Health inspection·December 30, 2021

F 0655 Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Findings: Residents Affected - Some Resident 75 was admitted on [DATE], with diagnoses including urinary tract infection, fracture (break in a bone) of the neck, and congestive heart failure (CHF, when the heart muscle does not pump as strong as it should). During a review of the clinical record on 12/30/21, indicated there was no evidence of documentation a BCP was completed for Resident 75. Resident 14 was admitted on [DATE], with diagnoses including fracture of the right femur (thigh bone), osteoporosis (fragile bones), and CHF. During a review of the clinical record on 12/30/21, indicated there was no evidence of documentation a BCP was completed for Resident 14. Resident 13 was admitted on [DATE], with diagnoses including fracture of the femur (thigh bone), dysphagia (difficulty of swallowing), and hypertension (abnormally high blood pressure). During a review of the clinical record on 12/30/21, indicated there was no evidence of documentation a BCP was completed for Resident 13. Resident 6 was admitted on [DATE], with diagnoses including compression fracture of the vertebra (back bone, spine), osteoporosis, and parkinson's disease ( damage in the brain that affects movement, often including tremors). During a review of the clinical record on 12/30/21, indicated there was no evidence of documentation a BCP was completed for Resident 6. During an interview on 12/20/21, at 3 PM, Director of Nursing stated, Each department fill out their sections in the baseline care plan form, and the Assessment Nurse (MDS) scans it to the residents medical record. During a review of the facility document titled Care Planning/Interdisciplinary Team Care Planning Conference dated 6/17, indicated .7. Interdisciplinary Team (IDT) meetings may take place face-to-face in a conference room or in the resident's room. May involve teleconference or written communications with family and Physicians. Residnet and/or resident representative will be encouraged to review and sign care plans . Page 1 of 12 055466 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0655 Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to provide residents with the written summary of the Baseline Care Plan (BCP, Baseline Care Plan is developed and implemented for each resident that includes the instructions needed to provide effective and person centered care of the resident that meet professional standard of quality care and must be developed within 48 hours of a resident's admission) for seven (7) residents out of 12 sampled residents, Residents 4, 16, 18, 6, 13, 14, 75. Residents Affected - Some Failure to provide written summary of the BCP to the residents had the potential to compromise person-centered care to each resident, and to safeguard against adverse events that are most likely to occur right after admission. Findings: 1. Review of Resident 4 record on 12/29/21 at 11: 00 AM, indicated he was admitted on [DATE] with diagnosis of orthostatic syncope, secondary diagnosis of chronic upper gastrointestinal bleed. A review of BCP Summary dated 12/20/21, did not indicate acknowledgment of patient or family representative. 2. Review of the Resident 16 record indicated he was admitted on [DATE] with diagnosis of aspiration pneumonia. A review of BCP Summary dated 02/02/2021, did not indicate acknowledgement of patient or family representative. 3. During a review of Resident18 record on 12/29/21 at 9:00 AM, indicated she was admitted on [DATE] with diagnosis of mechanical fall ( an external mechanical force or object caused to fall) unoperable left humerus (the arm bone between the shoulder and elbow) fracture, and cancer of the pancreas. A review of BCP Summary dated 11/15/21 did not indicate acknowledgment of patient or family representative. During an interview on 12/29/21 at 9:00 AM Resident 18, stated . I cannot recall seeing a paper about my care. During an interview on 12/30/2021 at 11:30 AM with ADM and DON stated . we do not do that. During an interview on 12/29/21 at 11:00 with MDSC, stated . practice of letting resident and or responsible party sign and acknowledge the BCP started only last week. Review of the facility Policy and Procedure (P&P) titled Care Planning/Interdisci Team Care Planning Conference dated 4/02 indicated Procedure, 5. Every effort will be made to schedule care plan meetings at the best time of the day for the resident and family. If resident and/or resident representative is not willing to participate in care planning process the facility will document why in EHR. 7. IDT (Interdisciplinary Team) meetings may take place face-to-face in a conference room or in the resident's room. May involve teleconference or written communications with family and Physicians. Resident and or resident representative will be encouraged to review and sign care plans. 055466 Page 2 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

