Inspection·October 26, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm 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. 2. During an interview on 10/23/23 at 10:25 a.m. with Resident 62, Resident 62 stated the shower in hall D's hot water goes out and takes a while to reheat. Residents Affected - Some During an interview on 10/25/23 at 9:30 a.m. with Resident 55, Resident 55 stated, The shower temperature goes up and down, the girls [Certified Nursing Assistants-CNA's] will get it right then someone will turn water on somewhere else and it will drop cold, and then it will regulate itself and get hot, it goes up and down like that. During an interview on 10/25/23 at 2:30 p.m. with Maintenance Director (MD), MD stated the water temperature was not fixed in hall D. MD stated, We had the same issue in hall A. During an interview on 10/26/23 at 9:06 a.m. with CNA 13, CNA 13 stated, The shower at the end of the hallway has temperature problems, it does have changes in temperature [during showers]. During an interview on 10/26/23 at 9:29 a.m. with CNA 15, CNA 15 stated, The shower temperature in the back of the hall fluctuates, either too hot or cold, you just have to know how to use it. CNA 15 stated the issue with the water temperature in the shower rooms were reported but was never fixed. During a review of the facility's policy and procedure (P&P) titled, Hot Water Temperature Checks, (undated), the P&P indicated, g. All hot water temperature deficiencies that are of an on-going nature; OVER TWO WEEKS; will be fully analyzed to determine cause and a complete report made to the Administrator immediately there after. Based on observation, interview, and record review, the facility failed to provide for three of eight sampled residents (Resident 14, Resident 62, Resident 55) a home-like environment when: 1. Resident 14's bathroom wall paint was peeled off. 2. Water temperature in the shower rooms were turning cold during showers. These failures had the potential to negatively affect residents' quality of life. Findings: 1. During an observation on 10/23/23 at 10:20 a.m. in Resident 14's bathroom, there was paint peeled off around the wall of the hand soap dispenser. During a concurrent observation and interview on 10/23/23 at 3:11 p.m. with Maintenance Assistant (MA), in Resident 14's bathroom, the bathroom wall paint was peeled off around the soap dispenser. MA stated there was an old hand soap dispenser that was removed and when it was removed, it pulled off the wall paint. MA stated they did not fix it (wall paint) and had no record of a repair in the maintenance log. During a review of the facility's policy and procedure (P&P) titled, Interior General Maintenance, dated 12/31/15, the P&P indicated, Maintenance to be responsible for minor repairs and touch ups. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 2 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on observation, interview, and record review, the facility failed to provide prompt efforts to act on and resolve grievances for two of seven sampled residents (Resident 54 and Resident 70). This failure resulted in residents experiencing frustrations and had the potential to affect their quality of life. Findings: During an interview on 10/24/23 at 10 am in the Resident Council Meeting (RCM, organized group of residents who meet regularly to discuss concerns about their rights, qality of care and quality of life), Resident 54 stated, I attend the meeting, and issues are not resolved. They [the facility] do not resolve anything, they blame the state (California Department of Public Health) for everything. Resident 54 stated, the rose garden is important and the ramp to get out there needs to be fixed, I have to lift my walker to get in and out of the rose garden, the facility does not fix things correctly.Resident 54 stated she loved the rose garden and is the only nice place she can go but she required assistance to go in and out due to the steep ramps. During an interview on 10/24/23 during the 10 am RCM, Resident 70 stated, the [garden] is important for us to get outside get fresh air, sunshine, and vitamin D. My wife comes to visit, and she has to help me in my wheelchair to get outside and back in. During a record review of the Resident Council Minutes (RCM), dated May 2023, July 2023, and August 2023 (for three months), the RCM indicated, Maintenance Repairs Needed: Ramp going outside needs to be changed, ramp going outside steep, ramp needs to be improved. During a review of the RCM dated September 2023, the RCM indicated, Department Response: Had someone come look at it (ramp into garden). Will be completed by 1/1/24 [eight months to resolve]. During an observation on 10/24/23 at 11:45 a.m. at the hallway, going to the patio (rose garden), there were two ramps going to the patio. One ramp with angle of 45 degrees steep and the other ramp with 15 degrees steep. During an interview on 10/26/23 at 9:20 a.m., with Maintenance Director (MD), MD stated, I have known about the ramp going outside to the garden for about two months, we have not fixed it, I have had to look around due to pricing. MD verified the finding and stated the ramp is steep and residents needed asisstance to go through. During an interview on 10/24/23 at 10:08 a.m. with Resident 54, Resident 54 stated they are unaware of how to formally file a grievance or contact the state (CDPH). During a concurrent interview and record review on 10/24/23 at 3:00 p.m., with Social Services Director (SSD), the facility's Grievance Log (GL), dated 