Inspection·June 10, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain a safe and comfortable environment for two of 13 sampled residents (Resident 1 and Resident 8) when Resident 1 and Resident 8 ' s wheelchairs were covered with black and brown unknown substances and were visible to passersby. This failure violated Residents 1 and Resident 8 ' s rights to a comfortable and homelike environment that would respect the residents' dignity and well-being. Findings: During a review of Resident 1's admission Record (AR- a document that provides resident contact details, a brief medical history, level of functioning, preferences, and wishes), dated 6/11/25, the AR indicated, Resident 1 was admitted from an acute care hospital on [DATE] to the facility, with diagnoses that included Encephalopathy (a disorder caused by a buildup of toxins in the brain that can happen with advanced liver disease), Protein-Calorie Malnutrition (not consuming enough protein and calories, resulting to weight loss), Anxiety (a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities) and Dysphagia (difficulty swallowing). During a review of Resident 1's Minimum Data Set (MDS-comprehensive, standardized assessment of residents' functional capabilities and health needs), dated 4/28/25, the MDS indicated, Resident 1 ' s BIMS (Brief Interview for Mental Status) score was 4 out of 15 (0-7 indicated severe cognitive impairment [memory loss, poor decision making-skills], 8-12 moderate cognitive impairment, 13-15 cognitively intact). During a review of Resident 8's AR, dated 6/9/25, the AR indicated, Resident 8 was admitted from an acute care hospital on [DATE] to the facility, with diagnoses that included End Stage Renal Disease (ESRD- a medical condition in which a person's kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis [the process of removing waste products and excess fluids from the body] or a kidney transplant to maintain life), Cerebral Infarction (stroke, bleeding inside the brain), and Congestive Heart Failure (CHF- weakness in the heart where fluid accumulates in the lungs). During a review of Resident 8's MDS, dated [DATE], the MDS indicated, Resident 8 ' s BIMS (Brief Interview for Mental Status) score was 13 out of 15 (0-7 indicated severe cognitive impairment [memory loss, poor decision making-skills], 8-12 moderate cognitive impairment, 13-15 cognitively intact). (continued on next page) 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. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 055147 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 055147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Madera Rehabilitation & Nursing Center 517 South A Street Madera, CA 93638 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)