Health inspection·October 19, 2023

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 observation, interview, and record review, the facility failed to provide grooming to one of 12 sampled residents (Resident 37), when they did not shave their facial hair. Residents Affected - Few This failure had the potential to cause Resident 37 to feel undignified and upset. During a review of Resident 1's Minimum Data Set (MDS - an assessment tool used to guide care), dated 9/5/23, the MDS indicated Resident 37 was admitted 8//23 and was a female. The MDS also indicated Resident 37 had a Brief Interview for Mental Status (BIMS - a tool used to assess mental function) score of 12, meaning moderately impaired. Additionally, the MDS indicated Resident 37 needed extensive assistance (resident involved in activity, staff provide weight-bearing support), from one person to shave and complete personal hygiene. During a concurrent observation and interview on 10/16/23, at 10:27 a.m., Resident 37 was observed with hair on their chin, cheeks, and upper lip. Resident 37 stated their facial hair was too long and they told staff last week that they wanted to shave, but they wouldn't do it. Resident 37 stated they shaved all their life, and they were mad and upset that staff didn't shave them. During a concurrent observation and interview on 10/16/23, at 10:30 a.m., with Certified Nursing Assistant (CNA) 2, Resident 37 was observed. CNA 2 stated Resident 37's facial hair was long and needed to be cut. CNA 2 stated it was important for their dignity. CNA 2 stated they would shave them right away. During an interview on 10/16/23, at 12:16 p.m., with Resident 37, Resident 37 stated staff shaved them, and it made them feel good. During an interview on 10/19/23 at 11:35 a.m., with Licensed Vocational Nurse (LVN) 1, LVN 1 stated Resident 37 told them they wanted their facial hair shaved when they were admitted . LVN 1 stated they advised a CNA to shave the resident's facial hair at that time, but they were not sure if it was done. LVN 1 stated nurses and CNAs were supposed to ask female residents if they wanted to shave their facial hair especially if they were alert and oriented. LVN 1 stated it was important for dignity. LVN 1 stated Resident 37 was alert and oriented. During an interview on 10/19/23 at 12:00 p.m. with Director of Nursing (DON), DON stated CNAs should have asked residents if they wanted to shave their facial hair when they did activities of daily living, showered them and anytime as needed. DON stated it was a resident right and it was important for their dignity. During a review of the facility's policy and procedure (P&P) titled, Quality of Life - Dignity, (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 4 Event ID: 055775 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 055775 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Orinda Care Center, LLC 11 Altarinda Road Orinda, CA 94563 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)