Health inspection·July 15, 2025

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and facility P&P review, the facility failed to provide the appropriate pain management for three of three sampled residents (Residents 1, 2, and 3). * The facility failed to accurately document the monitoring of pain levels for Residents 1, 2, and 3 and administer the pain medications according to the physician's orders. This failure had the potential to put Residents 1, 2, and 3 at risk for ineffective pain management.Findings: Review of the facility's P&P titled Pain Assessment and Management dated 2001 showed the purpose of this procedure are to help the staff identify pain in the resident, develop interventions consistent with the resident's goals and needs, and address the underlying causes of pain. The Assessing Pain section showed to assess pain using a consistent approach and a standardized pain instrument appropriate to the resident's cognition level. Review of the facility's P&P titled Administering Medications dated 2001 showed the medications are administered in a safe and timely manner, and as prescribed. 1. Closed medical record review for Resident 1 was initiated on 7/11/25. Resident 1 was admitted to the facility on [DATE]. Review of Resident 1's H&P examination dated 6/24/25, showed Resident 1 had a displaced intertrochanteric fracture of the right femur (thigh bone). Review of Resident 1's MDS assessment dated [DATE], showed Resident 1 had severe cognitive impairment. Review of Resident 1's Order Summary Report dated 7/11/25, showed a physician's order dated 6/22/25, to administer acetaminophen (used to treat minor aches and pains) tablet 325 mg two tablets by mouth every four hours as needed for mild pain (1-3) (on a 0 to 10 pain scale with 0 = no pain and 10 = worst pain). Non-pharmacological interventions as follows: 1. Relaxation 2. Adjust room temperature/lighting 3. Reposition 4. Toileting 5. Music/TV 6. Snacks 7. Warm/Cold Compress 8. Other. Review of Resident 1's MAR for June 2025 showed Resident 1 was administered two tablets of the acetaminophen 325 mg medication for mild pain (1-3) on the following dates and times:- on 6/25/25 at 0236 hours, for a pain level of 5; and- on 6/25/25 at 1006 hours, for a pain level of 10. On 7/15/25 at 1126 hours, an interview and concurrent closed medical record review was conducted with RN 1. RN 1 verified the above findings. RN 1 verified the acetaminophen medication was administered to Resident 1 outside of the pain scale parameter on multiple occasions. RN 1 stated the licensed nurses should have called Resident 1's physician if the pain levels were not in the pain scale parameter and if the resident wanted something stronger. On 7/15//25 at 1431 hours, an interview and concurrent closed medical record review was conducted with the DON. The DON verified the above findings. The DON stated the licensed nurses should have clarified the pain management orders with Resident 1's physician to ensure the resident had available pain medication for moderate to severe pain. 2. Medical record review for Resident 2 was initiated on 7/11/25. Resident 2 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 2's H&P examination dated 4/29/25, showed Resident 2 had acquired absence of the right limb below the elbow (amputation). The resident reported experiencing throbbing pain, particularly in her right arm. Review of Resident 2's MDS assessment dated Residents Affected - Few Page 1 of 3 055929 055929 07/15/2025 Crystal Cove Care Center 1445 Superior Avenue Newport Beach, CA 92663

