Health inspection·August 14, 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 interview and record review, the facility failed to provide services which met professional standards of practice for two of the five sampled residents (Resident 1, and Resident 5) when Resident 1 and Resident 5's medications were not available, and the license nurse did not notify the physician the medications were not administered. This failure had the potential risk for Resident 1 and Resident 5 to experience worsening of existing health conditions and delayed medical response. During a record review on 8/7/25 at 11:47 a.m. with the Licensed Vocational Nurse (LVN) at the nurses' station, Resident 1's admission Record (AR- a document that provides resident contact details, a brief medical history, level of functioning, preferences, and wishes), dated 8/7/25 was reviewed. The AR indicated Resident 1 was admitted [DATE] with diagnoses of left knee osteoarthritis (a degenerative joint disease, in which the tissues in the joint break down over time), asthma (a chronic lung disease caused by inflammation and muscle tightening around the airways making it hard to breathe), hypertensive heart disease (problems with your heart that can develop if you have high blood pressure), hypothyroidism (thyroid gland doesn't make enough thyroid hormone), attention-deficit (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) disorder, hyperlipidemia (high cholesterol), major depressive disorder (persistent feeling of sadness and loss of interest), anxiety (differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety) disorder and dry eye syndrome. During a concurrent interview and record review on 8/7/25 at 11:50 a.m. with the LVN, Resident 1's MAR dated 7/2025 was reviewed. The MAR indicated the Gabapentin (medication used to treat epilepsy [a brain condition that causes abnormal brain electrical activities]) 600 milligrams (mg-unit of measurements) tablet - give 2 tablets by mouth at bedtime for pain, Nortriptyline Hydrochloride (medication used to treat depression and its commonly prescribed for various pain) 10 mg capsule- give 10 mg by mouth at bedtime for depression, Sertraline Hydrochloride (medication used to treat depression and panic disorder) 100 mg tablet - give 100 mg by mouth at bedtime for depression and Icosapent ethyl (omega-3 fatty acids) 1gm capsule-give 1 capsule by mouth two times a day for HLD (hyperlipidemia-abnormal high levels of fats), all scheduled to start on 7/10/25, were not administered due to pending pharmacy delivery. The LVN stated when medications are unavailable and not given, the licensed nurse (LN) should have notified the physician so the physician could decide whether Resident 1 can skip the dose, needs an alternative medication, or should go to the hospital. The LVN stated she could not find any documentation the LN notified the provider. The LVN stated failure to follow the facility's unavailable medication procedure could put Resident 1 at risk for worsening chronic conditions. During a review of Resident 5's admission Record (AR- a document that provides resident contact details, a brief medical history, level of functioning, preferences, and wishes), dated 8/7/25, the AR indicated Resident 5 was admitted to the facility on [DATE] with diagnoses: right knee effusion (fluids in the tissues around your joint causing swelling), right knee arthritis (joint Residents Affected - Few (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: 056338 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 056338 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morning Star Post Acute 111 Barstow Ave. Clovis, CA 93612 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)