Health inspection·April 21, 2021

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview and record review, the facility failed to provide a homelike environment for twenty-two (22) of forty-three (43) residents (Residents 1, 2, 4, 5, 6, 10, 13, 14, 16, 17, 20, 21, 23, 24, 25, 28, 31, 32, 35, 36, 40, and 41) when meals were served in the dining room on gray, institutional-like, plastic trays. This failure resulted in a violation of the residents' right to a homelike environment. Findings: During an observation on 4/12/21, at 11:56 a.m., in the Founder's dining room, Residents 1, 2, 4, 5, 6, 10, 13, 14, 16, 17, 20, 21, 23, 24, 25, 28, 31, 32, 35, 36, 40, and 41, were served their lunch on gray, institutional-like, plastic trays. The staff left the trays in front of the residents for the entire meal service. During an interview on 4/12/21 at 12:26 p.m., with Certified Nursing Assistant (CNA) 6, CNA 6 stated the facility used to take the food off the trays. CNA 6 confirmed Residents 1, 2, 4, 5, 6, 10, 13, 14, 16, 17, 20, 21, 23, 24, 25, 28, 31, 32, 35, 36, 40, and 41, were served their food on gray plastic trays. CNA 6 stated the residents' food had been served on the gray plastic trays since the communal dining had reopened about a month ago. CNA 6 stated she did not remember when the last training for resident dining was. CNA 6 stated she thought her last resident dining in-service training was at orientation four (4) years ago. During an interview on 4/12/21 at 3:40 p.m., with the Director of Nurses (DON), the DON stated the Founder's dining room accommodated mostly independent residents, who needed very little assistance. The DON stated the facility had been leaving the food on the trays for now, but it will go back to normal soon. The DON stated communal dining had opened about a month ago. The DON stated the facility would return to taking the food off the trays. The DON stated the previous Infection Preventionist (IP) and the new IP had made the plan to return to communal dining and had referenced the All Facilities Letter after the pandemic. The DON stated the staff were not trained to take the food off the trays when in-serviced on communal dining. The DON stated the new communal dining plan was not in writing. The DON stated the facility did not have a policy for communal dining. During an interview on 4/12/21 at 3:45 p.m., with the Administrator (ADM), the ADM stated the facility used to take the food off of the trays. The ADM stated the facility had not discussed taking the food off of the trays when the plan was made. The ADM stated, The facility had not gotten around to it [taking food off trays] yet. The ADM stated the facility did not have a written plan, or policy and procedure for communal dining. During a concurrent interview and record review, on 4/12/21 at 4:18 p.m., with the Director of Staff Development (DSD), the facility training document titled, In-service Meeting Minutes dated 3/11/21 was reviewed. The facility training document indicated thirteen (13) staff were trained on reopening the dining rooms. The document indicated staff were to sanitize the tables prior to the meal service, ensure social distancing, wear masks, and perform hand hygiene when serving meals in the dining room. The training had not included removing food from trays. During an interview, on 4/14/21 at 11:49 a.m., with CNA 15, CNA 15 stated the facility had started (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 2 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0584 Level of Harm - Minimal harm or potential for actual harm communal dining about two (2) months ago. CNA 15 stated the meals were left on the gray plastic trays the whole meal. CNA 15 stated she had attended the staff training in March 2021 for communal dining. CNA 15 stated the training had not included taking the food off the trays to make it more homelike. CNA 15 stated they had always left the food on the gray plastic trays. CNA 15 stated she did not know why the food was left on trays when served. CNA 15 stated dining would be more pleasant if the food was taken off the trays. Residents Affected - Some During an interview, on 4/15/21 at 10:24 a.m., with the Social Services Director/Rehabilitative Nurse Aid (SS/RNA), the SS/RNA acknowledged the meals in the Founder's dining room were served on gray plastic trays. The SS/RNA stated the facility used to take the food off the trays. The SS/RNA stated the facility had gotten used to serving food on trays for the past year. The SS/RNA stated the IP and DSD had made the plan to open communal dining. The SS/RNA stated the IP and DSD had not gone into details with the dining plan. The SS/RNA stated there was no plan in writing or policy on communal dining. The SS/RNA stated the facility should have taken the food off the gray plastic trays. The SS/RNA stated the food should be taken off the plastic trays to promote residents' dignity. During an interview, on 4/16/21 at 9:11 a.m., with Resident 32, Resident 32 stated the food served on plastic trays was not homelike. Resident 32 stated she had thought the facility had to serve the food on plastic trays. A request was made for the facility's policy and procedure for communal dining from the DON, DSD, SS/RNA, and ADM. The facility failed to provide a policy and procedure prior to the exit of the survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 3 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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. Based on observation, interview and record review, the facility failed to ensure a comprehensive, person-centered care plan (a plan that provides direction for individualized care of the resident) was developed and implemented to meet the identified needs of the residents when four of eight residents (Residents 7, 19, 22 and 142) did not have a care plan for their Rehabilitative Nursing Assistant (RNA helps residents gain/improve strength and mobility) program. These failures had the potential to result in Residents 7, 19, 22 and 142's rehabilitative needs to go unmet. Findings: During a review of Resident 7's Physician Order, undated, the Physician Order indicated, .RNA program 5weeks for LT (left) upper arm AAROM (active assisted range of motion) and Rt (right) upper AROM (active range of motion) EX (exercise) . There was no care plan found for the RNA program that was ordered on 2/11/21. During a review of Resident 19's Physician Order, undated, the Physician Order indicated, RNA Program. There was no care plan found for the RNA Program ordered 2/5/21. During a review of Resident 22's Physician Order, undated, the Physician Order indicated, RNA Program. There was no care plan found for the RNA Program ordered 2/24/21. During a review of Resident 142's Physician Order, undated, the Physician Order indicated, RNA Program. There was no care plan found for the RNA Program ordered 4/9/21. During a concurrent interview and record review on 4/16/21, at 11:15 a.m., with the Rehabilitative Nursing Assistant (RNA) Director, the RNA Director reviewed the facility list of residents who currently have orders for RNA and stated there are 24 residents working with RNA. The RNA Director stated all residents who have an order for RNA should have a care plan. The RNA Director stated a care plan was necessary to direct the needs and care of residents and it was a physician's order. The RNA Director stated the interdisciplinary team (IDT- team of healthcare professionals from different professional disciplines who work together to manage the physical, psychological, and spiritual needs of the resident) met weekly to discuss the care plans for each resident. The RNA Director stated she did not realize Residents 7, 19, 22 and 142 did not have a care plan for their RNA program. During a concurrent interview and record review on 4/21/21, at 8:29 a.m., with the Director of Nursing (DON), the DON stated it was the nurse's responsibility to do all care plans including RNA program order. The DON reviewed care plans for Residents 7, 19, 22 and 142. The DON stated Residents 7, 19, 22 and 142 did not have a care plan for their RNA program. The DON stated there should have been care plans for Residents 7, 19, 22 and 142. The DON stated care plan guide residents' specific needs and limitations. During a review of facility's policy and procedure (P&P) titled, Resident Care Plans, undated, the P&P indicated .The Resident care plan is started on admission of the resident .It will indicate care to be given, goals to be accomplished, methods, approaches and modification necessary to achieve best results for the resident . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 4 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 necessary care and services to ensure activities of daily living (skills required to manage one's basic physical needs including personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating) were maintained for one of eight sampled residents (Resident 142), when Restorative Nurse Assistant (RNA - helps residents gain/improve strength and mobility) exercises were not provided per the physician's order. Residents Affected - Few This failure had the potential for Resident 142 to decline in her ability to carry out activities of daily living (ADLs), strength and mobility. Findings: During a review of Resident 142's Physician Orders dated 4/1/21 through 4/30/21, the Physician Orders indicated Resident 142 had an order for RNA program on 4/9/21. During a concurrent interview and record review on 4/16/21, at 11:22 a.m., with the RNA Director, the RNA Director stated Resident 142 was admitted to the facility on [DATE], and had an order for RNA program. The RNA Director stated she did not find a record indicating Resident 142 was assessed and evaluated for RNA program. The RNA Director stated Resident 142 should had been assessed and evaluated right away for the RNA program. The RNA Director stated she did not find documentation that indicated the RNA worked with Resident 142. The RNA Director stated RNA should have worked with Resident 142 to prevent decline in her activities of daily life (ADL). During an interview on 4/9/21, at 7:09 a.m., with Certified Nursing Assistant (CNA) 2, CNA 2 stated Resident 142 was in the yellow zone (area for residents who have been exposed or residents with unknown exposure to a virus) and he was responsible to provide RNA exercises to Resident 142. CNA 2 stated he did not remember when he started working with Resident 142. CNA 2 stated he did not have a written guide on the type of exercises he was working with for Resident 142. CNA 2 stated, The guide is in my head. CNA 2 stated he did not chart he provided RNA exercises to Resident 142. CNA 2 stated the practice is to chart every day. CNA 2 stated the RNA program was important to prevent decline of ADL's. During an interview on 4/21/21, at 11:12 a.m., with the Director of Nursing (DON), the DON stated the primary doctor ordered the RNA program for Resident 142 to improve strength and prevent decline of ADL's. The DON stated Resident 142 was in the yellow zone because she was admitted from the hospital. The DON stated the CNAs in the yellow zone were trained to provide RNA exercises to residents. The DON stated the RNA should have worked with Resident 142. During a review of the facility's policy and procedure (P&P) titled, Policy and Procedure Restorative Nursing, undated, the P&P indicated, . Services provided is twice daily, seven days a week . Our philosophy is motivation, to encourage our residents to want to do more for themselves, have strength to transfer, ambulate, feed themselves, advance in ADL care, and promoting self-esteem . