Inspection·January 27, 2023

F 0578 aware of the document missing the needed signatures and not valid. 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: 555295 If continuation sheet Page 2 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and facility P&P review, the facility failed to ensure the physician and resident's RP were notified of a change in the resident's condition for one of 12 final sampled residents (Resident 13). * The facility failed to notify Resident 13's physician and RP of significant and continued weight losses. This failure had the potential for the resident to have a delay in care and treatment. Findings: Review of the facility's P&P titled Nutrition (Impaired)/Unplanned Weight Loss - Clinical Protocol revised 9/2017 showed the staff will report to the physician significant weight gains or losses or any abrupt or persistent change from baseline appetite or food intake. Review of the facility's P&P titled Weight Assessment and Intervention revised 9/2008 showed care planning for weight loss or impaired nutrition will be a multidisciplinary effort and will include the physician, nursing staff, dietitian, and resident or resident's legal surrogate. Medical record review for Resident 13 was initiated on 1/25/23. Resident 13 was readmitted to the facility on [DATE]. Review of the Dietary assessment dated [DATE], showed Resident 13 was 68 in height (5 feet 8 inches tall) and her usual body weight was 180 pounds. The RD documented the resident's weight goal was 174 lbs +/3% per month (plus or minus three percent per month). Her most recent weight was 173.8 lbs. Review of the Resident Weight Tracking System Report showed Resident 13's initial/baseline weight obtained on 8/15/22, showed 173.8 lbs. * On 9/21/22, an IDT Nutrition Alert note showed Resident 13's weight was 164.6 lbs, a loss of 9.2 lbs/5.3% in one month. The RD documented the resident had a DTI on her heel, poor intake, and currently received health shakes with meals and a multivitamin for healing. There was no documentation of Resident 13's responsible party or physician being notified of the significant weight loss in one month on 9/21/22. Review of the Resident Weight Tracking System Report showed Resident 13's weight obtained on 11/3/22, showed 163.1 lbs. * On 11/8/22, an IDT Nutrition Alert note showed Resident 13 weighed 163.1 lbs, a loss of 8.8/5.4% lbs in one months. The RD documented the resident had a Stage 4 pressure ulcer on her right heel and poor intake. The resident was currently receiving Prostat (protein supplement), Zinc (vitamin supplement), and a multivitamin (supplement). There was no documentation of Resident 13's responsible party being notified of the significant weight loss in one month on 11/8/22. Review of the Resident Weight Tracking System Report showed Resident 13's weight obtained on 12/8/22, showing 154.3 lbs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 3 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few * On 12/13/22, an IDT Nutrition Alert note showed Resident 13 weighed 154.3 lbs, a loss of 13.1 lbs/7.8% in three months and a severed unplanned weight loss of 19.5 lbs/11% in six months. The RD documented the weight loss was acceptable due to the resident being overweight. The RD documented the resident had a Stage 4 pressure ulcer on her right heel and poor intake. The resident was currently receiving Prostat, Zinc, a multivitamin, and Magic Cup at lunch as supplements. The RD documented no new interventions. There was no documentation of Resident 13's RP being notified of the significant weight loss in three months on 12/13/22. Review of the physician's progress note showed Resident 13 was examined by her PCP on 12/25/22. The PCP noted Resident 13 had a weight of 153 lbs and weight loss. The PCP did not note the exact weight loss and ordered Remeron (antidepressant medication). On 1/25/23 at 0900 hours, a concurrent interview and medical record review was conducted with Desk Nurse 1. Desk Nurse 1 stated the RNAs took the weights and the desk nurses documented the weights in the clinical records. Desk Nurse 1 stated the MD was to be notified if there were significant weight changes. Desk Nurse 1 verified there was no documentation showing Resident 13's RP or physician was notified of the above significant weight changes. On 1/26/23 at 0917 hours, a telephone interview was conducted with the RP. The RP stated she had not been notified regarding any significant weight losses for the months of August to December 2022 for Resident 13. On 1/26/23 at 1058 hours, a concurrent interview and medical record review was conducted with Desk Nurse 2. Desk Nurse 2 stated the RP, IDT, and physician were notified for significant weight changes. Desk Nurse 2 verified there was no documentation showing Resident 13's RP or physician was notified of the above significant weight changes. Cross reference to F692, examples #2 and #3. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 4 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review, the facility failed to ensure the plan of care for one of 12 final sampled residents (Resident 13) was revised to reflect the resident's current condition and assessments. * The facility failed to revise Resident 13's care plan to reflect the resident's weight loss. This failure placed the resident at risk of not being provided appropriate, consistent, and individualized care. Findings: Medical record review for Resident 13 was initiated on 1/25/23. Resident 13 was readmitted to the facility on [DATE]. Review of the medical record showed Resident 13 had continued significant unplanned weight loss from August to December 2022. Review of the plan of care showed a care plan problem was developed to address Resident 13's nutrition dated 1/3/23. The care plan failed to address Resident 13's current and continued significant unplanned weight loss. On 1/25/23 at 0900 hours, a concurrent interview and medical record review was conducted with Desk Nurse 1. Desk Nurse 1 stated he was not sure about who should be updating the care plans. Desk Nurse 1 reviewed the medical record and verified the above findings. On 1/26/23 at 1500 hours, a concurrent interview and medical record review was conducted with the RD. The RD verified the care plans regarding the resident's weight loss had not been updated with the current and continued significant weight losses. Cross reference to F692, example #4. