Inspection·March 6, 2025

F 0660 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of Resident 1's Social Service Progress Note dated 3/3/20205 with a late entry date of 2/27/2025, the Social Service Progress Note indicated the facility helped Resident 1 purchase a bus ticket but Resident 1 did not leave any family information. The Social Service Progress Notes indicated Resident 1 was discharged from the facility with no medication, per Resident 1's physician. During a telephone interview on 3/5/2025 at 1:20 p.m., Registered Nurse Supervisor 2 (RNS 2) stated on 2/27/2025 she received an order from Resident 1's nurse practitioner to discharge Resident 1 home with no medications. RNS 2 stated she endorsed the discharge instructions to the incoming shift (3 p.m. to 11 p.m.) RNS 3. RNS 2 stated she instructed Resident 1 that there was an order to discharge him without his medications and to follow up with his physician in one week. RNS 2 stated Resident 1 wanted to leave the facility, so she prepared the Notice of Transfer and Discharge form but Resident 1 refused to sign it. RNS 2 stated she did not document on the Notice of Transfer and Discharge form or in Resident 1's clinical record her communication with him or his refusal to sign the form. During a telephone interview on 3/5/2025 at 2:03 p.m., RNS 3 stated Resident 1's discharge was unplanned, and he (Resident 1) insisted on leaving the facility despite being discharged without his medications. RNS 3 stated she thought all of Resident 1's discharge papers were given to Resident 1 by RNS 2 during the at 7 a.m. to 3 p.m. shift (2/27/2025) and she (RNS 3) discharged Resident 1 on 2/27/2025 at 7 p.m. During an interview on 3/5/2025 at 2:26 p.m., the Social Service Director (SSD) stated Resident 1 requested to leave the facility with a bus ticket to his home (out of state) and wanted to leave even if his physician discharged him with no medications. The SSD stated there was no discharge planning started or documented in Resident 1's medical record. During an interview on 3/5/2025 at 3:32 p.m., RNS 1 stated Resident 1's discharge planning process should have been initiated when he was admitted to the facility. RNS 1 stated discharge instructions should have been prepared and explained to Resident 1 and a copy given to him before he was discharged from the facility. RNS 1 stated it was important for Resident 1 to have a copy of his discharge instructions, a list of his medications and/or prescriptions, follow up appointments and if ordered, provision of his care at home to ensure his overall health and well-being. During an interview on 3/6/2025 at 3:10 p.m., the Director of Nursing (DON) stated if the facility and its interdisciplinary team was not able to implement a thorough discharge plan for a resident, then the resident will not be prepared and safely discharged . The DON stated the actual discharge process should involve the nursing and social services department and must work hand in hand to ensure the resident safely transition from the facility to the community to be able to thrive. During an interview on 3/6/2025 at 3:50 p.m., the Administrator (ADM) stated all resident's discharge preparation and procedures should be documented in the resident's chart. During a review of the facility's policy and procedure (P/P) titled, NP03 Discharge and Transfer of Residents revised 12/21/2023, the P/P indicated the facility must ensure the discharge planning of the residents must be complete and appropriate, and that necessary information is communicated to the resident and/or the continuing care provider. During a review of the facility's P/P titled, P-NP03 Discharge and Transfer of Residents revised 12/21/2023, the P/P indicated: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555114 If continuation sheet Page 2 of 5 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 555114 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Driftwood Healthcare Center 4109 Emerald St Torrance, CA 90503 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 0660 1. The residents' discharge planning shall begin on the residents' admission to the facility Level of Harm - Minimal harm or potential for actual harm 2. The primary physician and the interdisciplinary team will review the resident's progress and determine a possible discharge date Residents Affected - Few 3. Prior to discharge, the facility will provide the resident/resident representative with a Notice of Proposed Transfer and Discharge Document and copy of a signed/completed form will be placed in the resident's medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555114 If continuation sheet Page 3 of 5 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 555114 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Driftwood Healthcare Center 4109 Emerald St Torrance, CA 90503 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure one of three sampled