Inspection·March 20, 2025

F 0600 more difficulty with these functions than is expected for someone's age). Level of Harm - Minimal harm or potential for actual harm During an interview on 3/19/2025, at 11:45 a.m., Resident 1 stated on 3/17/2025 at night (approximately 11 p.m.) she was in her bed sleeping when she was awakened because she felt cold air on her private area and something cold on her left hip and groin area. Resident 1 stated her diaper was unfasted on the left side, and her pubic area was exposed and when she looked up, she saw a man who appeared to be a resident, wearing a knit cap with a pom-pom (round ball of yarn) on top of the cap, standing to the left side of her bed looking down on her. Resident 1 stated she screamed, and the resident opened the door and left her room leaving the door open. Resident 1 stated she called out for help and when Registered Nurse (RN) 1 came to her room, she told RN 1 that a man came into her room and unfastened her diaper and touched her private area. Resident 1 stated, RN 1 asked her, are you sure you weren't dreaming? You were probably sleeping, and then she (RN 1) left the room, as if she (RN 1) didn't believe her. Resident 1 stated, a Certified Nursing Assistant (CNA) came into her room, and she (Resident 1) told her what happened, and CNA 1 left the room. Resident 1 stated she saw Licensed Vocational Nurse (LVN) 1 in the hallway and called her, and LVN 1 came to her room and stayed with her. Resident 1 stated she told everyone who came in her room what happened, and she felt like they did not believe her and thought she was making it up. Residents Affected - Few On 3/19/2025, at 1:30 p.m., the facility's video surveillance was viewed with the Administrator (ADM) present. The ADM stated the incident reported by Resident 1 occurred on 3/17/2025 at approximately 11 p.m., and the video's date and time indicated the incident occurred on 3/16/2025 from 7:58 p.m., through 8:30 p.m., which was not accurate. The ADM stated the identity of the man seen in the video was Resident 2. The video's footage and sequence of events are as follows: At 7:58 p.m., Resident 2 is seen, wearing a knitted cap with a pom-pom on the top of it, pushing a walker with a seat attached, entering Resident 1's room, closing the door behind him. At 8:07 p.m., Resident 2 exits Resident 1's room At 8:12 p.m., Resident 2 enters Resident 1's room and closes the door. At 8:14 p.m., Resident 2 exits Resident 1's room. At 8:15 p.m., RN 1 walks by Resident 1's room and turns her head to look into Resident 1's room, walks past the room toward the end of the hall. At 8:16 p.m., RN 1 is seen in the doorway of Resident 1's room (not fully in the room) and is observed standing in the doorway talking to someone in the room, gesturing with her hands and then she leaves room. At 8:19 p.m., CNA 1 is seen standing in the doorway of Resident 1's room, talking to someone in the room, CNA 1 then leaves the room. At 8:30 p.m., LVN 1 enters room During an interview on 3/19/2025, at 3 p.m., RN 1 stated on 3/17/2025 she was walking down the hallway when she heard someone in Resident 1's and Resident 3's room asking for help. RN 1 stated, she thought Resident 3 was asking for her diaper to be changed and left the room to call CNA 1 for assistance. RN 1 stated, she thought Resident 1 was asleep and didn't return to the room until CNA 1 and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555114 If continuation sheet Page 2 of 6 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 03/20/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few LVN 1 alerted her that Resident 1 reported to them that a man had been in her room and touched her private area. During an interview on 3/19/2025, at 3:28 p.m., LVN 1 stated on 3/17/2025 at approximately 11 pm., while she was passing medications, she heard Resident 1 calling out from her room. LVN 1 stated Resident 1 appeared very upset and reported that a man had been in her room and touched her private area. LVN 1 stated, she asked Resident 1, are you sure you were not asleep? You could have been sleeping. LVN 1 stated Resident 1 described the man who had been in her room as wearing a knitted hat with a pom-pom on top of it, who was using a walker with a seat attached. LVN 1 stated Resident 1 pointed to her (Resident 1's) left hip area and said, he touched her there. LVN 1 stated she called RN 1 into the room and reported the incident to her. During an interview on 3/20/2025, at 11:46 a.m., CNA 1 stated on 3/17/2025 