Health inspection·March 7, 2025

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 3/7/20025 at 9:30 a.m., with Registered Nurse (RN) 1, RN 1 stated an informed consent should be drug specific for the use of psychoactive medication, as it explained the risks and benefits, and side effects. RN 1 stated the resident or RP needed to give consent to administer a psychoactive medication. RN 1 stated the staff needed to make sure the consents were completed and in the resident's chart before medication was started. RN 1 stated, This is not the proper way to do it, the policy is we consent before giving the medication. RN 1 stated if the consent was not in the chart there would be no way to know if the resident was educated and made the informed decision whether to receive the medication or not. RN 1 stated it could also affect the resident's behavior. During a concurrent interview and record review on 3/7/2025 at 9:50 a.m., with the Assistant Director of Nursing (ADON), Resident 46's chart was reviewed. No informed consent for Seroquel or Duloxetine HCI was found in the chart. The ADON stated there was no consent for Seroquel or Duloxetine HCI in the chart. The ADON stated the resident or RP needed to be informed completely about the side effects, the effectiveness, and the reason the medication was needed before medication was started. The ADON stated if no informed consent was obtained the resident could potentially have taken medication they did not want to take. The ADON stated that it was very important to make sure the consent was in the chart and that the resident or RP had been informed. The ADON stated the resident or RP had the right to decline the medications. During an interview on 3/7/2025 at 10:55 a.m., with the Director of Nursing (DON), the DON stated it was the staff's responsibility to verify if the informed consent was signed and in the chart before medication was administered. The DON stated the resident and/or RP has the right to make an informed decision to accept or decline the mediation. The DON stated starting the medication without an informed consent could potentially affect the resident by taking medication they did not want to take. During a review of the facility's policy and procedure (P&P) titled, Informed Consent, revised 4/2024, the P&P indicated, to ensure the facility respects the resident's right to make an informed decision prior to deciding to undergo certain medical therapies and procedures. The P&P indicated informed consent/notice will be documented and placed in the resident's medical record. The P&P indicated the facility will maintain documentation of verification of the informed consent/Notice in the resident's medical record. During a review of the facility's policy and procedure (P&P) titled, Psychotherapeutic Drug Management, revised 5/2024, the P&P indicated, when obtaining consent for use of psychotherapeutic drugs, the resident will be informed of the risks and benefits for the use of these medications. The P&P indicated consent will remain in place until medication is discontinued or until consent is revoked by resident/responsible party. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 2 of 49 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 03/07/2025 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 0553 Level of Harm - Minimal harm or potential for actual harm Allow resident to participate in the development and implementation of his or her person-centered plan of care. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to: Residents Affected - Few 1. Ensure one of 25 sampled residents (Resident 275) participated in care planning meetings. This deficient practice violated Resident 275's rights to be fully informed of the resident's plan of care and had the potential to result in delay of care and services. Findings: During a review of Resident 275's admission Record (front page of the chart that contains a summary of basic information about the resident), the admission Record indicated, Resident 275 was admitted to the facility on [DATE]. Resident 275's diagnoses included chronic obstructive pulmonary disease ([COPD] - a chronic lung disease causing difficulty in breathing), hypertension ([HTN] - high blood pressure), and congestive heart failure ([CHF] - a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling). During a review of Resident 275's History and Physical (H&P), dated 1/7/2025, the H&P indicated, Resident 275 had the capacity to understand and make medical decision. During a review of Resident 275's Minimum Data Set ([MDS] - a resident assessment tool), dated 1/7/2025, the MDS indicated, Resident 275 required moderate assistance (helper does less than half the effort) from staff with eating, oral hygiene, and personal hygiene. During an interview on 3/4/2025 at 12:15 p.m., with Resident 275, Resident 275 stated she is a retired nurse, and no facility staff offered for the resident to attend her care plan meetings to discuss her care. During a concurrent interview and record review on 3/5/2025 at 2:35 p.m., with the Director of Nursing (DON), Resident 275's Baseline Care Plan, dated 1/2/2025, was reviewed. The DON stated the Baseline Care Plan did not indicate Resident 275 or her representative was among the members who attended the meeting. The DON stated it was the responsibility of the nursing or social service staff to notify and invite the resident or resident representative to attend the care plan meetings. The DON stated care plan meetings allowed Resident 275 to share information about her condition with the facility staff. The DON stated it was important for Resident 275 to be involved in care plan meeting so the facility's Interdisciplinary Team ([IDT] - team members from different disciplines who come together to discuss resident care) could discuss and ensure the resident's needs are met. The DON stated it was a violation of the resident's rights by not allowing Resident 275 to participate in the care planning process. During a review of the facility's policy and procedure (P&P), titled Care Planning, dated 10/24/2022, the P&P indicated, The facility will invite the resident, if capable, and their family to care planning meetings and use its best efforts to schedule care planning meetings at times convenient for the resident and family. During a review of the facility's P&P, titled Resident Rights, dated 5/1/2023, the P&P indicated, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 3 of 49 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 03/07/2025 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 0553 The resident has the right to be fully informed and participate in their treatment in a language that they can understand. 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: 555057 If continuation sheet Page 4 of 49 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 03/07/2025 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 0558 Reasonably accommodate the needs and preferences of 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 ensure one out of six sampled resident's (Resident 36 and Resident 224) call light was within reach. Residents Affected - Few This deficient practice had the potential to result in a delay in or an inability for the residents to obtain necessary care and services. Findings: A. During a review of Resident 36's admission Record ([Face Sheet] front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated Resident 36 was admitted to the facility on [DATE]. Resident 36's diagnoses included chronic obstructive pulmonary disease ([COPD]- a chronic lung disease causing difficulty in breathing), hemiplegia (paralysis of the arm, leg, and trunk on the same side of the body), and muscle weakness (a lack of muscle strength). During a review of Resident 36's History and Physical (H&P), date unknown, the H&P indicated, Resident 36 had the capacity to understand and make decisions. During a review of Resident 36's Minimum Data Set ([MDS] a resident assessment tool), dated 2/5/2025, the MDS indicated Resident 36's cognition sometimes understands. The MDS indicated Resident 36 was dependent on staff for hygiene, showering, and dressing. During an observation on 3/4/2025 at 11:10 a.m., in Resident 36's room, observed the call light not within reach. The call light was behind Resident 36's bed, on the floor. During a concurrent observation and interview on 3/4/2025 at 11:15 a.m. with Certified Nursing Assistant (CNA) 3, in Resident 36's room, observed the call light on the floor behind the bed. CNA 3 stated the call light was not within reach. CNA 3 stated the protocol was to make sure the call light was within reach at all times. CNA 3 stated it was important to have the call light within reach, so the resident does not try to get out a of the bed. CNA 3 stated keeping the call light within reach helped to prevent falls. During an interview on 3/6/2025 at 1:57 p.m. with Registered Nurse (RN) 1, RN 1 stated the call light should be near the resident and on the chest area at all times. RN 1 stated the call light was used to communicate with staff the resident's needs. RN 1 stated when the call light was not within reach it would cause a delay in service and care for the residents. B. During a review of Resident 224's admission Record, the admission Record indicated, Resident 224 was admitted to the facility on [DATE]. Resident 224's diagnoses included difficulty walking, muscle weakness, asthma (a chronic lung disease making it difficult to breathe), and congestive heart failure (CHF- heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling). During a review of Resident 224's H&P, dated 2/16/2025, the H&P indicated Resident 224 had the capacity to understand and make decisions. During a review of Resident 224's MDS, dated [DATE], indicated Resident 224 was able to comprehend (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 5 of 49 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 03/07/2025 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few most conversation. The MDS indicated Resident 224 was dependent on staff for activities of daily living (ADLs- activities such as bathing, dressing and toileting a person performs daily) such as showering and toileting and stand, chair/bed-to-chair transfer, and toilet transfer. During a review of Resident 224's Care Plan, revision dated 2/12/2025, the care plan indicated, Resident 224 had a self-care and mobility deficit. The staff interventions indicated to keep the call system within reach and answer promptly and encourage the resident to use bell to call for assistance. During a concurrent observation and interview on 3/4/2025 at 10:44 a.m. with CNA 5, in Resident 224's room, observed the call light device behind Resident's 224 bed on the floor, not within reach of the resident. CNA 5 stated the call light was not within Resident 224's reach. CNA 5 stated the call light should have been within reach. CNA 5 stated the call light was for safety purposes, emergencies, and if the resident was to need anything. CNA 5 stated if the call light was not within reach there was no way the staff would know the resident needed. CNA 5 stated not addressing Resident 224's call light could affect the resident mentally, physically and emotionally. During an interview on 3/4/2025 at 10:50 a.m. with Licensed Vocational Nurse (LVN) 5, LVN 5 stated the call light should be placed next to the resident for easy access. LVN 5 stated if the call light was not within reach the resident could not alert the nurse for an emergency, which would create a safety risk, and could impact access to pain medication. LVN 5 stated the needs of the resident would not be addressed in a timely manner and could potentially cause the resident to experience pain for longer than necessary. During an interview on 3/7/2025 at 10:55 a.m. with the Director of Nursing (DON), the DON stated the call light should be within the resident's reach. The DON stated when the call light was out of reach, the needs of the resident would not be met in a timely manner. During a review of the facility's policy and procedure (P&P) titled, Communication-Call System, dated 10/2022, the P&P indicated the facility will provide a call system to enable residents to alert the nursing staff from their beds and toileting/bathing facilities. The P&P indicated call cords will be placed within the resident's reach in the resident's room. The P&P indicated the purpose of a call system is to provide a mechanism for residents to promptly communicate with nursing staff. The P&P indicated call cords will be placed within the resident's reach in the resident's room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 6 of 49 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 03/07/2025 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of 25 sampled resident's (Resident 273) preference to have a shower was honored. This deficient practice had the potential to affect Resident 273's psychosocial wellbeing. Findings: During a review of Resident 273's admission Record (front page of the chart that contains a summary of basic information about the resident), the admission Record indicated, Resident 273 was admitted to the facility on [DATE]. Resident 273's diagnoses included urinary retention (a condition that makes it difficult to empty your bladder), dysphagia (difficulty of swallowing), and urinary tract infection ([UTI] - an infection in the bladder/urinary tract). During a review of Resident 273's History and Physical (H&P), dated 3/2/2025, the H&P indicated, Resident 273 had the capacity to understand and make decisions. During a review of Resident 273's Minimum Data Set ([MDS] - a resident assessment tool), dated 3/4/2025, the MDS indicated Resident 273 was independent in cognitive (ability to think and reason) skills for daily decision making. The MDS indicated Resident 273 required moderate assistance (helper does more than half the effort) from staff with oral hygiene, toileting hygiene, and personal hygiene. During a review of the facility's shower schedule, the shower schedule indicated Resident 273's shower days were on Mondays and Thursdays. During an interview on 3/4/2025 at 10:22 a.m., with Resident 273, Resident 273 stated he had been asking staff for showers instead of bed baths (a wash that you give to someone who cannot leave their bed) since his admission to the facility. Resident 273 stated he was told by staff they could not provide him with a shower because the staff needed an approval from the Physical Therapist ([PT] - a healthcare professional who helps people improve their movement aiming to restore function and prevent further problems). Resident 273 stated he was embarrassed for not having showered for 5 days. During an interview on 3/5/2025 at 10:17 a.m., with Certified Nurse Assistant 1 (CNA 1), CNA 1 stated Resident 273 had an approval from the PT for him to have a shower. CNA 1 stated Resident 273 should have been given a shower as scheduled on Thursday and Monday. CNA 1 stated Resident 273 was not given a shower since his admission. CNA 1 stated it was important for Resident 273 to shower to be clean and comfortable. During an interview on 3/5/2025 at 10:33 a.m., with the Director of Staff Development (DSD), the DSD stated Resident 273 had the right to choose their own shower day schedule. The DSD stated the risk of not honoring the resident's preference would cause the resident to be upset and embarrassed affecting his quality of life. During an interview on 3/5/2025 at 10:38 a.m., with the Director of Rehab (DOR), the DOR stated Resident 273 was able to stand up, ambulate (walk) and required minimum assistance (helper assist only (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 7 of 49 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 03/07/2025 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few prior to or following the activity) with transfer. The DOR stated there was no reason for staff not to give Resident 273 a shower. During a review of the facility's policy and procedure (P&P), titled Showering a Resident, dated 5/1/2018, the P&P indicated, Residents are offered a shower at a minimum of once weekly and given per resident request. During a review of the facility's P&P, titled Resident Rights, dated 5/1/2023, the P&P indicated, Residents are allowed to choose activities, schedules and health care that are consistent with their interest, assessments and plan of care including personal care needs such as bathing methods and grooming styles. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 8 of 49 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 03/07/2025 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. 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 inform and provide the Notice of Medicare Non-Coverage ([NOMNC] - a notice that indicates when your care is set to end from a skilled nursing facility) form 48 hours prior to the end of skilled nursing services to resident representative for one of three sampled residents (Resident 32). Residents Affected - Few This deficient practice had the potential to result in the resident not being able to exercise his right to file an appeal and unknowingly paying for non-covered care expenses. Findings: During a review of Resident 32's admission Record (front page of the chart that contains a summary of basic information about the resident), the admission Record indicated Resident 32 was admitted to the facility on [DATE]. Resident 32's diagnoses included unspecified dementia (a progressive state of decline in mental abilities), cerebrovascular accident ([CVA] - a stroke, loss of blood flow to a part of the brain), and dysphagia (difficulty of swallowing). During a review of Resident 32's Minimum Data Set ([MDS] - a resident assessment tool), dated 1/14/2025, the MDS indicated Resident 32's cognitive (ability to think and reason) skills for daily decision making was moderately impaired (decisions poor, cues/supervision required). The MDS indicated Resident 32 required set-up assistance (helper sets up, resident completes activity) from staff with eating, oral hygiene, and upper body dressing. During a concurrent interview and record review on 3/6/2025 at 9:09 a.m., with the Business Office Manager (BOM), Resident 32's Notice of Medicare Non-Coverage ([NOMNC] - a notice that indicates when your care is set to end from a skilled nursing facility) form was reviewed. The BOM stated she was responsible in providing and maintaining signed copies of the NOMNC form. The BOM stated Resident 32's last covered day for Medicare Part A skilled services ended on 11/18/2024. The BOM stated Resident 32's NOMNC was given to the resident representative on 11/17/2024. The BOM stated the facility process was to give NOMNC to the resident or resident representative 48 to 72 hours prior to the end of Medicare Part A skilled services so they would have time enough time to make an appeal. The BOM stated Resident 32's representative was deprived of her rights to appeal for financial coverage should the representative wish to continue Resident 32 to receive skilled care services. During a review of the facility's policy and procedure (P&P), titled Medicare Denial Process, dated 10/24/2022, the P&P indicated, The Notice of Medicare Non-Coverage (CMS-10123) is required to be delivered to the resident/representative at least two calendar days before Medicare covered services end. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 9 of 49 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 03/07/2025 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. 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 transmit the Minimum Data Set ([MDS] - a resident assessment tool) within 14 days after completion to the Centers for Medicare and Medicaid Services (CMS) for one of 25 sampled residents (Resident 93). Residents Affected - Few This deficient practice resulted in incorrect data transmitted to CMS and had the potential to affect continuity of care. Findings: During a review of Resident 93's admission Record (front page of the chart that contains a summary of basic information about the resident), the admission Record indicated Resident 93 was admitted to the facility on [DATE]. Resident 93's diagnoses included diabetes mellitus ([DM] - a disorder characterized by difficulty in blood sugar control and poor wound healing), cerebrovascular accident ([CVA] - a stroke, loss of blood flow to a part of the brain), and anemia (a condition where the body does not have enough healthy red blood cells). During a review of Resident 93's Minimum Data Set ([MDS] - a resident assessment tool), dated 10/21/2024, the MDS indicated Resident 93's cognitive (ability to think and reason) skills for daily decision making was independent (decisions consistent/reasonable). The MDS indicated Resident 93 was totally dependent (helper does all of the effort) on staff with eating, oral hygiene and personal hygiene. During a review of the CMS MDS Validation Report, the CMS MDS Validation Report indicated Resident 93's MDS assessment was submitted more than 14 days after the comprehensive assessment. During a concurrent interview and record review on 3/5/2025 at 12:02 p.m., with the Minimum Data Set Nurse (MDSN), Resident 93's MDS assessment, dated 10/21/2024, was reviewed. The MDSN stated Resident 93's MDS Assessment Reference Date ([ARD] - the specific date used as the endpoint of the observation period when assessing resident's condition) was 10/21/2024 and the MDS assessment was submitted late to the CMS on 11/21/2024. The MDSN stated Resident 93's MDS assessment should have been submitted to the CMS within 14 days from the ARD. The MDSN stated the MDS assessment reflects the condition and care provided to the resident. The MDSN stated it was essential to transmit the MDS assessment in a timely manner so the facility would be in compliance with the regulation. During a review of the facility's policy and procedure (P&P), titled MDS Completion and Submission Timeframes, dated 1/2018, the P&P indicated, The facility will conduct and submit resident assessments in accordance with current federal and state submission timeframes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 10 of 49 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 03/07/2025 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 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 interview and record review the facility failed to ensure a care plan for Seroquel (antipsychotic, class of medications that treat mental illness) or Duloxetine (antidepressant, used to treat depression [feeling of sadness and low mood] was formulated for one of 25 sampled residents (Residents 46). This deficient practice had the potential for the affected resident not to receive the care and services needed and the provision of a poor-quality care. Findings: During a review of Resident 46's admission Record, the admission Record indicated Resident 46 was initially admitted to the facility on [DATE] and latest readmission was on 2/7/2025. Resident 46's diagnoses included diabetes mellitus (DM- a disorder characterized by difficulty in blood sugar control and poor wound healing), chronic kidney disease (CKD-condition which the kidneys are damaged and cannot filter blood as well as they should), and bipolar disorder (sometimes called manic-depressive disorder; mood swings that range from the lows of depression to elevated periods of emotional highs). During a review of Resident 46's History and Physical (H&P), dated 2/19/2025, the H&P indicated Resident 46 had the capacity to understand and make decisions. A review of Resident 46's Minimum Data Set (MDS - a resident assessment tool), dated 2/12/2025, the MDS indicated Resident 46 was assessed to have clear comprehension (the action or capability of understanding something) in daily decision making. The MDS indicated Resident 46 was receiving antipsychotic and antidepressant medications. During a concurrent interview and record review on 3/7/2025 at 9:20 a.m., with Registered Nurse (RN) 1, Resident 46's electronic medical record and care plan was reviewed. No care plan was found for the administration of Seroquel and Duloxetine HCL. RN 1 stated there was not a care plan for the use of psychotropic medication. RN 1 stated a care plan should have been created for the psychotropic medication. RN 1 stated a care plan was important to let the staff know how to care for the resdient's behavior, provide proper care, what signs to look for and interventions to use. RN 1 stated if a care plan was not completed, proper treatment could not be given to the resident. During an interview on 3/7/2025 at 9:44 a.m., with the Minimum Data Set Nurse (MDSN), the MDSN stated care plans were initiated upon admission, with any change of condition and new orders. The MDSN stated care plans were a guide to give residents personal individualized care. The MDSN stated there should have been a care plan for the use of antipsychotic and antidepressant medication. The MDSN stated if a care plan was not developed the resident could be missing out on effective care they may need. During an interview on 3/7/2025 at 10:55 a.m., with the Director of Nursing (DON), the DON stated care plans were individualized to implement the plan of care to meet the resident's needs. The DON stated the staff incorporated the goals and interventions for the resident. The DON stated a care plan was needed when a resident was receiving psychotropic medications. The DON stated if a care plan was not developed interventions, goals, and the needs of the resident may not be met. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 11 of 49 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 03/07/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete During a review of the policy and procedure (P&P) titled, Care Planning, revised 10/2022, the P&P indicated, a comprehensive person-centered care plan is developed for each resident based on their individual assessed needs. The P&P indicated the care plan will include measurable objectives and timetables to meet a resident's medical, nursing, mental and psychosocial needs. During a review of the facility's P&P titled, Psychotherapeutic Drug Management, revised 5/2024, the P&P indicated nursing responsibility is to implement and update the care plan as indicated. The P&P indicated licensed nurses will not administer psychotherapeutic medication until an informed consent has been obtained and documented by the Attending Physician/LHP (Licensed Healthcare Professional) from the resident and/or surrogate decision maker. Event ID: Facility ID: 555057 If continuation sheet Page 12 of 49 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 03/07/2025 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** b. During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was initially admitted to the facility on [DATE] and last readmitted on [DATE]. Resident 1's diagnoses included schizophrenia (a mental illness that is characterized by disturbances in thought), bipolar disorder (sometimes called manic-depressive disorder; mood swings that range from the lows of depression to elevated periods of emotional highs), and chronic obstructive pulmonary disease (COPD- a chronic lung disease causing difficulty in breathing). Residents Affected - Some During a review of Resident 1's History and Physical (H&P), dated 8/21/2024, the H&P indicated Resident 1 did not have the capacity to understand and make medical decisions. A review of Resident 1's MDS, dated [DATE], the MDS indicated Resident 1 was assessed to have some understanding, responds to direct adequately to simple, direct communication only. The MDS indicated Resident 1 needed maximal assistance from staff for activities of daily living (ADLs- activities such as bathing, dressing and toileting a person performs daily) such as showering, personal hygiene and supervision from staff for sit to lying and lying to sitting. During a review of Resident 1's Order Summary, the Order Summary indicated an order was placed on 11/9/2024 for to start orthostatic hypotension monitoring every evening shift every Saturday while lying and sitting. During a review of Resident 1's MAR for the months of February and March 2025, the MARs showed the results of the orthostatic blood pressure (BP) which were: 3/1/2025 9:33 p.m. - 133/69 mmHg (Lying l /arm). 2/22/2025 9:07 p.m. - 127/63 mmHg (Lying upper r /arm). 2/1512025 9:35 p.m. - 118/76 mmHg (Sitting r /arm). 2/15/2025 9:34 p.m. - 122/78 mmHg (Lying right r /arm). 2/8/2025 9:05 p.m. - 122/70 mmHg (Sitting l /arm). 2/8/2025 9:05 p.m. - 128/72 mmHg (Sitting r /arm). 2/1/2025 8:40 p.m. - 119/71 mmHg (Lying l /arm). During a concurrent interview and record review on 3/6/2025 at 11:30 a.m., with Licensed Vocational Nurse (LVN) 4, Resident 1's Orthostatic Blood Pressure readings were reviewed for the month of February 2025 and March 2025. LVN 4 stated on 2/1/2025 the BP was 119/71, 2/22/2025 the BP was 127/63, and 3/1/2025 the BP was 133/69, the blood pressure readings for lying and sitting were the same. LVN 4 stated No, I don't really know how to take orthostatic blood pressures. During an interview on 3/7/2025 at 10:55 a.m., with the Director of Nursing (DON), the DON stated residents receiving antipsychotic medication were ordered for orthostatic BPs. The DON stated the orthostatic BPs would never be the same, there should always be a difference. The DON stated if it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 13 of 49 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 03/07/2025 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some documented that both siting and lying BPs were the same or taken at the same time, you would not be able to tell if the BPs were taken from both locations and taken correctly. The DON stated orthostatic BP's need to be done correctly, so the physician would know how to manage the medication, dosage and treatment plan depending on the results. The DON stated if the orthostatic BPs are not accurate the resident may receive a medication that needed to be discontinued or dosage decreased, which could potentially harm the resident. During a review of the facility's policy and procedure (P&P), titled Blood Pressure, Measuring, dated 1/2018, the P&P indicated orthostatic hypotension is defined as 20 millimeters of mercury (mmHg- unit of measurement0 decline in systolic blood pressure (the contraction phase of the hear) or a 10 mmHg decline in diastolic blood pressure (relaxing phase of the heart) upon standing. To measure orthostatic hypotension, note the changes in both the systolic and diastolic blood pressure in the standing position compared to the sitting position. 