Health inspection·May 21, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to implement their care plan for one of three sampled residents (Resident 1). This failure resulted in Resident 1 physically touching Resident 2 on the jaw with a closed fist. Findings: During a review of Resident 1's admission RECORD (AR), dated 5/6/25, the AR indicated, Resident 1 was admitted to the facility on [DATE] with a diagnosis of schizoaffective disorder (a mental health condition in which the person experiences hearing voices, hallucinations and/or false beliefs) bipolar (a mental health condition that causes extreme shifts in mood, energy, and activity levels) type, and adjustment disorder (an emotional or behavioral reaction to a stressful life event or change) with mixed anxiety (a feeling of worry, fear, or nervousness about something that's happening or might happen) and depressed mood (consistently feeling sad, empty, or hopeless, and losing interest in activities you once enjoyed). During a review of Resident 2's AR dated 1/24/25, the AR indicated, Resident 2 was admitted to the facility on [DATE] with a diagnosis of development disorder of scholastic skills (a person who has difficulty learning and using specific academic skills, like reading, writing, or math), anxiety disorder, panic (a sudden episode of intense fear or discomfort that can feel like a physical attack, even though there's no real danger) disorder, Bipolar disorder, and insomnia (a sleep disorder where you have trouble falling asleep, staying asleep, or both). During an interview on 5/21/25 at 11:58 a.m. with Administrator in training (AIT), AIT stated on 5/5/25 a family member (not specified who) reported seeing Resident 1 touched Resident 2's jaw with a closed fist in the dining area. AIT interviewed Resident 1 who stated he did not recall the incident. AIT interviewed Resident 2 who stated he was touched on his shoulder (not specific which) by Resident 1. AIT stated Resident 1 had a history of physical altercation with Resident 2 (no date given) and other residents. AIT stated due to Resident 1's multiple altercation with residents, there was a care plan in place that staff were to keep Resident 1 separated from other residents in the dining area. During a review of Resident 1's Care Plan Report (CP), dated 9/19/24, the CP indicated, Resident 1 was physically aggressive with another resident (not specified who) when he elbowed the other resident in the upper arm. An intervention listed on 9/19/24 was to monitor Resident 1's behavior and, If resident (Resident 1) is in the dining room Please (sic) make sure to keep him away from other residents due to behaviors. (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: 555053 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 555053 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley View Care Center 729 Browning Road 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)