Other·September 26, 2018

F000 INITIAL COMMENTS

F000 PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE The following reflects the findings of the Department of Public Health - Licensing and Certification during an ABBREVIATED Survey for Complaint: CA 00587242. Representing the California Department of Public Health-Licensing and Certification by Federal ID: 37312 RN, HFEN. The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility. One deficiency was issued for Complaint: CA 00587242.

F600 SS=G Free from Abuse and Neglect CFR(s): 483.12(a)(1)

F600 09/06/2018 §483.12 Freedom from Abuse, Neglect, and Exploitation The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms. §483.12(a) The facility must§483.12(a)(1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion; This REQUIREMENT is not met as evidenced by: Based on observation, interview, and record LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients . (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 1 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE review, the facility failed to ensure freedom from neglect for one of three sampled residents, Resident 1, when Resident 1 was not provided with a bed, wheelchair, shower chair or sling (a hammock like cloth device to hold the resident during transfer using a mechanical lift) able to safely and comfortably accommodate her size. As a result of these failures, Resident 1 suffered emotional distress due to isolation from group dining and activities and was placed at risk for injury from improperly sized equipment. Findings: Review of Resident 1's clinical record titled, "Admission Record" (a record which contains resident personal information) indicated Resident 1 was 57 years old and was admitted to the Skilled Nursing Facility (SNF) on 10/5/17 from the General Acute Care Hospital (GACH) with diagnoses that included morbid obesity (obesity so severe it interferes with normal activities including breathing), chronic pain syndrome, chronic embolism (obstruction of an artery by a blood clot or an air bubble) and thrombosis (development of a blood clot), edema (swelling due to retention of fluid in the body), cellulitis (bacterial infection of the skin), diabetes mellitus (disorder of glucose metabolism resulting in high blood sugar levels), muscle weakness, and history of falling. Review of Resident 1's clinical record titled, "Minimum Data Set" (MDS, a resident assessment tool that is used to develop a plan of care), assessment Section F Preferences For Customary Routine and Activities (a guide to create an individualized plan of care based on the resident's activity preferences)" dated FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 2 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE 10/12/17, indicated the following activities were "Very Important" to Resident 1; listening to music, keeping up with the news, doing favorite activities, going outside to get fresh air when the weather is good, and participating in religious services and practices. The MDS assessment for activities indicated it was "Somewhat important" to Resident 1 to be around animals such as pets, and to do things with groups of people. Review of Resident 1's MDS assessment dated 4/16/18, indicated a Brief Interview for Mental Status (BIMS, a test for memory and recall) score of 15 points out of 15 possible points, which indicated Resident 1 was cognitively (pertaining to memory, judgement and reasoning ability) intact. Review of Resident 1's GACH clinical record titled, "PT [Physical Therapy] Assessment Inpatient" dated 10/3/17, indicated, "Pt [patient] with massive obesity and is now with PT [physical therapy] order for eval [evaluation] and tx [treatment] per [physician]...Patient will benefit from having appropriate equipment to properly care for her by nsg [nursing] staff including bariatric mech [mechanical] lift (provided to bedside with sling) and bariatric chair as patient is willing to be oob [out of bed] with lift...Equipment Recommendations: Mechanical lift and bariatric chair needed..." On 5/18/18 at 12:30 p.m., during a concurrent observation and interview, Resident 1 was wearing a nasal cannula (tube into the nose) which supplied oxygen and sat on her bed with her legs spread out across both sides of the bed. Resident 1's body was larger and wider that the width of the bed could accommodate. Resident 1 stated she had been in the SNF since October 2017 and had been in the same bed since admission. Resident 1 stated the bed FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 3 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE was too small. Resident 1 stated, "No, I am not comfortable in this bed." Resident 1 stated she was told by the facility Administrator (Adm) in April 2018 that a bariatric bed (a large bed that can comfortably and safely accommodate an obese resident) would be ordered for her, but the bed never arrived. Resident 1 stated the facility did not provide a wheelchair that could accommodate her size and she would like to have one to attend activities and go outside. Resident 1 stated she felt deprived of activities because she had no wheelchair to get up and and attend the activities. Resident 1 stated, "I have never been to the activities room and dining room." Resident 1 stated she did not have a shower chair that would accommodate her size upon admission