Health inspection·July 8, 2025

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide laboratory services in a timely manner as ordered by a nurse practitioner (NP - a registered nurse with advanced training who can diagnose illnesses, prescribe medications, and manage patient care, often acting as a primary care provider) for one of three sampled residents (Resident 1). This deficient practice had the potential to delay necessary treatment and services to Resident 1.Findings:During a review of Resident 1's admission Record, the admission Record indicated the facility admitted the resident on 5/1/2025 with diagnoses including disorder of thyroid (occur when the thyroid produces too much or too little thyroid hormone, impacting your body's metabolism and overall function), diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), and obesity (a medical condition where someone has too much body fat). During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 5/7/2025, the MDS indicated Resident 1's cognition (mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was severely impaired. The MDS further indicated that Resident 1 was totally dependent on staff for oral/toileting/personal hygiene, upper/lower body dressing, and bed mobility.During a review of Resident 1's Change in Condition (CIC - a significant alteration in a person's health, caregiver support, or functional status that will not usually resolve itself without further intervention) Evaluation dated 6/30/2025, the CIC Evaluation indicated that Resident 1 had three episodes of diarrhea with foul (means something unpleasant or offensive) smell, and Resident 1's NP visited the resident and ordered the following: labs (medical procedures that involves testing a sample of blood, urine, or other substance from the body), banatrol (anti-diarrheal solution to provide nutrients for the dietary management of diarrhea formulated to provide nutrients for the dietary management of diarrhea), and a registered dietician (RD - a health professional who has special training in diet and nutrition) consult.During a review of Resident 1's Physician Order dated 7/1/2025, the physician order indicated an order to collect Resident 1's stool.During a review of Resident 1's Progress Notes dated 7/1/2025 at 12:16 a.m., the Progress Notes indicated that Resident 1's stool was collected and stored in the refrigerator.During a review of Resident 1's Lab Result Report dated 7/6/2025 timed at 8:05 p.m., the Lab Results Report (LRR) indicated that the stool was collected on 7/3/32025 and resulted in positive for clostridium difficile (C. diff- a highly contagious bacteria that causes severe diarrhea) toxins on 7/6/2025. During a concurrent interview and record review on 7/8/2025 at 2:40 p.m. with the Infection Prevention Nurse (IPN), reviewed Resident 1's Progress Notes and Lab Results Report dated 7/6/2025. The IPN stated that the antibiotic medication should be started only after a positive C. diff result is confirmed. However, the first stool specimen collected from Resident 1 on 7/1/2025, was not picked up by the laboratory, and there was a delay in obtaining a second specimen. The IPN stated this led to a delay in confirming the C. diff diagnosis and subsequently starting the necessary antibiotic treatment. During a concurrent interview and record review on 7/8/2025 at 3:02 p.m. with the Residents Affected - Few Page 1 of 2 056124 056124 07/08/2025 Tarzana Health and Rehabilitation Center 5650 Reseda Blvd Tarzana, CA 91356

F 0770 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Director of Nursing (DON), reviewed Resident 1's Progress Notes. The DON stated that Resident 1's stool specimen was collected and stored in the refrigerator on 7/1/2025. However, the laboratory did not pick up the specimen and there was a delay in obtaining the second stool specimen. The DON stated the stool specimen was sent out on 7/3/2025 and a positive C.diff test result was received on the evening of 7/6/2025, indicating the need for antibiotic treatment. The DON further stated vancomycin (medication to treat infection) was started on 7/7/2025. During a review of the facility's policy and procedure (P&P) titled, Laboratory Services and Reporting last reviewed on 4/24/2025, the P&P indicated, The facility must provide or obtain laboratory services when ordered by a physician, physician assistant, nurse practitioner, or clinical specialist in accordance with state law. The facility is responsible for the timeliness of the services.During a review of the facility's P&P titled, Culture and Sensitivity Lab Results last reviewed on 4/24/2025, the P&P indicated, The Nurse receiving the order for culture and sensitivity shall communicate the order to the oncoming nurse, 056124 Page 2 of 2