The Earlwood

F-F725

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 14 055032 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055032 B. Wing 04/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Earlwood 20820 Earl Street Torrance, CA 90503

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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 49145 potential for actual harm Based on interview and record review, the facility failed to obtain laboratory tests per medical doctor (MD) Residents Affected - Few order prior to resident scheduled appointment for one of three sampled residents (Resident 2).

This deficient practice resulted in Resident 2 ' s medical doctor appointment to be canceled and had the potential delay in necessary care and services.

Findings:

During a review of Resident 2 ' s Admission Record, the Admission Record indicated Resident 1 was admitted to the facility on [DATE REDACTED] with diagnoses including malignant neoplasm (a cancerous tumor) of the right breast and bone and thrombocytopenia (low blood platelet count).

During a review of Resident 2 ' s Minimum Data Set (MDS- resident assessment tool) dated 3/24/2025 indicated Resident 2 ' s cognition (ability to think, understand, learn, and remember) was intact and required moderate assistance (helper does less than half the effort) with toileting and dressing.

During an interview on 4/24/2025 at 9:49 a.m., with Resident 2, Resident 2 stated she had an appointment

on Friday 4/25/2025 with her oncologist (a doctor who specializes in cancer), but her laboratory tests were not drawn. Resident 2 stated because her laboratory tests were not drawn, she had to cancel her appointment with her oncologist. Resident 2 stated this had caused her to feel frustrated.

During an interview on 4/24/2025 at 10:50 a.m., with the Social Services designee (SSD), the SSD stated

she was responsible for informing the Registered Nurse (RN) to set up laboratory draw appointments for the residents. The SSD stated she told the RN (unknown), that Resident 2 required laboratory tests for her upcoming appointment on 4/25/2025, but the RN had left early that day, and she did not follow up to ensure

it was done. The SSD stated she will develop a system to ensure laboratory tests ordered were follow through with licensed staff as to prevent a delay in Resident 2 ' s care as SSD had to reschedule her MD appointment.

During a review of the facility ' s Social Worker Job Description revised 10/2020, the Social Worker Job Description indicated the duties included, Assist in obtaining resources from community social, health, and welfare agencies to meet the needs of the resident.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 14 055032 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055032 B. Wing 04/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Earlwood 20820 Earl Street Torrance, CA 90503

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 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 49145 potential for actual harm Based on observation and interview, the facility failed to implement and maintain infection control practices Residents Affected - Some when Certified Nurse Assistant (CNA) 1 and Licensed Vocational Nurse (LVN) 2 failed to perform hand hygiene between resident care and prior to entering and exiting resident rooms.

These failures had potential of cross contamination (physical movement or transfer of harmful bacteria from one person, object, or place to another) and placed residents and staff at risk for the spread of infection.

Findings:

During the initial tour of the facility on 4/25/2025, observed two of four resident rooms did not have hand sanitizing gel in the dispensers. Observed there were no hand sanitizing gel dispensers on the walls in the hallways.

During a concurrent observation and interview on 4/23/2025 at 10:53 a.m., outside of resident room, LVN 2 was observed not performing hand hygiene prior to entering a resident ' s room to change an oxygen machine or prior to exiting the resident ' s room. LVN 2 stated she was supposed to perform hand hygiene

before entering a resident room and prior to exiting a resident room and should have done so but forgot. LVN 2 stated hand sanitizing gel dispenser inside the resident room was empty. LVN 2 stated that not performing hand hygiene could potentially cause a spread of infection.

During a concurrent observation and interview on 4/23/2025 at 11:11 a.m., with CNA 1 outside a resident room, CNA 1 was observed not performing hand hygiene prior to entering and exiting the resident room. CNA 1 stated the hand sanitizer gel dispenser was empty, but she should have gone to the nurses ' station to wash her hands. CNA 1 stated hand hygiene was important to prevent the spread of infection.

During an interview on 4/23/2025 at 12:21 p.m., with the Infection Prevention Nurse (IPN), the IPN nurse stated she educates the staff on performing hand hygiene before entering a resident room, prior to leaving a resident room, and before and after resident care to prevent the transmission of infection and germs from resident to resident. IPN stated she was aware that some rooms did not have hand sanitizing gel because there was a back order on hand sanitizing gel, but the staff were educated to wash their hands at the station. IPN stated there were no hand sanitizing gel dispensers in the hallways because of the facility undergoing renovation.

During an interview on 4/25/2025 at 4:36 p.m., with the Director of Nursing (DON), the DON stated hand hygiene between residents ' care was the most important way to prevent cross contamination and the spread of infection in the facility. The DON stated staff should be washing their hands before and after resident care, prior to entering and exiting a resident ' s room because not doing so can affect the safety of the residents and the staff.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 14 055032 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055032 B. Wing 04/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Earlwood 20820 Earl Street Torrance, CA 90503

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 0880 During a review of the facility ' s policy and procedure (P&P), titled, Handwashing/Hand Hygiene, dated 9/18/2023, the P&P indicated, This facility considers hand hygiene the primary means to prevent the spread Level of Harm - Minimal harm or of infection. All personnel shall be trained in the importance of hand hygiene in preventing the transmission potential for actual harm of healthcare-associated infections. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. Hand hygiene products and Residents Affected - Some supplies shall be readily accessible and convenient for staff use to encourage compliance with hand hygiene policies. Use an alcohol-based hand rub before and after contact with the resident.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 14 055032 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055032 B. Wing 04/24/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Earlwood 20820 Earl Street Torrance, CA 90503

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 0882 Designate a qualified infection preventionist to be responsible for the infection prevent and control program in

the nursing home. Level of Harm - Minimal harm or potential for actual harm 49145

Residents Affected - Few Based on interview and record review, the facility failed to have an Infection Preventionist (IP) on staff with completed specialized training in Infection Control and Prevention.

This deficient practice had the potential for failure to monitor and implement Infection Control and Prevention

in the facility.

Findings:

During a record review of the Infection Prevention Nurse (IPN) certification, dated 12/30/2024, the IPN certification indicated it was from CDC Train certificate which did not indicate the hours completed.

During an interview on 4/23/2025 at 3:23 p.m., with the IPN, the IPN indicated she began working at the facility on 11/2024 as a new graduate licensed nurse and has been the IPN since 2/2025. The IPN stated the CDC Train certificate was the one she was told she needed and was unable to locate the correct Infection Preventionist certificate.

During an interview on 4/24/2025 at 4:36 p.m., with the Director of Nursing (DON), the DON indicated she was unaware that the IPN had the incorrect IP certificate. The DON stated it was important to have a full-time IP nurse with the correct IP certificate for the safety of the residents and staff. The DON stated the role of IP Nurse was crucial in maintaining infection control and prevention in the facility.

During a review of the facility ' s Infection Preventionist Job Description, revised 10/2020, the Infection Preventionist Job Description indicated, Plan, develop, implement, evaluate, and oversee the infection prevention and control program in accordance with current regulations and guidelines governing skilled nursing facilities. Must have, as a minimum, two years clinical experience in a hospital, nursing care facility, or other related healthcare facility.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 14 055032