Health inspection·July 14, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to report in a timely manner, a change of condition (COC, a change in the resident's normal physical, mental, or behavioral state) to the physician (MD, medical doctor), for one of 15 sampled residents (Resident 11). Restorative Nursing Aide (RNA 1) reported Resident 11 was unable to walk and reported left hip pain when putting weight on the left leg on 7/5/23. A change of condition report and notification to the MD was not completed until 7/12/23 (7 days after the initial report). This failure had the potential for a delay in intervention and care and cause a decline in function and ambulation (walking) in Resident 11. Findings: During a review of Resident 11's admission Record, the admission record indicated Resident 11 was admitted to the facility on [DATE] with diagnoses including but not limited to nondisplaced intertrochanteric fracture (bone breaks, but stays in place) of left femur (thigh bone), subsequent encounter for closed fracture (broken bone that does not penetrate the skin) with routine healing, difficulty in walking, hemiplegia (weakness to one side of the body) and hemiparesis (inability to move one side of the body). During a review of Resident 11's Minimum Data Set (MDS, a comprehensive assessment and care planning tool), dated 12/19/22, the MDS indicated Resident 11 required limited assistance with bed mobility, transfers, and walking in corridor. The MDS indicated Resident 11 did not have any functional range of motion (ROM, full movement potential of a joint) limitations in both upper and lower extremities. During a review of Resident 11's care plan titled, At Risk for Decline/Further Decline in Activities of Daily Living/ROM and Skin Breakdown, dated 12/26/22, the care plan indicated a goal for Resident 11 to maintain functional mobility, continue to participate with care, with an approach to include referral to rehab (therapy services to restore, promote, and maintain function) as needed. During a review of Resident 11's care plan titled, At Risk for Spontaneous/Pathological Fracture (broken bone with no apparent force/trauma or disease) related to osteoporosis (condition in which the bones become brittle) dated 8/11/20, the care plan indicated an approach to monitor for sudden acute (new) pain, redness/discoloration, swelling/tenderness, guarded movement of extremity and report to MD promptly. Page 1 of 28 555395 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of Resident 11's July 2023 Restorative Nursing Aide Program (RNP, nursing aide program that help residents to maintain their function and joint mobility) treatment record, the treatment record indicated on 7/5/23, the treatment record was blank and initialed by RNA 1. The treatment record progress note indicated a note, Resident unable to ambulate today. Resident stood up five times but unable to make a step forward. Resident complained of pain to left hip when putting weight on it. Charge nurse [unidentified] notified. During a review of Resident 11's July 2023 nursing notes, the nursing notes did not indicate any nursing documentation regarding RNA 1's report of Resident 11's inability to ambulate and left hip pain with weightbearing (putting weight on an extremity). During an observation and interview of Resident 11 in Resident 11's room, on 7/12/23 at 12:10 p.m., Resident 11 was sitting upright in a lower height bed. A wheelchair was next to Resident 11's bed. Resident 11 stated her name and stated she was able to walk a little bit with RNA 1. Resident 11 stated she will report pain to staff and they would stop walking. During an interview with RNA 1 and review of Resident 11's July 2023 RNA treatment notes on 7/12/23 at 12:32 p.m., RNA 1 stated Resident 11 was walking shorter distances during RNA treatment recently and it was reported to the charge nurse (RNA 1 was not able to remember who the registry [on-call] nurse was). RNA 1 stated on 7/5/23, Resident 11 was not able to take any steps due to pain. RNA 1 stated Resident 11's change of condition was reported to the charge nurse the same day on 7/5/23 and documented in the RNA treatment note on 7/5/23. During an interview with the Assistant Director of Nursing (ADON) and review of Resident 11's clinical records on 7/12/23 at 1:43 p.m., ADON confirmed RNA 1 reported and documented Resident 11 had left hip pain and was unable to walk during RNA treatment on 7/5/23. ADON stated inability to ambulate was considered a COC for Resident 11 and the charge nurse (unidentified) should have completed a COC report and reported it to the physician immediately and at least by the end of the shift. ADON stated after review of Resident 11's clinical records, there was no evidence of any nursing documentation indicating nursing staff addressed Resident 11's inability to ambulate and complaint of left hip pain with weightbearing on 7/5/23. ADON stated the charge nurse that day (7/5/23) should have reported the COC to the Registered Nurse (RN) Supervisor and notified the physician. ADON stated the charge nurse and RN should have assessed Resident 11 to determine if there were any interventions that needed to be addressed and to monitor Resident 11 closely. ADON stated a COC was any change in the normal state of the resident's condition and could be physical, mental, or behavioral. ADON stated the LVN should assess, then notify the RN to evaluate and determine if there were any nursing measures indicated and notify the MD and the family. ADON stated the COC report was not completed until today, 7/12/23 (seven days after the initial report of a change of condition). ADON stated Resident 11 had a history of left hip surgery and the resident was at risk for dislocation of the left hip or any other injury. ADON stated a delay in reporting, assessment, and intervention of the COC could have prevented having the MD informed to identify the problem and address the problem. During an observation and interview of Resident 11 in the activities room, on 7/13/23 at 9:44 a.m., Resident 11 was sitting in a wheelchair at a table and watching a Spanish-language Catholic mass on television. Resident 11 stated she had no pain. Resident 11 was able to move both arms up and down past the shoulder and bring both hands to the mouth. Resident 11 was able to lift both knees up and down and straighten both legs a little. Resident 11 denied any pain during movement of all extremities and stated everything was fine. 555395 Page 2 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0580 Level of Harm - Minimal harm or potential for actual harm During a review of the facility's Policy and Procedure (P&P) revised 2/12, titled, Notification of Change in Resident Condition, the P&P indicated All symptoms and unusual signs will be communicated to the physician, resident and/or family promptly. The charge nurse is responsible for physician and family notification when a change in a resident's condition is noted. Notification will be made prior to end of assigned shift. Residents Affected - Few During a review of the facility's P&P revised 7/17, titled, Charting and Documentation, the P&P indicated The following information is to be documented in the resident medical record .changes in the resident's condition. 