Inspection·December 8, 2022

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 meet professional standards during medication administration when physician orders were not followed for two of five sampled residents (Resident 28 and Resident 30). This failure had the potential to result in adverse drug interactions. Residents Affected - Few Findings: During an observation on 12/6/22, at 8:41 AM, in Resident 28's room, Registered Nurse (RN) 2 gave Resident 28 the following medications: Cholecalciferol (also known as Vitamin D3-made by the skin when exposed to sunlight) 25 mcg (microgram-unit of measurement), Cyanocobalamin (also known as Vitamin B12) indicated for Vitamin B12 deficiency 1000mcg, Finasteride (medication given for enlarged prostate) 5mg (milligram-unit of measurement), Famotidine (medication used for acid reflux) 20mg, Acidophilus (probiotic-taken for stomach health) , Calcium Carbonate (dietary supplement used when calcium in the diet is not enough) 1250mg. All medications were given through Resident's Gastric Tube (A tube inserted through the wall of the abdomen directly into the stomach). No water flushes were given in between these medications. During a concurrent interview and record review, on 12/6/22, at 8:45 AM, with RN 2, Resident 28's Medication Administration Record (MAR), dated November 2022 was reviewed. The MAR indicated, Flush with a minimum of 15ml [milliliter-unit of measure] H2O [water] in between each medication given. RN 2 stated, Resident 28 should have gotten the flushes. During an observation on 12/6/22, at 8:57 AM, in Resident 30's room, RN 2 gave Resident 30 Carvedilol (medication used to treat high blood pressure) 6.25 mg (mg-unit of measurement), Senna (medication to treat constipation) 8.6mg, and Vitamin B12 2,000U (U-Unit of measurement) through his gastric tube. No water flushes were given in between these three medications. During a concurrent interview and record review, on 12/6/22, at 9 AM, with RN 2, Resident 30's MAR, dated November 2022 was reviewed. The MAR indicated, Flush with a minimum of 15ml H2O in between each medication given. RN 2 stated, she did not do this and should have followed the MAR. During a review of the facility's policy and procedure (P&P) titled, Medication Administration-DP/SNF [Distinct Part-Skilled Nursing Facility], (undated), the P&P indicated, Purpose: to assure the most complete and accurate implementation of physicians' medication orders and to optimize drug therapy for each resident by providing for administration of drugs in an accurate, safe, timely, and sanitary manner. Tube administration (Gastric). 12. Flush tube with minimum of 15 ml of water after each medication. 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 5 Event ID: 555766 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 555766 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sierra View Medical Center 465 W Putnam Ave 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)