Inspection·September 12, 2025

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident does not have capacity to make healthcare decisions.A review of the Social Service Assessment dated, August 4, 2025, indicated, .relative/responsible party.niece (name listed).Does resident have advance directives? .NO.reason for no advance directive.low BIMS. A review of the Social Service Quarterly dated, July 18, 2025, indicated, .Advance Directive.changes over past quarter.describe.N/A.There was no documented evidence the resident or (RP) was provided follow up information about the right to formulate an AD.4. On September 11, 2025, Resident 28's record was reviewed. Resident 28 was admitted to the facility on [DATE].A review of Resident 28's MDS, dated [DATE], indicated Resident 28 had BIMS score of 0 (cognitive impairment).A review of the Advance Healthcare Directive form, dated April 14, 2025, indicated, .I have not executed any advance directives.Per H&P, resident does not have capacity to make healthcare decisions.A review of the Social Service Assessment dated, September 20, 2024, indicated, .relative/responsible party.son(name listed).cousin (name listed).Does resident have advance directives? .NO.reason for no advance directive.resident does not have capacity to formulate.A review of the Social Service Quarterly dated, August 7, 2025, indicated, .Advance Directive.changes over past quarter.describe.N/A.There was no documented evidence the resident or (RP) was provided follow up information about the right to formulate an AD.5. On September 11, 2025, Resident 36's record was reviewed. Resident 36 was admitted to the facility on [DATE].A review of Resident36's MDS, dated [DATE], indicated Resident 36 had BIMS score of 12 (moderate cognitive impairment).A review of the H&P dated May 11, 2025, indicated, .has capacity to understand and make decisions.A review of the Advance Healthcare Directive form, dated April 24, 2025, indicated, .I have not executed any advance directives.I would like more information.(SSD sent referral to Ombudsman on April 24, 2025).A review of the Social Service Assessment dated, May 12, 2025, indicated, .relative/responsible party.sister(name listed.Does resident have advance directives? .NO.reason for no advance directive.has yet to formulate an AD yet. A review of the Social Service Quarterly dated, August 7, 2025, indicated, .Advance Directive.changes over past quarter.describe.N/A.There was no documented evidence the resident or (RP) was provided follow up information about the right to formulate an AD.6. On September 9, 2025, at 2:51 p.m., an interview was conducted with Resident 123. Resident 123 stated someone went over a lot of information when she came to facility but was unsure if she received information about an AD and would like more information about it.On September 11, 2025, Resident 123's record was reviewed. Resident 123 was admitted to the facility on [DATE].A review of Resident 123's MDS, dated [DATE], indicated Resident 123 had BIMS score of 13 (moderate cognitive impairment).A review of the Advance Healthcare Directive form, dated April 14, 2025, indicated, .I have not executed any advance directives.I do not wish to execute an Advance Directive for Health Care at this time.A review of the Social Service Assessment dated, May 23, 2025, indicated, .relative/responsible party.Does resident have advance directives? .NO.reason for no advance directive.(this section is left blank).A review of the Social Service Quarterly dated, September 9, 2025, indicated, .Advance Directive.changes over past quarter.describe.N/A.There was no documented evidence the resident or (RP) was provided follow up information about the right to formulate an AD.7. On September 9, 2025, at 10 a.m. an interview was conducted with Resident 126. Resident 126 stated she was unsure about wanting to formulate an AD and does not remember if follow up was provided.On September 11, 2025, Resident 126's record was reviewed. Resident 126 was admitted to the facility on [DATE].A review of Resident 126's MDS dated [DATE], indicated a BIMS score of 14 (cognitively intact)A review of the Advance Healthcare Directive form, dated May 9, 2025, indicated, .I have not executed any advance directives.I would like more information. (SSD sent referral to Ombudsman on May 9, 2025).A review of the Social Service Assessment dated, May 14, 2025, indicated, .relative/responsible party.(son name listed).Does (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 2 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident have advance directives? .NO.reason for no advance directive.Has yet to formulate an AD at this time.A review of the Social Service Quarterly dated, August 5, 2025, indicated, .Advance Directive.changes over past quarter.describe.N/A.There was no documented evidence the resident or (RP) was provided follow up information about the right to formulate an AD.8. On September 9, 2025, at 12:15 p.m. an interview was conducted with Resident 155. She stated she remembered asking about the formulation of an AD and did not receive any updates about it and would like to know what happened? On September 11, 2025, Resident 155's record was reviewed. Resident 155 was admitted to the facility on [DATE].A review of Resident 155's MDS, dated [DATE], indicated Resident 155 had BIMS score of 15 (cognitively intact).A review of the Advance Healthcare Directive form, dated January 2, 2025, indicated, .I have not executed any advance directives.I would like more information. (SSD sent referral to Ombudsman on January 2, 2025.).A review of the Social Service Assessment dated, December 27, 2024, indicated, .Does resident have advance directives? .NO.reason for no advance directive.none desired.A review of the Social Service Quarterly dated, July 3, 2025, indicated, .Advance Directive.changes over past quarter.describe.N/A.There was no documented evidence the resident or (RP) was provided follow up information about the right to formulate an AD.9. On September 9, 2025, at 2:11 p.m. an interview was conducted with Resident 157. She stated she was offered info about an AD before but was not interested then, and she was told they were going to check back again but didn't give her more information.On September 11, 2025, Resident 157's record was reviewed. Resident 157 was admitted to the facility on [DATE].A review of Resident 157's MDS, dated [DATE], indicated Resident 157 had BIMS score of 13 (moderate cognitive impairment).A review of the Advance Healthcare Directive form, dated February 18, 2025, indicated, .I have not executed any advance directives.I would like more information. (SSD sent referral to Ombudsman on February 18, 2025).A review of the Social Service Assessment dated, April 11, 2025, indicated, .Does resident have advance directives? .NO.relative/responsible party.cousin (name listed).reason for no advance directive.resident already has an advance directive dated for October 12, 2017.A review of the Social Service Quarterly dated, August 8, 2025, indicated, .Advance Directive.changes over past quarter.describe.N/A.There was no documented evidence the resident or (RP) was provided follow up information about the right to formulate an AD or that the facility had a copy available.10. On September 8, 2025, at 10:15 a.m. an interview was conducted with Resident 168. Resident 168 stated he was unsure about wanting to formulate an AD and does not remember if follow up was provided.On September 11, 2025, Resident 168's record was reviewed. Resident 168 was admitted on [DATE]. A review of Resident 168's MDS dated [DATE], indicated