Inspection visit
Inspection
10 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 10 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0578
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to
participate in experimental research, and to formulate an advance directive.
Based on record review, interviews, and facility policy review, the facility failed to ensure they periodically
reassessed and documented a resident's mental capacity prior to allowing a resident to make
life-sustaining treatment decisions for 1 (Resident #2) of 2 residents reviewed for advance directives. The
facility also failed to identify or arrange for an appropriate representative when Resident #2 was assessed
as being unable to make health care decisions.
Findings included:
A review of a facility policy titled Advance Directives, revised in September 2022, revealed, The resident
has the right to formulate an advance directive, including the right to accept or refuse medical or surgical
treatment. The policy revealed, If the resident is incapacitated and unable to receive information about his
or her right to formulate an advance directive, the information may be provided to the residents [sic] legal
representative. The policy revealed, The interdisciplinary team [IDT] assesses the residents [sic]
decision-making capacity and identifies the primary decision-maker if the resident is determined to not have
decision-making capacity. The interdisciplinary team conducts ongoing review of the residents [sic]
decision-making capacity and invokes the resident representative or health care agent if the resident is
determined not to have decision-making capacity. Changes are documented in the care plan and medical
record. The policy revealed, If the resident or representative indicates that he or she has not established
advance directives, the facility staff will offer assistance in establishing advance directives. Information
about whether or not the resident has executed an advance directive is displayed prominently in the
medical record in a section of the record that is retrievable by any staff.
A review of Resident #2's admission Record revealed the facility admitted the resident on 12/06/2001 with
diagnoses that included dysphagia (a condition with difficulty in swallowing food or liquid), aphasia (a
communication disorder), and anoxic brain injury (injuries that completely cut off the oxygen supply to the
brain). The admission Record did not include any contacts or family involved with the resident and listed the
resident as the responsible party.
A review of Resident #2's quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD)
of 09/06/2023, revealed the resident had a Brief Interview for Mental Status (BIMS) score of 99, which
indicated the resident was unable to complete the interview. The MDS revealed the Staff Assessment for
Mental Status (SAMS) indicated the resident had some difficulty in new situations related to their cognitive
skills for daily decision-making. The MDS revealed the resident had a Physician Orders for Life-Sustaining
Treatment (POLST) form in their medical records and revealed the POLST indicated Do not attempt
resuscitation/DNR [do not resuscitate]. The MDS revealed the POLST was signed by a physician, nurse
practitioner, or physician assistant and was signed by the resident or a legally
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 9
Event ID:
056288
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
12/05/2023
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 0578
recognized decision maker. The MDS revealed the resident did not have an advanced directive.
Level of Harm - Minimal harm
or potential for actual harm
A review of Resident #2's care plan revealed a focus statement, with an initiation date of 02/23/2016 and
revised on 11/19/2020, that indicated the resident had impaired cognitive function or impaired thought
processes. The care plan revealed interventions related to the resident's impaired cognitive function
included instructions for staff to educate the resident/family/caregiver regarding the resident's capabilities
and needs; engage the resident in simple, structured activities that avoid overly demanding tasks; observe
the resident for and document/report to the physician as needed any changes in the resident' cognitive
function; use consistent simple, directive sentences and provided the resident with necessary cues; and
use task segmentation to support short-term memory deficits. The resident's care plan revealed a focus
statement, with an initiation date of 08/07/2018 and revised on 11/19/2020 that indicated the resident had a
potential for psycho-social well-being problems. The care plan revealed interventions that included
instructions for staff to encourage participation from the resident and indicated the resident depended on
others to make their own decisions. The care plan revealed a focus statement, with an initiation date of
01/26/2021, that revealed the resident had a POLST for a DNR status. The care plan revealed interventions
included that the DNR POLST form would be in the medical records at all times; social services/nursing
would discuss/change the resident's code status as indicated by the resident/family; instructions for staff to
notify the hospital/clinic/ambulance of the resident's wishes as indicated within Health Insurance Portability
and Accountability Act (HIPPA) policy and procedures; and instructions for staff to recognize the resident's
wishes and to follow them as indicated.
Residents Affected - Few
A review of Resident #2's Physician Orders for Life-Sustaining Treatment (POLST), dated 12/06/2001,
revealed that if the resident was found with no pulse and/or breathing, the record indicated instructions for
staff to attempt cardiopulmonary resuscitation (CPR). The record revealed if the resident was found with a
pulse and/or breathing, the Medical Interventions indicated instructions for staff to provide Full Treatmentprimary goal of prolonging life by all medically effective means. The POLST form was signed by a physician
and the resident. The POLST did not show any indication that it had been voided.
