Health inspection·September 21, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **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 develop a plan of care to reflect the individual care needs for one of three sampled residents (Resident 2). * Resident 2's care plan for hearing had an incorrect intervention. This failure had the potential risk of not providing the appropriate and individualized care for Resident 2. Findings: Review of the facility's P&P titled Care Plan and Care Plan Update revised 2/2022 showed the facility will assure the completion of the resident assessment process enabling the development of an individualized comprehensive care plan for the resident. Medical record review for Resident 2 was initiated on 9/20/23. Resident 2 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 2's History and Physical examination dated 5/5/23, showed Resident 2 had blindness and hearing loss. Review of Resident 2's MDS dated [DATE], showed Resident 2 had severely impaired vision and minimal difficultly for hearing. Review of Resident 2's plan of care dated 8/28/23, showed the facility developed a care plan problem addressing a risk for communication problem related to hearing deficits. The care plan interventions for Resident 2 included to communicate by lip reading, writing, using gestures, and sign language. On 9/21/23 at 1235 hours, an interview was conducted with Resident 2. When asked about the extent of her visual impairment, Resident 2 stated she only could see a white screen in front of her. Resident 2 stated she was unable to see shadows, people, or objects. On 9/20/23 at 1607 hours, an interview and concurrent medical record review was conducted with the DON. The DON verified the above findings. The DON stated the care plans were to be individualized and tailored to every resident. The DON also stated the care plan intervention for Resident 2 was incorrect because Resident 2 was blind and would not be able to communicate with lip reading writing, using gestures, or sign language. The DON further stated it should be removed. Page 1 of 3 055983 055983 09/21/2023 Coventry Court Health Center 2040 S. Euclid Avenue Anaheim, CA 92802

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review, the facility failed to provide the necessary care and services to ensure one of three sampled residents (Resident 1) maintained his highest practicable physical well-being. Residents Affected - Few * The facility failed to administer acetaminophen (a fever and pain reducing medication) as prescribed by the physician for Resident 1. This failure had the potential to negatively impact Resident 1's well-being. Findings: Medical record review for Resident 1 was initiated on 9/20/23. Resident 1 was admitted to the facility on [DATE], and readmitted [DATE]. Review of Resident 1's History and Physical examination dated 7/25/23, showed Resident 1 was recently hospitalized for sepsis (a condition where the body is responding to an infection). Review of Resident 1's Order Summary Report dated 6/29/23 through 7/26/23, showed the following orders: - dated 7/6/23, to administer acetaminophen 325 mg two tablets by mouth every six hours as needed for the body temperatures > 99.9 degrees F. - dated 7/18/23, to administer acetaminophen 325 mg two tablets by GTevery six hours as needed for the body temperatures > 99.9 degrees F. Review of Resident 1's Vitals Documentation for temperatures showed the following: - On 7/9/23 at 0915 hours, the temperature = 102.2 F - On 7/11/23 at 1054 hours, the temperature = 102.4 F Review of Resident 1's MAR for July 2023 showed to monitor the vital signs and record any Covid signs and symptoms. The following temperatures were recorded: - on 7/9/23, the temperature = 102.2 F - on 7/10/23, the temperature = 102.2 F - on 7/11/23, the temperature = 102.4 F - on 7/12/23, the temperature = 102.4 F Further review of Resident 1's MAR for July 2023 showed Resident 1 did not receive acetaminophen 325 mg two tablets on 7/9, 7/10, and 7/12/23,for the temperatures > 99.9 F as ordered. On 9/20/23 at 1607 hours, an interview and concurrent medical record review was conducted with the DON. The DON reviewed Resident 1's MAR and verified the above findings. The DON reviewed the Nurse's 055983 Page 2 of 3 055983 09/21/2023 Coventry Court Health Center 2040 S. Euclid Avenue Anaheim, CA 92802

F 0684 Level of Harm - Minimal harm or potential for actual harm Progress Notes for 7/9, 7/10 and 7/12/23,and stated there was no documentation showing the medication order and interventions were carried out regarding Resident 1's elevated temperatures. The DON further stated the staff should have administered the ordered acetaminophen and provided the cooling measures. Residents Affected - Few 055983 Page 3 of 3