San Jose Nursing Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to coordinate assessments with the pre-admission screening and resident review (PASARR) program for residents with newly evident or possible serious mental disorder for 1 of 4 Residents (Resident #4) whose records were reviewed. The facility failed to refer Resident #4 for Level I screening after being diagnosed with a mental disorder. This deficient practice could affect residents with a mental diagnosis and can result in residents not receiving services as identified by PASARR. The findings were: Review of Resident #4's annual MDS assessment, dated 2/6/25, revealed he was admitted to the facility on [DATE]. His BIMS score was 2 of 15 reflective of severe cognitive impairment. His diagnoses included Hypertension (high blood pressure), Dementia, Depression and Psychotic Disorder. Review of Resident #4's Psychiatric Subsequent Assessment, dated 2/14/25, revealed diagnoses included Persistent mood (affective disorder) unspecified and Major Depressive…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good personal and oral hygiene for 1 of 7 Residents (Resident #35) for Quality of Life. The facility failed to assist Resident #35 with washing her face and brushing her teeth. This deficient practice could affect residents who were unable to carry out activities of daily living and result in resident's being dissatisfied and having poor self-esteem. The findings were: Review of Resident #35's face sheet, dated 3/31/25, revealed she was admitted to the facility on [DATE], with diagnoses including Parkinson's Disease and Dementia. Review of Resident #35's quarterly MDS assessment, dated 1/20/25, revealed her BIMS score was 10 of 15 reflective of moderate cognitive impairment. She had functional limitations in range of motion in both upper and lower extremities and she was dependent on staff for all ADL's including hygiene.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure that a resident who needs respiratory care, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 6 residents (Resident #26), reviewed for quality of care. Resident #26's nebulizer mask was uncovered and the elastic that holds it on to the resident's face was stretched around the uncovered nebulizer machine. The nebulizer mask had an unknown white substance on it. This failure could place residents at risk of cross contamination and respiratory illness. The findings were: Record review of Resident #26's face sheet dated 3/31/25 revealed the resident was an [AGE] year-old female admitted to the facility on [DATE]. The resident's diagnoses included Alzheimer's disease (general term for memory loss and other cognitive abilities serious enough to interfere with daily life), dementia, unspecified (general term for loss of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to, in accordance with accepted professional standards and practices, maintain medical records on each resident that were complete, accurately documented, and failed to safeguard medical record information against loss, destruction, or unauthorized use for 1 of 6 residents (Resident #19) reviewed for administration. Resident #19's nutrition assessment form had the correct resident name but the wrong admission date, wrong date of birth , the wrong height and ideal body weight range. This could place residents at risk for inaccurate health records and incorrect plans of action. The findings were: Record review of Resident #19's face sheet dated 3/31/25 revealed the resident was a [AGE] year-old female admitted to the facility on [DATE]. The resident's diagnoses included dementia with behavioral disturbances (general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to ensure the hospice services meet professional standards and principles that apply to individuals providing services in the facility, and to the timeliness of the services and failed to have a communication process, including how the communication will be documented between the LTC facility and the hospice provider, to ensure that the needs of the resident are addressed and met 24 hours per day for 1 of 3 residents (Resident #88), reviewed for hospice services. Resident #88's hospice binder and medical record had no hospice visit nursing notes and the facility staff nurses were not aware the hospice documentation was needed as part of the medical record. This failure could place residents at risk of decreased continuity of care, not receiving necessary care and services in a timely manner. The findings were: Record review of Resident #88's face sheet dated 4/1/25 revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review the facility failed to implement written policies and procedures that prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property for 2 of 5 staff (NA A and NA B) whose records were reviewed. The facility failed to ensure NA A and NA B were screened through the EMR and NAR registry to ensure they were employable. These deficient practices could affect any resident and contribute to resident abuse, neglect, exploitation and misappropriation of resident property. The findings were: This deficient practice could affect all residents and result in staff not being eligible to provide direct care to residents. The findings were: 1. Review of pre-employment search revealed NA A had not been screened through the EMR and NAR registries during 2023 through 2024. Review of employee/staffing schedule from 1/29/25 to 1/31/25 revealed NA A worked from 10:00 PM to 6:00 AM on 1/29/25. A VM on 1/30/25 at 5:32 PM was left for NA A requesting she return the call. NA did not return the call by the end of the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review the facility failed to ensure before allowing an individual to serve as a nurse aide, a facility must receive registry verification that the individual has met competency evaluation requirements for 2 of 3 Staff (NA A and NA B) whose records were reviewed. The facility failed to ensure NA A and NA B completed a nurse aide program and received their certification. This deficient practice could affect all residents and result in staff not being eligible to provide direct care to residents. The findings were: 1. Review of NA A's personnel file revealed there was no documentation NA A completed a nurse aide course and received a certification. Review of employee/staffing schedule from 1/29/25 to 1/31/25 revealed NA A worked from 10:00 PM to 6:00 AM on 1/29/25. A VM on 1/30/25 at 5:32 PM was left for NA A requesting she return the call. NA A did not return the call by the end of the investigation period. 