F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
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
interview, record review, and observation, the facility failed to meet this requirement when construction
materials were improperly stored in the room of three residents (Residents 2, 3 and 4). This had the
potential for accidents and hazards and created an environment that residents did not find home like.
Findings:
In an interview on 1/13/25 at 9:35 AM, Family Member 1 stated that her mother's room was set up for four
residents, but the fourth bed area was taken up by piles of flooring material and adhesive or paint with a
privacy curtain pulled around it. She stated that the materials were a tripping and hazard and made it
difficult to clean the room thoroughly.
In an interview on 1/15/25 at 10:00 AM, Facility Administrator A (FA) A stated that she was familiar with the
situation with the storage of materials in room [ROOM NUMBER] of the facility. room [ROOM NUMBER]
had been vacant, but then we needed the room and had no place to store the flooring. FA A stated that
maintenance stacked the flooring and paint/adhesive cans against the far, windowed portion of the room,
and believed that closing the curtain around it was enough to prevent any problems. FA A stated that they
had also just received an OSHA (Occupational Safety and Health Administration, assures safe and
healthful working conditions), inquiry regarding the incident, and learned it is not ok to store materials there.
In an observation on 1/15/25 at 10:20 AM, surveyors observed a pile of approximately two cartons of
laminate flooring on sawhorses and approximately 10, 20-gallon buckets of material stacked around them
on the resident sidewalk outside room [ROOM NUMBER].
In an interview on 1/15/25 at 10:35 AM, Resident 4 stated that she did see the cans and flooring in her
room but the staff removed it.
In an interview on 1/15/25 at 10:40 AM, Resident 2 confirmed there had been boxes and cans stored in her
room making it stuffy and dusty.
In an interview on 1/15/25 at 10:48 AM, Licensed Vocational Nurse (LVN) B stated that a family in room
[ROOM NUMBER] brought to her attention that they were concerned about flooring materials that were
stored in the room. LVN B stated that they were sealed boxes of laminate flooring and a small package of
half-gallon sized paint containers. Nothing was open, she stated, There were no fumes, they were just
being stored there.
(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:
056346
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
056346
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Bridgeview Post Acute
521 Lorel Way
Yuba City, CA 95991
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 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
In an interview on 1/15/25 at 12:50 PM, Maintenance Director (MAINT) C stated that there were two types
of items being stored in room [ROOM NUMBER]: boxes of flooring and some sealed cans of glue. MAINT C
stated that they had never been opened, and he did not feel them to be a hazard at the time. MAINT C
confirmed that storing those items there was a bad idea, did not conform to the facility's policy, and that the
facility's plan of correction was to move them immediately to a storage shed instead of on the sidewalk
outside the room.
In an interview on 1/15/25 at 1:00 PM, Resident 3 stated that he was aware there were flooring materials
and cans being stored in room [ROOM NUMBER], through the resident council meetings.
Review of the facility's policy titled, Receipt and Storage of Supplies and Equipment (undated) indicated,
Supplies shall be stored in their designated storage areas; Hazardous/toxic materials must be properly
stored and labeled in accordance with current regulations; and It shall be Maintenance's responsibility to
ensure that proper storage procedures are maintained.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056346
If continuation sheet
Page 2 of 2