a BIMS score of 15 (cognitively intact).A review of the Advance Healthcare Directive form, dated February 4, 2025, indicated, .I have not executed any advance directives.I would like more information. (SSD sent referral to Ombudsman on February 4, 2025.).A review of the Social Service Assessment dated, April 11, 2025, indicated, .Does resident have advance directives? .NO.relative/responsible party.sister (name listed).reason for no advance directive.resident did not formulate an advance directive.A review of the Social Service Quarterly dated, August 2, 2025, indicated, .Advance Directive.changes over past quarter.describe.N/A.There was no documented evidence the resident or (RP) was provided follow up information about the right to formulate an AD.On September 11, 2025, at 2:24 p.m. a concurrent interview and record review was conducted with the Social Service Director (SSD). The SSD stated during admission, if the resident was capable of making decisions, they were asked if an AD was available. The SSD stated, if the resident was not cognitively able, the responsible party was asked. The SSD stated, if an AD was available, a physical copy was placed in the medical record. The SSD stated, if no AD was available, the facility offered to assist the resident or representative in formulating one. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 3 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete SSD stated AD requests would be sent to the Ombudsman for verification, and she kept them until the Ombudsman arrived to sign off. The SSD stated that she conducted monthly audits to evaluate residents interested in formulating an AD. The SSD stated the social service assessment were completed upon admission, then quarterly and annually. The SSD stated it was important to have an AD available so that the resident needs were met and their medical care wishes were honored.A concurrent record review was conducted with the SSD for Residents 1, 9, 13, 28, 36, 123, 126, 155, 157, and 168. The SSD stated she did not document follow-up during quarterly assessments for ten residents (Residents 1, 9, 13, 28, 36, 123, 126, 155, 157, and 168) to determine if they wished to formulate an AD. The SSD stated she had not followed up with all residents to honor their requests for the right to formulate an AD, and she should have. The SSD further stated without an AD in place, there was a risk residents' treatment preferences might not be followed.A review of the facility policy and procedure titled, Advance Directives dated January 2018, indicated, .upon admission, the resident will be provided with written information concerning the right to refuse or accept medical or surgical treatment and to formulate an advance directive if he or she chooses to do so.If the resident is incapacitated and unable to receive information about his or her right to formulate an advance directive, the information may be provided to the residents' legal representative.information about whether or not the resident has executed an advance directive shall be displayed prominently in the medical record.if the resident indicates that he or she has not established advance directives, the facility staff will offer assistance in establishing advance directives.the resident will be given the option to accept or decline the assistance.staff will document the resident's decision to accept or decline assistance.an ongoing review of the resident's decision-making capacity and communicate significant changes to the resident's legal representative.review annually with the resident his or her advance directives to ensure that such directives are still the wishes of the resident. Such reviews will be made during the annual assessment process and recorded.inquiries concerning advance directives should be referred to the.social service director. Event ID: Facility ID: 555330 If continuation sheet Page 4 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide a written Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN- a notice to provide information to residents/beneficiaries if they wish to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility) for one of three residents reviewed for SNF ABN (Resident 92).This failure resulted in Resident 92 not being informed in writing about potential liability for payment of non-covered Medicare Part A services, placing the resident at risk of unexpected financial burden.Findings:A review of Resident 92's admission Record was conducted. Resident 92 was admitted to the facility on [DATE], with a diagnosis which included asthma (respiratory condition characterized by difficulty in breathing). Resident 92's Medicare Part A coverage began on April 17, 2025, and ended on July 1, 2025. Resident 92 remained in the facility for long term care after Medicare coverage ended.A review of Resident 92's record showed no documentation of a completed SNF ABN form or written notice informing the resident of financial liability for continued services after Medicare Part A ended. On September 11, 2025, at 4 p.m., a concurrent interview and record review of SNF ABN for residents who received Medicare Part A Services was conducted with the Administrator (ADM). The ADM stated for Resident 92 the SNF ABN was not provided. The ADM further stated this had the potential to result in the resident not being informed in writing that he was financially liable for continued skilled services.A review of the facility policy and procedure titled Medicare Advanced Beneficiary Notice, dated January 2018, indicated .If the benefit coordinator believes that Medicare (Part A of the Fee for Service Medicare Program) will not pay for otherwise covered service(s), the resident is notified in writing why the service(s) will not be covered and of the resident's potential liability for payment of the non-covered service(s).the facility issues the Skilled Nursing Facility Advanced Beneficiary Notice to the resident prior to providing care that Medicare usually covers, but may not pay for because the care considered not medically reasonable and necessary, or custodial. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 5 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure reasonable care for the protection of resident's property for two of three residents (Residents 120 and 147) when: 1. The personal inventory list was not available for Resident 120 and2. The inventory of personal belongings list was incomplete for Resident 147.These failures resulted in the inability to verify and account for residents' belongings which had the potential to result in psychosocial harm for Residents 120 and 147.Findings: 1. On September 8, 2025, at 9:37 a.m. an interview was conducted with Resident 120 in her room. Resident 120 stated she had her partial dentures upon admission. Resident 120 stated she does not have her partial dentures and feels shy without it. A review of Resident 120's admission Record dated September 12, 2025, indicated an admission date of March 19, 2024, which included a diagnosis of schizoaffective disorder (mental disorder). A review of Resident 120's History and Physical dated March 21, 2024, indicated resident has intermittent capacity to make decisions. A review of Resident 120's Minimum Data Set (MDS - an assessment tool) dated June 26, 2025, indicated a Brief Interview for Mental Status (BIMS – a tool to assess cognitive function) score of 14 (intact cognitive function). On September 11, 2025, at 4:21 p.m. an interview was conducted with the Registered Nurse Supervisor (RNS). The RNS stated when a resident comes in with dentures, the