Health inspection·September 26, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow their policy and procedure (P&P) when there were missing documentation for bowel and bladder elimination for one of three sampled residents (Resident 1). Residents Affected - Few These failures had the potential to cause unsafe conditions and poor quality of life for Resident 1. Findings: During a review of Resident 1's clinical record, the admission Record (contains demographic and medical information), indicated Resident 1 was admitted to the facility on [DATE], with diagnoses of chronic obstructive pulmonary disease (COPD- a group of diseases that cause airflow blockage and breathing-related problems), type 2 diabetes (high sugar level), and a fracture (a partial or complete break) of the right femur ( a long bone that runs the length of your upper leg or thigh). During a concurrent interview and record review on September 26, 2023, at 12:10 PM, with the Director of Nursing (DON), Resident 1's Bladder Elimination, dated September 1, 2023, through September 26, 2023, had missing documentation for the following dates and times: A. September 21, 2023, night shift (10:00 PM to 6:00 AM- the next day). B. September 23, 2023, night shift. C. September 25, 2023, evening shift (2:00 PM to 10:00 PM). During a subsequent interview and record review on September 26, 2023, at 12:12 PM, with the DON, Resident 1's Bowel Elimination, dated September 1, 2023, through September 26, 2023, had missing documentation for the following dates and times: A. September 21, 2023, night shift. B. September 25, evening shift. The DON acknowledged the missing bladder elimination and bowel elimination dates and times and stated it is understood that staff must chart every shift for the bowel and bladder elimination, and if it is not charted then we do not know if it was done. Page 1 of 2 055076 055076 09/26/2023 Spring Valley Post Acute LLC 14973 Hesperia Rd Victorville, CA 92395

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and record review on September 26,2023, at 12:33 PM, with the DON, the facility's P&P titled, Activities of Daily Living (ADLs- personal care such as bathing, toileting, eating), Supporting, dated October 2014, indicated, .Residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Resident who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene . The DON stated the policy was not followed and should have been. 055076 Page 2 of 2