555395 Page 3 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 observation, interview, and record review, the facility failed to ensure a comfortable and safe temperature in one of two hallways in Station 2 and two of 34 resident's rooms, affecting three of 34 sampled residents (Residents 7, 19 and 33). This deficient practice had the potential to affect the resident's safety and well being. Findings: During an observation on 7/11/23 at 10:48 am, Resident 7 was sitting in the wheelchair (w/c) in the hallway. The resident was fanning her face. During a concurrent interview, Resident 7 stated it was hot in the hallway and complained that the temperature gets very hot at the facility. During an interview on 7/11/23 at 3 pm, Resident 7 was in her room, lying in bed. Resident 7 complained the room felt too hot, and she was not comfortable. During an observation on 7/11/23 at 3:02 pm, Licensed Vocational Nurse 1 (LVN 1) entered Resident 7's room and informed Resident 7 that only the maintenance department could adjust the temperature in the resident's room. Resident 7's face was flushed. During an observation and concurrent interview on 7/11/23 at 3:15 pm, the Maintenance Supervisor (MS) took the temperature in the main hallway in Station 2 and it registered 84 degrees Fahrenheit (a temperature scale). MS took the temperature in Resident 7's room and it registered between 82 - 84 degrees Fahrenheit. During an observation on 7/11/23 at 3:18 pm, Resident 33 was sitting on his wheelchair in Station 2 hallway. The hallway temperature was 84 degrees Fahrenheit. Surveyor attempted to interview Resident 33 but the resident did not answer questions asked. During an interview on 7/12/23 at 4 pm, the Assistant Director of Nursing (ADON) stated hot temperature can cause dehydration and heat stroke to the elderly, and it should be avoided. The ADON stated the facility should maintain a nice and cool temperature. During an interview on 7/13/23 at 12:45 pm, Resident 19 was in her room sitting on a wheelchair. Resident 19 stated the air conditioning in her room was broken and that it gets too warm in the room. During an interview on 7/13/23 at 3:51 pm, MS stated they would install portable air condition units in Resident 7's and Resident 19's rooms to keep the temperature cool in these rooms. During a review of Resident 7's admission Record, the admission record indicated the facility admitted the resident on 5/16/18 with diagnoses including sensorineural (SNHL) hearing loss ( damage to the inner ear and is a permanent hearing loss), high blood pressure and osteoporosis ( a condition in which bones become weak and brittle). During a review of Resident 7's Minimum Data Set (MDS- a standardized assessment tool) dated 5/27/23, the MDS indicated Resident 7's hearing was highly impaired and the resident used hearing aids. 555395 Page 4 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident 7's cognitive ability (ability to understand and make decisions)was intact . Resident 7 required extensive assistance with one staff physical assist for bed mobility, extensive assistance with one-person physical assist with dressing and supervision with set up for eating. During a review of Resident 19's admission Record, the admission record indicated the facility admitted the resident on 1/29/13 with diagnoses including fibromyalgia (a chronic [long-lasting]disorder that causes pain and tenderness throughout the body), high blood pressure and chronic pain. During a review of Resident 19's MDS dated [DATE], the MDS indicated Resident 19's cognitive abilities were intact. Resident 19 required extensive assistance with one-person physical assist for bed mobility, transfers and dressing. During a review of Resident 33's admission Record, the admission record indicated the facility admitted the resident on 5/1/23 with diagnoses including requiring surgical aftercare, muscle weakness and difficulty walking. During a review of Resident 33's MDS dated [DATE], the MDS indicated Resident 33's cognitive abilities were mildly impaired. Resident 33 required extensive assistance with one-person physical assist for bed mobility, dressing and eating. During a review of the facility's Policy and Procedures titled Building Systems, Heating, Ventilation, and Air Conditioning Systems, effective 1/1/99, the P&P indicated skilled nursing facilities must have comfortable and safe temperature levels that range from 71 to 81 degrees Fahrenheit. 555395 Page 5 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. 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's Policy and Procedure (P&P) failed to indicate that an alleged resident abuse must be reported within two hours to the Department, Ombudsman (an official appointed to investigate individuals' complaints against maladministration), and to the local law enforcement for one of one resident (Resident 10). This failure resulted in Resident 10 potential for further abuse. Residents Affected - Few Findings: During a review of Resident 10's admission Record, dated 4/24/23, the admission Record indicated, Resident 10 was admitted to the facility on [DATE], with multiple diagnoses including urinary tract infection (UTI, an infection in any part of the urinary system, including the kidneys, bladder, or urethra), type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), muscle weakness. During a review of Resident 10's Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 6/2/23, the MDS indicated the resident did not have impairments with cognitive skills (able to make own decisions). Resident 10 required supervision from staff for eating, toilet use, and personal hygiene. During a review of Resident 10's Licensed Nurses Progress Note (LNPN), dated 7/12/23, the LNPN indicated, Resident 29 used her walker to tap Resident 10's wheelchair multiple times while Resident 10 was sitting on it. The LNPN indicated, the incident happened at 1:45 p.m. During a review of the facility's California Report of Suspected Dependent Adult/Elder Abuse Form (SOC 341), dated 7/12/23, the SOC 341 indicated, Resident 29 used her walker to tap Resident 10's wheelchair multiple times while Resident 10 was sitting on it to push Resident 10 to go away. The incident happened on 7/12/2023 at 1:45 p.m. and the SOC 341 was faxed on 7/12/23 at 8:48 p.m. During a review of the facility's policy and procedure (P&P) titled, Policy Abuse Investigation, dated 3/2012, the P&P indicated, In the event of SUSPECTED OR WITNESSED abuse, we are required to report it to the proper agencies within the time frames listed: a. If the events causing reasonable suspicion results in serious bodily injury, the report must be made IMMEDIATELY after forming the suspicion (but not later than two (2) hours after forming the suspicion). b. If the events that cause reasonable suspicion do not result in serious bodily injury to a resident, the covered individual shall report the suspicion not later than 24 hours after forming the suspicion. During an interview on 7/13/23 at 2:34 p.m., with the Director of Nursing (DON), The DON stated and verified that the P&P was not updated to the current regulation. The DON stated the P&P should indicate that all allegations of abuse should be reported within two hours. The DON stated the P&P should be updated to reflect the current reporting timeframe. The DON stated if the abuse allegation was not reported timely, there could be a potential for [NAME] 555395 Page 6 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report an allegation of resident abuse for one of one resident (Resident 10) to the Department, Ombudsman (an official appointed to investigate individuals' complaints against maladministration), and to the local law enforcement, within two hours. This failure had the potential for Resident 10 to be at risk of further abuse. (Cross reference F607 and F943) Findings: During a review of Resident 10's admission Record, dated 4/24/23, the admission Record indicated, Resident 10 was admitted to the facility on [DATE], with multiple diagnoses including urinary tract infection (UTI, an infection in any part of the urinary system, including the kidneys, bladder, or urethra), type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), muscle weakness. During a review of Resident 10's Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 6/2/23, the MDS indicated the resident did not have impairments with cognitive skills (able to make own decisions). Resident 10 required supervision from staff for eating, toilet use, and personal hygiene. During a review of Resident 29's admission Record, dated 5/5/23, the admission Record indicated, Resident 29 was admitted to the facility on [DATE], with multiple diagnoses including dysphagia (difficulty swallowing foods or liquids) following cerebral infarction (also called ischemic stroke, occurs as a result of disrupted blood flow to the brain), and hyperlipidemia (a condition in which there are high levels of fat particles [lipids] in the blood). During a review of Resident 29's Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 6/17/23, the MDS indicated