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 provide care and treatment according to standards of clinical practice for two of 12 sampled residents (Resident 4 and Resident 21) when: Residents Affected - Some 1. The Omeprazole (a medication used to treat frequent heartburn and stomach ulcers) was not administered according to current physician's order for Resident 4. This failure resulted in a medication error. 2. The facility's procedure on management of indwelling catheter and closed drainage system was not implemented for Resident 21. This failure had the potential to cause cross contamination of infection that may jeopardize the health and safety of Resident 21. Findings: 1. During a medication pass observation with Licensed Vocational Nurse (LVN) 3, on 12/29/21, at 4:14 PM, LVN 3 was preparing medications to administer to Resident 4. LVN 3 took one capsule from a medication blister pack with a label indicating, .Omeprazole 20 mg (milligrams) . take 1 cap (capsule) by mouth every day before breakfast as needed for GERD (gastroesophageal reflux disease - also known as acid reflux) . and returned the blister pack in the second drawer of the medication cart. During a concurrent interview and record with LVN 3 on 12/29/21 at 4:16 PM, the electronic Medication Administration Record and Physician's Orders for 12/29/21 indicated, . order date 12/20/21 . start date 12/20/21 . Omeprazole 20 mg capsule, delayed release [generic] - 2 caps (40 mg) by mouth twice daily for GERD. LVN 3 stated, oh, she's supposed to take 2 capsules before breakfast and before dinner . the electronic medication administration record (EMAR) is the bible of medication administration that we follow . LVN 3 acknowledged she forgot to verify the medication label with the EMAR and physician orders. During an interview with the Director of Nursing (DON) on 12/30/21, at 11:48 AM, the DON stated the nurse should always verify the medication label with the physician's order and MAR for current and accurate orders. Review of the facility's policy and procedure titled, Medication Administration General Guidelines, dated 05/16, indicated, .Medication Preparation: . 3. Prior to administration, review and confirm medication orders for each individual resident on the Medication Administration Record. Compare the medication and dosage schedule on the resident's MAR with the medication label. If the label and MAR are different, and the container is not flagged indicating a change in directions, the prescriber's orders are checked for the correct dosage schedule. Apply a direction change sticker to label if directions have changed from the current label . Medication Administration: 1. Medications are administered in accordance with written orders of the prescriber . 2. During an observation on 12/28/21, at 3:25 PM, in resident's room, Resident 21 was lying in bed in a lowest position. An uncovered transparent urinary drainage bag (collecting bag) dated 12/22 was attached on the right side of the foot of the bed while the bottom part of the bag with the drain valve was touching the floor. The collecting tube attached to the urinary drainage bag was kinked resulting in urine collected in the tubing. During a concurrent interview, Certified Nursing Assistant (CNA) 1 acknowledged the findings and stated the bag should have a protective cover and should not 055466 Page 3 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0658 touch the floor and that the tubing should not be twisted. Level of Harm - Minimal harm or potential for actual harm During an interview with the DON on 12/30/21, at 2:10 PM, the DON stated the facility does not have a policy specific for care and management of residents with indwelling catheters (a soft hollow tube inserted in the bladder to drain urine into a bag outside the body). The DON stated, we use Lippincott Nursing Manual as our policy. Residents Affected - Some Review of the Lippincott Nursing Manual procedure guidelines for Management of the Patient with an Indwelling (Self-Retaining) Catheter and Closed Drainage System, [2012] 10th ed., indicated, .Maintaining a closed drainage system . 2. Maintain unobstructed urine flow. a. Keep the drainage bag in a dependent position, below the level of the bladder. b. Urine should not be allowed to collect in the tubing because a free flow of urine must be maintained to prevent infection. - (rationale: b. Improper drainage occurs when the tubing is kinked or twisted, allowing pools of drainage to collect int eh loops of tubing.) c. Keep the bag off the floor. - (rationale: c. Prevents bacterial contamination) . 