Health inspection·August 22, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm room temperatures in room [ROOM NUMBER] beds 1 to 8 were measured with the facility ' s infrared temperature gun (ITG, a tool that can measure temperatures from a distance). The ambient room temperatures in room [ROOM NUMBER] on 7/3/23 @ 3:08 p.m. were as follows: 203-bed 5: 83.2 degrees F Residents Affected - Some 203-bed 6: 84.5 degrees F. 203-bed 7: 86.4 degrees F 203-bed 8: 86.6 degrees F 203-beds 1 to 203-bed 4 were between 82.3 to 83.2 degrees F. These beds ' head of bed were against the wall (hallway), unlike Residents 5, 6, 7, and 8, which were against the glass windows. During an interview on 7/3/23 at 3:11 p.m. with the Administrator (ADM), the ADM stated, It is my first day at the facility today, Monday, 7/3/23 . I was just informed during stand-up this morning that the HVAC Unit C had malfunctioned on 6/30/23 . I immediately implemented the Hydration cart, we brought in 2 portable AC units and placed one in room [ROOM NUMBER] and another in room [ROOM NUMBER] . During an interview on 7/3/23 at 3:26 p.m. with the Dietary Supervisor (DS), the DS stated, It has been hot here since Friday, June 30, 2023 . Something with the HVAC not working properly . the Maintenance Supervisor (MS)told the new ADM this morning at stand-up about the HVAC not working since 6/30/23. During an interview on 7/3/23 at 3:26 p.m. with the Licensed Vocational Nurse (LVN), the LVN stated, It had been hot in room [ROOM NUMBER] for like a week. The (female) residents in room [ROOM NUMBER] are totally dependent for care, and most of them are non-verbal and could not say if they are hot. We only started the popsicles this morning. The hydration cart is hit and miss. They just brought in the big fans at noon today, 7/3/23. During an interview on 7/3/23 at3:30 p.m. with the Registered Nurse/Licensee (RN/L) by phone and with the MS (face-to-face), the MS stated, The HVAC Unit was inspected and serviced (by Vendor 1) prior to the facility ' s survey . I can ' t remember the date .Then the fan blade motor for Unit C flew out and cut the coils . The only rooms affected were rooms [ROOM NUMBERS]. The weather on 6/16/23 was low to mid-80 ' s . The ambient room temperatures in room [ROOM NUMBER] was 72 to 82.2 degrees F. I informed the RN/L on 6/16/23, about the HVAC Unit C ' s fan blow out . We got a quote from a different company (Vendor 2) for repair and installation for $21,000.00 . I gave the quote to the RN/L . The RN/L stated, I think we were sabotaged . why would the fan blow up and cut the coil . the HVAC had no problem before the routine maintenance check done by [Vendor 1]. During a record review of Resident 5 ' s admission RECORD, undated, the admission Record indicated, Resident 5 was admitted to the facility on [DATE], with diagnosis which included Acute (sudden) Respiratory Failure with Hypoxia (a condition where there is not enough oxygen in the blood, causing shortness of breath, dizziness, blurred vision, extreme tiredness and difficulty in performing routine activities), COPD (chronic obstructive pulmonary disease, a group of lung diseases that make it hard to breathe) and Obesity (body weight that is greater than what is considered normal or healthy for a certain height). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555352 If continuation sheet Page 2 of 8 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 555352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Healthcare Center 2939 S. Peach Avenue Fresno, CA 93725 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 During a record review of Resident 6 ' s admission RECORD undated, the admission Record indicated, Resident 6 was admitted to the facility on [DATE], with diagnosis which included Chronic (long-term) Respiratory Failure and Persistent Vegetative State (a condition in which a person with severe brain damage is awake but lacks awareness of themselves or their environment) and history of Pneumonia (lung infection). Residents Affected - Some During a record review of Resident 7 ' s admission RECORD undated, the admission Record indicated, Resident 7 was admitted to the facility on [DATE], with diagnosis which included Seizures (a sudden, uncontrolled burst of electrical activity in the brain which causes changes in behavior, movements, feelings, and levels of consciousness). During a record review of Resident 8 ' s admission RECORD undated, the admission Record indicated, Resident 8 was admitted to the facility on [DATE], with diagnosis which included COPD and wheezing (a high-pitched whistling sound during breathing that is caused by partially blocked airway). During a record review of Resident 9 ' s admission RECORD undated, the admission Record indicated, Resident 9 was admitted to the facility on [DATE], with diagnosis which included edema (swelling), muscle weakness, and urinary retention (a condition in which a person is unable to empty all the urine from the bladder). During a record review of Resident 10 ' s admission RECORD undated, the admission Record indicated, Resident 10 was admitted to the facility on [DATE], with diagnosis which included Hypertension (high blood pressure) and