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 5 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure one of two sampled residents (Resident 27), received proper hearing treatment/hearing assistive device when Resident 27 was not assisted with making an appointment for a hearing consult when the hearing aid did not function properly for three months. Residents Affected - Few This failure resulted in Resident 27's hearing needs to be unmet. Findings: During an interview on 4/20/21, at 1:57 p.m., with Licensed Nurse (LN) 2, LN 2 stated Resident 27 had difficulty of hearing. LN 2 stated Resident 27 notified Social Services (SS) he cannot hear even with his hearing aid on. LN 2 stated Resident 27 had not worn his hearing aid. During an interview on 4/20/21, at 2:04 p.m., with SS, SS stated Resident 27 wanted his hearing aid remove because he heard less with his hearing aid on. SS stated Resident 27's hearing was getting worst. SS stated Resident 27's hearing aid had not been functioned properly for three months and the hearing aid was kept in her office because Resident 27 had lost his hearing aid before. During an observation on 4/20/21, at 2:12 p.m., Resident 27 was inside his room with LN 2. Resident 27 had to lean forward and placed his ear near to LN 2's mouth in order to hear what LN 2 said. Resident 27 stated to LN 2 You have to talk louder so I can hear you. During a concurrent interview and record review on 4/20/21, at 2:19 p.m., with LN 2, LN 2 stated she had to speak louder to Resident 27, and Resident 27 had to lean forward to hear what she said. Resident 27's Plan of Care, dated 2020 was reviewed. The Plan of Care indicated, .[Resident 27] suffers from communication deficit (inability to initiate and sustain appropriate conversation and use of inappropriate, repetitive language) as manifested by highly impaired hearing .assist with hearing aids . LN 2 stated Resident 27 should be wearing his hearing aid, and the hearing aid should have been fix a long time ago. During an observation on 4/20/21, at 2:22 p.m., LN 2 asked Resident 27 how he felt with his hearing aid not functioning properly. Resident 27 stated It has been a year, I have issues with hearing. During an interview on 4/20/21, at 2:51 p.m., with SS, SS stated she should have arranged a hearing appointment sooner, and she was not aware she had to make an Eyes Ears Nose Throat (EENT- a physician specialized in ears eyes nose and throat) referral. SS stated the hearing aid was important for Resident 27 to be able to hear and be aware of his surroundings. During an interview on 4/21/21, at 8:28 a.m., with the Director of Nursing (DON), the DON stated Resident 27 should have had his hearing appointment as soon as possible to help Resident 27 with his hearing problem. During a review of Resident 27's Record of admission (a one-page summary of important information of a patient), dated 9/11/20, the Record of admission indicated, Resident 27 was admitted in the facility with diagnoses of unspecified Hearing Loss. During a review of the facility's policy and procedure (P&P) titled, Vision, Hearing, and Dental (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 6 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0685 Level of Harm - Minimal harm or potential for actual harm Services, undated, the P&P indicated, .The Social Services assist with tracking vision, hearing, and dental needs of residents and in making appointments to follow-up with such needs . Hearing evaluations and appointments are made on an as needed basis . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 7 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to administer parenteral fluids (Parenteral fluids administered by injection through the tissue and circulatory system) in accordance with professional standards of practice for one of 15 sampled residents (Resident 32), when Resident 32 was admitted to the facility on [DATE] with a peripherally inserted central catheter (PICC, tube that is inserted into a vein in the upper arm to the heart) for the purposes of administering intravenous (IV - through the vein) antibiotics. The facility did not have an approved policy and procedure that followed the standards of practice to instruct and guide nurses on the care of the PICC line. Four of four Registered Nurses (RN) were not trained and did not follow the standards of practice in the care of the PICC line nor the administration of the IV antibiotics. Residents Affected - Few These failures had the potential to cause Resident 32 to experience adverse outcomes such as life threatening blood infection and cellulitis (skin infection that happens when bacteria spread through the skin to the deepest tissue)due to nursing staff not having the knowledge, training, and competency to safely care for Resident 32's PICC line and administer her IV antibiotics. Because of the serious potential harm to Resident 32 who received IV antibiotic therapy through a PICC line from Nursing staff who did not follow the professional standards of practice, nor have the training or competencies to perform PICC line care and medication administration per PICC line, an Immediate Jeopardy (IJ) situation (a situation that involves immediate action to remove the threat of harm or potential harm) was called on 4/15/21 at 4:43 p.m., under Code of Federal Regulations (CFR) 483.25 Parenteral Fluids (F694) with the facility Administrator (ADM), Director of Nurses (DON), the Infection Preventionist (IP - are professionals who make sure healthcare workers and residents are doing all the things they should to prevent infections), and Director of Staff Development (DSD). IJ template was provided to the ADM. The facility submitted an acceptable IJ Plan of Removal (POR) Version 3) on 4/19/21 at 6:50 a.m. The IJ POR included but was not limited to the following: 1) The IP , DSD, and DON were immediately trained by a primary Care Physician (PCP) on standards of care for PICC, 2) Policies and Procedures (P&P) based on current standards of practice for the care of residents with central lines were revised and updated, in serviced, and implemented, 3) Physician orders for medication administration, use of IV pump as ordered, and frequency and care of residents with central lines were followed, 4) Trained and competent RNs were assigned to care for the resident with central line each shift, 5) Licensed Vocational Nurses (LVN) were immediately reassigned to care for residents without central lines, and, 6) A process was developed to ensure that (future) resident needs are identified prior to admission and could be met by qualified and competent staff. The components of the IJ POR were validated onsite to be fully implemented through observations, interviews, and record review. The IJ was removed on 4/20/21 at 1:37 p.m. with the ADM, DON, IP and DSD. Findings: During a review of Resident 32's Record of Admission (document with resident demographic and medical diagnosis) undated, and the Minimum Data Set (MDS- a resident assessment tool used to identify a resident's cognitive and physical functional level) assessment dated [DATE], indicated Resident 32 was a [AGE] year old female who was admitted to the facility on [DATE] from a general acute care hospital (GACH) with diagnosis of osteomyelitis (severe infection in the bone), epidural abscess (an infection that forms in the space between the skull bones and the brain lining), atrial fibrillation (irregular heartbeat), and hypertension (high blood pressure). Resident 32's MDS - Brief Interview for Mental Status (BIMS) score was 13, which indicated Resident 32 had intact memory and judgement and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 8 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0694 had no cognitive deficits. Level of Harm - Immediate jeopardy to resident health or safety During a review of Resident 32's Discharge Documentation dated 3/19/21 at 3:36 p.m., from the GACH, indicated . In summary this is a patient admitted for progressive neck pain found to have imaging evidence of osteomyelitis and discitis (inflammation of spinal disc, rubbery pads between the vertebrae, the specialized bones that make up the spinal columns). Neurosurgery was consulted who recommended medical management. IR (Interventional Radiology - minimally-invasive image-guided procedures to diagnose and treat diseases) was consulted twice for bone biopsy (The removal of a sample of bone marrow and a small amount of bone through a large needle) but deemed too high risk to proceed. ID (Infectious Disease) was consulted for empiric (experience-based therapy) and recommended the therapy stated above x (every) 8 weeks. There was concern that this could be due to underlying malignancy .Patient discharged to SNF (Skilled Nursing Facility) with weekly labs . Neurosurgery recommended a hard collar (device used to limit neck movement and promote healing) when OOB (out of bed); patient to continue collar until cleared by neurosurgery. Lack of improvement in inflammatory markers (causes for swelling) and symptoms may suggest abx (antibiotic) failure vs (versus) alternative dx (diagnosis) such as malignancy. Residents Affected - Few During a review of Resident 32's Physician's Telephone Order (PTO) dated 3/19/21, indicated an order for PICC line site care weekly on Mondays AM (morning). Start date on 3/29/21 .RN only to provide PICC line site care . [The PICC line care PTO did not indicate the directions for dressing changes and site care]. During a review of Resident 32's PTO dated 3/28/21 indicated an order for Rocephin IVPB (Intravenous Piggy Back - a method of administering antibiotics with small volume of intravenous solution given intermittently by a trained nurse), 2 grams (g) = {equals} 50 milliliters (unit of measurement) daily until 5/19/21 for cervical spine abscess (pocket of pus in the neck and spinal tissues). During a review of Resident 32's Physician's Order (PO) dated 3/30/21, indicated an order for Saline/Heparin daily cervical neck abscess every 6 hours until May 20, 2021. During an observation and interview, on 4/14/21 at 10 a.m., with Resident 32, in her room, Resident 32 was alert, oriented, and responded when greeted, Resident 32 had a PICC line located on her right upper arm. Resident 32's PICC line port (entrance point to PICC line tube) did not have a port protector cap (an alcohol-filled cap to prevent infection). A green elastic pressure dressing (typically used after blood had been drawn from a vein) was in place on Resident's 32's right upper arm. When asked who changed the PICC line dressing, Resident 32 stated, The DON, IP, and DSD usually change the [PICC] dressing every Monday . but they changed the dressing last Wednesday (4/7/21). Resident 32 stated, I am just here for the IV antibiotic treatment. I do not want my PICC line to get infected. During an interview on 4/14/21 at 10:06 a.m., with the MDS Coordinator (a Registered Nurse responsible for the resident MDS assessments), the MDS Coordinator stated, the PICC line entry port should have a protector cap to prevent cross-contamination (the process by which bacteria and other micorogranisms are tranfered from one substance to another). The MDS Coordinator stated, We don't have the protector cap in stock and have to order them from the pharmacy. During a concurrent record review and interview regarding the lack of port protector cap on Resident 32's PICC entry port, on 4/14/21 at 11:57 a.m. with the IP, the P&P titled Guidelines for Preventing Intravenous Catheter-Related Infections, dated August 2014, indicated General Guidelines .Facility staff who manage infusion catheters will have training and demonstrated clinical competency in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 9 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0694 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few intravenous therapy including .indications for IV catheter use .proper procedures for the insertion and maintenance of IV catheters . appropriate infection control measures to prevent IV catheter-related infections. The IP stated he had no comment as to why there was no protector cap on Resident 32's PICC entry port. During an interview regarding Resident 32's PICC line care, on 4/14/21 at 4:01 p.m. with IP, the IP stated . The PICC line did not have a protector cap at the port entry . I did not put port protector caps because we don't have them nor use them. The IP stated Resident 32's PICC dressing change as ordered to be done on Mondays (4/5/21 and 4/12/21) were not done because the pharmacy had not delivered sterile gloves in his size (extra-large). The IP stated Resident 32's PICC line dressing was only changed on 4/7/21 by the DSD under his guidance. The IP stated he had not informed Resident 32's PCP that the PICC line dressing had not been changed. The IP stated, I was not aware I needed to notify the PCP. The IP stated he had not put the PICC Line dressing change on the Medication Administration Record (MAR) because he did not know how. The IP stated he documented the PICC line dressing change in the