Health inspection·January 12, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 1/12/23 at 5:30 P.M., an interview was conducted with the ADON. The ADON stated the facility had not implemented an alternative form of communication for Resident 35. Per a facility policy, dated March 2018 and titled Reasonable Accommodations of Needs-Preferences, The facility supports each resident's right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences . Event ID: Facility ID: 555290 If continuation sheet Page 2 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide the choice to wake up late for one of one residents reviewed for choices (369) . This failure had the potential for psychosocial harm. Findings: Resident 369 was admitted to the facility on [DATE], with diagnoses which included insomnia (hard to fall asleep), per the facility's admission Record. A review of Resident 369's history and physical (H & P), dated 1/1/23, indicated Resident 369 had the capacity to understand and make decisions. A review of Resident 369's MDS (an assessment tool) dated 1/3/23, indicated Resident 369 had a BIMS score (ability to recall) of 14 indicating intact cognition. On 1/9/23 at 9:36 A.M., an observation and an interview with Resident 369 and family members (FMs) were conducted in her room. Resident 369 was lying in bed, with FMs at bedside. Resident 369's FM stated Resident 369 had a routine of sleeping later in the day. Resident 369 stated, They wake me up too early for breakfast. On 1/11/23 at 9:49 A.M., an interview was conducted with Resident 369 and FMs. Resident 369's FM stated, We told them regarding her late wake up time, they still wake her up early and she is a night owl person (someone who tends to be awake late into the night.) On 1/11/23 at 10:11 A.M., an interview with CNA 11 was conducted. CNA 11 stated she was frequently assigned to Resident 369 and was familiar with her care. CNA 11 stated breakfast trays were served at 7-7:30 A.M., so she would wake Resident 369 up, and open the curtains. CNA 11 stated she was not aware Resident 369 preferred to wake up late. On 1/11/23 at 10:37 A.M., a joint interview and record review with LN 11 was conducted. LN 11 stated Resident 369's FM informed staff Resident 369 preferred therapy to be scheduled in the afternoon. LN 11 stated she did not think about Resident 369's sleep patterns. LN 11 stated the CNAs woke her up in the morning for breakfast. LN 11 stated her choice to sleep late should have been accommodated. LN 11 stated, That was her right. On 1/12/23 at 8:51 A.M., an interview with the ADON was conducted. The ADON stated the expectation was for the staff to work around the resident's schedule. The ADON stated the staff would have to respect Resident 369's sleeping and waking up schedule as per the resident's choice because that was her right. A review of the facility's policy titled, Resident Self Determination and Participation, revised August 2022, indicated, Policy Statement: Our facility respects and promotes the right of each resident to exercise his or her autonomy regarding what the resident considers to be important facets of his or her life .1. Each resident is allowed to choose activities .including: a. daily routine, such (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 3 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0561 as sleeping and waking .schedules . 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: 555290 If continuation sheet Page 4 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a pressure ulcer (PU, an injury to the skin and underlying tissue resulting from pressure) was coded correctly in the MDS, (an assessment tool) for one of two residents reviewed for PU (14). This failure had the potential for incorrect information being sent to Centers for Medicare and Medicaid (CMS, the organization responsible for creating health and safety guidelines for healthcare facilities). Findings: Resident 14 was admitted to the facility on [DATE], per the facility admission Record. On 1/10/23 at 8:02 A.M., an observation of Resident 14 was conducted. Resident 14 was in bed, on a specialized mattress used to prevent PUs. Resident 14 did not respond to questions. On 1/10/23 at 2 P.M., a review of the following records were conducted: A facility document, titled MDS Resident Matrix, indicated Resident 14 had a Stage 4 (a deep wound reaching the muscle, ligament, or bone) PU. The document indicated the PU was acquired while Resident 14 was in the facility. A facility document, titled Change of Condition and dated 11/28/22, indicated Resident 14 had a new, open area on her skin. A Significant Change MDS, dated [DATE], indicated Resident 14 had a new PU, which was present upon admission/entry or reentry. On 1/12/23 at 9:27 A.M., an interview was conducted with LN 2. LN 2 stated Resident 14 had developed the PU a few months ago, and had not had a PU prior to that time. On 1/12/23 at 11:15 A.M., an interview was conducted with Minimum Data Set Nurse (MDSN) 31. MDSN 31 stated the Significant Change MDS was completed due to the new PU. MDSN 31 stated the PU was new and not present prior to 11/28/22. Per MDSN 31, the Significant Change MDS was miscoded by another MDSN, and as the MDSN supervisor he had signed it as well. MDSN 31 stated, It's an inaccurate code. It could potentially have an effect on our quality measures (tools to measure health care processes and outcomes). Per a facility policy, dated November 2019 and titled Certifying Accuracy of the Resident Assessment, Any person completing a portion of the Minimum Data Set/MDS .must sign and certify the accuracy of that portion of the assessment . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 5 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to develop and implement residents' care plans related to: 1. Toileting for one of one residents reviewed for bowel and bladder (369) 2. Refusal of vaccinations for two of five residents reviewed for vaccinations (57 and 169). These failures had the potential to not meet the goals of treatment and needs of Residents 369, 57 and 169. Findings: 1. Resident 369 was admitted to the facility on [DATE], per the facility's admission Record. A review of Resident 369's history and physical (H & P), dated 1/1/23, indicated Resident 369 had the capacity to understand and make decisions. A review of Resident 369's MDS (an assessment tool) dated 1/3/23, indicated Resident 369 had a BIMS score (ability to recall) of 14 indicating intact cognition. The MDS section, Activities of Daily Living (ADLs, activities related to personal care such as toileting) indicated Resident 369 required extensive assistance and needed two plus persons physical assist on toileting. A review of Resident 369's care plan titled, Bladder incontinence, dated 1/2/23, indicated, .initiate toileting schedule . On 1/9/23 at 9:36 A.M., an observation and an interview with Resident 369 was conducted in her room. Resident 369 was lying in bed, with family members (FMs) at bedside. Resident 369's FM stated Resident 369 had been taking some medications that made her go to the bathroom frequently. Residents' FM had stated the staff let her sit in her urine and feces. On 1/11/23 at 9:49 A.M., an observation and an interview with Resident 369 was conducted. Resident 369 was sitting on a wheelchair, with FM at bedside. Resident 369 stated she felt uncomfortable sitting in her urine and feces. Resident 369 stated she had been in the facility for two weeks and no one took her to the toilet. On 1/11/23 at 10:11 A.M., an interview with CNA 11 was conducted. CNA 11 stated she was frequently assigned to Resident 369 and was familiar with her care. CNA 11 stated during the time Resident 369 was assigned to her, she had not taken Resident 369 to use the toilet. On 1/11/23 at 10:37 A.M., a joint interview and record review with LN 11 was conducted. LN 11 stated Resident 369's care plan indicated she needed maximum assist and staff were to help Resident 369 to the toilet per her care plan. On 1/11/23 at 11:06 A.M., a joint interview with LN 11 and COTA 11 was conducted. COTA 11 stated Resident 369 required maximum assistance with toileting. COTA 11 stated the staff should have assisted (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 6 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 Resident 369 to the toilet per the care plan. Level of Harm - Minimal harm or potential for actual harm On 1/12/23 at 8:51 A.M., an interview with the ADON was conducted. The ADON stated the staff should have implemented Resident 369's care plan and the CNAs should have checked with the LNs and therapist if Resident 369 was safe for transfer and to initiate Resident 369's toileting schedule. Residents Affected - Few A review of the facility's policy titled, Develop-Implement Comprehensive Care Plans, revised March 2018, indicated, Policy Statement: The facility develops a person-centered comprehensive care plan developed and implemented to meet his/her .goals, and address the resident's medical, physical, mental and psychosocial needs . 2a. Resident 57 was readmitted to the facility on [DATE], per the facility's admission Record. A review of Resident 57's H & P, dated 11/29/22, indicated Resident 57 had the capacity to understand and make decisions. On 1/11/23 at 9:01 A.M., a joint interview and record review with the Infection Preventionist (IP) was conducted. The IP stated Resident 57 refused the COVID-19 (communicable disease) vaccine because it was against his personal belief. The IP stated there was no care plan in Resident 57's medical record on his refusal of the COVID-19 vaccine. The IP stated a care plan should have been developed for Resident 57 because it would direct the staff of education needs and infection prevention measures. On 1/12/23 at 9:12 A.M., an interview with the ADON was conducted. The ADON stated a care plan should have been developed for residents who refused to get vaccines. The ADON stated the care plan would reflect what kind of personalized care should be provided to Resident 57. A review of the facility's policy, titled Develop-Implement Comprehensive Care Plans, revised March 2018, indicated, Policy Statement: The facility develops a person-centered comprehensive care plan developed and implemented to meet his other preferences and goals .Guidelines: 1. The comprehensive care plan describes .ii. Any services that are not provided due to the resident's exercise of right to refuse treatment . 