Health inspection·December 18, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete measurement of how much oxygen the blood is carrying as a percentage] reading.During a review of Resident 30's PN, dated 12/11/25 at 12:50 p.m. the PN indicated, resident [30] is lethargic but responds to painful stimuli.breath sounds in the upper and lower lobes [parts of the lungs] are coarse [rattling noise].During a review of Resident 30's PN, dated 12/10/25 at 2:30 p.m. the PN indicated, Change of Condition.noted with LLL [left lower lobe] diminished with crackles.follows simple commands but lethargic.Recommendations: chest x-ray [picture of the lungs].During a review of Resident 30's Radiology Results Report (RRR), dated 12/11/25, the RRR indicated, Examination Date: 12/11/25 15:39 [3:39 p.m.]. Reported Date: 12/11/25 17:28 [5:28 p.m.] .Conclusion: Bibasilar airspace disease [air sacs in the lower parts of the lungs are filled with fluid, pus or blood].During a review of Resident 30's PN, dated 12/11/25 at 11:14 p.m. the PN indicated, RT [respiratory therapist-healthcare professional who helps patients who are having trouble breathing] assessed PT [patient], coarse and gurgling [lung sounds]. During a review of Resident 30's PN, dated 12/12/25 at 12:22 a.m., the PN indicated, placed pt on 1L [one liter] NC [nasal cannula- a small plastic tube, which fits into the person's nostrils for providing supplemental oxygen] due to saturation being below 90% [low oxygen saturation considered a medical concern] .During a review of Resident 30's PN, dated 12/12/25 at 1:03 a.m., the PN indicated, Received resident's Chest Xray result for examination date 12/11/25.Awaiting further orders at this time.During a review of Resident 30's PN, dated 12/12/25 at 6:39 a.m., the PN indicated, At approximately 2300 [11:00 p.m.] assigned CNA reported resident had gurgling breath sounds.During a concurrent record review and interview on 12/17/25 at 8:23 a.m. with Infection Preventionist (IP), Resident 30's PN, dated 12/10/25 through 12/14/25 were reviewed. The PN indicated Resident 30 had a change in condition on 12/10/25 when his lung sounds were noted as diminished (quieter). The PN indicated a chest x-ray was ordered on 12/11/25. The PN indicated the results of the chest x-ray were placed in the medical record on 12/11/25 at 5:28 p.m. The PN indicated the physician did not read the results and order antibiotics (medication to treat an infection) until 12/14/25. The IP stated Resident 30 had a chest x-ray completed on 12/11/25 and the physician did not read the results until 12/14/25, three days later.During an interview on 12/17/25 at 9:27 a.m. with Director of Nursing (DON), DON stated the nursing staff notified the physician by fax on 12/11/25; however, the physician did not review and respond until 12/14/25. The DON stated when the physician does not respond the staff should have called the physician to ensure he received the test results. During a review of the facility's P&P titled, Lab and Diagnostic Test Results-Clinical Protocol, dated 11/2018, the P&P indicated, Assessment and Recognition: 1. The physician will identify and order diagnostic and lab testing based on the resident's diagnostic and monitoring needs. 2. The staff will process test requisitions and arrange for tests.Review by Nursing Staff: 1. When test results are reported to the facility, a nurse will first review the results.3. A nurse will identify the urgency of communicating with the Attending Physician based on physician request, the seriousness of any abnormality, and the individual's current condition.b. To assess a condition change or recent onset of signs and symptoms.Identifying Situations that Warrant Immediate Notification: 1. Nursing staff will consider the following factors to help identify situations requiring prompt physician notification concerning lab or diagnostic test results.Whether the resident/patient's clinical status is unclear or he/she has signs and symptoms of acute illness or condition change. Physician Responses: 1. Time frames. A physician will respond within an appropriate time frame, based on the request from nursing staff and the clinical significance of the information. a. A physician should respond within one hour regarding a lab test result requiring immediate notification, and by the end of the next office day to a non-emergency message regarding non-immediate lab test notification with a request for response. Event ID: Facility ID: 555053 If continuation sheet Page 2 of 15 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 12/18/2025 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to follow its policy and procedure (P & P) titled, Safe and Homelike Environment, for one of six sampled residents (Resident 13), when cold air entered the room from the closed sliding door. This failure resulted in Resident 13 feeling cold in her room and had the potential for Resident 13 to become hypothermic (extreme cold temperature). Findings:During a concurrent observation and interview on 12/15/25 