Health inspection·November 18, 2022

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 80) had an accurate discharge assessment. Resident 80 was discharged to the community. This deficient practice had the potential to cause improper planning for Resident 80's care upon discharge from the facility. Residents Affected - Few Findings: During a review of Resident 80's face sheet on 11/17/22, the face sheet indicated Resident 80 was admitted to the facility in 2022. During a review of Resident 80's discharged summary, dated 9/3/22, the discharge summary indicated under disposition, Resident 80 was discharged to an Assisted Living (a type of housing in a community setting for people who need various levels of medical and personal care). During a review of Discharge Minimum Data Set (MDS - an assessment tool used to direct health care needs) dated, 9/3/22; Section A2100 indicated 03 which meant Resident 80 was discharged to an Acute Care Hospital. During a concurrent interview and record review, with the MDS Coordinator (MDSC), on 11/17/22, at 11:11 a.m., the MDSC stated, the Discharge MDS was inaccurate. The MDSC confirmed, Resident 80 was discharged to Assisted Living. During a review of the facility's policy and procedure (P&P), dated November 2019, the P&P indicated, under policy interpretation and implementation 3. The information captured on the assessment reflects the status of the resident during the observation (look-back) period for that assessment. Page 1 of 9 056381 056381 11/18/2022 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on observation, interview, and record review, for one of 18 sampled residents (Resident 75), the facility failed to develop an individualized nursing care plan to address Resident 75's right and left arm discolorations. This failure had the potential for Resident 75 to have delayed and or inappropriate care. Findings: During an observation on 11/14/22, at 12:13 p.m., observed Resident 75 with multiple purplish marks on their right and left arms. During a concurrent observation and interview on 11/15/22, at 10:33 a.m., with Assistant Director of Nursing (ADON), observed Resident 75's arms. ADON stated Resident 75 had multiple discolorations on their right and left arms. During a record review of Resident 75's Weekly Skin Assessment, dated 10/31/22, the assessment indicated Resident 75 had skin discolorations on both arms and hands. During a concurrent interview and record review on 11/17/22, a 10:12 a.m., with the ADON, reviewed Resident 75's care plans. ADON stated Resident 75 did not have a nursing care plan for their skin discolorations on their right and left arms. ADON stated Resident 75 should have had a nursing care plan for their skin issues. ADON stated Resident 75 needed a nursing care plan for skin issues and skin changes. ADON stated residents were at risk for inappropriate care if they did not have an individualized nursing care plan. During a review of the facility's policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered, revised March 2022, the P&P indicated, Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. 056381 Page 2 of 9 056381 11/18/2022 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to provide appropriate fingernail care for two of 18 sampled residents (Residents 19 and 26). Residents Affected - Few This failure had the potential to cause Residents 19 and 26 injury, pain and infection. During a concurrent observation and interview on 11/15/22, at 10:42 a.m., with Resident 19, Resident 19's fingernails were observed long with dark gray matter under the fingernails of both hands. Resident 19 stated staff had never cut residents fingernails. Resident 19 stated it made them feel upset. During a concurrent observation and interview on 11/15/22, at 11:01 p.m. with Assistant Director of Nursing (ADON), Resident 19's fingernails were observed. ADON stated Resident 19's fingernails were, long and a little dirty. ADON stated Resident 19's fingernails needed to be cut. During an interview on 11/16/22, at 3:07 p.m., with ADON, ADON stated staff should have cleaned Resident 19's fingernails. ADON stated long and dirty fingernails were a risk for infection and pain. During a concurrent observation and interview on 11/15/22, at 11:07 p.m., with ADON, Resident 26's fingernails were observed with dark gray matter under the fingernails of both hands. ADON stated Resident 26's Fingernails were, long and dirty. During an interview on 11/16/22, at 2:57 p.m., with ADON, ADON stated CNAs were supposed to clean resident fingernails. ADON stated Resident 26 could not cut their own fingernails. ADON stated Resident 26's fingernails were not cleaned, and they were missed. ADON stated Resident 26's dirty fingernails were a risk for infection, pain, and injury. During a review of the facility's policy and procedure (P&P) titled, Activities of Daily Living (ADLs), Supporting, revised March 2018, the P&P indicated, Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and oral hygiene. During a review of the facility's policy and procedure (P&P) titled, Fingernails/Toenails, Care of, revised March 2018, the P&P indicated, Nail care includes daily cleaning and regular trimming. 