Health inspection·August 5, 2025

F 0689 Level of Harm - Actual harm Residents Affected - Few rest, to keep the leg comfortable and for pain control. The DON stated Resident 1 declined after the fall because she did not want to eat. During a concurrent interview and record review on 8/5/25 at 10:45 a.m. with Licensed Vocational Nurse (LVN) 1, Resident 1's MDS Section GG- Functional Status (MDSGG), dated 5/7/25 was reviewed. The MDSGG indicated, .Mobility.Coding: . If helper assistance is required because resident's performance is unsafe.score according to amount of assistance provided.03. Partial/moderate assistance- Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.Toilet transfer The ability to get on and off a toilet or commode [portable toilet which enables a patient to sit comfortably]. The MDSGG indicated, a code of 03 was selected for Resident 1's toilet transfer mobility. LVN 1 stated Resident 1's MDSGG indicated Resident 1 needed partial assistance from staff for toilet transferring, which was the ability to get on and off the toilet. LVN 1 stated prior to her fall, Resident 1 drank nutritional drinks as her main source of nutrition instead of eating food and rarely needed PRN pain medications. LVN 1 stated Resident 1 had prior falls where she would suddenly and unexpectedly move and fall down. LVN 1 stated Resident 1 fell on 7/20/25 at 6:30 a.m. LVN 1 stated CNA 1 assisted Resident 1 to the bathroom, sat her on the commode and then CNA 1 left the bathroom to go to Resident 1's closet. LVN 1 stated CNA 1 saw Resident 1 standing up from the commode and witnessed her fall. LVN 1 stated Resident 1 was diagnosed with a left hip fracture at the hospital. LVN 1 stated Resident 1 was in pain, so nurses administered PRN pain medications more frequently. LVN 1 stated Resident 1's PRN medications were changed to be administered routinely to keep her as comfortable as possible due to the increased pain she was experiencing. LVN 1 stated Resident 1 became more tired, possibly from the side effects of taking pain medications more frequently. LVN 1 stated Resident 1's food intake declined and was not drinking her usual nutritional drinks. LVN 1 stated Resident 1 passed away on 7/26/25, which was 6 days after she fell. LVN 1 stated it was important to provide Resident 1 with the supervision necessary to prevent accidents because it could have prevented her fall, injury, pain and death. LVN 1 stated Resident 1 was living an uneventful life and this fall changed that for her. During a phone interview on 8/5/25 at 11:22 a.m. with CNA 1, CNA 1 stated Resident 1 was confused at times, but could say her preferences and liked a usual routine. CNA 1 stated Resident 1 could transfer with the assistance of one person. CNA 1 stated on 7/20/25 at 6:30 a.m. CNA 1 noticed Resident 1 was attempting to get up to use the bathroom. CNA 1 stated she assisted Resident 1 to walk to the bathroom located inside Resident 1's room. CNA 1 stated she assisted Resident 1 to sit down on the commode and then stepped out of the bathroom but left the door open. CNA 1 stated Resident 1 had a commode located over the toilet in the bathroom. CNA 1 stated Resident 1 was adjusting herself on the toilet, got up too quickly, lost her balance and fell. CNA 1 stated she could not get to Resident 1 quickly enough before she fell. CNA 1 stated the door to Resident 1's bathroom was too narrow for her to reach Resident 1 before she fell. CNA 1 stated she was unable to quantify how far away she was from Resident 1 when she fell. CNA 1 stated she left Resident 1 in the bathroom to give her privacy. CNA 1 stated Resident 1 fell on her left side straight down on her left hip and was complaining of pain. CNA 1 stated Resident 1 appeared to be scared after the fall. CNA 1 stated Resident 1 was sent to the hospital due to the significant pain. CNA 1 stated Resident 1 came back from the hospital and stopped being able to get up to use the bathroom due to being bed bound. CNA 1 stated Resident drank less of her nutritional drinks after the fall and then passed away. CNA 1 stated it was important to provide Resident 1 with the necessary supervision to prevent accidents because the staff did not want her to get injured or to fall. During an observation on 8/5/25 at 11:34 a.m. in Resident 1's former bathroom, a commode was positioned over the toilet with silver hand railing noted to the left (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555530 If continuation sheet Page 2 of 7 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 555530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chowchilla Memorial Healthcare District 1104 Ventura Ave. Chowchilla, CA 93610 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 - Actual harm Residents Affected - Few of the toilet and in front of the toilet. The space between the toilet and the wall in front of the toilet appeared to be approximately 3 feet. During an interview on 8/5/25 at 11:39 a.m. with CNA 2, CNA 