dentures are documented in the resident's inventory list. The RNS further stated she could not locate Resident 120's inventory list. On September 12, 2025, at 10:58 a.m. an interview was conducted with the Director of Nursing (DON). The DON stated upon admission, staff should have completed an inventory list of all belongings which could have included the dentures. The DON stated the inventory list is important to account for all the resident's belongings and if an item was missing and was listed on the inventory list, the facility would be obligated to replace it. 2. On September 9, 2025, at 10:58 a.m. an interview with Resident 147 was conducted. Resident 147 stated he had been missing personal belongings, which included two sweaters and three t-shirts. A review of Resident 147's admission record indicated Resident 147 was admitted to the facility on [DATE], with diagnoses which included dementia (forgetfulness). A review of Resident 147's Minimum Data Set (MDS – an assessment tool) dated August 25, 2025, indicated a Brief Interview for Mental Status (BIMS – a tool to assess cognitive functioning) score was 12 (moderate cognitive impairment). On September 11, 2025, at 1:38 p.m., a concurrent interview and record review of Resident 147's inventories of personal belongings were conducted with Licensed Vocational Nurse (LVN) 1, LVN 1 stated the staff who filled out the list of inventories of personal belongings did not have the signature of the staff. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 6 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On September 12, 2025, at 3:09 p.m., a concurrent interview and record review of Resident 147's inventory of personal belongings was conducted with LVN 2. LVN 2 stated upon admission the staff should sign the inventory form to account for the personal belongings. LVN 2 stated, once an item was documented on the inventory list, it served as a proof that the resident had the belonging upon admission. LVN 2 stated if the inventory list form was not completed and signed, the facility could not verify what belongings the resident actually had at admission. LVN 2 further stated the list of personal belongings did not have the staff signature, and the lack of signature had the potential to result in missing and unaccounted for items. A review of the facility policy and procedure titled Personal Property, dated January 2018, indicated .The resident's personal belongings and clothing shall be inventoried upon admission and as such items are replenished. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 7 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure all residents were free from abuse when one of five residents (Resident 168) reviewed for abuse was verbally abused by another resident (Resident 10), after Resident 168 asked Resident 10 to lower the volume of his music. Resident 10 verbally threatened Resident 168 and called him derogatory names.The facility failure resulted in Resident 168 feeling threatened by Resident 10, which could negatively impact the resident's psychosocial well-being. Findings:On September 8, 2025, at 11:11 am, a concurrent observation and interview was conducted with Resident 10 in his room. It was noted that loud music could be heard from the hallway. Resident 10 stated there was an incident with Resident 168 and acknowledged that he continues to play his music loud and does not care if it bothers anyone.A review of Resident 10's admission Record dated September 10, 2025, indicated the resident was admitted on [DATE], with diagnoses which included bipolar disorder (mental disorder).A review of Resident 10's History and Physical dated May 8, 2025, indicated that resident's decision-making capacity is intact.A review of the facility Grievance Report dated June 12, 2025, indicated .Resident [Resident 74] stated that roommate [Resident 10] has his TV too loud at night.Residents were not able to come to an agreement. Resident (Resident 74) agreed to move rooms.A review of Resident 10's Activity Note dated July 24, 2025, indicated .Activities Director (AD) spoke with resident at bedside regarding playing music at high volumes while in their room. AD asked resident if they would like headphones for their music. Resident refused and proceeded to ask who sent someone to ask me if I wanted headphones claiming that somebody already tried to talk to him regarding this matter and proceeded to say insults and curse words about them out loud. Resident proceeded to go around the building shortly after the conversation.A review of Resident 10's records indicated there were no additional interventions or care plans in place to address the resident's ongoing loud music behavior.A review of Resident 10's Minimum Data Set (MDS - an assessment tool) dated August 12, 2025, indicated a Brief Interview for Mental Status (BIMS - a tool to assess cognitive function) score was 14 (cognitively intact).On September 8, 2025, at 11:55 a.m. an interview was conducted with Resident 168 in his room. Resident 168 stated Resident 10 played his music too loud, and the loud music has been occurring for months. Resident 168 stated he felt threatened by Resident 10, who had also called him names such as retard. A review of Resident 168's admission Record dated September 10, 2025, indicated an initial admission date of July 19, 2024.A review of Resident 168's History and Physical dated May 8, 2025, indicated decision making capacity is intact.A review of Resident 168's MDS dated [DATE], indicated BIMS score of 15 (cognitively intact).A review of Resident 168's Progress Notes dated August 17, 2025, indicated, .Resident stated that (name of Resident 10) was playing music very loudly. When asked to turn down the music the resident (Resident 10) turn (sic) it up. (Name of Resident 10) turned off the music after some time and began making verbal threats to (name of Resident 168). (name of Resident 10) stated that he was going to be at (sic) (name of Resident 168) .On September 12, 2025, at 11:38 am a concurrent interview and record review were conducted with the AD. The AD stated he informed the Social Services Director (SSD) of Resident 10's refusal of headphones. The AD stated he did not know if any other interventions were implemented to address the loud volume.On September 12, 2025, at 1:10 pm, a concurrent interview and record review was conducted with the SSD. The SSD stated the Grievance Report dated June 12, 2025, addressed the issue by removing the complainant and did not address the loud volume. On September 12, 2025, at 2:46 p.m., an interview was conducted with Licensed Vocational Nurse (LVN) 3. LVN 3 stated if there was a complaint about loud music it should be addressed and care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 8 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete planned. LVN 3 stated it was important to know what interventions should be implemented to address the problem.On September 12, 2025, at 2:48 pm an interview was conducted with the Director of Nursing (DON). The DON stated she was aware of the grievance filed in June and the behavior of the resident (Resident 10) should have been addressed. The DON stated a care plan should have been initiated to implement interventions. The DON stated on August 17, 2025, the resident (Resident 10) played his music loudly, which led to a verbal altercation between the two residents (Resident 10 and Resident 168). The DON stated if there was an intervention or care plan, the altercation on August 17, 2025, could have been prevented.A review of the facility's policies and procedures titled, Abuse