Health inspection·May 19, 2023

F 0684 indicated the facility did not have oral suctioning machines. Level of Harm - Actual harm During a review of Resident 1's Face Sheet (FS- a document containing resident profile information), dated 11/2/2022, the FS indicated, Resident 1 was initially admitted to the facility on [DATE] and was re-admitted on [DATE] with diagnoses which included anoxic brain injury (harm to the brain due to lack of oxygen), cerebral palsy (CP- a group of disorders that affect a person's ability to move and maintain balance and posture), dysphagia, constipation, seizures (sudden, uncontrolled body movements and changes in behavior that occur because of abnormal electrical activity in the brain) and a surgical history of a tracheostomy (a procedure to help air and oxygen reach the lungs by creating an opening into the trachea (windpipe) from outside the neck) with removal and PEG placement. Residents Affected - Few During a review of Resident 1's Minimum Data Set (MDS- a resident assessment tool used to identify cognitive (mental processes) and physical functional level) assessment, dated 3/1/2023, the MDS indicated, Resident 1's Brief Interview for Mental Status (BIMS - screening tool used to assess resident cognitive level) score was 0 of 15 points which indicated Resident 1 had severe cognitive impairment. During a concurrent observation and interview, on 4/6/2023 at 9:42 a.m., with Licensed Vocational Nurse (LVN) 1, at nurses' station 3 & 4 (combined nurses' station), LVN 1 stated she was aware there were no suction machines in the residents ' room but she was aware of the locations of the portable suction machines. LVN 1 stated she was aware of the choking incident of Resident 1 that occurred on 4/1/2023. LVN 1 stated on 4/3/2023, all Licensed Nurses were in-serviced by the Assistant Director of Nursing (ADON) on oral suction machines. LVN 1 stated resident rooms were not equipped with wall-suctioning. LVN 1 was able to demonstrate each nursing station had a portable suction machine stored in each unit's utility storage room. LVN 1 stated she had not received training on how to use the portable suction machines (they have 3) available at the facility. LVN 1 stated she was not completely comfortable using the portable suction machine but if needed to use it, even during an emergency, she could figure it out. During an interview on 4/6/2023, at 10:50 a.m., with LVN 2, LVN 2 stated she and CNA 1 responded to Resident 1's room on 4/1/2023 after a report from the Environmental Services (EVS) staff that white stuff was coming out from [Resident 1's] mouth, possibly choking. LVN 2 stated, I knew it must be from his Tube Feeding (TF).LVN 2 stated, I heard gurgling sounds coming from [Resident 1] deep in his chest and white fluid coming from his mouth. LVN 2 stated, I told [CNA 1] to lift the HOB and [Resident 1] looked like he was choking. He [Resident 1] looked like he needed deep suctioning, outside my scope of practice and all I could do is oral suction. LVN 2 stated she used nursing judgement when she determined Resident 1 needed deep suction instead of oral suction because she heard the gurgling deep in [Resident 1's] lungs. LVN 2 stated she called EMS or 911. LVN 2 stated she and CNA 1 sat Resident 1 up and while LVN 2 slapped his back, CNA 1 placed a pulse oximeter and blood pressure cuff on Resident 1 to check his blood pressure and oxygen level. LVN 2 stated, The CNA's have this equipment readily available while waiting for EMS to arrive. LVN 2 stated, The oxygen reading on the pulse oximeter was 91 or 92%. [documented in the Transfer document completed by LVN 2 and provided to EMS indicated Resident 1 ' s oxygen level was at 90%] (oxygen saturation- a measurement of how much oxygen your blood is carrying as a percentage of the maximum it could carry. For a healthy individual, the normal O2 should be between 96% to 99%). LVN 2 stated she did not apply oxygen to Resident 1 for decreased oxygen levels before EMS arrived. LVN 2 stated I was not sure if [Resident 1] routinely used oxygen. I did not see an oxygen tank in the room. LVN 2 stated the oral suction machine was not used or brought to Resident 1's bedside and she did not ask for help or assistance from any other staff or Licensed Nurses before the EMS staff arrived. LVN 2 stated the ambulance was located just (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 2 of 8 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 05/19/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few around the corner and arrived within minutes of her placing the 911 call. LVN 2 stated she would have grabbed suction, but EMS showed up quickly. LVN 2 stated while providing EMS staff with a brief report of Resident 1's condition, two other EMS staff were attending to Resident 1 at his bedside. LVN 2 stated an EMS staff asked her if [the facility] had