Health inspection·April 14, 2023

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure that one of 3 sampled residents (Resident 1) was free from unnecessary drugs when blood pressure (BP, the pressure of blood pushing against the walls of arteries-carry blood from the heart to other parts of the body) was not monitored prior to administration of a medication for regulation of blood pressure (Midodrine) according to physician orders. Residents Affected - Some This failure had the potential to result in Resident 1 receiving an inadequate or excessive amount of medication for her blood pressure treatment. Findings: During a review of Resident 1's admission Record, the admission Record indicated that Resident 1 was initially admitted in 2018. Resident 1's diagnoses included diastolic congestive heart failure (condition where lower left chamber of the heart is not able to fill properly with blood), end stage renal disease (condition in which the kidney's cease to function on a permanent basis), and dependence on renal dialysis (procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly.) During a review of Resident 1's Order Recap Report, dated 12/01/2022-12/31/2022, the Order Recap Report indicated, Resident 1 had an order for Midodrine HCl tablet (medication used to treat low blood pressure) 10 milligrams (mg), give 1 tablet by mouth three times a day for hypotension (low blood pressure), hold if systolic blood pressure >150 (SBP, top number in BP reading, an indication of the pressure exerted on the blood vessel walls when the heart beats). During a concurrent interview and record review, on 2/22/23 at 6:25 a.m., with Licensed Vocational Nurse (LVN) 1, Resident 1's electronic Medication Administration Record (e-MAR), dated 11/1/2022-11/30/2022 was reviewed. The e-MAR indicated each dose of Midodrine: 9 a.m., 1:30 p.m., and 5 p.m., had a row labeled, ' BP.' All the e-MAR Midodrine BP boxes were marked with an ' x' for the entire month of November 2022. LVN 1 stated the Midodrine BP boxes were for staff documentation of the BP reading for the associated Midodrine administration time. During a concurrent interview and record review, on 2/22/23 at 8:48 a.m., with Director of Nursing (DON), Resident 1's e-MAR, dated 12/1/2022-12/31/2022, and progress notes were reviewed. The DON stated the row ' BP' on the e-MAR should have the BP reading for the Midodrine administration time recorded prior to administration of the medication. The DON stated the December 2022 e-MAR indicated there were no BP entries on the Midodrine BP row for December 2022. The DON provided documentation of some BP readings, but was unable to provide documentation for a total of nine missing entries for 9 a.m.; eight missing entries for 1:30 p.m., , and nine missing entries for 5 p.m. (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: 055215 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 055215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakland Healthcare & Wellness Center 3030 Webster Street Oakland, CA 94609 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)