Health inspection·April 1, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure intravenous (IV - fluids/medication given directly into the bloodstream) antibiotic medications was provided according to the physician's orders upon discharge from the General Acute Hospital (GACH), for one of five residents (Resident A). Residents Affected - Few This failure resulted in Resident A not receiving the IV antibiotics as prescribed, and needed to extend the IV medication to address Resident A's infection. Findings: On March 6, 2025, at 10:30 a.m., an unannounced visit was conducted for the investigation of a complaint for quality of care. On March 6, 2025, at 11:15 a.m., a review of Resident A's medical record was conducted. Resident A's admission Record, indicated Resident A was admitted to the facility on [DATE], with diagnoses which included sepsis (a life-threatening blood infection), bacteremia (bacteria in the blood stream), and xenogenic heart valve (a type of tissue from another species - a pig or a cow). A review of Resident A's Extended Care Facility admission Orders and Transfer (Discharge) Summary, dated December 8, 2024, at 1:20 p.m., indicated, .will continue with prolonged IV ampicillin (medication to treat infection) 2 G (gram - a unit of measurement) q (every) 6 (six) hours and IV Ceftriaxone (medication to treat infection) 2 g (gram) q (every)12 hours until 1/11/25 (January 11, 2025) via PICC (peripherally inserted central catheter - a thin flexible tube inserted into a vein in the upper arm and threaded into a larger vein near the heart). Close follow up with infectious disease . A review of Resident A's Physician's Progress Notes, dated December 20, 2024, by [name of physician], indicated, .continue Ampicillin 2G (gram) IV q (every) 4 hrs (hours) .Continue Ceftriaxone 2G (gram) IV q(every)12 hrs (hours)-Continue both for 6 (six) weeks from 11/30/24 (November 30, 2024) . A review of Resident A's Order Summary Report, included the following physician's orders: - .Ampicillin Sodium Injection Solution Reconstituted 1 GM .Use 2 gram intravenously every 6 (six) hours for BACTEREMIA until 1/13/2025 (January 13, 2025) ., date ordered December 8, 2024; - .Ampicillin Sodium Injection Solution Reconstituted 1 GM .Use 2 gram intravenously every 6 (six) hours for BACTEREMIA for 4 (four) days ., date ordered December 9, 2024; - .Ampicillin Sodium Injection Solution Reconstituted 1 GM .Use 2 gram intravenously every 6 (six) Page 1 of 3 056214 056214 04/01/2025 Ramona Rehabilitation and Post Acute Care Center 485 W. Johnston Avenue Hemet, CA 92543

F 0684 hours for Bacteremia until 01/11/2025 (January 11, 2025) ., date ordered December 30, 2024; Level of Harm - Minimal harm or potential for actual harm - .Ampicillin Sodium Injection Solution Reconstituted 1 GM .Use 2 gram intravenously every 6 (six) hours for Bacteremia until 01/31/2025 (January 31, 2025) ., date ordered January 14, 2025; Residents Affected - Few - .Ampicillin Sodium Injection Solution Reconstituted 1 GM .Use 2 gram intravenously every 6 (six) hours for Bacteremia until 02/01/2025 (February 1, 2025) ., date ordered January 19, 2025; and - .Ceftriaxone Sodium Intravenous Solution Reconstituted 2 GM .Use 2 gram intravenously every 12 hours for bacteremia unitl January 13, 2025 .for 34 days , date ordered December 8, 2024. A review of Resident A's Medication Administration Record (MAR), for the month of December 2024 and January 2025, indicated Ceftriaxone IV was not documented as administered on the following dates and times: - December 11, 2024, at 9:00 p.m.; - December 16, 2024, at 9:00 p.m.; - December 31, 2024, at 9:00 p.m.; - January 9, 2024, at 9 a.m. A review of Resident A's MAR, for the month of December 2024, and January 2025, indicated Ampicillin IV was not documented as administered on the following dates and times: - December 14, 2024, starting 6 p.m. to December 30, 2024, at 6 a.m. (total of 64 doses); - December 30, 2024, at 6 p.m.; - January 9, 2025, at 12 p.m.; - January 19, 2025, at 12 p.m.; and - January 22, 2025, at 12 p.m. A review of Resident A's care plans indicated the following: - IV therapy for severe sepsis, dated December 10, 2024, Interventions: Ampicillin as ordered, Ceftriaxone as ordered, monitor the site for edema, redness-report abnormal to medical doctor; and - Risk for infection related to Diagnosis, severe sepsis, dated December 10, 2024, Interventions: administer antibiotics therapy as ordered. A review of Resident A's Progress Notes/ Discharge Summary, dated February 1, 2025 (by primary provider) indicated, .pt (patient) finished 6 (six) weeks if IV Rocephin (Ceftriaxone) as recommended. Her IV Ampicillin was cut short prematurely but restarted so that she completed 6 weeks of IV Ampicillin .significant development that occurred during SNF (skilled nursing facility) stay: Interruption of IV Ampicillin before the end of 6 weeks of treatment so restarted . 056214 Page 2 of 3 056214 04/01/2025 Ramona Rehabilitation and Post Acute Care Center 485 W. Johnston Avenue Hemet, CA 92543

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On March 6, 2025, at 2:05 p.m., an interview and concurrent record review was conducted with the Assistant Director of Nursing (ADON). The ADON stated IV orders were given to the Registered Nurse (RN) and placed on a white board at station one with the times the medication was due and stop dates. The ADON stated to keep the IV antibiotics on time, when a resident is admitted , the hospital records were reviewed to ensure IV therapy would be continued. The ADON stated the RN supervisor was responsible for adding new residents to the board if admissions or new orders were received. The ADON reviewed Resident A's IV antibiotic orders and stated, a registry night shift RN reviewed Resident A's orders upon admission and did not know why the Ampicillin was changed from 34 days to 4 days the following day. The ADON stated the progress notes from Resident A's doctor, written on December 20, 2024, indicated to continue Ampicillin 2 gm (gram) and the Ceftriaxone 2gm (gram) for 6 (six) weeks, but did not know why the Ampicillin was not restarted until December 30, 2024, and for every 6 hours. On March 6, 2025, at 4:55 p.m., an interview and record review were conducted with the Director of Nursing (DON). The DON stated she reviewed Resident A's notes and did not understand why the Ampicillin was stopped and restarted multiple times; it should have been given consistently for the 34 days it was originally ordered. A review of the undated facility ' s policy and procedure titled, Administering IV Antibiotics, indicated, .safe and effective administration of intravenous (IV) antibiotics in compliance with state and federal regulations .only licensed nurses may administer IV antibiotics .before administration .verify the physician's order in the resident's medical record .document all administration details, including date, time, medication name, dosage, route, infusion rate, and any observed reactions. Assess IV site regularly for signs of infection, extravasation, or complications .report medication errors immediately to the supervisor and physician, document the incident . 056214 Page 3 of 3