Health inspection·February 9, 2024

F 0552 Ensure that residents are fully informed and understand their health status, care and treatments. 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: Residents Affected - Some 1. Ensure the residents and/or responsible party (RP) were informed in advance, of the risks and benefits of psychoactive medication (a drug that changes brain function and results in alterations in perception, mood, consciousness, or behavior) for three of seven sampled residents (Resident 38, 54, and 46). This deficient practice violated the residents' right to make an informed decision regarding the use of psychoactive medications. Findings: During a review of Resident 38's admission Record, the admission Record indicated Resident 38 was initially admitted to the facility on [DATE] and last readmitted on [DATE]. Resident 38's diagnoses included schizoaffective disorder (a mental disorder with symptoms of hallucinations or delusions and mood disorder like depression), anxiety disorder - (persistent and excessive worry that interferes with daily activities), and cardiomyopathy (disease in which the heart muscle becomes weakened, stretched, or has another structural problem, often contributes to the heart's inability to pump, or function well). During a review of Resident 38's History and Physical (H&P), dated 8/11/2023, the H&P indicated Resident 38 does not have the capacity to understand and make decisions. During a review of Resident 38's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated 1/26/2024, the MDS indicated Resident 38 had moderately impaired cognition (ability to learn, reason, remember, understand, and make decisions). During an interview on 2/8/2024 at 2:00 p.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated there was a new order for resident 38 for Zyprexa (medication for mental health condition) 5 milligrams (mg - a unit of measure for mass) Qday (once a day) old order was Zyprexa 5 mg BID (twice a day). LVN 1 stated there is not an updated consent in the resident's chart showing the new order. LVN stated that there should have been a new informed consent any time there is a change in medication order or a new order for medication. During a review of Resident 46's admission Record, the admission Record indicated Resident 46 was initially admitted to the facility on [DATE] and last readmitted on [DATE]. Resident 46's diagnoses included epilepsy (a chronic disorder of the brain characterized by recurrent brief episodes of Page 1 of 15 555368 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some involuntary movement that may involve a part of the body or the entire body), schizophrenia (a mental disorder that affects a person's ability to think, feel and behave clearly), and anxiety disorder - (persistent and excessive worry that interferes with daily activities). During a review of Resident 46's History and Physical (H&P), dated 1/19/2024, the H&P indicated Resident 46 does not have the capacity to understand and make decisions. During an interview on 2/8/2024 at 2:00 p.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated there is a new order for Resident 46 on 1/21/2024 for clonazepam 0.5 mg PO AM, 1 mg PM clonazepam (a medication used to treat panic disorder, anxiety) there needs to be an informed consent signed by the resident/resident representative. LVN 1 stated there is no informed consent in the chart for Resident 46. LVN 1 stated if a informed consent is not signed it can affect the resident because they did not give consent to start the medication. LVN 1 stated it is the resident rights to be informed and make decision if they want to start a medication. During a review of Resident 54's admission Record, the admission Record indicated Resident 54 was initially admitted to the facility on [DATE] and last readmitted on [DATE]. During a review of Resident 54's physician admitting orders dated 3/7/2023 diagnoses included bipolar disorder (a mental illness characterized by extreme mood swings), schizophrenia (a mental disorder that affects a person's ability to think, feel and behave clearly), and hypertension (when the pressure in your blood vessels is too high). During a review of Resident 54's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated 12/1/2023, the MDS indicated Resident 54 had a BIMS (brief interview for mental status) of 03 which suggested severe cognitive (ability to learn, reason, remember, understand, and make decisions impairment. During a concurrent interview and record review on 2/8/2024 at 11:16 a.m. with Assistant Director of Nursing (ADON), Resident 54's informed consent for psychotherapeutic drugs or prolonged use of a device, dated 3/7/2023 was reviewed. The informed consent was for medication Haldol (medication used to treat schizophrenia) and Lithium (medication used to treat mood stabilizing), the section I have obtained Informed Consent from the: resident, resident representative or legal empowered representative was not filled out or signed. ADON stated the informed consent is not complete, resident/resident representative did not