at 11:21 a.m. with Resident 13 in Resident 13's room, a piece of plastic was covering bottom of the closed patio sliding door. Resident 13 stated the air leaking from under the sliding door made her feel cold. Resident 13 stated the room was freezing cold.During an interview on 12/18/25 at 11:57 a.m. with Environmental Supervisor (ES), ES stated Resident 13 complained about being cold in her room. ES was unable to provide documentation a door company was contacted regarding Resident 13's patio door leaking cold air.During a review of the facility's Policy and Procedure (P&P) titled, Safe and Homelike Environment, (undated), the P&P indicated, Comfortable and safe temperature levels, means that the ambient temperature should be in a relatively narrow range that minimizes residents' [sic] susceptibility to loss of body heat and risk of hypothermia/ hyperthymia[sic] and is comfortable for the residents. Event ID: Facility ID: 555053 If continuation sheet Page 3 of 15 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 12/18/2025 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on interview and record review, the facility failed to follow its policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered (CCP) for three of six sampled residents (Resident 6, Resident 21, and Resident 32) when:Resident 21's CCP titled, Resident 21 is on Prophylactic Antibiotic Therapy [medications to prevent disease] r/t [related to] diagnosis of latent [inactive] tuberculosis (TB - a serious, contagious bacterial infection that usually attacks the lungs with two forms: latent and active [disease]) was not followed. Resident 32 did not have CCPs developed for anxiety (feelings of unease) and use of hydrOXYzine (medication to help reduce anxiety).These failures had the potential for Resident 6, Resident 21, and Resident 32 to have a delay in care. Findings:1. During a review of Resident 21's CCP titled, Resident 21 is on Prophylactic Antibiotic Therapy r/t diagnosis of latent tuberculosis, dated 11/4/25. The CCP indicated, Goal: Resident 21 will be free of any s/s (sign and symptoms) of TB with intervention of Any antibiotic may cause diarrhea, nausea, vomiting, anorexia [low appetite], and hypersensitivity/allergic reactions. Monitor q-shift [every shift] for adverse reaction.During a concurrent interview and record review on 12/17/25 at 1:47 p.m. with Infection Preventionist (IP), Resident 21's Physician Orders (PO), dated 12/17/25, and Medication Administration Record (MAR), dated November and December of 2025, were reviewed. The PO indicated, monitor vital signs and s/s of respiratory illness: 0. none observed, 1. fever or chills, 2. cough, 3. shortness of breath, 4. fatigue, 5. muscle or body aches, 6. headache, 7. new loss of taste or smell, 8. sore throat, 9. congestion or runny nose, 10. nausea or vomiting, and 11. diarrhea, three times a day for respiratory illness monitoring. IP stated Resident 21's MAR does not have records of s/s of respiratory illness. IP stated the PO indicated Resident 21's s/s of respiratory illness should be monitored.2. During a record review of Resident 32's Order Summary Report (OSR), dated 12/18/25, the OSR indicated hydrOXYzine HCl Oral [by mouth] Tablet 10 MG [milligrams-unit of measure] (Hydroxyzine HCl) Give 1 tablet by mouth every 24 hours as needed for anxiety with order date of 11/6/25. During a concurrent interview and record review on 12/17/25 at 3:49 p.m. with Health Information (HI), Resident 32's CCPs were reviewed. HI stated Resident 32 does not have CCP for anxiety or use of hydrOXYzine.During a review of the facility's P&P titled, Care Plans, Comprehensive Person-Centered, dated 2001, the P&P indicated, Policy Statement: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Policy Interpretation and Implementation. 9. Care plan interventions are chosen only after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making. 10. When possible, interventions address the underlying source(s) of the problem area(s), not just symptoms or triggers. 11. Assessments of residents are ongoing, and care plans are revised as information about the residents and the residents' condition change. Event ID: Facility ID: 555053 If continuation sheet Page 4 of 15 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 12/18/2025 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)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on interview and record review the facility failed to follow its policy and procedure (P&P) titled, Resident Participation- Assessment/Care Plans, when one of one sampled resident (Resident 10)'s representative (RP) was not followed up to attend the Interdisciplinary Team Meetings (IDT-a meeting where professionals meet to collaborate, develop, review, and coordinate a care plan) to participate and follow-up after those meetings when the RP was not in attendance for the last six months. This failure had the potential to result in Resident 10's unmet care needs. Findings: During an interview on 12/15/25 at 3:03 p.m. with