and Neglect Prohibition Policy, dated June 2022, indicated, .The following actions to prevent abuse.identifying, correcting, and intervening in situations in which abuse.is more likely to occur.care planning.of residents with needs and behaviors which might lead to conflict. Event ID: Facility ID: 555330 If continuation sheet Page 9 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to incorporate the recommendations from the PASARR level II determination and evaluation into the care plan for one (Resident 123) of two residents reviewed for PASRR (Pre-admission Screening & Resident Review- a federal requirement to determine whether or not an individual who has an active diagnosis of mental illness or intellectual disability meets the criteria for admission to a nursing facility and identify what specialized services an individual needs). This failure had the potential for Resident 123's special needs not to be met while in the facility. Findings:A review of Resident 123's admission record indicated Resident 123's was admitted to the facility on [DATE], with diagnoses which included schizoaffective disorder (a mental disorder).A review of Resident 123's PASRR report indicated, Your (Resident 123) Level I screening conducted at (name of facility) followed by a Level II Evaluation on March 27, 2024 .The facility staff will receive a copy of this Determination Report .and will incorporate the recommendations into your care plan.A review of Resident 123's PASRR individualized determination report, indicated, . Recommended Specialized Services: .Psychotherapy [talk therapy]/Counselling - Individual and group or family treatment provided by a licensed mental health professional; Therapy may include a combination of strategies and techniques such as supportive, cognitive behavioral, psychodynamic, art/music, counseling .Psychiatry consultation and/or Follow-up Care-Services to provide psychopharmacological intervention [using medicine to treat mental health conditions] and monitoring of mental conditions. These providers will evaluate the efficacy and necessity of psychiatric medications .On September 11, 2025, at 10:18 a.m., a concurrent interview and record review of Resident 123's individualized determination report was conducted with the Case Manager (CM). The CM stated the Resident 123's recommendation were not followed. The CM further stated psychotherapy/counseling and the psychiatry consultation were not addressed in the resident's current care plan. On September 11, 2025, at 10:31 a.m., a concurrent interview and record review of Resident 123's care plan with the Case Manager (CM). The CM stated the Resident 123's care plan did not include the recommendation of psychotherapy in the individualized determination report. The CM further stated psychotherapy was not provided to Resident 123. The CM stated these recommendations should be followed as long as the resident remains in the facility.A review of facility's Policy and Procedure titled admission Criteria, dated January 2019, indicated .Upon completion of the Level II evaluation, the state PASRR representative determines if individual has a physical or mental condition, what specialized or rehabilitative he or she needs. Event ID: Facility ID: 555330 If continuation sheet Page 10 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide the necessary care and services to maintain cleanliness and proper hygiene of resident's fingernails, for one of two residents reviewed (Resident 174).This failure had the potential for Resident 174 to be at risk for infection due to the unsanitary condition of his fingernails.Findings:A review of Resident 174's medical records was conducted. Resident 174 was admitted to the facility on [DATE], with diagnoses which included acquired absence of right eye and glaucoma (cloudy vision) on left eye.A review of Resident 174's care plan titled, .Activities of Daily Living (ADL) Self-Care Performance Deficit r/t (related to) impaired balance, limited mobility and muscle weakness, included the interventions, Bathing/showering: check nail length and trim and clean on bath day and as necessary.report changes to the nurse.On September 9, 2025, at 11:47 a.m., a concurrent observation and interview were conducted with Resident 174, Resident 174 was observed sitting on his bed, alert, oriented, and with his right eye shut. Resident 174's fingernails were observed to be long and yellowish in color. Resident 174 stated he was able to maintain his own nailcare before when he could see better and would not mind if the staff helped cut his fingernails, so he did not scratch himself.On September 9, 2025, at 11:55 a.m., a concurrent observation and interview of Resident 174's fingernails were conducted with Certified Nursing Assistant (CNA) 6. CNA 6 stated Resident 174's fingernails were had long yellow. CNA 6 stated Resident 174's fingernails should have been maintained to prevent risk for infection.On September 12, 2025, at 10:24 a.m., an interview was conducted with the Director of Staff Development (DSD). The DSD stated CNAs were expected to check resident's fingernails daily and ensure they were not long, ridged, or dirty. The DSD stated CNAs should have maintained Resident 174's fingernails by offering to file them down or keep them clean to avoid infection control risks for the resident.On September 12, 2025, at 10:55 a.m., an interview was conducted with the Director of Nursing (DON). The DON stated CNAs were responsible for providing daily hygiene to the residents including cleaning their fingernails. The DON stated Resident 174 should have been offered nail care daily to prevent scratching himself, which could result in an open skin or abrasions which could be a source of infection problems.A review of the facility document titled, HR Manual: Job Description Certified Nursing Assistant revised 2015, indicated, .Certified Nursing Assistant (CNA) delivers efficient and effective nursing care.performs various patient care activities.patient care includes, but not limited to.assists patient with or performs Activities of Daily Living (ADL). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 11 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 Based on interviews and record reviews, the facility failed to complete monitoring for a skin related change of condition for one of one resident (Resident 12) reviewed for quality of care.This failure resulted in inconsistent evaluation of the wound and placed Resident 12, who had diabetes (abnormal blood sugar) and peripheral vascular disease (a problem with blood flow), at risk for infection, delayed wound treatment, and worsening of the condition of the left second toe.Findings:A review of Resident 12's admission Record dated September 10, 2025, indicated an admission date of July 20, 2025 with a diagnoses which included peripheral vascular disease and diabetes mellitus.A review of Resident 12's History and Physical dated August 25, 2025, indicated resident can make needs known but cannot make medical decisions.A review of Resident 12's Minimum Data Set (MDS - an assessment tool) dated September 2, 2025, indicated a Brief Interview for Mental Status (BIMS - a tool to assess cognitive function) score was 05 (severe cognitive impairment).A review of Resident 12's Podiatric Evaluation and Treatment Report dated August 18, 2025, indicated .Peripheral Arterial Disease.Trimmed and electrical Debridement with Dremel drill.Nail removal.Left.T1 Avulsion (tearing of body part)/Removal.A review of Resident 12's N Adv - Skin Check dated August 18, 2025, indicated, .Left Dorsum 2nd Digit (Second