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 5 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and facility document review, the facility failed to ensure the post-fall neurological assessments were completed timely for one of 12 final sampled residents (Resident 27). This failure had the potential to delay the detection and response to changes in neurological status post fall for the residents. Findings: Review of the facility's P&P titled Assessing Falls and Their Causes revised March 2018 showed after a fall, the resident will be observed for delayed complications of a fall for approximately 48 hours. Review of the facility's P&P titled Neurocheck revised 4/2021 showed each resident will be assessed for 48 hours following suspected head injury. The assessment will be documented on the Neuro-check List as follows: -Every 30 minutes for two assessments, -Every hour for the next two assessments, -Every two hours for the next three assessments, -Every four hours for the next four assessments, and -Every eight hours until 48 hours post fall. Medical record review for Resident 27 was initiated on 1/27/23. Resident 27 was readmitted to the facility on [DATE]. Review of Resident 27's Interdisciplinary Note dated 11/12/22 at 0651 hours, showed Resident 27 was heard calling out for help and was found on the floor in her room. Review of Resident 27's Interdisciplinary Note dated 11/22/22 at 1252 hours, showed Resident 27 fell on [DATE] at 0300 hours. Review of Resident 27's 48 Hours Neuro-Checklist showed the log was initiated on 11/12/22 at 0515 hours (approximately two hours post fall). The log failed to showed the scheduled neurological assessments were done on the following: -On 11/12/22 at 0330 and 0400 hours, for both of the 30 minute post fall assessments. -On 11/12/22 at 1845 and 2245 hours, and 11/13/22 at 0245 hours, for two of the three scheduled every four hour assessments. Review of Resident 27's medical record failed to show a post-fall neurological assessment was completed prior to the assessment on 11/12/22 at 0515 hours. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 6 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0689 Level of Harm - Minimal harm or potential for actual harm On 1/27/23 at 0826 hours, an interview and concurrent medical record review were conducted with the DON. The DON stated for all unwitnessed falls, a post-fall neuro-checklist should be completed per the log schedule. The DON reviewed Resident 27's Interdisciplinary Notes and verified Resident 27 had an unwitnessed fall on 11/12/22 at 0300 hours. The DON verified Resident 27's 48 Hours Neuro-Checklist was initiated more than two hours late and had missing entries. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 7 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of 14 final sampled residents (Resident 13) maintained acceptable parameters of nutritional status when: Residents Affected - Few 1. The facility failed to implement interventions to maintain Resident 13's nutritional status when Resident 13 experienced the following weight loss: - a significant unplanned monthly weight loss of 9.2 lbs (5.3%) from 8/15/22 to 9/15/22 - a significant unplanned monthly weight loss of 8.8 lbs (5.4%) from 11/3/22 to 12/8/22 - a severe unplanned three-month weight loss of 13.1 lbs (7.8%) from 9/8/22 to 12/8/22 - a severe unplanned six-month weight loss of 19.5 lbs (11%) from readmission weight on 8/15/22 to 12/8/22 2. The facility failed to provide documentation showing the physician was notified of Resident 13's unplanned significant monthly weight loss of 9.2 lbs (5.3%) from 8/15/22 to 9/15/22. 3. The facility failed to provide documentation Resident 13's RP was notified of the following changes in condition for Resident 13: - significant unplanned monthly weight loss of 9.2 lbs (5.3%) from 8/15/22 to 9/15/22 - significant unplanned monthly weight loss of 8.8 lbs (5.4%) from 11/3/22 to 12/8/22 - severe unplanned three-month weight loss of 13.1 lbs (7.8%) from 9/8/22 to 12/8/22 - severe unplanned six-month weight loss of 19.5 lbs (11%) from readmission weight on 8/15/22 to 12/8/22 4. The facility failed to revise the resident centered plan of care for Resident 13 for the following changes in condition: - significant unplanned monthly weight loss of 9.2 lbs (5.3%) from 8/15/22 to 9/15/22 - significant unplanned monthly weight loss of 8.8 lbs (5.4%) from 11/3/22 to 12/8/22 - severe unplanned three-month weight loss of 13.1 lbs (7.8%) from 9/8/22 to 12/8/22 - severe unplanned six-month weight loss of 19.5 lbs (11%) from readmission weight on 8/15/22 to 12/8/22 Findings: A professional reference review of American Academy of Family Physicians Journal titled, Unintentional Weight Loss in Older Adults, dated 2014 showed, Unintentional weight loss (i.e., more than a 5% (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 8 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 Level of Harm - Actual harm Residents Affected - Few reduction in body weight within six to 12 months) occurs in 15% to 20% of older adults and is associated with increased morbidity and mortality. In this population, unintentional weight loss can lead to functional decline in activities of daily living, increased in-hospital morbidity, increased risk of hip fracture in women, and increased overall mortality. Further, cachexia (loss of muscle mass with or without loss of fat) has been associated with negative effects such as increased infections, pressure ulcers, and failure to respond to medical treatments . https://www.aafp.org/afp/2014/0501/p718.html - afp20140501p718-b1. A professional reference review of the National Library of Medicine titled Pressure Ulcer and Nutrition dated 2018 showed, Unplanned weight loss is a major risk factor for malnutrition and pressure ulcer development. Suboptimal nutrition interferes with the function of the immune system, collagen synthesis, and tensile strength. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5930532/#: A professional reference review of Dietetics in Healthcare Communities, a dietetic practice group of the American Dietetic Association titled Unintended Weight Loss in Older Adults: ADA Evidence Based Practice Guidelines dated 2011 showed, Most reference tables do not include elderly individuals in their subject pool, and thus these tables are not age adjusted. Standard height and weight tables and BMI tables are therefore not valid for use in older adults. https://higherlogicdownload.s3.amazonaws.com/THEACADEMY/4556f4af-bcea-4fd9-8fc9-5647e0d15658/UploadedImages 1. Review of the facility's P&P titled Nutrition (Impaired)/ Unplanned Weight Loss- Clinical Protocol revised 9/2017 showed in part, the section for Assessment and Recognition 2. The staff and Physician will define the individual's current nutritional status (weight, food/fluid intake, and pertinent laboratory values) and identify individuals with anorexia, weight loss or gain, and significant risk for impaired nutrition .4. The staff will report to the Physician significant weight gains or losses or any abrupt or persistent change from baseline appetite or food intake. For the section titled Treatment/Management showed 2. The staff and Physician will identify pertinent interventions based on identified causes and overall resident condition, prognosis and wishes. For the section titled Monitoring showed 1. The Physician and staff will monitor nutritional status, an individual's response to interventions . Medical record review for Resident 13 was initiated on 1/24/23. Resident 13 was readmitted to the facility on [DATE], with diagnoses which included Muscle Wasting and Atrophy (wasting or thinning of muscle tissue), Muscle Weakness, Peripheral Vascular Disease (circulatory condition which narrowed blood vessels reduce blood flow to the limbs), Dysphagia (difficulty swallowing), and Unspecified Dementia (progressive loss of intellectual functioning). Review of Resident 13's Discharge MDS dated [DATE], showed under Section K, Resident 13 weighed 184 lbs and had not experienced a 5% weight loss or gain in the past month or 10% weight loss or gain in the past six months. Review of Resident 13's History and Physical Examination dated 8/16/22, showed Resident 13 was readmitted from the hospital with urosepsis (infection in the blood caused by infections of the urinary tract), with intravenous (administered into a vein) antibiotics. The Physician noted Resident 13 was stable in the last month with no new event. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 9 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 Review of Resident 13's Physician's Order dated 8/18/22, showed the following orders: Level of Harm - Actual harm - 8/18/22, a mechanical soft ground diet Residents Affected - Few - 8/23/22, four ounces of cranberry juice TID (three times a day) - 8/30/22, four-ounce health shake with meals - 8/31/22, MVI (multi-vitamin) - 10/29/22, Zinc Sulfate (a mineral for wound healing) 220 mg daily - 30 cc prostat (protein supplement). Review of the facility document titled Resident Weight Tracking System Report from 8/14/22 through 1/25/23, showed the following weights and comparisons for Resident 13: * On 8/15/22 = 173.8 lbs, -10.2 lbs, a 5.5% significant weight loss since previous admission [comparison weight on 8/7/22, 184 lbs], * On 9/15/22 = 164.6 lbs, -9.2 lbs, a 5.3% significant weight loss in one month [comparison weight on 8/15/22, 173.8 lbs], * On 12/8/22 = 154.3 lbs, -8.8 lbs, a 5.4% significant weight loss in one month [comparison weight on 11/3/22, 163.1 lbs]; -13.1 lbs, a 7.83% severe weight loss in three months [comparison weight on 9/8/22, 167.4 lbs]; and -19.5 lbs, an 11% severe weight loss since readmission [comparison weight on 8/15/22, 173.8 lbs]. Review of the facility document titled Dietary Assessment completed by the RD on 8/15/22, showed Resident 13 was 68 inches and weighed 173.8 lbs. Resident 13 was confused and had a poor appetite and intake, 25-50% on a regular texture diet. Resident 13 was noted with coughing and choking with meals. Resident 13's skin was intact. The RD noted Resident 13 had weight loss of six lbs in the acute care hospital. The RD recommended to downgrade the diet to mechanical soft with ground meat, offer snacks, and encourage fluid between meals. Resident 13 was at risk for unintended weight loss and dehydration due to poor appetite and intake, infection, HTN (hypertension), dementia and needed assistance with meals. Resident 13 was at risk for pressure ulcer due to limited mobility. The RD documented for MDS triggers, Resident 13 was on IV treatment for infection and hydration. BMI was elevated, but the intake was poor, and no goal was identified for the resident's weight loss at this time. Review of Resident 13's IDT notes written by the RD dated 8/23/22, showed no recent weight, new DTI on heel, and poor intake. The IDT recommended to add cranberry juice with meals for fluid, vitamin C, and calories. Review of Resident 13's IDT notes written by the RD dated 8/30/22, showed current weight was not available, DTI on heel, and poor intake; and recommended to add health shake with meals, evaluate for MVI (multivitamin) supplement. Review of Resident 13's IDT notes written by the RD dated 9/14/22, showed current weight was 167.4 lbs, weight loss of 6.4 lbs in three weeks. The resident's heel was debrided now unstageable. No new (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 10 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 recommendations noted. Level of Harm - Actual harm Review of Resident 13's IDT notes written by the RD dated 9/21/22, showed current weight was 164.6 lbs, weight loss of 2 lbs in a week. Intake was variable. No new recommendations were noted. Residents Affected - Few Review of the facility document titled Dietary Assessment completed by the RD on 11/3/22, showed a significant change for Resident 13. Resident 13 was on a mechanical soft ground diet, appetite was poor, and intake was 25-50%. Resident 13 was confused with swallowing difficulty and high risk for pressure ulcer. Resident 13 had a stage 4 pressure ulcer located on the right heel. Lab data dated 10/31/22, showed, BUN (blood urea nitrogen) 11 ok. Current weight was 163 lbs, with weight loss of 19.6 lbs which was 10.7% in three months between admissions. Under the section titled Care Plan showed weight goal of 163 lbs +/3% per month x 90 days. Review of Resident 13's MDS dated [DATE], showed under Section A0310, 4. Significant change in condition. The MDS showed a BIMS score of 12 indicating Resident 13 was mostly interviewable but with some confusion. Section K of the MDS indicated Resident 13's weight was 163 lbs, and Resident 13 had experienced a 5% or more weight loss in the past month or 10% or more weight loss in the past six months and was not on a physician-prescribed weight-loss regimen. Review of Resident 13's IDT notes written by the RD dated 11/8/22, showed current weight was 163.1 lbs, weight loss of 1.3 lbs in a month. The resident's right heel was open and debrided. The document showed a recommendation for magic cup (a fortified ice cream) at lunch. Review of Resident 13's IDT notes written by the RD dated 12/6/22, showed current weight was 157.7 lbs, 3.4 lbs weight loss in a month; (elevated BMI) acceptable weight loss due to overweight. Resident 13 had a pressure ulcer to the right heel and poor intake. The document showed no interventions due to showing positive results from treatment. Review of Resident 13's IDT notes written by the RD dated 12/13/22, showed current weight was 154.3 lbs, a 3.4 lbs weight loss in a week; (elevated BMI) acceptable weight loss due to overweight. Resident 13 had the right heel Stage 4 pressure ulcer and poor intake. The document showed no new interventions, continue current treatment, and to review next week. Review of Resident 13's IDT notes written by the RD dated 12/27/22, showed the current weight was 152.6 lbs, a 2.9 lbs weight loss in a week. The document showed the resident's right heel Stage 4- nursing report improving, and heel protectors were helping. Intake was decreasing. The Social Service staff reported Resident 13 was not as alert as she used to be. The document showed need to encourage better intake, continue current treatment, and review next week. Review of Resident 13's Physician Progress Notes from 8/16/22 to 10/27/22, showed Resident 13 was stable in the last month, no new event noted. The section where to record the resident's body weight was blank. Review of Resident 13's Physician Progress Note dated 11/22/22, showed Resident 13 was stable in the last month, no new event noted. Resident 13's weight was recorded as 161 lbs. There was no documentation of weight loss. Review of Resident 13's Physician Progress Note dated 12/25/22, showed Resident 13 was stable in the last month. Resident 13's weight was recorded as 153 lbs. The progress note further showed, weight (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 11 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 loss secondary to? will start on Remeron (an antidepressant used to enhance appetite). Level of Harm - Actual harm On 1/24/23 at 0841 hours, an observation of the breakfast meal and concurrent interview was conducted with Resident 13. Resident 13 stated she did not want to eat any of her breakfast meal and preferred only to drink the four-ounce health shake (a nutritional supplement). Residents Affected - Few On 1/24/23 at 1300 hours, an observation of the lunch meal and concurrent interview was conducted with Resident 13 with CNA 1 present. Resident 13 was propped up in bed with CNA 1 assisting Resident 13 with her lunch meal. Resident 13 stated she did not like any of the food. CNA 1 stated Resident 13 did not eat solid foods and preferred