Health inspection·January 25, 2024

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 1/22/2024 during the 7 a.m. to 3 p.m., stated the call light should have been placed closed to Resident 344's bed for easy reach, so that the resident was able to get services in a timely manner. CNA 1 also stated this way, Resident 344 can be prevented from repeat falls. During a review of the facility's policy and procedure titled Call system, Residents dated September 2022, indicated each resident is provided with a means to call staff directly for assistance from his/her bed. The purpose of the call system is to provide a mechanism for residents to promptly communicate with nursing staff. Event ID: Facility ID: 555609 If continuation sheet Page 2 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on observation, interview and record review, the facility failed to ensure one of three sampled resident (Resident 28) or his/her representative was assisted to formulate an Advance Healthcare Directives (AD-a written statement of a person's wishes regarding medical treatment made to ensure those wishes are carried out should the person be unable to communicate them to a doctor) upon admission to the facility, and the AD was maintained in the resident's clinical records at all times. This deficient practice had the potential to cause conflict with Resident 28's wishes regarding health care treatment especially in an event of emergency. Findings: During a review of Resident 28's admission Record indicated the facility admitted Resident 28 on 8/27/21 with diagnoses that included dementia (a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities) and hypertension (high blood pressure). During a review of Resident 28's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 12/2/23, indicated Resident 28 had severely impaired memory and cognitive (ability to think and reasonably) impairment. The MDS indicated Resident 28 required supervision or touching assistance with eating, and partial/moderate assistance with oral hygiene, toilet hygiene, and chair/bed-to-chair transfer, and substantial/maximal assistance with lower body dressing and personal hygiene. During an observation and record review on 1/22/24 at 11:51 AM, Resident 28's Advanced Healthcare Directive Acknowledgement Form (AHDAF) was flagged in Resident 28's in the paper clinical chart that was on the desk of the nursing station. Resident 28's AHDAF was observed blank without the physician's and resident's /representative's signature. During a concurrent interview and record review on 1/23/24 at 8:54 AM, with the Social Services Director (SSD). Resident 28's blank Advanced Healthcare Directive Acknowledgement Form (AHDAF) was reviewed. The SSD stated she had not completed Resident 28's AHDAF and she was going to call her responsible party (RP) today to follow up. The SSD stated the facility admitted Resident 28 on 8/27/21 and her AHDAF should be offered, completed, and followed up upon the resident's admission to the facility. The SSD stated it was important to inform the resident and his or her RP about their rights to formulate an Advance Healthcare Directive, so the facility would know If the resident had an advance directive or not upon admission and provide treatments as the resident's wishes. During a review of the facility's policy and procedure (P&P) titled, Advance Directive, dated 9/22, the P&P indicated, the resident has the right to formulate an advance directive, including the right to accept or refuse medical or surgical treatment and prior to or upon admission of a resident, the social service director, or designee inquires of the resident, his/her family members and/or his or her legal representative, about the existence of any written advance directives. During a review of the facility's policy and procedure (P&P) titled, Advance Directive, dated 2022, the P&P indicated, information about whether or not the resident has executed an advance directive is displayed prominently in the medical record in a section of the record that is retrievable by any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 3 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0578 staff. 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: 555609 If continuation sheet Page 4 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 necessary services in activities of daily living (ADL) to maintain good personal hygiene by ensuring the toenails were not thick and discolored and the fingernails were trimmed for one of two sampled residents (Resident 21) who had long untrimmed fingernails and toenails. Residents Affected - Few This deficient practice had the potential for Resident 21 not to receive necessary services to maintain and achieve their highest potential and wellbeing. Findings: 1. A review of Resident 21's admission record indicated the resident was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses frailty (the condition of being weak and delicate), diabetes mellitus (high blood sugar) and chronic obstructive pulmonary disease (COPD-an inflammatory lung disease that causes obstructed airflow from the lungs and difficulty breathing). A review of Minimum Data Set (MDS, a standardized assessment and care screening tool), date 10/23/2023, indicated Resident 21's cognitive skills (ability to tik, reason and make daily decisions) was severely impaired. The MDS indicated Resident 21 was dependent (helper does all the effort) on staff with maximal assistance (require helper assist more than half of effort) for lower body dressing, putting on/taking off footwear, moderate assistance (require helper