Health inspection·August 11, 2022

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure bowel movements (BMs) were documented for three of 12 sampled residents (Residents 9, 20 and 28), on 8/1/22 through 8/5/22. This failure had the potential to result ineffective bowel management for Residents 9, 20 and 28. Findings: During a concurrent interview and record review on 8/10/22, at 2:33 p.m., with Infection Preventionist (IP), the Bowel and Bladder Log, dated August 2022 was reviewed. The log indicated that BMs were not documented for Residents 9, 20 and 28 on 8/1/22 through 8/5/22, IP stated that their policy was for Certified Nursing Assistants (CNAs) to document BMs for residents every shift in the Bowel and Bladder Log. IP stated that it was important to document resident BMs because staff wouldn't know if residents had a bowel movement, when their last bowel movement was, or if they were constipated. IP stated that resident's may have been restless due to constipation, but they wouldn't have known if their BMs weren't documented. During an interview on 08/11/22, at 8:28 a.m., with CNA 1, CNA 1 stated that she was supposed to document resident BMs in the Bowel and Bladder Log every shift. During a record review of Resident 9's Minimum Data Set (MDS, an assessment tool used to guide care), dated 6/2/22, the MDS indicated resident 9's, Bowel Continence, was Always incontinent. During a record review of Resident 20's MDS, dated [DATE], the MDS indicated resident 20's, Bowel Continence, was Always incontinent. During a record review of Resident 28's MDS, dated [DATE], the MDS indicated resident 28's, Bowel Continence, was Always incontinent. During a review of the facility's policy and procedure (P&P) titled, Bowel (Lower-Gastrointestinal Tract) Disorders - Clinical Protocol, revised September 2017, the P&P indicated, .the staff and physician will help identify individuals with previously identified lower gastrointestinal tract conditions and symptoms. The P&P indicated, Examples of lower gastrointestinal tract conditions and symptoms include: .fecal incontinence. The P&P indicated, .the nurse shall assess and document/ report the following: .Quantitative and qualitative description of diarrhea (how many episodes in what period of time, amount consistency, etc.). The P&P indicated, The staff and physician will monitor the individual's response to interventions and overall progress; for example, overall degree of comfort or Page 1 of 13 555499 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0690 distress, frequency and consistency of bowel movements. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 555499 Page 2 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0726 Level of Harm - Minimal harm or potential for actual harm Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on interview and record review, the facility failed to ensure competency skills checks for one of three licensed nursing staff and one of two certified nurse assistants were completed. Residents Affected - Few This failure had the potential for care to be provided by licensed nurses and certified nurse assistant in an unsafe and incompetent manner. Findings: During a concurrent interview and review of employee personnel files, on 8/10/22, at 2:35 p.m., with Director of Staff Development (DSD), the files indicated Licensed Vocational Nurse (LVN) 4 was hired on 5/24/20 and Certified Nurse Assistant (CNA) 2 was hired on 7/9/20. The personnel files also indicated there was no competency skills check done for LVN 4 and CNA 2 at the start of employment. DSD, indicated competency checklist was not in the employee file because it was not done. During an interview on 8/11/22, at 10:29 a.m., with the Infection Preventionist Director of Staff Development Consultant (IPDSDC), the IPDSDC confirmed, competency evaluation for LVN 4 and CNA 2 was not done. During an interview on 8/11/22, at 1:23 p.m., with the Director of Nursing (DON), DON stated, quality of care and safety of residents can be affected when LVN 4 and CNA 2 was not evaluated for competency skills. During a review of facility's policy and procedure (P&P) titled, Competency of Nursing Staff, dated May 2019, the P&P indicated, 1. All nursing staff must meet the specific competency requirements of their respective licensure and certification requirements defined by State law. 2. In addition, licensed nurses and nursing assistants employed (or contracted) by the facility will: a. participate in a facility-specific, competency-based staff development and training program; and b. demonstrate specific competencies and skill sets deemed necessary to care for the needs of residents, as identified through resident assessments and described in the plans of care.6. Facility and resident-specific competency evaluations will be conducted upon hire, annually and as deemed necessary based on the facility assessment. 