sign the form. ADON stated with out a signature you can not tell if the resident/resident representative agreed to taking these medications. During an interview on 2/8/2024 at 2:40 p.m. with Registered Nurse Supervisor (RN)1, RN 1 stated that a consent not signed could affect the resident by being non-compliant, if they are not informed of the medication being given. RN 1 stated it is the resident right to be informed. During an interview on 2/8/2024 at 3:59 p.m. with Director of Nursing (DON), DON stated informed consents should be completed as soon as the patient is admitted or when there is a new order or a change for a psychotropic medication. DON stated an informed consent is very important so the resident can make an informed decision on care. DON stated if an informed consent is not done for a medication the resident could be possibly taking a medication they did not want to take. DON stated it is the resident right to give consent to take a medication. During a review of the facility's policy and procedure (P&P) titled, Consent-Informed, dated 2024, 555368 Page 2 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the P&P indicated, the nurse will witness that the informed consent has been obtained by the physician from the patient/resident of legal guardian for treatments, procedures, and all psychotropics with significant risk. Informed consent is decision made freely by the patient/resident or a legally authorized representative after he/she has full knowledge and understanding of the risks, benefits, and available options about the various treatment alternatives. Confirm documentation of informed consent on the medical record. The physician signs and dates prior to treatment/procedure being performed. The patient/resident or legal guardian signs and dates prior to treatment/procedure being performed. The completed consent form is placed in the resident's medical record. 555368 Page 3 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and complete a comprehensive and resident centered care plan for four of 12 sampled residents (Residents 46, 38, 54 and 194) 1. Did not develop a care plan addressing the use of medication Clonazepam for Resident 46. 2. Failed to complete the care plan goals for Residents 38, 54, and 194. This deficient practice had the potential to negatively affect the delivery of nursing care, medical interventions, and goals to Residents 46, 38, 54, and 194. Findings: a. During a review of Resident 46's admission Record, the admission Record indicated Resident 46 was initially admitted to the facility on [DATE] and last readmitted on [DATE]. Resident 46's diagnoses included epilepsy (a chronic disorder of the brain characterized by recurrent brief episodes of involuntary movement that may involve a part of the body or the entire body), schizophrenia (a mental disorder that affects a person's ability to think, feel and behave clearly), and anxiety disorder - (persistent and excessive worry that interferes with daily activities). During a review of Resident 46's History and Physical (H&P), dated 1/19/2024, the H&P indicated Resident 46 does not have the capacity to understand and make decisions. During a review of Resident 38's admission Record, the admission Record indicated Resident 38 was initially admitted to the facility on [DATE] and last readmitted on [DATE]. Resident 38's diagnoses included schizoaffective disorder (a mental disorder with symptoms of hallucinations or delusions and mood disorder like depression), anxiety disorder - (persistent and excessive worry that interferes with daily activities), and cardiomyopathy (disease in which the heart muscle becomes weakened, stretched, or has another structural problem, often contributes to the heart's inability to pump, or function well). During a review of Resident 38's History and Physical (H&P), dated 8/11/2023, the H&P indicated Resident 38 does not have the capacity to understand and make decisions. During a review of Resident 38's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated1/26/2024, the MDS indicated Resident 38 had moderately impaired cognition (ability to learn, reason, remember, understand, and make decisions). During a review of Resident 54's admission Record, the admission Record indicated Resident 54 was initially admitted to the facility on [DATE] and last readmitted on [DATE]. During a review of Resident 54's physician admitting orders dated 3/7/2023 diagnoses included 555368 Page 4 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some bipolar disorder (a mental illness characterized by extreme mood swings), schizophrenia (a mental disorder that affects a person's ability to think, feel and behave clearly), and hypertension (when the pressure in your blood vessels is too high). During a review of Resident 54's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated 12/1/2023, the MDS indicated Resident 54 had a BIMS (brief interview for mental status) of 03 which suggested severe cognitive (ability to learn, reason, remember, understand, and make decisions impairment. During a concurrent interview and record