Health inspection·June 24, 2025

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 record review, the facility failed to provide respiratory care consistent with professional standards of practice for one of four residents (Resident 1) on oxygen therapy when Resident 1's BiPAP (a breathing support method that delivers positive pressure to the lungs through a mask) application was not documented by licensed nurses. This failure had the potential to result in inadequate monitoring of the resident's condition, and the potential to negatively affect the residents' health, safety and well-being. Residents Affected - Few Findings: Review of Resident 1's clinical record indicated she was admitted on [DATE] with diagnoses including chronic respiratory failure with hypoxia (inability to keep oxygen and carbon dioxide at normal levels), congestive heart failure (heart works less efficiently and can lead to buildup of fluid in the lungs and shortness of breath), chronic obstructive pulmonary disease (a lung disease that makes it difficult to breathe), obstructive sleep apnea (a sleep related breathing disorder that occurs when the upper airway becomes blocked during sleep), chronic pulmonary edema (excess fluid builds up in the lungs making breathing difficult), and dependence on supplemental oxygen. Review of Resident 1's physician order, dated 1/24/25, indicated to apply BiPAP full face large mask at bedtime for obstructive sleep apnea. Review of Resident 1's Respiratory Administration Record (RAR) indicated the licensed nurses applied the BiPAP at bedtime for Resident 1. Further review of the RAR indicated missing entries for the bedtime application of Resident 1's BiPAP on following dates: February 2025: No documentation on 2/5, 2/15, 2/22, 2/23, and 2/28; March 2025: No documentation on 3/3, 3/6, 3/7, 3/12, 3/19, 3/21, 3/23, 3/24, and 3/31; April 2025: No documentation on 4/5, 4/8, 4/12, 4/13, 4/18, 4/20, 4/23, 4/26, 4/29, and 4/30; May 2025: No documentation on 5/6, 5/8, 5/11, 5/15, 5/16, 5/21, 5/22, and 5/24. During an interview and concurrent record review with director of nursing (DON), on 5/3/25 at 1:50 p.m., she reviewed Resident 1's RAR and confirmed the application of the BiPAP was not documented as completed on the above dates. The DON confirmed if the nurses applied the BiPAP at bedtime, they should document in Resident 1's RAR. The DON acknowledged that if the applications of the BiPAP were not documented, they were not done. The DON confirmed the licensed nurses should initial that the Page 1 of 2 056082 056082 06/24/2025 Canyon Springs Post-Acute 180 North Jackson Avenue San Jose, CA 95116

F 0684 BPAP is applied at bedtime as per the physician order. Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy titled BiPAP Support , revised March 2015, indicated to document the time the BiPAP was started and to notify the physician if the resident refuses the procedure. Residents Affected - Few 056082 Page 2 of 2