Health inspection·March 21, 2024

F 0578 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. 3. A review of Resident #89's admission Record revealed the facility admitted the resident on 10/31/2023. Per the admission Record, Resident #89 was their own responsible party. Residents Affected - Few A review of Resident #89's quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 02/06/2024, revealed the resident had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident was cognitively intact. In an interview on 03/20/2024 at 3:25 PM, Resident #89 stated no one from the facility had talked with them about advance directives. In an interview on 03/21/2024 at 8:13 AM, the Director of Nursing stated she did not have much detail about advance directives. In an interview on 03/21/2024 at 8:58 AM, the Administrator stated advance directives should be discussed during the admission progress. Based on record reviews, review of the facility policy, and interviews, the facility failed to ensure there was documented evidence to indicate advance directives were discussed during the admission process for 3 (Residents #11, #31, and #89) of 5 sampled residents reviewed for advance directives. Findings included: A review of the facility policy titled, Advance Directives, reviewed in December 2020, revealed, Long Term Care Residents 1. During the admitting process the patient/family and/or surrogate decision maker will be asked if he/she has executed an Advance Healthcare Directive. This information will be recorded on the admission form and forwarded to Social Services. 1. A review of Resident #11's admission Record revealed the facility admitted to the resident on 06/15/2016. Per the admission Record, Resident #11 was their own responsible party. A review of Resident #11's quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 01/09/2024, revealed Resident #11 had a Brief Interview for Mental Status (BIMS) score of 13, which indicated the resident was cognitively intact. In an interview on 03/19/2024 at 11:51 AM, the social services (SS) staff person stated she was responsible for offering the advance directive form to the residents and/or their responsible party and for the discussion/education of the details with the resident and/or their responsible party. The Page 1 of 3 056155 056155 03/21/2024 Oakdale Nursing and Rehabilitation Center 275 South Oak Avenue Oakdale, CA 95361

F 0578 Level of Harm - Minimal harm or potential for actual harm SS staff person stated Resident #11 refused to complete the advance directive form and she had no documentation to indicate the resident's refusal. In an interview on 03/20/2024 at 10:22 AM, the Director of Nursing stated she could not speak about the details of the advance directive process. Residents Affected - Few In an interview on 03/20/2024 at 10:40 AM, the Administrator stated he expected SS to offer advance directives information to residents and their responsible party. In an interview on 03/20/2024 at 11:02 AM, Resident #11 stated the facility had not offered information about advance directives. 2. A review of Resident #31's admission Record revealed the facility admitted the resident on 03/20/2021. Per the admission Record, Resident #13 was their own responsible party. A review of Resident #31's quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 02/28/2024, revealed Resident #31 had a Brief Interview for Mental Status (BIMS) score of 13, which indicated the resident was cognitively intact. In an interview on 03/19/2024 at 11:51 AM, the social services (SS) staff person stated she was responsible for offering the advance directive form to the residents and/or their responsible party and for the discussion/education of the details with the resident and/or their responsible party. The SS staff person stated Resident #13 declined to complete the advance directive form and she had no documentation to indicate the resident's refusal. In an interview on 03/20/2024 at 10:22 AM, the Director of Nursing stated she could not speak about the details of the advance directive process. In an interview on 03/20/2024 at 10:40 AM, the Administrator stated he expected SS to offer advance directives information to residents and their responsible party. In an interview on 03/20/2024 at 10:49 AM, Resident #31 stated they had not been offered information about advance directives by the facility. 056155 Page 2 of 3 056155 03/21/2024 Oakdale Nursing and Rehabilitation Center 275 South Oak Avenue Oakdale, CA 95361

F 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Potential for minimal harm Based on interviews and document review, the facility failed to ensure the activity program was directed by a qualified professional. This deficient practice affected all 99 residents who currently resided in the facility. Residents Affected - Many Findings included: A review of the Job Description & Competency Evaluation, for the Director of Activities, updated 01/16/2019, revealed Position Qualifications: Minimum Education: Completion of a rehabilitation/recreational therapy course work High school graduate or equivalent required. In an interview on 03/19/2024 at 8:24 AM, Activity Assistant (AA) #3 and AA #4 revealed the Administrator was the Activity Director (AD). In an interview on 03/20/2024 at 11:18 AM, the Administrator stated he understood the responsibility for the requirement to be an activity professional. The Administrator acknowledged he was not eligible for certification as a therapeutic recreation specialist or activity professional, he did not possess two years of experience in a social or recreational program within the last five years, he was not a qualified occupational therapist or occupational therapist assistant; and he had not completed a training course approved by the state. In an interview on 03/20/2024 at 12:27 PM, the interim Human Resources Manager stated the facility terminated the employment of the previous AD on 02/02/2024. In an interview on 03/21/2024 at 8:13 AM, the Director of Nursing stated the Administrator was appointed the AD by the chief financial officer and chief executive officer after several employees were laid off. In a follow-up interview on 03/21/2024 at 9:31 AM, the Administrator stated he was aware of the training course since the AD was terminated; however, he had not had time to complete the course. 056155 Page 3 of 3