and hypertension (high blood pressure). During a review of Resident 9's Minimum Data Set (MDS) standardized assessment and screening tool dated 9/11/2023, the MDS indicated the resident had intact cognition (thought process) and required one-person physical assist with bed mobility, transfer, dressing, and toilet use. The MDS indicated the resident had pain occasionally during the assessment. During an interview on 10/3/2023, at 12:15 p.m. with Resident 9, Resident 9 stated he was still having backpain despite receiving Tramadol ( narcotic pain medicine). Resident 9 stated Tramadol was not affording relief for his backpain. He stated his back pain is 4/10 and that he had told the nurses about his backpain not being relieved by Tramadol. During a review of Resident 9's Physician Order (PO) dated 9/5/2023, the PO indicated an order of Tramadol 50 milligrams([mgs.] unit of measurement) give one tablet by mouth every 6 hours as needed for severe pain 7-10 pain scale (numerical rating of pain with 0 being no pain and 10 being the worst pain possible). During a review of Resident 9's PO dated 9/5/2023, the PO indicated an order of Acetaminophen (a medication used to relieve mild pain) tablet 500 mgs. give one tablet every 6 hours as needed for mild pain, pain scale of 1-3 and Acetaminophen 325 mgs. 2 tablets by mouth every 6 hours as needed for moderate pain scale of 4 to 6. During a review of Resident 9's Medication Administration Audit Report dated 10/3/2023, the report indicated pain was assessed at 9:38 p.m., Tramadol 50 mgs. by mouth was administered at 10:00 p.m., for a pain level of 8 (severe pain) and was reassessed at 11:36 p.m. During a concurrent interview and record review on 10/5/2023, at 11:51 a.m., with Licensed Vocational Nurse (LVN) 2, LVN 2 stated and verified Resident 9 had received Tramadol at 10:00 p.m. and was reassessed an hour and 36 minutes after administration of Tramadol. LVN 2 stated Resident 9 was always complaining of pain and the licensed nurse should have reassessed Resident 9's pain level within 30 minutes to an hour of administering it, to make sure the medicine was effective enough. During an interview on 10/5/2023, at 1:59 p.m., with RN Supervisor (RNS) 1, RNS 1 stated pain reassessment should be performed within an hour after administration of Tramadol to ensure accuracy of assessment and efficacy of intervention. 555010 Page 6 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0697 Level of Harm - Minimal harm or potential for actual harm During a review of Resident 9's Care Plan(CP) dated 9/5/2023, the CP indicated Resident 9 had chronic pain syndrome related to his back pain. The CP's goals indicated Resident 9's pain will be relieved within 30 minutes after pain medication is given. The CP's interventions included to assess intensity of pain using pain scale of 1 to 10, instruct resident to report any pain as soon as it begins, to reassess resident's pain after 30 - 45 minutes and notify physician for possible need for increased pain medication as needed. Residents Affected - Few During a review of facility's policy and procedure (P/P) titled, Pain Management Protocol, revised 10/2017, the P/P indicated an ongoing evaluation of the status of resident's pain is vital and monitoring should include assessment of the effectiveness of pain medication with routine and medication administered as needed (PRN) medicines approximately 30 minutes after administration. The P/P indicated when pain is identified, pain rating should always be included in the documentation and in every prn medication administered. 555010 Page 7 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide the necessary social services for five of 15 sampled residents (Resident 38, Resident 40, Resident 42, Resident 47, Resident 53) by : Residents Affected - Some a. not following up on an ophthalmology consultation recommendation to adjust new glasses for Resident 38. b. not following up on a dental recommendation for a full mouth x-ray and dentures for Resident 40. c. not ensuring Resident 42 was initially assessed and received individualized intervention to meet his mental and psychosocial needs. d. not following up on dental recommendations for a full mouth x-ray for Resident 47. e. not following up on an optometrist consultation for new reading glasses for Resident 53. This failure resulted in a delay of care and services. Findings: a. During a review of Resident 38's Face Sheet, the Face Sheet indicated, Resident 38 had diagnoses of but not limited to malignant (spreads fast) neoplasm (a type of abnormal and excessive growth of tissue) of the mouth, major depressive disorder (a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of pleasure in normally enjoyable activities), muscle wasting (a condition where muscles lose mass and strength) and atrophy (decrease in size or wasting away of a body part or tissue). During a review of Resident 38's History and Physical (H&P), dated 2/14/2023, the H&P indicated, Resident 38 had the mental capacity to understand and make