Toe).description.Avulsion.new wound.onset.New.A review of Resident 12's N Adv - Skilled Evaluation dated August 19, 2025, and August 21, 2025, indicated, .Skin Group.no skin issues.On September 10, 2025, at 12 p.m., a concurrent interview and record review was conducted with the Treatment Nurse (TN). The TN stated Resident 12's skin avulsion on the left second toe was a new skin finding and should have been considered a change of condition. The TN further stated a change of condition should have been documented and monitored to track the progress of the wound.On September 12, 2025, at 10:58 a.m. an interview was conducted with the Director of Nursing (DON). The DON stated the left second toe avulsion was caused by the podiatry treatment on August 18, 2025. The DON stated a change of condition should have been completed right away including monitoring every shift for three days, to determine if the wound is improving or deteriorating.A review of the facility policy and procedure titled, Change in a Resident's Condition or Status, dated January 2018, indicated, .A ‘significant change' of condition.requires interdisciplinary review.The nurse will record.information relative to changes in the resident's medical.condition or status. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 12 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 - Minimal harm or potential for actual harm Based on interviews and record review, the facility failed to adequately monitor nutritional status for one of two residents (Resident 126) when meal intakes were not consistently documented.This failure had the potential to result in inability to track intake trends, identify weight loss risk, and delay in corrective action subsequently resulting in nutritional decline.Findings:On September 9, 2025, at 10 a.m., an interview was conducted with Resident 126. Resident 126 stated she has lost weight and eats less than half of the meals served.A review of Resident 126's admission Record dated September 12, 2025, indicated an admission date of May 7, 2025, with a diagnosis which included moderate protein-calorie malnutrition (poor protein and calorie intake).A review of Resident 126's History and Physical dated May 8, 2025, indicated resident had the capacity to understand and make decisions.A review of Resident 126's Minimum Data Set (MDS an assessment tool) dated August 12, 2025, indicated a Brief Interview for Mental Status (BIMS - a tool to assess cognitive function) score of 14 (cognitively intact).A 30-day review of Resident 126's NutritionAmount Eaten record for breakfast, lunch between August 11, 2025, and September 10, 2025, indicated the following:- August 11, 2025, to August 15, 2025: no meals documented- August 16, 2025: no dinner documented- August 17, 2025, to August 19, 2025: no meals documented- August 20, 2025: no breakfast or lunch documented- August 21, 2025, to August 27, 2025: no meals documented- August 28, 2025, to August 29, 2025: no dinners documented- August 31, 2025: no dinner documented- September 1, 2025: no lunch or dinner documented- September 3, 2025: no dinner documented- September 6, 2025, to September 7, 2025: no dinners documented- September 9, 2025: no breakfast or lunch documentedSeptember 10, 2025: no dinner documentedOn September 11, 2025, at 10:59 a.m. a concurrent interview and record review was conducted with Licensed Vocational Nurse (LVN 4) 4. LVN 4 stated from August 11, 2025, to September 10, 2025, there were multiple missed meals documented for Resident 126. LVN 4 stated it was the responsibility of the certified nurse assistants (CNA) to document all meals daily. LVN 4 further stated it was important to record meal intakes to assess for malnutrition and weight loss.On September 11, 2025, at 2:17 p.m. an interview was conducted with Certified Nurse Assistant (CNA 7) 7. CNA 7 stated all meal intakes should be documented because it was important to determine whether a resident is experiencing weight loss.On September 12, 2025 at 2:48 p.m. an interview was conducted with the Director of Nursing (DON). The DON stated CNAs were responsible for documenting every meal intake, and licensed nurses were expected to review meal intake documentation daily. The DON stated this was important to identify and prevent weight loss. A review of the facility policy and procedure titled, Food and Nutrition Services, dated January 2018, indicated, .Nursing personnel.will evaluate.and document.food and fluid intake of residents. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 13 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure for four of five certified nurse assistants (CNAs 1, 2, 4, and 5) performance evaluations were completed. This failure had the potential for staff performance needs not to be identified and addressed in a timely manner. Findings:On September 10, 2025, five CNAs personnel files were reviewed. The review indicated the following:1.CNA 1 was hired on February 1, 2016. The most recent annual performance evaluation was dated April 27, 2020.2. CNA 2 was hired on August 13, 2024. No annual performance evaluation found.3. CNA 4 was hired on June 4, 2024. No annual performance evaluation found; and4. CNA 5 was hired on June 4, 2024. No annual performance evaluation found.On September 10, 2025, at 8:33 a.m., a concurrent interview and record review of performance evaluation records was conducted with the Director of Staff Development (DSD). The DSD stated for four of five CNAs (CNA 1, 2, 4, and 5), the annual performance evaluation was not found in the respective personnel file. The DSD stated each CNA is required to have an annual performance evaluation. The DSD further stated, if staff were found to need improvement in certain areas, additional training would be provided to ensure residents received proper care and services. The DSD stated, the lack of evaluations created a potential risk that staff deficiencies would go unaddressed, which could lead to inadequate resident care. The DSD stated performance evaluations are to be kept in personnel files for at least five years. A review of facility policy and procedure titled Performance Evaluation, dated January 2018, indicated .The job performance shall be reviewed at least annually. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 14 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow dental recommendations for one of two residents (Resident 138) reviewed for dental services. This failure had the potential for nutrition problems, discomfort, and decreased quality of life. Findings:A review of Resident 138's records was conducted. Resident 138 was admitted to the facility on [DATE], with diagnoses which included oropharyngeal dysphagia (difficulty swallowing). A review of Resident 138's Minimum Data Set (MDS - an assessment tool) dated August 11, 2025, indicated a Brief Interview of Mental Status (BIMS - a tool to assess cognitive function of an individual) score of 13 (moderate cognitive intact). A review of Resident 138's Nutritional Assessment, dated November 26, 2024, indicated, .Oral Condition.oral condition issues.edentulous (missing teeth). A review of Resident 138's Psychosocial Note, dated August 18, 2025, indicated, .Resident was seeing (sic) by (name of dental company) on 08/15/25. A review of Resident 138's Dental Progress Note, dated August 15, 2025, indicated, .resident wants FUD (full upper dentures).Rec (recommendations) PC@CE (Perio Chart test - a procedure to check the pockets of gum to determine how deep they could clean the teeth) w/ (with) updated Med (medical) Hx (history).DC054 (a MediCal form) completed