2b. Resident 169 was admitted to the facility on [DATE], per the facility's admission Record. A review of Resident 169's H & P, dated 12/26/22, indicated Resident 169 did not have the capacity to understand and make decisions. On 1/11/23 at 9:01 A.M., a joint interview and record review with the IP was conducted The IP stated Resident 169 refused the COVID-19 vaccine because she did not believe she needed a vaccine. The IP stated there was no care plan in Resident 169's medical record on her refusal of the COVID-19 vaccine. The IP stated a care plan should have been developed for Resident 169 because it would direct the staff of education needs and infection prevention measures. On 1/12/23 at 9:12 A.M., an interview with the ADON was conducted. The ADON stated a care plan should have been developed for residents who refused to get vaccines. The ADON stated the care plan would reflect what kind of personalized care should be provided to Resident 169. A review of the facility's policy, titled Develop-Implement Comprehensive Care Plans, revised March (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 7 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 2018, indicated, Policy Statement: The facility develops a person-centered comprehensive care plan developed and implemented to meet his other preferences and goals .Guidelines: 1. The comprehensive care plan describes .ii. Any services that are not provided due to the resident's exercise of right to refuse treatment . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 8 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 Based on observation, interview, and record review, the facility failed to provide treatment in accordance with the facility's policy and procedure when one of 16 sampled residents (Resident 7) was not properly positioned in the semi-Fowler's position (defined as a body position at 30 degrees head-of-bed elevation) during the administration of medications via a G-Tube (gastrostomy tube, a tube inserted through the belly that brings nutrition or medications directly to the stomach). Residents Affected - Some This failure had the potential for not meeting Resident 7's therapeutic needs and had the potential of causing aspiration (breathing in medication or fluid into the lungs), which could lead to serious lung problems such as pneumonia (lung infection). Findings: During a medication pass observation on 1/10/23, at 9:12 P.M., with Licensed Nurse 1 (LN 1), LN 1 was observed giving 6 medications through Resident 7's G-tube (gastrostomy tube, a tube inserted through the belly that brings nutrition or medications directly to the stomach) while Resident 7 was laying on their bed with their body positioned leaning down and facing toward their left side. During an interview on 1/10/23, at 2:27 P.M., with LN 1, LN 1 stated Resident 7 was leaning down to the left and LN 1 agreed Resident 7 was not properly positioned in the semi-Fowler's position. LN 1 said . (proper position) is important to make sure the medication is administered right . (if medication is not administered right) could cause resident to aspirate, medication can go to the lungs and not go down to the stomach. During an interview on 1/12/23, at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked by a surveyor: Why is it important to position residents appropriately during G-tube medication administration and what is the correct position?, the ADON said: (It is important) to avoid aspiration. The correct position is 30 to 45 degrees in the semi-Fowler's position. A review of the facility's policy and procedure (P&P) titled, Maintaining Patency of a Feeding Tube (Flushing), dated November 2018, indicated, .4. Position resident in semi-Fowler's or higher position . A review of the facility's P&P titled, Administering Medications through an Enteral Tube, dated November 2018, indicated, .4. Prepare the resident .c. Assist the resident to semi-Fowler's position (30o - 45o) . The American Society for Parenteral and Enteral Nutrition (ASPEN) is a nationally recognized organization. ASPEN members include dieticians, nurses, pharmacists, physicians, and scientists who are involved in providing clinical nutrition to patients. According to ASPEN Safe Practices for Enteral Nutrition Therapy, dated 2016, practice recommendations to prevent aspiration during Enteral Nutrition (nutrition or medications provided through the gastrointestinal tract via a tube) include: 1. Maintain elevation of the HOB (head of bed) to at least 30o or upright in a chair . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 9 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 a physician's order for a referral to a endocrinologist (Endo, a doctor who specializes in diabetes [a long-term condition that impacts the way the body processes blood sugar] management) was carried out for one of 16 sampled residents with diabetes (35). Residents Affected - Few This failure resulted in Resident 35 having elevated blood sugars for an extended period of time, and increased the potential for infection. Findings: Resident 35 was readmitted to the facility on [DATE] with diagnoses to include diabetes, per the facility admission Record. On 1/11/23, a record review was conducted. Resident 35's History & Physical, dated 10/20/22, indicated diagnoses of diabetes and chronic osteomyelitis (a bone infection). Resident 35's physician's order, dated 10/11/22, indicated Resident 35 was prescribed insulin (a medication to lower blood sugar.) In addition, the physician ordered blood sugar monitoring four times a day. Resident 35's MAR from 11/1/22 through 1/12/23 indicated the blood sugar range was between 150-399 milligrams per deciliter (mg/dl, a measurement of blood sugar). The National Institutes of Health defined a normal blood sugar range as 70-110 mg/dl. A physician's progress note, dated 11/21/22, indicated Resident 35's blood sugar was trending from 200-350 and a referral to an endocrinologist was written. A nursing progress note, dated 11/21/22, indicated Resident 35 had, High reading of blood sugar this week ranging from 204-368, MD aware with order for Endo referral. Per a Health Status Note, dated 12/22/22, the Resident Relations Coordinator (RRC) then sent an additional message to the physician regarding the need for a referral. The RRC indicated when she called the endocrinologist, the referral for Resident 35 had not been received. The RRC then called the facility physician, who was not available. No further documentation from the RRC regarding the referral was found. Resident 35's nursing progress note, dated 12/29/22, indicated BS (blood sugar) this week ranges from 210-338. Still for endo referral. No further documentation regarding the referral was found. On 1/11/23 at 3:30 P.M., a concurrent interview and record review was conducted with LN 21. LN 21 stated she was aware of the resident's elevated blood sugars. LN 21 stated Resident 35's blood sugars were consistently in the 200-300 mg/dl range, which was above the acceptable range. On 1/11/23 at 3:30 P.M., a concurrent interview and record review was conducted with the RRC. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 10 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 RRC stated the last communication to the facility physician was documented on 12/22/22, and no further follow up had been made to confirm the referral or set up an appointment. The RRC stated the lack of follow-up was an oversight, and the doctor should have been informed that no appointment had been made. On 1/12/23 at 9:14 A.M., a telephone interview was conducted with Resident 35's family member (FM). The FM stated she was aware of Resident 35's high blood sugars in December 2022. The FM stated due to her concern with the elevated blood sugars, she had attempted to schedule an appointment herself but had been unable to. On 1/12/23 at 1:22 P.M., an interview was conducted with LN 11. LN 11 stated she had a conversation with the FM about Resident 35's elevated blood sugars. LN 11 stated there had been no order changes to Resident 35's insulin to control the blood sugar. LN 11 stated the LNs had been notifying the facility physician if the blood sugars were above 301 mg/dl and giving extra insulin as ordered. LN 11 stated she was aware of the endocrinology referral but did not follow up with the RRC as she thought this was the social worker's job to follow up. LN 11 stated, It is not good for his blood sugars to be elevated. LN 11 stated she was aware of Resident 35's risk for infection, and elevated blood sugars were an additional risk factor. LN 11 stated someone should have followed up about the referral to an endocrinologist. On 1/12/23 at 1:46 P.M., an interview was conducted with the Social Services Director (SSD). The SSD stated the social work department was responsible for all outside referrals but nursing was responsible for referrals that were more medical in nature. The SSD stated a medical referral such as endocrinology would be the responsibility of the nursing team. The SSD stated there was no specific work flow or policy which listed who was responsible for referrals. The SSD stated there was no written policy or standard on who was responsible for ensuring the referral was completed. The SSD stated the social work assistant was usually designated this task but the position had been vacant for a period of time. The SSD stated this task had been delegated to the RRC. The SSD stated she was not aware of an endocrinology referral for Resident 35 and the RRC had not informed her of any problems completing the referral. Per a facility policy, dated 7/1/20 and titled Resident Referrals, .social services personnel and/or designee shall coordinate most resident referrals with outside agencies .social services will collaborate with the nursing staff or other pertinent disciplines to arrange for services that have been ordered by the physician . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 11 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure one of one residents reviewed for bowel and bladder was scheduled for toileting program per the resident's care plan (369). This failure had the potential for Resident 369 to develop skin breakdown and urinary tract infection (UTI). Findings: Resident 369 was admitted to the facility on [DATE], with diagnoses which included hepatic encephalopathy (a decline in brain function that occurs as a result of severe liver disease), per the facility's admission Record. A review of Resident 369's history and physical (H & P), dated 1/1/23, indicated Resident 369 had the capacity to understand and make decisions. A review of Resident 369's MDS (an assessment tool) dated 1/3/23, indicated Resident 369 had a BIMS score (ability to recall) of 14, indicating intact cognition. The MDS section, Activities of Daily Living (ADLs, activities related to personal care such as toileting) indicated Resident 369 required extensive assistance and needed two plus persons physical assist on toileting. On 1/9/23 at 9:36 A.M., an observation and an interview with Resident 369 was conducted in her room. Resident 369 was lying in bed, with family members (FMs) at bedside. Resident 369's FM stated Resident 369 had been taking some medications that made her go to the bathroom frequently. Residents' FM had stated, The staff let her sit in her urine and feces. On 1/11/23 at 9:49 A.M., an observation and an interview with Resident 369 was conducted. Resident 369 was sitting in a wheelchair, with FM at bedside. Resident 369 stated she felt uncomfortable sitting in her urine and feces. Resident 369 stated she had been in the facility for two weeks and no one took her to the toilet. On 1/11/23 at 10:11 A.M., an interview with CNA 11 was conducted. CNA 11 stated she was frequently assigned to Resident 369 and was familiar with her care. CNA 11 stated during the time Resident 369 was assigned to her, she had not taken Resident 369 to use the toilet. CNA 11 stated the only time Resident 369 got out of the bed was when the therapists worked with her. CNA 11 stated Resident 369 started to have some redness on her bottom. On 1/11/23 at 10:37 A.M., a joint interview and record review with LN 11 was conducted. LN 11 stated Resident 369's care plan indicated she needed maximum assist and staff were to help Resident 369 to the toilet. LN 11 stated Resident 369 needed toileting in order to prevent skin problems. On 1/11/23 at 11:06 A.M., a joint interview with LN 11 and COTA 11 was conducted. COTA 11 stated Resident 369 required maximum assistance with toileting. COTA 11 stated the staff should have assisted Resident 369 to the toilet per the care plan. On 1/12/23 at 8:51 A.M., an interview with the ADON was conducted. The ADON stated the staff should (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 12 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete have evaluated bladder and bowel program for Resident 369 and should have initiated a toileting schedule for Resident 369. The ADON stated a toileting program could prevent the possibility of skin breakdown and UTI. A review of the facility's policy titled, Urinary Continence and Incontinence - Assessment and Management, revised September 2010, indicated, Policy Statement .3. The physician and staff will provide appropriate services and treatment to help residents improve bladder function and prevent urinary tract infections .Policy Interpretation and Implementation .16. The physician and staff will address treatable causes or contributing factors related to urinary incontinence, including .e. implementing .bowel management program to meet assessed needs . Event ID: Facility ID: 555290 If continuation sheet Page 13 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure four of four sampled residents (Residents 10, 13, 48, 169) were free from unnecessary psychotropic (drugs that affects brain activities associated with mental processes and behavior) medications including Seroquel (an antipsychotic medication for bipolar disorder, depression, and schizophrenia) and Nuplazid (an antipsychotic medication for Parkinson disease psychosis) when: 1. Resident 10 was administered Seroquel without an appropriate indication and/or clinical justification, no resident-centered behavioral interventions were implemented prior to initiation and during use of Seroquel, inadequate behavioral monitoring was documented during use of Seroquel, and manufacturer specified monitoring were not done during use of Seroquel; 2. Resident 169 was administered Seroquel without an appropriate indication and/or clinical justification, no resident-centered behavioral interventions were implemented prior to initiation and during use of Seroquel, and manufacturer specified monitoring were not done during use of Seroquel; 3. Resident 13 was administered Seroquel without an appropriate indication and/or clinical justification, no resident-centered behavioral interventions were implemented prior to initiation and during use of Seroquel, Seroquel dose was increased without adequate behavioral monitoring and resident specific behavioral interventions, and manufacturer specified monitoring were not done during use of Seroquel; 4. Resident 48 was administered Nuplazid without appropriate clinical justification and no resident-centered behavioral interventions were implemented prior to initiation and during use of Nuplazid. These failures resulted in unnecessary medications for Residents 10, 169, 13, and 48, which increased the potential for medication interactions, adverse reactions, and unidentified risks associated with the use of psychotropic medications that included but not limited to sedation, respiratory depression, constipation, anxiety, agitation, and memory loss. Findings: 1. During a review of Resident 10's admission Record, dated 1/12/23, the admission Record indicated, Resident 10 was admitted back to the facility, from the hospital, on 4/25/22, and had diagnoses including dementia and unspecified psychosis. A review of the Minimum Data Set (MDS, a care area assessment and screening tool), dated 2/25/20, indicated the resident had behavioral symptoms (verbal behavioral symptoms directed toward others (threatening others, screaming at others, cursing at others), no antipsychotics, and no mental health diagnoses. Resident 10's medical record indicated she had been receiving Seroquel in various doses since May 2020. Her current Order Summary Report, dated 1/12/22, indicated a provider order for: 4/27/22 quetiapine (Seroquel) 12.5 mg at bedtime for psychosis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 14 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many A review of MDSs dated 5/14/20, 8/12/20, 11/11/20, and most recent 12/29/22, indicated the resident had no exhibition of hallucinations/delusions or behavioral symptoms. During a review of Resident 10's Medication Administration Record (MAR), dated 12/1/22-12/31/22 and 1/1/23-1/31/23, the MAR indicated, Anti-Psychotic Monitor of episodes of Psychotic behavior AEB [as evidenced by]: Persistent yelling. Drug: Seroquel every shift. During a review of Resident 10's Hospital Discharge Summary, dated 5/8/20, the Hospital Discharge Summary indicated discharge medications: Eliquis 5 mg twice a day, valsartan, hydrocodone, thiamine, senna, multivitamin, metoprolol 25mg 3 times twice a day, hydralazine as needed, famotidine, colace, and amiodarone 100 mg daily in addition to ipratropium During a concurrent interview and record review on 1/11/23, at 11:24 A.M., Licensed Nurse 2 (LN 2) reviewed Resident 10's Hospital Discharge Summary, dated 5/8/20, and validated there were no orders for Seroquel on the Hospital Discharge Summary. LN 2 verified Resident 10 was started on Seroquel at the facility when admitted back from the hospital on 5/8/20. LN 2 validated non-pharmacological interventions for the use of Seroquel were not attempted or implemented for Resident 10. LN 2 stated it is important to use non-pharmacological interventions as first line of defense before giving psych meds (antipsychotic medications) because of serious side effects associated with the use of (antipsychotic medications). During a follow-up concurrent interview and record review on 1/11/23, at 1:29 P.M., LN 2 validated Resident 10 did not have documentation in the clinical record of a history of persistent yelling on admission on [DATE]. LN 2 reviewed a progress note, dated 2/20/20 at 5:30 A.M., written by Licensed Nurse 3 (LN 3), that indicated, .episodes of yelling .offered pain medication, strongly refused. Per resident she's not in pain . LN 2 reviewed a progress note, dated 2/20/20 at 2:32 P.M., written by LN 3, that indicated, .episodes of yelling .offered pain medication, strongly refused. Per resident she's not in pain . LN 2 reviewed a progress note, dated 2/22/20 at 3:42 P.M., written by Licensed Nurse 4 (LN 4), that indicated, Resident alert and responsive, episodes of yelling . LN 2 reviewed a progress note, dated 2/23/20 at 2:56 P.M., written by LN 4, that indicated, Resident alert and responsive with confusion .episodes of yelling . LN 2 reviewed a Nursing Weekly Observation Note dated 3/5/20, documented by LN 4, that indicated, Mental/Emotional/Behavioral Status change in last 7 days noted episodes of yelling 3 times over 7 days, lower left leg pain, will transfer to emergency room for evaluation . LN 2 validated the facility did not document the number of times Resident 10 exhibited behaviors of persistent yelling during each shift, and only documented yes or no for behaviors. LN 2 stated it was important to know how many times a resident showed behavior so nursing staff could determine if the medication was effective, or the dose was too high or too low. When asked if yelling can be a behavior seen with dementia patients, LN 2 said Yes, yelling can be a behavior from dementia. LN 2 validated, no documentation of monitoring lipids (blood cholesterol levels) or eye exams in the resident's clinical records. During a telephone interview on 1/12/23, at 2:49 P.M., with the Consultant Pharmacist (CP), when asked if Seroquel has an indication for psychosis, the CP stated, it is an antipsychotic, psychosis is a general term. When asked about the Boxed Warning (strongest form of warning required by the Food and Drug Administration [FDA] for prescription drug labeling) for using antipsychotics in dementia patients, the CP stated, there is increased mortality and (antipsychotics) shouldn't be used unless benefit is greater than the risk. When asked if appropriate to start or continue antipsychotic medication when behavior not present or if no non-pharmacological inventions, the CP stated, You should try non-pharmacologic interventions before antipsychotics are initiated .resident specific (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 15 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many interventions are important because it could work for that resident. The CP stated, yes some behaviors such as yelling or refusing care could be part of disease state. The CP stated, labs were important to identify if the drug is causing any side effects. During an interview on 1/12/23, at 4:13 P.M., with the Assistant Director of Nursing (ADON), the ADON stated, it was important to use medications as indicated to ensure we are medicating properly. The ADON validated Resident 10's diagnosis for Seroquel is unspecified psychosis and dementia with behavioral disturbances. The ADON stated, the Boxed Warning for Seroquel in dementia patients is it could increase mortality (death). When asked what behaviors were being monitored and documented, the ADON stated, persistent yelling. The ADON validated there was no documentation of non-pharmacological intervention prior to and during administration of Seroquel. The ADON validated no documentation of lipids (blood cholesterol levels) or eye exams in the resident's clinical records. The ADON stated, it was important to monitor (the labs specified by the manufacturer), so nursing staff could know if resident was having adverse reactions from the medications. During a review of the facility's policy and procedure (P&P) titled, Antipsychotic Medication Use, dated December 2016, the P&P indicated, .8. Diagnoses alone do not warrant the use of antipsychotic medication . antipsychotic medications will generally only be considered if the following conditions are also met: a. The behavioral symptoms present a danger to the resident or others; AND: (2) behavioral interventions have been attempted and included in the plan of care .10. For enduring psychiatric conditions, antipsychotic medications will not be used unless behavioral symptoms are .c. not sufficiently relieved by non-pharmacological interventions . A review of the Prescribing Information (PI, detailed description of a drug's uses, dosage range, side effects, drug-drug interactions, and contraindications that is available to clinicians) for Seroquel, revised June 2016, indicated, Obtain liver function tests . obtain lens exam at start of therapy and then every 6 months. 