Health inspection·December 6, 2019

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent observation and interview on 12/5/19, at 9 a.m., with the Administrator (ADM), the ADM observed Resident 59's attempt to get out of the restroom unassisted. The ADM stated she did not know Resident 59 could ambulate unassisted. The ADM stated she had previously spoken to Resident 59 and Resident 59 did not want to change rooms. The ADM listened to the previous interview with Resident 59 where Resident 59 stated it was hard to get in and out of her restroom and stated Resident 59 was confused. The ADM stated she did not think if was difficult for Resident 59 to navigate in and out of her restroom. During an interview on 12/5/19, at 9:13 a.m., with Licensed Nurse (LN) 3, LN 3 stated ninety percent of the time Resident 59's wheelchair was stored outside of the room in the hall way. LN 3 stated this was necessary in order to give the residents and staff more room inside the room. LN 3 stated Resident 59 would wheel her wheelchair into her room, transfer herself to her bed, and then staff would move the wheelchair into the hall. During a concurrent observation and interview with the Director of Nursing (DON), on 12/5/19, at 9:30 a.m., the DON observed Resident 59's room, and looked at the configuration of how the bedroom and bathroom door collided and impeded opening of both doors at the same time. The DON stated the doors were a problem and the facility should have put only non-ambulatory residents in that room. The DON stated Resident 59 did not want to move to a different room. The DON stated storing Resident 59's wheelchair in the hall was a fire hazard. She stated Resident 59 ambulated hunched over and it would be hard for Resident 59 to ambulate to the hall and retrieve the wheelchair by herself. The DON stated, It's a fall waiting to happen. During a review of the clinical record for Resident 59, the face sheet (a document containing resident profile information and medical diagnosis) indicated Resident 59 was admitted to the facility on [DATE]. The Minimum Data Set (MDS) (assessment of healthcare and functional needs) assessment dated [DATE], Section C, indicated Resident 59's cognitive status was moderately impaired with a Brief Interview for Mental Status (BIMS) score of 9 of 15 points (0-7 indicated severe impairment, 8-12 indicated moderately impaired, 13-15 indicated cognitively intact). The MDS assessment, Section G, indicated Resident 59's functional status required supervision and one-person physical assistance for bed mobility, transfers, walking in room, walking in corridor, locomotion on unit and toilet use. The Fall Risk assessment dated [DATE], indicated Resident 59 had a fall risk score of 12 and If the total score was 10 or greater, the resident should be considered at HIGH RISK for potential falls. A prevention protocol should be initiated. The Care Plan for At Risk for Falls [related to] Weakness, dated 1/9/18, indicated, Assist to toilet [every] 2 hours and [as needed], Assist with transfers, encourage safety precautions. The Care Plan for Potential for Rehabilitation of Mobility dated 4/12/18, indicated, Requires 1 person assist. The Clinical Physician Order dated 4/12/19, indicated, Nursing Rehab[ilitation] ambulate 200 [feet] using a [front wheel walker] 5 days a week. The Physician Order dated 1/8/18, indicated, Ambulate [with] assistance. During an interview on 12/6/19, at 10:36 a.m., with CNA 2, she stated there was no room in Resident 59's room to store Resident 59 and her roommates' wheelchairs. CNA 2 stated Resident 59's wheelchair was often stored in the hall outside of the room when Resident 59 was sleeping. CNA 2 stated Resident 59's wheelchair was not accessible to her the majority of the time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 2 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure staff followed professional standards of practice for two of two sampled residents (Resident 22 and Resident 45) who used indwelling urinary catheters (a flexible tube inserted into the bladder to drain urine) when Resident 22's and Resident 45's urinary catheter tubing was not secured to prevent discomfort and accidental dislodgment of the catheter. Residents Affected - Some This failure had the potential to cause discomfort, injury to the urethra (duct that leads from the bladder and transports urine out of the body) and accidental dislodgment of the indwelling catheter. Findings: 1. During a concurrent observation and interview on 12/3/19, at 10:09 a.m., with Resident 22, Resident 22 was in bed, her urinary catheter bag hung on the right side of her bed frame. Resident 22 pointed to the urinary catheter tubing after she removed her blanket. Resident 22's catheter tubing hung loose and was not secured to her leg. During a concurrent observation and interview on 12/3/19, at 11:01 a.m., with Licensed Nurse (LN) 1, in Resident 22's room, LN 1 uncovered Resident 22's blanket and stated the urinary catheter tubing on Resident 22 was not secured to prevent pulling. LN 1 stated the urinary catheter should have been secured with a band around Resident 22's thigh to prevent pulling. LN 1 stated not having a secured catheter tubing could cause irritation and potentially dislodge the catheter. Resident 22's urinary catheter tubing was hanging loose and was not secured to her leg. During a concurrent interview and record review on 12/4/19, at 12:59 p.m., with LN 2, LN 2 reviewed Resident 22's clinical record and stated Resident 22's urinary catheter was ordered on 10/4/19. LN 2 stated it was the responsibility of nursing staff to ensure the catheter tubing was secured on the resident's thigh to prevent accidental dislodgment of the catheter and to prevent injury. LN 2 reviewed the facility policy and procedure titled, Catheter Care, Urinary dated 9/14, and stated it was the standard of practice and the facility's policy to secure the catheter tubing to prevent dislodgement. During an interview on 12/4/19, at 1:25 p.m., with the Director of Nursing (DON), the DON stated it was the facility's policy to secure the catheter utilizing a leg band. The DON stated the catheter tubing should be secured to prevent dislodgement and trauma. The DON stated it was the nursing staff's responsibility to ensure the catheter tubing was secured to the resident. 