decisions. During a review of Resident 38's Minimum Data Set (MDS) a standardized assessment and care planning tool, dated 8/21/2023, the MDS indicated, Resident 38 was able to understand and had the ability to express ideas and wants. The MDS indicated Resident 38 required supervision for bed mobility, transferring, walking, locomotion on and off the unit, dressing, eating, toilet use, and personal hygiene. During a review of Resident 38's Ophthalmology Consultation report dated 7/2/2023, the report indicated a recommendation for a referral to adjust his new glasses. b. During a review of Resident 40's Face Sheet, the Face Sheet indicated Resident 40 was admitted on [DATE] with diagnoses of but not limited to osteoarthritis (a type of degenerative joint disease that results from breakdown of joint and underlying bone), anemia (a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of blood cells), dementia (a decline in cognitive abilities that impacts a person's ability to perform every day activities), muscle wasting and atrophy. 555010 Page 8 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 40's H&P dated 4/27/2023, the H&P indicated Resident 40 did not have the mental capacity to make decisions. During a review of Resident 40's MDS dated [DATE], the MDS indicated Resident 40 usually understands and comprehends most conversations. The MDS indicated Resident 40 required limited assistance with bed mobility, transferring, walking, locomotion on and off the unit, dressing, toilet use, personal hygiene, and needed supervision while eating. During a review of Resident 40's dentist report from Elite Mobile Dental. dated 5/23/2023, the report indicated Resident 40 was recommended to have a full mouth x-ray. The report also indicated Resident 40 was interested in receiving dentures. c. During a review of Resident 42's Face Sheet, the Face Sheet indicated Resident 42 was admitted on [DATE] with diagnoses that included but not limited to post-traumatic stress disorder ( [PTSD] a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event), hemiplegia (muscle weakness or partial paralysis on one part of the body), alcohol abuse (excessive use of alcohol that can be harmful to health and interferes with daily life) and paranoid schizophrenia (a serious mental disorder in which a person interprets reality abnormally). During a review of Resident 42's MDS dated [DATE], the MDS indicated Resident 42's cognition was intact and required one-person physical assist with bed mobility, transfer, dressing, toilet use and personal hygiene. During a concurrent interview and record review on 10/5/2023, at 2:48 p.m. with Director of Social Services (DSS), DSS stated the initial assessment for Resident 42 was incomplete and should have been completed within seven days from admission. Record Review of Resident 42's medical record indicated Social Services Progress Notes, Social Services Initial Assessment, and room visit logs were not found on resident's chart and was verified with SSD. SSD stated sometimes things get missed that was why she did not document what services she had provided for the resident. During a subsequent interview on 10/5/2023, at 3:51 p.m. with DSS, DSS stated she provided services to the residents by talking and assuring them they are safe, allowing them to verbalize any feelings, make referrals as needed and identify any residents' concerns. DSS stated she did room visits to Resident 42 but did not document nor a create a room visit log. During an interview on 10/6/2023, at 3:03 p.m. with Director of Nursing (DON), DON stated when a resident is admitted from General Acute Care Hospital (GACH) whatever diagnosis the GACH had identified and assessed like PTSD, the facility continues the care and services for that diagnosis in the facility. DON stated DSS is responsible for providing therapeutic communication and psychosocial (pertaining to social factor effects on a resident's feelings and behavior) support to all residents. DON stated DSS should have documented her assessments and visits when providing services to Resident 42. During a review of Resident 42's Brief Trauma Questionnaire and Life Events Checklist completed and dated 10/5/2023, the questionnaire indicated Resident 42 was admitted on [DATE] and suffered from PTSD related to getting beaten up in a boarding care, car accident and molestation (getting touch or attacked in a sexual way). d. During a review of Resident 47's Face Sheet, the Face Sheet indicated Resident 47 was originally admitted to the facility on [DATE] with diagnoses of but not limited to diabetes (high blood sugar 555010 Page 9 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0745 Level of Harm - Minimal harm or potential for actual harm levels), asthma (an inflammatory disease of the airways of the lungs), heart failure (impairment of the heart's blood pumping function) and muscle wasting and atrophy. During a review of Resident 47's H&P dated 8/30/2023, the H&P indicated Resident 47 had the mental capacity to make decisions. Residents