Elmwood Care Center
Inspection Findings
F-Tag F0609
F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
it was important to initiate a thorough investigation summary to ensure no other residents had experienced
the similar allegation of abuse and to ensure safety of all residents. During a phone interview on 9/30/25 at 10:50 a.m. with LTCO 1, LTCO 1 confirmed they did not receive notifications of the alleged abuse of Resident 1 and Resident 2. LTCO 1 stated they checked their records found no documentation or reports related to the alleged incidents.During a record review of the facility's policy and procedure (P&P), titled Abuse Investigation and Reporting, dated March 2017, the P&P indicated, All reports of resident abuse, neglect, exploitation, misappropriation of resident property, mistreatment and/or injuries of unknown source ( abuse) shall be promptly reported to local, state and federal agencies.and thoroughly investigated by facility management. Findings of abuse investigations will also be reported.Role of the Administrator.1. If an incident of resident abuse.neglect or injury of unknown source is reported, the Administrator will assign the investigation to an appropriate individual.The Administrator will ensure any further potential abuse.Role of
the investigator.3. The investigator will notify the ombudsman that an abuse is being conducted. The ombudsman will be invited to participate in the review process.Reporting.1. All alleged violations involving abuse.including injuries of an unknown source.will be reported by the facility Administrator, or his/her designee to the following agencies.a. The State licensing/certification agency.b. The local/State Ombudsman.2. Suspected abuse, neglect, .or mistreatment (including injuries of unknown source.) will be reported within two hours.If the events that cause the allegation do not involve abuse or not resulted in serious bodily injury, the report must be made in twenty-four hours.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/25/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Elmwood Care Center
2829 Shattuck Avenue Berkeley, CA 94705
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)
F-Tag F0610
F 0610
Respond appropriately to all alleged violations.
Level of Harm - Minimal harm or potential for actual harm
Based on interviews and record reviews, the facility failed to ensure a thorough investigation was conducted and completed within five working days following an allegation of abuse for one sampled resident (Resident 2) and the facility did not not have an investigation summary documenting the findings and result of the investigation.This failure had the potential for the allegation of abuse to remain uninvestigated and placed Resident 2 at risk for ongoing abuse due to the absence of protective interventions and corrective actions.
During a record review of Resident 2's admission Record (AR), printed on 9/29/25, the AR indicated Resident 2 was admitted to the facility in December 2024 with diagnoses of cellulitis (skin infection) of abdominal wall and ileostomy status (presence of an opening in the stomach where waste comes out into a bag. During a record review of Resident 2's SBAR (Situation, Background, Appearance, Review and Notify) record, dated 1/27/25, the SBAR record indicated Resident 2 verbalized that a Certified Nurse Assistant (CNA) was verbally inappropriate and rude towards Resident 2. SBAR showed Resident had verbalized that the CNA told her, You're here because God doesn't like you.During an interview on 9/29/25 at 11:39 a.m. with the Infection Preventionist (IP) also Director of Nursing designee, IP stated they were unable to locate the investigation summary for Resident 2. IP stated the investigation summary should have been done and completed within five working days to ensure there was sufficient time to conduct a thorough investigation of the alleged abuse. The IP further stated she could not determine what transpired during the investigation because there was no documentation showing the findings or results of the investigation.During an interview on 9/29/25 at 2:36 p.m. with the Administrator (ADM), ADM stated if there was an allegation of abuse, an investigation would be conducted. ADM stated she would also notify the State Survey Agency, Long-Term Care Ombudsman (LTCO) and the Police Department immediately or within 24 hours, as required by regulation, to rule out abuse. ADM stated she had five working days to complete a thorough investigation of an allegation of abuse. ADM stated it was important to have the investigation summary completed to ensure no other residents had experienced the same allegation of abuse and to ensure the residents involved were protected from further harm.During a record review of the facility's policy and procedure (P&P), titled, Abuse Investigation and Reporting, dated March 2017, the P&P indicated, All reports of resident abuse, neglect, exploitation, misappropriation of resident property, mistreatment and/or injuries of unknown source ( abuse) shall be promptly reported to local, state and federal agencies.and thoroughly investigated by facility management. Findings of abuse investigations will also be reported.6. The Administrator, or his/her designee, will provide the appropriate agencies or individuals listed above with a written report of the findings of the investigation within five working days of
the occurrence of the abuse.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
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Facility ID:
If continuation sheet
ELMWOOD CARE CENTER in BERKELEY, CA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in BERKELEY, CA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from ELMWOOD CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.