2. During a concurrent observation and interview on 12/3/19, at 11:05 a.m., with Certified Nurse Assistant (CNA) 5, in Resident 45's room, Resident 45 laid in bed with her urinary catheter tubing laying across her thigh. CNA 5 stated Resident 45's catheter tubing was not secured on Resident 45's thigh. CNA 5 stated the urinary catheter tubing needed to be secured in place to prevent accidental dislodgment of the catheter. CNA 5 stated Resident 45 could suffer severe pain if the catheter was accidentally dislodged. During a concurrent observation and interview on 12/3/19, at 11:30 a.m., with LN 5, in Resident 45's room, LN 5 looked at Resident 45's urinary catheter tubing and stated the catheter tubing was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 3 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some secured. LN 5 stated the tubing should be secured on Resident 45's thigh to prevent movement of tubing and damage to the urethra. LN 5 stated Resident 45 could also suffer pain, bleeding, and if the urinary tubing was accidentally dislodged it could lead to a urinary tract infection. LN 5 stated, I do not know why the tubing is not anchored correctly. During a concurrent observation and interview on 12/5/19, at 12 p.m., with LN 10, in Resident 45's room, LN 10 stated she was familiar with the care for Resident 45. LN 10 stated Resident 45 was admitted to the facility with a urinary catheter. Resident 45 was lying on her bed on her left side with pillows supporting her back and legs. Both of Resident 45's legs were contracted and supported by pillows. LN 10 stated Resident 45 had a catheter bag filled with 400 milliliters (ML-unit of measure) of amber colored urine. The tubing leading down to the urine bag was hanging loosely and not secured to Resident 45's leg. LN 10 stated the tubing was not anchored onto the resident using a leg strap to prevent dislodgment of the urinary catheter. LN 10 stated dislodgment of the catheter would cause great discomfort, bleeding, and tearing of the urethra. LN 10 stated Resident 45 would also need an unnecessary procedure to replace the catheter if it was accidentally dislodged. LN 10 stated the tubing should be secured with a leg band to prevent injury to Resident 45. During an interview on 12/6/19, at 8:21 a.m., with the DON, the DON stated Resident 45 was continuously using the catheter. Resident 45 was admitted to the facility on [DATE], with a catheter in place. The DON stated Resident 45 was bedridden and had a fracture (broken bone) to both legs. The DON stated Resident 45's catheter was not secured in order to prevent dislodgement of the urinary catheter. The DON stated dislodgement of the catheter could cause trauma to the resident's urethra causing bleeding, and pain and exposure to bacteria which could cause Resident 45 to contract an infection of the urinary tract. During a review of the facility policy and procedure titled, Catheter Care, Urinary dated 9/14, indicated, .The purpose of this procedure is to prevent catheter-associated urinary tract infections .Steps in the Procedure .Secure catheter utilizing a leg band . During review of the professional reference titled, GUIDELINE FOR PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS 2009 dated 6/6/19, retrieved from https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines-H.pdf, indicated, . Properly secure indwelling catheters after insertion to prevent movement and urethral traction [pulling] . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 4 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 - Some 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 establish an environment free from accidents and hazards for two of 27 sampled residents (Resident 13, 96) when: 1. Resident 13 and Resident 96 smoked in an area without smoking fire safety accommodations to ensure the residents remained safe while they smoked. This failure potentially placed Resident 13 and 96 at risk for smoking related injuries. 2. Resident 59 was not accommodated with staff assistance when ambulating to the restroom as indicated in her plan of care. This failure had the potential for Resident 59 to fall and sustain injuries from fall. Findings: 1. During an interview with Resident 96 on 12/3/19, at 8:42 a.m., Resident 96 stated he smoked every day. Resident 96 stated he smoked without supervision and he was able to access his cigarettes that he kept at his bed side. During an observation of Resident 96 on 12/3/19 at 8:47 a.m., Resident 96 announced to his nurse that he was going out to the patio area to smoke. Resident 96 smoked outside without a smoking apron and without supervision. During a review of the clinical record for Resident 96, the Minimum Data Set (MDS) assessment (an assessment of functional needs and memory function) dated 11/18/19, indicated Resident 96 had no memory impairment with a Brief Interview for Mental Status (BIMS) score of 15 of 15 points. During an interview on 12/4/19, at 2:57 p.m., with Resident 13, Resident 13 stated he had been a smoker for 54 years. Resident 13 stated he obtained his cigarette and lighter from the nurse's station each time he went out to smoke. Resident 13 stated the facility staff were not present when he smoked. Resident 13 stated he was not provided with a smoking apron to protect his clothes from falling ashes while he smoked. Resident 13 stated he would have to yell out for help if an emergency occurred. During an observation on 12/4/19, at 3:01 p.m., in the outside facility smoking patio area. The smoking patio area was not equipped with a fire extinguisher or a fire retardant blanket. During a review of Resident 13's face sheet (a document containing resident identifiable and personal information) dated 12/5/19, indicated Resident 13 was admitted to the facility with diagnoses which included nicotine dependence cigarette, dependence on wheelchair, muscle weakness, post-traumatic stress disorder, acquired absence of left leg, and acquired absence of right leg. During a review of the clinical record for Resident 13, the MDS assessment dated [DATE], indicated Resident 13 had no memory impairment with a BIMS score of 15 of 15 points. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 5 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 During a concurrent observation and interview on 12/4/19, at 3:57 p.m., with Resident 13, outside at the designated smoking area, Resident 13 was observed smoking unsupervised. Resident 13 stated he sustained a burn on his left hand four days ago while he disposed of his cigarette butt. Resident 13 stated he reported the cigarette burn to LN 2. Resident 13's left hand had a round dark brown scab the size of a pencil eraser. Residents Affected - Some During a concurrent observation and interview on 12/4/19, at 4:02 p.m., with Licensed Nurse (LN) 14, outside at the designated smoking area, LN 14 stated she was familiar with the care for Resident 13. Resident 13 was observed smoking unsupervised. LN 14 stated Resident 13 had been a smoker for a long time, and was currently smoking unsupervised. LN 14 stated the residents that smoked at the facility smoked unsupervised. LN 14 stated she was unaware of how Resident 13 acquired the scab on his left hand. LN 14 stated there was no fire extinguisher nearby and there was no fire retardant blanket near the smoking area. LN 14 stated the residents who smoked were not given smoking aprons to protect their clothes when they smoked. During a concurrent