A review of Resident #2's Order Summary Report revealed an order dated 01/26/2021 that revealed, DNRComfort focused treatment, No artificial means of nutrition, including feeding tubes. The Order Summary
Report revealed an order dated 12/16/2008 that revealed, Resident does not have capacity to make health
care decisions, If not due to Asphsia [sic]. A review of the order details related to this order revealed it was
revised on 10/09/2021, it did not require reassessment, and the order was indefinite.
A review of Resident #2's Physician Orders for Life-Sustaining Treatment (POLST), dated 01/24/2021,
revealed if the resident was found with no pulse and not breathing, the record revealed Do Not Attempt
Resuscitation/DNR (Allow Natural Death). The form revealed if the resident was found with a pulse and/or
breathing, the Medical Interventions indicated Comfort-Focused Treatment- primary goal of maximizing
comfort. The record revealed two intersecting lines drawn on the resident's signature line. The record
revealed the resident had no advance directive. The record revealed it had been signed by a physician and
dated 01/24/2021.
A review of Resident #2's BIMS, dated 03/15/2021, revealed the resident received a score of 4, which
indicated the resident had severe cognitive impairment.
A review of Resident #2's significant change in condition MDS, with an ARD of 11/16/2021, revealed
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056288
If continuation sheet
Page 2 of 9
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
12/05/2023
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 0578
Level of Harm - Minimal harm
or potential for actual harm
the resident had a BIMS score of 4, which indicated the resident was severely cognitively impaired. The
MDS revealed the resident had a POLST form in their medical records and indicated the resident wanted
CPR. The MDS revealed the POLST was signed by a physician, nurse practitioner, or physician assistant
and was signed by the resident or a legally recognized decision maker. The MDS revealed the resident did
not have an advanced directive.
Residents Affected - Few
During an interview on 12/04/2023 at 11:02 AM, the Social Services Director (SSD) stated Resident #2 had
no family involved. She said the resident could spell out words on their communication board. The SSD said
she did not feel she was qualified to answer if the resident was capable of answering the questions on the
POLST form. She said the nursing staff and a resident's physician made changes to a POLST.
During an interview on 12/04/2023 at 2:12 PM, Licensed Vocational Nurse (LVN) #7 stated she had worked
at the facility for less than two years. She reported Resident #2 was their own responsible party. She
reported the resident communicated through a communication board. LVN #7 stated she thought the
resident would know what CPR, DNR, and tube feeding were. She reported that nursing staff completed the
POLST form at the time of admission. She said Resident #2's profile on the electronic record she had
access to indicated the resident's BIMS score was high enough to make decisions.
During an interview on 12/04/2023 at 2:40 PM, the SSD stated a physician determined if a resident was not
capable of making decisions, and it would be kept in the resident's medical record. She said if a physician
determined a resident was not capable of making decisions, the IDT would meet, and the team would reach
out to the family to see if they would be the resident's responsible party. She stated that if the resident had
no family, they would reach out to the bioethics committee, which consisted of the IDT, two physicians, and
the Ombudsman. She stated they would meet and discuss what was in the best interest of that resident.
She said nursing staff would initiate the conversation related to a resident's capacity. She stated that, in the
past, there had been a letter of capacity for Resident #2.
During an interview on 12/04/2023 at 2:48 PM, the Assistant Director of Nursing (ADON) stated the MDS
Coordinator (MDS-C) completed the BIMS interview to determine the scores. She stated a score of 99
would mean the resident was not capable of making decisions, and they would need to find a responsible
party that would help with decisions for the resident. She stated if the resident did not have anyone, they
would have to refer to the courts for a conservatorship. She stated Resident #2 was nonverbal. She stated
staff could ask questions and, with the resident using their communication board, they could understand
the resident's wants and needs.