nursing notes. The IP was unable to provide a PICC Line dressing change nursing note since Resident 32's admission on [DATE]. The IP stated he did not measure the PICC line during dressing changes [to check for migration/movement]. The IP stated he used a black permanent marker on the skin near the PICC line insertion site to measure the catheter line. The IP stated the pen did not need to be sterile. The IP stated he had always done it that way. When asked what standard of practice the IP followed for PICC Line dressing changes, the IP stated he followed the instructions on the dressing packaging. A review of the PICC line dressing package provided by the IP indicated, Latex Free Dressing Change Kit. The IP validated the Dressing kit did not have instructions for changing a PICC line dressing. During an interview on 4/14/21 at 4:30 p.m., with the ADM, the ADM stated the DON decided to accept Resident 32 with a PICC line because she (DON) thought she could provide the PICC line care by herself. During a concurrent observation and interview on 04/14/21 at 5:01 p.m., with the DON and the IP outside of Resident 32's room, Resident 32 was seated at the edge of the bed with the green pressure dressing still covering the PICC line on Resident 32's right arm. When asked about the choice of dressing used, the IP entered Resident 32's room and prepared to don gloves. When asked what he intended to do, he stated in a loud tone of voice, What do you want me to do? If you want me to take off the pressure dressing, I will! The IP was requested to provide the standard of practice for IV PICC line care. After the IP exited the room, the DON entered the room and removed the pressure dressing from Resident 32's right upper arm. After the DON had the left the room, Resident 32 stated that her right arm hurt. Upon examination of Resident 32's right upper arm, two non-blanching, (when the redden skin is pressed it does not lose the red pigmentation) red lines were present. A crinkled off-white paper taped over the [transparent dressing] was dated 4/7/21. The tegaderm edges was lifted and loose and did not cover the entire PICC line site. The standard of practice for IV PICC line care was not provided as requested. During an observation and interview on 04/15/21 at 6:51 a.m. with the IP in Resident 32's room, the IP informed Resident 32 that he would be administering the IV antibiotics today. Resident 32 stated, The DON always hangs my morning medicine, she is the only one that has ever done it since I have been here. The IP donned non-sterile gloves and opened the brown plastic bag which had a pharmacy label (PL) dated 4/12/21 indicating the Physician's IV antibiotic order for Resident 32. The PL indicated, .Assemble [drug name] to NACL (a solution that contains 1:1 ration of sodium and chloride, as directed and immediately infuse 100 ml 2 (GM - unit of measure), over one hour IV via IV pump daily (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 10 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0694 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few until 5/19/2021 * Infuse contents entire bag . The IP took out a vial of Ceftriaxone (brand name for Rocephin) 2 grams for IV use Single-dose. The IP mixed the Ceftriaxone powder with the 50 ml bag of saline and prepared for infusion. The IP connected the tubing to the injection port but did not use the IV tubing regulator to ensure the right drops per minute was administered. Instead, the IP took his cell phone out of his pocket and counted the number of drops infusing per minute by using his cell phone as a timer. The IP stated, It should be 50 drops per minute . I was never trained on how to use this tubing. During calculation of rate per minute; for 50 ml to infuse in one hour, the drops to infuse would be 8.3 drops per minute. During a concurrent interview and record review, on 4/19/21, at 11:24 a.m., with the Director of Nurses (DON), Resident 32's Physician's Orders (PO's) dated 3/19/21, indicated the PICC Line dressing was to be changed weekly. The PO did not indicate type of dressing for the PICC Line or instructions on the procedure to change the dressing. The DON stated she needed to clarify the PO for the PICC Line dressing change. During an interview on 4/20/21 at 9:25 a.m., with the IP, the IP stated the facility had about eight (8) PICC Lines in four (4) years. The IP stated, .We [RN's] are rusty . The IP stated the RN's should have had training on PICC Line medication and care before admission of residents who needed this therapy. During an interview and record review, on 4/20/21 at 11:23 a.m., with the Director of Staff Development (DSD), the DSD confirmed the Licensed Nurse Competencies (Core abilities required for nursing procedures) training were not done in 2019, 2020, or 2021 for the three RN's employed at the facility (DSD, DON and MDS/RN). The DSD confirmed there were no Licensed Nurse Competencies done at orientation for the IP, who began about three month ago. The DSD stated RN competencies were supposed to be done at orientation and annually. The DSD stated she was responsible for RN competencies. The DSD stated she did not know who was responsible for the DON competencies. The DSD stated she thought the Administrator (ADM) would do the training for the DON, because she was the DON's boss. During an interview on 4/20/21 at 11:28 a.m., with the DON and the ADM, the DON, .We should assess the residents prior to admission to ensure we can provide care for them . I admit we are lacking on education . we do not get residents with PICC line all the time. The DON stated skills competencies for licensed nurses should be done annually. During an interview on 4/20/21 at 11:52 a.m., with the ADM, the ADM stated the DSD was responsible for ensuring the nursing competencies were done. The ADM stated the DSD was responsible for the DON's competency training. The ADM stated the facility did not have a way to track the nursing competencies. During a concurrent interview, and record review on 4/21/21 at 9:00 a.m., with the DON, the Licensed Nurse Competencies for 2019, 2020, and 2021 were reviewed for the four RN's currently employed at the facility. The DON confirmed there was no record of Licensed Nurse Competencies for the DON for 2019, 2020, or 2021. The DON confirmed there was no record of Licensed Nurse Competencies for the Minimum Data Set Coordinator (MDSC) (MDS) (a standardized assessment and care planning tool), for 2020 or 2021. The DON confirmed there were no Licensed Nurse Competencies for the Director of Staff Development (DSD) for 2019, 2020, or 2021. The DON confirmed the IP was hired about three months ago and had no Licensed Nurse Competencies on file. The DON stated the Licensed Nurse Competencies were supposed to be done annually, but were not. The DON stated the Licensed Nurse Competencies were the responsibility of the DSD. The DON stated she would have to help the DSD get coordinated with a tracking (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 11 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0694 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few plan for the nursing competencies. The DON stated the Licensed Nurse Competencies were important to ensure the nurses were competent in patient care. During a review of the facility policy and procedure titled, Nursing Services-Building Competency ongoing Training and In-Services dated 2/20/20, indicated, .The purpose of this policy is to define and set up expectations regarding a system to enhance the competency skills of the nursing department .This process includes verification of education and competence Upon hire and then ongoing basis to substantiate evidence of proficiency and skill for the quality of resident care .Including but not limited to ongoing evaluation of competency, and education .[Name of facility] will follow clinical skills of competency and will have at a minimum annual performance reviews . During a review of the Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011 https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines-H.pdf, dated October 2017, indicated, 1. Use either sterile gauze or sterile, transparent, semipermeable dressing to cover the catheter site 2. If the patient is diaphoretic (sweating heavily) or if the site is bleeding or oozing, use a gauze dressing until this is resolved. 3. Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled. 4. Do not use topical antibiotic ointment or creams on insertion sites, except for dialysis catheters, because of their potential to promote fungal infections and antimicrobial resistance. 5. Do not submerge the catheter or catheter site in water. Showering should be permitted if precautions can be taken to reduce the likelihood of introducing organisms into the catheter (e.g., if the catheter and connecting device are protected with an impermeable cover during the shower). 6. Replace dressings used on short-term CVC sites every 2 days for gauze dressings. 7. Replace dressings used on short-term CVC sites at least every 7 days for transparent dressings, except in those pediatric patients in which the risk for dislodging the catheter may outweigh the benefit of changing the dressing. 8. Replace transparent dressings used on tunneled or implanted CVC sites no more than once per week (unless the dressing is soiled or loose), until the insertion site has healed 14. Monitor the catheter sites visually when changing the dressing or by palpation through an intact dressing on a regular basis, depending on the clinical situation of the individual patient. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or bloodstream infection, the dressing should be removed to allow thorough examination of the site. 15. Encourage patients to report any changes in their catheter site or any new discomfort to their provider. During a review of the Journal of Infusion Nursing The Official Publication of the Infusion Nurses Society Infusion Therapy Standards of Practice, dated January/February 2016, indicated, . Standard 1.1 The Infusion Therapy Standards of Practice is applicable to any patient care setting in which vascular access devices (VADs) [a sterile tube that provides access to your veins for the delivery of intravenous (in the vein) medication such as a PICC (Peripherally inserted central catheter- external device placed in upper arm) line] are placed and/or managed and where infusion therapies are administered. 1.2 Infusion therapy is provided in accordance with laws, rules and regulations . federal and state regulatory and accrediting bodies . 1.3 Infusion therapy practice is established in organizational policies, procedures, practice guidelines, and/or standardized written protocols/orders . 3. SCOPE OF PRACTICE .Practice Criteria . D. Nursing Personnel . 5. Registered Nurse (RN) a. Complete an organized educational program on infusion therapy due to the lack and/or inconsistency of infusion therapy in basic nursing criteria . b. Do not accept assignments and tasks when one . is inadequately prepared to perform the assignment or task . d. Delegate tasks, activities, and components of care after determination of competency to perform the specific task . f. Use critical thinking and nursing judgement to apply the Five Rights of Delegation . 4. INFUSION TEAM . A. Assign vascular access device (VAD) . management (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 12 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0694 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and surveillance only to individuals and or teams with infusion therapy education, training, and validated competency . 5. COMPETENCY ASSESSMENT AND VALIDATION Standard . 5.2 The clinician is responsible and accountable for attaining and maintaining competence with infusion therapy administration . 5.3 Competency assessment and validation is performed initially and on an ongoing basis. 5.4 Competency validation is documented in accordance with organizational policy . C. Validate clinician competency by documenting the knowledge, skills, behaviors, and ability to perform the assigned job. 1. Validate initial competency before providing patient care . when the scope of practice changes, and with the introduction of new procedures, equipment, or technology. 2. Validate continuing competency on an ongoing periodic basis . 