2023 was reviewed. SSD stated, We do not like grievances, we try and get the issues resolved when the residents bring it to our attention, because like I said we don't like grievances. SSD reviewed the grievance log for 2023, SSD stated there was only one grievance filed in January 2023 and none there after. During a review of the facility's policy and procedure (P&P) titled, Resident Concern/Grievance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 3 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0585 Level of Harm - Minimal harm or potential for actual harm Program, dated 2006, the P&P indicated, A resident's concern or grievance may be verbal or non-verbal and does not have to be in writing. The Resident Concern/Grievance Program is intended to reflect the facility policy which acknowledges the rights of the residents to voice concerns and the expectation of the 'prompt effects by the facility' to resolve them. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 4 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. During a concurrent interview and record review on 10/25/23 at 11:18 a.m. with Regional Nurse Consultant (RNC) 1, Resident 17's Transfer Documents (TD), dated 7/30/23, 9/22/23, and 10/1/23 were reviewed. The TD indicated there was no documentation the Ombudsman was notified about the transfers. RNC 1 stated the Ombudsman was not notified about the transfers. During a review of the facility's P&P titled, Transfer or Discharge Notice, dated March 2021, the P&P indicated, 1.Transfer and discharge includes movement of a resident from a certified bed in the facility to a non-certified bed in another part of the facility, or to a non-certified bed outside the facility.6. A copy of the notice is sent to the Office of the State Long-Term Care Ombudsman at the same time the notice of transfer or discharge is provided to the resident and representative. Based on interview and record review, the facility failed to follow their policy and procedure (P&P) titled, Transfer or Discharge Notice, when the facility did not send a notice of transfer to the Ombudsman (representatives who assist resident in long-term care facilities with issues related to day-to-day care, health, safety, and personal preferences) for two of five sampled residents (Resident 59 and Resident 17). This failure had the potential to result in residents being discharged inappropriately and not having an advocate who could inform them of their admission, transfer, and discharge rights and options. Findings: During a concurrent interview and record review on 10/25/23 at 2:40 p.m. with Social Services Director (SSD), Resident 59's SSD Clinical Record (CR), dated 7/22/23 reviewed. The CR indicated Resident 59 was transfered to the hospital. There was no documentation in the CR that Ombudsman was notified about the transfer. SSD stated she was unable to provide documentation of notification to Ombudsman. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 5 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 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 observation, interview, and record review, the facility failed to develop a plan of care for two of two sampled residents (Resident 29, Resident 19) when: Residents Affected - Few 1. Resident 29's plan of care did not include nail care. 2. Ensure an accurate assessment to reflect Resident 19's loose fitting dentures. These failures resulted in residents not receiving the services they needed which had the potential for negative health outcomes. Findings: 1. During an interview on 10/24/23 at 12:00 p.m. with Family Member (FM) 1, FM 1 stated Resident 29 was in the hospital in July or August for surgery. A hospital nurse showed FM 1 Resident 29's long nails on his right hand, which had a contracture (a fixed tightening of muscles, tendons, ligaments, or skin, preventing normal movement of the body part). FM 1 stated the hospital nurse was concerned the long nails could cause Resident 29's skin to be pierced by them. During a concurrent observation and interview on 10/24/23 at 12:14 p.m. with CNA 11 in Resident 29's room, CNA 11 carefully opened Resident 29's smallest finger, and the nail was observed to be approximately 1/4 to 1/2 inch beyond the fingertip. CNA 11 confirmed this nail was very long and had not been recently clipped. During a concurrent observation and interview on 10/24/23 at 12:25 p.m. with Assistant Director of Nursing (ADON) and Regional Nurse Consultant (RNC) 1 in Resident 29's room, ADON carefully opened Resident 29's smallest finger, and the nail appeared freshly cut. Resident 29's other fingers were observed, and most of the nails were not long, but the right thumb nail was noted to be approximately 1/8 of an inch beyond the fingertip. RNC 1 stated the nail was too long. ADON stated the nail was too long if it had been clipped 48 hours prior as ordered by the physician. During a review of Resident 29's Order Summary Report (OSR), dated 5/19/23, the OSR indicated, Diabetic Nail Care: Clip, Clean and File fingernails Q [every] Sunday. Special Instructions: Diabetic Nail care by a Licensed Nurse every day shift every Sun [Sunday]. During a concurrent interview and record review on 10/25/23 at 3:46 p.m. with ADON, Resident 29's Care Plan (CP), dated 10/23/23 was reviewed. ADON stated the CP did not include a care plan to keep the nails clipped to prevent the nails from piercing the skin in the contracted hand, and stated the CP should include that intervention. During a review of the facility's policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered, dated March 2022, the P&P indicated, The care plan interventions should be derived from information obtained from the resident and his/her family/responsible party.The comprehensive, person-centered care plan should: b. Describe the services that are to be furnished in an attempt to assist the resident to attain or maintain that level of physical, mental, and psychosocial wellbeing that the resident desires or that is possible. