Inspection·June 20, 2024

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure to meet the interests of and support the physical, mental, and psychosocial well-being of one of three sample selected residents (Resident 1), when Resident 1 was not able to be out of her bed due to Mechanical Lifting Device (MLD) sling (a flexible strap or belt used in the form of a loop to support or raise a weight) not being available at the facility. Residents Affected - Few This failure resulted in Resident 1 staying in her bed for two days and possibility of developing pressure ulcer and mental health issues. Findings: A review of Resident 1's admission Record indicated Resident 1 was admitted to the facility with multiple diagnoses including multiple mclerosis (an autoimmune disease that has a potentially disabling disease of the brain and spinal cord [central nervous system]). 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) section GG, indicated Resident 1 has impairment on upper and lower extremity on both sides. A review of Resident 1's Care Plan for Activity of Daily Living (ADL, Activities needed for self-care and mobility and include activities such as bathing, dressing, grooming, oral care, ambulation, toileting, eating, transferring, and communicating.) indicated, Resident 1 needed an MLD for transfer with two assists. During an interview on 6/20/24 at 10:50 a.m. with Resident 1, Resident 1 stated the facility did not have a sling for the MLD and she was not able to be transfer from the bed to the chair for two days. She was unhappy about the situation and wanted to be out of her room. During an interview on 6/20/24 at 10:40 a.m. with the Certified Nurse Assistant (CNA) 1, CNA 1 stated the facility did not have enough slings and Resident 1 had to stay in the bed for two days. During an interview on 6/20/24 at 10:45 a.m. with CNA 2, CNA 2 stated because of a lack of slings in the facility, some residents had to stay in the bed for a long time. During an interview on 6/20/24 at 11:30 with the Administrator (ADM), ADM stated that she was aware of the lack of slings in the facility. ADM stated all residents who need slings should be able to have access to one as needed. (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: 056327 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 056327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Walnut Creek Skilled Nursing & Rehabilitation Cent 1224 Rossmoor Parkway Walnut Creek, CA 94595 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)