observation and interview on 12/4/19, at 4:30 p.m., with the DON and Resident 13, the DON stated she was unaware Resident 13 had burned himself while smoking. The DON observed Resident 13 and stated he had a small circular scab on his left hand. Resident 13 stated he had burned himself four days ago while disposing the cigarette butt in the receptacle. During a review of the clinical record for Resident 13, the Progress note dated 12/5/19, indicated, .Res [resident] has a scab to top of left hand. Measurements: 0.2 [by] 02 [2 centimeter] .Dr. [name] notified, new orders to monitor [every] q shift until healed . During an interview on 12/4/19, at 4:01 p.m., with the DON, the DON stated supervision was needed when residents went out to smoke, but also the facility was not locked and residents could come and go as they pleased. During an interview on 12/4/19, at 3:59 p.m., with Administrator (ADM), the ADM stated residents smoked by themselves if the assessment indicated the ability to smoke independently. The ADM stated the facility didn't supply staff to observe residents while smoking. The ADM stated the facility was not going to supply staff to observe the residents while smoking and expose the employees to second hand smoke. The facility policy and procedure titled, Smoking Policy dated 3/02, indicated, .Provide maximum safety to all resident at all times. It is the intent of the facility to provide an environment to allow those residents who wish to smoke, the opportunity to do so in a safe environment, with optimal safety to themselves . During an interview on 12/4/19, at 3:59 p.m., with ADM), the ADM stated residents smoked by themselves if the assessment indicated the ability to smoke independently. The ADM stated the facility didn't supply staff to observe residents while smoking. The ADM stated the facility was not going to supply staff to observe the residents while smoking and expose the employees to second hand smoke. The facility policy and procedure titled, Smoking Policy dated 3/02, indicated, .Provide maximum safety to all resident at all times. It is the intent of the facility to provide an environment to allow those residents who wish to smoke, the opportunity to do so in a safe environment, with optimal safety to themselves . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 6 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 2. During a concurrent observation and interview on 12/03/19, at 11:05 a.m., with Certified Nursing Assistant (CNA) 5, in Resident 45's room, Resident 45 laid in bed with her urinary catheter tubing laying across her thigh. CNA 5 stated Resident 45's catheter tubing was not secured on Resident 45's thigh. CNA 5 stated the urinary catheter tubing needed to be secured in place to prevent accidental dislodgement of the catheter. CNA 5 stated Resident 45 could suffer severe pain if the catheter was accidentally dislodged. Residents Affected - Some During a concurrent observation and interview on 12/03/19, at 11:30 a.m., with LN 5 in Resident 45's room, LN 5 looked at Resident 45's urinary catheter tubing and stated the catheter tubing was not secured. LN 5 stated the tubing should be secured on Resident 45's thigh to prevent movement of tubing and damage to the urethra. LN 5 stated Resident 45 could also suffer pain, bleeding, and if the urinary tubing was accidentally dislodged it could lead to a urinary tract infection. LN 5 stated, I do not know why the tubing is not anchored correctly. During a concurrent observation and interview on 12/5/19 at 12 p.m., with LN 10, in Resident 45's room, LN 10 stated she was familiar with the care for Resident 45. LN 10 stated Resident 45 was admitted to the facility with a urinary catheter. Resident 45 was lying on her bed on her left side with pillows supporting her back and legs. Both of Resident 45's legs were contracted and supported by pillows. LN 10 stated Resident 45 had a catheter bag filled with 400 milliliters (ML) of amber colored urine. The tubing leading down to the urine bag was loosely hanging and not secured on Resident 45's leg. LN 10 stated the tubing was not anchored onto the resident using a leg strap to prevent dislodgement of the urinary catheter LN 10 stated dislodgement of the catheter would cause great discomfort, bleeding, and tearing of the urethra. LN 10 stated Resident 45 would also need an unnecessary procedure to replace the catheter if it was accidentally dislodged. LN 10 stated the tubing should be secured with a leg band to prevent injury to Resident 45. During an interview on 12/6/19 at 8:21 a.m., with the DON, the DON stated Resident 45 was on continuous use of the catheter. Resident 45 was admitted to the facility on [DATE], with a catheter in place. The DON stated Resident 45 was bedridden and had a fracture (broken bone) to both legs. The DON stated Resident 45's catheter was not secured to prevent dislodgement of the urinary catheter. The DON stated dislodgement of the catheter could cause trauma to the resident's urethra causing bleeding, and pain and expose Resident 45 to a possible urinary tract infection. During a review of the facility policy and procedure titled, Catheter Care, Urinary, dated 9/14, indicated, .The purpose of this procedure is to prevent catheter-associated urinary tract infections .Steps in the Procedure .Secure catheter utilizing a leg band . During a review of the professional reference titled, GUIDELINE FOR PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS 2009 dated 6/6/19, retrieved from https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines-H.pdf, indicated, Properly secure indwelling catheters after insertion to prevent movement and urethral traction [pulling] . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 7 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 interview and record review, the facility failed to ensure support personnel were competent to effectively carry out the function for food and nutrition services when two of two sampled Maintenance Assistants (MA 1 and MA 2) did not clean and sanitize the facility ice machine in accordance to the manufacturer's recommendations. (Cross reference F908.) This failure had the potential for the ice machine to not function properly, cause contamination of the ice, and lead to resident illnesses. Findings: During a concurrent interview and record review on 12/4/19, at 8:18 a.m., with MA 1 and the Housekeeping & Maintenance Supervisor (HMS), MA 1 stated he had been cleaning and sanitizing the ice machine once a month since 9/2019. MA 1 stated he followed the manufacturer's guidelines located inside the ice machine binder. MA 1 stated he diluted a cleaner with two gallons of room temperature water, flushed the machine twice, and allowed the machine to make ice three times. MA 1 stated he would discard the ice three times and would consider the ice machine clean once these steps were followed. MA 1 