the resident did not have impairments with cognitive skills (able to make own decisions). Resident 29 did not require assistance from staff for Activities of Daily Living (ADLs, activities related to personal care). During an interview on 7/13/23, at 10:00 a.m., with Social Service Worker (SSW), SSW stated, SSW was notified on the night of 7/12/23 for a possible resident to resident abuse related to Resident 29 using her walker to push Resident 10's wheelchair while Resident 10 was sitting on it. SSW stated, Registered Nurse Supervisor initiated the reporting process. During a review of Resident 10's Licensed Nurses Progress Note (LNPN), dated 7/12/23, the LNPN indicated, Resident 29 used her walker to tap Resident 10's wheelchair multiple times while Resident 10 was sitting on it. The LNPN indicated, the incident happened at 1:45 p.m. During an interview on 7/13/23, at 2:07 p.m., with the Assistant Director of Nursing (ADON), the ADON stated, Resident 10's assigned nurse reported the incident around 6 p.m. on 7/12/23. Then the ADON reported it the Director of Nursing (DON) as a chain of command. Stated, the ADON faxed and tried to call Ombudsman around 8:45 p.m. 555395 Page 7 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of the facility's California Report of Suspected Dependent Adult/Elder Abuse Form (SOC 341), dated 7/12/23, the SOC 341 indicated, Resident 29 used her walker to tap on Resident 10's wheelchair multiple times while Resident 10 was sitting on it to push Resident 10 to go away. The incident happened on 7/12/2023 at 1:45 p.m. and the SOC 341 was faxed on 7/12/23 at 8:48 p.m. During an interview on 7/13/23 at 02:34 p.m., with the DON, the DON stated, abuse should be reported to law enforcement, Ombudsman, and the Department within 2 hours. The DON stated, if abuse was not reported early, there would be a potential for further altercations, and a higher risk for bodily injury. 555395 Page 8 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to implement a comprehensive care plan for the use of splints (a device that safely stretches tight muscles and joints) to right elbow and left knee as ordered by the physician on 1 of 1 sampled resident, Resident 20. This failure had the potential to cause further decline of Resident 20's contractures (a permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joint to shorten and become very stiff) to the right elbow and the left knee. Findings: During an observation on 7/11/23 at 10:36 a.m., in Resident 20's room, the resident was lying in bed, asleep, with splints on the right elbow and the left knee. Resident 20 was not able to be interviewed. During a review of Resident 20's admission Record, dated 5/12/23 indicated the resident was admitted to the facility on [DATE] with diagnoses which included Alzheimer's disease (a brain disease that causes a decline in memory, thinking, learning and organizing skills over time), dementia (a loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life), heart failure (a condition that develops when your heart doesn't pump enough blood for your body's needs), dysphagia (difficulty swallowing) following cerebral infarction (also known as a stroke, refers to damage to tissues in the brain due to a loss of oxygen to the area), type 2 diabetes mellitus (a disease that occurs when your blood glucose, also called blood sugar, is too high). During a review of Resident 20's History and Physical (H&P) dated 5/03/23 indicated the resident does not have the capacity to understand and make decisions due to Alzheimer's Disease. During a review of the Minimum Data Set (MDS), a standardized care and screening tool, dated 5/30/2023, indicated the resident had total dependence on staff for bed mobility, dressing, eating, personal hygiene and toilet use. During a review of Resident 20's Order Summary Report, dated 6/24/23, indicated an active order for restorative nursing aide (RNA) to apply left splint to prevent contractures for 4 hours or as tolerated ever day shift. Order date: 5/25/23; Start date: 5/28/23. During a review of Resident 20's Order Summary Report, dated 6/24/23, indicated an active order for RNA program to apply right elbow splint for 4 hours or as tolerated every day shift: Order date: 5/15/23; Start date: 5/19/23. During A review of Resident 20's Care Plan (CP) titled Problem at risk for decline/further decline in ADL/ROM and further skin breakdown, date initiated 11/22/2019, and revised 3/7/2023, indicated no documentation related to the implementation of splints to right elbow or left knee. During an observation on 7/13/23 at 09:30 a.m., in Resident 20's room, observed splints to left knee and right elbow in place. 555395 Page 9 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0656 Level of Harm - Minimal harm or potential for actual harm During an interview with (RNA1) on 7/13/23 at 2:28 p.m., RNA1 stated that the resident receives passive range of motion (PROM). RNA1 stated that the splints are applied at 8:30 a.m. and removed at 12:30 p.m. every day and Resident 20 tolerates the gentle exercises well. RNA1 stated splints are applied to Resident 20 for 4 hours a day as tolerated to right elbow and left knee. RNA1 states that Resident 20 has been on the RNA program for a long time. Residents Affected - Few During a review of Resident 20's Restorative Charting Records, dated 5/2023, 6/2023 and 7/2023 indicated that the RNAs did not apply splints to Resident 20's right elbow and left knee every day as ordered by the physician. The splints were applied (Monday through Friday) and were not applied on the weekends (Saturday and Sunday). During an interview on 7/13/23 at 3:04 p.m., with the MDS Coordinator (MDS), the MDS stated that her job is to do assessments on residents, complete the MDS and create a CP based on the resident's needs. The MDS stated that the facility staff uses Point Click Care (PCC), an electronic health record (EHR), to document and keep record of the MDS and the CPs. The MDS stated that a CP was not found for Resident 20's splints in the EHR and the splints were also not included in the MDS. The MDS stated that the CP may be found in the RNA charting log at the nursing station. The MDS stated that it is important to have a CP for Resident 20's splints to collaborate care and prevent decline of the resident. During a review of the facility's RNA charting log on 7/13/23 at 03:22 p.m., located at Station 3 nursing station indicated that there was no CP for splints located in the RNA charting log. During an interview on 7/13/23 at 3:38 p.m., with the Assistant Director of Nursing (ADON), the ADON stated that she is aware of Resident 20's splints and the RNA program to prevent contractures. The ADON stated that the licensed nurses are responsible for the CP. She stated that there will be negative outcomes if a CP is not developed for a resident because the staff will not be able to implement the needed interventions and there will be a delay in services. The ADON stated that there was no CP for splints in Resident 20's medical record and that a correction to the CP will be made to include a CP for splints. During a review of the facility's policy and procedure titled Care Plans, Comprehensive Person- Centered revised 12/2016, indicated a comprehensive, person center care plan that includes measurable objectives and timetables to meet the resident's physical psychosocial and functional needs is developed and implemented 555395 Page 10 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to provide functioning hearing aids for one of four sampled residents (Resident 7) . Residents Affected - Few This deficient practice resulted in Resident 7 not being able to hear and feeling upset not able to hear her daughter during visitation. Findings: During a review of Resident 7's admission Record, the admission record indicated the facility admitted the resident on 5/16/18 with diagnoses including sensorineural (SNHL) hearing loss ( damage to the inner ear and is a permanent hearing loss), high blood pressure and osteoporosis ( a condition in which bones become weak and brittle). During a review of Resident 7's Minimum Data Set (MDS- a standardized assessment tool) dated 