Health inspection·April 25, 2025

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the head of bed for two (2) of three (3) sampled residents (Resident 2 and Resident 11) was maintained at 30 to 45 degrees (unit of measurement) while receiving gastrostomy tube (g-tube, a small tube inserted through a surgical opening in the abdomen directly into the stomach used to deliver nutrition, fluids, and medications to individuals who cannot eat or drink safely through their mouth) feeding, in accordance with the physician's order and facility's policy and procedure. This deficient practice had the potential to cause complications including aspiration (a medical sense, occurs when food, liquid, or foreign objects enter the airway and lungs) that can lead to hospitalization and death. Findings: 1. During a review of Resident 2's admission Record, the admission Record indicated Resident 51 was originally admitted to the facility on [DATE] and readmitted on [DATE]. Resident 2's diagnoses included anoxic brain damage (occurs when the brain is completely deprived of oxygen), respiratory failure (a serious condition where the body cannot get enough oxygen into the blood), and tracheostomy tube (a surgical procedure where a hole is created in the front of the neck) placement. During a review of Resident 2's Minimum Data Set (MDS, a resident assessment tool), dated 3/16/2025, the MDS indicated Resident 2's cognitive (ability to think and reason) skills for daily decision making was severely impaired (never/rarely made decisions). The MDS indicated Resident 2 was dependent (helper does all the effort. Resident does none of the effort to complete the activity) with oral hygiene, toileting hygiene, shower/bath, upper and lower body dressing, putting on/off footwear and personal hygiene. The MDS indicated Resident 2's nutritional approach included was a feeding tube while a resident in the facility. During a review of Resident 2's Order Summary Report as of 3/25/2025, the Order Summary Report indicated the following: Head of bead at least 30 degrees, ordered on 4/24/2024. Compleat pediatric (tube-feeding formula for children), 190 milliliters (ml, a metric unit used to measure capacity) per hour on pump, ordered on 2/11/2025. During a review of Resident 2's Care Plan, the Care Plan indicated alteration in nutrition related Page 1 of 17 555589 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to inability to take oral feedings and fluids, revised on 5/3/2025. The staff intervention included was to elevate head of bed during GT feeds at least 30 degrees or more. During an observation on 4/23/2025 at 8:36 AM, in Resident 2's room, Resident 2's head of bed was observed to be almost flat in bed. Tube feeding of Compleat pediatric was observed infusing at the rate of 190 ml/hr. During a concurrent observation and interview on 4/23/2025 at 8:40 AM, with Registered Nurse 5 (RN 5), in Resident 2's room, RN 5 checked and read the settings of Resident 2's head of bed. RN 5 stated that Resident 2's head of bed was positioned at 15 degrees. RN 5 stated the resident's head of bed should not be positioned that low because Resident 2 has excessive secretions and might aspirate (accidental breathing in of food or fluid into the lungs). During an interview on 4/24/2025 at 11:33 AM, with RN 2, RN 2 stated Resident 2 was known for having excessive secretions. RN 2 stated it was important for Resident 2's head of bed to be positioned in upright position, at least 30 degrees to prevent aspiration. During an interview on 4/25/2025 at 9 AM, with Respiratory Therapist 2 (RT 2), RT 2 stated residents on mechanical ventilator (a medical device that provides breathing support) and tube feeding should not be left in flat position, and the head of bed should be raised above 30 degrees. RT 2 added that when a resident's head is not positioned above 30 degrees, risk for aspiration is high, and this might cause discomfort like coughing, choking and changes in breathing to the resident. 2. During a review of Resident 11's admission Record, the admission Record indicated the resident was originally admitted to the facility on [DATE] and was re admitted on [DATE] with congenital ( a condition or trait that exists at birth) hypoplasia and dysplasia of lung (condition where the baby's lungs have not fully developed) , chronic respiratory disease (diseases that affect the lungs and airways), encounter for attention to gastrostomy. During a review of Resident 11's MDS dated [DATE], MDS indicated the resident was severely impaired with cognitive skills for daily decision making. Resident 11 was dependent with transfers (how resident moves to and from bed, chair and wheelchair), eating, dressing, and