Health inspection·December 31, 2024

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on interview, record review, and facility policy review, the facility failed to ensure one (Resident 1) of three sampled residents was free from unnecessary drugs when facility's interdisciplinary team (IDT) did not re-evaluate use of Seroquel (an antipsychotic medication) at the time of admission and/ or within two weeks for its appropriateness and indication for use to consider whether or not the medication could be reduced, tapered, or discontinued. Interdisciplinary team is a group of healthcare professionals who work together to treat a patient condition. This failure had the potential for Resident 1 to receive unnecessary medications and placed her at risk to suffer adverse effects from the medication. Findings: During a review of Resident 1's admission Record (AR), dated 12/23/24, the AR indicated, Resident 1 was admitted from acute care hospital on 8/22/24. During a review of Resident 1's Admission-Minimum Data Set (MDS- Resident Assessment and care guide tool) dated 8/26/24, the MDS indicated Resident 1 had no potential indicators of psychosis e.g., hallucinations (perceptual experiences in the absence of real external sensory stimuli) or delusions (misconceptions or beliefs that are firmly held, contrary to reality). MDS indicated Resident 1 had no physical or verbal behavioral symptoms directed towards others e.g., verbal/vocal symptoms like screaming or disruptive sounds, hitting, kicking, pushing, scratching, or grabbing at others. MDS indicated Resident 1's diagnosis included chronic obstructive pulmonary disease with acute exacerbation (COPD-a worsening group of lung diseases that block airflow and make it difficult to breathe). During a review of Resident 1's Order Summary Report dated 8/22/24, indicated the physician prescribed Resident 1 Seroquel oral tablet 25 mg give one tablet by mouth at bedtime for mood disorder manifested by yelling and hitting for 14 days. Further review of Resident 1's Order Summary Reports dated 9/3/24 and 9/18/24, indicated physician continued prescribing Resident 1 Seroquel oral tablet 25 mg, to give one tablet by mouth at bedtime for mood disorder manifested by yelling and screaming. During a review of Resident 1's Medication Administration Record (MAR), dated 8/23/24 to 8/31/24 and 9/1/24 to 9/18/24, the MARs indicated Resident 1 was administered Seroquel 25 mg give one tablet by mouth at bedtime for yelling, hitting and screaming. During an interview on 12/23/24 at 11:17 a.m. with Certified Nursing Assistant (CNA) 1, CNA1 stated CNA1 cared for Resident 1 four days a week. CNA1 stated Resident 1 had behavior of calling out for (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: 555914 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 555914 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE We Care Skilled Nursing Facility 21863 Vallejo Street Hayward, CA 94541 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)