5/27/23, the MDS indicated Resident 7's hearing was highly impaired and the resident used hearing aids. Resident 7's cognitive ability (ability to understand and make decisions)was intact . Resident 7 required extensive assistance with one staff physical assist for bed mobility, extensive assistance with one-person physical assist with dressing and supervision with set up for eating. During a review of Resident 7's plan of care revised 3/6/23, the plan of care indicated Resident 7 had impaired cognition and communication as evidenced by problems understanding others due to hard of hearing, bilateral hearing loss; has hearing aid but prefers to use then when her family visits. During an observation on 7/11/23 at 10:48 am, Resident 7 was sitting on a wheelchair in the hallway. During a concurrent interview, Resident 7 stated her right hearing aid was missing. During a follow up interview on 7/11/23 at 10:50 am, Resident 7 stated she felt so bad she could not hear her daughter because her right hearing aid was missing over the weekend. During an observation on 7/11/23 at 11:10 am, Restorative Nursing Aid 1 (RNA 1) brought Resident 7's hearing aids for the right and left ear. Resident 7 placed the hearing aids on and stated she could not hear anything with them. RNA 1 replaced the old batteries of the hearing aids and Resident 7 clapped her hands close to her ears and stated she still could not hear using the hearing aids. During an interview on 7/13/23 at 8:47 am, Licensed Vocational Nurse 1 (LVN 1) stated Resident 7's right hearing aids were kept in the medication cart. LVN 1 stated Resident 7 had the same hearing aids since admission to the facility. LVN 1 stated on 7/11/23 when the unlicensed (unidentified) staff asked LVN 1 for Resident 7's right hearing aid, LVN 1 found it in the Medication cart, broken in pieces. LVN 1 stated Social Worker Designee put it back together and LVN 1 gave it to Resident 7 to wear. LVN 1 stated Resident 7 complained she could not hear with the hearing aids on. LVN 1 stated today (7/13/23), LVN 1 found the hearing aid, again broken in pieces and that she informed the Social Services Department of her observation. During an observation on 7/13/23 at 9 am, LVN 1 was going to provide the left hearing aid to Resident 7 and observed that it did not have a battery. LVN 1 attempted to replace the left hearing aid with a new battery but after several attempts she stated the battery was not staying in place. LVN 1 555395 Page 11 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0676 stated she will notify the Social Services Department of her observation. Level of Harm - Minimal harm or potential for actual harm During an interview on 7/13/23 at 11:33 am with the Assistant Director of Nursing (ADON), the ADON stated Resident 7 had a consultation with the Audiologist (ear doctor) in 2019. During a concurrent record review of Resident 7's Allied Health/Nurse Visit notes dated 5/24/19, the notes indicated the reason for the visit was hearing loss. Resident 7's Progress Notes indicated to return to clinic for an annual follow up. The ADON stated it was a failure of both the Nursing Department and the Physicians who should have ensured Resident 7 had a f/u visit with the audiologist to get her hearing aids checked. The ADON stated there were no audiology follow up consults on file for Resident 7. Residents Affected - Few During a review of the Facility's Policy and Procedures ( P&P) titled Sensory Impairments- Clinical Protocol, revised March 2018, the P&P indicated the physician would identify and order appropriate consultations to help manage the causes, complications, and risks of sensory impairments. 555395 Page 12 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. Based on observation, interview and record review, the facility failed to ensure safe serving of food. During a food tray line observation ( system of food preparation in which trays move along) on 7/12/23 , 20 hot food items during the 12 pm tray line were under 145 degrees Fahrenheit (F- unit of temperature measurement) for starch and vegetables, meat or entrees, and soup, according to the facility's Policy and Procedure for Resident Meal Service. This deficient practice had the potential for residents to be exposed to food-borne illness. Findings: During a tray line observation in the kitchen on 7/12/23 at 11:50 am, with Dietary Supervisor (DS), DS checked the temperature of the hot food on the steam tables just before the 12 pm tray line for lunch with the following findings: 1. Regular texture ham: 104 degrees 2. Regular texture yams: 130 degrees F 3. Turkey breast: 130 degrees F 4. Chicken patty: 140 degrees F 5. Ground cauliflower: 140 degrees F 6. Four (4) individual porridge cups: 120 degrees F each 7. Ground chicken: 130 degrees F 8. Puree cauliflower: 140 degrees F 9. Puree yams: 140 degrees F 10. Tomato soup: 140 degrees F 11. Vegetable soup: 140 degrees F 12. Mashed potatoes: 140 degrees F 13. Liquid cauliflower: 110 degrees F 14. Chicken noodle soup: 160 degrees F 15. Cream of mushroom soup: 130 degrees F 16. Chicken: 140 degrees F 555395 Page 13 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In a concurrent interview, DS stated the temperature of the regular texture ham needed to be 140 degrees F. DS stated the facility had two tray lines for lunch, one at 11 am and one at 12 pm. DS stated food temperatures on the steam table were only checked once at the 11 am tray line. The DS stated, cooks, or the DS do not check the temperatures for the 12 pm tray line. DS stated the food being served for the 12 pm tray line was the same food put on steam tables for the 11 am tray line. DS stated, because the temperatures of the 20 food items was below recommended temperatures, it could put the residents at risk for getting sick from the food. DS stated food served from the tray line should be served at 140 degrees F but declined to state why it was important. DS stated it was not safe to serve the turkey breast and that it needed to be reheated. DS stated the regular texture ham and yams, turkey breast, four individual porridge cups, ground chicken, liquid cauliflower, and cream of mushroom soup were not safe to be served and needed to be reheated. DS stated it was important to check food temperatures before each tray line with each meal because residents could get sick or hospitalized . DS stated food might not taste good if the recommended temperature of 140 degrees F was not met, when served. DS rechecked the food temperatures and stated turkey breast needed to be thrown away because the temperature after being reheated was 130 degrees F. During an interview on 7/12/23 at 12:36 pm, with the Registered Dietician (RD), RD stated he monitored the documentation of the tray line temperatures. RD stated, staff checked the temperatures of food on the steam tables before the tray line at 11 am but not for the 12 PM tray line. RD stated, the facility had a fragile resident population. During a concurrent interview and record review on 7/13/23 at 12:25 pm with Dietary Tech (DT), DT reviewed the facility's resident diet orders for all residents at the facility. The document included a list of all current residents and their diet orders. DT stated that there were 30 resident who ate food orally and were served food from the kitchen. DT stated the 30 residents had the potential to be served lunch from the kitchen on 7/12/2023. During a concurrent record review and interview on 7/14/23 at 11:50 am, of the facility's Policy and Procedure (P&P) titled , Resident Meal Service, effective 10/1/94 and Daily Food Temperature Log were reviewed with RD. RD stated hot food should be served as follows: starch or vegetables will be served at least 145 degrees F, meat or entrees should be served at least 145 degrees F and soups and beverages should be served at 180 degrees F. RD stated the Daily Food Temperature Log indicated hot foods should be more than 140 degrees. RD stated, the log was incorrect and should reflect what the P&P indicated. RD stated the log did not include a section for documenting the temperature of soups and porridge. RD stated, the Daily Food Temperature Log should include a section