Health inspection·May 20, 2025

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few their representatives which included the reason for the room change and information to assist with the adjustment to a new room or roommate. The SSD stated there was no written documentation or signed notice provided to Resident 56 prior to the move. The SSD stated this communication was important to help Resident 56 adjust and prevent emotional distress. During an interview on 5/15/25 at 3:12 p.m. with the Director of Nursing (DON), the DON stated there was no written notice or supporting documentation provided to Resident 56 prior to the room change. The DON stated the facility policy required a written notice to be provide in advance of a room move, and this communication should have been documented in Residents 56's medical record. The DON stated the expectation was that the communication should have been provided to Resident 56 before the room change. During a review of the facility's policy and procedure (P&P) titled Room Change/Roommate Assignment, dated 3/2021, the P&P indicated, .Prior to changing a room or roommate assignment, all parties involved in the change/assignment .are given .advanced written notice of such change. Advanced written notice of a roommate change includes why the change is being made and any information that will assist the roommate in becoming acquainted with his or her new roommate . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 2 of 51 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 05/20/2025 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)

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide Skilled Nursing Facility Advanced Beneficiary Notice (SNF-ABN- a notice to provide information to residents/beneficiaries if they wish to continue receiving the skilled services that may be paid for Medicare and assume responsibility) for one three sampled residents (Resident 78) when the Medicare coverage was terminated for Resident 78. Residents Affected - Few This deficient practice resulted in not protecting Resident 78's rights and Resident 78's Representative (RR) right to appeal the termination of Medicare Part A and possibly denying Resident 78's needed services. Findings: During observation on 5/13/25 at 10:13 a.m., in Resident 78's room during the initial tour of the facility, Resident 78 was lying in bed. Resident declined to answer questions. During a review of Resident 78's admission Record, (AR- a document containing resident profile information) dated 5/15/25, the admission Record indicated Resident 78 was admitted to the facility on [DATE] with diagnoses which included muscle wasting and atrophy (refers to the shrinking and weakening of muscle tissue due to various causes, including inactivity, aging or certain medical conditions), muscle weakness and retention of urine (unable to empty all urine from the bladder). During a concurrent interview and record review on 5/15/25 at 8:28 a.m. with the Business Office Assistant (BOA), the BOA stated her duties included but not limited to assisting residents to fill up applications for medi-cal (California's name for the federal Medicaid program [joint federal and state program that provides free or low-cost health coverage]). The BOA reviewed Resident 18's medical record titled, Skilled Nursing Facility Beneficiary Protection Notification Review. The BOA stated the SNF-ABN indicated Resident 78 start date was on 9/1/24 and the last covered day of Medicare Part A Services was on 11/29/24. The BOA stated Resident 78 remained in the facility after the last covered day. The BOA stated Resident 78 had Medicare Part A remaining days and a SNF ABN was not issued to Resident 78 because she did not know it was supposed to be issued. The BOA stated the SNF ABN letter should have been issued when the Notice of Medicare Provided Non-Coverage (NOMNC) was issued to Resident 78. The BOA stated the SNF ABN was very important because it provided Resident 78 steps to follow if Resident 78 wanted to continue receiving Medicare A benefits and steps to follow for an appeal. The BOA stated Resident 78 and RR were not able to appeal because they were not given the forms and information. During an interview on 5/20/25 at 4:55 p.m. with the Administrator (ADM), the ADM stated his expectation was to ensure Business Office issues SNF ABN and NOMNC letters to all residents needing the form. The ADM stated SNF ABN and NOMNC letters were supposed to be issued prior to the last covered Medicare part A Day to residents. During a review of facility's document titled, Form Instructions Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) Form CMS 10055, dated 2024, the document indicated, . Medicare requires Skilled Nursing Facilities [SNFs] to issue the SNF ABN to Original Medicare, also called fee-for-service [FFS] , patients prior to providing care that Medicare usually covers, but may not pay for in this instance . The SNF ABN provides information to the patient so that she/he can (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 3 of 51 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 05/20/2025 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)

F 0582 Level of Harm - Minimal harm or potential for actual harm decide whether or not to get the care that may not be paid for by Medicare and assume financial responsibility. SNFs must use the SNF ABN when applicable for SNF Prospective Payment System services (Medicare Part A) . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 4 of 51 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 05/20/2025 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to report unusual occurrences for two of three sampled residents (Residents 28 and 244) when: 1. Resident 28 was attacked by Resident 29 (squeezed his toes and punched him 4 to 6 times in the lower left leg) and the facility did not contact local law enforcement or report the resident-to-resident abuse to the State Survey Agency. This failure put Resident 28's safety at risk, possibly other residents, as well as family and staff members in the facility. 2. Resident 244 was found on the floor by her bed, deceased and the facility did not report this unusual occurrence to the resident's responsible party (RP- a family member of designated person who is the point of contact for the nursing home staff. They can be kept informed about the resident's condition, receive updates, and ask questions) nor the State Survey Agency. This failure placed all residents' well-being and safety at risk residing in the facility due to lack of knowledge of reporting requirements. Findings: 1. During a concurrent observation and interview on [DATE] at 10:33 a.m., with Resident 28, in Resident 28's room, Resident 28 had dark purple bruising on his lower left leg. Resident 28 stated Resident 29 crawled over to his bed, grabbed his toes, started squeezing them and punched his left ankle and leg at least five times. Resident 28 stated Certified Nursing Assistant (CNA) 7 was already at his bedside, but other staff members came in and separated Resident 29 from him and he moved to another room in the facility. Resident 28 stated he had bruising to his leg and the facility had his left leg x-rayed, which were negative. Resident 28 stated he never spoke to the local police department. During a concurrent observation and interview on [DATE] at 8:05 a.m., with Resident 29, in Resident 29's room, a request was made to interview Resident 29 and he refused. During a review of Resident 28's admission Record (AR-a document containing resident profile information), dated [DATE], the AR indicated, Resident 28 was admitted to the facility on [DATE] with diagnosis of muscle weakness, difficulty in walking, morbid obesity (very severe, where someone is significantly overweight, often 100 pounds or more over their ideal weight) due to excess calories, chronic pain, repeated falls, embolism (a blood clot that blocks and stops blood flow) and thrombosis of unspecified artery (when a blood clot [a thrombus] forms inside a blood vessel, blocking the flow of blood). During a review of Resident 28's Minimum Data Set (MDS - a resident assessment tool used to identify resident cognitive and physical function) assessment, dated [DATE], the MDS assessment indicated Resident 28's Brief Interview for Mental Status (BIMS -assessment of cognitive (the mental processes involved in gaining knowledge and comprehension) status for memory and judgment) assessment score was 15 out of 15 (a score of 13-15 indicates cognitively intact, 08-12 indicates moderately impaired, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 5 of 51 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 05/20/2025 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and 00-07 indicates severe impairment, 99 indicates unable to complete the interview). The BIMS assessment indicated Resident 28 was cognitively intact. During a review of Resident 28's Social Services Note (SSN), dated [DATE] at 9:38 a.m. the SSN indicated, .Writer spoke with patient in regard to another patient crawling out of bed and striking patients leg three times . He requested a X-ray be done to his leg as he has prior problems with that leg and he just wants his mind to be cleared with an x-ray. Writer informed nursing to request order from MD [Medical Doctor] . A grievance filed on behalf of patient. Nursing staff to continue to monitor report any changes. Writer sent referral to MD . During a review of Resident 28's Progress Notes (PN), dated [DATE] at 10:52 a.m. the PN indicated, . Resident was moved in the a.m. following his admit due to an alleged altercation with his roommate. X-ray was request and orders carried out Left Knee and Left Tibia 2 view . During a review of Resident 29's admission Record, dated [DATE], the AR indicated, Resident 29 was admitted to the facility on [DATE] with diagnosis of muscle weakness, difficulty in walking and major depressive disorder (causes a persistently low or depressed mood and a loss of interest in activities that you used to enjoy). During a review of Resident 29's MDS assessment, dated [DATE], the MDS assessment indicated Resident 29's BIMS assessment score was 15 out of 15. The BIMS assessment indicated Resident 29 was cognitively intact. During an interview on [DATE] at 2:05 p.m. with Licensed Vocational Nurse (LVN) 8 stated she was the nurse responsible for Resident 28 at the time of the confrontation. LVN 8 stated Resident 28 was the victim and Resident 29 had hit him. LVN 8 stated Resident 29 had also tried to hit CNA's as well. LVN 8 stated she did not tell the Administrator what occurred but did tell the Director of Nursing (DON). During an interview on [DATE] at 2:50 p.m. with the Abuse Coordinator/Administrator (ACA), the ACA stated he did not believe the punches were abuse but heard Resident 28 was punched. During an interview on [DATE] at 3:15 p.m. with the ACA, the ACA stated he was not sure when he was notified of the incident and he did not document when he was notified. The ACA stated he made the DON responsible for the incident investigation . The ACA stated punching someone would be abuse but had to speak to the DON on why the incident was not reported. The ACA stated after he spoke to the DON about the resident altercation, Yes, we should have reported this. During an interview on [DATE] at 11:46 a.m. with the DON, the DON stated staff called her over the phone and told her about the incident when it occurred. The DON stated she was out of town when this occurred and she did not do an investigation into this incident. The DON stated Resident 28 was attacked and the incident would qualify as resident abuse. The DON stated the expectation would be to report the incident to the State Survey Agency and to local police. The DON stated it did not appear that either of those reports were done. The DON stated the facility did not follow the facilities policy and procedures Unusual Occurrence Reporting, Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating and Identifying Types of Abuse. During an interview on [DATE] at 2:35 p.m. with the Unit Nurse Supervisor (UNS), the UNS stated a resident getting punched would be physical abuse. The UNS stated the abuse coordinator should have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 6 of 51 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 05/20/2025 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few filled out form SOC 341 [Report of Suspected Dependent Adult/Elder Abuse], turn that into the State Survey Agency and notify the police. During an interview on [DATE] at 3:14 p.m. with the ACA, the ACA stated he did not think a call to local police was completed and could not provide proof of notification of the incident. The ACA stated he did not complete a SOC 341 nor report the incident to the State Survey Agency. The ACA stated, I should have done all that and I didn't. The ACA stated the policy and procedures Unusual Occurrence Reporting, Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating and Identifying Types of Abuse were not followed. The ACA stated a potential outcome of not reporting this incident would be I don't know, you tell me what the outcome could be. The ACA stated, I'm not sure, we report it because we are supposed to. During an interview on [DATE] at 3:45 p.m. with CNA 7, CNA 7 stated she was already in the room speaking to Resident 28 when Resident 29 crawled over, grabbed Resident 28's foot and started punching him. CNA 7 stated she could not recall everything because it all happened so fast. During an interview on [DATE] at 3:54 p.m. with the Assistant Director of Nursing (ADON), the ADON stated the incident qualified as physical abuse toward Resident 28. The ADON stated the incident should have been reported to the State and police because of mandatory reporting laws. The ADON stated something else could have happened to the resident because the reports were not made. The ADON stated the non-reporting put Resident 28's safety at risk. During a review of the facility's policy and procedure (P&P) titled, Identifying Types of Abuse, dated 9/2022, the P&P indicated, . As part of the abuse prevention strategy, volunteers, employees and contractors hired by this facility are expected to be able to identify the different types of abuse that may occur against residents . abuse toward a resident can occur as: a. resident-to-resident abuse . Physical Abuse: 1. Physical abuse includes, but is not limited to hitting . punching . During a review of the facility's P&P titled, Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, dated [DATE], the P&P indicated, . all reports of a resident abuse(including injuries of unknown origin) . are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported . Reporting Allegations to the Administrator and Authorities: 1. If resident abuse . is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law . 2. The administrator or the individual making the allegation immediately reports his or her suspicion to the following persons or agencies: a. The state licensing/certification agency responsible for surveying/licensing the facility . law enforcement officials . 3. Immediately is defined as: a. Within two hours of an allegation involving abuse . or . b. Within 24 hours of an allegation that does not involve abuse or result in serious bodily injury . During a review of the facility's P&P titled, Unusual Occurrence Reporting, dated [DATE], the P&P indicated, . as required by federal or state regulations, our facility reports unusual occurrences or other reportable events which affect the health, safety, or welfare of our residents, employees or visitors . g. Allegations of abuse . h. Other occurrences that interfere . the welfare, safety, or health of residents . 2. Unusual occurrences shall be reported via telephone to appropriate agencies as required by current law and/or regulations within 24 hours of such incident or otherwise required by federal and state regulations . 3. A written report detailing the incident and actions taken by the facility after the event shall be sent delivered to the state agency (and other appropriate agency as required by law) within 48 hours of reporting the event or as required by federal and state (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 7 of 51 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 05/20/2025 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)

