Health inspection·March 6, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) was administered medication as ordered by the physician. This failure resulted in Resident 1 not receiving her medication and the potential for adverse side effects. Residents Affected - Few Findings: During a review of Resident 1's Order Recap Report (ORR-physician order) dated 2/1/25-2/28/25, the ORR indicated, Rosuvastatin Calcium Tablet 20 mg (milligrams-unit of measurement) give 1 tablet by mouth at bedtime for hyperlipidemia (elevated fat in the blood) .start date 11/16/24. During a review of Resident 1's Medication Administration Record (MAR) dated 2/25, the MAR indicated, Rosuvastatin Calcium 20 mg give 1 tablet by mouth at bedtime. There was a 9 (indicating other/see nurse notes) documented on the MAR for 2/2, 2/6, 2/11-2/13, 2/19-2/21 and 2/27-2/28. During a review of Resident 1's Progress Notes (PN) dated 2/2/25, the PN indicated, Emar -Administration Note.Rosuvastatin Calcium.pending delivery. During a review of Resident 1's PN dated 2/6/25, the PN indicated, Emar -Administration Note.Rosuvastatin Calcium.not available, pending delivery. During a review of Resident 1's (PN dated 2/11/25, the PN indicated, Emar -Administration Note.Rosuvastatin Calcium.on order. During a review of Resident 1's PN dated 2/12/25, the PN indicated, Emar -Administration Note.Rosuvastatin Calcium.pending delivery. During a review of Resident 1's PN dated 2/13/25, the PN indicated, Emar -Administration Note.Rosuvastatin Calcium.Not available, pending delivery. During a review of Resident 1's PN dated 2/19/25, the PN indicated, Emar -Administration Note.Rosuvastatin Calcium.pending delivery. During a review of Resident 1's PN dated 2/20/25 and 2/21/25, the PN indicated, Emar -Administration Note.Rosuvastatin Calcium.Not available, pending delivery. During a review of Resident 1's PN dated 2/27/25 and 2/28/25, the PN indicated, Emar -Administration Note.Rosuvastatin Calcium.Pending delivery. (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: 056261 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 056261 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orchards at Tulare 604 E. Merritt Ave. Tulare, CA 93274 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)