Inspection·April 16, 2024

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 provide bathing assistance for one of two sampled residents (Resident 1) for two extended intervals: a five-day interval from 3/25/24 to 3/29/24 and a four-day interval from 3/31/24 to 4/3/24. Residents Affected - Few This failure resulted in Resident 1 feeling emotional distress and that the facility did not support Resident 1's need for dignity. Findings: During a review of the admission Record (a document used to communicate basic information about a resident) for Resident 1, undated, the Record indicated Resident 1 was admitted to the facility in October 2023 with unspecified muscle weakness and paraplegia (the loss of muscle function in the lower part of the body including both legs). During a review of Resident 1's Minimum Data Set (MDS, an assessment tool used to plan care) dated 10/24/23, the MDS indicated Resident 1 had a score of 15 on the Brief Interview for Mental Status. (BIMS, is a scoring system used to determine the resident's cognitive status in regard to attention, orientation, and ability to register and recall information. A BIMS score of thirteen to fifteen is an indication of intact cognitive status.) The MDS indicated Resident 1 had impairment of both upper and lower extremities, was totally dependent on staff for transfers between surfaces and bathing, and had no behaviors of refusal of care. During a review of Resident 1's plan of care titled, Activities of Daily Living (ADL, those activities needed for self-care and mobility and include activities such as bathing, dressing, grooming, oral care, ambulation, toileting, eating, transferring, and communicating), dated 12/28/23, the care plan indicated Resident 1 had an intervention of, will have needs anticipated and met by staff. During a concurrent observation and interview on 4/16/24 at 10:48 a.m., with Resident 1 Resident 1 lay in bed with the head of bed elevated in a hospital gown. Resident 1 stated staff had not provided a shower although Resident 1 had requested one for what seemed like weeks. Resident 1 stated personal hygiene care was not provided as often as Resident 1 needed even after Resident 1 complained to the Director of Nursing (DON). Resident 1 became tearful and stated the facility failure to provide bathing and hygiene after repeated requests made Resident 1 feel like, they don't care about any of us here. Resident 1 stated the lack of showering made Resident 1 feel the facility did not support Resident 1's dignity. During a concurrent interview and record review on 4/16/24 at 11:41a.m., with the DON, Resident 1's Bathing Record and Progress notes from 3/17/24 through 4/16/24 were reviewed. The DON stated (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: 555292 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 555292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alhambra Post Acute 331 Ilene Street Martinez, CA 94553 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)