stated he had been trained to clean and sanitize the ice machine by MA 2. MA 1 retrieved the binder for logging the cleaning and sanitizing of the ice machine with the manufacturer's guidelines and stated the binder contained the wrong manufacturer's guidelines. MA 1 stated the facility had the manufacturer's guidelines for the previous ice machine used in the facility. The HMS retrieved and reviewed the manufacturer's guidelines for the current ice machine titled, [Manufacturer's name] Instruction Manual dated 11/7/18, and stated it indicated to use [manufacturer's name] [name of product] cleaner 10.5 ounces diluted with two gallons of warm water and rinse four times, then sanitize with 5.25% Sodium Hypochlorite Solution (bleach) one ounce diluted with two gallons of warm water and rinse two times. The HMS stated the facility had only been using bleach (a 8.25% sodium hypochlorite germicidal concentration) to clean and sanitize the ice machine and was not using any cleaning solution. The HMS stated the bleach the facility was using was the wrong concentration according to the manufacturer's guidelines. The HMS stated the facility did not currently have the cleaner or sanitizer the manufacturer's guidelines indicated they should be using. During an interview on 12/6/19, at 10:51 a.m., with the Dietary Supervisor (DS), she stated no competencies had been checked on MA 1 or MA 2 on the cleaning of the ice machine. The facility policy and procedure from their Food Service Policy & Procedures Manual titled Sanitation and infection control dated 2011, indicated Policy: Ice machine will be cleaned and sanitized once a month .Procedures: 1. Follow manufacturer recommendations .5. Clean .rinse, sanitize with appropriate solution and air dry .7. If another department is responsible for cleaning the ice machine, make sure the process is being followed according to policy for technique and time frame. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 8 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview and record review, the facility failed to ensure the nutritional needs of residents were being met in accordance with established dietary national guidelines when the Registered Dietitian Nutritionist (RDN) did not sign to demonstrate approval of the facility's food menus. This failure placed the residents at risk for not receiving adequate nutrition which could further compromise their medical status. Findings: During a review of the facility's menu titled, Week 3 [Sunday through Saturday] (01-05) Cycle 4 2019 Therapeutic Spreadsheets on 12/3/19, at 3:15 p.m., the signature line for all seven days was left blank with dates below the line for signatures to be obtained on 10/6/19, 11/3/19, 12/1/19, and 12/29/19. During an interview on 12/4/19, at 11:03 a.m., with the RDN, the RDN stated the facility used an outside contractor to provide the menus for the facility. The RDN stated it was her responsibility to make nutritional analysis of menu items and it was her responsibility to approve the menus. The RDN stated she had been working at the facility as the RDN since 11/19, and it was her belief that the previous RDN had approved the current menus but had not signed them. The RDN stated she had approved and signed the menus that morning, 12/4/19, but had not approved the menus before that date. During an interview on 12/4/19, at 11:28 a.m., with the Dietary Supervisor (DS), DS stated the RDN was supposed to approve the menus before the facility used them and the current RDN had approved the current menus that morning. The DS stated the menus had been in use and were approved by the previous RDN but he had not signed them. The DS stated, according to facility policy, the RDN was to sign the menus when he or she approved them. During a review of the facility policy and procedure titled, Menus dated 2018, indicated .3. Menus may be prepared by individuals other than a Registered Dietitian Nutritionist; however, approval for nutritional adequacy must be completed by a Registered Dietitian Nutritionist. Menus should be signed by the Registered Dietitian Nutritionist to verify menu review and approval . During a review of the contract between the facility and the contracted nutritional consulting company titled Agreement to Provide Consultant Services, dated 7/29/19, indicated .Responsibilities of the consultant .The RDN will provide consultation as follows. 1. Provides consultation to administration regarding planning, policy development, and priority-setting, based on initial and ongoing evaluations of the food service needs .7. Documents nutritional information in accordance with the policies of the facility and accepted professional practice . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 9 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 store food in accordance with professional standards for food service safety when multiple food items available for resident consumption were stored without being covered and without open dates inside Freezer 1, walk in refrigerator, kitchen dry food storage areas and inside refrigerators in nursing station 1 and 3. These findings had the potential to cause gastric upset from the consumption of improper stored food. Findings: During a concurrent observation and interview on 12/3/19, at 8:27 a.m., with the Dietary Supervisor (DS), in the Freezer 1, one large cardboard box was left open with multiple individual butter pats (squares). The DS stated the box of butter pats should have been closed or placed inside a sealed container to prevent freezer burn. During a concurrent interview and record review on 12/3/19, at 9:21 a.m., with the DS, the DS reviewed the facility policy and procedure titled, Sanitation and Infection Control Subject: Freezer Storage dated 2018, the DS stated the policy indicated all foods inside the freezer needed to be stored in an airtight, moisture-resistant wrapper. The DS stated the cardboard box the butter pats were stored in was not air tight or moisture-resistant. The facility policy and procedure titled, Sanitation and Infection Control Subject: Freezer Storage dated 2018, indicated, .5. All foods should be stored in an airtight moisture-resistant wrapper such as plastic bag or freezer paper to prevent freezer burn . During a concurrent observation and interview on 12/3/19, at 8:27 a.m., with the DS, in the walk in refrigerator, an opened and unsealed bag of powdered parmesan cheese with no open date, an opened bag of shredded cheddar cheese with no open date, an opened bag of sliced cheddar cheese with no open date, and an opened and unsealed bag of tortillas were found. The DS stated all opened items should have been dated and needed to be resealed to preserve and protect the food items. During a concurrent interview and record review on 12/3/19, at 9:21 a.m., with the DS, the DS reviewed the facility policy and procedure titled, Sanitation and Infection Control Subject: Refrigerated Storage dated 2018, and stated it indicated opened cheese should be discarded after 2-3 weeks. The DS stated opened cheese in the refrigerator needed to have the date it was opened on the package in order for staff to know how long the food item was opened for. During a review of the facility policy and procedure titled, Sanitation and Infection Control Subject: Refrigerated Storage dated 2018, indicated, .7. All refrigerated foods will be covered properly .9 .unused portions of packaged foods should be covered, labeled and dated .Suggested refrigerated storage guidelines .Dairy products (opened) .Cheese . 