Health inspection·December 9, 2021

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, and record review, the facility failed to honor the rights and dignity of one of 14 sampled residents (Resident 16), when the resident, who required assistance to eat, was fed her lunch by a standing CNA 1 (Certified Nurse Assistant). The facility's failure to treat the resident with dignity decreased the resident's quality of life. Findings: Resident 16 was admitted to the facility on [DATE] with diagnoses including Alzheimer Disease, AD (causes memory loss, mental decline, and confusion), Chronic obstructive pulmonary disease, COPD (resulting in chronic cough, bronchitis, asthma, shortness of breath), kidney disease, and high blood pressure. Resident 16's Minimum Data Set (MDS), an assessment tool, dated 11/11/21, indicated resident required total dependence on one/two staff physical assist for bed mobility, transfer to bed/chair, for daily feeding, had impaired hearing/vision, limited verbal skills. During an observation on 12/8/21, at 1:03 PM - 1:08 PM, Resident 16 was observed sitting up quietly in a high-backed wheelchair in her room, fed by CNA 1, who stood during the entire observation. During an interview on 12/9/21, at 1 PM, with CNA 1, CNA 1 stated, .I know we aren't supposed to stand while feeding resident, I'm supposed to be sitting . During a review of staff training materials, training materials indicated, .Caring for the Resident with Dignity and Respect .The Dining Experience: Residents gather for meals daily. A large portion of one's day is spent in dining and interactions during mealtime can be meaningful to the individual residents. Areas of potential non-compliance related to the dining experience may include: .3. Staff standing over residents as they are assisted with dining .Best Practice for maintaining a dignified dining experience may include: .3. Develop an environment to ensure that direct care staff can assist with feeding residents comfortably. Ensure there is adequate space and furniture to allow direct care staff to sit comfortable next to residents to enhance proper feeding techniques. Staff should be seated at eye level when possible and in a manner to promote socialization, even for those residents who have limitations with cognition and/or communication. Provide training to staff, in which they had to feed each other, demonstrating the emotions and sensations of being fed by a staff person standing, not positioned comfortably . 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 3 Event ID: 555869 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 555869 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel Heights Community Care 2740 California St San Francisco, CA 94115 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)