personal hygiene. The MDS also indicated Resident 11 's nutritional approach included was a feeding tube while a resident. During a record review of Resident 11's Order Summary Report, the Order Summary Report, dated 4/1/2025, indicated orders dated 3/19/2025, for the following: a. Enteral feed (a feeding tube such as a g-tube) Pediasure Peptide (a type of feeding formula) at 210 milliliter per hour (ml/hr., measurements of volume) every four (4) hours 3 times a day. b. Keep head of bed at 30 to 45 degrees during feeding. During a record review of Resident 11's Resident Care Plan, dated 3/12/2025, the Resident Care Plan indicated a concern and problem for alteration in nutrition related to inability to take in oral feedings and fluids. The staff intervention included was to elevate the head of bed during g-tube 555589 Page 2 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0693 feeds at least 30 degrees or more. Level of Harm - Minimal harm or potential for actual harm During concurrent observation in Resident 11's room and interview with Registered Nurse 1 (RN 1) on 4/24/2025 at 7:48 AM Resident 11 was observed lying flat on bed while the resident's g-tube feeding was infusing. RN1stated the head of the bed should be elevated up to 30-35 degrees to prevent aspiration and for safety. Residents Affected - Some During a concurrent interview and record review on 4/25/2025 at 11:45 AM with Licensed Vocational Nurse 2 (LVN 2), the facility policy and procedure (P&P) titled, Gastrostomy Tube Feeding, revised 6/2024. LVN 2 stated the P&P indicated nourishment will be provided to all residents with gastrostomy tubes as ordered. The P&P also indicated 4. Explain procedure to resident and elevate the head of the bed. 555589 Page 3 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. During a review of Resident 11's admission Record, the admission Record indicated the resident was originally admitted to the facility on [DATE] and was re admitted on [DATE] with congenital ( a condition or trait that exists at birth) hypoplasia and dysplasia of lung (condition where the baby's lungs have not fully developed) , chronic respiratory disease (diseases that affect the lungs and airways), encounter for attention to gastrostomy (G-tube, a surgical opening fitted with a device to allow feedings to be administered directly to the stomach common for people with swallowing problems). Residents Affected - Few During a review of Resident 11's MDS, dated [DATE], the MDS indicated the resident was severely impaired with cognitive skills for daily decision making. Resident 11 was dependent on transfers (how resident moves to and from bed, chair and wheelchair), eating, dressing, and personal hygiene. The MDS also indicated Resident 11's respiratory treatments included oxygen therapy, suctioning, and tracheostomy care while in the facility. During a record review of Resident 11's Order Summary Report, dated 4/1/2025, the Order Summary Report indicated an order dated 3/22/2025 for Respiratory LTV (long term vent) mechanical ventilation: SIMV. During a record review of Resident 11's Resident Care Plan, dated 3/12/2025, the Resident Care Plan indicated Resident 11 with ineffective breathing and airway related to tracheostomy dependent and ventilator dependent. During a concurrent observation in Resident 11's room and interview with RN 1 on 4/24/2025 at 7:48 AM, Resident 1 was observed lying flat in bed while connected to an LTV vent mechanical ventilation and G-tube feeding while RN 1 suctioned (removal of mucus and secretions that cannot be cleared with coughing to open the airway and help so the resident can breathe better) the resident. RN1 stated Resident 11's head of bed should be elevated up to 30 to 35 degrees to prevent aspiration and for safety. During a concurrent interview and record review on 4/25/2025 at 11:45 AM with Licensed Vocational Nurse 2 (LVN 2), the facility policy and procedure (P&P) titled, Prevention of ventilator-associated pneumonia ([NAME]), dated 2003 was reviewed. LVN 2 stated the P&P indicated to maintain patient's head of bed at 30 to 45 degrees. LVN 2 also stated the facility did not follow their P&P. During a review of the facility P&P titled, Prevention of ventilator-associated pneumonia ([NAME]), dated 2003, the P&P indicated to maintain patient's head of bed at 30 to 45 degrees. Based on observation, interview, and record review, the facility failed to ensure the head of bed for two (2) of six (6) sampled residents (Resident 2 and Resident 11) who were on continuous mechanical ventilator (a medical device that provides breathing support) was maintained at 30 to 45 degrees (unit of measurement) in accordance with the physician's order and facility's policy and procedure. This deficient practice had the potential to cause complications including aspiration (a medical sense, occurs when food, liquid, or foreign objects enter the airway and lungs) and ventilator- associated pneumonia (serious lung infection that can occur in mechanically ventilated residents) that can lead to hospitalization and death. 