Health inspection·January 30, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to follow physician orders and adhere to its medication administration policy and procedures for one of two sampled residents (Resident 1) when: Residents Affected - Few 1. Staff did not seek physician clarification for a potential frequency change for a Lactulose (a medication which can be used to reduce the amount of ammonia in the blood of residents with liver disease) order when Resident 1 did not have four bowel movements in a day. 2. Staff did not notify Resident 1's physician of their continued inability to obtain an ordered medication of Rifaximin (An antibiotic that is used to treat and prevent complications in patients with cirrhosis). 3. Staff did not check Resident 1's blood pressure or heartrate prior to the administration of Propranolol (a medication used to treat high blood pressure). These failures had the potential to lead to negative outcomes for Resident 1. Findings: 1.During a review of Resident 1's admission Record undated, indicated in part, Resident 1 had diagnoses including cirrhosis of the liver (a chronic liver disease characterized by the formation of scar tissue that replaces healthy liver tissue), hepatic encephalopathy (a brain dysfunction that occurs when a damaged liver fails to filter toxins from the blood), ascites (a condition where excess fluid accumulates in the abdominal cavity), and hypertension (a condition where the blood vessels have consistently elevated blood pressure). During a concurrent record review and interview, on 1/24/25, starting at 2:12 p.m., with Certified Nursing Assistant (CNA 1) and the Director of Nursing (DON 1), Resident 1's medical record was reviewed. Resident 1 had a physician order for Lactulose Oral Solution 10 GM (grams)/15ML (milliliters) (Lactulose) give 30 ml by mouth every four hours for liver disease increase or decrease frequency toward goal of four bowel movements per day. The CNA 1 confirmed Resident 1 had two bowel movements on 12/22/24, two bowel movements on 12/23/24, and two bowel movements on 12/24/24. The DON 1 verbalized Resident 1's physician should have been notified on those dates when Resident 1 had less than 4 bowel movements a day to inquire if a frequency change in the order was needed. The DON 1 could not provide documentation indicting this was done. 2. During a concurrent record review and interview, on 1/24/25, with Licensed nurse (LN 1) and DON 1, Resident 1's Medication Administration Record (MAR) was reviewed. Resident 1's MAR indicated in Page 1 of 2 056379 056379 01/30/2025 Oxnard Manor Healthcare Center 1400 West Gonzales Road Oxnard, CA 93036

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few part, a physician order for Rifaximin Oral Tablet 200 MG (Rifaximin) Give two tablet by mouth three times a day for Cirrhosis of Liver. The medication start date was 12/20/24. The LN 1 verbalized that this medication was placed on hold due to the pharmacy not having the medication and that Resident 1's physician was notified of it on 12/20/24. The LN 1 verbalzied the oncoming nurses should have followed up with the pharmacy and kept Resident 1's physician informed of the continued unavailability of the medication. The DON 1 confirmed there was no documentation indicating from 12/21/24 through 12/25/24, staff had informed Resident 1's physician of the continued absence of the Rifaximin or had followed up with the pharmacy about obtaining the Rifaximin for Resident 1. 3. During a concurrent record review and interview, on 1/24/25, at 2:56 p.m., with the DON 1, Resident 1's MAR was reviewed. Resident 1 had a physician order for Propranolol HCL Oral Tablet 10MG (Propranolol HCL) Give one tablet by mouth two times a day for HTN (Hypertension) hold for SBP (Systolic Blood Pressure) less than 110mmhg (millimeters of mercury) or HR (Heart rate) less than 60 (60 beats per minute). The medication start date was 12/20/24. On eight occasions from 12/20/24 to 12/24/24, facility records indicated the medication was administered without checking Resident 1's heartrate or blood pressure prior to the administration of the medication. The DON 1 verbalzied there was no documentation on those occasions indicating Resident 1's blood pressure or heartrate was checked shortly before the administration of the medication as was ordered by the physician. During a review of the facility's policy and procedure titled Medication-Administration dated 1/12, indicated its purpose was To ensure the accurate administration of medications for residents in the facility. The policy further indicated,Medications and treatments will be administered as prescribed to ensure compliance with dose guidelines .Tests and taking of vital signs, upon which administration of medications or treatments are conditioned, will be performed as required and the results recorded .When administration of the drug is dependent upon vital signs or testing, the vital signs/testing will be completed prior to administration of the medication and recorded in the medical record. 056379 Page 2 of 2