for new FUD.Rec new FUD.dental prophy with Cavitron (a dental procedure to remove build of tartar on teeth) .FMX (full max x-ray)/year. Further review of Resident 138's records indicated there was no documentation that the Social Service Director (SSD) followed up on the dental recommendations. On September 8, 2025, at 3:27 p.m., a concurrent observation and interview was conducted with Resident 138. Resident 138 was sitting in his wheelchair, alert and with missing upper teeth. Resident 138 stated he would like dentures and was unsure if he would be getting them. On September 11, 2025, at 8:48 a.m., an interview was conducted with Certified Nursing Assistant (CNA) 8. CNA 8 stated he has provided care for Resident 138, and he had some missing teeth but did not wear dentures and was unaware of any recent dental visits. On September 11, 2025, at 8:48 a.m., an interview was conducted with the Social Service Director (SSD). The SSD stated she was responsible for coordinating dental appointments. The SSD stated Resident 138 was seen by the dentist on August 15, 2025, and received a dental visit note but did not follow up, as she did not understand the recommendations. The SSD stated she should have called the dental office for clarification to ensure Resident 138's dental needs were addressed. On September 11, 2025, at 2:10 p.m., an interview was conducted with the Dental Staff (DS) from the dental company. The DS stated Resident 138 had recommendations for dentures, prophylaxis, Perio Charting, and full mouth x-rays on August 15, 2025. The DS stated, these were important for assessing gum health and preparing for dentures. The DS stated full upper dentures were recommended for Resident 138. On September 12, 2025, at 10:50 a.m., a concurrent interview and record review of Resident 138's recent after visit note was conducted with the Director of Nursing (DON). The DON stated there was no documentation of follow up for Resident 138's dental needs. The DON stated the SSD should have clarified the dental orders to ensure treatment was completed. The DON stated this was important to prevent any nutrition issues, discomfort, and maintain overall well-being. A review of policy and procedure titled, Dental Services, dated January 2018, indicated, .routine and emergency dental services are available to meet the resident's oral health services in accordance with the resident's assessment and plan of care.social services representatives will assist residents with appointments, transportation arrangements. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 15 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 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 safe and sanitary food preparation and storage practices in the kitchen when: 1. One jar of minced garlic in the walk- in refrigerator was found to be past its used by date and was readily available for use; 2. Several Romaine lettuces were observed in the walk-in refrigerator not properly stored within their designated bags and exposed to open air; 3. One brown cutting board was found with multiple deep indentations; 4. Two hot water thermos water spurs were found with calcium build up and brown grime above the spurs; 5. Two dietary staff did not follow the manufacturer's guidelines for testing QUAT sanitizer concentration with a test strip; and 6. Two dietary staff did not know the correct concentration of the dishwasher sanitizer. These failures can create unsafe conditions and lead to foodborne illness (stomach illness acquired from ingesting contaminated food) in a vulnerable population of 152 of the 159 residents who received food prepared in the kitchen.Findings:1. On September 8, 2025, at 10:19 a.m., a concurrent observation and interview was conducted with the Dietary Services Supervisor (DSS) in the walk-in refrigerator. A 32 oz (ounce) jar of minced garlic was observed on the shelf and was half empty. The jar had an open date of July 30, 2025, and a use-by date of August 20, 2025. The DSS stated the jar was expired and should have been thrown out. The DSS stated there was potential for food borne illness if the minced garlic continued to be used in the food prepared in the kitchen. On September 8, 2025, at 3:10 p.m., an interview was conducted with the Registered Dietitian (RD). The RD stated all kitchen items should be labeled to avoid passing the use-by date of the item. The RD further stated this could result in preparing food with expired ingredients and cause food borne illness to the residents. A review of the U.S. Federal and Drug Administration (FDA) Food Code 2022, indicated, .Annex 3: Manufacturer's use-by dates .Manufacturers assign a date to products for various reasons, and spoilage may or may not occur before pathogen growth renders the product unsafe. Most, but not all, sell-by or use-by dates are voluntarily placed on food packages . Although it is a guide for quality, it could be based on food safety reasons. It is recommended that food establishments consider the manufacturer's information as good guidance to follow to maintain the quality (taste, smell, and appearance) and salability of the product. If the product becomes inferior quality-wise due to time in storage, it is possible that safety concerns are not far behind . 2. On September 8, 2025, at 10:23 a.m., an observation and interview with the DSS occurred in the walk-in refrigerator. A bag of Romaine lettuce was observed on a shelf, exposed to open air and touching the rack. The DSS stated that lettuce was used for salad and should not be exposed to open air or in contact with the rack to avoid potential cross-contamination, which could lead to foodborne illness in residents. On September 8, 2025, at 3:10 p.m., an interview was conducted with the RD. The RD stated all food items stored in the refrigerator or freezer should be stored properly in designated containers or bags, sealed and not exposed to air to ensure freshness and prevent cross contamination or food borne illness. A review of facility's policy and procedure titled, Storing Produce, dated 2023, indicated, .keeping fresh vegetables tightly wrapped with as little air in the bag/container as possible will keep them fresh longer .when storing vegetables that should remain crisp, such as lettuce and other leafy greens .will stay longer if you place them in a sealed bag or container. 3. On September 8, 2025, at 10:37 a.m., a concurrent observation and interview was conducted with the DSS near the cook's preparation table. One brown cutting board was observed to have multiple deep indentations. The DSS stated the cutting board was not in good condition and should have been discarded. The DSS stated there was potential for plastic coating on the board to become loose or grime stuck in the grooves to get in the food which could lead to cross (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 16 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 contamination and food borne illness. On September 8, 2025, at 3:10 p.m., an interview was conducted with the RD. The RD stated cutting boards in the kitchen should be in good condition without any indentations, ensuring they are easy to wash and clean. The RD further stated that some microorganisms (germs) can grow in the grooves and can potentially cause problems during food preparation for the residents. During a review of the professional reference U.S. FDA (Food and Drug Administration) Food Code 2022, Section 4-501.12 Cutting Surfaces, the FDA Food Code indicated, 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. 