Health inspection·August 18, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, for one of two sampled residents (Resident 1), the facility failed to ensure Resident 1 received care and services with reasonable accommodation when the bathroom did not have a grab bar on the left side to assist Resident 1's toileting needs. Residents Affected - Few This failure had the potential to result in decreased independence to perform activities of daily living (ADLs). Findings: During a review of Resident 1's admission Record dated 8/8/23, the admission Record indicated Resident 1 was admitted to the facility in June 2022 with diagnoses that included aphasia (loss of ability to understand or express speech, due to brain damage), hemiplegia (paralysis of one side of the body), muscle weakness, osteoarthritis (type of arthritis when cartilage/ flexible tissue at the end of the bones wear down) and the need for assistance with personal care. During a review of Resident 1's Minimum Data Set (MDS, an assessment tool used to direct resident care) dated 7/27/23, the MDS indicated Resident 1 had a Brief Interview for Mental Status (BIMS, an assessment tool for resident's orientation to time and capacity to remember) score of 13 out of 15 indicating Resident 1 is cognitively intact. The MDS also indicated, under Section G, Resident 1 was able to transfer from bed to chair and use the toilet with staff assistance. During an interview on 8/8/23 at 1:15 p.m. with Certified Nursing Assistant (CNA) 1, CNA 1 stated Resident 1 refused to go to the bathroom despite a lot of encouragement from the staff. CNA 1 also stated Resident 1 was able to hold onto the grab bar to stand up. During a concurrent observation and joint interviews on 8/18/23 at 1 p.m. with Resident 1 and CNA 2, CNA 2 stated she did not know why Resident 1 did not want to use the bathroom. CNA 2 stated a bedside commode is provided at the bedside for Resident 1 to use for bowel movements and a urinal was at the bedside. Resident 1 stated the bathroom did not have a grab bar to hold onto during transfers from the chair to the toilet. An observation of Resident 1's bathroom was done. There was a grab bar on the right side of the toilet, while none was on the left side. Resident 1 stated not being able to use the right grab bar because of right side paralysis and only the left hand was good. Resident 1 stated not feeling safe if there was not a left side grab bar. During an interview on 8/8/23 at 1:09 p.m. with Director of Nursing (DON), DON stated Resident 1 was not able to move right side of the body because of right side paralysis but was able to hop on the left leg and use the left arm to hold onto the grab bar in the bathroom. DON stated Resident 1 needed some staff assistance on the right side. (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 5 Event ID: 555399 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 555399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avondale Villa Post-Acute 788 Holmes Street Livermore, CA 94550 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)