for checking and documenting the temperature of soups and porridge. RD stated, the practice of not including soups and porridge on the Daily Food Temperature Log placed the residents at risk for food-borne illness, because staff cannot confirm the temperatures were checked since staff do not document those temperatures in the log. During a review of the facility's P&P, titled, Resident Meal Service, effective 10/1/94, the P&P indicated food temperatures will be taken to ensure all hot foods had proper serving temperature and that temperatures will be recorded daily. The P&P indicated starch or vegetables will be served at least 145 degrees F, meat or entrees will be served at least 145 degrees F, soups and beverages will be served at 180 degrees F. During a review of the facility's Daily Food Temperature Log, the log indicated cold foods needed to be 40 degrees F or less and hot foods needed to be 140 degrees F or more. The log indicated to check the temperatures of regular and puree textures of vegetable, regular, chop, ground, and puree 555395 Page 14 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0800 Level of Harm - Minimal harm or potential for actual harm entrée, regular, ground, and puree starch, ground, and puree meat. The log indicated to document the time the temperatures were taken. The log from 7/1/23 to 7/12/23, did not indicate that food temperatures were checked after 11 am, before serving. Residents Affected - Some 555395 Page 15 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on observation, interview, and record review, the facility failed to ensure necessary qualifications were met and in-services (education) were provided, for one of one kitchen staff (Dietary Supervisor, DS) when the DS was hired without having a California Food Handler (CFH, designated to ensure employees who handle food receive reasonable level of training in food safety practices to reduce the potential for food-borne illnesses [caused by contaminated food that can lead to food poisoning) card from the American National Standards Institute (ANSI). In addition, the facility failed to ensure in-services (education) were provided to 14 of 14 kitchen staff and nursing staff, as indicated in the facility's Registered Dietician (RD) and DS job descriptions, when: These failures had the potential to result in food-borne illnesses throughout the facility and compromise the health and nutritional needs of the residents. Findings: During a kitchen tour and interview on 7/11/2023 at 8:36 AM, the DS introduced self and stated they were the Dietary Supervisor. During a concurrent interview and record review of the DS's employee file and job description, on 7/13/2023 at 2:41 PM, with the Human Resources (HR), the HR stated the HR could not find the DS's CFH card. The HR stated the DS was promoted from lead cook to dietary supervisor approximately nine months prior to the recertification survey. The HR stated it was indicated under the education portion of the job description; the dietary supervisor must hold a CFH card from an ANSI approved training provider. During a review of the facility's Dietary Supervisor job description, undated, indicated the DS would assist the dietician in the provision of food service and nutritional programs. The job description indicated the DS, Must hold a current CFH card from an ANSI approved training provider. During an interview on 7/13/2023 at 2:47 PM, with the Registered Dietician (RD) and the HR, the RD stated the DS did not have a CFH card. The RD stated the DS was hired as the DS approximately nine months and the RD did not think the DS was required to have a CFH card. The RD and the HR stated per the facility's policy/job description, the current DS was not qualified to be the DS. The RD stated it was the RD's job to hire a DS and ensure staff were qualified. The HR stated it was the HR's job to ensure qualifications were met and it was a misstep on the HR's part for not checking the qualifications of the DS. During an interview on 7/13/2023 at 3:50 PM, with the RD, the RD stated the RD did not have any documented evidence to indicate in-services were given to kitchen or nursing staff. The RD stated the RD had not done any formal in-services in at least one year. During a review of the list of kitchen staff that handle food, undated and provided by the RD, the list indicated 14 kitchen staff handled food and the DS was included in the list. During a review of the facility's job description for Registered Dietician, undated, the job description indicated to perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The job description indicated the requirements listed were representative of 555395 Page 16 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0801 Level of Harm - Minimal harm or potential for actual harm the knowledge, skill and/or ability required. The essential job functions indicated the RD would routinely inspect the food service area(s) and practices for compliance with company policies, procedures, standards, and applicable Federal, State, and local regulations. The job description also indicated the RD would provide in-service training to nursing staff on topics related to Nutrition and Food Service and other duties may be assigned. Residents Affected - Some During a review of the County of Los Angeles Public Health-Environmental Health, undated, indicated, the California Senate [NAME] No. 602 requires a food handler who is hired prior to June 1, 2011 to obtain a food handler card on or before July 1, 2011. The bill would require food handlers hired after June 1, 2011 to obtain a food handler card within 30 days of his or her date of hire. It would require each food handler to maintain a valid food handler card for the duration of his or her employment. http://publichealth.lacounty.gov/eh/business/certified-food-handler-manager.htm 555395 Page 17 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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 food was served at a safe and appetizing temperature for 10 of 10 residents who were served yam for lunch on 7/12/23. The temperature of the yam on the test tray from the tray line was 129.6 degrees Fahrenheit (F- unit of temperature measurement). Residents Affected - Some This failure resulted in Resident 10 complaining about the temperature of food served in the facility. This deficient practice also placed the residents at risk for food-borne illness (illness caused by contaminated food). Findings: During a review of Resident 10's admission Record, dated 4/25/23, the admission Record indicated the resident was admitted to the facility on [DATE] with diagnoses that included stage 4 (severe) chronic kidney disease (damage to the kidneys so they cannot filter blood the way they should) and type II diabetes (DM2a condition that happens because of a problem in the way the body regulates and uses sugar as fuel). During a review of Resident 10's Minimum Data Set (MDS- a standardized resident assessment and care screening tool), dated 6/2/2023, the MDS indicated the resident had intact cognition (ability to think, remember, and reason). The MDS indicated Resident 10 was independent (no help or staff oversight at any time) with bed mobility, transfers, locomotion, and dressing and Resident 10 required supervision (oversight, encouragement, cueing) with walking, eating, toilet use, and personal hygiene. During a review of the facility's undated residents' diet orders, the diet orders indicated Resident 10 was on a regular textured diet (no modifications to the texture of the food), lower (less) protein, lower sodium (salt), fortified (enriched) diet. During a concurrent observation and interview on 7/12/23 at 11:30 am, Resident 10 was in a wheelchair in the hallway with the resident's representative (RP). Resident 10's RP stated the food served in the facility was usually cold and never warm. The RP stated the bread was never warm, it was always cold. The RP stated that the meat and vegetables were always served cold, never warm to touch. The RP stated Resident 10 got soup every day and the soup was always cold. Resident 10's RP stated the RP brought food to Resident 10 every day because the