Health inspection·August 15, 2023

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 two of three sampled Hospice (end of life care) residents (Residents 1 and 2), were free from unnecessary medications when: Residents Affected - Few 1. Resident 1 was ordered morphine sulfate (an opioid narcotic), without adequate indications of what level of pain (mild, moderate or severe), this medication was expected to treat. 2. Resident 2 was ordered Dilaudid (an opioid narcotic), without adequate indications of what level of pain the medication was expected to treat. This failure had the potential for Licensed Nursing (LN) to administer too much pain medication which could lead to over sedation and negative clinical outcomes, or give too little and subject the residents to uncontrolled pain, which could have a negative psychosocial and emotional impact on the quality of end of life care that Residents 1 and 2 received. Findings: 1. A review of the facility's policy and procedure titled, Medication Orders , revised 5/1/10, indicated, When recording PRN pain medication orders, specify: the type, route, dosage, frequency, strength, and reason for administration. A review of Resident 1's record indicated that she was admitted to the facility on [DATE] for Hospice care with the diagnosis of congestive heart failure, (heart does not pump blood as it should). Resident 1 was not capable of making her own health care decisions. During a review of Resident 1's Order Summary Report Active Orders, dated 8/15/23, the Order Summary Report Active Orders , indicated, Resident 1 had been ordered morphine sulfate (concentrate) oral solution 20MG/ML (unit of measure, MG, milligrams, ML, milliliters), give 0.25 ml by mouth every one hour as needed for pain and SOB [shortness of breath] , on 7/29/23. The order had not included if this dose was for mild, moderate or severe pain and indicated that there was only one dose for all levels of pain. During a concurrent interview and record review, on 8/15/23 at 9:52 am, with LN A, Resident 1's Orders were reviewed. LN A confirmed the Orders indicated that Resident 1 had been prescribed morphine sulfate 0.25 ml by mouth every one hour as needed for pain and SOB. LN A stated Resident 1 was on Hospice and the morphine order did not need to identify what level of pain it was expected to treat. 2. A review if Resident 2's records indicated admission to the facility 8/2/23 for Hospice care Page 1 of 2 056222 056222 08/15/2023 Marquis Care at Shasta 3550 Churn Creek Rd. Redding, CA 96002

F 0757 with the diagnosis of bone cancer and lung cancer. Resident 2 had good cognition and was her own RP. Level of Harm - Minimal harm or potential for actual harm During a review of Resident 2's, Order Summary Report Active Orders, dated 8/15/23, the record indicated, Resident 2 had been ordered, dilaudid oral liquid 1MG/ML give two mg by mouth every two hours as needed for pain or SOB. The order had not included whether this dose was to relieve mild, moderate or severe pain and indicated that all levels of pain were to be treated with this one dose. Residents Affected - Few During a concurrent interview and record review on 8/18/23 at 9:42 am, with LN C, Resident 1's Orders were reviewed. LN C confirmed that the Orders indicated, Resident 2 had been prescribed Dilaudid oral liquid, give 2 mg by mouth every two hours and had not included whether this was to relieve mild, moderate or severe pain. LN C stated Resident 2 was on Hospice and parameters for when and how to use Dilaudid was not required. During a concurrent interview and record review on 8/15/23 at 10:00 am, with LN B, Resident 1's, Order Summary Report Active Orders, dated 8/15/23, and Resident 2's Order Summary Report Active Orders, dated 8/15/23, were reviewed. LN B confirmed Resident 1's morphine sulfate order as written, was supposed to cover any pain level, mild, moderate and severe, and that the pain medication order should have been specific as to what level of pain it was expected to treat. During a concurrent interview and record review on 8/15/23 at 12:21 pm, with Resident Care Manager (RCM), Resident 1's, Order Summary Report Active Orders, dated 8/15/23, and Resident 2's Order Summary Report Active Orders, dated 8/15/23, were reviewed. RCM confirmed Resident 1 and 2's orders for pain medication had not covered pain management for all three levels of pain, mild, moderate and severe, and should have. RCM confirmed that the pain medication orders indicated that Resident 1 and 2 only had one option for pain relief, regardless of how bad the pain was. 056222 Page 2 of 2