Health inspection·January 14, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 1/14/2024 at 10:16 p.m. with Director of Nursing (DON), the DON stated hand hygiene and nail cleanliness was part of resident care and it can affect the resident's dignity. If Resident 8 was refusing to the care it should have been care planned or documented and it was not documented. During a record review of the facility's policy and procedure titled, Standard of Professional performancephysical Comfort, hygiene, and activities of daily living, reviewed 2/2020, the policy indicated: a. The nurse will ensure hygiene and activities of daily living or residents are met according to patient needs, patient abilities and timing of services. Documentation supporting that this standard will be done in the electronic medical record and or as an outcome to the plan of care. b. The primary nurse and will be responsible for providing hygiene assistance according to patient conditions and needs. c. The facility will provide patient an opportunity for grooming by self, with assistance, or by the nurse daily. During a review of the facility's policy and procedure titled, Resident Rights, revised 4/1997, the policy indicated the resident has the right to a dignified existence. The policy indicated care for residents in a manner and in an environment that maintains or enhances resident's dignity and respect. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 2 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Allow resident to participate in the development and implementation of his or her person-centered plan of care. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** During an interview and record review the facility failed to include resident and resident representative in Interdisciplinary ([IDT]- team members from different departments working together with a common purpose to set goals and make decisions that ensure residents receive the best care) care planning and informed of any changes in care, treatment, and interventions for one of four sampled residents (Resident 166). This failure had the potential to violate Resident 166 and resident representative right to be an active participant to Resident 166's care. Findings: During a review of Resident 166's Registration Record, the Registration Record indicated Resident 166 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis of altered mental status. During a review of Resident's 166's Discharge Summary (from [GACH] General Acute Care Hospital) dated 1/10/2024 indicated Resident 166 with diagnoses including glioblastoma (malignant tumor affecting the brain or spine) type 2 diabetes (a chronic disease characterized by elevated levels of blood glucose [or blood sugar] in a bloodstream), and confusion due to cerebral edema (swelling of the brain). During an interview on 1/13/2024 at 3:03 p.m. with Resident 166's family member (FM) 1, FM 1 stated family member always stayed with Resident 166 all the time (24/7 twenty-four hours a day seven days a week). FM 1 stated she was not informed when Resident 166 Decadron (medication used to decreased swelling of the brain) was tapered (lowering of doses) and discontinued. FM 1 stated other family member was not aware of what symptoms to watch. FM 1 stated on 12/28/2024, Resident 166 was transferred to the hospital due to altered mental status. FM 1 stated no family member were invited to IDT care planning meeting. FM 1 stated it was important for facility staff to inform them of any changes with medications or treatment as they were always at Resident 166 bedside, and they were the one who can see any changes right away. During an interview on 1/13/2024 at 3:50 p.m. with Registered Nurse (RN) 2, RN 2 stated IDT meeting was held every week for all residents in the facility. RN 2 stated Resident 166 and FM 1 were not included with the IDT meeting. RN 2 stated it was important to inform Resident 166 and/or family member with any changes within care, treatment, and changes in medications so they will be an active participant with their care. During an interview ion 1/14/2024 at 10:26 a.m. with the Director of Nursing (DON), the DON stated IDT meeting was held weekly. The DON stated Resident 166 and FM 1 was not invited on the IDT meeting. The DON stated it was important to include residents and resident representative in IDT meeting for them to be informed of any changes in care, treatment and interventions including medication change. The DON stated Resident 166 and or FM 1 should be an active participant with their care. During a review of facility's policies and procedure (P&P) titled Interdisciplinary Team Conference dated 1/1/1994, the P&P indicated The IDT conference committee meets at least weekly .discuss the residents' status, needs, progress in meeting goals, and the discharge plan. The resident and /or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 3 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0553 fami9y or responsible party may attend the conferences as needed. 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: 555599 If continuation sheet Page 4 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to develop a baseline care plan addressing assistance for feeding for one (1) of four (4) sampled residents (Resident 63). This deficient practice had the potential to negatively affect the delivery of necessary care and services for Resident 63 and negatively impact the resident's physical and psychosocial well-being. Findings: During a review of Resident 63's Registration Record, the Registration Record indicated Resident 63 was admitted to the facility on [DATE]. Resident 63's diagnoses included hypertension (high blood pressure), diabetes mellitus (chronic disease that impairs blood sugar regulation in the body), and anemia (a condition that develops when your blood produces a lower-than-normal amount of healthy red blood cells). During a review of Resident 63's History and Physical (H& P) dated 1/8/2024, the H&P indicated Resident 63 was alert and oriented and able to move extremities. During a record review of the Speech Therapist (ST) notes dated 01/11/2024, the ST notes indicated that Resident 63 continues to need assistance with feeding due to vision impairment. The note also indicated Certified Nurse Assistant (CNA) took over feeding. During a concurrent observation and interview on 1/12/2024 at 6:30 p.m. at Resident 63's room, while Restorative Nurse Assistant 1(RNA 1) was feeding Resident 63, RNA 1 stated Resident 63 was legally blind on both eyes and hard of hearing (HOH). RNA 1 stated if Resident 63 was not being assisted to eat Resident 63 will not eat because Resident 63 cannot see anything, even shadows. RNA 1 stated sometimes family members feed the resident. During a concurrent interview and record review on 1/13/2024 at 10:36 a.m. with the Director of Staff development (DSD), Resident 63's care plans, dated 1/7/2024, was reviewed. There were no care plans indicating Resident 63 needed assistance with feeding. The DSD stated Resident 63's need with feeding assistance was not addressed on the nutritional care plan and there was no separate care plan for feeding. During a record review of the facility's policy and procedure(P&P) titled, General Statement/ Mission of the Transitional Care Unit, reviewed 10/2020, the P&P indicated: A. The Transitional Care Unit (TCU) conducts concurrent quality management and improvement activities to promote the high quality of care given to patients. This program consists of ongoing monitoring by nursing staff to ensure that patient care plans are current and complete. B. The Multidisciplinary Team Conference meets to discuss each patient's plan of care in the Team Conference. The committee acts to: A. Assure that a plan of care has been established to meet each of the residents' needs and is coordinated between all services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 5 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few B. Provide a means for multidisciplinary team members review and reassessment of each patient's plan of care on a regular basis. C.Maintain a current and updated patient care plan. During a record review of the facility's policy and procedure(P&P) titled, Standard of Care- Transitional Nursing Care, reviewed 3/2022, the P&P indicated: A.Planning: A plan that includes the priorities and interventions used to achieve the outcomes is developed by the RN. a.Physical and psychosocial measures are planned to prevent, improve, and control specific problems of the aged. b.The plan is individualized and developed with the patient and significant others in healthcare providers when appropriate. B.Implementation: the nurse implements as prescribed in the plan of care a.Nursing interventions are individualized to meet specific situations that allow for alternative approaches. b.Interventions are documented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 6 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 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 interview and record review, the facility failed to develop a comprehensive care plan (a resident-specific plan with defined clinical goals and interventions used to manage identified medical issues or other areas of concern) and person-centered care plans for two out of four sampled residents Resident 163 and 166). 1. Ensure Resident 163 who had pain on her left ankle develop specific interventions to address pain medications and interventions to alleviate (lessen) her pain. 2. Ensure Resident 163 who have an indwelling foley catheter were care planned to assess continued need of indwelling catheter. 