2-3 weeks During a concurrent observation and interview on 12/3/19, at 8:28 a.m., with the DS, in the dry storage, an opened bag of penne pasta was in a sealed plastic bag with no date. The DS stated the pasta needed to be dated when it was opened per facility policy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 10 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 During a concurrent interview and record review on 12/3/19, at 9:21 a.m., with the DS, the DS reviewed the facility policy and procedure titled, Sanitation and Infection Control Subject: Canned and Dry Goods Storage dated 2018, and stated it indicated all opened food items in dry storage needed to have an open date. During a review of the facility policy and procedure titled Sanitation and Infection Control Subject: Canned and Dry Goods Storage dated 2018, indicated, .All open food items will have an open date .resalable plastic bags will be used for .opened packages of items such as pastas .Food items will be labeled and dated when placed into containers . During an interview on 12/3/19, at 8:45 a.m., with the DS, she stated per the facility's outside food policy, residents could store food brought into the facility from an outside source in a refrigerator or freezer at either Nurses' station 1 or 3. The DS stated it was the policy of the facility to ensure the resident's name and the date the food item was brought into the facility was written on the food container. During a concurrent observation and interview on 12/3/19, at 8:46 a.m., with the DS, the refrigerator at Nurses' Station 3 contained two Styrofoam containers of leftover food with no date, an unsealed box with a pre-cooked pumpkin pie with no name and no date, an opened glass jar of pickle chips with no name and no date, and one chocolate pudding cups with no name. The DS discarded the food items that were unsealed, had no name, and/or no date and stated all food items had to be sealed and have the resident's name and date written on the container. During a concurrent observation and interview on 12/3/19, at 8:46 a.m., with the DS, the freezer at Nurses' Station 1 contained a tamale in a plastic bag with no date, and the refrigerator contained three chocolate pudding cups with no name and an unsealed squeeze bottle of apple sauce. The DS stated the apple sauce was facility provided and should have been sealed or closed at the top. During a concurrent interview and record review on 12/3/19, at 9:21 a.m., with the DS, the DS reviewed the facility policy and procedure titled, Sanitation and Infection Control Subject: Food Brought in from Outside Sources dated 2018, and stated it indicated all food brought in from outside the facility needed to be dated, labeled, and discarded in a timely manner. During an interview on 12/4/19, at 8:13 a.m., with the Housekeeping and Maintenance Supervisor (HMS), she stated the housekeepers and staff monitored the food in the Nurses' station refrigerators and freezers and discarded food after three days of storage. The HMS stated if there was no date on the food item, staff would throw the item away because they wouldn't be able to know how long the item had been stored. HMS stated the staff were supposed to monitor the food twice a day when they monitored the temperatures of the refrigerators and freezers. The facility policy and procedure titled Sanitation and Infection Control Subject: Food Brought in from Outside Sources dated 2018, indicated, .Items will be dated, labeled and discarded in a timely manner . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 11 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to maintain medical records that were complete and accurately documented for three of 27 sampled residents (Resident 110, Resident 43, and Resident 45) when: 1. The physician's visit and assessment of Resident 110 was not documented on the progress note for [DATE]; and the Physician Orders for Life-Sustaining Treatment (POLST-a summary of medical orders to be followed during a medical emergency and end of life wishes) dated [DATE], was not revised by the physician to reflect end of life wishes. This failure had the potential for end of life wishes not to be respected in the event of an emergency. 2. Minimum Data Set assessment (MDS - a standardized assessment and care screening tool) coding requirements were not followed for two of 27 sampled residents (Resident 43 and Resident 45) when aspirin medications were coded under the classification of anticoagulant (medication used to stop the formation of blood clots) and should not have been. This failure resulted in inaccurate information submittal to the MDS database. Findings: 1. During a concurrent interview and record review of Resident 110's POLST on [DATE], at 11:40 a.m., with Licensed Nurse (LN) 13, the POLST form dated [DATE], was reviewed. The POLST indicated Resident 110's Cardiopulmonary Resuscitation status (CPR- an emergency life-saving procedure performed when someone's breathing or heartbeat has stopped) indicated, Attempt Resuscitation/CPR. LN 13 stated, she spoke with Resident 110's family member (FM) 1 and FM 2 on [DATE], regarding Resident 110's CPR status and requested no CPR be performed. LN 13 stated, Resident 110's physician was notified about the family's request to change the CPR status to do not resuscitate (DNR) on [DATE]. LN 13 stated, a new POLST which reflected Resident 110's change in life sustaining treatment as requested by Resident 110's family was not signed by Resident 110's physician. LN 13 stated she e-mailed a new POLST to reflect the family's choice of DNR for Resident 110 to Resident 110's family who were to complete and return the updated POLST form by fax to the facility. During a concurrent interview and record review on [DATE], at 11:50 a.m., with the Director of Nursing (DON), Resident 110's POLST form in the clinical record was reviewed. The DON stated the POLST dated [DATE] was the only completed POLST in resident 110's clinical record. The POLST form from [DATE] indicated Resident 110's CPR status was Attempt Resuscitation/CPR. The DON stated she could not find a more current POLST in the chart. The DON stated resident 110's physician saw the Resident on [DATE], the day of Resident's death on [DATE]. The DON was