Health inspection·September 13, 2019

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on interview, observation, and record review, the facility failed to accommodate the needs of Residents 45, 120, and 121, three of 18 sampled residents, when they had to wait 15 - 30 minutes for the nurse call lights to be answered by staff. Residents Affected - Few This failure resulted in not meeting the needs of the residents. Findings: 1. Resident 45 was admitted to the facility with diagnoses including difficulty walking, muscle weakness, pressure ulcers on both heels, and depression. The resident's Minimum Data Set (MDS), an assessment tool, indicated some knowledge difficulties, no difficulties understanding or being understood, required a wheelchair/walker for mobility, and two person staff assist for transfer to bed/chair and bed positioning. During an interview on 9/9/19, at 9:35 AM, accompanied by Activity Director, Resident 45 was seated in his wheel chair in his two bed room and stated his call lights take 15 - 30 minutes for staff to answer and sometimes, they (staff) hang up on me. The resident stated he needs help to use the bathroom and had one or two accidents because staff did not come in time to help him. He stated he told Certified Nurse Aide 1 (CNA) on day shift (7-3 PM shift). But it hasn't gotten any better. He said this happens all the time on the evening shift (3-11 PM). During an interview on 9/9/19, at 10:45 AM, CNA 1 stated Resident 45 had complained about long waits for help on evening shift and had informed Administrator. During an interview on 9/10/19, at 12:35 PM, the Administrator knew of resident's complaints about slow responses to call lights on evening shift. He discussed the matter with staff. He expected an improvement. During an observation of the call light system on 9/9/19, at 2:10 PM, this surveyor stood in front of the nurses station next to Receptionist 1. Resident 45 put his call light on. Receptionist 1 answered the call light, on interoffice phone, replied quickly and unclear, and hung up. She did not wait to hear resident's response. The resident could not hear the receptionist's reply. 2. Resident 120 was admitted to the facility with diagnoses including intestinal surgery, anemia, kidney disease, muscle weakness, gait abnormalities (unsteady walking), and mobility issues. The residents Minimum Data Set (MDS), an assessment tool, indicated minimal knowledge difficulties, no difficulties understanding or being understood, required wheelchair or walker for mobility and one person staff assist for transfer to bed/chair. Page 1 of 3 056205 056205 09/13/2019 Pacifica Nursing and Rehabilitation Center 385 Esplanade Avenue Pacifica, CA 94044

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 9/9/19, at 10:20 AM, Resident 120 was seated in his wheelchair in his room. He stated he waits up to 20 minutes for help to the bathroom. He stated the staff don't want him to walk to the bathroom without assistance but he can't wait 20 minutes for help. He said it happens often on the evening shift. During an interview on 9/10/19, at 12:35 PM, the Administrator knew of resident's complaints about long wait time on call lights during evening shift and stated he discussed the matter with staff. After talking with staff he expected an improvement. 3. Resident 121 was admitted to the facility with diagnoses including back surgery, difficulty walking, muscle weakness, pulmonary disease, and anxiety disorder. The resident's Minimum Data Set (MDS), an assessment tool, indicated slight knowledge difficulties, no difficulties understanding or being understood, required wheelchair or walker for mobility, and required one person staff assist for bed positioning and transfer to bed/chair. During an interview on 9/9/19, at 12:20 PM, Resident 121 was lying in bed, in a crowded four bed room, watching television. The resident stated that she waits up to 20 minutes for help to the bathroom during the evening shift. Resident also stated when she puts her call light on staff answer 'A' bed instead of hers, 'B' bed. And then they leave without checking whose light was on. During a concurrent interview and observation Resident 121 pressed her call light to show what she meant. The light went on outside the room, above the door, and on the wall, next to residents 'B' bed. The outside light is a single red light with dividers for each bed. Certified Nurse Aide 2 (CNA) went to 'A' bed, the first bed in the room, not to 'B' bed, and did not check whose light was on. During an interview on 9/10/19, at 12:35 PM, the Administrator knew of resident's complaints about long waits for call lights, during evening shift, and stated the matter was discussed with staff. After talking with staff he expected an improvement. Review of undated policy and procedure on Call System, Purpose: To provide a mechanism for residents to communicate to staff a need for assistance .Procedure: .3. Answer call bells promptly .4. Always be courteous when responding to a request for assistance .6. Listen to resident's request. Do not make him/her feel that you are too busy to help. 7. Respond to request .8. Return to resident with item or reply promptly .11. Routine calls should be answered within three minutes . 056205 Page 2 of 3 056205 09/13/2019 Pacifica Nursing and Rehabilitation Center 385 Esplanade Avenue Pacifica, CA 94044

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to label medications in accordance with acceptable professional standards when medications and biologicals were not dated after opening. This failure had the potential for residents to receive medications that are not effective, and for test results to be inaccurate which could lead to compromised health. Findings: During an observation of medication cart 2 on the second floor, on 9/10/19 at 10:45 AM, the following were noted: an opened and undated vial of Levemir (medication to lower blood sugar) in the left upper drawer; an opened, and undated vial of Novalog (medication to lower blood sugar) in the left upper drawer; and, an opened and undated plastic bottle of glucometer test strip (a plastic strip for blood/control testing). During an interview with Registered Nurse (RN) 1 on 9/10/19 at 12 noon, RN 1 acknowledged that the Levemir, Novalog vials, and the test strip bottle were opened and undated. RN 1 stated, They should have been dated when they were opened. During an interview with the Director of Staff Development (DSD) on 9/10/19, the DSD acknowledged the observation and stated, Staff were trained to date the medication upon opening during in-service. During an observation of medication cart 4 on the 3rd floor and concurrent interview on 9/12/19 at 1:30 PM, an opened and undated green top bottle of quality control solution (a solution to test the accuracy of blood sugar machine and test strips) was in the right top drawer. RN 2 acknowledged the opened bottle was not dated. RN 2 stated, It should have been dated when opened. The DSD stated, Staff were trained to date the medication upon opening during in-service. During an interview with the Director of Nursing (DON) on 9/13/19 at 11:17 AM, she stated, I've been telling them to date the medication bottles when they open. During a review of the facility policy and procedure titled, Medication Ordering and receiving From Pharmacy Provider Medication Labels, it indicated, .2. Multi-dose vials shall be labeled to assure product integrity, considering the manufacturer's specifications. (Example: Modified expiration dates upon opening the multi-dose vial.) . 056205 Page 3 of 3