Health inspection·January 23, 2026

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one of five sampled residents (Residents 22) received appropriate services to prevent a decline in range of motion (ROM, full movement potential of a joint) and mobility by failing to provide Resident 22 Restorative Nursing Aide (RNA, nursing aide program that help residents to maintain their function and joint mobility) treatment for ambulation (walking) on 1/19/2026. This deficient practice had the potential for Resident 22 to decline in ambulation and overall physical functioning.Findings: During a review of Resident 22's admission Record, the admission Record indicated Resident 22 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including but not limited to non-Hodgkin lymphoma (cancer in white blood cells) and encounter for palliative care (specialized medical care that focuses on providing relief from pain and other symptoms of serious illness). During a review of Resident 22's Minimum Data Set (MDS, resident assessment tool) dated 10/16/2025, the MDS indicated Resident 22 was moderately impaired in cognitive (ability to think, understand, learn, and remember) skills for daily decision making. The MDS indicated Resident 22 did not have any limitations in range of motion in both arms and legs. The MDS indicated Resident 22 required supervision with eating and oral hygiene and moderate assistance with sit to stand, bed to chair transfer and with walking 10 feet. During a review of Resident 22's Order Summary Report dated 1/22/2026, the Order Summary Report indicated a physician order dated 7/7/2025 for RNA for ambulation with front-wheeled walker (FWW, type of mobility aid with wide base of support and two wheels in the front) once a day five times a week. During a review of Resident 22's Care Plan dated 7/7/2025, the Care Plan indicated Resident 22 was at risk for decline in ability to ambulate with assistance. The Care Plan goal indicated Resident 22 will maintain ability to ambulate with assistance of RNA. The Care Plan interventions indicated RNA for ambulation with FWW once a day five times a week as tolerated. During a review of Resident 22's RNA Documentation Survey Report for January 2026, the RNA Documentation Survey Report indicated no documentation (blank) for RNA treatment on 1/19/2026. During an observation and interview on 1/22/2026 at 10:30 a.m., Restorative Nursing Aide 2 (RNA 2) approached Resident 22 who was sitting in a wheelchair outside of Resident 22's room. Resident 22 stood up and walked using a FWW with RNA 2 down the hallway and sat down to rest after the nursing station. Resident 22 stated she was tired and wanted to rest. During a concurrent interview and record review on 1/22/2026 at 10:37 a.m., with the Director of Staff Development (DSD), Resident 22's January 2026 RNA Documentation Survey Report was reviewed. DSD stated if the RNA Documentation Survey Report was blank, it meant Resident 22 did not receive RNA treatment that day or the RNAs did not document any treatments for that day. DSD confirmed on 1/19/2026, the RNA treatment was blank and was not documented. DSD reviewed the Nurse Staff Sign-In Sheet and indicated only one RNA worked on 1/19/2026 (Restorative Nursing Aide 1 [RNA 1]). DSD stated the other RNA assigned that day (1/19/26) did not report to work that day. DSD stated the facility did not have a process to make up any missed RNA treatments if an RNA did not come to work on a scheduled day. DSD stated it was important for residents who had RNA treatment orders to receive their RNA treatments as ordered, because if residents did not receive their RNA treatments, residents could have a decrease in mobility or their joints could get stiff and cause contractures (loss of motion of a joint). During an interview on 1/22/2026 at 2:24 p.m., RNA 1 stated she was the only RNA that worked on 1/19/2026. RNA 1 confirmed she did not perform any RNA treatments for ambulation for Resident 22 because she did not have time and focused on residents who required ROM exercises and splints (rigid material or apparatus used to support (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 2 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and immobilize a broken bone or impaired joint) first. During an interview on 1/22/2026 at 3:34 p.m., with the Director of Nursing (DON), the DON stated the RNA program was to help residents maintain their present level of functioning such as their ROM and ambulation. The DON stated if a scheduled RNA did not come to work, then the facility should offer overtime to the working RNA until all the RNA treatments were completed and documented. The DON stated on 1/19/2026, this process did not happen and currently the facility did not have a process to make up any missed RNA treatments on a different day that week. The DON stated residents should receive their RNA treatments as ordered and if a resident did not receive their RNA treatments as ordered, then residents could develop stiffness, contractures, or may not be able to walk any more. During a review of the facility's policies and procedures (P&P) titled, Restorative Nurse Services, revised 1/2025, the P&P indicated The facility provides and each resident shall receive restorative nursing care as needed to help promote optimal safety and independence.as determined by their comprehensive care plan. Event ID: Facility ID: 555706 If continuation sheet Page 3 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 - Few 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** Based on observation, interviews, and record review, the facility failed to ensure that six discontinued medication orders, contained in seven medication bubble packs for Resident 92 who was discharged from the facility more than two years ago were