Health inspection·June 9, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few will also work double shift today (6/5/2025).During an interview with DON on 6/5/2025 at 2:47 p.m., DON, reviewed photos that was attached to the complaint sent to District Office, and DON stated and confirmed, Photo #1 was of CNA 1 and Photo #2 was of Resident 1. DON stated, there has been a breach on Resident 1's privacy. The DON identified and stated the pictures were that of Resident 1. The DON confirmed and stated taht CNA 1 did not follow the facility's policies and procedures regarding:1. Videotaping, Photographing, and Other Imaging of Residents dated 1/2025 which indicated Staff may not take or release images or recordings of any resident without explicit written consent. Written consent must be obtained from the resident or representative prior to obtaining images or recordings of the resident for any purposes other than investigation of abuse, neglect or emergencies, and photography obtained for personal/family use at the verbal request of the resident or family.2. Resident Rights dated 1/2025, which indicated, Unauthorized release, access, or disclosure of resident information is prohibited. All release, access, or disclosure of resident information must be in accordance with current laws governing privacy of information issues. 3. Protected Health Information (PHI - any information about a person's health or healthcare that can be used to identify them), Management and Protection of dated 1/2025, which indicated Protected Health Information (PHI) shall not be used or disclosed except as permitted by current federal and state laws.During a follow-up interview with CNA 1 on 6/5/2025 at 2:50 p.m., CNA 1 stated, Yesterday (6/4/2025), she (CNA 1) was with Resident 1, and he (Resident 1) was making jokes, she (CNA 1) then posted a story on Instagram with him (Resident 1), and I (CNA 1) shouldn't have done that. CNA 1 stated, she did not tell (Resident 1) that everyone would see it (video clip). CNA 1 further stated, she (CNA 1) was texting her friends on Instagram while she was in his (Resident 1's) room in which she Facetime called and posted on her (CNA 1)'s Instagram story. CNA 1 stated having video called (FaceTime) with friends and posting Resident 1's picture on her (CNA1's) personal social media.During an interview with Resident 1 on 6/5/2025 at 3:03 p.m., Resident 1 stated, he did not know that someone took a video of him, and it was posted on social media. Resident 1 stated, Why would she pick on me like that?. Resident 1 stated, he had been trying to keep his stay in the facility low key (a term used by someone who wants to hide or not draw further attention) and no other people know he was in the facility or why he was there, only him and his RP 1. During a telephone interview on 6/6/2025 at 7:30 a.m., Resident 1's Responsible Party (RP 1) stated on 6/5/2025 at 4:30 p.m. the facility called RP 1 to inform RP 1 of an incident in which CNA 1 posted pictures of herself (CNA 1) and Resident 1 in the background on CNA 1's personal social media account. RP1 reported feeling stunned by the incident and did not understand why CNA 1 was in Resident 1's room and why facility staff were allowed to take pictures of residents. RP1 stated HIPAA rights were supposed to protect residents from incidents such as these. RP1 visited Resident 1 on 6/5/2025 after the facility called and stated Resident 1 reported being interviewed the night prior by a staff member. RP 1 was not sure what the extent of damage was as RP1 was not informed how many people saw the picture or what the purpose of posting the picture was. RP1 denied being informed the picture posted was a direct picture of Resident 1. RP 1 stated it was one thing to post a picture of someone in the background and another to post a direct shot of the person. During the same interview on 6/6/2025 at 7:30 a.m., RP 1 further stated Resident 1 was a very private person and did not ever have social media and would not want to be displayed in such a vulnerable condition to the public. The RP 1 stated Resident 1's rights to privacy, dignity, and respect were violated by the facility and was concerned as to who had access to the Resident 1's unauthorized images. RP 1 stated The rule of thumb is once you put it up on social media it is there forever., it is in the cloud, it is out there forever even if you take it down. RP1 stated Resident 1 was not able to understand (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555748 If continuation sheet Page 2 of 4 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 555748 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Berkley East Healthcare Center 2021 Arizona Ave Santa Monica, CA 90404 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 - Few or give consent to having a picture taken or posted on social media. RP 1 stated Resident 1 was a very private person and did not have social media