Health inspection·February 13, 2026

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident over in the wheelchair and fall. During a concurrent observation and interview on 2/13/26 at 10:10 a.m. with Resident 2 outside room [ROOM NUMBER] in the hallway, Resident 2 was sitting in his wheelchair with two family members. Resident 2 stated room [ROOM NUMBER] was his room. Resident 2 stated the transition strip made it difficult to go in and out of his room. Resident 2 stated sometimes the transition strip would cause the wheelchair to spin. Resident 2 stated the transition strip would cause the wheelchair to turn as he crossed the transition strip. Resident 2 stated the transition strip could cause a fall. During a record review of Resident 2's AR, dated 2/13/26, the AR indicated Resident 2 had a diagnosis of Chronic Obstructive Pulmonary Disease (a progressive, incurable lung disease that causes severe, long-term breathing difficulty), Hypertensive Heart Disease (chronic high blood pressure leading to heart muscle thickening, stiffening, and eventual failure), Dorsalgia (pain in any part of the back, including the neck, mid-back, or lower back), and Dementia (a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking). During a record review of Resident 2's BIMS, dated 2/9/26, the BIMS score was 11. During a concurrent observation and interview on 2/13/26 at 10:30 a.m. with Resident 3 in room [ROOM NUMBER], Resident 3 was sitting in her wheelchair next to bed 2. Resident 3 stated she had been using the wheelchair for mobilization for seven years due to a history of fibromyalgia (a chronic, non-progressive neurological condition characterized by musculoskeletal pain, fatigue, sleep disturbances and disruption in mental processes). Resident 3 stated the transition strip in her room was not an issue for her because she was strong enough to pass it in her wheelchair, but the transition strip could be difficult for other residents. Resident 3 stated she has seen residents go backward in their wheelchair to get in and out of their rooms because the back wheels were bigger which made it easier to pass the transition strip. Resident 3 stated going backward in the wheelchair could cause a fall. Resident 3 stated some residents shuffle (not lifting the feet off the floor completely when walking), and an uneven and cracked transition strip could cause them to trip and fall. Resident 3 stated the transition strip should be smooth, flat, and even to provide easy access to pass. During a record review of Resident 3's AR, dated 2/13/26, the AR indicated Resident 3 had a diagnosis of Sepsis (a life-threatening medical emergency caused by the body's extreme, dysfunctional response to an infection, resulting in widespread inflammation, tissue damage, and potential organ failure), Type 2 Diabetes Mellitus (a chronic metabolic disorder characterized by high blood sugar due to insulin resistance), Cellulitis (acute, spreading bacterial infection of the deep dermis and subcutaneous tissue) and Hypertensive Heart Disease. During a record review of Resident 3's BIMS, dated 2/18/26, the BIMS score was 14. During a concurrent observation and interview on 2/13/26 at 10:35 a.m. with Resident 4 in room [ROOM NUMBER], Resident 4 was lying in bed 3. Resident 4 stated she used a walker and wheelchair for mobilization. Resident 4 stated the bump (transition strip) on the floor at the entrance was difficult to pass. Resident 4 stated she was unable to get pass the transition strip using her walker and wheelchair and must call staff for assistance when going in and out of her room. During a record review of Resident 4's AR, dated 2/13/26, the AR indicated Resident 4 had a diagnosis of Discitis of lumbar region (medical condition characterized by inflammation of the intervertebral disc space in the lower back), Sepsis, Type 2 Diabetes Mellitus, and Cutaneous Abscess of back (a localized, painful collection of pus, dead tissue, and bacteria that forms within the deep skin layers on the back). During a record review of Resident 4's BIMS, dated 1/17/26, the BIMS score was 13. During an interview on 2/13/26 at 10:44 a.m. with Certified Nursing Assistant (CNA) 1, CNA 1 stated pushing the residents in and out of the rooms in the wheelchair was difficult because the transition strips were bumpy. CNA 1 stated some transition strips were more cracked and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055423 If continuation sheet Page 2 of 4 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 055423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manning Gardens Care Center, Inc 2113 E. Manning Avenue Fresno, CA 93725 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some uneven than others and could cause a fall. During an interview on 2/13/26 at 10:54 a.m. with CNA 3, CNA 3 stated the transition strips to the residents' rooms were difficult to