Health inspection·September 5, 2023

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure medications were stored in a secure location for one (1) of three (3) sampled residents (Resident 1), when Resident 1's medication was located unattended at the counter next to the sink near the door of Resident 1's room. This deficient practice had the potential for other residents, unauthorized staff, and visitors to have access to medications and the potential for misuse and ineffective treatment. Findings: During a review of Resident 1's, admission Record , printed on 8/24/23, the admission record indicated Resident 1 was originally admitted to the facility in 2017 and readmitted in 2022 with a medical diagnosis of acute and chronic respiratory failure ( a serious condition that makes it difficult to breathe on your own) and Chronic obstructive pulmonary disease (COPD- is a chronic inflammatory lung disease that causes obstructed airflow from the lungs and causes breathlessness). During an observation on 8/24/23 at 11:25 a.m., at Resident 1's room , a vial of medication labeled Acetylcysteine ( a medication that is used to loosen thick mucus in individuals with respiratory disorders), nebulizer kit (device that helps in transforming liquid medications into a fine spray (aerosol) or mist, which can then be carried into the respiratory system through inhalation) and normal saline was left at the counter next to sink unattended, easily accessible to unauthorized staff or residents. During a concurrent observation and interview on 8/24/23 at 11:42 p.m., with LVN1(Licensed Vocational Nurse), the vial of medication Acetylcysteine, nebulizer kit, and normal saline were still left at the counter next to sink unattended. LVN 1 stated it is not safe to leave medication unattended as other residents can accidentally take it and can be dangerous. LVN 1 also stated it is important that the medication should be stored in locked cart when not in use. During a review of Resident 1's, Order summary , the doctor's orders indicated, Resident 1 has an order for Acetylcysteine Solution 20% 4 ml inhale orally two times a day for Bronchiectasis (a condition in which the lungs' airways become damaged, making it hard to clear mucus.) to use with albuterol. During an interview on 8/24/23 at 3:02 pm., with DON (Director of Nursing), the DON stated medications should not be left unattended and should be secured safely. (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: 555104 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 555104 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concord Post Acute 1050 San Miguel Road Concord, CA 94518 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)