Health inspection·July 24, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Based on interview and record review, for one of four sampled residents (Resident 1), the facility failed to ensure Resident 1 was free from verbal abuse when Certified Nursing Assistant (CNA) 1 yelled at Resident 1 Why don't you shut the hell up! during a verbal altercation. This failure had the potential to result in further conflict and emotional distress. Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility in July 2022 with diagnoses that included alcohol abuse with intoxication and anxiety disorder (mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities). During a review of Resident 1's Minimum Data Set (MDS, a resident assessment instrument used to identify resident care problems to be addressed in an individualized care plan), dated 7/12/24, the MDS indicated a Brief Interview for Mental Status (BIMS, a scoring system used to determine the resident's cognitive status in regard to attention, orientation, and ability to register and recall information) score of 15. A BIMS score of 13-15 is an indication of intact cognitive status. During an interview on 7/24/24 at 11:50 a.m. with Resident 1, Resident 1 stated on 7/6/24, CNA 1 entered the room and went to Resident 2's bedside (Resident 1's roommate). Resident 1 stated while CNA 1 was at Resident 2's bedside, Resident 2 hollered and cried even louder. Resident 1 stated the privacy curtains were drawn and Resident 1 thought CNA 1 might have harmed Resident 2. Resident 1 stated telling CNA 1 to leave the room to get the charge nurse. Resident 1 stated that was when CNA 1 yelled back Why don't you shut the hell up? at Resident 1. Resident 1 stated feeling uncomfortable and told CNA 1 Do not talk to me like that, who the hell you think you are? During an interview on 7/24/24 at 11:45 a.m. with CNA 1, CNA 1 stated passing by Resident 1's room when Resident 2 started to holler and cry. CNA 1 stated she went to Resident 2's side of the room to offer help. CNA 1 stated Resident 2 continued to holler, while Resident 1 repeatedly, and loudly, yelled at CNA 1 to get out of the room. CNA 1 stated between Resident 2 hollering and Resident 1 yelling, she was not being able to hear what Resident 2 was trying to say. CNA 1 stated she yelled at Resident 1 Why don't you shut the hell up!. During a review of Resident 1's Care Plan for Exhibiting Verbal Behaviors toward staff, initiated on 4/10/24, the care plan indicated interventions that included for staff to; Allow time for expression of feelings, provide empathy, encouragement, and reassurance .If resident becomes combative or (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: 056476 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 056476 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Post Acute 1911 Oak Park Boulevard Pleasant Hill, CA 94523 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)