Urinary Tract Infection (UTI, bladder infection). During a record review of Resident 11 ' s admission RECORD undated, the admission Record indicated, Resident 11 was admitted to the facility on [DATE], with diagnosis which included Hemiplegia (a loss or impairment of voluntary movement on one side of the body), hypertension, and muscle weakness. During a record review of Resident 12 ' s admission RECORD undated, the admission Record indicated, Resident 12 was admitted to the facility on [DATE], with diagnosis which included Muscle Weakness, Pain, and Senile Dementia (loss of ability to think, remember, and reason to such an extent that it interferes with one ' s daily life and activities). During a review of an on-line article titled, Extreme Heat, published by the Centers for Disease Control (CDC, a United States Federal agency whose mission is to protect public health by preventing and controlling disease, injury, and disability) dated 6/19/17, and retrieved from (https://www.cdc.gov/disasters/extremeheat/medical.html), indicated People with chronic medical conditions are more vulnerable to extreme heat because they may be less likely to sense and respond to changes in temperature and they may be taking medications (tranquilizers, water pills, allergy pills, heart pills, laxatives (stool softener) and drugs used to treat mental illnesses) that can make the effect of extreme heat worse. Conditions like respiratory infections, heart disease, mental illness, kidney diseases, diabetes, poor blood circulation, and obesity are risk factors for heat-related illness. Individuals who are overweight or obese tend to retain more body heat. Additional factors that increase one ' s risk of getting a heat illness include dehydration (not having enough fluids in the body). During a review of the All Facilities Letter - Hot Summer Weather Advisory 20-23, published by the California Department of Public Health (CDPH), dated 7/2023, indicated, the AFL reminds health care facilities to implement recommended precautionary measures to keep individuals safe and comfortable during extremely hot weather. Facilities must have contingency plans in place to deal with the loss (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555352 If continuation sheet Page 3 of 8 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 555352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Healthcare Center 2939 S. Peach Avenue Fresno, CA 93725 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 - Some of air conditioning, or in the case when no air conditioning is available, take measures to ensure patients and residents are free of adverse conditions that may cause heat-related health complications .Facilities must report extreme heat conditions that compromise patient health and safety and/or require an evacuation, transfer, or discharge of patients. The summer season, along with its potential for fluctuating high temperatures, is approaching. The California Department of Public Health (CDPH), Center for Health Care Quality (CHCQ), reminds all health care facilities that the elderly and other health compromised individuals are more susceptible to temperature extremes and possible dehydration. Facility administrators should monitor weather predictions for fluctuations in extreme temperatures and take extra precautions to be sure appropriate air conditioning equipment is well maintained and operating effectively. CDPH recommends the following to prepare for high summer temperatures:1. Ensure a comfortable climate for staff, visitors, patients, and residents: (a) Engage facilities management to deliver a comfortable ambient environment and safe storage conditions: for example, ensure climate control, adequate ventilation, and proper PPE usage; preserve power infrastructure through power management and partnerships; and procure/service critical cooling equipment. (b) Contingency planning: facilities must have contingency plans in place to deal with the loss of air conditioning, or in the case when no air conditioning is available, take measures to ensure patients and residents are free of adverse conditions that may cause heat-related health complications. Facilities should use portable fans and other temporary cooling devices when indicated. (i) Ensure fans are used properly: 1. Ceiling fans: setting fan to rotate counterclockwise will push air down. Check to see if your ceiling fan can do this. 2. REMINDER: While electric fans might provide some comfort, when temperatures are hot, they won't prevent heat-related illness. 3. Avoid the use of high-speed settings on fans. 4. Orient fans to promote airflow from clean-to-less-clean direction, for example, from other parts of a facility towards locations with known or suspected COVID-19 cases, and then to the outside. 5. Mount fans in open windows or place them near open windows to direct indoor air to flow outside. 6. Position fans so that air does not blow from one person to another. 7. Do not have residents congregate in outside areas where window fans are located. 