2 stated Resident 1 had fallen in the past and did not have good balance. CNA 2 stated Resident 1 required one person to assist her. CNA 2 stated she would bring Resident 1 to the hallway bathroom when she needed to use the bathroom because it was more spacious. CNA 2 stated Resident 1 required one person to stay with her while toileting. CNA 2 stated CNA 1 told CNA 2 that Resident 1 was in the bathroom when CNA 1 left to get something for Resident 1 to put on and then Resident 1 fell. CNA 2 stated Resident 1 went to the hospital. CNA 2 stated Resident 1 was in pain when staff would reposition her, was on bedrest, received bed baths and could not get up to use the toilet. CNA 2 stated Resident 1's intake of her nutritional drinks declined until it stopped, it was difficult to understand what Resident 1 was trying to say and then she passed away. CNA 2 stated, it was important to provide Resident 1 with the supervision necessary to prevent accidents because she was not able to recover after breaking her hip and subsequently passed away. CNA 2 stated CNA 1 should have stayed with her at all times and not stepped away for a second in order to prevent Resident 1's fall. During a phone interview on 8/5/25 at 11:59 a.m. with LVN 2, LVN 2 stated Resident 1 had prior falls and was a fall risk. LVN 2 stated Resident 1 fell in the bathroom and was lying with her legs towards the inside of the bathroom, head positioned towards the bathroom door and was lying on her left side. LVN 2 stated she did an assessment on Resident 1, and she was complaining of left hip pain with a skin tear to her left elbow. LVN 2 stated the hospice company was notified of Resident 1's fall, hospice informed Resident 1's family and the family desired for Resident 1 to be sent to the hospital. LVN 2 stated CNA 1 did not have enough time or space to catch Resident 1 as she fell. LVN 2 stated in the days following Resident 1's fall, she began declining, talking less, not drinking her nutritional drinks anymore and then passed away. LVN 2 stated it was important to provide Resident 1 with the supervision necessary to prevent accidents to ensure her safety and to prevent falls. During a concurrent interview and record review on 8/5/25 at 12:19 p.m. with the DON, Resident 1's MDSGG, dated 5/7/25 was reviewed. The MDSGG indicated, .Mobility.Coding: .If helper assistance is required because resident's performance is unsafe.score according to amount of assistance provided.03. Partial/moderate assistance- Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.Toilet transfer The ability to get on and off a toilet or commode. The MDSGG indicated a code of 03 was selected for Resident 1's toilet transfer mobility. The DON stated Resident 1 required partial assistance from one person to assist her with toilet transferring according to her MDSGG. The DON stated Resident 1 fell on 7/20/25. The DON stated Resident 1 was confused, complaining of pain and had decreased appetite after her fall. The DON stated Resident 1's pain medication changed from PRN to routine in an attempt to keep her comfortable. The DON stated Resident 1 passed away on 7/26/25. During a phone interview on 8/7/25 at 1:47 p.m. with the Hospice Clinical Supervisor (HCS), the HCS stated Resident 1 was placed on hospice in November 2023 with a diagnosis of heart disease (group of conditions affecting the heart and blood vessels). The HCS stated Resident 1's condition was fairly stable during this time, although Resident 1 had some falls. The HCS stated Resident 1 was confused intermittently but was able to make her needs known. The HCS stated Resident 1 did not require many PRN medications prior to her fall on 7/20/25. The HCS stated Resident 1 required 1 person assistance and should not have been left alone to use the bathroom on 7/20/25.During a phone interview on 8/12/25 at 11:47 a.m. with CNA 2, CNA 2 stated she had taken care of Resident 1 during the month when Resident 1 fell. CNA 2 stated her usual practice was to take Resident 1 to the bathroom in the hallway because she would take Resident 1 to the bathroom in a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555530 If continuation sheet Page 3 of 7 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 555530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chowchilla Memorial Healthcare District 1104 Ventura Ave. Chowchilla, CA 93610 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 - Actual harm Residents Affected - Few wheelchair, and it could fit Resident 1's wheelchair inside of it. CNA 2 stated Resident 1 was not safe to be left alone in the bathroom and needed to stay in close proximity to her. CNA 2 stated Resident 1 could make her preferences known, like if she wanted privacy or independence in the bathroom, but Resident 1 had never expressed to CNA 2 she wanted privacy or independence. During a phone interview on 8/12/25 at 3:44 p.m. with CNA 1, CNA 1 stated Resident 1 was able to ambulate to the bathroom with