10. DOCUMENTATION IN THE MEDICAL RECORD Standard 10.1 Clinicians document their initial and ongoing assessments . 10.2 Documentation contains accurate, complete, chronological, and objective information in the patient's medical record regarding the patient's infusion therapy and vascular access with the clinician's name, licensure or credential to practice, date, and time. 10.3 Documentation is legible, timely, accessible to authorized personnel, and efficiently retrievable. 10.4 Documentation reflects the continuity, quality, and safety of care . Practice Criteria A. Documentation includes . 1. Patient . responses to therapy, interventions, and education. 2. Specific site preparation, infection prevention, and safety precautions taken, using a standardized tool for documenting . 3. The type, length, and gauge/size of the vascular access device (VAD) inserted . date and time inserted . 6. peripherally inserted central catheters (PICCs): a. External catheter length and length of catheter inserted. b. Arm circumference: before insertion of a PICC and when clinically indicated to assess the presence of edema [swelling] and possible deep vein thrombosis [DVT-blood clot] . 7. Condition of site, dressing, type of catheter stabilization, dressing change, site care, patient report of discomfort or any pain with each regular assessment of the access site, and patient report of changes related to the VAD or access site. 9. condition of the . access site prior to and after infusion therapy. 10. Results of VAD functionality assessment including patency, absence of signs and symptoms of complications, lack of resistance when flushing, and presence of a blood return upon aspiration. 41. VASCULAR ACCESS DEVICE (VAD) ASSESSMENT, CARE AND DRESSING CHANGES . H. Perform dressing changes . 1. Change transparent semipermeable membrane (TSM) dressings at least every 5 to 7 days and gauze dressing at least every 2 days . 4. Change the dressing . if dressing becomes loose/dislodges . During a review of the APIC POSITION PAPER: SAFE INJECTION, INFUSION, AND MEDICATION VIAL PRACTICES IN HEALTH CARE (2016) dated January 2016, indicated, Disinfect catheter hubs, needleless connectors, and injection ports before accessing. Use either an antiseptic containing port protector cap37-41 or vigorously apply mechanical friction with chlorhexidine/alcohol,42-43 sterile 70% isopropyl alcohol,44-47 or other approved disinfectant swab. Change disinfecting port protectors as directed per manufacturer's recommendations. Follow institutional policy when using the wiping method to disinfect catheter hubs, needleless connectors, and injection ports. Published studies, guidelines and organizations vary (from 3 to 15 seconds) on the amount of time to disinfect when using the wiping method.22,42,48-53 Some of these studies were product and /or device specific therefore results may not be able to be extrapolated to other types of devices. Allow adequate dry time (unless directed otherwise by manufacturer's instructions) before entry . During a review of the Peripherally Inserted Central line Catheter(PICC) Dressing Change undated , indicated, .A transparent dressing on a Peripherally Inserted Central Catheter (PICC) is changed every 7-10 days and/or if it is damp, visibly soiled, loosened or if redness/drainage is noted at the site. The preferred dressing to use on a PICC site is the Tegaderm CHG (Trademark) dressing, unless a skin reaction to the dressing occurs. To determine appropriate dressing and exit site care to use if skin reaction (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 13 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0694 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete occurs, refer to Management of Dressing Related Dermatitis algorithm. The use of a securement device is recommended to ensure secure stabilization of a PICC. The Tegaderm (Trademark) CHG dressing is considered a securement device. If not using the Tegaderm (Trademark) CHG dressing, a Statlock (Trademark) device must be used to secure the catheter. If a gauze dressing is used or if gauze is placed under a transparent dressing and obscures the exit site, the dressing must be changed every 48-72 hours, or more often if it becomes damp/soiled/loose. Aseptic technique is an essential component of all central vascular catheter access procedures to reduce the risk of catheter related blood stream infection. PICC exit sites are visually examined when changing the dressing and by palpation through an intact dressing every shift. For outpatients, sites are examined at each visit. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or bloodstream infection, the dressing is to be removed to allow thorough examination of the site. Tegaderm CHG (Trademark) dressings are not appropriate for use in patients younger than 2 months of age. For changing the dressing on a cuffed PICC, follow procedure for dressing change of cuffed central venous catheter. Event ID: Facility ID: 056279 If continuation sheet Page 14 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. Based on interview and record review the facility failed to obtain medical doctors (MD) signatures for Advance Directive (a written statement of a person's wishes regarding medical treatment, to ensure those wishes are carried out should the person be unable to communicate them to a doctor) orders for two of two residents (Resident 16 and Resident 19). This failure had the potential for both residents to not have their wishes on the Advance Directives followed which could cause undue stress and harm to the residents. Findings: During a review of Resident (Res) 19's Advance Directives order, dated 11/9/20, the doctor's signature was missing, the spot where the doctor would sign was flagged with a yellow sticker tab with red letters and an arrow indicating where to sign. During a review of Res 16's Advance Directives order, dated 1/22/21, the MD signature was missing. During an interview on 4/13/21, at 10:58 a.m., with the Medical Records Custodian (MRC), the MRC stated, It is a group effort t to follow up on unsigned orders. The MRC stated it was her responsibility to ensure medical records for new admissions are completed. During a concurrent interview and record review, on 4/13/21, at 2:47 p.m., with the Director of Staff Development (DSD), the Advance Directive order for Res 16 and Res 19 were reviewed. The DSD verified the Advance Directive for Resident 16 and Resident 19 were not signed by the MD in the hard chart. The DSD stated the expectation is the unsigned MD order is to be faxed, called, and repeated until order is signed. The order should be followed up by staff nurses that are working within 24 hours (of obtaining the order). The DSD stated it was the DSD's responsibility to conduct audits and verify all MD orders are followed up on and signed. During a concurrent interview and record review, on 4/19/21, at 11:26 a.m., with the DSD, the policy Following up on Physicians Orders, dated 3/24/17, was reviewed. The policy indicated, . the nurse receiving the order is to carry out the order. The DSD stated the nurse that receives the order is to carry out the order and Medical Records is to audit new order for completion. The DSD stated the nurse who received the order should put the orders in the area designated for unsigned orders, next to the patient's food refrigerator in the nurse's station. The DSD stated, They should not have been incomplete because it is the Advance Directive, it could delay end of life care and not honor the patient's wishes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 15 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the Registered Nurses (RN) obtained the competencies and skill sets necessary to provide nursing and related services to meet the residents' needs safely when four (4) of four Registered Nurses (RN) had not done the required annual competency training/testing, which included: IV (intravenous, in to the vein) Antibiotic Administration, PICC (peripherally inserted central catheter, direct line into vein for medication administration)Line Dressing Change. This failure affected one of 43 sampled residents, (Resident 32), who required PICC line medication administration and care, and had the potential to affect all residents when their nursing needs were not met according to their plan of care. Findings: During an interview and record review, on 04/14/21, at 4:01 p.m., with the Infection Preventionist (IP) the IP stated Resident 32's PICC line dressing was not changed on 4/12/21 as scheduled. The IP stated the PICC line dressing was due to be changed every Monday but was missed on 4/12/21. The IP stated he had not called the doctor to let him know the dressing was not changed. The IP confirmed the PICC line did not have a cap [to protect it from bacterial infection]. The IP stated the facility did not cap PICC lines. The IP stated he had not put the PICC line dressing change on the Medication Administration Record (MAR) because he did not know how. The IP stated he documented the PICC line dressing change in the nursing notes. The IP was unable to provide a PICC Line dressing change nursing note since Resident 32's admission on [DATE]. The IP stated he did not measure the PICC line during dressing changes [to check for migration]. The IP stated he used a black permanent marker on the skin near the PICC line insertion site to measure the catheter line. The IP stated the pen did not need to be sterile. The IP stated he had always done it that way. When asked what standard of practice the IP followed for PICC line dressing changes, the IP stated he followed the instructions on the dressing packaging. A review of the PICC line dressing package provided by the IP indicated, Latex Free Dressing Change Kit. The Dressing kit did not have instructions for changing a PICC line dressing. During a review of Residents 32's Medication Record, dated 4/14/21, the Medication Record indicated, .3/28/21 Rocephin IVPB (IV medication to be hung via mediation pump and saline bag) 2g (grams)=50mL(milliliters, units of measurement) daily until 5/19/21 cervical abscess (a swollen area within body tissue located in the spine) .QD6A (daily at 6am) . During a concurrent interview and record review, on 4/19/21, at 11:24 a.m., with the Director of Nurses (DON), Resident 32's Physician's Orders (PO's) dated 3/19/21, indicated the PICC line dressing was to be changed weekly. The PO did not indicate type of dressing for the PICC line or instructions on the procedure to change the dressing. The DON stated she needed to clarify the PO for the PICC line dressing change. During an interview on 4/20/21 at 9:25 a.m., with the IP, the IP stated the facility had about eight residents with (8) PICC lines in four (4) years. The IP stated, .We [RN's] are rusty . The IP stated the RN's should have had training on PICC Line medication and care before admission of residents who needed this therapy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 16 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During an interview and record review, on 4/20/21 at 11:23 a.m., with the Director of Staff Development (DSD), the DSD confirmed the Licensed Nurse Competencies (Core abilities required for nursing procedures) training were not done in 2019, 2020, or 2021 for the three RN's employed at the facility. The DSD confirmed there were no Licensed Nurse Competencies done at orientation for the IP, who began about three month ago. The DSD stated RN competencies were supposed to be done at orientation and annually. The DSD stated she was responsible for RN competencies. The DSD stated she did not know who was responsible for the competencies of the DON. The DSD stated she thought the Administrator (ADM) would do the training for the DON. During an interview on 4/20/21 at 11:52 a.m., with the ADM, the ADM stated the DSD was responsible for ensuring the nursing competencies were done. The ADM stated the DSD was responsible for the DON's competency training. The ADM stated the facility did not have a way to track the nursing competencies. During a concurrent interview, and record review on 4/21/21 at 9:00 a.m., with the DON, the Licensed Nurse Competencies for 2019, 2020, and 2021 were reviewed for the four RN's currently employed at the facility. The DON confirmed there was no record of Licensed Nurse Competencies for the DON for 2019, 2020, or 2021. The DON confirmed there was no record of Licensed Nurse Competencies for the Minimum Data Set Coordinator (MDSC) (MDS) (a standardized assessment and care planning tool), for 2020 or 2021. The DON confirmed there were no Licensed Nurse Competencies for the DSD for 2019, 2020, or 2021. The DON confirmed the Infection Preventionist (IP) was hired about three months ago and had no Licensed Nurse Competencies on file. The DON stated the Licensed Nurse Competencies were supposed to be done annually, but were not. The DON stated the Licensed Nurse Competencies were the responsibility of the DSD. The DON stated she would have to help the DSD get coordinated with a tracking plan for the nursing competencies. The DON stated the Licensed Nurse Competencies were important to ensure the nurses were competent in patient care. During a review of the facility policy and procedure titled, Nursing Services-Building Competency ongoing Training and In-Services dated 2/20/20, indicated, .The purpose of this policy is to define and set up expectations regarding a system to enhance the competency skills of the nursing department .This process includes verification of education and competence Upon hire and then ongoing basis to substantiate evidence of proficiency and skill for the quality of resident care .Including but not limited to ongoing evaluation of competency, and education .