removed from medication storage and properly disposed of in accordance with the facility's policy and procedure titled Medication Destruction (revision date: 01/2025). This deficiency affected one of five sampled medication storage locations (Director of Nursing [DON] office). This deficient practice of failing to ensure removal of discontinued medications that could be expired, ineffective or toxic increased the risk for misuse and drug diversion of Resident 92's medications.Findings:During a review of Resident 92's admission Record, dated [DATE], the admission Record indicated Resident 92 was admitted to the facility on [DATE] and discharged on [DATE].During a review of Resident 92's History & Physical, dated [DATE], the document indicated Resident 92 had fluctuating capacity to understand and make decisions.During a concurrent observation and interview on [DATE] at 12:57 p.m. with the DON in the DON's office, regarding disposition of controlled (drugs or chemicals regulated by the government because they have a high potential for abuse, misuse, and addiction) and noncontrolled medications, the DON opened the locked storage cabinet and one of the drawers of the locked storage cabinet contained an opaque linen bag which contained Resident 92's Discharge summary, dated [DATE], with discharge date of [DATE] and the following seven medication bubble packs (a method of organizing medication where individual doses [pills or capsules] are sealed in small plastic cavities [bubbles] ) or cards:1. 25 tablets of Quetiapine fumarate (a medication used to treat schizophrenia [a mental illness that is characterized by disturbances in thought], bipolar disorder [sometimes called manic-depressive disorder; mood swings that range from the lows of depression to elevated periods of emotional highs] and as an adjunct treatment option for depression (a serious mood disorder causing persistent sadness and loss of interest, affecting thoughts, feelings, and daily activities) 25 milligrams ([mg] a unit of measurement for mass) that indicated, A.M. (morning dose), Give 1 tablet by mouth two times a day for dementia (a progressive state of decline in mental abilities) w/ (abbreviation for with) behavioral.2. 24 tablets of Quetiapine fumarate 25 mg that indicated, P.M. (evening dose), Give 1 tablet by mouth two times a day for dementia w/ behavioral.3. 26 tablets of Quetiapine fumarate 50 mg that indicated, bedtime, Take 1 tablet by mouth every night at bedtime.4. One capsule of Duloxetine hydrochloride (HCl) (a medication used to treat depression and other mood disorders) delayed release (DR) 20 mg that indicated, A.M., Give 1 capsule by mouth one time a day for depression mb (abbreviation for manifested by) sad.5. One tablet of Pantoprazole sodium delayed release (DR) 40 mg that indicated, A.M. before meals, Give 1 tablet by mouth before meals for gastrointestinal (GI) prophylaxis.6. Zero quantity of Allopurinol (a medication used to treat gout [a painful inflammatory form of arthritis caused by high uric acid levels forming crystals in joints]) 300 mg that indicated, A.M., Give 1 tablet by mouth one time a day for gout).7. 12 tablets of Olmesartan medoxomil (a medication used to treat high blood pressure) 40 mg that indicated, A.M., Give 1 tablet by mouth one time a day for hypertension (HTN): hold for systolic blood pressure (SBP) less than 110. The DON stated, I'll be very honest and I am sorry, I forgot these medications were here in storage. The DON stated the resident's family was supposed to pick up the medications. The DON stated she did not write on any piece of paper that she contacted the resident. The DON stated she forgot because it was covered by thermometer, other supplies in the cabinet and was hidden in the bag. The DON stated usually the medications would be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 4 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete safe in the DON's office instead of the medication room. The DON stated, unfortunately they (referring to the resident's family) never returned the call. The DON stated if a noncontrolled medication was discontinued, then it should be destroyed within 90 days or sooner. The DON stated she would not be able to return those medications to Resident 92, because they were probably outdated or not the right doses anymore. The DON stated she would inform the physician, Resident 92 and resident's family about this. During a review of the facility's P&P, titled Medication Destruction, dated 01/2025, the P&P indicated, Medications will be disposed of in accordance with federal, state and local regulations governing management of non-hazardous pharmaceuticals, hazardous waste and controlled substances. The P&P indicated, Disposal of non-controlled medications, Facility should dispose of discontinued medication, out-dated medications, or medications left in facility after a resident has been discharged within 90 days of the date the medication was discontinued by Physician/Prescriber. Non-controlled medications shall be disposed of in the presence of two nurses, in accordance with applicable State Law. Event ID: Facility ID: 555706 If continuation sheet Page 5 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to maintain the ice machine and scoop bucket under sanitary conditions. The facility failed to:1.Ensure the ice machine does not contain black dust-like substances during inspection.2.Ensure the scoop bucket was clean and sanitary, which had multiple stains in black, brown, and pink colors.This deficient practice had the potential to cause food-borne illnesses (illness caused by food contaminated with bacteria, viruses, parasites, or toxins ).Findings:During an initial kitchen tour observation and interview on 01/20/26 at 08:33 am, with the Director of Food Services (DFS). The iced machine was observed filled with black dusty substance. The scoop bucket was filled with multiple stains inside the bucket. The DFS stated the ice machine, and the scoop bucket should be always kept clean and sanitary. The DFS stated the maintenance staff was responsible for cleaning the ice machine.During an interview on 01/21/26 at 1:12 pm with the Housekeeping Supervisor (HS), the HS stated that he had spent several hours cleaning the ice machine but may have missed the area containing dust. The HS stated he will ensure the machine will be properly cleaned and will follow the manufacturer's guidelines moving forward. The HS stated that the scoop bucket was cleaned earlier that morning (1/20/26) but will make sure it was thoroughly cleaned and maintained in a sanitary condition to prevent contamination.During a review of the facility's policy and procedures (P&P) titled, Ice Machine and Storage Chest revised in 1/2025, the P&P indicated, Ice machine shall be maintained in accordance with manufacturer cleaning and sanitizing schedules to prevent biofilm, mold, and scale buildup. Ice machines shall be visually inspected weekly for scale, slime mold and or residue. The policy indicated that the ice scoop will be cleaned and sanitized daily by the dietary department. The ice scoop will be kept in a clean container when not in use and will not contain standing water. Event ID: Facility ID: 555706 If continuation sheet Page 6 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure medical records for three of five sampled residents (Residents 1, 5, and 7) were accurate, complete and readily accessible by failing to: 1. Document Resident 1 received Restorative Nursing Aide program (RNA, nursing aide program that help residents to maintain their function and joint mobility) treatment on 12/19/2025, 12/26/2025, 1/13/2026, and 1/19/2026. 2. Document Resident 5 received RNA treatment on 12/26/2025, 12/31/2025, and 1/19/2026. 3. Document Resident 7 received RNA treatment on 12/26/2025, 12/31/2025, and 1/19/2026. 4. Clarify daily dose of Risperdal ([Generic name - Risperidone] a medication used to treat bipolar disorder [sometimes called manic-depressive disorder; mood swings that range from the lows of depression to elevated periods of emotional highs]) for Resident 1.These deficient practices resulted in inaccurate and unclear medical documentation, misunderstanding among facility's licensed nursing staff and had the potential to cause inaccurate care planning, medication errors and/or inappropriate treatment of mental disorders for Residents 1, 5 and 7.Findings: 1. During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including but not limited to metabolic encephalopathy (brain dysfunction caused by chemical imbalances), dementia (a progressive state of decline in mental abilities), and muscle weakness. During a review of Resident 1's Minimum Data Set (MDS, resident assessment tool) dated 10/25/2025, the MDS indicated Resident 1 was severely impaired in cognitive (ability to think, understand, learn, and remember) skills for daily decision making. The MDS indicated Resident 1 did not have any limitations in range of motion (ROM, full movement potential of a joint) in either side of the upper extremity (UE, shoulder, elbow, wrist/hand) and had functional limitations in ROM in one side of the lower extremity ([NAME], hip, knee, ankle/foot). The MDS indicated Resident 1 required dependent assistance with dressing, bathing, and maximal assistance with sit to lying and rolling left and right. During a review of Resident 1's Order Summary Report dated 1/21/2026, the Order Summary Report indicated an order dated 11/26/2025 for RNA program for passive range of motion (PROM, movement at a given joint with full assistance from another person) exercises to both [NAME] once a day five times a week as tolerated. During a review of Resident 1's Care Plan initiated on 11/25/2025, the Care Plan indicated Resident 1 was at risk for developing both [NAME] contractures (loss of motion of a joint). The Care Plan goal indicated Resident 1 will have reduced risk for developing both [NAME] contractures related to impaired mobility. The Care Plan intervention indicated for RNA program for PROM exercises to both [NAME] once a day five times a week as tolerated. During an observation and interview on 1/21/2026 at 9:03 a.m., Certified Nursing Assistant (CNA 3) and Certified Nursing Assistant (CNA 1) assisted Resident 1 to put on clothes. Resident 1 was lying on his back and the left leg was crossed over the upper right leg. The left knee was bent and the right leg was straight. CNA 3 and CNA 1 required multiple attempts to put on jeans on Resident 1's legs. CNA 3 stated it was difficult to put on the pants because the right leg could not move and the left leg was bent. During a concurrent interview and record review on 1/22/2026 at 10:37 a.m., with the Director of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 7 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Staff Development (DSD), Resident 1's December 2025 and January 2026 RNA DSR were reviewed. The DSD stated if the RNA DSR was blank, it meant Resident 1 did not receive RNA treatment that day or the RNAs did not document any treatments for that day. DSD confirmed the RNA DSR was blank on 12/19/2025, 12/26/2025, 1/13/2026, and 1/19/2026. The DSD reviewed the Nursing Sign-In sheets and DSD stated one or two RNAs worked on those days. The DSD stated if RNAs completed the RNA treatment, then RNAs should document each time an RNA treatment was completed right after the treatment or at least by the end of the shift. The DSD stated it was important to document each treatment timely so that staff could know if the resident completed their RNA treatments and the resident's