Dinuba Healthcare

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of two sampled residents (Resident 1)'s care plan was implemented after a fall incident. This failure had the potential for Resident 1 to experience subsequent falls.

Inspectors wroteBased on interview and record review, the facility failed to:Ensure their Advance Directive (legal document that specifies a person's medical care and end of life wishes, should the person become unable to communicate those wishes) questionnaire contained all the necessary regulatory requirements for five of eleven sampled residents (Resident 1, Resident 10, Resident 8, Resident 76, and Resident 3). 2. Ensure one of 22 sampled residents (Resident 13) had a signed and dated Advance Directive. These failures had the potential for residents' rights to formulate an advanced directive and for medical care wishes and/or end of life issues to not be honored.

Inspectors wroteBased on observation, interview, and recorded review, the facility failed to follow its policy and procedure (P & P) titled, Assistance with Meals, for three of four sampled Residents (Resident 11, Resident 32, Resident 22) when the Certified Nursing Assistant's (CNA)'s was standing while assisting Resident 11, Resident 32, and Resident 22 during lunch meal. This failure had the potential for Resident 11, Resident 32, and Resident 22 to negatively impact their dignity while being assisted with meals.

Inspectors wroteBased on interview and record review, the facility failed to ensure Minimum Data Set (MDS- resident assessment tool) assessment was accurate for one of five sampled residents (Resident 76). This failure resulted in an inaccurate medical record.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure communication services were available for one of 22 sampled residents (Resident 58) who did not speak English. This failure had the potential for Resident 58's needs go unmet.

Inspectors wroteBased on interview and record review, the facility failed to ensure an activity assessment and activity care plan was completed for one of five sampled residents (Resident 10). This failure resulted in Resident 10 not having the opportunity to discuss his activity preferences and have his preferences honored.

Inspectors wroteBased on interview and record review, the facility failed to:Complete a care plan for smoking for one of one sampled resident (Resident 76). 2. Ensure a smoking assessment was available to facility staff. 3. Conduct an Interdisciplinary Team (IDT- various healthcare staff meet to share information and updates, collaborate to solve problems, and develop and update the resident's care plan) meeting that included Resident 76's smoking. These failures had the potential to jeopardize Resident 76's safety.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the safe administration of medications when:1. IV (Intravenous- method of delivering fluids, medicine or nutrition directly into a vein) Emergency Infusion Supply (E-kit- basic supplies for IV access, fluids, and antibiotics) was expired.2. Discontinued narcotics (a drug or substance that affects mood or behavior) were not stored safety.3. Medication was left unattended on top of the medication cart. These failures had the potential for medications to be administered incorrectly and unsafely.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was served according to the facility's policy and procedure for two of two sampled residents (Resident 84 and Resident 92). These failures had the potential to result in food borne illness to Resident 84 and Resident 92.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of one Oxygen e-tank (highly flammable, compressed gas cylinder) was transported in a safe and secure manner by staff. This failure had the potential to result in injury and death to residents, staff, and visitors.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the transportation for one of five sampled residents (Resident 1) was arranged for a dialysis (a treatment or people whose kidneys are failing, removing waste products and excess fluid from the blood) appointment. This failure resulted in Resident 1 crying waiting for almost five hours (5 p.m. until 9:51 p.m.) waiting for transportation, late medication administration, and potential for adverse health outcomes and emotional distress.

Inspectors wroteBased on observation, interview, record review, and facility document and policy review, the facility failed to ensure food was palatable, which affected 3 (Residents #6, #8, and #41) of 3 residents reviewed for food concerns and had the potential to affect all residents receiving meals from the dietary department.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure dietary staff utilized proper hand hygiene during meal service on 07/16/2024, which had the potential to affect all residents receiving meals from the dietary department, aside from the 12 residents with pureed diet orders, as the pureed trays were served by a different staff member.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to provide a Skilled Nursing Facility (SNF) Advanced Beneficiary Notice (ABN), Centers for Medicare and Medicaid (CMS) Form 10055 prior to being discharged from Medicare Part A skilled nursing services when residents had not exhausted all of their allotted Medicare days and planned to remain in the facility. The deficiency affected 2 (Resident #57 and Resident #61) of 3 residents reviewed for beneficiary notifications.

Inspectors wroteBased on record review, interview, and facility document and policy review, the facility failed to ensure Minimum Data Set (MDS) assessments were accurate for 2 (Resident #41 and Resident #63) of 2 residents reviewed for MDS discrepancies.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to post daily staffing in a conspicuous location and failed to update the posting with any changes due to changes in staffing. This had the potential to affect all residents that resided in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement infection prevention and control practices when: 1. One of three sampled Certified Nursing Assistant's (CNA 1) failed to sanitize blood pressure (BP) cuff (an inflatable cuff, which measures the systolic (the measure of pressure within the arteries while the heart beats) and diastolic pressure (the measure of pressure your blood is exerting against the artery walls while the heart muscle is resting) after use. 2. One of three sampled CNA's (CNA 1) did not perform hand hygiene after providing resident care. These failures had the potential to result in the transmission of infection and communicable diseases to residents and staff.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff did not use residents' nutrition freezer to store personal food items. This failure had the potential to cause food-borne illness and affect the residents' health.

Inspectors wroteBased on interview and record review, the facility failed to develop and update the person-centered comprehensive care plan for three of 24 sampled residents (Resident 7, Resident 51, and Resident 58). This failure had the potential for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide on-going activities based on comprehensive assessments and preferences for three of 24 sampled residents (Resident 29, Resident 25, and Resident 49). This failure had the potential to negatively affect residents' self-worth, psychosocial well-being, and satisfaction with daily living.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow their policy and procedure titled Quality of Life - Dignity for two of 24 residents. (Resident 67 and Resident 55) when: 1. DSD informed Resident 67 he had to change rooms against his will. 2. Certified Nursing Assistant (CNA) 1 referred to Resident 55 in a disrespectful term. These failures had the potential to decrease Resident 67 and Resident 55's feelings of self-worth and self-esteem.

Inspectors wroteBased on interview and record review, the facility failed to follow their policy and procedure (P&P) titled Advance Directives to determine, on admission, whether residents had advance directives (a document indicating a person's wishes for end-of-life care) for two of 24 sampled residents (Resident 51 and Resident 68). This failure had the potential for residents' end-of-life care requests not to be honored.

Inspectors wroteBased on interview and record review, the facility failed to follow their Policy and Procedure (P&P) to conduct and submit two of 24 sampled resident assessments (Resident 17 and Resident 83) in accordance with current federal and state submission timeframes. This failure had the potential to negatively affect the provision of individualized care and services.

Inspectors wroteBased on interview and record review, the facility failed to accurately document physical assessments on the Minimum Data Set (MDS- a comprehensive assessment screening tool) for two of 24 sampled residents (Resident 81 and Resident 79). This failure had the potential to negatively impact the care of Resident 81 and Resident 79.

Inspectors wroteBased on interview and record review, the facility failed to follow their policy and procedure (P&P) for documenting telephone orders for one of 24 sampled residents (Resident 23). This failure had the potential to result in confusion regarding Resident 23's physician-ordered care.