Health inspection·June 13, 2024

F 0684 - 2/3/24 at 0919 hours,not available at this time. Level of Harm - Minimal harm or potential for actual harm - 2/3/24 at 1917 hours,not available at this time. - 2/4/24 at 1000 hours, no additional notes shown. Residents Affected - Few - 2/4/24 at 1739 hours, no additional notes shown. - 2/5/24 at 0952 hours, no additional notes shown. - 2/5/24 at 1728 hours, no additional notes shown. - 2/6/24 at 1817 hours, the pharmacy follows up in progress. - 2/7/24 at 1043 hours, new order (clarified). On 6/13/21 at 1415 hours, an interview was conducted with the ADON. The ADON stated thepharmacy delivered themedications within the day that they were ordered. In addition, a follow-up with the pharmacy wouldbe done if the medications were not delivered. The ADON stated there was a nationwide shortage of Marinol, and the ADON verified there was no follow up with the pharmacy regarding the delay of thismedication delivery until 2/8/24, six days after the order was obtained. The ADON verified there was no documented evidence the physician was notified Resident 2 was not administered Marinol on these days. On 6/13/24 at 1613 hours, the DON was informed and acknowledged the above findings. 2. Review of the facility's P&P titled Change of Condition Reporting dated 5/2019 showed it is the policy of this facility that all changes in a resident's condition will be communicated to the physician. The purpose is to clearly define the guidelines for the timely notification of a change in the resident condition. According to the National Institute of Neurological Disorders and Stroke titled Stroke Overview-What is Stroke dated 4/20/24, showed signs of stroke can range from mild weakness to paralysis, or numbness on one side of the face or body. A stroke is a serious medical emergency and requires immediate medical attention, just like a heart attack. Stroke is the fifth leading cause of death in the United States. It is the most common cause of adult disability. With stroke, the sooner treatment begins, the better. Knowing the signs of stroke and calling 911 immediately can help save the person from death or disability. Timely treatment can save brain cells and greatly reduce or even reverse the damage. Healthcare professionals also use a variety of brain imaging techniques to assess stroke risk, diagnose stroke, determine stroke type (and the extent and exact location of damage), and evaluate individuals for clinical studies and beast treatment, including CT (computed tomography, MRI (magnetic resonance imaging), and catheter-based angiography. According to the CDC's guidelines titled Risk Factors for Stroke dated 5/14/24, conditions that can increase risks are high blood pressure, high cholesterol, heart disease, and obesity. According to the CDC's guidelines titled Signs and Symptoms of Stroke dated 5/15/24, sudden numbness or weakness in the face, arm, or leg, especially on one side of the body, and to call 911 right away. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555249 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555249 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sea Cliff Healthcare Center 18811 Florida St Huntington Beach, CA 92648 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Medical record review for Resident 5 was initiated on 5/31/21. Resident 5 was admitted to the facility on [DATE], and readmitted on [DATE]. Resident 5 [NAME] medical history of hypertension, congestive heart failure, hyperlipidemia, and obesity. Review or Resident 5's Weights and Vital Summary dated 5/14/24, showed two documented sets of vital signs for Resident 5 dated 5/14/24 at 0921 and 1535 hours. Review of Resident 5's Progress Notes dated 5/14/24 at 0932 hours, showed Resident 5 complained of feeling numb and stated, I feel like I'm having a stroke. Review of Resident 5's Progress Notes dated 5/14/24, showed no documented evidence the resident's physician was contacted when Resident 5 complained of numbing and feeling like he was having a stroke until 5/14/23 at 1543 hours (six hours and 11 minutes later), when Resident 5 was being sent out to an acute care hospital. Review of Resident 5's Progress Notes dated 5/14/24 at 1550 hours, showed Resident 5 was transferred to the acute care hospital via 911 due to the uneven smile and left-side numbness. Review of Resident 5's Discharge Summary Final Report from the acute care hospital dated 5/17/24, showed Resident 5 was brought in by the ambulance and had a tingling sensation on the left side of the body. Resident 5 stated the feeling started fromhis foot, then went tohis lungs and brain. Resident 5 thought his speech wasa little altered. In addition, the differential diagnoses (possible causes) listed stroke. On 5/31/24 at 1125 hours, an interview was conducted with Resident 5. Resident 5 stated he had an incident when he was not treated right and stated he could barely talk; had weakness, progressive numbness, and tingling; and thought he was having a stroke. Resident 5 stated when he told the overnight CNA, she did not alert anyone until theshift change, and it took a while to get to the acute care hospital on the following day. On 6/7/24 at 1147 hours, an interview was conducted with the ADON. When asked if a resident stated, I feel like I'm having a stroke if an RN should have assessed the resident, the ADON stated, yes, they should have. On 6/7/24 at 1417 hours, an interview was conducted with LVN 4. LVN 4 stated the physician and nursing supervisor should have been notified when Resident 5 stated, I feel like I'm having a stroke . On 6/7/24 at 1453 hours, a follow-up interview was conducted with LVN 4. LVN 4 stated a message was sent to the physician on 5/14/24 at 1225 hours, stating Resident 5 complainedof numbing on the left side and worried about a stroke. On 6/7/24 at 1532 hours, an interview was conducted with the DON. When asked if LVN 4 should have notified the RN or physician to assess the resident, the DON stated, yes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555249 If continuation sheet Page 3 of 3