Health inspection·June 25, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the call light was within reach for one of three sampled residents, (Resident 2). Residents Affected - Few This failure had the potential to result for Resident 2's needs being unmet, and the inability to call for help. Findings: On June 25, 2024, at 10:36 a.m., an unannounced visit to the facility was conducted to investigate a complaint regarding quality of care issue On June 25, 2024, at 12:59 p.m., observed Resident 2 lying in bed on his back, with eyes closed, respirations even and unlabored. Resident 2's call light was observed on the left side of his bed on the ground, not within resident's reach. On June 25, 2024, at 1:05 p.m., a concurrent observation and interview were conducted with the Certified Nursing Assistant (CNA). The CNA observed Resident 2's call light on the floor, on the left side of the bed. The CNA picked up the call light up and placed it on the left side of Resident 2's bed. The CNA stated that call lights should be within reach and Resident 2's call light was not within reach, when it was on the floor. A review of Resident 2's medical records indicated he was admitted to the facility on [DATE], with diagnoses of encounter for surgical aftercare following surgery on the genitourinary system, chronic kidney disease, stage four, (the kidneys are severely damaged and unable to filter waste), atrial fibrillation, (irregular heart beat), pressure ulcer of sacral region, stage 2, bilateral primary osteoarthritis, (a progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints) of knee, Alzheimer's disease, (progressive mental deterioration that can occur in middle or old age, due to generalized degeneration of the brain), and vascular dementia, (a decline in thinking skills caused by conditions that block or reduce blood flow to various regions of the brain). Resident 2's History and Physical dated June 9, 2024, indicated he did not have the capacity to understand and make decisions. A review of Resident 2's Care Plan dated June 9, 2024, indicated Focus .has an alteration in musculoskeletal status r/t (related to) .OA, (osteoarthritis), of knees Be sure call light is within reach and respond promptly . Page 1 of 4 056214 056214 06/25/2024 Ramona Rehabilitation and Post Acute Care Center 485 W. Johnston Avenue Hemet, CA 92543

F 0558 A review of the facility's policy and procedure titled Call System revised November 2022, indicated .2. Make sure call cords are placed within the resident's reach at all times . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 056214 Page 2 of 4 056214 06/25/2024 Ramona Rehabilitation and Post Acute Care Center 485 W. Johnston Avenue Hemet, CA 92543

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the Treatment Nurse (TN), followed infection control guidelines when she did not perform hand hygiene after removing contaminated gloves and prior to donning clean gloves for during wound care for one of three residents, (Resident 5). Residents Affected - Few This failure had the potential to contaminate the TN's hands and the resident's wounds. Findings: On June 25, 2024, at 2:18 p.m., the Treatment Nurse, (TN) was observed providing skin care to Resident 5. The TN placed a sterile drape with Triamcinolone Acetonide External Cream 0.1% (a topical steroid that helps lessen skin rash and irritations) in a medicine cup on Resident 5's overbed table, located on the left side of Resident 5's bed. The TN donned clean gloves, removed Resident 5's socks, used a body wipe to clean under Resident 5's breasts, groin, and abdominal fold, changing gloves between each area. The TN applied the cream to these areas and to Resident 5's buttocks and sacral area after assisting the resident to turn. The TN removed her gloves, discarded the sterile drape, and lef the room. The TN was not observed performing hand hygiene in between glove changes. On June 25, 2024, at 2:26 p.m., an interview was conducted with the TN. The TN stated that she should have performed hand hygiene after removing her gloves and before donning clean gloves. On June 25, 2024, at 2:45 p.m., an interview was conducted with the Infection Preventionist, (IP). The IP stated that the TN should have performed hand hygiene with alcohol-based hand rub before donning clean gloves. A review of Resident 5's medical record indicated she was admitted to the facility on [DATE], with diagnoses cellulitis, (infection of the skin and the tissues beneath the skin),of right and left lower limb, fracture, (broken bone) of second and third lumbar (lower back) vertebra, and chronic obstructive pulmonary disease, (COPD - a chronic inflammatory lung disease that causes obstructed airflow from the lungs). A review of Resident 5's History and Physical dated June 7, 2024, indicated she had the capacity to make decisions. A review of Resident 5's Order Summary Report dated June 6, 2024, indicated: Cleanse redness with Normal Saline, pat dry. Apply Triamcinolone Acetonide External Cream 0.1% every shift for Left Groin. AND every shift for Right Groin. AND every shift for Peri area. AND every shift for Left inner Thigh. AND every shift for Right inner Thigh Cleanse MASD, (Moisture-associated skin damage - occurs when skin is repeatedly exposed to various sources of bodily secretions), with Normal Saline, pat dry. Apply Triamcinolone Acetonide External Cream 0.1 %., every shift for Sacrococcyx. (tail bone) AND every shift for Left Buttock. AND every shift for Right Buttock. A review of the facility's policy and procedure titled Dressings, Dry/Clean revised September 2013, indicated .6. Put on clean gloves. Loosen tape and remove soiled dressing .7. Pull glove over 056214 Page 3 of 4 056214 06/25/2024 Ramona Rehabilitation and Post Acute Care Center 485 W. Johnston Avenue Hemet, CA 92543

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dressing and discard into plastic or biohazard bag . 8. Wash and dry your hands thoroughly .9. Open dry, clean dressing(s) by pulling comers of the exterior wrapping outward, touching only the exterior surface . 12. Wash and dry your hands thoroughly. 13. Put on clean gloves. 14. Assess the wound and surrounding skin for edema, redness, drainage, tissue healing progress and wound stage. 15. Cleanse the wound with ordered cleanser. If using gauze, use clean gauze for each cleansing stroke. Clean from the least contaminated area to the most contaminated area (usually, from the center outward). 16. Use dry gauze to pat the wound dry. 17. Apply the ordered dressing and secure with tape or bordered dressing per order. (Note: Use non-allergenic tape as indicated.) Label with crate and initials to top of dressing. 18. Discard disposable items into the designated container. 19. Remove disposable gloves and discard into designated container. Wash and dry your hands thoroughly . A review of the Centers for Disease Control and Prevention's guidelines titled Clinical Safety: Hand Hygiene for Healthcare Workers updated FEBRUARY 27, 2024, indicated . If your task requires gloves, perform hand hygiene before donning gloves and touching the patient or the patient's surroundings. Always clean your hands after removing gloves . When to change gloves and clean hands . If moving from work on a soiled body site to a clean body site on the same patient or if a clinical indication for hand hygiene occurs . 056214 Page 4 of 4