Health inspection·September 14, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, for two of two sampled residents (Resident 1 and Resident 2), the facility failed to ensure a homelike environment with clean bed and bath linens that are in good condition when facility did not have enough towels and bed linens and used washcloths that had frayed edges. This failure resulted in an unfamiliar and uncomfortable environment for residents. Findings: During a review of Resident 1's admission Record, printed 9/15/23, the admission Record indicated Resident 1 was admitted on [DATE] with diagnoses that included pain in the right leg and the thoracic spine (upper and middle part of the back). During a review of Resident 1's Minimum Data Set (MDS, a resident assessment instrument used to identify resident care problems to be addressed in an individualized care plan), dated 6/10/23, the MDS indicated Resident 1's Brief Interview for Mental Status (BIMS, is a scoring system used to determine the resident's cognitive status regarding attention, orientation, and ability to register and recall information) score of 15. A BIMS score of thirteen to fifteen is an indication of intact cognitive status. During an interview with Resident 1 on 9/14/23 at 10:50 am, Resident 1 stated being able to perform personal hygiene tasks with some help from staff. Resident 1 stated the washcloths that were provided were small pieces that were torn or cut out from a towel and were worn out. Resident 1 stated the washcloths looked like rags. During a concurrent observation and interview on 9/14/23 at 11:30 a.m. with Personal Custodian (PC), the Storage E was observed. PC stated the towels, bed linens, and gowns were stored in that storage for residents. PC stated there were two linen storage closets for the unit. There were no towels or washcloths inside the storage. During a concurrent observation and interview on 9/14/23 at 11:41 a.m. with Maintenance Staff (MS), Storage Closet D was observed. The storage had no washcloths and no towels on the shelves marked with Towels, washcloth. MS stated clean laundry was delivered and stored in the storage closets at 6 am ready for use for the morning shift. MS stated, if there were no towels or wash cloths left, the staff should go to the laundry to ask for them. Page 1 of 2 056213 056213 09/14/2023 Tampico Healthcare Center 130 Tampico Street Walnut Creek, CA 94598

F 0584 Level of Harm - Minimal harm or potential for actual harm During a review of Resident 2's admission Record, printed 9/15/23, the admission record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses that included irritable bowel syndrome and pain in the left foot. During a review of Resident 2's MDS dated [DATE], the MDS indicated Resident 2 had a BIMS score of 15. Residents Affected - Some During an interview on 9/14/23 at 12:30 p.m. with Resident 2, Resident 2 stated the facility runs out of bed linens especially at night. Resident 2 stated she has to get changed more often at night and usually had to wait for the staff to go to the laundry to get the sheets. During an interview on 9/14/23 at 3:12 p.m., with Certified Nursing Assistant (CNA) 1, CNA 1 stated towels and linens could be a problem as they often ran out of them. CNA 1 also stated the washcloths that were used are cut up towels. During a concurrent observation and joint interviews with Director of Nursing (DON) and Assistant Administrator (AA) on 9/14/23 at 3:30 p.m., the Storage Closet D was observed. There were four pieces of terry cloth that had frayed edges that were on the shelf labeled Washcloths. The Washcloths were the same color and material as the big towels that were on the shelf labeled Towels. AA stated the Washcloths looked like rags. During an observation on 9/14/23 at 3:36 p.m., Storage E did not have any towels or washcloths. During another concurrent observation and joint interview on 9/14/23 at 3:38 p.m. with MS and DON, the linen rack in the laundry room was observed. MS stated the bins that were received from the shower room and resident rooms did not have wash cloths in them. MS stated the CNAs might have been throwing them away. MS also stated they run out of washcloths and sometimes towels too. There were no washcloths in the clean rack observed. MS stated the laundry staff had just delivered clean laundered linens and towels to the unit for the afternoon shift. When asked if there were any extra washcloths in the laundry, MS stated the laundry staff stocked all the washcloths in the storage closets and laundry did not have any left. DON stated the facility had a linen closet where all the towels and washcloths were stored for emergency use. DON opened the closet, there were no washcloths. 056213 Page 2 of 2