food has not been good the last few months. During a concurrent observation and interview on 7/12/23 at 1:18 pm, Certified Nurse Assistant 3 (CNA) identified the food on Resident 10's plate. CNA 3 stated Resident 10 was served steamed cauliflower, sweet potato (yams), and slices of ham. During a concurrent observation and interview on 7/12/23 at 1:20 pm, with CNA 3 and Resident 10, CNA 3 removed Resident 10's tray. CNA 3 stated Resident 10 did not want her plate because Resident 10's RP usually brought the resident food every day. CNA 3 stated she did not ask Resident 10 if there was an issue with the food served or how Resident 10 liked the food served before removing the tray from Resident 10. During a concurrent temperature check and interview on 7/12/23 at 1:23 pm, with Dietary Supervisor (DS), DS confirmed the surveyor's food thermometer was calibrated accurately before checking the 555395 Page 18 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some temperatures of the food on a test tray requested during the kitchen's 12 PM tray line. The yams (sweet potatoes) had a temperature of 129.5 degrees F. The DS stated, the temperature of the yams from the test tray were not within appropriate temperature and that it was bad for the resident but would not state the reason why. During an interview on 7/13/23 at 12:25 pm, with Registered Dietician (RD), RD stated, when staff served hot food to residents that was under the appropriate temperature range, it exposed the residents to food-borne illness and food might not taste good to eat because it was not hot enough. RD stated he was not aware residents complained that food being served was not hot. RD stated the kitchen staff do not perform spot checks or audit on the temperature of the residents' food after it leaves the tray line. RD stated, if food was served out of the acceptable temperature range, food might not taste good because it was not hot enough. RD stated, serving food not within the acceptable temperature range could potentially expose residents to food-borne illnesses. During a concurrent interview and record review on 7/13/23 at 12:35 pm, with Dietary Tech (DT), DT provided a list of residents who were served regular textured yams for lunch meal on 7/12/2023. DT stated 10 residents were served the yams on 7/12/23 for lunch out of 30 residents in the facility who eat orally. During an interview on 7/14/23 at 11:50 am, with RD, RD stated hot food should be served to residents at 145 degrees F. During a review of the facility's Policy and Procedure (P&P) titled, Scope of Service: Nutritional Services Department, effective 10/1/1994, the P&P indicated the nutritional services department sought to provide quality nutritional service to all residents, medical staff, and employees within the policies established by the facility. The P&P indicated the menu shall provide a meal that was appetizing in flavor and appearance and shall be planned to present a variety of foods to the residents. 555395 Page 19 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one of 24 sampled residents (Resident 10) was served the food preferences listed on Resident 10's lunch tray card. This deficient practice had the potential to result in resident 10's frequent meals refusal, decreased meal satisfaction and consumption and potentially negatively affect Resident 10 nutritional status. Findings: During a review of Resident 10's admission record, dated 5/23/22, indicated, Resident 10 was admitted to the facility on [DATE] with diagnosis included Type 2 Diabetes Mellitus (a group of diseases that result in too much sugar in the blood), hypertension (blood pressure that is higher than normal), and hyperlipidemia (high levels of fat in the blood). During a review of Resident 10's Minimum Data Set (MDS), dated [DATE], indicated, Resident 10 had the ability to express ideas and wants, and ability to understand verbal content. MDS indicated, Resident 10 needs supervision as in oversight, encouragement or cueing regarding eating. During a review of Resident 10's Order Summary Report, dated 6/24/23, indicated, Resident 10's diet order was No added Salt diet, regular texture, low protein, low sodium fortified. During a concurrent observation and interview on 07/11/23, at 12:22PM, with CNA 4, outside Resident 10's room, CNA 4 was observed bringing Resident 10's lunch tray in and immediately brought it out. CNA 4 stated, Resident 10 has been refusing food because her daughter would bring food in every day. During an interview on 07/12/23, at 11:30AM, with Resident 10 and her daughter, in the hallway, Resident 10's daughter stated, Resident 10 wanted rice but hasn't received it for months, food was usually cold, so she had to bring food in every day. During a concurrent observation and interview on 07/12/23, at 1:18PM, with CNA 4, outside Resident 10's room, CNA 4 was observed bringing Resident10's lunch tray and brought it out to the tray cart. CNA 4 stated, Resident 10 refused lunch, CNA 4 stated, Resident 10's tray had steamed cauliflower, sweet potato puree and 3 slices of ham. No rice was observed on Resident 10's lunch tray. During a concurrent interview and record review of Resident 10's Nutritional Screening and Data Collection Form on 07/12/23, at 2:51PM, with the Registered Dietician (RD), RD stated, the form included residents' food preferences assessment. RD stated rice and soup for lunch and dinner were documented. The kitchen should have honored Resident 10's preferences for having rice. RD stated, if the residents did not get the food they like, there would be a high risk for meal refusal and potential for malnutrition. During a review of Resident 10's baseline care plan, initiated on 5/23/22, indicated the concern identified was Nutrition/Hydration/Eating related to history of weight loss, malnutrition, and the approach included respect and honor resident's food preferences. 555395 Page 20 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of Resident 10's nursing care plan, revised on 6/9/23, indicated Resident 10 was at risk for weight fluctuation, malnutrition and dehydration, and the approach included honor and respect resident decision on meal request. During a concurrent interview and record review of Resident 10's tray card (a printed card that included resident's diet and food preferences) on 07/13/23, at 11:15AM, with Diet Technician (DT), Resident 10's tray card was reviewed. DT stated, Resident 10's tray card indicated rice and soup for lunch and dinner. DT stated, the kitchen had rice, rice should have been on Resident 10's tray. If there was no rice, staff must have overlooked it. During a review of facility's policy and procedure titled, Nutritional Screening and Assessment, revised 12/98, indicated, The Dietary Services Supervisor will visit residents within 72 hours of admission and complete the food preferences interview and document findings in the Resident Profile card and Nutritional Screening and Assessment form. Religions, cultural and/or ethnic preferences will be noted. During a review of facility's policy and procedure titled, Maintaining the [NAME] (a printed card that specify a resident's preferences) and Resident Profile Cards, revised 12/98, indicated The Resident Profile Card will be kept current, and include diet order, order changes and dates, adaptive equipment, food preferences, nourishments and snacks and allergies. During a review of facility's policy and procedure titled, Tray cards, revised 12/98, indicated to ensure that the correct diet is served, and food preferences are honored. 