555499 Page 3 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure accurate accountability and effective storage of controlled medications (those with high potential for abuse or addiction), and availability of routine and emergency drugs when: 1. Two out of 2 medication cart controlled drug sign-in/sign-out sheets (a sheet used to reconcile inventory of controlled medications in the medication cart by the outgoing and incoming nurse during a shift change) were missing signatures of the outgoing and incoming nursing shift; 2. There was no record of controlled drug destruction available upon request; 3. One out of 5 emergency kits (e-kit, a kit containing medications and supplies for immediate use during a medical emergency) was not replaced in a timely manner in accordance with the facility policy and procedures (P&P); 4. Two out of 5 e-kits expired; and 5. Expired and discontinued medications were not removed from active stock These failures had the potential for the facility to not have accurate accountability of controlled medications, abuse or misuse of these medications, use of ineffective medications or those with reduced potency, and medications being unavailable for use during an emergency. Findings: 1. On [DATE] at 12:50 p.m., a review of the controlled drug sign-in/sign-out for Medication Cart 2 alongside Licensed Vocational Nurse 1 (LVN 1) identified missing signatures by the outgoing and incoming nurse for each shift (7 a.m., 3 p.m., and 11 p.m.). LVN 1 acknowledged the record was missing signatures between nursing shift changes and stated, I think everyone knows to sign the narcotic book. A review of the controlled drug sign-in/sign-out sheet, dated [DATE] to [DATE], indicated 46 missing signatures (for the dates indicated) between nursing shift changes. On [DATE] at 11:13 a.m., a review of the controlled drug sign-in/sign-out for Medication Cart 1 alongside LVN 1 identified and confirmed multiple missing signatures by the outgoing and incoming nurse for each shift. A review of the controlled drug sign-in/sign-out sheet, dated [DATE] to [DATE], indicated 98 missing signatures (for the dates indicated) between nursing shift changes. During an interview on [DATE], at 11:58 a.m., with Director of Nursing (DON), when asked if nurses were expected to sign the controlled drug sign-in/sign out sheet between shift changes, DON stated, I believe so . let me get one of my nurses. During an interview on [DATE], at 12:01 p.m., with Infection Preventionist (IP) and DON, IP 555499 Page 4 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some verified and stated the incoming and outgoing nurse were to count controlled medications together, and both sign the sheet between each shift change. The DON then stated, Looks like we need to practice. During an interview on [DATE], at 12:58 p.m., with Consultant Pharmacist (CP), CP confirmed the controlled sign-in/sign-out sheet had to be signed between shift changes to acknowledge a count of controlled drugs in the medication cart matched the controlled drug record. A review of the facility's policy and procedure titled, Medication Storage in the Facility, dated [DATE], indicated, At each shift change, a physical inventory of all controlled medications . is conducted by two licensed nurses and is documented on the controlled medication accountability record. 2. The controlled drug destruction log was requested for review during the survey. During an interview on [DATE], at approximately 1 p.m., with DON, DON was unable to locate the narcotic destruction log and stated he would try to find it. During an interview on [DATE], at 1:10 p.m., with CP, CP stated the narcotic destruction log stayed with the DON. During an interview on [DATE], at 11:16 a.m., with DON, DON confirmed he was not able to find or locate the narcotic destruction log. A review of the facility's policy and procedure titled, Disposal of Medications and Medication-Related Supplies, dated [DATE], indicated, The nurse(s) and/or pharmacist witnessing the destruction ensure that the following information is entered on the medication disposition form. 1. Date of destruction 2. Resident's name 3. Name and strength of medication 4. Prescription number 5. Amount of medication destroyed 6. Signatures of witnesses . The medication disposition form is kept on file in the facility for 3 years. 