3. Ensure Resident 166 who was had a care plan initiated for receiving Decadron (medication used to decreased swelling of the brain) was tapered (lowering of doses) and Keppra (medication used to treat seizures [ burst of uncontrolled electrical activity between brain cells]) develop specific intervention including monitoring adverse reactions and precautions. These failures had the potential for the residents' care needs not to be addressed and the lack of ability to identify the resident's ongoing needs. Findings: During a review of Resident 163's Registration Record, the Registration Record indicated Resident 163 was admitted to the facility on [DATE] with diagnoses of left ankle sprain (an injury that occurs when the ankle rolls, twists, or turns in an awkward way). During a review of Resident 163's History and Physical (H&P), the H&P indicated diagnoses including fall at home, left ankle injury and diabetes (a condition in which the body fails to metabolize (process) glucose (sugar) correctly). The H&P indicated Resident 163 had a large hematoma (bruise) on the lateral portion of left ankle and was very painful to wiggle Resident 163 left ankle, During a review of Resident 163's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 12/30/23, the MDS indicated Resident 163 had moderate cognitive (ability to learn, remember, understand, and make decision) impairment in daily decision making. The MDS indicated Resident 163 was dependent with oral hygiene, toileting, lower, upper, and lower body dressing. The MDS indicated Resident 163 was occasionally in pain with a numeric rating scale of 10 (pain scale 0 zero being no pain and 10 as the worst pain you can imagine). During a review of Resident 166's Registration Record, the Registration Record indicated Resident 166 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis of altered mental status. During a review of Resident's 166's Discharge Summary from General Acute Care Hospital [GACH] ) dated 1/10/2024 indicated Resident 166 with diagnoses including glioblastoma (malignant tumor affecting the brain or spine) type 2 diabetes (a chronic disease characterized by elevated levels of blood glucose [or blood sugar] in a bloodstream), and confusion due to cerebral edema (swelling of the brain). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 7 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and record review on 1/13/2024 at 3:50 p.m. with Registered Nurse (RN) 2, RN 2 stated Resident 163's Tramadol was discontinued on 12/27/2023 due to Resident 163 developed ileus (inability of the intestine (bowel) to contract normally and move waste out of the body). RN 2 stated licensed staff did not reassess if Resident 163 can be given a different pain medication after Resident 163 Tramadol was discontinued on 12/27/2023. RN 2 stated there was no individualized care plan for Resident 163's pain on her left ankle. RN 2 stated licensed staff should informed Resident 163's physician of Resident 163's left ankle pain and ordered Tylenol does not help to alleviate (help) Resident 163 left ankle pain with Tylenol. 2.During a review of Interdisciplinary Summary (Nurse Note) dated 1/2/23 timed at 6 am, the Nurse Note indicated foley catheter (indwelling urinary catheter) inserted per physician order. During a concurrent observation and interview on 1/13/24 at 12:30 pm with Resident 163, observed Resident 163 with indwelling urinary catheter. Resident 163 stated her foley catheter was uncomfortable and she wants to have it removed. Resident 163 stated she does not know the reason of having the indwelling urinary catheter. During a concurrent interview and record review on 12/13/24 1:44 pm with RN 3, RN 3 stated a bladder scan was done on 1/2/24 and indwelling urinary catheter was inserted secondary to urinary retention (a condition in which you cannot empty all the urine from your bladder). RN 3 stated there was no order on 1/2/24, the order was entered on 1/12/24. RN stated the need for continued indwelling urinary catheter should have been assessed by licensed nurses. RN stated there was no documentation if indwelling urinary catheter can be removed or reason of continued used. RN stated indwelling urinary catheter had the potential for Resident 163 to develop CAUTI. 3.During a concurrent interview and record review on 1/13/2024 at 3:50 p.m. with RN 2, reviewed care plan for Resident 163 and 166. RN 2 stated Resident 163 care plan for pain management and indwelling catheter were not individualized to addressed Resident 163 pain management and indwelling catheter. RN 2 stated there were no care plan for Resident 166 to address Resident 166 receiving Decadron and Keppra. RN 2 stated it was important to have an individualized and comprehensive care plan for each residents including current medication to ensure licensed nurses will have guidelines on what adverse reaction and side effects to look for. During an interview ion 1/14/2024 at 10:26 a.m. with the Director of Nursing (DON), the DON stated care plan should be individualized based on the needs, diagnoses, and medications of the residents. The DON stated Resident 163 should have an individualized care plan to reflect effectiveness of her pain medication and the continued need of her foley catheter. The DON stated Resident 166 should have a care plan for tapering (reduction of doses) of his Decadron to ensure licensed nurses can monitor the effect of the medication. The DON stated Resident 166 should have a care plan for Keppra medication to ensure licensed nurses know what to monitor while residents was receiving the medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 8 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** During an observation., interview and record review Physical Therapy (PT-health specialist that treat residents to improve movement ) 1 failed to apply gait belt (assistive device which can be used to help safely transfer a resident from a bed to a wheelchair, assist with sitting and standing, and help with walking around) to one of four sampled residents ( Resident 177). This failure had the potential for increased risk of fall for Resident 177. Findings: During a review of Resident 177's Registration Record, the Registration Record indicated Resident 177 was admitted to the facility on [DATE] with diagnosis of right hip arthroplasty (a surgical procedure in which surgeon removed the diseased parts of the hip joint and replaced them with new). During an observation on 1/13/24 at 9:24 a.m. in the hallway, observed Resident 177 walking in the hallway with a front wheeled walker (assistive device for walking) . PT 1 was on Resident 177 right side holding Resident clothing while walking. Observed a family member (name unknown) following with a wheelchair while Resident 177 was walking. During an interview on 1/13/24 at 11:05 a.m. with PT 1, PT 1 stated Resident 177 needs contract guard (healthcare provide place one or two hands on the patient's body to help with balance) assist when he walks. PT 1 stated she should have applied a gait belt to Resident to help with his balance and for safety. PT 1 stated if Resident 177 would fall, gait belt would help control a fall. PT 1 stated gait belt was used for safety and balance. During a review of Resident 177's Physical Therapy evaluation dated 1/1/2024, the Physical Therapy evaluation indicated Resident 177 gait (persons manner of walking) analysis was antalgic (abnormal pattern of walking secondary to pain that ultimately causes a limp) and decreased cadence (number of steps taken). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 9 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a resident with an indwelling urinary catheter (a flexible tube used to empty the bladder and collect urine in a drainage bag) was assessed for continued need and removed according to facility's policy and procedure (P&P) for one of four sampled residents (Resident 163). This failure resulted in continued discomfort to Resident 163 and had the potential for Resident 163 to have catheter associated urinary tract infection (CAUTI- a urinary tract infection [ UTI- an infection in any part of the urinary system, the kidneys, bladder, or urethra] associated with urinary catheter use). Findings: During a review of Resident 163's Registration Record, the Registration Record indicated Resident 163 was admitted to the facility on [DATE] with diagnoses of left ankle sprain (an injury that occurs when the ankle rolls, twists, or turns in an awkward way). During a review of Resident 163's History and Physical (H&P), the H&P indicated diagnoses including fall at home, left ankle injury and diabetes (a condition in which the body fails to metabolize (process) glucose (sugar) correctly). The H&P indicated Resident 163 had a large hematoma (bruise) on the lateral portion of left ankle and was very painful to wiggle Resident 163 left ankle. During a review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 12/30/23, the MDS indicated Resident 163 had moderate cognitive (ability to learn, remember, understand, and make decision) impairment in daily decision making. The MDS indicated Resident 163 was dependent with oral hygiene, toileting, lower, upper, and lower body dressing. The MDS indicated Resident 163 was always incontinent in urination. During a review of Interdisciplinary Summary (Nurse Note) dated 1/2/23 timed at 6 