Inspection·November 19, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 follow professional standards of practice for food service safety and sanitary conditions, for one of one ice machine, when the facility did not implement Manufacturer's Limited 3 Year Parts And Labor Warranty (MW) and Air- and Water-Cooled User Manual Cleaning, Sanitation and Maintenance (AWM) and the exterior of the ice machine had white, black and green substance. This failure had the potential for the growth of microorganisms which could increase the risk of foodborne illness for all the residents at the facility.Findings:During a concurrent observation and interview with the Certified Dietary Manager (CDM) on 11/19/2025 at 11:20 a.m. in the kitchen, the ice machine was noted to have some white, black and green substance on the exterior side of the ice machine. The CDM confirmed the presence of the white and green substance on the ice machine. The CDM stated the white substance was calcium buildup. The CDM stated she was unable to confirm what the green substance was. The CDM stated the Maintenance Director (MTD) would be able to explain in more detail what the green substance was.During a concurrent observation and interview with the MTD and CDM on 11/19/2025 at 11:28 a.m. in the kitchen, the ice machine was observed to have some white, black and green substance on the exterior side of the ice machine. The MTD confirmed the presence of the substances. The surveyor wiped the green substance on the side of the ice machine with a clean white paper towel, and a brownish green substance was seen on the paper towel. The MTD ran his finger along the side of the ice machine that had the black substance and had a small quantity of the substance on his finger. The MTD acknowledged the substances and stated it was almost time for his monthly cleaning. The MTD stated the black substance was condensation from the ice machine. The MTD stated the green substance was buildup of water. The MTD stated his main objective was to clean the inside of the machine. The MTD stated he cleaned the inside of the ice machine but did not clean the outside of the ice machine. The CDM stated the front of the machine was the area that was cleaned by the dietary staff. The CDM stated dietary staff always wiped down the front panel/dispensing area only. The CDM stated she thought maintenance did monthly cleaning and they cleaned the whole machine.During an interview with the Dietary Aide (DTA) 1 on 11/19/2025 at 11:40 a.m. in the CDM's office, DTA 1 stated the dietary staff cleaned the front of ice machine every day. DTA 1 stated it was the responsibility of maintenance department to clean the ice machine.During an interview with DTA 2 on 11/19/2025 at 11:54 a.m. in the CDM's office, DTA 2 stated he was unsure how often the ice machine was cleaned. DTA 2 stated a maintenance staff was responsible for cleaning the kitchen floor but was not sure if the maintenance staff was responsible for cleaning the ice machine. DTA 2 stated dietary staff did not know where the cleaning log was because they did not have access to that document.During an interview with DTA 3 on 11/19/2025 at 12:18 p.m. in the CDM's office, DTA 3 stated cleaning the ice machine was a daily responsibility assigned to the aides. DTA3 stated dietary staff were unaware of where the cleaning log was. During an interview with the CDM on 11/19/2025 at 12:40 p.m. in the CDM's (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 056225 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 056225 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 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)