056381 Page 3 of 9 056381 11/18/2022 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility had four medication errors out of 28 medication pass observations which resulted in an error rate of 14.29%. Physician Orders were not followed during medication administration for Resident 67 and 63. For Resident 67, this had a potential to cause poor pain control when Lidocaine 5% patches (a patch with local anesthetic applied to skin to help control pain) were cut in half, and another 1/2 patch was applied on the left knee without physician orders. For Resident 63, Cozaar 50 milligram (mg) tablet (a type of medication that helps manage high blood pressure), was not given and could result in poor management of high blood pressure. Residents Affected - Some Findings: 1. During an observation and interview on 11/15/22 at 08:40 a.m., with Registered Nurse (RN) 1, RN 1 stated they would prepare Resident 67's medications that included Lidocaine 5% patches. RN 1 removed two Lidocaine 5% patches for Resident 67 from the medication cart. RN 1 opened one Lidocaine 5% patch and cut it in half, then wrote the current date and initial. RN 1 opened the second patch and cut it in half. RN 1 stated that they cut the patch in half because it was too big for Resident 67's shoulder. RN 1 stated they will save the half patch for the next day since Resident 67 only needs it in three areas. RN 1 proceeded to Resident 67's room. Resident 67 was lying in bed. RN 1 uncovered the Resident 67's shoulders. RN 1 removed a 1/2 patch from each of Resident 67's shoulders, then RN 1 applied 1/2 patch of Lidocaine 5% to each of Resident 67's shoulders. RN 1 uncovered Resident 67's left knee. RN 1 stated the Lidocaine 5% patch was not applied from the day before. RN 1 applied the 1/2 Lidocaine 5% patch to Resident 67's left knee. Review of Resident 67's Physician Orders (PO) titled Order Summary Report for the month of November 2022 showed Lidocaine Patch 5% Apply to each shoulder topically one time a day for 12 hrs., on at 9 AM, off 9 PM, and Remove Lidocaine patch at 2100 at bedtime with order date of 10/21/22. Resident 67's Order Summary Report did not indicate an order for Lidocaine Patch 5% for their left knee. During an interview on 11/15/22 at 2:44 p.m., with RN 1 said they only applied 1/2 Lidocaine 5% patch on each shoulder, and they applied 1/2 Lidocaine patch on Resident 67's left knee. RN 1 stated the Lidocaine 5% patches were not removed at 9 p.m. RN 1 said the Lidocaine 5% patch were only ordered for Resident 67's shoulders, there was no PO order for the left knee. RN 1 said they should have called the doctor to get an order for Lidocaine 5% patch for the left knee. RN 1 further added that they documented the Lidocaine 5% patch applied on the left knee under Supplementary Documentation under the MAR, and RN 1 did not reply when asked if the PM shift nurse would know to remove the Lidocaine 5% patch on the left knee if there was no PO for it. 2. During an observation and interview on 11/15/22 at 08:00 a.m., with Licensed Vocational Nurse (LVN) 1, LVN stated they needed to check Resident 63's blood pressure then they would start preparing Resident 63's medication. LVN 1 proceeded to check Resident 63's blood pressure and heart rate, Resident 63's BP 135/63 and heart rate 43 beats per minute (bpm). LVN 1 prepared Resident 63's medications that included Cozaar 50 mg tablet given by mouth. LVN 1 stated they would not administer Resident 63's Cozaar 50 mg tablet, since their heart rate was 43 bpm. Review of Resident 63's Physician's Orders titled Order Summary Report for the month of November 2022 showed Cozaar Tablet 50 MG (Losartan Potassium) Give 1 tablet by mouth two times a day for hypertension hold for systolic blood pressure less than 120 and heart rate less 50. 