Health inspection·July 10, 2023

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide a notice prior to transfer or discharge to the resident, the resident's representative and representative of the Office of the State Long-Term Care Ombudsman for one of two sampled facility-initiated discharges (Resident 1). This failure had the potential for the resident or resident's responsible party to not having an opportunity to respond or seek help from ombudsman to confer or to contest the discharge. Findings: Review of Resident 1's record indicated he was admitted to the facility on 12/2018 and was discharged to a board and care (BHC) home on 3/17/23. Review of a faxed documentation indicated, the ombudsman office was notified of Resident 1's discharge on [DATE]. Review of Resident 1's face sheet (document providing resident information at a quick glance) indicated a family member was a responsible party (person responsible for making healthcare and/or financial decisions on behalf of a resident). Review of Resident 1's Minimum Data Set, (MDS, an assessment tool), dated 12/27/22, indicated the resident did not have any problems with memory or with daily decision-making skills. There was no documentation in Resident 1's record indicating he was informed of his discharge. During a follow-up interview on 6/27/23 at 1 p.m., the SSD stated Resident 1 was a combination of family and facility-initiated discharge and the facility did not give discharge or transfer notices. During an interview on 6/27/23 at 2:05 p.m., the administrator acknowledged understanding the transfer or discharge notices were to be provided prior to discharge. Review of Transfer or Discharge Notice policy, dated January 2018, indicated a resident, and/or his or her representative was to be given a thirty-day advance notice of an impending transfer or discharge from the facility. A copy of the notice was to be sent to the Office of the State Long-Term Care Ombudsman. All Facilities Letter (AFL) 17-27, dated 12/26/17 and addressed to long-term care facilities indicated, Effective January 1, 2018, AB 940 requires a LTC facility to notify the local LTC Ombudsman at the same time notice is provided to the resident or the resident's representatives when a facility-initiated transfer or discharge occurs. The facility must send notice to the local LTC Ombudsman for any transfer or discharge that is initiated by the facility, whether the resident agrees with the Page 1 of 4 555838 555838 07/10/2023 Camden Postacute Care, Inc 1331 Camden Avenue Campbell, CA 95008

F 0623 facility's decision. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 555838 Page 2 of 4 555838 07/10/2023 Camden Postacute Care, Inc 1331 Camden Avenue Campbell, CA 95008

F 0660 Plan the resident's discharge to meet the resident's goals and needs. 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 develop and implement a discharge plan of care to include the resident's participation, preferences and needs to optimally prepare and transition him to a new living environment for one of two sampled residents (Resident 1). Also, the medical record lacked documentation of Resident 1's referral and communication with the Board and Care Home (BCH). This failure had the potential for the resident not liking and/or not adjusting to his new home. Residents Affected - Few Findings: Review of Resident 1's record indicated he was admitted to the facility on 12/2018 and was discharged to a BHC home on 3/17/23. Review of Resident 1's Minimum Data Set, (MDS, an assessment tool), dated 12/27/22, indicated the resident did not have any problems with memory or with daily decision-making skills. Resident 1 had a care plan, dated 1/9/20, indicating he was a long term resident with minimal and no possibility of discharge to lower level of care due to his disease status. During an interview on 5/23/23 at 11:37 a.m., the administrator (ADM) stated the long term stay care plan should have been discontinued and a new care plan should have been developed to reflect Resident 1's current status. Resident 1 had other care plans addressing problems of alleged sexual behavior of touching another resident's breast, dated 12/14/22; verbalization of wanting to kill himself, dated 6/18/21; impaired visual function related to legal blindness, dated 1/29/20; and episodes of spitting and continuous drooling, dated 1/29/20. Review of Resident 1's planning note, dated 3/8/23 at 12 midnight, indicated the interdisciplinary team (IDT, group of health care members who meet to plan care for the resident) that consisted of the social services director (SSD) and family member, discussed Resident 1's daily episodes of sexual advances towards staff, touching staff, asking for hugs and kisses, purposely licking his hands and smearing saliva on carts, computer monitor, top of medication carts, and staff repeatedly redirecting resident to stop. The same note indicated a family member then asked for assistance to a BCH. During an interview on 5/23/23 at 10:47 a.m., the certified nurse assistant (CNA) stated Resident 1 was alert, saw only shadows, used a cane to walk, spitted saliva everywhere, threw utensils outside his door, and had grabbed butt and breast of women. There was no IDT documentation in Resident's record up to the time of discharge addressing whether the resident was involved in selecting his new living location, a trial visit was offered, any referrals were made, the BCH was informed and/or conducted an assessment to ascertain the resident's preferences, needs and problem behaviors to determine if the new living arrangement was suitable for the resident and BCH. During an interview on 5/23/23 at 11 a.m., the SSD stated the BCH operator was a nurse and she was to assess Resident 1's status. 555838 Page 3 of 4 555838 07/10/2023 Camden Postacute Care, Inc 1331 Camden Avenue Campbell, CA 95008

F 0660 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 6/5/23 at 10 a.m., the SSD stated Resident 1 was alert and oriented, he used a front wheel walker to walk around the facility, and there was no documentation in the record about communication with the BCH because the facility had had been doing business with them for years. During an onsite visit on 6/27/23, documentation of Resident 1's discharge planning prior to discharge on [DATE] was requested and not provided. Review of Discharge Summary and Plan policy, dated January 2018, indicated when a resident's discharge was anticipated, a post-discharge plan was to be developed to assist the resident to his/her new living environment. A discharge summary was to include the resident's ability to perform activities of daily living, such as the need for staff assistance, sensory and physical limitations, such as decrease in vision, mental and psychosocial status of resident behavior and mood. The post-discharge plan was to be developed by the IDT to include a description of the resident's stated discharge goals, and factors that may make the resident vulnerable and how those factors were to be addressed. 555838 Page 4 of 4