Health inspection·September 12, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure one of three sampled residents (Resident 1) received incontinent care in a timely manner, when Resident 1 was left unchanged in a soiled incontinent disposable brief. Residents Affected - Few This failure resulted in Resident 1 wearing a soiled/wet incontinent brief for an extended period of time and made him feel highly annoyed . Findings: During a review of Resident 1's Face Sheet, undated, the Face Sheet indicated Resident 1 was admitted in April 2023 with a diagnosis of muscle weakness. During a review of Resident 1's Minimum Data Set (MDS, an assessment tool used to direct resident care), dated 4/30/23, the MDS indicated Resident 1's Brief Interview for Mental Status (BIMS-a mental status exam) was 14 out of 15, indicating cognitively intact mental status. The MDS assessment also indicated, Resident 1 required one staff's extensive assist with toilet use and he was incontinent of both bowel and bladder. During a review of Resident 1's Activities of daily living (ADL) care plan, dated 4/23/23, the care plan indicated Resident 1 had ADL self-care performance deficit and limited mobility (movement) and staff was to provide supportive care, assistance with ADLs and mobility as needed. The care plan also showed the staff was to Document assistance provided. During a review of Resident 1's Diarrhea care plan, dated 7/1/23, the care plan indicated Resident 1 had loose bowel movement of three times within eight hours on 6/30/23. During an interview on 8/1/23 at 12:10 p.m., Resident 1 stated he had bad loose bowel movement on 6/30/23. Resident 1 stated he remembered the day because it was his birthday. Resident 1 stated he was left for three (3) hours in a soiled incontinent brief; when he called for assistance twice, two different staff members came, but didn't assist him to provide incontinent care. Resident 1 stated finally a night shift Certified Nursing Assistant (CNA) came and changed his soiled brief at 11:00 p.m. that night. Resident 1 stated I was highly annoyed by this. During an interview on 9/12/23 at 1:00 p.m., CNA 1 stated she documented the care provided in residents' electronic medical record at least every two hours throughout her shift. During an interview on 9/12/23 at 1:11 p.m., CNA 2 stated she documented the care provided in resident's electronic medical record right after an ADL care was provided to residents, and at least Page 1 of 2 555104 555104 09/12/2023 Concord Post Acute 1050 San Miguel Road Concord, CA 94518

F 0677 every two hours. Level of Harm - Minimal harm or potential for actual harm During a concurrent interview and record review on 9/12/23 at 12:43 p.m. with Director of Nursing (DON), Resident 1's ADL Task documentation dated June 2023 and Nursing progress notes from 6/25/23 till 7/5/23 were reviewed. The DON stated ADL task documentation indicated, on 6/30/23, Resident 1 was assisted only twice with toilet use at 1:52 p.m. and 10:29 p.m. The DON stated if the task completion was not documented at any other time other than those two times, it meant Resident 1 did not receive Incontinent care at any other time that day. The DON also stated she was unable to find additional documentation of ADL care provided to Resident 1 in the nursing progress notes. Residents Affected - Few During a review of the facility's Policy and Procedures (P&P) titled, ACTIVITIES OF DAILY LIVING (ADLS), SUPPORTING dated March 2018, the P&P indicated, Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene .Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: elimination(toileting). 555104 Page 2 of 2