unable to find documentation to reflect the visit conducted by Resident 110's physician on [DATE]. During an interview on [DATE], at 1:34 p.m., with the Administrator (ADM), the ADM stated Resident 110's family wanted to change the POLST orders from full treatment to DNR. The ADM stated Resident 110's physician was notified on [DATE] of Resident 110's family request for a change in the POLST orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 12 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0842 Level of Harm - Minimal harm or potential for actual harm During a telephone interview on [DATE], at 2:26 p.m., with FM 2, FM 2 stated he and FM 1 spoke with a nurse on the phone about Resident 110's decline in health and POLST orders on [DATE]. He stated the family wanted Resident 110's POLST orders to be changed from full treatment status to DNR status. FM 2 stated he was e-mailed a blank POLST form to be completed and returned by fax to the facility, but Resident 110 passed away prior to the family completing the POLST form and faxing it back. Residents Affected - Some During an interview on [DATE], at 3:04 p.m., with LN 12, LN 12 stated she was told at shift change report that Resident 110's family was requesting Resident 110 be a DNR status. LN 12 stated she also read a communication note from LN 13 which reflected the family's request for a change in the POLST order from CPR to DNR. During a concurrent interview and record review on [DATE], at 3:23 p.m., with the DON, the Medication Treatment Record (MAR) indicated Resident 110 was a full code. The DON stated the current code status for residents was located at the top of each resident's MAR. The DON stated when there was a change in POLST orders for a resident a new POLST was created and signed by the physician and resident/family. The DON stated the process for completing a new POLST if the family was not local to the area was for staff to e-mail or fax the POLST form to the family, the family would complete it and send it back to the facility, then the resident's physician would sign the new POLST form. During a review of the facility's policy and procedure titled, Advance Directives, dated 4/13, indicated, .11. The Resident's Attending Physician will clarify and present any relevant medical issues and decisions to the resident or legal representative as the resident's condition changes in an effort to clarify and adhere to the resident's wishes . 2. During a concurrent interview and record review on [DATE], at 10:14 a.m., with the MDS Coordinator (MDSC), the MDSC reviewed the clinical record for Resident 43 and stated section N was coded to indicate Resident 43 had received anticoagulant (AC-prevent blood clots) medication daily for the seven-day assessment observation period. The MDSC reviewed Resident 43's physician orders and medication administration record (MAR) and stated Resident 43 had a physician prescription for aspirin 325 milligram (mg - a unit of measurement). The MDSC stated Resident 43 did not have a physician order for AC medications and had not received AC medications during the MDS assessment review time frame [DATE]. The MDSC reviewed the MDS Resident Assessment Instrument (RAI) Version 3.0 assessment Manual, dated 10/2019 and stated the RAI manual indicated the medication aspirin should not be coded on the MDS assessment under AC medication. The MDSC stated the MDS assessment was incorrectly coded. The MDSC stated the MDS assessment was inaccurate because Resident 43 was not taking AC medications. During a review of the clinical record for Resident 43, the MDS assessment dated [DATE], indicated, Section N . Medications received .resident [43] received the following medications . during the last 7 days . Anticoagulant . During a review of the clinical record for Resident 43, the Order Summary Report dated 12/2019 indicated, Aspirin Tablet 325 MG give 1 tablet .[every] morning . During a concurrent interview and record review on [DATE], at 10:19 a.m., with the MDSC, the MDSC reviewed the clinical record for Resident 45 and stated section N was coded to indicate Resident 45 had received AC medication daily for the seven-day observation period. The MDSC reviewed Resident 45's physician orders and MAR and stated Resident 45 had a physician prescription for aspirin 81 mg and no AC medications. The MDSC stated she incorrectly coded aspirin as an AC medication on the MDS assessment. The MDSC reviewed the MDS RAI Version 3.0 Manual, dated 10/2019, and stated the RAI manual (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 13 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some indicated aspirin should not be coded under AC medication. The MDSC stated the MDS assessment was inaccurate because Resident 45 was not taking AC medications. During a review of the clinical record for Resident 45, the MDS assessment dated [DATE], indicated, Section N . Medications received .resident [45] received the following medications . during the last 7 days . Anticoagulant . During a review of the clinical record for Resident 45, the Order Summary Report dated 12/2019 indicated, Aspirin Tablet 81 MG give 1 tablet . [every] morning . During a review of the MDS RAI Version 3.0 Manual, dated 10/2019, indicated, . N0410: Medications Received . Anticoagulant . record the number of days an anticoagulant medication was received by the resident at any time during the 7-day look-back period . do not code . medications such as aspirin . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 14 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 potential for actual harm Based on observation, interview and record review, the facility failed to maintain an infection control program to prevent the transmission of infections for one of six sampled residents (Resident 11) when an oxygen humidifier (a device that introduced moisture to a gas) and a nasal cannula (NC) tubing were not replaced after five days and continued to be used for 13 days. Residents Affected - Few This failure placed Resident 11 at risk for developing respiratory infections. Findings: During an observation on 12/3/19, at 10:32 a.m., in Resident 11's room, Resident 11 was resting in bed with her NC tubing attached to a humidifier next to the bed. There was no date on the NC tubing and the water bottle attached to the humidifier was dated 11/20/19. During a concurrent observation and interview on 12/3/19, at 10:44 a.m., with licensed nurse (LN) 4, LN 4 observed Resident 11's humidifier and NC tubing and stated there was no date on the NC tubing and the date on the humidifier was 11/20/19. LN 4 stated the facility's policy was to change the humidifier and NC tubing every five days to prevent respiratory infections caused by bacterial growth that could happen in the water. LN 4 stated it had been 13 days since the NC tubing and humidifier were changed for Resident 11. During an interview on 12/4/19, at 12:56 