2. During a review of Resident 169's admission Record, dated 1/12/23, the admission Record indicated, Resident 169 was admitted to the facility on [DATE], and had diagnoses including dementia. A review of the Minimum Data Set (MDS, a care area assessment and screening tool), dated 12/29/22, indicated the resident had no exhibition of hallucinations/delusions or behavioral symptoms, no active psychiatric/mood disorder diagnoses, and had received antipsychotic medication. During a review of Resident 169's Order Summary Report, dated 1/12/22, the Order Summary Report indicated a provider order for: 12/24/22 quetiapine 25mg two times a day for Dementia with behavioral disturbances. During a review of Resident 169's Medication Administration Record (MAR), dated 12/1/22-12/31/22 and 1/1/23-1/31/23, the MAR indicated, Anti-Psychotic Monitor of episodes of Behavior Disturbances AEB [as evidenced by]: Irritability. Drug: Seroquel every shift. During a concurrent interview and record review on 1/12/23, at 10:42 A.M., Licensed Nurse 1 (LN 1) stated, resident is on Seroquel because she is irritable, sometimes she is talking about her husband. LN 1 validated non-pharmacological interventions for the use of Seroquel were not attempted or implemented for Resident 169. LN 1 verified no documentation of monitoring lipids (blood cholesterol levels), eye exams, or TSH (thyroid stimulating hormone) in the resident's clinical records. LN 1 stated, it is important to monitor based on manufacturer recommendations to check if having side effects. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 16 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During a telephone interview on 1/12/23, at 2:49 P.M., with the Consultant Pharmacist (CP), when asked about the Boxed Warning (strongest form of warning required by the Food and Drug Administration [FDA] for prescription drug labeling) for using antipsychotics in dementia patients, the CP stated, there is increased mortality and (antipsychotics) shouldn't be used unless benefit is greater than the risk. When asked if appropriate to start or continue antipsychotic medication when behavior not present or if no non-pharmacological inventions, the CP stated, you should try non-pharmacologic interventions before antipsychotics are initiated, resident specific interventions are important because it would work for that resident. The CP stated, yes some behaviors yelling or refusing care could be part of disease state. The CP stated, labs are important to identify if the drug is causing any side effects. During an interview on 1/12/23, at 4:13 P.M., with the Assistant Director of Nursing (ADON), the ADON stated, it is important to use medications as indicated to ensure we are medicating properly. The Boxed Warning for Seroquel in dementia patients is it can increase mortality (death). The ADON validated there was no documentation of non-pharmacological intervention prior to and during administration of Seroquel. The ADON stated, it is important to monitor (the labs specified by the manufacturer), so we know if resident have adverse reactions from the medications. A review of the Prescribing Information (PI, detailed description of a drug's uses, dosage range, side effects, drug-drug interactions, and contraindications that is available to clinicians) for Seroquel, revised June 2016, indicated, Obtain liver function tests, fasting lipids . obtain lens exam at start of therapy and then every 6 months. 3. During a review of Resident 13's admission Record, dated 1/12/23, the admission Record indicated, Resident 13 was admitted to the facility on [DATE], and had diagnoses including psychosis, depression, and anxiety. A review of the Minimum Data Set (MDS, a care area assessment and screening tool), dated 6/10/21, indicated the resident had no exhibition of hallucinations/delusions or behavioral symptoms. During a review of Resident 13's Medication Administration Record (MAR), 1/1/23-1/31/23, the MAR indicated a provider order for: Quetiapine fumerate tablet 25mg give 1 tablet by mouth two times a day for psychosis, start date 7/12/22 During a review of Resident 13's Medication Administration Record (MAR), dated 12/1/22-12/31/22 and 1/1/23-1/31/23, the MAR indicated, Anti-Psychotic Monitor of episodes of psychosis AEB [as evidenced by]: Yelling when personal care is being rendered. Drug: Seroquel every shift. During a concurrent interview and record review on 1/12/23, at 12:36 P.M., Licensed Nurse 6 (LN 6) validated there was no documentation of non-pharmacological intervention prior to and during administration of Seroquel. LN 6 stated the behaviors monitored for Resident 13 are yelling when personal care is being rendered. LN 6 stated on 7/10/22 there were 4 behaviors of yelling .they (providers) were trying to decrease it (Seroquel dose) but resident's daughter requested for it to be increased because resident kept calling daughter and doing the yelling. LN 6 reviewed a progress note, dated 7/11/22, written by Licensed Nurse 3 (LN 3), that indicated, Resident is cussing and saying the F word when informed that she had her routine inhaler and rescue inhaler. Had multiple episodes of calling the main telephone number and been calling her call button . LN 6 reviewed a progress note, dated 7/12/22, written by the ADON, that indicated, .called daughter regarding her concerns about patient; per [daughter] she would like Seroquel to be back to previous dose 25mg [twice a day] . LN 6 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 17 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many validated there was no documentation of resident specific behavioral interventions when Resident 13 was having behaviors. LN 6 stated it is important to try behavior interventions because they [residents] are repetitive, for safety for the patient and to have success in providing care . if that doesn't work then you tap into antipsychotics if redirection doesn't work. LN 6 verified no documentation of monitoring lipids (blood cholesterol levels), eye exams, or liver function in the resident's clinical records. LN 6 stated, it is important to monitor based on manufacturer recommendations to see how the drug is affecting [the resident] and side effects. During a telephone interview on 1/12/23, at 2:49 P.M., with the Consultant Pharmacist (CP), when asked if appropriate to start or continue antipsychotic medication when behavior not present or if no non-pharmacological inventions, the CP stated, you should try non-pharmacologic interventions before antipsychotics are initiated, resident specific interventions are important because it would work for that resident. The CP stated, yes some behaviors yelling or refusing care could be part of disease state. The CP stated, labs are important to identify if the drug is causing any side effects. During an interview on 1/12/23, at 4:13 P.M., with the Assistant Director of Nursing (ADON), the ADON stated, it is important to use medications as indicated to ensure we are medicating properly. The ADON stated Resident 13 is getting Seroquel for psychosis unspecified . behavior documented is yelling when personal care is being rendered .psychosis is broad and have a lot of behaviors .if we tried everything like non-pharmacological interventions, if nothing else works then antipsychotic can be appropriate. The ADON validated there were no documentation of non-pharmacological intervention prior to and during administration of Seroquel and behavioral interventions had not been resident specific. The ADON stated, documenting behaviors are important to know if the medication is working. The ADON reviewed Resident 13's Gradual Dose Reduction, dated 6/7/22, the Gradual Dose Reduction indicated, Seroquel dose decreased to 12.5mg [twice a day]. The ADON reviewed the subsequent Gradual Dose Reduction, dated 7/12/22, the Gradual Dose Reduction indicated Seroquel increased back to 25mg [twice a day] due to yelling. The ADON validated the resident had been on the lowered dose of Seroquel 12.5mg [twice a day] from 7/2/22 to 7/12/22 (10 days) before the dose had been increased back to 25mg [twice a day]. When asked what the expectation is during dose increase of antipsychotics, the ADON stated, the expectation is to document the behavior when attempted to increase dose .important to document behaviors for us to know if the medication is working .daughter wanted to increase (Seroquel dose). The ADON validated the Resident 13's daughter was not a doctor and had not been qualified to assess the need for Seroquel dose increase. The ADON stated, it is important to monitor (the labs specified by the manufacturer), so we know if resident have adverse reactions from the medications. A review of the Prescribing Information (PI, detailed description of a drug's uses, dosage range, side effects, drug-drug interactions, and contraindications that is available to clinicians) for Seroquel, revised June 2016, indicated, Obtain liver function tests, fasting lipids . obtain lens exam at start of therapy and then every 6 months. 