a suction machine. LVN 2 stated, I told the EMS worker, no we don't have one, I called you guys [EMS]. LVN 2 stated EMS staff suctioned Resident 1 until he was loaded to the ambulance. LVN 2 stated LVN 3 educated her on where the portable suction machines were kept in the facility. LVN 2 stated she never had to use the portable suction machine but feels comfortable using it. LVN 2 stated training on the use of the portable suction machine /set-up was done right after she was hired. LVN 2 stated another in-service was done after Resident 1 was sent to the hospital to make sure everyone knew where the suction cart is. During an interview on 4/6/2023, at 11:10 a.m., with LVN 3, LVN 3 stated she was the House Supervisor on 4/1/2023. LVN 3 stated she was told by another staff member, at around 11:30 a.m. that Resident 1 had been sent out and EMS was wanting to speak with her. LVN 3 stated EMS reported that LVN 2 stated We don't have suction machines. LVN 3 stated she notified the Director of Nursing (DON) via text message of this event and the statement made by LVN 2 regarding not knowing the location and how to use the oral suction machines. LVN 3 stated she showed LVN 2 the location of where the portable suction machine was kept at the facility at nurse's stations 3 and 4. LVN 3 stated, [LVN 2] said she didn't know about portable suction machine availability, sorry. During an interview on 4/6/2023, at 11:25 a.m., with CNA 1, CNA 1 stated she was the CNA assigned to Resident 1 on 4/1/2023. CNA 1 stated she entered Resident 1's room and saw Resident 1 laying in bed. CNA 1 stated LVN 2 told her to raise the HOB to 90 degrees. CNA 1 stated after raising the HOB, she noticed Resident 1 was trying to cough it up. CNA 1 stated LVN 2 told her Just let [Resident 1] try to finish coughing it out and she asked LVN 2 how she could help with the situation. CNA 1 stated LVN 2 did not ask her to bring the portable suction machine to Resident 1's room. CNA 1 stated she had brought the portable suction machine to a Licensed Nurse before and knew where the oral suction machines were located and what supplies are needed to provide oral suction. CNA 1 stated she did not suggest using the portable oral suction machine for Resident 1 to LVN 2 at the time of the emergency. During an interview on 4/6/2023, at 1:55 p.m., with the DON, the DON stated LVN 3 called her on 4/1/2023, to report Resident 1 was sent out to the GACH. The DON stated LVN 3 also informed her that the EMS staff notified LVN 3 that LVN 2 stated the facility did not have suction machines that were readily available for use in an emergent situation. The DON stated she directed LVN 3 to immediately educate LVN 2 about the location and the availability of the portable suction machines. The DON stated she and the ADON discussed the need for immediate training of all Licensed Nurses about the location of the portable oral suction machines, when and how to use it during an emergency such as when a resident was coughing up a lot of secretions. The DON stated the ADON immediately began training the nursing staff on 4/3/2023. The DON stated she was familiar with Resident 1 and his care needs and that her expectation of the Licensed Nurses regarding any report of resident distress would be immediate assessment, identification of cause for distress, and performance of nursing interventions (such as suction) based on the nurse's clinical assessment of the resident's condition (such as choking). The DON stated calling 911 was important, but it was her expectation that the Licensed Nurse would stay in the room with the resident during any emergency. The DON stated, [LVN 2] should have asked for help to call 911, manage resident symptoms, or for someone to get the suction machine. The DON stated it was her expectation LVN 2 would be able to provide oral suctioning as needed especially during an emergency. The DON stated she did not understand why LVN 2 would not have performed a physical assessment such as listening to Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 3 of 8 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 05/19/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few 1's lung sounds with a stethoscope, provide oral suction, or choking interventions to help clear Resident 1's airway while waiting for EMS staff to arrive. The DON stated she did not know why LVN 2 would state that the facility did not have portable oral suction machines because this was covered and discussed during the new hire orientation. The DON stated LVN 2 and all Licensed Nurses, including CNAs, were required to have a current Cardiopulmonary Resuscitation (CPR) training and certification card (choking interventions are part of this course) to be employed at the facility. During a review of the facility Progress Note (PN) dated 4/1/2023, at 2:28 p.m., the PN indicated, .Late Entry Effective