Inspection·August 18, 2023

F 0689 Level of Harm - Actual harm Residents Affected - Few During a review of Resident 1's Minimum Data Set (MDS-assessment tool), dated May 26, 2023, the MDS indicated, Resident 1's Brief Interview for Mental Status (BIMS) score was 7 (a score of 0-7 means severe cognitive impairment). Resident 1's MDS section G (Functional Status) dated July 18, 2023, was reviewed. The MDS indicated, Resident 1 required extensive assistance (full staff support) with one to two persons physical assist with Activities of Daily Living (ADL's- including but not limited to Transfer, Dressing, Eating, Toilet use, and Bathing). During a review of Resident 1's Progress Notes, dated July 18, 2023, the Progress Notes indicated, admission Date: 2/25/22. Diagnoses: Metabolic Encephalopathy [a problem in the brain caused by a chemical imbalance in the blood], Cerebral Infarction [lack of adequate blood supply to brain cells deprives them of oxygen and vital nutrients which can cause parts of the brain to die off], Cognitive Communication Deficit [speech impairment], Dementia [memory loss], Unsteadiness on feet, Psychotic Disturbance [severe mental disorders that cause abnormal thinking and perceptions], Mood Disturbance [feelings of distress], Anxiety Disorder [excessive feelings of worry], Schizoaffective Disorder [mental disorder], and Difficulty in walking. During a concurrent interview and record review on 8/3/23 at 3:30 p.m., with DON, Resident 1's Treatment Administration Record (TAR), dated July 2023 was reviewed. The TAR indicated, on 7/4/23 at 4:00 p.m. hourly check, the resident was on the (outside) patio. DON stated, At 4:35 p.m., family arrived, resident [1] was not in his room, and we started searching. At 5:10 p.m. the fire department [fire rescue service personnel] arrived and made the facility aware that resident [1] had been located and was being taken to the hospital. During an interview on 8/8/23 at 2:55 p.m. with SSD/CNA 1, SSD/CNA 1 stated she was assigned to monitor (check/watch) Resident 1 on 7/4/23 but did not witness him (Resident 1) leave the facility. SSD/CNA 1 stated, I don't know what was the temperature that day [7/4/23], but it was hot that day. According to the Weather Channel (weather.com), on 7/4/23, [at the location of the facility] had a temperature, Record High of 112° F (Fahrenheit-temperature measurement). When heat index reaches above 97° F, it's dangerous, and it can cause sunstroke, muscle cramps and heat exhaustion. During an interview on 8/11/23, at 5:05 p.m., with DON, DON stated, No hydration assessment was done [when Resident 1 was outside at the patio]. All departments [heads] participate in rounding however due to being a holiday [7/4/23], no management [department heads] was in the facility. Social Services Designee was his CNA [SSD/CNA 1] that day. During a review of Resident 1's Care Plan, undated, the Care Plan indicated, The resident is an elopement risk r/t [related to] history of attempts to leave the facility unattended, impaired safety awareness. Interventions: Distract resident from wandering, monitor for fatigue [exhaustion], provide structured activities. During a review of Resident 1's EMS [Emergency Medical Service/Ambulance] Care Summary (ECS), dated July 4, 2023, the ECS indicated, at 5:13 p.m., [Resident 1's] blood pressure [pressure of circulating blood against the walls of blood vessels] was 160/100 [normal blood pressure is below 120/80]. Heart rate was 160 [normal heart rate is 60 to 100 beats per minute]. Temperature was 100.2 degrees [normal body temperature is 97.6 - 99.6 degrees] Fahrenheit [unit of measurement]. During a review of hospital records of Resident 1, the Emergency Department Note (EDN), dated July 4, 2023, the EDN indicated, Ambulance offload time 7/4/2023 at 5:49 p.m. Vital signs are notable for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055448 If continuation sheet Page 2 of 3 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 055448 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dinuba Healthcare 1730 South College Ave. Dinuba, CA 93618 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 - Actual harm Residents Affected - Few Tachycardia [increased heart rate] of 142 beats per minute, febrile [elevated temperature] at 101.1 degrees Fahrenheit. Final Diagnosis: Heat Stroke and sunstroke [a severe heat illness that results in an elevated body temperature]. Altered Mental status [Confusion]. Disposition [plan]: admit to observation. During a review of hospital records of Resident 1, the History and Physical Report (H&P), dated July 4, 2023, the H&P indicated, [Resident 1's] chief complaint was heat exposure, pt [Patient - Resident 1] was found outside sitting on wheelchair for unknown amount of time. GCS [Glasgow Coma Scale-a scale used to objectively describe the extent of impaired consciousness of trauma patients] of 9 [score of 9-12 means moderate impairment], pt [Patient - Resident 1] is nonverbal. PT [Patient - Resident 1] is Tachycardic [increased heart rate] in the 150's [normal heart rate is 60 - 100]. Assessment/Plan: Altered mental status [confusion], Heat Stroke. During a review of Resident 1's hospital records Discharge Summary (DCS), dated July 6, 2023, the DCS indicated, Dates of service: 7/4/23 to 7/6/23 [stayed two days in the hospital]. Diagnosis: Heat Stroke. During a review of the facility's policy and procedure titled, Safety and Supervision of Residents, dated 2017, the P&P indicated, The care team shall target interventions to reduce individual risk related to hazards in the environment, including adequate supervision. During a review of the facility's policy and procedure (P&P) titled, Resident Hydration and Prevention of Dehydration, dated 2017, the P&P indicated, Nurses will assess for signs and symptoms of dehydration during daily care. Nurses' aides will provide and encourage intake of bedside, snack, and meal fluids. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055448 If continuation sheet Page 3 of 3