F 0609 agencies . Level of Harm - Minimal harm or potential for actual harm 2. During a review of Resident 244 Nurse's Note (NN), dated [DATE] at 4:15 p.m. the NN indicated, . At 2:03 p.m. charge nurse notified unit manager/writer that resident was unresponsive with no RR [respirations] or Pulse. Writer and ADON [Assistant Director of Nursing] responded immediately and verified patient pulseless and non-breathing. Resident noted on floor. Bed in lowest position and on LAL [low air loss] mattress. Writer notified at 2:08 p.m. and DON at bedside assessed resident and no pulses, no respirations, no breath sounds, and no BP [blood pressure] were noted. Skin clear with exception of mottled [caused by decreased blood flow and oxygen to the skin, often due to small blood vessels constricting] skin to RLE [right lower extremity]. No visible signs of injury noted related to rolling on to floor. Resident on Hospice care. Per LN [licensed nurse] earlier in the day pt was noted with COC. Routine morphine administered at 8:20 a.m. to support comfort focus treatment with pain assessment at 10:42 am by LN noting no signs of pain in resident. At 11:15 a.m. LN assessed patient for residuals per order and administered noon medication, all needs met at this time. CNA last checked on resident at 12:50 p.m. and resident was in bed and care was given with no s/sx [signs and symptoms] of distress. [Medical Director] notified and Time of death 2:08 p.m. Two RN's [Registered Nurse] at bedside at the time of confirmation. Family and [Hospice] notified. Postmortem care completed . Residents Affected - Few During a review of Resident 244's admission Record, dated [DATE], the AR indicated, Resident 244 was admitted to the facility on [DATE] with diagnosis of hemiplegia (a medical condition that causes paralysis (a medical condition characterized by the loss or impairment of voluntary movement and muscle function) or weakness on one side of the body) and hemiparesis ( a condition where you have weakness on one side of your body, making it difficult to move or use that side as effectively as the other) following cerebral infarction (a medical emergency called a stroke, when a blood clot or blockage cuts off the blood supply to a part of the brain, leading to brain tissue death affecting non-dominant left side), dementia (a brain disease that causes a decline in thinking, memory, and other cognitive abilities), dysphagia (swallowing difficulty), left hand contracture ( a condition that causes one or more fingers to bend toward the palm of the hand) and muscle weakness. During a review of Resident 244's MDS - assessment, dated [DATE], the MDS assessment indicated Resident 244's BIMS assessment score was 00 out of 15. The BIMS assessment indicated Resident 244 was severely cognitively impaired. During a review of Resident 244's Section GG (GG)- Functional Abilities (assessment of functional abilities), dated [DATE], the GG indicated, . [box checked] Impairment on both sides. Upper extremities (shoulder, elbow, wrist, hand) Lower extremity (hip, knee, ankle, foot) . Code 1= Dependent- Helper does ALL of the effort. Resident does none of the effort to complete the activity. Or, the assistance of two or more helpers is required for the resident to complete the activity . Code 1 for A. Eating. Code 1 for Oral hygiene. Code 1 for Toileting hygiene. Code 1 for Shower/bathe self. Code 1 for Upper body dressing. Code 1 for Lower body dressing. Code 1 for Putting on/taking off footwear. Code 1 for Personal hygiene . Code 1 for Roll left and right. Code 1 for Sit to lying. Code 1 Lying to sitting on side of bed. Code 1 for Sit to stand. Code 1 for Chair/bed to chair transfer. Code 1 for Tub/shower transfer . During a review of Resident 244's Weights and Vitals Summary (VS), dated [DATE], the VS indicated, XXX[DATE] . Blood Pressure: 122/68 mmHg (millimeters of mercury- unit of measurement) . Pain Level Summary: 2 . Pulse Summary: 68 BPM (beats per minute) . Respiration Summary: 18 breaths per minute . Temperature Summary: 97.8 Forehead non-contact . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 8 of 51 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 05/20/2025 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm During a review of Resident 244's Physician/Mid-level Provider Discharge Summary (DS), dated [DATE], the DS indicated, . Pertinent Physical and Laboratory Findings: N/A [Not attempted] . Course of Treatment: Hospice Care, Skilled Nursing . Condition on discharge: [Empty] . Follow-up and Discharge Medication Instructions: Resident Exp-at 2:08 p.m. All personal belongings were given to family . [signed Medical Director] . Residents Affected - Few During a review of Resident 244's Death Certificate (DC), dated [DATE], the DC indicated, . Certificate of Death: [Resident 244] . Immediate Cause: A. Respiratory Failure [sequentially list conditions if any leading to cause on line A] . B. Aspiration Pneumonia C. Cerebral Infarction . Death reported to coroner: No . Biopsy Performed: No . Autopsy Performed: No . During an interview on [DATE] at 9:39 a.m. with Hospice [ a type of medical care that provides comfort and support to people who are nearing the end of their life] Nurse (HN), the HN stated he was Resident 244's hospice nurse. HN stated he was not notified until two and half hours after Resident 244 passed away. HN stated this was unusual and normally they are notified within minutes of one of their residents passing away. During a concurrent interview and record review on [DATE] at 10:33 a.m. with the DON, Resident 244's Electronic Medical Record (EMR) was reviewed. The EMR indicated Resident 244 was found on the floor deceased next to her bed. The DON stated when she walked into Resident 244's room she was on the floor lying on her right side, parallel to her bed. The DON stated she did an assessment and found she was pulseless and not breathing. The DON stated with the help of staff members, they put Resident 244 back in bed and she called the Medical Director. The DON stated over the phone she described her physical assessment and the physician called Resident 244's death a brain bleed that caused her to fall out of bed. The DON stated she spoke with the responsible party/family member (RP/FM) 4. The DON stated she was not sure if she had told the RP/FM 4 that Resident 244 was found on the ground, but she knew that it was not documented what was said. DON stated a person found on the ground would be considered to be a fall and a change of condition should be made. The DON stated again, she told the RP/FM 4 that her mom had died but was not sure if she mentioned the fall or was found on the floor. The DON stated her assessment showed no evidence of trauma so she did not find Resident 244's death to be unusual, even though she was confirmed to be found deceased on the floor. During an interview on [DATE] at 2:39 p.m. with the UNS, the UNS stated LVN 10 went to her office and told her Resident 244 was found on the floor and passed away. The UNS stated she went in the room and Resident 244 was on the floor and staff were scared. The UNS stated she went and got the DON and she came and did an assessment and called the MD. The UNS stated Resident 244 having been found on the floor would be a fall. The UNS stated she did not call the family, the DON did all of that. During an interview on [DATE] at 2:56 p.m. with LVN 10, LVN 10 stated she was the nurse for Resident 244 at the time of her death. LVN 10 stated CNA 9 reported Resident 244 was on the floor, LVN 10 went in Resident 244's room and saw her on the floor, checked Resident 244 for pulse and she had none. LVN 10 stated no one knew how she got on the floor. LVN 10 stated the RP/FM 4 should have been notified and told about the fall because it was unwitnessed. LVN 10 stated a fall was an accident. LVN 10 stated the DON had asked her what happened and when she was telling her she was very emotional and had to leave the facility. LVN 10 stated they didn't ask me any questions when I came back in. During an interview on [DATE] at 4:02 p.m. with the ADON, the ADON stated she went in the room with the UNS and saw Resident 244 on the floor, facing the window. The ADON stated it was an unwitnessed fall and the RP/FM 4 should have been notified of the fall. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 9 of 51 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 05/20/2025 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on [DATE] at 5:23 p.m. with CNA 9, CNA 9 stated CNA 8 was in Resident 244's room and he had stopped her as she walked by and told her Resident 244 was on the ground. CNA 9 stated she was shocked. CNA 9 stated this was a fall, she was down on the ground. During an interview on [DATE] at 5:33 p.m. with the MD, the MD stated he felt from her medical history that she died from pretty much natural causes, or a bleed. The MD stated he knew Resident 244 was found on the floor, deceased . The MD stated he felt like she died naturally and slid off the bed after. The MD stated it did not trigger a coroners report for him. The MD stated he didn't put it together that a fall was considered an accident. During an interview on [DATE] at 5:33 p.m. with CNA 8, CNA 8 stated he found Resident 244 on the floor. CNA 8 stated he was giving care to Resident 24's roommate, looked over and saw Resident 244's bed was empty. CNA 8 stated he saw Resident 244 and her bed sheets on the floor and was shocked at what happened. CNA 8 stated he was very emotional and he couldn't take seeing her like that. CNA 8 stated that Resident 244 having been found on the floor was an unwitnessed fall and an accident for sure. During an interview on [DATE] at 10:04 a.m. with the RP/FM 4, the RP/FM 4 stated her mom could not communicate, nor move at all in bed. The RP/FM 4 stated she was the responsible party for Resident 244. The RP/FM 4 [very upset and emotional] stated I had no idea she was found on the ground, oh my God, oh my God this is terrible. The RP/FM 4 stated no person from the facility told her or her family Resident 244 was found on the floor deceased it makes a huge difference that she was. The RP/FM 4 stated The DON just lied to us and it would be very unusual for her mother to be on floor. The RP/FM 4 stated the HN told her it was not normal that hospice was not notified timely. The RP/FM 4 stated if she had known she was found on the floor deceased she would have bought an autopsy but did not because she was told by the facility she died naturally. The RP/FM 4 stated she would have needed to know the way her mom was found and would have done things differently. The RP/FM 4 stated the facility withheld vital information that would have been very important to me and what to do next. During a review of the facility's P&P titled, Unusual Occurrence Reporting, dated [DATE], the P&P indicated, . as required by federal or state regulations, our facility reports unusual occurrences or other reportable events which affect the health, safety, or welfare of our residents, employees or visitors . d. Death of a resident . because of unnatural causes . e.g. [for example] . accidents .h. Other occurrences that interfere . the welfare, safety, or health of residents . 2. Unusual occurrences shall be reported via telephone to appropriate agencies as required by current law and/or regulations within 24 hours of such incidents or otherwise required by federal and state regulations . 3. A written report detailing the incident and actions taken by the facility after the event shall be sent delivered to the state agency (and other appropriate agency as required by law) within 48 hours of reporting the event or as required by federal and state agencies . During a review of the facilities P&P titled, Change in a Resident's Condition or Status, dated February 2021, the P&P indicated, .Policy Statement: Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's medical . and/or status (e.g. [for example] changes in level of care . etc . Policy Interpretation and Implementation . The nurse will notify the resident's attending physician or physician on call when there has been a: a. accident or incident involving the resident .Unless otherwise instructed by the resident, a nurse will notify the resident's representative when: . the resident is involved in any accident or incident that results in an injury including injuries of an unknown source . there is a significant change in the resident's physical . status . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 10 of 51 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 05/20/2025 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)

F 0641 Ensure each resident receives an accurate assessment. 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 the Minimum Data Set Assessment (MDS-assessment of physical and psychological functions and needs) accurately reflected resident's health and functional status for one of five sampled residents (Resident 21) when Resident 21's deep tissue injury (DTI-localized area of discolored, intact skin, often purple or maroon, or a blood-filled blister due to damage to the underlying tissues) was inaccurately coded in the MDS assessment. Residents Affected - Few This failure had the potential to result in Resident 21's care needs not met and the potential for DTI to worsen. Findings: During a concurrent observation and interview on 5/13/25 at 9:40 a.m. during initial tour in Resident 21's room, Resident 21 was lying in bed. Resident 21 observed not able to move left upper extremity and lower extremities, and limited movement of right upper extremity. During a review of Resident 21's admission Record (AR- a document with personal identifiable and medical information) dated 5/15/25, the AR indicated Resident 21 was admitted tot he facility on 4/17/25 with diagnoses which included dysphagia (difficulty swallowing), hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and hemiparesis (partial or incomplete paralysis or weakness on one side of the body) and Pressure-Induced Deep Tissue Damage of Sacral Region (occurs when sustained pressure restricts blood flow to the tissues over the sacrum, leading to tissue damage During a concurrent observation and interview on 5/15/25 at 9:35 a.m. with Certified Nursing Assistant (CNA) 2, CNA 2 stated she was familiar with Resident 21's care. CNA 2 stated she took care of Resident 21 and assisted the treatment nurse when providing treatment to Resident 21. CNA 2 stated Resident 21 has a wound on her buttocks area but not sure how big. CNA 2 stated Resident 21 requires extensive assistance with turning and repositioning. CNA 2 stated, She [Resident 21] is not able to move her legs without assistance and her left arm too, she can use her right arm to grab the bar to assist with turning. During a concurrent interview and record review on 5/16/25 at 11:06 a.m. with the Treatment Nurse (TXN), the TXN reviewed Resident 21's progress note dated 4/18/25 and stated Resident 21 was admitted with deep tissue injury to sacrococcyx area (bones at the bottom[base] of the spine). TXN stated he sent a picture of Resident 21's wound to the wound doctor and the wound doctor said to put a diagnosis of DTI of the wound and gave treatment order to be started for Resident 21's DTI. The TXN stated Resident 21's DTI improved and size was smaller compared to the size when Resident 21 was admitted to the facility. During a concurrent interview and record review on 5/20/25 at 10:10 a.m. with the Minimum Data Set Nurse (MDSN), the MDSN reviewed Resident 21's five day MDS assessment dated [DATE] section M (Skin Conditions), Resident 21's deep tissue injury was not coded in the MDS assessment. The MDSN reviewed Resident 21's treatment orders and stated Resident 21 had treatment order for DTI which was started on 4/18/25. The MDSN stated she did not code Resident 21 as having DTI and she should have. The MDSN stated it was her responsibility to ensure MDS assessments were accurate. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 11 of 51 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 05/20/2025 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)

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 5/20/25 at 4:09 p.m. with the Director of Nursing (DON), the DON stated the MDSN reports directly to the Administrator (ADM) and DON. The DON stated her expectation was for the MDSN to ensure accuracy of assessments. The DON stated the assistant director of nursing (ADON) completes the quarterly assessments in the point click care (PCC- software platform specializing in electronic health records [EHRs] and revenue cycle management for long-term care and senior living communities), the MDSN reviews and used the assessment to complete her MDS assessment. The DON stated there was a section of the MDS requiring a bedside assessment but not sure which section. During an interview on 5/20/25 at 4:52 p.m. with ADM, the ADM stated the MDSN reports directly to the administrator. The ADM stated his expectation was, MDSN to code MDS correctly and accurately. During a review of facility policy and procedure (P&P) titled, Certifying Accuracy of the Resident Assessment dated 11/19, the P&P indicated, . 2. Any person who completes any portion of the MDS assessment, tracking form, or correction request form is required to sign the assessment certifying the accuracy of that portion of that assessment. 3. The information captured on the assessment reflects the status of the resident during the observation . period for that assessment . During a review of professional reference titled, Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual version 1.19.1 10/24, indicated. Definitions . a pressure ulcer/injury is localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of intense and/or prolonged pressure or pressure in combination with shear. The pressure injury can present as intact skin or an open ulcer and may be painful . Step 1: Determine Deepest Anatomical Stage . At Admission, code based on findings from the first skin assessment that is conducted on or after and as close to the admission as possible . Visualization of the wound bed is necessary for accurate staging . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 12 of 51 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 05/20/2025 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to follow-up with a positive Preadmission screening and Resident Review (PASARR-a federal requirement to ensure residents with mental disorder or intellectual disorder or intellectual disabilities are not inappropriately placed in a nursing home) level I screening for one of three sampled residents (Resident 52) when Resident 52's PASARR level I screening required PASARR Level II mental health evaluation on 9/24/24 and was not completed. This failure had the potential for Resident 52 to not receive the appropriate services related to her mental disorder. Findings: During a review of Resident 52's admission Record (AR-a document containing resident profile information), dated 5/20/25, the AR indicated, Resident 52 was admitted to the facility on [DATE] with diagnoses which included: unspecified psychosis (a severe mental condition in which thought, and emotions are so affected that contact is lost with reality), major depressive disorder (persistent sadness, loss of interest in activities and difficulty with relationships impacting a person's thinking and behavior), anxiety disorders (a group of conditions characterized by excessive fear, worry, and anxiety that significantly interfere with daily life). During a review of Resident 52's Minimum Data Set (MDS- a resident assessment tool used to identify resident cognitive and physical function), dated 3/25/25, the MDS section C indicated Resident 52 had a Brief Interview for Mental Status (BIMS-assessment of cognitive status for memory and judgment) assessment score of 14 out of 15 (a score of 13-15 indicates cognitively intact, 08-12 indicates moderately impaired, and 00-07 indicates severe impairment, 99 indicates unable to complete the interview), which indicated Resident 52 was cognitively intact. During a review of Resident 52's PASARR Level I Screening Report (PLISR) dated 9/24/24. The PLISR indicated .Resident Review (RR) (Status Change), .Diagnosed Serious Mental Illness (SMI) .- Yes, Specify the diagnosis .- Unspecified Psychosis . State Use Only comments: Level I - Positive for SMI/Negative for ID (intellectual disability) /DD (developmental disability) /RC (related conditions) . During a review of Resident 52's Notice of PASARR Level I Screening Result (NPSR) dated 9/24/24. The NPSR indicated . A Serious Mental illness (SMI) Level II mental health evaluation is required. Result: Positive for SMI/Negative for ID/DD/RC . During a review of Resident 52's Notice of Attempted Evaluation (NAE) dated 9/24/24. The NAE indicated, . In the event of a possible SMI level I screening, a SMI level II mental health evaluation is required to determine if the individual can benefit from specialized services. However, a SMI level II mental health evaluation was not scheduled for the following reason: facility staff were unresponsive to two or more separate attempts of communication within 48 hours of the level I screening During an interview on 5/15/25 at 9:25 a.m. with the admission & Marketing Director (AMD), the AMD stated the facility receives the PASARR level I for residents via file exchange from the hospital. The AMD stated if the PASARR level I screening was positive, the Minimum Data Set Nurse (MDSN ) follows up with PASARR level II evaluation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 13 of 51 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 05/20/2025 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and record review on 5/15/25 at 9:29 a.m. with the MDSN, Resident 52's PLISR dated 9/24/24, NPSR dated 9/24/24, NAE dated 9/24/24 and Progress Notes (PN) were reviewed. The MDSN stated Resident 52's PASARR level I screening was positive for SMI. The MDSN stated communication between MDSN and PASARR representative should be documented in Resident 52's PN. The MDSN validated there was no evidence of communication between MDSN and PASARR representative. The MDSN stated there was no follow up to ensure PASARR level II evaluation was completed for Resident 52. The MDSN stated the MDSN was responsible for the follow up process on the PASARR level II evaluation. The MDSN stated it was important that Resident 52 was assessed for PASARR level II evaluation if Resident 52 was taking antipsychotropic (medication used to treat psychosis, a condition characterized by symptoms like hallucinations, delusions, and disorganized thinking) medication. The MDSN stated it was important to complete the PASARR level II evaluation, so the state agency had accurate records. During a concurrent interview and record review on 5/15/25 at 11:56 a.m. with the Director of Nursing (DON), Resident 52's PLISR dated 9/24/24, NPSR dated 9/24/24, NAE dated 9/24/24 and PN were reviewed. The DON validated a PASARR Level II evaluation was triggered for Resident 52. The DON stated the importance of the PASARR evaluation was to make sure residents were placed appropriately based on their clinical needs and that services were provided based on their diagnosis. The DON validated there was no documentation of communication between MDSN and PASARR representatives. The DON stated the communication should have been documented in a PN in Resident 52's medical records. The DON stated it was important to document the communication between MDSN and PASARR representatives so there was appropriate information to complete the evaluation. The DON validated the NAE indicated .facility staff were unresponsive to two or more separate attempts of communication within 48 hours of the level I screening . The DON stated the expectation was to follow up with contracted party/PASARR representative or DHS (Department of Health Services) to make sure the evaluation was completed. The DON stated it was important to follow up on the PASARR Level II evaluation to make sure Resident 52's mental health was supported. The DON stated the PASARR level II evaluation was not completed, therefore the PASARR policy was not followed. The DON stated there was a potential risk for the omission of necessary services for Resident 52. The DON stated Resident 52's mental disorder could have deteriorated if Resident 52 did not have the support needed. During a review of Job Description: Director of Nursing (DON), dated 2/2024, the document indicated, .General Purpose . oversees and supervises the care of all residents . Essential Duties . Develop and implement nursing policies and procedures and ensure compliance. Responsible for ensuring resident safety and that all residents are treated with utmost respect Work closely with all other departments to ensure excellent overall resident care . coordinate MDS and care planning . During a review of the facility's policy and procedure titled, admission Criteria PASARR, dated 03/2019, indicated, .Policy Statement- our facility admits only residents whose medical and nursing care needs can be met. Policy Interpretation and Implementation .9.a. The facility conducts a level I PASARR screen for all potential admission . To determine if the individual meets the criteria for a MD (Mental Disorder), ID (Intellectual Disability/Developmental Disability) or RD (Related Conditions). b. If the level I screen indicates that the individual may meet the criteria for a MD, ID, or RD . is referred to the state PASARR representative for the level II (evaluation and determination) screening process . During a review of professional reference from the California Department of Health Care Services (DHCS) (a government agency that provides healthcare services to low-income and disabled Californians) titled, Preadmission Screening and Resident Review, undated, (found at https://www.dhcs.ca.gov/services/MH/Pages/PASRR.aspx), the reference indicated .The (DHCS), PASRR Section is responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 14 of 51 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 05/20/2025 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete determining if individuals with serious mental illness (SMI) and/or intellectual/developmental disability (ID/DD) or related conditions (RC) require: Nursing facility services, considering the least restrictive setting, Specialized services. This is achieved by completing the PASRR process. The PASRR process consists of a Level I Screening, Level II Evaluation, and a final Determination. Level I Screening-The Screening is submitted online by the facility and is a tool that helps identify possible SMI and/or ID/DD/RC. Level II Evaluation- If the Screening is positive for possible SMI and/or ID/DD/RC, then a Level II Evaluation will be performed. The Level II Evaluation helps determine placement and specialized services. The Department of Health Care Services (DHCS) is responsible for SMI Level II Evaluations, which by law must be performed by a third-party contractor Event ID: Facility ID: 056225 If continuation sheet Page 15 of 51 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 05/20/2025 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)