555589 Page 4 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0695 Findings: Level of Harm - Minimal harm or potential for actual harm 1. During a review of Resident 2's admission Record, the admission Record indicated Resident 51 was originally admitted to the facility on [DATE] and readmitted on [DATE]. Resident 2's diagnoses included anoxic brain damage (occurs when the brain is completely deprived of oxygen), respiratory failure (a serious condition where the body cannot get enough oxygen into the blood), and tracheostomy tube (a surgical procedure where a hole is created in the front of the neck) placement. Residents Affected - Few During a review of Resident 2's Minimum Data Set (MDS, a resident assessment tool), dated 3/16/2025, the MDS indicated Resident 2's cognitive (ability to think and reason) skills for daily decision making was severely impaired (never/rarely made decisions). The MDS indicated Resident 2 was dependent (helper does all the effort. Resident does none of the effort to complete the activity) with oral hygiene, toileting hygiene, shower/bath, upper and lower body dressing, putting on/off footwear and personal hygiene. The MDS indicated Resident 2 was on continuous oxygen therapy, required suctioning, tracheostomy care, and mechanical ventilator while in the facility. During a review of Resident 2's Order Summary Report as of 3/25/2025, the Order Summary Report indicated the following: Synchronized Intermittent Mandatory Ventilation (SIMV, mode of mechanical ventilation where the ventilator delivers a set number of breaths at a set rate and volume, but the patient can also take spontaneous breaths in between the mandatory breaths) settings, ordered on 4/24/2024. Head of bead at least 30 degrees, ordered on 4/24/2024. During an observation on 4/23/2025 at 8:35 AM, in Resident 2's room, Resident 2's head of bed was observed to be almost flat in bed. During a concurrent observation and interview on 4/23/2025 at 8:39 AM, with Registered Nurse 5 (RN 5), in Resident 2's room, RN 5 checked and read the settings of Resident 2's head of bed. RN 5 stated that Resident 2's head of bed was positioned at 15 degrees. RN 5 stated the resident's head of bed should not be positioned that low because Resident 2 has excessive secretions and might aspirate (accidental breathing in of food or fluid into the lungs). During an interview on 4/24/2025 at 11:33 AM, with RN 2, RN 2 stated Resident 2 was known for having excessive secretions. RN 2 stated it was important for Resident 2's head of bed to be positioned in upright position, at least 30 degrees to prevent aspiration. During an interview on 4/24/2025 at 2:21 PM, with Respiratory Therapist 1 (RT 1), RT 1 stated residents on mechanical ventilator should not be left in flat position, and the head of bed should be raised above 30 degrees. 555589 Page 5 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services to meet the needs of one of four sampled residents (Resident 17) in accordance with the facility policy by failing to administer Resident 17's 8 AM due medications on 4/25/2025 as indicated on the physician's order. This deficient practice had the potential for Resident 17 to experience tachycardia (a fast heartbeat of more than 100 times per minute), high blood pressure (when your blood pressure is consistently higher than normal), pain and decline in overall health status. Findings: During a review of Resident 17's admission Record, the admission Record indicated Resident 2 was originally admitted to the facility on [DATE]. Resident 2's diagnoses included chronic respiratory failure with hypoxia (a condition where the body cannot get enough oxygen). During a review of Resident 17's Minimum Data Set (MDS, a resident assessment tool), dated 4/13/2025, the MDS indicated Resident 17's cognitive (ability to think and reason) skills for daily decision making was severely impaired (never/rarely made decisions). The MDS indicated Resident 17 was dependent (helper does all the effort) with eating, oral hygiene, toileting hygiene, shower/bath, upper and lower body dressing, putting on/taking off footwear and personal hygiene. During a review of Resident 17's Physician's orders, the Physician's Orders indicated the following: o Catapres (a medication used to treat high blood pressure) patch, 0.3 milligram (mg, a unit of measurement of