Health inspection·July 29, 2025

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some patients. This is particularly important if the patient cannot be reliably source controlled (resident cannot wear a mask) throughout the personal contact. An N-95 respirator instead of a facemask is recommended for any aerosol generating procedures and any other procedures that might pose a higher risk for transmission if the patient were to have COVID-19. B. During a review of Resident 7's admission Record, the admission Record indicated the facility initially admitted Resident 7 on 9/29/2022 and readmitted on [DATE] with a diagnosis of acute kidney failure (a sudden and rapid loss of the kidneys' ability to filter waste and maintain proper fluid and electrolyte balance in the body) and anxiety. During a review of Resident 7's MDS, dated [DATE], the MDS indicated Resident 7 was severely impaired with thought process and required dependent assistance from staff to complete ADLs. During a review of Resident 7's lab and radiology, dated 7/28/2025, the lab and radiology result indicated that Resident 7 was positive for COVID. During a concurrent observation and interview on 7/28/2025 at 12:41 p.m. with RN 1 and Guest Marketer (GM) 1, observed GM 1 enter Resident 7's room. RN 1 stated that GM 1 entered Resident 7's room without a gown and gloves. RN 1 asked GM 1 to wear a gown and gloves before entering the room. RN 1 stated it was important for the staff or visitors to wear gloves, gown and hand washing before entering a novel respiratory precaution room to protect the residents and to protect themselves. GM 1 stated that she did not know that she needed to wear a gown and gloves before entering Resident 7's room.During an interview on 7/28/2025 at 12:45 p.m. with the Infection Preventionist (IP), the IP stated that staff must wear PPE, do hand washing before and after entering the room to prevent the spread of the infection and to protect themselves. During a concurrent interview on 7/29/2025 at 2:15 p.m. with Assistant Director of Nursing (ADON), the ADON stated that for COVID isolation the staff needed to wear proper PPE upon entering the room, to prevent the spread of the virus and must do handwashing before and after entering the room.C. During a review of Resident 8's admission Record, the admission Record indicated the facility admitted Resident 8 on 2/25/2025 with a diagnosis of hypertension (high blood pressure) and anemia. During a review of Resident 8's MDS, dated [DATE], the MDS indicated Resident 8's thought process was intact and required dependent assistance from staff to complete ADLs.During a review of Resident 8's Lab and Radiology, result dated 7/28/2025, the Lab and Radiology indicated that Resident 8 was positive for COVID.During a review of Resident 9's admission Record, the admission Record indicated the facility initially admitted Resident 9 on 8/31/2016 and readmitted on [DATE] with a diagnosis of hypertension and type 2 diabetes (a condition where your body doesn't use insulin properly, a hormone that helps regulate blood sugar). During a review of Resident 9's MDS, dated [DATE], the MDS indicated Resident 9's thought process was intact and independent assistance from staff to complete ADLs.During a concurrent observation and interview on 7/28/2025 at 3:03 p.m. with Certified Nursing Assistant (CNA) 2 and License Vocational Nurse (LVN) 1, observed CNA 2 entered Resident 8 and Resident 9's room without wearing gown and gloves. LVN 1 stated CNA 2 entered Resident 8 and Resident 9's room without wearing gown and gloves. LVN 1 asked CNA 2 to wear gown and gloves before entering a COVID isolation room to prevent the spread of infection. During a concurrent interview on 7/28/2025 at 3:10 p.m. with LVN 2 and CNA 2, CNA 2 stated that she did not know that Resident 8 and Resident 9's room was a COVID isolation because there was no red tape on the floor by the door. LVN 2 give an in service to CNA 2 that she needs to wear a gown, glove and hand washing before entering the COVID isolation room and when leaving the COVID room to wash hands.During an interview on 7/28/2025 at 12:45 p.m. with the Infection Preventionist (IP), the IP stated that staff must wear PPE, hand washing before and after entering the room to prevent the spread of the infection and to protect themselves.During a concurrent interview on 7/29/2025 at 2:15 p.m. with Assistant Director of Nursing (ADON), the ADON stated that for COVID (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555132 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 555132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Vista Nursing and Transitional Care LLC 6120 N. Vineland Ave North Hollywood, CA 91606 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete isolation the staff need to wear proper PPE upon entering the room, to prevent the spread of the virus and include handwashing before and after entering the room.During a review of the facility policy and procedure titled, COVID-19 Management in LTC California, last review date of 1/2025, the policy and procedure indicated, Gloves and gown are to be donned before entering a room where the resident is isolation and doffed before exiting the room. When there are high rates of COVID-19 transmission in the community, healthcare providers (HCP) are more likely to encounter asymptomatic or pre-symptomatic patient. For this reason, in addition to standard precautions, the CDC recommends that HCP wear eye protection in addition to a facemask for any close contact with patients. This is particularly important if the patient cannot be reliably source controlled (resident cannot wear a mask) throughout the personal contact. An N-95 respirator instead of a facemask is recommended for any aerosol generating procedures and any other procedures that might pose a higher risk for transmission if the patient were to have COVID-19. During an outbreak, the facility will advise visitors of the outbreak, but will allow visitation, if it is still requested, and provide them with the N95 respirator with instructions on how to do a seal check. Visitors will be advised on which personal protective equipment should be donned and instructed on how to don and doff the equipment before the visit. Event ID: Facility ID: 555132 If continuation sheet Page 3 of 3