Health inspection·April 17, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of four residents' (Resident 3) routine medication was available to be administered to the resident. As a result, Resident 3 was not consistently administered her daily thyroid medication. Findings: A review of Resident 3's admission Record indicated the resident was admitted to the facility on [DATE] with diagnoses to include hypothyroidism (low thyroid hormones). A review of Resident 3's physician order dated 10/2/23, indicated the resident was to receive levothyroxine (thyroid medication) 125 micrograms, two tablets daily, that was scheduled to be given at 6:30 A.M. On 4/16/24 at 3:26 P.M., a telephone interview was conducted with Resident 3. Resident 3 stated, The pharmacy here's not good, refills and deliveries don't get done. Resident 3 stated during the first week of April (2024) there were four days she did not receive her levothyroxine. Resident 3 stated when she asked about the availability of her levothyroxine, the licensed nurse (LN) told her there was none. On 4/17/24 at 2:25 P.M., a joint interview and record review was conducted with LN 5. LN 5 stated he worked on 4/8/24 and went to administer Resident 3's levothyroxine at 6:30 A.M., and the medication had been unavailable. LN 5 stated he informed Resident 3 that her medication was unavailable, and the resident told him that she had not received her levothyroxine for four days. LN 5 reviewed Resident 3's medication administration record (MAR) and stated he documented by mistake that Resident 3's levothyroxine had been administered on 4/8/24. LN 5 stated Resident 3's medication had not been available to administer to the resident and the pharmacy had not delivered it yet. LN 5 stated Resident 3 should have received her levothyroxine as ordered. A review of the pharmacy receipts titled Consolidated Delivery Sheets indicated Resident 3's levothyroxine refill (a 30-day supply) had been delivered to the facility on 4/9/24. Resident 3's previous levothyroxine refill (30-day supply) had been delivered on 2/27/24. On 4/17/24 at 3:30 P.M., an interview was conducted with the director of nursing (DON). The DON stated Resident 3's levothyroxine should have been available and administered to the resident as ordered. (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 4 Event ID: 056017 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 056017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Jolla Post-Acute 2552 Torrey Pines Rd LA Jolla, CA 92037 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)