2. Review of NA B's personnel file revealed there was no documentation NA B completed a nurse aide course and received a certification. Review of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review the facility failed to provide training to their staff that at a minimum educated these staff on procedures for reporting incidents of abuse, neglect, exploitation, or the misappropriation of resident property for 2 of 5 staff (NA A and NA B) whose records were reviewed for abuse training. Staff NA A and NA B did not have their training for abuse or neglect for the year 2024. This deficient practice could affect any resident and contribute to resident abuse and or neglect. The findings were: 1. Review of employee personnel file revealed NA A had not completed training for resident abuse or resident neglect for the year 2024. Review of in-service dated 10/4/24 for ANE, Resident Rights, Restraints, and Fall prevention revealed NA A did not attend the in-service. A VM on 1/30/25 at 5:32 PM was left for NA A requesting she return the call. NA did not return the call by the end of the investigation period. 2. Review of pre-employment search revealed NA B had not completed training for resident abuse or resident neglect for the year 2024. Review of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interviews and record review the facility failed to ensure all resident assessments completed within the previous 15 months in the resident's active record were maintained in the resident's active medical records for 6 of 6 residents reviewed for MDS assessments. (Resident #1, Resident #10, Resident #13, Resident #18, Resident # 21, and Resident #35) in that -MDS assessments for Resident #1, Resident #10, Resident #13, Resident #18, Resident # 21, and Resident #35 were not accessible to staff and ready to review, when the DON/Owner was not on site and able to unlock the cabinet in which all resident MDS assessments were stored. These failures affected 6 residents and placed them at risk of not having their assessments available for review. Findings included: Record review of Resident #1's face sheet revealed an admission date of 02/09/2016 and included the following diagnoses: Schizophrenia (mental disorder characterized by reoccurring episodes of psychosis that are corrected with a general misperception of reality) , paranoid state (thought process that is believed to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations and interviews the facility failed to provide a safe functional, sanitary, and comfortable environment for residents, staff, and the public. The facility failed to ensure good general safety precautions were in place in one outside building, 39.11 feet away from the nursing facility; where food was stored, staff complete laundry services for residents, and facility maintenance items were stored. Findings Included: During an observation on 03/06/2024 at approximately 5:45 p.m., the following observations were made: A building adjacent to the main nursing facility building was used to house the laundry room, food pantry, and the maintenance room. The maintenance room and laundry room were separated by a cinder brick wall, the pantry and the maintenance room were separated by a gypsum wall. The building measured at approximately 39.11 feet away from the main building. The following discrepancies were noted: 1. Dryer electrical cord was wrapped around the flexible gas connection. 2. Flexible gas tubing connected to the dryer was being held in place by a wire tie…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interviews and record review, the facility failed to ensure that the assessments accurately reflected the resident's status for 1 of 3 residents (Resident #35) reviewed for assessments: The facility reported diagnoses included depression, psychotic disorder( serious illness that affects the mind and make it hard for someone to think clearly make good judgements), schizophrenia (mental disorder characterized by reoccurring episodes of psychosis that are corrected with a general misperception of reality), and post-traumatic stress disorder( a mental health condition that is triggered by a traumatic event) on Resident #35's most recent MDS assessment, (dated 01/04/2024). No medical record available in the resident's chart or that the DON/Owner could provide supported the resident having been given those diagnoses at that time or historically. This failure could affect residents who had been at the facility more than 14 days by contributing to inadequate care based on inaccurate assessments. The findings were: Record review of Resident #35's face sheet, (with at report date of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objective and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 2 (Resident #4 and resident # 141) of 8 residents reviewed for care plans. Resident #4 had no care plan in his chart. Resident #141's care plan was incomplete and only had two pages in the care plan. The findings included: Record review of Resident #4's electronic face sheet dated 05/10/2018 reflected he was initially admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included: nontraumatic intracerebral hemorrhage (bleeding in the brain), vitamin D deficiency, hyperlipidemia (too much fat in the blood), and age-related nuclear cataract (clouding and thickening of the eye lens). Record review of Resident #4's MDS assessment dated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to permit each resident to remain in the facility, and not transfer or discharge the resident from the facility for 1 of 2 (Resident #1) residents reviewed for transfer and discharged rights. The facility failed to readmit Resident #1 after an acute care hospital stay resulting in Resident #1 not being permitted to stay in the facility pending placement or appeal. This deficient practice could place residents residing in the facility at risk of not being able to remain at the facility, resulting in violation of their rights. Findings: Record review of Resident #1's admission record, dated 07/18/23, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included Parkinson's disease, COPD, high blood pressure, dementia, repeated falls, and weakness. The face sheet indicated a family member was designated as his responsible party. Record review of Resident #1's progress notes, dated 11/24/23, revealed the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to ensure before transferring or discharging a resident, the notice of transfer or discharge was made by the facility at least 30 days before the resident was transferred