Affected - Some During a review of Resident 47's MDS dated [DATE], the MDS indicated Resident 47 had the ability to understand and express ideas and wants. During a review of Resident 47's dentist report from Elite Mobile Dental dated 7/15/2023, the report indicated Resident 47 was recommended to have a full mouth x-ray. During an interview on 10/5/2023 at 3:42 pm with the DSS, the DSS stated pain is one of the negative outcomes for a resident whose does not receive dental services they need. e. During a review of Resident 53's Face Sheet, the Face Sheet indicated, Resident 53 was admitted to the facility on [DATE] with diagnoses including but not limited to benign (not harmful) prostatic (prostate [a gland of the male reproductive system] enlargement) hyperplasia (abnormal enalrgment), kidney disease (a gradual loss of kidney function), and bradycardia (an abnormally slow heart rate). During a review of Resident 53's H&P, dated 5/24/2023, the H&P indicated, Resident 53 had the mental capacity to understand and make decisions. During a review of resident 53's Optometric Consultation report dated 8/16/2023, the report indicated a recommendation for new reading glasses. During a review of Resident 53's MDS dated [DATE], the MDS indicated, Resident 53 used glasses. The MDS indicated, Resident 53 was able to understand and had make himself understood. The MDS indicated, Resident 53 required limited assistance with bed mobility, transferring, walking, locomotion on and off the unit, dressing, toilet use, and hygiene. (please add the interview that it was not carried out) During a review of facility's Job Description of Director of Social Services indicated DSS would develop preliminary and comprehensive assessments of the social service needs of each resident and would assure that the social service progress notes are informative and descriptive of the services provided and of the resident's response to the service. During an interview on 10/6/2023 at 10:41 am with the DSS, the DSS stated she was not able to find proof that any of the residents with recommendations for new glasses received them. The DSS stated she did not follow up on any recommendations from the dentist or ophthalmology and missed the recommendation because her system to track residents with recommendations does not work and will follow up on the recommendations now. The DSS stated negative outcomes for residents with ophthalmology recommendation that are not being followed would be problem with activities of daily living and not being able to see and for residents with dentist recommendation not being followed could be a loss of weight. During an interview on 10/6/2023 at 2:34pm with the Director of Nursing (DON), the DON stated the negative outcome for a resident whose recommendation by the eye doctor are not followed is not being 555010 Page 10 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some able to see properly and a potential risk for residents that do not have their dental recommendations followed up on are not being able to eat properly and loss of weight. During a review of the facility's policy and procedure titled, Social Service Department, undated, the P&P indicated, Social Services staff will coordinate Dental, Optometry, and Audiology evaluations for Residents. Social Services will maintain a system to monitor the Dental, Optometry, and Audiology evaluations. 555010 Page 11 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to provide routine dental service for three of 15 residents (Resident 40, Resident 47, and Resident 53). Residents Affected - Some This failure resulted in Resident 40 and Resident 47 not receiving a recommended full mouth x-ray and Resident 53 not receiving new dentures. Findings: a. During a review of Resident 40's Face Sheet, the Face Sheet indicated Resident 40 was admitted on [DATE] with diagnoses of but not limited to osteoarthritis (a type of degenerative joint disease that results from breakdown of joint and underlying bone), anemia (a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of blood cells), dementia (a decline in cognitive abilities that impacts a person's ability to perform every day activities), muscle wasting and atrophy. During a review of Resident 40's H&P dated 4/27/2023, the H&P indicated Resident 40 did not have the mental capacity to make decisions. During a review of Resident 40's Minimum Data Set (MDS) a standardized assessment and care planning tool dated 8/1/2023, the MDS indicated Resident 40 usually understands and comprehends most conversations. The MDS indicated Resident 40 required limited assistance with bed mobility, transferring, walking, locomotion on and off the unit, dressing, toilet use, personal hygiene, and needed supervision while eating. During a review of Resident 40's dentist report from Elite Mobile Dental dated 5/23/2023, the report indicated Resident 40 was recommended to have a full mouth x-ray. The report also indicated Resident 40 was interested in receiving dentures. During an interview on 10/3/2023 