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Complaint Investigation

Double Tree Post Acute Care Center

Inspection Date: December 22, 2025
Total Violations 1
Facility ID 056177
Location SACRAMENTO, CA
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Inspection Findings

F-Tag F0600

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview and record review, the facility failed to protect the resident's right to be free from abuse for one of seven sampled residents (Resident 1) when Resident 2 hit Resident 1 in the head.This failure resulted in Resident 1 having pain and dizziness and had the potential for Resident 1 to experience physical and/or psychosocial harm.Findings:During a review of Resident 1's clinical record, Resident 1 was admitted [DATE REDACTED] with diagnosis that included Dementia (a progressive state of decline in mental abilities).During a review of Resident 1's Minimum Data Set (MDS- a federally mandated resident assessment tool) the MDS, dated [DATE REDACTED] indicated Resident 1 had a Brief Interview for Mental Status (BIMS- a tool to assess cognition) BIMS score of 7 out of 15 which indicated Resident 1 had severe cognition impairment. During a review of Resident 2's clinical record, Resident 2 was admitted [DATE REDACTED] with diagnosis that included chronic pain syndrome (pain that lasts longer than three months), psychoactive substance abuse (a pattern of compulsive substance use).During a review of Resident 2's MDS dated [DATE REDACTED], Resident 2 had a BIMS score of 15 out of 15 which indicated Resident 2 had intact cognition.During a review of Resident 1's Change of Condition (COC) note, dated 12/13/25, the COC indicated Resident 1 was hit in the head by Resident 2 and Resident 1 complained of pain in the area he was struck and dizziness. The COC indicated Resident 1 was sent to the hospital for evaluation.During an

interview on 12/22/25 at 10:35 a.m. with Resident 1, Resident 1 stated another resident hit him behind his ear. Resident 1 stated he has continued pain behind his right ear.During a review of Resident 2's Situation, Background, Appearance, Review and Notify (SBAR) communication form, dated 12/12/25. The SBAR indicated Resident 2 got upset and hit Resident 1 with a closed fist and Resident 1 returned an open-handed hit to Resident 2's chest three times.During an interview on 12/22/25 at 10:47 a.m. with Resident 2, Resident 2 stated Resident 1 hit him in his chest while he was in bed and Resident 2 got up and hit Resident 1 in the head. Resident 2 stated there was no one in the room during the altercation.During an interview on 12/22/25 at 2:25 p.m. with the Director of Nursing (DON), the DON confirmed residents have the right to be free from abuse.During a review of the facility's Policy and Procedure (P&P) titled, Residents Rights revised December 2016, the P&P indicated, . residents' right to be free from abuse.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

📋 Inspection Summary

DOUBLE TREE POST ACUTE CARE CENTER in SACRAMENTO, CA inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

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 SACRAMENTO, 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 DOUBLE TREE POST ACUTE CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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