Health inspection·July 24, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some CNA 6 stated CNA 6 told Resident 119 to go the bathroom in the brief and CNA 6 will change the brief after. During a concurrent interview and record review on 7/24/2025 at 11:42 am with Licensed Vocational Nurse 5 (LVN 5), Resident 119's MDS dated [DATE] and Bowel and Bladder Assessment (BBA) dated 6/20/2025 were reviewed. LVN 5 stated Resident 119 was occasionally incontinent which meant sometimes Resident 119 was able to hold Resident 119's bowel and bladder and sometimes Resident 119 could not. LVN 5 stated Resident 119 wants to get up all the time to go to the bathroom but was only walking with during physical therapy, and to be safe, a brief was kept on Resident 119. LVN 5 stated it was not a good feeling to be told to go to the bathroom in Resident 119's brief because Resident 119's independence could be hindered. LVN 5 stated this was a dignity issue and could also put Resident 119 at risk for skin breakdown or infection. During an interview on 7/24/2025 at 4:02 pm, with the Director of Nursing (DON), the DON stated it was not acceptable to tell residents who were occasionally incontinent to go to the bathroom in their brief. The DON stated staff needed to either get residents up to go to the toilet, commode, or offer a bed pan (device used as a container for the urine and/or feces of a person who is confined to a bed and therefore not able to use a toilet). The DON stated telling the resident to go to the bathroom in their brief and wait to be changed after, would impact the resident's self-esteem in a negative way, causing issues with dignity, and could offend the resident. During a review of the facility's P&P titled, Resident Rights, revised 3/2025, the P&P indicated employees shall treat all residents with kindness, respect, and dignity. The P&P indicated federal and state laws guarantee certain basic rights to all residents of this facility. The P&P indicated the resident rights included the right to: a dignified existence, be treated with respect, kindness, and dignity, participate in decision-making regarding his or her care, and be informed of, participate in, his or her care planning and treatment. b. During a review of Resident 10's AR, the AR indicated Resident 10 was initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included multiple sclerosis (disease that affects the brain and nerves causing weakness and problems with movement), protein calorie malnutrition (a condition resulting from insufficient intake of both protein and calories), adult failure to thrive (a decline in older adults characterized by weight loss, decreased appetite, and reduced physical activity, often accompanied by cognitive [mental process involved in knowing, learning, and understanding things] and functional decline), major depressive disorder (a serious mental health condition characterized by persistent feelings of sadness, loss of interest, and a reduced ability to function in daily life) and monoplegia of lower limb (paralysis or weakness affecting the legs) affecting unspecified side. During a review of Resident 10's History and Physical (H&P) dated 5/06/2025, the H&P indicated Resident 10 had the capacity to understand and make decisions. The H&P indicated Resident 10 was at risk for malnutrition, weight loss and falls. During a review of Resident 10's Minimum Data Set (MDS- a resident assessment tool), dated 6/20/2025, the MDS indicated Resident 10 needed substantial/maximal assistance (helper does more than half the effort) from staff with eating, oral hygiene, upper and lower body dressing and personal hygiene. The MDS indicated Resident 10 was dependent (helper does all of the effort) on staff for toileting hygiene, shower, and putting off footwear. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 2 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 10's untitled Care Plan (CP) initiated on 1/13/2025, the CP indicated Resident 10 was at risk for social isolation and ineffective coping. The CP interventions indicated for staff to talk to Resident 10 in a calm and non-threatening manner. During a review of Resident 10's untitled CP initiated on 1/23/2025, the CP indicated Resident 10 had little interest or pleasure in doing things, feeling down, depressed or hopeless. The CP interventions indicated for staff to allow Resident 10 to vent feelings and provide a safe environment. During an observation in Resident 10's room on 7/21/2025 at 1:13 PM, Resident 10 was resting in bed. Certified Nurse Assistant 2 (CNA 2) placed the lunch tray on top of Resident 10's side table. As CNA 2 was walking out of Resident 10's room, CNA 2 stated CNA 2 was serving out trays for the feeders (Term feeder can be considered dehumanizing and often discouraged in favor of more respectful language like residents needing feeding assistance or patients requiring assisted feeding). During an interview with CNA 2 on 7/21/2025 at 1:14 PM, CNA 2 stated it was not OK to refer a resident as a feeder because it could affect their dignity. CNA 2 stated labeling the residents as feeders could result in negative emotions such as feeling upset or sad. CNA 2 stated calling a resident a feeder could potentially result in depression or trigger emotional distress. CNA 2 stated, calling a resident a feeder could make them feel degraded. During an interview with Resident 10 on 07/23/2025 at 3:14 PM, Resident 10 stated Resident 10 overheard outside Resident 10's doorway when staff stated they were going to assist the feeders. Resident 10 stated Resident 10 did not like the way the word feeder sounded as it made Resident 10 feel bad because Resident 10 was not able to feed self and needed staff's assistance. Resident 10 stated hearing the staff say the word feeder just reminded her of how useless she had become. During an interview with the Director of Nursing (DON) on 07/24/2025 at 1:06 PM, the DON stated, it was not acceptable to use the word feeder when staff were assigned to a resident who needed assistance with eating. The DON stated the residents' dignity would be affected if staff refer to them as feeder. The DON stated residents could get offended or upset if staff refer to them as feeders. c. During a review of Resident 75's AR, the AR indicated Resident 75 was admitted to the facility on [DATE], with diagnoses that included gastrostomy (creation of an artificial external opening into the stomach for nutritional support), unspecified dementia (long term and often gradual decrease in the ability to think and remember severe enough to affect a person's daily functioning) and essential hypertension (high blood pressure). During a review of Resident 75's MDS dated [DATE], the MDS indicated Resident 75 had severely impaired cognition for daily decision making. The MDS indicated Resident 75 was dependent on staff for oral hygiene, toileting, showering/bathing self, lower body dressing, putting on/taking off footwear, and personal hygiene. During a review of Resident 75's Order Summary Report (OSR) dated 7/10/2025, the OSR indicated for staff to administer Diabetisource (liquid formula used for G-tube feeding) at 55 milliliter per hour (ml/hr.- unit of measurement) for 20 hours via (through) enteral feeding pump for a total of 1,320 ml per 1,100 kilo calories (kcal, unit of energy) in 24 hours (Pump on at 12 pm and pump off at 8 am if dose was completed). During an observation on 7/21/2025 at 9:01 am with the Director of Staff and Development (DSD), in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 3 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident 75's room. Resident 75 was awake, lying in bed. The DSD pulled the privacy curtain to check Resident 75's G-tube site. The DSD was unable to close the privacy curtain completely leaving approximately 4 feet and 6 inches gap from the wall. The DSD pulled up Resident 75's gown exposing Resident 75's abdominal area to Resident 75's roommate and the hallway. During an interview on 7/21/2025 at 9:04 am with the DSD, the DSD stated the DSD pulled up Resident 75's gown to check Resident 75's G-tube site and was unable to close the privacy curtain with 4 feet and 6 inches gap from the wall exposing Resident 75's body parts to the resident's roommate and passersby. The DSD stated the privacy curtain needed to be closed completely prior to providing care and treatment to the residents to provide privacy. During a concurrent interview on 7/23/2025 at 9:31 am with the DON, the DON stated, the resident's privacy curtain needed to be closed completely to provide privacy and dignity to the resident while staff provided care. The DON stated the residents' body parts should not be exposed during care and treatment. During a review of the facility's Policy and Procedure (P&P) titled, Resident Rights, revised 3/2025, the P&P indicated employees shall treat all residents with kindness, respect, and dignity. During a review of the facility's P&P titled, Quality of Life-Dignity, revised 2/2020, the P&P indicated each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, feeling of self-worth and self-esteem. Staff speak respectfully to residents at all times, including addressing the resident by his or her name of choice and not labeling or referring to the resident by his or her room number, diagnosis, or care needs. During a review of the facility's P&P titled, Dining/Assistance with Meals, revised 7/2017, the P&P indicated residents shall receive assistance with meals in a manner that meets the individual needs of each resident. c. Avoiding the use of labels when referring to residents (e.g., feeders). During a review of the facility's P&P titled, Dignity/Privacy, revised 8/2009, the P&P indicated staff shall promote, maintain and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 4 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure Certified Nursing Assistant 3 (CNA 3) fed one of one sampled resident (Resident 40) in a respectful manner by not standing over the resident while assisting with eating during a meal. This deficient practice had the potential for Resident 40 to have decreased feelings of self-worth. Findings: During a review of Resident 40's admission Record (AR), the AR indicated Resident 40 was admitted to the facility on [DATE] with diagnoses that included pneumonia (an infection/inflammation in the lungs), hypoxemia (low level of oxygen in the blood) and dysphagia (difficulty swallowing). During a review of Resident 40s Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 5/29/2025, the MDS indicated, Resident 40 had moderately intact cognition (mental action or process of acquiring knowledge and understanding) for daily decision making. The MDS indicated, Resident 40 was dependent (helper did all the effort and lifted or held trunk or limbs) to staff for eating, oral hygiene, toileting, shower, upper/lower body dressing and putting on/off footwear and personal hygiene. During a dining observation on 7/21/2025 at 1:33 pm while in Resident 40's room, Certified Nursing Assistant 3 (CNA 3) was observed standing over next to Resident 40's bed while feeding the resident. The CNA 3 stated, Resident 40 needed assistance during meals. The CNA 3 stated she should sit when feeding Resident 40. During an interview on 7/21/2025 at 1:41 pm, with the Director of Staff and Development (DSD), the DSD stated, CNA 3 needed to sit down and maintain eye contact with Resident 40 while assisting meals to provide respect. During an interview on 7/23/2025 at 10:48 am with Registered Nurse 1 (RN 1), RN 1 stated staff needed to sit down in a chair while feeding the residents to give attention and to provide residents with dignity during mealtime. During a review of the facility's P&P titled, Dining/Assistance with Meals, revised on 7/2017, the P&P indicated dining room residents: residents who cannot feed themselves will be fed with attention to safety, comfort and dignity: not standing over residents while assisting them with meals. Event ID: Facility ID: 555729 If continuation sheet Page 5 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0558 Reasonably accommodate the needs and preferences of each resident. 