Health inspection·January 12, 2024

F 0641 Ensure each resident receives an accurate assessment. 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 ensure one of 16 sampled residents (Resident 25) received an accurate assessment, reflective of the resident's status at the time of the assessment, including hearing assessment. Resident 25 had hearing loss and used hearing aids, however, the Minimum Data Set (MDS, an assessment and care screening tool) did not code the use of hearing aids. Residents Affected - Few This failure contributed to facility's inability to develop and implement an individualized care plan related to Resident 25's use of hearing aids, which could negatively affect the resident's communication with staff and impact her quality of life. Findings: A review of the admission Record indicated Resident 25 was admitted to the facility in 2023 with multiple diagnoses which included generalized muscle weakness and pneumonia. A review of Resident 25's hearing assessment documented in the 'Initial admission Record' dated 11/15/23, indicated the resident had hearing aids. A review of Resident 25's physician order dated 11/15/23 indicated the following: Monitor hearing aid(s) to left and right ears, every shift .Apply .hearing aids; to left and right ears, apply in am & remove in pm every day shift. A review of Resident 25's MDS assessment dated [DATE] indicated the resident was able to express her ideas and wants without difficulties. According to the MDS assessment, Resident 25 did not use hearing aids or other appliances to help with hearing. A review of Resident 25's clinical record indicated there was no personalized care plan developed addressing the resident's hearing aids, monitoring if they worked properly and assisting the resident to place and remove them. During an interview on 1/10/24, at 2:20 p.m., Certified Nursing Assistant (CNA 1) stated Resident 25 was hard of hearing and used hearing aids every day to help with hearing. During an interview on 1/10/24 at 2:30 p.m., Licensed Nurse (LN 1) confirmed that Resident 25 had difficulties with hearing what was said and had used hearing aids in both ears. During a concurrent interview and record review on 1/11/24, at 1:30 p.m., the Social Services Director (SSD) stated he was responsible for the MDS assessment addressing the resident's hearing, Page 1 of 12 055242 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few speech, and vision. The SSD stated Resident 25 was hard of hearing and used hearing aids. Upon reviewing the MDS assessment dated [DATE], the SSD acknowledged that the assessment was not coded correctly and was not accurate. During a concurrent interview and record review on 1/12/24, at 10:40 a.m., the MDS Coordinator (MDSC) confirmed Resident 25's comprehensive MDS assessment dated [DATE] did not indicate the resident used hearing aids. The MDSC stated Resident 25 was not properly assessed during the MDS assessment because the hearing aids were not reflected on the MDS. The MDSC stated an inaccurate MDS coding of hearing aids had a potential to contribute to Resident 25 having hearing care assessment not being triggered for initiation of a comprehensive care plan and as a result the resident had no care plan addressing the use of hearing aids. The MDSC stated it was important to accurately assess the resident because it could affect the resident's communication. During an interview on 1/12/24, at 11:29 a.m., the Director of Nursing (DON) stated an accurate MDS assessment is necessary to help identify issues and promptly recommend services to correct the problem. The DON acknowledged that not having a care plan addressing resident's hearing aids could impact the resident's communication with staff as well as her quality of life. A review of the facility's policy and procedure titled, Resident Assessment. Accuracy of Assessment (MDS 3.0) dated 10/2020, indicated, It is the policy of this facility to ensure that the assessment accurately reflects the resident's status. A review of the facility's policy and procedure titled, Resident Assessment and Associated Processes, revised 12/2023, indicated that comprehensive and accurate assessments will be done for each resident and each resident's . functional and health status, and strengths and needs will be identified. The policy explained that comprehensive assessment included the completion of the MDS as well as the CAA (Care Area Assessment) process, followed by development .of the comprehensive care plan .The assessment information will be used to develop .the resident's comprehensive care plan. The policy indicated that each individual who completed the assessment will sign and certify the accuracy of the assessment. 