assist less than half of effort) for toilet use hygiene, shower personal hygiene. During concurrent observation and interview on 1/22/24 at 10:20 AM, all of Resident 21's fingernails were long, about 4-5mm (millimeter- a unit of measurement) long, with long discolored thick toenails on left and right big toes, 4th toes of both feet had toenails measuring 8 to 9 mm long that curved to 3rd toe. In an interview, Resident 21 stated his nails had not been trimmed for a long time. A review of Resident 21s Care Plan (CP) initiated on 11/10/21, indicated Resident 21 had alteration in physical functioning due to medical conditions and required extensive assist with bed mobility, dressing, locomotion, personal hygiene. The CP goal included Resident 21 will be kept comfortable and ADL needs will be met daily x 3 months and the resident will be participate/assist with ADLs to the highest degree possible within physical and medical current level of function by next review. The CP was revised on 8/29/23 with the target date 2/1/24. During a concurrent observation and interview on 1/24/24 at 8:46 AM with Director of Nursing (DON) in Resident 21's room, with Resident 21's permission, the DON assessed Resident 21's fingernails which were long and measuring about 4-5 mm long from the tip of finger. The DON immediately called one Certified Nursing Assistant to trim Resident 21's fingernails. In an interview the DON stated she will ask podiatrist (physician and surgeon who treats the foot, ankle, and related structures of the leg) to come to see Resident 21 as soon as possible for his long, discolored, and thick toenails. During a review of the facility's policy and procedure (P&P) titled, Activities of Daily Living , supporting, dated 03/2018, the P&P Resident who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 5 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 coordinate and communicate the care services of one of two sampled residents (Resident 6) with the hospice (an end-of-life care with focus on the resident's quality of life) staff as indicated in the facility's policy and procedure for hospice care titled, Hospice and Nursing Facility Services Agreement, Residents Affected - Few This deficient practice had the potential to negatively affect the resident's psychosocial and physical well-being and/or delay the delivery of hospice care services to Resident 6. Findings: During a review of Resident 6's admission record indicated, Resident 6 was initially admitted to the facility on [DATE], and admitted to the hospice care and services on 8/15/2023, with diagnoses that included hemiplegia (a severe or complete loss of strength or paralysis on one side of the body) and hemiparesis (a mild loss of strength in a leg, arm, or face) following unspecified cerebrovascular disease (a group of conditions that affect blood flow and the blood vessels in the brain) affecting left non-dominant side, atherosclerosis heart disease (a buildup of cholesterol plaque in the walls of arteries causing obstruction of blood flow from the heart to the brain) and adult failure to thrive (weight loss, decreased appetite and poor nutrition, and inactivity). During a review of the Minimum Data Set (MDS- a comprehensive assessment and screening tool) dated 10/27/2023, the MDS indicated the resident has impaired cognitive patterns (a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life), needed assistance from staff members for locomotion in and out of the bed, and was always incontinent of bowel and bladder. A review of Resident 6's POLST (a written medical order from a physician, that helps give people with serious illnesses more control over their own care by specifying the types of medical treatment they want to receive during serious illness.) dated 8/15/2023 indicated Resident 6 was on selective treatment and was on no artificial means (treating medical conditions while avoiding burdensome measures, prefer to forgo the use of medically provided fluids and nutrition) of nutrition. A review of Resident 6's Physician's order, dated 8/15/2023 indicated Resident 6 began hospice with the current hospice service agency on 8/15/2023. During a concurrent interview and record review on 1/22/2024 at 2:01 p.m. with License Vocational Nurse (LVN)1, Resident 6's hospice binder did not include any hospice nurses' visiting notes, no care plans, no IDTs. (interdisciplinary team conference). LVN1 stated there were no hospice nurses' visiting notes, no care plans, no IDT in Resident 6's hospice binder. LVN1 stated nurses and staff will not be able to get an immediate update about Resident 6's latest conditions and care as there were no visiting notes in Resident 6's hospice binder. During a concurrent interview and record review on 1/22/2024 at 3:06 p.m. with the Director of Nursing (DON), Resident 6's hospice binder was reviewed with DON. The DON stated, Resident 6's hospice binder did not include any hospice nurses notes when they visited the residents, and no care plans, or IDTs in the hospice binder, which could result in the nurses and staff not able receive immediate update about Resident 6's latest conditions and needed care or services, as there were no records to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 6 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0684 indicate the agency staffs communicated with the facility staffs Resident 6's hospice binder. Level of Harm - Minimal harm or potential for actual harm During an interview with Social Services Designee (SSD) on 1/25/2024 at 8:46 a.m., SSD stated she did not know there was no hospice nurses' visiting notes and