Health inspection·April 21, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a comprehensive and person-centered care plan for one of four sampled residents (Resident 1) to address the resident's refusal to participate in physical therapy (PT) exercises as ordered by the physician. This deficient practice had the potential to result in a delay or lack or provision of necessary care and services for Resident 1. During a review of Resident 1's Face Sheet, the Face Sheet indicated Resident 1 was originally admitted to the facility on [DATE] with diagnoses including cerebral infarction (damage to tissues in the brain due to a loss of oxygen to the area), muscle weakness and difficulty in walking (uncontrollable walking patterns). During a review of Residents 1's Minimum Data Set ([MDS], a standardized assessment and care screening tool) dated 2/28/2023, the MDS indicated Resident 1 was able to usually be understood by others and required extensive assistance (resident involved in activity, staff provide weight-bearing support) for Activity's of daily living (ADL's) such as bed mobility, transfer, walking, eating, personal hygiene and toileting. During a review of Resident 1's Physician Orders dated 2/10/2023, 3/30/2023, the Orders indicated Resident 1 was to continue skilled PT services daily (QD) x 4 weeks and QD 3 times a week (TID) for 4 weeks consecutively. The orders also indicated treatment (TX) diagnosis (Dx) of difficulty in walking to include therapeutic exercises, therapeutic activity, (the systematic and planned performance of body movements or exercises to improve and restore function), neuro re-education (activities for balance and core control), gait training (walking on a treadmill and completing muscle strengthening activities) and wheelchair mobility training. During a concurrent record review and interview on 4/21/2023 at 11:40 a.m. with Director Of Rehabilitation Services (DOR), Resident 1's Physical Therapy Treatment Encounter Notes were reviewed. The PT notes indicated the following: 1. On 2/10/2023 at 3:09 p.m., Resident 1 refused to perform any standing activity. 2. On 2/17/2023 at 3:20 p.m., Resident 1 refused sit to stand, walk 10 feet and bed/chair transfer. 3. On 3/27/2023 at 3:20 p.m., Resident 1 refused sit to stand and chair/bed transfer Page 1 of 2 056167 056167 04/21/2023 Centinela Skilled Nursing & Wellness Centre West 950 Flower Street Inglewood, CA 90301

F 0656 4. On 4/4/2023 at 4:22 p.m., Resident 1 refused sit to stand and chair/bed transfer. Level of Harm - Minimal harm or potential for actual harm DOR stated, when residents refused therapy, the facility would conduct an interdisciplinary (IDT) meeting and develop a care plan. DOR stated, developing of care plan was very important because the care plan would indicate interventions, goals, and solutions for Resident 1 to participated in therapy. DOR stated, it was important to find solutions in order to reduce the risk of the resident losing her strength. Residents Affected - Few During a review of Resident 1's Care Plans, there were no care plans documented to address Resident 1's refusal of PT services. During an interview on 4/21/2023 at 12:30 p.m. with Director of Nursing (DON), DON stated, Care Plans were the basis of care for residents, and it was essential because we put goals and interventions that the facility needed to follow for resident care. DON stated, it was very important to develop a care plan for Resident 1 refusing therapy to help provide staff guidance of care in order to improve Residents 1 ability to walk and be able to return back home. During a review of facility's policy and procedure (P&P) titled, Comprehensive Person-Centered Care Panning. Dated 11/2018, the P&P indicated, it was the policy of the facility to provide person-centered, comprehensive, and interdisciplinary (IDT) care that reflected best practice standards for meeting health, safety, psychosocial, behavioral, and environmental needs of residents to obtain or maintain the highest physical, mental and psychosocial well-being. The P&P also indicated the comprehensive care plan would be periodically reviewed and revised by IDT after each assessment, at the onset of new problems, change in condition, to address changes in behavior and care, and other times as appropriate or necessary. 056167 Page 2 of 2