055242 Page 2 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to observe professional standards of nursing practice for one of 16 sampled residents (Resident 25) when the use of hearing aids was not monitored as directed by the physician. Residents Affected - Few This failure had the potential to affect Resident 25's ability to communicate with staff and negatively impact the resident's quality of life. Findings: A review of the admission Record indicated Resident 25 was admitted to the facility in 2023 with multiple diagnoses which included generalized muscle weakness and pneumonia. A review of Resident 25's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 11/21/23 indicated the resident was able to express her ideas and wants without difficulties. A review of Resident 25's hearing assessment documented in 'Initial admission Record' dated 11/15/23, indicated that the resident had hearing aids. A review of Resident 25's physician order dated 11/15/23 indicated the following: Monitor hearing aid(s) to left and right ears, every shift .Apply .hearing aids; to left and right ears, apply in am & remove in pm every shift. During an observation and interview on 1/9/24, at 9:49 a.m., Resident 25 was sitting in wheelchair in her room. Resident 25 stated she could not hear well. The resident leaned forward, turned her head to the side and signaled that she was having difficulty hearing when asked questions. Resident 25 stated one of her hearing aids was broken and pointed to a small box in her nightstand drawer. The resident explained she accidentally dropped one of her hearing aids on the floor a week ago, and the tip fell off. The resident stated she has not been able to use her hearing aid since then. During an observation on 1/9/24, at 2:15 p.m., Resident 25 was sitting in wheelchair in her room and did not have her hearing aids on. During an observation and interview on 1/10/24, at 9:55 a.m., Resident 25 was in the wheelchair in her room and was not wearing hearing aids. Resident 25 pointed to her ears when the Department attempted to talk to her and stated she could not hear what was said. When Resident 25 was asked if the staff checked on her and asked her why she was not wearing the hearing aids, the resident stated, Nobody checked and nobody asked me why I don't have them on. Resident 25 stated it was difficult for her to communicate with staff without hearing aids. A review of the electronic Medication Administration Record (eMAR) indicated Licensed Nurse 1 (LN 1) had documented she monitored and placed Resident 25's left and right hearing aids in the morning on 1/9/24 and 1/10/24. The MAR indicated the nursing staff removed Resident 25's hearing aids in the evening of 1/9/24 and 1/10/24. During an observation and interview in Resident 25's room on 1/10/24, at 2:20 p.m., a Certified Nursing Assistant (CNA 1) stated Resident 25 was hard of hearing and used hearing aids every day to 055242 Page 3 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0658 Level of Harm - Minimal harm or potential for actual harm help with hearing. CNA 1 stated she checked on the resident every morning to make sure the resident had her hearing aids and if the resident needed help placing them, she would help her. CNA 1 stated the last time she checked on Resident 25's hearing aids was several days ago. The CNA asked the resident why she was not wearing her hearing aids and the resident replied she could not use them because one of them had been broken for a week. Residents Affected - Few During an interview and record review on 1/10/24, at 2:30 p.m., LN 1 stated Resident 25 had difficulties in hearing what was said and had hearing aids in both ears. LN 1 explained the nurses were to monitor and apply Resident 25's left and right hearing aids every morning and remove them in the evening per physician order. LN 1 stated she did not apply Resident 25's hearing aids this morning. LN 1 was asked if she applied Resident 25's hearing aids yesterday and she stated, No, [I] didn't, didn't check yesterday .Not aware they were broken. Upon reviewing Resident 25's MAR for 1/9/24 and 1/10/24, LN 1 verified that she documented she monitored and applied left and right hearing aids on both days. LN 1 acknowledged that the documentation was not accurate. A review of the undated facility's policy titled, Charting and Documentation, indicated, All services provided to the resident .or any changes in the resident's medical, physical, functional .condition, shall be documented in the resident's medical chart .Documentation in the medical record will be objective (not opiniated or speculative), complete, and accurate. During an interview and record review on 1/10/24, at 4:20 p.m., the Director of Nursing (DON) stated that being able to hear well was an important aspect of a resident's quality of life. Upon reviewing Resident 25's MAR for 1/9/24 and 1/10/24, the DON confirmed