or discharged for 1 of 2 residents (Resident #1) reviewed for discharge requirement. The facility refused to accept Resident #1 back on 11/25/2023 after emergently discharging Resident #1 to acute care (on 11/23/2023) for attacking an LVN and CNA. Resident #1's Responsible Party was not given a 30-day discharge notice when the facility refused to readmit Resident #1 from the acute care hospital on [DATE]. These failures could place residents at risk of being discharged and not having access to available advocacy services, discharge/transfer options and appeal process. Findings Include: Record review of Resident #1's admission record, dated 07/18/23, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included Parkinson's disease,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to establish and follow a written policy on permitting residents to return to the facility after they are hospitalized or placed on therapeutic leave for 1 of 2 residents (Resident #1) reviewed for discharge requirement, in that: 1. The facility failed and refused to readmit Resident #1 from the hospital where he was transferred for evaluation and treatment. 2. The facility failed to give Resident #1 or his RP a 30 day discharge notice. These deficient practices could affect residents discharged from the facility and their ability to return to the facility. Findings Include: Record review of Resident #1's admission record, dated 07/18/23, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included Parkinson's disease, COPD, high blood pressure, dementia, repeated falls, and weakness. The face sheet indicated a family member was designated as his responsible party. Record review of Resident #1's…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure it received registry verification for 1 (CNA A) of 4 employees reviewed for registry verification prior to allowing an applicant to serve as a nurse aide in that: The facility failed to ensure CNA A had a current nurse aide certification while employed at the facility, while actively providing care for residents. This failure could result in residents being provided care by staff who have not provided documentation of training and competency in providing care. The findings included: Review of CNA A's personnel file reflected a date of hire of [DATE]. The last Employability Status Check Search that was completed on [DATE] reflected CNA A's NAR status expired on [DATE]. Review of the daily nursing staff schedule , for [DATE] reflected CNA A worked on [DATE] on shift 10-6 (10:00 PM - 6:00 AM) under the Aides section. During an interview on [DATE] at 2:00 p.m. CNA A stated she worked at the facility as a CNA and had been working as a CNA since may…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs for 7 of 7 residents (Resident #11, #30, #32, #4, #22, #18 and #1) reviewed for care plans in that: Residents #11, #30, #32, #4, #22, #18 and #1 were not assessed for pain per the physician's orders and as per the measurable objectives and timeframes addressed on the comprehensive person-centered care plan. This failure could place residents at risk of receiving inadequate interventions not individualized to their care needs. The findings were: a. Record review of Resident #11's face sheet, dated 3/3/22 revealed a [AGE] year old female admitted on [DATE] with diagnoses that included chronic renal failure (longstanding disease of the kidneys leading to kidney failure), hypothyroidism (abnormally low activity of the thyroid gland resulting in slowing of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to assess each resident quarterly (every 3 months) using the Minimum Data Set form specified by the state and approved by CMS for 1 of 6 residents (Resident #25) whose MDS assessments were reviewed, in that: Resident #25's Quarterly MDS Assessment was not completed or submitted. This deficient practice could place residents at-risk of not having their assessments completed timely. The findings were: Record review of Resident #25's face sheet, with a report date of 06/01/2022, revealed the resident was admitted on [DATE] with diagnoses that included: HTN NOS (hypertension or high blood pressure), Senile Dementia uncomp (mental deterioration or loss of intellectual ability, that is associated with or the characteristics of old age), Diabetes Mellitus (refers to a group of diseases that affect how the body uses blood sugar (glucose), and Vitamin D Deficiency ( low level of the Vitamin D). Record review of Resident #25's information provided by the facility…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to transmit a resident assessment within the required time frame for 2 of 5 residents (Residents #4 and #32) reviewed for data encoding and transmission in that: 1. Resident # 4's last MDS assessment submitted was on 10/04/2022 and no other MDS was transmitted prior to the survey. 2. Resident #32's last MDS assessment submitted was on 10/06/2022 and no other MDS was transmitted prior to the survey. This failure could affect residents who resided in the facility and put them at risk of not having their assessments transmitted timely. The findings were: 1. Record review of Resident #32's face sheet, dated 1/10/23 revealed an [AGE] year old female admitted on [DATE] with diagnoses that included senile dementia (mental deterioration in old age, characterized by loss of memory and control of bodily functions), anxiety and chronic pain syndrome. Record review of Resident #32's medical record revealed the resident's last MDS assessment was completed on 1/05/2023…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to provide pharmaceutical services to include procedures that assured the accurate dispensing and administering of all drugs to meet the needs of 1 of 6 residents (Resident #4) reviewed for medication administration in that: LVN D left Resident #4's medication at the bedside. This deficient practice could affect residents and place them at risk of not receiving the therapeutic dosage and drug diversion. The findings were: Record review of Resident #4's face sheet, dated 9/24/18, revealed a [AGE] year old female admitted on [DATE] and re-admitted on [DATE] with diagnoses that included hypertension (high blood pressure), anxiety, depressive disorder, chronic pain syndrome and osteoarthritis (degeneration of joint cartilage and the underlying bone). Further review of the face sheet, under Allergies, revealed Resident #4 was identified as having seasonal allergies. Record review of Resident #4's most recent quarterly MDS, dated [DATE] revealed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.