Stonebrook Post Acute

According to the Admission Record, the resident had a medical history to include a diagnosis of bipolar disorder.

Per the Admission Record, the resident received a diagnosis of major depressive disorder with psychotic symptoms on 01/20/2023.

A quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 02/11/2025, revealed Resident #22 had a Brief Interview for Mental Status (BIMS) score of 3, which indicated the resident had severe cognitive impairment.

The MDS indicated the resident had an active diagnosis to include depression.

Resident #22's Care Plan Report included a focus area initiated 12/03/2024, that indicated the resident had depression manifested by complaints of depression with mood disorder and episodes of tearfulness and sleeplessness.

Interventions directed the staff to administer antidepressant medication as ordered by the physician.

Resident #22's Order Summary Report, revealed an order dated 08/21/2024, for duloxetine hydrochloride capsule delayed related particles 20 milligrams, give one capsule by mouth every 12 hours related to major depressive disorder.

Resident #22's medical record revealed no evidence to indicate the facility referred the resident to the appropriate state-designated authority for a Level II PASARR evaluation once the resident was identified to have a diagnosis of major depressive disorder on 01/20/2023.

During an interview on 03/06/2025 at 11:32 AM, the Receptionist stated she was responsible for the process of PASARR in the facility.

The Receptionist stated she was unaware another screening needed to be done when a resident received a new mental illness diagnosis.

555421

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 555421 B.

Wing 03/06/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Stonebrook Healthcare Center 4367 Concord Boulevard Concord, CA 94521