the nursing staff had documented they applied hearing aids in the morning and removed them in the evening on both days. The DON stated the documentation was not accurate. The DON stated she expected the nurses to check if the hearing aids were working and Resident 25 was wearing them before signing the MAR. A review of the 'Nursing Practice Act Rules and Regulations' issued by the Board of Registered Nursing, indicated, Article 2. Scope of Regulations 2725(b). The practice of nursing within the meaning of this chapter means those functions .that help people cope with difficulties in daily living that are associated with their actual or potential health or illness .and that require a substantial amount of .knowledge or technical skill, including .(2) Direct and indirect patient care services, including, but not limited to, the administration of .therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by .physician .as defined by Section 1316.5 of the Health and Safety Code. (State of California Department of Consumer Affairs). 055242 Page 4 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

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 ensure that two of 16 sampled residents (Resident 36 and Resident 462) who were dependent on staff for maintaining activities of daily living (ADLs, activities done every day such as eating, personal hygiene, bathing, dressing, and toileting), received the necessary services to maintain good nail care. Residents Affected - Few These failures had the potential to negatively impact Resident 36's psychosocial well-being and had the potential for Resident 36 and Resident 462 to acquire self-inflicted skin injuries due to long fingernails. Findings: 1. A review of the admission Record indicated the facility readmitted Resident 36 in 2023 with multiple diagnoses which included rheumatoid arthritis (an inflammatory and disabling disease of the joints) and fibromyalgia (a disorder that causes fatigue, pain, and tenderness throughout the body). A review of the Minimum Data Set (MDS, standardized assessment and care planning tool), dated 12/20/23, indicated Resident 36 was cognitively intact and did not have behaviors of rejection of ADL care. A review of Resident 36's ADLs care plan initiated on 3/19/23 indicated the resident had self-care performance deficit related to multiple diseases. The nursing measures indicated the resident was dependent on staff for bathing, personal hygiene, and toileting. One of the care plan interventions directed staff to check the resident's nail length, trim, and clean on bath days and as necessary. During an observation and interview on 1/9/24, at 10:26 a.m., Resident 36 was observed in bed, awake, and conversant. Resident 36's fingernails were observed about one centimeter (unit of measurement) long and had jagged edges. Resident 36 looked at her long fingernails and stated, look like claws. Resident 36 stated she would like her fingernails trimmed and had asked one of the staff to trim them about a week ago, but the staff never came back. A review of Resident 36's 'Nail Care' flowsheet dated 12/10/23 through 1/10/24 indicated the resident's nail care was not provided during the 30-days period. During an interview and concurrent observation with a Certified Nursing Assistant (CNA 1) in Resident 36's room on 1/10/24, at 8:55 a.m., CNA 1 acknowledged Resident 36's fingernails were long, sharp, and with jagged edges. CNA 1 stated Resident 36's fingernails needed to be cut because she could scratch herself and cause skin injury. CNA 1 stated the CNA's usually inspected the resident's fingernails when giving bed bath and trimmed the nails if needed. CNA 1 stated she had given a bed bath to Resident 36 earlier that day and missed to check on the resident's nails. During an interview and record review on 1/10/24, at 2:35 p.m., the Director of Staff Development (DSD) reviewed Resident 36's Nail Care flowsheet history and validated there was no documented evidence the resident's nail care was provided in the last 30 days. During a continued interview and record review on 1/10/24, at 3:42 p.m., the DSD stated beside the nail care done by CNAs, residents also received nail care as part of the activities program. Upon reviewing the 'Activities' progress notes from 12/1/23 through 1/10/24, the DSD acknowledged Resident 055242 Page 5 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 36's clinical records contained no documentation her fingernails were trimmed. The DSD stated there was no documented evidence the resident was offered and refused nail care from 12/1/23 through 1/10/24. During an interview on 1/10/24, at 4:20 p.m., the Director of Nursing (DON) stated that maintaining residents personal hygiene and grooming was everybody's responsibility. The DON stated it was her