Health inspection·August 4, 2023

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, for one of three sampled residents (Resident 1), the facility failed to ensure Resident 1 received written notice before getting a new roommate. This failure resulted in emotional distress for Resident 1. Findings: During a review of Resident 1's admission Record, the record indicated Resident 1 was admitted to the facility in July 2022 with diagnoses that included mild cognitive impairment, weakness, difficulty walking and need for assistance with personal care. Family Member (FM) 1 was listed as Resident 1's responsible party/resident representative. During a review of Resident 2's admission Record, the record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses that included dementia, and cognitive communication deficit. During a concurrent interview and review of Resident 1's clinical record on 8/4/23 at 11:40 a.m. with Social Services Assistant (SSA), SSA stated after Resident 2's admission, Resident 2 was moved to Resident 1's room on 5/24/23. SSA stated there was no documentation in Resident 1's clinical record that Resident 1 or FM 1 was notified of the room change. During an interview on 8/15/23 at 10:04 a.m. with FM 1, FM 1 stated there was no advance notice that Resident 1 was getting a new roommate. FM 1 stated Resident 1 did not agree with the room change and was upset about it. During a review of Resident 1's Social Service Notes indicated the following: - On 1/13/23, signed by Social Services Director (SSD), the notes indicated facility will continue to update Resident 1 and FM 1 of any changes in condition. There was no documentation about Resident 1 getting a new roommate. - On 4/17/23, signed by SSD, indicated the same notes as written and signed on 1/13/23. There was no documentation that Resident 1 was getting a new roommate. - On 5/30/23, signed by SSD, the notes indicated SSD met with FM 1's concerns about Resident 1's new roommate. There was no documented resolution. Page 1 of 2 055212 055212 08/04/2023 The Vineyards Healthcare Center 76 Fenton Street Livermore, CA 94550

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and review of facility's room change policy on 8/4/23 at 11:55 a.m. with Director of Nursing (DON), DON stated there was no care plan to address room change for Resident 1 and Resident 2. DON stated there was no documentation that an advance notice was given to Resident 1 or FM 1 before Resident 1 moved in. DON stated advance notice should have been given to FM 1. During a telephone interview on 8/7/23 at 2:49 p.m. with SSD, SSD stated a staff member should have talked to Resident 1 notifying of the room change but notification would not come from the Social Services Department. During a review of the facility's policy and procedure titled Room Change/Roommate Assignment, last revised October 2022, the policy indicated Advance notice of a roommate change will include why the change is being made and any information that will assist the roommate in becoming acquainted with his or her new roommate. 055212 Page 2 of 2