2. During a review of Resident 55's admission Record, the admission Record indicated, Resident 55 was initially admitted to the facility on [DATE] and latest readmission was on 3/17/2024. Resident 55's diagnoses included ESRD (End Stage Renal Disease-irreversible kidney failure), congestive heart failure (CHF- a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling), and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest). During a review of Resident 55's H&P, dated 3/22/2024, the H&P indicated Resident 55 did not have the capacity to understand and make decisions. During a review of Resident 55's MDS, dated [DATE], the MDS indicated Resident 55 was assessed to have clear comprehension in daily decision making. The MDS indicated Resident 55 required supervision from staff for ADLs such as tub/shower transfer, walk 10 feet, wake 50 feet with two turns, and walk 150 feet. During a review of Resident 55's Order Summary, an order was placed on 3/17/2024 for Resident 55 to start Midodrine HCI 5 mg, give 5 milligrams (mg) orally every 8 hours for hypotension; hold if systolic (top number in a blood pressure reading) blood pressure (SBP) is greater than 110, not to be taken after the evening meal or less than 3-4 hours before bed. During a concurrent interview and record review on 3/7/2025 at 1:20 p.m., with LVN 5, Resident 55's MAR for February 2025 and March 2025 was reviewed. The MAR showed Midodrine HCI 5 mg tablet was administered when the SBP and 10:00 p.m. dosage was not within parameters which were: 2/1/2025 -2:00 p.m. SBP 126. 2/3/2025 - 6:00 a.m. SBP 119 - 10:00 p.m. SBP 104. 2/4/2025 - 6:00 a.m. SBP 116 - 2:00 p.m. SBP 116. 2/5/2025 - 6:00 a.m. SBP 113. 2/6/2025 - 6:00 a.m. SBP 126 - 10:00 p.m. SBP 109. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 14 of 49 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 03/07/2025 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 0658 2/7/2025 - 6:00 a.m. SBP 111. Level of Harm - Minimal harm or potential for actual harm 2/8/2025 -10:00 p.m. SBP 109. 2/10/2025 -6:00 a.m. SBP 120. Residents Affected - Some 2/11/2025 -10:00 p.m. SBP 106. 2/13/2025 - 6:00 a.m. SBP120 10:00 p.m. SBP 105. 2/15/2025 - 6:00 a.m. SBP 116 - 10:00 p.m. SBP 105. 2/16/2025 - 6:00 a.m. SBP118 2:00 p.m. SBP 118 - 10:00 p.m. SBP 98. 2/17/2025 - 10:00 p.m. SBP 98. 2/18/2025 - 10:00 p.m. SBP 106. 2/19/2025 - 6:00 a.m. SBP 115 - 10:00 p.m. SBP 102. 2/20/2025 -6:00 a.m. SBP 113. 2/21/2025 - 6:00 a.m. SBP 136 10:00 p.m. SBP 115. 2/22/2025 - 6:00 a.m. SBP 120. 2/23/2025 - 6:00 a.m. SBP 130 - 2:00 p.m. SBP 130. 2/24/2025 - 6:00 a.m. SBP116 10:00 p.m. SBP 108. 2/25/2025 - 6:00 a.m. SBP 114. 2/26/2025 - 6:00 a.m. SBP 124. 2/28/2025 - 6:00 a.m. SBP124 10:00 p.m. SBP 105. 3/1/2025 - 6:00 a.m. SBP 120. 3/2/2025 - 6:00 a.m. SBP 125. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 15 of 49 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 03/07/2025 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 0658 3/3/2025 - 6:00 a.m. SBP 115. Level of Harm - Minimal harm or potential for actual harm 3/4/2025 - 6:00 a.m. SBP 113. 3/5/2025 - 6:00 a.m. SBP 112 - 2:00 p.m. SBP112 - 10:00 p.m. SBP 101. Residents Affected - Some 3/6/2025 - 6:00 a.m. SBP 123. LVN 5 stated the medication should not have been administered when the SBP was greater than 110 and the 10:00 p.m. dose of Midodrine HCI should not have been given at all. LVN 5 stated it could possibly put the resident at risk for hypertension or a stroke. During a concurrent interview and record review on 3/7/2025 at 1:40 p.m., with the DON, Resident 55's MAR for February 2025 and March 2025 was reviewed. The Medication order indicated Midodrine HCI 5mg tablet, give 5mg orally every 8 hours for hypotension, HOLD if SPB was greater than 110; not to be taken after the evening meal or less than 3-4 hours before bed. The DON stated there were many entries when the medication was administered with the SBP greater than 110 and administered the 10:00 p.m. dose. The DON stated the 10:00 p.m. dose should have been clarified with the physician. The DON stated the licensed nursing staff should have held the medication when the SBP was greater than 110 and not administer the 10:00 p.m. dose at all. The DON stated this could affect the resident, it could cause potential harm, an episode of hypertension, or a stroke. During a review of the facility's P&P titled, Medication -Administration, revised 5/2018, the P&P indicated, Test and taking of vital signs, upon which administration of medications or treatments are conditioned, will be performed as required and the results recorded. When administration of the drug is dependent upon vital signs or testing, the vital signs/testing will be completed prior to administration of the medication and recorded in the medical record. The resident's MAR will be reviewed for allergies and/or special consideration for administration including, vital sign parameter and lab results as appropriate. 3. During a review of Resident 96's admission Record, the admission Record indicated, Resident 96 was admitted to the facility on [DATE]. Resident 96's diagnoses included chronic obstructive pulmonary disease (COPD- a chronic lung disease causing difficulty in breathing), dementia (a progressive state of decline in mental abilities), congestive heart failure (CHF- a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling), hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and hemiparesis (weakness or the inability to move on one side of the body, making it hard to perform everyday activities like eating or dressing). During a review of Resident 96's H&P, dated 11/3/2024, the H&P indicated Resident 96 did have the capacity to understand and make decisions. During a review of Resident 96's MDS, dated [DATE], the MDS indicated Resident 96 was assessed to have clear comprehension in daily decision making. The MDS indicated Resident 96 was dependent on staff for ADLs such as toileting, upper and lower body dressing, personal hygiene, putting on/taking off footwear, and lying to sitting. During an observation on 3/6/2025 at 9:20 a.m., with LVN 4, medication administration, in Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 16 of 49 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 03/07/2025 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 96's room. Resident 96 complained of shoulder pain. LVN 4 let resident know it was not time for her oral pain medication, but she had the gel that would help the pain. LVN 4 was observed to check the medication Diclofenac Sodium External Gel 1% (a medication to treat pain and inflammation), label, and then prepared the gel. LVN 4 proceeded to apply the gel to Resident 96's right shoulder. During a concurrent interview and record review on 3/6/2025 at 1:38 p.m., with LVN 4, Resident 96's Order Summary was reviewed, an order was placed on 2/3/2025 for Resident 96 to start Diclofenac Sodium External Gel 1%, apply to bilateral (both) knee topically every 12 hours as needed for knee pain, apply 4 gram (a metric unit of measurement) 4.5 inches to bilateral knee. LVN 4 stated the medication order was for Diclofenac Sodium External Gel 1% applied to bilateral knee for pain. LVN 4 acknowledged administering the medication to Resident 96's right shoulder. LVN 4 stated I remember the resident did have an order for placing the diclofenac gel to the shoulder, LVN 4 reviewed the orders and stated No, there was not a current order for Diclofenac gel applied to shoulder. LVN 4 stated I checked the system for the right medication, I guess I didn't realized there was no order for the shoulder just the knees. LVN 4 stated that it could affect the resident by potentially giving more medication than needed, cause adverse reaction, or harm the resident. During an interview on 3/7/20025 AT 9:30 a.m., with Registered Nurse (RN) 1, RN 1 stated it was important to follow the physician's order before administering a medication. RN 1 stated double check the medication label with the order in the chart, if not done there could potentially be a medication error. RN 1 stated it could affect the resident by potentially giving a wrong medication, wrong dosage, or have an adverse reaction. During an interview on 3/7/2025 at 10:55 a.m., with the DON, the DON stated before a medication was administered the medication's 5 rights needed to be checked, right patient, right medication, right dosage, right time and right route. The DON stated a medication should not be given if there is not an order for that medication or route, notify the physician. The DON stated it was not within the nursing scope of practice to not follow the physician's order. The DON stated this could potentially harm the resident. During a review of the facility's P&P titled, Medication -Administration, revised 5/2018, the P&P indicated, the purpose is to provide practice standards for safe administration of medications for residents in the facility. The licensed nurse must know the following information about any medication they are administering, the drug's route of administration, the drug's indication for use and desired outcome. Nursing staff will keep in mind the seven rights of medication when administering medication, right medication, right amount, right resident, right time, right route, right indication, and right outcome. The rule of 3 - the licensed nurse administering medications will perform 3 checks comparing the physician's order, pharmacy label, and medication administration record (MAR). Based on interview and record review, the facility failed to meet the professional standards of nursing practice by failing to: 1. Properly obtain accurate orthostatic blood pressure (a form of low blood pressure that happens when standing after sitting or lying down) readings for two of two sampled residents (Residents 1 and 25). This deficient practice had the potential for Residents 1 and 25 to experience a delay in interventions if they were positive for orthostatic hypotension (low blood pressure). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 17 of 49 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 03/07/2025 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Ensure medication, Diclofenac Sodium External Gel 1% (a medication to treat pain and inflammation), was administered to the correct site as ordered by the physician for one of five sampled residents (Resident 96). This deficient practice had the potential to result in unintended complications of the medication, which could potentially lead to overdose or an adverse reaction for Resident 96. 3. Administer Midodrine HCI (a medication to treat low blood pressure) following parameters set by physician order for one of four sampled residents (Resident 55). This deficient practice had the potential to result in unintended consequences of the management of blood pressure such as hypertension (HTN- high blood pressure) for Resident 55. Findings: 1a. During a review of Resident 25's admission Record, the admission record indicated Resident 25 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included muscles weakness, schizophrenia (a mental illness that is characterized by disturbances in thought), and restlessness and agitation. During a review of Resident 25's Minimum Data Set (MDS- a resident assessment tool), dated 12/8/2024, the MDS indicated Resident 25 was cognitively intact (ability to reason, understand, remember, judge, and learn). During a review of Resident 25's Order Summary, the Order Summary indicated an order was placed on 12/5/2024 to have orthostatic hypotension monitoring done every evening shift on Saturdays while lying and sitting. During a review of Resident 25's Care Plan, dated 11/16/2023, the care plan indicated Resident 25 uses psychotropic (used to treat mental illness) medications related to schizoaffective disorders (a mental illness that can affect thoughts, mood, and behavior). The interventions indicated to monitor orthostatic hypotension while sitting and lying weekly on Saturdays. During a review of Resident 25's Medication Administration Record (MAR), for the month of February 2025, the MAR indicated the following blood pressure readings: 2/22/2025 8:20 p.m. - 128/70 millimeters of mercury (mmHg- unit of measurement) -Lying rightt (r)/ arm. 2/22/2025 11:30 a.m. -124/72 mmHg -Lying r/arm. 2/22/2025 1:34 a.m. - 126/74 mmHg -Lying r/arm. 2/15/2025 10:13 p.m. - 128/70 mmHg -Lying r/arm. 2/15/2025 11:34 a.m. - 126/74 mmHg Lying r/arm. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 18 of 49 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 03/07/2025 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 0658 2/15/2025 2:01 a.m. - 128/74 mmHg -Lying Left (l)/arm. Level of Harm - Minimal harm or potential for actual harm 2/8/2025 10:28 p.m. - 132/78 mmHg -Lying r/arm. 2/8/2025 7:46 p.m. Residents Affected - Some - 128/74 mmHg -Lying r/arm. 2/8/2025 1:46 p.m. -124/78 mmHg -Lying r/arm. 2/8/2025 1:43 a.m. -126/74 mmHg -Lying l/arm. 2/1/2025 9:21 p.m. -139/76 mmHg -Lying l/arm. 2/1/2025 6:52 p.m. - 137/74 mmHg -Sitting l/arm. 2/1/2025 1:32 p.m. - 148/79 mmHg -Sitting l/arm. 2/1/2025 1:22 a.m. - 128/74 mmHg -Lying l/arm. During a concurrent interview and record review on 3/6/2025 at 1:41 p.m. with the Director of Staff Development (DSD), Resident 25's Orthostatic Blood Pressure readings were reviewed for the month of February 2024. The DSD stated on 2/8/2025, 2/15/2025, 2/22/2025 the blood pressure readings for both lying and sitting were the exact same. The DSD stated on 2/8/2025 it was 132/78 for both lying and sitting, on 2/15/2025 it was 128/70 for both lying and sitting, and on 2/22/2025 it was 128/70 for both lying and sitting. The DSD stated that is suspicious because there would always be a change in the blood pressure reading even if the change was minor, but the fact that it was the same reading on 3 separate dates it was suspicious something was not done correctly. During an interview on 3/6/2025 at 2:00 p.m. with the DSD, the DSD stated it is inaccurate if a nurse stated that the purpose of taking orthostatic blood pressure readings was to determine the high and low ranges of their blood pressures. The DSD also stated it would be inaccurate if the staff stated the method of taking orthostatic blood pressures was by having the resident sit up wait a few minutes and then take the blood pressure because there would not be enough information to determine if the resident had orthostatic hypotension. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 19 of 49 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 03/07/2025 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 one of six sampled residents (Resident 104) with care and services to perform activities of daily living (ADLs, basic daily activities such as eating and transferring) by failing to provide Resident 104 with an appropriate wheelchair (WC, chair fitted with wheels for transport) for transfers and out of bed activities. Residents Affected - Few This deficient practice had the potential for Resident 104 to experience a decline in overall physical and mental wellbeing. Findings: During a review of Resident 104's admission Record, the admission record indicated Resident 104 was readmitted to the facility on [DATE] with diagnoses including muscle weakness and lack of coordination. During a review of Resident 104's Initial History and Physical (H&P) dated 12/3/2024, the H&P indicated Resident 104 had the capacity to understand and make decisions. During a review of Resident 104's Minimum Data Set (MDS, resident assessment tool) dated 12/9/2024, the MDS indicated Resident 104 had severe cognitive impairment (mental processes involved in gaining knowledge and comprehension, includes thinking, knowing, remembering, judging, problem-solving). The MDS indicated Resident 104 did not exhibit any behavior of rejecting care for health and well-being. The MDS indicated Resident 104 had functional limitations in range of motion (ROM, full movement potential of a joint) on both sides of the upper extremities (shoulder, elbow, wrist/hand) and both sides of the lower extremities (hip, knee, ankle/foot). The MDS indicated no mobility devices were used. The MDS indicated Resident 104 required dependent assistance for bed to chair transfers. During a review of Resident 104's Care Plan revised on 1/6/2025, the care plan indicated Resident 104 had functional abilities (self-care and mobility) deficit. The goal indicated Resident 104 will improve current level of function. The interventions indicated to provide necessary equipment and adequate time for self performance or participation with daily care tasks. During a concurrent observation and interview on 3/4/2025 at 11:54 a.m. in Resident 104's room, Resident 104 was observed laying on the bed. Resident 104 was able to move the left arm up and down about halfway and both legs a little. Resident 104 stated the right arm was bad and required use of the left arm to assist moving the right arm up and down. Resident 104 stated he was never given a wheelchair (WC) since admission to the facility and had been asking for a WC. Resident 104 stated that he could not go outside or do activities because he was waiting for a WC. Resident 104 stated he was waiting for his wife to buy a WC because the facility was not providing a WC for him. There was no WC observed in Resident 104's room. During an interview on 3/5/2025 at 8:53 a.m., in the therapy gym, with the Director of Rehabilitation (DOR), the DOR stated when a resident was admitted to the facility, physical therapy staff would identify a resident's sitting balance and endurance to see what device was best for a resident such as a WC. The DOR stated there were many benefits for a resident to get out of bed and be out of the room and this required the facility providing the proper equipment such as a WC. The DOR stated if a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 20 of 49 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 03/07/2025 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident was in bed all the time, then the muscles would atrophy (to become smaller). The DOR stated residents benefit from getting out of bed and out of the room, because residents would use their muscles and receive environmental stimulation. During a concurrent observation and interview on 3/5/2025 at 10:17 a.m., with Resident 104, in Resident 104's room, there was no WC observed. Resident 104 stated in an excited tone that he was going to get his WC that day (3/5/2025). Resident 104 stated once he got his WC he would be out and about in the facility. During a concurrent observation and interview on 3/5/2025 at 1:03 p.m., with Resident 104, in Resident 104's room, Resident 104 was observed laying in bed. Resident 104 stated he was still waiting for the facility to order him a WC. Resident 104 stated he would like to get out of bed and around the facility. Resident 104 stated it was the first time the staff indicated they would get him a WC. During an interview on 3/5/2025 at 1:16 p.m., in the therapy gym, with the DOR, the DOR stated he found a WC for Resident 104, but the WC was wet because it was outside in the rain and had to wait for the WC cushion to dry before Resident 104 could use the WC. The DOR stated residents should always have the opportunity to get out of bed and that the facility should have started the process of assessing and providing Resident 104 for an appropriate WC once Resident 104 was admitted in 12/2024. The DOR stated therapy staff should not have waited until that day (3/5/2025) to start assessing and providing a proper WC for Resident 104. The DOR stated it was the responsibility of staff to encourage and ask the resident if they wanted to get out of bed. During an interview on 3/5/2025 at 1:29 p.m., with Certified Nursing Assistant (CNA 4), CNA 4 stated he had never gotten Resident 104 out of bed before. During an interview on 3/5/2025 at 1:32 p.m., with Licensed Vocational Nurse (LVN 1), LVN 1 stated staff should encourage residents to get out of bed, because residents who stay in bed had a risk of contracting pneumonia (infection of lungs). During an interview on 3/6/2025 at 12:39 p.m., with the Director of Nursing (DON), the DON stated all residents should get out of bed, because it helped a resident's mental health to meet and talk to other people and for physical health such as increased circulation. The DON stated the facility provided the proper WC or devices so that residents could get out of bed and out of the room. The DON stated that no resident wanted to be in bed all the time. During an interview on 3/6/2025 at 11:24 a.m., with the Medical Records Supervisor, the Medical Records Supervisor stated the facility did not have a policy and procedure for providing wheelchairs and equipment and getting residents out of bed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 21 of 49 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 03/07/2025 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 0679 Provide activities to meet all resident's needs. 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 one of three sampled residents (Resident 24), with activities outside of the resident's room. Residents Affected - Few This failure caused the resident to feel isolated and lacking socializing with residents outside her room. Findings: During a review of Resident 24's admission Record, the admission record indicated the facility admitted Resident 24 on 5/18/2016 and re-admitted on [DATE], with diagnoses that included hemiplegia and hemiparesis affecting left side (conditions that causes paralysis and weakness) and epilepsy (a chronic brain disorder that causes recurrent seizures). During a review of Resident 24's Minimum Data Set (MDS - a resident assessment tool) dated 2/10/2025, the MDS indicated Resident 24 had the ability to express ideas and wants and the ability to understand others. The MDS also indicated it was very important for Resident 24 to do things with groups of people and go outside to get fresh air when the weather is good. During a review of Resident 24's Care Plan focusing on activities, initiated 1/11/2019 and revised on 8/26/2022, the care plan indicated interventions for Resident 24 included, The resident needs a variety of activity types and locations to maintain interests and The resident needs assistance/escort to activity functions. During an observation and interview on 3/5/2025 at 8:33 am, with Resident 24, Resident 24 was observed in the hallway near her room in a Geri-chair (a supportive reclining chair that provides more support and comfort than a wheelchair). Resident 24 stated the only time she leaves the room is when housekeeping deep cleans weekly. Resident 24 stated the Activities Director (AD) does come to her room and offer games. Resident 24 stated she wanted to get out of the room sometimes and go to the activity room with the other residents and outside to get some sun. During an interview on 3/5/2025 at 2:39 pm with the AD, the AD stated the facility provided one to one activities with Resident 24 in Resident 24's room, three times a week. The AD also stated when Resident 24 is asked to go to the activities room, she usually declined. The AD stated staff will continue to encourage Resident 24 to participate in group activities and to go outside if it is not too cold so she will not feel isolated or left out. During an interview on 3/5/2025 at 4:02 pm with the Director of Rehabilitation (DOR), the DOR stated Resident 24 has expressed wanting to go outside of her room and the building. The DOR stated on 11/25/2024, he ordered a custom wheelchair for Resident 24 so the resident would be safe and comfortable when out of the bed. The DOR stated Resident 24 could become sad or depressed if no one takes her out of her room for activities. During a review of the facility's policy & procedure (P&P) titled Activities Program, revised 4/1/2021, the P&P indicated, The facility provides an activity program designed to meet the needs, interests, and preferences of the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 22 of 49 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 03/07/2025 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide appropriate services to prevent a decline in joint range of motion (ROM, full movement potential of a joint) for two out of 10 sampled residents (Resident 3 and 27) who had limited ROM by failing to: 1. Ensure Resident 3 received timely quarterly (every three months) Rehabilitation Joint Mobility Assessments (JMA) to monitor changes in joint range of motion. 2. Ensure Resident 27 had a left elbow splint was placed five days a week. These deficient practices had the potential to cause further decline in Resident 3 and Resident 27's ROM and overall quality of life. Findings: A. During a review of Resident 3's admission Record, the admission record indicated Resident 3 was re-admitted to the facility on [DATE] with diagnoses including but not limited to hemiplegia (weakness to one side of the body) and hemiparesis (inability to move one side of the body) cerebrovascular disease (disease of the blood vessels, especially blood vessels to the brain) affecting left non-dominant side. During a review of Resident 3's Minimum Data Set (MDS, a resident assessment tool) dated 11/20/2024, the MDS indicated Resident 3 had severe cognitive impairments (mental processes involved in gaining knowledge and comprehension, includes thinking, knowing, remembering, judging, problem-solving). The MDS indicated Resident 3 had functional limitations in ROM on one side of the upper extremity (UE, shoulder, elbow, wrist/hand) and one side of the lower extremity (LE, hip, knee, ankle/foot). The MDS indicated Resident 3 required supervision assistance with eating, oral hygiene, and was dependent with bathing, lower body dressing, and bed to chair transfers. During a review of Resident 3's care plan revised on 4/3/2024, the care plan indicated Resident 3 required a Restorative Nursing Aide program (RNA, nursing aide program that help residents to maintain their function and joint mobility) to maintain maximum joint capacity, minimize risk for contractures, and minimize risk for functional decline. The goal indicated Resident 3 will maintain maximum joint capacity, maintain/minimize risk for functional decline, and minimize risk for contractures (loss of motion of a joint). The care plan interventions indicated for passive range of motion (PROM, movement at a given joint with full assistance from another person) exercises for both UE and both LE, apply resting hand splint (rigid material or apparatus used to support and immobilize a broken bone or impaired joint) and elbow extension splint on left UE up to four hours or as tolerated. During a review of Resident 3's Rehabilitation Joint Mobility Assessments (JMAs), the JMAs indicated completion dates of 8/23/2024 and 11/20/2024. During an observation on 3/5/2025 at 12:28 p.m. in the dining room, Resident 3 was observed sitting in a wheelchair and eating lunch with the right hand. Resident 3's left elbow was in a splint and left wrist/hand was in a splint. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 23 of 49 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 03/07/2025 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and record review on 3/5/2025 at 1:10 p.m., with the Director of Rehabilitation (DOR), the DOR stated the JMAs were completed upon admission, quarterly, and as needed. DOR reviewed Resident 3's JMAs and stated the last JMA completed was on 11/20/2024 and another quarterly JMA should have been completed by 2/2024. DOR stated it was not completed and the quarterly JMA due 2/2024 was late. DOR stated rehabilitation staff completed JMAs to monitor and identify any contractures upon admission and to track the ROM. DOR stated it was important to complete the JMAs quarterly to catch any declines in ROM as soon as possible to prevent contractures, because contractures can happen quickly, and staff needed to identify any contractures quickly. During an interview on 3/6/2025 at 11:18 a.m., with the Director of Nursing (DON), the DON stated JMAs should be completed at least quarterly and timely. B. During a review of Resident 27's admission Record, the admission record indicated Resident 27 was initially admitted to the facility on [DATE] and was last readmitted on [DATE]. Resident 27's diagnoses included muscle weakness (a decrease ability to generate and control muscle force, leading to a reduced strength and difficulty in performing normal movements), pressure ulcer stage 4 (full-thickness skin and tissue loss with exposed muscle, tendon, ligament, cartilage or bone), and hemiplegia (a condition by paralysis of one side of the body). During a review of Resident 27's History and Physical (H&P), date 9/25/2024 the H&P indicated, Resident 27 had capacity to understand and make decisions. During a review of Resident 27's MDS, dated [DATE], the MDS indicated Resident 27's cognition was severely impaired. The MDS indicated Resident 27 was dependent on staff for toileting hygiene, showering, and dressing. During a review of Resident 27's physician orders titled, Order Summary Report, dated 12/26/2024, the Order Summary Report indicated Resident 27 was to have a left elbow extension splint placed one time a day for four to six hours on Monday, Tuesday, Wednesday, Thursday, and Fridays. During a review of Resident 27's Medication Administration Record ([MAR] -a daily documentation record used by a licensed nurse to document medications and treatments given to a resident), dated 2/1/2025, 2/17/2025, 2/24/2025, and 3/3/2025, the MAR indicated Resident 27's left elbow extension splint was not placed on the resident. During a concurrent interview and record review on 3/4/2025 at 2:40 p.m. with Restorative Nurse Assistant (RNA) 3, Resident 27's MAR, dated 2/1/2025, 2/17/2025, 2/24/2025, and 3/3/2025 was reviewed. The MAR indicated on 2/1/2025, 2/17/2025, 2/24/2025, and 3/3/2025 the left elbow extension splint was not placed on Resident 27. RNA 3 stated the left elbow splint was to be placed on Resident 27 five days a week on Mondays, Tuesdays, Wednesdays, Thursdays, and Fridays. RNA 3 stated the MAR showed the splint was not placed on Resident 27. RNA 3 stated when the splint is not placed regularly it could cause a decline in the resident left elbow. During a concurrent interview and record review on 3/4/2025 at 2:40 p.m. with Registered Nurse (RN) 