Family Member (FM) 1, FM 1 stated she has never been asked to participate in care planning or care conferences to discuss the care provided to Resident 10. FM 1 stated she had concerns about the care being provided to Resident 10 that had not been addressed by the facility. During a concurrent interview and record review on 12/17/25 at 9:32 a.m. with Director of Nursing (DON), Resident 10's IDT Care Conference Summary (IDTCCS), dated 6/19/25 and 9/11/25 were reviewed. The IDTCCS indicated Resident 10's RP [FM 1] had not been attending the quarterly meetings. The IDTCCS indicated there was no follow up to Resident 10's FM 1 to discuss the meeting and care provided to Resident 10. DON stated the FM 1 was not answering when we called. DON stated we should have followed up and called the FM 1 again. DON stated the importance of the FM 1 being a part of the IDT meetings was because it provides them with updates on care and for them to provide any further guidance in the care, they want the resident to receive. DON stated Social Services should be sending a letter to the FM 1 to indicate the date and time of the next meeting. DON stated there was no follow-up with the FM 1 from the last two care conferences. During an interview on 12/17/25 at 9:39 a.m. with Social Services Director (SSD), SSD stated she sends out a certified letter to the representative a week before the IDT meeting. During a concurrent interview and record review on 12/17/25 at 9:40 a.m. with SSD, Resident 10's IDTCCS, dated 6/16/25 and 9/11/25 were reviewed. The IDTCCS indicated there was no follow up to the FM 1 after the meeting. SSD stated the RP did not participate in the meeting and there was no follow-up to the FM 1 after the meeting. SSD stated a certified letter was not sent to the FM 1 indicating the next meeting date and time prior to the IDT Care Conference. SSD stated she should have continued to call the FM 1 the next few days to follow up. SSD stated the IDT Care Conferences are not completed until the RP is notified. SSD stated the IDT Care Conferences held in June and September have not been completed. SSD stated the last time she spoke with FM 1 was in March 2025, six months ago. SSD stated FM 1 not participating in the IDT care conferences is a concern and should have followed up.During a review of the facility's P&P titled, Resident Participation- Assessment/Care Plans, dated 2/2021, the P&P indicated, Policy Statement: The resident and his or her representative are encouraged to participate in the resident's assessment and in the development and implementation of the resident's care plan. Policy Interpretation and Implementation: 1. The resident and his or her legal representative are encouraged to attend and participate in the resident's assessment and in the development of the resident's person-centered care plan.5. Facility staff supports and encourages resident/representative participation in the care planning process by.b. holding care planning meetings at times of day when the resident, representative and family members can attend and are functioning at their best; c. providing sufficient notice in advance of the meeting.9. The social services director or designee is responsible for notifying the resident/ representative and for maintaining records of such notices. Event ID: Facility ID: 555053 If continuation sheet Page 5 of 15 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 12/18/2025 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)

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to provide activities which reflected two of five sampled residents' (Resident 5 and Resident 53) choices and/or interests. This failure had the potential to negatively impact mental and psychosocial well-being of Resident 5 and Resident 53. Findings: 1a. During a review of Resident 5's Quarterly Activities Participation Review (QAPR), dated 11/9/25, the QAPR indicated, [Resident 5] needs encouragement and assistance during activities. [Resident 5] likes to play ball/balloon toss and sensory touch materials.Resident is up daily in his wheelchair and is dependent on staff to take him to activities. Activity staff will continue to provide assistance and encouragement during activities. During a review of Resident 5's Care Plan (CP), dated 2/3/25, the CP indicated, [Resident 5] is dependent on staff for meeting emotional, intellectual [related to thinking], physical, and social needs.Provide 1:1 [one-to-one] room visit if unable to attend group activities to monitor activity needs and offer activity materials and socialization. Resident enjoys: playing ball/balloon toss.sensory touch items.The resident needs assistance/escort to activity functions.During an observation on 12/15/25 at 10:00 a.m. the activities schedule posted in the hallway outside the activity/dinning room showed balloon volleyball at 10:00 a.m. During an observation on 12/15/25 at 10:02 a.m. staff are setting up the activities room for balloon volleyball. Six residents participated in balloon volleyball. Resident 