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to develop and implement a baseline care plan (a plan that provides direction for individualized care of the resident) within 48 hours of resident's admission for one of two sampled residents (Resident 79) when Resident 79's care plans was not created for the oxygen (O2- a colorless, odorless and tasteless gas essential for life) therapy per physician's order. This failure had the potential for Resident 79 to not receive oxygen therapy as prescribed by the physician which had the potential to result in hypoxia (a condition where tissues and organs don't receive enough oxygen) and respiratory failure (a condition where the lungs are unable to adequately provide oxygen to the blood or remove carbon dioxide). Findings: During an observation on 5/13/25 at 1:23 p.m. with Resident 79 during the tour in Resident 79's room, Resident 79 was lying in bed with the head of the bed elevated wearing a nasal cannula (NC- thin plastic tube that delivers oxygen directly into the nose through two small prongs) in his nostril. The O2 tubing hung from the resident down the left side of the bed connected to an oxygen concentrator (device that produces oxygen for breathing). The O2 setting was at 2 LPM (liters per minute-unit of measurement). Resident 79 opened his eyes but did not respond to any questions asked. During a review of Resident 79's admission Record (AR-a summary of important information regarding a patient which include patient identification, past medical history, insurance status, care providers, family contact information and other pertinent information), dated 5/16/25, the AR indicated, Resident 79, was admitted to the facility on [DATE] with diagnoses which included: encounter for palliative care (medical consultations focused on providing comfort and support to patients with serious, life-limiting illnesses), parkinsonism (condition which affects the body's movements), major depressive disorder (persistent sadness, loss of interest in activities and difficulty with relationships impacting a person's thinking and behavior), Alzheimer's disease (a progressive disease that destroys memory and other important mental functions), hydrocephalus (buildup of fluid in the brain), . During a review of Resident 79's Minimum Data Set (MDS-a federally mandated resident assessment tool), dated 4/11/25, the MDS section C indicated, Resident 79 had a Brief Interview for Mental Status (BIMS-an assessment tool used by facilities to screen and identify memory, orientation, and judgement status of the resident) score of 03 out of 15 (a score of 13-15 indicates cognitively intact, 08-12 indicates moderately impaired, and 00-07 indicates severe impairment, 99 indicates unable to complete the interview), which indicated Resident 79 was severely impaired. During a review of Resident 79's MDS assessment dated [DATE], the MDS section O indicated Resident 79's Special Treatment, Procedures, and Programs included Resident 79 on Hospice care (a type of care that focuses on providing comfort and relief to terminally ill patients and their families, rather than focusing on curing the illness). During a review of Resident 79's Order Summary Report (OSR) dated 10/7/24 at 5:01 p.m. The OSR indicated .O2 at 2-5 LPM via NC PRN (as needed) per concentrator /tank as needed for Dyspnea (difficulty or discomfort in breathing) . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 16 of 51 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 05/20/2025 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)

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of Resident 79's Progress Notes (PN) dated 10/8/24 at 10:52 p.m. The PN indicated, .Resident is on monitoring for s/p (status post) new admit to facility under{name}hospice . During a concurrent interview and record review on 5/16/25 at 11:45 a.m. with Licensed Vocational Nurse (LVN) 6, Resident 79's O2 order and care plans were reviewed. The LVN 6 stated, I do not see any care plan, there should be a care plan if the resident is on O2. LVN 6 stated it was important to have a care plan for O2 because it showed the interventions needed for Resident 79. LVN 6 stated the care plan guided the Licensed Nurses (LNs) and helps LNs know what problems Resident 79 had. LVN 6 stated the care plan should have been initiated when O2 was started on 10/7/24. During a concurrent interview and record review on 5/16/25 at 11:47 a.m. with the Minimum Data Set Nurse (MDSN), Resident 79's O2 order and care plans were reviewed. The MDSN stated there was no care plan for O2. The MDSN stated there should have been a care plan to ensure LNs were providing Resident 79 his O2 needs. The MDSN stated the care plan ensured staff with access to resident 79's care know what interventions the resident needs. The MDSN stated the care plan should have been completed as soon as the O2 was ordered on 10/7/24. During a concurrent interview and record review on 5/16/25 at 1:46 p.m. with the Director of Nursing (DON), the baseline care plan policy, the duties, job description for Registered Nurse (RN) & LVN, Resident 79's O2 order and care plans were reviewed. The DON stated care plans were initiated when residents were admitted to the facility. The DON stated baseline care plans should have been completed based on Resident 79's assessment on admission. The DON stated a baseline care plan should have been completed within 48 hours of admission. The DON stated there was no baseline care plan completed when resident 79 was admitted on [DATE]. The DON stated, It would be appropriate for Resident 79 to have a care plan so that anyone participating in his care would have information regarding the plan of Resident 79's care and other non -physician support can be incorporated in his care. The DON stated having a care plan could improve the care of Resident 79. The DON stated the care plan policy was not followed. The DON stated it was important for staff to follow the policy to ensure adherence to systems that will support residents' care. During a review of the facility's document titled, Job Description, LPN/LVN, dated 2/2024, the document indicated . Charting and Documentation- .Transcribe physician's order to resident . treatment/ care plans as required. Care Plan and Assessment Functions- Review care plans daily to ensure that appropriate care is being rendered . Review resident care plans for appropriate resident goals, problems, approaches, and revisions based on nursing needs .Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to nursing care facilities . During a review of the facility's document titled, Job Description, Registered Nurse (RN), dated 2/2024, the document indicated, . Participate in the development of a written plan of care (preliminary and comprehensive) for each resident that identifies the problems/needs of the resident, indicates the care to be given, goals to be accomplished, and which professional service is responsible for each element of care . Review resident care plans for appropriate resident goals, problems, approaches, revisions based on nursing needs. Ensure that all personnel involved in providing care to the resident are aware of the residents' care plan. Ensure that nursing personnel refer to the resident's care plan prior to administering daily care to the resident. Review nurses' notes to determine if the care plan is being followed. Assist the Resident Assessment/ Care Plan Coordinator in planning, scheduling, and revising the MDS . Review resident's medical and nursing treatments to ensure that they are provided in accordance with the resident's care plan and wishes . Must be knowledge able of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 17 of 51 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 05/20/2025 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)

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to nursing care facilities . During a review of Job Description: Director of Nursing (DON), dated 2/2024, the document indicated, .General Purpose . oversees and supervises the care of all residents . Essential Duties . Develop and implement nursing policies and procedures and ensure compliance. Responsible for ensuring resident safety and that all residents are treated with utmost respect Work closely with all other departments to ensure excellent overall resident care . coordinate MDS and care planning . During a review of the facility's policy and procedure titled, Care Plans-Baseline, dated 12/2016, indicated, .Policy Statement- A baseline plan of care to meet the resident's immediate needs shall be developed for each resident within forty-eight (48) hours of admission. Policy Interpretation and Implementation 1. To assure that the resident's immediate care needs are met and maintained .2. The Interdisciplinary Team will review the healthcare practitioner's orders . and implement a baseline care plan to meet the resident's immediate care needs including but not limited to: a. Initial goals based on admission orders. b. Physician orders .3. The baseline care plan will be used until the staff can conduct the comprehensive assessment and develop an interdisciplinary person- centered care plan. 4. The resident and their representative will be provided a summary of the baseline care plan that includes but is not limited to: a. the initial goals of the resident . During a review of the facility's policy and procedure titled, Oxygen Administration, dated 10/2010, indicated, .the purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation-1. Verify that there is a physician's order for this procedure .2. Review the resident's care plan to assess for any special needs of the resident . During a review of National Library of Medicine.org Professional Reference titled, Nursing Process, dated 4/10/23, (found at https://www.ncbi.nlm.nih.gov/books/NBK499937/) the reference indicated, . Planning: The planning stage is where goals and outcomes are formulated that directly impact patient care based on guidelines. These patient-specific goals and the attainment [the level of knowledge, skills, or qualifications a learner has acquired at a specific point in time] of such assist in ensuring a positive outcome. Nursing care plans are essential in this phase of goal setting. Care plans provide a course of direction for personalized care tailored to an individual's unique needs. Overall condition and comorbid conditions play a role in the construction of a care plan. Care plans enhance communication, documentation, reimbursement, and continuity of care across the healthcare continuum . vital to positive patient outcomes . the nursing process to guide care is clinically significant going forward in this dynamic, complex world of patient care. Aging populations carry with them a multitude of health problems and inherent risks of missed opportunities to spot a life-altering condition . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 18 of 51 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 05/20/2025 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a comprehensive resident-centered care plans for 11 of 24 sampled residents (Residents 7, 12, 18, 21, 32, 39, 45, 53, 76, 78, and 79) when the Activities Director (AD) did not develop resident-centered activity care plans for Residents 7, 12, 18, 21, 32, 39, 45, 53, 76, 78, and 79 since their admission to the facility. These failures resulted in Residents' 7, 12, 18, 21, 32, 39, 45, 53, 76, 78, and 79 not having activities they could engage in, which could lead to boredom, loss of interest, inactivity, depression, feelings of isolation and decreased socialization with others while residing in the facility. Findings: During a review of Resident 7's admission Record (AR- a document containing resident profile information) dated 5/16/25, the AR indicated, Resident 7 was admitted to the facility with diagnoses which included Alzheimer's Disease (a disease characterized by a progressive decline in mental abilities), dysphagia (difficulty swallowing), and contractures (stiffening/shortening at any point, that reduces the joint's range of motion) of right and left hand. During a review of Resident 12's AR dated 5/16/25, the AR indicated, Resident 12 was admitted to the facility on [DATE], with diagnoses which included hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body), dysphagia and contracture of left hand. During a review of Resident 18's AR dated 5/16/25, the AR indicated, Resident 18 was admitted to the facility on [DATE] with diagnoses which included emphysema (long-term lung condition that causes shortness of breath), chronic obstructive pulmonary disease (COPD-chronic lung disease causing difficulty in breathing) and Alzheimer's Disease. During a review of Resident 21's AR dated 5/15/25, the AR indicated, Resident 21 was admitted to the facility on [DATE] with diagnoses which included dysphagia, hemiplegia and hemiparesis, and difficulty in walking. During a review of Resident 32's AR dated 5/16/25, the AR indicated Resident 32 was admitted to the facility on [DATE] with diagnoses which included muscle weakness, epilepsy (recurrent seizures[episodes of abnormal brain activity]) and absence of right and left upper limb, absence of right leg below knee and absence of left leg above knee. During a review of Resident 39's AR dated 5/16/25, the AR indicated, Resident 39 was admitted to the facility on [DATE] with diagnoses which included muscle weakness, difficulty in walking, hemiplegia and hemiparesis. During a review of Resident 45's AR dated 5/16/25, the AR indicated Resident 45 was admitted to the facility on [DATE] with diagnoses which included muscle wasting and atrophy (decrease muscle size and strength) diabetes mellitus (DM-disorder characterized by difficulty in blood sugar control and poor wound healing). During review of Resident 53's AR dated 5/15/25, the AR indicated, Resident 53 was admitted to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 19 of 51 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 05/20/2025 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some facility on [DATE] with diagnoses which included fracture of right femur (break in the longest bone in the body), muscle weakness and respiratory disorder. During a review of Resident 76's AR dated 5/16/25, the AR indicated Resident 76 was admitted to the facility on [DATE] with diagnoses which included hemiplegia and hemiparesis, muscle weakness and osteoporosis (weak and brittle bone). During a review of Resident 78's AR dated 5/16/25, the AR indicated, Resident 78 was admitted to the facility on [DATE] with diagnoses which included DM, muscle weakness and muscle wasting and atrophy. During a review of Resident 79's AR dated 5/16/25, the AR indicated Resident 79 was admitted to the facility on [DATE] with diagnoses which included dementia (a progressive state of decline in mental abilities), depression (persistent low mood or loss of interest in activities for extended periods) and Alzheimer's Disease. During an interview on 5/16/25 at 8:18 a.m. with Activities Director (AD), the AD stated activities were important because the activities helped resident be active, stimulated their minds and was important for their social well-being. The AD stated other residents who are not able to participate in activities were provided one on one activities by the activity assistant. The AD stated she did not know how often residents were provided one on one activity per week. The AD reviewed Residents' 7, 12, 18, 21, 32, 39, 45, 53, 76, 78, and 79's activity care plans and stated Residents' 7, 12, 18, 21, 32, 39, 45, 53, 76, 78, and 79's care plans had the same focus, goals, and interventions. The AD stated the care plans were not individualized or person-centered to meet the needs of each resident. The AD stated care plans needed to be personalized and addressed the needs of each resident. The AD stated the activity care plans for Residents' 7, 12, 18, 21, 32, 39, 45, 53, 76, 78, and 79 were not individualized to their activity needs. The AD stated she was not sure if they were meeting the activity needs of each resident. During a concurrent interview and record review on 5/16/25 at 9:17 a.m. with Activities Assistant (AA), the AA reviewed activities electronic charting and stated she did not have a list of residents who were needing one on one activities. The AA stated every morning, she went down the hallways to resident rooms and distributed coffee or any beverages and snacks to all residents. The AA stated she provided one on one to residents by spending few minutes with each resident talking with them while distributing snacks/coffee. The AA stated, I think in a week, I visit residents at least once and spent at least five minutes talking with them. The AA stated she thinks activities provided was enough to meet each resident's activity needs. The AA stated she did not know the care plans for each residents, she went around and talked to each resident. During an interview on 5/20/25 at 4:15 p.m. with the Director of Nursing (DON) the DON stated activities care plans were the responsibilities of the AD. The DON stated she talked with the AD regarding care plans and that the care plans had to be individualized and addressed the needs of each residents. The DON stated care plans should be personalized because not all residents are the same. During a review of facility policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered, dated 3/2022, the P&P indicated, .A comprehensive, person-centered care plan for the resident should be developed by the interdisciplinary team [IDT-group of individuals from different backgrounds who collaborate to achieve a common goal], with input from the resident, and his/her family or legal representative . The care plan intervention should be derived from information obtained from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 20 of 51 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 05/20/2025 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)