care plans in Resident 6's hospice binder. SSD also stated the facility has no access to hospice's Hospice MD (HMD, hospice documentation system) from the facility. Hospice nurses have no access to the Point Click Care (PCC, facility documentation system). SSD stated that there is no way to get updated care information for Resident 6 due to absent of hospice nurse visiting notes, update care plan and updated IDTs. SSD stated there is no way to know if the hospice nurse had visited the resident on the scheduled dates. Residents Affected - Few The facility's policy and procedure (P&P) titled, Hospice and Nursing Facility Services Agreement, dated 11/11/2022, indicated both parties shall maintain appropriated documentation of services provided under this agreement in accordance with applicable state and federal law and regulations and Accreditation Standards. Patients' medical records and documentation maintained by each Party shall be available for review and inspection by the other Party as necessary for the proper evaluation, screening, and provision of services to patients under this agreement. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 7 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 ensure one of three sampled residents (Resident 24) receiving gastrostomy tube feeding (nutrition through gastrostomy tube feeding tube [GT-a flexible tube surgical inserted through abdomen into the stomach for feeding, fluid, and medication administration] was being fed continuously in accordance with the resident's physician's orders. This deficient practice had the potential to result in altered nutritional status resulting from inconsistent caloric intake and loss of weight to the resident. Findings: A review of Resident 24's face sheet (admission Record) indication the resident was admitted to the facility on [DATE], with diagnoses that included but not limited to dysphagia (difficulty swallowing), oropharyngeal phase (swallowing problems occurring in the mouth and/or the throat). A review of Resident 24's Minimum Data Set (MDS - an assessment and care screening tool) dated November 16, 2023, indicated the resident's cognitive ability is severely impaired and can not make decisions by own self. During an observation January 22, 2024, at 10:40 a.m. Resident 24's feeding tube pump was observed in the off position. A review of the physician order, dated 8/30/2023, indicated provide enteral feeding: Diabeticsource AC (a nutritional formula) via G-tube at 70 cc (cubic centimeter-a unit of measurement/hour x 20 hours (144 cc volume, 1680 kcal, 84 g protein) and 1142 cc free water every day shift. During a concurrent interview and record review on January 23, 2023, at 10:15 a.m. with Licensed Vocational Nurse (LVN) 2, Resident 24's enteral feed order, dated August 30, 2023, was reviewed. The enteral feed order did not include start and stop time for enteral g-tube feeding. LVN 2 stated MD orders should have start and stop time for enteral g-tube feeding. During an interview on January 23, 2023, at 10:26 a.m. the Director of Nursing stated it is the facilities practice starting GT feeding at 2:00 p.m. and stop at 10:00 a.m. as recommended by the facility's Registered Dietitian (RD). During a review of Resident 24's Dietary progress note, dated January 8,2024, the progress note did not indicate a time for start / stop of GT feeding. During a review of Resident 24's Physician's orders, dated 8/30/23, did not include timing of nutrition. During a review of Resident 24's care plan, dated 8/30/24, titled, enteral feeding dated February 11, 2022, indicated to administer Diabetisource AC via G-tube at 70 cc/hr x 20 hrs, and administer 1142 cc free water. The plan of care did not indicate the time when the feeding should be started and stopped to ensure the resident received the GT feeding accurately and completely as ordered by the physician. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 8 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 FORM CMS-2567 (02/99) Previous Versions Obsolete During a review of the Facility's policy and procedure titled, Enteral Feeding, indicated the nurse confirms that orders for enteral nutrition are complete. The nurse confirms that orders for enteral nutrition are complete. Complete orders include: a. The enteral nutrition product: b. delivery site ( tip placement); c. the specific enteral access device ( nasogastric, gastric, jejunostomy tube, etc.; d. administration method ( continuous, bolus, intermittent); e. volume and rate of administration; f. the volume/rate goals and recommendations for advancement toward these; and g. instructions for flushing ( solution, volume, frequency, timing and 24- hour volume). Event ID: Facility ID: 555609 If continuation sheet Page 9 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. 