expectation the resident's nails were checked every time the resident had a shower or bed bath and fingernail care was done as needed. The DON added that nail care was a part of the daily activities of living provided by CNAs. During an interview and record review on 1/12/24, at 10:30 a.m., the DON stated that nail care was a part of daily activities of living provided by CNAs and activities staff. The DON provided a paper document dated 12/22/23 and timed at 11:30 (not identified a.m. or p.m.) where activities staff documented Resident 36 was offered nail care but she refused. A review of Resident 36's electronic progress notes by 'Activities' dated 12/22/23 at 4:29 p.m., contained no documented evidence the resident was offered nail care and she refused. 2. A review of the clinical record indicated Resident 462 had diagnoses including dementia (characterized by loss of memory and judgement that interferes with daily function) without behavioral disturbance. The Brief Interview for Mental Status (BIMS, a tool used for cognitive screening) dated 1/8/24 indicated Resident 462 was cognitively impaired with a score of 4. Further review of Resident 462's clinical record reflected a care plan dated 1/5/24 for ADL Self Care Performance Deficit related to a diagnosis of Dementia. The care plan interventions included to monitor/document any changes or reasons for self-care deficit. A concurrent observation and interview was conducted on 1/11/24, at 9:01 a.m. Resident 462 was lying in bed, her fingernails were long with blackish substance underneath her nails. Resident 462 stated whatever when she was asked if she preferred to have long fingernails. A follow up observation and interview was conducted on 1/11/24, at 4:16 p.m. inside Resident 462's room with CNA 2. The CNA stated Resident 462's fingernails were long and dirty and needed a little trim. Resident 462 stated, it would be nice when she was asked if she wanted CNA 2 to trim her fingernails. A review of Resident 462's 'Nail Care' flowsheet from 1/5/24 to 1/12/24 indicated resident had no nail care provided. A concurrent interview and record review was conducted with the DSD on 1/12/24, at 8:56 a.m. The DSD stated, the CNAs were allowed to trim the fingernails if a resident was not diabetic. The DSD further stated if a resident refused nail care from the CNA, the licensed nurse would document the resident's refusal in the progress notes. The DSD confirmed Resident 462 was not diabetic. The DSD further confirmed there was no documented evidence the CNA offered nail care to Resident 462 and there was no documented evidence Resident 462 refused for her fingernails to be trimmed. A review of the undated facility policy titled, Activities of Daily Living (ADLs), Supporting indicated, .Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with . hygiene .finger . nail care . If residents with cognitive 055242 Page 6 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0677 Level of Harm - Minimal harm or potential for actual harm impairment or dementia resist care, staff will attempt to identify the underlying cause of the problem and not just assume the resident is refusing or declining care. Approaching the resident in a different way or at a different time, or having another staff member speak with the resident may be appropriate. Residents Affected - Few 055242 Page 7 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to perform and document baseline and follow-up measurements of a PICC Line (peripherally inserted central catheter: a long, flexible tube inserted into one of the veins in the upper arm and used to deliver medication) external length and right upper arm circumference (distance around upper arm) for one of 16 sampled residents (Resident 54). Residents Affected - Some This failure had the potential to result in Resident 54 having unidentified complications of right arm swelling and, dislodgement, occlusion, and leakage of the PICC line when it was not monitored. Findings: During a review of Resident 54's admission records, the records indicated Resident 54 was admitted to the facility in 2023 with diagnoses including sepsis (body's overactive and extreme response to an infection), bacteremia (bacteria in the blood), and Methicillin Resistant Staphylococcus Aureus Infection (MRSA, a bacteria that causes infections in different parts of the body). During a review of Residents 54's clinical records, there was no documented evidence of the PICC line monitoring. There were no documented measurements of the external catheter and right upper arm circumference since admission. During a review of Resident 54's record titled, Hospital Discharge Summary, dated 12/8/23, the record indicated that on 12/7/23, the PICC line initial length measured two centimeters (cm, a unit of measurement), upper arm