CNAs guiding her by hand. CNA 1 stated Resident 1 could not pivot (to turn or rotate) after standing up from the toilet. CNA 1 stated she did not observe a decline in Resident 1's mobility and function prior to her falling. CNA 1 stated if a resident required partial assistance, she would be really close to them in proximity. CNA 1 stated if a resident was attempting to stand up, she would be right next to them. CNA 1 stated Resident 1 needed assistance with activities which required greater movement, like using the bathroom. CNA 1 stated she left Resident 1's bathroom on 7/20/25 because she thought Resident 1 wanted independence. CNA 1 stated Resident 1 did not tell her on 7/20/25 prior to her fall she wanted to be independent. CNA 1 stated in the past, she would occasionally take Resident 1 to the bathroom in the hallway. CNA 1 stated on 7/20/2025, she took Resident 1 to the bathroom in her room because it was closer and more convenient. During a concurrent phone interview and record review on 8/15/25 at 10:45 a.m. with the DON, Resident 1's Fall Risk Evaluation (FRE), dated 5/12/25 was reviewed. The FRE indicated, .Score: 11.Category: At Risk.Level of consciousness/mental state.Intermittent confusion.Ambulation/ elimination [removal of waste from the body] status.Chair bound.assist with elimination.Gait/balance.Balance problem while standing.Balance problem while walking. The DON stated Resident 1 started hospice on 11/17/23. The DON stated Resident 1 had a history of multiple falls. The DON stated since starting hospice, Resident 1 had falls on 9/7/23, 9/12/23, 1/3/24, 8/29/24, and 7/20/25. The DON stated according to Resident 1's FRE, her score of 11 meant she was at risk for falls. The DON stated CNA 1 said she could not fit in Resident 1's bathroom with Resident 1 while Resident 1 was voiding. The DON stated the expectation was CNA 1 should have been with Resident 1 while she used the bathroom and to assist as needed. The DON stated there was no known decline in Resident 1's abilities prior to her fall on 7/20/25. The DON stated CNA 1 was outside Resident 1's bathroom and could not get to her quickly enough before Resident 1 fell. During a review of Resident 1's Care Plan Report (CPR), dated 7/15/21, the CPR indicated, .Resident has history of falling [related to] unsteady gait.Interventions.Ask any other staff member to help stay with other residents when transferring other residents or getting supplies.[Interdisciplinary Team- group of health care professionals with various areas of expertise who work together toward resident goals (IDT)] to review fall on 9/12/23.IDT to review unwitnessed fall with laceration [cut] to left forehead requiring 5 sutures [stitches to hold the edges of a wound together] on 1/11/23.IDT will review fall from 9/7/23.Provide toileting assistance as needed. During a review of Resident 1's Progress Notes (PN), dated 7/20/25, the PN indicated, .At approximately [6:30 a.m.] this writer was called upon to residents' room by CNA. Upon entering room resident was noted on the bathroom floor laying on her left side with her leg and hip under her and her head slightly raised.resident.lost her balance when she was holding on to the rails to either side of her and fell to the ground.Resident present with two skin tears to left elbow. When palpating [to examine by touching] left leg resident shouted out in pain. Resident stated it hurts.PRN medication given as ordered. Resident continues to [complain of (c/o)] left hip pain. [Hospice company name] contacted. RP requested to have resident sent out for further evaluation. [Doctor of Medicine (MD)].called and agreed with Hospice order to send out .During a review of Resident 1's Hospice Narrative Note (NN), dated 7/20/25, the NN indicated, .phone call.stating that [patient (pt)] suffered a fall [at 6:30 a.m.] fell in bathroom fall was a witnessed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555530 If continuation sheet Page 4 of 7 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 555530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chowchilla Memorial Healthcare District 1104 Ventura Ave. Chowchilla, CA 93610 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 - Actual harm Residents Affected - Few fall, pt had c/o pain to [left (L)] hip.2 skin tears to L elbow, pt having c/o pain to L hip 10/10 (a pain level based on a numerical scale where 1 is the lowest pain and 10 is the most severe pain), pt cannot ambulate and said she cannot do it.Patient sent out to [Hospital name].During a review of Resident 1's [Skilled Nursing Facility/Nursing Facility- facilities which provide care to residents twenty-four hours a day, seven days a week (SNF/NF)] to Hospital Transfer Form (HTF), dated 7/20/25, the HTF indicated, .[Resident 1].Relevant diagnosis.Dementia.Pain location Left trochanter (hip).Ambulates only with human assistance.