Novato Healthcare Center

F-F658.

Findings:

In an interview on 2/13/25 at 1:03 p.m., the Plant Operations Manager (POM) confirmed the facility experienced a power outage on 12/14/24 due to bad storms in the area. The POM stated the facility ' s generator kicked in and he implemented the facility ' s emergency back-up plan. Extension cords were plugged into emergency outlets to provide power to beds, emergency lighting was used, and all fire doors were checked for electrical and were functioning. The POM stated the generator had run for 2.5 hours.

In an interview 2/13/25 at 2:50 p.m., the Director of Nursing (DON) confirmed the facility experienced a power outage on 12/14/25- 12/15/25. The DON verified she had not come to the facility during the power outage but was available by phone. The DON also confirmed administration of medications on 12/14/24 and 12/15/24 had not been documented unless there was computer access.

In an interview on 2/24/25 at 2:15 p.m., the DON stated paper e-MARs were unavailable to nurses during the power outage because the entire system was down. The DON stated she asked staff if they had administered medication, and they all stated they had but there was no documented evidence of the administration in the residents ' medical records unless there happened to be computer access at the time.

The DON clarified the e-MAR system had been updated after the power outage so there was no documentation of printed e-MARs during the power outage. The DON also clarified the e-MAR policy and procedure was from the computer system the facility used but was not a part of the facility ' s assessment.

In an interview on 2/24/25 at 3 p.m., the LN A confirmed he was working at the facility when the power outage occurred. The LN A stated the power outage occurred after he had passed his residents ' morning medications. The LN A verified he had not been provided a copy of his residents ' MARs when the power outage occurred. The LN A stated he was unaware of how medications would be passed if there was no access to the computer. The LN A also verified neither the Administrator (ADM) or the DON were at the facility when the power outage occurred. The LN A stated the LNs should be trained on what to do.

In an interview on 2/24/25 at 3:15 p.m., the LN B verified he was working at the facility when the power outage occurred. The LN B stated management was supposed to provide the LNs copies of the residents ' MARs but had not.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 7 555844 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 555844 B. Wing 02/24/2025

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

Novato Healthcare Center 1565 Hill Road Novato, CA 94947

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 0838 In an interview on 2/24/25 at 3:55 p.m., the LN D verified she was working at the facility when the power outage occurred. The LN D confirmed the ADM and DON were unavailable and did not come to the facility Level of Harm - Minimal harm or during the power outage. The LN D stated, .there was no back-up for the staff. potential for actual harm

In an interview on 2/24/25 at 4 p.m., the LN E confirmed she was working at the facility when the power Residents Affected - Many outage occurred. The LN E stated she had not signed off on the MAR and was unsure of the protocol during

the power outage. The LN E stated she wished there had been a training on the process.

In an electronic-mail (e-mail) sent to the surveyor on 2/26/25 at 9:31 a.m., the DON attached a copy of the facility's assessment per the surveyor's request.

In an e-mail sent to the surveyor on 2/26/25 at 12:33 p.m., the Administrator indicated, [The DON] informed me that you had a question about the facility assessment we had sent over. The numbers, data, in the facility assessment tool are specific to [the facility].

A review of the facility ' s policy and procedure titled eMAR Backup dated 10/8/14 indicated, The eMAR Backup is a process to create a paper image of the electronic Medication Administration Records .for a facility. The paper images serve as a backup for these records when circumstances (power disruption, loss of internet service, etc.) disable the facility ' s access to the .eMAR application .paper images are printed and facility staff can use them to document administration of the required medications .Each facility provides a computer designated as the eMAR backup computer. This computer must be attached to a backup power supply .a printer must also be provided and also must be attached to the backup power supply. The computer must have internet access .Disruptions are commonly caused by power outages or loss of Internet Service .It is recommended that each facility include criteria defining when the eMAR backup reports should be accessed and used in their facility ' s emergency plans .Also, it is highly recommended to put in place an audit process to identify how often staff will check that the eMAR Backup is working .

A review of the facility ' s policy and procedure titled Facility Assessment Tool updated 7/31/24 indicated,

The facility must conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations (including nights and weekends) and emergencies .The facility assessment will be used to .Inform contingency planning for events that do not require activation of the facility emergency plan, but do have the potential to affect resident care, such as, but not limited to, the availability of .other resources needed for resident care . [the facility is expected to reflect on resources needed to provide] Medication management .Awareness of any limitations of administering medications .Consider the following training topics .Emergency preparedness .Consider the following competencies .Disaster planning and procedures .power outage .Policies and procedures for the provision of care .Describe how the facility evaluates what policies and procedures may be required in providing care and how it ensure those meets current professional standards of practice [No description included] .Physical environment and building/plant needs .If applicable, describe the facility ' s processes to ensure adequate supplies and equipment are maintained to protect and promote the health and safety of residents .List health information technology resources, such as systems managing patient records . Consider including a description of .how downtime procedures are developed and implemented [No description of downtime procedures included] .Provide the facility-based and community-based risk assessment using an all-hazards approach (an integrated approach focusing on capacities and capabilities critical to preparedness for a full spectrum of emergencies and natural disasters) .

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 7 555844