Date 4/1/2023 .Writer and CNA entered room and observed [Resident 1] lying flat and choking. Writer instructed CNA to lift head of bed . Head of bed was raised, and resident began choking and was unable to clear his mouth or airway. Writer contacted EMS to transfer resident to ED. EMTs entered facility and began to suction resident and transfer him to gurney. EMT asked writer if she had a suction machine and writer stated she did not have the suction machine. It is outside the scope of practice for an LVN to suction so writer immediately contacted EMS [Emergency Medical Services] when resident was observed choking. EMT [Emergency Medical Technician] suctioned resident until they got him into the ambulance, and they turned on lights and sirens as they left. The PN indicated a correction to original PN dated 4/1/2023 at 2:28 p.m. An LVN can suction a resident but cannot deep suction. During a review of the Ambulance Report dated 4/1/2023, the Ambulance Report indicated that the dispatch center received the call for service at 11:02 a.m.ambulance enroute at 11:04 a.m., .at scene: 11:06 a.m., at patient: 11:08 a.m., Depart: 11:16 a.m.SpO2 83% . on .room air .effort labored ., .respirations 24 .Activities .Procedures, 11:11 a.m. Airway suctioning .11:14 a.m. oxygen application .SpO2 95% . on .effort normal ., .respirations 18 .Narrative .Choking, per nurse on scene . bed bound .male patient . in bed actively choking on phlegm .for a bit now .nurse was unable to tell time exactly when they noticed it and she could not give me an answer, I asked if they tried suctioning his airway and nurse stated we do not carry suction again I asked there is no suction in this facility and nurse stated No we don't.sent firefighter to get suction unit while preparing for transport .possible partial airway obstruction .suctioning airway consistently .vitals taken. O2 therapy @ 15 liters per minute and 6 liter per minute after airway was cleared .able to get pts airway cleared significant improvement . Depart: 11:16 a.m.Arrive Destination: 11:22 a.m. During a review of Resident 1's GACH History and Physical Examination (H&P) dated 4/1/2023 at 5:40 p.m., the H&P indicated .Chief Complaint Choking .History of Present Illness .There is no history provided other than ER [ED] physician notes noting that the patient had difficulty breathing and noticeable amount of secretions coming from his mouth. On arrival blood pressure 145/96, pulse rate 117, respiratory rate 21, 02 saturation 97% on oxygen, afebrile (no fever). Venous blood gas shows a pH 7.38, PC02 51, P02 52, HC03 30. CBC is unremarkable. Chemistry shows sodium 147, potassium 3.5, BUN 29, creatinine 0.6, .Twelve-lead EKG [An electrocardiogram (ECG or EKG) records the electrical signal from the heart to check for different heart conditions.] shows atrial flutter/tachycardia with RVR [rapid heart rate, greater than normal value of 60-100 bpm [beats per minute] 117 bpm. 1 view chest x-ray shows low lung volumes with pulmonary vascular crowding versus congestion. CT [Computed Tomography Scan- A procedure that uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body] of patient's abdomen and pelvis with contrast [a dye or other substance that helps show abnormal areas inside the body] shows pneumatosis [the abnormal presence of air or other gas within tissues] v. Localized bowel perforation [tear in the lining of the stomach] surrounding the ascending colon, significant fecal impaction [large, hard mass of stool that gets stuck so badly in your colon or rectum that you can't push it out], G-tube present .In the emergency room patient was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 4 of 8 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 05/19/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few given IV [brand name anti-seizure medication], IV antibiotics, IV fluids. General surgery was consulted, and patient will be consulted by general surgery, recommends at this time to keep n.p.o. [nothing by mouth] IV antibiotics .Impression and Plan .Active Diagnoses .Hypoxic episode (Hypoxemia- low level of oxygen in the blood]), Choking episode .Fecal impaction .Pneumatosis intestinalis of large intestine . #1 choking episode with hypoxemia Suction at bedside, okay to suction as needed [Antibiotic] pharmacy to dose for possible aspiration pneumonia as needed bronchodilators /As needed oxygen #2 Severe fecal Impaction with possible perforation n.p.o. IV fluids with D5 one half NS 75 m L/h IV Antibiotics with [name brand antibiotic] pharmacy to dose General surgery consult Repeat CT with contrast Bowel program per general surgery recommendations . #5 cerebral palsy/functional quadriplegia/chronic bedbound state/nonverbal Long-term resident of nursing home .Length of stay 3 to 4 days Disposition back to long-term care All available medications reconciled at time of encounter Course: Stable. Anticipated discharge location: Skilled nursing facility . During a review of Resident 1's GACH General Surgery Consultation, (GSC) dated 4/3/2023 at 1:54 p.m., the GSC indicated follow-up: The patient is best served by cleansing from above in hopes that we can get him to have some sort of clearance of the stool [poop] in his rectum. The patient's white count has already dropped into the normal range [a sign of improved infection status] and at some point he may be a candidate for a Gastrografin [a dye or other substance that helps show abnormal areas inside the body] enema. There is no role for surgery to relieve constipation [a condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don't happen very often], obstipation [severe or complete constipation] without a clear-cut perforation [hole], evidence of peritonitis [infection in the abdominal cavity] or pneumoperitoneum [presence of air or gas in the abdominal (peritoneal) cavity] . During an interview on 4/6/2023, at 11:20 a.m., with CNA 1, CNA 1 stated she was getting ready to start resident showers (on 4/1/2023) and asked LVN 3 to unhook Resident 1 from his tube feeding at around 9 am. CNA 1 stated she and another CNA used a mechanical lift to transfer Resident 1 from his bed to a reclining shower chair while maintaining the HOB level at 36 degrees. CNA 1 stated Resident 1 was moved right away after the TF was disconnected by LVN 3. CNA 1 stated she could not recall if the tube feeding was running or not. CNA 1 stated Resident 1 did not show any signs or symptoms of pain, discomfort, nausea during his shower. CNA 1 stated, [Resident 1] was behaving normally. CNA 1 stated Resident 1 was returned to his room where he was transferred back to the bed, shaved, and dressed. CNA 1 stated Resident 1's HOB and feet were elevated prior to her leaving the room. CNA 1 stated it was approximately 9:30 a.m. when she left Resident 1's room. During an interview on 4/6/2023, at 11:25 a.m., with LVN 3, LVN 3 stated CNA 1 asked LVN 3 to unhook Resident 1's TF (so that Resident 1 could be showered) while she was passing medications to other residents. LVN 3 stated she estimated that she turned the tube feeding off between 8:30 a.m. and 9 a.m. LVN 3 stated when she entered Resident 1's room, the TF was connected to Resident 1's feeding tube and running. LVN 3 stated she went back to Resident 1's room after his shower at approximately 9:30 a.m. LVN 3 stated she was helping on the unit due to a nurse having called in sick that day. LVN 3 stated she was not the primary nurse and did not know why Resident 1's TF was still running after 8 a.m. LVN 3 stated the MD order was for Resident 1's TF to be off at 8 a.m. and turned on at 12 p.m. During a concurrent interview and record review, on 4/6/2023 at 2:10 p.m., with the DON, LVN 3 and the Administrator (ADM) in the conference room, the facility's Policy and Procedure (P&P) titled, Enteral Feedings- Safety Precautions dated 11/2018 was reviewed. The P&P indicated, .Purpose To ensure the safe administration and during enteral nutrition . Preventing aspiration: 1. Check enteral tube (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 5 of 8 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 05/19/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few placement prior to feeding or administration of medication. 2. Check gastric residual volume as ordered. 3. Elevate the HOB at least 30 degrees during tube feeding and at least 1hour after feeding . 4. If a resident is on a enteral feeding while infusing ensure the HOB is elevated at least 30 degrees. If enteral feeding is infusing, pause enteral feeding to provide Activities of Daily Living (ADL) care to include pericare. 5. Monitor the resident for signs and symptoms of respiratory distress during enteral feedings and medication administration . Recognizing and reporting other complications 1. Symptoms of perforation of the stomach or small intestine/peritonitis . g. nausea .i. vomiting . LVN 3 stated when she went to Resident 1's room on 4/1/2023, to unhook Resident 1 from the tube feeding in preparation for his shower, it was between 8:30 a.m. and 9:00 a.m. LVN 3 stated she turned off the tube feeding at this time. LVN 3 and DON stated Resident 1 should not have been moved, repositioned, or showered before 9:30 a.m. to prevent Resident 1 from aspirating. The DON stated the P&P for enteral feedings was not followed by the staff which placed Resident 1 at an increased risk for aspiration. During a telephone interview on 4/6/2023 at 10:03 a.m., with the Director of Staff Development (DSD), the DSD stated that nurses received verbal discussion with the DON regarding the use of the suction machine during the new hire orientation and annual competency assessment. The DSD stated, I have not done any oral suction machine training to the [Licensed Nurses]. The DSD stated she