mass) every 24 hours, topically, weekly on Friday at 8 AM hypertension (HTN-high blood pressure). Ordered on 6/4/2024. o Ergocalciferol 15 mcg (unit of measurement) via gastrostomy tube (G-tube, is a small, flexible tube that's surgically inserted into the stomach through the abdomen to provide nutrition, fluids, and medicine), for supplement, ordered 1/11/2023. o Potassium (mineral that is important for many body functions) liquid 20 milliequivalent (unit of measurement)/15 milliliters (ml, metric unit used to measure capacity) give 15 ml via G-tube twice a day for hypokalemia (low potassium levels), ordered on 4/3/2023. o Baclofen (medication used to treat muscle spasms and stiffness) tablet, 20 mg, four times a day, via G-tube, for spasticity (condition characterized by stiff muscles), ordered on 1/11/2023. 555589 Page 6 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0755 o Level of Harm - Minimal harm or potential for actual harm Multivitamin 1 tablet, via G-tube, daily for supplement, ordered on 1/11/2023. o Residents Affected - Few Ocean spray (medication to treat dryness inside the nose) nasal (nose) spray, 1 spray to each nostril, twice a day for allergies, ordered on 1/11/2023. o Omeprazole (a medication that reduces the amount of acid produced in the stomach) 20 mg, twice a day, via G-tube, for gastroesophageal reflux disease (GERD the backward flow of liquid from the stomach into the esophagus), ordered on 12/11/2023. During a medication administration observation on 4/25/2025 at 10:21 AM with the Registered Nurse 6 (RN 6), RN 6 was observed preparing the following medications for Resident 17: Catapres patch. Ergocalciferol 15 mcg. Potassium liquid 20 milliequivalent, 15 ml. Baclofen 1 tablet. Multivitamin 1 tablet. Ocean spray. Omeprazole 20 mg suspension. During an observation on 4/25/2025 at 10:38 AM, in Resident 17's room, RN 6 administered all of Resident 17's seven (7) medications. RN 7 was at bedside when RN 6 administered Resident 17's medications, During an interview on 4/25/2025 at 10:41 AM with RN 7, RN 7 stated their medication administration time in the morning is scheduled at 8 AM, and medications can be administered one hour before or after 8 AM. RN 7 stated if the medications were administered late or early, the charge nurse should be informed, MD should be notified, and medication nurse should document a justification. RN 7 stated administering medications late, and close to the next scheduled dose might cause reaction and might harm the resident. During a concurrent record review of Resident 17's medication administration records (MAR - a daily documentation record used by a licensed nurse to document medications and treatments given to a resident) and interview with RN1 on 4/25/2025 at 11:49 AM, RN 1 verified that the following medications were due to be given at 8 AM: o 555589 Page 7 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0755 Catapres patch. Level of Harm - Minimal harm or potential for actual harm o Ergocalciferol 15 mcg. Residents Affected - Few o Potassium liquid 20 milliequivalent, 15 ml. o Baclofen 1 tablet. o Multivitamin 1 tablet. o Ocean spray. o Omeprazole 20 mg suspension. RN 1 stated RN 6 failed to administer Resident 17's 8 AM scheduled medications on time because RN 6 administered it late, after 9 AM. RN 1 stated failing to administer medication to a resident per the physician's order can lead to medical complications possibly resulting in hospitalization. RN 1 stated all 7 routine medications that were due to be given at 8 AM were given at 10:38 AM. RN 1 confirmed there were no justifications documented for the late administration of Resident 17's 7 medications. RN 1 stated missed blood pressure medications might lead to uncontrolled high blood pressure. RN 1 stated RN 6 informed her that Resident 17's 8 AM medications were administered late because she was assisting a Certified Nurse Assistant (CNA, unidentified) with cleaning another resident. RN 1 stated, it was important to give the medications on time and as ordered by the physician to ensure efficacy of the medications and to avoid possible adverse reactions or side effects that resident can experience. During a review of the facility's Policy and Procedure (P&P) titled, Medication Pass, revised 5/2021, the P&P indicated its objective is to provide guideline for the safe and effective administration of medication as ordered by the prescriber. The P&P indicated that all routine orders will be given within 60 minutes before or after the scheduled time. Nursing judgment may allow some variance, and explanation for variance should be documented. 