Health inspection·December 12, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dismissed. Resident 12 stated that the transportation issues and concerns has caused him to become distressed and stated, The whole thing has cause me to lose sleep. During an interview on 12/10/2025 at 1:35 p.m. with Certified Nursing Assistant (CNA) 1, CNA 1 stated Resident 12 has been having transportation issues because he only felt safe with one facility bus driver and does not feel safe with the other 2 bus drivers. CNA 1 stated that Resident 12 has experienced agitation and anxiety because of transportation concerns. CNA 1 also stated that Resident 12 has missed medical appointments because of safety issues with transportation. During an interview on 12/10/2025 at 1:47 p.m. with Social Worker (SW) 1, SW1 stated that Resident 12 is very cognitive (mental processes involved in gaining knowledge and comprehension) aware. SW1 stated that Resident 12 has gotten stuck on the facility's bus ramp when a bus driver was getting Resident 12 onto the bus, which has caused Resident 12 to feel unsafe with two of the facility's bus drivers. SW1 stated that Resident 12 has experienced increased distress and anxiety related to his transportation concerns and issues. During an interview on 12/10/2025 at 2:41 p.m. with Supervisor Registered Nurse (SRN) 1, SRN1 stated that Resident 12 has missed appointments recently due to transportation safety concerns. SRN1 stated that Resident 12 does not feel safe with two of the facility's bus drivers. SRN1 stated that she sent email communication on 12/2/2025 to the facility's administration about Resident 12's safety concerns with the two bus drivers. SRN1 stated that Resident 12 has been having trouble sleeping because he has been experiencing anxiety related to his concerns regarding transportation to his medical appointments. During an interview on 12/11/2025 at 11:50 a.m. with Standard and Compliance Manager (SCM), SCM stated that Resident 12's transportation to appointments were cancelled on the following dates: 12/8/2025, cancelled because Resident 12 refused assigned bus driver because the bus driver was one he did not feel safe with; 12/1/2025, cancelled due to driver availability; 11/26/2025, cancelled because of bus driver incapability. During an interview on 12/11/2025 at 11:32 a.m. with Supervisor Social Worker (SSW) 1, SSW1 stated that Resident 12 is very honest and has been very accurate with describing past events. During a review of Resident 12's Interdisciplinary Team (IDT) Meeting Report, dated 11/14/2025, the IDT Meeting Report indicated, Resident brought up a different concern regarding the ramp for the bus. He said that the ramp is too short making it hard for him to maneuver to get into the bus. He points out that [Nurse Practitioner] who happened to be present tried to help him get on the bus. He was redirected to focus on the topic at hand.but resident stated that he is voicing out his concerns and part of this meeting is to listen to what his concerns are. There was no documentation in Resident 12's record which indicated the IDT met with the resident to discuss his transportation concerns after the 11/14/2025 meeting. During a review of Resident 12's Nursing Notes, dated 11/26/2025, the Nursing Notes indicated, Resident had urology (medical specialty focusing on the urinary tract), lab and x-ray appointment today. However, he refused to go to the appointment. Spoke with resident and he stated that he would go to his appointments only with one of drivers [Bus Driver 1]. He stated that he spoke with drivers' supervisor and he mentioned the safety concerns that he has. During a review of Resident 12's Nursing Notes, dated 12/2/2025, the Nursing Notes indicated, [Resident 12] wants to cancel appointments today. He said that he feels not safe with [bus driver]. He only trusts [Bus Driver 1]. He said that last time he got stuck mid air and was afraid of falling off. He added that he was not buckled in properly. During a review of Resident 12's Nursing Notes, dated 12/8/2025, the Nursing Notes indicated, Received report regarding resident missing his appointments this morning as he did not feel safe with the driver that was going to take him to his appointment. He said that the driver that he feels safe with was available but he was told that another driver was going to take him instead. Sent email to administration: ‘[Resident 12] came back to the unit because he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 2 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 FORM CMS-2567 (02/99) Previous Versions Obsolete was assigned to [bus driver] today.He missed his appointment this morning.Please advise.' Sent another email message to administration: ‘To give more insight:.[Resident 12] said that it is not a preference for [Bus Driver 1] but a need to feel safe.During a review of the facility's policy and procedure (P&P) titled, Interdisciplinary Team Conference, dated 5/27/2025, the P&P indicated, The purpose of the Interdisciplinary Team is to develop and maintain an interdisciplinary plan of care that meets the individual and changing needs of the Resident in the Skilled Nursing Facility. Event ID: Facility ID: 555917 If continuation sheet Page 3 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 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 implement a physician's order for a fall mat for one of 29 sampled residents, Resident 49.This failure resulted in the potential for Resident 49 sustaining an injury in the event of a fall.Findings:During a review of the Face Sheet (Resident Demographics) the Face Sheet indicated, Resident 49 was admitted to the facility on [DATE] with diagnosis including Right side weakness and history of Cerebro Vascular Accident (CVA - a medical condition when there is a loss of blood flow to part of the brain).During a concurrent observation and interview on 12-8-2025 at 3:58p.m. with Resident 49, Resident 49 was observed with bandages on left arm and right hand while sitting up in his wheelchair. Resident 49 stated that he fell a couple of days ago from his bed onto the floor. Resident 49 stated that he was on the floor for 5 minutes before help arrived. No safety fall mat is observed in the room.During an observation on 12-9-2025 at 3:26p.m., Resident 49 was observed lying in his bed. There was a safety fall mat observed rolled up and leaning against Resident 49's bed.During a concurrent observation and interview on 12-9-2025 at 3:28p.m. with Certified Nursing Assistant (CNA) 2 in Resident 49's room, Resident 49 was observed lying in bed. The safety fall mat was observed rolled up and leaning against Resident 49's bed. CNA 2 stated that Resident 49 should have the safety fall mat unrolled and placed on the floor next to his bed. CNA 2 unrolled the safety fall mat and placed it on the floor.During an interview with Registered Nurse (RN) 1 on 12-11-2025 at 9:24a.m., RN 1 stated that fall mats were used to prevent injury for residents identified as high risk for falls. Per RN 1, the fall mat is expected to be unrolled on the floor next to the bed at all times when Resident 49 was in bed.During a review of Resident 49 ‘s Fall Risk Assessment, dated 9-5-2025, the Fall Risk Assessment identified Resident 49 as high risk for falls.During a review of Resident 49's physician's order dated 6-19-2025, the physician's order indicated, Floor mat next to bed for fall precaution.A review of Resident 49's Care Plan Report dated 12-10-2025 indicated, Resident 49 is at risk for falls/ fall related injury: history of fall, history of CVA. Floor mat next to bed as ordered.During a record review of the facility's Policy and Procedure (P &P) titled Accident / Fall Prevention, last reviewed 5-29-2025, facility's P &P indicated, the facility will routinely assess each Skilled Nursing Facility (SNF) resident for risk of accidents and implement preventive measures to decrease modifiable risks, as able. Event ID: Facility ID: 555917 If continuation sheet Page 4 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to provide routine dental care services to meet the needs of two of 29 sampled residents (Resident 26 and Resident 64).These failures resulted in a delay in care when:1.Resident 26 experiencing an 89-day delay in receiving further treatment for lingering unaddressed dental issues as Resident 26 waited for referral to an outpatient specialty dental provider.2. Resident 64's dental procedure was cancelled and could not be rescheduled for 41 days. Residents Affected - Few 1.During a review of Resident 26's medical record, the record indicated, Resident 26 was a [AGE] year-old resident of the locked memory care unity with a history of dementia (progressive or persistent loss of intellectual functioning and memory), hypertension (high blood pressure) and stroke (when blood flow to part of the brain is cut off, either by a blockage or bleeding, depriving brain cells of oxygen and nutrients, causing them to die within minutes and leading to potential lasting damage, disability). During an observation on 12/9/25 at 9:35 a.m., Resident 26 was observed in the activity room, unable to interview and unable to answer any questioning due to being primarily non-verbal. Resident 26 was able to open his mouth slightly and no dentures were visible. During an interview on 12/10/25 at 8:37 a.m. Supervising Registered Nurse (SRN2), SRN2 stated, No I cannot find any other note by the dentist on the date of service and examination for 9/10/25. SRN2 stated, Usually the dentist would write a note the day of the resident exam. During an interview on 12/11/25 at 1:27 p.m. with Dentist 1, Dentist 1 stated, she examined Resident 26 on 9/10/2025 and wrote a clarification note on 12/8/2025. During a review of Resident 26's Dental Hygienist Note dated, 9/10/25 indicated, Patient mouth debridement, exam. Reviewed medical history, CNA stayed with the resident at chairside.Resident was not very cooperative.slides down in the chair, closes his lips when anything is placed in his mouth. Resident is too uncooperative for dental x-rays and will need several cleanings. Refer to the outpatient specialty dental clinic for treatment with sedation including evaluation for extraction of number 6 tooth.refer to outpatient specialty dental clinic. During a review of Resident 26's medical record, there was no documentation of referral made to the outpatient specialty clinic. During a review of Resident 26's Dentist Note dated, 12/8/25 indicated, date of examination 9/10/25 3:51 p.m. dentist exam refused by patient. Due to mental status changes patient is not a candidate for referrals and due to the aggressive personality and mental state patient may not be accepted for treatment at the outpatient specialty dental clinic. The facility was unable to provide a dental policy applicable to the identified issue. 