Health inspection·December 23, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (medication to treat infection) medication. During a concurrent record review and interview with the facility's IPN on 12/23/2025 at 12:56 PM, Resident 2's CP for GERD revised on 11/3/2025 was reviewed. The CP intervention indicated staff were to provide diet as ordered and administer medication as ordered. The IPN stated the CP was not specific because the medication was not listed. During a concurrent record review and interview with the facility's IPN on 12/23/2025 at 12:56 PM, Resident 2's CP for sepsis related to pneumonia revised on 11/3/2025 was reviewed. The CP goal indicated that sepsis would be resolved after antibiotic therapy. The CP intervention indicated staff were to administer antibiotic medication as ordered. The IPN stated the CP was not specific. The IPN stated the CP was not updated and should have been discontinued because Resident 2 did not have active pneumonia nor ongoing antibiotic treatment at this time. The IPN stated the licensed nurse who administered the last dose of the antibiotic should have discontinued the CP. The IPN stated if a medication changed or was discontinued, the CP should have been updated. The IPN stated the risk of not updating CP included medication errors and negative effects on the residents' care. The IPN stated it was not acceptable to have a CP that was outdated, did not reflect changes based on the resident's current condition or did not meet the resident's needs. c. During a review of Resident 3's AR, the AR indicated Resident 3 was admitted to the facility on [DATE] with diagnoses including dyspepsia (discomfort or pain in the upper abdomen after eating) and muscle weakness. During a review of Resident 3's H&P dated 10/25/2025, the H&P indicated Resident 3 had fluctuating capacity to understand and make decisions. During a review of Resident 3's MDS dated [DATE], the MDS indicated Resident 3 had moderately impaired cognition. The MDS indicated Resident 3 required supervision from staff for eating. The MDS indicated Resident 3 required partial assistance from staff for oral hygiene, personal hygiene, toileting hygiene, showering, bed-to-chair transferring, and walking. During a review of Resident 3's OSR with active orders as of 12/22/2025, the OSR indicated a physician's order for licensed staff to administer mylanta (medication for gastrointestinal [GI] distress) 30 milliliters (ml- unit of measurement) as needed for GI distress starting on 10/23/2025. The OSR indicated a diet order of no added soft diet with mechanical soft texture and regular consistency starting on 10/23/2025. During a concurrent record review and interview with the facility's the IPN on 12/23/2025 at 12:56 PM, Resident 3's CP for dyspepsia and GI distress revised on 11/13/2025 was reviewed. The CP intervention indicated staff were to provide diet as ordered, administer medication as ordered, and frequently check for re-assurance. The IPN stated the CP was not specific and should have included the specific medication for Resident 3. The IPN stated the purpose of the CP was to provide staff with knowledge on care and specific interventions to address the needs of the residents. The IPN stated the CP served as a guideline for nurses to follow and helped ensure quality care. The IPN stated the CP needed to be resident-centered because each resident had different goals, needs, and specific interventions. The IPN stated the licensed nurse should initiate and complete the CP. During an interview with the facility's Director of Nursing (DON) on 12/23/2025 at 2:01 PM, the DON stated the purpose of the CP was to identify the interventions for each resident and determine if those interventions were working. The DON stated the CP should be specific and resident-centered to meet professional standards and ensure quality of care. The DON stated the CP should be individualized based on the residents' needs. The DON stated if there was a change in condition, a medication was resolved, or problems were addressed, the CP should be revised the same day. During a review of the facility's Policy and Procedure (P&P) titled Care Planning, revised on 1/25/2024, the P&P indicated It is the policy of the facility to provide person-centered, comprehensive and interdisciplinary care that reflects best practice standards for meeting health, safety, psychosocial, behavioral, and environmental needs of residents in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555199 If continuation sheet Page 2 of 4 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 555199 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706 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 order to obtain or maintain the highest physical, mental, and psychosocial well-being. The P&P further indicated that the care plan would be periodically reviewed and revised by Interdisciplinary Team (IDT, a group of healthcare professionals from different disciplines who worked together) at times as appropriate or necessary. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555199 If continuation sheet Page 3 of 4 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 555199 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706 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 follow the physician's order for one of three sampled residents (Resident 1) when the licensed nurse did not take Resident 1's heart rate prior to administration of losartan (medication for high blood pressure) as ordered, from 12/13/2025 to 12/22/2025. These violations had the potential to compromise Resident 1's health and safety.Findings: During a review of Resident 1's admission Record (AR), the AR indicated Resident 1 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including hypertensive heart disease (high blood pressure [HTN] damaged the heart over time) and generalized muscle weakness. During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 12/18/2025, the MDS indicated Resident 1 had moderate cognitive (ability to understand) impairment. The MDS indicated Resident 1 required supervision from staff with eating and oral hygiene. The MDS indicated Resident 1 required maximal assistance (helper did more than half the effort) from staff with toileting hygiene and toileting transferring. During a review of Resident 1's Order Summary Report (OSR) with active orders as of 12/22/2025, the OSR indicated a physician's order to hold losartan for heart rate less than 60 beats per minute-(BPM) daily, starting on 12/13/2025. During a review of Resident 1's Care Plan (CP) for hypertensive heart disease revised on 12/22/2025, the CP indicated staff were to maintain optimum quality of life for Resident 1. The CP interventions indicated staff were to obtain vital signs (measurements of temperature, heart rate, breathing rate, and blood pressure) and administer medication as ordered. During an interview with the Infection Preventionist Nurse (IPN) 1 on 12/23/2025 at 12:56 PM, the IPN stated it was important for the licensed nurse who received the physician order to carry out and transcribe to electronic MAR (EMAR). The IPN stated carrying out the physician order meant to do the action as ordered. The IPN stated that when the physician ordered to hold losartan for heart rate of less than 60 BPM, the licensed nurse should check the resident's heart rate prior to the medication administration and document the readings on the EMAR. During a concurrent interview and record review on 12/23/2025 at 12:56 PM. with the IPN, Resident 1's Medication Administration Record (MAR) dated 12/13/2025 to 12/22/2025 was reviewed. The MAR indicated Resident 1 received ten doses of losartan daily at 9 AM from 12/13/2025 to 12/22/2025. The IPN stated the MAR did not indicate heart rate readings were taken/documented prior to the administration of losartan daily at 9 AM from 12/13/2025 to 12/22/2025. The IPN stated it was important to monitor the heart rate as ordered. During a concurrent interview and record review on 12/23/2025 at 2:01 p.m., Resident 1's Vital Summary dated 12/13/2025 to 12/22/2025 was reviewed. The DON stated there were no heart rate readings documented on 12/13, 12/15, 12/16, 12/17, 12/18, 12/19, 12/20, and 12/22/2025 at 9 AM. The DON stated the licensed nurse did not carry out the physician order to check Resident 1's heart rate prior to the administration of losartan to Resident 1. The DON stated the licensed nurse should have followed the physician's order to check the resident's heart rate before administering losartan to Resident 1. During a review of the facility's undated Policy and Procedure (P&P) titled Physician Orders, the P&P indicated the facility should provide care and services to the resident in accordance with the physician's orders. During a review of the facility's undated P&P titled Documenting Physician Orders/ Notification, the P&P indicated the licensed nurse should implement and carry out the physician's orders within two hours upon receiving. During a review of the facility's P&P titled Vital Sign, revised 1/25/2024, the P&P indicated the vital signs would be taken as ordered by the physician and before giving medication when there were conditional parameters (limit that helped measure something) of administration. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555199 If continuation sheet Page 4 of 4