Health inspection·March 27, 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of two sampled residents (Resident 1) received showers per shower schedule. Resident 1 received only one shower in more than two weeks long stay at the facility. Residents Affected - Few This failure placed Resident 1 at risk for lack of cleanliness and comfort. Findings: During a review of Resident 1 ' s admission Record, printed on 3/27/24, the admission Record indicated Resident 1 was admitted to the facility on [DATE] and discharged from the facility on 2/09/24. During a record review of Resident 1 ' s Minimum Data Set (MDS, a resident assessment tool used to guide care) dated 2/13/24, the MDS assessment Section GG - Functional Abilities and Goals showed Resident 1 needed a setup or clean-up assistance (the helper assists prior to or following the activity) for shower. During a review of Resident 1 ' s Activities of Daily Living (ADL) Care plan dated 3/27/24, the care plan showed Resident 1 had an ADL self-care performance deficit and was at high risk for decline in functional limitations and contractures; and the facility was to keep Resident 1 clean, dry and well-groomed. During an interview on 3/27/24 at 12:28 p.m., Licensed Vocational Nurse (LVN 1) stated providing showers to residents and documenting their refusal of showers was only Certified Nursing Assistants (CNA) ' s responsibility. LVN 1 stated CNAs would notify her residents ' refusal of care only if they needed her help convincing the resident to take shower. During an interview on 3/27/24 at 12:41 p.m. with Certified Nurse Assistant (CNA 2), CNA 2 stated when a resident refused a shower, she would inform the nurse, document resident ' s refusal on the shower sheets and in residents ' electronic health record. CNA 2 stated providing showers to residents was important to prevent skin issues and infection; and for them to smell good. During an interview on 3/27/24 at 2:14 p.m., with the Director of Nursing (DON), DON stated when a resident refuses a shower, the CNAs should notify the nurses and they must document it in their nurse ' s progress notes. DON also stated the nurses should inform the resident ' s responsible party and their attending physician if the resident keeps refusing to receive showers. During a concurrent interview and record review on 3/27/24 at 2:50 p.m., with DON, Resident 1 ' s Page 1 of 2 555341 555341 03/27/2024 Canyon Creek Post-Acute 22103 Redwood Road Castro Valley, CA 94546

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few shower sheet dated 1/29/24 and 2/5/24 and Nursing Progress notes from 1/25/24 thru 2/8/24 were reviewed. The DON stated the record showed Resident 1 refused to receive shower on 1/29/24 and 2/5/24. The DON stated however she was unable to find documentation if nursing staff explained the risks and benefits and/or interventions taken to address Resident 1 ' s refusal. During a concurrent phone interview and record review on 4/5/24, at 12:58 p.m., with the DON, Resident 1 ' s Bathing/Shower record in the Electronic Health Record (EHR) for 1/2024 and 2/2024, and the facility ' s Shower Schedule revised on 3/6/24 were reviewed. The DON stated Resident 1 was scheduled to receive shower every Monday and Thursday in evening shift (between 3pm-11pm), indicating, Resident 1 should have received his showers on 1/25/24, 1/29/24, 2/1/24, 2/5/24 and 2/8/24. Bathing/Shower record showed Resident 1 did not receive his showers on 1/25/24, 1/29/24, 2/1/24, 2/5/24 and 2/8/24. Record also showed Resident 1 only received his shower on 2/7/24 during his over two weeks stay in the facility. During a review of the facility ' s policy and procedure (P&P) titled, Bath, Shower/Tub, revised February 2018, the P&P indicated, Purpose - to promote cleanliness, provide comfort to the resident and to observe the condition of the resident ' s skin. If the resident refused the shower/tub bath, the reason(s) why and the intervention taken including the signature and title of the person recording the data. 555341 Page 2 of 2