Health inspection·December 5, 2025

F 0686 Level of Harm - Actual harm Residents Affected - Few right, changing positions from sitting to lying. The MDS indicated Resident 1 was unable to stand due to medical condition and safety concerns. The MDS indicated Resident 1 was at risk for developing pressure ulcers/injuries. The MDS indicated Resident 1 had no wounds. During a review of Resident 1's Braden Scale (a standardized tool used by healthcare professionals to assess a patient's risk of developing pressure ulcers, or bedsores) Evaluation, dated 6/28/2025, the evaluation indicated Resident 1 was at risk of developing pressure ulcers. During a review of Resident 1's care plan titled, Potential for pressure ulcer development, and/ or impaired skin integrity, dated, 6/30/2025, indicated the following interventions:a). Assess the resident's nutritional status, including weight, weight loss, and serum albumin levels (the amount of albumin protein present in the blood. Normal serum albumin level range 3.4 to 5.4 grams (gmunit of measurement) per deciliter (g/dL). Abnormal levels can indicate various health issues, such as malnutrition [undernourished], or dehydration [a condition caused by the loss of too much fluid from the body]), if indicated.b). Assess the skin over bony prominences (sacrum [bone at the base of the spine], trochanters [bony prominence on the upper thigh bone], scapulae [bones at the shoulder blade], elbows, heels, inner and outer malleolus [bones on either side of the ankle], inner and outer knees, back of the head). These areas are at highest risk for breakdown resulting from tissue ischemia (restriction in blood supply) from compression (squeezed) against a hard surface.c). Encourage good nutrition and hydration (the process of replacing water in the body) to promote healthier skin.d). Keep skin clean and dry.e). Provide incontinence care promptly after resident's incontinent (uncontrolled urination and defecation) episode. During a review of Resident 1's Order Summary Report, Completed, Discontinued for 9/2025, the Order Summary Report indicated Resident 1 was on No Added Salt diet, Mechanical Soft texture (foods that are soft, easy to chew and swallow), thin consistency (liquids like water, flowing easily through a cup or straw without resistance). Resident 1's Order Summary Report did not indicate the resident was on any vitamins or protein supplements prior to 9/20/2025. During a review of Resident 1's skin assessment dated [DATE], the skin assessment indicated Resident 1 had no skin breakdown on admission. During a review of Resident 1's changes of condition ([COC] a clinical deviation from a resident's baseline), the COC indicated the following: 1). On 9/5/2025, Resident 1 had a dark purple skin discoloration on the left heel (no measurement indicated).2). On 9/16/2025, Resident 1 had a dark purple skin discoloration on the right 1st metatarsal head (no measurement indicated). 3). On 9/19/2025, the physician (MD 2) noted Resident 1 had a DTPI on the right lateral foot measuring 1.5 centimeters ([cm] a unit of measurement) in length ([L]- the measurement from the top to the bottom of the wound, at its longest point), 1 cm in width ([W]- the measurement of a wound from side to side, which is crucial for assessing the size and severity of the injury) and was unable to determine (UTD) the depth ([D]- the distance from the skin's surface to the bottom of the wound) of the wound (L x W x D), and left 1st metatarsal head measuring 2.5 cm x 2 cm x UTD. 4). On 9/20/2025, Resident 1 had Stage 3 pressure ulcer injury to the left hip that measured 1.6 cm x 3 cm x 0.1 cm. The COC indicated Resident 1 had a tendency to position himself back to the affected side, after being repositioned. The COC indicated Resident 1 removed offloading devices (equipment to reduce pressure on skin) such as pillows, despite explanation of risks and benefits. During a review of Resident 1's Interdisciplinary Team ([IDT] group of healthcare professionals [Physician, Director of Nurses, Registered Nurses/ Licensed Vocational Nurses], including resident/ resident representative, working together to develop a plan of care for the resident) meeting for the month of 