tolerance to the RNA treatment. During a concurrent interview and record review on 1/22/2026 at 1:58 p.m., with Restorative Nursing Aide (RNA 3), Resident 1's December 2025 and January 2026 RNA DSR were reviewed. RNA 3 confirmed she completed PROM exercises with Resident 1 on 12/19/2025, 12/26/2025, and 1/13/2026, but did not realize she did not document on Resident 1. RNA 3 stated she did not double-check if the documentation was completed and should ensure that documentation was completed for each resident. During a concurrent interview and record review on 1/22/2026 at 2:24 p.m., with Restorative Nursing Aide (RNA 1), Resident 1's January 2026 RNA DSR was reviewed. RNA 1 stated she performed RNA PROM exercises with Resident 1 on 1/19/2026 but did not have time to complete the documentation because she was the only RNA working that day. RNA 1 stated she should document all RNA treatments by the end of the shift but stated she did not always have time to complete the documentation. During an interview on 1/22/2026 at 3:34 p.m., the Director of Nursing (DON), the DON stated all RNA staff were supposed to document each time they provide RNA treatment with a resident. The DON stated it was important to document each time so that staff knew the job (RNA treatment) was completed, how the resident responded to the treatment, or if the RNA treatment did not happen. The DON stated RNA staff should be given time to complete documentation because it was important to document everything that was done for each resident. During a review of the facility's policies and procedures (P&P) titled, Documentation Policy, revised 1/2025, the P&P indicated it is the policy of this facility to document relevant findings in the clinical record. 2. During a review of Resident 5's admission Record , the admission Record indicated Resident 5 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including but not limited to metabolic encephalopathy, hemiplegia (weakness to one side of the body) and hemiparesis (inability to move one side of the body) following cerebral infarction (blockage of the flow of blood brain, causing or resulting in brain tissue death) affecting left non-dominant side. During a review of Resident 5's MDS dated [DATE], the MDS indicated Resident 5 was severely impaired in cognitive skills for daily decision making. The MDS indicated Resident 5 did not have any limitations in ROM in both sides of the upper extremities and had functional limitations on both sides of the lower extremities. The MDS indicated Resident 5 required maximal assistance with eating, oral hygiene. The MDS indicated Resident 5 required dependent assistance with dressing, sit to lying, and bed to chair transfers. During a review of Resident 5's Order Summary Report dated 1/21/2026 the Order Summary Report indicated an order dated 11/25/2025 for RNA program for PROM exercises to both [NAME] once a day five days a week as tolerated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 8 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 5's Order Summary Report dated 1/21/2026, the Order Summary Report indicated an order dated 11/25/2025 for RNA program for RNA to perform PROM exercises on left UE once a day five days a week as tolerated. During a review of Resident 5's Order Summary Report dated 1/21/2026, the Order Summary Report indicated an order dated 11/25/2025 for RNA program for RNA to apply resting hand splint (rigid material or apparatus used to support and immobilize a broken bone or impaired joint) on left hand for four hours once a day five days a week as tolerated. During a review of Resident 5's Care Plan initiated on 11/25/2025, the Care Plan indicated Resident 5 was at risk for decline in left UE ROM. The Care Plan goal indicated Resident 5 will be able to maintain current left UE ROM. The Care Plan intervention indicated for RNA to perform PROM exercises on left UE once a day, five times a week as tolerated. RNA to apply resting hand splint on left hand for four hours once a day five times a week as tolerated. During a review of Resident 5's Care Plan initiated on 11/25/2025, the Care Plan indicated Resident 5 was at risk for developing contractures to both [NAME]. The Care Plan goal indicated Resident 5 will have reduced risk of developing both [NAME] contractures. The Care Plan intervention indicated for an RNA program for PROM exercises to both [NAME] once a day five times a week as tolerated. During an observation and interview on 1/21/2026 at 9:32 a.m., with Resident 5, Resident 5 was lying in bed. Resident 5 was wearing a resting wrist/hand splint on the left wrist/hand. Resident 5's left arm was straight, and the left wrist/hand was resting on a pillow. Resident 5 denied any pain and was able to move the right arm a little. During a concurrent interview and record review on1/22/2026 at 10:37 a.m., with the Director of Staff Development (DSD), Resident 5's December 2025 and January 2026 RNA DSR were reviewed. DSD stated if the RNA DSR was blank, it meant Resident 5 did not receive RNA treatment that day or the RNAs did not document any treatments for that day. DSD confirmed the RNA DSR was blank on 12/26/2025, 12/31/2025, and 1/19/2026. DSD reviewed the Nursing Sign-In Sheet and DSD stated one or two RNAs were staffed on those days. DSD stated if RNAs completed the RNA treatment, then RNAs should document each time an RNA treatment was completed right after the treatment or at least by the end of the shift. DSD stated it was important to document each treatment timely so that staff can know if the resident completed their RNA treatments and the resident's tolerance to the RNA treatment. During a concurrent interview and record review on 1/22/2026 at 1:58 p.m., with Restorative Nursing Aide (RNA 3), Resident 5's December 2025 RNA DSR