Health inspection·January 8, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of Resident 3 ' s admission MDS dated [DATE], indicated, she was admitted on [DATE] with a BIMS score of 12 suggesting she had moderately impaired cognition. During an interview on 11/30/23, at 10:33 a.m., Certified Nursing Assistance (CNA B) stated, this morning Resident 4 ' s bed was dry, but last week he remembered Resident 4 ' s bed was wet when he checked at 7:15 a.m. CNA B stated he was only assigned to this patient today and last week. During an interview on 11/30/23, at 11:07 a.m., Resident 4 ' s daughter stated, during her visits she found her mom wet several times, wearing adult briefs too big for her. Resident 4 ' s daughter thought her mother ' s urine leaked on the sides when she urinates. Resident 4 ' s daughter stated she had tried to tell the nurses at the facility about it and the nurses had responded they will remind the CNA ' s about it. Resident 4 ' s daughter thinks her mother needed to be assisted to the restroom as she does not realize she is wet or needs to go to the restroom. During an observation on 11/30/23, at 11:11 a.m., Resident 4 was walking towards the back hallway of the facility with a Physical Therapist. Resident 4 was wearing pants and notable was her bulky-looking backside. During an interview on 11/30/23, at 11:18 a.m., Resident 4 confirmed the CNAs who worked evening shift did not check on her or sometimes they do, but she was surprised when she gets up her back was wet, and she would feel cold. Resident 4 stated the morning shift cleaned and changed her wet bed. A review of Resident 4 ' s admission MDS dated [DATE], indicated she was admitted [DATE], for multiple sclerosis, malnutrition, and asthma among other medical conditions. Resident 4 ' s BIMS score was 11 indicating she had moderately impaired cognition. Resident 4 was frequently incontinent of both bladder and bowel, required partial/moderate assistance to safely get on and off the toilet and did not reject care or ADL assistance. A review of the Activities of Daily Living (ADL) documentation for Resident 4 from 11/24/23 to 11/30/23 indicated, she was accompanied to the rest room only once per shift to either provide set-up, supervision, partial/moderate assistance, or get on or off the toilet by herself. Except for 11/25/23 and 11/26/23, there was no documentation she was helped by the evening shift during the early mornings until 1 minute before shift ends at 7 a.m. During an observation of Resident 4 ' s closet on 11/30/23, at 11:20 a.m., CNA B was asked to show the adult diaper supply of the resident. CNA B found medium size diapers in the closet. The rest room also had medium size pull ups (adult diapers meant to be worn like a regular underwear). CNA B stated he will check in the storage room to find small size pull ups for the resident. During an interview on 11/30/23, at 11:27 p.m., Licensed Nurse C stated he worked evenings and was aware of Resident 3 and Resident 4 ' s concerns. Licensed Nurse C stated he had been getting his CNAs to check on Resident 4 at least Q 2 hours. During a conference with the facility Administrator and Assistant Director of Nursing (ADON) on 11/30/23 at 12:04 p.m., the ADON stated she and Resident 4 ' s daughter has always spoken about Resident 4 during her visits. She was surprised Resident 4 ' s daughter had not mentioned her concern to her. When asked how they ensure the residents are provided the appropriate care supplies like the correct size adult diapers, the Administrator stated they do not have a policy or system to follow how sizes of adult diapers are determined, the CNAs usually know their assigned residents and obtain appropriate briefs for them. The Administrator stated they may have bigger sizes on stock and some brands have bigger sizes but they will check to ensure they have enough small size briefs for residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056300 If continuation sheet Page 2 of 3 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 056300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granada Rehabilitation & Wellness Center, LP 2885 Harris Street Eureka, CA 95503 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)

F 0550 needing them. Level of Harm - Minimal harm or potential for actual harm A review of the facility policy titled: Resident rights, revised 1/1/12, indicated, to promote and protect the rights of all residents at the facility, and employees are to treat all residents with kindness, respect, and dignity and honor the exercise of the residents ' rights. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056300 If continuation sheet Page 3 of 3