2. Review of the Face Sheet (Resident Demographics) indicated Resident 64 was admitted to the facility on [DATE] with diagnoses which included dysphasia (difficulty swallowing). During an interview on 12/8/2025 at 4:53 p.m. with Resident 64 and his family member (FM 1), Resident 64 stated he had difficulty chewing regular food due to his teeth. FM 1 reported Resident 64 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 5 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0790 Level of Harm - Minimal harm or potential for actual harm scheduled for a dental procedure at a local hospital on [DATE] to have extractions (teeth removed) to eventually be fitted with dentures. FM1 reported the resident's procedure was canceled because, They forgot to hold his aspirin (blood thinning medication). Resident 64 stated he was growing tired of eating mashed potatoes and was looking forward to getting closer to being fitted with dentures so that he could eat more varieties of foods. Residents Affected - Few During a review of the Physician Progress Notes dated 9/8/2025, the physician (MD 2) documented, The primary indication for teeth extractions is to prevent lower gum pain/irritation/lesions. MD 2 further documented, Recommendations: ASA (aspirin) to be discontinued 7 days prior to procedure, 1 mg (milligram- unit of measure) Lorazepam (mediation used to help people relax before surgery) 1 hour prior to the procedure, 2 gm Amoxicillin (antibiotic given prior to surgery to prevent infections) 1 hour prior to procedure at time of departure. [Dentist 1] will coordinate and order. During a review of the Dentist Pre-Op Surgery Consult dated 10/27/2025, Dentist 1 documented, [Resident] is scheduled for oral surgery on 11/5/2025 and in consultation with MD 2. we could do a pre-med with standard 2 grams of amoxicillin. to be given at 12:00 before his appointment at 1:00 pm. During a concurrent interview and review of Resident 64's orders, dated 9/8/2025-12/8/2025, with Registered Nurse (RN) 1, the physician's order dated 8/25/2025 indicated Resident 64 received 81 mg of aspirin every day. This order was discontinued on 11/16/2025 (11 days after Resident 64's scheduled dental procedure. RN 1 confirmed there were no orders in Resident 64's record instructing staff to hold aspirin, give Lorazepam, or give Amoxicillin prior to his dental procedure on 11/5/2025. RN 1 stated Resident 64's dental procedure was cancelled because the medication changes were not implemented. RN1 stated, the nursing staff needed orders to hold or administer medications. During an interview on 12/11/2025 at 1:27 p.m. with Dentist 1, Dentist 1 stated Resident 64 needed oral surgery to remove multiple broken and decayed teeth and eventually be fitted with dentures. Dentist 1 stated she made recommendations, arranged the procedure, and Resident 64's transportation to the procedure, but it was not her responsibility to document orders in the record. Dentist 1 stated she was not responsible for writing orders to hold medications or give pre-medications. Dentist 1 stated this was the primary physician's responsibility and had been since she started working at the facility. During an interview on 12/11/2025 at 2:38 p.m. with the Administrator (Admin) 1, Admin 1 stated she was unaware who was responsible for documenting Resident 64's pre-procedure orders in the record (Dentist 1 or MD 2). During a concurrent interview on 12/12/2025 at 12:52 p.m., Dentist 1's Credential File dated 7/23/2024 was reviewed with Admin 1. According to the Credential File, Dentist 1 was granted privileges including Prescription of medication pertinent to treatment or intra-oral conditions and in consultation with ward physician where desired. During the survey, the facility was unable to produce, upon request, any written and approved resident care policies indicating the facility's goals, directives, and governing statements that direct expectations for coordination of care between the physicians and dentists and documentation responsibilities. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 6 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation, interview, and record review, the facility failed to ensure kitchen staff were competent and adequately trained to safely carry out food services when: Multiple kitchen staff were not trained to intervene or discard hot food items that did not reach 70 degrees Fahrenheit ( F, unit of measurement for temperature) within two hours of the cooling process for potentially hazardous foods.The Food Service Technician (FST) did not receive training on the proper operation of the dishwasher.These failures had the potential to result in the spread of food borne illnesses (a sickness caused by consuming food or drinks contaminated with harmful substances) in a medically fragile population of 142 residents.Findings:1. During a concurrent observation and record review on 12/8/2025 at 3:12 p.m. in the Main Kitchen, the Hot Food Cooling Log, dated 12/8/2025, was reviewed. There were six portions of corned beef being cooled in the blast chiller (equipment that rapidly cools hot food). The document indicated the Temperature when Cooling Started at 1pm for the six portions of corned beef were #1 - none recorded, #2 150 F, #3 - 150 F, #4 - 141 F, #5 - 141 F, #6 - 140 FThe document also indicated, For the cooling process, once the temperature of the food hits 140 F, you have only two hours to get the temperature to 70 Fand an additional four (4) hours for a total of six (6) hours to get the temperature to 41 F. If not, then you must discard the food.During a concurrent observation and interview on 12/8/2025 at 3:13 p.m. with [NAME] Specialist (CS) 1 in the Main Kitchen, the temperatures for six portions of corned beef were checked and recorded as follows: #1 - 109 F, #2 - 99 F, #3 - 98.8 F, #4 - 88.4 F, #5 - 92.5 F, #6 - 96.4 F. CS 1 stated he would keep the corned beef in the blast chiller to continue cooling.During a concurrent observation and interview on 12/8/2025 at 3:15 p.m. with the Food Manager (FM) in the Main Kitchen, CS 1 was observed continuing the cooling process without any corrective actions (interventions such as discarding or reheating to ensure food safety) taken for the six portions of corned beef despite the temperatures not reaching 70 F within two hours. The FM stated the cooling process was okay to be continued without corrective actions taken.During an interview on 12/11/2025 at 8:28 a.m. with