Health inspection·September 19, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to treat a resident in a dignified manner with respect and value for one of three sampled residents (Resident 2) when a staff entered Resident 2 ' s room and removed her oxygen tubing (a plastic tube that carries oxygen from a tank or machine to a person, connecting to a nasal cannula [a tube that goes in the nose] or mask) without requesting permission from Resident 2 on August 19, 2024. This failure compromised Resident 2 ' s dignity, violated her right to respect, and affected her well-being and ability to make choices, which had the potential to cause psychosocial harm (mental distress and suffering) and lead to feelings of upset. Findings: A review of Resident 2's admission Record (a document containing clinical and demographic data), indicated Resident 2 was admitted to the facility on [DATE], with a diagnosis which included heart failure (a condition in which the heart is unable to pump blood effectively to meet the body's needs), Type 2 diabetes mellitus (a condition that affects how your body uses sugar (glucose), which is an important source of energy) and hypertension (blood pressure that is higher than normal) A review of Resident 2 ' s History and Physical Examination dated June 24, 2024, indicated .capacity: this resident [Resident 2] has the capacity to understand and make decisions. A review of Resident 2 ' s Comprehensive Minimum Data Set (MDS) dated [DATE], indicated Resident 2 was cognitively intact and required maximal assistance - helper does more than half the effort for most activity of daily living. A review of Resident 2 ' s physician order dated June 26, 2024, indicated . continuous oxygen at 2L/min [liters/minute, a measurement of oxygen flow] via nasal canula/mask . A review of State of California Form 341 [Suspected Dependent Adult/Elder Abuse form], dated May 1, 2024, indicated, . It was reported to facility administrator on 8/20/24 [August 20, 2024] at 1:00pm that resident [Resident 2] .[ License Vocational Nurse 1 (LVN 1)] turned off her concentrator and pulled her nasal canula on 8/19/24 [August 19, 2024] . A review of Resident 2 ' s Social Service notes date August 20, 2024, indicated, . Resident [Resident 2] alleges LVN [LVN1] took off her nasal canula . Patient [Resident 2] reports . just confused and unsure why the event took place She was referred to psychology . Page 1 of 2 055374 055374 09/19/2024 Upland Rehabilitation and Care Center 1221 E Arrow Hwy Upland, CA 91786

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of Resident 2 ' s IDT (Interdisciplinary Team is a team of professional disciplines, as appropriate, will work together to provide the greatest benefit for the resident) notes dated August 20, 2024, indicated . On August 2024 . [Resident 2 ' s daughter] reported [Resident 2] complained one of the nurse turning off her oxygen concentrator [ oxygen machines used as stationary sources to provide long-term oxygen therapy to patients] and pulling on her nasal, nurse than proceeded to walk out the room and did not return. [Resident 2] stated nurse did not explained why the concentrator turned off and her NC [nasal canula] pulled away . During an interview on August 27, 2024, at 3:30 PM with LVN 1, LVN 1 stated that she does not remember if she announced herself before entering Resident 2's room and unsure if Resident 2 was aware of her presence for the routine round. Furthermore, LVN 1 stated that while she was tidying up the area around bed #1, she decided not to announce herself to beds 2 and 3 because she didn ' t want to be stuck longer in the room. She acknowledged that she should have announced herself to respect the residents' rights and personal space, but she did not. During a follow-up interview on August 27, 2024, at 3:40 PM with LVN 1, LVN 1 admitted that she assumed the oxygen concentrator belonged to the resident at bed #1. She pulled the oxygen tubing, which she stored in a bag tied to the concentrator, and then left the room. LVN 1 further stated that she should have checked to whom the oxygen tubing belonged before removing it, but she did not. During concurrent observation and interview on August 27, 2024, at 3:55 PM, with Resident 2, Resident 2 was lying in bed, with a call light next to her. Resident 2 stated that she was aware a staff was in the room doing routine rounds and checking on the residents, and that CNA 1 had left to assist the resident in bed #1 with a shower. Resident 2 further stated she was confused when her oxygen tubing was suddenly pulled from behind her curtain, immediately after that, she saw LVN 1 leaving the room just as CNA 1 returned with the resident from bed #1. Resident 2 then asked CNA 1 to put her oxygen tubing back on her and further stated that she was very upset that day and had told her daughter about it. During a phone interview and concurrent record review with the Director of Nursing (DON), September 18, 2024, at 4:55 PM, the DON reviewed the facility's policy and procedure titled, Resident Rights revised October 4, 2016, indicated As a resident of this nursing facility, you have the right to a dignified existence, self-determination, . Planning and Implementing Care. You have the right to be informed of, and participate in, your treatment, including the right to: be fully informed, . Respect and Dignity. You have the right to be treated with respect and dignity, . The DON stated the policy and procedure was not followed. 055374 Page 2 of 2