Inspection·July 10, 2024

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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 services which met professional standards of practice for one of seven sampled residents (Resident 1) when license nurse did not administered Resident 1's physician's order for omeprazole (medication for gastroesophageal reflux disease [GERD]-a condition which causes stomach acid to flow back into the esophagus [tube between the mouth and stomach]) 20 milligrams (mg- unit of measurement) for seven consecutive days and the physician was notified of the missed doses. Residents Affected - Few This failure resulted in Resident 1 not receiving the omeprazole on 5/1/24, 5/2/24, 5/4/24, 5/5/24, 5/6/24, 5/7/24, 5/8/24 and placed Resident 1 at potential risk to experience symptoms of GERD such as heartburn [burning sensation in the chest], sensation of a lump in the throat, chest pain, difficulty swallowing and nausea. Findings: During a review of Resident 1's admission Record (AR), undated, the AR indicated, Resident 1 was admitted to the facility on [DATE] with diagnosis including GERD, dysphagia (difficulty swallowing), type 2 diabetes mellitus (problem with the way the body regulates and uses sugar as fuel), and diverticulitis (inflammation of bulging pouches in the wall of the large intestine [long tube from the small intestine to the anus]. During a concurrent interview and record review on 7/10/24 at 10:48 a.m. with Licensed Vocational Nurse (LVN) 1, Resident 1's Medication Review Report (MRR), dated 5/2024 was reviewed. The MRR indicated, . Omeprazole Oral Tablet Delayed Release 20 MG . Give 1 tablet by mouth one time a day for GERD . Resident 1's Medication Administration Report (MAR), dated 5/2024 was reviewed. The MAR indicated, . Omeprazole 20 mg . [5/1/24 box blank] .[5/2/24 box marked code 5] . [5/3/24 box checked] . [5/4/24 box marked code 9] . [5/5/24 box marked code 9] . [5/6/24 box marked code 9] . [5/7/24 box marked code 9] . [5/8/24 box marked code 5] . LVN 1 stated a checkmark indicated the medication was administered, and codes 5 and 9 were used when a medication was not given. LVN 1 reviewed Resident 1's progress notes and stated she was unable to locate documentation indicating the reason why the medication was not given and if the physician was notified. LVN 1 stated Resident 1's physician should have been notified the medication was not given for seven consecutive days. LVN 1 stated Resident 1 had missed multiple doses of omeprazole which placed him at risk for increased heartburn, nausea, and vomiting. During a concurrent interview and record review with the Supervising Registered Nurse (SRN) and the Assistant Director of Nursing (ADON) Resident 1's MAR was reviewed. The ADON stated code 5 indicated hold/see nurses notes and code 9 indicated other/see nurses notes. The ADON reviewed Resident 1's (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 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 07/10/2024 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)