Health inspection·June 14, 2024

F 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure a safe discharge home for one resident (Resident 1) of three sampled residents when Resident 1 was discharged home without verified home health service arrangements. Residents Affected - Few This failure resulted in Resident 1 not receiving the necessary continuity of care for his wound. Findings: A review of Resident 1 ' s admission record indicated admission to the facility on 5/15/24 with diagnosis which included cellulitis (a deep infection of the skin caused by bacteria), disruption of external surgical wound (wound re-opening), and the necessity for change or removal of nonsurgical wound dressings. A review of Resident 1 ' s discharge plan documented by the Social Services Assistant (SSA) dated 6/5/24 at 12:21 p.m. indicated, Discharge Destination .Home alone .Will home Care be provided? .Yes .Estimated start date .6/11/24 .Home Care Services to be provided .PT- physical therapy .OT- occupational therapy .skilled nursing services . A review of a telephone order entered by the Social Service Director (SSD) dated 6/5/24 at 12:52 p.m. indicated, [Resident 1] to discharge home on 6/9/24 with home health RNx [nursing services for] medication/symptom management, PTx strengthening exercises/home safety, and OTx ADLs [activities of daily living such as toileting, eating, grooming, etc.] training and medication. Follow up with PCP [primary care physician] within 7-10 days of d/c [discharge]. Has wound vac to left groin s/p [status post] surgical debridement, to be changed every 72 hours. A review of Resident 1 ' s practitioner note written by the Nurse Practitioner dated 6/7/24 at 9:07 a.m. indicated, .[Resident 1] is to discharge home with home health .support .per SS [social service] [Resident 1] does have [PCP] and has a f/u [follow-up] appt [appointment] already set up .[Resident 1] has follow up appt with vascular surgeon .on 6/13/24. Hehas [sic] a f/u appt with his PCP on 6/17/24 .Examination .SKIN: left fem [femoral] site with wound vac [a machine which uses vacuum-assisted closure of wound to assist in wound healing] right fem site with moderate amt [amount] of slough .Home health nurse to evaluate within 1-2 days .Follow up with your Primary Care Provider in 5-7 days and your specialist as advised. A review of Resident 1 ' s Treatment Administration Record (TAR) dated June 2024 indicated, Change Wound Vac/Negative Pressure Wound Therapy; Negative Pressure 125 mmgHg [millimeters of mercury, a measurement of pressure] intermittent Cleanse with NS [normal saline, a solution used to clean wounds] or wound cleanser .Place black foam into wound. Apply skin prep to intact skin around the wound (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: 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 06/14/2024 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)