[Activities of Daily Living- basic self-care tasks that individuals perform to maintain their well-being (ADL)].A = Needs Assistance.Toileting.Transfers.Usual Mental Status/Cognitive Function before the Acute Change in Condition.Alert, disoriented, but can follow simple instructions.High fall risk.Skin tear to left elbow. The HTF indicated check marks placed in the boxes next to Toileting and Transfers indicated Resident 1 Needs Assistance for both tasks. During a review of Resident 1's PN, dated 7/20/25, the PN indicated, .this writer received report from.nurse.from [name of hospital].emergency department. Verbal preliminary x-ray results of positive left intertrochanteric femoral fracture.During a review of Resident 1's Hospital Discharge Instructions Document (DID), dated 7/20/25, the DID indicated, .Reason for Visit.1) Fall 2) Hip pain-swelling.Discharge Diagnosis Hip fracture Fall Dementia.During a review of Resident 1's Hip and Pelvis [area of the body located between the hip bone] X-ray (imaging technique used to visualize bones in the body) Final Report (XFR), dated 7/20/25, the XFR indicated, .Reason For Exam fall.Technique: [X-ray] Hip [with] Pelvis 2 Views.Findings.Acute [sudden onset] comminuted [broken in two places or more] left intertrochanteric femoral fracture.During a review of Resident 1's PN, dated 7/20/25, the PN indicated, .At approximately [2:45 p.m.] resident returned from acute care.Per hospice [discontinue (DC)] new hospital orders and continue with current orders.[hydrocodone/acetaminophen- type of pain medicine] 5-325 mg [unit of weight] [by mouth (PO)] [tablets (tabs)] [every (Q)] 6 [hours] PRN.During a review of Resident 1's Hospice NN, dated 7/20/25, the NN indicated, .Hospital found Fractured femur and chronic fractured pubic bone [a break in a bone located in the pelvis that occurred a long time ago].PRN visit made, pt.stated she has pain with movement 8/10.pt will be on bed rest for a few days. Orders added for bed bath, pre-medicating pt before repositioning and assisting with repositioning.During a review of Resident 1's PN, dated 7/22/25, the PN indicated, .Noted that resident doesn't have much of an appetite and isn't as interested in drinking her [nutritional drink] as she was prior to fall.During a review of Resident 1's PN, dated 7/22/25, the PN indicated, .Resident has some pain when turning and moving during changing.resident is eating 50% of [nutritional drink]. Leg is warm to touch and slightly swollen.During a review of Resident 1's PN, dated 7/23/25, the PN indicated, .Resident was awake most of the night. Resident didn't sleep even with pain medication, resident is not drinking much water or [nutritional drink] at this time.During a review of Resident 1's PN, dated 7/23/25, the PN indicated, .resident noted with decreased fluid intake. Resident refused lunch an alternative meal was provided. Resident continued to refuse alternative meal.Resident noted with facial grimacing and moaning. PRN medication administered as ordered for pain.During a review of Resident 1's PN, dated 7/23/25, the PN indicated, .Resident continues to be medicated with Pain medication prior to repositioning, but still has pain noted during repositioning. Resident appetite noted to be less, even when offered her favorite supplement chocolate [nutritional drink]. Discoloration noted to bilateral heels.During a review of Resident 1's PN, dated 7/24/25, the PN indicated, .At approximately [10:00 a.m.] [Hospice company name] [Registered Nurse (RN)].in house, new orders to change [hydrocodone/acetaminophen] 5-325 1 tab Q 6 [hours] PRN to Routine Q 6 [hours]. MD.notified via phone.Agrees with [treatment (tx)].During a review of Resident 1's Hospice NN, dated 7/25/25, the NN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555530 If continuation sheet Page 5 of 7 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 555530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chowchilla Memorial Healthcare District 1104 Ventura Ave. Chowchilla, CA 93610 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 - Actual harm Residents Affected - Few indicated, .Pt is having a change of condition due a recent fall.Pt did not wake when this [Social Worker] greeted pt with a gentle tone.During a review of Resident 1's PN, dated 7/25/25, the PN indicated, .New orders received to start resident on puree diet [diet where foods are blended into a smooth, pudding-like consistency], and orders to apply skin prep [preventative measure and treatment used to protect and prepare the skin, to promote healing and prevent further breakdown] to discoloration to bilateral [both] heels.During a review of Resident 1's PN, dated 7/26/25, the PN indicated, .This writer entered resident's room to give her her 6 am medications and it was noted resident was no longer breathing and had no pulse. [Hospice company name] was called and [Hospice staff member name].arrived at.[5:15 a.m.]. Time of death called at [5:20 a.m.].