F 0656 the resident and his/her family/responsible party . Includes measurable objectives and times frames . Level of Harm - Minimal harm or potential for actual harm During a review of facility's policy and procedure titled, Activity Programs, dated 8/2006, the P&P indicated, .Our activity programs are designed to encourage maximum participation and are geared to the resident's needs . consist of individual and small and large group activities that are designed to meet the needs and interests of each resident . Activities include but are not limited to, daily coffee social, birthday and holiday parties . Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 21 of 51 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 05/20/2025 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)

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 provide care and services in accordance with professional standards of quality of care for seven out of 12 sampled Residents (Residents 24, 27, 29, 48, 56, 58, and 143) when: Residents Affected - Some 1. Resident 24 and Resident 29's oxygen (a colorless, odorless, tasteless gas essential to living organism) flow rate (the amount of oxygen being delivered to the body) were not administered according to their physician order. These failures resulted in Resident 24 and Resident 29 to not received the prescribed amount of oxygen via oxygen concentrator (a machine that pulls in oxygen from the surrounding air) and placed Resident 24 at risk for breathing problems which could include difficulty breathing, headache, and confusion. 2. No Oxygen in Use signage outside of Resident 143's room. This failure had the potential to result in Resident 143's accidental burn. 3. Resident 58 had a physician's order for oxygen at 3 liters per minute (LPM- unit of measurement) and she was receiving 2.5 LPM. This failure had the potential to place Resident 58's safety at risk by developing hypoxia (a condition where the body's tissues do not receive enough oxygen) and her specific needs not being met . 4. The facility failed to follow their policy and procedure (P&P) Change in Resident's Condition or Status for Resident 48 when he had an unwitnessed fall and the physician was not notified, nor a change in condition completed. This failure put Resident 48's safety at risk by not addressing his fall, increasing the risk of additional fallsand his specific needs not met . 5. Resident 27 was high fall risk for falls, had a physician order for a Dycem (a flexible, non-slip material used to stabilize surfaces and objects) device to be placed on the wheelchair which was not in place during observation and was falsely documented as presented by the nursing staff. This failure resulted in wheelchair instability and increased the risk of falls and injury. 6. Resident 27 had a physician order for a Magnetic resonance imaging (MRI - medical imaging used to create detailed, non-invasive images of the body's internal structures, to help doctors diagnose a wide range of conditions and monitor treatment effectiveness.) -due to gait instability and full history which was not scheduled or completed. This failure had the potential to result in delayed diagnosis and treatment for Resident 27. 7. Resident 56 was administered 4 L/min (liters-unit of measurement)/min (minute) of oxygen via Nasal cannula (NC- plastic device used to deliver supplemental oxygen) instead of 2L/min of oxygen per physician's order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 22 of 51 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 05/20/2025 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)

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some This failure had the potential to put Resident 56 at risk for oxygen toxicity (lung damage that can occur from breathing in too much extra oxygen which can cause coughing and troubled breathing. 8. Resident 56 had a physician order for a left knee X-ray (a type of electromagnetic radiation that can pass through certain objects, including the human body) due to pain which was not completed and marked completed in the electronic charting system without follow up. This failure had the potential to delay treatment for Resident 56. Findings: 1. During a concurrent observation and interview on 5/13/25 at 9:10 a.m. during initial tour in Resident 24's room, Resident 24 was lying in bed, eyes closed and TV on. Resident 24 stated he needed the oxygen to help him breath. Resident 24's oxygen flow rate on the oxygen concentrator indicated 3 l/minute via (through) nasal cannula (NC-a tube used to deliver supplemental oxygen through the nose), During a review of Resident 24's admission Record, (AR-a document with personal identifiable and medical information), dated 5/15/25, the AR indicated Resident 24 was re-admitted to the facility on [DATE] with diagnoses which included chronic obstructive pulmonary disease (COPD-a chronic lung disease causing difficulty in breathing), muscle weakness and end stage renal disease (ESRD-irreversible kidney failure). During a review of Resident 24's Medication Review Report (MRR) dated 5/15/25, the MRR indicated, .O2 [oxygen] 2 [two] LPM [liters per minute] VIA NASAL CANNULA PRN PER CONCENTRATOR /TANK as needed . During an observation on 5/13/25 at 8:59 a.m. during initial tour in Resident 29's room. Resident 29 observed lying in bed eyes closed and did not answer questions asked. Resident 29's bed was in lowest position and cup of water placed on top of overbed table positioned across the bed. Resident 29 observed with oxygen via NC connected to oxygen concentrator. Resident 29's oxygen flow rate was between 2.5 L and 3L. During a review of Resident 29's oxygen order dated 5/20/25, the order indicated, .O2 2 LPM VIA NASAL CANNULA PER CONCENTRATOR/TANK . During an interview on 5/13/25 at 8:45 a.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated oxygen flow rate should be according to physician order. LVN 1 stated, We could not give more than the ordered rate of oxygen. LVN 1 stated giving more oxygen to residents could cause hyperventilation (condition where a person breathes rapidly and deeply, leading to a decrease in the amount of carbon dioxide in the blood) which could result in more serious condition. LVN 1 stated she was the nurse for Resident 24 and Resident 29 and she did not check the flow rate of their oxygen when she administered their medications. During a concurrent interview and record review on 5/13/25 at 9:15 a.m. with Treatment Nurse (TXN), the TXN checked Resident 24's oxygen flow rate and stated, Oxygen is set at 3L/min. TXN reviewed Resident 24's oxygen order and stated Resident 24's oxygen order was 2L/min. TXN checked Resident 29's oxygen flow rate and stated, Oxygen is set between 2.5L/min and 3L/min. TXN reviewed Resident 29's oxygen order and stated, His [Resident 29] oxygen order is 2L/min. TXN stated Resident 24 and Resident 29 were receiving more than the ordered amount of oxygen prescribed by their physician and could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 23 of 51 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 05/20/2025 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)

F 0658 lead to more serious respiratory problem. Level of Harm - Minimal harm or potential for actual harm During a concurrent interview and record review on 5/15/25 at 2:15 p.m. with LVN 2, Resident 24's clinical record was reviewed. LVN 2 stated Resident 24's oxygen order was 2L/min via NC. LVN 2 stated licensed nurses were responsible in making sure physician order for oxygen were followed. LVN 2 stated residents receiving more than the ordered oxygen flow rate could, increases the amount of carbon dioxide [CO2-naturally occurring gas in the atmosphere] in the blood and decrease the amount of oxygen into the blood which could lead to delirium [a serious disturbance in a person's mental abilities], lethargy[feeling unusually tired, sluggish, or lacking in energy], cyanotic [bluish or purplish discoloration of the skin, lips, or nail beds caused by a lack of oxygen in the blood] and leads to cardiovascular issues. Residents Affected - Some During an interview on 5/20/25 at 3:58 p.m. with the Director of Nursing (DON), the DON stated her expectation was for licensed nurses to follow physician's orders for oxygen flow rate. The DON stated residents not receiving the correct physician order for oxygen could lead to respiratory problems. During a review of facility policy and procedure (P&P) titled, Physician Orders, Accepting, Transcribing, Carrying Out and Implementing (Noting), undated, the P&P indicated, .Licensed nursing personnel will ensure that telephone and verbal orders will be recorded and implemented . Appropriate dose administration times are established for each medication per facility guidelines . During a professional reference review retrieved from https://pubmed.ncbi.nlm.nih.gov/19377391/ titled, The use of medical orders in acute care oxygen therapy, dated 2009, the professional reference review indicated, . Oxygen is considered to be a drug requiring a medical prescription and is subject to any law that covers its use and prescription . authorized by a physician following legal written instruction to a qualified nurse . 2. During a review of Resident 143's admission Record, undated, the AR indicated, Resident 143 was admitted to facility on 5/3/25 with diagnoses which included muscle weakness, anemia (a condition where the body does not have enough healthy red blood cells), and syncope (fainting or passing out) and colllapse (to fall or cave in). During a review of Resident 143's Order Summary Report, undated, the Order Summary Report, indicated, . O2 2 LPM VIA NASAL CANNULA PER CONCENTRATOR/TANK . During observation on 5/13/25 at 8:30 a.m. during initial tour in Resident 143's room, Resident 143 was lying in bed and observed with oxygen via NC. Resident 143 refused to answer question asked. No signage outside of Resident 143's doorway to indicated use of oxygen in the room. During an interview on 5/13/25 at 8:35 a.m. with TXN, the TXN stated there should have been a signage outside of Resident 143's room to let people (visitors and families) know oxygen was being used in the room. TXN stated it was important to put signage outside the door for safety issues. During an interview on 5/20/25 at 4:05 p.m. with the DON, the DON stated it was important to ensure Oxygen in Use signage was placed outside the doors of residents using oxygen. The DON stated it was for safety issue. The DON stated it was the responsibility of all staff to ensure there was signage outside of each resident using oxygen. The DON stated, It was a team effort, if no signage or if sign fell on the ground to pick up the sign and placed outside residents' door. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 24 of 51 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 05/20/2025 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)

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of facility policy and procedure (P&P) titled Oxygen Administration dated 10/2010, the P&P indicated, . The following equipment and supplies will be necessary when performing this procedure . No Smoking/Oxygen in Use signs . Place an Oxygen in Use sign on the outside of the room entrance door . Place an Oxygen in Use sign in a designated place . 3. During an observation on 5/13/25 at 8:32 a.m., in Resident 58's room, Resident 58 was receiving oxygen from an oxygen concentrator that was set at 2.5 LPM. During a concurrent observation and interview on 5/14/25 at 10:50 a.m., in Resident 58's room with Licensed Vocational Nurse (LVN) 4, Resident 58 was receiving oxygen from an oxygen concentrator that was set at 2.5 LPM. LVN 4 stated Resident 58 had a physician order for her oxygen to be running at 3 LPM, but it was running at 2.5 LPM. LVN 4 stated she was the nurse responsible for Resident 58 and the physician orders should have been followed and they were not. During a review of Resident 58's AR, dated 5/20/25, the AR indicated, Resident 58 was admitted to the facility on [DATE] with a diagnosis of chronic obstructive pulmonary disease (a lung disease that causes chronic inflammation and narrowing of the airways, making it difficult to breathe) with (acute) exacerbation (a flare-up where symptoms become significantly more severe than usual and require immediate attention) and dependence on supplemental oxygen (provides extra oxygen to people who have trouble breathing and are not getting enough oxygen from their lungs alone). During a review of Resident 58's MDS assessment, dated 3/31/25, the MDS assessment indicated Resident 58's BIMS -assessment of cognitive status for memory and judgment) assessment score was 14 out of 15. The BIMS assessment indicated Resident 58 was cognitively intact. During a review of Resident 58's Medication Review Report (MRR), dated 5/20/25, the MRR indicated, .Order Summary: . Continuous O2 3L [Liters- unit of measurement] via NC [Nasal Cannula- a simple, flexible tube with two prongs that fit inside your nostrils that is used to deliver extra oxygen] per concentrator/tank related too Diagnosis of Acute Respiratory Failure [a life-threatening emergency your lungs aren't working properly to get enough oxygen into your blood and/or remove carbon dioxide] with Hypoxia [a condition where the body's tissues do not receive enough oxygen] . Active . Order date: 5/13/25 . Start date: 5/13/25 . During an interview on 5/16/25 at 1:55 p.m., with LVN 8, LVN 8 stated that she was Resident 58's nurse on 5/13/25. LVN 8 stated the oxygen was not set at what the physician had ordered (was 3 LPM at that time). LVN 8 stated it was important to follow the physician's order and they did not. LVN 8 stated Resident 58 did not receive the appropriate amount of oxygen and that could have caused respiratory distress, which could have resulted in hospitalization. During an interview on 5/20/25 at 1:38 p.m., with the Director of Nursing (DON), the DON stated it was important to follow the physician's order so their plan of care is supported. The DON stated Resident 58 would have been receiving clinically subtherapeutic oxygen delivery. The DON stated there was potential for Resident 58 to become hypoxic (a condition where the body's tissues do not receive enough oxygen). The DON stated the facility did not follow the policy and procedure Oxygen Administration. During an interview on 5/20/25 at 2:27 p.m., with the Unit Nurse Supervisor (UNS), the UNS stated the expectation for nursing staff was to set the oxygen rate exactly per the physician order. The UNS stated if the oxygen was not set per the physician order than the resident could go into (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 25 of 51 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 05/20/2025 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)

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some respiratory distress and have complications. The UNS the policy and procedure for Oxygen Administration was not followed. During a review of the facility's policy and procedure (P&P) titled Oxygen Administration, dated October 2010, the P&P indicated, .Purpose: The purpose of this procedure is to provide guidelines for safe oxygen administration . Preparation: Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration . During a review of RegisteredNursing.org professional reference titled, Does a Nurse Always Have to Follow a Doctor's Orders?, dated 1/18/25, (found at https://www.registerednursing.org/articles/does-nurse-always-follow-doctors-orders/#:~:text=Unless%20there%20is%20a% the reference indicated, .nurses cannot just randomly decide which order to follow and which not to follow. Unless there is a safety concern or an order that conflicts with personal or religious beliefs, failing to carry out orders can be grounds for discipline by the employer as well as the board of nursing, as it could be deemed neglect. During a review of the National Library of Medicine professional reference titled, Nursing Rights of Medication Administration, dated 9/4/23, (found at https://www.ncbi.nlm.nih.gov/books/NBK560654/) the reference indicated, .Nurses have a unique role and responsibility in medication administration, in that they are frequently the final person to check to see that the medication is correctly prescribed and dispensed before administration . Right Dose . Patient safety and quality of care are essential components of nursing practice and priorities that demand consideration to enable the delivery of high-quality, patient-centered care, and overall well-being. Medical errors are unfortunately very common in clinical practice, and in addition to compromising a patient's personal safety . 4. During a review of Resident 48's Progress Notes (PN), dated 5/2/25 at 1:31 p.m., the PN indicated, . Created by: LVN 4 . Resident [48] found on floor next to his bed at 1 p.m., no injury noted, staff assist resident back to bed, resident stated that he was going to the bathroom, educated resident the use of call light for assistant. Resident thinks that he can walk, writer asked Spanish speaking staff to explain that we can help resident with all needs, resident verbalize understanding. Bed to lowest position, placed floor mats too both sides, Will continue to monitor . During a review of Resident 48's AR, dated 5/20/25, the admission Record indicated, Resident 48 was admitted to the facility on [DATE] with a diagnosis of difficulty in walking, muscle weakness. During a review of Resident 48's MDS assessment, dated 5/2/25, the MDS assessment indicated Resident 48's BIMS assessment score was 7 out of 15. The BIMS assessment indicated Resident 48 was severely cognitively impaired. During an interview on 5/16/25 at 2:05 p.m., with LVN 8, LVN 8 stated if a resident was found on the ground it would be an unwitnessed fall. LVN 8 stated if the resident was found on the ground and has issues communicating, they were to contact the responsible party (RP), notify the DON and the physician. During an interview and record review on 5/20/25 at 1:43 p.m., with the DON, Resident 48's Electronic Medical Record (EMR) was reviewed. The EMR indicated Resident 48 had an unwitnessed fall which occurred on 5/2/25 at 1:31 p.m., but there was no physician notification, nor change of condition completed. The DON stated she was not aware of this fall that was documented in PN. The DON stated the physician was to be made aware of the fall as well and nothing was documented that he was. The DON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 26 of 51 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 05/20/2025 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)

