Health inspection·January 2, 2024

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to ensure one of six sampled resident's (Resident 1's) pain level was documented prior to administering Morphine Sulfate (a narcotic substance that dull the senses and relieve pain and can be highly addicting) and Methadone (a powerful drug used for pain relief) from 12/7/2023 to 12/12/2023 and failed to document Resident 1's pain level every shift from 12/7/2023 to 12/ 12/2023. Residents Affected - Some These deficient practices had the potential to negatively affect Resident 1's pain management regimen. Findings: During a review of Resident 1's admission Record (face sheet), the face sheet indicated Resident 1 was admitted at the facility on 12/7/2023 with a diagnosis that included atherosclerosis of the aorta (progressive buildup of plaque in the largest artery in the body), liver cirrhosis (a condition where the liver, organ that filters waste and toxins from the blood, is permanently damaged), chronic obstructive pulmonary disease (a group of diseases that cause airflow blockage and breathing-related problems to the body) and palliative care (a specialized medical care for people living with a serious illness, such as cancer or heart failure). During a review of Resident 1's Minimum Data Seat (MDS), a standardized assessment and care screening tool, dated 12/12/2023, the MDS indicated Resident 1 was able to make independent decisions that were consistent and reasonable. The MDS indicated Resident 1 required one-person substantial maximal assist to complete his activities of daily living (ADLs) such as toileting, personal hygiene and repositioning/ turning in bed. During a review of Resident 1's medical record titled, Order Recap Report, the Order Recap Report indicated: a. On 12/7/2023, an order for Resident 1 to take a medication called Morphine Sulfate 15 milligrams (mg, a unit of measurement in the metric system equal to a thousand of a gram), Give with a dose of ½ tablet, 7.5 milligrams) every 2 (two) hours as needed for pain. b. On 12/7/ 2023, an order to monitor Resident 1's pain every shift using the verbal pain scale with the following parameters: 1. No pain=0 2. Mild pain= 1 to 3 Page 1 of 3 055123 055123 01/02/2024 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0697 3. Moderate pain= 4 to 6 Level of Harm - Minimal harm or potential for actual harm 4. Severe pain= 7 to 9 5. Very severe pain=10 Residents Affected - Some c. On 12/8/2023, an order for Resident 1 to take a medication called Methadone with a dose of 5 (five) mg by mouth once a day for pain management. During a review of Resident 's care plan titled Alteration in comfort- Pain, dated 12/17/2023, the care plan indicated to assess the intensity of pain using the pain scale 1 to 10. During a review of Resident 1's medical record titled, Medication Administration Record (MAR) dated 12/2023, the MAR indicated: a. Resident 1 was given Morphine Sulfate 7.5 mg by mouth with a total of 8 doses and Resident 1 was given Methadone 5 mg by mouth with a total of four doses for 12/7/2023 to 12/12/2023. The MAR did not indicate Resident 1's pain level prior to administering Methadone and Morphine Sulfate. b. No monitoring of Resident 1's pain level every shift from 12/7/2023 to 12/12/2023. During an interview on 12/29/2023 at 11:20 a.m., with Licensed Vocational Nurse 1 (LVN 1), LVN 1 stated the licensed nurses must ask the residents of their pain level every shift, before administering pain medication and should document in their medical record (MAR) to ensure their pain level has been identified and the right pain medication was given to them. LVN1 confirmed there was a total of 8 doses of Morphine Sulfate 7.5 mg given to Resident 1 and there was a total of four doses of Methadone 5 mg given to Resident 1 and the pain level was not documented prior to medication administration. During a telephone interview on 12/29/2023 at 12:13 p.m., with Licensed Vocational Nurse 2 (LVN 2), LVN 2 stated the licensed nurses must assess the residents' pain level, location and quality of the pain before administering pain medication and every shift, because there is a possibility that the residents' might just need assistance with non-pharmacologic (therapy and treatment not involving drugs or medication) interventions such as repositioning, incontinence care, bed bath/ shower and sensory interventions (therapy and treatment focused more on sensory approach) such as listening to music or watching their favorite program in television, quiet time and/or verbalization of their concerns with a family or staff member. During a telephone interview on 12/29/2023 at 12:34 p.m., with Registered Nurse Supervisor 1 (RNS 1), RNS 1 stated the licensed nurses must assess the residents' pain level prior to giving pain medication because aside from making sure the residents are pain free and comfortable, the residents must also be safe. During an interview on 12/29/2023 at 1:20 p.m., with the Registered Nurse Supervisor 2 (RNS 2), RNS 2 stated and confirmed that there was an order for Resident 1's pain to be assessed every shift; however, not transcribed in Resident 1's medication administration record (MAR). RNS 2 confirmed there was a total of 8 doses of Morphine Sulfate 7.5 mg given to Resident 1 and there was a total of 4 doses of Methadone 5mg given to Resident 1, and stated residents on hospice care, just like any residents in the facility, must also be assessed of their pain level before given pain medication. 055123 Page 2 of 3 055123 01/02/2024 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0697 Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure (P/P) titled Pain Management Protocol revised 10/2017, the P/P indicated the purpose of pain management is to assess the residents' pain and evaluate their response to pain management and interventions. The P/P indicated that at the identification of pain, the pain rating should always be included in the documentation (flow sheet) and should reflect every prn (as needed) pain medication administered. Residents Affected - Some 055123 Page 3 of 3