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 6 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 2. During a concurrent interview and record review on 10/25/23 at 2:42 p.m. with Minimum Data Set (MDS) Coordinator, Resident 19's MDS assessment, dated 9/13/23 was reviewed. The MDS Section L labeled oral/dental indicated, Broken or loosely fitting full or partial dentures. The box marked, no. MDS Coordinator stated the MDS look back period is for 3 months, I would do a visual look of the resident. MDS coordinator stated I did see the loose-fitting dentures of the Resident. Residents Affected - Few During an observation on 10/23/23 at 10:29 a.m.in Resident 19 room, Resident 19 was wearing loose fitting dentures. During a interview on 10/26/23 at 10:52 a.m. with Licensed Vocational Nurse (LVN) 2, LVN 2 stated she noticed Resident 19's dentures were loose fitting. LVN 2 stated the dentures will fall out. During a review of the CMS (Centers for Medicare & Medicaid Services) RAI (Resident Assessment Instrument Version 3.0 Manual) dated October 2023, the RAI indicated, The RAI process has multiple regulatory requirements. 3. The assessment process includes direct observation, as well as communication with the resident and direct care staff on all shifts. an accurate assessment requires collecting information from multiple sources. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 7 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to follow its policy and procedure titled, Administering Medications when: Residents Affected - Few 1. The Director of Nursing of Nursing (DON) did not check the intravenous (IV-given inside of a vein) antibiotic (medication used to treat bacterial infection) for one of one sampled resident (Resident 92). 2. Resident 92' IV antibiotic were not administered at the right time according to physician's order. These failures had the potential for Resident 92 to recieve the wrong medication with potential to result in adverse health outcomes Findings: 1. During a concurrent observation and interview on 10/23/23 at 10:20 a.m. with Resident 92, in Resident 92's room, a Peripherally Inserted Central Catheter (PICC-used to deliver medications and other treatments directly to the large central vein near the heart) was on Resident 92's right upper arm. Resident stated he had IV antibiotics being hung once a day at different times, but not at the same time every day. During a concurrent observation and interview on 10/24/23 at 11:11 a.m. with DON, in Resident 92's room, DON was preparing to administer the IV antibiotic to Resident 92. DON did not check the IV antibiotic against the Medication Administration Record (MAR). DON stated she did not follow the triple check (compare the medication name on the prescription label, the medication order, and the MAR) procedure per facility policy, and she should have performed the triple check. During an interview on 10/25/23 at 2:32 p.m. with DON, DON stated medications should be prepared at the bedside and signed when they are given. 2. During a concurrent interview and record review on 10/25/23 at 2:37 p.m. with DON, Resident 92's MAR, dated 10/24/23 was reviewed. The MAR indicated Resident 92's IV antibiotic was given over an hour after its scheduled administration time of 11 a.m. on six days (10/8, 10/12, 10/16, 10/17, 10/18, and 10/20). DON stated, I don't believe they were given late, just not documented when they were given. DON stated the medication should have been given no later than one hour after the scheduled administration time. During a review of the facility's policy and procedure (P&P) titled, Administering Medications, dated April 2019, the P&P indicated, Medications are administered within one (1) hour of their prescribed time.The individual administering medications verifies the resident's identity before giving the resident his/her medications .The individual administering the medication checks the label THREE (3) times to verify the right reisident, right medication, right dosage, right time, and right method (route) of administration before giving the medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 8 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure one of 19 sampled residents (Resident 29) received nail care. This failure had the potential to cause injury to Resident 29. Residents Affected - Few Findings: During an interview on 10/24/23 at 12:00 p.m. with Family Member (FM) 1, FM 1 stated Resident 29 was in the hospital in July or August for a surgery. A hospital nurse showed FM 1 Resident 29's long nails on his right hand, which had a contracture (a fixed tightening of muscles, tendons, ligaments, or skin, preventing normal movement of the body part). FM 1 stated the hospital nurse was concerned the long nails could cause Resident 29's skin to be pierced by them. During a concurrent observation and interview on 10/24/23 at 12:14 p.m. with Ceritifed Nursing Assistant (CNA) 11 in Resident 29's room, Resident 29's right hand was observed. Resident 29's right hand was observed to have a contracture and