Health inspection·December 9, 2021

F 0688 issues identified. Level of Harm - Minimal harm or potential for actual harm Per the care plan, titled Rheumatoid arthritis, dated 11/4/19, list interventions, .Identify and record impact on function . There was no documented evidence a care plan was developed for ROM deficits. Residents Affected - Few On 12/8/21 at 8:12 A.M., Resident 34 was observed sitting on the side of bed, eating breakfast with her right hand. Resident 34's left hand was clutched in a fist. On 12/8/21 at 8:25 A.M., an interview was conducted with LN 1. LN 1 stated weekly nursing assessments required complete head to toe resident assessments. LN 1 stated the assessments were important to identify issues such as skin, behaviors, and new injuries. LN 1 stated if issues were identified, the issues needed to be communicated and documented. LN 1 stated if ROM deficits were identified, the physician, responsible party and director of rehab should also be informed, so a plan of care could be developed. LN 1 stated limited ROM could affect a resident's independence and movement, making them more dependent on staff. On 12/8/21 at 8:44 A.M., an interview was conducted with CNA 1. CNA 1 stated contractures (shortening of the muscles), meant the resident was unable to fully move or extend the muscle group. CNA 1 stated if she noticed a resident with a deficit in their ROM, she would inform the LNs, so they could assess the resident and then contact the physician. CNA 1 stated limited ROM should be corrected as soon as possible, or else the condition could worsen or become permanent, making the resident more dependent on staff. On 12/8/21 09:02 A.M., an interview was conducted with RNA 1. RNA 1 stated if a decrease in a resident's ROM was identified, it needed to be reported to the LNs and addressed immediately. RNA 1 stated physical therapy would get a physician's order to assess the resident, so a corrective plan could be developed. RNA 1 stated if the condition went unidentified the resident's flexibility could worsen, resulting in the resident's inability to perform his or her own activities of daily living. On 12/8/21 at 9:16 A.M., an interview was conducted with the DOR. The DOR stated if a resident had limited ROM, a physician's order would be obtained for the RNA or physical therapy department to conduct an assessment. The DOR stated stretching exercises could be initiated and the condition should be monitored and tracked. The DOR stated he expected CNAs and LNs to inform the physical therapy department if any issue were identified. On 12/8/21 at 9:27 A.M., the DOR examined Resident 34 as she sat on the side of her bed. The DOR stated Resident 34 was unable to fully extend her ring finger on the left hand, and she should be fully assessed. The DOR stated the limited ROM should have been captured by staff. On 12/8/21 at 9:50 A.M., an interview was conducted with the DON. The DON stated she expected staff to capture and identified any changes in resident conditions. The DON stated a decrease in ROM could affect a resident's independence. Per the facility's policy, titled ROM and Contracture Prevention, dated January 2021, .1. All residents will have a comprehensive .assessment performed to identify contracture problems . 2.recommendations, goals and interventions will be established . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555596 If continuation sheet Page 2 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkside Health and Wellness Center 444 W Lexington El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0801 Level of Harm - Minimal harm or potential for actual harm 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 safe and effective Dietetic Services oversight when: Residents Affected - Few 1. A menu alternative was produced without weighing the ingredients, 2. The same food alternative was allowed daily for one resident, and 3. Documentation of ongoing collaboration between the RD and the FNSD was not maintained. This failure to ensure effective oversight of the day-to-day dietetic services operations had the potential to place 50 residents at nutritional risk, and further compromise the residents' medical status. (Cross reference F803) Findings: 1. On 12/8/21 at 11:31 A.M., an observation of the lunch food production was conducted. The main entrée was a three-ounce portion of tilapia. Dietary Aide 1 (DA 1) was preparing a grilled cheese sandwich. Per DA 1, the grilled cheese sandwich was for Resident 23. DA 1 stated the facility offered an alternate menu of three or four items in the event a resident did not want the main entrée. DA 1 stated she used two slices, or two ounces of cheese, to make the sandwich. On 12/8/21 at 11:36 A.M., an observation of DA 1 was conducted. DA 1 placed two slices of cheese on a food scale and read the weight as under one ounce. DA 1 took two different slices of cheese from the box, placed them on the scale, and read the weight as one ounce. Per DA 1, We will have to use more cheese to make the grilled cheese sandwiches. On 12/8/21 at 11:40 A.M., an interview was conducted with the Food & Nutrition Services Director (FNSD). Per the FNSD, the alternates list was offered to residents in case they did not want the main entrée. The FNSD stated she was aware of the importance of weighing the cheese since it was providing the protein for the lunch meal. Per the FNSD, the grilled cheese sandwich was supposed to have two ounces of cheese. The FNSD stated she was responsible for ensuring the recipe was followed. The FNSD stated the alternates list was approved by the facility's RD. On 12/8/21 at 2 P.M., a review of the facility's grilled cheese sandwich recipe was conducted. The portion size was listed as, 1 sandwich = 2 oz protein. The recipe listed eight servings, or eight sandwiches, would require 16 slices of cheese (or two slices per sandwich). An additional document, titled Meal Service Alternatives Fall 2021 listed Grilled Cheese Sandwich as an alternate entrée, with the instruction to notify Dietary or Nursing if choosing an alternative item in place of the regular menu item served. 