Inspection visit

Health inspectionMarch 24, 2022

DELTA HEALTHCARE & WELLNESS CENTER, LPCMS #55535411 citations on this visit

11 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 11 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on interview and record review, the facility failed to maintain the dignity of one of 28 sampled residents (Resident 28), when Resident 28 was not assisted to the bathroom in time and had to urinate and had a bowel movements in his briefs (adult absorbent undergarments). This failure resulted in Resident 28 feeling embarrassed. Findings: During an interview on 3/21/22, at 12:50 PM, with Resident 28's wife (Family Member -FM) 1, FM 1 stated, Resident 28 could feel sensation to empty his bowel and bladder. FM 1 stated, Resident 28 will put on his call light to ask for assistance to the bathroom, but the facility staff do not assist him in time and then he (Resident 28) has to go in his diaper. FM 1 stated, when this happened, Resident 28 told her it made him feel embarrassed. During an interview and record review on 3/24/22, at 11:59 AM, with Director of Nursing (DON), Resident 28's medical record was reviewed. Resident 28's Clinical admission Evaluation (CAE), dated 2/15/22, the CAE indicated, Resident 28 was assessed on admission to be continent [able to sense and control elimination of urine and/or bowel] of bladder. DON stated, Resident 28 would sometimes use the urinal (plastic container for urine kept at male resident's bedside). Resident 28's Baseline Care Plan (BCP), dated 2/16/22, the BCP indicated, Resident 28 was frequently incontinent (unable to sense and control elimination of urine and/or bowel) of bladder, and occasionally incontinent of bowel. DON verified, neither the CAE nor the BCP asked for the Resident 28's personal preferences regarding toileting. Resident 28's Tasks documentation, Resident 28's Bladder Elimination (BE), dated 3/5/22 to 3/19/22, the BE indicated, Resident 28 was incontinent of urine 21 times and continent of urine 34 times. During a review of Resident 28's Tasks documentation, Resident 28's Bowel Elimination (BE2), dated 3/5/22 to 3/19/22, the BE2 indicated, Resident 28 was incontinent of bowel nine times and continent of bowel nine times. DON stated, Resident 28 was not on a bowel and bladder management program. DON stated, it was her expectation for staff to assist residents to the bathroom as needed. During a review of the facility's document titled, Resident Rights Under Federal Regulations (RRUFR), undated, the RRUFR indicated, Facility shall protect and promote the rights of each resident, including each of the following rights: 1. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside Facility. During a review of the facility's policy and procedure (P&P) titled, Resident Rights, dated 1/1/12, the P&P indicated, Residents of skilled nursing facilities have a number of rights under state and federal law. The Facility will promote and protect those rights. Resident's [sic] have freedom of choice, as much as possible, about how they wish to live their everyday lives and receive care, (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 13 Event ID: 555354 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0550 Level of Harm - Minimal harm or potential for actual harm subject to the Facility's rules and regulations and applicable state and federal laws governing the protection of resident health and safety. Employees are to treat all residents with kindness, respect, and dignity and honor the exercise of resident's rights.IV. In order to facilitate resident choices, Facility Staff will.Gather information about the resident's personal preferences on initial assessment and periodically thereafter, and document these preferences in the medical record. Residents Affected - Few During a review of the facility's P&P titled, Bowel and Bladder Management Program, dated 9/18/12, the P&P indicated, It is the policy of this facility to ensure that an Elder [resident] who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore/maintain as much normal bladder function as possible.2. A bowel and bladder (B&B) assessment shall be completed on all Elders within 14 days of admission and PRN [as needed]. If incontinence problems are identified, every effort will be made to determine the predisposing factors contributing to incontinence or risk for incontinence and whether or not the condition is reversible or irreversible. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 2 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on interview and record review, the facility failed to ensure two of 28 sampled residents (Resident 3 and Resident 32) were informed of their Advance Directive (AD- written statement of a person's wishes regarding medical treatment and end of life decisions, made to ensure those wishes are carried out should the person become unable to communicate their wishes) options. This failure had the potential for residents end of life wishes to not be honored. Findings: During a concurrent interview and record review on 3/23/22, at 12:02 PM, with Director of Admissions (DA), Resident 32's Record of admission Authorization (RAA), dated 5/13/16 was reviewed. Question 11 of the RAA indicated, Advance