had not received any staff concerns about the use of the suction machine. During an interview on 4/6/2023 at 11:25 a.m., with LVN 5, LVN 5 stated the expectation was to have the TF put on hold by the Licensed Nurse before starting peri-care (clean soiled private area) or laying the resident flat. LVN 5 stated she was always taught that it was okay to lay the resident flat while delivering peri care if the TF was turned off. LVN 5 stated she did not know and was not familiar with the facility P&P on enteral feedings indicated and what it meant for Resident 1's care. LVN 5 stated it was important to be aware of the P&P's in order to meet the residents' care needs. During a review of the facility's P&P titled, Checking Gastric Residual Volume (GRV), dated 11/2018, the P&P indicated .The purpose of this procedure is to assess tolerance of enteral feeding and minimize the potential for aspiration .2. Review the resident's care plan and provide for any special needs of the resident .2. Check GRV if clinical assessment reveals: a. the resident is not tolerating enteral feedings (nausea, vomiting, distention) .3. Evaluate residents who are receiving enteral nutrition for the risk of aspiration, including . b. supine position; c. improper position of the feeding tube; d. vomiting .4. Visually check the position of the feeding tube before the initiation of each feeding. 5. Keep the HOB elevated 30 degrees during feedings and for at least 1 hour after feedings .Steps in the Procedure .6a. If GRV is between 250-500 mL, take measures to reduce the risk of aspiration .b. If the GRV is greater than 500 mL, notify the physician. Assess resident for feeding intolerance. c. If the resident is on continuous tube feedings, the stomach should contain no more than the total intake from the last hour. If so, withhold feeding and notify the physician. d. If the resident is free of obvious symptoms of Gastro-Intestinal (GI) intolerance (distention, vomiting, and constipation) or respiratory distress, return aspirated GRV to the stomach (via the tube) . During a concurrent interview and record review, on 4/6/2023, at 1:55 p.m., with the DON and ADM, in the private living room, the DON stated it was important for Licensed Nurses and CNAs to be familiar with the P&P on enteral feedings in order to meet the needs of the residents' which required the use of TF. The DON stated the HOB should be elevated during TF to prevent aspiration and choking. The DON and ADM stated the facility P&P's were readily available and accessible to all staff and was located in the computer for easy access. The DON and ADM reviewed the facility documents titled, All Staff meeting agenda and CNA In-Service Attendance Record dated 3/31/2023 at 2:30 p.m., which (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 6 of 8 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 05/19/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few indicated the Policy and Procedure Manuals was discussed by the ADM for those present (attendance sheet indicated 43 facility staff members were in attendance) to ensure all staff had the knowledge to locate the P&P to provide the care needs of all residents. During a concurrent interview on 4/6/2023 at 2:10 p.m., with LVN 3, the DON and ADM in the private living room, LVN 3 stated when Resident 1 experienced a choking episode on 4/1/2023, she educated LVN 2 to the location of the portable suction machine. The DON stated the ADON started nursing staff in-service on 4/3/2023. The DON stated that 11 of 20 Licensed Nurses had been in-serviced as of 4/6/2023. The DON stated she was not sure why LVN 1 said she was not comfortable using the portable suction when LVN 1's signature was on the in-service sign in sheet dated 4/3/23 acknowledging the ADON demonstrated the use of the portable suction for each Licensed Nurse on duty. The ADM stated, Employees such as CNAs aren't expected to go to a policy for guidance. They should go to a seasoned nurse for questions. During a concurrent observation, interview, and record review on 4/6/2023, at 4:34 p.m., with LVN 4, LVN 5 and the DON, in the private living room, LVN 4 did not completely demonstrate all steps (per facility P&P) for suctioning during the return demonstration, did not test the suction prior to using for patient suctioning. LVN 4 stated the ADON provided an in-service on 4/3/2023 and the ADON showed her where the portable suction machine was located, how to turn the machine on and how to use it. LVN 4 stated the ADON did not reference or provide her with a copy of the facility suctioning P&P. LVN 4 stated, I have not seen this P&P before today. LVN 5 was able to perform all steps of suctioning per facility P&P and stated she received the same type of in-service as LVN 4. The DON stated the facility has not completed a competency skill validation for its Licensed Nurses in the facility