Health inspection·May 6, 2021

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some privileges, restrictions and concerns (for example, need for close monitoring) shall be noted on the care plan . According to the facility's policy, titled Care Plans, Comprehensive Person- Centered, revised 12/2016, A comprehensive, person-centered care plan that includes measurable and timetables to meet the resident's physical .and functional needs is developed and implemented for each resident . 2a. Resident 24 was admitted to the facility on [DATE], with diagnoses which included pneumonia (lung infection) and chronic obstructive pulmonary disease (COPD - lung disease that blocks airflow and makes it difficult to breathe), per the facility's Record of Admission. An observation was conducted for Resident 24 on 5/3/21 at 12 P.M. Resident 24 was sleeping and had oxygen (O2) running via nasal cannula (NC - tubing delivering O2 via nostrils). The oxygen concentrator indicated the flow rate of the oxygen was 2.5 liters per minute (LPM - rate of flow). A joint observation was conducted with the Director of Clinical Services (DCS) on 5/4/21 at 8:05 A.M. The DCS stated, The O2 is set between 2 and 2.5L (Liters). A review of Resident 24's medical record was conducted on 5/4/21 at 8:10 A.M. A physician's order, dated 2/12/20, indicated, oxygen at 2L per minute via NC (nasal cannula) as needed. A review of the resident's care plan, dated 10/19/20, titled, Resident Care Plan-Respiratory, indicated, resident is at risk for respiratory distress related to pneumonia and COPD: approaches: apply oxygen as ordered. A joint record review was conducted with the DCS on 5/4/21, at 8:15 A.M. The DCS stated the order was for 2L and it should be at 2L. The DCS stated, It (O2) should be what the physician ordered; it is for a reason based on resident's needs. According to the facility's policy, titled, Oxygen Administration, revised 10/2010, indicated, The purpose of this procedure is to provide guidelines for safe oxygen administration .1 .Review the physician's orders .for oxygen administration . According to the facility's policy, titled, Care Plans, Comprehensive Person- Centered, revised 12/2016, A comprehensive, person-centered care plan that includes measurable and timetables to meet the resident's physical .and functional needs is .implemented for each resident . 3. Resident 25 was admitted to the facility on [DATE] with diagnoses, which included chronic kidney disease (as the kidneys fail, waste and excess fluid from the blood builds up in the body), per the facility's Record of Admission. A review of the MDS (Minimum Data Set - an assessment tool) was conducted on 5/4/21. Resident 25 had a BIMS (Brief Interview for Mental Status) Score of 7 (severe intellectual impairment). On 5/3/21 at 2:31 P.M., an observation was conducted. Resident 25 was lying on the bed. Catheter tubing was visible under Resident 25's left leg. The catheter tubing was attached to a covered catheter bag that hung from the lower part of the bedframe. On 5/4/21 at 9:45 A.M., an interview and record review was conducted with LN 2. LN 2 stated nursing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 2 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some staff needed to know what cares were required, and what to monitor for, such as blockages of the catheter, presence of blood and/or cloudiness in the urine. LN 2 stated there should have been a care plan for a resident with a catheter. However, LN 2 could not locate a care plan for Resident 25's urinary catheter. On 5/6/21 at 3:18 P.M., an interview was conducted with the DON. The DON stated a care plan for an indwelling catheter should have been developed for Resident 25, to ensure catheter cares were provided as ordered. The facility's policy titled, Care Planning - Interdisciplinary Team, dated September 2013, included, . Policy Interpretation and Implementation 1. A comprehensive care plan for each resident is developed within seven (7) days of completion of the resident assessment (MDS) . The facility's policy titled Catheter Care, Urinary, dated September 2014, included, .Preparation: 1. Review the resident's care plan to assess for any special needs of the resident . 2b. Resident 4 was admitted to the facility on [DATE], with diagnoses which included chronic obstructive pulmonary disease (COPD- lung disease, too much oxygen [O2] could cause oxygen buildup, due to high carbon dioxide content in the blood that leads to drowsiness and possible death), per the facility's Record of Admission. A review of Resident 4's history and physical (H&P), dated 3/4/21, indicated Resident 4 had the capacity to understand and make decisions. On 5/3/21 at 2:41 P.M., an observation and interview of Resident 4 was conducted. Resident 4 was in bed, using oxygen (O2) via a concentrator (a device that concentrates the oxygen), running at 4 liters per minute (LPM) via nasal cannula (NC - tubing to deliver oxygen). Resident 4 stated she needed the oxygen when she was in bed, but did not need it when she was up in the wheelchair. On 5/3/21 at 5:50 P.M., a review of Resident 4's medical record was conducted. A care plan for oxygen use could not be found. An additional observation of Resident 4 was conducted on 5/3/21 at 6 P.M., 5/4/21 at 8:52 A.M., 11:45 A.M., and 3:37 P.M., 5/5/21 at 8:35 A.M., 1:50 P.M., and at 2:31 P.M. Resident 4 was connected to oxygen at 4 LPM/NC. On 5/5/21 at 1:51 P.M., an interview with certified nursing assistant (CNA) 31 was conducted. CNA 31 stated Resident 4 required oxygen when in bed and as needed. On 5/5/21 at 2:31 P.M., a joint observation, interview, and record review of Resident 4's medical record, was conducted with licensed nurse (LN) 2. LN 2 stated the physician's order for oxygen, dated 5/7/20, was 2 LPM/NC as needed for shortness of breath (SOB). LN 2 stated there was no care plan found in the medical record for the care and use of oxygen. LN 2 stated Resident 4's oxygen use should have been care planned due to risk for Resident 4 to develop skin break in the ears and cheeks. On 5/6/21 at 3:06 P.M., a joint interview and record review with the Director of Nursing (DON) was conducted. The DON stated residents with COPD should not be on a higher concentration of O2 because it was unsafe and could cause hyperventilation (rapid breathing), and harm to the residents. The DON acknowledged there was no care plan found in Resident 4's medical record. The DON stated Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 3 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 4's diagnosis and oxygen use should have been care planned so the staff would know the care to implement for the resident. The DON stated use of oxygen for residents with COPD could cause discomfort due to potential skin breakdown, and too much oxygen could cause collapse of the lungs. According to the facility's policy, titled Care Plans, Comprehensive Person- Centered, revised 12/2016, A comprehensive, person-centered care plan that includes measurable and timetables to meet the resident's physical .and functional needs is developed and implemented for each resident . 2c. Resident 42 was admitted to the facility on [DATE], with diagnoses which included acute respiratory disease (difficulty breathing), per the facility's Record of Admission. A review of Resident 42's history and physical (H&P), dated 3/4/21, indicated Resident 42 did not have the capacity to understand and make decisions. On 5/3/21 at 2:41 P.M., an observation and interview of Resident 42 was conducted. Resident 42 was up in a wheelchair, eating lunch, and was connected to an oxygen concentrator (a device that concentrates the oxygen) running at 3.5 liters per minute (LPM) via nasal cannula (NC - tubing to deliver oxygen). Resident 42 did not respond to interview questions and continued eating her meal. Observations of Resident 42 were conducted on 5/4/21 at 10:32 A.M., and 3:33 P.M. Resident 42 was using oxygen running at 3.5 LPM/NC. On 5/5/21 at 9:01 A.M., a review of Resident 42's medical record was conducted. There was no care plan found for the use of oxygen. On 5/5/21 at 1:59 P.M., an interview with certified nursing assistant (CNA) 31 was conducted. CNA 31 stated Resident 42 required oxygen when she became anxious and as needed. On 5/5/21 at 2:29 P.M., a joint observation, interview, and record review of Resident 42 was conducted with LN 2. LN 2 stated the physician's oxygen order, dated 2/29/20, was 2 LPM/NC as needed for shortness of breath (SOB). LN 2 stated Resident 42 needed oxygen to help control her breathing when she became anxious. LN 2 stated she did not found Resident 42's care plan in the medical record for the use of oxygen. LN 2 stated a care plan should have been developed to monitor the care and the effectiveness of treatment provided to Resident 42. On 5/6/21 at 3:09 P.M., a joint interview and record review with the director of nursing (DON) was conducted. The DON acknowledged there was no care plan found in Resident 42's record for the oxygen use. The DON stated care plan was important as it directed a resident's care. A review of the facility's policy, titled Care Plans, Comprehensive Person- Centered, revised 12/2016, indicated, A comprehensive, person-centered care plan that includes measurable and timetables to meet the resident's physical .and functional needs is developed and implemented for each resident . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 4 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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 implement a physician's order related to: Residents Affected - Few a. medication administration, and b. monitoring for side effects of a medication for one of one sampled residents (2). This failure had the potential to affect the resident's physical and emotional needs and care. Findings: Resident 2 was admitted to the facility on [DATE], with diagnoses, which included insomnia (inability to sleep) and anxiety (excessive worrying), per the physician's progress note, dated 4/29/19. a. A review of Resident 2's medical record was conducted on 5/5/21 at 11:45 A.M. A physician's order, with no date, indicated, d/c (discontinue) temazepam (medication to treat insomnia); start lorazepam (medication to treat anxiety and insomnia) 1 mg q (every) hs (bedtime) for insomnia. A concurrent record review and interview was conducted on 5/5/21 at 11:47 A.M. with the Director of Clinical Services (DCS). The DCS stated that the physician's order had no date, and had not been implemented. A concurrent record review and interview was conducted on 5/5/21 at 11:49 A.M. with the Director of Nursing (DON). In addition, the DON called the ordering physician for clarification of the order. The DON stated, The order was written on 4/29/21 and the resident (2) had been getting the discontinued medication since 4/29/21; and the new medication had not been started when ordered on 4/29/21. The MD order was not followed, it should have been. A concurrent record review and interview, via telephone, was conducted on 5/6/21 at 9:18 A.M. with the pharmacy consultant (PC). The PC stated the order was received on 4/30/21, and the medication was delivered to facility on 4/30/21. The PC stated, The resident did not receive the medication for 5 days, it could affect sleep since it is for insomnia. A review of the facility's policy, dated 4/2019, titled, Administering Medications, indicated, .Policy Interpretation and Implementation .4. medications are administered in accordance with prescriber orders . b. A review of Resident 2's medical record was conducted on 5/5/21 at 11:45 A.M. A physician's order, dated, 3/28/21, indicated, monitor side effects of temazepam (for insomnia) every shift. A review of the MAR (medication administration record) indicated missing documentation on 5/2/21, evening shift, and 5/4/21, day shift. A review of Resident 2's care plan, dated 8/6/19, indicated, resident has episodes