West Hills Health And Rehabilitation Center

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and other officials according to state law. All allegations are thoroughly investigated. The administrator initiates investigations. Within five (5) business days of the incident, the administrator will provide a follow-up investigation report. The follow up investigation report will provide sufficient information to describe the results of the investigation, and indicate any corrective actions taken if the allegation was verified. The follow-up investigation report will provide as much information as possible at the time of submission of the report. The residents and/or representative are notified of the outcome immediately upon conclusion of the investigation. During a review of the facility's P&P titled Abuse, Neglect, Exploitation or Misappropriation Prevention Program, last reviewed on 1/8/2025, the P & P indicated identify and investigate all possible incidents of abuse, neglect, mistreatment, or misappropriation.

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Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

West Hills Health and Rehabilitation Center

7940 Topanga Canyon Blvd.

Canoga Park, CA 91304

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

1's feet. CNA 1 stated that she reported the incident to Licensed Vocational Nurse 1 (LVN 1) because Resident 1 was about to cry when Resident 1 was talking about the incident. CNA 1 stated that Resident 2 touching Resident 1's feet without Resident 1's permission is inappropriate. Residents should not be touching other residents without permission. During an interview on 12/22/2025 at 2:45 p.m. with LVN 1, LVN 1 stated that on 12/18/2025, at around 8 a.m., CNA 1 reported to LVN 1 that Resident 1 reported to CNA 1 that Resident 2 tickled her foot last night (12/17/2025) and was crying. After CNA 1 reported to LVN 1, LVN 1 went to check on Resident 1. LVN 1 stated that she asked Resident 1 what happened and Resident 1 reported to LVN 1 that on the evening of 12/17/2025, Resident 2 came into Resident 1's room and tickled Resident 1's foot. LVN 1 stated that she asked Resident 1 if Resident 2 touched her anywhere else and Resident 1 responded No. LVN 1 continued to state that Resident 1 stated that she thought Resident 2 wanted to have sex with her (Resident 1). LVN 1 stated that after Resident 1 reported to her (LVN 1), LVN 1 reported the alleged incident to Registered Nurse 1 (RN 1). LVN 1 further stated she reported the incident to RN 1 because the incident between Resident 1 and Resident 2 is possible sexual abuse because Resident 2 touched Resident 1 without Resident 1's consent. During an interview on 12/22/2025 at 3:08 p.m. with RN 1, RN 1 stated that on 12/18/2025 at around 8:45 a.m. LVN 1 reported to her that Resident 2 tickled Resident 1's foot without Resident 1's consent and Resident 1 reported that she thought Resident 2 wanted to have sex with her. RN 1 stated that Resident 2 does not have the right to tickle or touch anyone without their consent, that's a type of sexual abuse. RN 1 stated that in RN 1's professional opinion, the alleged tickling was an alleged sexual abuse which is why RN 1 reported the incident to the Administrator (ADM) who is the abuse coordinator. During an interview on 12/23/2025 at 10:19 a.m., with the ADM, the ADM stated that she (ADM) is the facility's abuse coordinator. The ADM stated that on 12/18/2025 at around 9 a.m. when the incident was reported to her (ADM) by RN 1, she (ADM) did not think that the tickling of Resident 1's foot by Resident 2 was sexual in nature. The ADM continued to state that if the facility knew it was sexual in nature she (ADM) would have reported the allegation of sexual abuse. The ADM stated that because she (ADM) did not think the incident was sexual

in nature the ADM did not report the alleged sexual abuse to the SSA. During a review of the facility's P&P titled Abuse, Neglect, Exploitation or Misappropriation- Reporting and Investigation, last reviewed on 1/8/2025, the policy indicated, all reports of resident abuse (including injuries of unknown origin), neglect, or theft/misappropriation of resident property are reported to local, state, and federal agencies (as required by current regulations) and thoroughly investigated by facility management. If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected the suspicion must be reported immediately to the administrator and to other officials according to state law. The administrator or the individual making the allegation immediately reports his or her suspicion to the following persons or agencies: a. The state licensing/certification agency responsible for surveying/licensing

the facility.b. The local/state ombudsman. c. The resident's representative.d. Adult protective services (where state law provides jurisdiction in long term care); e. law enforcement officials; f. the resident's attending physician; g. and the facility medical director.

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If continuation sheet