4. On September 8, 2025, at 10:42 a.m., concurrent observation and interview was conducted with the DSS near the steam table. Two hot water thermos spurs were observed to have calcium build-up and brown grime above the spurs. The DSS stated the water spurs should not have any calcium build up and grime to avoid potential cross contamination or food borne illness. On September 8, 2025, at 3:10 p.m., an interview was conducted with the RD. The RD stated kitchen equipment should be clean and should not have any calcium build-up or grime. The RD stated the hot water spurs should be cleaned properly to prevent cross contamination and food borne illness. A review of facility policy and procedure titled, Sanitization, dated 2023, indicated, .FNS (Food and Nutrition Services) Director is responsible for instructing employee in the fundamentals of sanitation in food service and for training employees to use appropriate techniques.all utensils.counters.shelves, and equipment shall be kept clean. 5. A review of the Quaternary Ammonium sanitizer (Quat - sanitizing solution used to sanitize food contact surfaces and used equipment) test strip bottle's instructions indicated, .Immerse for 10 seconds.On September 10, 2025, at 8:08 a.m., a concurrent observation and interview was conducted with Dietary Aide (DA) 1. DA 1 was observed demonstrating how to check the Quat sanitizer in the red bucket. DA 1 placed the test strip in the red Quat sanitizer bucket for 15 seconds. DA 1 stated she should have only dipped the test strip for 10 seconds. DA 1 further stated it was important to follow the manufacturer's instructions to ensure the solution was safely prepared to prevent any cross contamination or stomach issues for the residents.On September 10, 2025, at 8:18 a.m., a concurrent observation and interview was conducted with DA 2. DA 2 was observed demonstrating how to check the Quat sanitizer in the red bucket. DA 2 placed the test strip in the red bucket Quat sanitizer for 15 seconds. DA 2 stated she should have dipped the strip for 10 seconds, according to the test kit instructions, to avoid cross contamination and prevent foodborne problems.On September 10, 2025, at 8:55 a.m., an interview was conducted with the Dietary Services Supervisor (DSS). The DSS stated all staff were expected to know and follow the manufacturer's instructions for both the Quat Test and the dishwasher concentration testing to prevent cross contamination and food borne illness in the residents.On September 10, 2025, at 3:10 p.m., an interview was conducted with the Registered Dietitian (RD). The RD stated the Quat sanitizer test strip should be dipped for 10 seconds per manufacturer's instructions to ensure the correct concentration of the sanitizing solution was prepared and the kitchen equipment and surfaces would be sanitized properly. The RD further stated not following the instructions could result in cross contamination and food borne illness to the residents.A review of facility policy and procedure titled Sanitation, dated 2023, indicated, .The FNS (Food Nutrition Services) Director is responsible for instructing employees in the fundamentals of sanitation in food service and for training employees to use appropriate techniques .A review of the professional reference USDA Food Code 2022, Section 3-304.14 Wiping Cloths, Use Limitation .Proper sanitizer concentration should be ensured by checking the solution periodically with an appropriate chemical test kit.A review of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 17 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 FORM CMS-2567 (02/99) Previous Versions Obsolete professional reference Food Code 2022, Section 4-501.114 Manual and Mechanical Ware washing Equipment, Chemical Sanitization - Temperature, pH, Concentration, and Hardness, (C) A quaternary ammonium compound solution shall (2) Have a concentration as specified under S 7-204.11 and as indicated by the manufacturer's use directions included in the labeling.6. A review of the dishwasher manufacturer's guidelines indicated, Required: 50-100 ppm [parts per million] available Chlorine (chemical solution used to sanitize dishes).On September 10, 2025, at 8:28 a.m., an interview was conducted with DA 2 near the dishwashing area. DA 2 stated the dishwasher chlorine needed to be between 100-200 ppm. DA 2 stated the correct concentration to check the sanitizer solution in the dishwashing machine should have been between 50-100. DA 2 stated she should have followed the instructions to ensure the chlorine solution was not too high and prevent cross contamination and food borne illness.On September 10, 2025, at 8:35 a.m., an interview was conducted with DA 3 near the dishwashing area. DA 3 stated the correct concentration to check the sanitizer solution in the dishwashing machine should be between 50-200 ppm. DA 3 stated she should have followed the test kit instructions to avoid food borne illness in the residents.On September 10, 2025, at 8:55 a.m., an interview was conducted with the Dietary Services Supervisor (DSS). The DSS stated all staff were expected to know and follow the manufacturer's instructions for both the Quat Test and the dishwasher concentration and further stated to avoid potential for cross contamination and food borne illness in the residents.On September 10, 2025, at 3:10 p.m., an interview was conducted with the RD. The RD stated the dishwasher chlorine needed to be 50 -100 ppm. The RD stated kitchen staff were expected to follow the manufacturer's instructions for checking the dish washer chlorine to ensure the machine was properly sanitizing the dishes, to prevent cross contamination and to avoid high chloride odor on the dishes.A review of facility's policy and procedure titled, Dishwashing, undated, indicated, .all dishes will be properly sanitized through the dishwasher.a temperature log (and chlorine log for low-temperature machines) will be kept and maintained by the dishwashers to assure that the dish machine is working correctly.the chlorine should read 50-100 ppm on dish surface in final rinse. Event ID: Facility ID: 555330 If continuation sheet Page 18 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 ensure proper infection control measures were implemented when:1. For Resident 86, Licensed Vocational Nurse (LVN) 4 did not wear personal protective equipment (PPE - equipment, such as gloves and gown, used to protect against infection or illness) when providing care to Resident 86, who was on enhanced barrier precaution (EBP-an infection control intervention to reduce transmission of multidrug-resistant organisms [MDRO- bacteria that have become resistant to multiple antibiotics).2. For Resident 116, Certified Nursing Assistant (CNA 1) did not wear personal protective equipment when providing care.3. For Resident 64, LVN 5 did not use the proper disinfecting wipes to clean the blood pressure machine between residents' use.4. For Resident 157, CNA 8 did not wear proper PPE when providing care and changing Resident' 157's gown.These failures had the potential to result in cross-contamination, increasing the risk of infection spread among an already vulnerable population of residents.Findings: Residents Affected - Some 1.On September 10, 2025, at 1:35p.m., during an observation of Licensed Vocational Nurse 4 (LVN 4), LVN 4 was observed entering Resident 86's room without wearing a gown while providing contact care. On September 10, 2025, at 1:45 p.m., during an interview with LVN 4, LVN 4 stated Resident 86 is on Enhanced Barrier Precaution. She further stated she forgot to wear the required isolation gown. LVN 4 stated she should have worn a gown for infection prevention. A review of Resident 86's medical record was conducted. Resident 86 was originally admitted to the facility on [DATE], with diagnosis which included gastrostomy status (an opening into the stomach for food). On September 12, 2025, at 8:29 a.m., an interview with the Infection Preventionist nurse (IP) was conducted. The IP stated her expectation was for all staff to follow designated precaution protocols and wear the required PPE to prevent the spread of infections. 