CS 2, CS 2 stated if the temperature does not reach 70 F in two hours, but it reaches 40 F in six hours, then the food would still be okay to serve to residents.During an interview on 12/11/2025 at 8:34 a.m. with CS 3, CS 3 stated that after two hours in the cooling process, the temperature may be 120 F to 100 F, but it would be okay to keep cooling. CS 3 further stated that as long as the temperature drops to 41 F after six hours, then the food would still be okay to serve to residents.During an interview on 12/11/2025 at 8:47 a.m. with CS 4, CS 4 stated that because of what happened on 12/8/2025, the FM told staff just this week that after two hours, if the temperature was not 70 F, the food should be discarded.During an interview on 12/11/2025 at 8:51 a.m. with CS 5, CS 5 stated when asked what the interventions were if the temperature did not reach 70 For below in two hours, she did not remember being trained on that by the facility.During a review of the facility document titled, Dietary In-service: Cooling of Potentially Hazardous Foods and Procedures Proper Defrosting of Proteins, undated, the document indicated, Cooling of Meats/Poultry/Gravy/Rice. after you take the food from the oven and start the cooling process and the temp reaches 140*F you have two hours to get the food to 70*F. The document did not include corrective actions to take if the temperature did not reach 70 F within 2 hoursDuring a review of the facility's policy and procedure (P&P) titled, Food & Nutrition Services - Food Preparation Guidelines, dated 8/9/2025, the P&P indicated, Precooked, extra food, and specified leftovers will be cooled. From greater than 140 F to less than 70 F within two hours, and from 70 F to less than 41 F in an additional four hours. The P&P further indicated, Foods not cooled within the six-hour guideline will either be reheated to 165 F for 15 seconds in two hours and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 7 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete served immediately or discarded, but did not specify which corrective actions to take if the temperature did not reach 70 F within 2 hours.During an interview on 12/11/2025 at 2:36 p.m. with the Director of Dietetics (DD), the DD stated if the temperature does not reach 70 F within two hours of the cooling process, it may be reheated or discarded but not served. The DD further confirmed that the facility's P&P and Dietary In-Service Training did not explicitly include which corrective actions to take if the temperature does not reach 70 F within two hours of the cooling process.During a review of the Food and Drug Administration's Food Code, dated 2022, the Food Code indicated, Safe cooling requires removing heat from food quickly enough to prevent microbial growth. The Food Code indicated, A longer time near ideal bacterial incubation temperatures.70 F - 125 F.is to be avoided. If the food is not cooled in accordance with this Code requirement, pathogens may grow to sufficient numbers to cause foodborne illness. The Food Code also indicated, Cooked hot food may be reheated to 165 F for 15 seconds and the cooling process started again using a different cooling method if the food is above 70 F and two hours or less into the cooling process. The Food Code further indicated, Cooked hot food should be discarded immediately if the food is above 70 F and more than two hours into the cooling process.2. During a concurrent observation and interview on 12/8/2025 at 1:11 p.m. in the Main Kitchen with the Food Manager (FM), the FST was observed operating the dishwasher. The temperature on the dishwasher's display screen remained within the range of 173-177 degrees Fahrenheit ( F, unit of measurement for temperature) during the entire rinse cycle. The FM confirmed the temperature should have reached and been maintained at 180 F but did not.During a concurrent interview and record review on 12/11/2025 at 2:36 p.m. with Food Services Supervisor (FSS) 2, the Sign-In Sheet for In-Service Training, dated January 2025 was reviewed. The document indicated the in-service was for the proper operation of facility dishwashers including appropriate wash/rinse temperature. The document indicated the FST did not receive in-service training. FSS 2 confirmed the FST was on leave when kitchen staff received the in-service and did not receive the training upon returning to work.During a review of the facility's policy and procedure (P&P) titled, Food & Nutrition Services Warewashing Manual & Mechanical, dated 3/17/2025, the P&P indicated, Hot water at a minimum temperature of 180 F will be maintained at the manifold of the final rinse. The P&P further indicated, The Food & Nutrition Services Director or designee is responsible for the training of employees in procedure and documentation of logs. Event ID: Facility ID: 555917 If continuation sheet Page 8 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 - Many 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 ensure food and beverage items for resident consumption were stored in a safe and sanitary manner when: Four boxes of Glucose Control drinks were found stored on the floor.One pound of damaged and unsealed butter was found in the Main Kitchen.Brown sticky residue was found in Unit A3's Common Area Kitchenette's ice machine.These failures had the potential to result in residents being served contaminated or expired foods, which may have led to the spread of food borne illnesses (a sickness caused by consuming spoiled food or drinks contaminated with harmful substances) in a medically fragile population of 142 residents.During a concurrent observation and interview on 12/10/2025 at 11:05 a.m. with Registered Nurse (RN) 1, in the Clean Supply room C231, there were four boxes of Glucose