Inspection·February 21, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure skin integrity nursing assessment was done weekly for one of three residents (Resident 1). This failure resulted in the potential delay in prevention and treatment of a Stage 2 (shallow open sore) pressure ulcer. Residents Affected - Few Findings: A review of Resident 1 ' s face sheet, undated, indicated Resident 1 was admitted to the facility on [DATE] with diagnoses of nontraumatic subdural hemorrhage (pool of blood between the brain and outermost covering), Type 2 diabetes mellitus (elevated blood glucose), and muscle weakness. A review of Resident 1 ' s facility document Braden Scale For Predicting Pressure Risk, dated 6/9/23, Braden Scale For Predicting Pressure Risk indicated Resident 1 ' s Braden score was 15 (score of 15-18 = At Risk). During a concurrent interview and record review on 2/16/24, at 11:34 a.m., with Director of Nursing (DON), the facility document admission Record Data Collection, dated 11/30/22, was reviewed. The admission Record Data Collection indicated Resident 1 had right buttock skin discoloration. DON stated resident did not have any pressure ulcers upon admission. A review of Resident 1 ' s Wound/Skin Healing Records, dated 5/13/23, 5/19/23, and 5/26/23, indicated right buttock redness. During an interview on 2/16/24, at 1:15 p.m., with Licensed Vocational Nurse (LVN) 1, LVN 1 stated Resident 1 had redness on buttock area. During an interview on 2/21/24, at 9:20 a.m., with the DON, DON stated skin assessment was not done between 5/26/23 and 6/12/23. DON further stated skin assessments must be done weekly to see if skin condition got worse or if it was healed. DON stated licensed nurses missed monitoring of skin discoloration. A review of Resident 1 ' s Progress Note, dated 6/12/23, by LVN 2, the Progress Note indicated LVN 2 noted a skin tear on Resident 1 ' s right buttock area measuring 2.5 cm x 1.0 cm, with reddened wound bed (open area of a wound). A review of Resident 1 ' s Skin Integrity Sheet, dated 6/13/23, by Registered Nurse (RN) 1, the Skin Integrity Sheet indicated RN 1 noted a Stage 2 right buttock pressure sore measuring 2.5 cm x 1.0 cm. (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: 056463 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 056463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Post Acute Care - Hayward 26660 Patrick Avenue Hayward, CA 94544 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)