of depression manifested by insomnia, monitor and record episodes . A concurrent record review and interview was conducted on 5/5/21 at 12 P.M. with the DCS. The DCS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 5 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stated there were two days of documentation missing and it meant it was not done. The DCS stated, It is important to do the monitoring for correct dosage and correct medication. According to the Scope of Regulations excerpt for the Business and Professions Code Division 2, Chapter 6. Article 2, Section 2725, Legislative Intent: Practice of Nursing Defined of the California Nursing Practice Act, dated 2012, . (b) The Practice of nursing . including all of the following . (2) Direct and indirect patient care services . necessary to implement a treatment, disease preventing or rehabilitative regime ordered by and within the scope of licensure of a physician Event ID: Facility ID: 555158 If continuation sheet Page 6 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide podiatry services for one of one residents (25) reviewed for Activities of Daily Living (ADL). Residents Affected - Few This failure had the potential to cause pain and possible infection if the overgrown toenails damaged the resident's skin. Findings: Resident 25 was admitted to the facility on [DATE], with diagnoses which included acute kidney failure (the kidneys did not function), per the facility's Record of Admission. A review of the MDS (Minimum Data Set - an assessment tool) was conducted on 5/4/21. Resident 25 had a BIMS (Brief Interview for Mental Status) Score of 7 which indicated, severe intellectual impairment, and required extensive assistance with ADL. On 5/5/21 at 8:26 A.M., an observation and interview was conducted with Resident 25. Resident 25 had long curling toenails on both feet. The last toenail of the right foot was approximately one and a half inches long. Resident 25's toenails on both feet were curling over the ends of his toes, and grew into each other. Resident 25 stated his toenails were digging into his feet and it was painful. On 5/5/21 at 8:30 A.M., an observation and interview was conducted with certified nurse assistant (CNA) 1 and Resident 25. CNA 1 stated Resident 25's toenails were very long. CNA 1 stated it was important toenails were cut because long toenails could result in skin tears. CNA 1 stated Resident 25's long toenails should have been reported to the licensed nurse (LN). On 5/5/21 at 8:38 A.M., an interview was conducted with the Director of Social Services (DSS). The DSS stated a podiatrist had visited the facility in March this year, 2021. The DSS stated the LN referred a resident for podiatry services to the DSS and the DSS scheduled onsite visits with the podiatrist. On 5/5/21 at 8:45 A.M., an observation and interview was conducted with the Director of Nursing (DON) and Resident 25. The DON stated Resident 25's toenails were too long. The DON stated it was her expectation CNAs who assessed Resident 25's skin, should have reported his podiatry needs to the LN. The DON stated it was the responsibility of CNAs and LNs to report and refer any residents in need of podiatry services. The DON stated it was an issue of dignity if the toenails were long and unkempt. The DON stated the long toenails could result in Resident 25 sustaining skin tears. On 5/5/21 at 10 A.M., a record review was conducted. Resident 25's Physician Orders, dated 2/28/21, included, .Podiatry care every 61 days and as needed for hypertrophic/mycotic (toenails which grew abnormally thick over time) toenails . Resident 25's care plan for Activities of Daily Living (ADLs) dated 2/24/21, included, .Assist with ADLs as needed .Personal Hygiene - Total Dependence The facility's policy titled, Activities of Daily Living (ADL), Supporting, dated March 2018, included, .Residents who are unable to carry out activities of daily living independently will receive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 7 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0677 the services necessary to maintain good nutrition, grooming . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 8 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not provide restorative nurse's aide (RNA) services as ordered for one of one resident (10) reviewed for RNA services. This failure had the potential for Resident 10's contractures to worsen. Findings: Resident 10 was re-admitted to the facility on [DATE], with diagnoses to include muscle wasting and atrophy (decrease in muscle mass due to extended immobility). An MDS (Minimum Data Set - an assessment tool), dated 1/27/21, indicated Resident 10 had a BIMS (Brief Interview for Mental Status - an assessment tool) score of 99 (99 indicates unable to assess mental status). On 5/3/21 at 1:07 P.M., an observation of Resident 10 was conducted. Resident 10 was in bed, lying on his left side, and head of the bed was elevated. Resident 10 was fully covered by a thick blanket, with only his head exposed. On 5/4/21 at 8:58 A.M., an observation of Resident 10 was conducted. Resident 10 was lying on his left side and his eyes closed. His contractures were not visualized. A review of Resident 10's physicians order was conducted. A physician order, dated 3/5/21, indicated, RNA to provide resident: each UE (upper extremity) joint .10 reps (repetitions) . or as tolerated 5x/week (five times a week). A physician order, dated 3/5/21, indicated, CNA (certified nurse assistant), RNA to apply bilateral handrolls (a roll of fabric placed in the hands to prevent contractures) 4 hrs (hours) on/off or as tolerated daily .q (every) shift. A review of Resident 10's care plan, titled, At risk for new and/or further development of Joint limitation/contracture secondary to Decreased mobility ., dated 3/5/21, indicated the following goals .Each UE joint .10 reps .or as tolerated .5x week (five times a week), and . Uses handroll(s) . The interventions included, .Apply handroll (s) 4 hrs (hours) on/off or as tolerated daily . On 5/5/21 at 10:06 A.M., an observation of Resident 10, and an interview with CNA 21 was conducted. Resident 10 was lying on his left side and slightly moving his bilateral lower extremities. CNA 21 asked Resident 10 to show his right hand, but the resident refused. CNA 21 stated Resident 10 had contractures at his left lower extremity (LLE), and on his right upper extremity (RUE). Resident 10 had a contracture on his right hand. There were no handrolls in Resident 10's right hand. CNA 21 stated she did not see a hand roll when changing Resident 10's linens. CNA 21 further stated at times Resident 10 refused the hand roll. On 5/5/21 at 11:30 A.M., an observation, and interview with RNA 21 was conducted. Resident 10 was in bed, with nothing in his right hand. Resident 10 opened his right hand on RNA 21's command. RNA 21 stated RNA 22 was the assigned RNA for Resident 10. RNA 21 stated physical therapy handed the RNA care plan to the RNAs when a resident required RNA services. RNA 21 stated the RNA binder provided the care plans and the list of residents who needed RNA services. RNA 21 stated, if RNA 22 was not available to provide the resident with RNA services, then RNA 21 would fill in. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 9 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 5/5/21 at 11:35 A.M., a joint record review of Resident 10's RNA treatment administration record (TAR) for April 2021 was conducted with RNA 21; On 4/1/21 Resident 10 was at a doctor's appointment and RNA was not provided. On 4/2/21 Resident 10 refused range of motion (ROM - passive flexion and extension exercises to help improve joint function) and handrolls. There was no documentation of RNA provided nor resident refusal from 4/3 to 4/16/21. On 4/17/21 Resident 10 refused ROM and handrolls. On 4/18/21 Resident 10 had refused RNA services. There was no documentation of RNA provided, nor resident refusal, from 4/19 to 4/25/21. On 5/5/21 at 2:06 P.M., an interview and record review was conducted with CNA 23. CNA 23 stated Resident 10's RNA TAR for April 2021 indicated, Resident 10 refused four days of RNA services and was not provided RNA services for a total of 20 days in April 2021. CNA 23 stated the order on the TAR indicated to perform RNA services five times a week to improve the resident's mobility and prevent contractures. On 5/5/21 at 3:35 P.M., an interview with the Occupational Therapist (OT) was conducted. The OT stated a resident received RNA services, as a physician's order, to maintain their function, strength and range of motion. The OT stated, if a resident went three days without RNA services, there was a tendency for regression of their joint mobility. On 5/6/21, at 3:11 P.M., an interview and record review with the Director of Nursing (DON) was conducted. The DON stated there should be someone to replace the RNA to render RNA services to the resident. The DON further stated, if the physician order for RNA was not followed, it could result in a potential harm to the resident, and a decline in the resident's condition. A review of the facility's policy titled, Restorative Nursing Services, revised July 2017, indicated, Residents will receive restorative nursing care .5. Restorative goals may include . maintaining or strengthening his/her physiological .resources . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 10 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident 4 was admitted to the facility on [DATE], with diagnoses which included chronic obstructive pulmonary disease (COPD- lung disease, too much oxygen [O2] could cause oxygen buildup, due to high carbon dioxide content in the blood that leads to drowsiness and possible death), per the facility's Record of Admission. Residents Affected - Few A review of Resident 4's history and physical (H&P), dated 3/4/21, indicated Resident 4 had the capacity to understand and make decisions. On 5/3/21 at 2:41 P.M., an observation and interview of Resident 4 was conducted. Resident 4 was in bed, using oxygen (O2) via a concentrator (a device that concentrates the oxygen), running at 4 liters per minute (LPM) via nasal cannula (NC - tubing to deliver oxygen). Resident 4 stated she needed the oxygen when she was in bed, and but did not need it when she was up in the wheelchair. An additional observation of Resident 4 was conducted 5/3/21 at 6 P.M., 5/4/21 at 8:52 A.M., 11:45 A.M., 3:37 P.M., and 5/5/21 at 8:35 A.M., 1:50 P.M., and at 2:31 P.M. Resident 4 was using oxygen at 4 LPM/NC. On 5/5/21 at 1:51 P.M., an interview with CNA 31 was conducted. CNA 31 stated Resident 4 required oxygen when in bed and as needed. CNA 31 stated Resident 4 asked her to turn on the oxygen concentrator. CNA 31 stated, If everything is set, I can, if nurses are not here, I could give her the cannula and just switch on the little switch. On 5/5/21 at 2:31 P.M., a joint observation, interview, and record review of Resident 4 was conducted with licensed nurse (LN) 2. LN 2 stated Resident 4's physician order for oxygen, dated 5/7/20, was 2 LPM/NC as needed for shortness of breath (SOB). LN 2 acknowledged Resident 4's O2 was running at 4 LPM/NC. LN 2 stated the physician's order should have been followed because residents with COPD should not be given a higher level of oxygen flow because it could cause rapid breathing. On 5/5/21 at 5:27 P.M., an interview with the Director of Staff Development (DSD) was conducted. The DSD stated, CNAs were never allowed to touch the resident's oxygen because they were not licensed, and instead of helping the resident, it could harm the resident. On 5/6/21 at 3:06 P.M., a joint interview and record review with the Director of Nursing (DON) was conducted. The DON stated residents with COPD should not be on a higher concentration of O2 because it was unsafe, could cause hyperventilation (rapid breathing), and could cause harm to the residents. The DON stated it was the LNs