Control drinks found stored on the floor under the handwashing sink. One box was opened and missing several Glucose Control drinks. RN 1 stated the drinks should be placed on the countertop, not on the floor, and began moving the boxes from the floor to the countertop.During an interview on 12/11/2025 at 2:35 p.m. with the Dietetics Director (DD), DD stated food and drinks should never be stored on the floor.During a review of the facility's policy and procedure (P&P) titled, Food & Nutrition Services - Food Storage (All Homes), undated, the P&P indicated, All foods or food items not requiring refrigeration will be stored above the floor, on shelves, racks, dollies, or other surfaces which facilitate thorough cleaning.During a concurrent observation and interview on 12/8/2025 at 2:04 p.m. with the Food Manager (FM) in the Walk-In Refrigerator of the Main Kitchen, a pound of butter was observed with multiple rips in the wrapper. The exposed butter was observed with dented corners. The FM stated the butter looks damaged and should be discarded.During an interview on 12/11/2025 at 2:36 p.m. with the Dietetics Director (DD), the DD stated stored food items in the walk-in refrigerator should not be exposed.During a review of the facility's policy and procedure (P&P) titled, Food & Nutrition Services Food Services, dated 9/18/2025, the P&P indicated, [facility name] will store food in a safe and sanitary manner.During a review of the Food and Drug Administration's Food Code, dated 2022, Section 3-305.11 indicated, Food shall be protected from contamination by storing the food. where it is not exposed to splash, dust, or other contamination.During a concurrent observation and interview on 12/9/2025 at 3:37 p.m. with Food Services Supervisor (FSS) 1 in Unit A3's Common Area Kitchenette, there was a brown sticky residue wiped with a paper towel from the ice dispenser chute. There was a brown, sticky buildup unevenly distributed along the edges and interior seams of the ice dispenser chute. FSS 1 confirmed the Common Area Kitchenette was accessible and utilized by the unit's residents.During an interview on 12/11/2025 at 9:33 a.m. with the Chief of Plant Operations (CPO), the CPO stated his department was responsible for the maintenance and cleaning of the dispenser chute/spout of the ice machines located in the Unit Common Area Kitchenette. The CPO stated quarterly cleaning and weekly walkthroughs were conducted, but unless someone told their department about the brown sticky substance, they would not know about it. When asked if there should be a brown sticky substance in the ice dispenser chute, the CPO stated he did not know and that such things just happen.During an interview on 12/11/2025 at 2:36 p.m. with the Dietetics Director (DD), the DD stated the brown substance found in the ice dispenser chute should not have been there as it could have been a big source for contamination and bacterial growth.During a review of the facility's policy and procedure (P&P) titled, Ice Machine Cleaning, Sanitation, and Maintenance Policy, dated 5/15/2025, the P&P indicated [facility name] is responsible for cleaning, sanitizing, and maintaining all ice machines in the licensed care area and in the kitchens every three months and as needed.During a review of the facility's P&P titled, Food & Nutrition Services - Sanitation, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 9 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 - Many FORM CMS-2567 (02/99) Previous Versions Obsolete dated 8/7/2024, the P&P indicated, Ice used in connection with food or drink will be from sanitary source, and will be handled and dispensed in a sanitary manner.During a review of the Food and Drug Administration's Food Code, dated 2022, Section 4-602.11 indicated, .Ice makers, and ice bins must be cleaned on a routine basis to prevent the development of slime, mold, or soil residues that may contribute to an accumulation of microorganisms. In addition, If the manufacturer does not provide cleaning specifications for food-contact surfaces of equipment that are not readily visible, the person in charge should develop a cleaning regimen that is based on the soil that may accumulate in those particular items of equipment. Event ID: Facility ID: 555917 If continuation sheet Page 10 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0841 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility. Based on interview and record review, the facility failed to provide clinical oversight to 142 vulnerable residents in the skilled nursing facility when:1. There was no Medical Director/Chief Medical Officer for the facility.2. Medical Staff credentialing and performance evaluations were not performed according to policy.3. Medical Staff failed to coordinate care between specialties for one of 29 sampled residents (Resident 64).4. The facility failed to adopt any current professional standards of practice for dental services.These failures resulted in a lack of resident care oversight by a Medical Director/Chief Medical Officer, no approval or adoption of current professional standards of practice for dental services and lack of resident care policies and procedures for dental services.Findings:1.During a review of the Facility Assessment, provided by the facility upon entrance, the Facility Assessment indicated, Facility Representatives (names/titles) involved in completing assessment:.Medical Director: (Representative) Physician (MD1) .Date(s) of assessment or update: 11/06/2025. The Facility Assessment further indicated, there was no current Medical Director/Chief Medical Officer and the position was vacant.During a concurrent interview and record review on 12/9/2025 at 12:47 p.m. with the Standards and Compliance Manager (SCM), the Facility