Health inspection·October 25, 2024

F 0641 Ensure each resident receives an accurate assessment. 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 ensure one of one resident ' s (Resident 1) Minimum data Set (MDS – a federally mandated resident assessment tool), dated 10/14/2024, indicated Resident 1 had broken teeth. Residents Affected - Few This deficient practice resulted an inaccurate depiction of Resident 1 ' s current health status. Findings: During a review of Resident 1 ' s admission Record, the admission Record indicated Resident 23 was originally admitted to the facility on [DATE] with diagnoses including seizures(a sudden, uncontrolled electrical disturbance in the brain which can cause uncontrolled jerking, blank stares, and loss of consciousness) , dementia (a progressive state of decline in mental abilities), age related osteoporosis (weak and brittle bones due to lack of calcium and Vitamin D) and muscle weakness. During a review of Resident 1's Minimum Data Set, dated [DATE], the MDS indicated Resident 1 had severe cognitive impairment and was dependent (helper does all the effort) with all activities of daily living (ADLs- routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves). The MDS indicated Resident 1did not have any obvious or likely cavity or broken natural teeth. During a review of Resident 1 ' s Nursing admission and Assessment, dated 10/8/2024 at 8:29 p.m., the assessment indicated Resident 1 was missing 2 front lower natural teeth. During an interview and record review on10/25/2024 at 1:00 p.m. with Registered Nurse (RN)1, Resident 1 ' s Nursing admission Assessment, dated 10/8/2024. and MDS dated [DATE], were reviewed. Resident 1 ' s admission assessment indicated Resident 1 had 2 missing front teeth and the MDS indicated Resident 1 did not have any dental problems. RN 1 stated Resident 1 was admitted from the hospital and her two lower front teeth was missing. RN1 stated Resident 1 ' s MDS was erroneously coded that resident did not have any dental issues and should be amended to indicate Resident 1 had dental issues. During an interview on 10/25/2024 at 1:32 p.m. with the Director of Nursing (DON), the DON stated assessments should be accurate to get a clear representation of the resident if you ' re reading about them from paper. During a review of the facility ' s policy and procedure (P&P) titled, Comprehensive Assessments and the Care Delivery Process, revised 12/2016 the P&P indicated comprehensive assessments will be Page 1 of 2 055539 055539 10/25/2024 Artesia Christian Home Inc. 11614 E. 183rd St Artesia, CA 90701

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few conducted and the objective of the information collection was to obtain, organize, and subsequently analyze information about the patient. During a review of Resident Assessment Instrument (RAI - a standardized evaluation that helps healthcare providers assess a resident's needs, strengths, and preferences) manual, Chapter 1, dated October 2019, the RAI indicated the assessment accurately reflects the resident ' s status. 055539 Page 2 of 2