Health inspection·January 12, 2026

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to safely transfer one of three sampled residents (Resident 1) from wheelchair to bed using a Hoyer lift (a mechanical device used to lift and transfer residents with limited mobility), when one of loops/straps of the sling (a supportive fabric, shaped like a hammock which holds the residents. Loops of the sling are attached to the bars of the Hoyer lift) broke, causing Resident 1 to land directly onto the floor. This failure resulted in Resident 1 hitting his left leg onto the bottom bar (base) of Hoyer lift, sustaining a laceration (deep cut in the skin) on left shin, requiring transfer to an acute care hospital for staples (metal or plastic clips applied to close a tear in the skin) and Resident 1 feeling lack of confidence in facility's capabilities. During a review of Resident 1's admission record, the record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses of bilateral Osteoarthritis of knee (natural wear and tear of the knee causing pain) and obesity (indicates a very high amount of excess body fat). During a review of Resident 1's Minimum Data Set (MDS, a resident assessment instrument used to identify resident care problems to be addressed in an individualized care plan), dated 9/10/25, indicated Resident 1's Brief Interview for Mental Status (BIMS, a scoring system used to determine the resident's cognitive status in regard to attention, orientation, and ability to register and recall information) score was 15 out of 15, indicating normal thinking and memory. During a review of Resident 1's Care Plan for left foot ulcer (slow healing open sore), dated 9/4/25, the Care Plan indicated Resident 1 required a mechanical lift for transfers to prevent further injury. The Care Plan for falls, dated 9/5/25, indicated Resident 1 was at risk for falls due to impaired balance and decreased coordination and he required assistance with activities of daily living.During an interview on 1/12/26 at 10:26 a.m, Resident 1 stated, a few months ago he was being transferred from wheelchair to bed, when the strap of the Hoyer Lift sling broke, causing him to fall on the floor. Resident 1 stated he had a cut on his leg and went to the hospital where staples were placed. Resident 1 stated I rather forget, it did not build any confidence in them [facility staff] talking about how he felt after the incident.During an interview on 1/12/26 at 12:06 p.m., Certified Nursing Assistant (CNA 1) stated on 10/30/25, while using the Hoyer lift to transfer Resident 1 from his wheelchair to bed, the strap of the sling broke causing Resident 1 to fall straight to the floor, hitting the base (bottom bar) of the Hoyer lift. CNA 1 stated Resident 1 was bleeding. CNA 1 stated the sling used during the time of the fall seemed to be too small compared to Resident 1's body size. CNA 1 stated they used the sling that was available for use at that time.During a concurrent interview and record review on 1/12/26 at 12:27 p.m. with Licensed Vocational Nurse 1 (LVN 1), Resident 1's progress notes, dated 10/30/25, were reviewed. LVN 1 stated that she heard a loud noise followed by a scream in Resident 1's room, upon arrival she found Resident 1 on his buttocks, sitting on the floor, in between the base of the Hoyer lift, with visible blood on the floor. LVN 1 noted a laceration (deep cut) (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 3 Event ID: 555341 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 555341 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canyon Creek Post-Acute 22103 Redwood Road Castro Valley, CA 94546 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)