Health inspection·December 27, 2023

F 0689 [Resident 1] was found outside the facility and witnessed fall . Level of Harm - Minimal harm or potential for actual harm During a review of Resident 1's PN, dated 12/15/23 at 4:37 p.m., the NP indicated, [Resident 1] noted missing around 11:02 [a.m.] .Facility received a call from adjacent facility at around 11:07 .resident had lost his balance .was found on the ground . Residents Affected - Few During a review of Resident 1's PN, dated 12/15/23 at 4:38 p.m., the PN indicated, [Resident 1] was sent out to ER [Emergency Room] .due to episode of elopement with fall, and sustained minor injury [abrasion on the right lateral elbow]. During an observation on 12/27/23 at 1:38 p.m. at the Bamboo Lane hallway where Resident 1 resided, the room was near to the nurse's station and at the end of the hallway was an alarmed exit door. During a concurrent observation and interview on 12/27/23 at1:50 p.m. with Housekeeper 1 (HSK 1) in the Bamboo Lane hallway with no nursing staff available, the HSK stated, Someone's not here. I don't know where they are. There are always staff in the nurse's station and they would be able to see if a resident goes out of the building. During an interview on 12/27/23 at 1:54 p.m. with Certified Nursing Assistant 1 (CNA 1) in the Bamboo Lane hallway, CNA 1 stated, I heard about the elopement .All exit doors are alarmed and there are cameras around .A resident can't leave without noticing because there are staff in the nurse's station and all the exit doors are alarmed. I heard, the exit door alarmed and a staff turned off the alarm without checking. During an interview on 12/27/23 at 2:03 p.m. with Licensed Nurse 1 (LN 1) in the hallway, LN 1 stated, The nurse's station has a desk nurse .there is always somebody in the front desk during office hours. If a resident exits in the front, they will notice that. All the exit doors are alarmed. During an interview on 12/27/23 at 2:05 p.m. with LN 1 in the hallway, LN 1 stated, [Resident 1] was able to walk but he also used a wheelchair. He was also alert but confused .He always attempted to stand and walk .During that time when he walked out of the facility, I was in a different lane .I was on break. It was 11 a.m. He was found in the neighboring building. I am not sure where he exited. If he exited in front, somebody would be able to notice him. If he exited in the back door, the door is alarmed and there are also cameras to monitor the residents. During an interview on 12/27/23 at 2:10 p.m. with CNA 2 in the hallway, CNA 2 stated, [Resident 1] was able to walk but unsteady and most of the time he was sitting in his wheelchair .I heard he exited on one of the alarmed doors and they found him in the next building. During an interview on 12/27/23 at 2:15 p.m. with the Social Services Director (SSD), the SSD stated, [Resident 1] went through the back door here (Bamboo Lane) .There is an alarm on the back door. I was told that somebody went to turn off the alarm and did not check .I found out late in the afternoon already that they found the resident in the next building. During an interview on 12/27/23 at 2:19 p.m. with 2:26 p.m. with the MDS Coordinator (MDSC), the MDSC stated, [Resident 1] is confused .He needs like constant redirection and supervision .I was seeing the episodes of wandering and he could be an elopement risk .It happened around 11 o'clock a.m. He exited through the Bamboo Lane exit door. The door has an alarm .We actually reviewed the cameras. The alarm was reset by our staff without checking who walked out the door .it was less than 10 to 15 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555261 If continuation sheet Page 2 of 3 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 555261 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Acc Care Center 7801 Rush River Drive Sacramento, CA 95831 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete minutes when they notice that [Resident 1] was not on his chair .he was able to walk up to 50 feet I guess . the resident could have falls, accidents and they can be hit by a car. It is a busy street out there. During a review of the facility's policy and procedure (P&P) titled, Safety and Supervision of Residents, revised 7/17, the P&P indicated, Resident safety and supervision and assistance to prevent accidents are facility-wide priorities .Resident supervision is a core component of the systems approach to safety. The type and frequency of resident supervision is determined by the individual resident's assessed needs .These risk factors and environmental hazards include bed safety .safe lifting and movement of residents, falls .water temperatures. Event ID: Facility ID: 555261 If continuation sheet Page 3 of 3