to the SNF. Resident 1 stated her Family Member (FM) brought a shower chair from home on 5/7/18 so that she would be able to shower. Resident 1 stated the SNF used a sling and a mechanical lift to transfer her and to obtain her weight but there was no sling available to accommodate her size and weight. Resident 1 stated she did not want the staff to weigh her because she was fearful the sling was not big enough to safely accommodate her. On 5/18/18 at 1:35 p.m., during an interview, the facility Social Service Director (SSD) stated, "There was a wheelchair in the facility but it was not the right size [for Resident 1] and it was returned to the General Acute Care Hospital [GACH] where it was borrowed from. [Resident 1] does not have a wheelchair to use while at the facility [SNF]." The SSD stated, "We are unable to find the right wheelchair to accommodate her [Resident 1]. It was too expensive. that's why [Adm] did not buy it." On 5/18/18 at 1:43 p.m., during a concurrent interview and document review, Resident 1 stated the Adm asked her to go social media FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 4 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE and solicit donations to purchase a wheelchair. Resident 1 provided a copy of wheelchair specifications printed from the Internet with a date of 4/6/18 and stated the printed specifications were provided to her by the Adm. Review of the the printed wheelchair specifications at "HTTPS:www.usedwheelchairs-usa.com/chairdetails" dated 4/6/18, indicated, "Used [brand name of wheelchair]. Price including insurance and shipping to [location]: $3465 - fully assembled and ready to ride! General Specifications... Maximum capacity 600.0 lbs., Length: 38.25" [inches], Width: 29.25"..." On 5/18/18 at 1:48 p.m., during an interview, the SSD stated, "The resident [Resident 1] should not be going to social media to solicit money to purchase a wheelchair. The resident needs were not accommodated for her to come out of her room as she desired." On 5/18/18 at 2:10 p.m., during an interview, Resident 1 stated she wanted a wheelchair. Resident 1 stated, "I'll be able to go to activities, enjoy meals in the dining room, go to the store. These activities did not occur due to lack of equipment [a wheelchair]. It makes me feel bad that I'm not able to get around, to get out and go to the doctor, the dentist, go to the store, or get a sunlight outside the building. I feel that I am getting depressed. I'm trying to do other things in order for me not to cry and feel depressed." Resident 1 was tearful while talking and started to cry. Resident 1 stated, "It's just upsetting that I cannot do the things I like to do. I try not to think about my situation. It makes me sad. I get lonely. My family can't visit me because it is so far for them to visit me." On 6/20/18 at 2:07 p.m., during an interview, the facility Activities Director (AD) stated, "As far as I can remember she [Resident 1] has not FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 5 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE attended group activities because she does not have a proper wheelchair...[Resident 1] prefers to go outside for fresh air. Without proper equipment or a wheelchair the resident cannot be taken outside...I have asked during the IDT [Interdisciplinary Team, a team of healthcare providers including nurses, social services, activities staff, dietary staff and physician who meet to plan care] meeting, but so far there were no ideas on how to get a proper chair for the resident to go to activities and go outside of the building. The only equipment she has is the shower chair and it is not appropriate for her to go around. The shower chair is to be used from bedroom to shower room and back to her room. Her need to go outside was not met because she doesn't have proper equipment or a wheelchair." On 6/20/18 at 3:14 p.m., during a concurrent interview and record review the MDS Coordinator (MDSC) reviewed Resident 1's, Care Plan titled "The resident has limited physical mobility r/t [related to] morbid obesity [obesity so severe as to interfere with normal activities including breathing]" dated 10/14/17. The Care Plan indicated "Interventions: Ambulation: The resident uses wheelchair for walking. Locomotion: The resident uses wheelchair for locomotion." The MDSC stated, "The care plan is not accurate because there is no wheelchair. An intervention should not be written unless there is proper equipment like a wheelchair to use." On 6/20/18 at 3:15 p.m., during an interview, Licensed Nurse (LN) 1 stated Resident 1 did not have a proper wheelchair. LN 1 stated, "[Resident 1] loves social activities like watching movies in the activity room, playing cards, monopoly, and crossword puzzles. Yesterday residents in the facility went to a picnic. [Resident 1] was not invited. Staff told FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 6 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE her that she doesn't have a wheelchair and can't go." On 6/20/18 at 3:58 p.m., during an interview, the facility Occupational Therapist (OT) stated "[Resident 1] was maximum dependent on admission and was unable to stand. Rehab [rehabilitation] goal was to sit up on a bariatric wheelchair [wheelchair that can comfortably and safely accommodate an obese resident]. She [Resident 1] was able