4. During a review of Resident 48's admission Record, dated 1/12/23, the admission Record indicated, Resident 48 was admitted to the facility on [DATE], and had diagnoses including neurocognitive disorder with lewy bodies, dementia, and depression. A review of the Minimum Data Set (MDS, a care area assessment and screening tool), dated 5/5/22, indicated the resident had no exhibition of hallucinations/delusions or behavioral symptoms, and had no antipsychotic medications. During a review of Resident 48's Order Summary Report, dated 1/12/22, the Order Summary Report (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 18 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many indicated a provider order for: 6/20/22 Nuplazid 34mg give 1 capsule by mouth at bedtime for hallucinations. During a review of Resident 48's Medication Administration Record (MAR), dated 9/1/22-9/30/22, 10/1/22-10/31/22, 11/1/22-11/30/22, 12/1/22-12/31/22 and 1/1/23-1/31/23, the MAR indicated, Anti-Psychotic Monitor of episodes of Paranoia AEB [as evidenced by]: responding to internal stimuli. Drug: Nuplazid every shift. During a concurrent interview and record review on 1/12/23, at 1:34 P.M., Licensed Nurse 6 (LN 6) stated Resident 48 is on Nuplazid for hallucination, dementia with behavioral symptoms. LN 6 reviewed Resident 48's Medication Administration Record (MAR) dated 12/1/22-12/31/22 and 1/1/23-1/31/23, the MAR indicated, Anti-Psychotic Monitor of episodes of Paranoia AEB [as evidenced by]: responding to internal stimuli . When asked what responding to internal stimuli meant, LN 6 stated she did not know. During a review of progress notes, dated 6/7/22, 6/8/22, 6/17/22, and 6/19/22, LN 6 stated the resident only had behaviors of confusion as evidenced by progress notes. LN 6 validated no documentation of hallucinations while the resident had been at the facility. LN 6 validated non-pharmacological interventions for the use of Nuplazid were not attempted or implemented for Resident 48. During a review of Progress Notes, dated 12/20/22, the Progress Notes indicated, Daughter states she [Resident 48] is having increased vivid dreams and hallucinations. They are not disturbing. Often of puppies and kittens. During an interview on 1/12/23, at 4:13 P.M., with the Assistant Director of Nursing (ADON), the ADON stated Resident 48 was diagnosed with Parkinson's disease by a Neurologist and is on Nuplazid for hallucinations. The ADON validated non-pharmacological interventions for the use of Nuplazid were not attempted or implemented for Resident 48 prior or during the use of Nuplazid. The ADON stated hallucinations or dreams about puppies and kittens are not harmful but if waking up in the middle of the night, the resident might be in distress. The ADON validated there were no documentation of harm resulted from hallucination of puppies and kittens. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 19 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the facility medication error rate did not exceed five percent or greater when observation of 30 opportunities during the medication pass resulted in six errors. The calculated medication error rate was 20 percent. Residents Affected - Some These failures placed Residents 7, 40, 43, and 46 at risk for not receiving the full therapeutic effects of medications when medications were not given according to the physician's orders and/or the manufacturer's specifications. Findings: 1. During a review of Resident 43's Physician's Pharmacy Order, dated [DATE], the Physician's Pharmacy Order, indicated a provider order for Aspirin Tablet Chewable 81 mg Give 1 tablet by mouth one time a day for stroke prevention, starting [DATE]. During a medication pass observation on [DATE], at 9:57 A.M., with Licensed Nurse 2 (LN 2), LN 2 was observed administering 13 medications to Resident 43, which included aspirin (A drug that reduces pain, fever, inflammation, and blood clotting) from a bottle that did not have an expiration date. During an interview on [DATE] at 10:38 A.M., with LN 2, LN 2 stated, Aspirin doesn't have an expiration date, important for meds (medications) to have expiration (date) so we know they're safe to give and are effective. When asked how giving an expired medication can affect the resident, LN 2 stated, Getting for stroke prevention, had a stroke 2 years ago and on other blood thinners, he can have a blood clot. During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), the CP stated, .important (to not have expired medication in medication carts) so that it (expired medication) does not get accidentally given .cannot assure that the dose will be what it was intended to be due to degradation or loss of efficacy .resident will not get the full dose. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked by a surveyor: Why is it important not to give expired medication?, the ADON stated, So that the med (medication) is in full efficacy. When asked by a surveyor: What happens if resident does not get the full dose?, the ADON stated, For aspirin, it will not address indication, for example this resident can have a stroke. During a review of the facility's policy and procedure (P&P) titled, Administering Medications, dated [DATE], the P&P indicated, .12. The expiration/beyond use date on the medication label is checked prior to administering . 2. During a review of Resident 43's Physician's Telephone Orders, dated [DATE], the Physician's Telephone Orders, indicated a provider's order for If patient has an ocular flare please use eye drops prednisolone (a drug used to treat eye allergies and inflammation) 6-8 drops a day in the affect eye (shake bottle well) . During a medication pass observation on [DATE], at 10:06 A.M., with LN 2, LN 2 was observed administering 13 medications to Resident 43, which included prednisolone eye drop. Observed LN 2 did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 20 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 - Some pull down the conjunctival sac (the space between the eyelid and eyeball) during prednisolone eye drop to left eye and the eye drops were seen administered onto Resident 43's eyelashes. Also, LN 2 did not apply finger pressure to lacrimal sac after eye drop administration. During an interview on [DATE] at 10:22 A.M., with LN 2, LN 2 stated, it was not appropriate administration, (eye) drop is supposed to be in his conjunctival sac but it went into his eye lashes, if not given correctly can lead to complications. During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), when asked why it is important to administer eye drops appropriately, the CP stated, To get the intended dose. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked why it is important to administer eye drops appropriately, the ADON stated, So patient can get full dose. During a review of Lexicomp, a nationally known drug reference database, the manufacturer for prednisolone indicated, Apply finger pressure to lacrimal sac during and for 1 to 2 minutes after instillation to decrease risk of absorption and systemic effects. 3. During a review of Resident 46's Physician's Pharmacy Order, dated [DATE], the Physician's Pharmacy Order, indicated a provider order for Humalog (Insulin Lispro (Human)- medication for blood sugar) per sliding scale subcutaneously before meals for DM (diabetes), starting [DATE]. During a review of Resident 46's Physician's Pharmacy Order, dated [DATE], the Physician's Pharmacy Order, indicated a provider order for Insulin Lispro 5 units subcutaneously with meals for DM (diabetes), starting [DATE]. During a medication pass observation for Resident 46 on [DATE], at 12:24 P.M., at Hall 100, with Licensed Nurse 1 (LN 1), LN 1 administered Humalog Insulin (medication for diabetes) to Resident 46 from a vial that was opened on [DATE] and stored in medication cart 100. During an interview on [DATE], at 12:24 P.M., with LN 1, LN 1 stated, expiration (of opened Humalog Insulin) is 28 days, yes it is expired, I will switch it out. When asked by a surveyor: How does giving expired insulin affect the resident?, LN 1 stated, Blood sugar will not be properly regulated. During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), the CP stated, .important (to not have expired medication in medication carts) so that it (expired medication) does not get accidentally given .cannot assure that the dose will be what it was intended to be due to degradation or loss of efficacy .resident will not get the full dose. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked by a surveyor: Why is it important not to give expired medication?, the ADON stated, So that the med (medication) is in full efficacy. When asked by a surveyor: What happens if resident does not get the full dose?, the ADON stated, For insulin, might have high blood sugar. During a review of the facility's policy and procedure (P&P) titled, Administering Medications, dated [DATE], the P&P indicated, .12. The expiration/beyond use date on the medication label is checked prior to administering . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 21 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 During a review of Lexicomp, a nationally known drug reference database, the manufacturer for Humalog indicated, Once punctured (in use), vials may be stored under refrigeration or at room temperature <30°C (<86°F); use within 28 days. Cartridges and prefilled pens that have been punctured (in use) should be stored at room temperatures <30°C (<86°F) and used within 28 days; do not freeze or refrigerate. Residents Affected - Some 4. During a review of Resident 43's Physician's Pharmacy Order, dated [DATE], the Physician's Pharmacy Order, indicated a provider order for Lidocaine Ointment 5 % Apply to L (left) knee two times a day for pain, starting [DATE]. During a concurrent interview and record review on [DATE], at 3:17 P.M., Licensed Nurse 2 (LN 2) reviewed Resident 43's Medication Administration Records (MAR) dated [DATE], the MAR indicated lidocaine ointment 5% was administered to Resident 43 on [DATE] at 11:07 A.M. LN 2 validated lidocaine ointment 5% was due at 9:00 A.M. and was given late at 11:07 A.M. During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), when asked why important to give pain medications in a timely manner, the CP stated, So the patient doesn't have to be in pain. If can't get pain relief can't have the same functionality if they weren't in pain. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked why important to give pain medications on time, the ADON stated, We have to give on time so patient won't have pain, to prevent pain. If patient has pain, will have limited ADLs (Activities of Daily Living) and mobility. During a review of the facility's policy and procedure (P&P) titled, Administering Medications, dated [DATE], the P&P indicated, .7. Medications are administered within one (1) hour of their prescribed time, unless otherwise specified (for example, before and after meal orders) . 5. During a review of Resident 40's Physician's Pharmacy Order, dated [DATE], the Physician's Pharmacy Order, indicated a provider order for Voltaren Gel 1 % (Diclofenac Sodium) Apply to Left upper arm topically every 12 hours for pain apply 2 gram, resume starting [DATE]. During a concurrent interview and record review on [DATE], at 3:53 P.M., Licensed Nurse 1 (LN 1) reviewed Resident 40's Medication Administration Records (MAR) dated [DATE], the MAR indicated Voltaren gel was administered to Resident 40 on [DATE] at 12:00 P.M. LN 1 validated Voltaren gel was due at 9:00 A.M. and was given late at 12:00 P.M. LN 1 stated (Voltaren) given for pain, if not given on time, patient going to have more pain. During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), when asked why important to give pain medications in a timely manner, the CP stated, So the patient doesn't have to be in pain. If can't get pain relief can't have the same functionality if they weren't in pain. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked why important to give pain medications on time, the ADON stated, We have to give on time so patient won't have pain, to prevent pain. If patient has pain, will have limited ADLs (Activities of Daily Living) and mobility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 22 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 - Some 6. During a review of Resident 7's Physician's Pharmacy Order, dated [DATE], the Physician's Pharmacy Order, indicated a provider order for levetiracetam solution 100 mg/ml (a medication for seizures) Give 15 ml via G-Tube two times a day for Epilepsy [condition that causes frequent seizures], starting [DATE]. During a review of Resident 7's Physician's Pharmacy Order, dated [DATE], the Physician's Pharmacy Order, indicated a provider order for Polyethylene Glycol 3350 Powder 17 gm [grams]/scoop (a medication for constipation) by mouth three times a day for constipation prevention mix with 8 oz [ounces] of fluids, starting [DATE]. During a medication pass observation on [DATE], at 9:12 A.M., with Licensed Nurse 1 (LN 1), LN 1 was observed giving 6 medications through Resident 7's G-tube (gastrostomy tube, a tube inserted through the belly that brings nutrition or medications directly to the stomach) which included levetiracetam and Polyethylene Glycol 3350 Powder without flushing (To wash out with a full stream of fluid) the G-tube between levetiracetam and Polyethylene Glycol 3350 Powder. During an interview on [DATE], at 9:26 A.M., with LN 1, LN 1 stated, supposed to flush (G-Tube) so medications don't mix, if mixed, medication might not work like it's supposed to. During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), the CP stated flushing is important to make sure getting enough fluids and flushing in between helps, its standard of practice. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), the ADON stated, flushing between medications is important So no mixing of medications. Interactions can happen with mixing two medications and there might be reaction, and maybe the medication is less effective. During a review of the facility's P&P titled, Administering Medications through an Enteral Tube, dated [DATE], the P&P indicated, .13. If administering more than one medication, flush with 10 - 15 mL water (or prescribed amount) between medications . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 23 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 - Some 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 medications had proper storage and labeling when: 1. Medication Cart 100 was left unlocked during medication pass; 2. Medication Cart 200 was left unlocked during medication pass; 3. For Resident 46, an expired insulin (medication for diabetes) vial was found in medication cart 100. These failures had the potential for lost, left, misuse or abuse of medications for two out of four medication carts; and unsafe and ineffective use of medications with decreased therapeutic effectiveness when used past the expiration date for one out of 16 sampled residents (Resident 46). Findings: 1. During a medication pass observation on [DATE], at 9:45 A.M., at Hall 100, with Licensed Nurse 1 (LN 1), LN 1 did not lock medication cart 100 during medication pass to Resident 40. During an interview on [DATE] at 9:55 A.M., with LN 1, LN 1 verified medication cart 100 was unlocked during medication pass to Resident 40 and stated, Important (to lock) in case anyone comes by .to keep meds (medications) secure. I forgot, it's my fault. During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), when asked by a surveyor: Why is it important to lock medication carts?, the CP stated, So that they (medications) aren't accidently retrieved by unauthorized personnel, residents or visitors. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked by a surveyor: Why is it important to lock medication carts?, the ADON stated, So we can avoid having non-nursing staff or anyone passing by to open cart and avoid having medication compromised. 2. During a medication pass observation on [DATE], at 9:57 A.M., at Hall 200, with Licensed Nurse 2 (LN 2), LN 2 did not lock medication cart 200 during medication pass to Resident 43. During an interview on [DATE] at 10:13 A.M., with LN 2, LN 2 verified medication cart 200 was unlocked during medication pass to Resident 43 and stated, Important (to lock medication cart) so nobody can take my meds (medications). During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), when asked by a surveyor: Why is it important to lock medication carts?, the CP stated, So that they (medications) aren't accidently retrieved by unauthorized personnel, residents or visitors. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked by a surveyor: Why is it important to lock medication carts?, the ADON stated, So we can avoid (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 24 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 having non-nursing staff or anyone passing by to open cart and avoid having medication compromised. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure (P&P) titled, Administering Medications, dated [DATE], the P&P indicated, .19. During administration of medications, the medication cart is kept closed and locked when out of sight of the medication nurse or aide . Residents Affected - Some 3. During a medication pass observation for Resident 46 on [DATE], at 12:14 P.M., at Hall 100, with Licensed Nurse 1 (LN 1), LN 1 administered Humalog Insulin (medication for diabetes) to Resident 46 from a vial that was opened on [DATE] and stored in medication cart 100. During an interview on [DATE], at 12:24 P.M., with LN 1, LN 1 stated, expiration (of opened Humalog Insulin) is 28 days, yes it is expired, I will switch it out. When asked by a surveyor: How does giving expired insulin affect the resident?, LN 1 stated, Blood sugar will not be properly regulated. During a telephone interview on [DATE], at 2:49 P.M., with the Consultant Pharmacist (CP), the CP stated, .important (to not have expired medication in medication carts) so that it (expired medication) does not get accidently given .cannot assure that the dose will be what it was intended to be due to degradation or loss of efficacy .resident will not get the full dose. During an interview on [DATE], at 4:13 P.M., with the Assistant Director of Nursing (ADON), when asked by a surveyor: Why is it important not to give expired medication?, the ADON stated, So that the med (medication) is in full efficacy. When asked by a surveyor: What happens if resident does not get the full dose?, the ADON stated, For insulin, might have high blood sugar. During a review of Lexicomp, a nationally known drug reference database, the manufacturer for Humalog indicated, Once punctured (in use), vials may be stored under refrigeration or at room temperature <30°C (<86°F); use within 28 days. Cartridges and prefilled pens that have been punctured (in use) should be stored at room temperatures <30°C (<86°F) and used within 28 days; do not freeze or refrigerate. During a review of the facility's policy and procedure (P&P) titled, Administering Medications, dated [DATE], the P&P 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: 555290 If continuation sheet Page 25 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0802 Level of Harm - Minimal harm or potential for actual harm Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation, interview and record review, the facility did not ensure kitchen staff performed their tasks safely and correctly when: Residents Affected - Many 1. a Dishwasher Diet Aide (DA 1) could not correctly test the sanitizer solution (liquid that removes bacteria) on dishes used for resident meals, 2. a [NAME] (CK) did not know the correct cool down procedure timeframe for cooked meats. As a result, 61 residents who consumed food from the kitchen had the potential to be exposed to bacterial contamination through unsafe meat or unsanitary dishes. Facility Census was 65. Findings: 1. During the initial kitchen tour on 1/9/23 at 8:55 A.M., an observation of the dishmachine and interview with DA 1 was conducted. DA 1 was observed taking the breakfast plates out of the dish machine after they had gone through the wash, rinse, and sanitizing cycles. DA 1 demonstrated how to test the dish machine sanitizer on a plate that went through the machine cycles. DA 1 took a test strip from a container and touched the plate, then checked it against the color code scale and number range on the container. The strip read less than 50 PPM (parts per million) and was a white color. DA 1 stated the sanitizer solution was not correct and the test result was not within normal limits because it should be 200 PPM and dark black color. DA 1 stated he was not trained on how to correctly test the dish machine sanitizing solution. During an interview with the CDM on 1/9/23 at 9:05 A.M., the CDM confirmed the sanitizer test strip result performed by DA 1 and acknowledged DA 1 was unable to verbalize an acceptable sanitizer test result for the dish machine. The CDM stated the normal range for making sure the dishes were sanitized was 50 to 100 ppm. The CDM stated that staff who washed the residents' dishes and utensils should know what the correct dish machine sanitizing solution levels are so they could inform the supervisor. During a kitchen observation on 1/9/23 at 9:15 A.M., a review of the dish machine sanitizer testing procedure in the dish machine area was conducted. The test procedure steps indicated 1) take a strip from the test strip container, 2) dip it inside the dish machine solution, 3) wait for a few seconds, then 4) compare the strip to the color code and number scale on the container (between dark green to dark gray), 50-100 PPM, which indicated a safe sanitizer level. A review of the January 2022- December 2022 Kitchen staff In-service training binder indicated DA 1 did not attend the June 2022 staff education training on dish machine sanitizer testing. During an interview with the RD on 1/11/23 at 10:11 A.M., the RD stated she expected staff to know how to conduct tests for dish sanitization test method. The RD stated the staff needed to know how to read the test results so they could inform their supervisor if the dishwasher was not sanitizing properly. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 26 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0802 Level of Harm - Minimal harm or potential for actual harm The 2022 US FDA Federal Food Code, section 4-302.14, titled Sanitizing Solutions, Testing Devices indicated Testing devices to measure the concentration of sanitizing solutions are required for 2 reasons: 1.) The use of chemical sanitizers requires minimum concentrations of the sanitizer during the final rinse step to ensure sanitization; and 2.) Too much sanitizer in the final rinse water could be toxic . Residents Affected - Many The facility policy and procedure titled Cleaning Dishes/Dish Machine dated 2017, indicated .staff should check the dish machine gauges throughout the cycle to assure proper temperatures for sanitation .must incorporate visual means or other visual audible alarm to alert the use to any concerns such as a sanitizer not dispensing properly . 