residents (Resident 5) was supervised by the facility staff while smoking. This deficient practice resulted in Resident 5 smoking unsupervised on/near the facility's parking lot with the use of a cigarette lighter, without wearing a smoking apron, or having a receptacle to safely dispose of his used cigarette(s). This deficient practice had the potential for Resident 5 to sustain burn injuries. Findings: During a review of Resident 5's admission Record (Face Sheet), the Face Sheet indicated Resident 5 was admitted to the facility on [DATE] with diagnosis including cerebrovascular disease ([stroke] a condition that affects the blood flow to the brain), right side hemiplegia (complete paralysis of one side of the body), and glaucoma (an eye condition that damages the optic nerve that can lead to vision loss or blindness). During a review of Resident 5's Minimum Data Set ([MDS] a resident assessment tool) dated 2/7/2025, the MDS indicated Resident 5 was forgetful and was not able to make reasonable decisions, had an impairment on side of his upper extremities (the region of the body that includes the arm, forearm, wrist and hand) and required a one person assist to complete his activities of daily living ([ADLs] activities such as bathing, dressing and toileting a person performs daily) During a review of Resident 1's History and Physical (H&P) dated 5/25/2023, the H&P indicated Resident 5 was pleasantly demented, and conversational but did not have the capacity to understand and make decisions. During a review of Resident 5's Care Plan on Potential for Safety Hazard and Injury Related to Smoking dated 7/18/2023, the Care Plan indicated Resident 5 refused to wear a protective smoking apron while smoking. The Care Plan's goal was for Resident 5 to have no injury to himself, others and no property damage. The interventions included allowing Resident 5 to smoke in designated smoking areas, the nursing personnel would keep smoking materials at the nursing station and return the materials to the nursing station after smoke break. During an observation on 3/6/2025 at 8:55 a.m., Resident 5 was observed sitting in his wheelchair in front of two large trash bins by the facility's parking lot with no staff present, without a smoking apron on or ashtray to dispose of cigarette ashes or used cigarette(s). Resident 5 was observed lighting a cigarette that was in his mouth with a cigarette lighter, and then placed the cigarette lighter inside the pocket of his coat. Resident 5 shrugged his left shoulder, moved his head from side to side, pointed to the smoking patio when asked why he was smoking alone in the facility's parking lot. During an interview on 3/6/2025 at 9:50 a.m., Licensed Vocational Nurse 4 (LVN 4) stated Resident 5 loved to go outside of the facility to get fresh air and to smoke. LVN 4 stated the licensed nurses keep residents' smoking supplies and they were only provided to residents when they wanted to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555114 If continuation sheet Page 4 of 5 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 555114 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Driftwood Healthcare Center 4109 Emerald St Torrance, CA 90503 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 0689 smoke. Level of Harm - Minimal harm or potential for actual harm During an interview on 3/6/2025 at 10:07 a.m., Certified Nursing Assistant 5 (CNA 5) stated she was busy caring for other residents, and she did not know Resident 5 was outside of the facility smoking by himself. CNA 5 stated Resident 5 needed supervision when he was smoking because he did not always understand directions. Residents Affected - Few During an interview on 3/6/2025 at 3:10 p.m., the Director of Nursing (DON) stated all staff were responsible to ensure residents' were safe and supervised when they were smoking. During a review of the facility's policy and procedure (P/P) titled, NP132 Smoking by Residents revised 7/27/2023, the P/P indicated the facility that accommodate residents who smoke will take reasonable precautions by providing a safe environment for the residents. During a review of the facility's policy and procedure (P/P) titled, P-NP132 Smoking Residents revised 7/27/2023, the P/P indicated the following: a. Smoking by the residents is allowed outside of the facility in designated, marked smoking areas with ashtrays made of safe and non-combustible material, metal containers with self-closing covers in which the ashtrays can be emptied, portable extinguisher and a fire retardant blanket, b. The facility may develop a smoking schedule to ensure a safe environment for the residents. During a review of the facility's P/P titled, Resident Safety revised 4/15/2021, the P/P indicated: a. The facility shall provide the residents a safe and hazard free environment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555114 If continuation sheet Page 5 of 5