to sit up on the edge of the bed [at the completion of therapy]." The OT stated the resident needed a bariatric wheelchair. The OT stated he requested a bariatric wheelchair from the Durable Medical Equipment (DME) Company, "But no wheelchair was delivered. I'm not quite sure what happened from there. When the DME representative came to the facility, it was between the DME Company and the Adm. No wheelchair was delivered." On 7/25/18 at 9:07 a.m., during an interview, Resident 1 stated, "I have not gotten a wheelchair yet. The Adm has not updated me yet on the status of the wheelchair. On 6/19/18 there was an outing to the zoo and I was not invited, maybe because I don't have a wheelchair. I would like to go since I have not been there. It turned out it was a picnic at the park." On 7/25/18 at 9:17 a.m., during an interview, Resident 1 stated, on July 20, 2018 she was given a shower and the sling used to transfer her from the shower chair back to bed began to rip. Resident 1 stated, "I was up on the air and I noticed a ripping sound and I looked; it was not the strap ripping but it was the actual sling ripping toward my left shoulder. The CNAs [Certified Nursing Assistants] put me to bed right away." Resident 1 stated, "I am supposed to have a shower today after lunch if there is a FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 7 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE sling." On 7/25/18 at 10:06 a.m., during an interview, Certified Nursing Assistant (CNA) 3 stated, "We are waiting for a sling to come in [delivered to the facility]. Today, I cannot give her a shower because there is no sling." On 7/25/18 at 10:40 a.m., during an interview, CNA 1 stated, "I have been providing care for [Resident 1] since October 2017. When she was admitted, a bed bath was given as she was uncomfortable, she didn't fit with the largest shower chair the facility had. When she received her shower chair from her family she started having showers. For eight months she was just receiving bed baths." CNA 1 stated Resident 1 had no wheelchair since she was admitted to the SNF. On 7/25/18 at 10:45 a.m., during an interview, CNA 2 stated, "I assisted [Resident 1] out of the shower room to her room approximately Thursday or Friday last week (7/19/18 or 7/20/18). I waited for [CNA 1]. We used the [mechanical lift] to put her back to bed. We used a sling. During the transfer from the shower chair to her bed [with the use of a sling] a tearing noise was heard. We put her to bed as fast as we could." CNA 2 stated, the sling was torn on the left side close to Resident 1's shoulder. CNA 2 stated falling out of sling would be harmful to Resident 1 because "The resident could fall and break something like her bones." On 7/25/18 at 11:17 a.m., during an interview, CNA 1 stated Resident 1 preferred a particular sling to transfer from her bed to the shower chair but that sling was not available for use on 7/20/18. CNA 1 stated on 7/20/18 Resident 1 was given a shower. CNA 1 stated the sling used during transfer on that day was not the FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 8 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE sling Resident 1 preferred and during the transfer of Resident 1 from the shower chair back to her bed the sling started to rip. CNA 1 stated, "We [CNA 1, CNA 2, and Resident 1] heard the sling ripping... I held her close over the bed and another CNA [CNA 2] pushed the button [a control button connected to the mechanical lift] down to lower her into the bed." CNA 1 stated the ripped area of the sling was on the left side above Resident 1's left shoulder. CNA 1 stated, "The sling was the largest we have. I am not sure if that was the largest size. That was the sling provided by the facility for us to use. The resident could get hurt very badly [if sling was ripped completely]." CNA 1 stated she gave the ripped sling to the Adm on 7/20/18. On 7/25/18 at 12 p.m.., during a concurrent observation and interview with CNA 1 and the Adm, CNA 1 showed two slings that were located in the Adm's office. CNA 1 took the slings out of a clear plastic bag. The manufacture's labels on the slings were wrinkled, faded and unreadable. CNA 1 stated the first sling was the sling Resident 1 preferred, was gray in color, and the four corners of the sling where the straps were sewn were damaged and the sling was unusable. The second sling was blue in color with a ripped area on the left side of the sling below the strap. The Adm stated, "There is no sling that she [Resident 1] can use at this time." On 7/25/18 at 12:55 p.m., during an interview, the Directory of Nursing (DON) stated she was aware that Resident 1 had not taken a shower because there was no sling available that would fit her. The DON stated a sling ripped during a transfer of Resident 1 and Resident 1 was fearful that she would fall if the sling was not the right size. The DON stated she did not FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 9 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE know the weight limit of the sling that ripped during the transfer of Resident 1. The DON stated, "[Resident 1] does not have a specific bariatric sling." The DON stated "The resident does not have a wheelchair yet. I don't know why. That decision is dependent on [Adm]." The DON was asked of the risks to Resident 1 due to not having