F 0658 Level of Harm - Minimal harm or potential for actual harm stated Resident 48 had a fall that same day at 2 a.m. that everyone knew about, but not the 1:31 p.m. fall. The DON stated a change of condition should have been completed for the second fall and it was not per the EMR. The DON stated the P&P Change in Resident's Condition or Status was not followed. The DON stated because it was not followed Resident 48 could have had another fall due to lack of staff support strategies for future fall prevention. Residents Affected - Some During an interview on 5/20/25 at 2:32 p.m., with the Unit Nurse Supervisor (UNS), the UNS stated for an unwitnessed fall a nurse should have notified a physician and completed a change of condition to adjust the plan of care. The UNS stated if this was not done the resident could have an injury from another fall. The UNS stated that a person had a second fall in the same day they would need additional fall interventions put in place. There was an attempt to interview LVN 4 on 5/20/25 at 5 p.m., but she refused to comment on the incident. During a review of the facilities P&P titled, Change in a Resident's Condition or Status, dated February 2021, the P&P indicated, .Policy Statement: Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's medical . and/or status (e.g. [for example] changes in level of care . etc . Policy Interpretation and Implementation . The nurse will notify the resident's attending physician or physician on call when there has been a: a. accident or incident involving the resident .Unless otherwise instructed by the resident, a nurse will notify the resident's representative when: . there is a significant change in the resident's physical . status . 5. During a review of Resident 27's AR dated 5/16/2025, the AR indicated Resident 27 was admitted to the facility on [DATE] with diagnoses which included Polyneuropathy (a condition where multiple nerves become damaged or dysfunctional throughout the body), difficulty in walking and history of falls. During a concurrent observation and interview on 5/16/25 at 9:26 a.m. with Resident 27 in Resident 27's room, Resident 27 sat at the edge of the bed, dressed in shorts and a tee shirt with compression socks on, and Resident 27's wheelchair was next to the bed. Resident 27's wheelchair was noted to have a seat cover with a picture of black and white feathers with red color accents on the feathers, No Dycem slip prevention mat was seen. Resident 27 stated she fell out of her wheelchair, outside the facility on 5/14/25 at night coming back from the market next door. During an interview on 5/16/25 at 10:17 a.m. with Certified Nursing Assistant (CNA) 4, CNA 4 stated Resident 27 told her she fell on Wednesday night (5/14/25). CNA 4 acknowledged Resident 27 should have prevention interventions in place, to keep Resident 27 safe from falls. Durning an observation on 5/20/25 at 10:07 a.m. Resident 27 was observed sitting on the wheelchair. Resident 27 stated the Dycem was not on her chair. Durning a concurrent interview and record review on 5/20/25 at 4:16 p.m. with Licensed Vocational Nurse (LVN) 3, Resident 27's Medication Administration Record (MAR), dated 5/20/25 was reviewed. The MAR indicated LVN 3 had document on multiple dates of monitoring for Dycem to prevent resident from sliding off. Monitor placement every shift for fall prevention, start date 10/22/2024. LVN 3 stated she had knowledge of Resident 27's fall on 5/14/25. LVN 3 stated she did document the placement of the Dycem was on the wheelchair, LVN 3 stated she did not see the Dycem and should not have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 27 of 51 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 05/20/2025 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)

F 0658 documented falsely. Level of Harm - Minimal harm or potential for actual harm Durning a concurrent interview and record review on 5/20/25 at 4:59 p.m. with the Unit Nurse Supervisor (UNS), Resident 27's MAR dated 5/20/25 was reviewed. The MAR indicated on 5/16/25 for the dayshift time, the UNS confirmed her initials, documented confirmed placement and monitoring of the Dycem. The UNS stated she did not personally see the placement and should not have documented falsely. The UNS stated she was not performing to facility expectation of documentation. Residents Affected - Some Durning an interview on 5/20/25 at 4:34 p.m. with the DON, the DON stated it is the expectation for the facility staff to document accurately and for the physician orders to be fulfilled. During a review of the facility's policy and procedures (P&P) tilted Charting and Documentation, dated April 2008, indicated .All observations, medications administered, services preformed .must be documented in the resident's medical record .Documentation .include at a minimum .assessment data and/or any unusual findings . 6. During a concurrent interview and record review on 5/16/25 at 2:30 p.m. with the DON, Resident 27's Progress notes, dated 5/8/25 were reviewed. The progress notes indicated, .follow up appointment orders .Outpatient referral for MRI due to gait inability . The DON acknowledged this note made on 5/8/25 as orders to follow, author indicated LVN 5. DON indicated the order was not carried out timely, the DON stated the expectation of the nursing staff was to complete the order as soon as possible for the accurate assessment of Resident 27. Durning an interview on 5/20/25 at 4:16 p.m. with LVN 5, LVN 5 was unable to provide a clinical rationale why the physician's orders of an MRI for Resident 27 had not been completed. During a review of the facility's P&P titled Lab and Diagnostic Test results-Clinical Protocol, dated November 2018, the P&P indicated, .physician identify and order diagnostic and lab testing based on the residents' .monitoring needs. The staff will process test requisitions and arrange for test .A nurse will determine whether the test was done . During a review of National Center for Biotechnology Informatiom.gov Professional Reference titled, Legal Implications- Nursing Management and Professional Concepts, dated 2024, (found at https://www.ncbi.nlm.nih.gov/books/NBK610473/#:~:text=A%20nurse%20may%20be%20charged,revocation%20of%20a% the reference indicated, .A nurse may be charged with fraud for documenting interventions not preformed or altering documentation cover up an error. Fraud can result in civil and criminal charges and also suspension or revocation of a nurse's license . During a review of My American Nurse. Com Professional Reference titled, Understand the risk of erroneous and incomplete documentation, dated 8/7/23, (found at https://www.myamericannurse.com/proper-documentation-protects-patients-and-your-license/#:~:text=Takeaways:,or%20li the reference indicated, .Nursing documentation plays a critical role in healthcare. Errors or incomplete information can affect data accuracy and ultimately best practices. Improper documentation also can contribute to adverse, sometimes fatal, patient outcomes. When you document completely and accurately, you reduce your liability risk and have the strongest legal defense in the event of a malpractice lawsuit or licensing board disciplinary action . 7. During a Review of Resident 56's AR dated 5/20/25, the AR indicated Resident 56 was admitted to the facility on [DATE] with diagnoses which included Chronic Obstructive Pulmonary Disease (COPD-a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 28 of 51 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 05/20/2025 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)

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some condition caused by damage to the airways or other parts of the lung that blocks airflow and makes it hard to breathe) and Asthma (a chronic lung condition making it difficult to breathe). During a concurrent observation and interview on 5/13/25 at 8:43 a.m. in Resident 56's room, Resident 56 was sitting in her wheelchair with oxygen via nasal cannula receiving 4L/min. Resident 56 stated she was always feeling short of breath, normally had oxygen on. During a concurrent interview and record review on 5/13/25 at 4:27 p.m. with LVN 3, Resident 56's order summary was reviewed, the order summary indicated Resident 56 should be receiving 2L/min of oxygen via NC ordered by the physician. LVN 3 checked Resident 56's oxygen setting and confirmed the resident was receiving 4 l/min of oxygen via NC. LVN 3 stated Resident 56 should not receive 4 l/min of oxygen that is not the physician order. LVN 3 stated she will monitor Resident 56, and inform the doctor, as well as update the care plan. LVN 3 stated it is important for Resident 56 who has diagnosis of COPD to not over inflate the lungs placing a lot of pressure on her lungs and it can lead to other issues like confusion. During an interview on 5/15/25 at 3:12 p.m. with the DON in the DONs office. The DON stated it was the expectation of the nurses to follow the physician orders as stated. During a review of the facility's policy and procedures (P&P) tilted Oxygen Administration, dated October 2010, indicated .Verify that there is a physician's order .review the physician's orders or facility protocol for oxygen administration .after completing the oxygen setup or adjustment, the following information should be recorded .the rate of oxygen flow . 8. During a record review on 5/15/25 at 9:20 a.m. of Resident 56's Progress notes dated 5/5/25, the progress note indicated the medical doctor gave a telephone order for a 3 view x-ray to the knee of Resident 56, and a copy of the order and face sheet was sent to via fax. During an interview on 5/15/25 at 11:14 a.m. with Resident 56, Resident 56 stated she was unable to bare weight on her left leg. Resident 56 stated she did not fall but did slip and head her left knee pop. Resident 56 stated the facility informed her she would get an x ray and it was not done. Resident 56 expressed frustration on being told something and not being done. During an interview on 5/15/25 at 2:17 p.m. with LVN 1, LVN 1 was unable to provide confirmation the x-ray was completed. LVN 1 stated the order was marked as complete, and results were not found. LVN 1 stated she cannot confirm the order was completed. LVN 1 stated the nurses had to carry out the physican orders as soon as possible and the nurses needed to communicate orders to each other via hand off report (verbal communication between shifts). During an interview on 5/15/25 at 3:12 p.m. with the DON, the DON acknowledged the order was not completed, and the x-ray person did not receive a fax about Resident 56. DON stated it is the expectation of orders to be carried out, this order was missed. During a review of the facility's P&P titled Lab and Diagnostic Test results-Clinical Protocol, dated November 2018, the P&P indicated, .physician identify and order diagnostic and lab testing based on the residents' .monitoring needs. The staff will process test requisitions and arrange for test .A nurse will determine whether the test was done . During a review of the facility's P&P titled Physician orders, accepting, transcribing, carrying (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 29 of 51 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 (X3) DATE SURVEY COMPLETED A. Building 05/20/2025 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)

