Health inspection·October 3, 2023

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, for one of three sampled residents (Resident 1), the facility failed to follow a written policy on permitting residents to return to the facility when Resident 1, who was transferred to the hospital on [DATE] and continued to require services provided by the facility, was not allowed to return on [DATE]. This failure resulted in an unnecessary hospital stay for nine days from [DATE] to [DATE].Findings: During a review of Resident 1's Detailed Summary, the Detailed Summary indicated Resident 1 was admitted to the facility on [DATE]. During a review of Resident 1's Progress Notes, dated [DATE], the Progress Notes indicated Resident 1 was admitted with diagnoses that included diabetes mellitus (abnormal blood sugar levels), chronic obstructive pulmonary disease (COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems), and right foot osteomyelitis (bone infection). During a review of Resident 1's Interdisciplinary Notes, dated [DATE], the Interdisciplinary Notes indicated Resident 1 was noted with altered mental status and did not recall place and event (way of measuring one's awareness, did not know where they are and why they are there). The Notes indicated Resident 1 was taken to the hospital for further evaluation. During a telephone interview on [DATE] at 3:03 p.m. with Case Manager (CM), CM stated Resident 1 was ready to be discharged from the hospital on [DATE]. CM stated he called Admissions Director (AD) on [DATE] but was told Resident 1 would not be allowed to return to the facility. CM also stated AD had indicated Resident 1 was already discharged from the facility. CM stated he was told by AD that Resident 1 did not have enough Medicare (federal health insurance that covers up to 100 days of care in a facility) days left and would require long-term stay. During an interview and concurrent review on [DATE] at 10:50 a.m. with Director of Nursing (DON), the facility's daily census from [DATE] to [DATE] was reviewed. DON stated when Resident 1 was transferred to the hospital on [DATE], Resident 1 was offered a seven-day bed hold (holding or reserving a resident's bed while the resident is absent from the facility for therapeutic leave or hospitalization). DON stated the seven-day bed hold expired on [DATE] so Resident 1 was discharged from the system. DON stated Resident 1 was clinically ready to return from the hospital on [DATE] and did not require special care different than what was provided before Resident 1's transfer to the hospital. DON stated the facility did not accept Resident 1 back because there was no available long-term bed at the time. DON was not able to explain further what long-term bed and short-term bed meant, but (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: 555189 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 555189 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mercy Retirement & Care Center 3431 Foothill Blvd. Oakland, CA 94601 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)