Health inspection·February 1, 2024

F 0911 Level of Harm - Potential for minimal harm Residents Affected - Some Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents. Based on observations, interviews, and facility document review, the facility failed to ensure residents' rooms accommodated no more than four residents when 1 (Ward 1) of 23 resident rooms was occupied by six residents, and 1 (Ward 2) of 23 resident rooms was occupied by four residents but had six beds available for use when at full occupancy. Findings included: Review of the facility's Resident Matrix, printed 01/29/2024, revealed six residents occupied room ward 1. During observations on 01/31/2024 beginning at 1:35 PM, six residents were observed to occupy [NAME] 1. [NAME] 2 was occupied by four residents but had six beds available for use when at full occupancy. During an interview on 02/01/2024 at 9:40 AM, Licensed Vocational Nurse #1 stated he had never had an issue with providing care to the residents. During an interview on 02/01/2024 at 9:45 AM, Certified Nursing Assistant #2 stated he had no issues providing proper care to the residents. During an interview on 02/01/2024 at 10:34 AM, the Director of Nursing (DON) stated he expected residents' rooms to be large enough to be safe for the residents who resided in them, for the staff to provide care for the residents, and spacious to accommodate the residents' personal belongings. During an interview on 02/01/2024 at 10:40 AM, the Administrator stated he believed there could be no more than four residents in a room. The Administrator stated he expected that residents' rooms would still have adequate space for their personal use and belongings, as well as space to provide adequate care. Page 1 of 4 555838 555838 02/01/2024 Camden Postacute Care, Inc 1331 Camden Avenue Campbell, CA 95008

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Many Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interviews, the facility failed to ensure residents' rooms measured at least 80 square (sq) feet (ft) per resident in 23 (Rooms 1 through 21, [NAME] 1, and [NAME] 2) of 23 resident rooms in the facility. Findings included: During the initial tour of the facility on 01/29/2024 at 10:25 AM, no residents voiced any concerns regarding the size of their rooms. On 01/31/2024 at 1:35 PM, the housekeeping supervisor (HS) measured the following rooms and confirmed the following dimensions: In room [ROOM NUMBER], there was 72 sq ft for each resident. In room [ROOM NUMBER], there was 72 sq ft for each resident. In room [ROOM NUMBER], there was 72 sq ft for each resident. In room [ROOM NUMBER], there was 74.6 sq ft for each resident. In room [ROOM NUMBER], there was 74.6 sq ft for each resident. In room [ROOM NUMBER], there was 74.6 sq ft for each resident. In room [ROOM NUMBER], there was 74.6 sq ft for each resident. In room [ROOM NUMBER], there was 78 sq ft for each resident. 555838 Page 2 of 4 555838 02/01/2024 Camden Postacute Care, Inc 1331 Camden Avenue Campbell, CA 95008

F 0912 In room [ROOM NUMBER], there was 72 sq ft for each resident. Level of Harm - Potential for minimal harm In room [ROOM NUMBER], there was 72 sq ft for each resident. Residents Affected - Many In room [ROOM NUMBER], there was 72 sq ft for each resident. In room [ROOM NUMBER], there was 72 sq ft for each resident. In room [ROOM NUMBER], there was 72 sq ft for each resident. In room [ROOM NUMBER], there was 72 sq ft for each resident. In room [ROOM NUMBER], there was 69 sq ft for each resident. In room [ROOM NUMBER], there was 69 sq ft for each resident when the facility was at full occupancy. In room [ROOM NUMBER], there was 69 sq ft for each resident. In room [ROOM NUMBER], there was 69 sq ft for each resident. In room [ROOM NUMBER], there was 74.6 sq ft for each resident when the facility was at full occupancy. In room [ROOM NUMBER], there was 74.6 sq ft for each resident. 555838 Page 3 of 4 555838 02/01/2024 Camden Postacute Care, Inc 1331 Camden Avenue Campbell, CA 95008

F 0912 In room [ROOM NUMBER], there was 74.6 sq ft for each resident. Level of Harm - Potential for minimal harm In [NAME] 1, there was 70 sq ft for each resident. Residents Affected - Many In [NAME] 2, there was 65 sq ft for each resident when the facility was at full occupancy. During an interview on 01/31/2024 at 2:42 PM, the HS stated he did not know how many sq ft each resident was supposed to have. During an interview on 02/01/2024 at 9:40 AM, Licensed Vocational Nurse #1 stated he never had an issue with providing care to the residents due to the sizes of the residents' rooms. During an interview on 02/01/2024 at 9:45 AM, Certified Nursing Assistant #2 stated the sizes of the rooms did not prevent him from providing proper care to the residents. During an interview on 02/01/2024 at 10:34 AM, the Director of Nursing (DON) stated he did not know what the exact sizes the rooms were supposed to be, but he did know there were regulations that specified what size the rooms were supposed to be. The DON stated he expected residents' rooms to be large enough to be safe for the residents who resided in them, for the staff to provide care for the residents, and spacious to accommodate the residents' personal belongings. During an interview on 02/01/2024 at 10:40 AM, the Administrator stated he believed there could be no more than four residents in a room, and the rooms were supposed to have 80 sq ft per resident. The Administrator stated he expected that residents' rooms would still have adequate space for their personal use and belongings, as well as space to provide adequate care. 555838 Page 4 of 4