3. Empty the bag at regular intervals, making sure that the drainage valve/spout is not contaminated . c. Avoid letting the drainage bag touch the floor. d. Change the drainage bag if contamination occurs . According to the Centers for Disease Control and Prevention (CDC) Guideline for Prevention of Catheter Associated Urinary Tract Infections (2009), retrieved from https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html, dated February 2017, indicated, .III. Proper Techniques for Urinary Catheter Maintenance . III.B. Maintain unobstructed urine flow. III.B.1. Keep the catheter and collecting tube free from kinking. III.B.2. Keep the collecting bag below the level of the bladder at all times. Do not rest the bag on the floor. 055466 Page 4 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0692 Provide enough food/fluids to maintain a resident's health. 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 effectively assess or develop therapeutic interventions to one of one sampled resident (Resident 14). Residents Affected - Few The failure resulted in Resident 14 experiencing severe weight loss. Findings: Weight loss in nursing home residents is linked to poor outcomes, including higher rates of hospitalization and death (American Journal of Nursing, 2008). Suggested parameters for evaluating significance of unplanned and undesired weight loss are: Interval: 1 month: significant loss is 5%, severe weight loss if greater than 5%. Interval 3 months: significant weight loss is 7.5%, severe loss if greater than 7.5%. Interval 6 months, significant weight loss 10%, severe weight loss if greater than 10%. (Centers for Medicaid/Medicare, CMS, Appendix PP 2017). Resident 14 was admitted on [DATE], with diagnoses including congestive heart failure (CHF, when the heart muscles do not pump as strong as it should). admission weight was documented on 11/4/21, as 137.2 lbs. admission diet order dated 11/3/21, indicated, .Pre cut meat for diet, no milk . During observation on 12/28/21, at 12:35 PM, Resident 14 was eating the facility served lunch that consist of a french dip sandwich, potato [NAME] soup, steamed green beans, cream puff and sweet potato fries. Resident 14 took a spoonful of the [NAME] soup, and took few of the steamed green beans. During an interview on 12/28/21, at 1 PM, Resident 14 stated, I told them I don't like greasy and fatty food. This is greasy and fatty. I have lost over 10 lbs. Resident 14 stated she will continue to eat her lunch, and does not want anything from the alternative menu. During an interview on 12/28/21, at 1:05 PM, Licensed Vocational Nurse (LVN) 1 stated, Her (Resident 14) appetite vary. During a review of facility document titled Vital Stats for period 11/3/21 thru 12/30/21 for Resident 14 indicated: 11/25/21 weight 139 pounds, 12/2/21 weight 132.2 pounds. Resident 14 lost 4.8 lbs (3.45%) in one week. 12/9/21 weight 127.2 pounds. Resident 14 lost 5.4 lbs (5.22%) in one week. 12/16/21 weight 125.8 pounds, 12/23/21 weight 120.6 pounds. Resident 14 lost 5.2 lbs (4.13%) in one week. 12/28/21 weight 114.8 pounds, an additional weight loss of 5.8 pounds. Resident 14 had a total weight loss of 22.4 lbs (16.33%) since admission (11/3 - 12/28/21). 055466 Page 5 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of the Resident 14's clinical records the nursing progress notes indicated the following: 12/2/21, there was no mention of current weight loss, 12/9/21, there was no mention of current weight loss and 12/23/21, there was no mention of current weight loss. During a review of Resident 14's clinical order dated 11/20/21, the physician order indicated, Regular diet with pre-cut meats, no milk, thin liquids. A review of physician progress notes dated 12/6/21 and 12/15/21, has no mention of Resident 14's weight loss. During a review of Resident 14's meal intakes from 12/1 - 12/28/21, indicated breakfast 20% - 80%, lunch 20% -70% and dinner 30% - 85%,100% X 7. During an interview on 12/30/21, 10 AM, LVN 3 stated, Weights are taken weekly, and as per doctors order. The Restorative Nurse Assistant (RNA, ) or the Certified Nurse Assistant (CNA, caregiver) take the residents weight, the licensed nurses are notified if there is a weight loss,and the physician (medical doctor) is notified. The Registered Dietitian (RD, a professional nutritionist, creates nutrition plans to improve the health and physical conditions of residents). RD follow up on residents weight loss, makes recommendations, like supplements and snacks. Residents are monitored. These are all documented in the nurses notes and the RD notes. During an interview on 12/20/21, at 10:55 AM, the RD stated, For assessments, I do the initial assessment on their admission, the quarterly assessment, and as needed for weight changes. Reviewed with RD Resident 14's weight record. RD acknowledged there was no evidence of completed assessments when Resident 14 was experiencing weight losses on 11/25 to 12/2/21, 12/3 to 12/9/21, and on 12/16 to 12/23/21. RD stated, I was not able to document. During an interview on 12/30/21, at 11:05 AM, the Director of Nursing (DON) stated, Assessment is done to newly admitted resident, diet is reviewed, they are assisted to fill out menus, and weights are monitored. The DON acknowledged Resident 14's weight loss and stated, The RD completes assessment and follows up. 055466 Page 6 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure medications were stored and labeled according to federal regulations and facility policy and procedure when: 1. There was no direction change refer to chart label on the Omeprazole (a medication used to treat frequent heartburn and stomach ulcers) medication blister pack (a card that packages doses of medication within small, clear, or light-resistant amber-colored plastic bubbles) for Resident 4. 