while she conducted her rounds, she was directed by RN 1 to assist Resident 1's roommate (Resident 3) who needed a diaper change. CNA 1 stated, when she went to the room Resident 1 was very upset and scared, and she kept repeating that a man came into her room and touched her private area. CNA 1 stated, Resident 1 gave her a description of a man wearing a knit cap. CNA 1 stated, she immediately left Resident 1's room to report the allegation of abuse to another staff member (LVN 1). During an interview on 3/20/2025 at 12:06 p.m., the Director of Nurses (DON) stated she was not at the facility alleged abuse occurred, it was reported to her. The DON stated when she arrived at the facility, she spoke to Resident 2 who told her she was not ok and assured her that she (DON) was there for her. The DON stated she encouraged Resident 2 to go to the General Acute Care Hospital (GACH) to be evaluated. During a review of the facility's policy and procedure (P/P) titled, Abuse Preventions, Screening and Training Program revised 2018, the P/P indicated the facility does not condone any form of resident abuse, neglect, misappropriation of resident property, exploitation, and or mistreatment and develops facility policies, procedures, training programs, screening and prevention systems to promote an environment free from abuse, neglect, misappropriation of resident property, exploitation and mistreatment. The administrator as abuse prevention coordinator is responsible for the coordination, and implementation of the facility's abuse prevention, screening and training program policies, sexual abuse is defined as non-consensual sexual contact of any type, sexual harassment, sexual coercion or sexual assault. The P/P indicated the administrator, or designated representative will provide a safe environment for the resident as indicated for the situation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555114 If continuation sheet Page 3 of 6 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 03/20/2025 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 0610 Respond appropriately to all alleged violations. 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 conduct thorough investigation for one of three sampled residents (Resident 1), when they did not interview other residents in the facility, following an allegation made by Resident 1 that Resident 2 came to her room, which was confirmed by the facility's video surveillance, and touched her private parts. Residents Affected - Few This deficient practice resulted in the inability of the facility to determine if Resident 2 had a behavior of entering other resident's rooms and touching them. Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including muscle weakness. During a review of Resident 1's History and Physical (H&P), dated 3/8/2025, the H&P indicated Resident 1 had the capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set ([MDS], a resident assessment tool), dated 3/14/2025, the MDS indicated Resident 1's cognitive (ability to think, understand, learn, and remember) skills for daily decision making were intact. During a review of Resident 1's Change of Condition ([COC] a significant change in resident's status that requires intervention) dated 3/17/2025, the COC indicated Resident 1 reported a sexual abuse encounter at approximately 11 p.m., on 3/17/2025. During a review of Resident 2's admission Record (Face Sheet), the Face Sheet indicated Resident 2 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including Parkinson's disease (a progressive disease of the nervous system marked by tremors) and dementia (a progressive state of decline in mental abilities). During a review of Resident 2's H/P, dated 3/4/2024, the H/P indicated Resident 2 did not have the capacity to make decisions. During a review of Resident 2's MDS, dated [DATE], the MDS indicated Resident 2 had moderate cognitive impairment (a brain condition that causes subtle changes in thinking and memory, resulting in more difficulty with these functions than is expected for someone's age). During an interview on 3/19/2025, at 11:45 a.m., Resident 1 stated on 3/17/2025 at night (approximately 11 p.m.) she was in her bed sleeping when she was awakened because she felt cold air on her private area and something cold on her left hip and groin area. Resident 1 stated her diaper was unfasted on the left side, and her pubic area was exposed and when she looked up, she saw a man who appeared to be a resident, wearing a knit cap with a pom-pom (round ball of yarn) on top of the cap, standing to the left side of her bed looking down on her. Resident 1 stated she screamed, and the resident opened the door and left her room leaving the door open. Resident 1 stated she called out for help and when Registered Nurse (RN) 1 came to her room, she told RN 1 that a man came into her room and unfastened her diaper and touched her private area. Resident 1 stated, RN 1 asked her, are you sure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555114 If continuation sheet Page 4 of 6 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 03/20/2025 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few you weren't dreaming? You were probably sleeping, and then she (RN 1) left the room, as if she (RN 1) didn't believe her. Resident 1 stated, a Certified Nursing Assistant (CNA) came into her room, and she (Resident 1) told her what happened, and CNA 1 left the room. Resident 1 stated she saw Licensed Vocational Nurse (LVN) 1 in the hallway and called her, and LVN 1 came to her room and stayed with her. Resident 1 stated she told everyone who came in her room what happened, and she felt like they did not believe her and thought she was making it up. During an interview 3/19/2025 at 12:30 p.m., Resident 4 (Resident 2's Roommate) stated Resident 2 liked to walk around in the room and leave the room at night, but he was not sure where he went when he left the room. On 3/19/2025, at 1:30 p.m., the facility's video surveillance was viewed with the Administrator (ADM) present. The ADM stated the incident reported by Resident 1 occurred on 3/17/2025 at approximately 11 p.m., and the video's date and time indicated the incident occurred on 3/16/2025 from 7:58 p.m., through 8:30 p.m., which was not accurate. The ADM stated the identity of the man seen in the video was Resident 2. The video's footage and sequence of events are as follows: At 7:58 p.m., Resident 2 is seen, wearing a knitted cap with a pom-pom on the top of it, pushing a walker with a seat attached, entering Resident 1's room, closing the door behind him. At 8:07 p.m., Resident 2 exits Resident 1's room At 8:12 p.m., Resident 2 enters Resident 1's room and closes the door. At 8:14 p.m., Resident 2 exits Resident 1's room. At 8:15 p.m., RN 1 walks by Resident 1's room and turns her head to look into Resident 1's room, walks past the room toward the end of the hall. At 8:16 p.m., RN 1 is seen in the doorway of Resident 1's room (not fully in the room) and is observed standing in the doorway talking to someone in the room, gesturing with her hands and then she leaves room. At 8:19 p.m., CNA 1 is seen standing in the doorway of Resident 1's room, talking to someone in the room, CNA 1 then leaves the room. At 8:30 p.m., LVN 1 enters room During a review of the facility's Investigative Report, dated 3/21/2025, the Investigative Report indicated, Resident 2 entered Resident 1's room, per Resident 1's witnessed account and confirmed via video footage. The facility took appropriate and immediate action and provided timely reporting to all agencies and interested parties, this appears to be an isolated, unavoidable, unanticipated and unexpected incident involving Resident 2. During an interview on 3/25/2025, at 9:45 a.m., the Director of Nursing (DON) stated the facility had concluded their investigation. The DON stated she and the Administrator (ADM) did not interview all interview able residents in the facility to inquire if Resident 2 or any other residents had entered their rooms without consent. The DON stated she and the ADM determined conducting interviews with staff, Resident 1, Resident 2 and their respective roommates was sufficient to determine that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555114 If continuation sheet Page 5 of 6 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 03/20/2025 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete incident on 3/17/2025 was an isolated event. The DON stated failure to interview other residents in the facility resulted in their investigation not being thorough, which could lead to unrecognized acts of abuse. The DON stated it was important to interview the residents to ensure no other allegation of abuse were occurring. During a review of the facility's policy and procedure (P/P) titled, Abuse Reporting and investigations revised 3/2018, the P/P indicated the facility promptly reports and thoroughly investigates allegations of abuse. Event ID: Facility ID: 555114 If continuation sheet Page 6 of 6