Health inspection·September 18, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain infection control practices during COVID-19 (a contagious virus that mainly affects the lungs and can range from) outbreak when:1. Multiple resident rooms housing COVID-19 positive residents were left with doors open.2. Resident 2 and Resident 3, who were COVID-19 positive, were observed outside of their isolation rooms.3. Certified Nurse Assistant (CNA) 1 who assisted Resident 3 inside the room did not have personal protective equipment (PPE, proper specialized clothing or equipment worn to protect against workplace hazards or diseases).These failures had the potential to expose staff, visitors, and other residents to COVID-19, increasing the risk of transmission and compromising the health and safety of residents and staff during an active outbreak.During a record review of Resident 2's admission Record (AR) printed on 9/18/25, the AR indicated Resident 2 was admitted to the facility in 2024 with diagnoses of type 2 diabetes (high blood sugar) and alcohol dependence with withdrawal (alcohol use disorder with physical or mental withdrawal symptoms). During a record review of Resident 3's AR printed on 9/18/25, the AR indicated Resident 3 was admitted to the facility in 2025 with diagnoses of pleural effusion (excess fluid build-up in the lungs) and essential hypertension (high blood pressure).During an observation on 9/18/25 at 10:47 a.m., the door to room [ROOM NUMBER], which was occupied by a COVID-19 positive resident and had a posted contact precaution (infection control measures, requiring healthcare workers to wear PPE to prevent the spread of microorganisms) sign, was observed left open. During an observation on 9/18/25 at 10:48 a.m., the door to room [ROOM NUMBER], which was occupied by a COVID-19 positive resident and had a contact precaution sign, was observed left open. During an observation on 9/18/25 at 10:49 a.m., the doors to room [ROOM NUMBER] and room [ROOM NUMBER], which were occupied by a COVID-19 positive residents and had a contact precaution sign, were observed left open. During an observation on 9/18/25 at 10:53 a.m., the door to room [ROOM NUMBER], which was occupied by a COVID-19 positive resident and had a posted contact precaution sign, was observed left open. During an observation and interview on 9/18/25 at 10:56 a.m., Resident 2 was walking with no assistance in the hallway using front wheeled walker. Resident 2 stated she was looking for a supervisor to speak with. Resident 2 was assisted to where Licensed Vocational Nurse (LVN) 1 who was right in front of room [ROOM NUMBER]. During an interview on 9/18/25 at 11:00 a.m. with LVN 1, LVN 1 stated Resident 2 was COVID-19 positive and should have remained in the room under isolation, and that the doors to all COVID-19 rooms should have been kept closed to prevent the spread of infection because COVID-19 is managed with contact and droplet transmission (viruses or bacteria spread through coughing, sneezing, or talking).During an observation on 9/18/25 at 11:20 a.m., Resident 1, seated in a wheelchair, was outside of his isolation room with his surgical mask lowered to his chin, leaving both nose and mouth exposed. During an observation on 9/18/25 at 12:01 p.m., CNA 1 was inside an isolation room without wearing complete PPE while assisting Resident 3, who was COVID-19 positive. The isolation room's trash receptacle for disposal of Residents Affected - Some (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 2 Event ID: 555819 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 555819 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elmwood Care Center 2829 Shattuck Avenue Berkeley, CA 94705 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)