9/2025, the IDT meetings did not indicate IDT skin committee conducted a meeting (as indicated in the facility's P&P titled Pressure Ulcer Prevention) to discuss and address Resident 1's skin breakdowns on 9/5/2025, 9/16/2025, 9/19/2025 and 9/20/2025, by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 2 of 8 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 12/05/2025 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 0686 Level of Harm - Actual harm Residents Affected - Few developing a resident-centered care plan specific to the resident's risk factor such as pressure reduction, positioning and bed mobility. During an interview on 11/21/2025 at 3:14 p.m., with CNA 1, CNA 1 stated she (CNA 1) reported Resident 1's left hip pressure ulcer to the Charge Nurse (date unknown). CNA 1 stated the Charge Nurse was notified about Resident 1 removing the pillows and throwing the pillows on the floor, after being turned and repositioned by staff on his right side. CNA 1 stated Resident 1 always repositioned himself by turning back on his left side (pressure area). CNA 1 stated the Charge Nurse instructed (CNA1) to continue using the pillows and to check Resident 1 more frequently, instead of providing a different intervention to resolve the concern (turning back on his left side [pressure area]). During an interview on 11/25/2025 at 1:46 p.m., with the Director of Nursing (DON), the DON stated Resident 1's shower sheets for the month of 9/2025 could not be found in the resident's clinical records. The DON stated Resident 1's shower sheets should be kept or filed in the resident's chart to ensure communication to other staff if there were any new skin issues identified. During a concurrent interview and record review on 11/26/2025 at 11:08 a.m., with Licensed Vocational Nurse (LVN) 3, Resident 1's ADL Skin Observation Log for 7/2025, 8/2025, and 9/2025, were reviewed. LVN 3 stated the skin observation log had missing documentation of skin observations during: 1). The morning shift (7:00 a.m. - 3:00 p.m.) on 7/23/2025, 8/2/2025, 8/6/2025, 8/9/2025, 8/10/2025, 8/17/2025, 8/27/2025, 8/30/2025 and 9/21/2025. 2). The evening shift (3 p.m. - 11 p.m.) on 7/23/2025, 8/25/2025, 8/28/2025, 8/31/2025 and 9/4/2025. 3). The night shift (11 p.m. - 7 a.m.) on 7/6/2025, 7/11/2025, 7/14/2025, 7/31/2025, 8/5/2025, 8/9/2025, 8/10/2025, 8/22/2025, 8/23/2025, 8/28/2025, 8/31/2025, 9/4/2025, 9/8/2025 and 9/20/2025.LVN 3 stated the missing documentation of skin observations every shift meant staff did not check Resident 1's skin. During an interview on 11/26/2025 at 11:38 a.m., with the Treatment LVN, the Treatment LVN stated Resident 1 could have developed the left hip wound due to prolonged pressure. The Treatment LVN stated pressure sores always started as Stage 1 (intact skin with a localized area of redness or changes in sensation, temperature, or firmness) and progresses to Stage 3 pressure ulcer when interventions to prevent skin breakdown were not implemented. The Treatment LVN stated residents who were bony (thin, so that the bones show under the skin) were at risk for skin breakdown because there were no fat or muscles to protect the skin from breakdown. During a concurrent interview and record review on 11/26/2025 at 2:12 p.m., with Registered Nurse (RN) 2, Resident 1's ADL Skin Observation Log for 7/2025, 8/2025, and 9/2025 were reviewed. RN 2 stated some of Resident 1's ADL skin observation log entries were blank and no charting on:1). The morning shift (7:00 a.m. - 3:00 p.m.) on 7/23/2025, 8/2/2025, 8/6/2025, 8/9/2025, 8/10/2025, 8/17/2025, 8/27/2025, 8/30/2025 and 9/21/2025. 2). The evening shift (3 p.m. - 11 p.m.) on 7/23/2025, 8/25/2025, 8/28/2025, 8/31/2025 and 9/4/2025. 