liquids only, specifically health shakes. CNA 1 stated they encouraged Resident 13 to eat but she refused. On 1/25/23 at 0821 hours, an interview was conducted with the DON. The DON stated the protocol when a resident experienced a significant weight loss was to notify the physician and have a meeting with the IDT to discuss the resident's weight loss and implement interventions. On 1/26/23 at 1113 hours, an interview and concurrent medical record review of the initial skin assessment dated [DATE], for Resident 13 was conducted with RN 2. RN 2 stated the initial skin assessment showed Resident 13's skin was intact with a skin tear to the right calf. The skin evaluation form dated 8/21/22, for Resident 13 was reviewed with RN 2. The skin evaluation form showed a DTI which measured 4.0 centimeters (cm) in length and 7.0 cm in width, UTD (undetermined) depth. Resident 13's wound assessment form dated 10/27/22, completed by the Surgical and Wound Care Physician (SWCP) was reviewed with RN 2. The wound assessment form showed Resident 13's right heel had a Stage 4 wound, measuring 4.0 cm in length, 6.0 cm in width and .4 cm in depth. The wound assessment form showed the right heel wound was deteriorating and positive for cellulitis (a common, potentially serious bacterial skin infection). The SWCP recommended Augmentin (an antibiotic) for 10 days. On 1/26/23 at 1159 hours, an interview was conducted with the DON. The DON confirmed weight loss was not indicated in a resident with a Stage 4 wound. On 1/26/23 at 1447 hours, an interview was conducted with CNA 1. CNA 1 was asked how she documented the percentage of the health shake taken for Resident 13. CNA 1 stated the health shake was included in the total meal intake. If Resident 13 drank the health shake and magic cup but not other food, the intake was 25-50%. On 1/26/23 at 1500 hours, a medical record review for Resident 13 and concurrent interview was conducted with the RD. The Dietary Assessment completed by the RD, dated 8/15/22, and the discharge MDS dated [DATE] were reviewed. The RD confirmed she was responsible for Section K of the MDS. The RD stated she did not complete Section K of the discharge MDS dated [DATE], for Resident 13. The RD acknowledged the weight for Resident 13 was 184 lbs on 8/7/22, as per the discharge MDS. The RD confirmed Resident 13 had lost close to ten pounds in the hospital and that the weight loss was significant. The RD stated she could not remember what weight she used to compare Resident 13's admission weight of 173.8 lbs to, but that Resident 13's usual body weight prior to discharge was 180 lbs. The RD confirmed Resident 13 was at risk for unintended weight loss, dehydration, and pressure ulcer development. The RD confirmed Resident 13's skin was intact; intake was poor; the goal for Resident 13 was to keep weight stable at the admission weight of 173.8 lbs; and weight loss was not a goal. The RD confirmed she recommended to downgrade the diet to mechanical soft and offer snacks. The IDT progress notes written by the RD dated 8/23/22 and 8/30/22, were reviewed with the RD. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 12 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 Level of Harm - Actual harm RD stated Resident 13 was followed by the IDT due to an acquired DTI to the right heel and poor intake. The RD confirmed there was no recent weight noted on the IDT notes dated 8/23/22 or 8/30/22. The RD confirmed cranberry juice was added with meals at the family request and health shakes with meals and MVI (multivitamin) were recommended. Residents Affected - Few The IDT notes written by the RD dated 9/14/22 and 9/21/22, were reviewed with the RD. The RD confirmed Resident 13's weight on 9/8/22 was 167.4 lbs. which was a 6.4 lb. weight loss since admission, a three-week time frame. The RD confirmed Resident 13's weight on 9/15/22, was 164.6 lbs, a 2 lbs weight loss in a week. The resident's right heel was debrided and now unstageable. The RD confirmed Resident 13's intake remained poor. The RD confirmed no interventions were implemented. The IDT progress notes failed to document Resident 13 experienced a significant unplanned weight loss of 9.2 lbs, 5.2% from 8/14/22-9/15/22, a one-month time frame. When asked why no interventions were implemented at this time, the RD stated the weight loss of 6.4 lbs on 9/8/22, was not significant, and Resident 13 was already on health shake with meals. The COC (change of condition) MDS completed by the RD dated 11/4/22, and corresponding Dietary Assessment marked significant change completed by the RD dated 11/3/22, were reviewed with the RD. The RD stated the Dietary Assessment marked significant change was completed for Resident 13 because she had a decline which included weight loss and a Stage 4 wound. The RD confirmed Resident 13 had a poor appetite with meal intake 25-50%. The RD confirmed the current weight was 163 lbs, a significant unplanned weight loss of 19.6 lbs, 10.7% in three months. The RD confirmed the section titled Care Plan showed weight goal of 163 +/- 3% per month x 90 days. The RD confirmed no interventions were recommended. When asked why Resident 13's weight goal had been reduced to 163 lbs, compared to the 173.8 lbs weight goal on 8/15/22, the RD stated she did not want Resident 13 to gain or lose weight. The RD stated Resident 13's average weight had changed and that was how she determined the new goal weight. The RD confirmed the COC MDS showed Resident 13 had experienced a significant unplanned weight loss of 5% or more in the past month or 10% or more in the past six months and was not on a physician-prescribed weight-loss regimen. The IDT notes written by the RD dated 11/8/22, were reviewed with the RD. The RD confirmed Resident 13 weighed 163.1 lbs, a 1.3 lbs weight loss in a month. The resident's heel wound was open and debrided. The IDT agreed to add magic cup (a fortified ice cream) at lunch. The RD was asked how she assessed if the interventions were working. The RD stated Resident 13's intake was poor, so they added the magic cup. The IDT notes written by the RD dated 12/6/22 and 12/13/22, were reviewed with the RD. Although Resident 13 had experienced a significant unplanned weight loss of 8.8 lbs, 5.4% in a month from 11/3/22-12/8/22; a severe weight loss of 13.1 lbs, 7.83% in three months from 9/8/22-12/8/22; and a severe weight loss of 19.5 lbs., 11% since readmission on [DATE], the RD confirmed the significant weight losses were not mentioned and that Resident 13's current weight was 157.7 lbs on 12/6/22, a 3.4 lbs weight loss in a month; and 154.3 lbs. on 12/13/22, a 3.4 lbs weight loss in a week. The RD confirmed Resident 13 had poor intake and a Stage 4 wound on the right heel. The RD confirmed she documented the weight loss was acceptable due to an elevated BMI. When asked why the IDT did not recommend an intervention at this point, despite the continued significant unplanned weight loss, the RD stated even though Resident 13 lost weight, the IDT could not figure out what else to do since Resident 13 was already on health shakes with meals and magic cup at lunch. The RD was not sure Resident 13 would eat any more and the wound treatment was improving so the IDT did not recommend any interventions. The RD confirmed it was not appropriate for Resident 13 to lose weight with a Stage 4 wound and added she didn't want Resident 13 to gain any weight. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 13 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 Level of Harm - Actual harm Residents Affected - Few On 1/26/23 at 1604 hours, an interview was conducted with the DON and ADON. The DON stated he returned from leave on 1/9/23, so it was difficult for him to speak about the IDT meetings since he was not present. The DON confirmed if a resident continued to experience unplanned weight loss, the facility must keep trying new interventions. The ADON stated weight loss for Resident 13 was not putting the resident in an unhealthy BMI range. When asked if the ADON was qualified to determine that statement, the ADON agreed the physician should determine if weight loss was indicated for a resident. 2. Review of the facility's P&P titled Nutrition (Impaired)/ Unplanned Weight Loss- Clinical Protocol revised 9/2017 showed the section titled, Assessment and Recognition .4. The staff will report to the Physician significant weight gains or losses or any abrupt or persistent change from baseline appetite or food intake. Review of the facility document titled Resident Weight Tracking System Report from 8/14/22 through 1/25/23, showed the following weights and comparisons for Resident 13: * On 9/15/22, 164.6 lbs, -9.2 lbs, a 5.3% significant weight loss in one month [comparison weight 8/15/22, 173.8 lbs]. On 1/25/23 at 0821 hours, an interview was conducted with the DON. The DON stated the protocol when a resident experienced a significant weight loss was to notify the physician and have a meeting with the IDT to discuss the resident's weight loss and implement interventions. On 1/25/23 at 1059 hours, an interview and concurrent medical record review of Resident 13's electronic Resident Weight Tracking System Report (RWTSR) was conducted with Desk Nurse 2. Desk Nurse 2 stated the nurses were responsible to notify the physician of significant weight changes. Desk Nurse 2 further stated the RNA obtained the resident weights and the LVN entered the weight in the computer system. The RWTSR calculated significant weight changes, and significant weight loss was coded in red. The physician would be notified of any significant weight changes and the LVN would document this in the resident's electronic record. According to the RWTSR, Resident 13 experienced a significant weight loss on 9/15/22 of 9.2 lbs, 5.3%. Desk Nurse 2 was unable to verify if the physician had been notified of Resident 13's significant weight loss. Cross reference to F580. 3. Review of the facility's P&P titled Weight Assessment and Intervention revised 9/2008 showed care planning for weight loss or impaired nutrition will be a multidisciplinary effort and will include the physician, nursing staff, dietitian, and the resident or resident's legal surrogate. Review of the facility document titled Resident Weight Tracking System Report from 8/14/22 through 1/25/23, showed the following weights and comparisons for Resident 13: * On 8/15/22, 173.8 lbs, -10.2 lbs., a 5.5% significant weight loss since previous admission [comparison weight on 8/7/22, 184 lbs.], * On 9/15/22, 164.6 lbs, -9.2 lbs., a 5.3% significant weight loss in one month [comparison weight on 8/15/22, 173.8 lbs.], * On 12/8/22, 154.3 lbs., -8.8 lbs., a 5.4% significant weight loss in one month [comparison weight on 11/3/22, 163.1 lbs.]; -13.1 lbs, a 7.83% severe weight loss in three months [comparison weight (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 14 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 on 9/8/22, 167.4 lbs.]; and -19.5 lbs, a 14.6% severe weight loss since readmission [comparison weight on 8/15/22, 173.8 lbs.]. Level of Harm - Actual harm Residents Affected - Few On 1/26/23 at 1055 hours, a review of Resident 13's electronic RWTSR and concurrent interview was conducted with DN 3. DN 3 was asked who was notified of resident significant weight changes. DN 3 stated everyone was notified: the physician, family, and RD. DN 3 confirmed Resident 13 experienced a significant weight loss on 9/15/22 of 9.2 lbs, 5.3%; on 12/8/22, a significant weight loss of 8.8 lbs, 5.4% in a month; 13.1 lbs, 7.83% severe weight loss in three months; and 19.5 lbs, 14.6% a severe weight loss since admission on [DATE]; but was unable to verify if Resident 13's RP was notified. On 1/26/23 at 0917 hours, a telephone interview was conducted with Resident 13's RP. Resident 13's RP confirmed she had not been contacted by the facility regarding Resident 13's significant weight losses. On 1/26/23 at 1159 hours, an interview was conducted with the DON. The DON confirmed the RP should be contacted regarding significant weight changes. Cross reference to F580. 4. Review of the facility's P&P titled Weight Assessment and Intervention, dated 2001 showed, the multidisciplinary team will strive to prevent, monitor, and intervene for undesirable weight loss for our residents . Care planning: 2. Individualized care plans shall address to the extent possible: a. The identified causes of weight loss; b. Goals and benchmarks for improvement; and c. Time frames and parameters for monitoring and reassessment. Review of Resident 13's plan of care dated 1/3/23, showed a care plan problem was developed to address Resident 13's nutrition with a goal weight of 153.6 lbs. The care plan failed to address Resident 13's current and continued significant and severe unplanned weight losses. On 1/25/23 at 1059 hours, review of Resident 13's electronic Resident Weight Tracking System Report (RWTSR) and concurrent interview was conducted with Desk Nurse 2. Desk Nurse 2 confirmed Resident 13 had experienced a significant weight loss on 9/15/22 of 9.2 lbs, 5.3%; on 12/8/22 a significant weight loss of 8.8 lbs, 5.4% in a month; 13.1 lbs, 7.83% severe weight loss in three months; and 19.5 lbs, 11% a severe weight loss since admission on [DATE]. Desk Nurse 2 was asked if the plan of care should reflect these changes in weight. Desk Nurse 2 stated the plan of care should reflect significant weight changes but was not sure if that was the desk nurses' responsibility. Desk Nurse 2 confirmed Resident 13's plan of care did not reflect the significant and severe weight losses. On 1/26/23 at 1500 hours, an interview was conducted with the RD. The RD confirmed she was responsible to update the resident's nutritional plan of care. The RD was asked why Resident 13's plan of care did not reflect the significant and severe weight losses. The RD stated she usually updated the care plan but did not know why she did not update Resident 13's care plan. The RD further stated she did not use the word significant on care plans. When asked why the word significant was not used, she stated she did not know why. The RD confirmed the weight losses for Resident 13 were a problem. The RD confirmed the weight goal documented on the care plan for Resident 13 was now 153.6 lbs which was 20.2 lbs. less than the goal weight established on admission and 30.4 lbs. less than Resident 13's last previous admission weight. The RD stated it was not appropriate for Resident 13 to lose that much weight but that she did not want Resident 13 to gain any weight. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 15 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0692 Cross reference to F657. Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 16 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of 12 final sampled residents (Resident 10) was provided respiratory care with a physician's order. This failure had the potential to negatively affect the resident's health and well-being. Residents Affected - Few Findings: Review of the facility's P&P titled Oxygen Administration revised October 2010 showed the residents should have a physician's order for safe oxygen administration. Medical record review for Resident 10 was initiated on 01/24/22. Resident 10 was admitted to the facility on [DATE], with the diagnosis including Obstructive Sleep Apnea. On 1/24/23 at 0954 hours, Resident 10 was observed in her room with a nasal cannula (a device used to administer oxygen to a person) on and attached to an oxygen device running at 1 lpm of oxygen flow. On 1/25/23 at 1110 hours, Resident 10 was observed in her room with a nasal cannula on and attached to an oxygen device running at 2 lpm of oxygen flow. On 1/27/23 at 0900 hours, Resident 10 was observed in her room with a nasal cannula on and attached to an oxygen device running at 2 lpm of oxygen flow. Review of Resident 10's Physician's Order Reconciliation dated 1/27/23, showed no order for oxygen administration. On 1/26/23 at 1408 hours, an interview and concurrent medical record review was conducted with LVN 1. LVN 1 stated Resident 10 had been on oxygen therapy since her readmission on [DATE]. When asked if Resident 10 had an order for oxygen, LVN 1 stated she did not see an oxygen order in Resident 10's medical record. On 1/26/23 at 1407 hours, an interview was conducted with RN 1. RN 1 stated the residents receiving oxygen should have an order for oxygen. On 1/27/23 at 0917 hours, the DON verified there should be a physician's order for oxygen administration for any resident receiving oxygen therapy. On 1/27/23 at 1530 hours, the Administrator and DON were informed and acknowledged the above findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 17 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one nonsampled residents (Resident 39) was provided an accurate dose of insulin (a medication used to lower blood sugar) during the medication administration observation. This failure had the potential to negatively affect Resident 39's health. Findings: Review of the facility's P&P titled Insulin Administration revised September 2014 showed the insulin syringes must match the unit dose of insulin. Medical record review for Resident 39 was initiated on 1/24/23. Resident 39 was admitted to the facility on [DATE]. On 1/26/23 at 0808 hours, during medication administration observation, LVN 1 drew up five units of insulin in a 100 unit/ml insulin syringe. The insulin syringe was marked in increments of two units per line. LVN 1 drew up five units of insulin in between lines four and six. Review of Resident 39's Physician's Order Reconciliation dated 1/27/23, showed an order for five units of insulin aspart to be administered subcutaneously (under the skin) three times a day for diabetes. Review of Resident 39's Medication Record for 01/2023 showed Resident 39 received insulin three times a day since 1/1/23. On 1/26/23 at 1113 hours, an interview was conducted with LVN 1. When asked what syringe was used to administer Resident 39's insulin, LVN 1 stated she used a 100 unit/ml syringe. LVN 1 further stated she drew up five units of insulin in between lines four and six of the syringe because there were no lines to demarcate five units. On 1/26/23 at 1401 hours, an interview was conducted with RN 1. When asked what types of insulin syringes were available for use, RN 1 stated the facility had only provided 100 unit/ml insulin syringes. RN 1 verified the lines on the 100 unit/ml syringe were two units each. When asked how five units of insulin would be measured on that syringe, RN 1 stated the nurses must estimate the amount of medication by drawing up insulin in between two of the marked lines. RN 1 further stated that procedure was not an accurate way to prepare insulin. On 1/27/23 at 1046 hours, an interview was conducted with the facility's pharmacy consultant. The pharmacy consultant stated the nurses should not be estimating insulin when using a 100 units/ml syringe to draw up five units of insulin because it could affect the medication's therapeutic dose. The pharmacy consultant stated it would be best for the nurses to use a smaller syringe marked with one unit per line when drawing up five units of insulin. On 1/27/23 at 1530 hours, the Administrator and DON were informed and acknowledged the above findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 18 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 - Few 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 medical record review and interview, the facility failed to ensure two of 12 final sampled residents (Residents 5 and 13) remained free of unnecessary medications as evidenced by: * Resident 13 was ordered and received an antibiotic that the microorganism was not sensitive to. This had the potential to negatively impact Resident 13's well-being. * There was no documented evidence of the rational for the use of Seroquel with black box warning for Resident 5. This failure had the potential for Resident 5 to have unnecessary side effects. Findings: 1. Medical record review for Resident 13 was initiated on 1/24/23. Review of Resident 13's physician's order showed an order dated 11/22/22, for Keflex (antibiotic) 500 mg every 12 hours for cellulitis of Resident 13's foot and an order dated 12/1/22, for ampicillin (antibiotic) 1.5 gram to inject intramuscular every six hours for Resident 13's foot. Review of Resident 13's wound culture for the resident's foot dated 11/23/22, showed Resident 13's wound was not sensitive to Keflex. However, there was no documented evidence for the change of medication until 12/1/22. On 1/27/23 at 1027 hours, the DON was informed and verified the above findings. 2. Medical record review for Resident 5 was initiated on 1/24/23. Resident 5 was admitted to the facility on [DATE]. Review of Resident 5's Psychiatry Initial Visit Note dated 10/6/22, showed Resident 5 was diagnosed with dementia with psychosis. Further review of this note showed Resident 5 was ordered Seroquel (antipsychotic) 25 mg at bedtime for psychosis. Review of Resident 5's Note to Attending Physician/Prescriber dated 10/12/22, showed the facility's pharmacist informed the prescriber of Resident 5's Seroquel medication use for resident's with dementia had a black box warning (highest safety-related warning that medications can have assigned by the Food and Drug Administration). Further review of the this note failed to show the section for the prescriber to document rationale for ordering the Seroquel was completed. On 01/27/23 at 0915 hours, a telephone interview was conducted with the Psychiatry Consultant. When asked about Resident 5's diagnosis of dementia with psychosis and order for Seroquel, the Psychiatry Consultant stated he ordered the Seroquel for Resident 5's psychosis but was not responsible for treating Resident 5's dementia. On 1/27/23 at 1027 hours, the DON verified there was no follow up in regards to the use of resident's Seroquel. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 19 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 and interview, the facility failed to ensure the sanitary requirements were met in the kitchen. Residents Affected - Many * The facility failed to ensure the cutting boards were in sanitary condition. * The facility failed to ensure the kitchen equipment was clean. * The facility failed to ensure the food items in the storage bins were properly labeled and dated. * The facility failed to ensure the food items in the residents' refrigerator were properly labeled and dated. * The facility failed to ensure the expired food items in the resident nourishment refrigerator were properly disposed. These failures had the potential to cause foodborne illness in a medically vulnerable resident population who consumed food prepared in the kitchen. Findings: Review of the CMS 672 Resident Census and Conditions of Residents completed by the facility dated 1/24/23, showed 42 of 42 residents in the facility received food prepared in the kitchen. 1. According to the USDA Food Code 2022, Section 5-401.12, Cutting Surfaces, cutting surfaces such as cutting boards and blocks that become scratched and scored may be difficult to clean and sanitize. As a result, pathogenic microorganisms transmissible through food may build up or accumulate. These microorganisms may be transferred to foods that are prepared on such surfaces. On 1/24/23 at 0820 hours, a concurrent observation and interview was conducted with the RD. Two cutting boards were observed to be heavily marred with knife marks. The RD verified the cutting boards needed to be replaced. 2. According to the USDA Food Code 2022, Section 4-601.11, Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils: (A) Equipment food-contact surfaces and utensils shall be clean to sight and touch. (B) The food-contact surfaces of cooking equipment and pans shall be kept free of encrusted grease deposits and other soil accumulations. (C) Nonfood-contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris. On 1/24/23 at 0831 hours, a concurrent observation and interview was conducted with the RD. Two medium-sized frying pans were observed to have blackened residue on the inside surface. The RD verified the pans should have been replaced. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 20 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 3. According to the USDA Food Code 2022, Section 3-302.12, Food Storage Containers, Identified with Common Name of Food, 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. Residents Affected - Many On 1/24/23 at 0845 hours, a concurrent observation and interview was conducted with the RD and Dietary [NAME] 1. An unlabeled and undated container with white granules was observed on a shelf. The RD stated the container had thickener inside. Dietary [NAME] 1 stated the container had sugar inside. The RD verified the container should have been labeled. 4. On 1/24/23 at 0911 hours, two unlabeled and undated chocolate health shakes were observed in the resident nourishment refrigerator. On 1/24/23 at 1457 hours, a concurrent observation and interview was conducted with the DON. The DON verified the above findings and stated the health shakes should have been labeled. 5. On 1/24/23 at 0911 hours, four pudding cups labeled, Use by 1/22/23, were observed in the resident nourishment refrigerator. On 1/24/23 at 1457 hours, a concurrent observation and interview was conducted with the DON. The DON verified the above findings and stated the pudding cups should have been thrown away. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 21 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0842 Level of Harm - Potential for minimal harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observation, interview, and facility document review, the facility failed to protect resident identifiable information. Residents Affected - Some * The facility's survey results binder for public viewing included ten confidential resident rosters. This failure had the potentail to result in confidential resident information being accessible to the public. Findings: On 1/27/23 at 1150 hours, the facility's survey results binder labeled Survey Results was observed located in a wall file pocket next to the resident room, across from the Nurses' Station for public view. Review of the survey binder included ten Confidential Resident Rosters (a list which identified the names of the residents by their identifiers given during survey, to protect the residents' identities) for the following surveys: - An abbreviated survey completed on 3/9/18, with four resident names and their identifiers. - An abbreviated survey completed on 2/25/19, with five resident names and their identifiers. - An abbreviated survey completed on 5/2/19, with nine resident names and their identifiers. - An abbreviated survey completed on 9/30/19, with two resident names and their identifiers. - A COVID-19 Mitigation Plan and Infection Control survey completed on 6/22/20, with two resident names and their identifiers. - A COVID-19 Mitigation Plan survey completed on 8/20/20, with two resident names and their identifiers. - An abbreviated survey completed on 10/15/20, with two resident names and their identifiers. - A COVID-19 Mitigation Plan survey completed on 10/20/20, with three resident names and their identifiers. - A Focused Infection Control survey completed on 12/20/20, with five resident names and their identifiers. - A COVID-19 Mitigation Plan survey completed on 2/4/21, with two resident names and their identifiers. On 1/27/23 at 1154 hours, an interview and concurrent facility document review was conducted with the Administrator. The Administrator stated they placed the survey results with the attached confidential resident rosters and verified the confidential rosters should not be located in the binder. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 22 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 facility P&P review, the facility failed to follow the infection control guidelines for two nonsampled residents (Residents 34 and 36) and one of 12 final sampled residents (Resident 28). Residents Affected - Some * During the medication administration observation, the RN failed to properly disinfect the vital sign equipment while providing care to Residents 34 and 36. * During the medication administration observation, LVN 1 failed to disinfect the blood pressure equipment while obtaining vital signs for Resident 28. These failures had the potential to cause the risk of transmission of disease causing microorganisms. Findings: 1. Review of the facility's P&P titled Cleaning and Disinfection of Resident-Care Items and Equipment revised July 2014 showed reusable items are cleaned and disinfected between residents. On 1/26/23 at 0827 hours, a medication administration observation was conducted with RN 1. RN 1 stated she had just checked Resident 36's vital signs. RN 1 was observed disinfecting a wrist worn blood pressure monitoring device with a PDI Sani-Hand wipe. The blood pressure reading device had a wrist strap covered in a cloth-like material. On 1/26/23 at 0839 hours, after completing Resident 36's medication administration, RN went into Resident 34's room and took the resident's blood pressure with the same blood pressure monitoring device, a forehead thermometer, and a portable pulse oximeter (a device placed on the finger to measure oxygen saturation and pulse rate). After obtaining the resident's vital signs, RN 1 used PDI Sani-Hand wipes to disinfect all three devices. Review of the PDI Sani-Hands label showed the wipes are instant hand sanitizing wipes to be used to hand hygiene. The label failed to show it was designed to be used on patient care equipment. On 1/26/23 at 1110 hours, RN 1 stated she usually used the PDI Sani-Hand to clean her vital sign equipment between resident use and believed it was appropriate for both hand hygiene and equipment disinfection but would double check. On 1/26/23 at 1318 hours, RN 1 stated they should not have used the PDI Sani-Wipes to disinfect resident care equipment. On 1/26/23 at 1451 hours, RN 1 stated she took the vital signs that morning for all of her residents. Review of the Daily Nursing Staffing for 1/26/23, showed RN 1 was assigned to all residents on Station 2. On 1/27/23 at 1024 hours, an interview was conducted with the DON. The DON stated Station 2 assignment on 1/26/23, were rooms 910, 912-916, 920, and 922-932. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 23 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Review of the facility's P&P titled Cleaning and Disinfection of Resident-Care Items and Equipment revised July 2014 showed medical equipment and resident-care equipment will be cleaned and disinfected per the CDC's recommendation. Review of the CDC's guidelines titled Guideline for Disinfection and Sterilization in Healthcare Facilities reviewed 2019 showed noncritical medical devices (e.g. blood pressure cuff) must be disinfected with an United States Environmental Protection Agency (EPA) registered hospital disinfectant using the label's safety precautions and directions as required by law. Medical record review for Resident 28 was initiated on 1/24/23. Resident 28 was admitted to the facility on [DATE]. On 1/26/23 at 0808 hours, a medication administration observation was conducted with LVN 1. LVN 1 cleaned Resident 28's blood pressure cuff with a wipe labeled PDI Sani-Hands -Instant Hand Sanitizing Wipes. When asked what disinfectant was used to clean medical devices, LVN 1 stated she should not have used the PDI Sani-Hands - Instant Hand Sanitizing Wipe to clean Resident 28's blood pressure cuff. LVN 1 further stated she should have used a disinfectant wipe. Review of the PDI Sani-Hands - Instant Hand Sanitizing Wipe label showed no contact time (amount of time a surface must stay wet with a disinfectant to kill bacteria and viruses) listed. On 1/26/23 at 0949 hours, an interview was conducted with the DON. When asked what the process was for disinfecting medical equipment, the DON stated the staff should use the facility's provided chemical disinfectants. The DON provided a list of facility disinfectants, which did not include PDI Sani-Hands Instant Hand Sanitizing Wipes. The DON further stated for equipment to be properly cleaned, the staff should follow the manufacture's contact time for disinfection. On 1/27/23 at 1530 hours, the Administrator and DON were informed and acknowledged the above findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 24 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, facility document review, and facility P&P review, the facility failed to ensure the resident care equipment was monitored and deemed appropriate for resident care. Residents Affected - Some * RN 1 used their own equipment brought from home to monitor her residents' vital signs. * LVN 1 used a device brought from home to obtain Resident 8's blood pressure prior to administering a blood pressure medication. These failures had the potential for inaccurate vital sign results and care interventions. Findings: Review of the facility's Medical Equipment Management Plan revised date March 2020 showed: - All equipment is tested for performance and safety prior to initial use on the residents. - The frequency of planned maintenance is based on manufacturer recommendation. 1. Review of the Daily Nursing Staffing showed the resident assignment was split between RN 1 and another nurse. The census was 41. On 1/26/23 at 0839 hours, during a medication administration observation with RN 1, RN 1 was observed checking Resident 34's blood pressure with a wrist band style portable monitor prior to administering the blood pressure medication. RN 1 also checked Resident 34's blood oxygen saturation and pulse with a small portable finger clamp style pulse oximeter and well as the resident's temperature with a digital forehead thermometer. The thermometer showed a reading of 94 degrees Fahrenheit. On 1/26/23 at 1029 hours, a interview was conducted with RN 1. RN 1 stated the wrist blood pressure monitor, digital thermometer, and pulse oximeter used were her own equipment brought from home. RN 1 stated she did not have the manufactures instructions with her for the devices. On 1/26/23 at 1409 hours, an interview was conducted with the Maintenance Supervisor. The Maintenance Supervisor stated he was not responsible for the maintenance or oversight of the patient care equipment brought in by the nursing staff. The Maintenance Supervisor stated the biomedical testing for the patient care equipment was performed by an outside vendor overseen by the Administrator. The Maintenance Supervisor reviewed the biomedical testing records dated 4/1/22, and verified two Direct Supply vital sign machines and one [NAME] electronic tympanic thermometer were tested. The Maintenance Supervisor verified no nurses' own vital sign equipment was listed. On 1/26/23 at 1417 hours, an interview was conducted with the Administrator. The Administrator stated the staff should only be using the facility provided vital sign equipment, and not their own equipment brought in from home. The Administrator stated all patient care equipment should be maintained and monitored for quality control. On 1/26/23 at 1451 hours, a follow-up interview was conducted with RN 1. RN 1 stated the nurses took the residents' vital signs and obtained all her residents' with her own vital sign equipment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 25 of 26 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Medical record review for Resident 8 was initiated on 01/24/23. Resident 8 was admitted to the facility on [DATE], with the diagnosis of hypertensive (high blood pressure) heart disease with heart failure. Review of Resident 8's Physician's Order Reconciliation for the date of 01/27/23, showed Resident 8 had an order for an antihypertensive (a medication to lower blood pressure) with instructions to obtain Resident 8's blood pressure twice a day. On 1/26/23 at 0808 hours, during medication administration observation, LVN 1 used a small hand-sized wrist style blood pressure device to take Resident 8's blood pressure. LVN 1 stated the wrist blood pressure device used on Resident 8 was her device brought from home. When asked if the facility provided her a blood pressure machine to use on the residents, she stated yes. However, LVN 1 further stated the facility's blood pressure machines were broken or were in use. LVN 1 stated her personal wrist blood pressure machine was not always accurate and it would be best to use the facility's blood pressure machine. On 1/26/23 at 1102 hours, an interview was conducted with the DON. When asked what the process was for staff to bring in personal equipment, he stated there was no process for checking the equipment. On 1/27/23 at 1530 hours, the Administrator and DON were informed and acknowledged the above findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555295 If continuation sheet Page 26 of 26