555589 Page 8 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Cross reference: F755 Residents Affected - Few Based on observation, interview, and record review, the facility failed to ensure its medication error rate was less than five (5) percent (%). Seven (7) medication errors (the observed or identified preparation or administration of medications or biologicals which is not in accordance with the prescriber's order/ manufacturer's specifications / accepted professional standards and principles) out of 30 opportunities (observed administered medications) for error, which yielded a facility medication error rate of 23.33 % for one (1) of four (4) sampled residents (Resident 17) observed during medication administration (med pass). Resident 17's scheduled 8 AM medications were not administered timely as indicated on the physician's order and facility policy. This deficient practice had the potential to result in adverse reactions (an undesired harmful effect resulting from a medication or other intervention) to Resident 17. Findings: During a review of Resident 17's admission Record, the admission Record indicated Resident 2 was originally admitted to the facility on [DATE]. Resident 2's diagnoses included chronic respiratory failure with hypoxia (a condition where the body cannot get enough oxygen). During a review of Resident 17's Minimum Data Set (MDS, a resident assessment tool), dated 4/13/2025, the MDS indicated Resident 17's cognitive (ability to think and reason) skills for daily decision making was severely impaired (never/rarely made decisions). The MDS indicated Resident 17 was dependent (helper does all the effort) with eating, oral hygiene, toileting hygiene, shower/bath, upper and lower body dressing, putting on/taking off footwear and personal hygiene. During a review of Resident 17's Physician's orders, the Physician's Orders indicated the following: o Catapres (a medication used to treat high blood pressure) patch, 0.3 milligram (mg, a unit of measurement of mass) every 24 hours, topically, weekly on Friday at 8 AM hypertension (HTN-high blood pressure). Ordered on 6/4/2024. o Ergocalciferol 15 mcg (unit of measurement) via gastrostomy tube (G-tube, is a small, flexible tube that's surgically inserted into the stomach through the abdomen to provide nutrition, fluids, and medicine), for supplement, ordered 1/11/2023. o Potassium (mineral that is important for many body functions) liquid 20 milliequivalent (unit of measurement)/15 milliliters (ml, metric unit used to measure capacity) give 15 ml via G-tube twice a day for hypokalemia (low potassium levels), ordered on 4/3/2023. 555589 Page 9 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0759 o Level of Harm - Minimal harm or potential for actual harm Baclofen (medication used to treat muscle spasms and stiffness) tablet, 20 mg, four times a day, via G-tube, for spasticity (condition characterized by stiff muscles), ordered on 1/11/2023. Residents Affected - Few o Multivitamin 1 tablet, via G-tube, daily for supplement, ordered on 1/11/2023. o Ocean spray (medication to treat dryness inside the nose) nasal (nose) spray, 1 spray to each nostril, twice a day for allergies, ordered on 1/11/2023. o Omeprazole (a medication that reduces the amount of acid produced in the stomach) 20 mg, twice a day, via G-tube, for gastroesophageal reflux disease (GERD the backward flow of liquid from the stomach into the esophagus), ordered on 12/11/2023. During a medication administration observation on 4/25/2025 at 10:21 AM with the Registered Nurse 6 (RN 6), RN 6 was observed preparing the following medications for Resident 17: Catapres patch. Ergocalciferol 15 mcg. Potassium liquid 20 milliequivalent, 15 ml. Baclofen 1 tablet. Multivitamin 1 tablet. Ocean spray. Omeprazole 20 mg suspension. During an observation on 4/25/2025 at 10:38 AM, in Resident 17's room, RN 6 administered all of Resident 17's seven (7) medications. RN 7 was at bedside when RN 6 administered Resident 17's medications, During an interview on 4/25/2025 at 10:41 AM with RN 7, RN 7 stated their medication administration time in the morning is scheduled at 8 AM, and medications can be administered one hour before or after 8 AM. RN 7 stated if the medications were administered late or early, the charge nurse should be informed, MD should be notified, and medication nurse should document a justification. RN 7 stated administering medications late, and close to the next scheduled dose might cause reaction and might harm the resident. During a concurrent record review of Resident 17's medication administration records (MAR - a daily 555589 Page 10 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0759 Level of Harm - Minimal harm or potential for actual harm documentation record used by a licensed nurse to document