Health inspection·September 19, 2023

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 9/7/23 at 1402 hours, an interview and concurrent observation was conducted with Resident 2. Resident 2 was in bed, wearing a religious pendant around their neck. Resident 2 stated they had not had activities in a while since the former Activities Director was at the facility. Resident 2 stated they did not get up and go out of their room anymore and would enjoy getting up in a chair. Resident 2 stated the religious activities were very important to him and they had not had any since the former Activities Director left. When asked how the lack of activities made the resident feel, Resident 2 replied they felt very lonely as the staff were busy and did not have time for personal relationships with him like the former Activities Director did. An 8.5x11 paper activity calendar for July 2023 was observed posted on the cork board across from the resident's bed, and no update activity calendar was observed. On 9/8/23 at 1113 hours, an observation of the facility's activity room was conducted. An 8.5x11 paper activity calendar for July 2023 was posted on the dry-erase board. No recent calendars were found in the activity room or around the facility. On 9/13/23 at 1132 hours, an interview was conducted with CNA 2. When asked who was doing the activities with the residents since the former Activity Director had left their position, CNA 2 replied no one. CNA 2 stated there were no 1:1 activity room visits or group activities. CNA 2 stated they used to get the residents up routinely in their wheelchairs or geri-chairs for activities, but not anymore since they had not been having any activities. Now, only a few residents got up in their chairs, and that was when their families were visiting. On 9/13/23 at 1136 hours, an interview was conducted with LVN 1. When asked who was doing the activities with the residents, LVN 1 replied the former Activity Director used to do room visits, play movies, and read books to the residents, but she had been gone for a few months. LVN 2 stated they had not seen any activities being conducted with the residents since the former Activity Director left. On 9/13/23 at 1142 hours, an interview was conducted with LVN 2. When asked what activities were being done for the resident, LVN 2 replied none since the former Activity Director left. On 9/13/23 at 1312 hours, an interview was conducted with the Subacute Unit Director. The Subacute Unit Director stated the former Activity Director's last day at the facility was 7/13/23, and that was why the posted activity calendars were from July 2023. The Subacute Unit Director stated they were actively trying to hire a new director. When asked about religious activities, the Subacute Unit Director stated there was a chaplain who came every one to two weeks though he was out for a bit after the former Activity Director had left. He was recently here for the resident visits, but the visits were not documented. When asked to show documentation that any activities were provided to the residents since the former Activity Director left, the Subacute Unit Director stated there were no records. On 9/13/23 at 1445 hours, a follow-up interview was conducted with the Subacute Unit Director. When asked which resident had the activity orders, the Subacute Unit Director stated all of their 23 residents should have the activity orders. Review of the physician's orders for Residents'2, A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, and V showed the orders for the residents to participate in the activity programs. On 9/20/23 at 0918 hours, a telephone interview was conducted with the Chaplain. When asked what type of visits the Chaplain had conducted after the facility's former Activity Director left on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555709 If continuation sheet Page 2 of 3 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 555709 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chapman Global Medical Center D/P Snf 2601 East Chapman Avenue Orange, CA 92869 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 0679 Level of Harm - Minimal harm or potential for actual harm 7/13/23, the Chaplain stated he stopped the resident visits there when the Director left and was going to resume once the facility hired a new Director. The Chaplain stated in August or early September 2023, he stopped by the facility, and they still did not have an Activity Director. The Chaplain stated they did not do any resident visits at that time. The Chaplain stated he went to the facility last week on 9/14/23, and did the resident visits for the first time since the former Activity Director left. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555709 If continuation sheet Page 3 of 3