Health inspection·April 22, 2022

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to meet the needs for two (Resident 8 and Resident 10) of 16 sampled residents when the facility did not develop and implement a care plan for Resident 8's dialysis (treatment of kidney failure that rids your blood of unwanted toxins, waste products and excess fluids by filtering your blood) care and for Resident 10's hospice care. This deficient practice may result in Resident 8 and Resident 10's physical, psychosocial and functional needs to go unmet. Findings: 1. A review of Resident 8's Facesheet, dated 4/20/22, the face sheet indicated Resident 8 was admitted on [DATE] with a diagnosis of an infected dialysis catheter (tube inserted into the vein). A review of Resident 8's Minimum Data Set (MDS- an assessment tool) dated 2/10/22, the MDS indicated Resident 8 is on dialysis treatment. During an interview on 4/20/22 at 9:53 a.m. with Dialysis Nurse, Dialysis Nurse stated, Resident 8 had been receiving dialysis at Dialysis Nurse's clinic since February 2022. Dialysis Nurse stated, the dialysis access site for Resident 8 had been her left upper chest catheter. Dialysis Nurse further stated, Resident 8's left upper arm graft had not been used since admission in February 2022. During a concurrent record review of Resident 8's care plan on 4/21/22 at 11:16 a.m. with Director of Nursing (DON), DON stated, the care plan for Resident 8 was not updated with the use of a dialysis catheter. She further stated, it is important to update the care plan because the care for a dialysis catheter is different from the care for a dialysis graft. 2. A review of Resident 10's Facesheet, dated 4/21/22, Facesheet indicated, Resident 10 was admitted on [DATE], under palliative care (specialized care that focuses on providing patients relief from pain and other symptoms of a serious illness, no matter the diagnosis or stage of disease). A review of Resident 10's MDS dated [DATE], MDS indicated, Resident 8 is on hospice (end of life care). During a concurrent record review of Resident 10's care plan on 4/21/22 at 11:27 a.m. with DON, there was no care plan for hospice care. DON stated, the hospice team does the care plan and any documents that are needed, the facility staff will ask from the hospice team. DON further stated, it is Page 1 of 8 555914 555914 04/22/2022 We Care Skilled Nursing Facility 21863 Vallejo Street Hayward, CA 94541

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few important for Resident 10's care plan to include hospice care to identify the services that are needed to better care for Resident 10. A review of the facility's policy (P&P) titled, Care Plans, Comprehensive Person-Centered, undated, the P&P indicated, 12. The comprehensive, person-centered care plan is developed within seven (7) days of the required comprehensive assessment (MDS). 13. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. 14. The interdisciplinary Team must review and update the care plan: a. When there has been a significant change in the resident's condition; 555914 Page 2 of 8 555914 04/22/2022 We Care Skilled Nursing Facility 21863 Vallejo Street Hayward, CA 94541

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview record review, the facility failed to provide care for one (Resident 8) requring dialysis when staff did not do a complete physical assessment before and after Resident 8's dialysis treatment. Residents Affected - Few This deficient practice resulted in an incomplete assessment of Resident 8's dialysis access site before treatment. Findings: A review of Resident 8's admission Record, the admission Record indicated, Resident 8 was admitted on [DATE], with a diagnosis of infected dialysis catheter. A review of Resident 8's Minimum Data Set (MDS- an assessment tool) dated 2/10/22, the MDS indicated, Resident 8 is on dialysis. During an interview on 4/20/22, at 9:53 a.m. with Dialysis Nurse, Dialysis Nurse stated, Resident 8 had been receiving dialysis at Dialysis Nurse's clinic since February 2022. Dialysis Nurse stated, the dialysis access site used for Resident 8 had always been the left upper chest catheter. Dialysis Nurse further stated, Resident 8's left upper arm graft had not been used since admission at the dialysis clinic in February 2022. During a concurrent record review of Resident 8's Hemodialysis Communication Notes, on 4/20/22, at 1:11 p.m. with Director of Nursing (DON), the Communication Notes for Resident 8 did not indicate vital signs and vascular access site were assessed before and after treatments in the month of April 2022. DON stated, Resident 8's vital signs and vascular site should be assessed before and after treatment to document any change that could happen before and after treatment. 555914 Page 3 of 8 555914 04/22/2022 We Care Skilled Nursing Facility 21863 Vallejo Street Hayward, CA 94541

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to store medications according to manufacturer recommendations and label medications appropriately when one bottle of Dorzolamide (prescription eye drops given for glaucoma, a condition where there is increased pressure in the eye) was stored in the refrigerator at 39 degrees Fahrenheit. This failure had the potential to cause resident to be administered ineffective medication resulting in worsening of their condition leading to damage of the eye. Findings: During a concurrent observation and interview on 04/20/2022, at 11:45 a.m., with Licensed Vocational Nurse 1 (LVN 1) inside the medication storage room, a bottle of dorzolamide was found stored inside the refrigerator. LVN 1 confirmed refrigerator temperature was 39 degrees Fahrenheit. LVN 1 stated, medications that are stored improperly could potentially be ineffective. During an interview with Director of Nursing (DON) on 04/20/2022 at 2:12 p.m., DON stated, medications should be stored according to manufacturer's recommendation. During a review of the medication insert for Dorzolamide given by the manufacturer, the insert indicated, the suggested storing conditions is between 59 and 86 degrees Fahrenheit. During a review of facility's policy and procedures titled Medication Storage in the Facility (undated), the policy stated Medications and biologicals are stored safely .properly, following manufacturer's recommendations . 555914 Page 4 of 8 555914 04/22/2022 We Care Skilled Nursing Facility 21863 Vallejo Street Hayward, CA 94541