circumference of 29 cm, and total catheter length of 42 cm. During a record review of Resident 54's Minimum Data Set (MDS, an assessment tool), dated 12/14/23, the MDS indicated Resident 54 had IV access but did not specify it was a PICC line. During a review of Resident 54's physician's order dated 12/8/23, the order indicated, PICC line to RUA [Right Upper Arm] measurement: Measure and Document Length of Exposed PICC Line Lumen [opening]. During review of Resident 54's Treatment Administration Record (TAR) dated 12/8/23 to 1/12/24, the TAR indicated there was no documentation for the measurement of Resident 54's PICC line length and arm circumference. During a concurrent interview and record review on 1/11/24, at 2:10 p.m. with the Director of Nursing (DON), the DON stated PICC line dressing is changed once a week, but she has to double check on how often they measure the arm circumference and external catheter. The DON confirmed the measurements from the Resident 54's hospital discharge notes. During an interview on 1/11/24, at 2:15 p.m. with the Assistant Director of Nursing (ADON), the ADON stated dressing change was performed weekly along with the measurements. She added that both were documented on the patient MAR. During a concurrent observation and interview on 1/11/24, at 2:20 p.m., the ADON assessed and confirmed the PICC line measured 14.2 cm for the external catheter and 35 cm for the upper arm circumference. The ADON stated there was no documentation on PICC line measurement in the electronic health 055242 Page 8 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some record (EHR). The ADON stated, there are no orders to measure and there are no documentations by the license nurse (LN). During a review of the undated facility's policy and procedure (P&P) titled, Infusion Therapy Manual for Skilled Nursing Facility - 7. Central Access Guidelines and Procedures, the P&P indicated, Documentation 3. Any amount of the catheter out of the skin before the insertion site shall be verified with the insertion report and document on the treatment record. NOTE: If there are any amount of the catheter out of the skin prior to the insertion site, verify that exact amount with the insertion report at the time of the chest x-ray; if you cannot, notify the MD [Medical Doctor] and anticipate an order for a new chest x-ray [to verify proper PICC placement] 5. Arm circumference shall be monitored and documented on the treatment record. 055242 Page 9 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to ensure E-kits (emergency medications) were replaced in a timely manner when medications were removed for a census of 55. Residents Affected - Some This failure had the potential risk for residents not to receive medications in a timely manner and worsen their medical conditions. Findings: During a concurrent observation and interview on 1/9/24 at 1:18 a.m., with Director of Nursing (DON) at Nursing Station One Medication Closet One, an Oral E-kit was identified sealed with a red plastic tie, indicating it had been opened by nursing staff. Inside the oral E-kit were three E-kit logs (a document completed by nursing staff whenever a medication is removed from the emergency supply), with entries into the kit documented on 1/4/24 at 7:30 a.m., 1/5/24 at 8 a.m., and 1/5/24 at 7:30 p.m. DON stated once a medication was removed from the E-kit, nursing staff were expected to notify the pharmacy and have it replaced within 24 to 48 hours. During a concurrent observation and interview on 1/9/24 at 11:54 a.m., with DON at Nursing Station Two Medication Refrigerator, a Refrigerator E-kit was identified with a red plastic tie. Inside was one E-kit log, dated 1/5/24. DON confirmed the E-kit should have been replaced with a new one. During a concurrent observation and interview on 1/9/24 at 12:01 p.m., with DON at Nursing Station Two Medication Closet Two, an Intravenous (IV, into the vein) E-kit was identified sealed with a red plastic tie. Inside the IV E-kit was one log, with entry into the kit documented on 1/3/24. The DON confirmed the finding and stated she would have expected nursing staff to have replaced it. During a concurrent observation and interview on 1/9/24 at 12:14 p.m. with DON at Nursing Station One Medication Refrigerator, two Refrigerator E-kits with identical medications were identified. One E-kit was sealed with a red plastic tie, indicating it had been opened, and one was sealed with a green plastic tie indicating it was unopened. DON confirmed the finding and stated nursing staff were expected to exchange the opened E-kit with the sealed E-kit upon delivery from the pharmacy. During a review of the facility's policy and procedure (P&P) titled, Medication Ordering and Receiving from Pharmacy, updated September 2019, the P&P indicated, I. If exchanging kits, when the replacement kit arrives, the receiving nurse gives that kit to the pharmacy personnel for the return to pharmacy . J. If exchanging kits, opened kits are replaced with sealed kits within (72 hours) of opening. 