3). The night shift (11 p.m. - 7 a.m.) on 7/6/2025, 7/11/2025, 7/14/2025, 7/31/2025, 8/5/2025, 8/9/2025, 8/10/2025, 8/22/2025, 8/23/2025, 8/28/2025, 8/31/2025, 9/4/2025, 9/8/2025 and 9/20/2025.RN 2 stated, if they were not charted, it meant the CNA did not check the resident's skin. RN 2 stated not checking the resident's skin was a problem because if the wound had developed or started, it would not be identified early. RN 2 stated Resident 1 did not have any wounds when admitted to the facility on [DATE]. During concurrent interview and record review on 12/5/2025 at 12:02 p.m., with Treatment LVN, Resident 1's care plan titled, Potential for Pressure Ulcer Development and/or Impaired Skin Integrity, dated 6/30/2025, was reviewed. The Treatment LVN stated interventions should have included repositioning Resident 1 every two (2) hours or more, waffle boots for protection on the feet, pillows between knees, legs, heels, or whatever area Resident 1 was laying on to relieve pressure. The Treatment LVN stated the care plan did not include turning and repositioning, which could mean nursing staff were not repositioning Resident 1. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 3 of 8 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 12/05/2025 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 0686 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Treatment LVN stated the facility did not revise Resident 1's care plan when Resident 1 always repositioned himself back on his left side, which was the affected area (with Stage 3 pressure sore). The Treatment LVN stated the facility had no documentation indicating to reposition Resident 1 every 2 hours was done nor was part of Resident 1's care. During a review of facility's P&P titled, Pressure Ulcer Prevention, dated 5/1/2018, the P&P indicated the facility should identify residents at risk for pressure ulcers and provide care and services to promote prevention of pressure ulcer development. The P&P indicated the licensed nurse should develop a care plan specific to the resident's risk factor such as pressure reduction, positioning, mobility and nutrition in consultation with the attending physician, interdisciplinary team- skin committee, Registered Dietitian, Director of Rehab Services. The P&P indicated nursing staff should monitor interventions for effectiveness and resident tolerance. The P&P indicated the care plan should be revised as indicated. The P&P indicated CNAs should inspect the resident's skin during ADL care, complete body checks on resident shower days and report unusual findings to the Licensed Nurse and the Licensed Nurse should document effectiveness of pressure ulcer prevention techniques in the resident's clinical record on a weekly basis. During a review of facility's P&P titled, Care Planning, dated 10/24/2022, the P&P indicated a comprehensive person-centered care plan should be developed for each resident based on their individual assessed needs. The P&P indicated the IDT should develop a comprehensive care plan for each resident based on MDS guidelines. The P&P indicated the care plan should serve as the course of action where the resident and resident's IDT work to address the resident's medical and nursing needs. The P&P indicated the resident's comprehensive care plan should describe the services to be furnished to attain or maintain the resident's highest practicable, physical, mental, and psychosocial well-being. The P&P indicated, the IDT should revise the Comprehensive Care Plan as needed to address changes in care and as dictated by changes in the resident's condition Event ID: Facility ID: 555057 If continuation sheet Page 4 of 8 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 12/05/2025 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to prevent one of six sampled residents (Resident 1) from having unplanned severe (greater than 5 percent weight loss in one month) weight loss by failing to:Implement Resident 1's Care Plan titled, Has Potential for Nutrition Problems which indicated to monitor and document Resident 1's meal percentage consumed for each meal. Implement Resident 1's Care Plan titled, Malnourished as evidenced by Nutritional Screening Tool Score of 02, which indicated to offer supplement to Resident 1 if his intake was below 50 percent. Follow the Registered Dietician's (RD) recommendations on 7/14/2025 and 9/3/2025 to provide large-portion meals to Resident 1. 