Inspection·April 9, 2024

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure one of three sample selected residents (Resident 1) had a safe and orderly discharge from the facility, when the facility discharged Resident 1 to home without preparation and orientation to the discharge and did not provide complete discharge medication for Resident 1. Residents Affected - Few This failure resulted in Resident 1 suffering from pain and did not have pain medication as ordered by the physician (MD). Findings: A review of Resident 1's admission Record indicated Resident 1 was admitted to the facility with multiple diagnoses including joint replacement surgery on left knee and chronic pain. During an interview on 4/5/24 at 11:17 a.m. with Resident 1, Resident 1 stated she was at the facility for one day and the facility discharged her home without giving her pain medication for home use as ordered by MD. Resident 1 stated she suffered from too much pain and the next day staff from the facility picked up Resident 1's pain medication from the pharmacy and dropped it off at her house. Furthermore, Resident 1 stated the discharge was not initiated by her, and it was the facility's decision. A review of Progress Notes, dated 10/3/23, indicated Patient (Resident 1) discharged home at 19:45 via private transport accompanied by daughter. Patient signed discharge paperwork. Medications given to discharge home with patient . A review of the MD order, dated 10/3/24, indicated Hydromorphone HCL (narcotic analgesics, pain medication) oral tablet 4 mg (milligram) give 1 tablet by mouth every 4 hours as needed for moderate pain. During an interview on 4/9/24 at 1:11 p.m., with Clinical Liaison (CL), CL stated when Resident 1 was discharged home, the facility did not have the pain medication (hydromorphone) ordered by MD and they had to send the order to the pharmacy. The next day, CL picked up the pain medication from the pharmacy and dropped it off at Resident 1's house. A review of non-visit MD order on 10/3/24 at 19:10 p.m., indicated MD discharged Resident 1 from the facility. During an interview on 4/9/24 at 1:00 p.m., with MD, MD stated he discharged Resident 1 home without visiting him, however MD did not remember why Resident 1 was discharged home. (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 3 Event ID: 056399 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 056399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Casa via Transitional Care Center 1449 Ygnacio Valley Road Walnut Creek, CA 94598 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)