Health inspection·September 6, 2019

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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. Based on observation, interview and record review, the facility failed to ensure expired oral medications and topical creams were removed from the current medication supplies. In addition, nasal sprays, eye drops, and pain patches were commingled with the current medication supplies readily available for residents' use. Also, the medication room temperature was not consistently monitored as required. These failures had the potential for unsafe storage of medications thereby losing the efficacy of the medications. Findings: 1a. On 9/4/19 at 9:32 A.M., a medication storage inspection of the treatment cart and interview was conducted with Licensed Nurse (LN) 1. The treatment cart had five drawers. In the first drawer, there was half a box of individual packets of hydrocortisone cream (topical medication used to help relieve redness, itching, swelling) with an expiration date of 8/19. In the fifth drawer, there was one opened tube of benzoyl peroxide 10 % (medication used to treat mild to moderate acne) with an expiration date of 9/18, and one tube ointment of a soothe and cool barrier (moisture ointment) with an expiration date of 8/19. LN 1 stated the LNs should have been checking at the expiration date of the medications and discarded the expired treatment medications. LN 1 acknowledged the policy and guidelines on storage of medications should have been followed. On 9/5/19 at 2:10 P.M., an interview was conducted with the Director of Nursing (DON). The DON LNs should have checked the treatment and medication carts to ensure medications were current. A review of the facility's policy titled, Storage and Expiration of Medications, Biologicals, Syringes and Needles, revised 10/31/16, indicated, Procedure . 3. General Storage Procedures: . 3.2 Facility should ensure that external use medications and biologicals are stored separately from internal use medications and biologicals . 5. Once any medication or biological package is opened, Facility should follow the manufacturer/ supplier guidelines with respect to expiration dates for opened medications . 5.2 Medications with a manufacturer's expiration date expressed in month and year (e.g. May 2019) will expire on the last day of the month . 2. On 9/4/19 at 10:17 A.M., a medication storage inspection, interview, and record review was conducted with LN 1. There were 15 missing signatures in the medication room temperature log in PM shifts. The dates were identified as follows: 1/3, 1/5, 1/7, 1/8, 1/9, 1/15, 1/16, 1/17, 1/21, 1/27, 1/29, Page 1 of 4 055500 055500 09/06/2019 Valley Vista Post Acute 1025 W. Second Avenue Escondido, CA 92025

F 0761 4/11, 4/12, 4/14, and 4/15/19. Level of Harm - Minimal harm or potential for actual harm LN 1 stated the medication room temperature should have been checked and monitored by the LNs twice a day for a potential that temperature would be out of range. LN 1 also stated LNs should have monitored the temperature consistently to maintain the effectiveness and potency of the medications. Residents Affected - Some On 9/5/19 at 2:10 P.M., an interview was conducted with the Director of Nursing (DON). The DON further stated the medication room temperatures should have been monitored twice a day consistently to ensure the potency of the medications. The DON stated who knows the temperature was off and could affect the medications' effectiveness. A review of the facility's policy titled, Storage and Expiration of Medications, Biologicals, Syringes and Needles, revised 10/31/16, indicated, Procedure . 3. General Storage Procedures: .11. Facility should ensure that medications and biologicals are stored at their appropriate temperatures according to the United States Pharmacopoeia guidelines for temperature ranges. 3a. On 9/4/19 at 12:03 P.M., a medication storage inspection of North medication cart and interview was conducted with LN 2. A half bottle of opened oral vitamin tablets was inside the drawer with an expiration date of 8/19. LN 2 stated the expired medications should have been removed from the cart. On 9/5/19 at 2:10 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated the treatment cart and the medication cart should have been checked to ensure medications were organized and current. The DON stated it was missed and could potentially hurt the residents. A review of the facility's policy titled, Storage and Expiration of Medications, Biologicals, Syringes and Needles, revised 10/31/16, indicated, Procedure . 3. General Storage Procedures: .5. Once any medication or biological package is opened, Facility should follow the manufacturer/ supplier guidelines with respect to expiration dates for opened medications .5.2 Medications with a manufacturer's expiration date expressed in month and year (e.g. May 2019) will expire on the last day of the month . 3b. On 9/4/19 at 12:03 P.M., a medication storage inspection of the medication cart and interview was conducted with Licensed Nurse (LN) 1. Multiple medication supplies were commingled inside the drawer such as: Nasal sprays, eye drops, pain patches, and anticoagulant liquid medications. LN 2 stated she was not sure of the facility's policy related to the storage of nasal sprays, eyes drops, pain patches, and oral medications. LN 2 stated oral medications should have been separated from nasal sprays, eye drops, and patches for safety reasons. On 9/5/19 at 2:10 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated LNs should have checked the treatment and medication carts to ensure the medications were organized and current. The DON stated it was missed and could potentially hurt the residents and storage of internal and external medications should have been separated. The DON also stated oral medications should have been separated from the other medications to prevent medication error and for infection control purposes. A review of the facility's policy titled, Storage and Expiration of Medications, Biologicals, Syringes and Needles, revised 10/31/16, indicated, Procedure . 3. General Storage Procedures: . 3.2 Facility should ensure that external use medications and biologicals are stored separately from internal 055500 Page 2 of 4 055500 09/06/2019 Valley Vista Post Acute 1025 W. Second Avenue Escondido, CA 92025

F 0761 use medications and biologicals .5.2 Medications with a manufacturer's expiration date expressed in month and year (e.g. May 2019) will expire on the last day of the month . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 055500 Page 3 of 4 055500 09/06/2019 Valley Vista Post Acute 1025 W. Second Avenue Escondido, CA 92025

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on observation, interview, and review of the Analysis of Client Accommodations, the facility failed to meet the required minimum square footage requirements of at least 80 square feet per resident (sq ft/resident) in 3 resident bedrooms (6, 8, and 11). This failure had the potential to impact resident care and quality of life. Findings: An observation from 9/3/19 through 9/5/19 was conducted during the survey. The following resident rooms contained less than 80 square feet for each resident: Room number Room Size 6 accommodated 3 residents 216 (72 sq ft/resident) 8 accommodated 3 residents 216 (72 sq ft/resident) 11 accommodated 2 residents 138 (69 sq ft/resident) Additionally, interviews and records reviews were conducted. There were no observed quality of care, or quality of life concerns that negatively affected the residents residing in the identified rooms during the recertification survey visit. A continuance of the waiver (variation) from the requirements of Code 42 of the Federal Regulations (CFR) section 483.70(d)(1)(ii) as granted, allowing less than 80 square feet per resident room, is hereby recommended. This recommendation is also made with the expectation that the facility will obtain a timely renewal of the current waiver granted by CMS. 055500 Page 4 of 4