and it was important to train and ensure all Licensed Nurses had the competency and skills to perform oral suctioning in the event a resident experienced a choking or aspiration emergency. During a review of a Memorandum from the Executive Officer of the Board of Vocational Nursing and Psychiatric Technicians dated 12/9/2022, retrieved from https://www.bvnpt.ca.gov, the Memorandum indicated, .Basic respiratory assessment is within the scope of the LVN practice. The LVN learns how to perform these tasks during their basic pre-licensure training, both in the classroom setting and in clinical rotations. Respiratory assessment is a technical skill to assist with data collection. Specifically, chest auscultation, endotracheal or nasal suctioning, removal and replacement of inner cannula, and removal of external speaking valves are all within the LVN scope of practice and part of the basic respiratory assessment performed by LVNs. Moreover, patient assessment is essential to ensuring that the patient's conditions are not changing or worsening. Assessment does not entail an LVN changing the directed treatment without consultation and direction from the physician or RN supervising the LVN. It does entail basic tasks like suctioning to keep a patient safe and comfortable . During an interview on 4/28/23 with the DON, the DON stated Resident 1 returned to the facility from the GACH on 4/21/23. During a concurrent observation and interview, on 4/28/2023, at 10:15 a.m., in Resident 1's room, Resident 1 laid in bed with the HOB elevated greater than 30 degrees and did not appear to have signs of distress. Resident 1 was well groomed, and room was clean and free of clutter. LVN 7 stated she was the primary nurse assigned to care for Resident 1 today. During a review of Resident 1's History and Physical (H&P) dated 11/19/2022, the H&P indicated Mobility/Restraints . Bed Bound .DIAGNOSIS .6. Chronic Constipation . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 7 of 8 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 05/19/2023 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 0684 Level of Harm - Actual harm During a review of Resident 1's Care Plan dated 4/26/2023, the Care Plan indicated .Focus .Date initiated: 6/22/2017, Status Active .Description .Resident has an alteration in elimination of bowel and bladder. Resident is currently incontinent of bowel and bladder. Potential for Constipation secondary to Decreased Mobility and Medication Use Residents Affected - Few 2. During a concurrent interview and record review, on 4/28/2023 at 10:40 a.m., with LVN 7 and the ADON, LVN 7 and the ADON reviewed Resident 1's UNTITLED [Care Plan] dated 11/18/22 which indicated Resident 1 gets his medication daily on a scheduled basis for constipation and there were also PRN (as needed) orders if Resident 1 does not have a BM. LVN 7 stated, The PRN orders are to be used beginning on day 2 of [Resident 1] not having a BM. LVN 7 stated Resident 1's plan of care indicated Resident 1 was to have at least one bowel movement every 3 days. LVN 7 stated she followed the MD orders and facility Bowel Regimen Policy PRN for her residents. During a record review, of Resident 1's Order Summary Report (OSR), dated 4/6/2023, the OSR indicated, Enteral Feed Order every shift Turn pump off at 0800 and start at 1200. Order Status Active Order Date 2/19/2023 .OSR, page 2 of 6 .MONITOR BOWL MOVEMENT Q SHIFT every shift .order status Active dated 3/30/2023 .OSR, page 4 of 6 .Bisacodyl Suppository 10 mg [(Name Brand)] Insert 1 suppository rectally as needed for CONSTIPATION ON 3RD DAY NO BM IF [Magnesium Hydroxide] NEFFECTIVE .Order Status Active dated 11/18/22 .OSR, page 5 of 6 .[Name Brand] Enema 7-19 GM (gram- a unit of measurement)/118ml (milliliter- a unit of measurement) 10 mg (milligram- a unit of measurement) [(Generic Name Brand)] Insert 1 applicatorful rectally as needed for Constipation on 3RD DAY NO BM IF [Name Brand] SUPP INEFFECTIVE .Order Status Active dated 11/18/22 .[Name Brand] Enema 7-19 GM/118ml 10 mg [(Generic Name Brand)] Insert 1 applicatorful rectally for Constipation. Give if no results from laxative suppository . Order Status Active dated 11/18/22 . page 5 of 6 . [Name Brand] Suspension1200 MG/15ML [(Generic Name Brand)] Give 20 ml via -Tube as needed for CONSTIPATION ON 2ND DAY NO BM .Order Status Active dated 2/3/2023 . During a concurrent interview and record review, on 4/28/2023 at 10:43 a.m., with LVN 7 and the ADON, LVN 7 and the ADON reviewed the facility's Bowel Regime Policy, dated 1/2023 which indicated, .Purpose: It is the policy of this facility to have individualized orders. No standing orders will be used. We will establish an individual bowel regime to meet the resident's needs. 1. BMs are monitored every shift a[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055410 If continuation sheet Page 8 of 8