Health inspection·September 27, 2023

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure services provided met professional standards of quality for one of ten sampled residents (Resident 1) when Registered Nurse (RN) 1 left Resident 1's three medications (2 tablets and 1 capsule) in a plastic cup on top of the medication cart unattended. Residents Affected - Few This failure had the potential for other residents to take and administer Resident 1's medications which could result in undesired effects and harm. Findings: During a concurrent observation and interview on 8/17/23, at 8:06 a.m. with RN 1 outside of Resident 1's room, RN 1 was preparing Resident 1's medications for administration. RN 1 placed Resident 1's buspirone (a medication that treat anxiety [a mental health condition characterized by feeling unease or fear]) 5 MG tab, Donepezil (a medication used to treat Dementia [progressive or persistent loss of brain functioning]) 5 MG and Ramipril (a medication use to treat high blood pressure [the force of blood pushing against the walls of the heart)]) 2.5 MG into a plastic medication cup on top of the medication cart. RN 1 stated, she was going to check Resident 1's blood pressure. RN 1 turned around and walked away from the medication cart into Resident 1's room left Resident 1's medication unattended and out of her line of sight. RN 1 stated, she left the medication on top of the cart because she needed to check Resident 1's blood pressure. RN 1 stated, it was the process at the facility to not leave meds on top of the medication cart unattended. RN 1 stated, medications had to be locked in the medication cart or in her possession until administered to the resident. RN 1 stated, it was important to not leave medications unattended because another resident could grab the medication and administer it in error. RN 1 stated, there was a potential for a medication error if a resident administered medications that were not ordered. During a review of Resident 1's admission Record (AR), dated 8/17/23, the AR indicated Resident 1 was admitted to the facility on [DATE], with diagnoses of Anxiety Disorder, Essential Hypertension (abnormally high blood pressure that is not the result of a medical condition) and Vascular Dementia (a form of dementia caused by an impaired supply of blood to the brain). During a review of Resident 1's Order Summary Report (OSR), dated 8/17/23, the OSR indicated Resident 1 had a doctors order for buspirone [hydrochloride] Tablet 5 MG (milligram [unit of measurement]) Give 1 tablet by mouth two times a day for anxiety [manifested by] excessive worrying over health . Start Date 07/06/2022 . Donepezil [hydrochloride] Tablet 5 MG Give 1 tablet by mouth one time a day for dementia . Start Date 07/06/2022 . Ramipril Capsule 2.5 MG Give 1 capsule by mouth one time a day for [hypertension] . Start Date 07/06/2022 . (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 09/27/2023 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)