Directives: I have been informed in writing of the facility's policy(ies) regarding implementation of medical directives, of my right to draw up a Living Will or other directive for medical treatment including a Durable Power of Attorney for Health Care Decisions and my right to refuse or accept medical treatment. Neither of the Yes or No response boxes were marked. DA verified, Resident 32's RAA did not have a markable option to indicate if Resident 32 already had an AD, if Resident 32 wanted more information on AD, or wanted to execute an AD. DA verified, there was no AD in Resident 32's medical record. During a concurrent interview and record review on 3/23/22, at 12:45 PM, with DA, Resident 3's RAA, dated 12/16/20, was reviewed. Question 11 of Resident 3's RAA indicated, Advance Directives: I have been informed in writing of the facility's policy(ies) regarding implementation of medical directives, of my right to draw up a Living Will or other directive for medical treatment including a Durable Power of Attorney for Health Care Decisions and my right to refuse or accept medical treatment. The Yes or No response boxes were marked yes. DA verified, Resident 3's RAA did not have a markable option to indicate if Resident 3 already had an AD, if Resident 3 wanted more information on AD, or wanted to execute an AD. DA verified, there was no AD in Resident 3's medical record. During a review of the facility's policy and procedure (P&P) titled, Advance Directives, dated 7/18, the P&P indicated, I. admission A. Upon admission, the admission Staff or designee will provide written information to the resident concerning his or her right to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment, and the right to formulate advance directives. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 3 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure the Minimum Data Set (MDS - resident assessment and care screening tool) discharge assessment was transmitted within the required time frame for one of one sampled resident (Resident 1). This failure had the potential to negatively affect the provision of necessary care and services for Resident 1. Residents Affected - Few Findings: During a review of Resident 1's MDS - Discharge Assessment (MDS-DA), dated 10/9/21, Resident 1's MDS-DA indicated, Resident 1's admission date (entry date to the facility) was on 9/13/21 and Resident 1's assessment completion date was on 10/22/21. Resident 1's discharge date from the facility was 10/9/21. During an interview on 3/23/22, at 3 PM, with MDS Nurse (MDSN), MDSN stated, Resident 1's MDS-DA was submitted late, it should have been transmitted 14 days after completion date. MDSN stated, Yes, it is a tag. During a review of the Centers for Medicare and Medicaid Services [CMS - a federal agency within the United States Department of Health and Human Services that administers Medicare program & works in partnership with state governments] Submission Report (CMS-SR), dated 3/23/22, CMS-SR indicated, Resident 1's Discharge MDS assessment was submitted on 3/23/22. The CMS-SR indicated, the assessment submission date was more than 14 days after Z0500B (RN signature) was signed and completed. During a review of the facility's policy and procedure (P&P) titled RAI-OBRA (Resident Assessment Institute - Omnibus Budget Reconciliation Act) required Assessment Summary, dated 10/19, the P&P indicated, Discharge Assessment -return not anticipated [non-comprehensive] completion date was no later than discharge date plus (+) 14 calendar days.transmission date was no later than MDS completion date + 14 calendar days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 4 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to accurately complete Preadmission Screening and Resident Review (PASRR- Federal requirement to screen for mental illness and intellectual disabilities to ensure individuals are placed in nursing homes with appropriate services to meet their needs) Level I Screening, for five of 28 sampled residents (Resident 39, Resident 40, Resident 3, Resident 32, and Resident 28). This failure resulted in a Level II screening not being performed and had the potential for residents to be admitted to the facility without appropriate services available to them. Residents Affected - Some Findings: During a review of Resident 39's PASRR, dated 11/12/21, the PASRR indicated, Section III- Serious Mental Illness Screen 10. Does the individual have a diagnosed mental disorder such as depression, Anxiety, Panic, Schizophrenia/Schizoaffective Disorder [mental disorder causing reality to be interpreted abnormally], Psychotic [disconnection from reality], Delusional [inability to differentiate something real from something imagined] and/or Mood Disorder [depression and/or periods of high energy followed by periods of depression]? The facility answered no. During a review of Resident 39's admission Record (AR), dated 11/12/21, the AR indicated, Schizophrenia, unspecified as one of Resident 39's admission diagnoses. During a review of Resident 40's PASRR, dated 2/25/22, the PASRR indicated, Section III - Serious Mental Illness Screen 10. Does the individual have a diagnosed mental disorder such as Depression, Anxiety, Panic, Schizophrenia/Schizoaffective