555395 Page 21 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 food storage, in one of one refrigerator freezer (Ice Cream Freezer 1). The facility failed to monitor and record daily temperatures and ensure Ice Cream Freezer 1's thermometer was in working condition, as indicated in the facility's Policy and Procedures (P&P). In addition, the Dietary Supervisor (DS) did not check refrigerator-freezer temperatures on 7/10/2023 and falsified the facility's Refrigerator-Freezer Temperature Log (RTL) to indicate the temperatures were checked. These failures had the potential to result in harmful organism growth that could lead to food-borne illnesses (caused by contaminated food that can lead to food poisoning) for the residents who had the ability to eat by mouth. Findings: During an interview and initial kitchen tour on 7/11/2023 at 8:50 AM, with the DS, the DS showed the temperature of Ice Cream Freezer 1's external and internal temperatures (external temperatures confirm internal temperatures). The external thermometer indicated a temperature of -14 degrees Fahrenheit (F, unit of temperature measurement). The internal thermometer indicated a temperature of 40 degrees F. The DS stated the internal thermometer had been broken for a while, but the DS did not know for how long. The DS stated the DS had not placed a maintenance request to follow up on the problem. The DS stated the DS did not know if the external freezer temperature was accurate because the internal thermometer was broken [could not compare temperatures]. The DS stated there was a possibility the food could be compromised because the DS did not know Ice Cream Freezer 1's accurate temperature. The DS stated the icicles observed in the freezer were signs of melting. The DS stated the broken thermometer, and the icicles were not a big deal because the items stored in the freezer were only ice cream, butter/margarine, and popsicles. During a concurrent interview and record review of the RFT Log on 7/11/2023 at 9:00 AM, with the DS, the DS reviewed the recorded temperatures of the facility's refrigerators and freezers. The temperatures for 7/10/2023 were blank. The DS stated the DS forgot to check the temperatures 7/10/2023. The DS stated the DS had been recording interval temperatures of Ice Cream Freezer 1 despite knowing the thermometer was broken. During a review of the facility's RFT Log (provided on 7/11/20), dated 7/2023, the log indicated no temperatures were documented on 7/10/2023. During a concurrent observation Ice Cream Freezer 1's temperatures and interview on 7/13/2023 at 9:17 AM, with the DS, the DS stated the external temperature of Ice Cream Freezer 1 was 38 degrees F and the internal temperature was 38 degrees F. The DS stated the DS put in a maintenance request for Ice Cream Freezer 1 after the initial kitchen tour on 7/11/2023. The DS stated the DS replaced the internal thermometer in Ice Cream Freezer 1 and the maintenance department had not checked Ice Cream Freezer 1. The DS stated the icicles inside Ice Cream Freezer 1 were an indication the internal temperature rose then cooled back down, creating icicles. The DS stated all food items inside Ice Cream Freezer 1 had the potential to be spoiled and were still being served to the residents. The DS stated a broken freezer was an urgent matter and all food items should have been thrown out immediately. 555395 Page 22 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 7/13/2025 at 9:35 AM, with the Dietary Technician (DT), the DT stated the DS was supposed to check the internal thermometer of Ice Cream Freezer 1. The DT stated if the internal and external temperatures did not match, it was an urgent issue. The DT stated melted ice and icicles were an indication the temperature inside Ice Cream Freezer 1 rose [high] enough to create condensation (water vapor becomes liquid), melted, followed by [a drop] in the temperature. The DT stated the food inside Ice Cream Freezer 1 should have been thrown out immediately because the staff did not know if the thermometers were broken and it was not safe to serve the food to the residents. During a concurrent interview and record review on 7/13/2023 at 12:04 PM, with the Maintenance Supervisor (MS), the MS reviewed the Maintenance Request Log for the Kitchen. The MS stated the MS conducted daily rounds that included viewing each department's maintenance log and there was no request for a broken thermometer on 7/11/2023. The MS stated external temperatures confirmed Ice Cream Freezer 1's internal temperature. The MS stated if the internal and external temperatures of Ice Cream Freezer 1 or the refrigerator did not match, staff were supposed to get a third thermometer to check internal temperatures and match with external temperatures. The MS stated if Ice Cream Freezer 1 had icicles this indicated there was either too much freezing or the temperature rose [resulting in water] then the water froze again. The MS stated Ice Cream Freezer 1 needed to be assessed by maintenance. The MS stated if the internal and external temperatures of Ice Cream Freezer 1 did not match or were above 0 degrees F, the food inside the freezer was at risk for spoiling and could make the residents sick. The MS stated it was not appropriate for kitchen staff to replace a potentially broken internal thermometer because maintenance needed to ensure accuracy and functioning of the thermometers and Ice Cream Freezer 1. During an interview on 7/13/2023 at 12:20 PM, with the DS, DS stated the DS did not put in a maintenance request for Ice Cream Freezer 1's broken thermometer and just replaced it himself. The DS stated the DS could not ensure the replaced thermometer was working properly because the thermometer [was not installed by] maintenance. The DS stated the DS knew maintenance should have been called. During an interview on 7/13/2023 at 12:25 PM, with the Registered Dietician (RD), the RD stated staff should not be replacing freezer internal thermometers and a maintenance request should have been submitted when the external and internal thermometer temperatures did not match. The RD stated it was not safe for [kitchen] staff to be logging temperatures knowing the thermometer was broken and icicles were present because of the possibility of a broken freezer. The RD stated it was not safe to serve the food inside Ice Cream Freezer 1 to the residents. During a concurrent interview and observation of the temperature check on 7/13/2023 at 4:30 PM, with the MS, the MS took the internal temperature of Ice Cream Freezer 1. The MS stated the external thermometer of Ice Cream Freezer 1 was 22 degrees F. Readings from two internal thermometers in Ice Cream Freezer 1 indicated, 20 degrees F and 26 degrees F. The MS stated that both the thermometer and the Ice Cream Freezer 1 needed to be assessed because the MS was not sure if Ice Cream Freezer 1 or Ice Cream Freezer 1's thermometer was broken. The MS stated according to the facility, the temperature of the freezers should be at 0 degrees F or colder [lower]. During a concurrent interview with the RD and record review of the RFT Log, on 7/14/2023 at 11:50 AM, the RD was shown a copy of the RFT log provided on 7/11/2023. The RD provided another copy of the log on 7/14/2023, the log indicated temperatures for 7/10/2023 were added. The RD stated it was not okay for the temperatures to be documented after the fact since the DS had stated the DS forgot to check the temperatures on 7/10/2023. The RD stated because the temperatures were filled in for 7/10/2023, it was falsification of the log. The RD stated the DS should have left the temperatures for 555395 Page 23 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0812 Level of Harm - Minimal harm or potential for actual harm 7/10/2023 blank and left a note indicating the DS forgot to check the temperatures. The RD stated the RD would talk to the DS because the DS was not supposed to go back and fill dates that were not checked. During a review of the facility's RFT Log (provide on 7/14/2023), dated 7/2023, the log indicated the temperatures for 7/10/2023 had been documented. Residents Affected - Few A review of the facility's job description for Dietary Supervisor, undated, the job description indicated the DS would have position qualifications that included oral communication- ability to communicate with others using spoken word, written communication- ability to communicate in writing clearly and concisely, leadership- ability to influence others to perform their jobs effectively and to be responsible for making decisions, and self-motivated, ability to be internally inspired to perform a task to the best of one's ability using his or her own drive or initiative. During a review of the facility's P&P, titled, Storage Procedure, dated 6/1995, the P&P indicated