Aspire Senior Living Pleasant Hill

In the surveyor’s words

From the most serious findings on record at Aspire Senior Living Pleasant Hill, in the surveyor’s own words.

• Immediate jeopardy, isolatedF678Mar 20, 2024

  Based on interview and record review, the facility failed to ascertain the resident's code status before initiating cardiopulmonary resuscitation (CPR, refers to any medical intervention used to restore circulatory and/or respiratory function that has ceased) for one sampled resident (Resident #5) who was a do not resuscitate (DNR) status out of 5 sampled residents. On [DATE], Registered Nurse (RN) A found the resident without spontaneous respirations and pulse and started CPR. The resident was resuscitated after CPR was performed and was taken by Emergency Medical Services (EMS) to the hospital and subsequently died [DATE] after he/she was placed on comfort care. The facility census was 79 residents. […]

• Immediate jeopardy, isolatedF600Apr 9, 2021

  Based on interview and record review, the facility failed to ensure a resident was free from neglect when facility staff failed to appropriately assess and respond to one sampled resident (Resident #1), who had a recent [CONDITION(S)] and two stent placements. On 4/3/21 the resident had frequent and ongoing complaints of chest pain in the early hours of the morning to Licensed Practical Nurse (LPN) A and Certified Nursing Assistant (CNA) A. Facility staff did not notify the physician or the paramedics. As a result of the lack of notification, the resident notified a family member who contacted local paramedics. Upon arrival at 6:00 A.M., paramedic assessment found the resident had elevated blood pressure and elevated pulse. […]

• Actual harm, isolatedF689Jun 9, 2026

  Based on interview and record review, the facility failed to ensure a comprehensive investigation was completed that included details of the circumstances of the fall, failed to complete a fall risk analysis of what occurred to cause the fall, failed to update the care plan and add interventions implemented to prevent the fall from recurring, and failed to complete a post fall assessment and failed to access for injuries for one sampled resident (Resident #3) out of three sampled residents who fell on 6/4/26 sustaining significant pain and bruising to the left side of face, head and neck. […]

• Actual harm, isolatedF600Nov 9, 2021

  Based on observation, interview and record review, the facility failed to ensure one sampled resident (Resident #1), who had a history of [MEDICAL RECORD OR PHYSICIAN ORDER] . The facility census was 67 residents. Record review of the facility's Abuse, Neglect, Misappropriation and Suspicious Injuries of Unknown Source policy, dated February 8, 2018 showed: -Residents have a right to be free of abuse. -Abuse is defined as willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Willful means the individual must have acted deliberately (not inadvertently or accidentally), not that the individual must have intended to inflict injury or harm. […]

• No harm, potential for more than minimal, widespreadF839Mar 14, 2025

  Based on interview and record review, the facility failed to ensure Unlicensed Registered Nurse (RN) A had a valid registered nurse (RN) license in order to provide nursing care to residents such as assessments, wound care, medication administration and all nursing cares allowed by law. This had the potential to affect all residents. The facility census was 78 residents. On 3/14/25, the Administrator was notified of the past noncompliance which took place over a period of time to include 5/3/24 through 1/30/25. Nurse licensing and state issued identification discrepancies were discovered during audits by the facility Wound Nurse. […]