Health inspection·June 4, 2025

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, facility staff failed to provide social service-related services to 14 of 14 sample residents (Residents: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14) when there was only one social worker (SW 1) in the building and quarterly care conference meetings for at least 14 residents were not completed during the period of March 2025 to June 2025. Residents Affected - Some This failure had the potential to result in residents not receiving appropriate and personalized care. Findings: The census on 06/04/2025 was 128 residents. During an interview on 06/04/2025 at 12:10 PM, SW 1 stated she was the only social worker in the building for approximately three months (March to June 2025). SW 1 stated with the facility workload, she was unable to coordinate and conduct IDT (interdisciplinary team) /care conference meetings. SW 1 explained that IDT meetings were attended by a variety of healthcare professionals, like nurses, therapists, social workers, and others, to discuss and manage resident care. During these meetings family members and/or responsible parties were invited to attend so that they could be made aware and participate in resident care discussions. SW 1 identified a list of 14 residents without IDT. SW 1 stated these IDT/care conference meetings should be conducted minimally quarterly (every three months). During a concurrent record review and interview on 06/04/2025 at 2:00 PM, Medical Record Staff (MRS) was asked to search the records of these 14 residents and provide the date the last IDT/care conference was conducted for these residents. Date of last IDT/care conference notes within a resident ' s medical record: Resident 1 = 10/18/24 (approximately 8 months ago) Resident 2 = 12/18/24 (approximately 6 months ago) Resident 3 = 11/12/24 (approximately 7 months ago) Resident 4 = 12/18/24 (approximately 6 months ago) Resident 5 = 10/15/24 (approximately 8 months ago) (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 3 Event ID: 056122 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 056122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Millbrae Care Center 33 Mateo Avenue Millbrae, CA 94030 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)