Health inspection·September 17, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to maintain timely and appropriate pharmaceutical services for one out of three sampled residents (Resident 1) when a prescribed medication was unavailable to be administered as ordered by the physician. This failure caused Resident 1 to experience worsening tremors, increased rigidity, loss of balance, confusion, and agitation due to not achieving the therapeutic dose. Findings: Resident 1 was admitted to the facility in early 2024 with diagnoses that included parkinsonism (brain condition that cause slowed movements, rigidity (stiffness), and tremors), fibromyalgia (a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues), muscle wasting, atrophy, and difficulty walking. During a review of Resident 1's Order Summary Report (OSR), dated 6/4/24, the OSR indicated, Rytary® Oral Capsule Extended Release 23.75-95 MG [mg, unit of measure] (Carbidopa-Levodopa) Give 2 capsules by mouth three times a day related to PARKINSONISM . During a review of Resident 1's Minimum Data Set (MDS, an assessment tool), dated 7/25/24, the MDS indicated Resident 1 had no memory impairment. During an interview on 9/16/24 at 4:39 p.m. with Resident 1, Resident 1 was lying in bed with the head of the bed slightly elevated. Resident 1 was alert, oriented, and well-groomed. When asked if she had any concerns, Resident 1 stated, I am worried that I may be running out of my medications again, and I don't want to have my symptoms exacerbated. My symptoms get so bad that I crawl like a dog. During an interview on 9/16/24 at 5:07 p.m. with Licensed Nurse (LN 1), LN 1 stated, Resident 1 only has two capsules of Rytary® remaining for tomorrow morning dose, and the pharmacy should deliver before noon when the next dose is due . During an interview on 9/17/24 at 11:11 a.m. with LN 2, LN 2 stated, . we get medications delivered to the facility at different times, 11 a.m. - noon, 6 p.m. - 7 p.m., and 3 a.m. Resident 1's medication has not yet been delivered. During an interview on 9/17/24 at 1 p.m. with Resident 1, Resident 1 stated they had not received their 1 p.m. dose of Rytary®, as scheduled. Resident 1 further stated their tremors were worsening and they had increased rigidity, loss of balance, confusion, and agitation due to not achieving (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: 055887 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 055887 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River Bend Nursing Center 2215 Oakmont Way West Sacramento, CA 95691 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)