medications and treatments given to a resident) and interview with RN1 on 4/25/2025 at 11:49 AM, RN 1 verified that the following medications were due to be given at 8 AM: o Residents Affected - Few Catapres patch. o Ergocalciferol 15 mcg. o Potassium liquid 20 milliequivalent, 15 ml. o Baclofen 1 tablet. o Multivitamin 1 tablet. o Ocean spray. o Omeprazole 20 mg suspension. RN 1 stated RN 6 failed to administer Resident 17's 8 AM scheduled medications on time because RN 6 administered it late, after 9 AM. RN 1 stated failing to administer medication to a resident per the physician's order can lead to medical complications possibly resulting in hospitalization. RN 1 stated all 7 routine medications that were due to be given at 8 AM were given at 10:38 AM. RN 1 confirmed there were no justifications documented for the late administration of Resident 17's 7 medications. RN 1 stated missed blood pressure medications might lead to uncontrolled high blood pressure. RN 1 stated RN 6 informed her that Resident 17's 8 AM medications were administered late because she was assisting a Certified Nurse Assistant (CNA, unidentified) with cleaning another resident. RN 1 stated, it was important to give the medications on time and as ordered by the physician to ensure efficacy of the medications and to avoid possible adverse reactions or side effects that resident can experience. During a review of the facility's Policy and Procedure (P&P) titled, Medication Pass, revised 5/2021, the P&P indicated its objective is to provide guideline for the safe and effective administration of medication as ordered by the prescriber. The P&P indicated that all routine orders will be given within 60 minutes before or after the scheduled time. Nursing judgment may allow some variance, and explanation for variance should be documented. 555589 Page 11 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 the food service area was maintained in a clean, sanitary, and functional manner while providing proper food handling in accordance with the facility's policy and procedure by failing to ensure: 1. One refrigerator (Refrigerator #10) was clean, without water drippings, and was not rusted (a form of corrosion visible on steel surfaces exposed to moist). 2. One can opener was not chipped and rusted. 3. The food processor was in good condition and without a brown, black to yellowish discoloration and calcium build ups (hard crusty deposit on surfaces and/ equipment). These deficient practices had the potential to result in pathogen (germ) exposure to residents, which could place the 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: 1. During an observation on 4/22/2025 at 7:48 AM in the facility kitchen, Refrigerator #10 was observed dirty with water dripping from condensation (water which collects as droplets on cold surface when humid air is in contact with it). The refrigerator had brownish to yellowish substances on its metal top portion. During a concurrent observation and interview on 4/24/2025 at 9:18 AM with the Food and Nutrition Service Director (FNSD) in the facility kitchen, the FNSD stated the Refrigerator 10 was dirty with water dripping from condensation. FNSD stated the refrigerator had brownish to yellowish substances on its metal top portion. FNSD stated this was not acceptable since it could contaminate the food inside Refrigerator 10. During an interview on 4/24/2025 at 9:46 AM with the dietary staff (DS1), DS 1 stated water dripping and rust in Refrigerator 10 was not acceptable because it can get to residents' food and cause tetanus (uncommon but serious infection caused by bacteria found in the environment), stomachache, and diarrhea. 2. During an observation on 4/22/2025 at 7:51 AM in the facility kitchen, the can opener was observed rusted and chipped. During concurrent observation and interview on 4/24/2025 at 9:19 AM with the FNSD in the facility kitchen, the FNSD stated the can opener was rusted and chipped and was not acceptable because it can cause food contamination (refers to the presence of unwanted materials or substances in food that may harm public health). During an interview on 4/24/2025 at 9:42 AM with the dietary staff (DS1), DS 1 stated a rusty and chipped can opener was not acceptable because it can get to the food and cause sickness like stomachache and possible diarrhea to the residents. 