Health inspection·January 30, 2024

F 0551 Level of Harm - Minimal harm or potential for actual harm to, yelling and threatening staff, physical assault to a charge nurse, disturbing other residents by looking for staff in their rooms and playing loud music at night, verbal assaults and name calling, throwing objects at staff, interfering with patient care and medication administration and physician's orders, not following infection control rules, and closing the Resident 1's door when asked by nursing staff to keep the door open for visual observation. Residents Affected - Few During a further interview on 1/30/2023, at 2:15 p.m., with the DON, the DON stated, the facility attempted to address RR 1's behavior many times. The DON stated, the facility's manager (FM) received numerous staff complaints about RR1's behavior and some staff resigned, as a result. The DON stated, management addressed the RR1 inappropriate behavior many times by attempted educational sessions with RR1 and there were instances when the security was called to the unit, but RR1's threats, outburst, and interruptions in provision of Resident 1's care nevertheless continued. During an interview on 1/30/2023, at 2:15 p.m., with Director of Nursing Services (DON), the DON stated, on 12/05/2023, the facility restricted RR 1's visitation hours to a one-hour visitation time a day. The DON stated, the facility determined that the presence of RR1 may present danger to the health and safety of Resident 1 and the facility's staff. The DON further stated, the RR1 is no longer included in email correspondence regarding Resident 1's health status and the facility only interacts with RR2 due to RR 1's challenging behavior that is causing emotional distress to staff and interference with Resident 1's care. During an interview on 1/30/2023, at 2:19 p.m., with the DON, the DON stated, on 9/20/2023, the facility held an arranged meeting with RR1, RR2, and the ombudsman, to address disruptive behavior of RR1. The DON stated, during the meeting, the resolution was achieved when RR1 agreed to improve the behavior toward staff and not to interfere with Resident 1's treatments and care. The DON further stated, the behavior of RR 1 did not improve as per conditions placed by the facility, to which RR1 and RR2 mutually agreed to during the meeting held on 9/20/2023. The DON stated, on 12/4/2023, the RR 1's visitation hours were reduced to one hour a day. The DON also stated, the email was sent to the RR2, and RR1 was not notified of restricted visitation time. During a further interview on 1/30/2023, at 2:21 p.m., with DON, the DON stated, during the meeting held on 9/20/2023, the facility and RR2 came to an agreement, that all communication and email correspondence regarding Resident 1's health status and treatment plan shall occur only between the facility and RR 2 and no longer involved any communication with RR 1. The DON further confirmed, RR 1 is a legal, appointed by the court, Resident 1's representative since 7/8/2023 and this status is current. During a record review, on 1/30/2023, at 2:30 p.m., a copy of a document, titled Petition for Appointment of Probate Conservator of the Person, (a court arrangement where a judge appoints a responsible person (a conservator) to care for another adult who cannot care for themselves (conservatee) (Resident 1) dated 7/8/2021 was reviewed. The document indicated; two (2) representatives were appointed as conservators for Resident 1 on 7/8/2021. The facility failed to provide legal evidence indicating RR 1 is no longer obligated to be communicated with regarding Resident 1's health status; the facility also failed to provide evidence report indicative RR 1 was informed of restricted visitation hours. During a review of the facility's policy and procedure (P&P) titled Visitation, dated 8/2023, the P&P indicated, Any clinically necessary or reasonable restrictions or limitations imposed by the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555380 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555380 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Encino Hospital Medical Center D/P Snf 16237 Ventura Blvd Encino, CA 91436 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 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete facility on a patient's visitation rights will be necessary to provide safe care to the patient or other patients. A justified clinical restriction may include, but not limited to: Court order, behaviors presenting direct risk or threat to the patient, facility staff, or others in the immediate environment, behavior disruptive of the functioning of the patient care unit, patient risk of infection by the visitor . During a review of the facility's policies and procedures (P&P) titled, Resident's Rights, dated 4/21/2023, the P&P indicated, Patients' rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient. Event ID: Facility ID: 555380 If continuation sheet Page 3 of 3