[Hospice staff member name] notified family and funeral home.Resident's daughter in law in facility at this time awaiting arrival of funeral home to pick up remains.During a review of Resident 1's Order Summary Report (OSR), dated 7/22/25, the OSR indicated, .Order Date Range: 07/20/2025-07/31/2025.Assist resident with repositioning until resident is able to reposition self again.Pre-medicate resident with [hydrocodone/acetaminophen], or morphine [pain medicine] prior to significant movement to keep resident comfortable.Resident to be on bed rest starting 7/20/2025 to alleviate pain.Resident to be on complete bed rest and to have BED BATH only, no shower until pain to left hip resolved.Send to [hospital name] [emergency room (ER)] post [after]-witnessed [observed] fall.During a review of Resident 1's DEATH SUMMARY (DS), dated 7/29/25, the DS indicated, .[Resident 1].date of death : 07/26/2025.ADMITTING DIAGNOSES.Repeated falls.Gait disorder with use of walker.HOSPITAL COURSE: The patient.who was admitted for continuation of medical care and rehabilitation.She had an uneventful stay till 07/20/2025 when she sustained a fall and fractured her hip. She was sent to the [Hospital name].she returned back with no intervention done.Family decided no surgical intervention remain in hospice for quality of life.After the fracture, she was bedbound. She has a quick decline and she expired on 07/26/2025.CAUSE OF DEATH: Dementia, Fall with complications.During a review of the facility's policy and procedure (P&P) titled, Falls and Fall Risk, Managing and Preventing, dated 4/1/24, the P&P indicated, .Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling. Staff will be able to identify residents who are at high risk for falls. Staff will assist and supervise those residents that are identified at risk for falls.Fall Risk Factors.cognitive impairment.lower extremity [the part of the body that includes the hip, thigh, knee, leg, ankle and foot] weakness.Medical factors that contribute to the risk of falls include.balance and gait disorders.The IDT (Interdisciplinary Team) Staff, with input of the attending physician, will implement a resident- centered fall prevention plan to reduce the specific risk factor(s) of falls for each resident at risk or with a history of falls.If falling recurs despite initial interventions, staff will implement additional or different interventions, or indicate why the current approach remains relevant.If underlying causes cannot be readily identified or corrected, staff will try various interventions, based on assessment of the nature or category of falling, until falling is reduced or stopped.All Residents will be assessed for risk of fall upon admission, quarterly and after a fall.All Residents determined to be at a risk for falls with a score of 10 or higher will be placed in the facility Fall Prevention Program to prevent injuries from fall. ALL staff will be made aware of residents that are at a high risk of fall and participate in ensuring the safety of the residents. During a review of the facility's P&P titled, Activities of Daily Living (ADL), Supporting, dated 3/18, the P&P indicated, .Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Residents who are unable to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555530 If continuation sheet Page 6 of 7 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 555530 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chowchilla Memorial Healthcare District 1104 Ventura Ave. Chowchilla, CA 93610 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 - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete carry out activities of daily living independently will receive the services necessary to maintain good.personal.hygiene.Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with.Mobility (transfer and ambulation, including walking).Elimination (toileting).During a professional reference review retrieved from https://rn-journal.com/journal-of-nursing/preventing-falls-in-the-elderly-long-term-care-facilities, the article titled, Preventing Falls in the Elderly Long Term Care Facilities, undated, the article indicated, .The elderly long-term care population is at increased risk for falls and fall related injuries.Systematically assessing residents' risk for falls and implementing appropriate fall prevention interventions can reduce the number of falls in the elderly long-term care residents.Falls can cause serious injuries and accidental death, in older people.The elderly in long-term care facilities are predisposed to falling and may fall for a variety of reasons. Predisposing factors include, unsteady gait [a person's manner of walking] and balance, weak muscles.Staff should be educated about predisposing [to give a tendency to beforehand] and precipitating [to bring something on] factors for falls and related prevention strategies and interventions. Staff needs to understand the different interventions available to them, in order to apply them when caring for patients. Event ID: Facility ID: 555530 If continuation sheet Page 7 of 7