Follow-up·July 25, 2024

Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit on 07/25/2024 at 9:00 AM. LPA Martinez met with Andrea Armstrong and explained the purpose of the visit. The purpose of the visit today is to conduct a quarterly visit. LPA Martinez followed up with the following: Staffing Concerns : Job Fairs conducted and continuos hiring. Medication Errors: A medication error was reported to Community Care Licensing Department (CCLD) by the facility. Medication Audit: A medication audit was completed on July 18, 2024. Reporting Requirements: The Department has received incident reports from the facility. Medication Training : June 12, 2024 and July 15, 2024. Facility Polices Regarding: Assessments, Monitoring of residents, Change in condition, Medication errors. Polices provided to CCLD. Quarterly Visit Review: Medication Error: Resident (R1) was given the wrong Metoprolol SUCC ER dosage. Per facility medication error communication note, R1 was administered the wrong dosage from June 06, 2024 to July 09, 2024. During the error medication review, it was learned R1 Medication Administrator Records (MAR) were not maintained. The February and May MAR had missing staff administration signatures: February 07, 2024-Metoprolo; May 23 and 25, 2024. LPA Martinez reviewed the MARs' caregiver notes for the missing administration signatures information, and there were no notes. LPA Martinez also requested new medication orders and discontinued medication orders for Metoprolol. The requested medication orders were not provided during today's visit. LPA Martinez was informed by staff that the orders would need to be requested from pharmacy. Continued... Facility staff will email medication orders to LPA Martinez by August 04, 2024. Because you have been cited for repeating the same violation within 12 months (California Code of Regulations Section 874 65(a)(4 )) , a civil penalty in the amount of $1,000.00 shall be assessed 07/25/2024. Please refer to LIC 421IM form for additional information. Reassessments: LPA Martinez reviewed resident 2 (R2) assessments and health condition changes. LPA Martinez reviewed a March 21, 2024 pre-assessment and a March 21, 2024 individualized service plan (ISP). The pre assessment- skin care section stated, "resident has no skin impairment." The healing wounds/bedsores section states, "requires staff monitoring and assistance with care of healing wound/pressure injuries from licensed nurse. The ISP skin care section states, "resident has no skin impairment." Healing wound section states, "Resident has home health for left leg...left leg with redness and flaky skin with scabs...no open wounds." LPA Martinez reviewed a medical visit summary dated April 09, 2024. This summary indicated R1 had a right leg wound and required wound care. Medical summary visit also included physician orders: wear compression sock during the day; keep wound clean and dry; elevate legs whenever possible; water consumption 1.7 liters per day; and lower salt intake. LPA Martinez did not observer an updated April 2024 assessment to implement the April 09, 2024 physician orders and to include home health care. Also, the assessment did not clarify if R1 was diagnosed with a pressure injuries or wounds. LPA Martinez reviewed an ISP dated May 01, 2024. The skin care section states, "resident has no skin impairment." Healing wound section states, "resident has no healing wounds or pressure injuries ." The May 01, 2024 ISP does not included R2's April 09, 2024 physician orders: wear compression sock during the day; keep wound clean and dry; elevate legs whenever possible; water consumption 1.7 liters per day; and lower salt intake. The assessment does not include if wounds have healed and does not indicate if R2's is receiving skin integrity observation/monitoring. Based on the facility file review, R2's assessment plan was not being updated and maintained. As a result, of today's quarterly visit, deficiencies can be found on the 809D page. An exit was conducted, and a copy of the 809 report, 809D Pages