Health inspection·May 12, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide adequate supervision to ensure safety when Resident 1 from eloped from the facility for a census of 37. This failure had the potential to result in serious injury or death for Resident 1. Findings: Resident 1 was admitted to the facility on [DATE] with diagnoses that included toxic encephalopathy (neurological disorder causing brain dysfunction) and congestive heart failure (heart can ' t pump enough blood). Review of Resident 1's admission Nursing Observation, dated 4/28/25 documented Resident as being alert & cooperative and oriented to person and time. Review of Resident 1 ' s Progress Notes dated 4/30/25 at 5 p.m. indicated the nurse was notified by a Certified Nursing Assistant (CNA) that Resident 1 was missing. A thorough search of the room and the building was conducted, but Resident 1 was not found. Resident 1 ' s responsible party and the police were informed. Review of Resident 1 ' s Progress Notes dated 4/30/25 at 5:17 p.m. indicated all the rooms were checked in hall 2 as well as staff rooms that the pt (patient) may have been able to enter. Pt was unable to be located after this and it was confirmed by other staff members that all rooms and locations within the building have been checked satisfactorily. Members of management checked the facility cameras and confirmed that the patient did in-fact leave the building and was heading east. Review of Resident 1 ' s Progress Notes dated 4/30/25 at 6:10 p.m. Resident 1 was brought back in the building by the Administrator in Training (AIT). Review of Resident 1 ' s MD orders indicated Resident 1's diet order, dated 4/28/25, was puree texture and mildly thick liquids. During a review of the facility ' s Investigation Summary- Unusual Incident Report, undated indicated on 04/30/25, at approximately 5 p.m. a CNA informed a nurse Resident 1 was not in their room and was missing from the facility. Code pink (missing person) was announced to all staff, and an instant search began in attempts to locate the patient. The facility surveillance cameras were reviewed to confirm the direction the patient headed in. Around 6 p.m. Resident 1 was located inside of the (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: 555913 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 555913 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Health Care of Sacramento 1411 Expo Parkway North Sacramento, CA 95815 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)