Health inspection·August 11, 2025

F 0692 Provide enough food/fluids to maintain a resident's health. 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 provide appropriate services to one of three sampled residents (Resident 1) when the Registered Dietitian (RD) did not reevaluate and address Resident 1's severe weight loss (a weight loss greater than 5% in one month, greater than 7.5% in three months, and greater than 10% in six months).This failure placed Resident 1 at risk for decline in nutritional status and physical health.Resident 1 was admitted on [DATE] with diagnoses that include left distal radius fracture (a break of the bone near the wrist of the left forearm) and cerebral palsy (a condition that affects a person's ability to move and maintain balance and posture). Resident 1 was transferred to acute care hospital on 7/2/25 and was discharged from the facility on 7/9/25.Review of Resident 1's weight record indicated an initial weight of 230 pounds on 5/23/25.During a review of Resident 1's Registered Dietitian Nutrition Assessment (RDNA), dated 5/21/25, the RDNA indicated Resident 1's hospital weight on 5/13/25 was 249.6 pounds. The RDNA showed Resident 1's BMI score (body mass index, a measure of body fat based on a person's height and weight) as 32.1 indicating obesity (having excessive body fat). Further review of the RDNA indicated Evaluation. He (Resident 1) endorsed having a fair appetite. He is fine with current portion sizes. He did not want snacks/supplements at this time. RD educated resident on the importance of eating to maintain strength.Interventions and Plan: Consider re-visiting snack/supplements if rt (resident) has weight loss. F/U (follow up) PRN (as needed).During a review of Resident 1's RD Medical Nutrition Therapy Note (RD Note), dated 5/28/25, the RD Note showed Resident 1's weight as 230 pounds on 5/23/25 and 227 pounds on 5/28/25. The RD Note indicated Resident 1 has a weight loss of 1.3% pounds in one week. The RD Note also indicated Resident is reviewed for inadequate intake. Resident's intake remains fair, however, calculated to meet estimated needs. Weight stable x (for) 1 (one) week with minor weight loss, may be related to swelling of fingers on admission. No edema noted at this time. No new labs (laboratory) to review. No new dietary interventions. Will continue to monitor and f/u (follow up) PRN (as needed).During a review of Resident 1's Progress Notes (PN), dated 6/19/25, the PN showed Resident 1's weight on 6/18/25 as 217 lbs., a 5.7% weight loss in in 26 days. The PN indicated Resident 1 eats 76% to 100% of his meals. The PN also indicated Weight loss of unknown etiology (cause). Beneficial for resident considering BMI now 29.4. During a review of Resident 1's PN, dated 6/26/25, the PN showed Resident 1's weight on 6/25/25 was 210.8 pounds, indicating an 8.3% weight loss in 33 days. The PN indicated Resident 1 eats 51% to 75% of his meals. The PN also indicated RD/IDT (Interdisciplinary Team) Recommendations: Weight loss of unknown etiology. Beneficial for resident considering BMI now 28.6. Continue to monitor.During a review of Resident 1's care plan (CP) titled, At Risk for Altered Nutrition Status R/T (related to) Malnourished as evidenced by Nutritional Screening Tool, created on 5/20/25 and last revised on 6/9/25, the CP included a goal of no significant weight change for 30 or 180 days. The CP interventions included monitor closely for weight gain/loss.During an interview on 8/11/25 at 11:33 AM, the RD stated, I did not really Residents Affected - Few (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: 555827 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 555827 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Atherton Park Post-Acute 1275 Crane Street Menlo Park, CA 94025 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)