Health inspection·October 25, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm she was in the facility the day Resident 1 eloped. The DON stated during the search, she received a call from RP 1 indicating Resident 1 had been found. The DON stated when Resident 1 arrived at the facility she did not have her wanderguard. The DON stated we found the wanderguard two days later behind the toilet. The DON stated her, and the Administrator (ADM) investigated the elopement incident but did not know how Resident 1 eloped from the facility without the staff's knowledge. Residents Affected - Few During a telephone interview on 10/4/23, at 2 p.m. with the DON, the DON stated she was unable to determine the time Resident 1 eloped from facility and did not know how long Resident 1 was missing from facility. The DON stated the incident placed Resident 1 at high risk for serious injuries which could have potentially affect her health and wellness. During a telephone interview on 10/4/23, at 2:25 p.m. with the ADM, the ADM stated Resident 1 eloped from the facility without staff's knowledge and placed Resident 1 in grave danger for serious injuries. During an interview on 10/25/23 at 9:45 a.m., with Responsible Party (RP) 1, RP 1 stated Resident 1 walked out the front door of the facility and went to a restaurant 8 miles away. RP 1 stated Resident 1 started talking to random people inside the restaurant and somebody recognized her and offered to take her home. RP 1 stated she did not know who the person was, just some random helpful person. RP 1 stated the person dropped off Resident 1 at her home and called the police to report the incident. RP 1 stated Resident 1 lives across the school where my niece goes to school. RP 1 stated my brother-in-law happened to be driving in front of Resident 1's house to pick up my niece and saw Resident 1 getting out of the car. RP 1 stated my brother-in-law called me and asked why is grandma home? And I'm like what are you talking about. RP 1 stated that's where we found out where she was, it was by complete chance. RP 1 stated it was by the grace of God the timing of it all. RP 1 stated by brother-in-law took Resident 1 back to the facility. During a review of Resident 1's Progress Notes, dated 9/5/23 at 1:01 a.m., the PN indicated, Writer notified by staff member that resident [Resident 1] became agitated and stated she was leaving and walked out the back door on East Wing to the smoking area. Staff member was in the room at the time and immediately followed behind resident and approximately 5 minutes was able to redirect resident back to the facility . Resident allowed writer to apply wanderguard (a device that helps monitor the movement of patients and prevent them from leaving the facility) to right wrist and is currently sitting at the nurse's station stating that she wants to leave and go home . During a review of Resident 1's PN dated 9/6/23 at 9:49 a.m., Resident is on alert charting for exit seeking behavior . During a review of Resident 1's PN dated 9/6/23 at 1:19 p.m., The PN indicated, At approximately 1145 [11:45 a.m.] CNA [certified nursing assistant 1] notified writer [Licensed Vocational Nurse (LVN) 1] that they could not find resident [Resident 1] Writer immediately notified staff and DON [Director of Nursing] . Staff noted to have last seen Resident 1 in the dining room [ROOM NUMBER] minutes prior to the search . During a review of the facility's policy and procedure (P&P) titled, Wandering and Elopements, dated March 2019, the P&P indicated, The facility will identify residents who are at risk of unsafe wandering and strive to prevent harm . During a review of the facility's document Section V Emergency Response Elopement, undated, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056288 If continuation sheet Page 2 of 3 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 056288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hanford Post Acute 1007 West Lacey Blvd Hanford, CA 93230 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm indicated It is the policy of this facility to protect residents from wandering away from the facility .Purpose . To protect residents that are not capable of protecting themselves. To provide the techniques and equipment to minimized safety risk . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056288 If continuation sheet Page 3 of 3