Health inspection·March 4, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to accommodate individual needs to ensure resident with the same gender shared bathroom, for 34 out of 92 residents (Residents 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33, and 34). Residents Affected - Some This failure had the potential to negatively affect the resident's psychosocial well-being. Findings: During the facility tour observation on 7/28/23 at 1:30 p.m., with the director of staff development (DSD) the following rooms were observed: Room AA (female room [FR]) and room BB (male room [MR]) shared the same bathroom. Room CC (FR) and room DD (MR) shared the same bathroom. Room EE (FR) and room FF (MR) shared the same bathroom. Room GG (FR) and room HH (MR) shared the same bathroom. Room II (MR) and room JJ (FR) shared the same bathroom. Room KK (MR) and room LL (FR) shared the same bathroom. Room MM (MR) and room NN (FR) shared the same bathroom. Room OO (FR) and room PP (MR) shared the same bathroom. Room QQ (FR) and room RR (MR) shared the same bathroom. During an interview with the DSD on 7/28/23 at 1:40 p.m., the DSD confirmed the above observations and stated the facility should ensure that male residents were not sharing the same bathroom with female residents. During a concurrent observation and interview with the social services assistant (SSA) on 7/28/23 at 3 p.m., the SSA confirmed Resident 1 was in room AA, and the room shared bathroom with room BB. The SSA further stated the facility should accommodate the individual needs of the residents to ensure that that there were no sharing of BR between male and female residents. Page 1 of 2 555792 555792 03/04/2024 Sunnyvale Post-Acute Center 1291 S Bernardo Avenue Sunnyvale, CA 94087

F 0558 Level of Harm - Minimal harm or potential for actual harm Review of Resident 1's Minimum Data Set (MDS, an assessment tool), dated 7/17/2023, indicated her brief interview for mental status (BIMS) score was 15, which indicated her cognition is intact. During an interview on 7/28/23 at 8:34 a.m., with Resident 1, she stated that she was not comfortable sharing BR with male resident and the facility staff was aware of her concern. Residents Affected - Some Review of the facility's policy and procedure, revised March 2021, titled, Accommodation of Needs, indicated our facility's environment and staff behaviors are directed toward assisting the resident in maintaining and/or achieving safe independent functioning, dignity, and well-being . The resident's individual needs and preferences are accommodated to the extent possible, except when the health and safety of the individual or other residents would be endangered. To accommodate individual needs and preferences, adaptations may be made to the physical environment, including the resident's bedroom, and bathroom, as well as the common areas in the facility. 555792 Page 2 of 2