necessary equipment such as a bariatric wheelchair and sling. The DON stated Resident 1 was not able to receive showers, get out of bed, or get out of her room. The DON stated being bedbound increased Resident 1's risk of developing blood clots. The DON stated Resident 1 was provided a different bed in June 2018. The DON stated, "I don't know if it is a bariatric bed." The DON stated Resident 1 told her the bed was taken from another room in the facility. The DON stated, "I don't know her [Resident 1's] weight. I don't know the weight limit of the bed." The DON stated the Restorative Nursing Assistant (RNA) told her Resident 1 was not weighed because there was no sling available to use with the mechanical lift that would accommodate Resident 1's size. The DON stated she was not aware of Resident 1's special equipment needs when she was transferred from the GACH to the SNF in October 2017. The DON stated, "99 percent of the time I am not involved with approving inquires [requests for placement of residents]. I am just being told that the resident is coming for admission. There was no discussion of her needs with me prior to admission." On 7/25/18 at 1:47 p.m., during an interview with the facility Marketing and Business Development staff member (MBD), the MBD stated, "I sent an email to the department heads about the clinical information of the resident [Resident 1] prior to admission." The MBD provided a printed copy of an email sent to the department heads dated 10/4/17. The FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 10 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE email indicated, "This lady is 370 lbs.[pounds] coming from [name of town]. ETA [expected time of arrival] 8:30 p [p.m.])...I am sure we could work with her. Discharge orders to follow." On 7/25/18 at 1:51 p.m., during an interview, the Adm stated, "Yes, I was aware of her needs when she was admitted." On 7/25/18 at 2:15 p.m., during an interview, the MBD stated the preadmission information supplied from the GACH regarding Resident 1's condition included Resident 1 had a BMI (Body Mass Index, a measure to determine weight status) greater than 100 (BMI of 30 or greater is considered obese). The MBD stated, "I did not focus on the BMI greater than 100. I don't know if I asked about BMI greater than 100. I don't know what it means." The MBD stated there was no response to his email regarding Resident 1 from the department heads and he informed the GACH to transfer the patient [Resident 1] to the SNF on 10/5/17. On 7/25/18 at 2:43 p.m., during an interview, RNA 1 stated, "I did not take her [Resident 1's] weight when she was admitted [readmitted on 7/19/18 after a short hospital stay]." RNA 1 stated, on 7/21/18 Resident 1 refused to be weighed because there was no sling. On 7/25/18 at 3:25 p.m., during an interview with the facility Business Office Manager (BOM), the BOM stated "[Resident 1] was on Medicare Part A [a government payer source for residents in a SNF requiring skilled care and other services including but not limited to medical supplies and equipment used in the facility] from 10/5/17 to 12/1/17. The BOM stated Resident 1 was on Medi-Cal [a government payer source for residents in a SNF] from 12/1/17 to present. The BOM stated, FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 11 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE "If the resident [Resident 1] needed equipment, like a specialized wheelchair then the facility will provide the equipment needed during her or his stay at the facility. We borrowed a bariatric wheelchair from [name of GACH] unfortunately it did not fit her. It was returned back to [name of GACH] in October 2017. Since that time we did not find a wheelchair for her ... The wheelchair has to be customized with estimated cost at $15,000.00 for a nonmotorized wheelchair. For motorized wheelchair is twice the cost of non-motorized. [Resident 1] does not have a wheelchair at this time." On 7/25/18 at 4:07 p.m. during an observation and interview, Resident 1 sat on her bed fanning herself with a cardboard fan. Resident 1 stated, "I didn't get a shower today because there was no sling to use. When I was admitted to the facility there was no shower chair large enough to fit me. I tried to take showers using the largest shower chair that the facility had. After four or five showers I stopped taking showers because of lack of proper equipment...I prefer a shower over a bedbath. I took the bedbath because that was the only means I can cleanse myself. I prefer a shower because it lowers my body temperature. I feel hot all the time." Resident 1 stated her FM brought in a shower chair that fit her in May 2018 so that she could receive showers again. Resident 1 stated, "The problem is there is no sling that is appropriate that I can fit and feel safe. I am scared to get up on the mechanical lift after the incident last week when we heard the sling tearing apart..." Resident 1 stated she had not received showers because there was no sling large enough to accommodate her size. On 7/25/18 at 4:10 p.m., during a concurrent interview and document review with the Adm in FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 12 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE her office, the Adm stated, "I could not determine if the slings [the two damaged slings] that were used for