responsibility to make sure the physician's order were followed. On 5/6/21 at 3:09 P.M., the DON stated only LNs were allowed to administer oxygen to residents. The DON stated she was not aware CNAs administered oxygen. The DON further stated CNAs should have understood the scope and limitation of their practice. The DON also stated it was unsafe for the CNA to perform beyond their scope of practice and could harm the residents. According to the facility's policy, titled Oxygen Administration, revised 10/2010, indicated, The purpose of this procedure is to provide guidelines for safe oxygen administration .1 .Review the physician's orders .for oxygen administration . A review of the facility's undated certified nursing assistant job summary was conducted. The CNAs (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 11 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0695 responsibilities did not include administering oxygen treatment to a resident. Level of Harm - Minimal harm or potential for actual harm Per the California Health and Safety Code-Division 2. Licensing provisions [1200-1797.8], Chapter 2. Health Facilities, Article 9 Section 1337 (a)(3), dated 7/28/09, Certified nurse assistant means any person who holds himself or herself out as a certified nurse assistant and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed the requirements of this article. These services shall not include any services which may only be performed by a licensed person and otherwise shall be performed under the supervision of a registered nurse, as defined in Section 2725 of the Business and Professions Code, or a licensed vocational nurse, as defined in Section 2859 of the Business and Professions Code. Residents Affected - Few 3. Resident 42 was admitted to the facility on [DATE], with diagnoses which included acute respiratory disease (difficulty breathing), per the facility's Record of Admission. A review of Resident 42's history and physical (H&P), dated 3/4/21, indicated Resident 42 did not have the capacity to understand and make decisions. On 5/3/21 at 2:41 P.M., an observation and interview of Resident 42 was conducted. Resident 42 was up in a wheelchair eating lunch, and was connected to an oxygen concentrator (a device that concentrates the oxygen) running at 3.5 liters per minute (LPM) via nasal cannula (NC - tubing to deliver oxygen). Resident 42 did not respond to interview question and continued eating her meal. Observations of Resident 42 were conducted on 5/4/21 at 10:32 A.M., and 3:33 P.M. Resident 42 was using oxygen running at 3.5 LPM/NC. On 5/5/21 at 1:59 P.M., an interview with CNA 31 was conducted. CNA 31 stated Resident 42 was on oxygen as needed. CNA 31 stated Resident 42 required oxygen when she became anxious. CNA 31 stated Resident 42 asked her to turn on the oxygen concentrator. CNA 31 stated, If everything is set, I can, if nurses are not here, I could give her the cannula and just switch on the little switch. On 5/5/21 at 2:29 P.M., a joint observation, interview, and review of Resident 42's record was conducted with LN 2. LN 2 stated the physician's order for oxygen, dated 2/29/20, was 2 LPM/NC as needed for shortness of breath (SOB). LN 2 stated Resident 42 needed oxygen to help control her breathing when she became anxious. LN 2 stated, LNs were responsible for administering oxygen to residents to make sure the dose was correct. LN 2 switched on the oxygen concentrator. LN 2 acknowledged Resident 42's oxygen was set at 3.5 LPM/NC. LN 2 stated, Oh it was not 2 LPM. On 5/5/21 at 5:27 P.M., an interview with the Director of Staff Development (DSD) was conducted. The DSD stated, CNAs were never allowed to touch the resident's oxygen because they were not licensed, and instead of helping the resident, it could harm the resident. On 5/6/21 at 3:09 P.M., a joint interview and record review with the director of nursing (DON) was conducted. The DON stated it was the LNs responsibility to ensure the physician's order for Resident 4 were followed. The DON stated only the LNs were allowed to administer oxygen to residents. The DON stated she was not aware that CNAs administered oxygen. The DON further stated CNAs should have understood the scope and limitation of their practice. The DON also stated it was unsafe for the CNA to perform beyond their scope of practice and could harm the residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 12 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few According to the facility's policy, titled Oxygen Administration, revised 10/2010, indicated, The purpose of this procedure is to provide guidelines for safe oxygen administration .1 . Review the physician's orders . for oxygen administration . A review of the facility's undated certified nursing assistant job summary was conducted. The CNAs responsibilities did not include administering oxygen treatment to a resident. Per the California Health and Safety Code-Division 2. Licensing provisions [1200-1797.8], Chapter 2. Health Facilities, Article 9 Section 1337 (a)(3), dated 7/28/09, Certified nurse assistant means any person who holds himself or herself out as a certified nurse assistant and who, for compensation, performs basic patient care services directed at the safety, comfort, personal hygiene, and protection of patients, and is certified as having completed the requirements of this article. These services shall not include any services which may only be performed by a licensed person and otherwise shall be performed under the supervision of a registered nurse, as defined in Section 2725 of the Business and Professions Code, or a licensed vocational nurse, as defined in Section 2859 of the Business and Professions Code. Based on observation, interview and record review, the facility failed to follow a physician's order related to oxygen use for three of three residents (24, 4, & 42) reviewed for respiratory care. In addition, the facility failed to ensure a certified nursing assistant (CNA) provided care within their scope of practice. These failures had the potential to cause harm to residents. Findings: 1. Resident 24 was admitted to the facility on [DATE], with diagnoses which included pneumonia (lung infection) and chronic obstructive pulmonary disease (COPD - lung disease that blocks airflow and makes it difficult to breathe), per the facility's Record of Admission. An observation was conducted for Resident 24 on 5/3/21 at 12 P.M. Resident 24 was sleeping and had oxygen (O2) via nasal cannula applied. The oxygen concentrator indicated the flow rate of the oxygen was 2.5 liters per minute (LPM). A joint observation was conducted with the Director of Clinical Services (DCS) on 5/4/21 at 8:05 A.M. The DCS stated, The O2 is set between 2 and 2.5 L. A review of Resident 24's medical record was conducted on 5/4/21 at 8:10 A.M. A physician's order indicated, oxygen at 2L per minute via NC (nasal cannula) as needed. A joint record review was conducted with the DCS on 5/4/21 at 8:15 A.M. The DCS stated the order is for 2L and it should be at 2L. The DCS stated, It (O2) should be what the physician ordered, it is for a reason based on residents needs. According to the facility's policy titled, Oxygen Administration, revised 10/2010, indicated, The purpose of this procedure is to provide guidelines for safe oxygen administration .1 . Review the physician's orders .for oxygen administration . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 13 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0710 Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to obtain a physician's order for one of three residents (25) reviewed for catheter care. Residents Affected - Few This failure had the potential to result in a lack of treatment and services for a resident with an indwelling catheter. Findings: Resident 25 was admitted to the facility on [DATE], with diagnoses which included chronic kidney disease (as the kidneys fail, waste and excess fluid from the blood builds up in the body), per the facility's Record of Admission. A review of the Minimum Data Set (MDS - an assessment tool) was conducted on 5/4/21. Resident 25 had a BIMS (Brief Interview for Mental Status) Score of 7, which indicated, severe intellectual impairment. On 5/3/21 at 2:31 P.M., an observation was conducted. Resident 25 was lying on the bed. Catheter tubing was visible under Resident 25's left leg. The catheter tubing was attached to a covered catheter bag that hung from the lower part of the bedframe. On 5/4/21 at 9:45 A.M., a record review and interview was conducted with LN 2. LN 2 could not locate a physician's order for Resident 25's urinary catheter. LN 2 stated there should be a physician's order for a resident with an indwelling catheter because nursing staff needed to know what orders the doctor wanted for the catheter care. On 5/6/21 at 3:18 P.M., an interview was conducted with the DON. The DON stated the LN should have notified the physician that Resident 25 had an indwelling catheter without a physician's order. The DON stated it was her expectation the doctor assessed the resident within two days of admission to the facility, to ensure all orders were in place. The facility's policy titled Physician Orders and Telephone Orders, dated January 2004, included Policies: 1. Physician's orders shall be obtained prior to the initiation of any medication or treatment from a person lawfully authorized to prescribe for and treat human illness .All orders must be specific and complete . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 14 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure the medication error rate was less than five percent. Fifteen medication errors out of 29 opportunities were identified during medication (med) administration, when nursing: Residents Affected - Few 1. Administered seven crushed medications all at once (instead of individually) via the PEG (Percutaneous endoscopic gastrostomy tube - a tube placed directly into the stomach for the administration of food, fluids, and medications) tube to Resident 37, 2. Administered four crushed medications all at once (instead of individually) via PEG tube to Resident 18, and 3. Omitted four oral medications for Resident 304. This failure resulted in a medication error rate of 51.72% Findings: 1. On 5/5/21 at 10:11 A.M., a med pass observation for Resident 37 was conducted with licensed nurse (LN) 2. LN 2 took Resident 37's med blister packs of: -Vitamin C 500 milligram (mg) tablet (tab) one tab, - Levothyroxine [med to treat hypothyroidism] (condition where the thyroid gland does not produce enough thyroid hormone) 150 microgram (mcg) tab one tab - Anastrozole (med to treat early breast cancer in women) 1 mg tab one tab, - Jardiance (med to help improve blood sugar) 10 mg tab one tab, - Metformin (med to help improve blood sugar) 1000 mg tab one tab, - Amlodipine (med to treat high blood pressure) 5 mg tab one tab, and - Carvedilol (med to treat high blood pressure) 12.5 mg tab one tab. LN 2 popped each tablet into a med cup. From the med cup, LN 2 poured the seven meds in a small plastic bag, crushed altogether, she felt the plastic bag, placed the crushed meds back to the pill crusher, poured the crushed pills back into the med cup, added 30 milliliters (ml) of water and mixed them. LN 2 checked Resident 37's PEG tube placement, and put the mixed meds in a gastrostomy (GT) syringe and administered via PEG. On 5/5/21 at 2:33 P.M., a concurrent interview and record review was conducted with LN 2. LN 2 stated she double crushed the medications by placing back the crushed meds in the plastic bag to the pill crusher before administering to Resident 37 to prevent from clogging the PEG tube. LN 2 acknowledged she should have administered the medications one at a time, but, she administered all the medications all at once. LN 2 stated administering medications at the same time could cause clogging of the PEG tube. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 15 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 5/5/21 at 3:25 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated crushing the medications and administering all medications at once via PEG tube could have caused the tubing to clog. The DON stated LN 2 did not follow the facility's policy. Per the facility's policy titled, Medication Administered Through an Enteral Tube, revised 11/2018, indicated, .Procedure .3. Administer each medication separately and flush between medications . 2. On 5/5/21 at 11:33 A.M., a med pass observation for Resident 18 was conducted with LN 2. LN 2 took Resident 18's med blister packs of: - Vitamin D3 25 mcg tab one tab, - Zinc 50 mg tab one tab, - Daily Vite Multivitamin tab one tab, and - Acetaminophen 325 mg 2 tabs. LN 2 popped each tablet into a medicine cup. From the medicine cup, LN 2 poured the four medicines in a small plastic bag, crushed altogether in the pill crusher, poured the crushed pills back into the medicine cup, added 30 milliliters (ml) of water and mixed them. LN 2 checked Resident 18's PEG tube placement, and put the mixed medications in a GT syringe and administered via PEG. On 5/5/21 at 2:33 P.M., a concurrent interview and record review was conducted with LN 2. LN 2 stated she crushed the medications before administering to Resident 18 to prevent clogging the PEG tube. LN 2 acknowledged she should have administered the medications one by one, but, she did it all at once. LN 2 stated administering medications at the same time could cause clogging of the PEG tube. On 5/5/21 at 3:25 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated LN 2 did not follow the facility's policy. The DON stated crushing the medications and administering all medications at once via PEG tube could have caused the tubing to clog. Per the facility's policy titled, Medication Administered Through an Enteral Tube, revised 11/2018, indicated, .Procedure . 3. Administer each medication separately and flush between medications 3. On 5/6/21 at 9:13 A.M., a medication pass observation for Resident 304 was conducted with licensed nurse (LN) 11. LN 11 took eight medication blister packs (contain medications to be taken at particular times of the day) from the medication cart for Resident 304. Four medication blister packs had no expiration dates. The medications were identified as: - Carbidopa- Levodopa (for Parkinson's disease). - Memantine Hydrochloride (for Alzheimer's disease). - Pioglitazone Hydrochloride (for diabetes). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 16 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0759 - Megestrol (appetite stimulant). Level of Harm - Minimal harm or potential for actual harm On 5/6/21 at 9:45 A.M., a concurrent observation, interview, and review of Resident 304's medication blister packs was conducted with LN 11. LN 11 stated the medications came from the hospice agency. LN 11 stated she did not see the expiration date in Resident 304's med labels. Residents Affected - Few On 5/6/21 at 9:50 A.M., a joint interview and review of Resident 304's medication blister packs with the Director of Clinical Services (DCS) and the Nurse Consultant (NC) was conducted. The NC stated when Resident 304's med blister packs arrived, there was no label on them. She stated she based it on the size and shape of the medicines from Resident 304's home meds which were in a bottle, peeled off the label from the bottle, and placed them on the medication blister packs. The NC stated LNs should have checked the residents' medications and the expiration dates before giving them. On 5/6/21 at 10:34 A.M., a follow up interview with LN 11 was conducted. LN 11 stated she did not give the four medications that had no expiration date, because it was past the time limit to give the medications. On 5/6/21 at 10:37 A.M., an interview with the Director of Nursing (DON) was conducted. The DON stated it was not safe for the residents to have missed their medications. A review of the facility's policy titled, Administering Medication, revised 4/2019, indicated, .Medications are administered in a safe and timely manner, and as prescribed . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 17 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure medications (med/s) were administered correctly when: Residents Affected - Few 1. Licensed nurse (LN) 2 crushed seven medications and administered all at once (instead of individually), via PEG tube (Percutaneous endoscopic gastrostomy tube - a tube placed directly into the stomach for the administration of food, fluids, and medications) to Resident 37; 2. LN 2 crushed four medications and administered all at once (instead of individually), via PEG tube to Resident 18. 3. LNs checked the medication label and expiration date of Resident 304's medications. These failures could cause harm to the residents due to unsafe administration of the medications. Findings: 1. Resident 37 was readmitted to the facility on [DATE], with diagnoses which included diabetes (high blood sugar) and with PEG tube, per the facility's Record of Admission. On 5/5/21 at 10:11 A.M., an observation of medication administration for Resident 37 was conducted with licensed nurse (LN) 2. Resident 37 was awake and lying in bed. LN 2 prepared and removed Resident 37's seven types of medications from the medication blister packs (contain medications to be taken at particular times of the day). Resident 37's medications were as follows: -Vitamin C 500 milligram (mg) tablet (tab) one tab, - Levothyroxine [med to treat hypothyroidism] (condition where the thyroid gland does not produce enough thyroid hormone) 150 microgram (mcg) tab one tab - Anastrozole (med to treat early breast cancer in women) 1 mg tab one tab, - Jardiance (med to help improve blood sugar) 10 mg tab one tab, - Metformin (med to help improve blood sugar) 1000 mg tab one tab, - Amlodipine (med to treat high blood pressure) 5 mg tab one tab, and - Carvedilol (med to treat high blood pressure) 12.5 mg tab one tab. LN 2 popped each tablet into a med cup. From the med cup, LN 2 poured the seven meds in a small plastic bag, crushed altogether, she felt the plastic bag, placed the crushed meds back to the pill crusher, poured the crushed pills back into the med cup, added 30 milliliters (ml) of water and mixed them. LN 2 checked Resident 37's PEG tube placement and put the mixed meds in a gastrostomy (GT) syringe and administered via PEG. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 18 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 5/5/21 at 2:33 P.M., a concurrent interview and record review was conducted with LN 2. LN 2 stated she double crushed the medications to prevent clogging Resident 37's PEG tube. LN 2 acknowledged she should have administered the medications one by one, but she did it all at once. LN 2 stated administering medications all at once could clog the PEG tube, and the resident would not receive their medications. On 5/5/21 at 3:25 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated LN 2 did not follow the facility's policy. The DON stated crushing the medication and administering all medications at once via PEG tube could have caused the tubing to clog. Per the facility's policy titled, Medication Administered Through an Enteral Tube, revised 11/2018, indicated, .Procedure . 3. Administer each medication separately and flush between medications 2. Resident 18 was admitted to the facility on [DATE], with diagnoses which included dysphagia (difficulty swallowing) and with PEG tube, per the facility's Record of Admission. On 5/5/21 at 11:33 A.M., an observation of medication administration for Resident 18 was conducted with LN 2. Resident 18 was lying in bed and did not respond to her name. LN 2 prepared Resident 18's four medications as: - Vitamin D3 25 mcg tab one tab, - Zinc 50 mg tab one tab, - Daily Vite Multivitamin tab one tab, and - Acetaminophen 325 mg 2 tabs. LN 2 popped each tablet into a medicine cup. From the medicine cup, LN 2 poured the four medicines in a small plastic bag, crushed altogether in the pill crusher, poured the crushed pills back into the medicine cup, added 30 milliliters (ml) of water and mixed them. LN 2 checked Resident 18's PEG tube placement and put the mixed medications in a GT syringe and administered via PEG. On 5/5/21 at 2:33 P.M., a concurrent interview and record review was conducted with LN 2. LN 2 acknowledged she should have administered the medications one by one, but she did it all at once. LN 2 stated administering medications all at once could clog the PEG tube, and the resident would not receive their medications. On 5/5/21 at 3:25 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated LN 2 did not follow the facility's policy. The DON stated crushing the medication and administering all medications at once via PEG tube could have caused the tubing to clog. Per the facility's policy titled, Medication Administered Through an Enteral Tube, revised 11/2018, indicated, .Procedure . 3. Administer each medication separately and flush between medications 3. Resident 304 was admitted to the facility on [DATE], with diagnoses which included Parkinson's disease (a brain disorder that leads to shaking, stiffness and difficulty with walking, balance and coordination), Alzheimer's disease (the disease that affects the brain that control memory, language, and thinking skills), and diabetes (high blood sugar), per the facility's Record of Admission. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 19 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0760 Level of Harm - Minimal harm or potential for actual harm On 5/6/21 at 9:13 A.M., an observation of medication administration for Resident 304 was conducted with licensed nurse (LN) 11. LN 11 took out eight medication blister packs from the medication cart for Resident 304. Four medication blister packs had no expiration date. The medications with no expiration dates were identified as: Residents Affected - Few - Carbidopa- Levodopa (for Parkinson's disease). - Memantine Hydrochloride (for Alzheimer's disease). - Pioglitazone Hydrochloride (for diabetes). - Megestrol (appetite stimulant). On 5/6/21 at 9:45 A.M., a concurrent interview and review of Resident 304's medication blister packs was conducted with LN 11. LN 11 stated she trusted the nocturnal (night) nurses who received the resident's medications. LN 11 acknowledged the medication labels were old and had no expiration dates. On 5/6/21 at 9:50 A.M., a joint interview and review of Resident 304's medication blister packs with the Director of Clinical Services (DCS) and the Nurse Consultant (NC) was conducted. The NC stated when Resident 304's med blister packs arrived, there was no label on them. She stated she based it on the size and shape of the medicines from Resident 304's home meds which were in a bottle, peeled off the label from the bottle, and placed them on the medication blister packs. The NC stated LNs should have checked the residents' medications and the expiration dates before giving them. On 5/6/21 at 10:34 A.M., a follow up interview with LN 11 was conducted. LN 11 stated she did not give the four medications that had no expiration date. LN 11 stated, I am checking the labels now. On 5/6/21 at 10:37 A.M., an interview with the Director of Nursing (DON) was conducted. The DON stated the expectation was for the LNs to assess and reconcile the residents' medications, and to make sure the medications were not expired for residents' safety. A review of the facility's policy titled, Administering Medication, revised 4/2019, indicated, . 12. The expiration/ beyond use date on the medication label is checked prior to administering . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 20 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure: 1. Medications (med) were labeled with an expiration date for one resident (304), and an opened bottle of normal saline was dated and labeled for one of three medication carts; 2. Expired bottles of iron supplements were co-mingled with current medications readily available for use; 3. Expired biologicals (glucose test solutions, glucose test strips, iodine swab sticks, nasal swabs, and laboratory [lab] tubes) were co-mingled with treatment supplies in two of three medication carts; and 4. The temperature was monitored for one of two medication storage rooms. These failures had the potential for residents to receive expired medications, and affect the efficacy of medications and effectiveness of treatment. Findings: 1a. Resident 304 was admitted to the facility on [DATE], with diagnoses which included Parkinson's Disease (a brain disorder that leads to shaking, stiffness and difficulty with walking, balance and coordination), Alzheimer's Disease (a disease affecting the brain that controls memory, language, and thinking skills), and diabetes (high blood sugar), per the facility's Record of Admission. On 5/6/21 at 9:13 A.M., an observation of medication administration for Resident 304 was conducted with licensed nurse (LN) 11. Four medication blister packs for Resident 304 had no expiration dates. The medications were as follows: - Carbidopa- Levodopa (for Parkinson's disease). - Memantine Hydrochloride (for Alzheimer's disease). - Pioglitazone Hydrochloride (for diabetes). - Megestrol (appetite stimulant). In addition, one whole blister pack of Losartan (medication to lower blood pressure) was labeled with two different dispensing pharmacies. On 5/6/21 at 9:45 A.M., a concurrent interview and review of Resident 304's medication blister packs was conducted with LN 11. LN 11 stated the medications came from the hospice agency. LN 11 acknowledged the medication labels were old and had no expiration dates. On 5/6/21 at 9:50 A.M., a joint interview and review of Resident 304's med blister packs with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 21 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0761 Director of Clinical Services (DCS) and the Nurse Consultant (NC) was conducted. Level of Harm - Minimal harm or potential for actual harm The DCS acknowledged the med label looked old, and there was no expiration date. Residents Affected - Few The NC stated when Resident 304's med blister packs arrived, there was no label on them. The NC stated she based it on the size and shape of the medicines from Resident 304's home meds which were in a bottle, peeled off the label from the bottle, and pasted them on top of the med blister packs. The NC stated LNs should have checked the residents' medications and the expiration dates before giving them. On 5/6/21 at 10:37 A.M., an interview with the Director of Nursing (DON) was conducted. The DON stated the LNs should have checked the medications were properly labeled for the safety of the residents. A review of the facility's policy titled, Storage of Medications, revised 11/2020, indicated, .4. Drug containers that have . improper, or incorrect labels are returned to the pharmacy for proper labeling before storing 1b. On 5/6/2021 at 10:20 A.M., an observation of treatment cart 1, and an interview with the Director of Clinical Services (DCS) was conducted. In the first drawer of treatment cart 1, one bottle of normal saline was opened, undated, and a third full. The DCS stated it was important to date and label an opened bottle with the resident's name to ensure it was being used for the correct resident. The DCS further stated the bottle should have been dated when opened. A review of the facility's policy, titled Dressings/Clean, dated, September 2013, indicated, .Date and initial all bottles .upon opening (unless product is single use) . 2. On 5/5/21 at 3:47 P.M., an observation of the medication storage room and an interview with the Director of Nursing (DON) was conducted. The medication storage room was located at nurse station 1. There were 12 bottles of iron supplement elixir, with expiration dates: 8/20, 10/20, and 11/20. The DON stated these expired medications should have been discarded for safety reasons. The DON further stated the licensed nurses (LN) should have checked the medication expiration dates. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .outdated .drugs or biologicals are returned to the dispensing pharmacy or destroyed . 3a. On 5/5/21 at 3:47 P.M., an observation of the medication storage room and an interview with the Director of Nursing (DON) was conducted. The medication storage room was located at nurse station 1. There were four small zip bags, each containing two bottles of glucose (blood sugar) test solutions (low and high) for glucometer readings (a device to check blood sugar levels). Two bags contained expired glucose test solutions. The bottles of test solutions for low glucose readings expired March 2021. The bottles of test solutions for high glucose readings expired January 2021. The DON stated the expired bottles of test solutions should not have been used because they could lead to inaccurate blood sugar readings on the glucometer. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .outdated .drugs or biologicals are returned to the dispensing pharmacy or destroyed . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 22 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0761 Level of Harm - Minimal harm or potential for actual harm 3b. On 5/6/21 at 10:20 A.M., an observation of treatment cart 1, and an interview with the Director of Clinical Services (DCS) was conducted. In the second drawer, a bottle of glucometer strips had an expiration date of 2019-3-31. The DCS stated these glucometer strips should not have been used, and could have resulted in false blood sugar readings. The DCS further stated treatment cart 1 should have been checked for expired supplies. Residents Affected - Few A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .outdated .drugs or biologicals are returned to the dispensing pharmacy or destroyed . 3c. On 5/6/21 at 11:33 A.M., an observation of an intravenous (IV - administered into a vein) medication cart, and an interview with the Director of Clinical Services (DCS) was conducted. The first drawer contained povidone-iodine (disinfectant) swab sticks. Five povidone-iodine swab sticks were expired with the date of 2020/9/20. The DCS stated the swab sticks should have been discarded because the disinfection may have been ineffective. The DCS further stated the carts should have been checked for expired medications and biologicals. The second drawer contained nasal swabs and lab tubes. Five nasal swabs had an expiration date of 2020/4. A sixth nasal swab had the expiration date of 2020/8/31. There were multiple lab tubes with expiration dates of 6/30/2020. The DCS stated the lab tubes may not be effective, resulting in incorrect lab results, and should have been discarded. On 5/6/21 at 3:11 P.M., an interview with the DON and the DCS was conducted. The DON stated the nurses using the IV medication cart should have checked the medications and biologicals were not expired. The DON stated it was a safety issue and expired medications and biologicals could potentially cause harm to a resident. The DON further stated expired nasal swabs and lab tubes could lead to inaccurate lab and culture results. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .outdated .drugs or biologicals are returned to the dispensing pharmacy or destroyed . 4. On 5/5/21 at 3:47 P.M., an observation of the medication storage room and an interview with the Director of Nursing (DON) was conducted. There was no thermometer in the medication storage room. There was a clipboard with a paper, titled, Temperature Log, dated 10/2020. There were no temperatures documented on the log to indicate the temperature of the medication storage room. The DON stated temperature checks for the medication storage room were not documented. On 5/6/21 at 3:11 P.M., a joint interview with the DON and the Director of Clinical Services (DCS) was conducted. The DON stated the temperature in the medication storage room should have been monitored, because temperature could affect medications and biologicals stored in the medication room. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .Drugs and biologicals used in the facility are stored .under proper temperature . 1b. On 5/6/2021 at 10:20 A.M., an observation of treatment cart 1, and an interview with the Director of Clinical Services (DCS) was conducted. In the first drawer of treatment cart 1, one bottle of normal saline was opened, undated, and a third full. The DCS stated it was important to date and label an opened bottle with the resident's name to ensure it was being used for the correct resident. The DCS further stated the bottle should have been dated when opened. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 23 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the facility's policy, titled Dressings/Clean, dated, September 2013, indicated, .Date and initial all bottles .upon opening (unless product is single use) . 2. On 5/5/21 at 3:47 P.M., an observation of the medication storage room and an interview with the Director of Nursing (DON) was conducted. The medication storage room was located at nurse station 1. There were 12 bottles of iron supplement elixir, with expiration dates: 8/20, 10/20, and 11/20. The DON stated these expired medications should have been discarded for safety reasons. The DON further stated the licensed nurses (LN) should have checked the medication expiration dates. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .outdated .drugs or biologicals are returned to the dispensing pharmacy or destroyed . 3a. On 5/5/21 at 3:47 P.M., an observation of the medication storage room and an interview with the Director of Nursing (DON) was conducted. The medication storage room was located at nurse station 1. There were four small zip bags, each containing two bottles of glucose (blood sugar) test solutions (low and high) for glucometer readings (a device to check blood sugar levels). Two bags contained expired glucose test solutions. The bottles of test solutions for low glucose readings expired March 2021. The bottles of test solutions for high glucose readings expired January 2021. The DON stated the expired bottles of test solutions should not have been used because they could lead to inaccurate blood sugar readings on the glucometer. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .outdated .drugs or biologicals are returned to the dispensing pharmacy or destroyed . 3b. On 5/6/21 at 10:20 A.M., an observation of treatment cart 1, and an interview with the Director of Clinical Services (DCS) was conducted. In the second drawer, a bottle of glucometer strips had an expiration date of 2019-3-31. The DCS stated these glucometer strips should not have been used, and could have resulted in false blood sugar readings. The DCS further stated treatment cart 1 should have been checked for expired supplies. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .outdated .drugs or biologicals are returned to the dispensing pharmacy or destroyed . 3c. On 5/6/21 at 11:33 A.M., an observation of an intravenous (IV - administered into a vein) medication cart, and an interview with the Director of Clinical Services (DCS) was conducted. The first drawer contained povidone-iodine (disinfectant) swab sticks. Five povidone-iodine swab sticks were expired with the date of 2020/9/20. The DCS stated the swab sticks should have been discarded because the disinfection may have been ineffective. The DCS further stated the carts should have been checked for expired medications and biologicals. The second drawer contained nasal swabs and lab tubes. Five nasal swabs had an expiration date of 2020/4. A sixth nasal swab had the expiration date of 2020/8/31. There were multiple lab tubes with expiration dates of 6/30/2020. The DCS stated the lab tubes may not be effective, resulting in incorrect lab results, and should have been discarded. On 5/6/21 at 3:11 P.M., an interview with the DON and the DCS was conducted. The DON stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 24 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few nurses using the IV medication cart should have checked the medications and biologicals were not expired. The DON stated it was a safety issue and expired medications and biologicals could potentially cause harm to a resident. The DON further stated expired nasal swabs and lab tubes could lead to inaccurate lab and culture results. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .outdated .drugs or biologicals are returned to the dispensing pharmacy or destroyed . 4. On 5/5/21 at 3:47 P.M., an observation of the medication storage room and an interview with the Director of Nursing (DON) was conducted. There was no thermometer in the medication storage room. There was a clipboard with a paper, titled, Temperature Log, dated 10/2020. There were no temperatures documented on the log to indicate the temperature of the medication storage room. The DON stated temperature checks for the medication storage room were not documented. On 5/6/21 at 3:11 P.M., a joint interview with the DON and the Director of Clinical Services (DCS) was conducted. The DON stated the temperature in the medication storage room should have been monitored, because temperature could affect medications and biologicals stored in the medication room. A review of the facility's policy, titled, Storage of Medications, dated April 2019, indicated, .Drugs and biologicals used in the facility are stored .under proper temperature . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 25 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide an alternative weekly meal menu for four of four residents (23, 50, 9, & 47) reviewed for food preferences. This failure had the potential for residents to suffer from a lack of daily nutritional requirements because the food was not appealing and there were no alternate choices. Findings: 1. Resident 23 was admitted to the facility on [DATE], with diagnoses which included polyneuropathy (a degeneration of the peripheral nerves of the body), per the facility's Record of Admission. A review of the MDS (Minimum Data Set - an assessment tool) was conducted on 5/4/21. Resident 23 had a BIMS (Brief Interview for Mental Status) Score of 8 (mildly impaired), and required supervision with meals (encouragement and oversight). On 5/3/21 at 5:39 P.M., an observation and interview was conducted. Resident 23 sat up in bed with a tray table over her legs. Resident 23 ate two tacos from a disposable polystyrene food container. Resident 23 stated the food in the facility was only just OK. Resident 23 stated her son often brought food to the facility for her to eat. On 5/5/21 at 10:35 A.M., an interview was conducted with the Dietary Manager (DM). The DM stated there was only one meal plan for residents with no alternate choices. The DM stated no one ever requested an alternative menu. On 5/6/21 at 9 A.M., a record review was conducted. The facility menu titled Food at a Glance, dated April 4 - May 8 (week 5), included an alternative dinner menu for 5/3/21 of vegetable soup, oriental chicken salad with dressing, a bread roll with butter, and for 5/4/21 an alternative menu of a cheese steak sandwich with a cucumber and tomato salad. On 5/6/21 at 10 A.M., an interview was conducted with the Registered Dietician (RD). The RD stated residents at the facility were not given a choice of foods for their meals. The RD stated it was important residents ate the meals provided so they could get better. The RD stated the residents should have the choices they preferred. The facility's policy titled, Resident Rights - Food and Nutrition Services Department, dated October 2018, included, .Procedure .3. Reasonable accommodations should be made by the Food and Nutrition Services Department to those residents with food preferences .6. Substitutes of like calorie value should be offered to the resident if the planned menu is refused . 2. Resident 50 was admitted to the facility on [DATE], with diagnoses which included atrophy (muscle wasting), per the facility's Record of Admission. A review of the MDS (Minimum Data Set - an assessment tool) was conducted on 5/4/21. Resident 50 had a BIMS (Brief Interview for Mental Status) Score of 10 (mildly impaired). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 26 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A concurrent observation and interview was conducted on 5/3/21 at 12 P.M. with Resident 50. Resident 50 sat in her wheelchair in her room, with her lunch tray on the overbed table. Resident 50 stated, The food is 'ewww;' there is no fresh fruit and the only vegetables are peas and carrots. A concurrent observation and interview was conducted on 5/3/21 at 6 P.M. with Resident 50. Resident 50 sat at the nurse's station lobby in her wheelchair, with her dinner tray on the overbed table. Resident 50 stated, Look at this food, it is awful. The food on the tray was a scoop of mashed potatoes, dry-looking grey fish, green-grey watery beans, and a bowl of soup with clear broth and some carrots. 3. Resident 9 was admitted to the facility on [DATE], with diagnoses which included acute pyelonephritis (kidney infection) and acute kidney failure (kidneys not working correctly), per the facility's Record of Admission. A review of the MDS was conducted on 5/4/21. Resident 9 had a BIMS Score of 10 (mildly impaired). A concurrent observation and interview, via a translator certified nursing assistant (CNA) 12, was conducted on 5/3/21 at 12:15 P.M., with Resident 9. Resident 9 stated, The food is not always good; there is too much chicken and I don't like milk with my meals. An 8 oz. (ounces) glass of milk was noted on the tray. CNA 12 stated, The residents don't like the food and especially the watered-down pink lemonade served with breakfast. They also don't like the egg cake that is served. A review of Resident 9's meal ticket indicated her diet order was controlled carbohydrate regular; no food preferences were noted. An additional observation was conducted on 5/3/21 at 6:15 P.M. for Resident 9. Resident 9 had an 8 oz, glass of milk, and grey, dried-looking fish, and green-grey watery beans on her tray. Resident 9 had eaten only a few bites of the food. 4. Resident 47 was admitted to the facility on [DATE], with diagnoses which included coronary artery disease (CAD - heart disease) and congestive heart failure (CHF - the heart does not pump blood effectively), per the History and Physical. A concurrent observation and interview via translator (CNA 12) was conducted on 5/4/21 at 11:30 A.M. Resident 47 stated the spaghetti was bad and for lunch she used a can of tuna and a mayonnaise packet and some crackers she kept in her room, plus the lettuce from her lunch tray to make her lunch. She kept juice in her room because the facility served sweet iced tea and she preferred unsweetened iced tea. She did not know she could ask for alternative foods. CNA 12 stated, There are no alternative menus available. The facility's policy titled, Resident Rights - Food and Nutrition Services Department, dated October 2018, included, .Procedure .3. Reasonable accommodations should be made by the Food and Nutrition Services Department to those residents with food preferences .6. Substitutes of like calorie value should be offered to the resident if the planned menu is refused FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 27 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not serve food in an appealing manner for five of five residents (23, 28, 9, 47, & 50) reviewed for food preferences. In addition, food concerns were identified during the confidential general resident council meeting for eight of 11 confidential residents. Residents Affected - Some This failure had the potential for residents to suffer from a lack of daily nutritional requirements, because the food was not palatable. Findings: 1. Resident 23 was admitted to the facility on [DATE], with diagnoses which included polyneuropathy (a degeneration of the peripheral nerves of the body), per the facility's Record of Admission. A review of the MDS (Minimum Data Set - an assessment tool) was conducted on 5/4/21. Resident 23 had a BIMS (Brief Interview for Mental Status) Score of 8 (mildly impaired), and required supervision with meals (encouragement and oversight). On 5/3/21 at 5:39 P.M., an observation and interview was conducted with Resident 23. Resident 23 sat up in bed with a tray table over her legs. Resident 23 ate two tacos from a disposable polystyrene food container. Resident 23 stated the food in the facility was only just OK. Resident 23 stated her son often brought food to the facility for her to eat. 2. Resident 28 was admitted to the facility on [DATE], with a diagnosis of dementia (loss of memory), per the facility's Record of Admission. A review of the MDS was conducted on 5/4/21. Resident 28 had a BIMS Score of 1 (severely impaired). On 5/3/21 at 5:50 P.M., an observation was conducted of Resident 28. Resident 28 sat in a wheel chair by Nurses Station 2. Resident 28 was fed her evening meal by a certified nursing assistant (CNA). The CNA fed Resident 28 from a selection of soup bowls on the meal tray in front of Resident 28. The food in the soup bowls was of a pureed consistency. Each soup bowl contained a scoop of food. One bowl contained a cream colored puree, another contained a green puree, a third bowl contained a brown puree, and the fourth bowl contained a yellow colored puree. On 5/4/21 at 10 A.M., an interview was conducted with the Dietary Supervisor (DS). The DS stated residents on a pureed diet were served food in soup bowls so the flavors did not mix. On 5/6/21 at 10 A.M., an interview was conducted with the Registered Dietician (RD). The RD stated the pureed diet should have been presented in an appealing manner. The RD stated a group of soup bowls containing individual foods was not appealing. The RD stated there were many ways pureed meals could be presented in an attractive and appealing manner. 3. Resident 50 was admitted to the facility on [DATE], with diagnoses which included atrophy (muscle wasting), per the facility's Record of Admission. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 28 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of the MDS (Minimum Data Set - an assessment tool) was conducted on 5/4/21. Resident 50 had a BIMS (Brief Interview for Mental Status) Score of 10 (mildly impaired). A concurrent observation and interview was conducted on 5/3/21 at 12 P.M. with Resident 50. Resident 50 sat in her wheelchair in her room, with her lunch tray on the overbed table. Resident 50 stated, The food is 'ewww;' there is no fresh fruit and the only vegetables are peas and carrots. A concurrent observation and interview was conducted on 5/3/21 at 6 P.M. with Resident 50. Resident 50 sat at the nurse's station lobby in her wheelchair, with her dinner tray on the overbed table. Resident 50 stated, Look at this food, it is awful. The food on the tray was a scoop of mashed potatoes, dry-looking grey fish, green-grey watery beans, and a bowl of soup with clear broth and some carrots. 