Health inspection·March 7, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of four sampled residents (Resident 1) was treated with dignity and respect when Resident 1's call light was removed from the wall and taken away from her on 2/20/2024. This failure violated Resident 1's right to have her call light accessible and within reach and resulted in Resident 1 to feel isolated and alone and without the ability to call staff for assistance. Findings: During a review of Resident 1 ' s admission Record (AR), dated 3/7/24, the AR indicated Resident 1 was admitted to the facility on [DATE]. Resident 1 had a history of Alzheimer (a brain disease that causes memory loss and other cognitive impairment), Right femur (upper leg bone) fracture (broken bone), Right Artificial Hip Joint (a surgical procedure in which an orthopaedic surgeon removes the diseased parts of the hip joint and replaces them with a new prosthesis), Muscle weakness, and Abnormal gait and mobility (unable to walk in a typical way). During a review of Resident 1's Minimum Data Set (MDS – an evaluation of a resident's cognitive and functional status), dated 2/16/24, the MDS indicated the Brief Interview for Mental Status (BIMS) score (an assessment of a resident's cognitive status for memory recall) was 9 (a score of 0 – 7 indicated severe impairment, 8 – 12 indicated moderate impairment, and 13 – 15 indicated minimal to no impairment). During a review of Resident 1's MDS for Functional Abilities And Goals (FAAG) dated 2/16/24, the FAAG indicated Resident 1 required assistance to complete activities of daily living (eating, toileting, bathing, transferring, etc.) During an interview on 3/7/24 at 9:15 a.m. with Resident 1 in Resident 1 ' s room, Resident 1 stated Certified Nursing Assistant (CNA) 1 came to her room on 2/20/24 around 12 o ' clock a.m. to check her briefs (an adult diaper). Resident 1 stated, CNA 1 threw the blanket off me, pushed and shoved me. I had a right hip incision from a hip replacement. I tried to cover my hip because it was hurting, she grabbed my hand and pulled it away. Then she took my call light away for no reason. Resident 1 stated, I like my call light on my bed so I can reach it to call staff for assistance. Resident 1 stated she used the call light to call staff for pain medication and when she soils her briefs. Resident 1 stated without the call light there was no way of calling staff for help. During an interview on 3/7/24 at 10:21 a.m. with CNA 2, CNA 2 stated she worked during the night (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055996 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 055996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Covenant Post Acute 3408 East Shields Avenue Fresno, CA 93726 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)