2. On 12/8/21 at 11:31 A.M., an observation of the lunch food production was conducted. The main entrée was a three-ounce portion of tilapia. Dietary Aide 1 (DA 1) was preparing a grilled cheese sandwich. Per DA 1, the grilled cheese sandwich was for Resident 23. DA 1 stated Resident 23 requested the grilled cheese sandwich daily as her lunch entrée. DA 1 stated the facility offered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555596 If continuation sheet Page 3 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkside Health and Wellness Center 444 W Lexington El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0801 an alternate menu of three or four items in the event a resident did not want the main entrée. Level of Harm - Minimal harm or potential for actual harm On 12/8/21 at 11:40 A.M., an interview was conducted with the FNSD. Per the FNSD, the alternates list was offered to residents in case they do not want the main entrée. The FNSD stated the alternates list was approved by the facility's RD. Residents Affected - Few On 12/8/21 at 2 P.M., a review of a facility document, titled Meal Service Alternatives Fall 2021, was conducted. The document listed Grilled Cheese Sandwich as an alternate entrée, with the instruction to notify Dietary or Nursing if choosing an alternative item in place of the regular menu item served. 3. On 12/8/21 at 11:40 A.M., an interview was conducted with the FNSD. Per the FNSD, she and the RD met weekly to discuss any resident nutritional concerns, kitchen sanitation, and staff training. The FNSD stated there was no documentation from their meetings of what was discussed. On 12/9/21 at 9:51 A.M., an interview was conducted with the RD. The RD stated it was her responsibility to review the menus for nutritional adequacy, including the alternates menu. The RD stated the alternates menu was necessary to provide a variety of food choices for the residents. Per the RD, the grilled cheese should have contained two ounces of cheese to provide an adequate amount of protein. The RD stated, I did not look at the nutrition information for the alternate items and I should have. The RD stated she was not aware Resident 23 was requesting the grilled cheese sandwich daily, and there had been no limit on the frequency of requested menu alternates. Per the RD, That is something I should know about. It would not be in the best interest of the resident to eat the same food daily. The RD stated she and the FNSD met weekly, but they did not document the meetings. The RD stated, We should document our discussions. Per a facility Job Description, dated 2018 and titled FNS Director, .Duties and Responsibilities: .3. Is responsible for the preparation and service of all food and ensures that approved menus and accompanying recipes are followed .8. Make menu adjustments as needed according to .resident request, with final approval of the Dietitian . Per a facility policy, dated 2018 and titled Personnel Management, .Responsibilities of the Consultant Dietitian .The Dietitian will .assure the professional food & nutrition service needs of the facility are met. This will include, but is not limited to .meal service accuracy and enforcement/education of State, County and Federal regulations . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555596 If continuation sheet Page 4 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkside Health and Wellness Center 444 W Lexington El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview and record review, the facility failed to ensure the nutritional adequacy of an alternate menu item offered to residents. Residents Affected - Few This failure had the potential to result in further compromised medical and nutritional status of residents. Findings: On 12/8/21 at 11:31 A.M., an observation of the lunch food production was observed. The main entrée was a three-ounce portion of tilapia. Dietary Aide 1 (DA 1) was preparing a grilled cheese sandwich. Per DA 1, the grilled cheese sandwich was for Resident 23, who requested the sandwich every day for lunch. DA 1 stated the facility offered an alternate menu of three or four items in the event a resident did not want the main entrée. DA 1 stated she used two slices, or two ounces of cheese, to make the sandwich. On 12/8/21 at 11:36 A.M., a concurrent interview and observation of DA 1 was conducted. DA 1 stated a portion size of the cheese was two slices to make one sandwich. DA 1 placed two slices of cheese on a food scale and read the weight under one ounce. DA 1 took two different slices of cheese from the box, placed them on the scale, and read the weight as one ounce. Per DA 1, We will have to use more cheese to make the grilled cheese sandwiches, it's supposed to be two ounces. On 12/8/21 at 11:40 A.M., an interview was conducted with the Food & Nutrition Services Director (FNSD). Per the FNSD, the alternates list was offered to residents in case they did not want the main entrée. The FNSD stated Resident 23 wanted the grilled cheese sandwich daily at lunch, and the facility had no limit to the number of times the alternate could be chosen each week. The FNSD stated it was her responsibility to ensure the recipes were followed. The FNSD stated the alternates list was approved by the facility's RD. On 12/8/21 at 2 P.M., a review of the facility's grilled cheese sandwich recipe was conducted. The portion size was listed as, 1 sandwich = 2 oz protein. The recipe listed eight servings, or eight sandwiches, would require 16 slices of cheese (or two slices per sandwich). On 12/9/21 at 9:51 A.M., an interview was conducted with the RD. The RD stated it was her responsibility to review the menus for nutritional adequacy, including the alternates menu. The RD stated the alternates menu was necessary to provide a variety of food choices for the residents. Per the RD, each ounce of cheese was equal to one ounce of protein, and the grilled cheese should have contained two ounces of cheese. The RD stated, I did not look at the nutrition information for the alternate items, and I should have. The RD stated there had been no limit on the frequency of menu alternates provided, but there should have been, in order to ensure nutritional adequacy of the resident's intake. Per the facility diet manual, dated 2018 and titled RDs for Healthcare, Inc. Diet Manual, Section 3, .4. The menus are planned to meet nutritional needs of residents in accordance with established national guidelines . Per the facility diet manual, dated 2018 and titled RDs for Healthcare, Inc. Diet Manual, Section (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555596 If continuation sheet Page 5 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555596 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkside Health and Wellness Center 444 W Lexington El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 3, Menu Planning to Meet Recommended Daily Dietary Allowances, .Meat Group: .Two ounces of cheese .may be used occasionally in place of 2 ounces of meat . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555596 If continuation sheet Page 6 of 6