5 was not in attendance. During an interview on 12/16/25 at 2:38 p.m. with Activities Assistant (AA) 1, AA 1 stated one activities assistant is assigned to room visits to see residents daily who do not participate in activities in the activity room. AA 1 stated activity documentation is completed in the activity's binder. During an interview on 12/16/25 at 3:01 p.m. with Activities Director (AD), AD stated her expectation for staff is to notify all residents of the activities that are happening daily and complete room visits for those residents who did not participate in the group activities daily. AD stated room visits should include activities such as coloring, word search, sudoku, dominos, and magazines. AD stated room visits should last between 10-15 minutes for each resident. AD stated staff should assist Resident 5 daily to join group activities in the activities room. AD stated if Resident 5 did not participate in the group activity, then a room visit should be provided to Resident 5. AD stated some room visit activities for Resident 5 could include providing lotion and/or sensory toys for stimulation. During a concurrent record review and interview on 12/16/25 at 3:06 p.m. with AD, Resident 5's Activity Attendance Record (AAR), dated 12/1/25 through 12/15/25 was reviewed. The AAR indicated Resident 5 only had room visits during the reviewed dates and the activities were social contact and hand massage only. AD stated, we could do more for him [Resident 5]. AD stated staff should have provided more engaging activities for Resident 5 using objects or games. AD stated there is no time or length of stay documented, but room visits should be 10-15 minutes long. AD stated because the time is not documented she cannot verify the staff completed the room visits per policy. 1b. During a review of Resident 53's QAPR, dated 12/11/25, the QAPR indicated, [Resident 53] enjoys playing bingo and Loteria [Spanish BINGO], ball/balloon toss, exercises, watching TV, singing. [Resident 53] uses a wheelchair at times and depends on staff to take him to the dining room for activities. Activity staff will continue 1:1 room visits to monitor his activity needs and provide materials and socialization.During a review of Resident 53's CP, dated 12/11/25, the CP indicated, [Resident 53] is dependent on staff for meeting emotional, intellectual, physical, and social needs r/t [related to] Physical limitations.Resident likes to: play bingo and Loteria, play ball/balloon toss, exercises, watch tv.singing. The resident needs 1:1 bedside/in-room visits and activities if unable to attend out of room events.Ensure that the activities the resident is attending are: Compatible with physical and mental capabilities; Compatible with known interests and Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555053 If continuation sheet Page 6 of 15 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 12/18/2025 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)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete preferences.Compatible with individual needs and abilities; and Age appropriate. During a concurrent record review and interview on12/16/25 at 3:11 p.m. with AD, Resident 53's AAR, dated 12/1/25 through 12/15/25 was reviewed. The AAR indicated Resident 53 had room visits eleven days out of fifteen days and was only given hand massages for his room activities. AD stated the activity staff could provide better room activities for Resident 53. During a review of the facility's P&P titled, Activity Evaluation, dated 2/2023, the P&P indicated Policy Statement: In order to promote the physical, mental, and psychosocial well-being of residents, a activity evaluation is conducted to maintained for each resident at least quarterly and with any change of condition that could affect his/her participation in planned activities. Policy Interpretation and Implementation: 1. An activity evaluation is conducted as part of the comprehensive assessment to help develop an activities plan that reflects the choices and interests of the resident.4. The resident's lifelog interests, spirituality, life roles, goals, strengths, needs and activity pursuit patterns and preferences are included.The activity evaluation is used to develop an individual activities care plan.that will allow the resident to participate in activities of his/her choice and interests Event ID: Facility ID: 555053 If continuation sheet Page 7 of 15 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 12/18/2025 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)

