Health inspection·June 17, 2025

F 0755 - every four hours, administer at 0000, 0400, 0800, 1200, 1600, and 2000 hours; Level of Harm - Minimal harm or potential for actual harm - three times a day in between meals, administer at 1000, 1400, and 2000 hours; - twice a day between meals, administer at 1000, and 1400 hours. Residents Affected - Few a. Review of Resident 3's medical record was initiated on 6/13/25. Resident 3 was admitted to the facility on [DATE]. Review ofResident 3's MDS assessment dated [DATE], showed a BIMS score of 11, indicating moderate cognitive impairment. Review of Resident 3's H&P examination dated 4/20/25, showed Resident 3 was able to make needs known and make own medical decisions. b. Review of Resident 4's medical record was initiated on 6/13/25. Resident 4 was admitted on [DATE]. Review of Resident 4's MDS assessment dated [DATE], showed a BIMS score of 12, indicating moderate cognitive impairment. c. Review of Resident 17's medical record was initiated on 6/13/25. Resident 17 was admitted on [DATE]. Review ofResident 17's MDS assessment dated [DATE], showed a BIMS score of 15, indicating moderate cognitive impairment. d. Review of Resident 16's medical record was initiated on 6/17/25. Resident 16 was admitted on [DATE]. Review ofResident 16's MDS assessment dated [DATE], showed a BIMS score of 6, indicating individual's cognitive function is intact. On 6/13/25 at 1006 hours, an observation and concurrent interview was conducted with LVN 2. LVN 2 was observed administering the medications to Resident 7. LVN 2 confirmed the medications given to Resident 7 were due at 0900 hours. LVN 2 stated she started the medication administration at 0830 hours because she had to provide assistance with another resident's change in condition. LVN 2 further stated she still needed to administer the medications scheduled for 0900 hours to Residents 4, 5, 11, 12, and 14. On 6/13/25 at 1008 hours, an observation and concurrent interview was conducted with LVN 1. LVN 1 was observed passing the medications. LVN 1 confirmed the medications were due at 0900 hours. LVN 1 stated she was late in the medication administration because a resident had a change in condition. LVN 1 further stated she needed to administer the medications scheduled for 0900 hours to Residents 1, 2, 3, 6, 8, 9, 10, 13, and 15. On 6/13/25 at 1023 hours, an interview was conducted with Resident 3. Resident 3 stated she had not received her medications yet. Resident 3 further stated sometimes the medications were administered late. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555103 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE French Park Care Center 600 E Washington Avenue Santa Ana, CA 92701 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 On 6/13/25 at 1032 hours, an interview was conducted with Resident 4. Resident 4 stated sometimes she receives her medications late. On 6/13/25 at 1035 hours, an interview was conducted with LVN 2. LVN 2 confirmed she just finished passing the medications scheduled at 0900 hours. Residents Affected - Few On 6/13/25 at 1039 hours, an interview was conducted with Resident 17. Resident 17 stated sometimes he receives his medications late. On 6/13/25 at 1050 hours, an observation and concurrent interview was conducted with LVN 1. LVN 1 was observed wheeling the medication cart back towards the nurses station. LVN 1confirmed she just finished passing the medications scheduled to be administered at 0900 hours. On 6/13/25 at 1120 hours, an interview was conducted with the DON. The DON stated the facility would notify the physician of the residents for the late medication administration today. On 6/17/25 at 1020 hours, an observation and concurrent interview was conducted with LVN 6. LVN 6 was observed administering medication to Resident 16. When LVN 6 was done administering the medications, LVN 6 was asked about medications administered to Resident 16. LVN 6 confirmed the medications given to Resident 16 were due at 0900 hours. LVN 6 stated she had a resident going for a medical appointment today and had to stop medication administration to assist the resident. On 6/17/25 at 1205 hours, an interview was conducted with the DON. The DON stated she expected the medications to be administered timely. The DON further stated the RN supervisor and unit managers were available to assist with a resident's change of condition, so medication administration wouldnot be interrupted to prevent any delay. On 6/17/25 at 1615 hours, an interview was conducted with the Assistant Administrator, DON, and ADON. The Assistant Administrator, DON, and ADON were informed and acknowledged the above findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555103 If continuation sheet Page 3 of 3