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 the residents' call light (a device used by patients to call for assistance from hospital staff) was within reach (an arm's length) of four of four sampled residents (Residents 10, 29,114 and 118).These deficient practices had the potential to result in delayed provision of necessary care and services for Residents 10, 29,114 and 118.Findings: Residents Affected - Some a. During a review of Resident 10's admission Record (AR), the AR indicated Resident 10 was initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included multiple sclerosis (disease that affects the brain and nerves causing weakness and problems with movement), protein calorie malnutrition (a condition resulting from insufficient intake of both protein and calories), adult failure to thrive (a decline in older adults characterized by weight loss, decreased appetite, and reduced physical activity, often accompanied by cognitive [mental process involved in knowing, learning, and understanding things] and functional decline), major depressive disorder (a serious mental health condition characterized by persistent feelings of sadness, loss of interest, and a reduced ability to function in daily life) and monoplegia of lower limb (paralysis or weakness affecting the legs) affecting unspecified side. During a review of Resident 10's History and Physical (H&P) dated 5/06/2025, the H&P indicated Resident 10 had the capacity to understand and make decisions. The H&P indicated Resident 10 was at risk for malnutrition, weight loss and falls. During a review of Resident 10's Minimum Data Set (MDS- a resident assessment tool), dated 6/20/2025, the MDS indicated Resident 10 needed substantial/maximal assistance (helper does more than half the effort) from staff with eating, oral hygiene, upper and lower body dressing and personal hygiene. The MDS indicated Resident 10 was dependent (helper does all of the effort) on staff for toileting hygiene, shower, and putting off footwear. During a review of Resident 10's Care Plan (CP) initiated on 11/11/2024 and revised on 6/16/2024, the CP indicated Resident 10 was at risk for fall and injury due to impaired function (a reduction or loss of an individual's ability to perform daily tasks and activities), bowel/bladder dysfunction (problems with the body's ability to control urination and bowel movements), decreased strength/endurance, weakness/fatigue and lack of coordination. During a review of Resident 10's CP initiated on 1/17/2025 and revised on 6/16/2025, the CP indicated Resident 10 was at risk for falls secondary to debilitated state due to multiple sclerosis. The CP intervention indicated for staff to answer the call light in a timely manner, encouraging the resident to call for assistance and to keep call light and bed controls within easy reach. b. During a review of Resident 118's AR, the AR indicated Resident 118 was initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses including metabolic encephalopathy (a condition where the brain function is impaired), dysphagia (difficulty swallowing), cognitive communication deficit (difficulties with communication) and muscle weakness. During a review of Resident 118's H&P dated 4/30/2025, the H&P indicated Resident 118 does not have the capacity to understand and make decisions. The H&P indicated Resident 118 was at risk for falls. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 6 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0558 Level of Harm - Minimal harm or potential for actual harm During a review of Resident 118's MDS dated [DATE], the MDS indicated Resident 118 required substantial/maximal assistance (helper does more than half the effort) from the staff for the activities of daily living such as eating, oral hygiene, and upper body dressing. The MDS indicated Resident 118 was dependent (helper does all of the effort) on staff for toileting hygiene, shower, lower body dressing, putting off footwear and personal hygiene. Residents Affected - Some During a review of Resident 118's CP initiated on 4/20/2025 and revised on 7/23/2025, the CP indicated Resident 118 had alteration in physical functioning due to adult failure to thrive. The CP interventions indicated for staff to place the call light and frequently used items within reach and answer the call light promptly. During a review of Resident 118's CP initiated on 5/29/2025 and revised on 7/23/2025, the CP indicated Resident 118 was at risk for falls & injuries related to bowel/bladder incontinence and contractures. The CP interventions indicated for staff to keep the call light within reach. During a review of Resident 118's CP initiated on 5/29/2025 and revised on 7/23/2025, the CP indicated Resident 118 required the use of bilateral grab bar when in bed for mobility and transferring to improve functional ability due to generalized weakness. The CP intervention indicated for staff to keep the call light within easy reach and answer promptly. During an observation of Resident 10's room and interview on 7/21/2025 at 11:09 AM, Resident 10 was resting in bed and the call light was not placed within Resident 10's reach. Resident 10's call light was on the floor and the cord was hanging from the right side of the bed. Resident 10 stated Resident 10 would not be able to reach the call light if Resident 10 needed assistance and Resident 10 did not feel safe. Resident 10 stated Resident 10 would have to wait until someone came in to check on Resident 10 in case Resident 10 needed assistance. During an observation of Resident 118's room and interview on 7/21/2025 at 11:06 AM, Resident 118 was resting in bed and the call light was not within the resident's reach. Resident 118's call light was located on the left top of bed by the pillow. Resident 118 stated Resident 118 could not reach the call light. Resident 118 stated, I can't see it, I can't reach it. I guess if I need help I usually just yell. During concurrent observation of Resident 118's room on 7/21/2025 at 12:16 PM, Resident 118's call light was under multiple blankets under Resident 118's left arm. Resident 118 stated Resident 118 did not know where the call light was and could not find it under all the blankets. During an interview with CNA2 on 7/22/2025 at 8:15 AM, CNA2 stated it was important to answer the call light immediately and to ensure the call light was within reach to use if assistance was needed. CNA 2 stated if the call light was not within reach, residents would get up on their own and could fall. CNA 2 stated, if the call light was on the floor, the call light was not within reach. CNA 2 stated a call light placed by the resident's head was also not within reach. During an interview with the Director of Nursing on 7/24/2025 at 1:33 PM, the DON stated it was not acceptable for a resident's call light to be out of reach because the resident was supposed to be able to call for assistance if they need help. The DON stated if a resident can't use the call light, it can potentially cause the resident harm by not alerting the staff that the resident needed help. The DON stated the resident could suffer a fall and get hurt. The DON stated if a resident had contractures or was unable to use regular button call light, the facility should provide a touch call (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 7 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0558 light that was sensor based which makes it easier for a resident to use. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's Policy and Procedure (P&P) titled Call Light, revised 10/2010, the P&P indicated, The purpose of this procedure is to respond to the resident's requests and needs. Residents Affected - Some During a review of the facility's undated P&P titled, Call System, Residents, the P&P indicated Residents are provided with a means to call staff for assistance through a communication system that directly calls a staff member or a centralized workstation. The P&P indicated if the resident has disability that prevents him/her from making use of the call system, an alternative means of communication that is usable for the resident is provided and documented in the care plan. During a review of the facility's P&P titled, Accommodation of Needs, revised 3/2021, the P&P indicated the facility's environment and staff behaviors are directed toward assisting the resident in maintaining and/or achieving safe independent functioning, dignity and well-being. I. The residents' individual needs and preferences are accommodated to the extent possible, except when the health and safety of the individual or other residents would be endangered. 2. The residents' individual needs and preferences, including the need for adaptive devices and modifications to the physical environment, are evaluated upon admission and reviewed on an ongoing basis. c. During a review of Resident 114's AR, the AR indicated Resident 114 was admitted to the facility on [DATE] with diagnoses that included hemiplegia (paralysis of one side of the body) and hemiparesis (muscular weakness of one half of the body), muscle weakness and lack of coordination. During a review of Resident 114's untitled CP dated 3/3/2025, the CP indicated Resident 114 was at risk for fall and injury due to impaired cognition and unsteady balance and gait (a person's manner of walking). The CP intervention indicated for the nursing staff placed Resident 114's call light within reach on the dominant side. During a review of Resident 114's Fall Risk Assessment (FRA- method of assessing a patient's likelihood of falling) dated 5/22/2025, the FRA indicated Resident 114 was assessed as high risk for falls due to Resident 114 being chairbound, had poor vision and presence of predisposing disease condition. During a review of Resident 114's MDS dated [DATE], the MDS indicated Resident 114 had severely impaired cognition for daily decision making. The MDS indicated Resident 114 was dependent to staff for oral hygiene, toileting, shower, upper/lower body dressing and putting on/off footwear and personal hygiene. During an observation on 7/21/2025 at 8:42 am, Resident 114 was asleep in bed. During a concurrent observation and interview on 7/21/2025 at 8:46 am with the Director of Staff and Development (DSD), Resident 114's call light was observed on the floor, and not within Resident 114's reach. The DSD stated Resident 114's call light needed to be within reach by the resident to call staff for help or assistance in case of emergency. The DSD stated Resident 114 was high risk for fall. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 8 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some d. During a review of Resident 29's AR, the AR indicated Resident 29 was admitted to the facility on [DATE] with diagnoses that included muscle weakness, bone disorder and abnormalities of gait and mobility (the ability to move). During a review of Resident 29's untitled CP dated 2/20/2025, the CP indicated Resident 29 was at risk for fall and injury due to impaired communication and unsteady balance and gait. The CP intervention indicated for the nursing staff placed Resident 114's call light within reach on the resident's dominant side. During a review of Resident 29's MDS dated [DATE], the MDS indicated Resident 29 had intact cognition for daily decision making. The MDS indicated Resident 29 needed supervision from staff for shower. The MDS indicated Resident 29 needed setup (helper sets up) from staff for eating, oral hygiene, toileting, upper/lower body dressing and putting on/off footwear. During a review of Resident 29's FRA dated 5/14/2025, the FRA indicated Resident 29 was assessed as at risk for falls due to Resident 29 taking one to two medications. During an observation on 7/21/2025 at 8:52 am, Resident 29 was awake, lying in bed and Resident 29's call light was hanging on the right bed side rails. During a concurrent interview on 7/21/2025 at 8:55 am with Resident 29, Resident 29 stated I could not find my call button. Can you please help me find it. During an interview on 7/23/2025 at 10:45 am with Registered Nurse 1 (RN1), RN 1 stated resident's call light needed to be within reach at all times for staff to meet the resident's needs. RN 1 stated, the call light needed to be within reach for the resident to use to call for assistance from the staff to maintain resident's safety. During a review of the facility's P&P titled, Call Light, revised on 10/2010, the P&P indicated when the resident is in bed or confined to a chair, ensure the call light is within easy reach of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 9 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure Resident 11's target behavior and adverse side effects (unwanted or undesirable effect) was monitored for the use of Alprazolam (antianxiety medication to treat anxiety [group of mental disorders characterized by feelings of anxiety [an unpleasant state of inner turmoil] and fear]) for one of five sampled residents (Resident 11) as indicated in the facility's policy Behavioral Assessment, Management, Psychoactive Medications and Monitoring and Resident 11's care plan. This deficient practice had the potential to result in the use of unnecessary psychotropic drug, which may result in significant adverse (harmful) consequences to Resident 11. Findings: During a review of Resident 11's admission Record (AR), the AR indicated Resident 11 was admitted to the facility on [DATE] with diagnoses that included anxiety disorder (group of mental disorders characterized by feelings of anxiety [an unpleasant state of inner turmoil] and fear]) and PTSD. During a review of Resident 11's Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 5/14/2025, the MDS indicated, Resident 11 had moderate cognition (mental action or process of acquiring knowledge and understanding) for daily decision making. The MDS indicated Resident 11 was dependent (helper did all the effort and lifted or held trunk or limbs) to staff for oral hygiene, toileting hygiene, shower, upper and lower body dressing, putting on/taking off footwear and personal hygiene. The MDS indicated Resident 11 had an active diagnosis of PTSD.During a review of Resident 11's Physician Order (PO) dated 7/22/2025, the order summary report indicated to administer Alprazolam 0.5 milligram (mg, unit of measurement), two (2) tablets by mouth every four (4) hours as needed for anxiety manifested by thrashing back and forth in bed for 14 days. During a concurrent interview and record review on 7/23/2025 at 10:25 am with Registered Nurse 1 (RN 1) of Resident 11's medical record in PointClickCare (PCC, a cloud-based software used in long-term and post-acute care facilities), there was no documented monitoring for Resident 11's target behavior for anxiety manifested by thrashing back and forth in bed since 7/22/2025. RN 1 stated, Resident 11's Alprazolam's side effects were not monitored since 7/22/2025. RN 1 stated it was important to monitor the target behavior of the residents to know if the medication was effective or not. RN 1 stated target behavior and medication side effects needed to be monitored every shift since July 22, 2025. During an interview on 7/24/2025 at 11:23 am with the facility's Director of Nurses (DON), the facility DON stated target behavior and medication side effects needed to be monitored and documented every shift to know if the medication was effective or not. During a review of the facility's policy and procedure (P&P) titled Behavioral Assessment, Management, Psychoactive Medications and Monitoring, revised 5/2024, the P&P indicated, the nursing staff will identify, document and inform physician about specific details regarding changes in an individual's mental status, behavior and cognition including the onset, duration, intensity and frequency of behavioral symptoms. The P&P indicated the Interdisciplinary team (IDT) will monitor the progress of individuals with behavior until stable. The P&P indicated the nursing staff, IDT, and the physician will monitor for side effects and complications related to psychoactive medications. Event ID: Facility ID: 555729 If continuation sheet Page 10 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop an individualized/person-centered care plan for one of one sampled resident (Resident 11). The facility did not address Resident 11's Post-Traumatic Stress Disorder (PTSD- when a person keeps feeling scared/anxious long after a traumatic event was over) in accordance with facility's Policy and Procedure (P&P) titled Comprehensive Person - Centered Care Planning.This deficient practice had the potential for Resident 11 to not receive necessary care and/or services to address Resident 11's specific needs.Findings:During a review of Resident 11's admission Record (AR), the AR indicated Resident 11 was admitted to the facility on [DATE] with diagnoses that included anxiety disorder (group of mental disorders characterized by feelings of anxiety [an unpleasant state of inner turmoil] and fear]) and PTSD.During a review of Resident 11's Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 5/14/2025, the MDS indicated Resident 11 had moderate impaired cognition (mental action or process of acquiring knowledge and understanding) for daily decision making. The MDS indicated Resident 11 was dependent (helper did all the effort and lifted or held trunk or limbs) to staff for oral hygiene, toileting hygiene, shower, upper and lower body dressing, putting on/taking off footwear and personal hygiene. The MDS indicated Resident 11 had an active diagnosis of PTSD.During an interview and concurrent record review on 7/22/2025 at 11:12 am, with the Social Services Director (SSD) of Resident 11's medical records (PointClickCare - PCC, a cloud-based software used in long-term and post-acute care facilities and chart), the SSD stated the there was no clinical documentation that a CP was initiated to address Resident 11's PTSD. The SSD stated, CP for PTSD should have been initiated and implemented by the SSD upon admission.During an interview on 7/24/2025 at 11:20 am with the facility's Director of Nursing (DON), the DON stated a comprehensive care plan and treatment to the residents was needed.During a review of the facility's Policy and Procedure (P&P) titled, Comprehensive Person - Centered Care Planning, revised 1/2025, the P&P indicated the facility's interdisciplinary team (IDT) shall develop a comprehensive p[person centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. The P&P indicated the facility will develop and implement a comprehensive person-centered care plan for each resident within seven (7) days of completion of the Resident Minimum Data Set (MDS) and will include residents needs identified in the comprehensive assessment. Event ID: Facility ID: 555729 If continuation sheet Page 11 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based observation, interview, and record review the facility failed to ensure one of two sampled residents (Resident 7) was provided a communication device with the language that the resident understood in accordance to facility's policy Communication with Persons with Limited English Proficiency.This deficient practice had the potential result in Resident 7 to not be able to express their needs and receive the necessary care and services. Findings: During a review of Resident 7's admission Record (AR) indicated Resident 7 was admitted to the facility on [DATE] with diagnoses that included type 2 diabetes mellitus (a disease in which the body's ability to produce or respond to the hormone insulin is impaired, resulting in elevated levels of glucose/sugar in the blood and urine), chronic kidney disease (CKD, is a progressive condition where the kidneys gradually lose their ability to filter waste and excess fluid from the blood) and muscle weakness. During a review of Resident 7's Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 6/20/2025, the MDS indicated, Resident 7 preferred English and did not need or want an interpreter to communicate with a doctor or a healthcare staff. The MDS indicated Resident 7 had severe cognition (mental action or process of acquiring knowledge and understanding) for daily decision making. The MDS indicated, Resident 7 was dependent (helper did all the effort and lifted or held trunk or limbs) to staff for oral hygiene, toileting hygiene, shower, upper and lower body dressing, and putting on/taking off footwear. During a concurrent observation and interview on 7/21/2025 at 10:12 am, together with Director of Staff and Development (DSD), Resident 7 was awake lying in bed, talking on her own dialect. Observed no communication tool at bedside. The DSD stated, she was not able to understand what Resident 7 stated. The DSD stated there was no hotline to call for language translation. The DSD stated there was no communication tool at bedside and a language translator to call. The DSD stated, the facility called the Resident 7's daughter if the resident needed anything to translate. During a concurrent observation and interview on 7/21/2025 at 10:17 am with Certified Nurse Assistant 4 (CNA 4), observe Resident 7 talking on her own language. The CNA 4 stated he could not understand what Resident 7 was trying to say. The CNA 4 stated, there was no communication tool at bedside and there was no hotline to call for language translation. During an interview on 7/22/2025 at 3:16 pm with Licensed Vocational Nurse 4 (LVN 4), the LVN 4 stated Resident 7 spoke her own language. The LVN 4 stated, she called Resident 7's daughter if she could not understand what Resident 7 was trying to say. The LVN 4 stated she had not used any language translator through phone. During an interview on 7/22/2025 at 3:44 pm with the Responsible Party 1 (RP 1), the RP 1 stated, Resident 7 spoke broken English language and could answer a simple yes or no. The RP 1 stated, Resident 7 could not express herself in English language. The RP 1 stated, Resident 7 needed a translator for the staff to know her needs. During an interview on 7/22/2025 at 3:54 pm with the Responsible Party 2 (RP 2), the RP 2 stated, it would be nice if the facility could have a language interpreter to understand Resident 7's concern because English was not her primary language and Resident 7 could not express herself in English. During an interview on 7/23/2025 at 9:32 am with the facility's Director of Nursing (DON), the facility DON stated, Resident 7 could not express herself in English. The [NAME] stated communication tool was needed to be at Resident 7's bedside and needed to be accessible for Resident 7 to use to communicate with the staff. The facility DON stated Nurses needed to know how to use the language translation hotline and ensure that staff understood residents to meet the residents needs. During a record review of the facility's policy and procedure (P&P) titled, Communication with Persons with Limited English Proficiency revised 6/2024, the P&P indicated to ensure meaningful communication with Limited English Proficiency Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 12 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete residents and their authorized representatives involving care, medical conditions, and treatment. The P&P indicated language assistance will be provided through the use of bilingual staff, interpreters, use of ALTA (Telephone Interpreter on Demand) and a communication board. The P&P indication communication board will have pictures translated in English and native language of the resident. The P&P indicated all staff will be provided with notice of this policy and procedure, and staff that may have direct contact with LEP individuals will be trained in effective communication techniques, including the effective use of an interpreter. Event ID: Facility ID: 555729 If continuation sheet Page 13 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 Based on interview and record review, the facility failed to minimize the risk for edema (a condition characterized by the swelling of body tissues due to an excessive buildup of fluid) to the legs and feet for one of one sampled resident (Resident 136), according to the facility's policy and procedure (P&P) titled, Applying Anti-Emboli (the blockage of a blood vessel by a substance [embolus] that has moved from another part of the body) Stockings (thrombo-embolic deterrent [TED- also known as anti-embolism stockings, are a type of medical compression stocking designed to prevent blood clots and swelling in the