Health inspection·March 28, 2024

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to provide an accessible call system for two of six sampled residents (Resident 1, and Resident 6) when Resident 1 and Resident 6's call light buttons were not within their reach. Residents Affected - Few This failure has the potential to result in the residents' not attaining their needs and not maintaining their highest practicable physical, mental, emotional, and psychosocial well-being. Findings: 1a. A review of Resident 1's clinical record indicated Resident 1 was admitted April of 2022 and had diagnoses that included cardiomyopathy (a disorder that affects the heart muscle and causes the heart to lose its ability to pump blood well), and dementia (impairment of the ability to remember, think, or make decisions that interferes with everyday activities). A review of Resident 1's Minimum Data Set (MDS- an assessment tool used to guide care) Cognitive Patterns, dated 1/10/24, indicated Resident 1 had a Brief Interview for Mental Status (BIMS- a tool to assess cognition) score of 11 out of 15 which indicated Resident 1 had a moderately impaired cognition. A review of Resident 1's MDS Mood Status, dated 1/10/24, indicated Resident 1 would always feel lonely or isolated from those around him. A review of Resident 1's MDS Functional Abilities and Goals, dated 1/10/24, indicated Resident 1 required substantial/maximal assistance with oral hygiene, toileting hygiene, shower/bathing, upper and lower body dressing, putting on/ taking off footwear, and personal hygiene. Resident 1 also required partial/moderate assistance with rolling left or right, toilet transfers, and tub/shower transfers. Resident 1 further required supervision or touching assistance with movement from sitting to lying or lying to sitting position, movement from sitting to standing position, and chair/bed-to-chair transfers. During a concurrent observation and interview on 3/28/24 at 2:05 p.m. with Resident 1, in Resident 1's room, Resident 1 was unable to locate his call light button and stated, I don't know where it [call light button] is. During a concurrent observation and interview on 3/28/24 at 2:21 p.m. with Certified Nurse Assistant (CNA) 1, in Resident 1's room, CNA 1 found Resident 1's call light button inside the top shelf of Resident 1's bedside drawer which was approximately 2 feet away from Resident 1's bed. CNA 1 and stated, .Normally, it [call light button] should be next to him [Resident 1] where he can reach it. When asked if the resident would be able to reach the call light button and use it if he would need help, CNA 1 stated, Probably no, especially if there's an emergency. During an interview on 3/28/24 at 3:18 p.m. with the Director of Nursing (DON), the facility's (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 2 Event ID: 055173 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 055173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Folsom Care Center 510 Mill Street Folsom, CA 95630 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)