[Name of facility] will follow clinical skills of competency and will have at a minimum annual performance reviews . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 17 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to meet the minimum requirement of a Registered Nurse (RN) on duty for eight (8) consecutive hours per day, seven (7) days a week when an RN was not on duty eight consecutive hours per day for twelve (12) of forty eight (48) sampled days . This failure had the potential for Resident 32 PICC (peripherally inserted central catheter) (direct line into vein for medication administration) line assessment and care on the p.m.'s, nights, or weekends which may have resulted in a change of condition not recognized and treated in a timely manner, and had the potential for residents not to receive services required to be provided by an RN. Findings: During a concurrent interview and record review, on 4/16/21 at 6:51 a.m., with the Infection Preventionist (IP), the IP stated Resident 32 was admitted on [DATE] with the PICC line for IV antibiotics. The IP stated the PICC Line was cared for in the morning by the DON and the IP. Resident 32's Physician's Order (PO) for the PICC line dated 3/19/21 indicated the PICC line was to be assessed every shift. The IP stated the facility had eight hour shifts. The IP stated the PICC Line had not been assessed on the p.m., or night shift by the facility's RN's. During a concurrent interview and record review, on 4/16/21 at 1:57 p.m., with the Administrative Assistant (ADMA), the facility's Time Card Reports, for the four (4) RN's did not indicate there was an RN to perform Resident 32's PICC Line assessment and care on the weekends, p.m.'s or night shift for eight consecutive hours seven days a week. The Time Card Report for the Director of Staff Development (DSD), dated 3/1/21-4/17/21 indicated the DSD had not worked any evenings or weekends for this time period. The Time Card Report for the Minimum Data Set Coordinator (MDSC) (MDS, a standardized assessment and care planning tool), dated 3/1/21-4/17/21 indicated the MDSC had not worked any evenings or weekends for this time period. The Time Card Reports for the IP dated 3/1/21-4/17/21 indicated the IP had not worked any evening shifts, and had worked one weekend day on 4/3/21 for eight hours. The Time Card Report for the Director of Nursing (DON), dated 3/1/21-4/17/21 indicated the DON had worked the early mornings from 3:00 a.m., until 8:00 a.m., on Saturdays and Sundays, but had not worked the evening shift for this period. The ADMA confirmed the facility had not provided an RN for eight (8) hours a day, seven (7) days a week. The ADMA stated she was unaware of the requirement for RN hours and would have to talk to the DON. During a concurrent interview and record review, on 4/16/21 at 2:45 p.m., with the Administrator (ADM), the RN Time Card Reports for 3/21 and 4/21 were reviewed. The ADM stated the DON was responsible for scheduling the RN hours. The ADM stated the facility did not have a policy for RN hours. The ADM stated she was not aware of the requirement for RN hours to be eight (8) consecutive hours a day, seven (7) days a week. The ADM confirmed the facility did not have a waiver for RN hours. The ADM confirmed there was not an RN available every shift to assess and provide care for Resident 32's PICC Line. The ADM stated, I guess I will have to fix that. During a concurrent interview, and record review, on 4/16/21 at 3:21 p.m., with the DSD, The DSD's Time Card Reports for 3/21 and 4/21 were reviewed. The DSD confirmed she had not worked on weekends in 3/21 or 4/21. The DSD stated it was very rare she worked on the weekends. The DSD stated she was not sure if the other RN's worked on the weekends. The DSD stated the facility should have had an RN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 18 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0727 for eight (8) hours on the weekends. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure titled, Nursing Hours, dated 4/20/21, the policy indicated, .[Name of Facility] will abide by the latest state staffing regulations .There are times when an RN scope of practice is required for patient care. RN hours can be utilized by the DSD, IP and MDS Director and DON. An RN is scheduled each day for coverage . Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 19 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure drugs and biological's (a substance such as vaccines or drugs derived from a living organism used for treatment) were stored in accordance with accepted professional standards of practice when: 1. The medications for two of 43 sampled residents (Resident 295 and 296) were found in the medication room after being discharged from the facility and one medication was found without a resident identifier label. 2. Medication cart 1 stored medication tablets inside a clear plastic container outside of their original packaging with no resident or medication identification. The facility demonstrated a system (a coordinated body methods) of storing and labeling medications in an unsafe manner and did not follow acceptable professional standards for storing medications which place the residents at risk of receiving the wrong medications, which could cause medication adverse reactions. Findings: 1. During a concurrent observation and interview, on 4/12/21, at 9:44 a.m., with Licensed Nurse (LN) 3, Resident 295's Levalbuterol Tartrate (a pressurized metered-dose inhaler medication treatment for bronchospasm - airway contraction), Resident 296's 2 bottles of Droxidopa (medication use to treat symptoms of low blood pressure), and one Albuterol Sulfate (a medication use to treat asthma- a condition in which a person's airway become inflamed, narrow and swell) without a Resident identifier label were found in the medication room. LN 3 stated the medications should have been disposed right away. During a record review of Resident 295's Record of admission (a one page summary of important information of a patient), dated 11/24/19, the Record of Admission, indicated Resident 295 was discharge on [DATE]. During a record review of Resident 296's Record of Admission, dated 11/12/20, the Record of Admission, indicated Resident 296 was discharge on [DATE]. During an interview on 4/12/21, at 3:38 p.m., with the Director of Nursing (DON), the DON stated the medication tablets outside of their original packaging were stored inside the clear plastic container was probably around a hundred medications. The DON stated the medications should have been disposed by the license nurses at the end of each shift. The DON stated unlabeled medications and medications from discharge residents should not be stored in the medication room for resident safety. During an interview on 4/13/21, at 4:06 p.m., with the Pharmasist (Pharm), the Pharm stated medications for discharged residents should be removed right away from the medication room on the day of discharge or as soon as possible. The medications stored in the medication cart removed from their original packaging should be disposed in a timely manner. The Pharm stated license nurse should keep medications organized to prevent medication errors. The Pharm stated we have to follow policy and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 20 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 procedures for resident safety. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure (P&P), Disposal of Medications, dated 12/8, the P&P indicated, Discontinued medications and /or medications left in the nursing care center after a resident's discharge, which do not qualify for return to the pharmacy, are identified and removed from current medication supply in a timely manner for disposition .The director of nursing and the consultant pharmacist will monitor for compliance with federal and state laws and regulations in handling of medications . Residents Affected - Few 2. During a concurrent observation and interview, on 4/12/21, at 10:30 a.m., with LN 3, LN 3 opened the medication cart 1, and stored in medication cart 1 was a clear plastic container with a blue lid containing medication tablets outside of their original packaging. LN 3 stated the medication tablets stored in the container were medications which residents refused, spit out or medication that had fallen on the floor. LN 3 stated she did not know how long the medication had been inside the medication cart. LN 3 stated the medication stored in the clear plastic container should have been disposed at the end of each shift. During an interview on 4/12/21, at 3:38 p.m., with the DON, the DON stated the medication tablets outside of their original packaging were stored inside the clear plastic container were probably around a hundred medication tablets. The DON stated the medications should have been disposed by the license nurses at the end of each shift. The DON stated unlabeled medications and medications from discharge residents should not be stored in the medication room. The DON stated this practice is for resident safety. During an interview on 4/13/21, at 4:06 p.m., with the Pharm, The Pharm stated medications for discharge residents should be removed right away from the medication room on the day of discharge or as soon as possible. The medications stored in the medication cart removed from the original packaging should be disposed in a timely manner. The Pharm stated license nurses should keep medication organized to prevent medication errors. The Pharm stated we have to follow policy and procedures for resident safety. During a review of the facility's policy and procedure (P&P), Disposal of Medications, dated 12/8, the P&P indicated, Discontinued medications and /or medications left in the nursing care center after a resident's discharge, which do not qualify for return to the pharmacy, are identified and removed from current medication supply in a timely manner for disposition .The director of nursing and the consultant pharmacist will monitor for compliance with federal and state laws and regulations in handling of medications . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 21 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 Residents Affected - Some 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 was stored in accordance with professional standards for food services when there were missing breakfast and dinner temperature logs on 4/11/21. These failures had the potential to result in serving food with unsafe food temperatures that could lead to growth of microorganisms to the residents eating in the facility. Findings: During a walking tour on 4/12/21, at 8:52 a.m., of the kitchen, the temperature logs for 4/11/21 were observed. The breakfast temperature had a missing temperatures for the baked salsa omelet, hash browns and sliced apples. Dinner temperatures on 4/12/21 for the honey dew salad was also missing. During a concurrent interview and record review on 4/12/21, at 9:05 a.m., with Dietary Supervisor (DS), the DS verified the missing temperatures for breakfast and dinner. The DS stated the cook was to take the temperatures of the food items served and document the temperatures on the log. The DS stated the temperature of the foods should not have been left blank. The DS stated temperatures are required to be taken of all the foods served to prevent growth of microorganisms. The DS stated serving food within the safe temperature prevents unsafe food being served to residents. During a concurrent interview and record review, on 4/12/21, at 9:45 a.m., with the Cook, The USDA Safe Minimum Cooking Temperatures Chart, dated 4/19/20, indicated the safe minimum temperature for poultry and casseroles is 165 degrees Fahrenheit (a measurement of temperature), and cut fruit can stay at room temperature for one hour and then must be kept chilled at 90 degrees Fahrenheit. The cook stated she had been busy and missed documenting the temperature. The cook stated the importance of documenting the temperature is to make sure the food is at the correct temperature and to prevent residents from getting sick. Review of facility document titled, Sierra View Homes Retirement Community Production Sheet, dated 4/11/21, the document indicated, .Baked salsa omelet 1 slice .Beg Temp: [blank], End temp [blank]. Hash Browns .Beg Temp [blank], End Temp [blank]. Spiced Apples .Beg Temp [blank], End Temp [blank]. Chicken Schnitzel .Beg Temp [blank], End Temp [blank] .Honeydew Salad .Beg temp [blank], End Temp [blank]. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 22 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. 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 consistent Administrative oversight for the well-being of each resident in the facility when: Residents Affected - Some 1. The facility did not ensure during the admission process, nursing staff were trained and competent to provide needs and services to one of sixteen sampled residents (Resident 32), when Resident 32 required PICC (peripherally inserted central catheter) (direct line into vein for medication administration) line care, and the nursing staff were not trained. This failure had the potential to result in life threatening infections or complications related to IV (intravenous) therapy due to untrained staff. 2. The facility did not develop and implement an effective system for policies and procedures to be current, reviewed annually, contain professional references, and approved by the Quality Assurance and Assessment (QAA) committee. This failure resulted in the facility's policies and procedures to not be created, updated, and maintained for the wellbeing of forty-three (43) residents. Findings: 1. During a concurrent observation, interview, and record review on 4/14/21 at 4:01 p.m., with the Infection Preventionist (IP), the IP stated Resident 32 was admitted [DATE] with a PICC line for administration of antibiotic medication. The IP stated he used the instructions on the PICC line dressing change package as a professional reference. The IP brought the PICC line dressing package for review of the directions. The PICC line dressing change package indicated, Latex Free Dressing Change Kit. The PICC line dressing change package did not have dressing change procedure instructions. The IP confirmed the facility did not use line protector caps on PICC lines to prevent contamination. The IP stated he did not measure the PICC line catheter [to monitor catheter displacement] with the dressing change. The IP stated he used a black, unsterile (, permanent marker to mark the resident's skin next to the catheter insertion site. The IP was unable to provide a professional reference used to change a PICC line dressing for Resident 32. The IP stated the facility did not have a policy on PICC line care. During an interview on 4/20/21 at 9:25 a.m., with the IP, the IP stated the facility had about eight (8) PICC lines in four (4) years. The IP stated, We [RN's] are rusty . The IP stated the RN's should have had training on PICC line medication and care before Resident 32 was admitted . During a review of Resident 32's admission record, Resident Information (document with resident demographic and medical diagnosis) undated, indicated Resident 32 was admitted to the facility on [DATE] with diagnosis which included osteomyelitis(infection in the bone) with vertebra (bones of the spine) and extra [NAME] and subdural abscess (swelling with pus on the spine). During a review of Resident 32's Physician Orders, dated 3/28/21, the Physician Order indicated, .Rocephin dose to given through May 19-2019 . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 23 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Residents 32's Medication Record, dated 4/14/21, the Medication Record indicated, .3/28/21 Rocephin IVPB (IV medication to be hung via mediation pump and saline bag) 2g (grams)=50mL(milliliters, units of measurement) daily until 5/19/21 cervical abscess (a swollen area within body tissue located in the spine) .QD6A (daily at 6am) . During a review of Resident 32's Minimum Data Set (MDS- a resident assessment tool used to identify resident cognitive and physical functional level) assessment dated [DATE] indicated Resident 32's Brief Interview for Mental Status (BIMS) assessment score of 13 (0-15 scale [0-6 severe cognitive deficit, 7-12 moderate cognitive deficit, 13-15 no cognitive deficit]) indicating Resident 32 had no cognitive deficits, and had intact memory and judgement. During an interview, on 4/20/21 at 11:40 a.m., with the Director of Nursing (DON), the DON stated the admitting nurse develops and implements the care plan for new admissions. The DON confirmed there was no care plan for Resident 32's PICC line care. The DON stated there should have been a care plan for Resident 32's PICC line care and dressing change, but there was not. The DON stated the plan of care should have been in place before Resident 32 was admitted . The DON stated the QAA would need to develop a new admission process that would include the Director of Staff Development (DSD) training nurses on any procedures required for the new admissions. During a review of the undated facility document titled, SKILLED admission CHECKLIST, the document listed thirty three items to be completed for admission. The SKILLED admission CHECKLIST did not indicate the facility would have appropriate competency training for nursing staff on resident's required procedures and a care plan prior to admission. 2. During an interview on 4/12/21 at 3:57 p.m., with the DON, the DON stated the IP and the DSD had planned the reopening of the dining rooms for the residents. The DON stated she was unable to find a plan or policy and procedure for reopening communal dining. During a concurrent interview and record review, on 4/14/21 at 3:10 p.m., with the Administrator (ADM), the ADM stated the facility did not have a policy on development and implementation of facility policies, but she would look for something. The ADM stated, I could create a policy if I you want me to. When asked about QAA policies and procedures, she stated she would look for them. The ADM stated she had only been an ADM for one year. The ADM returned and had brought a policy and procedure titled, PATIENT CARE POLICY/QUALITY ASSURANCE COMMITTEE. The ADM confirmed the PATIENT CARE POLICY/QUALITY ASSURANCE COMMITTEE policy was undated. The ADM stated, The facility's policies were all over the place, and they were scrambling to find them. The ADM stated the facility needed to have all the policies in one place so the staff could find them. The ADM stated she was aware of the situation [problems] with the facility's policies since last year. During a review of the policies and procedures provided by the facility, the policy titled Confidentiality was dated 8/12/2009, and had no revision date. The policy titled, Physical and Chemical Restraints and Devices was undated. The Policy titled, Sanitation of Equipment was dated 9/26/2012 and had no revision date. The Policy titled. Cleaning and Disinfecting of portable Equipment had no date, and included oxygen tubing. The Cleaning and Disinfecting of portable Equipment policy did not indicate oxygen and nebulizer tubing were to be dated. The policy titled, Brushes and Combs, Cleaning had no date. The policy titled, Antibiotic Stewardship was dated 10/18/2016 and had no revision date. The Policy titled, Food Preparation was dated 2018 and had no revision date. The policy titled, Antipsychotic Medication was dated 6/29/15, and had no revision date. The policy titled, Cleaning the Ice Machine was dated 10/31/13. The policy titled, (QAPI) Quality Assessment and Performance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 24 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0835 Implementation was dated 5/8/13, and had no revision date. Level of Harm - Minimal harm or potential for actual harm During an interview, on 4/15/21 at 10:24 a.m., with the Director of Social Services/Restorative Nurse Assistant (SS/RNA), the SS/RNA stated the facility had returned to communal dining about a month ago. The SS/RNA stated the IP and DSD had planned the reopening of the dining rooms at the facility. The SS/RNA stated the communal dining plan was not in writing. The SS/RNA stated she could not find a policy and procedure for communal dining that addressed the safety and dignity of the residents. The SS/RNA stated the staff were given verbal instructions on how to serve meals in the dining rooms by the DSD. The SS/RNA stated the staff were confused on what to do and the IP and DSD had not gone into details on opening the communal dining after a year of closure. Residents Affected - Some During a concurrent interview and record review, on 4/15/21 at 5:20 p.m., with the DON, the facility's binder titled, Nursing Procedure Guidance had a document titled, PICC Line Daily Charting undated, was reviewed. The DON stated the document was outdated and incorrect. The DON confirmed the Nursing Procedure Guidance binder was at the nursing station and available for use by the nursing staff. The DON stated she did not know why the outdated binder was at the nurse's station. During an interview, on 4/16/21 at 3:21 p.m., with the DSD, the DSD stated the facility's policy and procedures were antiquated (old, outdated). The DSD stated the facility needed to work on the policies. During a concurrent interview and record review, on 4/21/21 at 2:09 p.m., the QAA Committee meeting notes for the past year and the policy and procedure binder were reviewed with the ADM. The ADM stated QAA members included the ADM, DON, DSD, IP, SS/RNA, Activities Director (AD), Dietary Director (DD), Medical Director (MD), Pharmacist, Registered Dietician (RD), and a Board Member. The ADM stated the QAA committee was responsible for the development and implementation of facility policies and procedures. The ADM stated the QAA committee met quarterly. A review of the facility's policy and procedure binder indicated the policies and procedures were last reviewed and signed by the committee members 7/23/2019. The ADM stated the QAA committee should have reviewed the facility's policies and procedures annually. The ADM confirmed the ADM and DON wrote policies as needed. The ADM stated writing policies on the go was not something they normally did. The ADM confirmed the information on the policies written by ADM, DON, IP may have been incomplete or incorrect. The ADM stated, Moving forward, we will correct things [policies produced without QAA approval]. The ADM stated, I was aware the facility's policies needed a lot of work since last year, but had not gotten to it yet. During a review of the facility's policy and procedure titled, (QAPI) Quality Assessment and Performance Implementation dated 5/8/13, no revision date, indicated, [Name of facility] will continue to identify the root cause of problems identified and adjust, redefine, monitor and evaluate implementations for quality care FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 25 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0839 Employ staff that are licensed, certified, or registered in accordance with state laws. 