2. Be prepared for heat- and summer-related illness:(a) Heat-related illness: heat-related illnesses include heat stroke, heat exhaustion, heat cramps, sunburn, and heat rash, with varying susceptibilities across population segments. Health care facilities should be prepared to care for heat-related illnesses, particularly to identify population groups disproportionately affected by heat-related illnesses. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555352 If continuation sheet Page 4 of 8 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 555352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Healthcare Center 2939 S. Peach Avenue Fresno, CA 93725 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 - Some (b) Summer-related illnesses: the risk for mosquito-borne illnesses like [NAME] Nile Virus increases in the summer. Although relatively uncommon, health care providers should remain vigilant to detect new cases.3. Take precautions to maintain adequate hydration among patients, residents, staff, and visitors, particularly in vulnerable populations. CHCQ recommends facilities review CDPH's Fast Facts: Preventing Summer Heat Injuries and implement the following measures to keep residents and clients comfortable during extremely hot weather: · Dress in lightweight, loose-fitting clothing · Keep residents well hydrated with particular attention to dependent residents · Minimize physical activities during the hottest parts of the day · Stay indoors and out of the sun during the hottest parts of the day · Use fans as indicated in the Fast Facts page on preventing summer heat injuries · Open windows where feasible if screens are intact, to allow fresh air to circulate · Use cool compresses, misting, showers, and baths to promote cooling · Avoid hot and heavy meals · Encourage frozen treats such as popsicles between meals · Keep a hydration station readily available to residents, family, and staff · Be alert to adverse changes in patient and resident conditions that may be heat related · Develop and implement a system to monitor hydration status and be prepared to take appropriate interventions. · Pay special attention to patients with medications that make the patient susceptible to high temperatures, e.g., psychotropic medications. Licensing regulations require facilities to report all emergency and/or disaster-related occurrences that threaten the welfare, safety, or health of patients to the CHCQ. If the extreme heat conditions affect your facility by compromising patient health and safety and/or require an evacuation, transfer, or discharge of patients, you must contact your CHCQ district office. Please follow these guidelines for reporting such occurrence. The facility ' s Policy and Procedure (P&P) pertinent to Maintaining Safe and Comfortable ambient room temperatures was requested but not provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555352 If continuation sheet Page 5 of 8 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 555352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Healthcare Center 2939 S. Peach Avenue Fresno, CA 93725 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide oral hygiene for two of 12 sampled residents (Residents 1 and 3) when: Residents Affected - Few 1. Resident 1 ' s lips were dry, chapped, and crusty. 2. Resident 3 had a cracked area on the right corner of his mouth that was covered with dried blood. This failure resulted in Residents 1 and 3 to have poor oral hygiene and undignified appearance and placed them at risk to have bad breath and mouth lesion which could lead to bacterial, viral, or fungal mouth infections. Findings: 1. During a concurrent observation and interview on 7/3/23 at 2:27 p.m. with the Assistant Director of Nursing (ADON), inside Resident 1 ' s bedroom, Resident 1 was observed in bed awake and listening to music. Resident 1 was observed to have contractures (fixed tightening of muscle, tendons that prevents normal movement of the associated body part) to both arms and legs Resident 1 ' s lips was observed to be dry, cracked and the corner of his mouth had white-color substances. The ADON stated Resident 1 needs mouth care . He is totally dependent on staff for daily care especially oral care . The ADON stated, All Certified Nursing Assistants (CNA) are expected and required to provide good oral care to residents. All Licensed Nurses must check and monitor that this is done. During an interview on 7/3/23 at 2:30 p.m. with Certified Nursing Assistant (CNA) 1, CNA 1 stated, There are only three CNAs this morning for Station 2 . rooms 5, 6, 7, and 8 . we are short-staffed, and we have not done all of the resident ' s mouth care yet . we ' ve been so busy . CNA 1 stated, It is our job as CNAs to provide oral care to those residents who could not do it themselves . During a review of Resident 1 ' s admission RECORD (AR), undated, the AR indicated Resident 1 was readmitted to the facility on [DATE], with diagnoses which included Dysphagia (difficulty in swallowing), Gastrostomy tube (a tube inserted through the belly that brings nutrition directly to the stomach), Multiple Sclerosis (a condition that affects the brain and spinal cord and causes symptoms like blurred vision and problems with how a person moves, think and feel), and Palliative Care (specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness). During