at 2:20 pm with Resident 40, Resident 40 stated he spoke with the DSS about an appointment to see the dentist and has not been seen yet. Resident 40 stated its hard for him to eat and painful. Resident 40 stated he feels sad, depressed, and angry about not being able to see the dentist. b. During a review of Resident 47's Face Sheet, the Face Sheet indicated Resident 47 was originally admitted to the facility on [DATE] with diagnoses of but not limited to diabetes (high blood sugar levels), asthma (an inflammatory disease of the airways of the lungs), heart failure (impairment of the heart's blood pumping function) and muscle wasting and atrophy. During a review of Resident 47's H&P dated 8/30/2023, the H&P indicated Resident 47 had the mental capacity to make decisions. During a review of Resident 47's MDS dated [DATE], the MDS indicated Resident 47 had the ability to understand and express ideas and wants. During a review of Resident 47's dentist report from Elite Mobile Dental dated 7/15/2023, the report indicated Resident 47 was recommended to have a full mouth x-ray. 555010 Page 12 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 10/3/2023 at 9:59 am with Resident 47, Resident 47 stated she told the DSS she needed to see the dentist months ago because her teeth hurt all the time. Resident 47 stated the dentist came once and told her she has cavities but never came back to follow up with her. Resident 47 opened her mouth and showed she had multiple teeth that were black or missing. During a review of Resident 47's Physician Orders dated 8/28/2023, the Physician Orders indicated Resident 47 had a dental consult and follow up as needed. c. During a review of Resident 53's Face Sheet, the Face Sheet indicated, Resident 53 was admitted to the facility on [DATE] with diagnoses including but not limited to benign (not harmful) prostatic (prostate [a gland of the male reproductive system] hyperplasia (abnormal enalrgment), kidney disease (a gradual loss of kidney function), and bradycardia (an abnormally slow heart rate). During a review of Resident 53's H&P, dated 5/24/2023, the H&P indicated, Resident 53 had the mental capacity to understand and make decisions. During a review of Resident 53's Minimum Data Set (MDS) a standardized assessment and care planning tool, dated 8/28/2023, the MDS indicated, Resident 53 used glasses. The MDS indicated, Resident 53 was able to understand and had make himself understood. The MDS indicated, Resident 53 required limited assistance with bed mobility, transferring, walking, locomotion on and off the unit, dressing, toilet use, and hygiene. During a review of Resident 53's dentist report from Elite Mobile Dental dated 7/15/2023, the report indicated Resident 53's front upper dentures were old and worn out and had recommendation for new dentures. During a review of Resident 53's Physician Orders dated 5/23/2023, the Physician Orders indicated Resident 53 had a dental consultation and follow up as needed. During an interview on 10/5/2023 at 3:42 pm with the DSS, the DSS stated pain is one of the outcomes for a resident who does not receive dental services they need. During an interview on 10/6/2023 at 2:34 pm with the Director of Nursing (DON), the DON indicated one of the potential risks for residents that do not have their dental recommendations followed up on are not being able to eat properly and loss of weight. During a review of the facility's policy and procedure (P&P) titled, Dental Services, date revised on 1/2027, the P&P indicated, The facility will provide or obtain routine and emergency dental services to meet the need of each resident. 555010 Page 13 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store food in a sanitary manner to prevent growth of microorganisms (an organism that can be seen only through a specialized tool due to its small size) that could cause food borne illness (food poisoning: illness due to consuming spoiled food) for residents in the facility by not: a. ensuring Strawberry ready care shakes (nutritional shake that gets delivered frozen) were dated, when placed in the refrigerator to thaw (once thawed, shelf life is less than 14 days) b. ensuring a salad and bowl of lettuce was labeled and dated in the refrigerator. c.ensuring a bowl of tuna salad, a container of cornflakes, and a tupperware of peaches were not expired. c.ensuring the ice machine was maintained in a clean and sanitary way These deficient practices had the potential to affect residents of the facility and result in pathogen (germ) exposure, and placed residents at risk for developing foodborne illness (food poisoning) with symptoms including upset stomach, stomach cramps, nausea, vomiting, diarrhea, and fever and can lead to other serious medical complications and hospitalization. Findings: During an observation on 10/3/2023 at 10:48 a.m., with the dietary supervisor (DS), the dry storage area contained a container of corn flakes with a use by date of 9/28/2023. The DS removed the corn flakes from the shelf for