F 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, record review and interview, the facility failed to follow the lunch menu set for 4/18/22 when cut up watermelon was served to residents instead of apple crisp. Residents Affected - Some This deficient practice resulted in Resident 20 feeling disappointed. Findings: During a concurrent observation and interview on 4/18/22, at 10:45 a.m. with Dietary Manager (DM), there was cut up watermelon in the refrigerator. DM stated, it was left over from the weekend and it is still OK to use today. She further stated, it will be served for lunch. During an observation and interview on 4/18/22, at 12:38 p.m., Resident 20 was eating her lunch in her room and was reading the menu. Resident 20 noticed on the menu that apple crisp was the desert for 4/18/22's lunch. Resident 20 stated, there was no apple crisp on her lunch tray, but instead it was cut up watermelon. Resident 20 stated, she was disappointed there was no apple crisp. Resident 20 further stated, staff did not notify her of any changes in the menu this morning. During an interview on 4/21/22, at 10:42 a.m. with Registered Dietician (RD), RD stated menu changes should be communicated to the residents so that they will be aware. 555914 Page 5 of 8 555914 04/22/2022 We Care Skilled Nursing Facility 21863 Vallejo Street Hayward, CA 94541

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store food in a sanitary manner when ground pork was thawing on top of strawberry gelatin inside the refrigerator. Residents Affected - Some This deficient practice had the potential to cause food borne illness and affect all residents. The facility census was 17. Findings: During a concurrent observation and interview on 4/18/22, at 10:45 a.m. in the kitchen, ground pork was thawing in a shallow pan on top of strawberry gelatin in the refrigerator. DM stated, thawing meat should be at the very bottom of the refrigerator and not on top of anything to prevent food borne illnesses. During an interview on 4/21/22, at 10:42 a.m. with Registered Dietician (RD), RD stated, thawing of any meat should be done at the very bottom of a refrigerator and never on top of any food to prevent food borne illnesses. A review of the facility's policy titled, Policy: Thawing of Meats, dated 2018, the policy indicated, a. Use a drip pan under food being thawed so drippings do not contaminate other food. B. Thaw meat on the bottom shelf below prepared, ready-to-eat foods. 555914 Page 6 of 8 555914 04/22/2022 We Care Skilled Nursing Facility 21863 Vallejo Street Hayward, CA 94541

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure one nursing staff performed hand hygiene (handwashing or use of an alcohol-based hand sanitizer) during medication administration when Licensed Vocational Nurse 1 (LVN 1) failed to perform hand hygiene after removing gloves after giving medications to Resident 5 and Resident 8. Residents Affected - Few These failures had the potential to cause or spread infection which could result in hospitalization for Resident 5 and Resident 8. Findings: During an observation on 04/20/2022, at 9:00 a.m., outside of Resident 5's room, Licensed Vocational Nurse 1 (LVN 1), was observed doffing (taking off) gloves and exiting the resident's room after administering medications without performing hand hygiene. During a subsequent observation at 10:45 a.m., outside of Resident 8's room, LVN 1 also did not perform hand hygiene after doffing gloves after administering medication to Resident 8. During an interview on 04/20/2022, with Licensed Vocational Nurse 1 (LVN 1) , at 11:08 a.m., LVN 1 stated, hand hygiene should be done before entering resident rooms, after leaving resident rooms, between glove changes, before medication preparation, and before and after touching residents. LVN 1 confirmed she did not perform hand hygiene after all aforementioned events. LVN 1 further stated, hand hygiene when not done, can lead to spread of infection. During an interview on 04/20/2022, with Director of Nursing (DON), at 3:05 p.m., DON stated, staff to perform hand hygiene when going into resident rooms, coming out of resident rooms, before and after giving resident care. During a review of facility's policy and procedure titled, Handwashing/Hand Hygiene (undated), the policy indicated, All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors .Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively soap (antimicrobial or non-antimicrobial) and water for the following situations: .Before preparing or handling medications .After removing gloves .The use of globes does not replace handwashing/hand hygiene. Integration of globe use along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infections. 555914 Page 7 of 8 555914 04/22/2022 We Care Skilled Nursing Facility 21863 Vallejo Street Hayward, CA 94541

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some 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, interview and record review, the facility failed to provide 9 of 17 residents in the following multiple resident bedrooms 3, 10, 15 with at least 80 square feet per resident. This failure had the potential to result in a lack of sufficient space for the provision of care by facility staff and for the lack of sufficient space for residents to have personal belongings at the bedside. Findings: During an observation on 4/20/22, accompanied by the Maintenance Supervisor (MS), MS measured the following multiple resident rooms in feet (ft) and inches (in): 1) a. room [ROOM NUMBER]: b. 20.4' x 14' c. Total Square Feet: 286.6 d. #Residents 2: 3 e. Square Feet/resident 71.4' 2) a. room [ROOM NUMBER]: b.20.4' x 14' c. Total Square Feet: 286.6 d. # Residents: 3 e. Square Feet/resident 71.4' 3) a. room [ROOM NUMBER] b. 20.4' 14' c. Total Square Feet: 286.6 d. # Residents: 2 e. Square Feet/resident 71.4' During an interview on 4/21/22 at 12:57p.m. with Administrator (Admin), Admin stated, there have been no complaints regarding space for resident rooms 3, 10, or 15 from staff or residents. There were no negative consequences attributable to the decreased space in rooms [ROOM NUMBER]. 555914 Page 8 of 8