4. Conduct an interdisciplinary Team ([IDT] group of healthcare professionals working together to plan the care needed for each resident) meeting to address Resident 1's unplanned severe weight loss on 9/1/2025 and make recommendations or Care Plan to prevent further weight loss. These failures resulted in Resident 1 having severe weight loss of 12.6 pounds (lbs.) from 8/4/2025 to 9/1/2025 (within 28 days) and 15 pounds from 9/15/2025 to 9/23/2025 (within 8 days). Resident 1 was transferred to the General Acute Care Hospital (GACH) and underwent a Percutaneous Endoscopic Gastrostomy (PEG) tube placement (a feeding tube that is inserted directly into the stomach for administering nutrition, fluids for residents who have difficulty swallowing or cannot get enough nutrition by mouth). Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was initially admitted to the facility on [DATE] and readmitted on [DATE]. The admission Record indicated Resident 1's diagnoses included hemiplegia(total paralysis of the arm, leg and trunk on the same side of the body) and hemiparesis (weakness on one side of the body affecting the arm and/or face) following cerebral infarction (loss of blood flow to a part of the brain) affecting the left non-dominant side, unspecified protein-calorie malnutrition (serious condition from not getting enough protein and calories, causing poor growth, weight loss, weakened immunity and organ dysfunction), and dysphagia (difficulty swallowing). During a review of Resident 1's Nutritional Evaluation dated 6/30/2025, the Evaluation indicated Resident 1 had a score of 0-7 points (reference range 12-14 points, normal nutritional status, 8-11 points at risk of malnutrition, 0-7 points malnourished).During a review of Resident 1's Care Plan titled, Has potential for Nutrition Problems dated 6/30/2025, the Care Plan interventions indicated for RD to evaluate and make diet change recommendations as needed (PRN). The Care Plan interventions indicated the facility would monitor and record the Resident's intake on each meal. During a review of Resident 1's Care Plan titled, Malnourished as evidenced by Nutritional Screening Tool score of 02 dated 6/30/2025, the Care Plan indicated Resident 1 was at risk for increased susceptibility to infections, muscle wasting/weakness, chronic diseases, impaired wound healing, cognitive impairment, dehydration, constipation, weight loss, low Body Mass Index ([BMI - a calculation that uses a person's weight and height to estimate whether someone is at a healthy weight]). The Care Plan goal indicated Resident 1 would receive adequate nutrition and avoid weight loss as much as possible. The Care Plan Interventions included to record meal percentage for every meal and offer supplement to Resident 1 if intake was below 50%.During a review of Resident 1's History and Physical (H&P) dated 7/2/2025, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool) dated 7/4/2025, the MDS indicated Resident 1 had severe cognitive impairment (problems with the ability to think and reason). The MDS indicated Resident 1 required partial/moderate assistance (helper does less than half the effort) to perform Activities of Daily Living (ADLs) such as eating and was dependent (helper does all of the effort) for bed mobility (the ability to move) such as rolling left and right, changing positions from sitting to Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 5 of 8 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 12/05/2025 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 0692 Level of Harm - Actual harm Residents Affected - Few lying.During a review of Resident 1's Nutritional assessment dated [DATE], the Nutritional Assessment indicated Resident 1 was visually assessed as underweight with low albumin (blood test used to check general health and nutrition) level of 3.3 grams per deciliter ([g/dl] unit of measurement, therapeutic range of 3.5-5.7 g/dl). The Nutritional Assessment indicated Resident 1 was 146 lbs., with an ideal body weight (IBW) of 178 lbs. (32 lbs. under IBW) and BMI of 19.9. The Nutritional Assessment indicated Resident 1 was at risk for weight loss, due to low BMI. The Nutritional Assessment indicated the RD's Nutritional interventions and recommendations included to provide a mechanical (mech) soft diet with large portions to Resident 1. During a review of Resident 1's Physician's Orders dated 7/2025 -8/2025, the Orders did not indicate Resident 1 had Physician's orders for