Health inspection·May 16, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation, interview, and record review, the facility failed to maintain dignity for one of four sampled residents (Resident 1) when two Certified Nursing Assistants (CNA) had an argument regarding a staffing assignment while providing a shower to Resident 1. This failure resulted in Resident 1 crying and feeling afraid and decreased the facility's potential to protect residents' dignity. Findings: During a review of Resident 1's admission record, Resident 1 was admitted to the facility in May of 2024 with multiple diagnoses which included nontraumatic intracerebral hemorrhage (a condition in which a ruptured blood vessel causes bleeding inside the brain), hemiplegia and hemiparesis (weakness on one side of the body) affecting right dominant side, dysarthria (weakness in the muscle used for speech), aphasia (loss of ability to understand or express speech), muscle weakness, and major depressive disorder (persistently depressed mood or loss of interest in activities). Resident 1's Minimum Data Set (MDS, an assessment tool) indicated Resident 1 had moderate cognitive impairment. During a review of a document titled, Report of Suspected Dependent Adult/Elder Abuse (SOC 341), dated 5/4/24, the document indicated, Resident 1 received a cold shower by CNA 1 and newly assigned CNA 2 took Resident 1 into the communal shower room and finished off with warm water. During a review of a document submitted to the Department titled, Investigative Summary Report, dated 5/8/24, the document indicated, [Resident 1] was in the shower room crying because he received a cold shower .On the morning of 5/4/23, [CNA 1] placed Resident 1 in the shower chair in the room and put on the water so it can start to warm up .While waiting for the water to warm up, she was approached by another CNA stating that the assignment was changed and that the patient is no longer in her assignment. CNA 1 went to see CNA 2 who was at the station and asked her to give the shower instead. After repeated calls, CNA 2 then went in .On 05/06/2024 at 9:40 AM [morning], [CNA 2] stated that since the assignment was changed, CNA 1 and the other CNA complained that there will be more people .While arguing about the assignment in the resident's room, [CNA 2] heard [Resident 1] crying and when [CNA2] checked in the bathroom, she saw [Resident 1] crying in the chair, hair was dry, but the body was wet .Conclusion: Whether or not a cold shower was intentionally or unintentionally given, the fact remains that the misunderstanding leading to an argument between [CNA 1] and [CNA 2] (because of the change in assignment), had unintended consequences that affected the resident . During a concurrent observation and interview on 5/16/24 at 11:30 a.m. with Resident 1 in his room, Resident 1 was observed awake, sitting on a wheelchair by the door of the bathroom. Resident 1 (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 4 Event ID: 555450 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 555450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE American River Center 3900 Garfield Avenue Carmichael, CA 95608 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)