Health inspection·April 30, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on interview and record review, the facility failed to follow its policy and procedure for a change of condition for one of three sampled residents (Resident 1) when a S (Situation) B (Background) A (Appearance) R (Review and Notify) (SBAR-document used to notify the physician of a change of condition) was not completed, and Resident 1 was not monitored for a change of condition when experiencing a dislocated hip. This failure had the potential for staff to be unaware of Resident 1's worsening condition and the potential for a delay in care. Findings: During a review of Resident 1's Progress Notes (PN) dated 1/27/25 at 1:58 p.m., the PN indicated, Xray results received. The prosthetic (artificial body part) head is dislocated (joint that is no longer in proper alignment) superior (above another structure) to the acetabular cup (a prosthetic implant used in total hip replacement surgery to replace the natural acetabulum). No evidence of acute fracture or dislocation. [Physician name] made aware. New orders: Refer to [Physician name] . During a review of Resident 1's PN dated 1/29/25 (two days after the facility was aware of the dislocation) at 2:28 p.m., the PN indicated, T.O. (telephone order) noted by (Physician name) to send resident to ER (Emergency Room) (Hospital name) for eval (evaluation) and treat as indicated to Rt (right) hip per family request. Resident and daughter R/P (responsible party) aware. During a review of Resident 1's PN dated 1/29/25 at 2:51 p.m., the PN indicated, Radiology Result.Resident c/o (complain of) pain d/t (due to) dislocation of prosthetic head of left hip arthroplasty (damaged parts of a joint are removed and replaced with artificial components). Resident has sustained no falls or trauma. Resident and family stated that resident has history of spontaneous dislocation, but it normally resets itself. Due to continued pain and dislocation, received order to send to ER for further eval and treatment. During a review of Resident 1's PN dated 1/30/25 at 7:36 a.m., the PN indicated, This nurse called (hospital name) for update. Resident was admitted to med (medical) surg (surgical) for left hip dislocation. Pending orthopedic surgeon (physician that treats disorders of the bones, joints, ligaments, tendons and muscles) consult. During a concurrent interview and record review on 4/22/25 at 2:31 p.m. with Director of Nursing (DON), Resident 1's PN's were reviewed. DON was unable to provide a completed SBAR and monitoring for Resident 1 regarding the dislocation. DON stated there should have been an SBAR completed when notifying the physician of the change of condition and Resident 1 should have been monitored for any changes. (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 6 Event ID: 555658 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 555658 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River Walk Care Center 1100 West Morton Avenue Porterville, CA 93257 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)