am, the Nurse note indicated foley catheter (indwelling urinary catheter) inserted per physician order. During a concurrent observation and interview on 1/13/24 at 12:30 pm with Resident 163, observed Resident 163 with indwelling urinary catheter. Resident 163 stated her indwelling urinary catheter was uncomfortable and she wants to have it removed. Resident 163 stated she does not know the reason of having the indwelling urinary catheter. During a concurrent interview and record review on 1/13/24 1:44 pm with Registered Nurse (RN) 3, RN 3 stated a bladder scan (assess the volume of urine retained within the bladder) was done on 1/2/24 and indwelling urinary catheter was inserted secondary to urinary retention (a condition in which you cannot empty all the urine from your bladder). RN 3stated there was no order on 1/2/24, the order was entered on 1/12/24. RN 3 stated the need for continued indwelling urinary catheter should have been assessed by licensed nurses. RN 3 stated there was no documentation if indwelling urinary catheter can be removed or reason of continued used. RN 3 stated indwelling urinary catheter had the potential for Resident 163 to develop CAUTI. During a concurrent interview and record review on 1/13/2024 at 3:50 p.m. with RN 2. RN 2 stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 10 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 163 had an order for indwelling urinary catheter dated on 1/12/24. RN 2 stated per Nurse Note dated 1/2/24 timed at 6 am, the Nurse Note indicated foley catheter (indwelling urinary catheter) was inserted per physician order due to bladder scan reading of 670 milliliters (ml-unit of measurement). RN 2 stated Resident 163 indwelling catheter should have been assessed for continued need by doing the bladder protocol (steps taken by the facility to assess need and/or continued use of indwelling urinary catheter) per facility's policy and procedure. RN 2 stated indwelling urinary catheter had the potential to cause CAUTI. During an interview on 1/14/24 at 10:26 a.m. with the Director of Nursing (DON), the DON stated if residents was admitted to the facility with indwelling urinary catheter, RN should assess the reason of the need of the indwelling urinary catheter. The DON stated RN will initiate a bladder protocol and will need to reassess in 24 hours the need for continued indwelling catheter. The DON stated indwelling urinary catheter was a source for infection and should be removed if it was no indication. During a review of facility's P&P titled Indwelling urinary Catheter (foley): Insertion, Maintenance, Removal; Bladder Protocol and Bladder Scan dated 3/1/2017 (revised 3/1/2020), the P&P indicated Indications of the use of indwelling urinary catheter shall be limited to patients with failed attempts of external collection .The use of indwelling urinary catheter shall be limited to patients with failed attempts of external collection device .Failure of bladder protocol .and Acute obstructive retention . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 11 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 provide necessary care and services on one of four sample residents (Resident 63) to prevent complications during feeding by: a. Failing to obtain a physician's order for feeding assistance for Resident 63. b. Failing to create a comprehensive resident centered care plan indicating interventions to be implemented while feeding Resident 63 to prevent complications like aspiration (accidentally inhaling food or liquid through vocal cords into the airway) and choking (when person can't speak, cough, or breath because something is blocking the airway). This failure had the potential to result in Resident 63 aspirating and choking while eating. Findings: During a review of Resident 63's Registration Record, the Registration Record indicated Resident 63 admitted to the facility on [DATE]. Resident 63's diagnoses including hypertension (the force of the blood flowing through blood vessels is consistently too high), diabetes mellitus (chronic disease that impairs blood sugar regulation in the body), anemia (a condition that develops when your blood produces a lower-than-normal amount of healthy red blood cells). During a review of Resident 63's History and Physical (H& P) dated 1/8/2024, it indicated that resident 63 is alert and oriented and able to move extremities. During a record review of the Speech Therapist (ST) notes dated 01/11/2024, ST notes indicated Resident 63 continues to need assistance with feeding due to vision impairment. The note also indicated Certified Nurse Assistant (CNA) took over feeding. During a concurrent observation and interview on 1/12/2024 at 6:30 p.m. at Resident 63's room, while Restorative Nurse Assistant 1(RNA 1) was feeding Resident 63, RNA 1 stated Resident 63 was legally blind on both eyes and hard of hearing (HOH). RNA 1 stated if Resident 63 was not being assisted to eat Resident 63 will not eat because Resident 63 cannot see anything, even shadows. RNA 1 stated sometimes family members fed the resident. During a concurrent interview and record review on 1/13/2024 at 10:25 a.m. with the Director of Staff Development (DSD), Resident 63's current physician's order, dated 1/13/2024, was reviewed. The orders did not indicate Resident 63 needed feeding assistance. The DSD stated that there was no Medical Doctor (MD) to nurse order to feed Resident 63. The DSD further added that anything nurses will do to the resident should have a doctor's order (DO). During the continued concurrent interview and record review on 1/13/2024 at 10:36 a.m. with the DSD, Resident 63's care plans, dated 1/7/2024, was reviewed. There were no care plans indicating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 12 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 63 needed assistance with feeding. The DSD stated Resident 63's need with feeding assistance was not addressed on the nutritional care plan and there was no separate care plan for feeding. During an interview on 1/14/2024 at 10:25 a.m. with the Director of Nursing (DON), the DON stated nurses or staff should obtain a physician's order for feeding if needed or necessary for care to complete Activities of Daily Living (ADL). The DON stated it was important that anything necessary to gain the strength of the resident was communicated from rehabilitation to MD to Registered Nurse (RN). During a record review of the facility's policy and procedure(P&P) titled Standard of Professional Performance-Physical comfort, hygiene, and Activities of Daily Living reviewed 2/20, the P&P indicated the nurse provides physical comfort, hygiene, and activities of daily living. During a record review of the facility's policy and procedure(P&P) titled, General Statement/ Mission of the Transitional Care Unit, reviewed 10/2020, the P&P indicated A. The Transitional Care Unit (TCU) conducts concurrent quality management and improvement activities to promote the high quality of care given to patients. This program consists of ongoing monitoring by nursing staff to ensure that: a. Physician orders are current and new orders have been noted and appropriately implemented. b. patient care plans are current and complete. B. The Multidisciplinary Team Conference meets to discuss each patient's plan of care in the Team Conference. The committee acts to: A. Assure that a plan of care has been established to meet each of the residents' needs and is coordinated between all services. B. Provide a means for multidisciplinary team members review and reassessment of each patient's plan of care on a regular basis. C. Maintain a current and updated patient care plan. During a record review of the facility's policy and procedure(P&P) titled, Standard of Care- Transitional Nursing Care, reviewed 3/2022, the P&P indicated: A. Planning: A plan that includes the priorities and interventions used to achieve the outcomes is developed by the RN. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 13 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0693 Level of Harm - Minimal harm or potential for actual harm 1. Physical and psychosocial measures are planned to prevent, improve, and control specific problems of the aged. 2. The plan is individualized and developed with the patient and significant others in healthcare providers when appropriate. Residents Affected - Few B. Implementation: the nurse implements as prescribed in the plan of care 1. Nursing interventions are individualized to meet specific situations that allow for alternative approaches. 2. Interventions are documented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 14 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0697 Provide safe, appropriate pain management for a resident who requires such services. 