Health inspection·April 14, 2023

F 0555 Honor the resident's right to choose his or her attending physician. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure resident's primary care physician's current working phone number was listed on their face sheets (a document in each resident's clinical record that indicated a summary of the resident's important information) for three out of three residents (Resident 1, 2, and 3). This failure had the potential for residents, and residents' responsible parties (RP - responsible party) to be unable to contact the residents' primary care physician when needed. Residents Affected - Few Findings: Record review of Resident 1's face sheet indicated admission on [DATE] with the attending primary physician's name and his contact phone number. Record review of Resident 2's face sheet indicated admission on [DATE] with the attending primary physician's name and his contact phone. Record review of Resident 3's face sheet indicated admission on [DATE] with the attending primary physician's name and his contact phone number. During a phone interview with Resident 1's RP on 3/24/2023 at 8:25 a.m., the RP stated the facility provided her a non-working contact phone number for Resident 1's primary care physician when she requested to talk to Resident 1's physician. She stated she was unable to contact this physician with the phone number provided. During record review and concurrent interview with the director of nursing (DON) on 3/24/2023 at 3:15 p.m., the DON acknowledged the face sheets for Residents 1, 2, and 3 indicated the primary care physician's name and phone number. The health facilities evaluator nurse (HFEN) in the presence of the DON, called the primary care physician's phone number indicated on the face sheets four times. Each time HFEN called, received a busy tone, and was disconnected shortly thereafter. The DON acknowledged the physician's contact phone number indicated on the face sheets was not a working number. The DON confirmed this phone number was given to residents and their families upon request. The DON stated staff should have updated residents' face sheets with their physician's current working phone number. Review of facility's policy and procedure (P&P), Record of Admission, revised December 2006, it indicated, At the time of the resident's admission, a resident identification and summary record is completed. Our identification and summary record includes, but not limited to: The name and telephone number of the resident's attending and alternate physician. Page 1 of 3 056212 056212 04/14/2023 The Redwoods Post-Acute 1267 Meridian Avenue San Jose, CA 95125

F 0555 Level of Harm - Minimal harm or potential for actual harm Review of facility's P&P titled, Attending Physician Responsibilities, revised August 2014, it indicated, The attending physician will update the facility about his/her current office address, phone, fax, and pager numbers to enable timely communications, as well as the current office address, phone, fax and pager numbers of designated alternate practitioners (such as nurse practitioners and physician assistants). Residents Affected - Few 056212 Page 2 of 3 056212 04/14/2023 The Redwoods Post-Acute 1267 Meridian Avenue San Jose, CA 95125

F 0880 Provide and implement an infection prevention and control program. 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 maintain an infection prevention and control program to prevent the spread of infections when wash basins and a specimen collection hat were unlabeled in the shared bathrooms of residents' rooms one, two, and three. Residents Affected - Some These failures had the potential for disease transmission among residents if more than one resident were to use any single unlabeled item. Findings: During an observation and interview with certified nursing assistant A (CNA A) on 3/24/23 at 11:15 a.m., two unlabeled wash basins and one specimen collection hat (a wide-brimmed hat shaped basin placed inside a toilet used to collect urine samples) were on a windowsill in the shared bathroom between residents' rooms [ROOM NUMBERS]. The CNA A acknowledged both wash basins and specimen collector were in use; and that, each of these items were not labeled with names of the residents that use them. The CNA A stated the wash basins and specimen collector hat should have been labeled with the residents' names. He stated the bathroom was shared by four residents and, without resident's name labeled on these items, there was the potential that more than one resident would use them, which posed a risk for disease transmission between residents. During an observation with director of nursing (DON) on 3/24/23 at 11:35 a.m., two unlabeled wash basins were on top of a commode in the bathroom of residents' room [ROOM NUMBER]. The DON acknowledged both wash basins were not labeled with residents' names. He stated staff should have labeled each wash basin and urinal and specimen collection hat with a single resident name before use by, and only by, the resident whose name was on the label. Review of the facility's policy and procedure (P&P), Bedpan/Urinal, Offering/Removing, revised February 2018, indicated, Label the resident's bedpan/urinal. 056212 Page 3 of 3