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 ensure the Rehabilitative Nursing Assistant (RNA) Director worked within her scope of practice when the RNA Director assessed and evaluated six of seven newly admitted sampled resident's (Residents' 7, 19, 22, 32, and 141) limitations, mobility and function without professional qualification. Residents Affected - Few This failure had the potential for Resident 7, 19, 22, 32, and 141 to be placed at risk for potential injury due to the RNA Director not having the professional qualification to assess and evaluate resident's limitations, mobility and function. Findings: During a concurrent observation and interview with Resident 141, Resident 141 was sitting up in her wheelchair next to her bed leaning forward. Resident 141 stated she was admitted in the facility few days ago (4/8/21). Resident stated she did not remember working with a Physical Therapist (PT) or Occupational Therapist (OT) and exercising to get stronger. Resident 141 stated it was one a Certified Nursing Assistant (CNA) who was performing exercises with her. During a concurrent interview and record review on 4/14/21, at 9:21 a.m., with Licensed Nurse (LN) 1, LN 1 stated Resident 141 was admitted on [DATE]. LN 1 stated Resident 141 did not have an order for PT or OT but has an order for RNA program. LN 1 stated PT and OT did not screen Resident 141 to determine what exercises would benefit Resident 141. LN 1 stated the RNA Director evaluated the Resident 141 and decided what exercises were appropriate for Resident 141. LN 1 stated not all new admit residents have orders for PT or OT. LN 1 stated newly admitted residents with no order for PT or OT worked with RNA and RNA does the evaluation on residents. LN 1 stated she was not sure who told RNA to assess and evaluate residents on their function and mobility. During an interview on 4/17/21, at 7:25 a.m., with CNA 5, CNA 5 stated she worked as a RNA working with residents with their exercises every morning and afternoon. CNA 5 stated she was not trained by OT or PT but she was trained by RNA. CNA 5 stated she was trained by watching the RNA do RNA program exercises. CNA 5 stated RNA assessment and evaluation are part of RNA duties simply by watching what residents can do. CNA 5 stated PT and OT trained RNAs' when residents were ordered specific RNA program exercises. CNA 5 stated she was qualified to perform assessment and evaluation of residents because she was trained by the RNA Director. During an interview on 4/19/21, at 7:09 a.m. with CNA 2, CNA 2 stated he worked as a RNA providing exercises to residents. CNA 2 stated he was trained by RNA Director to perform exercises with residents. CNA 2 stated he did not have a written guide on what exercises are followed. CNA 2 stated the guide is in his head and not sure if he was following everything he was supposed to be doing with residents. CNA 2 stated he did not know if RNAs' was supposed to perform assessment and evaluation of resident's mobility and function. During a concurrent interview and record review on 4/20/21, at 8:46 a.m., with the RNA Director, the RNA Director stated she assessed and evaluated newly admitted residents for RNA program if there was no orders for OT or PT. The RNA Director stated she used the facility form titled, Sierra View Homes Restorative Nursing Program to assess and evaluate residents. The RNA Director reviewed assessment and evaluation for Resident 32 dated 3/27/21, and Resident 22 dated 3/13/21. RNA director stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 26 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0839 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she is unable to find the assessment and evaluation of Resident 17, 19 and 141. RNA director stated she performed the assessments and evaluations of new admissions if PT and OT were not ordered. The RNA Director stated the RNA program follows the same exercises for all residents. The RNA Director reviewed facility documents titled, Policy and Procedure Restorative Nursing and Restorative Policy, undated. RNA Director stated, Nurses should be assessing and evaluating residents, RNA Directors have no qualification to assess and evaluate residents. The RNA Director stated she trained new CNAs' to do RNA program exercises but did not have a written guide she was following. RNA Director reviewed the document titled, Job Description for RNA, RNA director stated, It is not in my job description to assess and evaluate residents. During a concurrent interview and record review on 4/21/21, at 8:29 a.m., with Director of Nursing (DON), the DON stated RNA assessed and evaluate new residents if there was no order for therapy. DON reviewed facility's document titled Policy and Procedure Restorative Nursing and Restorative Policy, DON stated the licensed nurse should have assessed resident's mobility and function. DON stated the RNA is not qualified to assess and evaluate residents mobility, limitation and function. During a interview on 4/21/21, at 9:47 a.m., with Director of Rehabilitation (DOR), The DOR stated RNA program was developed by therapy at discharge. The DOR stated RNA program is done at the end of therapy. DOR stated nurse should be assessing and evaluating residents function. DOR stated the RNA should not be assessing or evaluating residents function and mobility because they are CNA's and they do not have the qualification to assess or evaluate residents. During a review of the facility's policy and procedure (P&P) titled, Policy and Procedure Restorative Nursing [undated], the P&P indicated, .Screening of new residents: Upon admission, the Registered Nurse will screen the resident for appropriate recommendations of therapy. All residents with fractures, ORIF, hip/knee/shoulder replacements, frequent falls, dysphagia, aphasia will be recommended to be screened and evaluated with treatment as deemed necessary by the Physical Therapist/Occupational Therapist. Following of therapy an RNA program established for each resident by the appropriate therapist and order from the primary care physician. New residents not requiring advanced therapy services and long-term care residents are evaluated, and an appropriate RNA program established . During a review of the facility's document titled, Job Description, dated 7/12/16, the Job description indicated, .1. Under the direction of the Director of Nursing and the Charge Nurse performs nursing in the areas of range of motion, ambulation and application of splints and use of assistive devices. Assists the physical, occupational and speech therapists to carry out doctor ordered plans of care . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 27 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 Based on observation, interview, and record review, the facility failed to maintain an effective infection prevention and control program when: Residents Affected - Some 1. Two of three sampled licensed nurses, Licensed Nursed (LN) 3 and LN 4 did not follow the bleach germicidal wipes dwell time (the appropriate amount of time that a disinfectant must remain on a surface being cleaned to kill germs, viruses, and bacteria) to disinfect the glucometer for 11 of 43 sampled Residents (Resident 8, 11, 12, 15, 16, 17, 26, 29, 31, 34, and 37). This failure had the potential to expose Residents 8, 11, 12, 15, 16, 17, 26, 19, 31, 34, and 37 to blood borne infections due to the reoccurring blood glucose testing with the use of glucometer machines 2. Four of four pill cutters were found in the medication cart 1 and 2 unlabeled without residents identifiers and with unidentifed white residue. This failure had the potiential for cross contamination (the process by which bacteria and other micorogranisms are tranfered from one substance to another) of unclean and unidentified pill cutter. 3. The facility's ice machine dispenser in founder's dining room was not cleaned and disinfected according to the manufacturers guidelines. This failure had the potential for gastrointestinal diseases such as diarrhea [loose watery stools] for 22 of 22 residents (Residents 2, 6, 7, 8, 10, 14, 15, 16, 17, 19, 20, 22, 23, 24, 26, 27, 28, 29, 32, 37, 38 and 39). 4. Resident 141's nasal cannula oxygen tubing (device used to deliver supplemental oxygen) and humidifier (to hydrate the air flow and make oxygen therapy more comfortable) were undated. This failure had the potential to expose Resident 141 to healthcare-associated infections. Findings: 1. During a concurrent medication administration observation and interview, on 4/12/21, at 11:17 a.m., with LN 3, LN 3 used the glucometer to measure Resident 34's blood sugar level and disinfected the glucometer with a bleach germicidal wipe after use. LVN 3 stated the dwell time for the bleach germicidal wipes was one minute. The bleach germicidal wipes container label indicated three minutes dwell time. During a review of Resident 34's Physician Order, dated 9/24/20, the Physician Order indicated BSFS [finger stick blood sugar] QID 6 [every 6 hours] AC [before meals] and HS [at bedtime]. During an interview on 4/14/21, at 12:30 p.m., with the Director of Nursing (DON), the DON stated the glucometer does not need to be disinfected after each use because each residents had their own individual glucometer. During an interview on 4/14/21, at 1 p.m., with the Director of Staff Development (DSD), the DSD stated the glucometer does not need to be disinfected after each use because each residents had their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 28 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 own individual glucometer. Level of Harm - Minimal harm or potential for actual harm During an interview on 4/14/21, at 2:28 p.m., with LN 1, LN 1 stated the glucometer does not need to be disinfected after each use because each residents had their own individual glucometer. Residents Affected - Some During a concurrent observation, interview, and record review, on 4/19/21, at 4:46 p.m., with LN 4, LN 4 disinfected the glucometer with the bleach germicidal wipes and let the glucometer air dry. LN 4 stated she did not know what a dwell time was. LN 4 reviewed the bleach germicidal wipes which indicated a dwell time of 3 minutes. LN 4 stated she has been a nurse in the facility for 10 years and she did not know what a dwell time was. During a review of the facility's policy and procedure (P&P) titled, Blood Sampling-Capillary (Finger Sticks), dated 9/2014, the P&P indicated, The purpose of this procedure is to guide the safe handling of capillary-blood sampling device to prevent transmission of bloodborne diseases to residents and employees . Following the manufacturer's instructions, clean and disinfect reusable equipment, parts, and /or devices after each use . During a review of the Centers for Disease Control (CDC) Professional Reference titled, Blood Glucose Meters dated 5/2017 (www.cdc.gov.injectionsafety/providers/blood-glucose-monitoring_faqs.html) indicated, . Infectious agents, such as HBV, can be transmitted through indirect contact transmission, even in the absence of visible blood [4]. Indirect contact transmission is defined as the transfer of an infectious agent (e.g., HBV) from one patient to another through a contaminated intermediate object (e.g., blood glucose meter) or person (e.g., healthcare personnel hands) . Indirect contact transmission can also occur even if the patient never directly contacts the meter. Healthcare personnel hands can become contaminated with blood at various points while performing assisted blood glucose monitoring including pricking the patient's finger or handling the test strip. Blood can then be transferred to the meter when healthcare personnel handle the meter to obtain the reading. If the meter is not cleaned and disinfected after use, the blood remaining on the meter can be transferred to subsequent patients via healthcare personnel hands when they handle the meter and then assist with finger stick procedures .The disinfection solvent you choose must be effective against HIV, Hepatitis C, and Hepatitis B virus. Outbreak episodes have been largely due to transmission of Hepatitis B and C viruses. However, of the two, Hepatitis B virus is the most difficult to kill. Please note that 70% ethanol solutions are not effective against viral blood borne pathogens . 