Health inspection·September 16, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to investigate allegations of sexual abuse (non-consensual sexual contact of any type or sexual harassment), for one of three sampled residents (Resident 3) and report to California Department of Public Health (CDPH), Ombudsman (a representative that helps families and residents in long-term care facilities by investigating and resolving complaints and serving as an advocate), and to the local law enforcement within 2 hours, failed to suspend the individual involved in the abuse allegations.This deficient practice had the potential to place other facility residents at risk for abuse, and delay required onsite inspection by CDPH. A review of Resident 3's admission record indicated Resident 3 was admitted to the facility on [DATE] with a diagnosis including reduced mobility (having difficulty moving around easily or freely, affecting your ability to perform daily tasks like walking, standing), unspecified altered mental status (thinking, awareness, or behavior has changed from their normal state), essential primary hypertension (when the pressure in your blood vessels is too high). A review of Resident 3's Minimum Data Set (MDS- a resident assessment tool) dated 9/10/2025 indicated, the resident is cognitively intact (ability to acquire and understand knowledge), does not have change in behavior, dependent on toileting hygiene, (Helper does all of 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. Requires substantial/maximal assistance for shower/bath self (Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.) During an interview on 9/16/2025 at 10:59 AM with Certified Nursing Assistant (CNA) 1, CNA 1 stated, I have worked with Resident 3 once or twice, he is dependent on staff to transfer and feeding. Resident 3 is alert and oriented, able to express his needs, and recognizes staff. During an interview on 9/16/2025 at 11:56 AM with the social services director (SS), SS stated, a day after Resident 3 was transferred from the facility, I was contacted by a General Acute Care Hospital (GACH) social worker about abuse allegations against Resident 3. SS stated, the facility has not started investigation of the abuse allegations and have not reported to the appropriate agencies. SS stated, abuse allegations should be reported within 2 hours to CDPH, ombudsman, law enforcement, family, and physician. During an interview on 9/16/2025 at 1:40 PM with MDS coordinator, MDS stated, it is known Resident 3 has been aggressive to staff, the care plan and MDS assessment is in progress. Resident 3 did not exhibit signs of abuse. During an interview on 9/16/2025 at 2 PM with the Director of Staffing Development (DSD), the DSD stated, any abuse allegations should be reported to the abuse coordinator. The process for abuse allegations is, report the allegations within 2 hours and follow the facility abuse investigation protocol. During an interview on 9/16/2025 at 2:44 PM with the Director of Nursing (DON), the DON stated, we have a process for abuse allegations. We must report the allegations within 2 hours, suspend involved staff, and update care plans. Report to CDPH, ombudsman, law enforcement, physician and family members, and start investigations. The DON stated, a couple of days ago the facility SS informed me, she has received a call from GACH staff. GACH staff has informed the facility SS, department of health services (DHS) will be called for abuse allegations. DON stated, I told staff to document what took place, I did not start investigation. The employee involved in the abuse allegations is not suspended. During an interview on 9/17/2025 at 10:28 AM with the facility Administrator (ADM), the ADM stated, staff should have followed the abuse allegation protocol. The process for any abuse allegation is for the facility to initiate investigation by calling CDPH, reporting to ombudsman, isolating the victim, calling law enforcement, education, and suspend if the alleged abuser is staff. The ADM stated, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555849 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Del Sol Care Center 11620 West Washington Blvd Los Angeles, CA 90066 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete employee involved in the abuse allegations is suspended as of today 9/17/2025, reporting the abuse allegation to the appropriate agencies and investigation has started. A review of the facility's Policies and Procedure (P&P) titled Abuse Investigate/Prevent/Report Alleged Violation reviewed on January 2025 indicated, To ensure resident safety, employees accused of participating in the alleged abuse will be suspended until the findings of the investigation have been reviewed by the administrator. Ensures that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made. Event ID: Facility ID: 555849 If continuation sheet Page 3 of 3