large portions during meals. During a review of Resident 1's Weight Summary dated 8/4/2025, the Summary indicated Resident 1 weighed 148.6 lbs., on 8/4/2025. During a review of Resident 1's COC, dated 9/2/2025, the COC indicated Resident 1 weighed 136 lbs., on 9/2/2025 (8.5% weight loss in one month compared to 8/4/2025). The COC indicated the physician recommended to implement weekly weights and refer to RD. During a review of Resident 1's RD Nutritional/Dietary Note dated 9/3/2025, the Nutritional/Dietary Note indicated Resident's weight was 136 lbs., weight loss of 12.6 lbs. (8.5%) in one month and BMI of 18.4. The Nutritional Dietary/Note indicated to provide large portions at meals for the Resident. During a review of Resident 1's Physician's Orders for the month of 9/2025, the Orders did not indicate Resident 1 had Physician's orders for large portions during meals. During a review of Resident 1's ADL Meal Logs dated 8/2025 and 9/2025, the Logs did not indicate Resident 1's intake percentages were recorded for the following meals: 8/2/2025 for breakfast and lunch 8/6/2025 for breakfast and lunch 8/9/2025 for breakfast and lunch 8/10/2025 for breakfast and lunch 8/17/2025 for breakfast and lunch 8/25/2025 for dinner 8/26/2025 for lunch 8/27/2025 for breakfast and lunch 8/28/2025 for dinner 8/29/2025 for dinner8/30/2025 for breakfast and lunch 8/31/2025 for dinner 9/4/2025 for dinner 9/21/2025 for breakfast and lunch The ADL Meal Log also indicated the following intake percentages for Resident 1: 0-25% on 8/20/2025, 9/11/2025, 9/15/2025-9/16/2025, 9/18/2025-9/19/2025, 9/22/2025-9/23/2025 for breakfast, 9/15/2025, 9/18/2025, 9/22/2025- 9/23/2025 for lunch, 9/5/2025, 9/13/2025-9/14/2025 for dinner 26-50% on 8/2/2025, 8/8/2025, 8/10/2025 and 8/13/2025, 9/15/2025-9/16/2025 and 9/22/2025 for dinner, 9/7/2025, 9/12/2025- 9/14/2025 and 9/20/2025 for breakfast, 9/12/2025-9/14/2025, 9/16/2025, 9/19/2025-9/20/2025 for lunch. During a review of Resident 1's Nutrition-Nourishment and Nurses Notes dated 8/2025 and 9/2025, the Nutrition-Nourishment and Nurses Notes did not indicate Resident 1 was provided supplement for intakes of less than 50% on 8/20/2025, 9/11/2025, 9/15/2025-9/16/2025, 9/18/2025-9/19/2025, 9/22/2025-9/23/2025 for breakfast, 9/15/2025, 9/18/2025, 9/22/2025- 9/23/2025 for lunch, 9/5/2025, 9/13/2025-9/14/2025 for dinner.During a review of Resident 1's active Care Plans dated 9/2025, the Care Plans did not address Resident 1's actual and severe weight loss after it was identified on 9/1/2025.During a review of Resident 1's Weight Summary dated 9/15/2025 and 9/23/2025 sequentially, the Summary indicated Resident 1 weighed 139.2 lbs., on 9/15/2025 and 128.6 lbs., on 9/23/2025 (a total weight loss of 15 lbs. [11%]) During a review of Resident 1's Nurse Note dated 9/24/2025, the Note indicated the Physician ordered to transfer Resident 1 (on 9/24/2024) to the GACH due to Failure to Thrive (state of progressive decline, weight loss, poor nutrition and decreased appetite). During a review of Resident 1's GACH Physician's Notes dated 9/24/2025, the GACH Notes indicated Resident 1 had poor oral intake, unintentional weight loss and generalized weakness. The GACH notes indicated Resident 1 weighed 56 kilograms ([kg] unit of measurement [123.2 lbs.]) and BMI of 16.9. The GACH Notes indicated Resident 1 had diagnoses including Failure to Thrive and poor intake. During a review of Resident 1's GACH Gastrointestinal Physician Progress Note dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 6 of 8 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 12/05/2025 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 0692 Level of Harm - Actual harm Residents Affected - Few 10/4/2025, the Note indicated Resident 1's Assessment and Plan included dysphagia, malnutrition, Failure to Thrive and underwent a PEG placement on 10/2/2025. During a concurrent interview and record review on 11/26/2025 at 9:09 a.m., with the RD, Resident 1's RD evaluations and progress note dated 9/3/2025, were reviewed. RD stated she was informed of Resident 1's weight loss on 9/3/2025 and documented a recommendation of large portions for the Resident. During a concurrent interview and