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few [DATE], showed the resident's cognition was moderately impaired. Review of Resident 2's Order Summary Report for July 2025 showed the following physician's orders:- dated 6/14/25, to administer oxycodone hydrochloride (narcotic pain medication) 5 mg 1.5 tablet by mouth every four hours as needed for moderate pain (4-6) (on a 0 to 10 pain scale, 0 = no pain and 10 = worst pain). Hold if the RR (respiratory rate) was less than 12 per minute. Document the non-pharmacological interventions as follows: 1. Relaxation 2. Adjust room temperature/lighting 3. Reposition 4. Toileting 5. Music/TV 6. Snacks 7. Warm/Cold Compress 8. Other. - dated 12/15/24, to administer oxycodone hydrochloride (narcotic pain medication) 10 mg by mouth every four hours as needed for severe pain (7-10) (on a 0 to 10 pain scale, 0 = no pain and 10 = worst pain). Document the non-pharmacological interventions as follows: 1. Relaxation 2. Adjust room temp/lighting 3. Reposition 4. Toileting 5. Music/TV 6. Snacks 7. Warm/Cold Compress 8. Other. Review of Resident 2's MAR for June and July 2025 showed Resident 2 was administered the oxycodone hydrochloride 5 mg medication for moderate pain (4-6) on the following dates and times:- on 6/22/25 at 0926 hours, for a pain level of 8;- on 6/23/25 at 0930 hours, for a pain level of 9;- on 6/23/25 at 1330 hours, for a pain level of 9; - on 6/25/25 at 0413 hours, for a pain level of 7; - on 6/26/25 at 0616 hours, for a pain level of 7; - on 7/8/25 at 1442 hours, for a pain level of 7; - on 7/8/25 at 1905 hours, for a pain level of 7; and - on 7/8/25 at 2346 hours, for a pain level of 8. Review of Resident 2's MAR for June 2025 showed Resident 2 was administered the oxycodone hydrochloride 10 mg medication for severe pain (7-10) on the following dates and times:- on 6/27/25 at 1404 hours, for a pain level of 6; and- on 6/27/25 at 1828 hours, for a pain level of 5. On 7/15/25 at 1140 hours, an interview and concurrent medical record review was conducted with LVN 4. LVN 4 verified the above findings. LVN 4 stated the licensed nurses should have assessed Resident 2 and administered the pain medication according to the ordered pain scale parameters. LVN 4 stated the licensed nurses should have administered the right dosage of pain medication according to the resident's pain level. On 7/15//25 at 1440 hours, an interview and concurrent medical record review was conducted with the DON. The DON verified the above findings. The DON stated the licensed nurse should have followed Resident 2's physician order on pain management according to the resident's verbalized pain level. The DON stated the licensed nurse should follow Resident 2's physician orders for the pain medication parameters. 3. Medical record review for Resident 3 was initiated on 7/11/25. Resident 3 was admitted to the facility on [DATE]. Review of Resident 3's H&P examination dated 6/22/25, showed Resident 3 had a diagnoses of low back pain and status post lumbar (lower back) surgery. Review of Resident 3's MDS assessment dated [DATE], showed the resident was cognitively intact. Review of Resident 3's Order Summary Report for July 2025 showed the following physician's orders: - dated 6/19/25, to administer acetaminophen 325 mg two tablets by mouth every six hours as needed for mild pain (1-3) (on a 0 to 10 pain scale, 0 = no pain and 10 = worst pain). Non-pharmacological interventions as follows: 1. Relaxation 2. Adjust room temperature/lighting 3. Reposition 4. Toileting 5. Music/TV 6. Snacks 7. Warm/Cold Compress 8 . Other. - dated 6/19/25, to administer hydrocodone-acetaminophen (narcotic pain medication) 10-325 mg one tablet by mouth every six hours as needed for moderate pain (4-6) (on a 0 to 10 pain scale, 0 = no pain and 10 = worst pain). - dated 6/28/25, to administer hydrocodone-acetaminophen 10-325 mg one tablet by mouth every six hours as needed for moderate pain (4-6) (on a 0 to 10 pain scale, 0 = no pain and 10 = worst pain). Non-pharmacological interventions as follows: 1. Relaxation 2. Adjust room temp/lighting 3. Reposition 4. Toileting 5. Music/TV 6. Snacks 7. Warm/Cold Compress 8. Other. Review of Resident 3's MAR for June and July 2025 showed Resident 3 was administered two tablets of the acetaminophen 325 mg medication for mild pain (1-3) on the following dates and times: - on 6/26/25 at 0620 hours, for a pain level of 4; and- on 055929 Page 2 of 3 055929 07/15/2025 Crystal Cove Care Center 1445 Superior Avenue Newport Beach, CA 92663

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 7/5/25 at 0857 hours, for a pain level of 5. Review of Resident 3's MAR for June 2025 showed Resident 3 was administered the hydrocodone-acetaminophen 10-325 mg medication (ordered by Resident 3's physician on 6/19/25) for moderate pain (4-6) on the following dates and times:- on 6/23/25 at 1712 hours, for a pain level of 7; - on 6/25/25 at 1035 hours, for a pain level of 9; and - on 6/27/25 at 0930 hours, for a pain level of 9. Review of Resident 3's MAR for June and July 2025 showed Resident 3 was administered the hydrocodone-acetaminophen 10-325 mg medication (ordered by Resident 3's physician on 6/28/25) for moderate pain (4-6) on the following dates and times: - on 6/30/25 at 1843 hours, for a pain level of 7; - on 7/1/25 at 1309 hours, for a pain level of 7; - on 7/5/25 at 2042 hours, for a pain level of 8; and - on 7/10/25 at 1829 hours, for a pain level of 7. On 7/15/25 at 1107 hours, an interview and concurrent medical record review was conducted with LVN 2. LVN 2 verified the above findings. LVN 2 verified the PRN acetaminophen and hydrocodone-acetaminophen medication orders were administered to Resident 3 outside of the pain scale parameters. LVN 2 verified the PRN pain medications should have been offered based on the pain scale. LVN 2 stated if the pain level did not meet the parameter, the licensed nurse should have informed Resident 3's physician. On 7/15//25 at 1419 hours, an interview and concurrent medical record review was conducted with the DON. The DON verified the above findings. The DON stated the licensed nurse should have clarified the pain management orders with Resident 3's physician if the resident's pain level was severe or seven and above on the pain scale. 055929 Page 3 of 3