Health inspection·July 24, 2024

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 Based on observation, interview, and record review, the facility failed to follow its policy and procedure (P&P) titled, Nail Care, for one of three sampled (Resident 3) by failing to: Residents Affected - Few 1. Ensure assigned Certified Nursing Assistants (CNAs) trimmed and cleaned the fingernails of Resident 3, who had contractures (condition of shortening and hardening of muscles, tendons, or other tissues, often leading to deformity and rigidity of joints) to his left and right hands. 2. Ensure assigned CNAs notified assigned Licensed Vocational Nurses (LVNs) regarding Resident 3's long and overgrown toenails. 3. Ensure assigned LVNs notified the Social Services Director (SSD) that Resident 3 needed to be referred and seen by a podiatrist (medical specialists who help with problems that affect your feet or lower legs) for cleaning and trimming of Resident 3's long and overgrown toenails. These failures had the potential to cause injuries and infection to Resident 3. Findings: During a review of Resident 3's admission Record (AR), the AR indicated, the facility admitted Resident 3 on 6/17/2024, with diagnoses that included contracture of left and right hands, functional quadriplegia (the complete inability to move due to sever disability frailty caused by another medical condition without physical injury or damage to the spinal cord), and chronic respiratory failure (serious condition that makes it breathe on one's own). During a review of Resident 3's Minimum Data Set (MDS- a standardized resident assessment and care screening tool), dated 6/21/2024, the MDS indicated, Resident 3 had moderately impaired cognition (ability to think, remember, and function). The MDS indicated, Resident 3 was dependent (helper did all the effort or the assistance of 2 or more helpers was required for the resident to complete the activity) on staff for oral hygiene, toileting hygiene, showering/bathing self, upper and lower body dressing, and putting on/taking off footwear. The MDS indicated, Resident 3 required substantial/maximal assistance (helper did more than half the effort and helper lifted or held trunk or limbs) with personal hygiene. During a review of Resident 3's untitled Care Plan (CP), initiated 6/18/2024, the CP indicated, Resident 3 was at risk for rehospitalization and needed assistance with activities of daily living (ADL- the tasks of everyday life fundamental to caring for oneself) for weakness. The CP interventions included for staff to assist Resident 3 with ADL and mobility as needed, and to notify the medical doctor (MD) if ADL help increased from baseline. Page 1 of 2 055104 055104 07/24/2024 Sunset Manor Conv Hosp 2720 Nevada Avenue El Monte, CA 91733

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of Resident 3's untitled CP, initiated 6/20/2024, the CP indicated, Resident 3 was dependent on staff for meeting emotional, intellectual, physical, and social needs related to physical limitation. The CP interventions included Resident 3 needed assistance with ADL as required during the activity. During an observation on 7/24/2024 at 11:15 am, Resident 3's fingernails and toenails were observed. Resident 3's fingernails and toenails were long and overgrown, with build-up and brown colored substance under the nails. Resident 3 had splints on both hands and Resident 3's hands were contracted. During a concurrent observation and interview on 7/24/2024 at 11:54 am with LVN 1, Resident 3's fingernails and toenails were observed. LVN 1 stated Resident 3's left and right fingernails were long and dirty, and needed to be trimmed and cleaned. LVN 1 stated Resident 3's hands were contracted and could cause the fingernails to dig and cut into Resident 3's palms. LVN 1 stated Resident 3's left and right toenails were long and dirty, and needed to be trimmed and cleaned. LVN 1 stated staff needed to keep Resident 3's fingernails trimmed and cleaned because overgrown nails could cause cuts or scrapes to Resident 3's skin. LVN 1 stated it was the licensed staff's responsibility to ensure Resident 3's toenails were cut by the podiatrist. LVN 1 stated LVN 1 did not reach out to the SSD, Resident 3's MD, and/or the podiatrist to ensure Resident 3's toenails were trimmed. During a concurrent observation and interview on 7/24/2024 at 12:09 pm with CNA 1, Resident 3's fingernails and toenails were observed. CNA 1 stated Resident 3's left and right fingernails were long and overgrown and was brown with dirt. CNA 1 stated Resident 3's fingernails needed to be trimmed. CNA 1 stated only the podiatrist trimmed toenails on residents (in general), but that CNA 1 was supposed to inform the licensed nurses if Resident 3's toenails were overgrown and needed to be trimmed. CNA 1 stated Resident 3's fingernails needed to be kept trimmed and clean to ensure the nails did not grow too long and cut into Resident 3's skin since Resident 3 was contracted. CNA 1 stated Resident 3's dirty nails could cause an infection. During an interview on 7/24/2024 at 12:22 pm with the SSD, the SSD stated if (in general) if a resident's toenails needed to be trimmed, licensed nurses needed to inform the SSD so the podiatrist could be called for the resident. During an interview on 7/24/2024 at 3:54 pm with the Director of Nursing (DON), the DON stated residents' fingernails and toenails were to be assessed daily and trimmed and cleaned as needed as part of ADL care. The DON stated if Resident 3's fingernails and toenails were long, it posed an infection risk to Resident 3, and Resident 3 could get sick. The DON stated if Resident 3's toenails needed to be trimmed, licensed nurses needed to reach out to the SSD so arrangements could be made for the podiatrist to come out and trim and clean Resident 3's toenails. During a review of the facility's P&P titled, Nail Care, revised on 12/19/2022, the P&P indicated, the facility conducted assessments of residents' nails to determine the resident's nail condition, needs, and preferences for nail care, if possible. The P&P indicated, the facility provided routine cleaning and inspection of nails during ADL care on an ongoing basis. The P&P indicated, the facility provided routine nails care, that included trimming and filing, on a regular schedule and between scheduled occasions as the need arose. 055104 Page 2 of 2