record review on 11/26/2025 at 11:08 a.m., with Licensed Vocational Nurse (LVN) 3, Resident 1's ADL Meal Log, for the month of 8/2025, were reviewed. LVN 3 stated that not all meals were documented for 8/2025. LVN 3 stated this should not happen especially because Resident 1 was at risk of poor nutrition. LVN 3 stated Resident 1 could have lost weight and not received enough nutrients. During a concurrent interview and record review on 11/26/2025 at 2:12 p.m., Registered Nurse (RN) 2, the following Resident 1's records were reviewed: ADL Meal Log, dated 8/2025 Weights Care plan titled, Potential For Nutrition Problems, dated 6/30/2025 Nutritional assessment dated [DATE]. 5. RD's progress note, dated 9/3/2025 All active and discontinued diet orders 7/2025-9/2025. RN 2 stated staff should have documented all of Resident 1's meal intake to ensure Resident 1 did not lose weight. RN 2 also stated Resident 1's Care Plan indicated to monitor the Resident's meal consumption but staff did not follow it. RN 2 stated there should have been an order for large meal portions for Resident 1 per RD's recommendations on 7/14/2025 and 9/3/2025 but was not followed through with the physician. RN 2 stated there were no new orders for large meal portions after 7/14/2025 and 9/3/2025.During a concurrent interviews and record reviews on 11/26/2025 at 4:07 p.m. and 12/10/2025 at 2:54 p.m., with the Director of Nursing (DON), the facility's P&P titled, Assessment and Management of Resident Weights, dated 5/1/2018 and the following Resident 1 records were reviewed: ADL Meal Logs, dated 8/2025 and 9/2025Weights Care plans titled, Potential For Nutrition Problems, and Malnourished as evidenced by Nutritional Screening Tool Score of 02, dated 6/30/2025 COC dated, 9/2/2025 RD's progress note, dated 9/3/2025 Nursing Progress notes dated 7/2025-9/2025 All active and discontinued diet orders dated 7/2025-9/2025 All IDT meetings dated 7/2025-11/2025The DON stated Resident 1's meals were not consistently recorded (for every meal). The DON stated there was no supporting documentation to indicate that the RD's recommendations, to provide large portion meals were endorsed to the physician and provided to Resident 1. The DON stated not following Resident 1's care plans to monitor, record the residents' intake and provide supplement could have caused Resident 1 to lose weight. The DON also stated there was no documentation to support Resident 1 was offered supplements when Resident's intakes were below 50% on 8/20/2025, 9/11/2025, 9/15/2025-9/16/2025, 9/18/2025-9/19/2025, 9/22/2025-9/23/2025 for breakfast, 9/15/2025, 9/18/2025, 9/22/2025- 9/23/2025 for lunch, 9/5/2025, 9/13/2025-9/14/2025 for dinner. The DON stated she could not recall conducting IDT meetings after Resident 1's identified weight loss on 9/1/2025 and did not see documentation to indicate an IDT was conducted to address the Residents' actual weight loss. The DON stated an IDT should have been conducted to address Resident 1's weight loss and update the plan of care to ensure Resident 1 did not further decline. The DON stated staff did not follow the facility's Policy and Procedure (P&P) titled, Assessment and Management of Resident Weights. During a review of facility's P&P titled, Assessment and Management of Resident Weights dated 5/1/2018, the P&P indicated, significant weight changes were weight changes of 5% in one (1) month and the DNS or licensed nurse will notify the physician and dietician of significant weight changes, and document notification in the nurses' notes. The P&P also indicated the licensed nurse will notify the physician of the dietician's recommendations; If the physician does not implement the dietitian's recommendations, the facility will document the rational for non-implementation in the medical record. The P&P indicated the IDT care plan will be updated to reflect (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 7 of 8 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 12/05/2025 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 0692 individualized goals and approaches for managing the weight change. Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555057 If continuation sheet Page 8 of 8