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 medically related social services to one of 2 sampled residents (Resident 21) by failing to follow the physician's order to provide podiatrist service (a physician specialized in foot care and foot diseases) for the foot care with long, thick discolored nails to Resident 21. Residents Affected - Few This deficient practice resulted for Resident 21 not to have the toenails trimmed to prevent accidental injury and infection. Findings: A review of Resident 21's admission record indicated the resident was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses frailty (weak and delicate), diabetes mellitus (high blood sugar) and chronic obstructive pulmonary disease (COPD-an inflammatory lung disease that causes obstructed airflow from the lungs and difficulty breathing). A review of Minimum Data Set (MDS, a standardized assessment and care screening tool), date 10/23/2023, indicated Resident 21's cognitive skills (ability to tik, reason and make daily decisions) was severely impaired. The MDS indicated Resident 21 was dependent (helper does all the effort) on staff with maximal assistance (require helper assist more than half of effort) for lower body dressing, putting on/taking off footwear, moderate assistance (require helper assist less than half of effort) for toilet use hygiene, shower personal hygiene. During concurrent observation and interview in room [ROOM NUMBER] on 1/22/24 at 10:20 AM, observed resident 21's all toenails are long and with fungal on left and right sides big toes, 4th toes of both side toenails are long with 8 to 9 mm long that curved to 3rd toes. Resident stated his toenails were not trimmed for a long time and it has to be done by a foot specialist. A review of Resident 21's physician order, dated 11/8/23, indicated the physician ordered Resident 21 to be provided a nail care by the podiatry consultant. During an interview with Director of Nursing (DON) interview on 1/24/24 at 8:21 AM in DON office. The DON verified that there was an active physician's order for the resident to be seen by a podiatrist for nail care on 11/8/23. The DON states she could not find in Resident 21's medical record that a podiatrist rendered service to the resident as ordered by the physician. On 11/8/23. During a concurrent observation and interview on 1/24/24 at 8:46 AM with the DON in Resident 21's room, with resident 21's permission, DON assessed resident toenails. Resident 21's toenails were all long, thick and discolored and with fungal infection (infection due to fungus) on both the left and right-side big toes, the 4th toes of both feet had long toenails measuring about 8 to 9 mm (millimeter- a unit of measurement) long from the nail bed. The 3rd toenail was curved. The DON stated that she will ask podiatrist to come to see Resident 21 as soon as possible to trim the toenails condition. During an interview with Social Service Director (SSD) on 1/25/24 at 10:54 AM in SSD's office. The SSD stated that facility have in house podiatrist that comes see the residents every 3 months. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 10 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few SSD stated the last time Resident 21 was visited by the podiatrist was on 12/9/23. The SSD stated she was not sure why Resident 21 was missed during the podiatrist's last visit, which could be when the resident was most likely out to the dialysis center (a place where residents receive dialysis [a medical procedure with the use of machine to remove toxins and excess fluids from the blood and body). During a review of the facility's policy and procedure (P&P) titled, Activities of Daily Living, Supporting dated 3/2018, the P&P indicated the Resident who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. A review of the facility's revised policy and procedure titled, Referrals, Social Services,, dated 8/2008, indicated that social services shall coordinate most resident referrals. Referrals for medical services must be based on physician evaluation of resident need and a related physician order. Social services will collaborate with the nursing staff or other pertinent disciplines to arrange for services that have been ordered by the physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 11 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate dispensing, and administering of all drugs and biologicals) to meet the needs of each resident by failing to destroy expired Lorazepam ( a medication used to treat anxiety [the fear of the unknown]) for one of one sampled resident (Resident 6). The deficient practice had the potential for medication diversion (illegal distribution or abuse of prescription drugs or their use for purposes not intended by the prescriber) and unauthorized release of residents' personal information. Findings: During a review of Resident 6's admission record, it indicated Resident 6 was initially admitted on [DATE], she then admitted to the hospice on 8/15/2023 with diagnoses of, but not limited to, hemiplegia (a severe or complete loss of strength or paralysis on one side of the body) and hemiparesis (a mild loss of strength in a leg, arm, or face) following unspecified cerebrovascular disease (a group of conditions that affect blood flow and the blood vessels in the brain) affecting left non-dominant side, atherosclerosis heart disease (a buildup of cholesterol plaque in the walls of arteries causing obstruction of blood flow from the heart to the brain) and adult failure to thrive (weight loss, decreased appetite and poor nutrition, and inactivity). During a review of the Minimum Data Set (MDS- a comprehensive assessment and screening tool) dated 10/27/2023, the MDS indicated the resident has impaired cognitive patterns (a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life), needed assistance from staff members for locomotion in and out of the bed, and was always incontinent of bowel and bladder. During a review of Resident 6's Physicians order, dated 08/17/2023, the physicians order indicated continue Lorazepam Intensol Oral Concentrate two milligrams (mg) per milliliters (ml) until further notice per the hospice agency . During a medication pass observation on 1/23/24 at 10:34 a.m. with License Vocational Nurse (LVN) 1, one expired bottle Lorazepam Intensol Oral Concentrate two milligrams (mg) per milliliters (ml), opened box, dated 8/18/23, was