the resident [Resident 1] last week when she took a shower were bariatric slings." The Adm produced copies of invoices dated 12/16/16 and 10/26/17 which indicated a total of ten slings had been ordered on the invoices. The maximum weight capacity for all slings ordered was 450 pounds. On 7/31/18 at 4:10 p.m., during a concurrent interview and record review, the Registered Dietician (RD) stated she started working at the SNF in February 2018. The RD stated residents' weight were taken on admission, weekly for four weeks, then monthly. Review of Resident 1's weight record indicated missing weight documentation for the monthly weight for Resident 1 for February, March, April, and May 2018. The RD stated the weights for those months were not taken because there was no sling available to weigh Resident 1. The RD added Resident 1 went to the GACH from 7/13/18 to 7/19/18 and weekly weights were not done after readmission to the SNF because the sling that was used to lift Resident 1 was ripped and there was no available sling to measure Resident 1's weight. Review of Resident 1's clinical record titled, "Weights and Vitals" dated 7/25/18, indicated the following weights were taken using a mechanical lift and a sling: 10/20/17, 470 (initial admission weight recorded) pounds (lbs.), 10/22/17, 470 lbs., 11/11/17, 495 lbs., 1/4/18, 501 lbs., and 6/5/18, 495 lbs. Review of facility policy and procedure titled, "Safe Lifting Movement" dated 07/06, indicated "Policy: In order to protect the safety and wellbeing of staff and patients and to promote quality care, this facility uses appropriate techniques and devices to lift and move FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 13 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE patients. Process...3. Staff will document paitent transferring and lifting needs in the care plan. Such assessment shall include: Patient's preferences for assistance...Patient's size...9. Enough slings, in the sizes required by patients in need will be available at all times..." Review of the facility document titled, "California Standard Admission Agreement For Skilled Nursing Facilities and Intermediate Care Facilities" dated 05/11, indicated "...Attachment D-1, Supplies and Services Covered By the Medicare Program for Medicare Residents...Medicare Part A covered services include...durable medical equipment..." Review of facility policy and procedure titled, "Weight Assessment and Intervention" dated 1/18, indicated "Weight Assessment 1. The nursing staff will measure weights on admission, the next day, and weekly for two weeks thereafter. If no weight concerns at this point, weights will be measured monthly thereafter...5. The Dietician will review the unit Weight Record by the 15th of the month to follow individual weight overtime. Negative trends will be evaluated by the treatment team whether or not the criteria for "significant" weight change has been met." Review of facility policy and procedure titled, "Comprehensive Plan of Care" dated 4/05, indicated "Policy: Each resident must have a comprehensive care plan developed that includes goals, measurable objectives, and timetables to meet their medical, nursing, mental, and psychological needs...Fundamental Information: The comprehensive care plan must describe the services that are provided to the resident to attain or maintain the resident's highest practicable physical, mental, and psychosocial well being. The comprehensive plan of care FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 14 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE must: Address the resident's individual needs, strengths, and preferences..." Review of Internet resource: HTTPS://downloads.cms.gov/files/mds-30-raimanual-v115-october-2017.pdf , indicated "Section F: PREFERENCES FOR CUSTOMARY ROUTINE AND ACTIVITIES Intent: The intent of items in this section is to obtain information regarding the resident's preferences for his or her daily routine and activities...Nursing homes should use this as a guide to create an individualized plan based on the resident's preferences...Health-related Quality of Life...Obtaining information about preferences directly from the resident...is the most reliable and most accurate way of identifying preferences...Planning for Care: Quality of life can be greatly enhanced when care respects the resident's choice regarding anything that is important to the resident...Information about preferences that comes directly from the resident provides specific information for individualized daily care and activity planning..." Internet source: Skilled Nursing Facility (SNF)| www.Medicare.gov dated 8/6/18, indicated "Medicare Part A (Hospital Insurance) covers skilled nursing care provided in skilled nursing facility...Medicare-covered services include, but aren't limited to:...Medical supplies and equipment used in the facility..." FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 Facility ID: CA040000004 If continuation sheet 15 of 16 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555426 (X3) DATE SURVEY COMPLETED 08/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FRESNO POSTACUTE CARE 1233 A St Fresno, CA 93706 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 971011 ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) Facility ID: CA040000004 (X5) COMPLETE DATE If continuation sheet 16 of 16