2. Suppository medications for two discharged residents were not removed from the active medication storage cabinet. These deficient practices had the potential to cause harm to residents through infection and medication errors. Findings: 1. During a medication pass observation with Licensed Vocational Nurse (LVN) 3, on [DATE], at 4:14 PM, LVN 3 was preparing medications to administer to Resident 4. LVN 3 took one capsule from a medication blister pack with a label indicating, .Omeprazole 20 mg (milligrams) . take 1 cap (capsule) by mouth every day before breakfast as needed for GERD (gastroesophageal reflux disease - also known as acid reflux) . LVN 3 read the label and stated, oh, she's supposed to take two capsules before breakfast and before dinner . the E-MAR (electronic medication administration record) is the bible of medication administration that we follow . During a concurrent interview, LVN 3 acknowledged the medication label was incorrect and stated there should be a sticker label indicating, directions changed refer to chart attached to the medication label. Review of Resident 4's clinical record, the electronic Medication Administration Record and Physician's Orders for [DATE] indicated, . order date [DATE] . start date [DATE] . Omeprazole 20 mg capsule, delayed release [generic] - 2 caps (40 mg) by mouth twice daily for GERD. During an interview with the Director of Nursing (DON) on [DATE], at 11:48 AM, the DON stated the nurse should verify the medication label against the physician's order and notify the pharmacy for any change in dosage and/or frequency. The DON added, a sticker label should be attached to the medication label to alert the nurses of the changes. Review of the facility's policy titled, Medications and Medication Labels, dated 12/12, indicated, .Medications are labeled in accordance with currently accepted professional principles including appropriate auxiliary and cautionary instructions to promote safe medication use following state and federal laws. Procedures . 3. Improperly or inaccurately labeled medications are refused and returned to the dispensing pharmacy . 6. a. If the prescriber's directions for use change or the label is inaccurate, the nurse may place a direction change, change of order-check chart or similar label on the container indicating there is a change in directions for use, taking care not to cover important label information. b. when such a direction change label appears o the container, the medication nurse checks the resident's medication administration record (MAR) or the prescriber's order for current information . 055466 Page 7 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility's policy and procedure titled, Medication Administration General Guidelines, dated 05/16, indicated, .Medication Preparation: . 3. Prior to administration, review and confirm medication orders for each individual resident on the Medication Administration Record. Compare the medication and dosage schedule on the resident's MAR with the medication label. If the label and MAR are different, and the container is not flagged indicating a change in directions, the prescriber's orders are checked for the correct dosage schedule. Apply a direction change sticker to label if directions have changed from the current label . 2. During a medication storage inspection on [DATE], at 12:56 PM, the following suppositories for two expired residents were stored in the active medication storage cabinet: a. Two clear plastic bag, each containing six Acetaminophen (medication used to treat mild to moderate pain and to reduce fever) suppository (a dosage form used to deliver medications by insertion into a body orifice) 650 mg (milligrams) for Resident 2. b. One box containing twelve Bisacodyl (used on a short-term basis to treat constipation and also to empty the bowels before surgery and certain medical procedures) suppository 10 mg. The prescription number and resident's name on the medication label was marked with a black colored marker but remains visible and readable. LVN 1 read the medication label and verified it belongs to a resident who already expired. During a concurrent interview, LVN 1 acknowledged the findings and stated the Acetaminophen and Bisacodyl