Inspection·October 23, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm During a review of Resident 7 ' s MDS dated [DATE], the MDS indicated Resident 7 was able to understand was usually understood by others. The MDS indicated Resident 7 required partial/moderate assistance (staff less than half the effort. Staff lifts, holds, or supports trunk or limbs but provides less than half the effort) for ADLs such as bed mobility (ability to roll from lying on back to left and right side on the bed) and transfers. Residents Affected - Some During an interview on 10/23/2024 at 11:00 a.m. with Resident 7, Resident 7 stated CNA 4 sometimes would get upset when assisting her. Resident 7 stated, CNA 4 complained a lot and was harsh with her and Resident 9 (Resident ' s roommate). Resident 7 stated she would hear CNA 4 talk loudly to Resident 9 and was not nice to the resident. Resident 7 stated, she asked CNA 4 to wait for her (Resident 7) while having a bowel movement and CNA 4 told the resident no, she could not stay and wait for her. During a Review of Resident 8 ' s admission Record, the admission Record indicated Resident 8 was admitted to the facility on [DATE] and re-admitted on [DATE]. Resident 8 ' s diagnoses included major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest) and schizophrenia, (a mental illness that is characterized by disturbances in thought). During a review of Resident 8 ' s MDS dated [DATE], the MDS indicated Resident 8 was able to understand and be understood by others. The MDS indicated Resident 8 required supervision or touching assistance (staff provides verbal cues and/or touching/steadying and/or contact guard assist as resident completes activity) for ADLs such as transfers and walking. During an interview on 10/23/2024 at 11:10 a.m. with Resident 8, Resident 8 stated CNA 4 was sometimes assigned to her, and CNA 4 had a harsh personality. CNA 4 stated her words sounded mean and was loud towards residents including her roommate (Resident 9). During a Review of Resident 9 ' s admission Record, the admission Record indicated Resident 9 was admitted to the facility on [DATE] and re-admitted on [DATE]. Resident 9 ' s diagnoses included hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and hemiparesis (muscle weakness or partial paralysis) affecting left side and epilepsy (a chronic brain disorder that causes seizures, which are abnormal electric discharges in the brain). During a review of Resident 9 ' s MDS dated [DATE], the MDS indicated Resident 9 was able to understand and be understood by others. The MDS indicated Resident 9 was dependent on staff for ADLs such as toileting, personal hygiene, and lower body dressing. During an interview on 10/23/2024 at 12:00 p.m. with Resident 9, Resident 9 stated, CNA 4 was always working and was not nice to her. Resident 9 stated, CNA 4 was harsh when speaking to her during care and felt CNA 4 did not like her. Resident 9 stated, CNA 4 was fast when she repositioned the resident. During a review of the facility ' s Policy and Procedure, titled Resident Rights dated 5/1/2023, the P&P indicated the facility must treat each resident with respect, dignity, and care for each resident in a manner and in an environment, that promotes maintenance or enhancement of his or her quality of life, recognizing each resident ' s individuality. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 2 of 3 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 555057 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Flores Convalescent Hospital 14165 Purche Ave. Gardena, CA 90249 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to ensure Dietary staff followed proper sanitation practices in the kitchen by not sweeping and mopping the kitchen floors as indicated on the Cleaning Schedule. This deficient practice had the potential to result in attracting pests in the kitchen and contamination of food served to the residents. Findings: During an observation on 10/22/2024 at 11:30 a.m., in the kitchen, food residue, dirt, and other debris on the floors behind black cabinets, behind and on the side of the dish washing machine, under the sink, under the refrigerator, and under and on the side of the stove were observed. During an interview on 10/23/2024 at 11:19 a.m., with the Dietary Aid (DA), the DA stated the daily assigned dishwasher would sweep after washing the dishes. The DA stated if the kitchen floor was not cleaned well, resident ' s food could become contaminated and could attract bugs. During a concurrent record review and interview on 10/23/2024 at 11:33 a.m., with the Dietary Supervisor (DS), surveyor pictures of the kitchen were reviewed. The DS stated some areas in the kitchen did not appear to have been cleaned daily. During a review of the facility ' s Daily Cleaning Schedule Sanitation and Maintenance dated 9/1/2024-10/25/2024, the Cleaning Schedule indicated directions which included DS assigned duties and Dietary staff initialed each box daily, after completing task and before clocking out. The Cleaning Schedule indicated a line item titled Floor swept, mopped with Frequency to be completed 3 times daily. There was no supporting documentation to indicate the floors were swept and mopped on 9/8/2024, 9/29/2024, 9/30/2024, 10/2/2024, 10/3/2024, 10/4/2024, and 10/5/2024-10/12/2024. During a review of the facility ' s Policy and Procedure (P&P), titled, Cleaning Schedule dated 5/1/2018, the P&P indicated, dietary staff will maintain a sanitary environment in the dietary department by complying with the routine cleaning schedule developed by the Dietary Manager. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 3 of 3