Health inspection·May 13, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure services provided met professional standards of quality for one of six sampled residents (Resident 4) when Resident 4 was administered 4.5 L/min (liters-unit of measurement)/min (minute) of oxygen via Nasal cannula (NC- plastic device used to deliver supplemental oxygen) instead of 2L/min of oxygen per physician's order. Residents Affected - Few This failure had the potential to put Resident 4 at risk to oxygen toxicity (a lung damage that happens from breathing too much supplemental oxygen; it can cause coughing and trouble breathing; in severe cases it can even cause death). Findings: During a Review of Resident 4's admission Record, (AR- a document that provides resident contact details, a brief medical history, level of functioning, preferences, and wishes), dated 5/12/25, the AR indicated Resident 4 was admitted to the facility on [DATE], with diagnoses which included Congestive Heart Failure (CHF- weakness in the heart where fluid accumulates in the lungs), Hypertension (high blood pressure), Dyspnea (shortness of breath, difficulty breathing), and Asthma (a chronic lung condition making it difficult to breathe). During a concurrent observation and interview on 5/12/25 at 12:30 p.m., with the Infection Preventionist (IP), inside Resident 4's room, Resident 4 was lying in her bed, sleeping and with supplemental oxygen via nasal cannula receiving 4.5L/min. IP stated, she needs to check the physician order to verify if Resident 4 was supposed to receive 4.5L/min of supplemental oxygen. During a concurrent interview and record review on 5/12/25 at 12:45 p.m. with the IP, Resident 4's Physician Order Summary (POS) was reviewed. The POS indicated , . Oxygen 2LPM (liters per minute) via Nasal Cannula Continuously . Order Date 4/23/25 . The IP stated, Resident 4 current oxygen setting was incorrect and could potentially cause harm if not corrected immediately. The IP stated, the higher flow of oxygen could have a negative effect on Resident 4's overall health. The IP stated, she expect the licensed nurses to routinely check the oxygen setting during medication pass and as needed, and it was not done. During a concurrent interview and record review on 5/12/25 at 2:04 p.m. with the Minimum Data Set Nurse (MDSN), Resident 4's Progress Note (PN) was reviewed. The MDSN stated, she was unable to find any documentation indicating Resident 4 ' s oxygen level dropped below 90% (percent- unit of measurement) and a physician ' s order to increase the oxygen delivery from 2LPM to 4.5LPM. The MDSN stated, Resident 4 could get hurt from receiving too much oxygen. (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 5 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 05/13/2025 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)