review on 2/8/2024 at 11:16 a.m. with Assistant Director of Nursing (ADON), Resident 54's care plan for schizophrenia disorder, dated 3/7/2023 was reviewed. The care plan indicated, it was initially filled on 3/7/2023, and revised on 9/2023 and 12/2023 the goals were not filled out. The ADON stated the care plan was not filled out completely, there were no goals made. The ADON stated that a complete care plan has the problem, resident goals, interventions, and time frame moving towards the goal. The ADON stated that a care plan needs to be complete including the goal, so you know what you are working towards for the resident's comfort and wellbeing. b. During a review of the admission record for Resident 194 indicated the resident was initially admitted to the facility on [DATE] with diagnoses that included schizophrenia (A disorder that affects a person's ability to think, feel, and behave clearly), insomnia (persistent problems falling and staying asleep), cachexia (a state of ill health involving great weight loss and muscle loss) and anorexia (an eating disorder causing people to obsess about weight and what they eat). During a review of Resident 194's Minimum Data Set (MDS - assessment and care screening tool) dated 2/2/24, indicated the resident was assessed to have a moderately cognitively impairment, and was independent with activities of daily living, toileting and upper and lower body dressing. During a record review of Resident 194's care plan indicated resident had a diagnosis of schizophrenia. Upon review, resident 194's care plan for schizophrenia was incomplete as no signs and symptoms were listed on the concerns and goals section of resident 194's care plan. During an interview on 2/8/2024 at 11:40 a.m. with MDS Nurse (MDS), MDS stated care plans should be filled out completely. MDS stated the care plan is to show our quality of care, the end goal we are all working towards. MDS stated if there is no goal on the care plan how would we know what to work towards. During an interview on 2/8/2024 at 2:00 p.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated that care plans include the problem, goals, interventions, and time frame, it is re-evaluated every 3 months. LVN 1 stated care plans should be filled out completely, they are a guideline to help us with the care and goals the resident needs. LVN 1 stated if not filled out we would know what the main objective is with the resident. During an interview on 2/8/2024 at 2:40 p.m. with Registered Nurse Supervisor (RN) 1, RN 1 stated care plans should be fill out completely. RN 1 stated they are a form of communication for the staff. RN 1 stated if a goal is not filled out it could potentially affect the resident by not making sure the goal is met. During an interview on 2/8/2024 at 3:59 p.m. with Director of Nursing (DON), the DON stated care plans are for the all-around safety and care of the resident. The DON stated if the care plan is not 555368 Page 5 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some filled out completely the resident may not reach their goal, as the staff are not following what intervention to reach the specific goal. The DON stated it is about safety. During a review of the facility's policy and procedure (P&P) titled, Baseline Care Plan, dated 2024, the P&P indicated, Include the minimum healthcare information necessary to properly care for a resident including but not limited to: Initial goals based on admission orders. The facility must provide the resident and their representative with a summary of the baseline care plan that includes but is not limited to: the initial goals of the resident. During a review of the facility's P&P titled, Care Plans - Comprehensive, dated 2024, the P&P indicated, Each resident's comprehensive care plan is designed to: Reflect the resident's expressed wishes regarding care and treatment goals; Reflect treatment goals, timetables and objectives in measurable outcomes. 555368 Page 6 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to: 1. Discard expired and discontinued medications for four out of four sampled residents (Residents 12, 80, 48 and 36). Findings: a. During a review of Resident 12's admission record indicated Resident 12 was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE], with diagnoses that included type 2 diabetes mellitus (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe), and osteoarthritis (a type of arthritis that occurs when flexible tissue at the ends of bones wears down). During a review of Resident 12's Minimum Data Set (MDS - assessment and care screening tool) dated 1/24/24, indicated the resident was assessed to be cognitively intact. During a record review of Resident 12's MDS Section N- Medications indicated Resident 12 was taking a hypoglycemic agent (insulin). Resident 12 also had a discontinued order for Lactulose. b. During a review of Resident 80's admission record indicated Resident 80 was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE], with diagnoses that included chronic kidney disease (longstanding disease of the kidneys leading to renal