legs] Hose), by failing to: Ensure Resident 136's TED hose was applied nightly starting 7/17/2025 as ordered by Resident 136's physician. As a result of this failure, Resident 136 did not get TED hose applied to Resident 136's left leg and thigh for eight days. This failure had the potential for Resident 136 to develop increased edema and related complications. Findings: During a review of Resident 136's admission Record (AR), the AR indicated the facility admitted Resident 136 on 5/14/2025 with diagnoses that included polycythemia vera (PV- a rare, chronic blood cancer [abnormal cells] characterized by the overproduction of red blood cells, in the bone marrow [soft tissue in bone], leading to increased blood thickness and potential complications like blood clots), unspecified chronic kidney disease (CKD- damage to the kidneys so they cannot filter blood the way they should) stage three, and type II diabetes mellitus (DM2- A condition that happens because of a problem in the way the body regulates and uses sugar as fuel). During a review of Resident 136's untitled care plan (CP) initiated 5/15/2025, the CP indicated Resident 136 had the potential for skin breakdown related to plus three (+3- the amount of edema assessed) edema in bilateral (both) lower extremities. The CP goals indicated Resident 136 would not have any skin breakdown by the next review date. The CP interventions included to initiate treatment as per physician's orders. During a review of Resident 136's Minimum Data Set (MDS- a resident assessment tool) dated 5/17/2025, the MDS indicated Resident 136 had moderately impaired cognition (ability to think, remember, and reason). The MDS indicated Resident 136 required partial/moderate assistance (helper does less than half the effort and lifts or holds trunk or limbs but provides less than half the effort) with lower body dressing, sitting to lying (in bed), lying to sitting on side of bed, sitting to standing, and walking 10 feet. During a review of Resident 136's Order Summary Report (OSR), active as of 7/24/2025, the OSR indicated Resident 136's physician ordered Resident 136 may have TED hose- thigh high to be worn nightly on the left lower extremity (left leg) due to lymphedema (a condition characterized by swelling, usually in the arms or legs, due to a buildup of lymphatic fluid) at bedtime for lymphedema. The OSR indicated the order date and start date were 7/17/2025. During a review of Resident 136's Medication Administration Record (MAR- a report that serves as a legal record of the medications administered to a resident) dated 7/2025, the MAR did not indicate Resident's 136 order dated 7/17/2025 to apply TED hose to Resident 136's left leg nightly. During an interview on 7/24/2025 at 11:24 am, with Resident 136, Resident 136 stated, I am supposed to be using TED hose on the on the left leg at night. Resident 136 stated, No one is putting them on me. Resident 136 stated Resident 136 had been at the facility for at least a month and still hadn't been applied TED hose at night. During a concurrent interview and record review on 7/24/2025 at 11:58 am, with Licensed Vocational Nurse (LVN) 5, Resident 136's OSR, MAR, and Treatment Administration Record (TAR) were reviewed. LVN 5 stated Resident 136 had an order for TED hose at bedtime. LVN 5 stated there was no monitoring that Resident 136's TED hose was being applied. LVN 5 stated Resident 136's TED hose order was for lymphedema and if the TED hose was not applied, Resident 136's leg swelling could get worse. LVN 5 stated if Resident 136's (leg) swelling got worse, Resident 136 could be sent to the hospital for complications associated with Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 14 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete lymphedema from increased swelling. During an interview on 7/24/2025 at 4:02 pm, with the Director of Nursing (DON), the DON stated licensed nurses needed to follow the physician's orders and document when a resident's TED hose was applied and when removed in either the MAR or TAR to ensure the facility was complying with the physician's orders. The DON stated the purpose of TED hose was to prevent edema and treat edema, lymphedema, and deep vein thrombosis (DVT- a blood clot that forms in a deep vein, most commonly in the legs). The DON stated if staff did not apply the TED hose as ordered, the resident could develop increased edema/lymphedema, DVT, the feeling of heaviness, and pain or discomfort.During a review of the facility's Policy and Procedure (P&P) titled Applying Anti-Embolic Stockings (TED Hose), revised October 2010, the P&P indicated the procedure is to improve venous return to the heart, to improve arterial circulation to the feet, to minimize edema to the legs and feet and to prevent complications associated with DVT and pulmonary embolism. The P&P indicated for staff to verify there is a physician's order for anti-embolic stockings. The P&P indicated staff needed to document in the resident's medical record the date and time the anti-embolic stockings were applied, the resident's response to the procedure and the name and title of the individual who performed the procedure. Event ID: Facility ID: 555729 If continuation sheet Page 15 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that opened medication tablets were not placed inside a metal box and left on Resident 64's bed unattended. The Metal box was not labeled with an identifier for Resident 64 such as name, room number or date of birth . The Medication tablets did not have a sealed cover (refers to a tamper-evident seal or packaging feature that provides a visible indicator if the product has been opened or compromised. It's designed to protect the integrity and safety of the medication until administered to the resident) and did not have name or dosage. This deficient practice had the potential to place Resident 64, other residents, visitors or staff at risk of getting hold of the medication and if ingested (swallowed), had the potential for complications that can expose users to risks of abuse, misuse and addiction, which can lead to overdose or death. Findings:During a review of Resident 64's admission Record, the admission Record indicated Resident 64 was initially admitted to the facility on [DATE] with diagnoses that included but not limited to encounter for surgical aftercare following surgery on the digestive system (a wide range of surgical procedures performed on organs of the digestive tract. These procedures can be used to treat both cancerous and non-cancerous conditions), secondary neuroendocrine tumors (can occur when cancer cells from the original location spread to other parts of the body through the bloodstream), hypokalemia (a condition where the potassium levels in the blood are lower than normal. Potassium is an essential electrolyte that plays a crucial role in various bodily functions, including muscle contractions, nerve signaling, and maintaining fluid balance), chronic pain syndrome (a condition where pain persists for longer than three to six months, even after the initial injury or illness has healed) and unspecified dementia (the loss of cognitive functioning-thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities).and anxiety (a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome). During a review of Resident 64's Progress Notes (PN) dated 6/10/2025 indicated Resident 64's mental status when answering questions is appropriate and has appropriate affect during conversations (facial expressions, tone of voice, body language). During a review of Resident 64's Minimum Data Set (MDS- a resident assessment tool), dated 6/16/2025, the MDS indicated Resident 64 requires partial/moderate assistance (Helper does less than half the effort) for eating, oral hygiene, upper body dressing and personal hygiene. Resident 64 requires substantial/maximal assistance (helper does more than half the effort) from the staff for the activities of daily living (ADLs) such as toileting hygiene, lower body dressing and putting on/ and taking off footwear. Resident 64 is dependent (helper does all of the effort) on staff for showers. During a review of Resident 64's Care Plan (CP) initiated on 6/20/2025, the CP indicated Resident 64 is at risk for increased confusion related to dementia. The listed interventions included to remind the resident to verbalize needs, feelings, and concerns to the facility staff for interventions. During a review of Resident 64's CP initiated on 6/23/2025, the CP indicated Resident 64 uses anti-anxiety medications (medications that help regulate anxiety symptoms) related to anxiety disorder. Interventions indicated the risks from benzodiazepines (a class of medication used as a depressant that can induce sedation [calmness, relaxation, or sleepiness caused by certain drugs] and relieve anxiety), including lorazepam (a controlled substance that due to its potential for habit forming, abuse and dependence can be extremely dangerous and increase the risk of severe side effects, including slowed or difficult breathing and death), exposes users to risks of abuse, misuse and addiction, which can lead to overdose or death. The risks from concomitant (use at the same time) use of benzodiazepines and opioids (used (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 16 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medically primarily for pain relief) may result in profound sedation, respiratory depression (means the body doesn't get enough oxygen which can cause serious health problems), coma (a medical emergency, a state of prolonged loss of consciousness) and death. During a review of Resident 64's CP initiated on 7/10/2025, the CP titled Accommodation of needs indicated the Resident may self-administer medications as prepared by the licensed nurses per Medical Doctor (MD) orders and to be placed in a secured box for the resident to take per the residents request. The listed Interventions included to provide a safety box at the bedside for medication storage. During a review of Resident 64's Order Summary Report dated 7/22/2025, the Order Summary indicated to administer oxycodone (is a powerful pain medication belonging to the class of narcotic drugs. It's used to treat moderate to severe pain, and it can be habit-forming, causing mental and physical dependence) 5mg tablet (milligram- a unit of measure used in medicine to measure dosage of medication) tablet by mouth every 6 hours as needed for moderate pain level 4-6 for 30 days. During a review of Resident 64's Order Summary Report dated 7/22/2025, the Order Summary indicated, May self-administer medications per residents preference. During a review of Resident 64's Medication Administration Record dated 7/01/2025-7/31/2025, the MAR indicated, oxycodone HCl tablet 5 mg was administered to Resident 64 on Wednesday 7/23/2025 at 2:12 AM. During an observation of Resident 64 and a concurrent interview on 7/22/2025 at 4 PM, Resident 64 was resting in bed with both eyes closed. A small metal box with Velcro (a fastener for items consisting of two strips of thin plastic sheet, one covered with tiny loops and the other with tiny flexible hooks, which adhere when pressed together and can be separated when pulled apart) strips was placed at the foot of Resident 64's bed. The metal box was not labeled with an identifier for Resident 64 such as residents name, room number or date of birth . Resident 64 opened her eyes and stated, I have a concern about my medication. Per Resident 64, she has been in the facility for about six weeks and nurses have always left her medication on the side table. Resident 64 stated she always takes the medication herself before eating her meals. Resident 64 stated, the day shift medication nurse told her on Tuesday morning (7/22/2025) she could not leave the pills on the table anymore because the State Department was on site and the nurses were not allowed to leave any medication at bedside. Resident stated she was upset. During the same interview with Resident 64 on 7/22/2025 at 4 PM, Resident 64 stated, The nurse just told me to place the pills I had on the table inside the box, but I don't know what they are. It makes me feel unsafe to take medication that is not labeled. How