Health inspection·April 22, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow the care plan for one of three residents (Resident 1) when Resident 1 was left unattended in his room when a hospitality aide (HA - someone hired by the facility to provide non-medical assistance to residents, focused on their comfort, safety, and well-being) took a break and left Resident 1's room. This failure had the potential to result in physical and/or psychosocial harm to other residents when Resident 1 eloped (unsupervised wandering) from his room and entered Resident 2's room. Findings: A record review of facility job description titled Job Description for Hospitality Aide dated 4/1/22 indicated HAs must demonstrate the ability to .understand, plan and carryout resident care plans. A record review of facility policy titled Care Plans (undated) did not indicate any policy related to developing, implementing or following resident care plans. A record review of Resident 1's admission Record indicated he was admitted to the facility on [DATE] with diagnoses that included Wernicke's encephalopathy (a serious neurological condition caused by a deficiency of vitamin B1 often due to chronic alcohol abuse), Alzheimer's Disease (a progressive brain disorder that primarily affects memory, thinking, and behavior), and dementia with agitation (involves behavioral and psychological symptoms like anxiety, depression, and aggression, in addition to cognitive decline). A record review of Resident 1's Care Plan dated 2/17/24 indicated Resident 1 had a history of elopement with impaired safety awareness. Intervention listed was 1:1 supervision. Care plan also indicated Resident 1 had multiple behaviors (agitation, restlessness, aggression, yelling, and irritability) related to dementia. Intervention listed was 1:1 supervision. Care plan indicated Resident 1 had potential to wander into others rooms related to dementia. Intervention listed was 1:1 for redirection. Care plan further indicated Resident 1 had a communication problem related to expressive aphasia (difficulty expressing their thoughts and ideas through spoken or written language,), weak or absent voice, and word salad (confused or unintelligible mixture of seemingly random words and phrases). Intervention listed was 1:1 sitter to assist with care and communication. A record review of Social Service Progress Note dated 11/18/24 10:04 am indicated Resident 1 was considered a wandering and elopement risk and had a 1:1 sitter for all shifts. (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: 555281 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 555281 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oroville Hospital Post-Acute Center 1000 Executive Parkway Oroville, CA 95966 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)