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 provide pain management for two of two sampled residents (Resident 119 and 163) consistent with the facility's policy and procedure when: Residents Affected - Few a. The facility failed to ensure Resident 119's pain was assessed before and after pain medication was administered. b. The facility failed to communicate with Resident 163'S physician regarding pain management of her left ankle pain. c. The facility failed to develop an individualized comprehensive care plan to address Resident 163 pain management. These deficient practices had the potential to result in a poor pain management that can affect physical and psychological wellness. Findings: a. During a review of Resident 119's Registration Record, the record indicated the resident was admitted to the facility on [DATE]. During a review of Resident 119's History and Physical (H&P), dated 1/10/2024, the H&P indicated Resident 119 had a history of gastroesophageal reflux disease (when stomach acid repeatedly flows back into the tube connecting mouth and stomach). The H&P indicated Resident 119 recently received a kidney transplant (surgery to place a healthy kidney from a donor) on 12/1/2023 and had a diagnosis including dysphagia (difficulty swallowing). The H&P indicated Resident 173 was awake alert and oriented. During a review of Resident 119's Order sheet, the order sheet indicated on 1/11/2024 at 9:39 p.m. hexylresorcinol topical lozenges (medicine to ease sore throat), one lozenge orally, every three hours, as needed for sore throat was ordered. During a review of Resident 119's care plan titled, Long term Care Pain Interdisciplinary Plan of Care, initiated 1/1/2024, the care plan indicated one of the interventions was to evaluate effectiveness of pharmacological interventions. During a review of Resident 119's Medication Administration record (MAR) Summary, the MAR indicated hexylresorcinol topical (sore throat lozenge), one lozenge(s) orally, every three hours, as needed for sore throat was ordered. The medication was administered on: a. 1/11/2024 at 10:10 p.m. b. 1/12/2024 3:15 a.m. and 6:38 a.m. c. 1/13/2024 at 614 a.m. During a review of Resident 119's Interactive View Print Request-Last 48 hours of the Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 15 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0697 119's Pain Assessments, dated 1/11/2024 at 11:50 p.m. to 1/13/2024 at 2:48 p.m., the record indicated Resident 119's pain was assessed on: Level of Harm - Minimal harm or potential for actual harm a. 1/11/2024 at 11:50 p.m., one and a half hours after the sore throat medication was administered. Residents Affected - Few b. 1/12/2024 at 10:30 a.m., four hours after the sore throat medication was administered. c. 1/12/2024 at 11:55 p.m., seventeen hours after the sore throat medication was administered. d. 1/13/2024 at 11:50 a.m. five hours after the sore throat medication was administered. During a concurrent observation and interview on 1/12/2024 at 7:00 p.m. with Resident 119 in the resident's room, Resident 119 pointed to her throat and made a facial grimace. Resident 119 stated she only had one complaint and it was throat pain. Resident 119 stated she received lozenges, but it doesn't help. During a concurrent interview and record review on 1/13/2024 at 1:38 p.m. with Registered Nurse 2 (RN 2), Resident 119's MAR and pain assessments records were reviewed. Resident 119's records indicated Resident 119 received lozenges 4 times since it was ordered on 1/11/2024. The record indicated no assessment of pain level and characteristic prior to and after the administration of the sore throat lozenges were noted. RN 2 stated the Resident 119 received lozenges four times since admission. RN 2 stated Resident 119's pain was not assessed prior to the medication administration and after the administration and it should have been assessed to ascertain the effectiveness of the treatment rendered. During an interview on 1/14/2024 at 10:16 p.m. with Director of Nursing (DON), the DON stated pain assessment should be completed before and after medication administration. The DON stated pain assessment include indicating the pain level, location, characteristics, and response to treatment. The DON stated pain assessment after treatment was to ensure medication efficacy in the pain management regimen. b. During a review of Resident 163's Registration Record, the Registration Record indicated Resident 163 was admitted to the facility on [DATE] with diagnoses of left ankle sprain (an injury that occurs when the ankle rolls, twists, or turns in an awkward way). During a review of Resident 163's History and Physical (H&P), the H&P indicated diagnoses including fall at home, left ankle injury and diabetes (a condition in which the body fails to metabolize (process) glucose (sugar) correctly). The H&P indicated Resident 163 had a large hematoma (bruise) on the lateral portion of left ankle and was very painful to wiggle Resident 163 left ankle. During a review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 12/30/23, the MDS indicated Resident 163 had moderate cognitive (ability to learn, remember, understand, and make decision) impairment in daily decision making. The MDS indicated Resident 163 was dependent with oral hygiene, toileting, lower, upper, and lower body dressing. The MDS indicated Resident 163 was occasionally in pain with a numeric rating scale of 10 (pain scale 0 zero being no pain and 10 as the worst pain you can imagine). During a concurrent observation and interview on 1/12/2024 at 6:34 p.m. on Resident 163's room, Resident 163 stated she was constantly in pain and Tylenol (pain medications) does not help with her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 16 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few left ankle pain. Observed Resident 163 left ankle with bruising, swelling and tender to touch (pain when the area was touched, or pressure was applied). Resident 163 stated she was receiving Tramadol (pain medication) but was discontinued due to issues with her stomach. During a concurrent observation and interview on 1/13/2024 at 12:30 p.m. on Resident 163's room with Registered Nurse (RN) 4, RN 1 stated Resident 163's ankle was swollen, bruised and tender to touch. RN 1 stated Resident 163 received Tylenol for pain. RN 1 stated Resident 163's Tramadol was discontinued on 12/27/23 and no other pain medication was given to Resident 163 aside from Tylenol. During a concurrent interview and record review on 1/13/2024 at 3:50 p.m. with RN 2. RN 2 stated Resident Tramadol was discontinued on 12/27/2023 due to Resident 163 developed ileus (Inability of the intestine (bowel) to contract normally and move waste out of the body). RN 2 stated licensed staff did not reassess if Resident 163 can be given a different pain medication after Resident 163's Tramadol was discontinued on 12/27/2023. RN 2 stated there was no individualized care plan for Resident 163's pain on her left ankle. RN 2 stated licensed staff should informed Resident 163's physician of Resident 163's left ankle pain and Tylenol does not help to alleviate Resident 163 left ankle pain with Tylenol. During an interview on 1/14/24 at 10:26 a.m. with the Director of Nursing (DON), the DON stated it was important to assess if medication was effective for Resident 163. The DON stated if the reason for discontinuance of prior pain medication was resolved, licensed nurse should have contacted Resident 163's physician to assess if there was alternative pain medication that can be given to Resident 163. During a review of Resident 163's Interdisciplinary Summary (Nurse Note) dated 12/27/23 timed at 12 p.m., Nurse Notes indicated Resident 163's Tramadol was discontinued. During a review of Resident 163's Interdisciplinary Summary (Nurse Note) dated 12/29/23 timed at 1 p.m., Nurse note indicated Tylenol not helping Resident 163's left foot pain. During a review of Resident 163's Interdisciplinary Summary (Physical Therapy Note) dated 1/3/23 timed at 3:14 p.m., the Physical Therapy Note indicated Resident 163 was pre medicated (medication given prior to treatment) with Tylenol. The Physical Therapy Note indicated Resident 163 continued to have 10/10 (pain scale 0 zero being no pain and 10 as the worst pain you can imagine). During a review of Resident 163's Interdisciplinary Summary (Physical Therapy Note) dated 1/8/23 timed at 4:05 m., the Physical Therapy Note indicated, Resident 163 stated pain of 5/10 to left foot throughout the therapy session. During a review of Resident 163's Care Plan titled Pain dated 12/23/23, the Care Plan indicated interventions including evaluate effectiveness of pharmacological (medication) intervention, collaborate with care team for pain management and collaborate with physician . During a review of the facility's policy and procedure titled, Pain Assessment and Management - Standard of Care - Clinical Practice, effective 8/1/2019, the policy indicated: 1. Each patient had the right to expect a comprehensive pain assessment will be performed. 2. Each patient shall have the right to pain management through assessment and reassessment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 17 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 3. Each patient has the right to expect his/her report of pain to be accepted to have the pain assessed and reassess. 4. A routine pain assessment will include time, intensity of pain, quality of pain, and location. 