2. During a concurrent medication storage observation and interview, on 4/12/21, at 10:12 a.m., with LN 2, LN 2 opened medication cart two, in medication cart two, one unlabeled pill cutter with white residue was identifed. LN 2 stated the pill cutter should be labeled with resident's name. LN 2 stated the medication left in the pill cutter had the potential to get mixed with other resident's medications and the potential for cross contamination. During a concurrent medication storage observation and interview, on 4/12/21, at 10:31 a.m., with LN 3, LN 3 opened medication cart one, in medication cart one, three unlabeled pill cutters with white residue residue were identified. During an interview on 4/14/21, at 3:40 p.m., with the DON, the DON stated she did not know the license nurses were using pill cutter. The DON stated she was responsible for the nursing practice in the facility. During a review of the facility's policy and procedure (P&P) titled, Infection Control, dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 29 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 10/2018, the P&P indicated, . Prevent, detect, investigate and control infections in the facility. Maintain a safe, sanitary, and comfortable environment for personnel, residents, visitors, and the general public . Establish guidelines for the availability and accesibility of supplies and equipment necessary for standard and Transmission-Based Precautions . 4. During an observation and interview on 4/12/21, at 11 a.m., with Resident 141, Resident 141 was observed with an undated nasal cannula connected to an oxygen concentrator (device that concentrates the oxygen from a gas supply) with a humidifier. Resident 141 stated she needed the oxygen to help with her breathing. Resident 141 stated she did not remember when the tubings were last changed. During an interview on 4/12/21, at 11:23 a.m., with Certified Nursing Assistant (CNA) 2, CNA 2 verified Resident 141's nasal cannula and humidifier did not have a date. CNA 2 stated he did not know when the nasal cannula tubing and humidifier were last changed. CNA 2 stated he did not know whether the tubing should be labeled with date. During an interview on 4/16/21, at 2:22 p.m., LN 1, LN 1 stated the oxygen tubings and humidifiers are changed every week. LN 1 stated tubings and humidifiers are labeled with the date. LN 1 stated oxygen tubing and humidifiers needed to labeled with the date to make sure the tubing and humidifier are clean. The LN stated the tubing and the humidifier are dated to prevent infection because bacteria can grow in the tubing putting the resident at risk for respiratory infection. During a interview on 4/16/21, at 3:31 p.m., with the DSD, the DSD stated all oxygen tubings should be labeled and changed every week. The DSD stated labeling oxygen tubing is important to ensure the oxygen tubing are clean and replaced once a week to prevent respiratory infections. During a interview and record review on 4/21/21, at 8:29 a.m., with the DON, the DON stated the oxygen tubing and nebulizer should be replaced once a week and labeled. The DON reviewed the policy and procedure titled, Labeling peripheral IV line, oxygen. concentrator, humidifier . The DON stated labeling with the date is following the right procedure to prevent infection. During a review of the facility's policy and procedure (P&P) titled, Labeling peripheral IV line, oxygen, concentrator, humidifier, nebulizer, suction machine, and gastric tube feeding lines, dated 1/29/18, the P&P indicated, .to implement appropriate labeling of tubing(s) with date and time tubing was changed .Oxygen, concentrator, humidifier .are changed weekly when in use and as needed . Tubing is labeled with a black sharpie permanent marker . 3. During a concurrent observation and interview on 4/12/21, at 12:42 p.m., with the Maintenance Supervisor (MS), the MS stated the ice machine dispenser had gelatinous (having the consistency of jelly) gray substance, black fuzzy spots on top of the brown particles that was stuck on the bottom of the tray and the grill covering the drip tray drain was observed with yellowish particles attached to the grill wires. The MS stated the ice machine was supposed to be checked and cleaned when it was in use to ensure infection control was maintained. During a concurrent interview and record review on 4/12/21, at 1:20 p.m., with the MS, the MS reviewed the facility document titled, Food and Nutrition: Ice Machine Cleaning Log, undated, the MS stated according to the cleaning log the last time the ice machine dispenser was cleaned last in March 2020 and he did not think about checking and cleaning the ice machine dispenser. The MS stated, It just slipped my mind. The MS stated it was his responsibility to make sure the ice machine dispenser was cleaned every month. The Ice machine dispenser installation, operation, and maintenance manual (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 30 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 was reviewed and the MS stated, According to the manual, the ice machine has to be cleaned every month. The MS stated he will make sure to schedule cleaning of the ice machine dispenser every month. During a concurrent interview and review on 4/12/21, at 2:32 p.m., with Dietary Supervisor (DS), the DS viewed photos taken of the ice machine dispenser drip tray in Founder's Dining Room. The DS described substance as a brown and crusty material. The DS stated her expectation was to have the ice machine dispenser including the drip tray cleaned on a monthly. The DS stated the monthly cleaning would prevent residents and staff using the ice machine dispenser from getting sick. During a interview on 4/12/21, at 3:50 p.m., with the DON, the DON stated the MS was responsible for cleaning the ice machine dispenser in the founder's dining room and the ice machine in the kitchen. During a review of the facility's Beverage/Ice Dispensers [brand name] Installation, Operation and Maintenance Manual dated 2015, the manual indicated, .You are responsible for maintaining the dispenser accordance with the instructions in this manual . All cleaning must meet your local health department regulations. The following cleaning instructions are provided as a guide . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 31 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0943 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Based on interview and record review, the facility failed to develop, implement and maintain an effective training program for all staff, which included, at a minimum, training on abuse, neglect, exploitation, and misappropriation of resident property when no staff training on these topics were done by the facility in 2020. This failure had the potential to affect 43 residents and for abuse or neglect to go unrecognized and unreported due to lack of staff training. Findings: During a concurrent interview and record review, on 4/20/21 at 1:41 p.m., with the Director of Staff Development (DSD), ten employee files and the facility's training binder dated 2020 were reviewed for abuse training. The DSD stated the lesson plans and sign in sheet for abuse training were kept in a training binder. The facility's training binder dated 2020 indicated the last staff training on abuse prevention occurred in July 2019. The DSD stated she did not keep a list of staff who missed abuse training. The DSD stated she did not have a policy on staff training for abuse. The DSD stated she was not mandated to keep a list of staff who miss abuse training. The DSD stated she tried to get as many staff as she could, but didn't keep track. The DSD stated the facility did not keep a current record of abuse training in the employee file. The DSD stated the facility only kept the abuse training at orientation in the employee file. The DSD stated the facility had planned abuse training in July 2020, but it was canceled. The DSD stated she had changed to the Infection Preventionist (IP) role July 2020 through March 2021. The DSD stated the Director of Nurses (DON) had taken over as the DSD role in July 2020. The DSD stated she was sure the DON knew about the missed abuse training in 2020. The DSD stated the abuse training was not rescheduled because she was no longer in charge of staff training as of July 2020. The DSD stated it was important staff had abuse training so they did not forget how to report abuse. The DSD stated that the lack of abuse training could put residents at risk for abuse. During a concurrent interview and record review, on 4/21/21 at 8:32 a.m., with the DON, the DON confirmed the facility had not done the abuse training in 2020. The DON confirmed she was responsible for the DSD position starting the third of July 2020 and the DSD moved into the IP position full time. The DON stated the abuse training should have been made up. The DON acknowledged the facility's policy did not include the frequency abuse training would be done. The DON stated the DSD needed to keep a log of staff for abuse training completion. The DON stated she did not have an answer as to why the mandatory abuse training was missed last year. The DON stated there should have been abuse prevention training last year because it was mandatory training. The DON stated abuse training was important to keep the staff aware of types of abuse and recognize abuse. The DON stated all staff at the facility including the housekeepers, kitchen staff, licensed staff, and maintenance staff should have been trained on abuse, but were not. During a concurrent interview and record review, on 4/21/21 at 8:34 a.m., the facility's training binder and the facility's policy and procedure on abuse were reviewed with the Administrator (ADM). The ADM stated the facility will correct the policy and procedure on abuse training to include the requirement for annual abuse training. The ADM stated the DSD was responsible for abuse training. The ADM stated the facility should have had abuse training annually, but did not. The ADM stated she was unaware the abuse training was not done after it was originally cancelled. The ADM the abuse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 32 of 33 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 056279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Homes 1155 E. Springfield Avenue Reedley, CA 93654 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 0943 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many training should have been rescheduled. The ADM stated the abuse training was important to keep the staff's mind refreshed on abuse so they know the different types of abuse and how to report it. During an interview, on 4/21/21 at 10:17 a.m., with LN (Licensed Nurse) 1, LN 1 stated the abuse training was supposed to be annual but did not happen in 2020. The LN stated it was important to have abuse training so staff are aware of the kinds of abuse and how to report it. During an interview, on 4/21/21 at 10:26 a.m., with Certified Nurisng Assistant(CNA) 13, CNA 13 stated no abuse training was done in 2020. CNA 13 stated it was important for staff have abuse training every year because they may forget or be new. During an interview, on 4/21/21 at 10:51 a.m., with the Head Chef (HC), the HC stated abuse training was supposed to be every year. The HC validated there was no abuse training done in 2020. The HC stated, People forget and wouldn't know how to look for signs of abuse and do the reporting. During an interview, on 4/21/21 at 11:20 a.m., with LN 2, LN 2 stated, We have to make up missed abuse training. It is [the DSD] responsibility to make sure we all get our abuse training. During an interview, on 4/21/21 at 11:32 a.m., with Laundry Personnel (LP), the LP stated, .We need abuse training because we work with residents that are fragile and need a lot of care. We have to take care of them . During a review of the facility's policy and procedure titled, Adult/Elder Abuse dated 11/8/2012, the policy indicated, .The basic responsibility of every employee shall be to ensure the safety and well-being of each resident .All residents shall have the right to be free from verbal, sexual, physical, mental, or financial abuse, corporal punishment, isolation .Employees will be trained through orientation and on-going educational session about .What constitutes abuse, neglect, an misappropriation of resident property .Identify, correct, and intervene in situations in which abuse, neglect is more likely to occur . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056279 If continuation sheet Page 33 of 33