it was tightened into a fist. CNA 11 carefully opened Resident 29's smallest finger, and the nail was observed to be approximately ¼ to ½ inch beyond the fingertip. CNA 11 confirmed this nail was very long and had not been recently clipped. During a concurrent observation and interview on 10/24/23 at 12:25 p.m. with Assistant Director of Nursing (ADON) and Regional Nurse Consultant (RNC) 1 in Resident 29's room, Resident 29's right hand was observed. ADON carefully opened Resident 29's smallest finger the nail appeared freshly cut. Resident 29's other fingers were observed. The right thumb nail was noted to be approximately 1/8 of an inch beyond the fingertip. RNC 1 stated the nail was too long. ADON stated the nail was too long if it had been clipped 48 hours prior as ordered by the physician. During a review of Resident 29's Order Summary Report (OSR), dated 5/19/23, the OSR indicated, Diabetic Nail Care: Clip, Clean and File fingernails Q [every] Sunday. Special Instructions: Diabetic Nail care by a Licensed Nurse every day shift every Sun [Sunday]. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 9 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, record review, the facility failed to ensure one of eight sampled residents (Resident 14) physician's order for treatment was followed. This failure had the potential for delaying Resident 14's wound healing and result in infection. Residents Affected - Few Findings: During an observation on 10/23/23 at 10:20 a.m. in Resident 14's room, Resident 14's right side of nose by cheek had a wound about the size of a dime, red in color, with a glossy appearance, and opened to air. During a review of Resident 14's Order Summary Report (OSR), dated 10/18/23, the OSR indicated, Cleanse surgical site to right side of face with NS [normal saline-mixture of salt and water], pat dry, apply bacitracin [antibiotic-medication to treat bacterial infection] ointment, apply medi-honey [ointment used to treat certain wounds], cover with super absorbent dressing, daily, X [for] 30 days, everyday shift for s/p [status post-after] surgical incision [wound] removal of abnormal growth to face, for 30 Days. During a concurrent observation and interview on 10/23/23 at 2:57 p.m. with Licensed Vocational Nurse (LVN) 6, in Resident 14's room, Resident 14's surgical site was not covered with a dressing. LVN 6 stated Resident 14 does not have a dressing today. During a concurrent observation and interview on 10/23/23 at 3:29 p.m. in Resident 14's room, Resident 14's facial surgical site was not covered per physician's order. Resident 14 stated she had a growth which was removed surgically. During a concurrent interview and record review on 10/24/23 at 3:02 p.m. with LVN 1, the OSR dated October 2023 was reviewed. The OSR indicated, a dry dressing should have been placed over the surgical site. LVN 1 stated she did not place a dressing today or yesterday on Resident 14's surgical site as indicated in the order. LVN 1 stated she did not notify the physician. During a review of Resident 14's Care Plan (CP), dated October 2023, the CP indicated, Resident [14] had surgical site on R [right] side of face with interventions/tasks: treatment as indicated. During a review of the facility's policy and procedure (P&P) titled, Wound Care, dated October 2010, the P&P indicated, 1. Verify that there is a physician's order for this procedure. 13. Dress wound. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 10 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure manufacturers guidelines were followed for use of low air loss (LAL) mattresses (mattress used for prevention of pressure injuries) for five of 14 sampled residents (Resident 84, Resident 51, Resident 347, Resident 11, and Resident 246). This failure had the potential to result in developing new or worsening of pressure injuries. Residents Affected - Some Findings: During a concurrent observation and interview on 10/23/23 at 10 a.m. with Resident 84 in Resident 84's room, resident was laying on a LAL mattress with no sheet. Resident 84 stated they normally only put a draw sheet (1/2 sheet used to turn resident). During an observation on 10/23/23 at 10:06 a.m. in Resident 51's room, Resident 51 was laying on a LAL mattress with no sheet. During an observation on 10/23/23 at 10:14 a.m. in Resident 347's room, Resident 347 was laying on a LAL mattress with no sheet. During an observation on 10/23/23 at 10:56 a.m. in Resident 11's room, Resident 11 was laying on a LAL mattress with no sheet. During a concurrent observation and interview on 10/23/23 at 3:16 p.m. with Licensed Vocational Nurse (LVN) 3, in Resident 84's room, the setting on the LAL mattress pump was set at 100 pounds (lbs-unit of weight). LVN 3 stated Resident 84's weight was taken yesterday and is 177 lbs. LVN 3 stated the setting should be closer to the resident's weight. During a review of Resident 84's Weight Summary Report (WSR), dated 10/23/23, the WSR indicated, most recent weight 177 lbs. on 10/23/23. During a concurrent observation and interview on 10/23/23 at 3:17 p.m. with LVN 2 in Resident 51's room, Resident 51 was laying on the LAL mattress with no sheet. LVN 2 stated the LAL pump was set at 340 lbs. During a review of Resident 51's WSR, dated 10/23/23, the WSR indicated, most recent weight 214 lbs. on 10/16/23. During a concurrent observation and interview on 10/23/23 at 3:20 p.m. with LVN 2 in Resident 347's room, Resident 347 was laying on the LAL mattress with no sheet. LVN 2 stated the LAL pump was set between 380-400 lbs. LVN 2 stated Resident 347 did not appear to weigh 400 lbs. LVN 2 stated there is an order to check the settings on the LAL mattress daily. During a review of Resident 347's WSR, dated 10/23/23, the WSR indicated, most recent weight 110 lbs. on 10/23/23. During a concurrent observation and interview on 10/23/23 at 3:22 p.m. with LVN 2 in Resident 11's room, Resident 11 was laying on the LAL mattress with no sheet. LVN 2 stated the LAL pump was set at 340 lbs. LVN 2 stated 340 lbs. doesn't look like the correct weight for Resident 11. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 11 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0686 During an interview with on 10/23/23 at 3:23 p.m. with Resident 11, Resident 11 stated he weighed 198 lbs. Level of Harm - Minimal harm or potential for actual harm During a review of Resident 11's WSR, dated 10/23/23, the WSR indicated, most recent weight 196 lbs. on 10/16/23. Residents Affected - Some During a concurrent observation and interview on 10/26/23 at 8:55 a.m. with Resident 11, Resident 11 was laying on a LAL mattress with no sheet. Resident 11 only had a draw sheet under his bottom. The skin on his arms and legs was touching the mattress. Resident 11 stated, I need a sheet, this mattress is cold plastic, it feels awful. I said something to them about it and they gave me this thing. Resident 11 pointed at the draw sheet. During an interview on 10/26/23 at 9:02 a.m. with LVN 5, LVN 5 stated she overheard Resident 11 say that he wanted a sheet, but it is a special type of mattress that can't have a sheet. LVN 5 stated he asked the Certified Nursing Assistant (CNA) for one this morning and we already explained why to him why he could not have it. During an interview on 10/23/23 at 3:31 p.m. with Director of Nursing (DON) DON stated that the LAL mattress is supposed to be set according to the resident's current weight. DON stated if the mattress is not set correctly the wound may not heal properly or may get worse. DON stated she was not sure if there was an order to check the settings, but there should be. During an interview on 10/24/23 at 11:08 a.m. with Regional Nurse Consultant (RNC) 1, RNC 1 stated there was no order to check the LAL mattress settings for Resident 84 or Resident 51. During an interview on 10/24/23 at 3:36 p.m. with DON, DON stated a sheet is not recommended for use on a LAL mattress. During an interview on 10/26/23 at 9:02 a.m. with LVN 1, LVN 1 stated she thought the beds did not have a sheet because the mattress was too big. LVN 1 stated there are a total of 14 LAL beds in facility. During a concurrent interview and record review on 10/26/23 at 9:21 a.m. with Director of Staff Development (DSD), Operation Manual for Protekt Aire 8000BA48 (OM- operation manual for LAL mattress), (undated) was reviewed. The OM indicated, Cover with a cotton sheet to avoid direct skin contact and reduce friction. DSD stated she has never read the OM before and did not know a sheet was supposed to be used on the LAL. During a concurrent interview and record review on 10/26/23 at 9:35 a.m. with DON, OM, (undated) was reviewed. OM indicated, Cover with a cotton sheet to avoid direct skin contact and reduce friction. DON stated she could not find anything in the manufacturers recommendations that says facility should not use a sheet on the LAL mattresses. DON stated there should be a sheet to reduce friction when repositioning the residents. During a concurrent observation and interview on 10/26/23 at 11:07 a.m. in Resident 246's room, Resident 246 was laying on a LAL mattress with no sheet. Resident 246's skin was touching the mattress. Resident 246 stated it made her backside hurt. During a review of the facility's policy and procedure (P&P) titled, Prevention of Pressure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 12 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Injuries, dated April 2020, the P&P indicated, Select appropriate support surfaces based on the resident's risk factors, in accordance with current clinical practice.For prevention measures associated with specific devices, consult current clinical practice guidelines.Review the interventions and strategies for effectiveness on an ongoing basis. During a review of the facility's P&P titled, Support Surface Guidelines, dated September 2013, the P&P indicated, The use of low air loss mattress is based on.weight of the resident. Event ID: Facility ID: 555125 If continuation sheet Page 13 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow their policy and procedure (P&P) titled, Medication Storage, when: 1. Expired medication was not removed from one of three sampled medication refrigerators (Refrigerator C). 2. Diabetic testing strips (strips used to test blood sugar) were not labeled with the date they were opened on one of two sampled medication carts (D Hall Cart). 3. Medication refrigerator temperature was not monitored every shift for three of three sampled medication refrigerators (Refrigerator A, Refrigerator B, and Refrigerator C). These failures had the potential to result in unintended, harmful, or undesirable health outcomes to the residents. Findings: 1. During a concurrent observation and interview on [DATE] at 9:16 a.m. with Director of Staff Development (DSD), in the medication storage room. Refrigerator C had a package containing lidocaine (numbing medication) 2% suppositories (medication inserted in body through rectum or vagina) that had a best by date of [DATE]. DSD stated they were past the best by date and should not have been there. 