5. Reassessment of pain will occur within a reasonable time frame based on the interventions typically expected onset. Event ID: Facility ID: 555599 If continuation sheet Page 18 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to obtain informed consent (process by which a healthcare provider educates a resident about the risks and benefits, and alternatives of a given procedure or intervention) prior to the administration of psychotropic drugs (drug that affects brain activities associated with mental process and behavior) for two out of three sampled residents (Resident 119 and 67) as indicated in the facility's policy and procedure (P&P). These deficient practices resulted in the violation of residents' right to be informed in advanced by the physician of the risk and benefits of the drug and treatment alternatives. Findings: a. During a review of Resident 119's Registration Record, the record indicated the resident was admitted to the facility on [DATE]. During a review of Resident 119's History and Physical (H&P), dated 1/10/2024, the H&P indicated Resident 119 had a history of anxiety (feeling of fear, dread, and uneasiness) and stress at home. The H&P indicated Resident 119 recently received a kidney transplant (surgery to place a healthy kidney from a donor) on 12/1/2023. The H&P indicated Resident 173 was awake alert and oriented. The H&P indicated Resident 119's list of medication from home included Zoloft (medication to treat mood disorders)100 milligrams (mg, unit of measure) oral tablet daily, and alprazolam (medication to treat anxiety) 0.5 mg orally two times a day as needed. During a review of Resident 119's Order sheet, the order sheet indicated the following medication orders: a. On 1/10/2024 at 6:12 p.m. Zoloft 100 mg one tablet oral daily b. On 1/10/2024 Alprazolam 0.5 mg one tablet oral three times a day as needed for anxiety for fourteen days. During a review of Resident 119's Medication Administration record (MAR) Summary, the MAR indicated the following: a. Zoloft 100 mg was first at ministered in the Transitional Care Unit (TCU) on 1/11/2024 at 8:44 a.m. b. Alprazolam 0.5 mg was first administered in the on 1/11/2024 at 8:51 p.m. During a review of Resident 119's Patient Consent to Receive Psychotropic Medications, Resident 119 signed the consent, indicating she acknowledged receiving information on the psychotropic drugs on 1/13/2024 at 1:00 p.m. approximately 2 days after the medications were administered in the TCU. During a concurrent interview and record review on 1/13/2024 at 1:38 p.m. with Registered Nurse 2 (RN 2), Resident 119's MAR and psychotropic consents were reviewed. The MAR indicated Resident 119 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 19 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0758 Level of Harm - Minimal harm or potential for actual harm received Zoloft and Alprazolam on 1/11/2024. The consent indicated Resident 119 consented to the psychotropic drugs on 1/13/2024, two days after the drugs were administered. RN 2 stated Resident 119 consented to the drugs two days after the psychotropics were administered. RN 2 stated the consent should have been obtained prior to the administration of the doses because these drugs are like restraints (a measure that keep someone under control or within limits) and as indicated in the policy. Residents Affected - Some b. During a review of Resident 67's Registration Record, the record indicated the resident was admitted to the facility on [DATE]. During a review of Resident 67's History and Physical (H&P), dated 12/30/2023, the H&P indicated Resident 67 had a history of dementia (the loss of cognitive functioning - thinking, remembering, and reasoning - to such an extent that it interferes with a person's daily life and activities). The H&P indicated Resident 67 became more confused disoriented and agitated at times during her hospitalization. During a review of Resident 67's Minimum Data Set (MDS-a comprehensive assessment and care planning tool), dated 1/05/2024, the MDS indicated Resident 67 sometimes understood and sometimes understand others, had impaired vision and had moderately impaired decision-making skills. The MDS indicated Resident 67 required maximal assistance (helper does more than half the effort) for rolling left to right, sit to lying and lying to sitting. During a record review of Resident 67's active orders, dated 1/14/2024, the orders indicated the following medications: a. Lorazepam (medication to relieve anxiety) 0.5mg (milligram-unit of measurement) one tab every 8 hours as needed for anxiety (a feeling of worry), b. Trazodone (medication to treat depression [mental disorder that negatively affects how the resident feels] and sedative [inducing sleep]) 75 mg, one and half tablet as needed at bedtime. During a record review of the Resident 67's psychotropic consent to receive psychotropic medications, dated 12/30/2023, the consent indicated Lorazepam 0.5 mg/0.25 millimeters intravenous ([IVP]medication administered directly to the bloodstream) push every 8 hours as needed for anxiety. During a concurrent interview and record review on 1/13/2024 at 1:38 p.m. with Registered Nurse 2 (RN 2), Resident 67's active order and psychotropic consents were reviewed. The records indicated Resident 67's consent of lorazepam to be administered IVP did not match the lorazepam physician order for oral tablet. RN 2 stated the lorazepam route of administration in the order did not match the route in the consent. RN 2 stated the consent and order should be the same. RN2 stated it was not consented medication should not be administered, and it could be considered as unnecessary medication. During an interview on 1/14/2024 at 10:16 p.m. with Director of Nursing (DON), the DON stated psychotropic medications should be consented prior to administration of the medication. During a review of the facility's policy and procedure titled, Informed Consent for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 20 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0758 Psychotherapeutic Medications and devices, reviewed 3/2022, the policy indicated: Level of Harm - Minimal harm or potential for actual harm 1. Upon admission to the Transitional Care Unit, nursing will review orders and ensure an informed consent for any prescribed psychotropic medications is present in the medical record. Residents Affected - Some 2. Prior to the administration of medication and within 24 hours of medication order, nursing and the physician will obtain patient signature acknowledging their informed consent. 3. Every 24 hours, the Lead Registered Nurse or designee will validate the presence of informed consent for all psychotropic medications, contact the physician if the consent form was missing to facilitate obtaining the consent or discontinuing the medication as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 21 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0760 Ensure that residents are free from significant medication errors. 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 one (1) of four (4) sampled residents (Resident 63) was free from significant medication errors when: Residents Affected - Few a. The facility failed to ensure Resident 63's medication was not left at the bed side table; and b. The facility failed to ensure six of Resident 63's medication on 1/12/2024 were administered on time. This deficient practice of leaving medication at the bedside had the potential for other staff, visitors, or residents to access prescription medication at any time. This deficient practice of not administering six medications on time had the potential to result in untoward effects to Resident 63. Findings: During a review of Resident 63's Registration Record, the Registration Record indicated Resident 63 was admitted to the facility on [DATE]. Resident 63's diagnoses included hypertension (high blood pressure), diabetes mellitus (chronic disease that impairs blood sugar regulation in the body), anemia (a condition that develops when your blood produces a lower-than-normal amount of healthy red blood cells). During a review of Resident 63's History and Physical (H& P) dated 1/8/2024, the H&P indicated Resident 63 was alert and oriented and able to move extremities. During initial tour on 1/12/2024 at 6:30 p.m., Resident 63's bedside table was observed to have a prescription medication with Resident 63's name on it. During an interview on 1/12/2024 at 6:31 p.m. with Restorative Nurse Assistant (RNA1), RNA 1 stated she doesn't know if the medication at the bedside was for Resident 63. During an interview on 1/12/2024 at 7:10 p.m. with Registered Nurse (RN)6, RN6 stated she was behind with the medication pass today and that she left the nystatin powder (treats fungal or yeast infections of the skin) at the bedside. During a subsequent interview and record review on 1/12/2024 at 7:12 p.m. with RN6, Resident 6's Medication administration record (MAR) was reviewed. The MAR indicated Nystatin powder administration times were at 9:00 a.m.,4:00p.m. and 9:00 p.m., RN 6 stated that she was doing the scheduled medication of 4:00 p.m. RN 6 stated the medication was administered late. During an interview on 1/13/2024 at 12:25 p.m. with Registered Nurse 4(RN), RN 4 stated medication pass administration of scheduled medication can be administered one hour before or one hour after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 22 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0760 the scheduled time. Level of Harm - Minimal harm or potential for actual harm During a concurrent interview and record review on 1/13/2024 at 12:28p.m. with RN 4, Resident 63's medication administration record (MAR) was reviewed. The MAR indicated on 1/12/2024, Resident 63 received five 9 a.m. scheduled medications at 11:22 a.m., almost two and a half hours after the scheduled time: Residents Affected - Few 1. Amlodipine (medication for high blood pressure) 5 milligrams (mg- unit of measure), 1 tablet daily at 9:00 a.m. 2. Hydrocortisone (medication to reduce swelling, pain, or itching)15 mg,1.5 tablet daily at 9:00 a.m. 3. Magnesium oxide (antacid medicine to relieve sour stomach or acid indigestion) 400 mg, 1 tablet twice daily at 9:00 