Health inspection·May 1, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure reasonable accommodation of resident needs was provided for one of three sampled residents (Resident 1) when Resident 1 was scheduled to be out of the facility (4/18/24) for an appointment for four hours during lunchtime and was not provided with food (packed food). Residents Affected - Few This failure resulted in Resident 1 not having eaten any food from 10 a.m. until after 5 p.m. which placed Resident 1 at risk for hypoglycemia (low blood sugar). Findings: During record review of Resident 1's admission Record (AR- a document that provides resident contact details, a brief medical history), the AR indicated, Resident 1 was admitted to the facility on [DATE]. Resident 1's diagnoses included . TYPE 2 DIABETES MELLITUS (a disease that results in high blood sugar) . ACUTE KIDNEY FAILURE (a sudden condition where the kidneys cannot filter waste from the blood) . NEPHRITIC SYNDROME WITH DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS (a condition that results in damage and structural changes to the kidney) . During a review of Resident 1's Minimum Data Set (MDS- a standardized assessment and care screening tool), dated 4/18/24, the MDS indicated, Resident 1's Brief Interview for Mental Status (BIMS- an evaluation of attention, orientation, and memory recall) indicated a score of 11 (0-7 severe cognitive impairment, 8-12 moderate cognitive impairment, 13-15 no cognitive impairment), indicating Resident 1 had moderate cognitive impairment. During a concurrent observation and interview on 5/1/24 at 12:35 p.m., with Resident 1 in Resident 1's room, Resident 1 was laying in bed, talking with a visiting family member. Resident 1 stated, he was supposed to be gone for an infusion (introduction of a medicine through a vein) treatment from 10 am until 2 pm but he was not released until 4 pm. Resident 1 stated, the transportation picked him up two hours after the infusion was completed. Resident 1 stated, he was a diabetic and he was not sent with a meal or water to this appointment. Resident 1 stated, he was upset and thirsty because he was sent to his appointment without food and water. During an interview on 4/30/24 at 1:13 p.m., with Certified Nursing Assistant (CNA) 1, CNA 1 stated, the kitchen provided a sack lunch for the resident, according to their diet, for appointments (gone during lunch time). CNA 1 stated, residents should have been provided with a sack meal if the resident's appointment interfered with a scheduled mealtime because the resident's blood sugar could drop and resident could lose weight. Page 1 of 3 055849 055849 05/01/2024 Modesto Post Acute Center 159 E. Orangeburg Avenue Modesto, CA 95350

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 4/30/24 at 1:20 p.m., with Registered Nurse (RN), RN stated, a packed snack was expected to be sent with a resident who will be out of the facility for long hours. RN stated, it was important to send food with a resident because they needed to have food (to eat when hungry). During an interview on 4/30/24 at 2:04 p.m., with CNA 2, CNA 2 stated, a snack should have been sent with a resident who left the facility for a long appointment, during mealtime. During an interview on 4/30/24 2:35 p.m., with Assistant Director of Nursing (ADON), ADON stated, the facility was expected to have provided a meal from the kitchen when residents left the facility for an appointment. ADON stated, it was important to send food with the resident so they would not miss their mealtime and be hungry. ADON stated, residents who missed their meal could have weight loss and become malnourished. During a concurrent interview and record review on 4/30/24 at 3:05 p.m., with ADON, Resident 1's Order Summary Report (OSR), dated 4/30/24 was reviewed. The OSR indicated, . Residents have rheumatology [for conditions involving inflammation of bones, muscles and joints] appointment for [Rituximab brand name - medication used to treat certain cancers and autoimmune diseases or when the body attacks itself] dose on April 18th 10:00 am . ADON stated, Resident 1 had a rheumatology appointment on April 18, 2024, at 10:00 am for four hours. ADON stated, Resident 1 received (Rituximab brand name) infusion once a month. During a concurrent interview and record review on 4/30/24 at 3:05 p.m., with ADON, Resident 1's Progress Notes (PN), dated 4/18/24 was reviewed. The PN indicated, . 04/18/2024 14:44 [2:44 p.m.] . Currently patient is out for rheumatology appointment or [Rituximab brand name] dose . 04/18/2024 17:12 [5:12 p.m.] Resident came back from [appointment] this pm shift . ADON stated, Resident 1 had his appointment scheduled for 10:00 am and returned to the facility at 5:12 p.m. ADON stated, Resident 1 was not sent with any food and that was a mistake. During a concurrent interview and record review on 4/30/24 at 3:07 p.m., with ADON, Resident 1's Documentation Survey Report (DSR), dated 4/30/24 was reviewed. The DSR indicated, . April 2024 . 18 . Amount Eaten . 99 . 12:32 . Meal Substitute Provided . 99 . 12:32 . -99- Resident Not Available . ADON stated, the code 99 used in the documentation on April 18, 2024, meant the resident was not available in the building. ADON stated, Resident 1 was not in the building at 12:00 p.m., did not eat and was not offered a meal substitute. During a concurrent interview and record review on 4/30/24 at 3:22 p.m., with RN, Resident 1's OSR, dated 4/30/24 was reviewed. The OSR indicated, . Residents have rheumatology appointment for [Rituximab brand name] dose on April 18th 10:00 am . Resident 1's PN, dated 4/18/24 was reviewed. The PN indicated, . 04/18/2024 14:44 [2:44 p.m.] . Currently patient is out for rheumatology appointment or [Rituximab brand name] dose . 04/18/2024 17:12 [5:12 p.m.] Resident came back from [appointment] this pm shift . RN stated, Resident 1 was still out of the facility at 2:44 p.m. and returned to the facility at 5:12 p.m. During a concurrent interview and record review on 4/30/24 at 3:24 p.m., with RN, Resident 1's DSR, dated 4/30/24 was reviewed. The DSR indicated, . April 2024 . 18 . Amount Eaten . 99 . 12:32 . Meal Substitute Provided . 99 . 12:32 . -99- Resident Not Available . RN stated, it was documented the resident was not in the facility on April 18, 2024, at 12:32 p.m. RN stated, Resident 1 did not receive a meal or a meal substitute on April 18, 2024, at 12:32 p.m. 055849 Page 2 of 3 055849 05/01/2024 Modesto Post Acute Center 159 E. Orangeburg Avenue Modesto, CA 95350

F 0558 Level of Harm - Minimal harm or potential for actual harm During a review of Resident 1's Care Plan, dated 4/16/24, the Care Plan indicated . The resident has nutritional problem or potential nutritional problem. Risk for unavoidable weight loss [related to]: Diet restrictions . The resident will maintain adequate nutritional status as evidenced by maintaining weight within normal reference range and no [signs/symptoms] of malnutrition, and consuming at least 75% of at least 3 meals daily through review date . Provide and serve diet as ordered . Residents Affected - Few During a review of the facility's policy and procedure (P&P) titled, Accommodation of Needs , 3/21, the P&P indicated, . The resident's individual needs . are accommodated to the extent possible . 055849 Page 3 of 3