p.m., with the Director of Nursing (DON), she stated the NC tubing and bottles of water on the humidifiers needed to be changed every five days. The DON stated bacterial growth could happen in the water if left for more than five days and a resident could develop a respiratory infection if they inhaled contaminated water. During a review of the clinical record for Resident 11, the Order Summary Report dated 12/5/19, at 11:11 a.m., indicated Resident 11 had been on physician ordered oxygen at 2 liters (unit of measurement) (as needed) PRN since 2/27/19. During a review of the facility policy and procedure titled, Pre-filled oxygen humidifiers dated 8/94, indicated, Purpose .2. To prevent infection caused by oxygen use. Procedure .11. Change every 5 days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 15 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on interview, and record review, the facility failed to maintain the ice machine in accordance with manufacturer's instructions for use when the ice machine was not cleaned and sanitized per manufacturer's guideline. (Cross reference F802.) Residents Affected - Many This failure had the potential for the ice machine to not function properly, cause contamination of the ice, and lead to resident illness. Findings: During a concurrent interview and record review on 12/4/19, at 8:18 a.m., with Maintenance Assistant (MA) 1 and the Housekeeping & Maintenance Supervisor (HMS), MA 1 stated he had been cleaning and sanitizing the ice machine once a month since 9/2019 and followed the manufacturer's guidelines in the ice machine binder. MA 1 stated he diluted a cleaner with two gallons of room temperature water, flushed the machine twice, let the machine make ice three times and threw the ice away, then considered the ice machine clean and sanitized. MA 1 stated MA 2 trained him to clean and sanitize the ice machine. MA 1 retrieved the binder for logging the cleaning and sanitizing of the ice machine. MA stated the manufacturer's guidelines inside the binder belonged to the previous owned ice machine and were the wrong guidelines for the current ice machine. The HMS retrieved and reviewed the manufacturer's guidelines for the current ice machine titled, [Manufacturer's name] Instruction Manual dated 11/7/18, and stated it indicated to use [manufacturer's name] Scale Away cleaner 10.5 ounces diluted with two gallons of warm water and rinse four times, then sanitize with 5.25% Sodium Hypochlorite Solution (bleach) one ounce diluted with two gallons of warms water and rinse two times. The HMS stated the facility had only been using bleach (a 8.25% sodium hypochlorite germicidal concentration) to clean and sanitize the ice machine and was not using any cleaning solution. The HMS stated the bleach the facility was using was the wrong concentration of bleach according to the manufacturer's guidelines. The HMS stated the facility did not currently have the cleaner or sanitizer the manufacturer's guidelines indicated they should be using. During an interview on 12/4/19, at 8:51 a.m., with the Administrator (ADM), ADM stated the facility did not have the appropriate cleaner and sanitizer to clean and sanitize the ice machine according to manufacturer's guidelines. The ADM stated bacteria could grow in the ice machine and get the residents sick if not cleaned and sanitized properly. During an interview on 12/4/19, at 9:06 a.m., with the Dietary Supervisor (DS), DS stated an improperly cleaned and sanitized ice machine could cause gastrointestinal (stomach and intestine) illnesses in the residents. During a review of the facility policy and procedure titled, Sanitation and infection control dated 2011, indicated, Policy: Ice machine will be cleaned and sanitized once a month .Procedures: 1. Follow manufacturer recommendations .5. Clean .rinse, sanitize with appropriate solution and air dry . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 16 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0912 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview and record review, the facility failed to ensure the minimum square footage was maintained for 25 of 47 resident rooms (100, 102, 104, 106, 108, 110, 112, 114, 116, 118, 120, 122, 200, 204, 206, 208, 210, 212, 214, 216, 304, 306, 308, 310, and 314), and three of 25 sampled resident rooms (104, 216, and 304) did not provide residents and staff with enough space to accommodate resident needs when: 1. Staff had limited space and difficulty providing resident care in room [ROOM NUMBER]. 2. Resident 96 was not able to exit or enter his room when care was being given to his roommates in room [ROOM NUMBER]. 3. Resident 59 was not able to easily and safely ambulate herself to and from the restroom or store her wheelchair in room [ROOM NUMBER]. This failure resulted in inadequate space for staff to deliver care and the potential to impact the residents' safety and quality of life. (Cross reference F588.) Findings: 1. During an observation on 12/5/19, at 2:10 p.m., in the facility, resident rooms were measured with the Housekeeping/Maintenance Supervisor (HMS) and Maintenance Assistant 1 (MA 1). The amount of usable living space of the residents' rooms that did not meet 80 square feet per resident were as follows: Rm # SQ. FT. Number of Beds 100 212.1 3 102 213.92 3 104 200.55 3 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 17 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0912 106 Level of Harm - Minimal harm or potential for actual harm 214.5 3 Residents Affected - Some 108 224 3 110 215.94 3 112 292.5 4 114 202.2 3 116 214.03 3 118 220 3 120 224 3 122 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 18 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0912 220 Level of Harm - Minimal harm or potential for actual harm 3 200 222.61 3 Residents Affected - Some 204 230 3 206 222 3 208 224 3 210 222 3 212 224 3 214 224 3 216 297.6 4 304 236.32 3 306 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 19 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0912 234.32 Level of Harm - Minimal harm or potential for actual harm 3 308 Residents Affected - Some 234.32 3 310 234.32 3 314 236.43 3 During a concurrent observation and interview on 12/5/19, at 2:10 p.m., with the Housekeeping, Maintenance Supervisor (HMS) and Maintenance Assistant (MA), the HMS and MA measured facility rooms. The HMS and MA stated room [ROOM NUMBER] had three residents occupying it and measured 236.32 square feet (s.f.) equaling 78.77 s.f. per resident. During an observation on 12/3/19, at 10:01 a.m., in room [ROOM NUMBER], room [ROOM NUMBER] was observed to have three occupied beds. All three occupied beds had resident equipment which reduced walking and moving space. Resident in bed A had an oxygen concentrator at the bedside and an electric wheelchair that occupied the adjacent space. An oxygen concentrator was placed between bed B and bed