push residents in and out of their rooms in their wheelchairs and with the shower chair (an assistive device designed to provide a stable, water-resistant seating surface for individuals who have limited mobility, poor balance, or reduced physical strength). CNA 3 stated the shower chairs had small and hard wheels which made it more difficult to get pass the transition strips. CNA 3 stated going backward in a wheelchair could cause the wheelchair to tilt backward, resulting in a fall. CNA 3 stated the transition strip could cause a fall going forward in a wheelchair or shower chair since the transition strip was not flat, smooth, and even. CNA 3 stated assisting heavier residents in a wheelchair and shower chair was more difficult to get pass the transition strips and had a higher risk of falling. During a concurrent observation and interview on 2/13/26 at 11:48 a.m. with the Director of Staff Development (DSD), the transition strips to rooms 1, 2, 3, 4, 5, 6, 9, 10, 12, 14, 15, 16, 17, 18, 19, 20, and 21 were observed. The DSD stated the transition strips were cracked and uneven and could be a fall hazard. The DSD stated the transition strip should be flat, smooth, and even so residents and staff could pass without difficulty. The DSD stated the facility should be a safe, functional, sanitary, and comfortable environment for residents and staff. During an interview on 2/20/26 at 3:26 p.m. with the Administrator (ADM), the ADM stated the transition strip was not hazardous. The ADM stated residents walked past the transition strips 1000 times and there was no fall. The ADM stated Resident 1 chose to go backward in the wheelchair and caused himself to fall. The ADM stated the facility should provide a safe, functional, sanitary, and comfortable environment for residents and staff. During a review of the facility's policy and procedure (P&P) titled, Safety and Supervision of Residents, dated 7/2027, the P&P indicated, Policy Statement: Our facility strives to make the environment as free from accident hazards as possible. Resident safety and supervision and assistance to prevent accidents are facility-wide priorities. Policy Interpretation and Implementation: .2. Safety risks and environmental hazards are identified on an ongoing basis through a combination of employee training, employee monitoring, and reporting processes; QAPI (Quality Assurance and Performance Improvement - a mandatory, data-driven framework for nursing homes and home health agencies to improve care quality and resident safety) reviews of safety and incident/accident data; and a facility-wide commitment to safety at all levels of the organization. 3.When accident hazards are identified, the QAPI/Safety Committee shall evaluate and analyze the cause(s) of the hazards and develop strategies to mitigate or remove the hazards to the extent possible. During a review of the facility's P&P titled, Maintenance Service, dated 2001, the P&P indicated, Policy Statement: Maintenance service shall be provided to all areas of the building, grounds, and equipment. Policy Interpretation and Implementation: 1. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. 2. Functions of maintenance personnel include, but are not limited to: .b. maintaining the building in good repair and free from hazards. During a professional reference review retrieved from https://www.access-board.gov/files/ada/ADA-Standards.pdf titled, Americans with Disabilities Act (ADA) Standards, dated 2010, the professional reference indicated, ADA CHAPTER 1: APPLICATION AND ADMINISTRATION. (Section) 101.1 General. This document contains scoping and technical requirements for accessibility to sites, facilities, buildings, and elements by individuals with disabilities. The requirements are to be applied during the design, construction, additions to, and alteration of sites, facilities, buildings, and elements to the extent required by regulations issued by Federal agencies under the Americans with Disabilities Act of 1990 (ADA). CHAPTER 3: BUILDING BLOCKS. 302. Floor or Ground Surfaces. 302.1 General. Floor and ground surfaces shall be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055423 If continuation sheet Page 3 of 4 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 055423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manning Gardens Care Center, Inc 2113 E. Manning Avenue Fresno, CA 93725 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 0921 Level of Harm - Minimal harm or potential for actual harm stable, firm, and slip resistant and shall comply with 302. 303 Changes in Level. 303.1 General. Where changes in level are permitted in floor or ground surfaces, they shall comply with 303. 303.2 Vertical. Changes in level of 1/4 inch (6.4 mm) high maximum shall be permitted to be vertical. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055423 If continuation sheet Page 4 of 4