Health inspection·February 8, 2024

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 provide services which meet professional standards of quality for one of 20 sampled residents (Resident 18) when Resident 18 was not administered oxygen (O2) per physician orders. This failure resulted in Resident 18 not receiving oxygen. Residents Affected - Few Findings: During a concurrent observation and interview on 2/5/24 at 10:05 a.m. with Licensed Vocational Nurse (LVN) 1 in Resident 18's room, Resident 18 was lying down in bed and her nasal cannula (tube that goes in your nose and delivers oxygen) was in her nose. Upon checking the concentrator (machine that gives oxygen) the concentrator was off. LVN 1 stated Resident 18 should have continues oxygen on, and Resident 18's concentrator was off. During review of Resident 18's Order Summary Report (OSR) dated 2/6/2024, the OSR indicated, Oxygen 2 LPM [liter per minute] via nasal cannula every shift SOB [shortness of breath] R/T [Related to] every shift for SOB while in bed. During an interview on 2/6/24 at 2:28 p.m. with Director of Nursing (DON), DON stated expectation is to have oxygen concentrator on if resident has an order for oxygen. During a review of the facility's policy and procedure (P&P) titled, Oxygen Therapy, dated 2017, the P&P indicated, To ensure the safe storage and administer of oxygen in the Facility.A. Administer oxygen per physician orders. Page 1 of 5 555354 555354 02/08/2024 Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 an interview on 2/8/24 at 8:26 a.m. with Director of Nursing (DON), DON stated we have a RN who works on the weekends but does not work the full eight hours, or consistently works on the weekends. DON stated she has to come in a lot on the weekends especially on Sundays, and sometimes there is no coverage. During a concurrent interview and record review on 2/8/24 at 8:48 a.m. with Director of Staff Development (DSD), the facility's Census and Direct Care Service Hours Per Patient Day (DHPPD) dated 8/6/2023, 8/12/23, 8/13/23, 8/20/23, 9/3/23, 9/10/23, 9/16/23, 9/17/23, 9/30/23, 12/22/23, 12/24/23, and 12/30/23 were reviewed. DSD stated we have a weekend RN, but she does not come in on all weekends. DSD verified there was no RN on duty for the above dates. 555354 Page 2 of 5 555354 02/08/2024 Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291

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. Based on observation, interview, and record review, the facility failed to remove expired medication from the medication cart. This failure had the potential to result in medications administered not to be effective. Findings: During a concurrent observation and interview with Licensed Vocational Nurse (LVN) 1, on 2/6/24 at 8:55 a.m. in the hallway at the green medication cart, the following expired medications were found in the cart: Artificial tear solutions (eye drops-lubricate dry eyes) opened on 10/25/23. Morphine Sulfate (Pain medication) liquid un-opened expired on 9/19/23. Hyoscyamine (Decrease acid production in the stomach) 0.125 mg (milligram-unit of measurement) tablet expired on 12/12/23. LVN 1 verified the findings. During an interview on 2/6/24 at 2:18 p.m. with Director of Nursing (DON), DON stated expectation is to audit cart every day and when nurses find expired medications in their cart, they turn in to me (DON). During a review of the facility's policy and procedure (P&P) titled, MEDICATION STORAGE IN THE FACILITY, dated 2014, the P&P indicated, Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those if the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications.S. All Ophthalmic and Otic medications are to be dated upon opening and discarded 30 days after opening. Date open sticker can be attached to the container that the medication is stored in.(a) Unless otherwise specified in the individual monograph, or in the absence of stability data to the contrary, such beyond-use date shall be not later than (a) the expiration date on the manufacturer's container or (b) one year from the date the drug is dispensed, whichever is earlier. 555354 Page 3 of 5 555354 02/08/2024 Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291

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 ensure appropriate use of an antibiotic (medication used to treat infection) for one of 20 sampled residents (Resident 99). This failure had the potential for unnecessary antibiotic usage leading to antibiotic resistant bacteria (Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them). Residents Affected - Few Findings: During a concurrent interview and record review, on 2/7/24 at 10:17 a.m., with Infection Prevention Nurse (IPN), the facility's Infection Surveillance Monthly Report (ISMR), dated February 2024 was reviewed. The ISMR indicated Resident 99 had an onset date of 1/25/24, Infection: UTI (urinary tract infection), signs and symptoms: Dysuria (discomfort while urinating), Fatigue/Malaise (tiredness), New or marked increase in frequency, New or marked increase in urgency, Urinary complaints. IPN stated the resident, Resident 99, received the ordered medication Macrobid (antibiotic) as prescribed and completed the medication on 2/1/24. During a review of Resident 99's Pharmacy Order Summary (PO), dated January 2024, the PO indicated Resident 99 was prescribed Macrobid Oral Capsule 100 mg (milligram) Give 1 Tablet by mouth two times a day for UTI for 7 days. Order states: completed. Order date: 1/25/24. Start date: 1/25/24. End date: 2/1/24. During a concurrent interview and record review on 2/7/24 at 10:20 a.m. with IPN, Resident 99's Urine Culture (UC- a laboratory test check for bacteria or other germs in a urine sample), dated January 24, 2024, was reviewed. The UC indicated, four or more organisms (bacteria) present. IPN stated the sensitivity (a test to see what antibiotic will work best to treat the infection) results were not obtained, we should have obtained the sensitivity results to know if the Macrobid was the appropriate antibiotic. During a review of the facility's policy and procedure (P&P) titled, Antibiotic Stewardship, dated May 20, 2021, the P&P indicated, The Facility will implement an Antibiotic Stewardship Program (ASP) to promote the appropriate use of antibiotics optimizing the treatment of infection, reducing the threat of antibiotic resistance, reducing adverse events associated with antibiotic use and improve the outcomes for Residents. 555354 Page 4 of 5 555354 02/08/2024 Delta Healthcare & Wellness Center, LP 514 North Bridge Street Visalia, CA 93291

F 0912 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 interview and record review, the facility failed to provide the minimum square footage as required by regulation in 16 of the facility's resident bedrooms. This failure had the potential to provide insufficient space in the event of an actual emergency. Findings: During a concurrent interview and record review on 2/8/24 at 8:25 a.m. with Administrator, the facility's floor plan (FP) and facility census (FC) dated 2/5/24 was reviewed. The FP and FC 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]: 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 room [ROOM NUMBER]: 150 sq. ft - two residents room [ROOM NUMBER]: 247 sq. ft - three residents Administrator stated she had not received a waiver for less than 80 square foot per Resident. 555354 Page 5 of 5