During an interview on 12/05/2023 at 8:52 AM, the Administrator stated the facility staff did not have a copy
of the letter of capacity from 2021 when the order was entered. He said the medical director, who
completed the POLST, said he felt like the resident was capable of making those decisions when he signed
the POLST. The Administrator stated he expected the resident's medical record to be consistent. He stated
he did not believe a resident with a BIMS score of 99 or 4 would be capable of making health care
decisions. He stated Resident #2 had resided at the facility for a long time, and staff had indicated that their
cognition level had improved. He stated he did not know for sure what the process was for having a resident
deemed incapable of making healthcare decisions. He stated he understood the importance of having an
accurate record and making sure the documentation matched the resident's cognition level.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056288
If continuation sheet
Page 3 of 9
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
12/05/2023
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 0641
Ensure each resident receives an accurate assessment.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interviews, record review, and facility document and policy review, the facility failed to accurately assess
and document a resident's status in the Minimum Data Set (MDS), an assessment tool used to facilitate the
management of care, for 1 (Resident #66) of 3 residents reviewed who received dialysis.
Residents Affected - Few
Findings included:
A review of a facility policy titled Certifying Accuracy of the Resident Assessment, revised in November
2019, revealed, Any person completing a portion of the Minimum Data Set/MDS (Resident Assessment
Instrument) must sign and certify the accuracy of that portion of the assessment. Further review of the
section titled Policy Interpretation and Implementation revealed, 3. The information captured on the
assessment reflects the status of the resident during the observation ('look-back') period for that
assessment.
A review of a facility policy titled Resident Assessments, revised in March 2022, revealed, All members who
have completed any portion of the MDS resident assessment form must sign the document attesting to the
accuracy of such information.
A review of a document titled Centers for Medicare & Medicaid Services [CMS] Long-Term Care Resident
Assessment Instrument [RAI] 3.0 User's Manual, revised in October 2023, revealed that all treatments,
procedures, and programs that the resident received or performed after admission/entry or reentry to the
facility or within the last 14 days was to be checked in section O019: Special Treatments, Procedures, and
Programs. This included hemodialysis.
A review of Resident #66's admission Record revealed the facility initially admitted the resident on
08/01/2023 and readmitted the resident on 10/02/2023 with diagnoses that included end-stage renal
disease and dependence on renal dialysis.
A review of Resident #66's quarterly MDS, with an Assessment Reference Date (ARD) of 11/07/2023,
revealed Resident #66 had a Brief Interview for Mental Status (BIMS) score of 10, which indicated the
resident had moderate cognitive impairment. The MDS did not indicate the resident received dialysis.
A review of Resident #66's care plan revealed a focus statement, with an initiation date of 10/02/2023, that
indicated the resident required hemodialysis related to renal failure.
Interventions directed staff to encourage Resident #66 to attend their scheduled dialysis appointments on
Tuesdays and Saturdays.
A review of Resident #66's Order Summary Report revealed a physician's order dated 10/05/2023 that
indicated the resident was to receive hemodialysis on Tuesdays and Saturdays at a dialysis center.
During an interview on 12/05/2023 at 7:55 AM, Registered Nurse Supervisor (RN-S) #2 stated Resident
#66 received hemodialysis, and hemodialysis should be coded on the MDS to accurately reflect the
resident's status.
During an interview on 12/05/2023 at 9:45 AM, the Assistant Director of Nursing (ADON) stated
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056288
If continuation sheet
Page 4 of 9
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
12/05/2023
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 0641
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Resident #66's quarterly MDS dated [DATE] should have been coded to reflect that the resident received
hemodialysis. She stated the MDS Coordinator was responsible for accurately coding the MDS
assessments to fully reflect a resident's status.
During an interview on 12/05/2023 at 9:53 AM, the MDS Coordinator (MDS-C) stated Resident #66 had
been receiving hemodialysis since 10/07/2023, and the resident's quarterly MDS should have been coded
to reflect that the resident received hemodialysis. She stated she was responsible for completing MDS
assessments.
During an interview on 12/05/2023 at 10:01 AM, the Administrator stated hemodialysis should have been
coded on the quarterly MDS to accurately reflect the resident's hemodialysis treatments. He stated the
MDS coordinator was responsible for accurately coding MDS assessments. He said the MDS Coordinator
probably missed coding Resident #66's quarterly MDS correctly.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056288
If continuation sheet
Page 5 of 9
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
12/05/2023
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 0727
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
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.
Based on interviews, record review, and facility document and policy review, the facility failed to ensure a
registered nurse (RN) worked at least eight consecutive hours a day on two (11/10/2023 and 11/11/2023)
of the previous 30 days.
Findings included:
A review of a facility policy titled Departmental Supervision, Nursing, revised in August 2022, revealed, A
registered nurse provides services at least eight (8) consecutive hours every 24 hours, seven (7) days a
week. RNs may be scheduled more than eight (8) hours depending on the acuity needs of the resident.