2. During a concurrent observation and interview on [DATE] at 9:45 a.m. with Licensed Vocational Nurse (LVN) 4, in the medication storage room, the medication cart for D Hall contained two vials (containers) of diabetic testing strips that were not dated. LVN 4 stated they have both been opened, but have no date written on them. LVN 4 stated they should have been dated when opened. During an interview on [DATE] at 10:14 a.m. with Director of Nursing (DON), DON stated testing strips should be dated when they are opened. During a review of manufacturer guidlines Storage and Handling Assure Platinum Test Strips (MG), (undated), the MG indicated, When you first open the vial, write the date on the vial label. Use within 3 months of first opening the vial. 3. During a concurrent interview and record review on [DATE] at 2:30 p.m. with DON, Refrigerator Temperature Log (RTL) for Refrigerators A, B, and C were reviewed. The RTL's indicated the temperature was not recorded during Day shift on [DATE] and [DATE]. DON stated the blanks on temperature logs for Refrigerator A, B, and C mean they were not checked during Day shift on [DATE] and [DATE]. DON stated they are supposed to be checked every shift. During a review of the facility's P&P titled, Medication Storage, dated 2019, the P&P indicated, Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations. Temp is to be recorded twice daily if vaccine products are stored in the refrigerator. Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 14 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0761 or without secure closures are immediately removed from stock, disposed of according to procedures for medication disposal. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 15 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0790 Provide routine and 24-hour emergency dental care for each resident. 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 assist three of three sampled residents (Resident 19, Resident 44 and Resident 55) to receive dental services. This failure had the potential for these residents to have difficulty chewing food and maintaining nutritional needs. Residents Affected - Some Findings: During a concurrent observation and interview on 10/23/23 at 10:43 a.m. with Resident 44, Resident 44 had many missing front teeth. Resident 44 stated the facility had not sent her to a dentist to get dentures or partials. During a concurrent interview and record review on 10/25/23 at 11:56 a.m. with Social Services Director (SSD), Resident 44's DENTAL NOTES (DN), dated 8/5/20 was reviewed. DN indicated Resident 44 was seen on 8/5/20. SSD confirmed 8/5/20 was the last time Resident 44 received dental care. SSD stated Resident 44 should have been seen at least annually. During an observation on 10/23/23 at 10:29 a.m. in Resident 19's room, Resident 19 wearing loose fitting dentures. During an interview on 10/25/23 at 11:32 a.m. with SSD, SSD stated Resident 19 just saw the Dentist. SSD stated she knows the dentures are loose. During a record review of Resident 19's DN, dated 10/20/23 the DN indicated treatment recommendations new [dentures]. During a concurrent interview and record review on 10/25/23 at 2:07 p.m. with Director of Nursing (DON) Resident 19's DN, dated 10/20/23 was reviewed. DON stated there is no order for dental services and there should be a order for dental services. During a concurrent interview and record review on 10/26/23 at 2:07 p.m. with Regional Nurse Consultant (RNC) 2, Resident 19's Clinical Record (CR), was reviewed. The CR indicated there was no care plan for dental services. RNC 2 stated there was no care plan developed related to dental services. During a review of the facility's policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered, dated March 2022, the P&P indicated, The comprehensive, person-centered care plan should: a. Include measurable objective and time frames; b. Describe the services that are to be furnished in an attempted to assist the resident attain desires or that is possible, including services that would otherwise be provided for the able, but are not provided due to the resident exercising his or her rights (including the right to refuse treatments).During an interview on 10/25/23 at 9:47 a.m. with Resident 55, Resident 55 stated, I need my teeth cleaned, they [staff] said they would look into it [teeth]. One time, my daughter was here and a dentist stopped by but he didn't look at my teeth and I never saw him again. I really want a teeth cleaning. During a concurrent interview and record review on 10/25/23 at 4:44 p.m. with Social Service Director (SSD), Resident 55's Dental Consult (DC), dated September 2022 was reviewed. The DC indicated, Initial exam, no Dental Prophylaxis [Preventive dental cleaning] completed. SSD stated, The dentist came to the facility on [DATE], I don't know why they did not see the resident [Resident 55] that day (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 16 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0790 [10/20/23]. SSD stated she did not follow up. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure (P&P) titled Dental Consultant, dated April 2007, the P&P indicated, A consultant Dentist is retained by our facility and is responsible for: Performing or supervising an annual dental reevaluation for each resident. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 17 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 - Few 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 ensure one of two sampled residents (Resident 36)'s diet texture was followed according to the physician's order. This failure had the potential for Resident 36 to experience choking due to incorrect food texture. Findings: During an observation on 10/23/23 at 12:22 p.m. in the dining room, Resident 36 was eating and Resident 36's tray contained a piece of bread with crust on, the area of the crust was darker in color. During a concurrent interview and record on 10/23/23 at 12:26 p.m. with Director of Staff Development (DSD) Resident 36's Meal Ticket was reviewed. The Meal Ticket indicated, mechanical soft (food that is broken down for easy swallowing without biting or chewing). DSD stated Resident 36 is on mechanical soft diet. During a concurrent observation and interview on 10/23/23 at 12:37 p.m. with DSD, in the dining room, the bread crust was darker in color was noted on Resident 36's tray. DSD stated she did not verify if the piece of bread crust was a mechanical soft before serving the tray to Resident 36. DSD touched the bread crust and she stated it was hard. During a review of the facility's Fall Menus, dated October 2023, the Fall Menus indicated bread needs to be soft-no hard crust for Mechanical Soft diets. During a review of Resident 36's Care Plan (CP), dated October 2023, the CP indicated, Resident [36] is at risk for altered nutritional status r/t (related to) medical condition/dx [diagnosis] dementia [memory loss] and dysphagia [swallowing difficulties]. Serve diet as ordered: NAS [No added salt], mechanical soft, thin liquids, pureed vegetables. During a review of Resident 36's Order Summary Report (OSR), dated 6/8/23, the OSR indicated, NAS [No Added Salt] diet, Mechanical Soft texture, Thin Liquids consistency. During an interview on 10/26/23 at 10:10 a.m. with Dietary Manager (DM), DM stated the cook tests with tongs only but does not test softness on bread's crust for mechanical soft foods before it is placed on delivery tray. DM stated Resident 36's bread was not the right texture as noted by a side of the crust being hard in texture. During a review of the facility's policy and procedure (P&P) titled, Tray Identification, dated 2007, the P&P indicated, Nursing staff shall check each food tray for the correct diet before serving the residents. The Food Services Manager or supervisor will check trays for correct diets before the food carts are transported to their designated areas. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 18 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 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 ensure food items in the storage area were labeled and dated. This failure had the potential to result in foodborne illnesses. Residents Affected - Some Findings: During a concurrent observation and interview on 9/24/23 at 9:50 a.m. with Kitchen Manager (KM), in the kitchen refrigerator room, there were chicken nuggets without a label and date. KM verified the findings and stated the chicken nuggets should be labeled and dated. During a concurrent observation and interview on 9/24/23 at 9:51 AM with KM, in the kitchen dry store room. A box of crackers had no label indicating when they were opened. KM stated the crackers in the box should have a label on them. During a review of the facility's policy and procedure (P&P) titled, Labeling and Dating of Foods, dated 2023, the P&P indicated, All food items in the storeroom, refrigerator, and freezer need to be labeled and dated.Food delivered to facility needs to be marked with a received date. Note that the delivery sticker is dated, and it can serve as the delivery date for the product. Newly opened food items will need to be closed and labeled with an open date and used by the date that follows the various storage guidelines within this section-specifically the Dry Goods Storage Guidelines (page6.9), refrigerated Storage Guidelines (page 6.16). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 19 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0880 Provide and implement an infection prevention and control program. 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 on: 1. Surveillance for Infections when the monthly reports did not contain the complete information required. Residents Affected - Many 2. Monitoring Compliance with Infection Control when the facility did not complete the hand hygiene monitoring. These failures had the potential to result in a facility-wide infection outbreak affecting all residents, staff, and visitors. Findings: 1. During a concurrent interview and record review on 10/24/23 at 9:28 a.m. with Infection Preventionist (IP) 1 and IP 2. The facility's Infection Surveillance Monthly Report (ISMR) dated August and September 2023, were reviewed. IP 1 stated the infection surveillance were incomplete. The ISMR indicated there were no records of interpretation of data and laboratory results. IP 2 verified the finding. During a concurrent interview and record review on 10/26/23 at 9:08 a.m. with IP 1, IP 1 stated she lacks documentation and she was not performing and documenting laboratory records she was reviewing, skin care sheets. IP 1 stated she lacks documentation of infection control rounds or interviews, verbal reports from staff, infection documents, temperature logs, pharmacy records, antibiotic review, and transfer log/summaries. During a review of the facility's policy and procedure (P&P) titled, Surveillance for Infections, dated September 2017, the P&P indicated, The Infection Preventionist or designated infection control personnel is responsible for gathering and interpreting surveillance data. The surveillance should include a review of any or all the following information to help identify possible indicators of infections: a. Laboratory records; b. Skin care sheets; c. Infection control rounds and interviews; d. Verbal reports from staff; e. Infection documentation records; f. Temperature logs; g. Pharmacy records; h. Antibiotic review; and i. Transfer log/summaries. 