4. Resident 9 was admitted to the facility on [DATE], with diagnoses which included acute pyelonephritis (kidney infection) and acute kidney failure (kidneys not working correctly), per the facility's Record of Admission. A review of the MDS was conducted on 5/4/21. Resident 9 had a BIMS (Brief Interview for Mental Status) Score of 10 (mildly impaired). A concurrent observation and interview, via a translator certified nursing assistant (CNA) 12, was conducted on 5/3/21 at 12:15 P.M., with Resident 9. Resident 9 stated, The food is not always good; there is too much chicken and I don't like milk with my meals. An 8 oz. (ounces) glass of milk was noted on the tray. CNA 12 stated, The residents don't like the food and especially the watered-down pink lemonade served with breakfast. They also don't like the egg cake that was served. A review of Resident 9's meal ticket indicated her diet order was controlled carbohydrate regular; no food preferences were noted. An additional observation was conducted on 5/3/21 at 6:15 P.M. for Resident 9. Resident 9 had an 8 oz, glass of milk, and grey, dried-looking fish, and green-grey watery beans on her tray. Resident 9 had eaten only a few bites of the food. 5. Resident 47 was admitted to the facility on [DATE], with diagnoses which included coronary artery disease (CAD - heart disease) and congestive heart failure (CHF - the heart does not pump blood effectively), per the History and Physical. A concurrent observation and interview via translator (CNA 12) was conducted on 5/4/21 at 11:30 A.M. Resident 47 stated the spaghetti was bad and for lunch she used a can of tuna and a mayonnaise packet and some crackers she kept in her room, plus the lettuce from her lunch tray to make her lunch. She kept juice in her room because the facility served sweet iced tea and she preferred unsweetened iced tea. She did not know she could ask for alternative foods. CNA 12 stated, There are no alternative menus available. 6. In addition, during the group meeting with residents, the residents identified several issues with food. The residents in attendance were assigned numbers for confidentiality, from one to 11. The following remarks were translated by the Ombudsman, who attended the meeting: Confidential Resident (CR) 2 stated he ordered out for food because he did not like the food here. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 29 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0804 CR 3 stated there was too much chicken. Level of Harm - Minimal harm or potential for actual harm CR 4 stated there was too much chicken. Residents Affected - Some CR 5 stated she only ate breakfast; her daughter brought her lunch and dinner, and she kept snacks in her room that did not require cooking: cereal bars, fruit, and soda. Breakfast was usually oatmeal and a slice of bread, and sometimes eggs and sausage; and no one could get eggs over easy. If they (residents) asked for an alternative, they were told the facility did not have it. The food was served in small portions, like a small ball of tuna and rotten crackers. There was no presentation and the soup had no flavor. The only soup offered had rubbery, under-cooked macaroni in it that crunched when you bit into it. CR 6 stated I had hair in my food three times; I just ate ramen noodle soup in a cup. CR 7 stated we (residents) were not served enough Mexican food, and we requested it often. The potatoes were always hard. CR 8 stated she did not like the food; there was no flavor. CR 10 stated the portions were small; it was like eating in a prison. A review of the Resident Council Minutes, dated 3/25/21, indicated, .more Mexican food, would like for menu to change; more home made taste A review of the Resident Council Minutes, dated 4/29/21, indicated, .food needs more flavor, would like pancakes for breakfast An interview was conducted on 5/6/21 at 10 A.M. with the registered dietician (RD). The RD stated the residents concerns about the food and the menus was valid. The RD stated, Things have gone down hill here, there needs to be a lot of improvement in the kitchen and the diets so the residents have the choices they like. A review of the facility's policy, dated, 8/31/21, titled, Resident Rights - Food and Nutrition Services Department, indicated, .3. Reasonable accommodations should be made by the Food and Nutrition Services Department to those residents with a food preference FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 30 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to ensure potentially hazardous foods were clearly labeled with their use-by date. Residents Affected - Some This failure had the potential to cause the food to develop pathogens that contaminate food and may cause foodborne illness if consumed. Findings: On 5/3/21 at 11:30 A.M., during the initial kitchen tour observation, several potentially hazardous foods and time control for safety foods (PHF/TCS) were not labeled with a use-by date. These foods were stored in the walk-in refrigerator, a stand up refrigerator, the dry storage area, and the freezers. In the walk-in refrigerator a carton of liquid eggs was opened with no use by date. Canned tuna was opened and stored in a stainless steel container covered with plastic wrap with an opened date of 4/26/21, but no use-by date. In the dry storage area shaved almonds in a bag, prepared garlic cloves in a jar, a packet of opened instant vanilla pudding, a box of opened raisins, an opened bag of marshmallows, a bin of saltine crackers, a box of cornbread mix, and a container of ground ginger did not have use-by dates on the food packaging. In the large freezer, opened boxes of pre-cooked turkey sausage links, pork sausage links, breakfast waffles, a roll of ham, a roll of bacon, a box of opened blueberries, and a box of potato fries did not have a use-by date on them. In the stand up refrigerator fresh rock melon (cantaloupe) and sliced jicama were stored in a plastic jug with no use-by date. Fresh sliced banana (in the skin), and a container of apple sauce had no use-by date. On 5/3/21 at 11:40 A.M., a joint interview was conducted with the Dietary Supervisor (DS) and [NAME] (CK) 1. The DS stated use-by dates were kept in the facility's document titled, Dry Storage, Refrigerator Storage and Freezer Storage Quick Reference Guide, dated March 2016. The DS stated the opened tuna in the walk-in refrigerator should have been thrown out because it was opened seven days ago, and it could grow bacteria. CK 1 stated not all staff wrote the use-by dates on food. On 5/6/21 at 10 A.M., an interview was conducted with the Registered Dietician (RD). The RD stated staff must write the use-by date on all food outside of all food storage containers. The RD stated her expectation was kitchen staff should complete correct labeling and dating of foods. The RD stated under new management we were hopeful of seeing improvements in the operation of the kitchen. On 5/13/21 at 2:30 P.M., a record review was conducted. The facility's policy titled Food Storage, dated March 2020, included, .Use Use-By dates on all food stored in the refrigerators, and use-by dates according to the timetable in the Dry, Refrigerated and Freezer Storage Charts found in the Quick Reference Guide FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 31 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure the Quality Assessment and Assurance (QAA- checks on standards and quality of care) Committee had the Medical Director or designee in attendance during the Quality Assurance and Performance Improvement (QAPI) meetings. Residents Affected - Few The lack of participation of the medical director or designee in QAPI meetings had the potential risk to not identify care issues/services that could affect the quality of life of the residents. Findings: During an interview with the Director of Operations (DO), the Director of Clinical Services (DCS), the Administrator (ADM), and the Director of Nursing (DON) on 5/6/21 at 2:47 P.M., the DCS discussed concerns with the facility's process of the QAPI meeting. The DON stated she attended a QAA meeting on 3/6/21. The DON stated she was not aware if the Medical Director was notified. The DON acknowledged the Medical Director or designee was not present. The DO stated he found the QAA committee meeting documents in 2019 and some in 2020. The DO stated a QAA meeting was last held on 3/6/21. The DO acknowledged the QAA meeting sign-in sheet was signed by a different ADM, current DON, and no Medical Director. The DO stated acknowledged the Medical Director will be attending the QAPI meeting. A review of the facility's policy titled, Quality Assurance and Performance Improvement (QAPI) Program, revised February 2020, did not include a reference of committee members required to attend. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 32 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 5) Resident 10 was readmitted to the facility on [DATE], with diagnoses to include muscle wasting and atrophy (decrease in muscle mass due to extended immobility). An MDS (Minimum Data Set - an assessment tool), dated 1/27/21, indicated Resident 10 had a BIMS (Brief Interview for Mental Status; an assessment tool) score of 99 (unable to assess mental status). Residents Affected - Some On 5/3/21 at 1:07 P.M., an observation of Resident 10 was conducted. Resident 10 was in bed, lying on his left side, and the head of the bed was elevated. A review of Resident 10's medical record was conducted on 5/3/21. A physician order, dated 11/5/20, indicated to Cleanse with NS (normal saline) & pat dry to SC (sacro-coccygeal; tail-bone area) stage 4 apply Santyl (a medication to treat wounds) & cover with Island (a type of dressing) drsg (dressing) daily & as needed. On 5/5/21 at 10:06 A.M., an observation of Resident 10, and an interview with certified nursing assistant (CNA) 21 was conducted. Resident 10 was turned on to his left side. CNA 21 stated Resident 10 had a pressure ulcer (PU - injuries to skin and underlying tissue resulting from prolonged pressure on the skin) on his tail-bone area. CNA 21 repositioned Resident 10 to his right side. Resident 10's PU was covered with a dry and intact dressing. On 5/6/21 at 7:45 A.M., an observation of a PU dressing change, and an interview with licensed nurse (LN) 21, was conducted. LN 21 prepared the needed supplies to perform Resident 10's PU dressing change. LN 21 removed the dry and intact dressing. LN 21 doffed (removed) his gloves, washed his hands in the bathroom, and donned clean gloves. LN 21 took a gauze square soaked in NS and cleansed around the PU. LN 21 then took the same gauze square and wiped from the outside (dirty area) of the PU towards the PU (clean area), risking contamination of the PU. LN 21 took a clean dry gauze and pat dried the PU. LN 21 completed the PU dressing change. LN 21 stated the dressing change was daily and as needed, and all floor nurses performed the dressing changes. LN 21 stated the technique of cleaning a PU should have been from the cleanest to the dirtiest area. On 5/6/21 at 10:05 A.M., an interview with the Director of Nursing (DON) was conducted. The DON stated cleansing of the PU should have been done from the cleanest area to the dirtiest area, to prevent spreading infection to a healing PU. A review of the policy, titled, Dressings, Dry/Clean, dated September 2013, indicated, . Clean from the least contaminated area to the most contaminated area (usually, from the center outward) . Based on observation, interview and record review, the facility failed to ensure infection control practices were followed when: 1 a) The kitchen floors were dirty and in disrepair (cracked and broken floor), there were holes in the walls, and metal storage racks in the kitchen walk in refrigerator were old, rusty and covered in chipped paint, b) A utility room's floors and walls were in disrepair; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 33 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 2) The ice machine was dirty; Level of Harm - Minimal harm or potential for actual harm 3) Clean food scoops and plastic drinking glasses were stored wet, and meal trays and dishwashing racks were covered in a black/brown substance; Residents Affected - Some 4) Staff were not wearing PPE (personal protective equipment - gowns, gloves, masks, goggles or face shields) when handling biohazardous materials in the utility rooms; and 5) Staff did not correctly perform sterile technique during a wound dressing change. These failures had the potential to cause transmission of infectious and contaminated organisms to staff and residents. Findings: 1a) On 5/3/21 at 11:55 A.M., an observation of the kitchen was conducted. The baseboards along the kitchen walls were worn and dirty. There was a large hole in the baseboard under a kitchen sink and another hole in the baseboard located beside the back door of the kitchen. The linoleum on the kitchen floor was old, broken, and dirty. An exposed drain was on the floor in the dry storage area and the end of a hose (which was attached to a pipe) lay in the drain. On 5/3/21 at 11:58 A.M., an observation was conducted in the walk-in refrigerator. The walk-in refrigerator contained metal shelving for the storage of food. The metal shelving was old, and the racks were covered in chipped paint. The metal racks were rusty where the paint had chipped off. On 5/3/21 at 12 P.M., an interview was conducted with the Dietary Supervisor (DS). The DS stated the metal racks in the refrigerator were old and rusty, and could cause contamination if the rust or paint chips fell into food. The DS stated she did not know what the drain in the dry storage area was there for. The DS stated the kitchen needed many improvements to make it clean and sanitary. The facility's policy titled, Food and Nutritional Services Department Quality Improvement Plan With Yearly Indicators, Thresholds and Methods, dated January 2019, included, .Indicators:1. All work, storage, dining areas, and equipment should maintain acceptable sanitation standards The facility's policy titled Food Storage, dated March 2020, included, .Dry Storage: .2. The walls, ceiling, and floor should be maintained in good repair and regularly cleaned .4. Shelving should be sturdy and provided with a surface which is smooth and easily cleaned . 