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to follow its policy and procedure (P&P) titled, Hemodialysis [HD - a life-sustaining treatment that filters blood when failing kidneys cannot], for one of one sampled resident (Resident 56) when blood pressure (BP) was taken on the dialysis access arm. This failure had the potential for Resident 56 to acquire complications such as clotting, damage to the access, and increase risk of infection. Findings: During a review of Resident 56's admission RECORD (AR), dated 12/18/25, the AR indicated, END STAGE RENAL [kidney] DISEASE. During a review of Resident 56's Nursing - Pre Dialysis Evaluation & Communication (NPDEC), dated November and December 2025, the NPDEC indicated left AV shunt (a surgically created connection between an artery and a vein to provide reliable, long-term access for HD). The NPDEC indicated BP was taken on the left arm on 11/21/25 and 12/1/25. During a review of Resident 56's Nursing - Post Dialysis Evaluation (NPDE), dated November and December 2025, the NPDE indicated BP was taken on the left arm on 12/10/25, 12/12/25, and 12/15/25.During an interview on 12/18/25 at 9:24 a.m. with Licensed Vocational Nurse (LVN) 2, LVN 2 stated the HD access was on Resident 56's left arm. LVN 2 stated BP should not be taken on the HD access site. LVN 2 stated he did not know what could happen if BP is taken on the arm with HD access. During a P&P titled, Hemodialysis, dated 2025, the P&P indicated, Policy: This facility will provide the necessary care and treatment, consistent with professional standards of practice, physician orders, the comprehensive person-centered care plan, and the resident's goals and preferences, to meet the special medical, nursing, mental, and psychosocial needs of residents receiving hemodialysis. Compliance Guidelines. The resident will not receive blood pressures or laboratory sticks on the arm where the dialysis access device is located. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555053 If continuation sheet Page 8 of 15 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 12/18/2025 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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to ensure one of 27 twenty-seven sampled residents' (Resident 48) medication was ordered. This failure resulted in the delay of administering medication and potential for Resident 48 experiencing adverse health outcomes. During a concurrent observation and interview on 12/16/25 at 7:59 a.m. in the hallway, with Licensed Vocational Nurse (LVN) 1, LVN 1 was passing medication, she searched for Resident 48's Pantoprazole (stomach acid reducing medication) medication. LVN 1 was unable to locate Resident 48's medication in the medication cart.During a concurrent interview and record review on 12/16/25 at 8:06 a.m. with LVN 1, Resident 48's Medication Administration Record (MAR), dated December 2025 was reviewed. The MAR indicated, on 12/15/25 code 9 other see nursing notes.During a review of Resident 48's Order Summary (OS), dated 12/16/25 the OS indicated Protonix Tablet Delayed Release 40 mg (milligrams- unit of measure) (Pantoprazole Sodium) Give 1 tablet by mouth two time a day for GERD (medication used to treat heartburn) administer 30 to 60 minutes before a meal.During a concurrent interview and record review on 12/17/25 at 1:18 p.m. with Director of Nursing (DON) Resident 48's Progress Note (PN), dated 12/14/25 to 12/16/25 were reviewed. The PN indicated the following:12/14/25 at 5:53 p.m. Protonix Tablet Delayed Release 40 mg (milligrams- a unit of measure). Give 1 tablet by mouth two times a day for GERD.12/15/25 at 9:01 a.m. Protonix Tablet Delayed Release 40 mg, Give 1 tablet by mouth two times a day for GERD. Med [medication] is not available.12/16/25 at 8:13 a.m. Protonix Tablet Delayed Release 40 mg, Give 1 tablet by mouth two time a day for GERD. Med unavailable.12/16/25 at 8:42 a.m. Protonix Tablet Delayed Release 40 mg (Pantoprazole Sodium) Give 1 tablet by mouth two times a day for GERD. Received Interim Medication Regimen Review and recommended to be given 30 to 60 minutes before a meal. MD in agreement to change the order.12/16/25 at 9:34 a.m. Protonix Tablet Delayed Release 40 mg (Pantoprazole Sodium). Give 1 tablet by mouth two times a day for GERD administer 30 to 60 minutes before a meal. DON followed up with [pharmacy] to expedite the process to send the medication and anything he needs approval and ok to bill to facility.12/16/25 at 4:57 p.m. Protonix Tablet Delayed Release 40 mg. Medication is unavailable; pending pharmacy delivery. MD was notified and was ok to hold until mediation is available. No new orders. DON stated the nurses should not have run out of Resident 48's medication. During a review of facility's policy and procedure (P &P) titled Medication Administration, Review, dated 7/21, the P &P indicated, Keep medication cart clean, organized, and stocked with adequate supplies. Event ID: Facility ID: 555053 If continuation sheet Page 9 of 15 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 12/18/2025 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)