2. During a record review of the facility's CDPH - Healthcare-Associated Infections Program Adherence Monitoring Hand Hygiene (HAIP), dated September and October 2023, the HAIP indicated to observe at least 10 hand hygiene (HH) opportunities per unit. On the following dates, 10 HH were not completed: On 8/1/23, there were only five HH completed. On 8/10/23, there were only six HH completed. On 8/14/23, there were only five HH completed. On 8/15/23, there were only five HH completed. On 8/24/23, there were only six HH completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 20 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0880 On 8/28/23, there were only five HH completed. Level of Harm - Minimal harm or potential for actual harm On 8/31/23, there were only six HH completed. On 9/6/23, there were only seven HH completed. Residents Affected - Many On 9/12/23, there were only eight HH completed. On 9/13/23, there were only eight HH completed. During a concurrent interview and record review on 10/25/23 at 3:46 p.m. with IP 1, IP 1 stated she did not observe at least 10 hand hygiene opportunities per unit due to not having enough time to complete it. During a review of the facility's policy and procedure (P&P) titled, Monitoring Compliance with Infection Control, dated August 2019, the P&P indicated, 2. Monitoring includes regular surveillance of adherence to hand hygiene practices and availability of hand hygiene supplies, and the availability of personal protective equipment and its appropriate use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 21 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to implement an effective antibiotic stewardship program when one of six sampled residents (Resident 86) was reviewed and monitored for the use of an antibiotic. This failure had the potential for Resident 86 to continually take inappropriate or unnecessary antibiotic and may result in infections not treated appropriately. Residents Affected - Few Findings: During an interview on 10/24/23 at 9:28 a.m. with Infection Preventionist (IP) 1 and IP 2, IP 1 stated the antibiotic use was not monitored. IP 2 stated there was no justification documented if the antibiotic was appropriate for Resident 86. During a review of facility's Infection Surveillance Monthly Report dated September 2023, the ISMR indicated Resident 86 was on Cephalexin (medication to treat bacteria) Tablet 500 MG (milligrams-unit of measurements). During a concurrent interview and record review on 10/24/23 at 9:32 a.m. with IP 2, Resident 86's Urinalysis (UA-test of the urine for bacteria), dated August 2023 was reviewed, the Urinalysis indicated, UA Culture [identifies the bacteria] Indicated? Yes. IP 2 stated the hospital did not send resident with culture and sensitivity [identify the correct antibiotic for the infection] information and she did not request one (culture and sensitivity) either (to justify the use of antibiotic). During an interview on 10/26/23 at 9:08 a.m. with IP 1, IP 1 stated, I lack in my documentation. I do not know or have an infection prevention surveillance. IP 1 stated she did not send the UA culture and sensitivity results to the physician for review. During a review of the facility's policy and procedure (P&P) titled, Antibiotic Stewardship, dated 2016, the P&P indicated, The purpose of our Antibiotic Stewardship Program is to monitor the use of antibiotics in our residents. When a culture and sensitivity (C&S) is ordered lab results and the current clinical situation will be communicated to the prescriber as soon as available to determine if antibiotic therapy should be started, continued, modified, or discontinued. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 22 of 23 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 555125 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Meadows Care Center 4444 West Meadow Visalia, CA 93277 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 0924 Put firmly secured handrails on each side of hallways. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure a handrail was firmly secured and in good repair. This failure had the potential to expose residents and visitors to injuries or accidents as a result of a broken handrail. Residents Affected - Some Findings: During an observation on 10/23/23 at 10:26 a.m. in the hallway, the right corner of the handrail was loose and detaching from the center handrail. During a concurrent observation and interview on 10/23/23 at 10:26 a.m. with Maintenance Assistant (MA) in the hallway, MA verified the handrail was loose. MA stated he was not aware of it (handrail being loose). MA stated there was no documentation of maintenance was completed. During a review of the facility's policy and procedure (P&P) titled, Maintenance Policies & Procedures dated December 2015, the P&P indicated, Test handrails daily as you go through the Center to make sure they are securely fastened. Repair immediately any loose handrails. Replace damaged handrails immediately. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555125 If continuation sheet Page 23 of 23