C. Resident in bed C utilized a wheelchair for locomotion. During an interview on 12/5/19, at 3:41 p.m., with Certified Nursing Assistant (CNA 6), CNA 6 stated she had been working at the facility over a year. CNA 6 stated the resident in room [ROOM NUMBER] bed B required the use of a reclining chair which made it difficult to transfer the resident to his reclining chair and had limited space to do so. 2. During a concurrent interview and observation on 12/5/19, at 2:10 p.m., with the HMS and MA, the HMS and MA measured facility rooms. The HMS and MA stated room [ROOM NUMBER] was a four person room occupied by three residents. The MS stated the room measured 297.6 s.f. equaling 74.4 s.f. per resident. During a concurrent observation and interview on 12/04/19, at 9:14 a.m., with Resident 96, Resident 96 stated that he was in a room with 4 beds and did not know why he had the bed farthest from the room entrance. Resident 96 stated Bed B was the second bed from the door and was not occupied. Resident 96 stated he was unable to exit his room when one of the other two roommates where being changed, fed, and/or cleaned. Resident 96 stated staff pulled the residents' beds into the small walkway blocking his ability to exit when they provided care to his roommates. He stated if he was outside of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 20 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0912 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some his room while his roommates were being attended to, he was unable to enter his room and access his bed. He stated that he had complained to staff but the situation had not changed. Resident 96 had a front wheel walker and a motorized wheel chair that he used to get around in the facility. 3. During a concurrent interview and observation on 12/5/19, at 2:10 p.m., with the HMS and MA, the HMS and MA measured facility rooms. The HMS and MA stated room [ROOM NUMBER] had three residents occupying it and measured 200.55 s.f. equaling 66.85 s.f. per resident. During an observation on 12/3/19, at 10:15 a.m., Resident 59's room was a three-person room, with three beds in the room. Resident 59's bed was the first bed in the room and was located across from the restroom entrance. Resident 59's wheelchair was parked next to her bed, approximately two feet from the wall. Resident 59's bedroom door was opened wide and blocked access and the ability to open the only restroom door. Resident 59 was inside the restroom and struggled to open the restroom door which was blocked by the bedroom door. Resident 59 managed to push the bedroom door away from the restroom entrance in an effort to open the restroom door and exit the restroom. Resident 59 grunted as she ambulated hunched over without a walker. She maneuvered the two doors and grabbed the footboard of her bed and scooted sideways in between her wheelchair and her bed. She used her mattress for balance and support while she scooted between the bed and wheelchair. Resident 59 sighed as she finally sat in her wheelchair and breathed rapidly. During an interview on 12/3/19, at 2:35 p.m., with Resident 59 and Social Service Assistant (SSA), SSA translated for Resident 59. Resident 59 stated her bathroom door slammed shut and would not stay open and it made it hard for her to get in and out of the bathroom. Resident 59 stated whoever made that door with the bedroom door in front of it was not in their right mind. During an observation on 12/4/19, at 8:48 a.m., in room [ROOM NUMBER], Resident 59 was coming out of the bathroom. The bedroom door was open, covering the bathroom door which was shut. Resident 59 pushed on the inside of the bathroom door trying to open it while closing the bedroom door. Resident 59 was huffing and out of breath. Resident finally maneuvered around both doors and sat on her bed to catch her breath. Resident 59's wheelchair was in the hallway outside of the bedroom. During a concurrent observation and interview on 12/4/19, at 9:56 a.m., with CNA 2 and CNA 3, they stated they had to move beds in room [ROOM NUMBER] to get a mechanical chair lift in to get Resident 59's roommates in and out of bed. CNA 2 and 3 observed the doors to the bathroom and bedroom and stated it would be very difficult for Resident 59 to get out of the bathroom and navigate to her bed on her own, especially if her wheelchair was in the room as well. CNA 3 stated the resident could fall and injure herself. During a concurrent observation and interview on 12/5/19, at 9 a.m., with the Administrator (ADM), in room [ROOM NUMBER], the ADM observed Resident 59 attempting to get out of her bathroom. The ADM stated she did not agree with the observation that it was difficult for Resident 59 to navigate in and out of her bathroom. During an interview on 12/5/19, at 9:13 a.m., with Licensed Nurse (LN) 3, she stated 90% of the time Resident 59's wheelchair was stored in the hall to give the residents and staff more room in room [ROOM NUMBER]. During a concurrent observation and interview on 12/5/19, at 9:30 a.m., with the Director of Nursing (DON), the DON observed the opening and shutting of the bedroom and bathroom doors in room [ROOM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 21 of 22 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 055410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Post Acute 361 E. Grangeville Blvd Hanford, CA 93230 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 0912 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some NUMBER]. The DON stated the doors were a problem and the facility probably should have put only non-ambulatory residents in that room. The DON stated storing Resident 59's wheelchair in the hall was a fire hazard. She stated Resident 59 ambulated hunched over and it would be hard for Resident 59 to ambulate to the hall and retrieve her wheelchair by herself. The DON stated it's a fall waiting to happen. During an interview on 12/6/19, at 10:36 a.m., with CNA 2, she stated staff needed to use a mechanical chair lift to transfer both of Resident 59's roommates. She stated staff had to move the beds in Resident 59's room in order to use the mechanical lift because there was not enough room. CNA 2 stated there was no room in Resident 59's room to store the residents' reclining chairs or wheelchairs and Resident 59's wheelchair was often stored in the hall outside of the room when Resident 59 was sleeping. During a review of the facility policy and procedure titled Physical Environment dated 2015, indicated, .Bedroom must .measure at least 80 square feet per resident in multiple resident bedrooms . Recommend Room Waiver Based upon an acceptable plan of correction. _____________________________________ Health Facilities Evaluator Nurse Date Request waiver. ______________________________________ Facility Administrator Date FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 22 of 22