Disorder, Psychotic, Delusional, and/or Mood Disorder? The facility answered no. During a review of Resident 40's AR, dated 11/12/21, the AR indicated Major Depressive Disorder, Single Episode, Unspecified as one of Resident 40's admission diagnoses. During a review of Resident 28's PASRR, dated 2/16/22, the PASRR indicated, Section III - Serious Mental Illness Screen 10. Does the individual have a diagnosed mental disorder such as Depression, Anxiety, Panic, Schizophrenia/Schizoaffective Disorder, Psychotic, Delusional, and/or Mood Disorder? The facility answered no. During a review of Resident 28's AR, dated 2/15/22, the AR indicated Anxiety Disorder, Unspecified and Major Depressive Disorder, Single Episode, Unspecified as two of Resident 28's admission diagnoses. During a review of Resident 3's PASRR, dated 12/31/20, the PASRR indicated, Section V- Diagnosed Mental Illness 26. Does the resident have a diagnosed mental disorder such as Schizophernia/Schizoaffective Disorder, Psychotic/Psychosis, Delusional, Depression, Mood Disorder, Bipolar, or Panic/Anxiety? There was neither a yes or no response by the facility. During a review of Resident 3's AR, dated 8/30/21, the AR indicated, Major Depressive Disorder, Recurrent, Unspecified and Generalized Anxiety Disorder as two of Resident 3's admission diagnoses. During a review of Resident 32's PASRR, dated 5/13/16, the PASRR indicated, Section V- Diagnosed Mental Illness 26. Does the resident have a diagnosed mental disorder such as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 5 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0645 Level of Harm - Minimal harm or potential for actual harm Schizophrenia/Schizoaffective Disorder, Psychotic/Psychosis, Delusional, Depression, Mood Disorder, Bipolar, or Panic/Anxiety? The facility response was marked no. During a review of Resident 32's AR, dated 5/13/16, the AR indicated Major Depressive Disorder, Recurrent, Unspecified as one of Resident 32's admission diagnoses. Residents Affected - Some During an interview on 3/23/22, at 9:18 AM, with Director of Admissions (DA). DA stated, she completed all PASRR's, including weekends and holidays which were done remotely from her home. DA stated, she would speak with case managers to get information. DA stated, the questions on the PASRR form were answered with yes or no. DA stated, Level II screenings were triggered by a person being in a mental health facility, taking psychotropics, has schizophrenia or is manic/depressive. DA stated, a potential resident who had Major Depressive Disorder and and was taking an anti-depressant would not trigger a Level II screening, almost everyone has depression. DA stated, not all questions on Level I screening need to be answered and she had never encountered a Level II screening trigger. DA stated, PASRR's need to be completed accurately to make sure the facility can properly care for admitted residents. During an interview on 3/23/22, at 10 AM, with Administrator, Administrator stated, the facility had no process to ensure PASRR's were accurately completed. During a review of the facility's policy and procedure (P&P) titled, Pre-admission Screening Resident Review (PASRR), dated 7/18, the P&P indicated, Purpose.To ensure that all Facility applicants are screened for mental illness and intellectual disability (ID) or a related condition (RC) prior to admission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 6 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to implement its policy and procedure for fall prevention program for one of 28 sampled residents (Resident 31), who had incidents of repeated falls. This failure had the potential to result in additional falls with major injuries to Resident 31. Findings: During a concurrent observation and interview, on 3/24/22, at 7:34 AM, with Certified Nursing Assistant (CNA) 1, inside Resident 31's room, Resident 31 was observed sitting up on his wheelchair facing the foot of his bed. Resident 31's call light was laying on his bed, not within Resident 31's reach. A posted white paper on Resident 31's wall indicated, Call, don't fall. CNA 1 stated, Yes, [Resident 31's] call light was not within reach, the call light should be within [Resident 31's] reach so that [Resident 31] can call and safety can be provided. During a concurrent observation and interview, on 3/24/22, at 7:35 AM, with CNA 2, outside Resident 31's room, there was no star observed on Resident 31's door. CNA 2 stated, There should be a star outside [Resident 31's) door, so we would know that [Resident 31] is a fall risk. During a review of Resident 31's admission Record (AR), [undated], Resident 31's AR indicated, Resident 31 was originally admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses including fracture (partial or complete break of the bone) of the lower left end ulna (left wrist) and repeated falls. During a review of Resident 31's Minimum Data Set (MDS - resident screening and assessment tool), dated 2/13/22, Resident 31's MDS indicated, Resident 31's Brief Interview for Mental Status (BIMS- used to assess cognitive status in elderly residents) score was moderately impaired. During an interview on 3/24/22, at 7:56 AM, with the Director