Health inspection·September 13, 2019

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, for one of 12 (Resident 27) sampled residents, the facility failed to ensure accurate labeling of a medication when there was inaccurate labeling for Resident 12's Lantus (medication for high blood sugar). This failure had the potential for Resident 27 to receive the wrong medication dose. Findings: Review of Resident 27's admission Record indicated Resident 27 was admitted to the facility with diagnoses that included Diabetes Mellitus (a disorder that causes high blood sugar in the bloodstream). Review of the Physician's Orders (POs), dated 8/6/19, indicated an order for Resident 12 to receive 38 units of Lantus 100 units/milliliter (u/mL) subcutaneously (below the skin) every morning. The POs also indicated Resident 12 was to receive 30 units of Lantus 100 u/mL subcutaneously every evening. During an observation and concurrent interview on 9/11/19, at 9:37 a.m., Licensed Vocational Nurse (LVN) 1 held Resident 12's Lantus 100 unit/ml that indicated Resident 12 was to receive 32 units of Lantus every morning. LVN 1 stated Resident 12's Lantus label did not have the same dose instructions as the POs. LVN 1 stated a Direction Change sticker should have been applied to Resident 12's Lantus vial when the ordered dose was changed so that other nurses were aware and also for the next ordered Lantus medication label from the pharmacy would be the corrected dose (of 30 u/mL). During an interview on 9/11/19, at 12:22 p.m., Director of Nursing (DON) stated the Licensed Nurse receiving the new order from the physician was responsible for applying a direction change sticker to the medication container. Review of facility policy and procedure titled, Medications and Medication Labels, dated 2007, indicated, .Medications are labeled in accordance with currently accepted professional principles including appropriate auxiliary and cautionary instructions to promote safe medication use following state and federal laws .If the prescriber's directions for use or the label is inaccurate, the nurse may place a direction change, change of order-check cart, or similar label on the container indicating there is a change in directions for use, taking care not to cover important label information. When such a direction label appears on the container, the medication nurse checks the resident's Page 1 of 5 055892 055892 09/13/2019 Berkeley Pines Skilled Nursing Center 2223 Ashby Avenue Berkeley, CA 94705

F 0761 Level of Harm - Minimal harm or potential for actual harm medication administration record (MAR) or the prescriber's order for current information. If directions for use change, the provider pharmacy is informed prior to the next refill of the prescription so the new container will show an accurate label Residents Affected - Few 055892 Page 2 of 5 055892 09/13/2019 Berkeley Pines Skilled Nursing Center 2223 Ashby Avenue Berkeley, CA 94705

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store food in a sanitary manner when thawing meat was not stored below and separately from other foods. Residents Affected - Some This failure had the potential to result in foodborne illness. Findings: During an observation and concurrent interview on 9/10/19, at 9:25 a.m., a box of pasteurized eggs and an open box of four-ounce cartons of strawberry milk shakes were stored on the bottom shelf of the refrigerator next to thawing raw chicken. Dietary Supervisor (DS) stated the milk shakes were served directly to residents. The DS stated cross-contamination of raw foods on the surfaces of ready-to-drink/eat foods can occur and make residents sick. Review of the facility's policy and procedure titled, Food Preparation, dated 2018, indicated directions to store raw poultry (chicken) separately from ready-to-eat food to prevent cross contamination. Review of the facility's policy and procedure titled, Thawing of Meats, dated 2018, indicated directions to thaw meat on the bottom shelf below ready-to-eat foods. 055892 Page 3 of 5 055892 09/13/2019 Berkeley Pines Skilled Nursing Center 2223 Ashby Avenue Berkeley, CA 94705

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, record review, the facility failed to ensure the garbage storage area was maintained in a sanitary condition when one of two garbage dumpsters located outside the building did not have a closed lid and was overflowing with garbage bags. Residents Affected - Some This failure had the potential to lure and harbor disease carrying pests to spread germs. Findings: During an observation on 9/10/19, at 8:45 a.m., one of two dumpsters had an open lid with garbage bags overflowing. During an observation on 9/10/19, at 4 p.m., one of two dumpsters had an open lid with garbage bags overflowing. During an observation on 9/11/19, at 8:45 a.m., one of two dumpsters had an open lid with garbage bags overflowing. During an interview on 9/11/19, at 8:58 a.m., the Dietary Supervisor (DS) stated the lids on the garbage dumpsters should be closed to eliminate spread of infection. Review of the facility's undated policy titled, Garbage Storage Areas indicated .garbage container lids should be closed 055892 Page 4 of 5 055892 09/13/2019 Berkeley Pines Skilled Nursing Center 2223 Ashby Avenue Berkeley, CA 94705

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, for one (Resident 135) of 12 sampled residents, the facility failed to follow infection control practices to prevent spread of infection. Licensed Vocational Nurse (LVN 1) did not perform hand hygiene (wash hands with soap and water or use an alcohol-based hand rub) in between multiple glove changes. Residents Affected - Few For Resident 135, this deficient practice had the potential to result in infection. Findings: Review of the admission Record, printed 8/29/19, indicated Resident 135 was admitted to the facility with diagnoses that included a broken leg. Review of Resident 135's Physician's Order, dated 9/10/19, to receive wound care dressing change to the sacrum (a large, triangular bone at the base of the spine) every day and as needed for soiling or dislodgement. During an observation and concurrent interview on 9/12/19, at 1:05 p.m., Licensed Vocational Nurse (LVN) 1 first removed the old wound dressing, then changed gloves, applied new gloves, and cleaned the wound. Then LVN 1 changed gloves a second time, and applied a medication to the wound. LVN 1 changed gloves a third time, then applied a dry dressing to Resident 135's wound, removed the soiled gloves. LVN 1 did not perform hand hygiene between the three glove changes during Resident 135's wound care. LVN 1 stated her understanding was when working on just one resident, hand washing/hand hygiene was only done in the very beginning and at the end of the wound treatment, not between multiple glove changes during the wound treatment. In an interview on 9/13/19, at 8:52 a.m., Director of Nursing (DON) stated the licensed nurse should also do hand washing/hand hygiene in between glove changes. DON also stated when doing wound treatment, to at least do glove changes between three to four times depending on the treatment done. Review of the facility policy Hand Washing/Hand Hygiene, revised date August 2015, indicated .This facility considers hand hygiene the primary means to prevent the spread of infections .All personnel shall follow the hand washing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors .Hand hygiene is the final step after removing and disposing of personal protective equipment. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare-related infections 055892 Page 5 of 5