3. On [DATE] at 1:47 p.m., an inspection of the medication storage room with IP identified and confirmed an opened e-kit. Review of the drug removal records indicated medications were removed from the e-kit on [DATE], [DATE] and [DATE]. IP stated as soon as an e-kit was opened, it was to be reordered from the pharmacy and replaced immediately. She agreed that if this process was not followed, medications would potentially not be available when needed in an emergency. During an interview on [DATE], at 12:03 p.m., with DON, DON verified when an e-kit was opened it was to be reordered from the pharmacy and agreed the. He acknowledged and agreed the e-kit should have been reordered after it was first opened, more than 2 months prior. During an interview on [DATE], at 1:06 p.m., with CP, CP stated the opened e-kit should have been replaced after it was opened so emergency medications would be available when and if needed. A review of the facility's policy and procedure titled Medication Ordering and Receiving from Pharmacy, dated [DATE], indicated, . the nurse . notifies the pharmacy for replacement of the emergency drugs supply . used sealed kits are replaced with the new sealed kits within 72 hours of opening. 4. On [DATE] at 11:43 a.m., a concurrent interview and inspection of Medication Cart 2 with LVN 1 identified and confirmed a controlled medication e-kit with expiration date of [DATE]. Inside the 555499 Page 5 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some e-kit LVN 1 verified four 0.5 milliliter (ml, a unit of measure) prefilled syringes of morphine sulfate 10 milligram/0.5 milliliter (mg/ml, a measurement) expired [DATE], and three 1 ml vials hydromorphone 2 mg/ml (a pain medication) expired [DATE]. LVN 1 stated the staff should have replaced the e-kit the month prior to it expiring. During a concurrent interview and record review on [DATE], at 12:44 p.m., with LVN 1, all e-kit replacement fax requests to the pharmacy were reviewed from [DATE] to [DATE]. There were no requests submitted to the pharmacy to replace the expired e-kits. During an inspection of the medication storage room on [DATE], at 1:51 p.m., alongside IP, an expired intravenous (IV) antibiotic e-kit with expiration date [DATE] was identified and confirmed. During an interview on [DATE], at 12:03 p.m., with DON, DON acknowledged the controlled drug e-kit and IV antibiotic e-kit were expired. He confirmed they should have been replaced prior to their expiration. During an interview on [DATE], at 1:02 p.m., with CP, CP stated the facility was notified in [DATE] of the two e-kits due to expire on [DATE]. He stated the facility was responsible for ensuring the kits were replaced prior to their expiration dates. 5. On [DATE] at 10:40 a.m., an inspection of the medication storage room with DON identified five oyster shell calcium 250 mg plus vitamin D expired on 7/2022 and three bottles sevelamer 800 mg tablets (a medication used to treat chronic kidney disease) for a resident that had been discharged . DON confirmed expired, discontinued and medications for residents who were no longer at the facility were to be removed from the active supply and destructed. A review of the facility's policy and procedure titled Medication Storage in the Facility, dated [DATE], indicated, Outdated, contaminated, or deteriorated medications . are immediately removed from stock, disposed of according to procedures for medication disposal . A review of the facility's policy and procedure titled Disposal of Medications and Medication-Related Supplies, dated [DATE], indicated, Discontinued medications and medications left in the facility after a resident's discharge . are destroyed. 555499 Page 6 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility had a 6.9% error rate when two medication errors out of 29 opportunities were observed during a medication pass for two of seven Residents (Residents 1 and 30). These failures resulted in medications not given in accordance with the prescriber's orders and may affect the resident's clinical condition. Residents Affected - Some Findings: 1. During a medication pass observation on 8/8/22, at 10:39 a.m., with Licensed Vocational Nurse 1 (LVN 1), LVN 1 was observed preparing five medications, including aspirin 81 milligrams (mg, a measurement) tablet for Resident 30. A review of Resident 30's medical record indicated a physician's order, dated 5/19/21, for aspirin enteric coated (E.C., a coating formulation that allows aspirin to pass through the stomach to the small intestine before dissolving) 81 mg one tablet daily. During an interview on 8/9/22, at 12:36 p.m., with LVN 1, LVN 1 confirmed the order was for aspirin E.C. and stated she could not recall whether or not she administered the correct aspirin formulation. During an interview on 8/10/22, at 1:44 p.m., with Director of Nursing (DON), DON confirmed any medication given to a resident must be given as ordered by a physician. During a review of the facility's policy and procedure titled, IIA2: Medication Administration- General Guidelines, dated October 2017, indicated, Medications are administered in accordance with written orders of the attending physician. 