A review of a facility policy titled Staffing and Sufficient Nursing, revised in August 2022, revealed, A
registered nurse provides services at least eight (8) consecutive hours every 24 hours, seven (7) days a
week. RNs may be scheduled more than eight (8) hours depending on the acuity needs of the resident.
A review of a document titled NHPPD [Nursing Hours Per Patient Day] Audit, for the timeframe from
11/05/2023 to 12/05/2023, revealed that RN Supervisor (RN-S) #2 clocked in at 6:52 AM on 11/10/2023
and clocked out at 9:32 AM on 11/10/2023 for a total of 2.67 hours worked. Further review of the audit
revealed that RN-S #2 did not work on 11/11/2023. No other registered nurses, including the Director of
Nursing (DON), worked on 11/10/2023 or 11/11/2023.
During an interview on 12/05/2023 at 11:24 AM, the Assistant Director of Nursing (ADON), a licensed
vocational nurse, stated the facility employed two registered nurses, RN-S #2 and the DON. The ADON
said RN-S #2 was the weekend nursing supervisor, and the DON worked Monday through Friday. The
ADON stated that if one of them could not work, the other usually stepped in and worked the shift. The
ADON stated if neither RN-S #2 nor the DON were working, the corporate consultants were available by
telephone.
During an interview on 12/05/2023 at 11:32 AM, RN-S #2 stated she was the weekend nursing supervisor
and provided RN coverage when the DON could not work. RN-S #2 stated there were days she did not
work in November 2023. She stated she came in on Friday, 11/10/2023, then left early. RN-S #2 said on
11/10/2023 and 11/11/2023, no other RN worked in the facility.
During an interview on 12/05/2023 at 1:11 PM, the Administrator stated the facility only had two RNs, the
DON and RN-S #2, and if they were both absent from work, there was no RN coverage. The Administrator
stated the facility had an RN job posting on an internet job website and hoped to hire an additional RN. The
Administrator said there were nursing consultants who were always available if facility staff needed
anything, but there were times when they did not have RN coverage.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056288
If continuation sheet
Page 6 of 9
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
12/05/2023
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 0732
Post nurse staffing information every day.
Level of Harm - Potential for
minimal harm
Based on interviews and facility document and policy review, the facility failed to ensure daily staffing
information postings contained all required information, including the total number and actual hours worked
by registered nurses (RNs), licensed practical nurses (LPNs), or licensed vocational nurses (LVNs), and
certified nursing assistants (CNAs), and the resident census for each shift. This was noted during the
review of daily staff postings for the timeframe from 11/01/2023 through 12/04/2023 and had the potential
to affect all residents in the facility.
Residents Affected - Many
Findings included:
A review of a facility policy titled Posting Direct Care Daily Staffing Numbers, revised in August 2022,
revealed, Our facility will post on a daily basis for each shift nursing staffing data, including the number of
nursing personnel responsible for providing direct care to residents. The section of the policy titled Policy
Interpretation and Implementation specified, 1. Within (2) two hours of the beginning of each shift, the
number of licensed nurses (RNs, LPNs, and LVNs) and the number of unlicensed nursing personnel (CNAs
and NAs [nurse aides]) directly responsible for resident care is posted in a prominent location (accessible to
residents and visitors) and in a clear and readable format.
2. Directly responsible for resident care means that individuals are responsible for residents' total care or
some aspect of the residents' care including but not limited to: assisting with activities of daily living (ADLs),
administering medications, supervising care provided by CNAs, and performing nursing assessments.
Medication aides, feeding assistants, hospice staff, private duty aides and administrative staff are not
calculated in direct care staffing numbers. Shift staffing information is recorded on a form for each shift. The
information recorded on the form shall include the following:
a. The name of the facility;
b. The current date (the date for which the information is posted);
c. The resident census at the beginning of the shift for which the information is posted;
d. Twenty-four (24)-hour shift schedule operated by the facility;
e. The shift for which the information is posted;
f. The projected time worked during that shift for each category and type of nursing staff; and
g. Total number of licensed and non-licensed nursing staff working for the posted shift.