were reviewed. RNA 3 confirmed she completed ROM exercises with Resident 5 on 12/26/2025, 12/31/2025, but did not realize she did not document on Resident 5. RNA 3 stated she did not double check if the documentation was completed and should ensure that documentation was completed for each resident RNA 3 performed RNA treatment with. During a concurrent interview and record review on 1/22/2026 at 2:24 p.m., with Restorative Nursing Aide (RNA 1), Resident 5's January 2026 RNA DSR was reviewed. RNA 1 stated she performed RNA PROM exercises with Resident 5 on 1/19/2026 but did not have time to complete the documentation because she was the only RNA working that day. RNA 1 stated she should document all RNA treatments by the end of the shift but stated she did not always have time to complete documentation. During an interview on 1/22/2026 at 3:34 p.m., the Director of Nursing (DON) stated all RNA staff were supposed to document each time they provide RNA treatment with a resident. DON stated it was important to document each time so that staff knew the job was completed and how the resident responded to the treatment or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 9 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0842 Level of Harm - Minimal harm or potential for actual harm if the RNA treatment did not happen. DON stated RNA staff should be given time to complete documentation because it was important to document everything that was done for each resident. During a review of the facility's policies and procedures (P&P) titled, Documentation Policy, revised 1/2025, the P&P indicated it is the policy of this facility to document relevant findings in the clinical record. Residents Affected - Some 3. During a review of Resident 7's admission Record , the admission Record indicated Resident 7 initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including but not limited to acute kidney failure (sudden loss of kidney function to filter waste products) and hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side. During a review of Resident 7's MDS dated [DATE], the MDS indicated Resident 7 had severe impairment in cognitive skills. The MDS indicated Resident 7 did not have any limitations in ROM in both upper extremities and had impairments on both sides of the lower extremities. The MDS indicated Resident 7 required supervision with eating. The MDS indicated Resident 7 required dependent assistance from staff for sit to lying, bed to chair transfers, and lower body dressing. During a review of Resident 7's Order Summary Report dated 1/21/2026, the Order Summary Report indicated an order dated 9/11/2025 for RNA to perform PROM exercises on both upper extremities and both lower extremities once a day, five days a week as tolerated. During a review of Resident 7's Care Plan initiated on 9/11/2025, the Care Plan indicated Resident 7 was at risk for decline in ROM and strength in both UE. The Care Plan goal indicated Resident 7 will be able to maintain current ROM and strength in both UE. The Care Plan intervention indicated RNA to perform PROM exercises on both UE once a day five times a week as tolerated. During a review of Resident 7's Care Plan initiated on 9/11/2025, the Care Plan indicated Resident 7 was at risk for contracture on both [NAME] related to impaired mobility. The Care Plan goal indicated Resident 7 will have reduced risk/delay onset of contractures on both [NAME]. The Care Plan intervention indicated RNA to perform PROM exercises on both [NAME] once a day, five days a week as tolerated. During an observation and interview on 1/21/2026 at 1:43 p.m., Restorative Nursing Aide (RNA 1) performed RNA ROM exercises with Resident 7 in Resident 7's room. Resident 7 was lying in bed and RNA 1 was able to lift Resident 7's arm up and down to around shoulder level. Resident 7 was able to bend and straighten both elbows, wrists, and fingers. RNA 1 was able to bend both hips and knees about halfway and move both ankles up and down. During a concurrent interview and record review on1/22/2026 at 10:37 a.m., with the Director of Staff Development (DSD), Resident 7's December 2025 and January 2026 RNA DSR were reviewed. DSD stated if the RNA DSR was blank, it meant Resident 7 did not receive RNA treatment that day or the RNAs did not document any treatments for that day. DSD confirmed the RNA DSR was blank on 12/26/2025, 12/31/2025, and 1/19/2026. DSD stated one to two RNAs were staffed on those days. DSD stated if RNAs completed the RNA treatment, then RNAs should document each time an RNA treatment was completed right after the treatment or at least by the end of the shift. DSD stated it was important to document each treatment timely so that staff can know if the resident completed their RNA treatments and the resident's tolerance to the RNA treatment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 10 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0842 Level of Harm - Minimal harm or potential for actual harm During a concurrent interview and record review on 1/22/2026 at 1:58 p.m., with Restorative Nursing Aide (RNA 3), Resident 7's December 2025 RNA DSR were reviewed. RNA 3 confirmed RNA 3 completed ROM exercises with Resident 7 on 12/26/2025, 12/31/2025, but did not realize she did not document on Resident 7. RNA 3 stated she did not double check if the documentation was completed and should ensure that documentation was completed for each resident RNA 3 performed RNA treatment with. Residents Affected - Some During a concurrent interview and record review on 1/22/2026 at 2:24 p.m., with RNA 1, Resident 7's January 2026 RNA DSR was reviewed. RNA 1 stated she performed RNA PROM exercises with Resident 7 on 1/19/2026 but did not have time to complete the documentation because she was the only RNA