a review of Resident 1 ' s Minimum Data Set (MDS, a federally mandated process for clinical assessment of each resident's functional capabilities and health needs), dated 5/23/23, the MDS Functional Status indicated, Resident 1 was totally dependent on staff for personal hygiene such as brushing teeth (oral care). During a review of Resident 1 ' s Brief Interview for Mental Status (BIMS, an evaluation of attention, orientation, and memory recall), dated 5/23/23, Resident 1 had a BIMS score of 8 out of 15. (A BIMS score of 0-7 indicate severe cognitive impairment), 8-12 indicate moderate cognitive impairment memory loss and poor decision-making skills, and 3-15 indicate no cognitive impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555352 If continuation sheet Page 6 of 8 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 555352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Healthcare Center 2939 S. Peach Avenue Fresno, CA 93725 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of Resident 1 ' s CARE PLAN (CP) for Activities of Daily Living (ADL), dated 7/1/23, the CP indicated, Resident is extensive dependence with PERSONAL HYGIENE . Interventions: Resident needs will be anticipated by staff daily, assist with ADLs as needed, Resident requires 1-person physical assist, Encourage/Provide oral care daily and PRN (as needed) . The facility's Policy and Procedure for provision of care, specific to hygiene and oral/mouth care, was requested but not provided. 2. During a concurrent observation and interview on 7/3/23 at 2:39 p.m. with the ADON, inside Resident 3 ' s bedroom, Resident 3 was observed in bed awake. Resident 3 was observed with dry and chapped lips and a crack on the right corner of his mouth. The crack had dark red color substance over it. When asked if this has been reported and/or treated, the ADON stated, I don ' t know . I must ask the Licensed Vocational Nurse (LVN). During a concurrent observation and interview on 7/3/23 at 2:40 p.m. with the ADON, the ADON stated, The LVN did not know about Resident 3 ' s cracked lips . there was no report last night and/or today from the outgoing or currently working CNAs or Licensed Nurses (LN) about it . The ADON stated, The LVN will call Resident 3 ' s physician now. The DON confirmed Resident 3 needed mouth care and stated, Resident 3 is totally dependent on staff for daily care including mouth/oral care . The ADON stated, All CNAs are expected and required to provide good oral care to residents. During an interview, on 7/3/23 at 2:42 p.m., with CNA 2 stated, We are short-staffed today, I have room [ROOM NUMBER] and I am also helping the 2 other CNAs . I did not notice Resident 3 ' s mouth sore . or is it a cut? . I have not given mouth care to him yet . During a review of Resident 3 ' s admission RECORD (AR), undated, the AR indicated, Resident 3 was admitted to the facility on [DATE], with diagnoses which included Dysphagia (difficulty in swallowing), Seizures (a sudden, uncontrolled burst of electrical activity in the brain which causes changes in behavior, movements, feelings, and levels of consciousness), and Muscle Weakness. During a review of Resident 3 ' s MDS, dated [DATE], the MDS - Functional Status indicated, Resident 1 was totally dependent on staff for personal hygiene such as brushing teeth (oral care). During a review of Resident 3 ' s Brief Interview for Mental Status (BIMS, an evaluation of attention, orientation, and memory recall), dated 4/12/23, Resident 3 had a BIMS score of 14 out of 15. (A BIMS score of 0-7 indicate severe cognitive impairment), 8-12 indicate moderate cognitive impairment memory loss and poor decision-making skills, and 3-15 indicate no cognitive impairment. During a review of Resident 3 ' s CARE PLAN (CP) for Activities of Daily Living (ADL), dated 2/24/23, the CP indicated, Resident requires assistance with ADLs . Interventions: Assist with ADLs as needed, Provide oral care after meals and at bedtime . During a review of an article titled, ORAL HEALTH FOR OLDER ADULTS retrieved from https://www.healthinaging.org/blog/oral-health-for-older-adults/ dated 11/6/19, the article indicated the following: Older adults are at an especially high risk for mouth and tooth infections and the complications that can come with these problems. Practicing good oral hygiene, using fluoride treatments, and getting regular dental care reduces oral infections and their complications. The most important thing you (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555352 If continuation sheet Page 7 of 8 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 555352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Healthcare Center 2939 S. Peach Avenue Fresno, CA 93725 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 Level of Harm - Minimal harm or potential for actual harm can do to prevent infections is to maintain good oral hygiene. All older adults should be careful about their oral health. The facility's Policy and Procedure pertinent to the provision of care, specific to hygiene and oral/mouth care, was requested but not provided. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555352 If continuation sheet Page 8 of 8