do I even know if those pills are mine or what they are for? During an interview with License Vocational Nurse (LVN3) on 7/22/2025 at 4:29 PM, LVN3 stated nurses know they are not allowed to leave any medication at the bedside for patients to take at a later time. LVN3 stated, I have them take it with me standing there while I watch them swallow it. Just to make sure they did take it. It's not safe to leave medication at bedside or give the medication to the patient because, for example, when people are in pain, they have shaky hands and might drop the pill. Also, the nurses need to make sure the residents know what medications they are taking. During an observation and interview while inside Resident 64's room with LVN3 on 7/22/2025 at 4:33 PM, LVN3 stated she had not seen or used a metal type of box before. LVN3 stated she wouldn't know who the box belonged to, since it had no residents name or room number. LVN3 opened the metal box and confirmed there were 2 white pills inside that did not have a sealed cover. LVN stated she wouldn't know what medication the pills were because they were not in a sealed packet and were not labeled with a name or dosage. LVN stated, I think the larger pill is Potassium (a metallic element that is important in body functions such as regulation of blood pressure and of water content in cells, transmission of nerve impulses, digestion, muscle contraction, and heartbeat), but I can't be sure. LVN also stated she did not know when the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 17 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete should be taking those pills. During the same observation and interview with LVN3 on 7/22/2025 at 4:37 PM, LVN3 stated that it's an unacceptable practice for nurses to leave medication at the residents bedside that is not labeled with the residents name or medication that is opened and has no name or dosage. LVN3 stated it could be potentially harmful for Resident 64, a visitor, another resident and even staff for medication to be left at bedside even if the medication is placed inside the small metal box. LVN3 stated, Anyone can just casually walk by Resident 64's bed while the resident is asleep and take the metal box. If anyone was to take the pills not knowing what they are, it could cause harm, for example an overdose. During an interview with LVN6 on 7/23/2025 at 8:36 AM, LVN6 stated nursing staff should not leave any residents medication at the bedside. Per LVN6 even if a resident has an order for self-administration the resident has to be educated on the effects of the medications, and the nurse still needs to check the resident to see if they took the medications. LVN6 stated, For example, for blood pressure medications, the nurse must assess the vital signs (measurements of the body's most basic functions) first to see if the parameters (a measurable factor) are within the limit to administer the medication. If the nurse leaves the medications at bedside for self-administration and the patient doesn't take them, the blood pressure can go up. The resident can experience weakness, loss of consciousness and potentially it can be harmful to the resident, even cause harm or death. During an interview with the Director of Nursing (DON) on 7/24/2025 at 1:18 PM, the DON stated it is not acceptable for a nurse to leave residents medication at the bedside with no identifiers (residents name, date of birth , room number). The DON stated it is not acceptable to leave a metal box with medication inside that is not labeled with the residents name, date of birth or room number. Per the DON it is not acceptable for a metal box to have medication that does not have a name or a dose. The DON stated that these actions can potentially cause the resident harm. Per the DON, if a visitor or another resident gets a hold of the metal box and takes the medication inside the box, it can potentially cause harm, because nobody knows what medication is inside the box if it's not labeled, it can't be identified. During a review of the facilities Policy and Procedure (P&P) titled, Self-Administration of Medications, revised 10/2024, the policy indicated residents have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so.7. Self-administered medications are to be stored in a safe and secure place, which is not accessible by other residents. If safe storage is not possible in the resident's room, the medications of residents permitted to self-administer are stored in the medication cart or in the medication room. A licensed nurse transfers the unopened medication to the resident when the resident requests them. During a review of the facilities P&P titled, Administering Medications, revised 3/20/2025, the policy indicated, Medications shall be administered in a safe and timely manner, and as prescribed. During a review of the facilities P&P titles, Safety and Supervision of Residents, revised 3/20/2025, the policy indicated, Our facility strives to make the environment as free from accident hazards as possible. Resident safety and supervision and assistance to prevent accidents are facility-wide priorities. During a review of the facilities P&P titled, Accommodation of Needs, revised 3/2021, the policy indicated, The resident's individual needs and preferences are accommodated to the extent possible, except when the health and safety of the individual or other residents would be endangered. During a review of the facilities P&P titled, Resident Rights, revised 3/2025, the P&P indicated, Employees shall treat all residents with kindness, respect, and dignity. During a review of the facilities P&P titled, Quality of Life-Dignity, revised 2/2020, the P&P indicated that Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, feeling of self-worth and self-esteem. Event ID: Facility ID: 555729 If continuation sheet Page 18 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to promote bowel and bladder continence (ability to control the bladder and bowels) for one of one sampled resident (Resident 119) according to the facility's policy and procedure (P&P) titled, Urinary Continence and Incontinence (inability to control the bladder and bowels)Management and Assessment, by failing to: Ensure Resident 119, who was occasionally (less than seven episodes of incontinence) incontinent of bowel and bladder, was offered an alternative means to go to the bathroom. As a result of this failure, Resident 119 was instructed to go to the bathroom in Resident 119's brief (disposable absorbent garment designed to contain urinary or fecal incontinence). This failure had the potential for Resident 119 to lose more function of bowel and bladder and become more incontinent. Findings: During a review of Resident 119's admission Record (AR), the AR indicated the facility admitted Resident 119 on 6/17/2025 with diagnoses that included aftercare following joint replacement surgery, presence of left artificial (fake or manmade) hip joint (where the thigh bone and hip connect), and unspecified chronic kidney disease (damage to the kidneys so they cannot filter blood the way they should).During a review of Resident 119's untitled Care Plan (CP) initiated 6/19/2025, the CP indicated Resident 119 had an alteration in bowel and bladder as manifested by episodes of incontinence. The CP goals indicated Resident 119 would be continent during the waking hours through the review date of 9/30/2025. The CP interventions indicated to encourage Resident 119 to call for assistance with toileting, (staff) to establish voiding patterns, establish toileting program as needed, and to provide adaptive devices/equipment as needed such as an elevated toilet seat, bedside commode (portable toilet), grab bars, etc.During a review of Resident 119's Minimum Data Set (MDS- a resident assessment tool) dated 6/20/2025, the MDS indicated Resident 119 had moderately impaired cognition (ability to think, remember, and function). The MDS indicated Resident 119 was dependent (helper does all the effort. Resident does none of the effort to complete the activity, or the assistance of 2 or more helpers is required for the resident to complete the activity) with toileting hygiene. The MDS indicated Resident 119 was occasionally incontinent of urine. The MDS indicated Resident 119's bowel continence was not rated due to resident having an ostomy (hole made through the belly that allows fecal matter to pass through) or did not have a bowel movement for the entire seven (7) days. During a review of Resident 119's Bowel and Bladder Assessment (BBA) dated 6/20/2025, the BBA indicated Resident 119 was incontinent of bowel and occasionally incontinent of bladder. The BBA indicated Resident 119 was totally dependent with transfers/mobility and showed initiative and/or willingness (for bowel and bladder retraining). During an interview on 7/24/2025 at 10:45 am, with Resident 119 in Resident 119's room, Resident 119 stated, They (facility staff) make me go to the bathroom in my diaper and I hate it. Resident 119 stated Resident 119 had to go to the bathroom in Resident 119's brief because facility staff would not give Resident 119 a commode (portable toilet) or help Resident 119 up to the restroom. Resident 119 stated, I can hold it (bowel and bladder). Resident 119 stated Resident 119 had the urge so Resident 119 knew when Resident 119 had to go. Resident 119 stated, They (staff) are not checking to see if I need to change every two hours and haven't put me on a toileting schedule (scheduled developed for residents to go to the bathroom at specific times to promote continence). Resident 119 stated, I hate rolling over on the bed (to be changed), it's terribly painful. Resident 119 stated, It makes me feel horrible. During an interview on 7/24/2025 at 11:37 am, with Certified Nurse Assistant (CNA) 6, CNA 6 Resident 119 was unable to walk without assistance. CNA 6 stated Resident 119 was always incontinent (of bowel and bladder). CNA 6 stated when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 19 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete CNA 6 got Resident 119 up to take a shower, CNA 6 took Resident 119 to the toilet and Resident 119 was able to hold it (bowel and bladder) until then. CNA 6 stated CNA 6 told Resident 119 to go the bathroom in the brief and CNA 6 will change the brief after. CNA 6 stated Resident 119 only got up (to walk) during physical therapy.During a concurrent interview and record review with Licensed Vocational Nurse (LVN) 5, Resident 119's MDS dated [DATE] and Bowel and Bladder Assessment (BBA) dated 6/19/2025 were reviewed. LVN 5 stated Resident 119 was occasionally incontinent which meant sometimes Resident 119 was able to hold Resident 119's bowel and bladder and sometimes Resident 119 could not. LVN 5 stated Resident 119 wants to get up all the time to go to the bathroom but was only walking with during physical therapy, and to be safe a brief was kept on Resident 119. LVN 5 stated Resident 119 was totally dependent with toileting transfers and mobility because Resident 119 only got up during physical therapy. LVN 5 stated to promote continence staff could offer Resident 119 a bed pan (device used as a container for the urine and/or feces of a person who is confined to a bed and therefore not able to use a toilet) or be assessed for bedside commode. LVN 5 stated it was not a good feeling to be told to the bathroom in Resident 119's brief because Resident 119's independence could be hindered. LVN 5 stated this was a dignity issue and could put Resident 119 at risk for skin breakdown or infection.During an interview on 7/24/2025 at 4:02 pm, with the Director of Nursing (DON), the DON stated it was not acceptable to tell residents who were occasionally incontinent to go the bathroom in their brief. The DON stated staff needed to either get residents up to go to the toilet, commode, or offer a bed pan (device used as a container for the urine and/or feces of a person who is confined to a bed and therefore not able to use a toilet). The DON stated telling residents who were occasionally incontinent to go to the bathroom in their brief did not promote continence and the resident's bowel and bladder control could become poor resulting in a decline in continence