Health inspection·July 19, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to have the ordered antibiotic (medication used to treat infection) for one (Resident 1) of two residents. Residents Affected - Few This failure to have the antibiotic in the facility on 6/29/23 and 6/30/23 resulted in Resident 1 ' s delayed treatment of infection and rehospitalization. Findings: During a review of Resident 1 ' s face sheet, undated, the face sheet indicated Resident 1 was admitted to the facility June 2023, with diagnosis of Alzheimer ' s (progressive disease that destroys memory and other mental functions) disease and pneumonitis (inflammation of lung tissues) due to inhalation of food and vomit. A review of Resident 1 ' s Order Information Report as of 6/29/23, indicated an order, start date at 6/29/23 at 9:00 p.m., for amoxicillin-pot clavulanate (Augmentin) 600-42.9 mg/5 mL suspension 7.5 mL. The order indicated the Augmentin was to be given twice a day. During an interview on 7/19/23, at 9:30 a.m., with Director of Nursing (DON), DON stated the facility did not have the Augmentin. During an interview on 7/19/23, at 12:15 p.m., with Assistant Director of Nursing (ADON), ADON stated Resident 1 returned to the facility on 6/29/23 from the hospital with a discharge order for an antibiotic. The first dose was scheduled on 6/29/23 at 9:00 p.m. ADON stated PM shift Registered Nurse (RN) 1 ordered the antibiotic stat (urgent). Night shift Registered Nurse (RN) 2 faxed the antibiotic order to the pharmacy twice. At AM shift, there was still no antibiotic. ADON stated she would have aggressively contacted pharmacy and elevated the issue. During an interview on 7/19/23, at 12:50 p.m., with DON, DON stated Resident 1 missed two doses of antibiotics, the 9:00 p.m. dose for 6/28/23 and 9:00 a.m. dose for 6/29/23. During an interview on 7/19/23, at 2:00 p.m., with DON, DON stated not having the antibiotic affected patient care, accommodation of patient needs, disruption in treatment, and possible antibiotic resistance; it was imperative to complete antibiotic treatment. During an interview on 7/19/23, at 3:00 p.m., with AM shift Licensed Vocational Nurse (LVN) 1, LVN 1 stated she received report from RN 2 that the antibiotic had not arrived. LVN 1 stated during her 9:00 a.m. medication pass, she documented the antibiotic in the medication administration record (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: 555381 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 555381 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Hospital D/P Snf 2070 Clinton Ave Alameda, CA 94501 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)