F 0658 out and implementing (Noting) undated, the P&P indicated, Licensed nursing Level of Harm - Minimal harm or potential for actual harm During a review of the facility's P&P titled Physician orders, accepting, transcribing, carrying out and implementing (Noting) undated, the P&P indicated, Licensed nursing personnel will ensure .all physician orders are to be completed and clearly defined to ensure accurate implementation . Residents Affected - Some During a review of Job Description: LPN/LVN dated February 2024, the Charting and Documentation indicated Receive .orders from physicians and record on the Physicians' Order Form. Transcribe physician's order to resident charts, cardex, medication cards, treatment/ care plans, as required .Nursing Care Functions Requisition and arrange for diagnostic and therapeutic services, as order by the physician, and in accordance with our established procedures. Review the resident's chart for specific treatments, medication orders, diets, ect., as necessary. Make periodic checks to ensure that prescribed treatments are being properly administered by certified nursing assistants and to evaluate the resident's physical and emotion status . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 30 of 51 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 05/20/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a hazard free environment and adequate supervision to prevent accidents was provided for two of three sampled residents (Resident 23 and Resident 27) when: 1. Resident 23 was using two phone books covered with duct tape as a step-stool to assist in getting up into bed that were made by therapy staff. This failure put Resident 23's safety at risk by creating a hazardous environment that could have caused an accident or fall. 2. The facility failed to ensure Resident 27 received adequate supervision to prevent accidents despite being identified as a high fall risk. This failure resulted in repeated falls and unsafe situations, with an increased risk of potential bodily harm. Findings: 1. During a current observation and interview on 5/14/25 at 10:08 a.m., with Resident 23, in Resident 23's room, Resident 23 stepped on two blocks made of duct tape (a very strong adhesive tape with a waterproof backing, used to seal home ducts, hoses) to get into her bed. Resident 23 stated rehab made them for her and she needed to step on them to get in and out of bed. Resident 23 stated she was unsure of what they were made of. During a review of Resident 23's admission Record (AR-a document containing resident profile information), dated 5/20/25, the AR indicated, Resident 23 was admitted to the facility on [DATE] with diagnosis of muscle weakness, morbid (severe) obesity (a chronic condition characterized by an excessive accumulation of body fat that can negatively impact health), muscle wasting (when muscles shrink and become weaker) and atrophy (gradual wasting away or shrinking), unsteadiness on feet, ataxic gait (a wobbly, unsteady, and uncoordinated way of walking), chronic pain and other abnormalities of gait and mobility (movement). During a review of Resident 23's Minimum Data Set (MDS - a resident assessment tool used to identify resident cognitive and physical function) assessment, dated 4/29/25, the MDS assessment indicated Resident 23's Brief Interview for Mental Status (BIMS -assessment of cognitive status for memory and judgment) assessment score was 13 out of 15 (a score of 13-15 indicates cognitively intact (a person is able to think clearly, remember things well, and make sound decisions, essentially having normal brain function with no significant problems with thinking, learning, or reasoning abilities), 08-12 indicates moderately impaired, and 00-07 indicates severe impairment). The BIMS assessment indicated Resident 23 was cognitively intact. During an interview on 5/15/25 at 3:17 p.m., with the Director of Rehabilitation (DOR), the DOR stated the two blocks were actually phone books covered with duct tape. The DOR stated a facility staff member, Occupational Therapist (OT) 1, made the blocks. The DOR stated the phone books (a physical book that is like a directory or list of names, addresses, and phone numbers of people and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 31 of 51 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 05/20/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some businesses in a particular area) were designed to be a therapeutic intervention , but they were not appropriate. The DOR stated the stepping stool made of phone books was a potential safety hazard and could have increased Resident 23's risk for a falls because, she could slip. The DOR stated the facilities policy and procedure Staff Physical Therapist and Clinical Standards of Practice were not followed. During an interview on 5/16/25 at 1:55 p.m., with Licensed Vocational Nurse (LVN) 8, LVN 8 stated she had seen the phone books since January 2025 in Resident 23's room. LVN 8 stated she used them to help her get into bed. LVN 8 stated that Resident 23 could trip on them and they were a safety concern. LVN 8 stated she never said anything to anyone because she used them all the time. During an interview on 5/16/25 at 3:43 p.m., with OT 1, OT 1 stated Resident 23 used them for positioning. OT 1 stated that he did make the blocks and they were phone books wrapped in duct-tape. OT 1 stated the phone books were never intended to be used as an everyday thing and were not made for her to step on the bed. OT 1 stated she needed to be ordered something specifically for stepping on the bed, but that got overlooked. OT 1 stated the way Resident 23 used the blocks would have increased her fall risk During an interview on 5/20/25 at 1:29 p.m., with the Director of Nursing (DON), the DON stated the blocks were not the facilities preferred use for getting up into bed. The DON stated the blocks could have been safer and they were not appropriate. The DON stated the facilities policy and procedures Staff Physical Therapist and Clinical Standards of Practice were not followed. During an interview on 5/20/25 at 2:23 p.m., with the Unit Nurse Supervisor (UNS), the UNS stated the blocks should not have been used by Resident 23. The UNS stated they were a safety issue for the resident and the blocks were not professional. The UNS stated the facilities policy and procedures Staff Physical Therapist and Clinical Standards of Practice were not followed. During a review of the facility's policy and procedure (P&P) titled, Staff Physical Therapist undated, the P&P indicated, .General Purpose: The staff Physical Therapist evaluates and treats patients . Essential Duties: . Recommend and facilitate the ordering of necessary durable medical equipment for patients . Report any problems with department equipment so that it is maintained in good working order . During a review of the facility's P&P titled, Clinical Standards of Practice, undated, the P&P indicated, .All rehab services are delivered in a professional and quality manner . 2. During an interview on 5/15/25 at 3:22 p.m. with the DON, in the DON's office, Resident 27 was observed through a large window, propelling her wheelchair unsupervised out of the facility's parking lot toward the adjacent street. During a review of Resident 27's AR dated 5/16/2025, the AR indicated Resident 27 was admitted to the facility on [DATE] with diagnoses which included Polyneuropathy (a condition where multiple nerves become damaged or dysfunctional throughout the body), difficulty in walking and history of falls. During a review of Resident 27 ' s Minimum Data Set assessment, dated 4/7/25, the MDS assessment indicated Resident 27 ' s BIMS assessment score was 14 out of 15. The BIMS assessment indicated Resident 128 was cognitively intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 32 of 51 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 05/20/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 5/16/25 at 9:26 a.m. with Resident 27, in Resident 27's room. Resident 27 stated she was coming back from the Asian market around the corner. Resident 27 stated it was dark at this time, and she could not get her wheelchair over the bump in the pavement, I flipped over. Resident 27 stated she hit the ground hard and could not get herself back up and into her chair. Resident 27 stated she laid there on the ground, yelling for help. Resident 27 shared her call history on her personal cellphone with multiple calls to the facility and nobody answered, nobody came. Resident 27 stated eventually, she somehow got herself back in the chair and into the facility. Resident 27 stated she reported her fall. Resident expressed frustration with inconsistent support and the feel of needing help. Resident 27 stated, I don't feel I have anyone to advocate for me. During an interview on 5/16/25 at 10:17 a.m. with Certified Nursing Assistant (CNA) 4, CNA 4 stated, Resident 27 does a lot on her own, but when she falls it's bad. She told me she hit her head last time. CNA 4 stated when a resident falls, the resident is checked every 15 minutes, but when Resident 27 outside, I don't know. During an interview on 5/20/25 at 9:57 a.m. with the Receptionist, the receptionist stated, Resident 27 would go three times a day to get her cigarettes. The Receptionist stated he's seen Resident 27 go out front alone. The Receptionist stated each residence has a Leave of Absences (LOA) sheet and they are to sign themselves out. The receptionist reported his shift is over at 5 p.m., when the phone rings anyone can answer the phone, because it will ring throughout the facility. During an interview on 5/20/25 at 10:33 AM with LVN 4, LVN 4 stated, she observed Resident 27 leave the facility. LVN 4 stated Resident 27 signs herself out. LVN 4 could not provide documentation of Resident 27 signing herself out. LVN 4 acknowledged Resident 27 as a high fall risk and not knowing when she was off the property. LVN 4 stated when a resident was a high fall risk they were watched closely. LVN 4 was unable to provide clinical evidence of what watching closely was. LVN 4 acknowledged she was responsible for the residents' well-being and needed to provide adequate supervision for Resident 27 who was at high risk for falls. During a review of Resident 27's Progress Note (PN) dated 5/14/25 and Resident 27's call history, the PN and call history, indicated Resident 27 made calls to the facility on 5/14/25 at 8:34 p.m., 8:37 p.m., 8:39 p.m., and 8:40 p.m., with durations ranging from seventeen seconds to two minutes. No documentation was found indicating that staff were aware of the calls or responded to the resident's request for assistance. During a concurrent interview and record review on 5/20/25 at 3:33 p.m. with the DON, the facility's policy and procedure (P&P) titled Fall Prevention Program and Falling Star Program, undated, was reviewed. The P&P indicated, .residents at high risk .a visual identifier placed on the name plaque outside the door .a yellow armband for further identification . The DON acknowledged the resident had not signed the LOA form, and the team did not always know when she left the building. The DON confirmed consistent individualized interventions should have been in place. During a review of the facility's P&P titled, Falls and Fall Risk, Managing, dated December 2007, the P&P indicated, .staff will monitor and document each resident's response to interventions intended to reduce falling or the risk of falling .If the resident continues to fall, staff will re-evaluate the situation .staff and/or physician will document the basis for conclusions that specific irreversible risk factors exist . 2. During an interview on 5/15/25 at 3:22 p.m. with the DON, in the DON's office, Resident 27 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 33 of 51 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 05/20/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some observed through a large window, propelling her wheelchair unsupervised out of the facility's parking lot toward the adjacent street. During a review of Resident 27's AR dated 5/16/2025, the AR indicated Resident 27 was admitted to the facility on [DATE] with diagnoses which included Polyneuropathy (a condition where multiple nerves become damaged or dysfunctional throughout the body), difficulty in walking and history of falls. During a review of Resident 27 ' s Minimum Data Set assessment, dated 4/7/25, the MDS assessment indicated Resident 27 ' s BIMS assessment score was 14 out of 15. The BIMS assessment indicated Resident 128 was cognitively intact. During an interview on 5/16/25 at 9:26 a.m. with Resident 27, in Resident 27's room. Resident 27 stated she was coming back from the Asian market around the corner. Resident 27 stated it was dark at this time, and she could not get her wheelchair over the bump in the pavement, I flipped over. Resident 27 stated she hit the ground hard and could not get herself back up and into her chair. Resident 27 stated she laid there on the ground, yelling for help. Resident 27 shared her call history on her personal cellphone with multiple calls to the facility and nobody answered, nobody came. Resident 27 stated eventually, she somehow got herself back in the chair and into the facility. Resident 27 stated she reported her fall. Resident expressed frustration with inconsistent support and the feel of needing help. Resident 27 stated, I don't feel I have anyone to advocate for me. During an interview on 5/16/25 at 10:17 a.m. with Certified Nursing Assistant (CNA) 4, CNA 4 stated, Resident 27 does a lot on her own, but when she falls it's bad. She told me she hit her head last time. CNA 4 stated when a resident falls, the resident was checked every 15 minutes, but when Resident 27 outside, I don't know. During an interview on 5/20/25 at 9:57 a.m. with the Receptionist, the receptionist stated, Resident 27 would go three times a day to get her cigarettes. The Receptionist stated had seen Resident 27 go out front alone. The Receptionist stated each residence has a Leave of Absences (LOA) sheet and they are to sign themselves out. The receptionist stated his shift was over at 5 p.m., when the phone rings anyone could answer the phone, because it will ring throughout the facility. During an interview on 5/20/25 at 10:33 AM with LVN 4, LVN 4 stated, she observed Resident 27 leave the facility. LVN 4 stated Resident 27 signs herself out. LVN 4 could not provide documentation of Resident 27 signing herself out. LVN 4 acknowledged Resident 27 as a high fall risk and not knowing when she was off the property. LVN 4 stated when a resident was a high fall risk they were watched closely. LVN 4 was unable to provide clinical evidence of what watching closely was. LVN 4 acknowledged she was responsible for the residents' well-being and needed to provide adequate supervision for Resident 27 who was at high risk for falls. During a concurrent interview and record review on 5/20/25 at 3:33 p.m. with the DON, the facility's policy and procedure (P&P) titled Fall Prevention Program and Falling Star Program, undated, was reviewed. The P&P indicated, .Residents at high risk .a visual identifier placed on the name plaque outside the door .a yellow armband for further identification . The DON acknowledged the Resident 27 had not signed the LOA form, and the team did not always know when Resident 27 left the building. The DON confirmed consistent individualized interventions should have been in place. During a review of the facility's P&P titled, Falls and Fall Risk, Managing, dated 12/2007, the P&P (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 34 of 51 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 05/20/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm indicated, .staff will monitor and document each resident's response to interventions intended to reduce falling or the risk of falling .If the resident continues to fall, staff will re-evaluate the situation .staff and/or physician will document the basis for conclusions that specific irreversible risk factors exist . Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 35 of 51 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 05/20/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow its policy and procedures (P&P) titled, Answering the Call Light, for six of 12 sampled residents (Residents 7, 14, 46, 59, 78, and 293) when the staff did not response to Residents 7, 14, 46, 59, 78, and 293's call lights within 5 minutes. These failures had the potential to result in Residents 7, 14, 46, 59, 78, and 293 not attaining their needs and not maintaining their highest practicable physical, mental, emotional, and psychosocial well-being. Findings: During a concurrent observation and interview on 5/16/25 at 2:58 p.m. with Resident 7 in her room, Resident 7 was lying in bed, and did not respond to any questions. During a review of Resident 7's admission Record (AR-a document containing resident profile information), dated 5/20/25, the AR indicated, Resident 7 was admitted to the facility on [DATE] with diagnoses which included Alzheimer's disease (progressive brain disorder that gradually damages memory, thinking, and other cognitive functions), dysphagia (difficulty swallowing), essential hypertension (a condition where the force of blood against your artery walls is consistently too high), presence of cardiac pacemaker (a small, battery-operated device that helps regulate the heart's rhythm by providing electrical impulses when the heart's natural sinus node isn't functioning properly), all those symptoms and signs involving cognitive (the mental processes involved in knowing, learning, understanding, and thinking) functions and awareness, muscle weakness generalized, hypotension (a condition where blood pressure drops below normal levels), irritable bowel syndrome (a digestive system disorder characterized by abdominal pain and changes in bowel habits, such as diarrhea or constipation), pain, contracture(a condition where muscles, tendons, ligaments, or skin become tight and shortened, limiting the range of motion in a joint) right hand, contracture of muscle left hand, aphasia (loss of ability to understand or express speech caused by brain damage), anemia (a condition where the body has a lower than normal number of red blood cells, or the red blood cells don't function properly, leading to a reduced ability to carry oxygen). During a review of Resident 7's Minimum Data Set (MDS-a resident assessment tool used to identify resident cognitive and physical function), dated 5/15/25, the MDS section C indicated, Resident 7 had a Brief Interview for Mental Status (BIMS-assessment of cognitive status for memory and judgment) assessment score was not complete, (a score of 13-15 indicates cognitively intact, 08-12 indicates moderately impaired, and 00-07 indicates severe impairment, 99 indicates unable to complete the interview). During a review of Resident 7's MDS assessment dated [DATE], the MDS section GG indicated, Resident 7's Functional Abilities included impairment on both sides to the upper and lower extremities, Resident 7 uses wheelchair, Resident 7 is dependent (helper does all the effort, resident does none of the effort to complete self-care) on eating, oral hygiene, toileting hygiene, shower/bath self, upper body dressing, lower body dressing, putting on/taking off footwear and personal hygiene. Resident 7 is dependent on roll left and right, sit to lying, lying to sitting on side of bed, and chair/bed to chair transfer. Sit to stand, toilet transfer and tub/shower transfer was not attempted, and Resident 7 did not perform these activity prior to the current illness . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 36 of 51 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 05/20/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 7's MDS assessment dated [DATE], the MDS section H indicated, Resident 7's Bladder and Bowel function included Resident 7 is always incontinent (no episodes of continent voiding) for urinary continence. Resident 7 is always incontinent (no episodes of continence bowel movement) for bowel continence. During a review of Resident 7's MDS assessment dated [DATE], the MDS section M indicated, Resident 7's Skin Conditions included Resident 7 uses pressure reducing device for chair, and pressure reducing device for bed. During a concurrent observation and interview on 5/16/25 at 2:50 p.m. with Resident 14 in her room, Resident 14 was sitting in bed, with the head of the bed elevated . Resident 14 stated at night, the staff said it should take them 5-10 minutes to answer the call light, but it took them 30-40 minutes. Resident 14 stated it took the CNAs 4.5 hours to respond to the call light on a particular day last month. Resident 14 stated I was in my own dried stool. Why should it take that long? Resident 14 stated Resident 7 had been in her room for 2-3 years, had contracture and could no longer talk. Resident 14 stated she tried to advocate for Resident 7 and was told Resident 7 was none of her concern. Resident 14 stated I don't feel like I am treated with dignity and respect. During a review of Resident 14's AR dated 5/20/25, the AR indicated, Resident 14, was admitted to the facility on [DATE] with diagnoses which included: partial traumatic amputation (surgical procedure involving the removal of all or part of a limb) of left shoulder and upper arm, type 2 diabetes mellitus (a chronic disease characterized by high blood sugar levels) with diabetic neuropathy (nerve damage caused by high blood sugar levels), acquired absence of right upper limb below elbow, acquired absence of right leg below knee, acquired absence of left leg below knee, pain. During a review of Resident 14's MDS assessment dated [DATE], the MDS section C indicated, Resident 14's BIMS assessment score was 15 out of 15. BIMS scores indicated Resident 14 was cognitively intact. During a review of Resident 14's MDS assessment dated [DATE], the MDS section GG indicated, Resident 14's Functional Abilities included impairment on both sides to the upper and lower extremities, Resident 14 uses wheelchair, Resident 14 is dependent on oral hygiene, toileting hygiene, shower/bath self, lower body dressing and personal hygiene. Resident 14 is partial/moderate assistance (helper does less than half the effort in care) on upper body dressing. Resident 14 is dependent on chair/bed to chair transfer and tub/shower transfer. Resident 14 is partial/moderate assistance on roll left and right, sit to lying, lying to sitting on side of bed. During a review of Resident 14's MDS assessment dated [DATE], the MDS section H indicated, Resident 14's Bladder and Bowel function included Resident 14 is frequently incontinent for urinary continence. Resident 14 is frequently incontinent for bowel continence. During a review of Resident 14's MDS assessment dated [DATE], the MDS section M indicated, Resident 14's Skin Conditions included Resident 14 uses pressure reducing device for chair, and pressure reducing device for bed. During a review of Resident 14's MDS assessment dated [DATE], the MDS section N indicated, Resident 14's Medications included Antiplatelets (medications that work by preventing platelets from sticking together and forming clots ). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 37 of 51 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 05/20/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm During a concurrent observation and interview on 5/13/25 at 9:37 a.m. with Resident 46 during the initial tour in Resident 46's room, Resident 46 was sitting in her wheelchair looking through some documents. Resident 46 stated I cannot walk. Resident 46 stated, the facility is short-staffed. Resident 46 stated she wheeled herself to the staff before they attend to her. Resident 46 stated it usually took about 20-30 minutes before staff responded to her call light. Residents Affected - Some During a review of Resident 46's AR dated 5/20/25, the AR indicated, Resident 46, was admitted to the facility on [DATE] from acute care hospital with diagnoses which included: heart failure, adult failure to thrive, essential hypertension, specified osteoarthritis (a degenerative joint disease where cartilage breaks down, leading to pain, stiffness, and decreased range of motion), unequal limp length acquired, pain,, history of falling, unspecified protein calorie malnutrition, muscle weakness generalized. During a review of Resident 46's MDS assessment dated [DATE], the MDS section C indicated, Resident 46's BIMS assessment score was 14 out of 15. BIMS scores indicated Resident 46 was cognitively intact. During a review of Resident 46's MDS assessment dated [DATE], the MDS section GG indicated, Resident 46's Functional Abilities included Resident 46 uses walker and wheelchair. During a review of Resident 46's MDS assessment dated [DATE], the MDS section M indicated, Resident 46's Skin Conditions included Resident 46 uses pressure reducing device for chair, and pressure reducing device for bed. During a review of Resident 46's MDS assessment dated [DATE], the MDS section N indicated, Resident 46's Medications included Diuretics (medications that help the body get rid of excess fluid and salt by increasing urine production). During a concurrent observation and interview on 5/13/25 at 10:10 a.m. with Resident 59 during the initial tour in Resident 59's room, Resident 59 was sitting up in bed with the head of the bed elevated, with contracture of the neck to the right watching television. Resident 59 stated staff took too long to respond to the call light. During a review of Resident 59's AR dated 5/20/25, the AR indicated, Resident 59, was admitted to the facility on [DATE] from acute care hospital with diagnoses which included: other intervertebral disc degeneration (condition where cushions between the bones of the spine break down, wear down, or dry out over time), muscle weakness generalized, chronic obstructive pulmonary disease (a progressive lung disease characterized by difficulty breathing due to persistent airflow obstruction),, primary generalized osteoarthritis , , pain, adult failure to thrive . During a review of Resident 59's MDS assessment dated [DATE], the MDS section C indicated, Resident 59's BIMS assessment score was 15 out of 15. BIMS scores indicated Resident 59 was cognitively intact. During a review of Resident 59's MDS assessment dated [DATE], the MDS section GG indicated, Resident 59's Functional Abilities included impairment on one side to the upper extremity, Resident 59 uses wheelchair. Resident 59 is dependent on eating, oral hygiene, toileting hygiene, shower/bath self, upper body dressing, lower body dressing, putting on/taking off footwear and personal hygiene. Resident 59 is dependent on roll left and right, sit to lying, lying to sitting on side of bed, sit to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 38 of 51 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 05/20/2025 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)

