Health inspection·May 30, 2025

F 0695 b. 10:42 AM – HR: 104, BP 141/89, RR: 22, T: 98.1 F, and O2 sat: 91% on RA. Level of Harm - Minimal harm or potential for actual harm c. 10:54AM – HR: 97, BP: 134/82, RR: 20, T: 98.1F, O2 sat: 95% on RA. d. 16:30 PM – HR: 118 BP: 132/87, RR: 24, T:102 F, O2 sat: 97% Via nasal Cannula Residents Affected - Few A Review of Resident 1 ' s Situation, Background, Action, Response (SBAR) Communication Form dated 05/06/2025 at 10 AM, indicated Resident 1 was complaining SOB and a headache. The SBAR indicated to refer Resident 1 to psychiatric Medical Doctor (MD) for possible anxiety and to transfer via 911 for any emergent changes. A Review of Resident 1 ' s Situation, Background, Action, Response (SBAR) Communication Form dated 05/06/2025, indicated Resident 1 was complaining of SOB and a headache. The SBAR indicated to refer Resident 1 to psychiatric Medical Doctor (MD) for possible anxiety and to transfer via 911 for any emergent changes. The SBAR indicated that Resident 1 ' s O2 sat was 88% on room air and that 15 L of oxygen was administered via non-rebreather mask (a medical device used to deliver a high concentration of oxygen to a patient in emergency situations) and Resident 1 ' s O2 went up to 97%. The SBAR indicated the MD was notified at 4:30 PM. A review of Resident 1 ' s Physician ' s Order, dated 5/6/25 at 5:46 PM indicated to transfer Resident 1 to the GACH for shortness of breath via 911. A review of Resident 1 ' s Nursing Progress Notes dated 05/06/2025 at 11:41 AM, indicated Resident 1 complained of shortness of breath and a headache. The Note indicated when Registered Nurse (RN) 1 assessed Resident 1, Resident 1 was alert and oriented without shortness of breath and no wheezing present. The Note indicated the physician was informed. A review of Resident 1 ' s Nursing Progress Notes dated 5/06/25 at 3:42 PM indicated Resident 1 was alert and that after Resident 1 showered, Resident 1 of SOB and a headache. The Note indicated the MD was notified and new orders were pending. A review of Resident 1 ' s Nursing Progress Notes dated 05/06/2025 at 4:35 PM, indicated Resident 1 was still complaining of shortness of breath again, breathing was labored with bilateral wheezing upon lung auscultation (listening to the internal sounds of the body, usually using a stethoscope [a medical instrument for detecting sounds produced in the body that are conveyed to the ears of the listener through rubber tubing connected with a piece placed upon the area to be examined]). The Note indicated Resident 1 verbalized, I ' m short of breath, and the documented O2 sat (indicated a range from 88% - 90% and temperature of 102 F. The Note indicated that oxygen was administered, but Resident continued to experience SOB and was observed using accessory muscles (the contraction of muscles other than the diaphragm during inspiration) to breath. The Note indicated MD was notified, and 911 was called for emergency. A review of Resident 1 ' s Nursing progress notes dated 05/06/2025 at 4:40 PM, indicated 911 came to the facility to transport resident to the GACH. A Review of Resident 1 ' s GeneralAcute Care Hospital (GACH)Records dated 5/12/2025, indicated Resident 1 was admitted to the GACH on 5/6/25 with a chief complaint of SOB. Resident 1 ' s oxygen saturation (O2 sat, a measurement of the percentage of hemoglobin in the blood that is carrying oxygen) was 95 % on three (3) liters (L- a unit of measurement) via nasal cannula (NC- a device that gives (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555839 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 555839 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dreier's Nursing Care Center 1400 West Glenoaks Blvd Glendale, CA 91201 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 - Few you additional oxygen [supplemental oxygen or oxygen therapy] through your nose). The Records indicated Resident 1 ' s chest x ray (a medical imaging technique that uses a small amount of ionizing radiation to create images of the body's internal structures) results indicated Resident 1 had edema (swelling) and infection. During an interview on 5/28/2025 at 3:45PM, with Resident 1, Resident 1 stated not feeling well on 5/6/25and was experiencing shortness of breath. Resident 1 stated RN 1 did not administer oxygen even after Resident 1 verbalized having SOB. Resident 1 stated around 3 PM on 5/6/25, Resident 1 began to panic because she was struggling to breath. Resident 1 stated certified nurse assistant (CNA)1 brought in LVN 1 to Resident 1 ' s room and administered oxygen to Resident 1, and 911 was called. During an interview on 5/30/2025 at 7:45 AM, with family member (FM) 1, FM 1 stated that Resident 1 verbalized difficulties breathing on 5/6/25 around 10 AM to FM 1. FM 1 stated Resident 1 stated having trouble breathing and that facility staff were not administering O2 to Resident 1. FM 1 stated Resident 1 called FM 1 again around 3 PM that same day, and Resident 1 stated she was still in distress, and O2 was still not administered to Resident 1. FM 1 stated that during the call, FM 1 was placed on speakerphone and stated for someone to help Resident 1. FM 1 stated it was not long after that FM 1 received a call from the facility that Resident 1 was transferred to the GACH. During an interview on 05/30/2025 at 10:13 AM with CNA 1, CNA 1 stated being assigned to care for Resident 1 on 5/6/25 during the day shift (7 AM to 3 PM). CNA 1 stated on the morning of 5/6/25, Resident 1 stated not feeling well. CNA 1 stated LVN 1 was notified and assessed Resident 1. CNA 1 stated Resident 1 verbalized not feeling well and being SOB throughout CNA 1 ' s shift. During an interview on 5/30/25 at 12:10 PM with the Director of Nursing (DON), the DON stated on 5/6/25 around 4:40 PM, Resident 1 was transferred to the GACH due to respiratory distress. The DON stated on 5/5/25, Resident 1 ' s vital signs were monitored and appeared stable, and that Resident 1 did not require interventions, such as O2 administration or transfer to the GACH. The DON stated Resident 1 ' s O2 sat at 10:42 AM was 91% and O2 was not administered, and at 10:54 AM, when LVN 1 rechecked Resident 1 ' s O2 sat, it was 95%. The DON stated it was not until approximately 4:35 PM that Resident 1 complained of SOB and 911 was called. The DON stated Resident 1 had PRN order for O2 via NC, however, licensed nurses (LN) had not been administered the O2 to Resident 1 upon her initial complaints on 5/06/25 at 8 AM of having SOB and a headache. During an interview on 05/30/2025 at 12:46 PM with LVN 1, LVN 1 stated on 5/6/25 at around 8 AM or 9 AM, CNA 1 notified LVN 1 that Resident 1 was experiencing SOB. LVN 1 reported that he went to assess the resident and obtained Resident 1 ' s O2 sat. LVN 1 stated Resident 1 ' s O2 sat was low and LVN 1 reported to RN 1 immediately. LVN 1 statedRN 1 came and assessed Resident 1 and confirmed that her oxygen saturation was low, and that wheezing was heard in one of the resident ' s lungs. LVN 1 stated no O2 was administered to Resident 1. LVN 1 stated Resident 1 complained about SOB through the shift, and that LVN 1 should have administered Resident 1 ' s O2 via NC as needed. During an interview on 5/30/2025 at 1:44 PM with RN 1, RN 1 stated LVN 1 reported to RN 1 that Resident 1 had SOB after a shower on 5/05/2025 and that Resident 1 was anxious, and wheezing could be heard. RN 1 stated the MD was notified and orders for a psychologist consult was ordered. RN 1 stated not being informed of Resident 1 continuing to have SOB. RN 1 stated no O2 via NC was administered to Resident 1 upon RN 1 ' s initial assessment since Resident 1 was stable. During an interview on 5/30/2025 at 3 PM with RN 2, RN 2 stated Resident 1 experienced SOB on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555839 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 555839 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dreier's Nursing Care Center 1400 West Glenoaks Blvd Glendale, CA 91201 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 5/6/25 and that the MD had been notified. RN 2 stated upon further assessment, Resident 1 continued to complain of SOB and wheezing was heard. RN2 stated that the resident also had a fever at that time. RN 2 stated O2 was administered using a non-rebreather mask and 911 was called at around 4 PM. A review of the facility ' s policy and procedures (P&P) titled, Oxygen Administration, dated 2010, indicated the purpose of the policy is to provide guidelines for the safe administration of oxygen. Indicating staff should assess the resident for clinical indications, including signs and symptoms of hypoxia. These may include rapid breathing, increased pulse rate, restlessness, and confusion. The policy further states that a physician ' s order must be verified prior to initiating oxygen therapy and care plan should be in place to identify and monitor the resident s needs related to oxygen administration. Event ID: Facility ID: 555839 If continuation sheet Page 4 of 4