Health inspection·November 30, 2023

F 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on interview and record review, the facility failed to ensure there was a full time dietician or certified dietary manager. Residents Affected - Many This failure had the potential to put 32 out of 32 residents at risk for food-borne illnesses (illnesses caused by food contaminated with bacteria, viruses, parasites, and toxins) and/or malnutrition. Findings: During an interview on 11/29/23 at 11:27 a.m., with Registered Dietician (RD), RD stated she works at the facility 30 hours, which is full time. RD stated she is at the facility four days for 8 hours a day. During a record review of Richmond Post-Acute Dietary Work Schedule (undated), the work schedule indicated RD's schedule was Monday through Thursday, from 10 a.m. until 6:30 p.m., a total of 34 scheduled hours. During a review of facility policy and procedure titled Dietary Manager, (undated), indicated that the facility will have an approved CDM, dietary manager, or registered dietician .the position requires full time status. According to the California Code, Health, and Safety Code - HSC § 1265.4: A licensed health facility, shall employ a full-time, part-time, or consulting dietitian. A health facility that employs a registered dietitian less than full time, shall also employ a qualified full-time dietetic services supervisor to supervise dietetic service operations. Page 1 of 5 555735 555735 11/30/2023 Richmond Post Acute Care 955 23rd Street Richmond, CA 94804

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 ensure food was stored in accordance with professional standard for food service when five packages of frozen pancakes, four packages of frozen waffles, one large sheet tray of frozen meat, and one tray of pre-poured beverages were unlabeled and undated. This failure had the potential to put 32 out of 32 residents at risk for food-borne illnesses leading to hospitalization. Findings: During a concurrent observation and interview on 11/27/23 at 9:07 a.m., in the freezer, with [NAME] 1, five packages of frozen pancakes, four packages of frozen waffles were unlabeled, and one large sheet tray of meat product was unlabeled and undated. During the same concurrent observation and interview, in Refrigerator 1, one tray of pre-poured beverages (22 cups) was unlabeled and undated. [NAME] 1 stated that food needs label and date so staff can use old items first. During an interview on 11/29/23 at 11:27 a.m., with Registered Dietician (RD), RD stated all food should have label and date. During a review of facility's policy and procedure titled Labeling and Dating of Foods, dated 2020, the policy and procedure indicated All foods in the storeroom, refrigerator, and freezer need to be labeled and dated. 555735 Page 2 of 5 555735 11/30/2023 Richmond Post Acute Care 955 23rd Street Richmond, CA 94804

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to educate and offer a pneumococcal vaccine (an injection to reduce the risk of getting pneumonia; an infection of the lungs) to one resident (Resident 2) out of five sampled residents. Residents Affected - Few This failure had the potential for increased risk to residents eligible for pneumococcal vaccines to contract pneumonia which is preventable through vaccination. Findings: During a review of Resident 2's Health Record, the record indicated Resident 2 was admitted in May 2018. The immunizations tab indicated Resident 2 received a dose of Pneumovax (a type of pneumococcal vaccine, type unspecified) on 10/10/2022. No other type of pneumococcal vaccines were noted. During a concurrent interview and record review on 11/28/23 at 10:37 a.m., with Infection Preventionist (IP), Resident 2's Immunization Record, undated, was reviewed. The Immunization Record indicated Resident 2 was given Pneumovax Dose 1 on 10/10/22. IP stated that she offered pneumococcal vaccines to all residents upon admission or within 30 days. IP stated she verified immunization status either with acute care hospitals upon admission to the facility, or with resident family members. She further stated she will clarify with doctors on which pneumococcal vaccine to give or call pharmacy to get recommendations, as well as keeping in touch with the California Department of Public Health consultant for recommendations. IP was unable to state current Centers for Disease Control and Prevention (CDC) pneumococcal vaccination schedule. During a review of CDC current recommendations titled Pneumococcal Vaccines Timing for Adults, dated 2022, the current CDC Pneumococcal Vaccine Timing for Adults indicated, For adults 65 years or older who have only received PPSV-23 at any age, CDC recommends A) After 1 year, give 1 dose of PCV 15 or B) After 1 year, give 1 dose of PCV20. The CDC pneumococcal timing also indicated For adults 65 year or older who have only received PCV13 only at any age, the CDC recommends that after 1 year, receiving PCV20 or PPSV23. It further indicated adults who completed the PCV13 at any age and PPSV23 series when they are older than [AGE] years of age, CDC recommends receiving PCV20 after 5 years. During a review of facility's policy and procedure (P&P) titled, Pneumococcal Vaccine, dated August 2016, the P&P indicated 7. Administration of the pneumococcal vaccines are made in accordance with current Centers for Disease Control and Prevention recommendations . 555735 Page 3 of 5 555735 11/30/2023 Richmond Post Acute Care 955 23rd Street Richmond, CA 94804