or allow pictures to be taken by family/friends. RP1 stated Resident 1 did not wish to be seen in his current condition. RP 1 stated Resident 1 was an accomplished person and to be made a mockery of and shown in current condition was harmful and degrading to all, Resident 1 is well accomplished person. RP1 stated Resident 1's dignity was violated and stated any reasonable person would feel violated that can negatively affect their self-esteem.During an interview with Social Services Assistant 1 (SSA 1) and Social Services Assistant 2 (SSA 2) on 6/6/2025 at 11:32 a.m., SSA 1 and SSA 2 stated, it is not allowed to take photos and videos of residents without proper consents. SSA 2 stated, it is a violation of residents' privacy and disrespectful to take photos and videos of residents without a proper form of consents.During an interview with SSD on 6/6/2025 at 12:06 p.m., SSD stated, it is very important and on top of their priority to protect residents' privacy. SSD stated, residents should not be photographed and video recorded without their consents. SSD stated the ADM showed her a short video clip of CNA 1 and Resident 1, in which she was told that it was posted on CNA 1's Instagram story. During an interview with DSD on 6/6/2025 at 12:35 p.m., on 6/5/2025 towards the end of morning shift (7 am - 3:30 p.m.), the DSD stated she was made aware of the incident that CNA 1 took photo and video of Resident 1 and shared it on her social media. DSD stated, they have to investigate what happened and CNA 1 went home after that morning shift. DSD reviewed CNA 1's staffing assignment which indicated, CNA 1 worked double shift (morning shift to evening shift [3 p.m. - 11 p.m.) on 6/5/2025. DSD stated, she was not aware that CNA 1 continued working on 6/5/2025 after knowing that CNA 1 posted a video of Resident 1 on her social media. During a review of the video clip sent by the ADM on 6/6/2025 at 3:27 p.m., the video clip showed CNA 1 waving with Resident 1 inside Resident 1's room.During a review of Resident 1's Medical Record for consents and email received from the Medical Records Director (MRD) on 6/16/2025 at 5:25pm, as of 6/7/2025, there was no written consent signed by Resident 1 and/or RP 1 regarding release of images or recordings.During a review of the facility's P&P titled, Videotaping, Photographing, and Other Imaging of Residents, dated 1/2025, the P&P indicated, Residents will be protected from invasion of privacy and/or abuse that might occur from photographs, videotapes, digital images, and recordings during resident care or other facility activities . Staff may not take or release images or recordings of any resident without explicit written consent. Written consent must be obtained from the resident or representative prior to obtaining images or recordings of the resident for any purposes other than investigation of abuse, neglect or emergencies, and photography obtained for personal/family use at the verbal request of the resident or family. Transmitting unauthorized images of any resident through email, internet or social media is considered a violation of resident rights. Any image or recording taken that may be construed as humiliating or demeaning to a resident or residents is considered resident abuse and will be reported and investigated as such.During a review of the facility's P&P titled, Resident Rights, dated 1/2025, the P&P indicated The unauthorized release, access, or disclosure of resident information is prohibited. All release, access, or disclosure of resident information must be in accordance with current laws governing privacy of information issues. All inquiries concerning the release of resident information should be directed to the HIPAA compliance officer.During a review of the facility's P&P titled, Telephone, Employee Use of, dated 1/2025, the P&P indicated, Cellular phones may be used for personal calls and text messaging ONLY when the employee is on authorized meal and break periods. Employee cell phones will remain off and/or silent during all other work hours.During a review of the facility's P&P titled, Protected Health Information (PHI), Management and Protection of, dated 1/2025, the P&P indicated, Protected Health Information (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555748 If continuation sheet Page 3 of 4 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 555748 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Berkley East Healthcare Center 2021 Arizona Ave Santa Monica, CA 90404 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 (PHI) shall not be used or disclosed except as permitted by current federal and state laws . It is the responsibility of all personnel who have access to resident and facility information to ensure that such information is managed and protected to prevent unauthorized release or disclosure. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555748 If continuation sheet Page 4 of 4