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 Page 1 of 2 055744 055744 06/16/2023 Atlantic Memorial Healthcare Center 2750 Atlantic Avenue Long Beach, CA 90806

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few administration, the medication administration record (MAR) in the electronic medical record (EMR) for Resident 2 was appearing red in color which indicated there were overdue medications for Resident 2. Observed RN 1 entered Resident 2 ' s room at 10:54 a.m. to pass Resident 2 ' s 9 a.m. medications, Resident 2 asked RN 1 if she was going to give him his medication for pain because he was having pain on his left knee. RN 1 was observed giving Resident 2, one chewable tablet of calcium carbonate 500mg, one thiamine 100 mg tablet, one folic acid 1 mg tablet, one multivitamin tablet, one midodrine 10 mg tablet, and one Celebrex capsule. During medication administration with Resident 2, observed no meal tray set up on Resident 2 ' s room to take the calcium carbonate with food as ordered. After the medication administration was completed, RN 1 documented the medication administration in Resident 2 ' s EMR and those medications turned green in the MAR which indicated it was given. RN 1 stated she was still administering 9 a.m. medications to residents at 11 a.m. RN 1 stated she still have 5 more rooms to administer medications to which was around 14 more residents. RN 1 stated there were a lot of medications to give during the morning medication administration. RN 1 stated it was hard to give morning medications on time because mornings in the facility were very busy with family calling, having residents get ready for their appointments including dialysis (procedure to remove waste products and excess fluid from the blood). RN 1 stated 9 a.m. medications were sometimes late because there was a lot to do. During a concurrent observation and interview on 6/14/2023 at 11:04 a.m., with Licensed Vocational Nurse (LVN 1) LVN 1 was observed preparing medications at her medication cart as well and stated she have medications to give to four (4) more residents During an interview on 6/15.2023 at 3:13 p.m., with the Director of Nursing (DON), the DON stated facility ' s policy for medication administration timeframe was medications can be given 60 minutes before the scheduled time and 60 minutes after the scheduled time. The DON stated medications given at 11 am for 9 a.m. medications were considered late. During a review of the facility ' s policy and procedure (P/P) titled Medication Administration-General Guidelines dated 10/2019, the P/P indicated it was the facility ' s policy for medications to be administered within 60 minutes of the scheduled time. The P/P indicated the licensed nurse was to administer medications in accordance with written orders from the physician. 055744 Page 2 of 2