Health inspection·July 11, 2023

F 0641 Ensure each resident receives an accurate assessment. 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 accurately assess one resident (Resident 1) of five sampled residents, when the Minimum Data Set (MDS; an assessment tool) did not accurately reflect Resident 1 ' s nutritional status. Residents Affected - Few This failure decreased the facility ' s potential to identify residents' care needs. Findings: A review of an admission record indicated Resident 1 was re-admitted to the facility in April 2023 with diagnoses including dementia (loss of cognitive functioning, thinking, remembering, and reasoning) and dysphagia (swallowing difficulty). During a review of Resident 1 ' s MDS, dated [DATE], the MDS indicated Resident 1 had no weight loss of 5% (percent) or more in the last month or 10% or more in the last six months. A review of a document titled, Weights and Vitals Summary, indicated Resident 1 ' s weight was 176 pounds (a unit of weight measure) on 1/4/23 and 142 pounds on 5/5/23 (a loss of 34 pounds in the last four months). A review of Resident 1 ' s interdisciplinary team (IDT) note titled, RD [Registered Dietician] Weight Review, dated 3/31/23, indicated Resident 1 had a weight loss of six pounds in the last month and 26 pounds in the last three months. RD note further indicated Resident 1 had significant weight loss and inadequate oral intake. During an interview on 7/11/23 at 3:49 p.m. with the RD, RD stated in the last six months, Resident 1 had more than 30 pounds weight loss and that's significant. During an interview on 7/11/23 at 3:05 p.m. with MDS Coordinator (MDSC), MDSC stated, she would have checked Resident 1 ' s weight log and dietary notes to decide whether Resident 1 lost weight or not prior MDS documentation. MDSC stated she noticed a decline in Resident 1 ' s weight after she reviewed the weight log and IDT note, dated 3/31/23, and would have documented there was weight loss. MDSC further stated Resident 1 ' s MDS documentation was inaccurate and the documentation needs to be accurate, because the resident ' s care plan relies on MDS documentation and MDS helps in tracking the resident ' s progress and care. During an interview on 7/11/23 at 3:34 p.m. with Registered Nurse Clinical Resource (RNCR), RNCR stated, she reviewed Resident 1 ' s weight log and MDS and noticed a trend of weight loss of more than Page 1 of 4 056098 056098 07/11/2023 Cottonwood Healthcare Center 625 Cottonwood Street Woodland, CA 95695

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 30 pounds between 1/23 and 5/23 and inaccuracy of MDS documentation of weight loss. RNCR further stated, the MDS documentation should had been accurate because it guides staff and provides a track of the resident ' s care plan. A review of the facility's policy titled, Charting and Documentation, dated 7/17, indicated, Documentation in the medical record will be objective ., complete, and accurate. 056098 Page 2 of 4 056098 07/11/2023 Cottonwood Healthcare Center 625 Cottonwood Street Woodland, CA 95695

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 ensure professional standards were met for following physician orders for one of three sampled residents (Resident 1) when an as needed medication (PRN) was not given as ordered. Residents Affected - Few This failure had the potential to jeopardize Resident 1 ' s health and safety by increasing abdominal pain, abdominal cramping, and possible bowel perforation from a fecal (stool) impaction. Findings: A review of an admission record indicated Resident 1 was re-admitted to the facility in April 2023. During a record review of Documentation Survey Report, Resident 1 had no documented bowel movements from: February 18-24, 2023 (7 days); March 10-13, 2023 (4 days); March 15-20, 2023 (6 days); and, April 14-17 (4 days). Review of Resident 1's physician's orders showed the following as needed bowel care orders: 1. Bisacodyl (medication to promote bowel movement) .every 24 hours .if no results from MOM (milk of magnesia, medication to promote bowel movement) in 8 hours. 2. Bisacodyl .every 24 hours .if no BM (bowel movement) in 3 days. 3. Fleet Enema .every 24 hours .if no result from Dulcolax (bisacodyl) .if no result from enema in 6 hours call MD (physician). 4. MOM .every 24 hours .if no BM x 3 days. 5. Senna .every 24 hours .as needed for constipation. During these time periods, as needed laxative medications (medication to assist in having a bowel movement) were not given as ordered by the physician (MD). A review of Resident 1 ' s Medication Administration Record indicated the following regarding bowel movements: From February 18-24, 2023, Bisacodyl 10mg (milligram, and unit of measure) suppository was not administered PRN per physician orders. Fleet Enema (a solution inserted rectally to aid in constipation and produce a bowel movement) PRN was not administered per physician orders. Senna (a laxative medication) 2 tabs (tablets) PRN were not administered per physician orders. 056098 Page 3 of 4 056098 07/11/2023 Cottonwood Healthcare Center 625 Cottonwood Street Woodland, CA 95695

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few From March 10-13, 2023, Bisacodyl 10mg suppository was not administered PRN per physician orders. Fleet Enema PRN was not administered per physician orders. Senna 2 tabs PRN were not administered per physician orders. From March 15-20, 2023, Bisacodyl 10mg suppository was administered on the sixth day of Resident 1 having no bowel movements. Fleet Enema PRN was not administered per physician orders. Senna 2 tabs was administered on the sixth day of Resident 1 having no bowel movements. From April 14-17, 2023, [Magnesium Hydroxide] (an oral laxative) 30ml (milliliters) by mouth daily PRN if no bowel movements over 3 days was not administered per physician orders. Bisacodyl 10mg suppository was not administered PRN if no results from [Magnesium Hydroxide] per physician orders. Fleet Enema was not administered PRN per physician orders daily if no results from [Senna]. During an interview on 7/11/23 at 2:35 p.m. with Certified Nursing Assistant 2 (CNA 2), CNA 2 stated that she documents the resident ' s bowel movements (BM) in the chart and if she notices that the resident hasn ' t had a BM, she will notify the LN to possibly give the resident medication or increase fluid intake. During an interview at 7/11/23 at 3:14 p.m. with Licensed Nurse 1 (LN 1), LN 1 stated if she was told that a resident hadn ' t had a BM for several days, she would start to give a laxative or stool softener and assess bowel sounds (sounds of air or fluids moving through the intestines). LN 1 stated she would also notify the MD if the medications were ineffective in helping the resident have a BM. In an interview on 7/13/2023 at 1:03 p.m. with the Administrator (ADM), ADM stated that there is not a policy on BM, but the policy is to follow the physician (MD) orders and her expectation is for the staff to follow the MD orders and notify the MD if the laxative medicines did not produce any results. 056098 Page 4 of 4