Health inspection·April 25, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on interview and record review the facility failed to protect the rights of one of three residents (Resident 1) when Resident 1 was not provided routine showers. Residents Affected - Few This failure caused Resident 1 to feel upset with not having his care needs met and had the potential to negatively impact his psychosocial well -being. Findings: A review of Resident 1 ' s admission RECORD, indicated, he was admitted to the facility in early 2024 with diagnoses which included muscle weakness. A review of Resident 1 ' s Brief Interview for Mental Status (BIMS) Evaluation, (a tool used to screen for cognitive impairment) indicated, a score of 15, 13-15 points: Intact cognitive response. A review of Resident 1 ' s Minimum Data Set (MDS, a federally mandated resident assessment and screening tool which identifies care needs) Section GG-Functional Abilities Self -Care Shower/bathe self: The ability to bathe self, including washing, rinsing, and drying self. The area was coded 03. Mobility Tub/shower transfer: The ability to get in and out of a tub/shower. The area was coded 02. The legend indicated, Coding 03. Partial/moderate assistance- Helper does LESS THAN HALF the effort. Helper lifts or holds trunk or limbs and provides less than half the effort .02. Substantial/maximal assistance- Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. During an interview on 4/25/25, at 2:07 PM, Resident 1 stated he was scheduled to receive showers on Tuesday and Fridays and did not. Resident 1 pointed to a container of disposable wipes on his bedside table and stated he wiped himself with those since he was not offered showers. Resident 1 stated he never refused showers. Resident 1 further stated staff declined to provide him a shower on non-scheduled days because it wasn ' t his shower day. A review of a facility document titled, Resident shower schedule, revised 7/17/24, indicated, Tuesday/Friday night shift [6 PM-6 AM] staff were assigned to provide Resident 1 ' s showers. A review of Resident 1 ' s Certified Nurse Assistant (CNA) documentation titled, Task: Did the resident receive a bath or shower? contained the headings: Shower- Bed Bath-Resident not Available-Resident Refused-Not Applicable. The document indicated: 4/8/25-not applicable for 4/15/25 there was no documentation, and 4/22/25 bed bath. (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 4 Event ID: 055011 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 055011 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Post Acute 1611 Scenic Drive Modesto, CA 95355 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)