2. During a kitchen observation and interview on 1/10/23 at 2:35 P.M. with the [NAME] (CK 1), CK 1 stated the cool down process for cooling meats like roasts took a total of four hours, starting from 165 degrees Fahrenheit (F) to 41 degrees F or below. CK 1 further stated cooked meat should cool down from 165 degrees to 70 degrees in 2 hours. Then cool down from 70 degrees to 40 degrees in another 2 hours. During an interview on 1/10/23 at 2:38 P.M. with the CDM, the CDM stated the cooling process for cooked meat should take a total of six hours. The CDM al stated in order for the meat to cool down within six hours, it needed to be cut into smaller pieces. The CDM then stated when meat was cooked to a temperature of 165 degrees F or higher, it should take two hours for the meat to cool down to 70 degrees F, and four more hours to cool down from 70 to 40 degrees F. The CDM acknowledged CK 1 did not correctly verbalize the cooling process for cooked meats, and stated it was important for the cooks to know the correct method to prevent residents from eating unsafe food. A review of the January 2022-January 2023 Kitchen staff In-service training binder indicated the facility did not provide staff training on the cool down process for cooked meats or ambient temperature foods. During an interview with the RD on 1/11/23 at 10:11 A.M., the RD stated she expected kitchen staff, specifically the cooks, to know the correct cool down method for cooked meat. The RD stated the staff needed to know how to correctly cool down meat to prevent exposure to contamination. The 2022 US Federal FDA Food Code, section 3-501.14, titled Cooling, indicated, Safe cooling requires removing heat from food quickly enough to prevent microbial growth . If the food is not cooled in accordance with this code requirement, pathogens may grow to sufficient numbers to cause foodborne illness .within two hours of cooking, the internal food temperature shall reach 70 degrees Fahrenheit (F) or less and 41 degrees F or less after an additional four hours .the initial 2-hour rapid cooling is a critical element of this process . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 27 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 a safe and sanitary environment that lessened the risk for foodborne illness and cross contamination when: Residents Affected - Many 1. the dish machine sanitation cycle failed to sanitize dishes at the correct sanitizing level, according to facility policy and standards of practice; 2. five cucumbers with a visible substance resembling white mold and multiple dark brown spots were stored and comingled with other cucumbers and vegetables in the walk-in refrigerator; 3. a plastic container of rice and of flour were not labeled or dated with a use by date; and a plastic container of powdered sugar had an expired use by date; and 4. an ice machine chute (a channel which allows things to slide or pass) displayed a dark brown film build up and black spots around the rim. These failures potentially placed residents at risk for foodborne and other illnesses from exposure to bacterial, chemical and physical contamination of the food and dishware. Findings: 1. During the initial kitchen tour on 1/9/23 at 8:55 A.M., an observation of the dish machine and interview with DA 1 was conducted. DA 1 was observed taking the breakfast plates out of the dish machine after they had gone through the wash, rinse, and sanitization cycles. DA 1 performed a test of the dish machine water and a plate using a test strip to determine if the correct sanitizer level was on the dishes that came out of the machine. The sanitizer test result on the strip was not within normal limits, according to DA 1. DA 1 stated the sanitizer was not working. During an observation and interview with the CDM on 1/9/23 at 9:05 A.M., the CDM acknowledged the sanitizer strip test result performed by DA 1 then conducted another test of the sanitizing solution. The CDM test result confirmed the same result of the sanitizing solution limits were out of acceptable ranges, so the CDM determined the dish machine sanitizing section was not working. The CDM stated the normal range for making sure the dishes were sanitized was 50 to 100 PPM. The CDM stated it was important for the residents' dishes and utensils to be cleaned and sanitized. During an observation and interview with the MND on 1/9/23 at 9:45 A.M., the MND stated the dish machine sanitizing cycle had a clogged tube that prevented the solution from flowing through, after he performed repeated sanitizing solution tests. During an interview with the RD on 1/11/23 at 10:11 A.M., the RD stated she expected staff to know how to correctly test the dish sanitizer solution. The RD further stated the staff needed to know how to read the test results and so they could inform their supervisor to have the dish machine sanitizing process checked. The 2022 US FDA Federal Food Code, section 4-501.11, titled Good Repair and Proper Adjustment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 28 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 Residents Affected - Many (Equipment), indicated Proper maintenance of equipment to manufacturer specifications helps ensure that it will continue to operate as designed. Failure to properly maintain equipment could lead to violations of the associated requirements of the Code that place the health of the consumer at risk Adequate cleaning and sanitization of dishes and utensils using a ware washing machine is directly dependent on the exposure time during the wash, rinse, and sanitizing cycles. Failure to meet manufacturer and Code requirements for cycle times could result in failure to clean and sanitize . The facility policy and procedure titled Cleaning Dishes/Dish Machine dated 2017, indicated .all flatware, serving dishes, and cookware will be cleaned rinsed, and sanitized after each se. The dish machines will be checked prior to meal to assure proper functioning and appropriate temperatures . The facility undated policy and procedure titled Maintenance Schedules, indicated Preventive maintenance schedules shall be developed and implemented to assure that . equipment is maintained in a safe and operable manner . 2. During the initial kitchen tour on 1/9/23 at 9:34 A.M., five cucumbers with white streaks of a substance resembling mold and dark black spots were stored and comingled with other cucumbers in large case inside the walk-n refrigerator. A review of the facility's therapeutic menu spreadsheet from Week 2, Monday 1/9/22-1/3/22, indicated cucumber salad was to be served at dinner on 1/9/22. During a kitchen observation and interview on 1/9/23 at 2:45 P.M. with the CDM, the CDM identified the five cucumbers with the white mold-like substance and black spots on them in the walk-in refrigerator, then stated, they should have been thrown out. The CDM further stated since cucumber salad was on the menu to be served for dinner, they should have been removed. During an interview with DA 2 on 1/10/23 at 9:15 A.M., DA 2 was asked about the cucumbers with the white mold areas and dark black spots previously found in the walk-in refrigerator. DA 2 stated she did not use those molded cucumbers for the cucumber salad served for dinner last night. DA 2 further stated they should have been removed immediately after they were delivered from the vendor, but she did not catch it. During an interview with the RD on 1/11/23 at 10:11 A.M., the RD stated any food, especially produce with mold or other visible bacteria, should be discarded when it is not good, to prevent resident exposure to contamination. The 2022 US FDA Federal Food Code, section 3-302.15, titled .Fruits and Vegetables, indicated Pathogenic microorganisms, such as Salmonella spp .may be present on the exterior surfaces of raw fruits and vegetables . The facility policy titled Food Storage dated 2017, indicated .all foods should be checked to assure that the foods will be consume by their safe use by dates or discarded . 3. During a kitchen observation of the dry goods section on 1/9/23 at 2:50 P.M., there were two large (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 29 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 Residents Affected - Many plastic container bins unlabeled and without a use-by date in the Cook's prep area. One bin had a white substance inside that resembled flour and the other bin contained rice. There was also a large plastic container of powdered sugar with an expired use-by date of 2/24/22. During a kitchen observation and interview with the CDM on 1/9/23 at 2:51 P.M., the CDM acknowledged the unlabeled and undated bins and stated they should have been properly labeled by the kitchen staff. The CDM stated it was important for the rice and flour bins to be labeled so they are easily identified, and the dated with the use-by date so it showed if the food was no longer good to use. The CDM further stated the powdered sugar should not be used or kept on the shelf because it was expired. During an interview on 1/11/23 at 10:11 A.M., an interview was conducted with the RD. The RD stated food should not be used if it is expired. The RD also stated food should be discarded on or before the expiration date. The 2022 US FDA Federal Food Code, section 3-302.12, titled Food Storage Containers, Identified with Common Name of Food, indicated .Except for containers holding FOOD that can be readily and unmistakably recognized such as dry pasta, working containers holding FOOD or FOOD ingredients that are removed from their original packages for use in the FOOD ESTABLISHMENT, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the FOOD. The 2022 US FDA Federal Food Code, section 3-602.11, titled Food Labels, indicated .(A) food packaged in a Food establishment, shall be labeled . (B) Label information shall include: (1) The common name of the FOOD, or .an adequately descriptive identity statement . The facility policy and procedure titled Food Storage dated 2017, indicated .all containers must be legible and accurately labeled and dated . The facility policy and procedure titled Food Storage dated 2017, indicated .all foods should be checked to assure that the foods will be consumed by their safe use by dates or discarded . 