Inspection·August 14, 2023

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to provide a complete and accurate discharge notice to ensure a safe discharge for one of three sampled residents (Resident 1) when a written 30-day notice of proposed discharge did not indicate the location to which Resident 1 would be discharged to. This failure resulted in Resident 1 not knowing where she would be residing after the 30 days, causing Resident 1 distress and anxiety. Findings: During a review of Resident 1 ' s admission Record (AR) the AR indicated, Resident 1 was admitted to the facility on [DATE] with diagnoses of . Parkinson ' s Disease . (a progressive disease of the nervous system) .Bipolar disorder .(characterized by both manic and depressive episodes) .Epilepsy .(A disorder in which nerve cell activity in the brain is disturbed) . 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 [DATE], the MDS indicated Resident 3's Brief Interview for Mental Status (BIMS - screening tool used to assess resident cognitive level) score was 15 out of 15 [0-7 indicated severe cognitive impairment - (memory loss, poor decision making-skills) 8-12 moderate cognitive impairment 13-15 cognitively intact] indicating Resident 1 was cognitively intact. During an interview on 4/25/23, at 9:40 a.m., with Resident 1, Resident 1 stated, she received a letter from the Administrator (ADM) on 3/31/23 during a care conference meeting. Resident 1 stated, it was a Thirty Day Notice of Proposed Discharge. During an telephone interview on 7/28/23, at 10:25 a.m., with Family Member (FM), FM stated, she was at the care conference meeting on 3/31/23 when the 30 day notice of proposed discharge was given to Resident 1 and FM. FM stated, How can the facility give us a 30 day notice of discharge without a place to go FM stated, this situation had caused Resident 1 to be anxious and distressed. During a telephone interview on 7/28/23 at 2:00 p.m., with Social Services Director (SSD), SSD stated, the discharge notice was provided to the Resident 1 and FM during a care conference meeting held on 3/31/23. SSD stated, this was a facility-initiated discharge. SSD stated, during the care conference meeting, I was not able to definitively tell the FM and Resident [Resident 1] where they would be going after the 30 days. SSD stated, I don't feel there should be a destination documented on the 30-day notice because we did not have an exact location for Resident 1. (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: 056225 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 056225 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orchard Post Acute 4840 E.Tulare Avenue Fresno, CA 93727 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)