a.m. and 9:00 p.m. 4. Polyethylene glycol (medication to soften stool and increase bowel movements) 17-gram powder daily at 9:00 a.m. 5. Lidocaine (medication for pain) topical one patch at 9:00 apply to affected area apply for 12 hours then remove. RN 4 stated five medications were not administered on time, and it should have an explanation on the MAR if the medication was not given on time. RN 4 stated the timing was important especially with the medication because the gap between the next scheduled medication could be too close and could affect Resident 63. During an interview on 1/14/2024 at 10:15 a.m. with the Director of Nursing (DON), the DON stated that nurses were expected not to leave medication at the bedside because of the risk of anyone could have an access with a prescribed medication. The DON stated the unsecured medication could be taken by a staff, visitor, or another resident. The DON explained that Licensed Nurses were expected to administer medications on time or one hour before or one hour after the scheduled medication. The DON further added that if the medication was administered late an explanation on the MAR should have been documented. During a record review of the facility's policy and procedure (P&P) titled, Medication Administration-Medication Management-Torrance Memorial Medical Center, dated 12/1/2021, the P&P indicated a standardized medication schedule will be followed. The P&P indicated medications that have not been defined as time critical will be administered within one hour of the scheduled time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 23 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0760 Level of Harm - Minimal harm or potential for actual harm During a record review of the P&P titled Medication Administration, reviewed 3/2022, the P&P indicated the doses shall be administered within one hour of the scheduled times unless otherwise indicated by the prescriber. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 24 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** During an observation, interview and record review the facility failed to store medication in a locked compartments and not left at residents' bedside for two of four sampled residents (Resident 170 and 171). This failure had the potential for medication errors, and lack of oversight for Resident 170 and 177. Findings: During a review of Resident 170's Registration Record, the Registratin Record indicated Resident 170 was admitted to the facility on [DATE] with diagnoses including weakness and fall secondary to orthostatic hypotension (a form of low blood pressure that happens when standing up from sitting or lying down). During a review of Resident 170's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 1/10/2024, the MDS indicated Resident 170 had intact cognition (ability to learn, remember, understand, and make decision). The MDS indicated Resident 170 required supervision with oral hygiene and personal hygiene, moderate assistance with toileting, bed mobility, transfers, dressing, toilet use, and dressing. During a review of Resident 170's Physician Order dated 1/3/2024, the Physician Order indicated order for Systane (eye lubricant) eye drops one drop each eye every two hours while awake. The Physician Orders indicated albuterol 90 microgram (mcg-unit of measurement) aerosol inhaled every six hours PRN (as needed) for wheezing (symptom cause by narrowing and spasm in the small airways of the lungs). During a review of Resident 171's Registration Record, the Registration Record indicated Resident 171 was admitted to the facility on [DATE] with diagnoses including right ankle open reductio internal fixation (ORIF-a type of surgery used to stabilize and heal a broken bone). During a review of Resident 171's History and Physical (H&P) dated 1/10/2024, H&P indicated Resident 171 with diagnosis of asthma (disease that affects the lungs) During a review of Resident 171's Physician Order dated 1/8/2024, the Physician Order indicated order for Systane eye drops one drop each eye PRN (as needed) for dry eyes. The Physician Orders indicated order for albuterol 2.5 milligram (mg-unit of measurement) equals (=) three milliliter (ml- unit of measurement) inhaled every six hours PRN for wheezing. During an observation on 1/12/2024 at 7:05 p.m. inside Resident 170's rom, observed Systane eye on top of the bedside table. Observed albuterol inhaler inside Resident 1701's bedside drawer. During an observation on 1/12/2024 at 7:58 p.m. inside Resident 171's rom, observed Systane eye drops and albuterol inhaler inside a small plastic bag on top of Resident 171's the bedside table. During an interview on 1/13/2024 at 11:45 a.m. inside Medication Room with Registered Nurse (RN) 2, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 25 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some RN 2 stated medication should not be left at Resident 170 and 171's bedside. RN 2 stated if Residents 170 and 171 will self-administer, it should have a physician order, assessment from interdisciplinary team ([IDT] team members from different departments working together with a common purpose to set goals and make decisions that ensure residents receive the best care) and care planed. RN stated there will lack of oversight if medications were left at the bedside which had the potential for Resident 170 and 171 to double dose on their medications. During an interview on 1/14/2024 at 10:26 a.m. with the Director of Nursing (DON), the DON stated medications should not be left on Resident 170 and 171's bedside. The DON stated prior to self-administration, Residents 170 and 171 should assess by IDT team, have a physician order, document the assessment, and develop a care plan to ensure patient safety. During a review of facility's policy and procedures (P&P) titled Medication Administration dated 1/12/2022, indicated Patient self-administration of medication; Provide education to the patient ., observed the patient completing a return demonstration of the medication preparation and administration .document the education, return demonstration and administration in the medical record. Store the medication in the medication cart or automated dispensing cabinet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 26 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview the facility failed to ensure one of one ice machines in the facility kitchen was clean. Residents Affected - Many This deficient practice had the potential to result in an outbreak of food borne illness (illness caused by food contaminated with germs). Findings: During an observation of one of one ice machine in the facility kitchen and interview on 1/12/2024 6:09 p.m., with the Food Service Lead (FSL), the ice machine bin was opened, the front panel interior bin was wiped with a clean paper towel, and dirt (dark gray colored) residue was noted. The KL stated the ice machine was dirty and it should be clean. During an interview on 1/13/2024 at 12:15 p.m. with the Patient Services Manager, Food & Nutrition Services (PSM), PSM stated the ice machine should be clean as indicated in the facility policy. During a review of the facility policy and procedure titled, Dispensing Ice, dated 10/6/2020, the policy indicated the food and nutrition services department prepares and dispense ice under strict procedures to prevent the transmission of disease. The policy indicated the ice holding bin in the kitchen will be clean. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 27 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview the facility failed to ensure the opened orange juice, apple juice, and vegetable salad were labeled with the residents' name, room number, and date it was opened in two out of two resident refrigerators in the Transitional Care Unit (TCU). Residents Affected - Few These deficient practices had the potential to result in contamination of residents' food items which can cause food-borne illnesses (food poisoning). Findings: During a concurrent observation and interview on 1/12/2024 at 8:26 p.m. with Registered Nurse 3 (RN 3), in the TCU, two resident refrigerators were observed. The resident refrigerator in the pantry area was noted with an opened orange juice and apple juice. The juices did not have a label with the residents' names, room numbers, and dates opened. RN 3 stated all juices should be labeled with date opened because all juices will be discarded within 72 hours of open date. The resident refrigerator in the dining/activity room was observed and an opened vegetable salad was noted with no label of the resident's name, room number, and date it was opened. RN 3 stated foods should also be dated and have the name of the resident for infection control purposes and so it will be given to the right resident. During a review of the facility's policy and procedure titled, Patient Food from Outside Sources- Food Services, effective 9/12/2023, the policy indicated: a. When food is brought into the hospital for patients nursing will follow defined food handling practices. b. The purpose of the policy was to prevent the potential transmission of disease carrying organisms from food prepared and held under unsafe conditions. c. Nursing will ensure that all outside food is covered and labeled with patient's name, room number, and a use by date three days from when the food was received. These foods may be held in the refrigerator for three days, after which they will be discarded. d. Immediately discard unidentified food items found in patient refrigerators. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 28 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on interview and record review, the facility failed to address/ implement facility assessment elements when: a. The facility failed to include the Infection Prevention Nurse (IPN) dedicating mandated hours in the Transitional Care unit (TCU) for 40 of 40 residents in the facility assessment. b. The facility failed to obtain an offsite contract for dialysis (a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly) center as indicated in the facility assessment. c. The facility failed to implement Certified Nurse Assistants' (CNA) 1 hour in service education to be provided twice per month, including dementia management, abuse/neglect, and patient rights and responsibilities as indicated in the facility assessment. These deficient practices had a potential to result in the provision of inadequate care and services to the facility's resident population. Findings: a. During an interview on 1/13/2024 at 12:59 p.m. with the IPN, the IPN stated she was responsible for the whole hospital, and she was the manager for the whole Infection Prevention Unit. The IPN stated she cannot provide the breakdown of hours of IPNs designated for TCU. The IPN said that she could not provide any proof that she was doing the IP role solely for the unit. During a concurrent interview and record review on 1/13/2024 at 2:26p.m. with the Director of Nursing (DON), the Facility Assessment, dated 2024, was reviewed. The facility assessment did not include the IPN, and the facility assessment did not indicate the full-time hours required for the IPN. The DON stated the facility assessment doesn't indicate about the full-time hours for IPN. The DON stated the IPN had an important role since there were outbreaks and the TCU needed someone who would implement infection Prevention Control Policy throughout the unit. b. During an entrance conference with the DON on 1/12/2024 at 6:24 p.m., the DON stated that the facility doesn't have any dialysis contract. During a concurrent interview and record review on 1/13/2024 at 9:15 a.m. with the DON the facility's assessment dated 01/2024-12/2024, was reviewed. The facility assessment indicated special care needs provided will be offsite dialysis. The DON stated that the facility assessment was reviewed last 12/2023 and indicated offsite dialysis will be provided. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 29 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0838 Level of Harm - Minimal harm or potential for actual harm c.During a review of TCU in-service records, records indicated 4 staff attended on 12/19/2023 for the lines, tubes, and drain in-service and six staff attended the in-service on 12/5/2023 for the trauma informed care. During a review of the TCU In-service calendar (January, February, March 2024), the calendar indicated 2 dementia and no abuse or patient rights training. Residents Affected - Many During an interview on 1/13/2023 at 1:25 p.m. with the Director of Staff Development (DSD) regarding the in-services provided to the staff, The DSD stated that she cannot mandate nurses to go to her in-services. The DSD stated there were only 4 staff who attended on 12/19/2023 for the lines tubes and drain in-service. The DSD added that on 12/5/2023 6 attended for the trauma informed care in-services. The DSD stated for the 3 months calendar TCU-In-Service (January, February, March 2024) she has scheduled 2 dementia and no abuse or patient rights training. The DSD stated education was important so staff would know any updates and to refresh their knowledge. The DSD stated although she was present during the review of the facility assessment back in December 2023, she was not aware of the facility assessment requirement to provide CNA's 1 hour of in-services twice a month for dementia management, abuse, neglect, or patient rights training. The DSD stated she would need to coordinate with the DON about the facility assessment and will provide the in-services if needed. During an interview on 1/14/2023 at 10:16 a.m. with the DON, the DON stated the facility assessment needed to be revised since the facility does not have a facility contract with any dialysis center. The DON further added that the in-services part in the assessment will also be revised if needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 30 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 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 follow infection control to prevent the spread of infection when: Residents Affected - Few 1. Plant Engineer exited Resident 163's room who was on contact isolation (precautions intended to prevent transmission of infectious agents) with isolation gown and gloves and failed to do hand hygiene (cover both hand washing using soap and water, and cleaning hands with waterless or alcohol-based hand sanitizers) after doffing (remove) personal protective equipment (PPE-equipment used to prevent or minimize exposure to hazards). This failure had the potential to result in cross contamination (physical movement or transfer of harmful bacteria from one person, object, or place to another) and place residents and staff at risk for infection. Findings: During a review of Resident 163's Registration Record, the Registration Record indicated Resident 163 was admitted to the facility on [DATE] with diagnoses of left ankle sprain (an injury that occurs when the ankle rolls, twists, or turns in an awkward way). During a review of Resident 163's Physician Orders dated 12/27/23 timed at 8:37 am and 1/8/24 timed at 10:10 am, the Physician Orders indicated enteric precaution (contact precautions -gloves and gown and handwashing with soap and water must be performed), Clostridium Difficile infection (C-diff- a germ that causes diarrhea and colitis (an inflammation of the colon) During an observation on 1/13/23 at 1:10 pm with Plant Engineer (PE) 1 outside Resident 163's room, observed PE exited room [ROOM NUMBER]'s room and was in the hallway wearing isolation gown and gloves. During a concurrent observation and interview on 1/13/23 at 1:02 pm with PE 1, observed PE 1 removed his isolation gown and gloves inside Resident 163's room. PE 1 did not wash his hands prior to exiting the room. PE 1 stated isolation gown and gloves should be removed prior to exiting Resident 163's room and performed hand washing to prevent spread of infection. During an interview on 1/14/24 at 10:26 a.m. with the Director of Nursing (DON), the DON stated PPE should be removed and hand washing prior to exiting Resident 163's room for infection control. During a review of facility's policies and procedures (P&P) titled Infection Control and Prevention Program Overview dated 1/20/23, the P&P indicated the facility Has adopted a program of infection control and prevention involving every hospital department and affecting every member of the hospital community. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 31 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to implement their protocol for Antibiotic (drug to treat infection) Stewardship (effort to measure and improve how antibiotics, medications that fight infections, are prescribed) program for one of three sampled residents (Resident 163). Resident 163 was prescribed Piperacillin-tazobactam (antibiotic) 3.375 gram (gm-unit of measurement) intravenous piggyback (IVPB-small bag of solution attached to a primary infusion line) every eight hours without any laboratory confirmation to screen for a Urinary Tract Infection (UTI, an infection in any part of the urinary system, the kidneys, bladder, or urethra) and without a stop date. Residents Affected - Few This deficient practice had the potential to result in the resident developing antibiotic resistance (not effective to treat infection) from unnecessary or inappropriate antibiotic use. Findings: During a review of Resident 163's Registration Record, the Registration Record indicated Resident 163 was admitted to the facility on [DATE] with diagnoses of left ankle sprain (an injury that occurs when the ankle rolls, twists, or turns in an awkward way). During a review of Resident 163's History and Physical (H&P), the H&P indicated diagnoses including fall at home, left ankle injury and diabetes (a condition in which the body fails to metabolize (process) glucose (sugar) correctly). The H&P indicated Resident 163 had a large hematoma (bruise) on the lateral portion of left ankle. During a review of Resident 163's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 12/30/23, the MDS indicated Resident 163 had moderate cognitive (ability to learn, remember, understand, and make decision) impairment in daily decision making. The MDS indicated Resident 163 was dependent with oral hygiene, toileting, lower, upper, and lower body dressing. During a review of Resident 163's Physician Order dated 1/2024, the Physician Order indicated an order for piperacillin-tazobactam (Zosyn-medication used to treat infection) 3.375 gram (gm-unit of measurement) intravenous piggyback (IVPB-small bag of solution attached to a primary infusion line) every eight hours. During a review of Resident 163's pharmacy form (untitled), the form indicated Resident 163 was prescribed piperacillin-tazobactam (Iso-Osm) Premix 3.375 gram/ 50 ml IVPB every eight hours and was started 1 / 4/2024 at 2:00 p.m. The pharmacy form indicated the stop date for the piperacillin-tazobactam was