Health inspection·August 27, 2024

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to provide services to obtain prescription eyeglasses for one of four sampled residents (Resident 1). Residents Affected - Few This failure resulted in Resident 1's impaired vision and had the potential to result in decreased participation in activities requiring visual acuity. Findings: A review of Resident 1's Minimum Data Set (MDS, an assessment used to guide care), dated 5/25/24, indicated Resident 1 had clear speech, was able to understand and be understand by others, and had adequate vision with corrective lenses. During an interview on 7/1/24 at 1:00 p.m. with the Social Services Associate (SSA), the SSA stated referrals were sent to the eye doctor on 6/4/24, they will be in the facility to evaluate the Residents on 7/9/24. During an observation and concurrent interview on 7/1/24 at 2:09 p.m. Resident 1 was awake, lying in bed, he did not have his eyeglasses, he stated, my glasses were taken by someone here, no one will help me make an appointment. During an observation and concurrent interview on 7/22/24 at 2:05 p.m. in Resident 1's room, Resident 1 stated, he did not get his glasses, he did not have an appointment. During an interview on 7/22/24 at 2:19 p.m. with SSA A, SSA A stated Resident 1 was on the referral list but was not seen. During an interview on 7/22/24 at 2:26 p.m. with the Social Services Director (SSD), the SSD stated Resident 1 should have been seen 4/29/24, the referral was sent 4/12/24. There is no documentation indicating the reasons Resident 1 was not seen on 4/29/24 or 7/9/24. During a phone interview on 8/19/24 at 10:06 a.m. with Resident 1, Resident 1 stated he has not been scheduled for an appointment for his glasses. During a interview on 8/27/24 at 12:03 p.m. with the SSD, the SSD stated Resident 1 had an appointment for his glasses yesterday (8/26/24), SSD was unaware of the outcome. SSD was calling the office for his follow up information. During a follow up call on 8/27/24 at 3:11 p.m. with the SSD, the SSD stated, Resident 1 went to Page 1 of 2 055407 055407 08/27/2024 Cupertino Healthcare & Wellness Center 22590 Voss Avenue Cupertino, CA 95014

F 0685 the eye doctor yesterday but was on a gurney therefore could not be seen. Level of Harm - Minimal harm or potential for actual harm A review of Resident 1's physician orders dated 11/15/2022, indicated an order, Eye health and vision consult, with follow up treatment as indicated. Residents Affected - Few 055407 Page 2 of 2