1, Resident 27's MAR, dated 2/1/2025, 2/17/2025, 2/24/2025, and 3/3/2025 was reviewed. The MAR indicated on 2/1/2025, 2/17/2025, 2/24/2025, and 3/3/2025 the left elbow extension splint was not placed on Resident 27. RN 1 stated on the MAR there was no documentation that the left elbow splint was placed on Resident 27. RN 1 stated the resident did not receive the treatment for left elbow extension splint on 2/1/2025, 2/17/2025, 2/24/2025, and 3/3/2025. RN 1 stated if it was not documented was not done. RN 1 stated the left elbow splint is used to prevent contractures (a permanent tightening of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 24 of 49 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 03/07/2025 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the muscles, tendons, and skin that causes the joints to shorten and become very stiff). RN 1 stated not placing the left elbow extension splint could cause Resident 27's arm to become flaccid (muscle weakness or paralysis where muscles are soft, limp, and lacking in tone) over time or become contracted. During a review of the facility's policy and procedures (P&P) dated 1/2018, titled Resident Mobility and Range of Motion, the P&P indicated as part of the resident's assessment, staff will identify the resident's current ROM of his or her joints. During a review of the facility's P&P titled, Splinting, dated 5/2018, the P&P indicated to prevent contractures or decrease tone and to protect joint alignment. The P&P indicated the RNA is responsible for splint application, will document, and initial on the schedule for splint application each time splint is applied and removed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 25 of 49 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 03/07/2025 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure one out of six sampled residents (Resident 57) head of bed ([HOB] -raising the head of the bed to help patients reduce the risk of aspiration in patients receiving enteral nutrition) was in proper position while the enteral tube feed ([TF]- a delivery of nutrition bypassing the mouth directed to the stomach when a patient cannot safely eat nutrition directly ) was running. This deficient practice of not having the HOB in proper position placed Resident 57 at risk for aspiration (inhalation of food, liquids, other material into the lungs). Findings: During a review of Resident 57's admission Record ([Face Sheet] front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated Resident 57 was initially admitted to the facility on [DATE] and was last readmitted on [DATE]. Resident 57's diagnoses included gastro-esophageal reflux disease ([GERD]- a condition which stomach contents, including acid flow back up into the esophagus), dysphagia (swallowing difficulties), and gastrostomy (a surgical opening fitted with a device to allow feedings to be administered directly to the stomach common for people with swallowing problems). During a review of Resident 57's History and Physical (H&P), date unknown the H&P indicated, Resident 57 did not have capacity to understand and make decisions. During a review of Resident 57's Minimum Data Set ([MDS] a resident assessment tool), dated 12/13/2024, the MDS indicated Resident 57's cognition (ability to learn, reason, remember, understand, and make decisions) had the ability to sometimes understand. The MDS indicated Resident was dependent on staff for personal hygiene, showering, and dressing. During an observation on 3/5/2025 at 8:03 a.m. in Resident 57's room, Resident 57's was observed in the bed lying flat on her back while the tube feeding (TF) was running. During a concurrent observation and interview on 3/5/2025 at 8:06 a.m. with Licensed Vocational Nurse (LVN) 6, in Resident 57's room, Resident 57 was observed in the bed lying flat on her back while the TF was running. LVN 6 stated Resident 57's HOB should be up more. LVN 6 stated the HOB should be 30 to 45 degrees (a unit of measurement of angles) when the TF is running. LVN 6 stated if the HOB is not 30 to 45 degrees the resident is at risk for aspiration and could get aspiration pneumonia (a lung infection that occurs when food, liquid, other material is inhaled into the lungs). During a review of the facility's policy and procedure (P&P) titled, Enteral Feedings-Safety Precautions, dated 11/2018, the P&P indicated to ensure the safe administration of enteral nutrition. The P&P indicated prevention of aspiration was to elevate the HOB at least 30 degrees during tube feeding and at least one hour after feeding. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 26 of 49 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 03/07/2025 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. 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: Residents Affected - Few 1. Assess the insertion site of a Peripherally Inserted Central Catheter ([PICC Line] - a flexible tube that is inserted into a vein in the upper arm and guided into a large vein above the right side of the heart) at least once every shift and change the dressing every 7 days for one of one sampled resident (Resident 21). This deficient practice had the potential for Resident 21's PICC line insertion site to develop infection and other complications. Findings: During a review of Resident 21's admission Record (front page of the chart that contains a summary of basic information about the resident), the admission Record indicated, Resident 21 was initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident 275's diagnoses included sepsis (a life-threatening infection), diabetes mellitus ([DM] - a disorder characterized by difficulty in blood sugar control and poor wound healing), and hypertension ([HTN] - high blood sugar). During a review of Resident 21's Minimum Data Set ([MDS] - a resident assessment tool), dated 1/29/2025, the MDS indicated, Resident 21's cognitive (ability to think and reason) skills for daily decision making was severely impaired (never/rarely made decisions). The MDS indicated, Resident 21was totally dependent (helper does all of the effort) from staff with oral hygiene, toileting hygiene, and personal hygiene. During a review of Resident 21's Order Summary Report (a document containing active orders), dated 3/6/2025, the order summary report indicated Resident 21's physician prescribed Meropenem (drug used to treat infection) 1 gram ([gm] - metric unit of measurement, used for medication dosage and/or amount) intravenously ([IV] - into or within the vein) every 12 hours for 7 days for sepsis. During an observation on 3/4/2025 at 10:54 a.m., in Resident 21's room, Resident 21 was observed with a PICC line to the left upper arm. During a concurrent interview and record review on 3/5/2025 at 2:53 p.m., with the Director of Nursing (DON), Resident 21's IV Medication Administration Record ([MAR] - a daily documentation record used by licensed nurse to document medications/treatment given to a resident) from 2/28 to 3/5/2025 were reviewed. The DON stated Resident 21's PICC line site was not assessed once every shift by Registered Nurse (RN) and the dressing was not changed since it was inserted. The DON stated it was important to monitor the PICC line site for redness, swelling, and pain and document in IV MAR to identify infection and for resident safety. During a review of the facility's policy and procedure (P&P), titled PICC Line Maintenance and Cleaning in a Skilled Nursing Facility, dated 5/1/2018, the P&P indicated, The facility ensure safe and effective maintenance and cleaning of Peripherally Inserted Central Catheters (PICC lines) to prevent infection, maintain patency, and ensure patient safety. The P&P indicated to record all assessments, dressing changes, flushing, cap changes, and any observed complications in the patient's medical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 27 of 49 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 03/07/2025 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 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 interview and record review, the facility failed to: Residents Affected - Few 1. Ensure pain was managed for one of 25 sampled residents (Resident 224) in a timely manner. This deficient practice resulted in Resident 224 experiencing unnecessary pain. Findings: During a review of Resident 224's admission Record, the admission Record indicated, Resident 224 was admitted to the facility on [DATE]. Resident 224's diagnoses included difficulty walking, muscle weakness, asthma (a chronic lung disease making it difficult to breathe), and congestive heart failure (CHF- heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling). During a review of Resident 224's History and Physical (H&P), dated 2/16/2025, the H&P indicated Resident 224 had the capacity to understand and make decisions. A review of Resident 224's Minimum Data Set (MDS - a resident assessment tool), dated 2/21/2025, indicated Resident 224 was assessed to comprehend (the action or capability of understanding something) most conversation. The MDS indicated Resident 224 was dependent on staff for activities of daily living (ADLs- activities such as bathing, dressing and toileting a person performs daily) such as showering and toileting and stand, chair/bed-to-chair transfer, and toilet transfer. During a concurrent observation and interview on 3/4/2025 at 10:34 a.m., with Resident 224, in Resident 224's room, the resident call light device was obseved behind the bed on the floor, not within reach for the resident. Resident 224 stated their back had been hurting for a while and wanted Tylenol (a medication for pain) for the pain. Resident 224 stated the call light was not pressed. Resident 224 stated, I lost it, I don't know where it is, I want some Tylenol for my back. During a review of Resident 224's Physician Order Summary (physician orders), dated 3/6/2025, the physician orders dated 2/6/2025 indicated to administer Tylenol tablet 325 milligrams (mg- metric unit of measurement, used for medication dosage and/or amount), give 2 tablets by mouth every six hours as needed for mild pain 1-3 (zero is no pain and ten as the worst pain a person may experience). During a review of Resident 224's Care Plan, revision dated 2/12/2025, the care plan indicated Resident 224 had a self-care and mobility deficit. The interventions indicated to keep the call system within reach and answer promptly and encourage the resident to use bell to call for assistance. During a review of Resident 224's care plan, revision dated 2/28/2025, the care plan indicated Resident 224 had complained of lower back pain. The goal was pain would be a bearable level per resident tolerance. The intervention indicated to anticipate the resident's need for pain relief and respond immediately to any complaint of pain. During an interview on 3/4/2025 at 10:50 a.m. with Licensed Vocational Nurse (LVN) 5, LVN 5 stated that pain needed to be addressed as soon as possible; it was important for the resident. LVN 5 stated that the resident would experience pain longer than necessary if they could not alert nursing due (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 28 of 49 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 03/07/2025 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to the call light not being within reach. LVN 5 stated the resident could potentially isolate and not interact with others due to the pain not being addressed in a timely manner. During an interview on 3/7/2025 at 10:55 a.m. with the Director of Nursing (DON), the DON stated if a resident was in pain we would address it as soon as possible. The DON stated if the call light was not within reach the resident would have no way to alert nursing about their pain. The DON stated it was important for residents to get their needs met in a timely manner to not have pain longer than necessary. During a review of the facility's policy and procedure (P&P) titled, Pain Management, revised 5/2018, the P&P indicated, facility staff is responsible for helping the resident attain or maintain their highest level of well-being while working to prevent or manage the resident's pain. Nursing staff will implement timely intervention to reduce the increase in severity of pain. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 29 of 49 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 03/07/2025 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 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one out of six sampled residents (Resident 100) orders for prescribed eye drops were carried out. This deficient practice of not following the physician orders for prescribed eye drops had the potential for worsening of Resident 100's eye conditions. Findings: During a review of Resident 100's admission Record ([Face Sheet] front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated Resident 100 was admitted to the facility on [DATE]. Resident 100's diagnoses included respiratory failure (a condition in which you blood does not have enough oxygen or has too much carbon dioxide), epilepsy (a condition characterized by recurrent, unprovoked seizures, caused by abnormal electrical activity in the brain), and polycystic kidney (a genetic disorder characterized by the growth of numerous fluid-filled cysts in the kidneys). During a review of Resident 100's History and Physical (H&P), the H&P indicated Resident 100 did not have capacity to understand and make decisions. During a review of Resident 100's Minimum Data Set ([MDS] a resident assessment tool), dated 12/13/2024, the MDS indicated Resident 100's cognition (ability to learn, reason, remember, understand, and make decisions) was moderately impaired. The MDS indicated Resident 100's vision was impaired. The MDS indicated Resident 100 required substantial assistance from staff for personal hygiene, showering, and dressing. During a review of Resident 100's ophthalmologist (eye doctor) services, dated 2/7/2025, the ophthalmologist indicated Resident 100 had glaucoma (a eye disease that damage the optic nerve, potentially leading to vision loss and blindness, due to increased pressure inside the eye) to both eyes and aged related nuclear cataracts (affects the central part of the eye's lens, leading to a gradual clouding and yellowing, potentially causing blurry vision) to both eyes. During a review of Resident 100's ophthalmologist services report, dated 2/7/2025, the report indicated the ophthalmologist indicated to start the following medications: 1. Latanoprost (to lower eye pressure to treat glaucoma) 1 drop at bedtime in both eyes. 2. Cosopt (to lower eye pressure) 1 drop two times a day in both eyes. During a concurrent interview and record review on 3/6/2025 at 9:21 a.m. with Registered Nurse (RN) 1, Residents 100's ophthalmologist services report was reviewed. The ophthalmologist services report had indicated Resident 100 was to start to start the following medications: 1. Latanoprost 1 drop at bedtime in both eyes. 2. Cosopt 1 drop two times a day in both eyes. RN 1 stated the order was faxed on 2/10/2025 after Resident 100's eye appointment. RN 1 stated once the orders are faxed over to the facility; staff will call the physician for clarification of the order. RN 1 was not able to locate the clarification to the physician for the eye drops medications. RN 1 stated the eye drops Latanoprost and Cosopt were not initiated and needed to be carried out. RN 1 stated the resident needed the medications to prevent further complications of his decrease vision and decrease his discomfort (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 30 of 49 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 03/07/2025 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 0711 of not being able to see well. Level of Harm - Minimal harm or potential for actual harm During a review of facility's policy and procedure (P&P) titled, Telephone Orders for Medication, dated 5/2018, the P&P indicated to reduce errors associated with misinterpreted verbal or telephone communication of physician orders. The P&P indicated the receiver documents the order immediately on the prescriber order form including 1. Date and time order is received 2. Patient name 3. Drug name 4. Strength 5. Dose 6. Frequency 7. Route 8. Quantity and/or duration 8. Name of prescriber 9. Signature of or recipient. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 31 of 49 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 03/07/2025 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on interview, and record review, the facility failed to: 1. Complete initial and annual skills competencies for four of four Restorative Nursing Aide (RNA, nursing aide program that help residents to maintain their function and joint mobility) staff. This deficient practice had the potential to cause injury and worsening contractures (loss of motion of a joint) for 51 current residents who required RNA treatments. 2. Ensure their Licensed Vocational Nurse knew what the purpose of checking orthostatic hypotension (a condition where blood pressure drops significantly when a person stands up from a sitting or lying position or sits up from a lying position) was for and how to obtain blood pressure readings to check for orthostatic hypotension. This deficient practice had the potential to place residents at risk for a delay in care and services which could result in falls or injury. Findings: 1. During a concurrent interview and record review with the Director of Staff Development (DSD), on 3/6/2025 at 9:58 a.m., Restorative Nursing Aide 1 (RNA 1), Restorative Nursing Aide 2 (RNA 2), Restorative Nursing Aide 3 (RNA 3), and Restorative Nursing Aide 4 (RNA 4)'s employee files were reviewed. The DSD stated there were no annual RNA competencies completed for RNA 1, RNA 2, and RNA 3. The DSD stated RNA 4 was a newly hired RNA and did not complete an initial RNA competency upon hire. The DSD stated RNA staff had different job tasks than Certified Nursing Assistants and the RNA staff focused primarily on resident mobility, range of motion (ROM, full movement potential of a joint), ability to do activities of daily living (ADLs - routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves) such as feeding, ambulation, and putting on and taking off splints (rigid material or apparatus used to support and immobilize a broken bone or impaired joint) and orthotics (an external device to support, align, or correct a movable part of the body). The DSD stated RNA staff would need to know how to perform specific RNA tasks with residents. The DSD stated the purpose of an annual competency skills check was to make sure the staff was up to date on their skills and that the staff was competent to do their job for the residents. The DSD stated if there was not an initial or annual competency skills check for the RNAs, then the residents who received RNA treatments could have injuries, RNA staff may not know how to identify declines in ROM or mobility, and residents may not receive their RNA treatments properly. The DSD stated the rehabilitation department should be the staff to complete the annual competencies and be included in the employee file. During an interview on 3/6/2025 at 10:41 a.m., with the Director of Rehabilitation (DOR), the DOR stated the rehabilitation department did not complete any initial or annual skills competencies for RNA staff. During an interview on 3/6/2025 at 12:39 p.m., with the Director of Nursing (DON), the DON stated the RNA program was to assist residents in keeping their functional abilities and to prevent contractures (loss of motion of a joint). The DON stated there were specific RNA staff to carry out the RNA program. The DON stated there should be an annual competency for all clinical staff and the annual competencies were important to complete, because the facility needed to make sure that whatever skills the staff were completing care wise, that the staff were doing it right with the residents. The DON stated it was important for the RNA staff to complete initial and annual competencies specifically (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 32 of 49 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 03/07/2025 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 0726 for RNA skills and tasks. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure (P&P), revised 5/1/2018, titled, Restorative Nursing Program Guidelines, the P&P indicated nursing aides are trained in the techniques that promote resident involvement in the activity. Residents Affected - Some During a review of the facility's undated Job Description for Restorative Nurse Aide, the Job Description indicated the Restorative Nurse Aide performs restorative nursing duties to the residents.2a. During a concurrent interview and record review on 3/6/2025 at 11:30 a.m., with Licensed Vocational Nurse (LVN) 4, Resident 1's orthostatic (measuring blood pressure both while lying down and standing to assess for a significant drop in blood pressure upon standing) blood pressure readings were reviewed for the month of February 2025 and March 2025. LVN 4 stated on 2/1/2025, 2/22/2025, and 3/1/2025 the blood pressure readings for lying and sitting were the same. LVN 4 stated No, I don't really know how to take orthostatic blood pressures. LVN 4 stated I did not ask for guidance on how to take orthostatic blood pressures. During an interview on 3/7/2025 at 10:55 a.m., with the DON, the DON stated residents on antipsychotic medication were ordered for orthostatic blood pressures. The DON stated the orthostatic blood pressures would never be the same, there should always be a difference. The DON stated if it was documented that both siting and lying blood pressures were the same or taken at the same time, could tell if the blood pressures were taken from both positions and taken correctly. The DON stated orthostatic blood pressures need to be done correctly, so the physician would know how to manage the medication, dosage and treatment plan depending on the results. The DON stated if the orthostatic blood pressures are not accurate the resident may receive a medication that needed to be discontinued or dosage decreased, which could potentially harm the resident. 2b. During an interview on 3/5/2025 at 3:46 p.m. with LVN 2, LVN 2 was asked how orthostatic blood pressure readings were obtained. LVN 2 stated she would first start but introducing herself to the resident, perform hand hygiene, and explain to the resident what she would be doing. LVN 2 stated she would ask the resident to sit down and then apply the blood pressure cuff on their arm and obtain a blood pressure reading. LVN 2 stated she would then document the blood pressure reading and clean the equipment she used. LVN 2 stated the purpose of taking orthostatic blood pressure is to determine if the resident's blood pressure is too high or too low and to determine what their high and low ranges are. LVN 2 further stated that before taking any of the blood pressure, it is important to ensure that if the resident was doing any activities beforehand, to let them rest for a bit so she could obtain a more accurate reading. During a concurrent interview and record review on 3/6/2025 at 1:41 p.m. with the Director of Staff Development (DSD), Resident 25's orthostatic blood pressure readings were reviewed for the month of February 2025. The DSD stated on 2/8/2025, 2/15/2025, 2/22/2025 the blood pressure readings for both lying and sitting were the exact same. The DSD stated that is suspicious because there would always be a change in the blood pressure reading even if the change was minor, but the fact that it was the same reading on 3 separate dates it was suspicious something was not done correctly. During an interview on 3/6/2025 at 2:00 p.m. with the DSD, the DSD stated it is inaccurate if a nurse stated that the purpose of taking orthostatic blood pressure readings was to determine the high and low ranges of their blood pressures. The DSD also stated it would be inaccurate if the staff stated the method of taking orthostatic blood pressures was by having the resident sit up wait a few minutes and then taking the blood pressure because there would not be enough information to determine if the resident had orthostatic hypotension. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 33 of 49 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 03/07/2025 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a follow-up concurrent interview and record review on 3/6/2025 at 4:15 p.m. with LVN 2, Resident 25's Order Summary Report and Medication Administration Record (MAR) for the month of February 2025 was reviewed. LVN 2 stated Resident 25 had an order to monitor vital signs every shift which included checking their blood pressure, and on Saturday's, there was also an order to check orthostatic hypotension blood pressures. LVN 2 stated she did not question or ask another staff member what the difference was in checking a blood pressure every shift and checking the orthostatic blood pressures on Saturday. LVN 2 also stated she does not recall or remember if there were any in-services provided on how to obtain orthostatic blood pressure readings. During a review of the facility's P&P, titled Blood Pressure, Measuring, dated 1/2018, it indicated orthostatic hypotension is defined as 20 millimeters of mercury (mmHg- unit of measurement0 decline in systolic blood pressure (the contraction phase of the hear) or a 10 mmHg decline in diastolic blood pressure (relaxing phase of the heart) upon standing. To measure orthostatic hypotension, note the changes in both the systolic and diastolic blood pressure in the standing position compared to the sitting position. During a review of the facility's job description for LVN Charge Nurse, dated 5/2008, the job description indicated the LVN should have knowledge of an ability to provide basic principles of nursing care and techniques. It also stated they perform tests, treatments, and procedures as ordered by the physician in accordance to written plan of care and facility policy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 34 of 49 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 03/07/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review the facility failed to: 1. Follow its policy and procedure (P&P) to replace the portable container non-antibiotic medication Emergency-Kit (E-Kit) within 48-72 hours. 2. Implement its P&P titled, Disposal of Medication and Medication-Related Supplies, which indicated to ensure accurate destruction of all medications including narcotic (drug which relieves pain and induces drowsiness, stupor, or unconsciousness) were conducted with the signature of licensed nurse. These deficient practices placed all residents at risk for not providing medication during emergency situations and had the potential of loss or diversion of controlled medication. Findings: 1. During a concurrent observation and interview on 3/6/2025 at 2:16 p.m., in station 1 medication storage room with Licensed Vocational Nurse (LVN) 4, one E-Kit with prescription #836, with a red zip tie and one E-Kit with prescription #890 with a red zip tie was observed. LVN 4 stated a red zip tie meant the E-Kit had been opened. During a concurrent interview and record review on 3/6/2025 at 2:20 p.m., with LVN 4, Emergency Drug Kit Slips were reviewed. LVN 4 stated the E-Kit in the first refrigerator was opened on 2/25/2025 at 10:00 a.m. and the E-Kit had not been replaced. LVN 4 stated the E-Kit in the second refrigerator was opened on 12/23/2024 at 12:20 a.m. and the E-Kit had not been replaced. LVN 4 stated the E-Kits should have been replaced within 48 hours after they were opened. LVN 4 stated it was important to have the E-Kit available to administer medication to residents during emergency situations. LVN 4 stated if the medication was not available there would be a delay of treatment for the resident. During an interview on 3/6/2025 at 2:39 p.m., with the Director of Nursing (DON), the DON stated it was the responsibility of the licensed nursing staff to check and document all the E-Kits were sealed and intact. The DON stated there was no documentation or monitoring log by the licensed nursing staff that showed the E-Kits were being checked daily. The DON stated the E-Kits should be replaced immediately not to exceed 72 hours. The DON stated there could potentially be an emergency and the medication in the E-Kit would not be available. The DON stated this could cause a delay in care for residents. During a review of the facility's P&P titled, Medication Ordering and Receiving from Pharmacy, undated, the P&P indicated, emergency needs for medication are met by using the facility's approved emergency medication supply or by special order from the provider pharmacy. The P&P indicated as soon as possible, the nurse calls the pharmacy for replacement of the kit/dose and flags the kit with a color-coded lock to indicate need for replacement of kit/dose. The P&P indicated, if exchanging kits, opened kits are replaced with sealed kits within 72 hours of opening. The P&P indicated If replacing used medications, the replacement doses are added to the kit withing 72 hours of opening. 2. During a concurrent observation and interview on 3/6/2025 at 3:06 p.m., with the DON in her office, a controlled medication area inspection was conducted. The DON produced multiple Controlled Drug (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 35 of 49 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 03/07/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Record sheets (a log containing the time, quantity, and nurse's signature each time a dose is administered) that were destroyed by her and facility's pharmacy consultant. The DON stated the facility's Controlled Drug Record dated 12/12/2024, had twenty-four resident medications disposed (to get rid of) without the signature of licensed nurse witnessing the destruction of the medications. The disposed medications included the following: Residents Affected - Many 1. Lorazepam (medication used to relieve anxiety) 1 milligrams (mg- metric unit of measurement, used for medication dosage and/or amount) tablet. 2. Hydrocodone-Acetaminophen (narcotic medication used to treat pain) 5-325 mg tablet. 3. Temazepam (a sedative-hypnotic medication to help one sleep) 7.5 mg capsule. 4. Morphine Sulfate (narcotic medication used to treat pain) 0.25 milliliter (mL-unit of volume). 5. Temazepam 15 mg capsule. 6. Tramadol HCL (narcotic medication used to treat pain) 50 mg tablet. 