Health inspection·May 22, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure medication was not left at the bedside and that medication was administered under the supervision of a licensed nurse for one of five sampled residents (Resident 2). This deficient practice had the potential to cause medication error and harm to Resident 2. Findings During a review of Resident 2's Face Sheet (admission Record), the Face Sheet indicated Resident 2 was admitted to the facility on [DATE] with diagnoses including diabetes (a group of diseases that result in too much sugar in the blood), dysphagia (difficulty swallowing foods or liquids), and muscle weakness (lack of muscle strength). During a review of Resident 2's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated 4/11/2023, the MDS indicated Resident 2 was able to understand and be understood by others. The MDS indicated Resident 2 required supervision while eating, limited assistance (resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance) for personal hygiene, was totally dependent on staff for transferring, and required extensive assistance (resident involved in activity, staff provide weight-bearing support for other aspects of activities of daily living (ADLs) such as dressing, bed mobility, and toilet use. During a concurrent observation and interview on 5/22/2023 at 5:12 p.m. with Resident 2, in Resident 2's room, three medications in a medicine cup was observed on Resident 2's bedside table and Resident 2 took the medications without a licensed nurse supervision. Resident 2 stated she was not sure what the medications were and that nurses would sometimes leave her medication at the bedside table for her to take on her own. During a review of Resident 2's Medication Administration Record (MAR), dated 5/23/2023, the MAR indicated Resident received Gabapentin 400 mg capsule, Oyster Calcium 500 mg tablet, and Metamucil 400 mg capsule during the 5 p.m. medication pass. During an interview with Licensed Vocational Nurse (LVN 1) on 5/22/2023 at 5:22 p.m., LVN 1 stated she gave medication to Resident 2 and that the resident was able to take the medication herself. During an interview and concurrent record review with LVN 2 on 5/22/2023 at 6 p.m., Resident 2's physician orders were reviewed. LVN 2 stated Resident 2 did not have an order to self-administer Page 1 of 2 055170 055170 05/22/2023 Pico Rivera Healthcare Center 9140 Verner Street Pico Rivera, CA 90660

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medications. LVN 2 also stated if a nurse left the resident's room before the resident took the medication, the resident might not take the medication or take the medication too late which could cause harm to the resident. During a review of the facility's Policy and Procedure (P&P) titled, Policy & Procedure: Med Pass, undated, the P&P indicated to prepare, administer, and chart the medication correctly. The P&P also indicated medications should not be left at the bedside for residents unless ordered by the MD and always observe resident taking medication, even when the medication may be administered independently. 055170 Page 2 of 2