Health inspection·June 26, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure that the facility use no more than two layers of linen when use a low air loss mattress (LAL - a specialty bed that alternates pressure to help heal and prevent pressure injuries [an injury that breaks down the skin and underlying tissue when an area of skin is placed under pressure]) for one of two sampled residents (Resident 1). Residents Affected - Few This deficient practice had the potential to impede wound healing process and cause further skin breakdown. Findings: A review of Resident 1's admission Record indicated the facility admitted the resident on 4/8/2024 and readmitted the resident on 5/20/2024 with diagnoses including type two (2) diabetes mellitus (DM - a chronic condition that affects the way the body processes blood glucose [sugar]) and pressure induced deep tissue damage (damage of underlying soft tissue from pressure and/or sheer) of left buttock. A review of Resident 1's Minimum Data Set (MDS- a standardized assessment and screening tool) dated 4/15/2024, indicated Resident 1's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was moderately impaired and required maximum assistance with mobilities such as rolling left to right in bed, sitting to lying, and lying to sitting on side of bed. A review of Resident 1's Order Summary Report, indicated an order for a LAL mattress for wound management, ordered on 5/21/2024. A review of Resident 1's Surgical Consult dated 6/25/2024, indicated that Resident 1 had a wound on the sacrococcyx (pertaining to both the sacrum [a large, triangular bone located at the bottom of the backbone] and coccyx [tail bone]) extending to left/right buttocks and to continue pressure reducing mattress. During a concurrent observation and interview on 6/26/2024 at 8:20 a.m., with Certified Nursing Assistant 1 (CNA 1) and CNA 2 in Resident 1's room, observed Resident 1 laying on a LAL mattress with multiple layers consisting of one fitted sheet, one disposable incontinence pad (provides a protective layer between individuals and the furniture they're on when dealing with episodes of incontinence [lack of voluntary control over urination or defecation]), and an adult incontinence brief. CNA 1 stated that no more than two layers should be used with a LAL mattress. CNA 1 stated there should only be one fitted sheet with either one disposable incontinence pad or an adult incontinence brief. CNA Page 1 of 4 055146 055146 06/26/2024 North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

F 0686 1 and CNA 2 removed the disposable incontinence pad. Level of Harm - Minimal harm or potential for actual harm During an interview on 6/26/2024 at 8:24 a.m., with Treatment Nurse 1 (TN 1), TN 1 stated that the facility gave instructions to not use more than two layers of linen with a LAL mattress. TN 1 stated staff should use either a disposable incontinence pad or an adult incontinence brief with one fitted bed sheet only, otherwise there was no use for the LAL mattress to promote wound healing. Residents Affected - Few During a concurrent interview and record review on 6/26/2024 at 9:55 a.m., with Registered Nurse 1 (RN 1), reviewed Resident 1's physician's orders for the LAL mattress for wound management dated 5/21/2024 and the wound treatment orders for sacrococcyx dated 6/18/2024. RN 1 stated that Resident 1 had pressure injuries on buttocks and staff should not use more than two layers of linen between the resident's skin and the LAL mattress to promote wound healing. RN 1 stated if more than two layers of linen are used, it would defeat the purpose of using the LAL mattress that is specially designed for wound healing. During a concurrent interview and record review on 6/26/2024 at 10:25 a.m., with the Director of Nursing (DON), reviewed the facility's policy and procedure (P&P) titled, Use of Support Surfaces, last reviewed on 1/10/2024. The DON stated that the meaning of, Limit the amount of linen and pads placed on the bed, was not to place more than two layers of linen with the LAL mattress use, otherwise it would defeat the purpose of the LAL mattress use. The DON further stated that the LAL mattress was specially designed to promote wound healing or to prevent pressure injuries, so that staff should use only one layer of either an incontinence pad or an adult incontinence brief with one fitted bed sheet. A review of the facility's P&P titled, Use of Support Surfaces, last reviewed on 1/10/2024, indicated, Support surface refers to a specialized mattress, mattress overlay, or chair cushion designed to manage pressure Support surfaces will be utilized in accordance with manufacturer recommendations Limit the amount of linen and pads placed on the bed. 055146 Page 2 of 4 055146 06/26/2024 North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

F 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure one of five sampled residents (Resident 1), who's toenails were long, thick, and curved, received foot care and treatment. Residents Affected - Few This deficient practice had the potential to result in complications such as an infection or injury to the resident and had the potential to result in a negative impact on the resident's self- esteem. Findings: A review of Resident 1's admission Record indicated the facility admitted the resident on 4/8/2024 and readmitted the resident on 5/20/2024 with diagnoses including type two (2) diabetes mellitus (DM - a chronic condition that affects the way the body processes blood glucose [sugar]) and pressure induced deep tissue damage (damage of underlying soft tissue from pressure and/or sheer) of left buttock. A review of Resident 1's Minimum Data Set (MDS- a standardized assessment and screening tool) dated 4/15/2024, indicated Resident 1's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was moderately impaired and required maximum assistance with mobilities such as rolling left to right in bed, sitting to lying, and lying to sitting on side of bed. A review of Resident 1's Order Summary Report, indicated an order that Resident 1 may see podiatrist, ordered on 5/20/2024. During a concurrent observation and interview on 6/26/2024 at 8:13 a.m., with Resident 1, observed that Resident 1's great toenails on both feet were long and curved with pink color nail polish on them. Observed other toenails were jagged and long, and underneath the middle toenail of Resident 1's left foot was a blackish color. Resident 1 stated she wanted to know when the facility was going to trim Resident 1's toenails. During a concurrent observation and interview on 6/26/2024 at 8:13 a.m., with Certified Nursing Assistant 1 (CNA 1) and CNA 2 in Resident 1's room, observed Resident 1's toenails. CNA 2 stated that Resident 1's toenails were long, thick, and curved, and needed to be trimmed. During a concurrent interview and record review on 6/26/2024 at 9:48 a.m., with Registered Nurse 1 (RN 1), reviewed Resident 1's physician's orders dated 5/20/2024 which indicated may see podiatrist,. RN 1 was unable to locate the podiatrist consult notes from 4/8/2024 to 6/26/2024. RN 1 further stated that the facility originally admitted Resident 1 on 4/8/2024, and if Resident 1 missed the podiatrist visits due to hospitalizations, then the facility needed to refer to social services personnel to arrange a podiatrist special visit depending on the resident's foot condition. During an interview on 6/26/2024 at 10:22 a.m., with the Director of Nursing (DON), the DON stated that Resident 1 missed the podiatrist's regular visits since the initial admission, 4/8/2024. The DON stated that Resident 1's long and curved toenails needed to be trimmed by a podiatrist, The DON stated since Resident 1 had a diagnosis of DM, the facility was going to arrange for a special visit with the podiatrist to provide Resident 1's foot care. 055146 Page 3 of 4 055146 06/26/2024 North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

F 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the facility's policy and procedure (P&P) titled, Nail Care, last reviewed on 1/10/2024, indicated, Identify conditions that increase the risk of for foot or nail problems, such as diabetes . If trimming is allowed, clip nails using nail clippers straight across and even with the tops of the fingers/toes. A review of the facility's P&P titled, Nursing Care of the Resident with Diabetes Mellitus, last reviewed on 1/10/2024, indicated, Skin and Foot Care Toenails should only be trimmed by personnel qualified to do so (this can be a regular staff and does not have to be a podiatrist), according to facility policy. 055146 Page 4 of 4