2. During a medication pass observation on 8/8/22, at 11:14 a.m., with LVN 1, LVN 1 was observed preparing five medications, including Senna 8.6 mg (a medication for constipation) for Resident 1. LVN 1 was unable to locate Senna 8.6 mg tablets in the medication cart and stated she would notify the physician. A review of Resident 1's physician's telephone orders, dated 8/8/22 at 3 p.m., indicated, D/C [discontinue] previous Senna orders [for] residents who has Senna. Change to Senna 8.6 mg [with] docusate sodium 50 mg 2 tabs [tablets] orally every morning. During an interview on 8/9/22, at 11:06 a.m., with LVN 1, LVN 1 verified the Resident 1's medication order for Senna was not updated to reflect the physician's telephone order. She stated Resident 1's Senna order was, still the same and I don't see any notes. During an interview on 8/9/22, at 12:05 p.m., with DON, DON stated it was the nurse's responsibility to communicate with the physician anytime a medication was not available for administration. During an interview on 8/9/22, at 12:08 p.m., with Infection Preventionist (IP), IP verified Resident 1's medication order for Senna was not updated to reflect the physician's telephone order given at 3 p.m. on 8/8/22. IP confirmed the Senna with docusate tablet was not administered to Resident 1 on 8/8/22, as ordered by the physician. 555499 Page 7 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of Resident 1's medical record indicated the order for Senna 8.6 mg tablets was not discontinued until 8/9/22, an entire day after the physician ordered for it to be discontinued. The medical record indicated Senna 8.6 mg with docusate 50 mg tablet, 2 tablets orally once daily for constipation, started 8/9/22. During an interview on 8/10/22, at 1:44 pm., with DON, DON confirmed medications should be administered as ordered by the physician. During an interview on 8/11/22, at 11:43 a.m., with DON, DON stated in his previous experience he would ensure telephone orders for medications were updated in a resident's record, within an hour. During a review of the facility's policy and procedure titled, Telephone orders, dated February 2014, indicated, Orders must be reduced to writing, by the person receiving the order, and recorded in the resident's medical record. 555499 Page 8 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review, the facility failed to ensure proper storage of medications when: 1. Medications and biologicals requiring refrigeration were not stored within manufacturer's specifications; and 2. Medication storage room and medication refrigerator temperatures were not monitored routinely per facility policy and procedure (P&P) The deficient practices had a potential for improperly stored and inadequately monitored medications, which could lead to unsafe and ineffective medication use for residents. Findings: 1. On 8/10/22 at 2:16 p.m., an inspection of the medication refrigerator with Infection Preventionist (IP) identified an internal thermometer with a temperature that measured 25 degrees Fahrenheit. Inside the refrigerator were various types of resident insulins (medication to treat elevated blood sugar) and six vials of Aplisol (an injectable used to test for tuberculosis). When asked if 25 degrees Fahrenheit was a safe temperature to store Aplisol at, IP stated she did not know. She then looked at the manufacturer's box which indicated the product was to be stored between 36 to 46 degrees Fahrenheit and stated, No. During a separate inspection of the medication refrigerator on 8/11/22 at 10:36 a.m., with Director of Nursing (DON), the DON verified the internal thermometer measured 32 degrees Fahrenheit. DON stated he was uncertain if that was a safe temperature to store medications at and would need to check the facility policy. DON verified 32 degrees Fahrenheit was too cold and stated, that is outside the range, so we need to bump that up. DON acknowledged and agreed it was unsafe to administer medications when they were not stored correctly. During an interview on 8/11/22, at 11:23 a.m., with Consultant Pharmacist (CP), CP confirmed medications that required refrigeration should be stored between 36 and 46 degrees Fahrenheit. CP confirmed the facility was to regularly monitor the temperature to ensure it stayed within that range. A review of the facility's policy and procedure titled Medication Storage in the Facility, dated April 2008, indicated, Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations . Medications requiring 'refrigeration' or 'temperatures between 2?C [degrees Celsius] (36?F [degrees Fahrenheit]) and 8?C (46?F)' are kept in a refrigerator with a thermometer to allow temperature monitoring . Medication storage conditions are monitored on a routine basis and corrective action taken if problems are identified. 