failure), chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe), and gastroesophageal reflux disease (a digestive disease in which stomach acid or bile irritates the food pipe lining). During a review of Resident 80's Minimum Data Set (MDS - assessment and care screening tool) dated 11/9/2023, indicated the resident was assessed to be cognitively intact. During a record review of Resident 80's Physician Orders indicated Resident 80 had a discontinued order for Sucralfate. During a concurrent observation and interview, on 2/09/24, at 10:46 AM, with LVN 1, at Medication Cart 1, expired and discontinued medications were observed in Cart 1 for Resident 12 and 80. LVN 1 stated all expired and discontinued medications should not be in medication carts. LVN acknowledge Resident 12's expired and discontinued insulin and Resident's 80 discontinued medication was in Medication Cart 1. LVN 1 stated the risk of having expired and discontinued medications in a medication cart can lead to medication errors and administering a wrong medication to residents. LVN 1 stated These medications should not be in the cart. c. During a review of Resident 48's admission record indicated Resident 48 was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE], with diagnoses that included type 2 diabetes mellitus (a long-term condition in which the body has trouble controlling blood sugar 555368 Page 7 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and using it for energy), chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe), and hypothyroidism (a condition in which the thyroid gland doesn't produce enough thyroid hormone). During a review of Resident 48's Minimum Data Set (MDS - assessment and care screening tool) dated 11/9/2023, indicated the resident was assessed to have a severe cognitive impairment and did not have the capacity to understand and make decisions. During a record review of Resident 48's MDS Section N- Medications indicated Resident 48 was taking a hypoglycemic agent (insulin). During an concurrent observation and concurrent interview, on 2/09/24, at 11:12 AM, with LVN 2, at Medication Cart 2, an expired medication was observed in Cart 2 for Resident 48. LVN 2 stated Resident 48's insulin vial for nighttime had open date for 1/7/24 and should have been discarded by 2/4. LVN 2 stated the risk of having expired medication in a medication cart could result in medication being inactive and to not work for the resident. I don't know why this is here, I'm sorry, I don't work the night shift, I only work the morning shift. d. During a review of Resident 36's admission record indicated Resident 36 was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE], with diagnoses that included type 2 diabetes mellitus (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe), and polyosteoarthritis (the process of having arthritis in five or more joints at the same time). During a review of Resident 36's Minimum Data Set (MDS - assessment and care screening tool) dated 11/15/23, indicated the resident was assessed to be cognitively intact. During a record review of Resident 12's MDS Section N- Medications indicated Resident 12 was taking a hypoglycemic agent (insulin). Resident 12 also had a discontinued order for Lactulose. During a concurrent observation and interview, on 2/09/24, at 11:28 AM, with LVN 1, at the Medication Storage room, expired medication were observed in the refrigerator for Resident 36. LVN 1 stated the medication was opened on 1/8/24 and should have been discarded after 28 days which would have be 2/5/24. LVN 1 stated the risk of having expired medications in a medication storage refrigerator can lead to the medication being ineffective. During a review of the facility's policy and procedures titled, Administering Medications, revised 2024, indicated to check the expiration date on medications and to return any expired medications to the pharmacy. During a review of the facility's policy and procedures titled, Mediation Storage, revised 2024, indicated that the pharmacy and all medication rooms are routinely inspected by the consultant pharmacist for discontinued, outdated, defective, or deteriorated medications with worn, illegible, or missing labels. 555368 Page 8 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0773 Level of Harm - Minimal harm or potential for actual harm Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to: Residents Affected - Few 1. Notify the physician of an abnormal level of Lithium (a medication to treat mood disorders) for one out of three sampled residents (Resident 54). This deficient practice had the potential for Resident 54 to suffer adverse consequences (unwanted, uncomfortable, or dangerous effects that a drug may have such as impairment or decline in an individual's mental or physical condition or functional and psychosocial status). Findings: During a review of Resident 54's admission Record, the admission Record indicated Resident 54 was initially admitted to the facility on [DATE] and last readmitted on [DATE]. During a review of Resident 54's physician admitting orders