1b) On 5/5/21 at 4:24 P.M., an observation was conducted of two utility rooms located opposite the nursing stations one and two. The utility room located by nursing station two had old tile flooring that was cracked, stained and dirty. The corners of the floor along the baseboards was dirty. The inside of the sluice (a receptacle where waste products are flushed) was covered in a rust colored stain. The facility's policy titled, Infection Control Plan, undated, included, .Policy - The facility shall establish an infection control program designed to provide a safe, sanitary and comfortable environment for residents and staff to help prevent the development and transmission of disease and infection . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 34 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 2) On 5/3/21 at 1:25 P.M., an observation of the ice machine was conducted. The ice machine contained mold on the inside rim. A build-up of scale lined the inside walls of the ice machine. On 5/3/21 at 1:30 P.M., an interview was conducted with the DS. The DS stated the ice machine was old and needed to be replaced. The DS stated there should not have been mold and scale inside the ice machine because that was a health risk. On 5/6/21 at 10 A.M., an interview was conducted with the Registered Dietitian (RD). The RD stated the ice machine needed to be replaced because it was old and dirty. On 5/6/21 at 2 P.M., a record review was conducted. The facility's Daily and Weekly Cleaning Schedule included the daily cleaning of the ice machine with the last daily and weekly cleaning entries being 4/26/21. The facility's policy titled Food and Nutritional Services Department Quality Improvement Plan With Yearly Indicators, Thresholds and Methods, dated January 2019, included, .Ice Machine .Sanitation of Equipment .Frequency: Weekly .2 .Make sure the door liner, door gasket and door frame are free of scale and/or mold 3) On 5/4/21 at 10:30 A.M., an observation was conducted in the facility's kitchen. A storage rack stood along the wall opposite the serving galley. The storage rack contained a tray of clean drinking tumblers. Five tumblers on the tray had drops of water covering the inside and outside. In the utensil drawer below the storage rack were two serving scoops (sizes #6 and #8). Both scoops contained water. Resident meal trays, and dishwashing racks were stacked at the end of the dishwashing sanitizer. The meal trays were old, cracked and had a black stain covering the rims, inside and underside. The dishwashing racks were covered in a black/brown substance. On 5/4/21 at 10:40 A.M., an interview was conducted with [NAME] (CK) 2. CK 2 stated the tumblers and food scoops should have been stored dry because bacteria could grow on the wet surfaces. CK 2 stated the meal trays and dishracks were old and dirty. CK 2 stated the trays and dishracks should have been replaced. CK 2 stated the dirty meal trays and dishracks could carry bacteria that would make people ill. On 5/6/21 at 9 A.M., an interview was conducted with the Director of Operations (DO). The DO stated the new owner was aware of the poor condition of the facility. The DO stated the building was in need of a lot of refurbishment. On 5/6/21 at 10 A.M., an interview was conducted with the RD. The RD stated there was room for improvement in the condition of the kitchen. The RD stated under new management we were hopeful of seeing improvements in the operation of the kitchen. On 5/6/21 at 2 P.M., a record review was conducted. Per the 2017 US Food and Drug Administration (FDA) Food Code, Section 4-901.11, titled Equipment and Utensils, Air Drying Required; included, .Items must be allowed to drain and air-dry before being stacked and stored. Stacking wet items such as pans prevents them from drying and may allow an environment where micro-organisms can begin to grow The facility's policy titled, Food and Nutritional Services Department Quality Improvement Plan With Yearly Indicators, Thresholds and Methods, dated January 2019, included, .Indicators:1. All work, storage, dining areas, and equipment should maintain acceptable sanitation standards (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 35 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 4) On 5/5/21 at 3 P.M., during the tour of the laundry, an interview was conducted with the Central Supply Supervisor (CSS). The CSS stated laundry contaminated with feces was rinsed off by the CNAs in the utility rooms in the facility. On 5/5/21 at 3:10 P.M., an observation was conducted of two utility rooms located opposite nursing stations one and two. There was no supply of PPE in either utility room. On 5/5/21 at 3:20 P.M., an interview was conducted with certified nursing assistant (CNA) 9. CNA 9 stated she wore gloves to wash the feces from the soiled sheets into the sluice located in the utility room. CNA 9 stated she did not wear any other PPE to perform this task. On 5/5/21 at 3:30 P.M., an interview was conducted with CNA 10. CNA 10 stated she wore gloves to wash feces off the soiled linen in the utility room. CNA 10 stated she did not wear a gown or face shield when she performed this task. CNA 10 stated she stood back while hosing down the contaminated sheets in the sluice so she would not splash herself. CNA 10 stated she was not told to wear PPE for this task. On 5/5/21 at 3:40 P.M., an interview was conducted with CNA 11. CNA 11 stated he wore gloves to clean the feces off the soiled linen. CNA 11 stated he never wore a gown or face shield to wash the feces off soiled linen in the utility rooms. CNA 11 stated he always stood far enough back from the hose so he did not get splashed by feces. CNA 11 stated he did not know he should wear a gown or face shield when performing this task. On 5/5/21 at 3:50 P.M., an observation of utility room [ROOM NUMBER] and an interview with the Infection Practitioner Assistant (IPA) and the CSS, was conducted. The IPA stated the CNAs had to get their PPE from elsewhere; it was not kept in the utility rooms. They must rinse the linens when there was fecal material on the linens, and bag them to go to the laundry to be washed. They (CNAs) were not routinely monitored, and did not wear gowns or shields. The IPA stated there was a possibility for the CNAs to be splashed with contaminated materials . On 5/5/21 at 4:45 P.M., an interview was conducted with the IP. The IP stated the CNAs should get PPE for themselves from an isolation cart before washing feces off the soiled linen. The IP stated it was important the CNAs wore PPE for infection control. On 5/6/21 at 3:20 P.M., an interview was conducted with the DON. The DON stated she did not know CNAs were cleaning feces off the soiled linen in the utility rooms before the linens went to the laundry. The DON stated it was important the CNAs wore PPE so they were not at risk of infection. The facility's undated policy titled, Laundry Department, included, Policy: Careful precautionary procedures must be followed by laundry personnel to prevent the spread of infectious diseases to other staff members, residents and visitors. All soiled linen is considered potentially infectious .Employees in the soiled areas shall wear an outer garment over their uniforms and gloves .The supervisor of laundry services will work closely with the infection control team to establish and maintain consistently high standards .Special procedures will be observed for the safe handling of infected or contaminated linen The facility's undated policy titled, Infection Control Plan, included, .Policy - The facility shall establish an infection control program designed to provide a safe, sanitary and comfortable environment for residents and staff to help prevent the development and transmission of disease and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 36 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 infection Level of Harm - Minimal harm or potential for actual harm The CDC Guidelines for Healthcare-Associated Infections, Appendix D, Linen and Laundry Management, dated March 2020, included, . Best practices for personal protective equipment (PPE) for laundry staff: Practice hand hygiene before application and after removal of PPE. Wear tear-resistant reusable rubber gloves when handling and laundering soiled linens. If there is risk of splashing, for example, if laundry is washed by hand, laundry staff should always wear gowns or aprons and face protection (e.g., face shield, goggles) when laundering soiled linens Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 37 of 38 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to implement an Antibiotic Stewardship Program. Residents Affected - Some This failure had the potential to increase the risk of residents developing antibiotic-resistant organisms from unnecessary or inappropriate antibiotic use. Findings: A concurrent record review (of facility residents currently taking antibiotics) and an interview was conducted on 5/5/21 at 10:52 A.M., with the Infection Practitioner (IP). The IP stated the antibiotics were prescribed by physicians based on symptoms; waiting for labs or cultures was uncommon. The IP stated, We try to discuss it with the MD (medical doctor) but they don't like being told what to do. We are not using the McGeer's criteria (a tool to review antibiotic use), but would like to implement it soon. An interview with the Director of Nursing (DON) was conducted on 5/5/21 at 3:28 P.M. The DON stated, It is sometimes difficult to approach physicians about their orders; they need to be more aware of the process and lab (laboratory) results need to be used as a criteria, not just one symptom. The Medical Director needs a stronger involvement in antibiotic stewardship. A joint interview was conducted on 5/6/21 at 3:13 P.M. with the DON and the Director of Clinical Services (DCS). The DON stated, We haven't implemented the Antibiotic Stewardship Program, we need to. A review of the facility's policy, dated 12/2016, titled, Antibiotic Stewardship, indicated, Antibiotics will be prescribed and administered to residents under the guidance of the facility's Antibiotic Stewardship Program FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555158 If continuation sheet Page 38 of 38