2. On September 11, 2025, at 9:36 a.m., during a concurrent observation and interview with Certified Nursing Assistant 1 (CNA 1), CNA 1 was observed entering Resident 116's room without wearing an isolation gown while providing resident care. CNA 1 stated Resident 116 is on Enhanced Barrier Precaution and stated she forgot to wear the required gown. A review of Resident 116's medical record was conducted. Resident 116 was admitted to the facility on [DATE], with diagnoses which included dependence on renal dialysis. A review of Resident 116's Order Summary, dated May 15, 2025, indicated, .Enhanced Barrier Precautions-Resident to be placed on Enhanced Barrier Precautions r/t presence of a dialysis site and HX of ESBL. PPE: Gown and gloves while performing direct care (dressing, bathing, transferring, changing of linen, performing peri care, wound care and handling medical devices such as feeding tube, central lines and indwelling catheters . On September 12, 2025, at 8:29 a.m., an interview with the IP was conducted. The IP stated staff are expected to follow the designated precaution protocols for each resident and wear the appropriate PPE. The IP further stated the CNA 1 should have worn PPE to prevent the spread of infection. 3. On September 10, 2025, at 9:44 a.m., during a concurrent observation and interview with LVN 5 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 19 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 outside Resident 64's room, LVN 5 was observed cleaning the blood pressure machine with hand sanitizing wipes. LVN 5 stated that he disinfected the blood pressure machine with the hand sanitizing wipes for infection control and indicated that the hand sanitizing wipes were appropriate for sanitizing the medical equipment. On September 12, 2025, at 8:29 a.m., an interview with the IP was conducted. The IP stated medical devices used for residents should be disinfected with disposable germicidal surface wipes after each resident use to reduce cross contamination. The IP further stated hand sanitizing wipes were not recommended for disinfecting blood pressure machines. A review of the manufacturer's product information, titled [Brand name] Disposable Germicidal Surface Wipes, indicated, .disposable germicidal surface wipes are an ideal cleaning and disinfecting solution for hard, non-porous surfaces .this product kills the following bacteria in two minutes on pre-cleaned hard, non-porous surfaces at room temperature . A review of the facility policy and procedure titled, Cleaning and Disinfection of Resident-Care items and Equipment, dated January 2018, indicated, .Resident care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA bloodborne Pathogens standards. 4. On September 11, 2025, at 10:31 a.m., an EBP sign was observed posted outside Resident 157's room. CNA 8 entered the room and assisted Resident 157 with a gown change while wearing gloves and no isolation gown. On September 11, 2025, at 10:35 a.m., an interview was conducted with CNA 8. CNA 8 stated she did not look at the EBP sign before entering Resident 157's room. CNA 8 stated not wearing the proper PPE could cause cross-contamination and spread germs between residents. On September 11, 2025, at 8:05 a.m., an interview with the IP was conducted. The IP stated residents on EBP are identified by an orange dot and a posted sign outside of the door to alert staff or visitors. The IP stated all staff were expected to check the precaution signs posted and wear appropriate PPE. The IP stated CNA 8 should have worn a gown to prevent potential spread of infection. A review of Resident 157's record indicated Resident 157 was admitted to the facility on [DATE], with diagnoses which included extended spectrum beta lactamase (ESBL) resistance (when antibiotics not effective). A review of Resident 157's Order Summary Report, dated July 30, 2025, indicated, .Enhanced Barrier Precautions r/t (related to) hx (history) of C. auris (bacteria), MRSA (bacteria), ESBL (bacteria), E. coli (bacteria) of the urine.PPE: gown and gloves while performing direct care. A review of Resident 157's care plan dated August 1, 2024, indicated, .Resident on Enhanced Barrier Precautions related to MDRO, positive HX (history) of ESBL, CDIFF, CAURIS .Interventions .place resident on EBP room/area. A review of the facility policy and procedure titled, Enhanced Barrier Precaution, dated June 2022, indicated, .post clear signage at the door or wall outside the resident room. Enhanced Barrier Precautions expand the use of PPE and refer to the use of gown and gloves during high contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing.MDROs (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 20 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 may be indirectly transferred from resident to resident during these high contact care activities.EBP may be indicated for residents with.wounds or indwelling medical devices, regardless of MDRO colonization status.infection or colonization with an MDRO. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 21 of 22 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 555330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Postacute Care 8781 Lakeview Avenue Riverside, CA 92509 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure the call light system was working properly for one of twelve resident call lights (Resident 5). This failure had the potential to delay medical care needed for Resident 5.Findings:On September 8, 2025, at 9:36 a.m., an interview with Resident 5 was conducted. Resident 5 stated his call light was not working because the staff did not come to help when it was pressed. Resident 5 further stated they just walked by, and he needed to scream to get their attention. On September 8, 2025, at 9:37 a.m., a concurrent observation and interview with Certified Nursing Assistant 2 (CNA 2) was conducted. CNA 2 pressed Resident 5's call light button and stated the call light was not working.On September 8, 2025, at 9:39 a.m., a concurrent observation and interview with the Licensed Vocational Nurse 3 (LVN3) was conducted. LVN 3 stated the call light was not working. LVN 3 stated it should be working, in order to properly respond to resident needs.On September 12, 2025, at 3:36 p.m., an interview with Resident 173 (Resident 5's roommate) was conducted. Resident 173 stated, he would press his own call light button to summon staff for Resident 5. On September 12, 2025, at 9:53 a.m., during an interview with the Director of Nursing (DON), the DON stated call light button serves as a notification for residents who need assistance. The DON further stated, if the call light was not functioning, the residents' needs could not be addressed in a timely manner.A review of the facility policy and procedure titled, Answering the Call Light dated January 2018, indicated The purpose of this procedure is to respond to the resident's requests and needs.be sure that the call light is plugged and functioning at all times . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555330 If continuation sheet Page 22 of 22