Health inspection·June 30, 2023

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to resolve the grievance for one of three residents (1) when Resident 1's complaint about missing her chips, sodas, and baby wipes was not acted on. This failure had the potential to cause frustration for the Resident 1. Findings: Review of Resident 1's admission Record indicated she was admitted to the facility on [DATE]. During an interview with Resident 1 on 6/30/23 at 11:55 a.m., she stated her sodas were missing, and her baby wipes which were stored in the closet were also missing. Resident 1 stated she reported them to the staff. During a concurrent observation, Resident 1's soda pack was placed on the bed next to her bed, and her closet did not have a lock. Review of the facility's grievance binder indicated on 5/2/23 Resident 1 filed a grievance about her missing chips, sodas, and wipes with the recommendations to have Resident 1's items placed in a closet with a lock and Resident 1 had the key. However, the grievance did not indicate that the recommendations were acted on. During an interview with the business office clerk A (BOC A) on 6/30/23 at 2:25 p.m., he stated he worked in the social services office and just transferred to the business office on 6/20/23. The BOC A reviewed Resident 1's 5/2/23 grievance, and confirmed that nothing had been done for Resident 1's complaint on missing items. During an interview with Resident 1 on 6/30/23 at 3:45 p.m., she confirmed that her closet did not have a lock, and she did not have a key. Review of the facility's policy, Grievances/Complaints, Filing, dated 4/2017, indicated The Administrator and staff will make prompt efforts to resolve grievances to the satisfaction of the resident and/or representative . 7. The Administrator had delegated the responsibility of grievance and/or complaint investigation to the Grievance Officer who is Social Services and Designee . 12. The resident, or person filing the grievance and/or complaint on behalf of the resident, will be informed (verbally and in writing) of the findings of the investigation and the action that will be taken to correct any identified problems: a. The Administrator, or his or her designee, will make such reports orally within 5 working days of the filing of the grievance or complaint with the facility. b. A Page 1 of 2 056376 056376 06/30/2023 A Grace Sub Acute & Skilled Care 1250 S. Winchester Boulevard San Jose, CA 95128

F 0585 written summary of the investigation will also be provided to the resident, and a copy will be filed in the business office. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 056376 Page 2 of 2