Health inspection·April 9, 2025

F 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to track, find, replace, and follow up with two of two Residents (Resident 2 and Resident 3) whose dentures were lost at the facility. Residents Affected - Few This failure resulted in two Residents not having their teeth to eat and talk which impacted their dignity and psychosocial well-being. Findings: During a review of Resident 2 ' s admission record titled Face Sheet, undated, the Face Sheet indicated Resident 2 was admitted to the facility on [DATE] for Heart Failure (A chronic condition where the heart doesn ' t pump blood as well as it should.). During a review of Resident 2 ' s Minimum Data Set (MDS- an assessment tool to guide care), the MDS assessment indicated Resident 2 had a Brief Interview for Mental Status (BIMS- a mental status exam) score of 15 indicating intact cognition. The MDS assessment also indicated Resident 2 required set up and assistance with oral hygiene, to include managing, denture soaking, and rinsing with use of equipment. During a record review of the Resident 2's Care Plan Essentials, dated 12/21/23, the care plan indicated Resident 2 had upper dentures on admission to facility. During an interview on 4/9/25 at 12:10 p.m. with Resident 2, Resident 2 stated her upper dentures were lost about 2 months ago. Resident 2 stated, the facility would get upset with her whenever she would ask about them. Resident 2 stated she was having to eat soft foods because of not having teeth to chew meat. Resident 2 stated she mostly ate mashed potatoes and soup. Resident 2 stated her dental insurance would cover the denture replacement, but no one at the facility had gotten back to them regarding her lost dentures. Resident 2 stated that it was upsetting not having her dentures. Resident 2 stated she felt like the facility blamed her for her missing dentures. Resident 2 also stated staff told her they found another Resident's dentures in the laundry room but they were not hers. During an interview on 4/9/25 at 1:40 p.m. with Director of Social Services (DSS), DSS stated they were aware of Resident 2 ' s lost dentures. DSS stated they found lost dentures in the laundry room, but they did not belong to Resident 2. During a review of Resident 3 ' s admission record titled, Face Sheet, undated, the Face Sheet indicated Resident 3 was admitted to the facility on [DATE] with a diagnosis of Cerebral Infarction, (A condition where the brain tissue dies due to lack of blood flow and oxygen), and is on hemodialysis, (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: 056389 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 056389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vale Healthcare Center 13484 San Pablo Avenue San Pablo, CA 94806 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)