suppository belongs to the two residents who already expired. LVN 1 stated it should not be stored in the active medication storage cabinet and should have been discarded right after the resident expired. During an interview with the Director of Nursing (DON) on [DATE], at 11:48 AM, the DON stated unused, expired, and discontinued medications including discharged residents are disposed in a medical waste container in the medication room and should not be kept in the active medication storage cabinet. The DON stated there is a separate area to store medications for disposal or destruction in the medication storage room. Review of the facility's policy titled, Disposal of Medications, dated 12/12, indicated, Policy 1. Discontinued medications and/or medications left in the nursing care center after a resident's discharge, which do not qualify for return to the pharmacy, are identified and removed from current medication supply in a timely manner for disposition . 3. Methods of disposition are consistent with applicable state and federal requirements, local ordinances, and standards of practice . Review of the facility's policy titled, Storage of Medications, dated 09/10, indicated, . Procedures . 14. Outdated, contaminated, discontinued or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according to procedures for medication disposal (Refer to Section 5.4 Disposal of Medications) . 055466 Page 8 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to ensure the garbage are contained and a dumpster are covered. Residents Affected - Some This facility's failure has the potential to attract pest to the area. Findings: During an observation and concurrent interview on 12/29/21, at 2:36 PM, the Environmental Manager acknowledged two garbage containers, and one dumspter were uncovered. There was a plastic bag of garbage lying on the ground. by one of the open garbage container. Environmental Manager stated that he has to remind the housekeepers. During an interview on 12/29/21, the Director of Nursing stated, We do not have a policy for garbage disposal or pest control. During an interview on 12/20/21, at 3:45 PM, the Administrator stated, We do not have a policy for garbage disposal. We have look at the maintenance , the environmental and the infection control. We cannot find a policy for garbage. 055466 Page 9 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm 3. Resident 13 was admitted with diagnoses including osteoporosis (fragile bones). Minimum Data Set (MDS, a standardized tool) dated 11/7/21 Brief Interview of Mental Status (BIMS, a brief memory test to help determine cognitive function) score of 13 indicates little to no cognitive impairment. Under functional status Resident 13 requires staff assistance in performance of activity of daily living including toileting and personal hygiene. Residents Affected - Some During observation on 12/28/21, at 11:10 AM, a suction equipment was on an overbed table. The canister and tubing was unlabeled, undated. On concurrent interview, Resident 13 stated, That is my external catheter. A nurse can help you more about it. During an interview on 12/28/21, at 12:32 PM, LVN 2 acknowledged the canister and the tubing were unlabeled, undated, and uncovered. LVN 2 stated, We change the canister and tubing weekly, it has to be dated or else we won't know when to change them. It can cause an infection. During an interview on 12/29/21, at 3:35 PM, LVN 4 stated, The purewick is like a sanitary pad applied in the perineal area to catch the urine. It is connected to the collecting tubing, and the urine was suctioned to the canister. For the aftercare, we bring the canister to the bathroom and dump the urine in the toilet. We rinse the canister just like a bedpan, and set it up again. We do not rinse the urine drainage tubing. The canister and the tubing are change weekly. During a review of the untitled facility document dated 3/3/21, indicated The purewick collection system is for management of urinary incontinence. The external urinary collection device is utilized as an alternative to an indwelling catheter. The term external urinary collection devices by suction or pressure it is connected to a urinary drainage container such as a bag or a bottle . Set up .b. Use standard suction tubing, connect the purewick to external catheter to the collection canister. Peri-care and placement: a . Separate legs, gluteus muscles and labia. b. With soft gauze align distal end of the purewick . During an interview on 12/29/21, at 2 PM, the untitled facility document dated 3/3/21 was reviewed with Director of Nursing (DON). The DON stated, The canister is rinsed with water, it's like a bedpan. We don't disinfect them. We do not rinse the tubing. During a review of the facility Policy and Procedure titled, Cleaning and Disinfection of Resident Care Items and Equipment dated 10/2018, indicated, Policy