Health inspection·September 28, 2023

F 0777 Provide or obtain x-rays/tests when ordered and promptly tell the ordering practitioner of the results. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure that one of two sampled residents ' diagnostic tests were completed as ordered by Resident 1 ' s physician to confirm the diagnosis of dementia (a progressive condition marked by the development of multiple cognitive deficits). Residents Affected - Few This deficient practice had the potential to result in Resident 1 not receiving the adequate dementia care and being able to achieve her highest level of functioning. Findings: During an observation on 9/28/23, Resident 1 was observed sitting in a wheel chair in her room watching television. A review of Resident 1 ' s admission Record indicated the facility admitted the resident on 9/07/2022, with diagnoses that included metabolic encephalopathy (an alteration in consciousness caused due to brain dysfunction), unspecified dementia without behavioral disturbances, psychotic disturbances, mood disturbances and anxiety. A review of Resident 1 ' s History and Physical Examination (HPE) signed and dated by the attending physician on 9/10/2022, indicated the resident did not have the capacity to understand and make decisions. The HPE indicated as a reason: Dementia/Alzheimer ' s (A progressive disease that destroys memory and other important mental functions). A review of Resident 1 ' s Minimum Data Set (MDS; a care assessment screening tool) dated 9/21/2023, indicated the resident had severely impaired cognition (thought process). The MDS indicated Resident 1 required extensive assistance (resident involved in activity; staff provide weight bearing support) with bed mobility, transferring between surfaces, dressing, toilet use and personal hygiene. The MDS indicated Resident 1 required supervision (oversight, encouragement or cueing) while eating. A review of Resident 1 ' s Care Plan for dementia dated 9/7/2022 with a revision date of 8/31/2023 Indicated Resident 1 was At risk for impaired cognitive function/dementia or impaired thought process. The care plan indicated a goal for the resident was to maintain current level of cognitive function through the review date. A review of Resident 1 ' s document titled Physician ' s orders dated 10/11/2022 indicated a handwritten order for Head MRI (magnetic resonance imaging - a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body) without contrast for Page 1 of 2 055706 055706 09/28/2023 The Orchard - Post Acute Care 12385 E. Washington Blvd Whittier, CA 90606

F 0777 Diagnosis of Dementia. The physician ' s orders form indicated Return to care in two months. Level of Harm - Minimal harm or potential for actual harm During an interview on 9/28/23 at 9:15 AM with Family Member 1 (FM1), FM1 stated that Resident 1 ' s neurologist had ordered an MRI to be completed last year 2022 and to her knowledge it was never done. FM 1 stated she asked the facility but did not receive an answer if the MRI was done. Residents Affected - Few During an interview and concurrent record review of Resident 1 ' s Physician ' s orders dated 10/11/2022 and Resident 1 ' s medical records with the Director of Nursing (DON), the DON stated she could not find documented evidence in Resident 1 ' s records that indicated the MRI ordered by the neurologist was ever completed. The DON stated she could not find written documentation in Resident 1 ' s medical records that Resident 1 ' s neurologist was informed of the MRI not being completed or the follow up appointment was attempted to be scheduled as ordered by Resident 1 ' s neurologist. The DON stated the MRI should have been ordered the next day or at most two days after the order was received from the neurologist. During an interview with the DON on 9/28/23 at 4:40 PM, the DON stated the facility does not have a policy and procedure for following or carrying out physicians with laboratory orders. The DON stated it is the facility ' s standard of practice that all physicians ' orders should be followed and carried out within two days at most, if in case order cannot be carried out physician should be notified immediately and nurse responsible should document in resident record physician notification and response from physician. 055706 Page 2 of 2