Health inspection·December 5, 2023

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 interview and record review the facility failed to exercise the resident's right as a resident of the facility for one out of three resident (Resident 1) when Resident 1 was not allowed to leave out on pass to get her Covid-19 (Covid-19: a sickness caused by virus called severe acute respiratory syndrome coronavirus 2) booster vaccine (lessens the severity of Covid-19 by teaching the person's immune system to recognize and fight the virus that causes the disease) outside the facility. This failure had the potential to effect on health and well-being to Resident 1 Findings: During record review of Resident 1's face sheet (a document that gives a resident's information at a quick glance) indicated, Resident 1 admitted to facility on 11/8/2021 and discharged home on 1/3/2022. Resident 1's admission diagnoses including compression fracture of T11-T12 vertebra (broken bones of the spine[Spine: column of bones running from head down to the lower back]), osteoporosis (a bone disease that develops when bone mineral density and bone mass decreases, or when quality or structure of bone changes), and bronchiectasis (a condition in which the lungs' airways become damaged, making it hard to clear mucus). Review of Resident's minimum data set (MDS: clinical and functional assessment tool) dated 11/4/2021 indicated, Resident 1's brief interview for mental status (BIMS) indicated Resident 1 had short-term (forgetting information to which the subject has been recently exposed) and long- term (trouble recalling the information previously learned) memory problem. Review of Resident1's immunization record from acute hospital (a level of healthcare wherein a resident receives immediate yet brief treatment) dated 11/4/2021 indicated, Resident 1 received Covid-19 vaccine o 1/28/2021 and 3/11/2021. Review of Resident 1's electronic medical record (digital version of resident's health record) for psychological note dated 12/22/2021 indicated, Resident 1's family member requested for resident to be taken out of the facility to get Covid-19 booster vaccine at healthcare clinic in local community. This note further indicated facility staff explained to family member that Resident 1 was on Medicare (the federal health insurance program covers in-patient care in skilled nursing facilities [SNF: an in-patient rehabilitation and medical treatment center staffed with trained medical professionals), and family were not supposed to go on leave of absence unless it was an emergency, and Resident 1 was not able to receive her Covid-19 booster vaccine during her stay in facility. During an interview with facility's infection preventionist (IP) on 12/1/2023 at 2:08 p.m., IP Page 1 of 2 555757 555757 12/05/2023 Milpitas Care Center 120 Corning Avenue Milpitas, CA 95035

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few confirmed Resident 1 received initial Covid-19 vaccine on 3/11/2021 more than 6 months ago and she was eligible to take Covid-19 booster vaccine on 12/22/2021 based on guidance from all facilities letter (AFL: a letter from Center for Health Care Quality [CHCQ: the largest center in California Department of Public Health to protect the quality and safety of health care for all Californians], licensing and certification[L&C: responsible for the oversight of licensed healthcare facilities and agencies] program to health facilities that are licensed or certified by L&C with information contained in the AFL may include changes in requirements in healthcare, enforcement, new technologies, scope of practice or general information that affects the health facility) 21-42 dated 11/12/2021. IP also confirmed AFL21-42 indicated residents were encouraged to use local community vaccination sites to get vaccinated. IP stated facility should have followed the AFL 21-42 and allowed Resident 1 to go to a healthcare clinic with her family member to get her booster vaccine 12/22/2021. During an interview with facility's social service director (SSD) on 12/1/2023 at 3:06 p.m., SSD stated the facility should have not stopped resident's family member to get her Covid-19 booster vaccine. SSD also stated Resident 1's should have exercise her rights and allowed her to get her booster vaccine. During concurrent interview and record review of Resident 1 with director of Nursing (DON) on 12/1/2023 at 3:18 p.m., DON stated facility should have followed the AFL 21-42 for Covid-19 booster vaccine guidance for all residents. DON also stated Resident 1 was eligible to get his Covid-19 booster vaccine and facility should have allowed Resident 1's family member to took Resident 1 to the outside clinic to get her Covid-19 booster vaccine on 12/22/2021. During a review of AFL 21-42, titled, Coronavirus Disease 2019 (Covid-19) Vaccination and Booster Dose Guidance, dated 11/12/2021, the AFL21-42 indicated, Vaccine recipients are eligible for a booster vaccine at least 6 months after completing their initial series. Vaccination appointments in Nearby Pharmacies or Healthcare Provider ' s offices: SNF residents and HCP (healthcare personnel) who are willing and able to travel to a vaccination site are encouraged to use vaccination sites in their local community (i.e., nearby pharmacies or healthcare provider ' s office); this may be the fastest way to get vaccinated. There are multiple online resources to locate and schedule an appointment. During a review of facility's policy and procedure (P&P) titled, Resident Rights, revised 12/2016, the P&P indicated, communication with and access to people and services, both inside and outside the facility. Equal access to quality care, regardless of source of payment. 555757 Page 2 of 2