disposal. During an observation and concurrent interview on 10/3/2023 at 10:54 a.m., with the DS, refrigerator one (1) contained strawberry Ready Care shakes without a date of when they were moved from the freezer to the refrigerator to thaw. The DS stated there was not a date on the Ready Care shakes for when they were brought to the refrigerator to thaw. During an observation on 10/3/2023 at 10:58 a.m., with the DS, refrigerator 2 contained a salad (chicken, egg, lettuce, shredded cheese, and shredded carrots) and lettuce that were not dated. Refrigerator 2 also contained, a bowl of tuna and a Tupperware of peaches dated 10/2/2023 (expired 1 day prior to the observation). The DS removed the tuna and peaches from refrigerator 2 for disposal. During an interview on 10/5/2023 at 2:46 p.m., the DS stated the potential outcome for having undated and expired food items in the kitchen was food borne illness, and need to ensure expired items are not served to their high-risk residents. During an interview on 10/5/2023 at 3:24 p.m., dietary assistant (DA 1) stated it was the job of all kitchen staff to ensure there was no expired or undated food in the kitchen. During an observation and concurrent interview on 10/5/2023 at 10:02 a.m., with the maintenance supervisor (MS), the MS opened the ice machine door and there were brown crusty areas that were chipping on the metal frame of the ice machine. The MS stated the brown crusty areas were rust and he 555010 Page 14 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many should have requested to have the ice machine replaced since it could contaminate the ice served to the residents. During an interview on 10/5/2023 at 3:39 p.m., the MS stated there was rust on the ice machine and when he cleaned it in September 2023, he saw the rust. The MS stated he did not inform the administrator (admin) or the DS but the outside company that comes and services the ice machine monthly was aware. The MS stated they were going to replace the top portion of the ice machine, but it was not done yet. The MS state the importance of not having any rust on the ice machine was resident safety. During a review of the facility's policy and procedure (P/P) titled Ice Machine Cleaning Procedures dated 2020, the P/P indicated information regarding the operation, cleaning and care of the ice machine was to be obtained in the owner's manual. During a review of the facility's P/P titled Storage of Food and Supplies dated 2020, the policy indicated food was to be stored properly and in a safe manner. The P/P indicated no food will be kept longer than the expiration date on the product. The P/P indicated individual packages of refrigerated or frozen food taken from the original packing box need to be labeled and dated. The P/P indicated supplemental shakes which are taken from the frozen state and thawed in the refrigerator must be dated as soon as they are placed in the refrigerator. 555010 Page 15 of 16 555010 10/06/2023 Long Beach Post Acute 1201 Walnut Avenue Long Beach, CA 90813

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 failing to ensure the dryer was running at the proper temperature. Residents Affected - Many This deficient practice had the potential to place residents at risk for infection. Findings: During observations on 10/3/2023, at 3:50 pm, on 10/5/2023, at 8:16 am and at 9:00 am, the dryer temperature was reading between 124 to 128 degrees Fahrenheit ([F] scale of measuring temperature), loud and rattling noise was heard at the back of one of the dryers during the drying cycle. During an interview on 10/3/2023, at 8:16 a.m. with Laundry Aide (LA1), LA 1 stated the temperature of the dryer should be 160 degrees F to 180 degrees F to kill bacteria on the linens and clothes. During an interview on 10/3/2023, at 8:34 a.m. with Maintenance Supervisor (MS), MS stated the temperature of the dryer should be maintained between 160 to 180 degrees F to kill the bacteria and prevent spread of infection among residents. MS stated a laundry technician came to check and fixed both dryers last 9/20/2023 because the dryers were not warm enough to dry the clothes. During a telephone interview on 10/5/2023, at 9:05 a.m. with Laundry Technician (LT), LT stated the temperature of the dryer should be maintained to 180 degrees F when drying resident's clothes and linens. LT stated the dryer was checked last September 2023 because the dryers were not drying the clothes enough. LT stated there was a noise coming from the motor of one of the dryers. During an interview on 10/6/2023, at 3:03 p.m. with Director of Nursing (DON), DON stated the temperature of the dryer should be maintained at 180 degrees F when drying clothes and linens of residents in order for the germs to be killed. During a review of facility's policy and procedure (P/P) titled Laundry Department- Post in Laundry, P/P Manual and Use for Training revised 8/2016, the P/P indicated the dryers run for approximately 45 minutes and the temperatures are set up to 180 degrees F. 555010 Page 16 of 16