inside the locked drawer of the Medication Cart 2. In a concurrent interview, LVN1 stated the expired Lorazepam should have been discarded and destroyed right away according to the facility's policy. LVN 1 stated the Lorazepam was not supposed to be stored in the medication cart to prevent misuse. LVN 1 stated disposing of expired controlled medication in a timely manner can prevent harm to resident's health and this may prevent release of residents' personal information. During an interview on 1/24/24 at 9:04 a.m. with LVN 2, LVN 2 stated expired controlled medications need to be discarded right away according to the facility's policy. LVN 2 stated expired controlled medications are not supposed to be stored in any medication cart or in the medication storage area to prevent misuse and causing harm to the residents. During an interview on 1/24/24 at 9:24 a.m. with Director of Staff Development (DSD). DSD stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 12 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete all the expired medications will need to discard according to facility's policy right away and the expired medications are not supposed to be stored in the medication carts or in the medications storage room. The facility's policy and procedure (P&P) titled, Discarding and Destroying Medications revised in November/2022, indicated disposal of controlled substances must take place immediately (no longer than three days) after discontinuation of use by the resident. Event ID: Facility ID: 555609 If continuation sheet Page 13 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure one of one outdoor refuse container (a waste container that a person controls that includes dumpsters, trash cans, garbage pails, and plastic trash bags) was closed with a tight-fitting lid and kept covered in accordance with the facility's policy and procedure titled, Food Related Garbage and Refuse Disposal. Residents Affected - Some This failure had the potential to attract insects and harborage of pests in the refuse area that can cause a wide spread of diseases and affect the residents, staff, and visitors. Findings: During an observation on January 23, 2024, at 9:00 a.m., in the presence of the Dietary Supervisor (DS) at the facilities parking lot, the outdoor refuse container was observed with no tight fitting/secured lid. During an interview on January 23, 2024, at 9:20 a.m. with the DS, she stated the dumpster container is supposed to be covered. During a review of the facility's policy and procedure titled, Food- Related Garbage and Refuse Disposal dated 2021 (revised October 2017), indicated, all garbage and refuse containers are provided with tightfitting lids or covers and must be kept covered. Garbage and refuse containing food wastes will be stored in a manner that is inaccessible to pests. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 14 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 interview, and record review, the facility failed implement the facility's policy and procedure on infection control to prevent spread of infection by failing to: Residents Affected - Some 1. Ensure the facility monitors the water system for Legionella (bacteria most found in water, including groundwater, fresh and marine surface waters that causes severe pneumonia [severe infection in the lungs]. Legionella is transmitted through breathing in Legionella-contaminated, aerosolized [the form of a fine spray] water and is also possible from breathing in Legionella contaminated soil or while drinking water) as evidenced by not conducting water testing for Legionella. 2. Ensure the staff was wearing the correct personal protective equipment (PPE- gown, mask and gloves) before entering a contact isolation (diseases spread by direct or indirect contact) precaution room for one of one sampled resident (Resident 34). This deficient practice had the potential to result in the infection (a process when a microorganism, such as bacteria, fungi, or a virus, enters a person's body and causes harm) and a widespread infection in the facility to the residents, staffs, and visitors. Findings: 1. During an interview and record review on 1/23/24 at 2:55 PM, with the Maintenance Supervisor (MS), the facility's policy and procedure (P&P) titled, Legionella Water Management Program, revised on 7/2017, was reviewed. The MS stated the facility did not conduct water testing for the presence of legionella. The MS stated he provided regular maintenance to the identified areas in the water system that could grow Legionella as indicated in the P&P, such as cleaning the shower heads every six months, assessing leaking pipes, cleaning the heating tank and checking the room water temperature every day. The MS stated he was following the P&P to ensure the water system in the facility would not grow Legionella, therefore, the facility did not need to test the water for Legionella. During an interview on 1/23/24 at 3:30 PM, with the Infection Preventionist (IP), the IP stated the facility had never had a Legionella case, so the facility did not do water testing for Legionella. The IP stated the staff followed the facility P&P's prevention measures for legionella, such as cleaning the heating tanks every day and cleaning and running the shower heads. The IP stated they monitored and made sure the staff do everything that was in the P&P, and by doing so, the water system in the facility should not be at risk for Legionella. The IP stated when the facility sees if there was a risk for Legionella, such as an incident of Legionella in the facility, then the facility will escalate to do the water testing. The IP stated the Centers for Disease Control and Prevention (CDC) did not require water testing for Legionella. During an interview on 1/23/24 at 3:35 PM, with the Administrator (ADM), the ADM stated she worked in this field (facility management) for over 40 years, and she had never heard of the requirement to test water for Legionella in the facility. The ADM stated the facility had never tested water for Legionella because there was no legionella incident in the past and they were doing everything on the facility's protocol to prevent Legionella, such as monitoring the water temperature, cleaning the heating water tank, checking the pipes, cleaning shower heads with vinegar. The ADM stated the facility was monitoring the staff were doing all the measures to prevent Legionella contamination. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 15 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of the facility's policy and procedure (P&P) titled, Legionella Water Management Program, revised on 7/17, indicated the water management program included A system to monitor control limits and the effectiveness of control measures. 2. A review of Resident 34's admission Record indicated Resident 34 was originally admitted on [DATE] and re-admitted to the facility on [DATE], with diagnoses of, but not limited to, hemiplegia (a severe or complete loss of strength or paralysis on one side of the body) and hemiparesis (hemiparesis is a slight weakness in leg, arm, or face) following other cerebrovascular disease (a group of conditions that affect blood flow and the blood vessels in the brain) affecting left side of his body and sepsis (the body's extreme response to an infection) and elevated white blood cell count (immune system issue). During a review of Resident 34's Minimum Data Set (MDS- a comprehensive assessment and screening tool) dated 10/25/23, the MDS indicated Resident 34 was able to follow simple commands, and required maximum assistance with the toilet, personal hygiene, change of position and transfer. During an observation on 1/22/24 at 9:09 a.m., in front of Resident 34's room, housekeeper (HK) was inside the room mopping the floor next to Resident 34's bed without wearing an isolation gown for the contact isolation precaution. There was a red Stop sign on the wall below resident's name tag indicating all who enter the contact isolation room should wear PPE, and wash their hands with soap and water before and after. The sign also cautioned visitors to check with the registered nurse before entering, due to a highly infectious disease contained in the room. There is also an isolation cart in front of Resident 34's room for PPE supplies for staffs and visitors. During an interview on 1/22/24 at 9:15 a.m., with HK, HK stated it is not right to clean the isolation room without wearing a gown. HK stated by not wearing a gown to clean inside the room, the person could spread germs and bacteria to other residents and staff. Hand washing is very important to stop the spread of infections. During an observation on 1/22/24 at 9:26 a.m., in front of Resident 34's room, Restorative Nurse Assistant (RNA) was observed delivering an IV (a way of giving a drug or other substance through a needle or tube inserted into a vein) pole to Resident 34's bed side without wearing any PPE for contact isolation precaution. RNA did not perform hand hygiene before leaving Resident 34's room. During an interview on 1/22/24 at 9:28 a.m. with RNA, RNA stated he did not see the red contact isolation signage in front of Resident 34's room. RNA stated he needed to wear PPE before entering the room and he was supposed to wash his hands before leaving the room. RNA stated wearing gowns, gloves and hand washing are very important to help to stop the spread of infection. During an interview on 1/22/24 at 10:33 a.m. with LVN1, LVN1 stated Resident 34 is in transmission-based precautions for vancomycin-resistant enterococci (VRE, resistant to some powerful antibiotics) urine for this re-admission on 1/10 /24. LVN1 stated everyone in the facility should follow transmission-based precautions (the type of precautions used to depend on the mode of transmission of a specific disease) for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection. A review of the revised policy and procedure dated September 2022, titled Isolation-Categories of Transmission- Based Precautions indicated staff and visitors wear a disposable gown upon entering the room and remove before leaving the room and avoid touching potentially contaminated surfaces with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555609 If continuation sheet Page 16 of 17 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 555609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendale Healthcare Center 1208 S. Central Ave Glendale, CA 91204 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete clothing after gown is removed. Staff and visitors wear gloves (clean, non-sterile) when entering the room. Gloves are removed and hand hygiene performed before leaving the room. The policy also indicated when a resident is placed on transmission-based precautions, appropriate notification is placed on the room entrance door and on the front of the chart so that personnel and visitors are aware of the need for and the type of precaution. The signage informs the staff of the type of Centers for Disease Control and Prevention (CDC) precaution(s), instructions for use of PPE, and/or instructions to see a nurse before entering the room. Event ID: Facility ID: 555609 If continuation sheet Page 17 of 17