Health inspection·February 6, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on interview, and record review the facility failed to provide shower to one of three sampled residents (Resident 1) per shower schedule. Residents Affected - Few This failure placed Resident 1 at risk for poor hygiene, compromised skin integrity and overall well-being. Findings: During a record review of Resident 1 ' s admission Record printed on 2/6/24, the record indicated Resident 1 was a admitted to facility on 12/27/23 and discharged on 1/28/24. During a review of Resident 1 ' s Minimum Data Set (MDS, an assessment to guide plan of care) dated 12/31/23, the assessment indicated Resident 1 was able to understand others and was able to make herself understood. The assessment indicated Resident 1 ' s Brief Interview of Mental Status (BIMS, an assessment for cognition) score was 13 out of 15, indicating intact mental status. The MDS assessment also indicated Resident 1 was dependent on staff to provide her showers/baths. During a review of Resident 1 ' s Activities of Daily Living (ADL) Care Plan dated 12/27/23, the care plan indicated Resident 1 had ADL decline due to her recent hospitalization. The Care Plan indicated to provide bathing per schedule and preferences . During a phone interview with Resident 1 on 2/5/24 at 2:07 p.m., Resident 1 stated she received only one bed-bath, and one shower during her one month stay at the facility[GS1] and It made her feel horrible and impacted her progress in health. During an interview with Certified Nursing Assistant (CNA 1) on 2/6/24 at 10:18 a.m. CNA 1 stated CNAs were responsible for providing showers/bed baths to residents at the facility. CNA 1 stated they get the shower schedule for their residents at the beginning of their shift. During an interview and record review with Licensed Vocational Nurse (LVN 1) on 2/6/24 at 10:35 a.m. at Nursing Station 100, facility ' s document titled Building 100 AM assignment dated 2/6/24 and an undated Shower Schedule document were reviewed. The Building 100 AM assignment document had columns indicating CNAs names, assigned rooms, break times and room numbers for residents assigned for shower for that day. LVN 1 stated the Supervisor on duty was responsible for creating the shower assignment schedule based on the Shower Schedule document. The Shower Schedule document had columns with days of the week and rows with room numbers underneath the schedule shower day of the week. LVN 1 stated CNAs get a copy of that assignment sheet at the beginning of each shift and it lets them know the residents who need showers during their shift. Page 1 of 2 055150 055150 02/06/2024 Diablo Valley Post Acute 3806 Clayton Road Concord, CA 94521

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with Certified Nursing Assistant (CNA 2), 2/6/24 at 11:49 a.m. If a resident refuses a shower and/or bed bath, refusal needs to be brought to the nurses ' attention. The nurse then works with the resident to understand why the resident does not want to bathe, and efforts of encouragement and/or solutions to over1come barriers, are offered to get the resident clean. During an interview with Licensed Vocational Nurse (LVN 2) on 2/6/24 12:05 p.m., If a resident refused shower, I would ask the resident as to why they refused because, it's important for good hygiene and to keep them free from infection. If a resident still declines a shower or bed bath, I would notify family and doctor, and document this in the progress notes. During a concurrent interview and record review with the Assistant Director of Nursing (ADON) on 2/6/24 11:05 a.m., Resident 1 ' s Electronic Health Record (EHR) for Census (for room change information), ADL documentation for Showers/Baths, Nursing Progress notes from 12/27/23 till 1/28/24 were reviewed. The ADON stated ADL documentation dated January 2024 indicated Resident 1 received bed bath on 1/9/24 and 1/12/24, however did not receive any showers. The ADL documentation also indicated Resident 1 refused showers/bathing on 1/5/24 and 1/16/24. The ADON stated she was unable to find any documentation regarding Resident 1 ' s refusal of shower/bathing, and nurses ' attempt to explain risks and benefits to Resident 1 on 1/5/24 and 1/16/24 in progress notes. The ADON stated showers/bathing was important for the residents to prevent skin breakdown, to maintain dignity and hygiene. The ADON stated receiving shower and/ or a bath was resident ' s basic need. The ADON also stated Resident 1 moved to four different rooms during her stay at the facility, indicating Resident 1 should have received at least 11 showers during her one month stay, as shower schedule was based on the room numbers. During an interview record review with Director of Nursing (DON) on 2/6/24 at 1:02 p.m., Shower/Skin sheets for the month of 1/2024 were reviewed. The DON stated CNAs completed the shower/skin sheets when they provided shower to the residents. The Shower/Skin sheet indicated to indicate/add resident ' s name, room number, if resident received shower/ tub/ or bed bath and to complete the skin assessment. The DON stated she was unable to find any shower sheets for Resident 1 for the month of 1/2024. During a review of the facility ' s Policy and Procedure (P&P) titled Bath/Shower 2/2018, the P&P indicated the purpose of this procedure are to promote cleanliness, provide comfort to the resident and to observe the condition of resident ' s skin. During a review of the facility ' s P&P titled Activities of Daily Living (ADLS) dated 3/2018, indicated, 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: Hygiene (bathing, dressing, grooming, and oral care.) 055150 Page 2 of 2