Health inspection·July 18, 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 obtain medication for one of three sampled residents (Resident 1) when Fosamax (a medication used to prevent and treat osteoporosis [thinning of the bone]) was not available for administration to Resident 1. The failure to obtain and administer ordered medication had the potential to result in ineffective treatment and pain. Findings: A review of Resident 1's admission Record indicated Resident 1 was admitted to the facility in May 2021, with diagnoses of quadriplegia (paralysis of all four limbs) and osteoporosis. A review of Resident 1's Minimum Data Set (MDS, a resident assessment tool used to guide care) dated 3/1/24, indicated a score of 15 on the Brief Interview for Mental Status (BIMS, an assessment tool for a resident's orientation to time, and capacity to remember. The BIMS score ranges from 0-15, with 15 as an indication of intact skills). A review of Resident 1's Order Details indicated the following medication orders: - Dated 5/23/24, at 23:00, the order summary indicated Fosamax Oral tablet 70 milligrams (mgs) (Alendronate Sodium). Give 1 mg by mouth every Monday (first dose on 5/27/24) for Osteoporosis. This order was discontinued on 5/23/24, at 23:08. - Dated 5/23/24, at 23:08, the order summary indicated Fosamax Oral tablet 70 milligrams (mgs). Give 1 mg by mouth in the morning every Friday (first dose on 5/24/24) for Osteoporosis. This order was discontinued on 5/23/24, at 23:09. - Dated 5/23/24, at 23:09, the order summary indicated Fosamax Oral tablet 70 milligrams (mgs). Give 1 mg by mouth every Monday (first dose on 5/27/24) for Osteoporosis. A review of Resident 1's Medication Administration Record (MAR) dated May 2024, indicated, Fosamax Oral tablet 70 milligrams (mgs) .Give 1 mg by mouth in the morning every Friday (Fri) for osteoporosis .Start Date 5/24/24 0600. Resident's MAR dated 5/24/24 and 5/31/24 had entries to indicate Registered Nurse 1 (RN 1) had administered the Fosamax scheduled for 0600 a.m. A review of Resident 1's MAR dated June 2024, indicated, Fosamax Oral tablet 70 milligrams (mgs) .Give 1 mg by mouth in the morning every Friday (Fri) for osteoporosis. Resident's MAR dated 6/7/24 (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: 056052 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 056052 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Healthcare Center 27350 Tampa Avenue Hayward, CA 94544 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)