Health inspection·January 2, 2024

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to follow a physician's order for treatment and care as ordered for one of two sampled residents (Resident 1). Residents Affected - Few This failure had the potential to result in increased swelling and complications to Resident 1's affected elbow. Findings: During a review of Resident 1's admission physician office note dated 09/08/2023, Resident 1 was admitted to the facility for 10 days for respite care (provides short-term relief for primary caregivers). During a review of Resident 1's nurses notes dated 09/08/23, this indicated Resident 1 was alert to self only with episodes of confusion with redirection from staff. During a review of Resident 1's physician office visit note dated 09/08/23, Resident 1 had left elbow bursitis (a painful swelling, usually around your joints) and to compress Resident 1's elbow with an ACE Bandage (a stretchable bandage that provides a gentle pressure that helps reduce swelling) or compression sleeve (applies a therapeutic compression to the elbow joint to improve blood flow and promote healing of elbow injuries). Additional physician orders dated 09/11/23, indicated Resident 1 had an order for compression to left elbow with an Ace Bandage or sleeve. During a review of Resident 1's order summary dated 12/1/23, there were no orders for an Ace Bandage or sleeve for Resident 1's affected elbow. During a review of Resident 1's nurses notes dated 09/10/23, nurses' notes indicated Resident 1 had a left elbow pocket of fluids and family to call his concierge physician for orders, however there was no documentation found that an Ace wrap and/or compression was applied to Resident 1's elbow. During a concurrent interview and record review on 12/01/23 at 10:40 a.m., with licensed nurse (LN)1, Resident 1's nurses note dated 09/10/23 was reviewed, this indicated Resident 1 had a left elbow pocket of fluids and family stated they would call the concierge physician who would call in to the facility with orders. LN 1 confirmed there was no documentation that a follow up for orders was done by the nurses. During a concurrent interview and record review on 12/01/23 at 11:00 a.m. with the director of nursing (DON), DON stated the facility follows standard practice when orders are called in or received, the nurse verifies the orders, and the orders are implemented with no delay for respite care or (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055991 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055991 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mission Park Healthcare Center 623 West Junipero Street Santa Barbara, CA 93105 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)