3. Within two (2) hours of the beginning of each shift, the charge nurse of designee computes the number
of direct care staff and completes the Nurse Staffing Information form. The charge nurse completes the
form and posts the staffing information in the location(s) designated by the administrator. The policy further
specified, 5. The previous shift's forms are maintained with the current shift form for a total of 24 hours of
staffing information in a single location. Once the form is removed, it is forwarded to the office of the director
of nursing services (DNS) and filed as a permanent record.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056288
If continuation sheet
Page 7 of 9
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
12/05/2023
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 0732
Level of Harm - Potential for
minimal harm
A review of the facility's Staffing Information 2023 forms for the timeframe from 11/01/2023 through
12/04/2023 revealed the forms included the facility name, date, and daily census, along with staffing
information. The forms did not include the census at the beginning of each shift, did not include the number
of staff working as RNs, LPNs or LVNs, and CNAs, and reflected the number of actual hours worked per
shift for the following categories:
Residents Affected - Many
- morning (AM) shift: 12 Hour Licensed Staff-nurses, 8 Hour Licensed Staff-CNA, Restorative Nursing
Assistants, and Orientee/Extra hours;
- evening (PM) shift: 8 Hour Licensed Staff-CNA and Orientee/Extra hours; and
- night shift (NOC): 12 Hour Licensed Staff-nurses and 8 Hour Licensed Staff-CNA.
The column labeled # that reflected the actual hours worked for each listed category combined the hours
for RNs and LVN/LPNs into one total. The forms were signed each day by the Administrator.
During an interview on 12/05/2023 at 11:50 AM, the Administrator stated the facility's staffing forms
combined the hours for RNs with LVNs/LPNs.
During a follow-up interview on 12/05/2023 at 1:11 PM, the Administrator stated he expected the daily staff
postings to follow State and Federal regulations.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056288
If continuation sheet
Page 8 of 9
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
12/05/2023
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 0912
Level of Harm - Potential for
minimal harm
Residents Affected - Some
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single
resident rooms.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, interviews, and facility document review, the facility failed to provide at least 80 square feet
per resident in four of four multiple occupancy resident rooms (Rooms 106, 108, 110, and 119). This failure
had the potential to decrease resident freedom of mobility and could compromise the provision of care.
Findings included:
Observations of resident rooms during the initial tour of the facility on 12/03/2023 and each day of the
survey from 12/03/2023 to 12/05/2023 revealed there were four multiple occupancy resident rooms (Rooms
106, 108, 110, and 119) with four residents residing in each room.
During an interview on 12/05/2023 at 10:00 AM, the Environmental Services Director (ESD) stated he
measured the square footage in each room on 12/05/2023 at 9:45 AM.
A review of a document provided by the ESD on 12/05/2023 revealed measurements of the square footage
in each room were not at least 80 square feet per resident, as indicated below:
- room [ROOM NUMBER] measured 318.3 square footage (79.5 square feet per resident)
- room [ROOM NUMBER] measured 295.1 square footage (73.7 square feet per resident)
- room [ROOM NUMBER] measured 300.2 square footage (75 square feet per resident)
- room [ROOM NUMBER] measured 317.0 square footage (79.2 square feet per resident)
During an interview on 12/05/2023 at 10:40 AM, the Administrator stated that he planned to request a state
waiver for the square footage requirements in these rooms.
We recommend a room waiver.
______________________________________
Health Facilities Evaluator Supervisor II
Date
We request a room waiver.
______________________________________
Administrator
Date
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056288
If continuation sheet
Page 9 of 9
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Back to topCitations
10 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F727 - Except when waived under paragraph (f) or (g) of this section, the
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.
F732 - Nurse Staffing Information
Post nurse staffing information every day.
F912 - Measure at least 80 square feet per resident in multiple resident
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
- 0030GeneralS&S Dpotential for harm
List the names and contact information of those in the facility.
- 0363GeneralS&S Dpotential for harm
Install corridor and hallway doors that block smoke.
F918 - Bathroom Facilities
Have generator or other power source capable of supplying service within 10 seconds.
F920 - Dining and Resident Activities
Ensure proper usage of power strips and extension cords.
- 0929GeneralS&S Dpotential for harm
Ensure precautions for handling oxygen cylinders and equipment are correctly followed.
FAQ · About this visit
Common questions about this visit
What happened during the December 5, 2023 survey of HANFORD POST ACUTE?
This was a inspection survey of HANFORD POST ACUTE on December 5, 2023. The surveyor cited 10 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at HANFORD POST ACUTE on December 5, 2023?
Yes, 10 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate ..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.