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility had five resident rooms (Rooms 4, 5, 8, 9 and 10) with multiple beds that provided less than 80 square feet (sq ft) per resident. This deficient practice had the potential to result in inadequate space for the delivery of care to each of the residents in each room and for storage of the residents' belongings. Findings: During an interview on 11/30/23 at 8:34 a.m. with Maintenance Director (Maint), Maint stated the following rooms and corresponding square footage per bed were identified: 1. room [ROOM NUMBER] had two beds and it measured 154 sq ft, providing 77 sq ft per resident; 2. room [ROOM NUMBER] had two beds and it measured 154 sq ft, providing 77 sq ft per resident; 3. room [ROOM NUMBER] had three beds and it measured 220 sq ft, providing 73.33 sq ft per resident; 4. room [ROOM NUMBER] had three beds and it measured 220 sq ft, providing 73.33 sq ft per resident; and 5. room [ROOM NUMBER] had three beds and it measured 220 sq ft, providing 73.33 sq ft per resident. During random observations of care and services from 11/27/23 through 11/30/23, there was sufficient space for provision of care for the residents in all rooms. There was no heavy equipment kept in the rooms that might interfere with resident's care and each resident had adequate personal space and privacy. There were no complaints from the residents regarding insufficient space for their belongings. There were no negative consequences attributed to the decreased space and/or safety concerns in the five rooms. 555735 Page 4 of 5 555735 11/30/2023 Richmond Post Acute Care 955 23rd Street Richmond, CA 94804

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one resident room's water temperature was in the proper range. This failure resulted in the hot water in room [ROOM NUMBER] being too hot at 138 degrees Fahrenheit. Findings: During a concurrent observation and interview on 11/27/23 at 10:22 a.m. with Infection Preventionist (IP) in room [ROOM NUMBER], the hot water in the bathroom sink measured 138 degrees Fahrenheit. IP stated the water temperature would be lowered to under 120 degrees Fahrenheit. During a concurrent observation and interview on 11/27/23 at 12:30 p.m. with IP in room [ROOM NUMBER], IP stated the hot water temperature in the bathroom sink had been lowered. IP measured the hot water temperature, which was 138 degrees Fahrenheit. IP stated the water temperature would be lowered further to under 120 degrees Fahrenheit. During a concurrent observation and interview on 11/29/23 at 8:39 a.m. with Maintenance Director (Maint) in room [ROOM NUMBER], Maint stated the hot water temperature in the bathroom sink had been lowered. Maint measured the hot water temperature, which was 115 degrees Fahrenheit. Maint stated the water temperature should be between 105 and 120 degrees Fahrenheit. Maint stated water temperature of 138 degrees Fahrenheit could harm a resident's skin and/or be uncomfortable for a resident. During a review of facility's policy and procedure (P&P) titled, Hot Water, undated, the P&P indicated, The acceptable temperature for the hot water temps will be between 105 degrees F and 120 degrees F. 555735 Page 5 of 5