of Nursing (DON), DON stated, part of our policy to prevent falls were to place a falling star outside of Resident 31's door and to keep Resident 31's call light within reach. During a review of the facility's policy and procedures (P&P) titled, Fall Prevention Program, dated 10/10/14, the P&P indicated, Purpose: to prevent accidents by providing an environment that is free from hazards over which the facility has control.Procedure: 1. Fall Prevention.c. elders who have frequent falls will be identified by use of star symbol to alert all staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 7 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on interview and record review, the facility failed to ensure care was provided to maintain bowel and bladder continence (ability to sense and control elimination of urine and/or bowel) for one of 28 sampled residents (Resident 28), when Resident 28 was not assisted to the bathroom in time and had to urinate and/or have bowel movements in Resident 28's briefs (adult absorbent undergarments). This failure had the potential for Resident 28 to not maintain his level of continence. Findings: During an interview on 3/21/22, at 12:50 PM, with Resident 28's wife (Family Member -FM) 1, FM 1 stated, Resident 28 could feel sensation to empty his bowel and bladder. FM 1 stated, Resident 28 will put on his call light to ask for assistance to the bathroom, but the facility staff did not assist him in time and then he (Resident 28) has to go in his diaper. During an interview and record review, on 3/24/22, at 11:59 AM, with Director of Nursing (DON), Resident 28's medical record was reviewed. The Clinical admission Evaluation (CAE), dated 2/15/22, the CAE indicated, Resident 28 was assessed on admission to be continent of bladder. DON stated, Resident 28 will sometimes use the urinal (plastic container for urine kept at male resident's bedside). Resident 28's Baseline Care Plan (BCP), dated 2/16/22, the BCP indicated, Resident 28 was frequently incontinent [unable to sense and control elimination of urine and/or bowel] of bladder, and occasionally incontinent of bowel. DON verified, neither the CAE nor the BCP asked for Resident 28's personal preferences regarding toileting. During a review of Resident 28's Bladder Elimination documentation (BE1), dated 3/5/22 to 3/19/22, the BE1 indicated, Resident 28 was incontinent of urine 21 times and continent of urine 34 times. Resident 28's Bowel Elimination (BE2), dated 3/5/22 to 3/19/22, the BE2 indicated, Resident 28 was incontinent of bowel nine times and continent of bowel nine times. DON stated, Resident 28 was not on a bowel and bladder management program. DON stated, it was her expectation for staff to assist residents to the bathroom as needed. During a concurrent interview and record review, on 3/24/22, at 3:04 PM, with DON, Resident 28's medical record was reviewed. DON stated, there were no care plans to address Resident 28's bowel and bladder continence maintenance. During a review of the facility's P&P titled, Bowel and Bladder Management Program, dated 9/18/12, the P&P indicated, It is the policy of this facility to ensure that an Elder [resident] who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore/maintain as much normal bladder function as possible.2. A bowel and bladder (B&B) assessment shall be completed on all Elders within 14 days of admission and PRN [as needed]. If incontinence problems are identified, every effort will be made to determine the predisposing factors contributing to incontinence or risk for incontinence and whether or not the condition is reversible or irreversible. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 8 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 implement its policy and procedure for Oxygen Administration for one of 28 sampled residents (Resident 89). This failure had a potential to result in Resident 89's hypoxia (low oxygen levels in the blood). Residents Affected - Few Findings: During a concurrent observation and interview on 3/21/22, at 11:20 AM, inside Resident 89's room, Resident 89 was observed with a nasal cannula (a plastic tube placed into the nose used to deliver supplemental oxygen) in his nose while sitting on his wheelchair. Resident 89's oxygen concentrator's (a medical device that gives extra oxygen) humidifying jar (humidifier bottle - may be used to alleviate a sore, dry and/or bloody nose) was empty of water. Restorative Nursing Assistant (RNA) stated, the humidifying jar should not be empty of water. During a review of Resident 89's, admission Record (AR), [undated], Resident 89's AR indicated, Resident 89 was admitted to the facility on [DATE], with diagnoses including acute respiratory failure (a condition which the blood does not have too much oxygen) and Chronic Obstructive Pulmonary Disease (COPD - a condition involving a constriction of the airways and difficulty in breathing). During a review of Resident 89's Order Summary Report (OSR), dated 3/14/22, Resident 89's OSR indicated, Resident 89's physician ordered Oxygen 2 Liters per minute [LPM - unit of measure per minute] via nasal cannula continuously every shift related to Acute Respiratory Failure.oxygen humidifier bottle and tubing to be changed on Monday & Thursday every night (NOC) shift.monitor oxygen saturation [level of oxygen in the blood] to titrate [a way to adjust and limit potential side effects by taking time to see how the body will react to the drug] to keep above 90% every shift related to hypoxia. During an interview on 3/21/22, at 11:35 AM, with the Director of Nursing (DON), DON stated, the humidifier jar should have water in it and to be checked and changed by night shift licensed nurses and not the CNA [Certified Nursing Assistant] or RNA. During a review of the facility's policy and procedures (P&P) titled Oxygen Administration, dated 3/21/22, the P&P indicated, Steps in Procedure: .12. Check the mask, tank, humidifying jar, etc., to be sure they are in good working order and are securely fastened. Be sure there is water in the humidifying jar and the the water level is high enough that the water bubbles as the oxygen flows through.14. Periodically check water level in humidifying jar. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 9 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to ensure a Registered Nurse (RN) was scheduled and on duty eight hours a day, seven days a week. This failure had the potential for resident care to be negatively impacted. Findings: During a concurrent interview and record review, on 3/24/22, at 2:43 PM, with the Director of Nursing (DON), the facility's staff schedule titled, Nursing Schedule 2022 (NS), dated 3/22, was reviewed. The NS indicated, only Licensed Vocational Nurses (LVN) were scheduled. DON stated, she was the only RN in the facility and did not always work seven days a week. DON stated, she did not have a printed schedule for herself, and her contract indicated a Monday through Friday schedule, eight hours per day. During the survey entrance conference on 3/21/22, at 9:30 AM, the Administrator stated, the facility did not have any staffing waivers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 10 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop/implement a policy for anticoagulant (medication used to prevent blood clots and to prevent stroke) use for two of 28 sampled residents (Resident 31 and Resident 90). This failure had the potential for Resident 31 and Resident 90 to experience unnoticed excessive bleeding and bruising. Residents Affected - Few Findings: During a concurrent interview and record review on 3/23/22, at 9:21 AM, with Licensed Vocational Nurse (LVN) 1, Resident 31's Order Summary Report (OSR), dated 1/31/22 was reviewed. Resident 31's OSR indicated, Resident 31 was to receive Eliquis (anticoagulant medication) tablet 5 milligrams (mg- unit of measure) by mouth two times a day. LVN 1 stated, Resident 31 did not have monitoring for the use of Eliquis medication, we should be monitoring for bleeding or bruising, blood in the urine or in [Resident 31's] feces [stools]. If the signs and symptoms were not monitored, the resident may have excessive bleeding. During a review of Resident 31's admission Record (AR), [undated], Resident 31's AR indicated, Resident 31 was originally admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses including Atrial Fibrilation (A-fib- an irregular and often very rapid heart rhythm that can lead to blood clot in the heart.) During a concurrent interview and record review on 3/23/22, at 9:22 AM, with LVN 1, Resident 90's Order Summary Report (OSR), dated 3/15/22 was reviewed. Resident 90's OSR indicated, Resident 90 was ordered to receive Brilinta (anticoagulant medication) tablet 90 mg by mouth two times a day. LVN 1 stated, Resident 90 did not have monitoring for the use of Brilinta medication, we should be monitoring for bleeding or bruising, blood in the urine or in [Resident 90's] feces [stools]. If the signs and symptoms were not monitored, the resident may have excessive bleeding. During a review of Resident 90's, admission Record (AR), [undated], Resident 90's AR indicated, Resident 90 was admitted to the facility on [DATE], with diagnoses including cerebral infarction (stroke-a blockage or bleed of the blood vessels, either interrupts or reduces the supply of blood to the brain) and hypertension (elevated blood pressure). During an interview on 3/23/22, at 10 AM, with the Director of Nursing (DON), the DON stated, the facility did not have a policy for anticoagulant use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 11 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of 28 sampled residents (Resident 31), who received psychotropic medication (any drug that is capable of affecting mood, emotions and behavior) was adequately monitored, by failing to properly identify the specific targeted behavior for the use of Prozac (a medication used to treat depression). This failure had the potential for Resident 31 to experience adverse side effects related to psychotropic medication including sedation (drowsiness), dizziness, and may lead to falls and injuries. Findings: During a concurrent interview and record review, on 3/23/22, at 9:21 AM, with Licensed Vocational Nurse (LVN) 1, Resident 31's Order Summary Report (OSR), dated 2/1/22, was reviewed. Resident 31's OSR indicated, Resident 31 was ordered to receive Prozac capsule 40 milligrams (mg- unit of measure) one time a day for