Health inspection·June 19, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to establish and communicate which licensed nurse was responsible for providing care to one of three sampled residents (Resident 1) on the evening shift (3:00 p.m. to 11:00 p.m.) of 4/9/25. This failure resulted in Resident 1 not receiving scheduled medications in a timely manner, and had the potential to result in other care needs not being met. Residents Affected - Few Findings: Review of Resident 1's medical record indicated she was admitted on [DATE] and had diagnoses including, but not limited to dementia (a progressive state of decline in mental abilities), diabetes mellitus (DM, a disorder characterized by difficulty in blood sugar control and poor wound healing), hypertensive heart disease (a heart condition that develops from chronic high blood pressure), and heart failure (a condition in which the heart does not pump blood as well as it should). Review of Resident 1's medication administration record (MAR), dated 4/2025, indicated Resident 1 was scheduled to receive the following evening medications: 1.) Lactobacillus oral capsule (a supplement that contains beneficial bacteria) at 5:00 p.m.; 2.) Metformin (a medication used to treat DM) 500 milligrams (mg, unit of dose measurement) at 5:30 p.m.; 3.) Metoprolol (a medication used to treat high blood pressure and heart failure) 25 mg at 5:00 p.m.; and 4.) Insulin Lispro injection (medication used to treat DM) 100 units per milliliter (u/ml, unit of dose measurement) per sliding scale (amount to be administered depends on blood sugar reading) at 5:00 p.m. For lactobacillus, metformin, and metoprolol, the MAR did not specify what time the medications were given on 4/9/25. However, for the insulin lispro injection, the MAR indicated the medication was administered by licensed vocational nurse A (LVN A) at 6:59 p.m. (almost two hours after the scheduled administration time) on 4/9/25. The facility's monthly nursing assignment, dated 4/2025, was reviewed. The monthly nursing assignment indicated licensed vocational nurse B (LVN B) was scheduled to provide care to Resident 1's area of the facility on 4/9/25. During an interview with LVN A on 6/19/25 at 10:44 a.m., LVN A stated there was an evening shift during which there was confusion about the licensed nurse assignment for Resident 1. LVN A stated he was the nurse supervisor on this particular evening shift. LVN A explained that LVN B was usually scheduled to provide care to Resident 1's area of the facility on the evening shift, but it had been requested that LVN B not provide care to Resident 1. LVN A further explained that since LVN B could not provide care to Resident 1, licensed vocational nurse C (LVN C) was supposed to take on that responsibility. LVN A confirmed LVN C was not informed that she was supposed to provide care to Resident 1 on this particular evening shift. LVN A stated he or LVN B should have communicated this to LVN C. Page 1 of 2 055388 055388 06/19/2025 San Jose Healthcare & Wellness Center 75 N. 13th Street San Jose, CA 95112

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few LVN A confirmed that on this particular evening shift, he was the one who administered Resident 1's scheduled 5:00 - 5:30 p.m. medications at around 7:00 p.m. LVN A confirmed these medications were administered late, as they should have been administered within one hour before or after the scheduled times. The facility's undated document, titled LVN Staff Nurse Job Description, indicated the LVN was responsible for giving and receiving nursing reports upon beginning and ending of their assigned shift. It also indicated the LVN was responsible for reviewing and assisting in revision of nursing assignments. The facility's policy titled Medication - Administration, revised 1/1/2012, indicated, Medications may be administered one hour before or after the scheduled medication administration time. 055388 Page 2 of 2