2. During a concurrent interview and record review on 8/08/22, at 1:10 p.m., with LVN 1, the medication room temperature log for 5/1/2022 to 8/2/22 were reviewed. The medication temperature log indicated temperature readings were documented in the morning and the evening. A review of the log identified 65 temperature readings that were not completed. LVN 1 acknowledged and confirmed temperatures were not routinely monitored. She stated nurses should check to see if temperatures for the 555499 Page 9 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0761 medication room and refrigerator was logged, at least once on your shift. Level of Harm - Minimal harm or potential for actual harm During a concurrent interview and record review on 8/08/22, at 1:13 p.m., with IP, the medication storage room temperature log was reviewed. IP confirmed the temperature monitoring for the medication storage room was not routinely performed. Residents Affected - Some During an interview on 8/08/22, at 1:36 p.m., with DON, DON confirmed the temperature for the storage room and refrigerator should be documented, at least once (daily). DON acknowledged and agreed if there was any deviation from the manufacturer's storage specifications, it would not be possible to confirm whether the medications were still safe and effective for use without routine temperature monitoring. A review of the facility's medication refrigerator temperature log, dated May 2022 to August 2022, indicated a column for morning and evening temperature readings. Review of the document identified 75 temperature readings that were not performed. During an interview on 8/09/22, at 12:58 p.m., with CP, CP stated the medication storage room and refrigerator monitoring, should be done religiously. He agreed and confirmed temperatures for both should have been documented on the respective logs. A review of the facility's policy and procedure titled, Medication Storage in the Facility, dated April 2008, indicated, Medication storage conditions are monitored on a routine basis and corrective action taken if problems are identified. 555499 Page 10 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to meet food safety requirements for food storage and kitchen sanitation when multiple surfaces had dust, food particles and/or granular particles, two cans were dented, two items were missing use by dates, and one bag potatoes contained potatoes with roots. These failures has the potential to compromise the safety of the food served through cross contamination and cause illness or hospitalization to residents who consume it. Findings: During the initial tour of the kitchen on 8/8/22 at 10:15 a.m. with Dietary Manager 1, (DM 1), the following was observed: 1. The cart used to transport various food products to residents was observed to have a granular substance on the shelves and imbedded in the grip on the handle of the cart. 2. The stainless-steel lip on the walls surrounding the dishwasher area was observed to have substantial dust over the length of the wall mounted lip. 3. The stainless-steel counter on the dirty side of the dishwasher was observed to be very wet with food particles on the surface. 4. The dishwasher was observed to have dry particles stuck to the exterior sides of the dishwasher and granulated particles on top of the dishwasher. 5. The tray rack used to store clean dishes was observed to have dust and dirt on each of the tray support lips inside the rack. 6. The drying pads used for drying clean dishes were observed to be worn to the point of leaving granular particulates on the trays underneath on three trays in the tray rack. 7. Three trays underneath the drying mats were observed to have granular particulates and a dried substance on the trays under the mats. 8. The countertop on the left side of the sink was tacky to the touch. 9. The drawers holding clean cooking utensils were observed to have granular particles on the inside of the drawers. 