perishable food must be refrigerated at the correct temperature. The P&P indicated frozen foods must be stored at 0 degrees F or less. During a review of the facility's P&P, titled, Preventative Maintenance Program, undated, the P&P indicated the Dietary Services Supervisor was responsible for: training all employees in the proper use of equipment, instructing employees in the proper method of reporting equipment failure, conducting periodic visual external inspections of all equipment noting condition, efficiency, loose parts, or excessive of that equipment. The P&P indicated freezer elements must be kept free of frost build-up, check thermometers routinely, and that refrigerator and freezer temperatures will be monitored daily by the Dietary Services Supervisor and recorded on the Temperature Log and abnormal temperatures will be reported to maintenance the same day. 555395 Page 24 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to remain free of pests and did not having an effective pest control for one of four planters (Planter 1) by failing to: Residents Affected - Few a. Eliminate harborage conditions (locations and conditions where the mosquito can live, thrive [grow strong], reproduce, and feed) for mosquitoes to live. b. Eradicate (destroy/kill) mosquitoes (small flying insects that can bite people and spread infectious diseases) observed inside the facility. This failure had the potential to result in vector-borne diseases (diseases that result from an infection transmitted to human by insects such as a mosquitoes) for all residents residing at the facility. Findings: a. During an observation on 7/12/23, at 9:10 am, in the East end of the main dining room, one live mosquito flew and landed on Surveyor 1's right back shoulder. The East end of the main dining room was partitioned off from the rest of the dining room. During a concurrent observation and interview on 7/12/23, at 10:01 am, with the Activities Director (AD), in the main dining room, four residents were observed sitting in the [NAME] section of the dining room. AD stated the dining room was used to provide activities to the residents. AD stated the East end of the main dining room was open sometimes, and that the residents also used the section. AD stated, the East section was sometimes closed to provide privacy for families to visit with residents. During an interview on 7/12/23, at 10:23 am, the Environmental Services Director (EVSD) stated a pest control company came to the facility monthly. During a concurrent interview and record review on 7/12/23, at 10:27 am, with EVSD, the facility's Service Report, dated 6/15/23, indicated the pest control company had not treated or inspected the facility for mosquitoes. EVSD stated the pest control company did not provide services to treat mosquitoes at the facility. During a concurrent observation and interview on 7/12/23, at 10:47 am, with the EVSD, in the main dining room, a potted plant was observed at the East wall of the dining room. The base of the plant was submerged (under water) within another pot, full of water. EVSD stated he could see what appeared to be mosquito larvae in the water, swimming around. EVSD stated there was a risk that residents would experience pain and discomfort if they were bitten by mosquitoes. EVSD stated the pest control company needed to address the concern regarding mosquitoes, as observed in the dining room of the facility. EVSD stated there was a risk residents could be bitten by mosquitoes if the pest control does not address the mosquitoes found inside the facility. b. During an observation on 7/12/23, at 11:35 am, in the hallway outside a resident's room, a live mosquito was observed on the surveyor's left forearm. During a concurrent observation and interview on 7/12/23, at 1:20 pm, with the Director of Nursing 555395 Page 25 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (DON), in the East section of the main dining room, Surveyor 2 waved one live flying mosquito away from the surveyor's left arm. The DON stated the mosquito was present because there were a lot of plants at the facility. During a review of the facility's Policy and Procedure (P&P) titled, Integrated Pest Management, reviewed 1/18/23, the P&P indicated the facility has to be maintained pest free at all times. 555395 Page 26 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0943 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Based on interview and record review, the facility failed to train staff to report all allegations of resident abuse to the Department, Ombudsman (an official appointed to investigate individuals' complaints against maladministration), and to the local law enforcement, within 2 hours. Five of seven sampled staff did not know the correct timeframe (within 2 hours) of reporting any allegation of resident abuse. This failure had the potential for residents to be at risk of abuse. (Cross reference F607 and F609) Findings: During an interview on 7/13/23, at 2:07 p.m., the Assistant Director of Nursing (ADON), ADON stated, resident abuse needed to be report within two hours, if there is serious bodily injury, to the Department, Ombudsman, and law enforcement. ADON stated, if the abuse did not cause serious bodily injury, the abuse should be reported within 24 hours. ADON stated, verbal abuse should be reported within 24 hours. During a concurrent interview and record review on 7/13/23 at 2:34 p.m., with the Director of Nursing (DON), the facility's policy and procedure (P&P) titled, Policy Abuse Investigation, date 3/2012 was reviewed. The P&P indicated, In the event of SUSPECTED OR WITNESSED abuse, we are required to report it to the proper agencies within the time frames listed: a. If the events causing reasonable suspicion results in serious bodily injury, the report must be made IMMEDIATELY after forming the suspicion (but not later than two (2) hours after forming the suspicion). b. If the events that cause reasonable suspicion do not result in serious bodily injury to a resident, the covered individual shall report the suspicion not later than 24 hours after forming the suspicion. The DON stated the P&P was wrong. The DON stated the P&P should indicate that all allegations of abuse should be reported within 2 hours. The DON stated the P&P should be updated to reflect the correct reporting timeframe. The DON stated if the abuse allegation was not reported timely, then there could be a potential for further resident altercations and risk for bodily injury. During a concurrent interview and record review on 7/13/23 at 2:37 p.m., with the Director of Staff Development (DSD), the facility's training binder with all courses and trainings completed in 2023, was reviewed. The DSD stated that on 2/6/23, she trained the staff on the time frame for reporting resident abuse. The DSD stated the course content included reporting abuse no later than two hours if the resident had serious bodily injury, otherwise a report can be made within 24 hours. The DSD stated that on 5/23/23, she trained the staff on resident abuse. The DSD stated she trained the staff the reporting timeframe was two hours if the resident has serious bodily injury, otherwise a report can be made within 24 hours. The course material for the training provided to staff on 5/23/23, indicated staff did not need to report abuse within two hours if there is no serious bodily injury. 555395 Page 27 of 28 555395 07/14/2023 El Encanto Healthcare Center 555 South El Encanto Road City of Industry, CA 91745

F 0943 Level of Harm - Minimal harm or potential for actual harm During an interview on 7/13/23, at 3:15 p.m., with Activity Assistant (AA), AA stated, she did not know the timeframe of reporting an allegation of resident abuse. During an interview on 7/13/23, at 3:24 p.m., with Licensed Vocational Nurse (LVN) 3, LVN 3 stated, any incident of resident abuse must be reported within 24 hours to the Department and Ombudsman. Residents Affected - Few During an interview on 7/13/23, at 3:33 p.m., with Certified Nursing Assistant (CNA) 5, CNA 5 stated, any incident of resident abuse must be reported within 24 hours to the supervisor and abuse coordinator. 555395 Page 28 of 28