working that day. RNA 1 stated she should document all RNA treatments by the end of the shift but stated she did not always have time to complete documentation. During an interview on 1/22/2026 at 3:34 p.m., the Director of Nursing (DON) stated all RNA staff were supposed to document each time they provide RNA treatment with a resident. DON stated it was important to document each time so that staff knew the job was completed and how the resident responded to the treatment or if the RNA treatment did not happen. DON stated RNA staff should be given time to complete documentation because it was important to document everything that was done for each resident. During a review of the facility's policies and procedures (P&P) titled, Documentation Policy, revised 1/2025, the P&P indicated it is the policy of this facility to document relevant findings in the clinical record. 4. During a review of Resident 1's admission Record , dated 1/22/2026, the admission record indicated Resident 1 was originally admitted to the facility on [DATE] with initial admission date of 8/19/2025 and readmission date as 10/23/2025 with diagnoses that included but not limited to unspecified dementia (a progressive state of decline in mental abilities), unspecified severity with mood disturbance, bipolar disorder, unspecified and depression (a mental disorder with depressed mood or loss of pleasure or interest in activities for long periods of time), unspecified. During a review of Resident 1's History and Physical, dated 11/4/2025, the document indicated Resident 1 had fluctuating capacity to understand and make decisions. During a review of Resident 1's MDS dated [DATE], the MDS indicated Resident 1's cognitive skills for daily decision making were severely impaired. The MDS indicated Resident 1 needed supervision or touching assistance from the facility staff for performing activities of daily living (ADLs – routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves) such as eating and oral hygiene, and was dependent for toileting hygiene, showering, upper body dressing, lower body dressing, putting on or taking off footwear and personal hygiene. During a review of Resident 1's Order Summary Report dated 1/22/2026, the order summary report indicated but not limited to the following physician order: Risperdal oral tablet 2 milligrams ([mg] a unit of measurement for mass), give 1 tablet by mouth at bedtime for Bipolar with psychotic features manifested by (m/b) kicking, inform consent obtained by doctor, from resident's daughter for the use of Risperdal, order date 10/23/2025, start date 10/24/2025. Monitor behavior manifested by (m/b) hitting staff and document number (no.) of episodes every shift, order date 10/23/2025, start date 10/23/2025. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 11 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0842 Monitor episodes of kicking every shift, order date 10/23/2025, start date 10/23/2025. Level of Harm - Minimal harm or potential for actual harm During a concurrent interview and record review on 1/22/2026 at 2:58 p.m. with Registered Nurse Supervisor (RNS) 1, Resident 1's Monthly Psychotropic Summary Sheet, dated 11/4/2025 to 11/30/2025 and 12/1/2025 to 12/31/2025, and informed consent, dated 12/5/2025 for Risperdal were reviewed. The psychotropic summary sheet indicated, Medication: Risperdal 2 mg PO (by mouth) QHS (every night at bedtime) and 1 mg PO QAM (every day in the morning), Behavioral manifestations: bipolar with psychotic features m/b kicking. The document indicated number of behavior episodes per shift, total episodes, adverse reactions, observation comments, date and the nurse's signature. The document indicated a section for dosage changes with the note, 12/5/2025: Decrease Risperdal 0.5 mg 1 tab PO (by mouth) daily, GDR (gradual dose reduction). RNS 1 stated there was a GDR for Resident 1's Risperdal to reduce to Risperdal 0.5 mg 1 tablet po (by mouth) daily. RNS 1 stated, this was an incorrect order. RNS 1 scratched the note by drawing a line over it, stated the note was documented for a wrong resident and that it was a typographical error because Resident 1 was still on Risperdal 2 mg, 1 tablet by mouth at bedtime. RNS 1 stated there was a risk that the inaccurate documentation could have led to change in dosage when Resident 1's behaviors did not indicate the dose should be lowered. RNS 1 then pointed out that the informed consent for Resident 1's Risperdal indicated Risperdal 0.5 mg, 1 tablet by mouth daily for psychotic features m/b kicking. RNS 1 stated the dose on informed consent was incorrectly documented. RNS 1 stated he would need to check with medical records if there were other facility residents on Risperdal. Residents Affected - Some During a concurrent interview and record review on 1/22/2026 at 3:37 p.m. with RNS 1 and Licensed Vocational Nurse (LVN) 2, LVN 2 stated there were no other residents who were supposed to be on Risperdal. LVN 2 stated there was a GDR. RNS 1 stated there was no GDR because he could not find a progress note from the physician. RNS 1 stated he would call Resident 1's psychiatrist or medical doctor (MD) 2 to verify current dose of Risperdal. RNS 1 stated the psychiatrist (MD 2) was not aware of any dose changes. LVN 2 stated it was Resident 1's primary physician (MD 1) who reduced Resident 1's Risperdal dose not the psychiatrist (MD 2). During an interview on 1/22/2026 at 3:44 p.m. with LVN 2 and RNS 1, LVN 2 stated she had requested a GDR from MD 1 during his evening visit to the facility on [DATE]. LVN 2 stated MD 1 reduced Resident 1's Risperdal from 1 mg every morning to 0.5 mg every morning and to continue Risperdal 2 mg at bedtime on 12/4/2025. LVN 2 stated Resident 1's Risperdal 0.5 mg every morning was discontinued on 1/9/2026 and