Health inspection·May 3, 2024

F 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a follow up call and /or assessment was done to verify durable medical equipment was provided to Resident 1 as ordered (DME, are equipment and supplies for everyday or extended use). Residents Affected - Few This failure posed a risk for an unsafe transition from the facility to the home setting. Findings: During an interview on 4/4/24 at 1:47 p.m., Resident 1's family member 1, stated, when the resident was discharged from the facility on 3/5/24, the family member was told by the facility's Social Service Director (SSD), that the DME would be delivered at their house. The family member stated, they did not receive the delivery of the DME. Further stated, they had to move the resident around the house for safe transfers, and after a few days, the family had to purchase a wheelchair to safely move the resident around the house because the resident could not walk. A review of Resident 1's admission Record, indicated, Resident 1 was admitted to the facility on [DATE], with diagnoses that included hemiplegia (paralysis that affects only one side of your body) and hemiparesis (muscle weakness or partial paralysis on one side of the body) following cerebral infarction (commonly known as stroke, caused by a blockage in a blood vessel in the brain, leading to brain damage). The admission record also indicated; the resident was discharged to home from the facility on 3/5/23 at 12:30 p.m. Review of Resident 1's Minimum Data Set (MDS, an assessment tool used to direct resident care) dated 3/5/24, under Section GG titled, Functional Abilities and Goals indicated, Resident 1 was unable to walk and used a wheelchair for mobility. The MDS also indicated, Resident 1 was dependent in the assistance of 2 or more helpers on surface-to-surface transfer (such as when transferring between bed and chair or wheelchair). Review of the physician's order dated 2/27/24, indicated an order for home health services referrals for Registered Nurse, Physical Therapy and Occupational Therapy services. The physician's order also indicated an order for DME of a wheelchair, hospital bed and patient lift (home health services are wide range of health services provided in a home for an illness ; patient lift is an equipment designed to lift and transfer patients from one place to another). Review of Resident 1's Discharge Summary dated 3/5/24, indicated, .discharged to daughter's house on 3/5/24. Home health ordered . home health to deliver DME to daughter's house. (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 05/03/2024 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)