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review, the facility failed to follow its policy and procedure (P&P) titled, Food Preparation Guidelines, for eight of eight sampled residents (Resident 4, Resident 16, Resident 23, Resident 29, Resident 34, Resident 37, Resident 39, and Resident 49) when food was not mechanical soft to meet their diet orders. This failure had the potential for undesired outcomes such as weight loss or chocking. Findings:During an observation on 12/16/25 at 12:05 p.m. in the kitchen during tray line, lunch meals were prepared. Dietary Aide (DA/C-Cook as needed) served Resident 4, Resident 16, Resident 23, Resident 29, Resident 34, Resident 37, Resident 39, and Resident 49 garlic bread, lasagna, broccoli, and a parsley garnish. During an interview and record review on 12/16/25 at 12:24 p.m. with Dietary Manager (DM), Resident 4, Resident 16, Resident 23, Resident 29, Resident 34, Resident 37, Resident 39, and Resident 49 meal tickets and Winter Menu (spreadsheet), dated 2025, were reviewed. Resident 4, Resident 16, Resident 23, Resident 29, Resident 34, Resident 37, Resident 39, and Resident 49 indicated mechanical soft texture. The Winter Menu indicated lasagna chopped with no hard edges, broccoli chopped and soft, no parsley garnish, and chop/soak/drain garlic bread. DM stated Resident 4, Resident 16, Resident 23, Resident 29, Resident 34, Resident 37, Resident 39, and Resident 49 lunch trays needed to be corrected for mechanical soft texture.During a review of the facility's P&P, titled, Food Preparation Guidelines, dated 2025, the policy indicated, Policy: It is the policy of this facility to prepare foods in a manner to preserve or enhance a resident's nutrition and hydration status. Policy Explanation and Compliance Guidelines: 1. The cook, or designee, shall prepare menu items following the facility's written menus and standardized recipes. 4. Food shall be provided in a form (i.e. regular, cut, chopped, ground, pureed) that meets each resident's individual needs in accordance with his or her assessment and care plan. Event ID: Facility ID: 555053 If continuation sheet Page 10 of 15 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 12/18/2025 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)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on observation, interview, and record review, the facility failed to follow its policy and procedure (P&P) titled, FOOD PREFERENCES, for 20 of 21 sampled residents (Resident 32, Resident 1, Resident 2, Resident 4, Resident 7, Resident 9, Resident 21, Resident 22, Resident 36, Resident 37, Resident 44, Resident 48, Resident 49, Resident 50, Resident 55, Resident 12, Resident 17, Resident 34, Resident 41, and Resident 6) when residents' meals ticket did not have likes and/or dislikes completed. This failure had the potential for food requests to not be honored. Findings:During an interview on 12/15/25 at 10:07 a.m. with Resident 32, Resident 32 stated he does not really like the food but will eat food to not lose weight. Resident 32 stated he has told staff (unknown) multiple times he wants his eggs well done, and it has not been accomplished. Resident 32 stated he has told them multiple times he does not like gravy and still it's being served. Resident 32 stated he wants fresh fruit and not canned fruit.During a record review on 12/15/25 at 12:09 p.m. Resident 1, Resident 2, Resident 4, Resident 7, Resident 9, Resident 21, Resident 22, Resident 36, Resident 37, Resident 44, Resident 48, Resident 49, Resident 50, and Resident 55, meal tickets were reviewed. Their meal tickets indicated missing likes, dislikes, or both.During an interview on 12/15/25 at 12:10 p.m. with Resident 1, Resident 34, Resident 44, Resident 50, and Resident 9, Resident 1 stated he ordered a chocolate pudding and did not receive it. Resident 34 stated he has not been asked regarding his food preferences. Resident 44 stated she has not been asked regarding her food preferences and the food is repeated often and would like to eat something different. Resident 50 stated she has not been asked regarding her food preferences. Resident 9 stated he has not been asked regarding his food preferences. During a review of Resident 32's meal ticket, dated 12/15/25, the meal ticket did not have any listed likes (such as likes eggs well done and fresh fruit).During a review of Resident 12's meal ticket, dated 12/15/25, the meal ticket did not indicate any dislikes and likes.During a review of Resident 17's meal ticket, dated 12/15/25, the meal ticket did not indicate any dislikes and likes.During a review of Resident 34's meal ticket, dated 12/15/25, the meal ticket did not indicate any dislikes and likes.During a review of Resident 41's meal ticket, dated 12/15/25, the meal ticket did not indicate any dislikes and likes.During a concurrent observation and interview on 12/15/25 at 12:25 p.m. with Resident 6 in the dining room, Resident 6 had pureed fish on his lunch plate, and he ate part of it. Resident 6 stated he has not been asked regarding his food preferences and he is vegetarian. Resident 6 stated he does not want fish, eggs and cheese.During an interview on 12/16/25 at 3:31 p.m. with Dietary Manager (DM), DM stated she does not document resident's food preferences in the electronic health record. During a review of the facility's P&P titled, FOOD PREFERENCES, dated 