Risperdal 2 mg daily at bedtime was continued as per physician's orders. RNS 1 and LVN 2 stated it caused a lot of confusion regarding Resident 1's Risperdal order because of missing documentation and lack of communication. RNS 1 stated the GDR note would not reflect accurate treatment for Resident 1. RNS 1 rewrote the note 12/5/2025: Decrease Risperdal 0.5 mg PO (by mouth) daily, GDR. During a concurrent interview and record review on 1/23/2026 at 10:34 a.m. with the Director of Nursing (DON), Resident 1's Monthly Psychotropic Summary Sheet, dated 11/4/2025 to 11/30/2025 and 12/1/2025 to 12/31/2025 was reviewed. The DON stated a psychiatrist (MD 2) would usually recommend GDR for residents taking psychotropic medications. The DON looked at the Psychotropic Summary Sheet and stated she was really confused and did not know what to say. The DON stated the orders would need to be transcribed in the electronic health record (EHR) first before being handwritten on Psychotropic Summary Sheet. The DON stated the nurses would not check the paper every day but they should check the EHR daily. The DON stated there should be one system that involved psychiatrist (MD 2) to change psychotropic medication doses for Resident 1 to avoid confusion. DON stated the licensed nursing staff should inform MD 2 if MD 1 changed psychotropic medication order. The DON stated she needed time to read through all progress notes because she could not figure out history of dose changes for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 12 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Resident 1's Risperdal and the handwritten transcription and order for Risperdal was very unclear and confusing. During a review of the facility's policy and procedure (P&P), titled Dignity and Respect Psychoactive Medications, dated 01/2025, the P&P indicated, Gradual Dose Reduction - The facility shall document evidence that a GDR has been attempted unless clinically contraindicated in the medical record. The P&P indicated, GDR Documentation – The medical record shall reflect the date the gradual dose reduction was attempted, the outcome of the dose reduction attempt, and the plan regarding future GDR attempts. Physician documentation should contain the rationale for why GDR attempts are clinically contraindicated for the resident. Event ID: Facility ID: 555706 If continuation sheet Page 13 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 ensure:Certified Nursing Assistant (CNA) 1 was wearing gloves when handling soiled linen.Clean linen carts were accessed only by facility staff.Staff performed hand hygiene after touching the trash can lid to open the trash receptacle.This failure had the potential to increase the risk of infection and cross-contamination (the transfer of bacteria, viruses, microorganisms, or other harmful substances from one surface to another through improper or unsanitary equipment, procedures, or products) among residents. Findings: Residents Affected - Few 1. During an observation on 1/20/2026 at 8:46 a.m. in room [ROOM NUMBER], CNA 1 was observed handling soiled linen without gloves. During an interview on 1/21/2026 at 1:15 p.m. with CNA 1, CNA 1 stated gloves should have been worn when handling the soiled linen. CNA 1 stated the importance of wearing gloves when handling soiled linen was to prevent the spread of infection to other residents. CNA 1 stated there would be an increased risk of infection that may result in other residents getting sick and placing their overall health at risk. During an interview on 1/22/2026 at 8:58 a.m. with Registered Nurse Supervisor (RNS) 1, RNS 1 stated it was important to wear gloves while handling soiled linen to prevent spread of bacteria or cross-contamination to other residents. RNS 1 stated if gloves were not worn and hand washing was not performed after handling soiled linen, there would be a risk for infection and the spread of bacteria to other residents. During a review of the facility policy and procedure (P&P) titled Personal Protective Equipment Gloves revised January 2025, indicated The purpose of this protocol is to provide guidelines for the appropriate use of gloves in the skilled nursing facility to reduce the risk of infection transmission and to protect resident and staff from exposure to blood, body fluids, and other potentially infectious materials.1. Gloves shall be worn when there is anticipated contact with blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated items. 2. During an observation on 1/20/2026 at 12:34 p.m. in hallway near room [ROOM NUMBER], a visitor was seen accessing linen from the clean linen cart without staff assistance. During an interview on 1/22/2026 at 8:55 a.m. with Certified Nursing Assistant (CNA) 5, CNA 5 stated clean linen carts should only be accessed by facility staff to prevent the spread of bacteria. CNA 5 stated if visitors were seen accessing clean linen carts without staff assistance there would be a risk for infection to other residents due to cross-contamination. During an interview on 1/22/2026 at 8:58 a.m. with Registered Nurse Supervisor (RNS) 1, RNS 1 stated the importance of staff assisting visitors to obtain linen from the clean linen cart was to prevent cross-contamination. RNS 1 stated residents may contract infection from linen that was potentially contaminated. During a review of the facility's policy and procedure (P&P) titled Linens revised January 2025, the P&P indicated .4. Laundry and nursing staff will use standard precautions and us PPE (personal protective equipment) while handling all soiled linen. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 14 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of the facility's policy and procedure (P&P) titled Linens revised January 2025, the P&P did not indicate a procedure for individuals who were designated to access clean linen carts. 