Inspection·April 29, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure residents were free from abuse for one of five sampled residents (Resident 1) when Certified Nursing Assistant (CNA) 1 hit Resident 1 in the shoulder during transfer from the bed to the wheelchair. This failure violated Resident 1's right to be free from abuse. Findings: During a review of Resident 1's admission Record (a document containing demographic information), indicated, Resident 1 was admitted to the facility on [DATE]. During a review of Resident 1's Diagnosis Report (a document listing resident's diagnoses) dated 4/8/24, indicated Resident 1 was admitted to the skilled nursing facility with diagnoses which included, .Dementia (progressive or persistent loss of intellectual functioning) .Parkinson (a brain disorder that causes unintended or uncontrollable movements) .Type 2 Diabetes Mellitus (high blood sugar) . During a review of Resident 1's Minimum Data Set (MDS-a resident assessment tool used to identify resident cognitive and physical functional level) assessment dated [DATE], indicated Resident 1's Brief Interview for Mental Status (BIMS-assessment of cognitive status for memory and judgement) assessment score of 8 (a score of 13-15 indicates cognitively intact, 8-12 indicates moderate impairment, and 00-07 indicates sever impairment) which indicated Resident 1 had moderate cognitive impairment. During a concurrent interview and record review on 4/29/24 at 8:45 am., with the Administrator (ADM), Resident 1's Facility Reported Event dated 4/8/24, was reviewed. The ADM stated CNA 1 was providing care to Resident 1. The ADM stated Resident 1 became combative with staff while care was being provided and bit CNA 1. The ADM stated CNA 1 hit Resident 1 on the back. The ADM stated CNA 1 should have not hit Resident 1. The ADM stated it was a staff to resident abuse. During a telephone interview on 4/29/24 at 9:05 am., with Licensed Vocational Nurse (LVN) 1, LVN 1 stated on 4/8/24 CNA 4 notified me Resident 1 was uncooperative during care and CNA 1 hit Resident 1 in the back. LVN 1 stated it was an abuse to resident and should have never happened. During a telephone interview on 4/29/24 at 9:17 am., with CNA 1, CNA 1 stated she was familiar with Resident 1. CNA 1 stated Resident 1 was uncooperative with care and verbally aggressive. CNA 1 stated she was helping another CNA transfer Resident 1 from the bed to the wheelchair and Resident 1 bit (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 2 Event ID: 555485 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 555485 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kings Healthcare & Wellness Center LP 851 Leslie Lane Hanford, CA 93230 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)