Health inspection·October 2, 2023

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to implement their Policy and Procedure (P&P) for one of four sampled residents when Resident 1's social security card, a watch, and other personal items reported missing were not investigated thoroughly and documented. Residents Affected - Few This failure placed resident 1 at risk for emotional distress, potential financial hardship and affected Resident 1's sense of security and well-being. Findings: During a review of Resident 1's admission Record , printed on 9/29/23, the admission Record indicated Resident 1 was originally admitted to the facility on admitted to the facility in December 2019. The admission records also indicated that Resident 1 had a medical diagnosis including unspecified dementia (a loss of brain function that occurs with certain diseases, affecting one or more brain functions such as memory, thinking, language, judgment, or behavior). During a record review of Resident 1's Minimum Data Set (MDS, a resident assessment tool used to guide care) dated 7/10/23, the MDS assessment section C indicated Resident 1's Brief Interview of Mental Status (BIMS- an assessment for cognition status) score was 11 out of 15 which indicates moderately impaired mental status. During a review of Resident 1's Discharge Evaluation 1.0 – V 2 , printed on 9/29/23, the Discharge Evaluation indicated Resident 1 was discharged on 9/8/23 from the facility. During an interview on 9/29/23 at 12:43 p.m., with the administrator, the administrator stated when a resident reports any missing items in the facility, they would initiate a search and start a theft and loss form and do an investigation for 3 days. The administrator also stated, if the item was in the inventory, they would replace it or estimate the value and re-imburse them. During a concurrent interview and record review on 9/29/23 at 1:55 p.m., with the administrator, Resident 1's Inventory of personal effects dated 12/18/2020 were reviewed. The inventory of personal effects indicated Resident 1 owned a Gold colored Timex watch with Matching Gold Band . The administrator stated few days prior to discharge (9/8/23), Resident Representative (RR) for Resident 1 reported to him that Resident 1 s watch, his original social security card and few other documents were missing. The administrator also stated, the RR reported that the social security card and other documents were given to the Social Worker (SW) in January 2023 and the social worker reported she cannot produce them when the RR requested them back prior to discharge. The administrator stated when he inquired about the documents to SW, she told him she looked everywhere, and she cannot find them. Page 1 of 2 555313 555313 10/02/2023 The Rehabilitation Center of Oakland 210 40th Street Way Oakland, CA 94611

F 0602 Level of Harm - Minimal harm or potential for actual harm During a concurrent interview and record review on 9/29/23 at 2:00 p.m., with the administrator, the facility's loss and theft binder was reviewed. The administrator stated he had asked the social worker to initiate a theft and loss form for Resident 1 but cannot find a loss and theft form for Resident 1's reported missing items in the binder. The administrator stated he did not report the loss of social security card to police yet as he was hoping the social worker would be able to locate them. Residents Affected - Few During an interview and record review on 9/29/23 at 2:08 pm., with the administrator, the administrator stated Resident 1 is a Canadian Citizen and it's going to be a while to replace these crucial documents and it is going to be a hardship and would need assistance to get them replaced. The administrator also stated Resident 1 is in a new environment and must be feeling frustrated and upset. During a concurrent interview and record review on 10/2/23 at 10:40 p.m., with the administrator, the administrator stated he reported the missing social security card for Resident 1 to Oakland police department on 9/28/23 at 4 pm and the incident number was 2309001038. During a concurrent interview on 10/2/23 at 11:21 a.m. with SW and the administrator, SW stated she has not completed a loss and theft form for the reported missing items for Resident 1. SW also stated she did not document about the missing items reported to her in any of Residents or facility records. SW was unable to provide any documentation of an investigation done to locate the missing items reported on or before 9/8/23. During a review of the facility's P&P titled, Theft and Loss , revised 07/11/2017, the P&P indicated, PolicyThe Facility is committed to preventing the misappropriation of resident property. The facility investigates all reports of stolen items, reports to authorities as required by law, and maintains documentation of all reports of lost or stolen property .Procedure. IV. Social service staff documents reports of lost and stolen resident property on AP-11-Form C-Theft and Loss Log .B. The document includes, but is not limited to, the following: i. A description of the article; ii. Its estimated value; iii. The date and time the theft or loss was discovered; iv. If determinable, the date and time of loss or theft; and V. the action taken. 555313 Page 2 of 2