level that could lead to a lot of complications. The DON stated the resident could be put at risk for skin breakdown and infections. During a review of the facility's P&P titled, Urinary Continence and Incontinence- Management and Assessment, revised 8/2022, the P&P indicated the staff and practitioner would appropriately screen for and manage individuals with urinary incontinence, and that the physician and staff would provide the appropriate services and treatment to help residents restore or improve bladder function and prevent urinary tract infection (UTI- infection that happen when bacteria enter the urethra, and infect the urinary tract) to the extent possible. The P&P indicated the physician, and staff would address treatable causes or contributing factors related to urinary incontinence, including incorporating environmental interventions and assistive devices (e.g. grab bars, raised toilet seats, commodes, urinals, bed rails, and/or walkers to facilitate toileting. Event ID: Facility ID: 555729 If continuation sheet Page 20 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow standards of practice and facility protocol for oxygen therapy for four of four sampled residents (Residents 23, 39, 40, and 113) by failing to:a. Ensure Resident 39's nasal cannula ([NC] a small plastic tube, which fits into the person's nostrils for providing supplemental oxygen) was not touching the floor while in use.b. Ensure Resident 23's NC was safely stored without the nasal prongs touching the back of the oxygen concentrator.c. Ensure Resident 40 received two liters per minute (lpm) of oxygen via NC according to the physician's order.d. Ensure Resident 113's NC was not touching the floor while in use.These failures had the potential to result in the transmission of infectious microorganisms and increased risk of infection for Residents 23, 39, and 113 and had the potential to cause complications associated with oxygen therapy for Resident 40.Findings: Residents Affected - Some a. During a review of Resident 39's admission Record (AR), the AR indicated Resident 39 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included respiratory failure (a condition caused by inadequate supply of oxygen and/or the inability to remove carbon dioxide from the lungs) and pneumonia (an infection/inflammation in the lungs). During a review of Resident 39's History & Physical (H&P), dated 6/19/2025, the H&P indicated the resident had a history of lung cancer and did not have the capacity to understand and make decisions. During a review of Resident 39's Minimum Data Set (MDS, a resident assessment tool), dated 7/2/2025, the MDS indicated Resident 39 had moderately impaired cognition (ability to understand) and used oxygen therapy. During a review of Resident 39's Care Plan (CP), dated 7/20/2025, the CP indicated Resident 39 required continuous oxygen and monitored for shortness of breath, and provided oxygen inhalation as ordered. During a review of Resident 39's Order Summary Report (OSR), dated 7/22/2025, the OSR indicated continuous administration of oxygen at two lpm via NC for respiratory failure, ordered on 7/20/2025. During a review of Resident 39's Medication Administration Records (MAR - a daily documentation record used by a licensed nurse to document medications and treatments given to a resident), dated 7/1/2025 to 7/31/2025, the MAR indicated Resident 39 received oxygen via NC on 7/22/2025 during the day shift. During a concurrent observation and interview on 7/22/2025 at 10:44 am with Registered Nurse 3 (RN 3) in Resident 39's room, Resident 39 was lying in bed receiving oxygen through a NC with the NC tubing was touching the floor. RN 3 stated, Resident 39's NC tubing should not be touching the floor because the resident could get an infection, such as pneumonia. During an interview on 7/24/2025 at 4:02 pm with the Director of Nursing (DON), the DON stated the oxygen tubing should not touch the floor when in use because it's an infection control issue. The DON stated, the resident could possibly develop pneumonia from the oxygen tubing touching the floor. During a review of the facility's policy and procedure (P&P) titled, Oxygen Administration, last (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 21 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some revised 12/2024, the P&P indicated to provide safe oxygen administration guidelines and indicated professional standards of practice were followed. During a review of the facility's policy and procedure (P&P) titled, Standard Precautions, Enhanced Barrier Precautions, and Transmission Based Precautions, last revised 5/20/2025, the P&P indicated, its purpose was to provide infection control practices to reduce the potential for transmission of pathogens including COVID-19 and multi-drug resistant organisms and viruses. The P&P indicated, for environmental and equipment protection disinfection of equipment to prevent the spread of COVID-19, MDRO, and other infectious agents. b. During a review of Resident 23's AR, the AR indicated Resident 23 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus type 2 (a disease in which the body's ability to produce or respond to the hormone insulin is impaired, resulting in elevated levels of glucose/sugar in the blood and urine) and anemia (decrease in the total amount of red blood cells in the blood. During a review of Resident 23's MDS dated [DATE], the MDS indicated Resident 23 had moderately intact cognition for daily decision making. The MDS indicated Resident 23 was dependent (helper did all the effort and lifted or held trunk or limbs) to staff for toileting, shower, upper/lower body dressing and putting on/off footwear. During an observation on 7/21/2025 at 9:56 am, Resident 23 was sitting on the shower chair. Resident 23's nasal cannula was hanging on the oxygen concentrator with nasal prongs touching the back of the concentrator. During a concurrent observation and interview on 7/21/2025 at 9:56 am, with the Director of Staff and Development (DSD), the DSD stated Resident 23's nasal cannula was hanging on the oxygen concentrator. The DSD stated, nasal cannula needed to be inside the set-up bag (plastic bag) when not in use for infection control. c. During a review of Resident 40's AR, the AR indicated Resident 40 was admitted to the facility on [DATE] with diagnoses that included pneumonia (an infection/inflammation in the lungs), hypoxemia (low level of oxygen in the blood) and interstitial pulmonary disease (a condition that cause inflammation and scarring (fibrosis) of the lungs.) During a review of Resident 40's MDS dated [DATE], the MDS indicated Resident 40 had moderately intact cognition for daily decision making. The MDS indicated Resident 40 was dependent to staff for eating, oral hygiene, toileting, shower, upper/lower body dressing and putting on/off footwear and personal hygiene. During a review of Resident 40's OSR dated 7/16/2025, the OSR indicated to administer oxygen at two (2) liters per minute (L/min) via nasal cannula continuously for acute respiratory failure (a condition in which not enough oxygen passes from the lungs into the blood) with hypoxia (high levels of carbon dioxide [waste product that your body gets rid of when you exhale] every shift. During a concurrent observation and interview on 7/21/2025 at 9:23 am, with the DSD, the DSD stated Resident 40's was on oxygen 4.5 LPM via nasal cannula. The DSD stated Resident 40 was receiving oxygen at 4.5 LPM via nasal cannula. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 22 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 7/23/2025 at 10:48 am with Registered Nurse 1 (RN 1), RN 1 stated Resident 40 needed to receive 2 LPM of oxygen via nasal cannula according to the physician's order. RN 1 stated the physician's order needed to be followed to ensure Resident 40 was receiving the correct level of oxygen therapy. During an interview on 7/24/2025 at 11:17 am, with the facility's Director of Nursing (DON), the DON stated the physician's order needed to be followed. The DON stated excessive oxygen could cause dryness in the nose. The DON stated nasal cannula needed to be inside the plastic bag if not in use for infection control to prevent cross contamination (the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect). During a review of the facility's P&P titled, Oxygen Administration, revised 12/2024, the P&P indicated to verify that there was a physician's order for this procedure and review the physician's orders or facility protocol for oxygen administration. The P&P indicated, oxygen tubing (cannula/mask) shall be stored in a designated plastic bag when not in use. d. During a review of Resident 113's AR, the AR indicated Resident 113 was admitted to the facility on [DATE] with diagnoses that included pulmonary edema (a condition caused by too much fluid in the lungs causing breathing difficulty) and chronic obstructive pulmonary disease (COPD-a chronic lung disease causing difficulty in breathing). During a review of Resident 113's History & Physical (H&P) dated 6/15/2025, the H&P indicated the resident had the capacity to understand and make decisions. During a review of Resident 113's MDS dated [DATE], the MDS indicated Resident 113 had moderately impaired cognition and used oxygen therapy. During a review of Resident 113's OSR dated 7/24/2025, the OSR indicated continuous administration of oxygen at 2 lpm via NC for hypoxemia (low level of oxygen in the blood), ordered on 6/16/2025. During a review of Resident 113's Care Plan (CP), dated 6/16/2025, the CP indicated Resident 113 required continuous oxygen, monitored for shortness of breath, and provided oxygen inhalation as ordered. During a concurrent observation in Resident 113's room and interview on 7/24/2025 at 2:40 pm, Resident 113 was receiving oxygen through a NC. Resident 113 stated Resident 113 used oxygen, but wished Resident 113 didn't need it. During a concurrent observation and interview on 7/24/2025 at 2:51 pm in Resident 113's room, with Licensed Vocational Nurse 7 (LVN 7) Resident 113 was lying in bed receiving oxygen through a NC with the NC tubing touching the floor. LVN 7 stated Resident 113's NC tubing was touching the floor and should not have touched the floor at all. During an interview on 7/24/2025 at 4:02 pm with the Director of Nursing (DON), the DON stated oxygen tubing should not touch the floor when in use for infection control. The DON stated, the resident could develop pneumonia from the oxygen tubing touching the floor. During a review of the facility's P&P titled, Oxygen Administration, revised 12/2024, the P&P indicated to provide safe oxygen administration guidelines and indicated professional standards of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 23 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0695 practice were followed. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 24 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to:a. Post nurse staffing data in a prominent location readily accessible to residents and visitors for viewingb. Post resident census at the beginning of the shift for which the data was posted on 7/24/2025.c. Maintain the posted daily nurse staffing data for a minimum of 18 months, or as required by State law in accordance with the facility's policy and procedure titled Posting Direct Care Daily Staffing Numbers. These deficient practices of posting inaccurate nurse staffing information had the potential to mislead the residents and visitors and affect the quality of nursing care provided to the residents. Findings: a. During an observation on 7/21/2025 at 9:50 am, there was no Daily Staff posting found at Station four (4) or at a prominent location which was readily accessible to staff, residents and visitors. During a concurrent observation and interview on 7/21/2025 at 9:51 am, with the Director of Staff and Development (DSD), there was no Daily Staff posting posted at Station 4. The DSD stated, there was no staffing posting posted at Station 4. The DSD stated staffing information needed to be posted in an area visible to visitors, residents and staff in order to know that the facility met the state regulation and to know the total number of staff taking care of the residents. b. During a concurrent observation and interview on 7/24/2025 at 9:08 am, with the DSD, resident census was not indicated in the staff posting information for 7/24/2025. The DSD stated the Registered Nurse Supervisor was in charge of the Daily staffing posting information. The DSD stated, the resident census needed to be posted at the beginning of the shift for staff, residents and visitors to know the number of residents in the facility. c. During a concurrent record review and interview on 7/24/2025 at 9:32 am, with the DSD, the DSD stated, there were no records kept of the Daily Staffing posting information. The DSD stated there were no other clinical records that staffing data was kept for the past 18 months. The DSD stated, the purpose of keeping the staffing information was to maintain the records for state audit. During an interview on 7/24/2025 at 11:25 am with the facility Director of Nursing (DON), the DON stated the Daily Staffing posting information needed to be posted in prominent locations to be readily accessible to residents and visitors. The DON stated, resident census needed to be posted daily on the facility staffing information to determine the number of staff needed to provide care to the residents. The DON stated, staffing posting information needed to be kept for a minimum of 18 months as per state law. During a review of facility's policy and procedure titled, Posting Direct care and Daily Staffing, reviewed 3/20/2025, the P&P indicated, within two (2) hours of the beginning of each shift, the number of Licensed Nurse (Registered Nurse, Licensed Vocational Nurse (LVN) and the number of unlicensed nursing personnel (Certified Nurse Assistant) directly responsible for resident care will be posted in a prominent location (accessible to residents and visitors) and in a clear and readable format. The P&P indicated the resident census at the beginning of the shift for which the information is posted. The P&P indicated, records of staffing information for each shift will be kept for a minimum of eighteen (18) months or as required by state law (whichever is greater). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 25 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 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 record and track a prescribed narcotic for one of one sampled resident (Resident 29).This failure had the potential to result in diversion (the illegal selling of prescribed medications) of a controlled substance. Findings:During a review of the undated Narcotic (a substance used to treat moderate to severe pain) Disposal Log, the Narcotic Disposal Log indicated there were two narcotics, one for Morphine Sulfate IR tablets and Hydrocodone-Acetaminophen tablets, but nothing for the Morphine Sulfate 10 milligrams solution.During a review of the Order Summary Report, dated [DATE], the Order Summary Report indicated an active order for Morphine Sulfate Oral Solution 10mg/5mL to be given by mouth every two hours as needed for severe pain for 30 days.During a review of the Medication Administration Record, for the dated [DATE] and [DATE], the Medication Administration Record indicated that Resident 29 received a dose of 2 milliliters of a Morphine Sulfate Oral Solution of 10mg/5mL solution for a pain level of 8, on both days, and that the medication was effective at relieving Resident 29's pain.During a concurrent observation and interview on [DATE] at 9:27 a.m. with the Director of Nursing (DON), while in DON's office, for the storage of discontinued narcotics, a box of Morphine Sulfate 10 milligrams per 5 milliliters solution was found in the discontinued narcotics drawer and was not documented on the Narcotic Disposal Log. The prescribed medication of Morphine Sulfate 10 milligrams per 5 milliliters solution, 100mL volume, was filled by CVS Pharmacy, on [DATE], for Resident 29. The DON stated that medications are left for families to pick up within 30 days and that Social Services will notify the families when medications are at the facility for them to pick up. The DON accessed the medical records, and identified the resident was currently admitted in the facility, but there was no note indicating that Social Services had notified the family to pick up the medication. During an interview on [DATE] at 10:14 a.m. with the DON and the facility Administrator, the Administrator stated they do not have any documentation when the morphine was given to the facility nor when the family was contacted to pick up the morphine that was found in the drawer for storage of disposed narcotics, which was in the DON's office.During a review of the undated, Policy and Procedures for Pharmaceutical Services (relating to medicinal drugs, or their preparation, use, or sale), the Policy and Procedures for Pharmaceutical Services, section (i) Controlled Drugs (drugs or chemicals whose manufacture, possession, and use are supervised by a government), KK. indicated that the Director of Nursing is responsible for the accountability of these controlled substance drugs. Also, section WW, of the same policy, indicated Discontinued or expired Schedule II controlled drugs are to be disposed of in accordance with the California's Medical Waste Management Act. Morphine is a schedule II medication. Event ID: Facility ID: 555729 If continuation sheet Page 26 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on interview and record review, the facility failed to ensure irregularities identified from the monthly drug regimen review (MRR) reported by the facility's pharmacist were acted upon for one of five sampled residents (Resident 119) according to the facility's policy and procedure (P&P) titled, Medication Regimen Review, by failing to:Ensure Resident 119's consultant pharmacist recommendation to order laboratory test to monitor Resident 119's thyroid-stimulating hormone (TSH- blood test used to check how well the thyroid gland is working) while taking levothyroxine (also known as Synthroid- medication used to treat hypothyroidism [a condition where the thyroid gland does not produce enough thyroid hormone]) was acted upon.As a result of this failure, Resident 119 did not have an updated TSH level drawn since Resident 119's admission to the facility. This deficient practice had the potential for Resident 119 to receive the incorrect dose of levothyroxine and result in complications.Findings:During a review of Resident 119's admission Record (AR), the AR indicated the facility admitted Resident 119 on 6/17/2025 with diagnoses that included unspecified hypothyroidism, unspecified chronic kidney disease (damage to the kidneys so they cannot filter blood the way they should), and chronic lymphocytic leukemia of B-cell type (type of cancer [abnormal cells] where cancerous B lymphocytes [a type of white blood cell] accumulate in the bone marrow [soft tissue in the bone] and blood). During a review of Resident 119's Order Summary Report (OSR) active as of 7/24/2025, the OSR indicated on 6/17/2025 Resident 119's physician ordered levothyroxine sodium oral (by mouth) tablet 200 micrograms (mcg- unit of measurement), one tablet by mouth one time a day for hypothyroidism. During a review of Resident 119's Minimum Data Set (MDS- a resident assessment tool) dated 6/20/2025, the MDS indicated Resident 119 had moderately impaired cognition (ability to think, remember, and function). The MDS indicated Resident 119 had a thyroid disorder. During a review of Resident 119's Consultant Pharmacist's MRR (CPMRR) dated between 7/6/2025 and 7/9/2025, the CPMRR indicated Resident 119 was currently on Synthroid (levothyroxine) 200 mcg. The CPMRR indicated to get an order from the medical doctor (MD) for a TSH level on the next available laboratory day to better assess the appropriateness of the current dose.During a concurrent interview and record review on 7/24/2025 at 10:17 am, with Licensed Vocational Nurse 1 (LVN 1), Resident 119's OSR, laboratory results, and progress notes (PN) were reviewed. LVN 1 stated (in general) when the pharmacist completed an MRR on the residents, the facility received the MRR with the information and recommendations when pharmacy delivered the residents' medications. LVN 1 stated if the pharmacist was recommending a laboratory test, licensed nurses were supposed to notify the physician and determine if the physician agreed to the laboratory test. LVN 1 stated Resident 119 did not have any PN indicating Resident 119's physician was reached out to for a TSH laboratory order, and there was no order for TSH level in the OSR. LVN 1 stated it was important to ensure Resident 119's TSH level was drawn up and updated to ensure the correct dose of Synthroid was administered to Resident 119. During an interview on 7/24/2025 at 10:29 am with Registered Nurse 2 (RN 2), RN 2 stated it was important to have an updated TSH level for residents taking levothyroxine to ensure they received the accurate dose. RN 2 stated TSH levels should be drawn approximately every four to six months. RN 2 stated if the facility did not have Resident 119's TSH level then licensed nurses would not know what the level was. RN 2 stated it was the licensed nurses' responsibility to reach out to the physician if the pharmacist was recommending TSH level for levothyroxine use. RN 2 stated without knowing Resident 119's TSH level, Resident 119 could experience adverse (unwanted) side effects of levothyroxine, weight gain, fatigue, lethargy, body temperature changes, or medication allergies. During an interview on 7/24/2025 at 10:45 am, with Resident 119, Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 27 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 119 stated, I take Synthroid but I haven't had any labs checked here and I have been wanting to know what my (TSH) levels are. During an interview on 7/24/2025 at 4:02 pm, with the Director of Nursing (DON), the DON stated residents on Synthroid needed to have TSH levels drawn to ensure the appropriate dose of Synthroid was given. The DON stated if a pharmacist MRR recommended TSH laboratory test, licensed nurses were supposed to notify the physician to get an order for labs. The DON stated laboratory services could draw a resident's blood the next day after an order was placed. The DON stated if the MRR recommendations for TSH levels were not acted upon, the resident could have hypothyroidism symptoms such as weakness, tingling of lower extremities, increased confusion, and may not be getting the accurate dose of medication (Synthroid). During a review of the facility's P&P titled, MRR, revised 5/2019, the P&P indicated the consultant pharmacist reviewed the medication regimen of each resident at least monthly. The P&P indicated the goal of the MRR was to promote positive outcomes while minimizing adverse consequences and potential risks associated with medication. The P&P indicated the MRR involved a thorough review of the resident's medical record to prevent, identify, report, and resolve medication-related problems, medication errors, and other irregularities, for example: inadequate monitoring for adverse consequences and potentially significant medication-related adverse consequences or actual signs and symptoms that could represent adverse consequences. The P&P indicated within 24 hours of the MRR, the consultant pharmacist provided a written report to the attending physicians for each resident identified as having a non-life-threatening medication irregularity, with the report containing: the resident's name, medication name, irregularity identified, and the pharmacist's recommendation. The P&P indicated an irregularity referred to the use of medication that is inconsistent with the accepted pharmaceutical services standards of practice and was not supported by medical evidence; and/or impeded or interfered with achieving intended outcomes of pharmaceutical services. The P&P indicated it may also include the use of medication without adequate monitoring.The P&P indicated the attending physician documented in the medical record that the irregularity had been reviewed and what, if any action, had been taken. Event ID: Facility ID: 555729 If continuation sheet Page 28 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 - Some 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 properly store boiled eggs in one of one facility kitchen. This failure had the potential to result in foodborne illness in the residents who ate the boiled eggs. Findings:During an observation on 7/21/2025 at 8:27 a.m., five eggs without a date and time were observed in a black bowl on the kitchen counter across from the cooking stove.During an interview on 7/21/2025 at 8:28 a.m., with cooking staff, [NAME] 1, the cooking staff stated the eggs were prepared for residents that want their eggs boiled. The cooking staff could not provide an exact date or time the eggs were boiled and placed on the counter. Staff stated the eggs could go bad if I don't know the exact time the eggs were prepared before giving them to a resident.During an interview on 7/23/2025 at 7:59 a.m., with [NAME] 1 and DSS, while in the kitchen, both stated that eggs left out can develop salmonella (a common form of food poisoning) if not dated and timed to determine how long they have been unrefrigerated. If eggs are left out and not labeled with a date and time, they should be thrown out to prevent a resident from contracting salmonella. Event ID: Facility ID: 555729 If continuation sheet Page 29 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 four of four dumpster containers were covered.This failure had the potential to attract and expose the facility to pests and other scavengers to the facility. Findings:During an observation on 7/22/2025 at 7:24 a.m., four outside dumpster containers were uncovered. During an interview on 7/21/2025 at 8:24 a.m. with the IPN, while in the parking lot, the IPN stated that the dumpsters contain used diapers and when the weather is hot, the smell can be a problem for the surrounding community. The IPN also stated that the open dumpster containers with discarded foods can attract rats and raccoons.During a review of the Food-Related Garbage and Refuse Disposal policy, dated October 2017, the Food-Related Garbage and Refuse Disposal policy indicated that outside dumpsters provided by garbage pickup services were to be kept closed and free of surrounding liter.During a review of the facility's Sanitation (the process of keeping places free from dirt, infection, disease, etc. by removing waste, trash, and garbage) Policy, dated November 2022, the Sanitation policy indicated that garbage and refuse containers are to be in good condition, without leaks, and waste is properly contained in dumpsters with lids (or otherwise covered). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 30 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 implement the facility's infection control policy and procedure for two of five sampled residents (Residents 83 and 162).a. Certified Nursing Assistant 1 (CNA 1) did not wear the required Personal Protective Equipment (PPE- equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses like disposable masks, gloves and gowns) and did not perform hand hygiene while taking care of Resident 162 who was on Enhanced Barrier Precaution (EBP- infection control measures implemented in nursing homes to reduce the spread of multidrug-resistant organisms [MDROs- bacteria or other microorganisms that have become resistant to multiple antibiotics]).b. CNA 3 did not wear the required PPE in an EBP room and did not perform hand hygiene before and after touching Resident 83's urostomy bag (a medical device used to collect urine after certain types of bladder surgery).These deficient practices had the potential to result in infection and spread of infection among staff and residents.Findings: Residents Affected - Some a. During a review of Resident 162's admission Record (AR), the AR indicated Resident 162 was admitted to the facility on [DATE] with diagnoses that included malignant neoplasm of the stomach (a cancerous tumor that develops in the lining of the stomach), other artificial openings of gastrointestinal tract status (a series of organs that work together to digest food, absorb nutrients, and eliminate waste products), pneumonia (an infection of one or both of the lungs) and chronic obstructive pulmonary disease (COPD- a common lung disease causing restricted airflow and breathing problems). During a record review of Resident 162's untitled Care Plan (CP) initiated on 7/11/2025 and revised on 7/23/2025, the CP indicated Resident 162 was on EBP and was at high risk for development of MDRO. The CP interventions indicated to initiate EBP, and staff will perform hand hygiene, wear PPE (gown & gloves) before & after high contact care activities (activities involving close physical contact). During a review of Resident 162's History and Physical (H&P) dated 7/12/2025, the H&P indicated Resident 162 had the capacity to understand and make decisions. During a review of Resident 162's Order Summary Report (OSR) dated 7/12/2025, the OSR indicated EBP every shift for peripheral inserted central catheter (PICC- a thin, flexible tube inserted into a vein in the arm and threaded into a larger vein near the heart) line on the left upper arm. During an observation of Resident 162's room on 7/21/2025 at 9:40 AM, EBP sign was posted outside Resident 162's room. Resident 162 was resting in bed with an ongoing TPN IV formula (a specific mixture of nutrients delivered through a vein to individuals who cannot obtain adequate nutrition through their digestive system) infusing through the left arm PICC line. During an observation of Certified Nurse Assistant 1 (CNA1) on 7/21/2025 at 9:46 AM, CNA1 walked inside Resident 162's room, not wearing PPEs. CNA1 walked over to Resident 162's bed, turned off Resident 162's call light (a device that allows a patient to signal for assistance) and touched Resident 162's hands while Resident 162 handed CNA1 a cell phone and charger. During a concurrent observation of CNA1 and interview on 7/21/2025 at 9:43 AM, CNA1 walked out of Resident 162's room without performing hand hygiene. CNA1 stated CNA 1 should have performed hand hygiene because Resident 162 was on EBP. CNA 1 stated CNA 1 should have worn a gown and gloves when CNA 1 came in contact with Resident 162's hands. CNA1 stated wearing PPEs for a resident on EBP was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 31 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 necessary to prevent the spread of infections and bacteria. Level of Harm - Minimal harm or potential for actual harm During an interview with License Vocational Nurse 1 (LVN1) on 7/21/2025 at 10:00 AM, LVN 1 stated it was important for staff to wear appropriate PPEs when coming into contact with a resident on EBP. LVN 1 stated if staff do not wear the required PPEs when coming into contact with a resident on EBP, there was a high risk of the spread of infection to other residents. Residents Affected - Some During an interview with CNA 2 on 7/22/2025 at 8:15 AM, CNA 2 stated it was important for staff to wear the required PPEs when caring for a resident on EBP to prevent the spread of infection. During an interview with the Director of Nursing (DON) on 7/24/2025 at 1:03 PM, the DON stated, for residents on EBP, staff needed to wear gowns and gloves when providing care or coming into contact with residents. The DON stated staff should wear gloves if the staff touch the resident or resident's belongings. The DON stated it was not acceptable for staff not to follow the EBP precaution because staff can spread infection to themselves or other residents in the facility. During an interview with the facility's Infection Prevention Nurse (IPN) on 7/24/2025 at 9:53 AM, the IPN stated, EBP was a precaution to protect the residents from staff spreading infection to residents. The IPN stated, if a staff member was in contact with a resident that was on EBP and staff do not perform hand hygiene, there was high risk for cross contamination (bacteria from one source is spread to another) and the spread of infection. b. During a review of Resident 83's AR, the AR indicated Resident 83 was admitted to the facility on [DATE], with diagnoses that included malignant neoplasm (cancer) of the bladder, dementia (long term and often gradual decrease in the ability to think and remember severe enough to affect a person's daily functioning), and urinary tract infection (UTI- infection that affects part of the urinary tract). During a review of Resident 83's Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 6/27/2025, the MDS indicated Resident 83 had intact cognition (mental action or process of acquiring knowledge and understanding) for daily decision making. The MDS indicated Resident 83 needed moderate assistance (helper does less than half of the effort) on staff for oral hygiene, toileting, showering/bathing self, lower body dressing, and putting on/taking off footwear. During a review of Resident 83's OSR dated 7/7/2025, the OSR indicated to place Resident 83 on EBP every shift for the presence of foley catheter (thin, sterile tube inserted into the bladder to drain urine). During a review of Resident 83's CP titled Enhanced Barrier Precautions, dated 7/7/2025, the CP indicated Resident 83 had urostomy (a surgical procedure that creates a new way for your body to get rid of urine) and was high risk for development of MDRO. The CP indicated for nursing staff to initiate EBP and staff will perform hand hygiene, wear PPE (gown and gloves) before and after high contact care activities. During an observation on 7/21/2025 at 9:16 am, Resident 83 was awake lying in bed, with a urostomy bag draining on the right side of bed. During a concurrent observation and interview on 7/21/2025 at 12:52 pm, Resident 83 was lying in bed. Certified Nurse Assistant 3 (CNA 3) entered Resident 83's room and did not perform hand hygiene (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 32 of 33 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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 and did not wear gown and gloves before entering Resident 83's room. CNA 3 held Resident 83's urostomy bag and tube without donning (wearing) gloves. CNA 3 touched Resident 83's blanket and stepped out of Resident 83's room and did not perform hand hygiene. CNA 3 stated she forgot to wear a gown and gloves before entering Resident 83's room. CNA 3 stated she should have sanitized her hands before and after resident care and should have worn gown and gloves to prevent spread of infection. Residents Affected - Some During an interview on 7/22/2025 at 1:38 pm with the Director of Staff and Development (DSD), the DSD stated staff needed to perform hand hygiene before touching the catheter bag and needed to wear gown and gloves before touching Resident 83 who was on EBP to prevent the spread of infection. During a review of the facility's Policy and Procedure (P&P) titled, Standard Precautions, Enhanced Barrier Precautions and Transmission– Based Precautions, revised on 5/20/2025, the P&P indicated EBP primarily is the use of gowns and gloves for specific high contact care activities, based on the resident's characteristics that are associated with a high risk MDRO colonization and transmission: presence of indwelling medical devices (urinary catheter). The P&P indicated the use of PPE will apply following the standard precautions when caring for these EBP residents. The P&P indicated gowns and gloves will be used while performing the following high contact tasks associated with the greatest risk for MDRO contamination of health care personnel's hands, clothes and environment: device care for example urinary catheter or other indwelling devices. Gowns and gloves will be used while performing the following high-contact tasks associated with the greatest risk for MDRO contamination of HCP hands, clothes, and the environment: Any care activity where close contact with the residents is expected to occur Any care activity involving contact with environmental surfaces is likely contaminated by the residents. In multi-bed rooms, each bed space is considered a separate room and change of gowns and gloves and perform hand hygiene when moving form contact with one resident to contact with another resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555729 If continuation sheet Page 33 of 33