F 0725 stand, chair/bed to chair transfer, toilet transfer and tub/shower transfer . Level of Harm - Minimal harm or potential for actual harm During a review of Resident 59's MDS assessment dated [DATE], the MDS section H indicated, Resident 59's Bladder and Bowel function included Resident 59 is frequently incontinent for urinary continence. Resident 59 is frequently incontinent for bowel continence. Residents Affected - Some During a review of Resident 59's MDS assessment dated [DATE], the MDS section M indicated, Resident 59's Skin Conditions included Resident 59 has Moisture Associated Skin Damage (MASD). Resident 59 uses pressure reducing device for chair, and pressure reducing device for bed. Resident 59 gets application of ointments/ medications. During a review of Resident 59's MDS assessment dated [DATE], the MDS section N indicated, Resident 59's Medications included Diuretics and Antiplatelets. During a concurrent observation and interview on 5/13/25 at 12:46 p.m. with Family Member (FM) 1 in Resident 78's room, Resident 78 was lying in bed with the head of the bed elevated. FM 1 was sitting in room with Resident 78. FM 1 stated, sometimes the CNAs are standing out there doing nothing. FM 1 stated it takes about 20-30 minutes after the call light was initiated before staff respond. FM 1 stated the facility was short staffed. During a concurrent observation and interview on 5/14/25 at 12:10 p.m. with FM 3 in Resident 78's room, Resident 78 was lying in bed with the head of the bed elevated, eating a burger. FM 3 stated resident did not get adequate supervision when eating. FM 3 stated there was no respect and dignity. FM 3 stated, while visiting Resident 78, FM 3 could hear Resident 78 yelling while coming through the facility doors. FM 3 stated Resident 78 was hungry but was ignored. FM 3 stated on another day, FM 3 saw another resident screaming she had to go to the bathroom; the resident was left alone in the hallway and nobody paid attention to the resident. FM 3 stated some of the CNAs don't like being bugged. FM 3 stated when the family members needed anything for Resident 78, FMs go out to where the staff were and let the staff know what Resident 78 needed, and it took staff about 15- 20 minutes to get resident 78 what was needed. FM 3 stated Resident 59 is Resident 78's roommate. FM 3 stated when Resident 59 uses the call light, and it takes more than 15mins for staff to respond then Resident 59 starts yelling out. FM 3 stated I sometimes go out there and tell them Resident 59 needs help. During a review of Resident 78's AR dated 5/20/25, the AR indicated, Resident 78, was admitted to the facility on [DATE] with diagnoses which included: muscle wasting and atrophy (loss of muscle tissue and is often characterized by decreased muscle size and strength), muscle weakness generalized, unspecified abnormality of gait and mobility, type 2 diabetes mellitus, encounter for palliative care (medical consultations focused on providing comfort and support to patients with serious, life-limiting illnesses),retention of urine. During a review of Resident 78's MDS assessment dated [DATE], the MDS section C indicated, Resident 78's BIMS assessment score was 00 out of 15. BIMS scores indicated Resident 78 had severe cognitive deficit. During a review of Resident 78's MDS assessment dated [DATE], the MDS section GG indicated, Resident 78's Functional Abilities included Resident 78 uses wheelchair. Resident 78 is dependent on lower body dressing and putting on/taking off footwear. Resident 78 needs substantial/ maximal assistance (helper does more than half the effort) on toileting hygiene. Resident 78 needs partial/moderate assistance on oral hygiene, shower/bath self, upper body dressing, and personal hygiene. Resident 78 is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 39 of 51 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 05/20/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dependent on sit to stand, chair/bed to chair transfer, toilet transfer and tub/shower transfer. Resident 78 needs partial/moderate assistance on roll left and right, sit to lying, and lying to sitting on side of bed. During a review of Resident 78's MDS assessment dated [DATE], the MDS section H indicated, Resident 78's Bladder and Bowel function included Resident 78 has an indwelling urinary catheter for urinary continence. Resident 78 is always incontinent for bowel continence. During a review of Resident 78's MDS assessment dated [DATE], the MDS section M indicated, Resident 78's Skin Conditions included Resident 78 uses pressure reducing device for chair, and pressure reducing device for bed. During a concurrent observation and interview on 5/13/25 at 3:15 p.m. with Resident 293 during the initial tour in Resident 293's room, Resident 293 was lying in bed. Resident 293 stated it takes staff too long to answer the call light. Resident 293 stated it took about 20 -30 minutes for staff to respond. Resident 293 stated this can be frustrating because when I need help, I don't get it on time. During a review of Resident 293's AR dated 5/20/25, the AR indicated, Resident 293 was admitted to the facility on [DATE] with diagnoses which included: disorder of the autonomic nervous system (a condition where the nerves that regulate involuntary bodily functions (like heart rate, blood pressure, digestion) are not functioning correctly), difficulty in walking, muscle weakness generalized, pain due to vascular prosthetic devices implants and grafts (man-made materials used to replace or repair damaged blood vessels), immunodeficiency (a condition where the immune system is unable to effectively fight off infections and diseases), type 2 diabetes mellitus, anemia, unspecified mood affective disorder (mental health conditions characterized by persistent or severe disturbances in mood and emotions), unspecified hearing loss bilateral (hearing loss affecting both ears), essential hypertension, hypertensive heart disease, chronic ischemic heart disease (a condition where the heart muscle receives less oxygen-rich blood due to narrowed or blocked coronary arteries), foot drop right foot, injury of sciatic nerve at hip and thigh level right leg (results in range of symptoms, including pain, numbness, weakness, and difficulty with movement and sensation in the leg and foot) . During a review of Resident 293's MDS assessment dated [DATE], the MDS section C indicated, Resident 293's BIMS assessment score was 12 out of 15. BIMS scores indicated Resident 293 has moderate cognitive deficit. During a review of Resident 293's MDS assessment dated [DATE], the MDS section GG indicated, Resident 293's Functional Abilities included impairment on one side to the lower extremity, Resident 293 uses wheelchair. Resident 293 needs substantial/ maximal assistance on toileting hygiene, shower/bath self, lower body dressing, and putting on/taking off footwear. Resident 293 is partial/moderate assistance on personal hygiene. Resident 293 is partial/moderate assistance on roll left and right, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed to chair transfer, toilet transfer and tub/shower transfer. Resident 293 is partial/moderate assistance on picking up objects. During a review of Resident 293's MDS assessment dated [DATE], the MDS section H indicated, Resident 293's Bladder and Bowel function included Resident 293 is occasionally incontinent for urinary continence. During a review of Resident 293's MDS assessment dated [DATE], the MDS section M indicated, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 40 of 51 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 05/20/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident 293's Skin Conditions included Resident 293 has Moisture Associated Skin Damage (MASD). Resident 293 uses pressure reducing device for chair, and pressure reducing device for bed. Resident 293 gets application of ointments/ medications. During a review of Resident 293's MDS assessment dated [DATE], the MDS section N indicated, Resident 293's Medications included Anticoagulant (medications that prevent or reduce blood clot formation), Antiplatelets and Hypoglycemic (drugs used to lower blood sugar levels). During a review of the facility's Resident Council Minutes, dated 1/30/25, the document indicated .Review of past month's issues: .Call lights still take too long to respond .floor staff having attitude when responding to call lights. Concerns: Call lights have not improved on all shifts, still having to wait 30 minutes to be assisted with and CNA are still not assisting residents that are not assigned to that CNA. Call light takes too long to respond Call light is being ignored, and CNA will walk past light and yell back that they will be right back . During a review of the facility's Resident Council Minutes, dated 2/26/25, the document indicated .Concerns: Call lights still take too long to respond CNA limit time assisting with residents so they can get to the next resident. {Unnamed} resident states he/she doesn't get clean .Call lights still waiting 30 to 35 minutes to get assisted. Would like floor staff to acknowledge call lights . During a review of the facility's Resident Council Minutes, dated 3/27/25, the document indicated .Concerns: NOC (Night Shift) CNA are responding to call light with attitude when responding to a 30-to-40-minute wait on call light. CNA tells resident to quit messing with the call light . Residents wants more help and staff on floor at PM and NOC shifts to help with call lights . During a review of the facility's Resident Council Minutes, dated 4/25/25, the document indicated .Concerns: CNA at NOC/PM shift takes too long to respond. One night [resident] had to wait 4 hours for a CNA to respond to call light. CNA stated she was busy. CNAs still has attitude when responding to call light. There is no improvement on call lights Residents would like floor staff to be retrained (for the new hires). Residents feel that new floor staff don't know what they are doing. New CNA on the floor needs more training on how to assist a patient and to know how to change patients Wait 30 minutes on call light on PM shift from 3p.m. to 11p.m Call light takes too long to respond to . During the assigned facility task Resident Council dated 5/15/25 at 10:03 a.m. in the facility's dining room, there were concerns of staff not responding to the call light in a timely manner. Resident 14 stated there was no dignity and respect all the time. Resident 14 stated CNAs, especially the new CNAs, have attitude. Resident 14 stated she was given attitude when she told the CNAs regarding Resident 7's care because Resident 7 is unable to talk. Resident 14 stated the facility tells her complaints will be addressed, but complaints are not addressed. Resident 14 stated They always tell me; everything will be alright. It makes me feel like I am nothing. Resident 14 stated it shouldn't take 30-40 minutes to answer the call light. Resident 14 stated this happens on a regular basis, on the PM and NOC shift. Resident 14 stated she had used the bathroom and had dried stool all up her back and it took a CNA 4.5 hours to respond to her call light. Resident 14 stated she addressed it with the LNs, DSD and DON. Resident 14 stated DSD and DON took a report and there was no feedback. Resident 14 stated I am concerned about the call lights. During an interview on 5/20/25 at 1:39 p.m. with Licensed Vocational Nurse (LVN) 7, LVN 7 stated the call light policy states call lights should be answered within 15 mins . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 41 of 51 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 05/20/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 5/20/25 at 1:43 p.m. with Certified Nursing Assistant (CNA) 5, CNA 5 stated sometimes there were not enough CNAs on PM shifts. CNA 5 stated, sometimes CNAs were unable to get to all the residents. During a concurrent interview and record review on 5/20/25 at 1 :37p.m. with the Director of Staff Development (DSD), the call light policy was reviewed. The DSD stated the expectation was for CNAs to check residents who were unable to call for assistance every 2 hours or as needed. The DSD stated the expectation from staff was that the call lights should be answered within 7 minutes. The DSD stated the expectations were not met. The DSD stated the P&P indicated .Answer immediately, .within 5 minutes. The DSD stated the policy was not followed. During a concurrent interview and record review on 5/20/25 at 3:11 p.m. with the Director of Staff Development (DSD), the resident council minutes for the months of January 2025 - April 2025 were reviewed. The DSD validated there were lots of complaints about call lights from the resident council minutes. The DSD stated the minutes indicated call lights were not answered timely. The DSD confirmed been aware of the complaints. The DSD stated the complaints were not properly addressed by the facility; therefore, residents continue to complain. During a concurrent interview and record review on 5/20/25 at 3 :02 p.m. with the Director of Nursing (DON), the call light policy was reviewed. The DON stated the expectation were when residents turn on their call light, staff should respond and assess the needs of the residents and if unable to meet the needs, staff should refer to another department or discipline if needed. The DON stated staff should answer call light in a timely manner as soon as practically possible. The DON stated the policy was not followed. The DON stated it was important to follow the policy, so the patient gets timely responses to their needs. During a concurrent interview and record review on 5/20/25 at 3:28 p.m. with the Director of Nursing (DON), the resident council minutes for the months of January 2025 - April 2025 were reviewed. The DON stated a 4.5-hour response to the call light was not appropriate. The DON stated potential outcome of not responding to the call light would be that the residents' needs would not be acknowledged. The DON stated she was not aware of the incident of resident in own stool unattended to after initiating call light for 4.5 hours. The DON stated that a resident left unattended in own stool for 4.5 hours was not fair and was not right. During a concurrent interview and record review on 5/20/25 at 3:28 p.m. with the Administrator (ADM), the call light policy and the resident council minutes for the months of January 2025 - April 2025 were reviewed. The ADM stated the resident council minutes were reviewed with the activity's director after the resident council meetings. The ADM stated if there were issues in any department, something should be done about it. The ADM stated he was aware of the call light complaints. The ADM stated staff needed to be educated more on proper call light response time with more of a focus on the afternoon shift night shift. The ADM stated the call light policy was not followed. During a review of the facility's document titled, Job Description, Certified nursing assistant (CNA), dated 2/2024, the document indicated, . General purpose . to provide each of your assigned residents with routine daily nursing care and services in accordance with the resident's assessment and care plan . Essential Duties . create and maintain an atmosphere of warmth, personal interest and positive emphasis as well as a calm environment throughout the unit and shift, . ensure that residents who are unable to call for help are checked frequently, answer resident calls promptly, check residents routinely to ensure that their personal care needs are met, . cooperate with . other facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 42 of 51 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 05/20/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm personnel to ensure that nursing services can be adequately maintained to meet the needs of the residents, . assist residents with daily functions (dental and mouth care, bath functions, combing of hair, dressing and undressing as necessary), keep residents dry (change gown, clothing and linens, when it becomes wet or soiled), check each resident routinely to ensure that his/her personal care needs are being met in accordance with his/her wishes . Residents Affected - Some During a review of the facility's document titled, Job Description, LPN/LVN, dated 2/2024, the document indicated, . Directs the day-to-day functions of the nursing assistants in accordance with current rules regulations and guidelines ., ensure all nursing personnel assigned to you comply with written policies and procedures ., make daily rounds of your unit/ shift to ensure that nursing service personnel are performing their work assignments in accordance with acceptable nursing standards . ensure that personnel providing direct care to residents are providing such care in accordance with the resident care plans and wishes, ensure that residents who are unable to call for help are checked frequently . ensure that your assigned certified nursing assistants (CNAs) are aware of the residents care plan . During a review of the facility's document titled, Job Description, Registered Nurse (RN), dated 2/2024, the document indicated, . Ensure that all nursing service personnels are in compliance with their respective job descriptions ., ensure that a sufficient number of licensed practical and/ or registered nurses are available for your tour of duty to ensure that quality care is maintained, ensure that a sufficient number of certified nursing assistants are available for your tour of duty to ensure that routine nursing care is provided to meet the daily nursing care needs of each resident, . make daily rounds of nursing service department to ensure that all nursing service personnel are performing their work assignments in accordance with acceptable nursing standards, . visit residents on a daily basis in order to observe and evaluate each resident's physical and emotional status, . ensure that residents who are unable to call for help are checked frequently . During a review of Job Description: Director of Staff Development (DSD), dated 2/2024, the document indicated, .General Purpose . is responsible to plan and implement facility orientation, job skill training . for the nursing assistants as required by regulation. Work with the Director of Nursing and Administrator to ensure that the highest degree of quality care is maintained at all times . Essential Duties . plan and conduct meaningful in-service education programs according to requirements for nursing personnel and all facility staff to assure competency in and new skills and as directed by administrator. Make rounds and observe delivery of patient care . During a review of Job Description: Director of Nursing (DON), dated 2/2024, the document indicated, .General Purpose . oversees and supervises the care of all residents . Essential Duties . Develop and implement nursing policies and procedures and ensure compliance. Responsible for ensuring resident safety and that all residents are treated with utmost respect Work closely with all other departments to ensure excellent overall resident care . coordinate MDS and care planning . During a review of the facility's policy and procedure titled, Answering the Call Light, dated 09/2022, indicated, .Policy Statement- The purpose of this procedure is to ensure timely responses to the resident's requests and needs . Steps in the procedure 1. Answer the resident call system immediately .a. If the resident needs assistance, indicate the approximate time it will take for you to respond. b. if the resident's request requires another staff member, notify the individual. c. if the resident's request is something you can fulfill, complete the task within five minutes if possible. d. If you are uncertain as to whether or not a request can be fulfilled, or if you cannot fulfill the resident's request, ask the nurse supervisor for assistance.2. if assistance is needed when you (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 43 of 51 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 05/20/2025 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)