Assessment, dated 11/06/2025, was reviewed. The Facility Assessment indicated, the facility did not have a Medical Director/Chief Medical Officer. SCM confirmed the facility did not have Medical Director and MD1 was the Medical Director representative.During an interview on 12/11/2025 at 2:38 p.m. with Administrator (Admin) 1, Admin 1 stated that MD1 was overseeing the clinical medical decisions of the Medical Director/ Chief Medical Officer role. Admin 1 also stated that she was overseeing the administrative portion of the Medical Director/Chief Medical Officer role, which included managing the staff.During an interview on 12/11/2025 at 2:47 p.m. with MD1, MD1 stated that he was not the Medical Director/Chief Medical Officer for the facility and was not in the acting Medical Director/Chief Medical Officer role. MD1 stated in regard to the facility's Medical Director position, I did not accept that role. MD1 confirmed that he did not have any oversight over facility medical staff, and he was in a staff physician role. MD1 stated he reported to Admin 1. MD1 confirmed that the facility currently did not have Medical Director/Chief Medical Officer.During an interview on 12/11/2025 at 5:00 p.m. with Admin 1, Admin 1 confirmed Medical Director/Chief Medical Officer position had been vacant since April 2025. Admin 1 stated that the facility did not notify California Department of Public Health of change in Medical Director/Chief Medical Officer position.During a review of MD1's Job Duty Statement, dated 9/4/2025, the Job Duty Statement indicated, Class Physician and Surgeon.Under the general supervision of the Chief Medical Officer for [the facility], is responsible for the medical care of an assigned group of residents and supervision of nurses, attendants, and others engaged in the care of residents. There was no documentation in MD1's Job Duty Statement which indicated MD1 had supervision of facility medical staff duties.During a review of the Job Duty Statement for the Medical Director position dated 6/4/2018, the Job Duty Statement indicated essential functions included: providing administrative oversight of primary medical, dental, and onsite specialty care services to effectively attain the medical care standards providing for the overall care for the resident population.During a review of the facility's Organizational Chart: Medical Staff Admin/Dental/Medical/Mental Health/Pharmacy, dated January 2026, the Organizational Chart indicated, the Medical Director/Chief Medical Officer role was vacant.2. During a concurrent interview and record review with the credentialing (the process of verifying a healthcare provider's qualifications, education, licenses, training, experience and competency to ensure they meet professional standards for safe and effective resident care, allowing them to practice at the facility) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 11 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0841 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Staff Service Analyst (SSA), SSA stated when members of the medical staff applied for initial credentialing or re-credentialing, he coordinated the necessary documents for the credentialing packet and provided it to the Credentialing Committee for review. SSA stated the committee consisted of the Medical Director/Chief Medical Officer and a credentialing specialist. SSA stated the facility was currently without a Medical Director and the Administrator (Admin 1) was filling in that role.The facility's policy titled, Practitioner Credentialing dated 7/8/2025 was reviewed with SSA. According to the policy, Re-credentialling is required one year after the initial credentialing and then every two years thereafter. The policy also indicated the practitioner's performance should be reviewed and assessed annually by the Medical Director/Chief Medical Officer. The policy indicated, The individual record of experience will be reviewed annually for each applicant based on peer review and or performance improvement data. According to the policy, the Medical Director/Chief Medical Officer was responsible for the implementation and enforcement of the credentialing process.During an interview with Admin 1 on 12/11/2025 at 5 p.m., Admin 1 stated the facility has been without a Medical Director since April 2025.During a concurrent interview and record review on 12/12/2025 at 12:52 p.m. with Admin 1, Dentist 1's initial credential file was reviewed. Dentist 1 was initially credentialed on 6/23/2024. There was no documentation of an annual performance evaluation from June 2025 to present, and Dentist 1 did not go through the annual re-credentialling process in June 2025 per policy. Admin 1 confirmed Dentist 1's re-credentialing and performance evaluation was not conducted per policy. In addition, Admin 1 confirmed Medical Staff performance evaluations were not being conducted while the Medical Director/Chief Medical Officer position was vacant.During a review of the Job Duty Statement for the Chief Medical Officer dated 6/4/2018, the Job Duty Statement indicated, The Chief Medical Officer's Essential Functions included, Oversee the credentialling process for health practitioners to resident veterans. 