depression related to major depressive disorder manifested by sadness over loss of life roles. LVN 1 stated, Resident 31 had episodes of being withdrawn and wanted to be left alone in his room. LVN 1 stated, sadness was too general and should be specific to Resident 31's behavior being monitored. During a review of Resident 31's admission Record (AR), [undated], Resident 31's AR indicated, Resident 31 was originally admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses including major depressive disorder (persistently depressed mood) and repeated falls. During a review of the facility's policy and procedures (P&P), titled Behavior/Psychoactive Drug Management, dated 11/18, the P&P indicated, Purpose: to provide environment that supports resident to obtain or maintain the highest physical, mental, and psychosocial well-being.Procedure.v.6. The continued use of the medication and dose of the medication is clinically necessary to treat and manage the symptoms of the disease and the Attending Physician/ Prescriber and/or psychiatrist documents this information.documentation requirements: . iv. Occurrences of behavior for which psychoactive medications are in use will be entered with hash marks (#) on the medication administration record every shift. v. Monthly occurrence of behavior will be tallied and entered on the monthly psychoactive drug management form in addition to any occurrence of adverse reaction. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 12 of 13 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 555354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291 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 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide the minimum square footage as required by regulation in 15 of the facility's resident bedrooms. This had the potential to provide insufficient space in the event of an actual emergency. Findings: During a concurrent general observation of the facility, interview, and record review, on 3/24/22, at 6:21 PM, with Administrator, the facility's floor plan (FP) was reviewed. The FP indicated the following rooms did not provide the minimum square footage (sq. ft.) as required by regulation (80 sq. ft. per resident for multi occupation rooms): room [ROOM NUMBER]: 152 sq. ft. - two residents room [ROOM NUMBER]: 223 sq. ft. - three residents room [ROOM NUMBER]: 151 sq. ft. - two residents room [ROOM NUMBER]: 225 sq. ft. - three residents room [ROOM NUMBER]: 151 sq. ft. - two residents room [ROOM NUMBER]: 225 sq. ft. - three residents room [ROOM NUMBER]: 151 sq. ft. - two residents room [ROOM NUMBER]: 225 sq. ft. - three residents room [ROOM NUMBER]: 151 sq. ft. - two residents room [ROOM NUMBER]: 224 sq. ft. - three residents room [ROOM NUMBER]: 153 sq. ft. - two residents room [ROOM NUMBER]: 225 sq. ft. - three residents room [ROOM NUMBER]: 151 sq. ft. - two residents room [ROOM NUMBER]: 151 sq. ft. - two residents room [ROOM NUMBER]: 151 sq. ft. - two residents The Administrator confirmed the resident bedroom sizes on the floor plan. Administrator stated, the facility does not have a current room waiver. Residents had reasonable amounts of privacy, closets and storage were adequate and bedside tables were available. There was sufficient space for nursing care and for residents to ambulate and/or use walkers/wheelchairs. Toilet facilities were accessible. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555354 If continuation sheet Page 13 of 13

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Citations

11 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0550GeneralS&S Dpotential for harm
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
0578GeneralS&S Dpotential for harm
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
0640GeneralS&S Dpotential for harm
F640 - Automated data processing requirement-
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
0645GeneralS&S Epotential for harm
F645 - Preadmission Screening for individuals with a mental disorder and individuals
PASARR screening for Mental disorders or Intellectual Disabilities
0689GeneralS&S Dpotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0690GeneralS&S Dpotential for harm
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0727GeneralS&S Epotential for harm
F727 - Except when waived under paragraph (f) or (g) of this section, the
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
0757GeneralS&S Dpotential for harm
F757 - Unnecessary Drugs—General
Ensure each resident’s drug regimen must be free from unnecessary drugs.
0758GeneralS&S Dpotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0912GeneralS&S Bno actual harm
F912 - Measure at least 80 square feet per resident in multiple resident
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

FAQ · About this visit

Common questions about this visit

What happened during the March 24, 2022 survey of DELTA HEALTHCARE & WELLNESS CENTER, LP?

This was a inspection survey of DELTA HEALTHCARE & WELLNESS CENTER, LP on March 24, 2022. The surveyor cited 11 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at DELTA HEALTHCARE & WELLNESS CENTER, LP on March 24, 2022?

Yes, 11 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Health inspection·March 24, 2022