3.During a concurrent observation and interview on 1/22/2026 at 11:34 a.m. with the Director of Food Services (DFS), kitchen staff, including the DFS, were observed washing their hands and then touching the trash can lid to dispose of trash. The DFS stated to avoid direct contact with the lid, staff use a clean paper towel to open the trash can; however, he stated this practice could lead to cross-contamination and increase the risk of staff recontamination their hands. The DFS stated that the hands-free trash can was recently broken and that a replacement has already been ordered. During an interview on 01/22/2026 at 2:18 p.m. with the Director of Nursing (DON), the DON stated she was not aware that the kitchen trash was not hands-free. The DON stated from an infection control perspective, the current situation poses a risk for staff to inadvertently contaminate their hands after washing their hands. During an interview on 01/22/2026 at 2:18 p.m., with the Director of Nursing (DON) , the DON states she was not aware that the kitchen trash can was not hand free but will follow up and get a new one. DON states for infection control, it is potential for staff to mistakenly get hands dirty again. During a review of the facility's policy and procedure (P&P) dated 01/2025, titled Hand Washing-Hand Hygiene, the P&P indicated This Facility considers hand hygiene the primary means to prevent the spread of infections. Personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel and residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555706 If continuation sheet Page 15 of 16 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 555706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Amo Gardens Care Center 22419 Kent Avenue 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain an effective pest control program to prevent the infestation of gnats (fruit flies: flying, winged insects) by not ensuring a sanitary environment for three of five residents (Residents 6, 22, and 69). This deficient practice had the potential to cause an increased risk of pest infestation, which could compromise infection control measures and negatively impact the health, safety, and well-being of 73 residents that reside in the facility. Findings:During a review of Resident 6's admission Record, the admission Record indicated Resident 6 was admitted to the facility on [DATE] with diagnoses including congestive heart failure (CHF- a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling) and diabetes mellitus (DM- a disorder characterized by difficulty in blood sugar control and poor wound healing).During a review of Resident 6's Minimum Data Set (MDS- a resident assessment tool) dated 12/6/2025, the MDS indicated Resident 6's cognition (ability to think, understand, learn, and remember) was severely impaired and required moderate assistance (helper does less than half the effort) with activities of daily living (ADLs- routine tasks/activities such as bathing, dressing, and toileting a person performs daily to care for themselves).During a review of Resident 22's admission Record, the admission Record indicated Resident 22 was admitted to the facility on [DATE] with diagnoses including dementia (a progressive state of decline in mental abilities) and immunodeficiency (the decreased ability of the body to fight infections and other diseases).During a review of Resident 22's MDS dated [DATE], the MDS indicated Resident 22's cognition was severely impaired and required maximal assistance with oral hygiene, toileting, and showering.During a review of Resident 69's admission Record, the admission Record indicated Resident 69 was admitted to the facility on [DATE] with diagnoses including atrial fibrillation (irregular heartbeat) and urinary tract infection (UTI- an infection in the bladder/urinary tract).During a review of Resident 69's MDS dated [DATE], the MDS indicated Resident 69's cognition was moderately impaired and required maximal assistance with ADLs.During an observation 1/20/2026 at 9:28 a.m., in Resident 22's room, three gnats were observed on Resident 22's pillow, a cord next to Resident 22's bed, and one flying around Resident 22's coffee mug.During an interview on 1/20/2026 at 9:57 a.m., with Resident 6, Resident 6 stated the care was great except for the gnats in his room. Resident 6 stated he notices the gnats every day and has told the staff about it. During a subsequent interview on 1/21/2026 at 8:56 a.m., with Resident 6, Resident 6 stated gnats were still present, stating, In fact, there is one flying around me right now. Resident 6 expressed concern that the gnats were unsanitary.During an interview on 1/22/2026 at 1:50 p.m., with Restorative Nurse Assistant (RNA) 2, RNA 2 stated she observed gnats while feeding a resident and the resident attempted to swat the gnat and hit herself in the face. RNA 2 stated the gnats could potentially land on the resident's food which was unsanitary.During an interview on 1/22/2026 at 2:12 p.m., with the Infection Prevention Nurse (IPN), IPN stated there has been an ongoing issue with gnats. IPN stated the gnats were not sanitary, especially if they land on residents' food.During an interview on 1/23/2026 at 11:19 a.m., with the Director of Nursing (DON), DON stated the gnats were unsanitary and could potentially land in the residents' food causing the residents to feel uncomfortable.During a review of the facility's policy and procedure (P&P) titled, Pest Control Program, dated 1/2025, the P&P indicated, To maintain a safe, sanitary environment that is free from insects, rodents, and other pests through an effective, integrated pest management program. Event ID: Facility ID: 555706 If continuation sheet Page 16 of 16