3. During the survey, deficient practice was identified related to the coordination of care between the physician and the dentist which resulted in a 41-day delay of care for Resident 64 when he was unable to attend his dental procedure because pre- procedure orders were not documented and implemented. (Refer to F790).During a review of Resident 64's Physician Progress Notes dated 9/8/2025, the physician (MD 2) documented, The primary indication for teeth extractions is to prevent lower gum pain/irritation/lesions. MD 2 further documented, Recommendations: ASA (aspirin) to be discontinued 7 days prior to procedure, 1 mg (milligram- unit of measure) Lorazepam (mediation used to help people relax before surgery) 1 hour prior to the procedure, 2 gm Amoxicillin (antibiotic given prior to surgery to prevent infections) 1 hour prior to procedure at time of departure. [Dentist 1] will coordinate and order.During a review of the Dentist Pre-Op Surgery Consult dated 10/27/2025, Dentist 1 documented, [Resident] is scheduled for oral surgery on 11/5/2025 and in consultation with MD 2. we could do a pre-med with standard 2 grams of amoxicillin. to be given at 12:00 before his appointment at 1:00 pm.During an interview on 12/11/2025 at 1:27 p.m. with Dentist 1, Dentist 1 stated Resident 64 needed oral surgery to remove multiple broken and decayed teeth and eventually be fitted with dentures. Dentist 1 further stated Resident 64's did not attend his appointment for his procedure on 11/5/2025 because he was supposed to receive pre-procedure medications and the orders were not documented and implemented. Dentist 1 stated it was not her responsibility to document orders in the record. Dentist 1 stated she was not responsible for writing orders to hold medications or give pre-medications. Dentist 1 stated this was the primary physician's responsibility and had been since she started working at the facility.During an interview on 12/11/2025 at 2:38 p.m. with Admin 1, Admin 1 stated she was unaware who was responsible for documenting the pre-procedure orders in Resident 64's record. Admin 1 stated MD 1 was available as a Medical Director/Chief Medical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 12 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0841 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Officer designee for Medical Staff issues and was overseeing the clinical medical decisions of the Medical Director/Chief Medical Officer role.During an interview with MD 1, MD 1 stated he was not the Medical Director/Chief Medical Officer or designated Medical Director/Chief Medical Officer and had no supervisory responsibilities. MD 1 stated, I did not accept that role; I am a staff physician. MD 1 stated he was unaware who was responsible for documenting pre-procedure orders for Resident 64 and stated the providers should have coordinated. MD 1 was also unaware if the facility had policies related to who was responsible for documenting orders for pre dental procedures.During a joint interview with Admin 1 and the Standards and Compliance Manager (SCM) on 12/11/25 at 5 p.m., SCM stated Dentists are members of the Medical Staff but had different documentation requirements than the physicians; however, SCM was unable to state what the documentation requirements were. SCM confirmed the facility did not have policies related to Dentist documentation expectations.During a review of the facility's Job Duty Statement for the Chief Medical Officer dated 6/4/2018, the Job Duty Statement indicated Essential Functions of the role included, Provide administrative oversite of primary medical, dental and onsite specialty care services to effectively attain the medical care standards providing for the overall care for the resident veteran population.During a review of Dentist 1's Job Duty Statement, dated 8/05/2024, the Job Duty Statement indicated, Class: Dentist. Under the supervision of the Administrator and general direction of the Chief Medical Officer.Establish policies and procedures regarding dental care at the facility.During the survey, the facility was unable to identify who was responsible for documenting Resident 64's pre- procedure dental orders. In addition, the facility was unable to produce, upon request, any written and approved resident care policies indicating the facility's goals, directives, and governing statements that direct expectations for coordination of care between the physicians and dentists and documentation responsibilities.4. During an interview on 12/11/2025 at 2:45 p.m. with the Administrator (Admin) 1, Admin 1 stated she is currently filling the Medical Director/Chief Medical Officer position for administrative issues. Admin 1 stated, Dentist 1 follows dental industry standards of practice but could not confirm which professional dental standards the dentist follows. During an interview on 12/12/2025 at 11:47 a.m. with Director of Nursing (DON), Standards and Compliance Manager (SCM), Administrator (Admin) 2. DON, SCM and Admin 2 were asked, who had been providing clinical oversite for the skilled nursing facility medical services including dental. None of the Administrative staff provided an answer to the question indicating who was responsible for clinical oversight. DON, SCM and Admin 2 were asked, who writes resident care policies for dental services. None of the Administrative staff provided an answer to the question indicating who was responsible. DON, SCM and Admin 2 were asked, what dental industry standards had the facility adopted and or approved. None of the Administrative staff provided an answer to the question indicating what dental industry standards had been adopted and or approved. During an interview on 12/11/2025 at 1:27 p.m. with Dentist 1, Dentist 1 was asked who her supervisor was, Dentist 1 stated, I currently report to the Home Administrator (Admin 1)as my supervisor, we do not have a Chief Medical Officer.During an interview, on 12/11/2025 at 5:00 p.m., with the Admin 1 and SCM, Admin 1 and SCM were asked if there were written approved and implemented medical staff rules, regulations or bylaws related to dental care. Admin 1 stated, there are no bylaws but there are policies for the medical staff related to certain dental procedures. SCM and Admin 1 were asked, what were the requirements for