2023, the P&P indicated, POLICY: Resident's food preferences will be adhered to within reason. Substitutes for all foods disliked will be given from the appropriate food group. PROCEDURE: Food preferences will be obtained as soon as possible through the initial resident screen. Updating of food preferences will be done as the resident's needs change and/or during the quarterly review. Event ID: Facility ID: 555053 If continuation sheet Page 11 of 15 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 12/18/2025 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to follow its policy and procedure (P&P) titled, Food Safety Requirements, when molded bread was not thrown out. This failure had the potential for residents to acquire foodborne illness. Findings:During an observation on 12/15/25 at 8:42 a.m. in the kitchen's storage room, there was sandwich breads with handwritten date R [received by]: 11/26/25 and UB [use by] 12/2/25. The storage room contained a bag of English muffins with two muffins green in colored. During an interview on 12/15/25 at 8:45 a.m. with Dietary [NAME] (DC), DC stated there should not be any expired food. DC stated storage food should be checked daily and expired food thrown away in the trash. DC stated these breads are dated incorrectly and she is unsure of its manufactured expiration date. DC stated the English muffins where overlooked. During a review of the facility's P&P titled, Food Safety Requirements, dated 2025, the policy indicated, Policy. Food will also be stored, prepared, distributed and served in accordance with professional standards for food service safety. Policy Explanation and Compliance Guidelines: 1. Food safety practices shall be followed throughout the facility's entire food handling process. This process begins when food is received from the vendor and ends with delivery of the food to the resident. Elements of the process include the following. b. Storage of food in a manner that helps prevent deterioration or contamination of the food, including from growth of microorganisms. Event ID: Facility ID: 555053 If continuation sheet Page 12 of 15 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 12/18/2025 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)

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to follow its policy and procedure (P&P) titled Influenza (Flu- contagious respiratory disease) Vaccine when:1. The Infection Preventionist (IP) did not provide and document the education of explanation of risks and benefits for the flu vaccine for four of five sampled Residents (Resident 9, Resident 10, Resident 5, and Resident 2). 2. The IP did not contact Resident 53's representative (RP) for Resident 53 to receive the flu vaccine.These failures resulted in inaccurate documentation, and had the potential to spread infectious diseases.Findings:1. During a concurrent interview and record review on 12/17/25 at 8:49 a.m. with IP, Resident 9's Vaccine Consent Form. (VCF), dated 7/14/25 and Progress Note (PN), dated 7/14/25 were reviewed. The VCF indicated Resident 9's vaccine consent was signed on 7/14/25 by the RP. The PN did not indicate there was any education provided to Resident 9's RP about the risk and benefits of the flu vaccine. IP stated there was no documentation of education provided to Resident 9's RP for the flu vaccine. During a concurrent interview and record review on 12/17/25 at 8:53 a.m. with IP, Resident 10's VCF, dated 7/14/25 and PN, dated 7/14/25 were reviewed. The VCF indicated Resident 10's vaccine consent was signed on 7/14/25 by the RP. The PN did not indicate there was any education provided to Resident 10's RP about the risk and benefits of the flu vaccine. IP stated there was no documentation of education provided to Resident 10's RP, but the RP should have been educated on the risks and benefits of the Flu vaccine. During a concurrent interview and record review on 12/17/25 at 9:00 a.m. with IP, Resident 5's VCF, dated 7/14/25 and PN, dated 7/14/25 were reviewed. The VCF indicated Resident 5's vaccine consent was signed on 7/14/25 by the RP. The PN did not indicate there was any education provided to Resident 5's RP about the risk and benefits of the flu vaccine. IP stated there was no documentation of education provided to Resident 5's RP for the flu vaccine. During a concurrent interview and record review on 12/17/25 at 9:03 a.m. with IP, Resident 2's VCF, dated 11/21/25 and PN were reviewed. The VCF indicated Resident 2's vaccine consent was signed on 11/21/25 by Resident 2. The PN did not indicate there was any education provided to Resident 2 about the risk and benefits of the flu vaccine. IP stated there was no documentation of education provided to Resident 2 because he is Spanish speaking and another staff member translated for me. IP stated Resident 2's language barrier was not an excuse to not provide education about the risk and benefits of the flu vaccine. 