F 0725 enter the room, summon help by using the call signal . Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure titled, Resident Rights, dated 2/2021, indicated, .Policy Statement- Employees shall treat all residents with kindness, respect, and dignity. Policy Interpretation and Implementation: 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's rights to: a. a dignified existence. b. be treated with respect, kindness and dignity. c. be free from abuse neglect misappropriation of property and exploitation . u. Voice grievances to the facility or other agency that hears grievances without discrimination or reprisal and without fear of discrimination or reprisal. v. Have the facility[TRUNCATED] Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 44 of 51 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 05/20/2025 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to follow the facility's Policy and Procedure (P&P) Medication Storage when two of four sampled medication carts ((Cart 1 and Cart 2) were left unlocked and unattended by Licensed Nurses (LNs). These failures had the potential for residents, staff, and visitors to have unauthorized access to resident medications resulting in theft, overdose, and/or residents not having access to their medications. Findings: During a concurrent observation and interview, on 5/13/25 at 9:47 a.m. with Licensed Vocational Nurse (LVN) 8, in the hall near the nurse station, medication Cart 1 was observed unlocked and unattended. LVN 8 stated the unlocked medication cart was her cart and she should not have left the cart unlocked when she walked away to get supplies. LVN 8 stated a resident, staff member or visitor could have gotten into the medication cart and harmed themselves by taking unprescribed medication. During an interview on 5/13/25 at 10:30 a.m. with the Director of Nursing (DON), the DON stated, the medication carts should always be locked. DON stated it was the responsibility of the nurse that was assigned to the cart to make sure it was always locked. During an observation on 5/20/25 at 4:16 p.m., medication Cart 2 was observed left unattended and unlocked, with the medication keys attached to the medication cart. The nurse assigned to the cart was observed on the opposite side of the nurses' station counter, gathering juices, not keeping the medication cart in her line of vision. Assisstant Director of Nursing (ADON) was observed to approach the cart, remove the keys, lock the medication cart, and discreetly attempt to place the keys into heLVN 5's pocket. During an interview on 5/20/25 at 4:28 p.m. with LVN 5, LVN 5 stated the cart was not left unlocked, it was a pulse oximeter (a small, portable medical device that measures the oxygen saturation in the blood). LVN 5 acknowledged the ADON placed the medication keys in her pocket. LVN 5 stated she should not have lied, and it was important to keep medication cart locked for safety. During an interview on 5/20/25 at 4:31 p.m. with the ADON, at the nurses' station next to medication Cart 2. The ADON acknowledged the observation of her removing the keys from the unlocked medication cart (Caret 2), lock Cart 2 and placed the keys in LVN 5's pocket. The ADON stated LVN 5 should not have walked away from the medication cart with keys left in the lock of Cart 2 and out of her line of sight. The ADON stated the expectation of the nurses was to have the medication carts locked when unattended, to prevent unauthorized access. During a review of the facility's policy and procedure (P&P) titled, Storage of Medication dated 2019, indicated, .The facility stores all drugs and biological in a safely, securely and properly .only licensed nurses .are allowed access to medications. Medication rooms, carts, and medication supplies are locked or attended by people with authorized access . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 45 of 51 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 05/20/2025 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure food storage was stored under sanitary conditions in accordance with professional standards for food service safety when: Residents Affected - Many 1. A large plastic container of rice was in the dry storage pantry without a label and did not have an opened date or an expiration date. 2. Freezer 1 of 2 was observed without an internal thermometer. Refrigerator 1 of 3 was observed without an internal thermometer (a tool used to measure how hot or cold something is). These failures had the potential to contribute to the growth of foodborne pathogens (a tiny organism, like a germ, that could cause disease. Pathogens included things like bacteria, viruses and fungi) and posed a risk of foodborne illness (any illness resulting from eating contaminated/spoiled foods) symptoms which could range from nausea, vomiting, diarrhea, abdominal pain, fever, headache, and confusion to residents who received meals and nourishment from the facility's kitchen. Findings: 1. During a concurrent interview and observation on 5/13/25 at 8:22 a.m. with the Certified Dietary Manager (CDM), in the dry storage pantry, a large clear plastic container of rice had no label, open date or expiration date. The CDM stated, her expectation is that all food in the dry storage should be labeled with what the food item was, the open date and expiration date to prevent residents from receiving old or expired food. During an interview on 5/16/25 at 3:15 p.m. with the Registered Dietitian (RD), the RD stated, all foods in pantry need to label with name of food, open date and expiration date. The RD stated, if the food is not labeled correctly, it increases the risk of residents being served expired food or food, they may have an allergy to resulting in food born illness and possibly death. 2. During a concurrent interview and observation on 5/13/25 at 8:39 a.m. with the CDM in the kitchen , one of two freezers did not have an internal thermometer. The CDM stated, a thermometer was required inside of every freezer. The CDM stated the temperatures were to be taken every morning and documented in a temperature log book to prevent food from going into the Danger Zone (temperatures above 41 degrees Fahrenheit (F - unit of measure) and below 32 degrees F for cold storage. Food that goes into the Danger Zone could spoil, and bacterial growth could begin and expose residents to food borne illness). During a concurrent observation and interview on 5/13/25 at 8:41 a.m. with the CDM in the kitchen, one of three refrigerators did not have an internal thermometer . The CDM stated the refrigerator should have had an internal thermometer to monitor the temperature inside the refrigerator to ensure food is being kept at a temperature to prevent bacterial growth and resident food born illness. During an interview on 5/16/25 at 3:18 p.m. with the RD, the RD stated, every refrigerator and freezer need to have a working internal thermometer that was to be monitored to prevent food from being out of safe food storage temperatures . The RD statd the refrigerator needed to be maintained between 34- to 39-degrees F, and the freezer needs to be maintained below these temperatures, if not the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 46 of 51 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 05/20/2025 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)

F 0812 food will lose freshness and will not be safe, resulting in possible food born illness for the residents. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure (P&P), titled Food Preparation and Service, dated 11/2022, indicated, . Food and nutrition services employees prepare, distribute, and serve food in a manner that complies with safe food handling practices . thermometers need to be kept clean and calibrated to ensure food safety and to prevent food born illness . Residents Affected - Many During a review of California Code of Regulations, Title 22 - Social Security Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies, Chapter 8.5 - Intermediate Care Facilities/Developmentally Disabled-Habilitative Article 3 - Services Section 76888 - Food and Nutrition Services-Food Storage, Universal Citation: 22 CA Code of Regs 76888 dated December 27, 2024, indicated, . All readily perishable foods or beverages shall be maintained at temperatures of 7°C (45°F) or below, or at 60°C (140°F) or above, always, except during necessary periods of preparation and service. Frozen foods shall be always stored at minus 18°C (0°F) or below. There shall be an accurate thermometer in each refrigerator and freezer and in any other storage space used for perishable food . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 47 of 51 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 05/20/2025 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. During a review of Resident 193's admission record (AR), dated 5/20/25, indicated the resident was admitted to the facility on [DATE] with the following diagnosis: Myelodysplastic Syndrome (a group of blood disorders where the bone marrow, responsible for making blood cells, doesn't function properly), leukemia (a type of blood cancer). Residents Affected - Some During a concurrent observation and interview on 5/13/25 at 12:15 p.m. with the REC in the hall outside of Resident 193's room. The REC put on a yellow paper gown and purple gloves and took the lunch tray into Resident 193's room. Resident 193 had a sign outside of her door instructing staff and visitors to put on gloves, mask and gown prior to going into the resident's room. The REC stated that he would have put on a face mask but there were not any face masks in the personal protection equipment (PPE - equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses), bin outside of the resident's room. The REC stated he should have looked for a mask before he entered Resident 193's room. The REC stated, he could have exposed Resident 193 to infections. During an interview on 5/16/25 at 3:42 p.m. with the IP, the IP stated it was her responsibility to check the PPE bins and make sure they are stocked but all staff have access to masks, gloves, and gowns. IP stated her expectation for the REC would have been to go to the supply closet and get more masks or inform her so that she could get another box of masks for the PPE bin. The IP stated the REC should not have gone into Resident 193's room without a mask. IP stated the REC could transmit germs to Resident 193 and cause her to become ill. During an interview on 5/20/25 at 10:20 a.m. with the DON, the DON stated her expectation was for the REC to obtain and wear a face mask prior to going into Resident 193's room. The DON stated Resident 193 was vulnerable and staff not following the rules could put her life at risk. 4. During a concurrent observation and interview on 5/13/25 at 12:15 p.m. with CNA 1, in the hallway outside of the large dining room, a standing lift (is used to transfer residents) was placed against the wall. The standing lift had a white filmy residue, and powdery substance left on the black cushioned pads and on the bottom standing tray of the lift. CNA 1 stated that the lift was not clean, and it should have been cleaned prior to being placed in the hallway. CNA 1 stated the lift could have been contaminated with infectious matter and could spread infection to other residents in the facility. During an interview on 5/16/25 at 3:30 p.m. with the IP, the IP stated it was her expectation for the staff to clean the lift after each use. IP stated the lift has a lot of contact areas and infection could be easily transmitted from resident to resident. During a review of the facility's policy and procedure (P&P), titled Cleaning and Disinfecting Non-Critical Resident Care Items dated 6/2021, indicated, . noncritical care items are those that come into contact with skin but not mucous membranes . reusable items are cleaned and disinfected or sterilized between residents . Based on observation, interview and record review, the facility failed to maintain a clean and sanitary environment for four of 25 sampled residents ( Resident 27, 41, 76, and 193 ) when: 1. Resident 41's urinary catheter bag (a bag attached to a urinary catheter, which is a thin tube (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 48 of 51 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 05/20/2025 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm inserted into the bladder to drain urine when someone can't urinate normally) and urinary catheter tubing (a thin, flexible tube inserted into the bladder to drain urine) was observed to be on the floor. This failure placed Resident 41 at risk for cross-contamination ( the unintentional transfer of harmful substances from one person, object, or place to another) which could result in infections and illness. Residents Affected - Some 2. LVN 5 did not perform hand hygiene before she went into Resident 27 and 76's room and completed a fingerstick (a finger prick, a way to get a small blood sample from your fingertip) to check their glucose (sugar) levels. This failure placed Residents 27 and 76 at risk of cross-contamination, which could result in infections and illness. 3. The facility failed to follow neutropenic precautions (wearing a face mask, gown, and gloves, when in the room with resident to protect the resident from getting sick because their body's defense against germs is weaker than usual), when Resident 193 was on neutropenic precautions and the Receptionist (REC), went in to Resident 193's room and served a lunch tray without wearing a face mask. This failure had the potential to expose Resident 193 to bacterial and or viral pathogens (a tiny germ that can make you sick), which could lead to illness or death. 4. The facility failed to follow their policy and procedure (P&P), for Cleaning and Disinfecting Non- Critical Resident-Care Items when a standing lift (a device that helps people who can't stand up on their own get from a seated position to a standing position), was left with powder and other visible residue on the lift. This failure had the potential to spread skin infection or other contact infections to other residents in the facility Findings: 1. During an observation on 5/13/25 at 8:29 a.m., in Resident 41's room, Resident 41 was asleep in bed and his urinary catheter bag was on the ground. During a concurrent observation and interview on 5/13/25 at 1 p.m., with Certified Nursing Assistant (CNA) 6, in Resident 41's room, Resident 41 was in his wheelchair and had his urinary catheter tubing touching the floor. CNA 6 stated the catheter tubing should not have been on the ground. During a review of Resident 41's admission Record (AR-a summary of important information regarding a patient which include patient identification, past medical history, insurance status, care providers, family contact information and other pertinent information), dated 5/20/25, the admission Record indicated, Resident 41 was admitted to the facility on [DATE] with a diagnosis of generalized muscle weakness, overactive bladder (a condition characterized by a sudden, strong urge to urinate, often accompanied by frequent urination and, in some cases, urinary incontinence [loss of bladder control]), obstructive and reflux uropathy (a blockage in the urinary system, preventing urine from flowing properly) and urinary tract infection (an infection of the urinary system, which includes the kidneys, ureters, bladder, and urethra). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 49 of 51 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 05/20/2025 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 41's Minimum Data Set (MDS - a resident assessment tool used to identify resident cognitive and physical function) assessment, dated 4/29/25, the MDS assessment indicated Resident 41's Brief Interview for Mental Status (BIMS -assessment of cognitive status for memory and judgment) assessment score was 00 out of 15 (a score of 13-15 indicates cognitively intact (a person is able to think clearly, remember things well, and make sound decisions, essentially having normal brain function with no significant problems with thinking, learning, or reasoning abilities), 08-12 indicates moderately impaired, and 00-07 indicates severe impairment). The BIMS assessment indicated Resident 41 was severely impaired. During a review of Resident 41's Physician Order Summary (POS), dated 4/25/25, the POS indicated, . Order date: 4/25/25 . Communication Method: Phone Order Summary: Indwelling urinary (foley) catheter is in privacy bag and catheter leg strap on at all times During an interview on 5/16/25 at 10:34 a.m., with the Infection Preventionist ( IP- specialists who work to make sure healthcare facilities are safe and free from infections), the IP stated a catheter bag and tubing should never touch the ground because the ground was dirty and carries bacteria. The IP stated the urinary catheter bag and tubing issues put Resident 41 at risk for an infection due to cross-contamination of that bacteria. The IP stated an infection could lead to sepsis (a person's extreme and potentially life-threatening response to an infection) and a hospitalization for Resident 41. The IP stated the facility did not follow the policy and procedure Catheter Care, Urinary. During an interview on 5/16/25 at 11:25 a.m., with CNA 6, CNA 6 stated the catheter tubing was contaminated and it should not have been on the ground. CNA 6 stated this issue would have made the Resident 41 more prone to infection. CNA 6 stated the catheter bag should have been on the side of the bed, off the ground and not on the floor. During an interview on 5/16/25 at 2:05 p.m., with Licensed Vocational Nurse (LVN) 8, LVN 8 stated Resident 41's catheter bag and tubing should not have been on the ground and it was a safety issue. LVN 8 stated bacteria could get on the catheter and could have caused an infection for the Resident 41. LVN 8 stated an infection with Resident 41 could lead to hospitalization. During an interview on 5/20/25 at 1:19 p.m., with the Director of Nursing (DON), the DON stated the expectation would be for the urinary catheter bag and tubing to not have been on the floor. The DON stated this put Resident 41 at risk for infection control issues and cross-contamination of bacteria could have occurred. The DON stated the facility did not follow the policy and procedure Catheter Care, Urinary. During a review of the facility's policy and procedure (P&P) titled Catheter Care, Urinary, dated 9/2014, the P&P indicated, .Purpose: the purpose of this procedure is to prevent catheter associated urinary tract infections . Infection Control: be sure the catheter tubing and drainage bag are kept off the floor . 2. During an observation on 5/15/25 at 11:27 a.m., in Resident 76's room, LVN 5 did not perform hand hygiene before she completed a fingerstick to check Resident 76's glucose level. During an observation on 5/15/25 at 11:40 a.m., in Resident 27's room, LVN 5 did not perform hand hygiene before she completed a fingerstick to check Resident 27's glucose level. During a review of Resident 76's AR, dated 5/20/25, the AR indicated, Resident 76 was admitted to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 50 of 51 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 05/20/2025 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the facility on [DATE] with a diagnosis of type 2 diabetes mellitus (a condition where a body doesn't make enough insulin [a natural hormone that turns food into energy and manages your blood sugar level] or doesn't use insulin well). During a review of Resident 76's MDS assessment, dated 4/14/25, the MDS assessment indicated Resident 76's BIMS assessment score was 12 out of 15. The BIMS assessment indicated Resident 76 was moderately impaired. During a review of Resident 27's admission Record dated 5/20/25, the admission Record indicated, Resident 27 was admitted to the facility on [DATE] with a diagnosis of type 2 diabetes mellitus. During a review of Resident 27's MDS assessment, dated 4/7/25, the MDS assessment indicated Resident 27's BIMS assessment score was 14 out of 15 The BIMS assessment indicated Resident 27 was cognitively intact. During an interview on 5/15/25 at 11:55 a.m., with LVN 5, LVN 5 stated she did not realize she had not completed hand hygiene before having touched both residents. LVN 5 stated she should have completed hand hygiene before she touched them but did not. LVN 5 stated she put the residents at an increased risk of infection by not doing appropriate hand hygiene. During an interview on 5/16/25 at 10:34 a.m., with the IP, the IP stated by not performing hand hygiene before touching a resident, cross-contamination of bacteria could occur. The IP stated the expectation would be to have performed hand hygiene before having touched a resident. The IP stated as a result of not performing hand hygiene, the residents could have acquired an infection. The IP stated the facility P&P Handwashing/Hand Hygiene was not followed. During an interview on 5/16/25 at 2:05 p.m., with LVN 8, LVN 8 stated appropriate hand hygiene was important to control risk of infections. LVN 8 stated if hand hygiene was not performed before touching a resident, it could have resulted in an infection and ultimately a hospitalization. During an interview on 5/20/25 at 1:54 p.m., with the DON, the DON stated hand hygiene should have been completed before touching a resident. The DON stated the lack of hand hygiene would cause infection control concerns. The DON stated there was potential for an infection that could manifest into an illness. The DON stated the facility P&P Handwashing/Hand Hygiene was not followed. During an interview on 5/20/25 at 4:01 p.m., with the Assistant Director of Nursing (ADON), the ADON stated hand hygiene should have been completed before the resident's received care. The ADON stated by not completing hand hygiene the residents could have been exposed to contamination that could have caused an infection. During a review of the facility's policy and procedure (P&P) titled Handwashing/Hand Hygiene dated 10/2023, the P&P indicated, .Policy Statement: this facility considers hand hygiene the primary means to prevent the spread of healthcare associated infections . Administrative Practices to Promote Hand Hygiene . all personnel are expected to adhere to hand hygiene policies and practices to help prevent the spread of infections to other personnel, residents, and visitors . Indications for Hand Hygiene: 1. Hand hygiene is indicated: a. Immediately before touching a resident . Applying and Removing Gloves: 1. Perform hand hygiene before applying non-sterile gloves . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056225 If continuation sheet Page 51 of 51