documentation for dentists in the facility, SCM stated she had been researching dental documentation requirements and had not found anything by statute just industry standard of practice. SCM confirmed the facility dentist is a member of the medical staff but has different documentation requirements from the medical doctors, which are industry standards of practice. SCM and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 13 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0841 Level of Harm - Minimal harm or potential for actual harm Admin 1 were unable to say which industry standards of practice the facility used for dental care. During a review of Dentist 1's Job Duty Statement, dated 8/05/2024, the Job Duty Statement indicated, Class: Dentist. Under the supervision of the Administrator and general direction of the Chief Medical Officer.Establish policies and procedures regarding dental care at the facility. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 14 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0844 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel. Based on interview and record review, the facility failed to notify the California Department of Public Health (CDPH) in any capacity when the Medical Director/Chief Medical Officer position was vacated on 5/3/2025 with no replacement or interim physician in place. This failure resulted in the state agency being unable to provide timely oversight or intervention and resulted in allowing residents to remain for an extended period without required medical leadership and safeguards, thereby increasing the risk of delayed medical care, inadequate supervision over medical services, and potential harm to a medically compromised population of 142 residents. Refer to related deficiency F0841.During an interview on 12/12/2025 at 11:20 a.m. with the Standards and Compliance Manager (SCM), the SCM stated MD 3 was the interim Medical Director/Chief Medical Officer from January to May 2025. The SCM further stated when MD 3 left in May 2025 with no interim physician in place, the facility did not notify CDPH in any capacity of the lack of a Medical Director/Chief Medical Officer. The SCM stated the facility thought they had it under control.During an interview on 12/12/2025 at 12:44 p.m. with Nurse Practitioner (NP) 1, NP 1 stated there was no Medical Director/Chief Medical Officer currently in place. NP 1 stated she discussed her cases with a physician but did not have a designated physician supervisor to whom she reported.During a review of the facility's organizational chart titled, Medical Staff Admit/Dental/Mental Health/Pharmacy, dated January 2026, the chart indicated the Chief Medical Officer position was vacant.During a review of the facility's Medical Director/Chief Medical Officer's Duty Statement, undated, the document indicated the Medical Director/Chief Medical Officer was responsible to plan, organize, and direct the medical program of the facility. Event ID: Facility ID: 555917 If continuation sheet Page 15 of 16 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 555917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - West Los Angeles 11500 Nimitz Avenue Los Angeles, CA 90049 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to ensure the Quality Assessment and Assurance (QAA) met the minimum quarterly requirements and the minimum requirement of attendees. This failure had the potential to diminish oversight in developing, reviewing, and approving crucial clinical policies that affected a medically fragile population of 142 residents since May 3, 2025. Findings: During a review of the QAPI meeting minutes, on 12/12/2025 at 08:30 a.m., dated 2/13/2025 through 11/13/2025, the attendance sheet indicated that the Medical Director/Chief Medical Officer or an official qualified physician designee did not attend quarterly meetings between May through September 2025. During a concurrent interview and record review on 12/9/2025 at 12:47 p.m. with the Standards and Compliance Manager (SCM), The Facility Assessment, dated 2025-2026, was reviewed. The assessment indicated under the Staffing Section that there were 0 Medical Directors and 1 vacancy. The SCM confirmed that the Medical Director/Chief Medical Officer position was being temporarily filled by MD 1. During an interview on 12/11/2025 at 4:47 p.m. with Medial Doctor 1(MD1), MD1 indicated that the facility was currently without a Medical Director/Chief Medical Officer, and he was not responsible for the duties of the Medical Director/Chief Medical Officer. MD 1 stated that his position was as a staff physician with no oversight of medical staff or administrative duties. During an interview on 12/11/2025 at 5:06 p.m. with Administrator 1(Admin 1), Admin 1 indicated that the Medical Director/Chief Medical Officer position has been vacant since April 2025. During an interview on 12/12/2025 at 12:44 p.m. with Nurse Practitioner 1(NP1), NP1 indicated that she was not officially designated to the QAPI committee by the Medical Director/Chief Medical Officer because there was currently no facility Medical Director/Chief Medical Officer. NP1 further stated that she did not have a designated physician supervisor or Medical Director/Chief Medical Officer to whom she reported. During a review of the Quality Assurance & Performance Improvement (QAPI) Plan for Veterans Home of California [NAME] Los Angeles 2025/2026 (Plan) on 12/12/2025 at 8:30 a.m., The Plan stated, The QAPI Committee, which includes the Chief Medical Officer, is ultimately responsible for assuring compliance with federal and state requirements and continuous improvement in quality of care and customer satisfaction. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555917 If continuation sheet Page 16 of 16