2. During a concurrent interview and record review on 12/17/25 at 9:06 a.m. with IP, Resident 53's VCF and PN were reviewed. The VCF and PN did not indicate Resident 53 was offered the flu vaccine. IP stated Resident 53 did not receive his flu vaccine and there was no documentation Resident 53's RP was contacted for the flu vaccine. IP stated, I should have documented I called the RP, and followed up. During an interview on 12/17/25 at 10:23 a.m. with IP, IP stated there is no policy for contacting Resident's RP for immunizations. IP stated the process was to continue to call the Resident's RP or notify the medical doctor to ensure Resident 53 was offered the flu vaccine. During a review of the facility's P&P titled, Influenza Vaccination, undated, the P&P indicated, Policy: It is the policy of the facility to minimize the risk of acquiring, transmitting or experiencing complications from influenza by offering our residents.annual immunization.Policy Explanation and Compliance Guidelines.3. Additionally, influenza vaccinations will be offered to residents.5. Prior to the administration of the influenza vaccine, the person receiving the immunization, or his/her legal representative, will be provided with a copy of the CDC's current vaccine information statement relative to the influenza vaccination. 6. The vaccine information statement (VIS) will, as appropriate, be supplemented with visual presentations or oral explanations to assist vaccine recipients in understanding the benefits and potential side effects of the influenza vaccine.9. The resident's medical record.will include Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555053 If continuation sheet Page 13 of 15 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 12/18/2025 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)

F 0883 Level of Harm - Minimal harm or potential for actual harm documentation that the resident and/or the representative was provided education regarding the benefits and potential side effects of immunizations, and that the resident received or did not receive the immunizations due to medical contraindication or refusal. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555053 If continuation sheet Page 14 of 15 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 12/18/2025 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)

F 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. Based on interview and record review the facility failed to follow its policy and procedure (P&P) titled Infection Prevention and Control Program when three of five sampled residents (Resident 9, Resident 10, and Resident 5)'s representatives (RP) were not explained of risks and benefits of the Covid-19 vaccines (Coronavirus disease- a highly contagious respiratory disease). This failure had the potential for inaccurate medical records and spread of infectious diseases to staff and visitors. Findings:During a concurrent interview and record review on 2/17/25 at 8:49 a.m. with Infection Preventionist (IP), Resident 9's Vaccine Consent Form (VCF), dated 7/14/25 and Progress Note (PN), dated 7/14/25 were reviewed. The VCF indicated Resident 9's VCF was signed on 7/14/25 by the RP. The PN did not indicate there was any education provided to Resident 9's RP about the risk and benefits of the COVID-19 vaccines. IP stated there was no documentation of education provided to Resident 9's RP for the COVID-19 vaccines. During a concurrent interview and record review on 12/17/25 at 8:53 a.m. with IP, Resident 10's VCF, dated 7/14/25 and PN, dated 7/14/25 were reviewed. The VCF indicated Resident 10's VCF was signed on 7/14/25 by the RP. The PN did not indicate there was any education provided to Resident 10's RP about the risk and benefits of the COVID-19 vaccines. IP stated there was no documentation of education provided to Resident 10's RP, but the RP should have been educated on the risks and benefits of the vaccine. During a concurrent interview and record review on 12/17/25 at 9:00 a.m. with IP, Resident 5's VCF, dated 7/14/25 and PN, dated 7/14/25 were reviewed. The VCF indicated Resident 5's VCF was signed on 7/14/25 by the RP. The PN did not indicate there was any education provided to Resident 5's RP about the risk and benefits of the COVID-19 vaccines. IP stated there was no documentation of education provided to Resident 5's RP for the Covid-19 vaccines. During a review of the facility's P&P titled, Infection Prevention and Control Program, dated 7/1/25, the P&P indicated, Policy: This facility has established and maintains an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections as per accepted national standards and guidelines.8. COVID-19 Immunizations.c. Education about the vaccine, risks, benefits, and potential side effects will be given to residents or resident representatives.g. The resident's medical record includes documentation that indicates, at minimum, the following: i. That the resident or resident representative was provided education regarding the benefits and potential risks associated with COVID-19 vaccine. Event ID: Facility ID: 555053 If continuation sheet Page 15 of 15