7. Tramadol HCL 50 mg tablet. 8. Diazepam (medication used to relieve anxiety) 4 mg tablet. 9. Tramadol HCL 50 mg tablet. 10. Tramadol HCL 50 mg tablet. 11. Hydrocodone-Acetaminophen 5-325 mg tablet. 12. Temazepam 15 mg capsule. 13. Pregabalin (medication used to treat nerve pain) 75 mg capsule. 14. Alprazolam (medication used to treat anxiety) 0.5 mg tablet. 15. Hydrocodone-Acetaminophen 5-325 mg tablet. 16. Tramadol HCL 50 mg tablet. 17. Hydrocodone-Acetaminophen 5-325 mg tablet. 18. Hydrocodone-Acetaminophen 5-325 mg tablet. 19. Temazepam 15 mg capsule. 20. Morphine Sulfate 7.5 mg tablet. 21. Morphine Sulfate 15 mg tablet. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 36 of 49 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 03/07/2025 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 0755 22. Hydrocodone-Acetaminophen 5-325 mg tablet. Level of Harm - Minimal harm or potential for actual harm 23. Lorazepam 2 mg / per ml. 24. Morphine Sulfate 0.25 ml. Residents Affected - Many During an interview on 3/6/2025 at 2:39 p.m., with the DON, the DON stated the process of controlled substance destruction includes two signatures on the Controlled Drug Record, one from the Registered Pharmacy (RPH) Consultant and from a Registered Nurse (RN). The DON stated, she was the only licensed nurse responsible for the controlled substance destruction. The DON stated she was busy with other tasks on 12/12/2024 and that was the reason she was not able to sign the Controlled Drug Record sheets. The DON stated, she made a mistake and should have signed the destruction form along with the RPH Consultant, but she did not. The DON stated, the RPH Consultant was the only one signed the form for destruction of the medications. The DON stated if the narcotic/controlled substance destruction was not documented accurately, there was no validation that it was done and there was a risk for diversion and theft of the medications if the process was not completed accurately. During a review of the facility's policy and procedure (P&P) titled, Disposal of Medications and Medication-Related Supplies, undated, the P&P indicated, controlled substances are retained in a securely locked area with restricted access until destroyed by a Drug Enforcement Administration (DEA) representative; or by the facility director of nursing and/or consultant pharmacist and/or administrator. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 37 of 49 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 03/07/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to store medications properly by failing to: 1. Ensure an unopened Lantus (a long lasting insulin [a hormone that removes excess sugar from the blood, can be produced by the body or given artificially via medication]) pen, an unopened insulin vial and insulin pen of Glargine YFGN (a long lasting insulin [a hormone that removes excess sugar from the blood, can be produced by the body or given artificially via medication]) were stored inside the refrigerator per manufacturer's guidelines. 2. Ensure a multi-dose medication container was clean and free from particles stored in medication cart 1. These deficient practices had the potential for the loss of efficacy of Lantus and Insulin Glargine YFGN, cause ineffective management of the residents' diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing) and had the potential for the resident to receive contaminated medications. Findings: 1. During a concurrent observation and interview on 3/6/2025 at 1:45 p.m., with Licensed Vocational Nurse (LVN) 4 at medication cart 1, an unopened insulin pen of Lantus, an unopen insulin vial and an insulin pen of Glargine YFGN and was found on the cart. LVN 4 stated the insulins were stored in medication cart 1 and unopened. LVN 4 stated all insulin should be stored in the refrigerator until it was used or opened. LVN 4 stated the directions were to keep unopened insulin refrigerated until opened. During an interview on 3/7/2025 at 10:55 a.m., with the Director of Nursing (DON), the DON stated unopened insulin should be stored in the refrigerator and not put into the cart until it is opened. The DON stated this practice would decrease the potency and the effectiveness of the medication. The DON stated the blood sugar would be uncontrolled and negatively affect the resident. During a review of the facility's policy and procedure (P&P) titled, Medication Storage in the Facility; Storage of Medications, undated, the P&P indicated, medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the suppliers. The P&P indicated medications requiring refrigeration or temperatures between 36 degrees Fahrenheit and 46 degrees Fahrenheit are kept in a refrigerator with a thermometer to allow temperature monitoring. 2. During a concurrent observation and interview on 3/6/2025 at 1:45 p.m., with LVN 4 at medication cart 1, a multi-dose bottle of Clear Lax (a stool softener) was observed soiled and uncleaned, LVN 4 stated the medication bottle was soiled and unclean. LVN 4 stated it was an infection control issue, and the medication bottle should always be clean. LVN 4 stated if the bottle was unclean and contaminated the resident could get sick or be harmed. During an interview on 3/7/20025 at 9:36 a.m., with Registered Nurse (RN) 1, RN 1 stated all items (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 38 of 49 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 03/07/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some in the medication cart should be clean and free from any particles. RN 1 stated this was an infection control issue. RN 1 stated there could be bacteria on the dirty container which could cause the resident to become sick. During an interview on 3/7/2025 at 10:55 a.m., with the DON, the DON stated the licensed nursing staff assigned to a medication cart should check the cart and medications to make sure everything is in place and clean. The DON stated a medication bottle should never be dirty because there could be bacteria around the bottle. The DON stated this is an infection control issue. The DON stated this practice could make residents sick, if there is any cross contamination. During a review of the facility's policy and procedure (P&P) titled, Medication Storage in the Facility; Storage of Medications, undated, the P&P indicated, outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according to procedures for medication disposal and reordered from the pharmacy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 39 of 49 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 03/07/2025 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. During a review of Resident 100's admission Record indicated Resident 100 was admitted to the facility on [DATE]. The admission Record indicated Resident 100's diagnoses included respiratory failure (a condition in which you blood does not have enough oxygen or has too much carbon dioxide), epilepsy (a condition characterized by recurrent, unprovoked seizures, caused by abnormal electrical activity in the brain), and polycystic kidney (a genetic disorder characterized by the growth of numerous fluid-filled cysts in the kidneys). Residents Affected - Some During a review of Resident 100's History and Physical (H&P), dated unknown, the H&P indicated, Resident 100 did not have capacity to understand and make decisions. During a review of Resident 100's Minimum Data Set, dated [DATE], the MDS indicated Resident 100's cognition (ability to learn, reason, remember, understand, and make decisions) was moderately impaired. The MDS indicated Resident 100's vision was impaired. The MDS indicated Resident 100 required substantial assistance (a helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) from staff for personal hygiene, showering, and dressing. During a review of Resident 100's physician orders titled, Order Summary Report, dated 11/13/2024, the Order Summary Report indicated Resident 100 to have Keppra level drawn every month. During a concurrent interview and record review on 3/5/2025 at 3:37 p.m. with Registered Nurse (RN) 1, RN 1 stated, Resident 100's Order Summary Report, dated 11/13/2024 was reviewed. The Order Summary Report indicated Resident 100 was to have Keppra blood level draw every month. RN 1 stated the last Keppra blood level was drawn 11/15/2024. RN 1 stated December 2024, January 2025, February 2025, the Keppra blood level was not done. RN 1 stated Resident 100 had epilepsy and Keppra blood levels were to track of the therapeutic levels to prevent seizures. RN 1 stated not completing the Keppra blood draws can cause worsened the resident epilepsy disorder. During a review of the facility's policy and procedure (P&P) titled, dated 5/2018, the P&P indicated to ensure that laboratory, diagnostic, and radiology services are provided to meet resident needs. The P&P indicated laboratory services ordered will be documented on the 24-hour report or electronic health record, to ensure that services are coordinated, and results are received. Based on interview, and record review, the facility failed to have laboratory orders implemented for three of six sampled residents (Residents 25, 42 and Resident 100) by failing to: 1.Ensure Resident 25 and Resident 42 had laboratory orders drawn as ordered by the physician. 2. Ensure Resident 100 had a Keppra (anti-seizure drug) level blood draw (a procedure in which a needle is used to take blood from a vein, usually for laboratory testing) monthly. These deficient practices caused Resident 25 and Resident 42 a delay in care and placed Resident 100 at risk for seizures (a sudden, uncontrolled electrical disturbance in the brain which can cause uncontrolled jerking, blank stares, and loss of consciousness) Findings: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 40 of 49 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 03/07/2025 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 0770 Level of Harm - Minimal harm or potential for actual harm 1. During a review of Resident 25's admission Record (document containing basic information regarding a resident), The admission Record indicated Resident 25 was admitted on [DATE] and readmitted on [DATE] with diagnoses that included acute kidney failure (a sudden decline in kidney function), anemia (a condition in which the blood does not have enough healthy red blood cells), severe obesity (overweight), and Type 2 diabetes mellitus (a disorder characterized by difficulty in blood sugar control and poor wound healing). Residents Affected - Some During a review of Resident 25's Minimum Data Set (MDS- a resident assessment tool), dated 12/8/2024, the MDS indicated Resident 25 was cognitively intact (ability to reason, understand, remember, judge, and learn). During a review of Resident 25's Order Summary, dated 12/5/2024 the Order Summary Report indicated Resident 25 to have drawn a complete blood count ([CBC]- a blood test that measures the number and types of blood cells, including red blood cells, white blood cells, and platelets), complete metabolic panel ([CMP]- a blood test which measures various substances in the blood to provide information about the body's overall chemical balance, including kidney and liver function, electrolyte levels, and blood sugar levels) and a Hemoglobin A1C ([Hgb A1C]- a blood test that measures the average blood sugar level over the past 2-3 months) drawn every 3 months in November, February, May, and August. During a review of Resident 25's Care Plan, dated 5/28/2024, the care plan indicated Resident 25 had acute kidney injury and chronic kidney disease (a condition where the kidneys gradually lose their ability to filter waste products from the blood). The care plan interventions included monitoring laboratory reports and reporting to the physician if the potassium (a mineral the body needs to function) is high. 2. During a review of Resident 42's admission Record, the admission record indicated Resident 42 was initially admitted on [DATE] and readmitted on [DATE] with diagnoses that included Vitamin D deficiency (body has less than normal amounts of this vitamin), hyperlipidemia (high level of fats in the blood), and gastro-esophageal reflux disease (GERD- stomach contents flow back up into the esophagus, causing irritation and inflammation). During a review of Resident 42's Minimum Data Set, dated [DATE], the MDS indicated Resident 42 was cognitively intact (ability to reason, understand, remember, judge, and learn). During a review of Resident 42's Care Plan, dated 6/2/2023, the care plan indicated Resident 42 was at risk for poor food intake, weight loss, and dehydration. The care plan interventions included to obtain and monitor laboratory work as ordered, report results to the doctor, and follow up as indicated. During a review of Resident 42's Order Summary, dated 9/17/2024, the Order Summary report indicated to have a CBC and CMP, and a Lipid Panel (a blood test that measures the levels of various fats in the blood) drawn every 3 months, in September 2024, December 2024, March 2025, and June 2025. During a review of Resident 42's Care Plan, dated 8/27/2024, the care plan indicated Resident 42 was at risk for poor oral intake (decreased eating and drinking), weight loss, and dehydration (body losing more amounts of water than usual). The care plan goals included to obtain, monitor laboratory results as ordered and to report results to the doctor as needed. During a review of Resident 42's laboratory results dated [DATE], a CMP was not done for the month (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 41 of 49 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 03/07/2025 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 0770 of September. Level of Harm - Minimal harm or potential for actual harm During a review of Resident 42's laboratory results dated [DATE] a CMP was not done for the month of December. Residents Affected - Some During a concurrent interview and record review on 3/5/2025 at 1:48 p.m. with Licensed Vocational Nurse (LVN) 1, Resident 25 laboratory results and orders were reviewed. LVN 1 stated Resident 25 had orders for a CBC, CMP, and Hgb A1C to be drawn every 3 months in November, February, May and August. LVN 1 stated it was not done in the month of February. LVN 1 stated if laboratory tests are not done, the doctor would not know if there were any issues with the residents' blood work. During a concurrent interview and record review on 3/5/2025 at 2:11 p.m. with LVN 1, Resident 42's laboratory results and orders were reviewed. LVN 1 stated a CMP was not done. LVN 1 stated the doctor would not know if there would be any abnormal results with the CMP because it was not done. During a review of the facility's policy and procedure (P&P), titled Laboratory, Diagnostic and Radiology Services, dated 5/1/2018, the P&P indicated the facility is responsible for the quality and timeliness of services provided by the laboratory. