Health inspection·July 24, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record review, the facility failed to ensure 1 of 3 sampled residents (Resident 1) received necessary care and services in accordance with professional standards of practice when Licensed Vocational Nurse (LVN) 1 did not re-assess and/or document Resident 1's vital signs (Vital signs reflect essential body functions, including heartbeat, breathing rate, temperature, and blood pressure and health care providers monitor vital signs to check patients' level of physical functioning) after a change in blood pressure (Blood pressure is the measurement of the pressure or force of blood inside your arteries. Each time heart beats, it pumps blood into arteries that carry blood throughout the body) and oxygen saturation (is the amount of oxygen you have circulating in your blood) values were noted significantly lower from Resident 1's baseline for more than 12 hours. Residents Affected - Few This deficient practice placed Resident 1 at risk for delay in receiving higher level of care in a timely manner. Resident 1 was later transferred to the acute care hospital due to altered mental status and hyponatremia. Findings: 1.During a record review of Resident 1's admission Record, printed on 4/13/23, the admission Record indicated Resident 1 was admitted to the facility in November 2022. The admission Record indicated that Resident 1 had medical diagnoses including multiple fractures of the pelvis, urinary tract infection, and atrial fibrillation (Atrial fibrillation is an irregular and often very rapid heart rhythm). During an interview on 6/13/24 at 4:00 p.m. with Resident Representative (RR), RR stated on 11/22/22, when he visited Resident 1 at 7:30 p.m., she was very confused. RR stated he notified the charge nurse to assess Resident 1 and to send Resident 1 out to the hospital. RR stated Resident 1 was not sent to the hospital until 11/23/22 around 2 p.m. During a concurrent interview and record review on 6/19/24 at 12:43 p.m. with Registered Nurse (RN) 1, Resident 1's Progress Notes were reviewed. RN 1 stated on 11/23/22 in the morning, RR called the facility to check if Resident 1 was sent to the hospital. RN 1 stated she assessed Resident 1 and noted Resident 1 to be confused. RN 1 notified Nurse Practitioner (NP) and got orders for stat labs. RN 1 stated around lunch time Certified Nursing Assistant (CNA) reported Resident 1 was not responding well and appeared more confused and Resident 1 was sent to the hospital around 2 pm. During a concurrent interview and record review on 6/19/24 at 1:10 p.m. with RN 1, Resident 1's Skilled services documentation and weights and vitals summary were reviewed. RN 1 stated on 11/22/22 Resident 1 ' s blood pressure (Normal range 120/80 mm hg- Systolic pressure reflects the force produced by the heart when it pumps blood out to the body, while diastolic blood pressure [the bottom (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: 056457 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 056457 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenridge Post Acute 2150 Pyramid Drive El Sobrante, CA 94803 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)