Diablo Valley Post Acute
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
licensed nurse. During an interview on [DATE REDACTED] at 11:47 a.m. with the Medical Director (Med Dir), Med Dir 1 stated when a resident experienced a significant change in condition, such as severe chest pain, particularly for a resident with a history of a recent heart attack, the expectation was to administer the prescribed nitroglycerin and immediately activate emergency medical services by calling 911. Med Dir stated nitroglycerin administration may be held if the resident's bp was below 90/50 mmHg. Med Dir further stated delayed interventions for a resident experiencing chest pain could result in cardiac arrest and prolonged, unrelieved pain.During a record review of the facility's undated policy and procedure (P&P), titled, Pain Assessment and Management, the P&P indicated, The purposes of this procedure are to help staff identify pain in resident, and to develop interventions that are consistent with the resident's goals an needs and that address the underlying causes of pain.2. Monitor the resident for presence of pain and the need for further assessment when there is a change of condition.5. During the pain assessment gather the following information as indicated from the resident (or legal representative) .c. Characteristics of pain.(1) Location of pain. (2) Intensity of pain.(3) Characteristics of pain (e.g., aching, crushing, numbness, burning, etc.).(4) Pattern of pain (e.g., constant or intermittent).and (5) Frequency, timing, duration of pain.d. Impact of pain on quality of life.i. Current medical conditions and medications.Identifying causes of pain.3. Review
the resident's clinical record to identify conditions or situations that may predispose the resident to pain, including.d. circulatory/heart . (1) angina (chest pain) .During a record review of the facility's P&P, titled, Administering Medications, revised in [DATE REDACTED], the P&P indicated Medications are administered in accordance with prescriber orders, including any required timeframe.During a record review of the facility's P&P, titled, Change in a Resident's Condition or Status, revised in February 2021, the P&P indicated, 2. A ‘significant change' in condition is a major decline or improvement in the resident's status that.a. will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions.9. If a significant change in resident's physical or mental condition occurs, a comprehensive assessment of resident's condition will be conducted.During a record review of the facility's record, titled, Job Description: Registered Nurse (RN), prepared by Human Resources in February 2024, the RN job description indicated, The primary responsibility of your job is to supervise day-to-day nursing activities of
the facility.Such supervision must be accordance with current and federal, state, and local standards, guidelines and regulations that govern the facility.to ensure that highest degree of quality of care is maintained at all times.Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of resident served.Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to nursing care facilities.Must possess
a current, unencumbered, active license to practice as an RN in this state.Must remain in good standing State Board of Nursing at all times.
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
12/23/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Diablo Valley Post Acute
3806 Clayton Road Concord, CA 94521
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 F0755
F 0755
8/30/25 1630, 2020
Level of Harm - Minimal harm or potential for actual harm
8/31/25 0330 9/2/25 0900, 1300, 2030
Residents Affected - Some 9/3/25 6:13 pm
During an administrative record review of the Facility's Policy for Controlled Substances (November 2022) showed, Policy Interpretation and Implementation, Handling Controlled Substances, 3. Controlled substances are counted upon delivery. The nurse receiving the medication, along with the person delivering
the medication, must count the controlled substances together. Both individuals sign the designated controlled substance record (CDR).
During an administrative record review of the Facility's Policy for Controlled Substances (November 2022) showed, Dispensing and Reconciling Controlled Substances, 1. Controlled substance inventory is monitored and reconciled to identify loss or potential diversion in a manner that minimizes the time between loss/diversion and detection/follow-up.
During an administrative record review of the Facility's Policy for Controlled Substances (November 2022) showed, Dispensing and Reconciling Controlled Substances, 2. The system of reconciling the receipt, dispensing and disposition of controlled substances includes the following: a. Records of personnel access and usage (CDR, destruction log): b. Medication administration records (MAR): c. Declining inventor records (CDR): and d. Destruction, waste and return to pharmacy records.
During an administrative record review of the Facility's Policy for Controlled Substances (November 2022) showed, Dispensing and Reconciling Controlled Substances, 14. Accountability records for discontinued controlled substances are kept with the unused supply until it is destroyed or disposed of as required by applicable law or regulation.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
DIABLO VALLEY POST ACUTE in CONCORD, 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 CONCORD, 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 DIABLO VALLEY POST ACUTE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.