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 42 of 49 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 03/07/2025 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 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 ensure the dietary staff followed proper storage practices in the kitchen by: Residents Affected - Some 1. Not properly closing opened bags of dry food and ensuring the dry food products were stored in containers with tight fitting lids. 2. Not dating opened multi-use containers. This deficient practice had the potential to result in the attraction of pests and contamination of food served to residents. Findings: During an observation on 3/4/2025 at 8:20 a.m. in the kitchen dry storage room, three bags of dry cereal were observed with plastic wrap tied loosely around the bag, causing the bag to stay open. An opened gallon of pancake mix and waffle syrup without a label indicating the date it was opened was also observed. During a concurrent observation and interview on 3/4/2025 at 8:25 am in the kitchen dry storage room with Dietary Aide (DA), the DA stated the dry cereal bags were not tied close and could allow pests to enter the bag and contaminate the food. The DA stated the bottle of pancake mix and waffle syrup were not labeled with the opened date. The DA also stated, the bottle of pancake and waffle syrup should have been labeled with the opened date to ensure residents did not receive an expired product that could make them sick. During a concurrent interview and record review on 3/6/2025 at 1:05 p.m. with the Dietary Service Supervisor (DSS), the facility's policy and procedure (P&P) titled, Food Storage dated 3/1/2018, was reviewed. DDS stated the P&P indicated opened products should be placed in storage containers with tight fitting lids and storage products should be labeled and dated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 43 of 49 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 03/07/2025 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure safe and sanitary storage practices of foods brought to residents by family and other visitors were followed for one of three sampled residents (Resident 42) when: Residents Affected - Few 1. Resident 42's personal food item was not stored per manufacturer's directions. 2. Resident 42's personal food item was not labeled according to the facility's policy and procedure (P&P) titled, Food Brought in by Visitors which indicated perishable food will be labeled, dated, and discarded after 48 hours. This deficient practice had the potential for Resident 42 to experience foodborne illness (food poisoning). Findings: During a review of Resident 42's admission Record, the admission Record indicated Resident 42 was initially admitted on [DATE] and readmitted on [DATE]. Resident 42's diagnoses included Vitamin D deficiency, hyperlipidemia (high level of fats in the blood), and gastro-esophageal reflux disease (GERDstomach contents flow back up into the esophagus, causing irritation and inflammation). During a review of Resident 42's Minimum Data Set (MDS- a resident assessment tool), dated 11/21/2024, the MDS indicated Resident 42 was cognitively intact (ability to reason, understand, remember, judge, and learn). During an observation on 3/4/2024 at 10:06 a.m. in Resident 42's room, a bottle of opened, and used creamy horseradish was seen on her bedside table with a label that indicated to refrigerate after opening. The bottle did not have a label with the resident's name on it. During an interview on 3/4/2025 at 3:23 p.m. with Resident 42, Resident 42 stated the creamy horseradish belonged to her and was brought to the facility by her sister. During a concurrent observation and interview on 3/4/2025 at 4:00 p.m. with Licensed Vocational Nurse (LVN) 2, in Resident 42's room, LVN 2 stated the opened bottle of creamy horseradish left on Resident 42's bedside table was not labeled or refrigerated and was not sure when the bottle was opened. LVN 2 stated, the resident personal food items that required refrigeration should be stored in the refrigerator in the dining room and should be dated and labeled with the resident's name. LVN 1 stated there was no LVN 2 further stated if eaten, this could have caused an upset stomach. During an interview on 3/6/2025 at 2:32 p.m. with the Dietary Service Supervisor (DSS), the DSS stated perishable food (food likely to go bad quickly) items could only be left out at the bedside for no longer than 2 hours and must be thrown away after 2 hours to avoid the resident eating food that was spoiled. If it has been less than 2 hours, the residents can have it be placed in the refrigerator in the activity room meant to store residents' food for up to 48 hours. During a review of the facility's P&P titled, Food Brought in by Visitors, dated 5/1/2023, the P&P indicated perishable food requiring refrigeration will be discarded after 2 hours at bedside, and if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 44 of 49 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 03/07/2025 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 0813 Level of Harm - Minimal harm or potential for actual harm refrigerated, it will be labeled, dated, and discarded after 48 hours. The P&P indicated if the resident desires to have food brought in, the Dietary Staff would provide education regarding safe food handling practices and need to have the resident's name and date it was brought to the facility. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 45 of 49 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 03/07/2025 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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a contingency plan (a pre-defined set of actions to be taken if an original plan fails or an unexpected event occurs) was developed and included in the Facility Assessment (a process for evaluating a facility's resident population and identifying the resources needed to provide care and services). This deficient practice had the potential for the facility to ineffectively respond during unexpected circumstances and negatively impact resident care. Findings: During a concurrent interview and record review on 3/5/2025 at 9:25 a.m., with the Administrator (ADM), the Facility's assessment dated [DATE], was reviewed. The ADM stated the Facility's Assessment was incomplete. The ADM stated the Facility's Assessment did not include the contingency plan including staffing needs during emergency that would affect resident's care. The ADM stated the Facility Assessment was an overview of the resident population and it reflected the services provided by the facility to the residents. The ADM stated a contingency plan should be included in the Facility Assessment so the facility would be able to identify risks and operate fully without delay to safeguard the health and safety of the residents during unforeseeable events. During a review of the facility's, undated policy and procedure (P&P) titled, Facility Assessment, the P&P indicated The facility must use the Facility Assessment to inform contingency planning for events that do not require activation of the facility's emergency plan, but do have the potential to affect resident care, such as, but not limited to the availability of direct care nurse staffing or other resources needed for resident care. During a review of Centers for Medicare and Medicaid Services (CMS), reference QSO-24-13-NH (Quality, Safety and Oversight-guidance clarifications and instructions for facilities) dated 6/18/2024 titled, Revised Guidance for Long-Term Care Facility Assessment Requirements, indicated the new requirements specify that the facility must conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations including nights and weekends and emergencies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 46 of 49 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 03/07/2025 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 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 document in resident clinical records, when one of 25 sampled residents (Resident 76), was sent to General Acute Care Hospital (GACH) from dialysis center (a health office/clinic for treatment to cleanse the blood of wastes and extra fluids artificially through a machine when the kidneys have failed) due to unresponsiveness (a state where resident was not responding to stimuli). This deficient practice had the potential to cause delay in communication among staff and placed Resident 76 at risk of not receiving appropriate care. Findings: During a review of Resident 76's admission Record, the admission Record indicated, Resident 76 was admitted to the facility on [DATE]. Resident 76's diagnoses included End Stage Renal Disease ([ESRD] irreversible kidney failure), anemia (a condition where the body does not have enough healthy red blood cells), and dysphagia (difficulty of swallowing). During a review of Resident 76's Minimum Data Set ([MDS] - a resident assessment tool), dated 12/19/2024, the MDS indicated, Resident 76's cognitive (ability to think and reason) skills for daily decision making was moderately impaired (decisions poor/cues/supervision required). The MDS indicated, Resident 76 was totally dependent (helper does all the effort) from staff with toileting hygiene, upper body dressing, and personal hygiene. During a review of Resident 76's progress notes, dated 3/3/2025, the progress notes indicated Resident 76 was picked at 4:20 a.m. for dialysis in stable condition. During a concurrent interview and record review on 3/6/2025 at 11:26 a.m., with Registered Nurse 1 (RN 1), Resident 76's clinical records were reviewed. RN 1 stated on 3/3/2025 at approximately 9:00 a.m., she received a call from Resident 76's representative informing her that Resident 76 was transferred to the hospital from the dialysis center due to unresponsiveness. RN 1 stated Resident 76's clinical record was incomplete due to missing note of Resident 76's transfer to the hospital. RN 1 stated she was busy and forgot to document. RN 1 stated resident medical records should be complete to provide continuity of care and to prevent communication breakdown among healthcare providers. During a review of the facility's policy and procedure (P&P), titled Nursing Documentation, dated 5/1/2018, the P&P indicated, any communication with family, durable power of attorney, or physician, should be noted in the nurse's notes. During a review of the facility's P&P, titled Care Standards, dated 5/1/2018, the P&P indicated, care should be documented in the medical record according to state and/or federal regulations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 47 of 49 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 03/07/2025 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 0865 Have a plan that describes the process for conducting QAPI and QAA activities. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide meeting minutes (notes) of the Quality Assurance and Performance Improvement ([QAPI] - a data driven proactive approach to improvement used to ensure services are meeting quality standards) program to prove three repeat deficiencies in the areas of Resident Rights, Laboratory Services, and Pharmacy Services, cited during the previous recertification survey of 2024, were discussed and evaluated. Residents Affected - Some This deficient practice had the potential for repeated deficiencies and placed the residents at risk for harm if areas identified were not investigated, analyzed and ensure corrective actions or activities to improve performance were effectively implemented. Findings: During a review of documents titled, Statement of Deficiencies (SOD), dated 3/8/2024, the SOD indicated the facility had deficiencies related to Resident Rights, Laboratory Services, and Pharmacy Services. During an interview on 3/7/2025 at 11:47 a.m., with the Administrator (ADM), the ADM stated the facility did not have any minutes or any evidence of QAPI program efforts to correct the previous and repeat deficiencies identified by the California Department of Public Health ([CDPH] - licensing and certification agency). The ADM stated it was important to discuss and develop a QAPI program for the deficient practices identified by the CDPH so the facility would be in compliance with their policy and procedure (P&P) and for areas of improvement. The ADM stated an effective QAPI program should have identified and analyze the root cause, develop intervention and goal and how the facility would monitor and audit the program. During a review of the facility's, undated P&P, titled QAPI Plan, the P&P indicated, the QAPI Steering committee analyzes performance to identify and follow up on areas of opportunity. The P&P indicated the facility should continually identify opportunities for improvement and uses the criteria to prioritize opportunities such as aspects of care affecting large numbers of residents and regulatory requirements. The P&P indicated meeting minutes will be recorded and shared with the QAPI Steering committee, executive leadership, and staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 48 of 49 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 03/07/2025 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 0907 Provide enough space and equipment to meet each resident's needs Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to ensure five wheelchairs (WC, chair fitted with wheels for transport) and one geriatric chair (a large, padded chair designed to help persons with limited mobility) were not stored outside, under the rain. Residents Affected - Some This deficient practice had the potential to cause damage to medical equipment and prevent safe use of WCs and geriatric chairs for residents residing the facility. Findings: During an interview on 3/5/2025 at 8:53 a.m. with the Director of Rehabilitation (DOR), the DOR stated the facility had difficulty maintaining and keeping WCs, because the WCs get lost. During an observation and interview on 3/5/2025 at 1:16 p.m. in the therapy gym, the DOR stated he prepared and cleaned a WC for a resident, but it was stored outside in the rain, and now needed to be dried. The DOR stated because the WC was outside and was wet, the WC could not be used for the resident today and hopefully, would be dried by tomorrow for resident use. The DOR stated there was no other WC for the resident to use because the resident required a custom WC. The wheelchair was observed with thick and wet cushion and could not be used. During an observation and interview at 3/5/2025 at 3:56 p.m., the Maintenance Supervisor (MS) walked outside to a rectangular outdoor area bordered by resident rooms. In the outside rectangular patio area, there were four WCs and one geriatric chair. The MS stated the covered shed was full and mainly for activity equipment. The MS stated the four WCs and one geriatric chair outside in the rain and elements, should have been stored inside the resident's room. The MS stated the medical equipment should be stored in a covered storage area, and not outside because they could get wet, dirty, or hot. The MS stated the facility had no covered storage space to store extra WCs and equipment. During an interview on 3/6/2025 at 12:39 pm. with the Director of Nursing (DON), the DON stated WCs and other medical equipment should not be stored outside ,uncovered area but in a covered storage area. During an interview on 3/6/2025 at 11:24 a.m., the Medical Records Supervisor stated the facility did not have a policy regarding storing medical equipment in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 49 of 49