4. During an observation of the ice machine and interview with MND on 1/10/23 at 2:15 P.M., the MND stated he cleaned the exterior and inside of the ice machine bin where the ice is stored, on a monthly basis. The MND stated an outside vendor cleaned the inside of the ice making machine parts including the condenser and evaporator, every six months. The MND stated he does not check the inside condenser or evaporator after the vendor cleans it. During an observation on 1/11/23 at 8:35 A.M. of the inside of the ice machine making parts, the ice machine chute (a hole opening where the ice cubes drop into the bin) located behind the water curtain evaporator displayed a brown sticky substance and multiple black spots. The MND acknowledged the ice machine chute area that area with the brown substance and black spots was where the ice was being dispersed into the ice bin use and it needed to be clean in order to prevent contamination for the residents. The MND stated the brown substance and black spots around the chute could be scrubbed away and cleaned using the ice machine cleaning chemicals. During an observation and interview with the CDM on 1/11/23 at 8:40 A.M., the CDM acknowledged the brown substance and black spots around the ice machine chute area. The CDM stated the ice machine (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 30 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 Residents Affected - Many chute area should have been clean because it touches the newly formed ice cubes that will be used by the residents. During an observation and interview with the RD on 1/11/23 at 10:11 A.M., the RD stated the ice machine chute area should be clean, white, bright, and shiny after the ice machine cleanings. The RD stated she expected the ice machine to be cleaned and maintained on a more regular basis and in a manner to prevent contamination of the ice cubes. The 2022 US FDA Federal Food Code, section 4-501.11, titled Good Repair and Proper Adjustment (Equipment), indicated Proper maintenance of equipment to manufacturer specifications helps ensure that it will continue to operate as designed. Failure to properly maintain equipment could lead to violations of the associated requirements of the Code that place the health of the consumer at risk . The 2022 US FDA Federal Food Code, section 4-602.1, titled Equipment Food-Contact Surfaces and Utensils, indicated .Surfaces of .equipment contacting food that is .such as .ice makers and ice bins must be cleaned on a routine basis to prevent the development of slime, mold, or soil residues that may contribute to an accumulation of microorganisms . A review of the ice machine's manufacturer's guidelines dated 6/17, indicated .Section 4 MaintenanceCleaning and Sanitizing .An extremely dirty ice machine must be taken apart for cleaning and sanitizing .Cleaning/Sanitizing Procedure .removes mineral deposits from areas and surface that are in direct contact with water .Parts removal for Cleaning/Sanitizing .A. remove water curtain .C. remove water trough . The facility policy titled Cleaning Instructions- Ice Machine and Equipment dated 2017, indicated Ice machine equipment .will be cleaned and sanitized on a regular basis .follow manufacturer's cleaning and sanitizing instructions . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 31 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 0865 Have a plan that describes the process for conducting QAPI and QAA activities. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to identify and develop an effective QAPI (Quality Assurance and Performance Improvement) plan. This failure had the potential to affect the care provided to the residents. Residents Affected - Few Cross reference:

F761

F880 Findings: On 3/23/23 at 1:30 P.M., an interview was conducted with the Administrator (Admin). The Admin stated QA items were usually identified from survey deficiencies, through IDT (interdisciplinary team), or staff meetings. The Admin stated QAPI's purpose was to identify and prioritize opportunities for improvement, then initiate corrective actions to address any gaps in their system. Per the Admin, their corrective actions did not address the effectiveness of the audits. The Admin stated after the recertification survey, the QAPI Committee met and reviewed their deficient practices, but did not discuss in detail how the audits were being conducted. Per the Admin, We should have followed up on each audit to see whether our corrective action was effective. Per a facility policy, effective 7/1/20 and titled QA/Quality Assurance and Performance Improvement Committee, .Goals of the Committee .1. Establish, maintain and oversee facility systems and processes to support the delivery of quality of care and services; 2. Promote the consistent use of facility systems and processes during provision of care and services; 3. Help identify actual and potential negative outcomes relative to resident care and resolve them appropriately; 4. Support the use of root cause analysis to help identify where patterns of negative outcomes point to underlying systematic problems .6. Coordinate the development, implementation, monitoring, and evaluation of performance improvement projects to achieve specific goals .2. b.) Choosing and implementing tools that best capture and measure data about the chosen indicators; c.) Appropriately interpreting data . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 32 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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** Based on observation, interview, and record review, the facility failed to implement and maintain an infection control procedures when: Residents Affected - Some 1. Registered Nurse 2 (RN 2) failed to observe infection control measures by failing to properly disinfect resident's glucometer for one of 3 randomly selected residents (Resident 35) according to manufacturer's specifications; 2. Licensed Nurse 1 (LN 1) failed to observe infection control measures by failing to properly disinfect resident's glucometer for two of 3 randomly selected residents (Resident 46 and 170) according to manufacturer's specifications. These failures had the potential for the development and the spread of infection to 3 of 3 randomly selected residents. Findings: 1. During a review of Resident 35's admission Records, dated 1/10/23, the admission Records indicated Resident 35 was admitted to the facility on [DATE] with diagnoses including, diabetes and long term use of insulin. During a review of Resident 35's Physician's Pharmacy Order, dated 10/11/22, the Physician's Pharmacy Order , indicated a provider order for Insulin Aspart per sliding scale with meals for DM (diabetes), starting 10/12/22. During a medication pass observation on 1/9/23, at 11:14 A.M., with Registered Nurse 2 (RN 2), RN 2 was observed using a glucometer to check Resident 35's concentration of blood glucose. RN 2 was observed wiping the glucometer with bleach disposable wipes and did not disinfect the glucometer according to the manufacturer specified wet time (the time the glucometer was to be in contact with the bleach disposable wipes in order to kill micro-organisms). During an interview on 1/9/23, at 11:25 A.M., with RN 2, when asked what the wet time was for disinfecting the glucometer, RN 2 stated, What do you mean wet time, usually 5 minutes. I just cleaned it, that's what they told me. They didn't tell me about wet time. When asked if the glucometer stayed wet for 5 minutes, RN 2 stated, No, I did not do that. When asked why it is important to disinfect the glucometer, RN 2 stated, Because germs can transfer to patient if not disinfected .virus (germs) can transfer to wounds or patient and dangerous to pass from one to the next. 2. a. During a review of Resident 46's admission Records, dated 1/10/23, the admission Records indicated Resident 46 was admitted to the facility on [DATE] with diagnoses including diabetes. During a review of Resident 46's Physician's Pharmacy Order, dated 3/17/22, the Physician's Pharmacy Order , indicated a provider order for Humalog (Insulin Lispro (Human)) per sliding scale subcutaneously before meals for DM (diabetes), starting 3/17/22. During a review of Resident 46's Physician's Pharmacy Order, dated 12/28/22, the Physician's Pharmacy Order , indicated a provider order for Insulin Lispro 5 units subcutaneously with meals for DM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 33 of 34 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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 (diabetes), starting 12/28/22. Level of Harm - Minimal harm or potential for actual harm During a medication pass observation on 1/9/23, at 11:34 A.M., with Licensed Nurse 1 (LN 1), LN 1 was observed using a glucometer to check Resident 46's concentration of blood glucose. LN 1 was observed wiping the glucometer with bleach disposable wipes and did not disinfect the glucometer according to the manufacturer specified wet time. Residents Affected - Some During an interview on 1/9/23, at 11:49 A.M. with LN 1, when asked what the wet time was for disinfecting the glucometer, LN 1 stated, I don't know what the wet time is. When asked why important to clean properly, LN 1 stated, To make sure it's not contaminated. Want to make sure patient don't get sick getting bacteria from other patients b. During a review of Resident 170's admission Records, dated 1/10/23, the admission Records indicated Resident 46 was admitted to the facility on [DATE] with diagnoses including diabetes. During a review of Resident 170's Physician's Pharmacy Order, dated 1/4/23, the Physician's Pharmacy Order , indicated a provider order for Insulin Regular Human Solution per sliding scale subcutaneously before meals for DM (diabetes), starting 1/4/23. During a medication pass observation on 1/9/23, at 11:45 A.M., with Licensed Nurse 1 (LN 1), LN 1 was observed using a glucometer to check Resident 170's concentration of blood glucose. LN 1 was observed wiping the glucometer with bleach disposable wipes and did not disinfect the glucometer using the manufacturer specified wet time. During an interview on 1/9/23, at 11:49 A.M. with, LN 1, when asked what the wet time was for disinfecting the glucometer, LN 1 stated, I don't know what the wet time is. When asked why important to clean properly, LN 1 stated, To make sure it's not contaminated. Want to make sure patient don't get sick getting bacteria from other patients During a telephone interview on 1/12/23, at 2:49 P.M., with the Consultant Pharmacist (CP), when asked why it is important to properly clean glucometers between residents, the CP stated, To reduce transmission of infections. During an interview on 1/12/23, at 4:13 P.M., with the ADON, when asked why it is important to have appropriate contact time for disinfecting shared glucometers, the ADON stated, To avoid transmission of organisms. If not clean, resident can get infections from other residents. During a review of the manufacturer's instructions for wet time for the bleach wipes provided by the facility, the manufacturer's instructions indicated, Treated surface must remain visibly wet for a full four (4) minutes. Use additional wipe(s) if needed to assure continuous 4 minute wet contact time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555290 If continuation sheet Page 34 of 34