055242 Page 10 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure dental services were provided for one of 16 sampled residents (Resident 3) in a timely manner, when there was no follow up regarding Resident 3's authorization for a set of dentures for over four (4) months. Residents Affected - Some This failure resulted in delay of dental services for Resident 3 and placed the resident at risk for oral pain related to inability to effectively chew foods and had the potential risk for unintended weight loss. Findings: A review of the admission Record indicated the facility admitted Resident 3 in 2022 with multiple diagnoses including depression and anxiety disorder (intense, excessive, and persistent worry and fear about everyday situation). A review of Resident 3's Minimum Data Set (MDS, a standardized assessment and screening tool) dated 10/10/23, indicated Resident 3 was cognitively intact. The MDS assessment indicated Resident 3 had no natural teeth or tooth fragments (edentulous). A review of Resident 3's physician order dated 10/4/22 indicated, May have dental consult with follow up treatment as needed. During a concurrent observation and interview on 1/9/24 at 10:12 a.m., Resident 3 was lying in bed, head of bed at 45 degree angle. The breakfast tray was noted on the bedside table in front of the resident and the food was barely eaten. Resident 3 stated, Eating slowly. Have trouble chewing my food. [My] gums hurt. The resident opened her mouth and showed that there were no teeth or dentures. Resident 3 stated, Have been waiting for dentures Dentist came and told I'll get my dentures .Nobody tells when and why do not have them yet. I've asked several people. A review of Resident 3's 'Patient is edentulous' care plan initiated 7/28/23 indicated the resident's goal was to be free from pain in the oral cavity. The nursing interventions indicated, Monitor/document/report to MD [Medical Doctor] as needed s/sx [signs and symptoms] of oral/dental problems needing attention: pain(gums .palate) . Coordinate arrangements for dental care, transportation as needed. A review of Resident 3's clinical records contained a dental evaluation dated 5/17/23. The document indicated, TAR [Treatment Evaluation Request] for new [dentures] set. A review of the quarterly Social Services Assessment/Evaluation, dated 10/5/23 did not address Resident 3's needs for dentures or follow up with dental office regarding dentures as 'Additional Assessed Needs.' A review of Resident 3's electronic clinical records including social services progress notes and paper chart, had no documented evidence the facility addressed resident's dentures and followed up regarding the authorization for dentures. During a concurrent interview and record review with Social Services Director (SSD) on 1/11/24, at 1:10 p.m., the SSD stated the social services department was responsible for arranging dental 055242 Page 11 of 12 055242 01/12/2024 Fairmont Rehabilitation Hospital 950 S. Fairmont Avenue Lodi, CA 95240

F 0790 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some services and outside consults. The SSD stated he was familiar with Resident 3 and was aware that the resident had been having difficulties with chewing and needed dentures. The SSD stated the resident was evaluated by the dentist on 5/17/23. The SSD stated after 5/17/23, he had followed up with the dental company via email once on 8/24/23 and was informed the next day that the authorization for dentures was not received yet. When the SSD was asked if there was any follow up regarding Resident 3's dentures with the dental office in the last 5 months, the SSD stated, No further requests were made. If resident had checked with me, I'd contact them again. The resident did not ask, and I did not contact dental office and no follow up. The SSD did not provide any answer when asked what the reasonable time would be to make a follow up with the dental office. During a concurrent interview and record review on 1/11/24, at 2:30 p.m., Resident 3's issues with dentures were discussed with Director of Nursing (DON). The DON reviewed the dental record dated 5/17/23 regarding pending authorization and acknowledged that there was no follow up addressing the resident's dentures. The DON stated, Valid complaint. Poor follow up regarding dentures .not acceptable practice. A review of the facility's 'Dental Services' policy revised 1/2022 indicated, It is a policy of this facility to ensure that if residents who require dental services .have access to such services without barrier. 055242 Page 12 of 12