Health inspection·July 21, 2023

F 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) was provided with a psychiatry consult (a comprehensive evaluation of mental or emotional causes of distress) as ordered by the resident ' s physician on 5/14/2023. This deficient practice had the potential to negatively affect Resident 1 ' s psychosocial (relating to the interrelation of social factors and individual thought and behavior) well-being. Findings: A review of Resident 1 ' s admission Record indicated the facility admitted the resident on 3/6/2023 with diagnoses including Alzheimer ' s disease (a progressive disease that destroys memory and other important mental functions), anxiety disorder (a mental health disorder characterized by feelings of worry or fear that are strong enough to interfere with one ' s daily activities), osteoarthritis (a degenerative joint disease, in which the tissues in the joint break down over time), and Vitamin D (a nutrient your body needs for building and maintaining healthy bones ) deficiency (your body is not getting enough vitamin D to stay healthy). A review of Resident 1 ' s Minimum Data Set (MDS - a standardized assessment and care screening tool) dated 4/14/2023 indicated Resident 1 was able to understand others and was usually understood by others. The MDS further indicated that Resident 1 required limited assistance for activities of daily living (ADL - bed mobility, walking, dressing, toilet use, and personal hygiene). A review of Resident 1 ' s physician order dated 5/14/2023, indicated that the physician ordered a psychiatry consult. During a concurrent interview and record review on 7/19/2023, at 1:20 p.m., Licensed Vocational Nurse 1 (LVN 1) reviewed the progress notes for Resident 1 from 5/14/2023 to 6/3/2023. LVN 1 stated that she was unable to locate a psychiatrist consultation progress note indicating the psychiatric consult was provided for Resident 1 as ordered by the physician on 5/14/2023. During a concurrent interview and record review on 7/19/2023, at 4:25 p.m., the Director of Nursing (DON) reviewed Resident 1 ' s progress notes from 5/14/2023 to 6/3/2023. The DON stated that there was no documented evidence of a psychiatrist consultation progress note or supporting documents indicating that Resident 1 was seen by a psychiatrist (a medical doctor specializing in the diagnosis and treatment of mental illness) for the psychiatric consult ordered by the physician on 5/14/2023. Page 1 of 4 055013 055013 07/21/2023 Eisenberg Village 18855 Victory Bl Reseda, CA 91335

F 0742 Level of Harm - Minimal harm or potential for actual harm A review of the facility policy and procedures titled, Psychosocial Assessment, last reviewed on 6/8/2023, indicated, To identify the specific maladaptive/dysfunctional factors that impacted the resident ' s psychosocial functioning. Services are rendered, either directly or by referrals, to minimize/eliminate the distress caused by those factors. Residents Affected - Few 055013 Page 2 of 4 055013 07/21/2023 Eisenberg Village 18855 Victory Bl Reseda, CA 91335

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report abnormal (outside of normal range) laboratory results to a resident's physician timely for one of three sampled residents (Resident 1). The facility received Resident 1 ' s abnormal laboratory results on 5/3/2023 and reported it to Resident 1 ' s physician five days later, on 5/8/2023. This deficient practice had the potential to cause a delay of obtaining appropriate medical treatment for Resident 1 which could have resulted in a negative impact to the resident ' s overall physical, mental, and psychosocial well-being. Findings: A review of Resident 1's admission Record indicated the facility admitted the resident on 3/6/2023 with diagnoses including Alzheimer ' s disease (a progressive disease that destroys memory and other important mental functions), anxiety disorder (a mental health disorder characterized by feelings of worry or fear that are strong enough to interfere with one's daily activities), osteoarthritis (a degenerative joint disease, in which the tissues in the joint break down over time), and Vitamin D (a nutrient your body needs for building and maintaining healthy bones ) deficiency (your body is not getting enough vitamin D to stay healthy). A review of Resident 1's Minimum Data Set (MDS - a standardized assessment and care screening tool) dated 4/14/2023 indicated Resident 1 was able to understand others and was usually understood by others. The MDS further indicated that Resident 1 required limited assistance from staff for activities of daily living (ADL – bed mobility, walking, dressing, toilet use, and personal hygiene). A review of Resident 1 ' s physician ' s orders indicated as follows: 1. On 5/3/2023, the physician ordered to check Resident 1 ' s laboratory tests including a complete blood count (CBC - a blood test that measures different parts and features on a person ' s blood) and 25-hydroxy Vitamin D test (a blood test that measures how much Vitamin D is in a person ' s body). A review of Resident 1 ' s laboratory results dated [DATE] indicated the following: 1. WBC at 12.5 thousand per cubic milliliter (K/uL - unit of measure). Normal range is 4 K/uL to 11 K/uL. 2. Vitamin D at 21.3 nanograms per millimeter (ng/mL - a unit of measurement). Normal range is 30 ng/mL to 100 ng/mL. A review of Resident 1 ' s Progress Note dated 5/8/2023 indicated the facility notified Resident 1 ' s NP regarding the Resident 1 ' s elevated WBC and low level of Vitamin D on 5/8/2023. During a concurrent interview and record review on 7/19/2023, at 1:09 p.m., Licensed Vocational Nurse 1 (LVN 1) reviewed Resident 1 ' s Lab results dated 5/3/2023 and Resident 1 ' s Progress Notes from 5/3/2023 through 5/8/2023. LVN 1 stated that the facility notified Resident 1 ' s NP of Resident 055013 Page 3 of 4 055013 07/21/2023 Eisenberg Village 18855 Victory Bl Reseda, CA 91335

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 1 ' s abnormal WBC and Vitamin D lab values on 5/8/2023. LVN 1 stated that the licensed nursing staff should have report abnormal lab results to the resident ' s physician as soon as the facility receives the results so that the physicians are able to order necessary interventions. During a concurrent interview and record review on 7/19/2023, at 4:15 p.m., the Director of Nursing (DON) reviewed Resident 1 ' s Lab results dated 5/3/2023 and stated that the facility notified Resident 1 ' s NP on 5/8/2023. The DON stated that the facility should have reported Resident 1 ' s Lab results from 5/3/2023 to Resident 1 ' s physician upon receiving them from the laboratory for further directions. The DON stated that the facility having reported the results of Resident 1 ' s lab results five days after being first made aware of the results would be considered late reporting to the physician. The DON stated that abnormal lab results should be notified to the resident ' s physician promptly. A review of the facility ' s policy and procedure titled, Laboratory Result Reporting, with a revision date of 6/8/2023, indicated all lab results must be reported to assure all residents receive quality care and to maintain or attain the highest practicable level of functioning. All lab results will be checked upon receiving by the charge nurse against previous results and panic values. Immediate notification (as soon as possible) for WBC greater than (>) 12,000. The charge nurse will document this notification in the medical chart and will check off on Lab Log that the physician was notified. A review of the facility ' s policy and procedure titled, Change in Patient Condition, with a revision date of 6/8/2023, indicated, the facility shall promptly notify the patient, his or her attending physician, and representative of changes in the patient ' s medical/mental condition. The Nurse supervisor/charge nurse will notify the patient ' s attending physician or on-call physician when there has been: A need to alter the patient ' s medical treatment significantly Except in medical emergencies, notifications will be made within twenty-four (24) hours of a change occurring in the patient ' s physical/mental/emotional condition or status. 055013 Page 4 of 4