Statement, Resident- care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current Centers for Disease Control (CDC) recommendation and the Occupational Safety and Health Administration (OSHA) .c. (1) Non-critical resident-care items includes bedpans . (2) Most non-critical items can be decontaminated where they are used . Per CDC Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) .4. Selection and Use of Low-Level Disinfectants for Noncritical Patient-Care Devices .4.b. Disinfect noncritical medical devices .with an Environmental Protection Agent (EPA) registered hospital disinfectant using the label's safety precautions and use directions . Based on observation, interview, and record review, the facility failed to implement and maintain 055466 Page 10 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0880 its infection control program when: Level of Harm - Minimal harm or potential for actual harm 1. Cleaning and disinfection of the glucometer (a device used to measure blood sugar level) was not performed after use for Resident 18 who was on fingerstick blood sugar monitoring. Residents Affected - Some 2. Resident 21's urinary drainage bag was left uncovered and touching the floor. 3. For Resident 13, the canister and the suction drainage tubing for urine collection was unlabeled and undated and the suction drainage tubing for urine collection was not cleaned after use. Failure to implement infection prevention practices may result in cross contamination of infection that may jeopardize the health and safety of the residents. Findings: 1. During a medication pass observation with Licensed Vocational Nurse (LVN) 3, on 12/29/21, at 4:35 PM, LVN 3 took out a glucometer from the third right drawer of the South medication cart and performed a fingerstick procedure (making a small prick into the fingertip to collect a blood sample on a strip that is inserted in the glucometer to obtain a reading of the blood sugar level) for Resident 18. LVN 3 did not clean and disinfect the glucometer before it was returned on the third right drawer of the South medication cart. During a concurrent interview, LVN 3 stated she used the Sani-Cloth (a brand of disinfectant wipes) wipes (with the purple top cover) to clean the glucometer. LVN 3 stated, I don't clean it after use, only before I use it. LVN 3 acknowledged she did not clean and disinfect the glucometer before and after use for Resident 18. During an interview with the Director of Nursing (DON) on 12/30/21, at 11:50 AM, the DON stated all glucometers should be cleaned and disinfected after each patient use. The Sani-Cloth is an approved disinfectant to use for Assure Platinum glucometers. Review of the Cleaning and Disinfecting the Assure Platinum Blood Glucose Monitoring System, revised 12/17, indicated, .The meter should be cleaned and disinfected after use on each patient. The cleaning procedure is needed to clean dirt, blood and other bodily fluids off the exterior of the meter before performing disinfection procedure. The disinfection procedure is needed to prevent the transmission of blood-borne pathogens . blood glucose meters need to be leaned and disinfected after each use . 2. During an observation on 12/28/21, at 3:25 PM, in resident's room, Resident 21 was lying in bed in a lowest position. An uncovered transparent urinary drainage bag (collecting bag) dated 12/22 was attached on the right side of the foot of the bed while the bottom part of the bag with the drain valve was touching the floor. The collecting tube attached to the urinary drainage bag was kinked resulting in urine collected in the tubing. During a concurrent interview, Certified Nursing Assistant (CNA) 1 acknowledged the findings and stated the bag should have a protective cover and should not touch the floor and that the tubing should not be twisted. During an interview with the DON on 12/30/21, at 2:10 PM, the DON stated the facility does not have a policy specific for care and management of residents with indwelling catheters (a soft hollow tube inserted in the bladder to drain urine into a bag outside the body). The DON stated, we use Lippincott Nursing Manual as our policy. 055466 Page 11 of 12 055466 12/30/2021 The Sequoias 501 Portola Road Portola Valley, CA 94028

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the Lippincott Nursing Manual procedure guidelines for Management of the Patient with an Indwelling (Self-Retaining) Catheter and Closed Drainage System, [2012] 10th ed., indicated, .Maintaining a closed drainage system . 2. Maintain unobstructed urine flow. a. Keep the drainage bag in a dependent position, below the level of the bladder . c. Keep the bag off the floor - c. Prevents bacterial contamination . 3. Empty the bag at regular intervals, making sure that the drainage valve/spout is not contaminated . c. Avoid letting the drainage bag touch the floor. d. Change the drainage bag if contamination occurs . 055466 Page 12 of 12