Health inspection·June 16, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure licensed nurses administer one out of 10 sampled residents (Resident 2) 9:00 a.m. medications on time per physician order and facility ' s policy and procedure. This deficient practice had the potential for Resident 2 to experience unnecessary pain, unnecessary heart burn (when stomach acid backs up into the tube that carries food from the mouth to the stomach causing a burning pain in the chest) and had the potential for Resident 2 to experience low blood pressure. Findings: During a review of Resident 2 ' s admission Record, (Face Sheet), the Face Sheet indicated Resident 2 was admitted to the facility on [DATE] with diagnoses of hypotension unspecified (low blood pressure), gastro-esophageal reflux disease ([GERD] a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe)), pain in the left knee, and unilateral primary osteoarthritis (breakdown of the knee joint), left knee. During a review of Resident 2 ' s Order Summary Report (OSR), the OSR indicated on 10/17/2022 an order was placed for calcium carbonate (medication used to treat too much acid in the stomach) chewable tablet 500 milligrams (mg, a unit of measurement) 1 tablet by mouth three times a day for acid indigestion and heart burn with meals, folic acid (a medication that plays an important role in forming red blood cells) one mg by mouth once a day for supplement, thiamine hydrochloride ([HCL] vitamin B1, is a vitamin, an essential micronutrient for humans and animals) give 1 time a day by mouth for supplement, and centrum tablet (multivitamin with minerals) give 1 tablet by mouth one time a day for supplement. The OSR indicated on 10/19/2022 an order was placed for Midodrine (a medication used to treat low blood pressure) HCl tablet, give one 10 mg tablet by mouth three times a day for hypotension. The OSR indicated an order was placed on 6/5/2023 for Celebrex (a medication used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis) capsule 100 mg, give one capsule by mouth once a day for pain management for 10 days. During a review of Resident 2 ' s Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 4/22/2023, the MDS indicated Resident 2 had the ability to be understood and to understand others. During a concurrent interview, observation, and record review on 6/14/2023 at 10:53 a.m., with Registered Nurse (RN 1), RN 1 was observed preparing Resident 2 ' s 9 a.m. medication for medication (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: 055744 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 055744 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Atlantic Memorial Healthcare Center 2750 Atlantic Avenue Long Beach, CA 90806 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)