Health inspection·May 7, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow its policy and procedures titled Requesting, Refusing and/or Discontinuing Care and Treatment, reviewed March 2025, for one of three sampled residents (Resident 1). By failing to notify Resident 1 ' s physician of the resident ' s refusal to take prescribed tuberculosis (TB, a contagious disease caused by the bacteria Mycobacterium tuberculosis, which typically affects the lungs) medications: 1. Isoniazid (used to treat TB and/or prevent its return) 300 milligrams (mg, metric unit of measure) refused on 4/9/25, 4/12/25, 4/13/25, 4/25/25, and 5/2/25. 2. Pyridoxine 50 mg (treats vitamin B6 deficiency) refused on 4/9/25, 4/12/25, 4/13/25, 4/25/25, and 5/2/25. 3. Rifampin (antimicrobial medication used to kill TB bacteria in the body) 300 mg refused on 4/20/25, 4/25/25, and 5/2/25. This deficient practice had the potential to result in Resident 1 becoming reinfected with active TB, a delay in care and treatment, or cause a decline on overall medical condition resulting in death. Findings: During a review of Resident 1's admission Record dated 5/7/25, the admission record indicated, the resident was admitted to the facility on [DATE] with diagnoses including anemia (a condition where the body does not have enough healthy red blood cells), TB, hypertension (high blood pressure), and abnormalities of gait (balance) and mobility. During a review of Resident 1 ' s Minimum Data Set (MDS—a resident assessment tool) dated 3/23/25, the MDS indicated, Resident 1 had severe cognitive (mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) impairment, and required partial/moderate assistance (helper does less than half of the effort) for eating, oral hygiene, toileting, showering/bathing, and dressing and required supervision or touching assistance for bed mobility and transfers. During a review of Resident 1 ' s Oder Summary Report dated 5/7/25, the report indicated an order for isoniazid oral tablet 300 mg by mouth one time a day for TB until 8/12/25, pyridoxine hydrochloride oral tablet 50 mg give 1 tab by mouth one time a day for supplement until 8/12/25, and rifampin Page 1 of 2 055748 055748 05/07/2025 Sunset Park Healthcare 2250 29th Street Santa Monica, CA 90405

F 0580 oral capsule 300 mg give two (2) capsules by mouth one time a day for TB until 8/12/25. Level of Harm - Minimal harm or potential for actual harm During an interview with Licensed Vocational Nurse (LVN) 1 on 5/7/25 at 2:47 pm, LVN 1 stated Resident 1 would refuse medications on occasion and LVN 1 would save the medications and try and give them later and then go back and change the documentation in the computer if the resident took the medications. LVN 1 stated the doctor would be notified of the resident ' s refusing after three consecutive days. Residents Affected - Few During a concurrent interview and record review on 5/7/25 at 5:27 pm with the Director of Nursing (DON), Resident 1 ' s Medical Administration Record (MAR) for April and May 2025 were reviewed. There were entries for medications refused: 1. Isoniazid refused on 4/9/25, 4/12/25, 4/13/25, 4/25/25 and 5/2/25. 2. Pyridoxine 50 mg refused on 4/9/25, 4/12/25, 4/13/25, 4/25/25 and 5/2/25. 3. Rifampin 300 mg refused on 4/20/25, 4/25/25 and 5/2/25. The DON verified there was no documentation in the resident ' s progress notes indicating the doctor was called for any of the medication refusals on 4/9/25, 4/12/25, 4/13/25, 4/25, 4/25/25 and 5/2/25. The DON stated the doctor went to the facility frequently and the refusals were reported to the doctor, but the refusals should have been documented in a progress note. During a review of the facility ' s policy and procedures titled Requesting, Refusing and/or Discontinuing Care and Treatment, reviewed March 2025, the policy indicated Detailed information relating to the . refusal of treatment are documented in the resident ' s medical record .The healthcare practitioner must be notified of refusal of treatment . 055748 Page 2 of 2