555589 Page 12 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 3. During an observation on 4/23/2025 at 6:42 AM in the facility kitchen, the food processor was observed to have a brown, black to yellowish discoloration and calcium build ups. During a concurrent observation and interview on 4/24/2025 at 9:20 AM with the FNSD in the facility kitchen, the FNSD stated the food processor to prepare pureed (smooth, thick liquid or paste made by crushing or grinding solid foods like fruits and vegetables, which is often made using a blender or food processor) food for residents was dirty, cracked, and with calcium build up. FNSD stated the food processor needs to be replaced to prevent food contamination. During an interview on 4/24/2025 at 9:47 AM with the dietary staff (DS1), DS 1 stated the food processor was used to puree food. DS1 stated the food processor was old and has molds from moisture. DS 1 also stated this was not acceptable because it can possibly cause sickness to residents like stomachache and diarrhea. During record review of facility's Policy and Procedure (P&P) titled, Cleaning Schedule use and Cleaning Equipment, revised 3/2021, the P&P indicated its purpose was to ensure proper cleaning procedures and adhered to in order to prevent any cross-contamination bacteria to food prepared. P&P also indicated, A. Equipment and work area are properly cleaned and sanitized . G. All food equipment used to grind, chop, mix or slice will be cleaned, sanitized and re-assembled after using . O. Refrigerators are wiped and food stored are checked daily for freshness. 555589 Page 13 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to observe infection control measures for one of four sampled residents (Resident 13) by failing to ensure that the Staff 1 washed hands after touching the floor while picking up the table napkin and continued to assist on feeding Resident 13. Residents Affected - Some This deficient practice had the potential to transmit infectious microorganisms (microbes that are temporarily harbored on the superficial surface of the body) and increase the risk of infection for the residents. Findings: During a review of Resident 13's admission Record, the admission Record indicated the resident was originally admitted to the facility on [DATE] and was re admitted on [DATE] dysphagia (difficulty swallowing), seizure (sudden burst of electrical activity in the brain), chronic respiratory failure (not enough oxygen travels from the lungs into the blood). During a review of Resident 13's Minimum Data Set (MDS- a resident assessment tool), dated 2/9/2025, the MDS indicated the resident was severely with cognitive skills for daily decision making (never/rarely make decisions). Resident 13 was dependent (with transfers (how resident moves to and from bed, chair and wheelchair), eating, dressing, and personal hygiene. During a record review of Resident 13's Order Summary Report, dated 3/5/2025, the Order Summary Report indicated order date 11/11/2025, diet, regular, puree and minced vegetable for all meals. During an observation on 4/22/2025 at 1:28 PM at the activity room, Certified Nursing Assistant (CNA1) and the Staff 1 were feeding Resident 13. Observed Resident 13 threw the table napkin on the floor and Staff 1 while wearing the same gloves used during feeding Resident 13 touched the floor while picking up the napkin, threw the napkin on the trashcan and continued to assist CNA1 on feeding Resident 13 without washing hands and/ or changing gloves. Staff 1 touched Resident 13's hands, the resident's ice cream and apple juice before giving it to the resident. During an interview on 4/24/2025 at 2:27 PM with Staff 1, Staff 1 stated she did not wash her hands and changed gloves after touching the floor when Staff 1 picked up the table napkin. Staff 1 stated she continued to assist CNA 1 on feeding Resident 13 and Staff 1 touched Resident 13's hands, ice cream and apple juice. Staff 1 also stated she should have washed her hands to prevent spreading germs that can possibly cause sickness to the resident. During an interview on 4/25/2025 at 2:23 PM with the Infection Preventionist Nurse (IPN), IPN stated hand washing before and after feeding resident was important. IPN also stated staff should wash their hands after touching the floor to prevent cross contamination (physical movement or transfer of harmful bacteria from one person, object or place to another) and spread of infection. During a review of facility's policies and procedure (P&P) titled Hand Hygiene revised date 5/2022 indicated effective hand hygiene removes transient microorganisms, dirt and organic material from the hands and decreases the risk for cross contamination from patients, patient care equipment and the environment. The P&P also indicated, cleaning hands promptly and thoroughly between patient contact and after contact with blood, body fluids, secretions, excretions, equipment and potentially 555589 Page 14 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0880 contaminated surfaces is an important strategy for preventing healthcare associated infection. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 555589 Page 15 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain a safe, clean, comfortable, sanitary and environment by: 1. Facility failed to ensure three (3) of six (6) restroom sinks (rooms [ROOM NUMBER]) have no yellowish, brownish, and chipped sideboard. 2. Facility failed to ensure the table in activity classroom was in good condition and did not have edges that were peeling off, exposing the wood part of the table and chipped off leaving sharp and rough edges 3. Facility failed to ensure the trash can in room [ROOM NUMBER] was not overflowing. These deficient practices caused an unsanitary and had potential for residents to be placed at risk of injury and/ or infection. Findings: 1. During an observation on 4/22/2025 at 10:02 AM in room [ROOM NUMBER]'s restroom, the back splash in the restroom was damaged. Observed that the linoleum was lifted exposing the wound underneath and the sink has yellowish, brownish colored substance and the sideboard was chipped. During an observation on 4/22/2025 at 10:23 AM in room [ROOM NUMBER]'s restroom, the back splash in the restroom was damaged. Observed the formica (hard durable plastic laminate used for countertops, cupboard doors, and other surfaces) was lifted, wood was exposed, and the sink had yellowish and brownish colored substances. During an observation on 04/22/2025 at 12:23 PM in room [ROOM NUMBER]'s restroom, the back splash in the restroom was damaged. Observed the formica was lifted, and wood was exposed and the sink with yellowish, brownish, and blackish colored substances. During a concurrent observation and interview on 4/24/2025 at 1:01 PM to 1:05 PM in room [ROOM NUMBER], 2 and 3's restroom with the certified nursing assistant (CNA 2), room [ROOM NUMBER]'s back splash in the restroom was damaged. Observed that the linoleum was lifted exposing the wound underneath and the sink has yellowish, brownish colored substance and the sideboard was chipped. Observed in room [ROOM NUMBER] the back splash in the restroom was damaged. Observed the formica was lifted, and wood was exposed and the sink with yellowish, brownish, and blackish colored substances. Observed in room [ROOM NUMBER], the back splash in the restroom was damaged. Observed the formica was lifted, wood was exposed, and the sink had yellowish and brownish colored substances. 555589 Page 16 of 17 555589 04/25/2025 Whittier Hospital Medical Ctr D/P Snf 9080 Colima Road Whittier, CA 90605

F 0921 Level of Harm - Minimal harm or potential for actual harm CNA 1 stated room [ROOM NUMBER], 2 and 3's restroom sinks back splash were damaged. CNA 1 stated, the formica was lifted, and wood was exposed, and it was not acceptable. CNA 1 stated, this can grow molds, and the tiny white particles on the wood, can go anywhere, to residents' eyes, nose, and it was not safe for residents. CNA 1 also verified, the side of the sinks in room [ROOM NUMBER], 2 and 3 's bathroom sink has yellowish, brownish and/ or blackish discoloration and was peeling. Residents Affected - Some 2. During an observation in the activity room on 4/22/2025 at 1:30 PM, the table edges were peeling off, exposing the wood part of the table and chipped off leaving sharp and rough edges. During a concurrent observation in the activity room and interview on 4/25/2025 at 9:37 AM with the Director of Support Services (DSS), the DSS stated the table has rough and sharp edges, it can cause cuts or injury to the residents, and it is not acceptable. 3. During an observation in room [ROOM NUMBER] on 4/23/2025 at 5:35 AM, room [ROOM NUMBER]'s trashcan was overflowing with used Personal Protective Equipment (PPE- equipment worn to minimize exposure to bacteria or viruses that cause serious illness), and gloves. During a concurrent observation and interview on 4/24/2025 at 1:07 PM with CNA 2, CNA2 stated room [ROOM NUMBER]'s trashcan was overflowing with used PPE, and it was not acceptable, and it was unsanitary. During an observation in room [ROOM NUMBER] on 4/25/2025 at 6:05 AM room [ROOM NUMBER]'s trashcan was not closed/ sealed properly with PPE yellow gown hanging outside the trash can. During a concurrent interview and record review on 4/25/2025 at 1:54PM with the infection preventionist nurse (IPN), the facility's Policy and Procedure (P&P) titled Subacute Pediatrics revised date 2/2006, the IPN stated the P&P indicated Policy: To the highest practicable extent the subacute pediatric unit shall provide a safe, clean, comfortable and nurturing homelike environment designed to promote normal child development. The IPN stated the facility did not follow their P&P. 555589 Page 17 of 17