dated 3/7/2023 diagnoses included bipolar disorder (a mental illness characterized by extreme mood swings), schizophrenia (a mental disorder that affects a person's ability to think, feel and behave clearly), and hypertension (when the pressure in your blood vessels is too high). During a review of Resident 54's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated 12/1/2023, the MDS indicated Resident 54 had a BIMS (brief interview for mental status) of 03 which suggested severe cognitive (ability to learn, reason, remember, understand, and make decisions impairment. During a concurrent interview and record review on 2/8/2024 at 11:16 a.m. with Assistant Director of Nursing (ADON), Resident 54's lab report, dated 1/26/2024 was reviewed. The lab report indicated; the lithium level was abnormal it was 0.3 mmol/L which was low (reference range is 0.6-1.2). The ADON stated the physician was not notified of the results. The ADON stated the abnormal results should immediately be reported to the physician. The ADON stated it should then be documented. The ADON stated if physician is not notified, they would not be informed on how to treat the resident. During an interview on 2/8/2024 at 2:00 p.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated you need to notify the physician as soon as you receive an abnormal result. LVN 1 stated the physician needs to be informed of the results so they can make an informed decision on the next action to take for the care of the resident. LVN 1 stated if the physician was not notified it can potentially affect the resident by getting sick, be under or overdosed, or even die. During an interview on 2/8/2024 at 2:40 p.m. with Registered Nurse Supervisor (RN) 1, RN 1 stated you need to notify the physician as soon as an abnormal lab comes in, you then document in nursing notes or on the results sheet. RN 1 stated it is very important that we notify the physician so he can intervene with a new order, monitor resident, or repeat lab. RN1 stated there could be a change of condition in the resident. 555368 Page 9 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0773 Level of Harm - Minimal harm or potential for actual harm During an interview on 2/8/2024 at 3:59 p.m. with Director of Nursing (DON), the DON stated notify the physician immediately of any abnormal labs and follow through with the orders given. DON stated staff needs to document the date they spoke to physician and what action the physician wants to take. DON stated the potential can be dangerous if the labs are abnormal. DON stated the physician needs to know if to increase or lower dose of medication to keep the resident stable. Residents Affected - Few During a review of the facility's policy and procedure (P&P) titled, Verbal Orders, dated 2024, the P&P indicated, Follow through wit orders by making appropriate contact or notification (e.g., lab or pharmacy). 555368 Page 10 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to: Residents Affected - Some 1. Ensure expired chocolate cookies in the reach in freezer were discarded after expiration date. 2. Ensure turkey lunchmeat, hamburger patties, polish sausages, tamales, and beef hot dogs in the reach in freezer were labeled with received date and use by date. 3. Ensure the ice machine was maintained clean. These deficient practices had the potential to result in pathogen (germ) exposure to residents and placed residents at risk for developing foodborne illness (food poisoning) with symptoms including upset stomach, stomach cramps, nausea, vomiting, diarrhea, and fever and can lead to other serious medical complications and hospitalization. Findings: During an observation on 2/6/2024 at 9:00 a.m. in the kitchen's reach in freezer, there were chocolate cookies with expired date of 2/5/2024 and turkey lunchmeat, hamburger patties, polish sausages, beef hot dogs and tamales not labeled. During an interview on 2/6/2024 at 9:20 a.m. with Dietary Aide (DA) 1, DA 1 stated the expiration on the cookies is 2/5/2024, it should have been thrown out. DA 1 stated the turkey lunchmeat, hamburger patties, polish sausage, beef hot dogs and tamales has no date on them. DA 1 stated if we use these there is a risk that the residents can potentially get sick, the food may not be good. During an interview on 2/9/2024 at 9:56 a.m. with the DM1, DM1 stated that food should be labeled with received date and expired date. DM1 stated if not labeled there is no way to know if the food is good or not. DM1 stated it could affect the residents by getting them sick. DM1 stated the policy is to label as soon as the food comes in to the facility. During a concurrent observation and interview on 2/9/2024 at 9:56 a.m. with Dietary Manager (DM) 1 in the ice machine room, checked the inside of the ice machine with a paper towel, an orange color substance was left on the paper towel. DM 1 stated it is not supposed to look like that. DM1 stated this could be harmful to the residents, the residents could get sick. During a review of the facility's policy and procedure (P&P) titled, Receiving, dated 9/2017, the P&P