Health inspection·November 1, 2023

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 record review and interview the facility failed to follow physician orders to get blood work done for Resident 1 which would have included Resident 1's blood sugar level. This failure to have blood work drawn caused the facility to not identify and treat Resident 1's diabetes, resulting in elevated blood sugar levels that interfere with healing processes. Residents Affected - Few Findings: During a review of Resident 1's acute care medical record, Resident 1's History and Physical dated 10/1/23, documented Resident 1 had an elevated Hbg A 1c (a measure of one's average blood sugar levels over the past 3 months) at 13.3% indicating her blood sugar was poorly controlled. During a review of the medical records, Resident 1's admission Record documented she was admitted to the facility on [DATE] from the acute care hospital. Resident 1's diagnosis included: Acute Respiratory failure, Pneumonia, Heart Failure, and Type 2 Diabetes without complications. During a review of the medical records, Resident 1's Order Summary Report (printed on 11/1/23) had the following orders for blood work: CBC on next available draw after admission, ordered 10/5/23 (prescriber entered) and end date 10/13/23; cbc, bmp, bnp one time only for follow up labs ordered 10/6/23 (prescriber entered) and end date 10/10/23; tsh, t3, t4 one time only for hypothyroid with recent abnormal lab. Ordered 10/6/23 (prescriber entered) and end date 10/10/23. [CBC: complete blood cell count BMP: basic metabolic panel, blood urea nitrogen (BUN), carbon dioxide, creatinine, glucose (sugar,) serum chloride, serum potassium, and serum sodium BNP: protein in your blood used as an indicator of heart failure. TSH, T3 and T4: thyroid gland testing] During concurrent interview and record review on 11/1/23 at 2:20 pm, Director of Nurses (DON) reviewed the order summary and acknowledged that the MD had ordered the blood work listed prior. DON reviewed the electronic record and found test results for the one of the labs ordered, the CBC. DON was not able to locate the remaining ordered blood work. DON stated that had the bmp been drawn the facility may have been able to have the MD order testing and medications for the diabetes. During an interview on 11/1/23 at 2:20 p.m., DON stated that the admission nurse enters the orders (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055499 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rocky Point Care Center 625 16th Street Lakeport, CA 95453 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)