10. The shelf storing dry seasonings was observed to have a granular particles and dust underneath the bottles of dry seasoning. 11. The wall surface between the counter and stove on both sides of the stove was observed to have stains and dried substances splattered across the surface. 12. The floor between the counter and both sides of the stove were observed to have stains, 555499 Page 11 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0812 splattered dried substances, and dust. Level of Harm - Minimal harm or potential for actual harm 13. One can of tuna located in the dry storage area was observed to be dented. 14. One can of baked beans located in the dry storage area was observed to be dented. Residents Affected - Many 15. A storage bin holding 17 soft and rooted potatoes was observed to be in the dry storage area labeled with a preparation date, (date placed in storage), of 7/12/22 and use by date (UBD), of 8/12/22. 16. A storage bin containing packaged dry pasta was observed to have white powder on the outside of pasta bags. 17. A one-gallon container of classic buttermilk dressing located in Refrigerator 1 was observed to be missing an opened on or a UBD on the container. 18. A one-gallon container of pickle relish was observed to be missing an opened on or a UBD on the container. During an interview with the DM1, on 8/8/22 at 11:15 a.m. DM1 stated it is the responsibility of the dietary aid to clean kitchen surfaces. DM1 stated the drying matts under the clean dishes on the trays in the rack were not changed appropriately and the trays were unclean. During an interview with the Dietary Assistant, (DA), on 8/8/22 at 11:30 a.m. DA stated keeping the surfaces in the kitchen clean is her responsibility. She stated she gets very busy and cannot get to cleaning kitchen surfaces. During an interview with Dietary Manager 2, (DM2), on 8/16/22 at 2:30 DM2 stated the kitchen follows the sanitation and storage standards set forth by RDs for Healthcare. During a review of a facility document titled, General Appearance of Food and Nutrition Department from RDs for Healthcare dated 2018, indicated Floors, floor mats and walls must be scheduled for routine cleaning and maintained in good condition, .Walls and ceilings must be washed thoroughly at least twice a year. Heavily soiled surfaces must be cleaned more frequently as necessary, .Leaking or severely dented cans and spoiled foods should be disposed of promptly to prevent contamination of other foods. 555499 Page 12 of 13 555499 08/11/2022 Redwood Healthcare Center LLC 3145 High Street Oakland, CA 94619

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on observation, interview and record review, the facility failed to provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. The facility had nine resident rooms (room A, B, C, D, E, F, G, H, I) with a total of 27 licensed beds that were occupied by 25 residents, that provided less than 80 square feet (sq. ft.) per resident. This failure had the potential to result in a lack of sufficient space for the provision of care by facility staff, and lack of sufficient space for residents to have personal belongings at the bedside. Findings: During observations between 8/8/2022-8/11/2022, the following resident rooms and corresponding square footage were identified: Room A had three beds that measured 17 ft. by 12.7 ft., providing 71.31 sq. ft. per resident. Room B had three beds that measured 17 ft. by 12.6 ft., providing 70.83 sq. ft. per resident. Room C had three beds that measured 17 ft. by 12.7 ft., providing 71.31 sq. ft. per resident. Room D had three beds that measured 17 ft. by 12.7 ft., providing 71.31 sq. ft. per resident. Room E had three beds that measured 17 ft. by 12.8 ft., providing 71.89 sq. ft. per resident. Room F had three beds that measured 17 ft. by 12.7 ft., providing 71.31 sq. ft. per resident. Room G had three beds that measured 17 ft. by 12.8 ft., providing 71.89 sq. ft. per resident. Room H had three beds that measured 17 ft. by 12.8 ft., providing 71.89 sq. ft. per resident. Room I had three beds that measured 17 ft. by 12.10 ft., providing 72.72 sq. ft. per resident. During random observations of care and services from 8/8/2022-8/11/2022, there was sufficient space for the provision of care for the residents in all rooms. There was no heavy equipment kept in the rooms that might interfere with resident care and each resident had adequate personal space and privacy. There were no complaints from residents regarding insufficient space for their belongings. There were no negative consequences attributed to the decreased space and/or safety concerns in the nine rooms. Recommend granting room size waiver. 555499 Page 13 of 13