indicated, All food items will be appropriately labeled and dated either through manufacturer packaging or staff notation. During a review of the facility's policy and procedure (P&P) titled, Food Storage: Cold Foods, 555368 Page 11 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dated 4/2018, the P&P indicated, All foods will be stored wrapped or in covered containers, labeled and dated, and arranged in a manner to prevent cross contamination. During a review of the facility's policy and procedure (P&P) titled, Refrigerators and Freezers, dated 2024, the P&P indicated, All food shall be appropriately dated to ensure proper rotation by expiration dates. Received dates (dates of delivery) will be marked on cases and on individual items removed from cases for storage. Use by dates will be completed with expiration dates on all prepared food in refrigerators. Expiration dates on unopened food will be observed and us by dates indicated once food is opened. Supervisors will be responsible for ensuring food items in pantry, refrigerators, and freezers are not expired or past perish dates. Supervisors should contact vendors or manufactures when expiration dates are in question or to decipher codes. During a review of the facility's policy and procedure (P&P) titled, Ice, dated 9/2017, the P&P indicated, Ice will be prepared and distributed in a safe and sanitary manner. The Dining Services Director will coordinate with the Maintenance Director to ensure that the ice machine will be disconnected, cleaned and sanitized quarterly and as needed, or according to manufacturer guidelines. 555368 Page 12 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide rooms that meet the required square footage of 80 square feet per resident for 43 out of 48 rooms. This deficient practice placed the residents at risk for injury, lack of privacy, inadequate space during care, emergency services, visitation with family and friends. Findings: During a review of the analysis of client accommodations indicated the following room did not meet the required size of 80 square feet per multiple resident rooms after measuring with maintenance supervisor. room [ROOM NUMBER]: 2 residents measuring total of 143 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total of 148.5 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 143 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 148.5 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 148.5 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 143 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 148.5 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet required is 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 148.5 square feet, required is 160 square feet. 555368 Page 13 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0912 room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required is 160 square feet. Level of Harm - Potential for minimal harm room [ROOM NUMBER]: 3 resident measuring total 222.72 square feet, required 240 square feet. room [ROOM NUMBER]: 3 resident measuring total 222.72 square feet, required 240 square feet. Residents Affected - Some room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 3 residents measuring total 225.04 square feet, required 240 square feet. room [ROOM NUMBER]: 2 residents measuring total 146.3 square feet, required 160 square feet. room [ROOM NUMBER]: 3 residents measuring total 223.1 square feet, required 240 square feet. room [ROOM NUMBER]: 3 residents measuring total 225.04 square feet, required 240 square feet. room [ROOM NUMBER]: 3 residents measuring total 225.04 square feet, required 240 square feet. room [ROOM NUMBER]: 3 residents measuring total 225.04 square feet, required 240 square feet. room [ROOM NUMBER]: 3 residents measuring total 221.95 square feet, required 240 square feet. room [ROOM NUMBER]: 2 resident measuring total 144.1 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 144.1 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 144.1 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 144.1 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. 555368 Page 14 of 15 555368 02/09/2024 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0912 room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. Level of Harm - Potential for minimal harm room [ROOM NUMBER]: 2 residents measuring total 147.4 square feet, required 160 square feet. Residents Affected - Some During an interview on 2/9/2024 at 8:37 a.m. with the Administrator (ADM). The ADM stated I do not know what the room accommodation size should be for the resident rooms, I will look into it and find out. I will find out how to get a room wavier. During an review of the facility's policy and procedure (P&P) titled, Resident Rooms, dated (Revised 2024), the P&P indicated Resident bedrooms must be designed and equipped for adequate nursing care, comfort and privacy of resident. Resident bedrooms will measure at least 80 square feet per resident in multiple resident bedroom and at least 100 square feet in single resident bedrooms. 555368 Page 15 of 15