Health inspection·January 8, 2025

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. During an interview on 1/8/25 at 12:16 p.m. with DM, DM stated he was not sure who was the abuse coordinator in the facility for handling allegations of abuse. DM stated the facility was in the middle of their investigation in the allegation of abuse FM 1 made for Resident 1 on 12/30/24. DM stated the investigation should have been done by 1/4/25 (within five days) but was not completed. During a review of the facility Investigation Report Summary (IRS), dated 1/9/25, the IRS indicated, the facility completed their investigation on 1/9/25 (10 days after the allegation of abuse was made). 3. During a concurrent interview and record review on 1/8/25 at 12:12 p.m. with DM, Resident 1's [NAME], dated 1/3/25 was reviewed. DM reviewed the [NAME] and stated Certified Nursing Assistant (CNA) 1 and CNA 2 had an allegation of abuse made towards them by FM 1 on 12/30/24. DM stated he had not read the [NAME] prior to this interview. DM stated CNA 1 and CNA 2 had been working in the facility since the allegation of abuse was made (12/30/24) despite the investigation not being completed. DM stated CNA 1 and CNA 2 were not being observed while working with the facility residents as the facility abuse policy and procedure indicated. DM stated CNA 1 and CNA 2 were not taken off the schedule until the investigation was completed as they should have been. During a review of the facility timesheets (TS), dated 1/2025, the TS indicated: a. CNA 1 worked in the facility after the allegation of abuse was made on 12/30/24 from 7 p.m. to 7:30 a.m. on 1/2/25, 1/3/25, 1/6/25, and 1/7/25. b. CNA 2 worked after the allegation of abuse was made on 12/30/25 from 7 a.m. to 7:30 p.m. on 1/1/25, and 1/2/25. During a review of the facility's policy and procedure (P&P) titled, SUSPECTED CHILD, ADULT, DISABLED PERSON OR ELDERLY ABUSE/NEGLECT/EXPLOITATION, dated 9/28/20, the P&P indicated, Patients have the right to be free from mental, physical, sexual and verbal abuse, neglect and exploitation. It is the policy of this hospital to protect patients from real or perceived abuse, neglect or exploitation from anyone, including staff members, students, volunteers, other patients, visitors or family members. This hospital mandates that, under the guidance of applicable laws, any healthcare worker having reasonable cause to believe that any person is in the state of abuse, exploitation or neglect shall report the information to the appropriate regulatory agency. Cases of suspected sexual assault, physical abuse or neglect will be given priority and will be investigated thoroughly. All cases of suspected abuse/neglect must be reported to authorities. A person (including an employee, volunteer or other person) associated with the hospital, who reasonably believes or who knows of information that would reasonably cause a person to believe that the physical or mental health or welfare of a patient of the hospital, who is receiving medical services, has been, is or will be adversely affected by abuse or neglect by any person shall, as soon as possible, report the information supporting the belief to the Department of Health, or the appropriate healthcare regulatory agency, by telephone, in writing or by personal visit. A healthcare provider who fails to report shall be referred by the Department of Health to the individual's licensing board for appropriate disciplinary action. The department manager, or his/her designee, shall be notified prior to making a report. If allegations exist that the patient is experiencing abuse, neglect or exploitation caused by a staff member(s), that staff member will not be assigned to the involved patient. A thorough investigation will be conducted, during which time his or her immediate supervisor will monitor the staff member's performance until the allegations are proven or disproved. At no time will a staff member suspected of improper actions toward a patient be allowed to interact with any patient without a second staff member in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056426 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 056426 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Adventist Health Delano 1401 Garces Hwy Delano, CA 93215 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 0607 Level of Harm - Minimal harm or potential for actual harm attendance. The hospital must also protect other patients from the acts of the staff member should these acts prove true. Therefore, assignment of the involved staff member to non-patient care activities would be optimum. If circumstances do not allow for this option, the staff member's interaction with patients must be monitored at all times during the investigation. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056426 If continuation sheet Page 3 of 3