blank. The form indicated there was no urinalysis (U/A- analysis of urine by physical, chemical, and microscopical means to test for the presence of disease, drugs) completed. During an interview on 1/13/2024 at 1:25 p.m. with the Infection Preventionist Nurse (IPN), the IPN stated that she was not responsible for the antibiotic stewardship. During a concurrent interview and record review on 1/13/2024 at 1:28 p.m. with the pharmacist (PD), Resident 163's pharmacy form and medical records were reviewed. Resident 163's medical records indicated the resident was on antibiotics for a UTI. Resident 163's records indicated Resident 163 did not have a urinalysis with culture and sensitivity (test to find the germs that caused the infection) completed before Resident 163's antibiotic was ordered. The PD stated the pharmacy team makes sure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 32 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0881 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few residents' antibiotic therapy in the Transitional Care Unit (TCU) was appropriate. The pharmacist stated that Resident 163 was currently on antibiotic therapy for a diagnosis of UTI. The PD stated Resident 163 did not have any urinalysis with culture and sensitivity on the medical chart. The PD stated a UA should have been obtained prior to antibiotic treatment. During an interview on 1/14/2024 at 10:26 a.m. with the Director of Nursing, the DON stated the pharmacist was the one who checks for antibiotic treatment eligibility. The DON stated the pharmacist also follows up with the physician on when the antibiotic stop date should be and if needed some laboratory tests to prevent residents from having a resistance to the antibiotic. During a record review of the facility's policy and procedure (P&P), dated 1/1/2023, titled Antibiotic Stewardship, the P&P indicated antibiotic therapy of patients will be reviewed in a systemic multi-disciplinary manner. Review will include but not limited to appropriateness of therapy, dose, duration, route, frequency, adverse event potential, and compliance with formulary restrictions (rules to follow to minimize drug cost) and disease specific order sets. The P&P indicated the purpose of antibiotic stewardship team was to formulate clinical, multi-disciplinary strategies around anti-infective therapy. Our mission was to mitigate over utilization of anti-infectives that may lead to adverse patient outcomes as well as promote the timely administration of appropriate, lifesaving anti-infective treatments to meet the needs of our community. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 33 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0882 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Based on interview and record review: a.The facility failed to ensure the Infection Preventionist Nurse (IPN) implemented the antibiotic (drug to treat infection) stewardship program (effort to measure and improve how antibiotics, medications that fight infections, are prescribed) for twenty-nine of twenty-nine sampled residents. b.The facility failed to ensure the (IPN) dedicated mandated hours to the Transitional Care Unit (TCU) as required by federal and state regulations. This deficient practice resulted in a lack of oversight in the Antibiotic (drug to treat infection) Stewardship (effort to measure and improve how antibiotics, medications that fight infections, are prescribed) program and Infection Control and Prevention Program for 29 out of 29 sampled residents in the TCU. Findings: During the entrance conference with the Director of Nursing (DON) on 1/12/2024 at 5:49 p.m., the DON stated there was no designated full time Infection Preventionist in the TCU. The designated IPN was the manager of the Infection Control Department. During an interview on 1/13/2024 at 12:59 p.m. with the IPN, the IPN stated she was responsible for the whole hospital, and she was the manager for the whole Infection Prevention Unit. The IPN stated she cannot provide the breakdown of hours designated for TCU. The IPN stated no IPN in the Infection Prevention Unit was solely responsible for the TCU. The IPN stated that does not provide oversight with the antibiotic stewardship in the unit. The IPN further added that she was not aware of how many residents had a foley catheter (medical device that helps drain urine from bladder) in the unit. The IPN stated that she would need to get the list in the nursing station so she would be able to discuss and identify the residents that are on it. IPN said that she could not provide any proof that she was doing the IP role solely for the unit. During a concurrent interview and record review on 1/13/2024 at 2:26p.m. with the Director of Nursing (DON), the Facility Assessment, dated 2024, was reviewed. The facility assessment did not indicate the State mandated full-time hours required for the IPN. The DON stated the facility assessment doesn't indicate about the full-time hours for IPN. The DON stated the IPN had an important role since there were outbreaks and the TCU needed someone full-time who would implement infection Prevention Control Policy throughout the unit. During a record review of the facility's policy and procedure (P&P), dated 1/1/2023, titled Antibiotic Stewardship, the P&P indicated antibiotic therapy of patients will be reviewed in a systemic multi-disciplinary manner. The P&P indicated the purpose of antibiotic stewardship team was to formulate clinical, multi-disciplinary strategies around anti-infective therapy. During a record review of the facility's (P&P) titled, Infection Control and Prevention Program (ICPP) Overview-Infection Prevention, effective 1/20/2023, the P&P indicated the Infection Control and Prevention Department: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 34 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0882 1.Will work collaboratively with all health system departments and disciplines to achieve an interdisciplinary approach to problem solving. Level of Harm - Minimal harm or potential for actual harm 2.Will consult with the pharmacy department regarding Antibiotic Stewardship. Residents Affected - Few The policy and procedure did not indicate mandated hours to be designated for the TCU. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 35 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure one of five sampled residents (Resident 173) received education regarding the benefits and potential side effects of the pneumococcal vaccine (medication help protect against infection that can cause serious illness like pneumonia [infection of the lungs]) before the vaccine was administered on 1/12/ 2024. Residents Affected - Few This deficient practice had the potential to result in misinformation that can negatively affect physical and mental wellness. Findings: During a record review of the Resident 173's Registration Record, the record indicated the resident was admitted to the facility in 1/5/2024. During a record review of Resident 173's History and Physical (H&P), dated 12/29/2023, the H&P indicated Resident 173 was diagnosed with left pneumothorax (collapsed lung where air leaks between the lungs and chest wall), acute hypoxic respiratory failure (impaired gas exchange between the lungs and the blood and not enough oxygen in blood), coronary artery disease (damage or disease in the heart's major blood vessels) and hypertension (condition in which the force of the blood is too high). The H&P indicated Resident 173 was awake alert and oriented to person, place, and year. During a record review of Resident 173's Order sheet, the order sheet indicated on 1/5/2024 at 4:38 p.m. pneumococcal vaccine 20 conjugate vaccine (Prevnar 20) 0.5 mL intramuscular one time was ordered. During a record review of Resident 173's Medication Administration record (MAR), the MAR indicated pneumococcal 20-valent conjugate vaccine 0.5 mL IM one time only was administered on 1/12/2024 at 6:10 p.m. During a concurrent interview with Registered Nurse 5 (RN 5) and record review of Resident 173's Immunizations Record on 1/14/2024 at 8:26 a.m., the record indicated the following questions that required either a YES or NO answers were left blank: a. Patient [Parent/Guardian] received vaccine information; b. Patient [Parent/Guardian] has had all questions answered; and c. Patient [Parent/Guardian] states understanding of risk and benefits. RN 5 stated the sections left blank meant that they were not completed. RN 5 stated sections left blank meant Resident 5 did not receive vaccine information, did not get questions answered, and did not state understanding of risk and benefits of the vaccination. During an interview on 1/14/2024 at 10:16 p.m. with Director of Nursing (DON), the DON stated if education or tasks were not documented it was not done. During a review of the facility's policy and procedure titled, Vaccination Protocol/ Vaccine information sheet, effective 12/20/2023, the policy indicated education and consultation will be given (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555599 If continuation sheet Page 36 of 37 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 555599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505 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 0883 regarding the benefits of immunization. The P&P indicated the nursing staff will educate on side effects to be expected. 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: 555599 If continuation sheet Page 37 of 37