056381 Page 4 of 9 056381 11/18/2022 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0759 Level of Harm - Minimal harm or potential for actual harm During an interview on 11/15/22 at 2:58 p.m., with LVN 1, LVN 1 stated they did not administer Resident 63's Cozaar 50 mg tablet, since their heart rate was 43 bpm. LVN 1 reviewed the PO for Cozaar. LVN 1 stated the order showed and so they should have not held because the systolic BP was 135. LVN 1 stated they should have called the MD to clarify the order first. Residents Affected - Some 056381 Page 5 of 9 056381 11/18/2022 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 did not destroy the controlled substance (CS - drug or other substance that is tightly controlled by the government because it may be abused or cause addiction), to render it unusable after removing them in their individual packaging. This deficient practice could result in a potential case of controlled substance diversion. Findings: During an observation and interview on 11/15/22 at 3:15 p.m., with Director of Nurses (DON) in the presence of Assistant Director of Nurses (ADON) in the DON's office, DON grabbed a gallon sized plastic container with gray colored top from behind their chair. Observed the inside of the container which contained a dark dry substance wrapped in thin plastic, dry whole capsules, and tablets. DON stated that the medications inside the container were the controlled substances that were Destroyed back in October by her and the pharmacist. DON stated when the pharmacist was in the facility, they verified the number of tablets/capsules from the bubble pack or bottle, removed them from the packaging and emptied them into the container. DON stated the pharmacists do not take the destroyed CS, because they have another company that incinerate the waste. Observation of a paper label in front with the manufacturer's name Stericycle CSRX System Container indicated to add water to fill about 1/3 of the container. DON stated they were not aware that they needed to add water in the container. During a review of the facility's document titled Disposal of Controlled Drugs In a Long-Term Facility dated 10/14/22 indicated that the facility had removed the controlled substances from their individual packaging's included different types of narcotics (substance used to treat moderate to severe pain. Narcotics are like opiates such as morphine and codeine, they bind to opioid receptors in the central nervous system) and sedatives (drug or substance that induces sedation to help calm a person down, relieve anxiety) totaling of more than 600 capsules and tablets During a review of Stericycle CSRX System Container manufacturer's instructions on 11/15/2022, instructions indicated the use of the following steps prevent diversion of controlled substance: Secure containers and brackets. One-way disposal path. Deactivation by activated carbon. A bittering additive and solidifier to further deter diversion. Compliant and effective disposal via incineration. The Stericyle CSRX container had to be securely fastened to the wall. When water was added the pods of activated carbon dissolved and when controlled substance was added, the activated carbon will deactivate the controlled substances, and the deterrent was release into the container preventing the ingestion of the liquid. [https://www.stericycle.com/en-us/solutions/regulated-waste-disposal/controlled-substance#tabs-8 0d706263d-item-cd9179f9af-tab] 056381 Page 6 of 9 056381 11/18/2022 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to follow proper sanitation and food handling practices by failing to wear hair restraints while inside kitchen. Residents Affected - Few This deficient practice had the potential to spread food borne illnesses. Findings: During a follow up observation of the kitchen and concurrent interview, on 11/14/22, at 10:15 a.m., observed a dishwasher repair vender not wearing a hairnet. Vendor stated they have been inside facility kitchen many times to work on the dishwasher and was never asked to wear a hairnet by the kitchen staff. Also observed maintenance staff enter the kitchen without a hairnet. Maintenance staff walked through the kitchen and exited out of the rear door. Maintenance staff stated they did not wear a hairnet because they were never asked to wear hairnet inside kitchen. During an interview on 11/14/22, at 10:17 a.m., with Dietary Manager (DM), the DM stated, all staff are required to wear hairnets inside the kitchen. During a review of the facility's policy and procedure (P&P) titled, Food Safety and Sanitation, dated 2017, the P&P indicated, under Procedure: 2c. Employees are required . Hair restraints are required and should cover all hair on the head. 056381 Page 7 of 9 056381 11/18/2022 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on observation, interviews and record review, the facility failed to provide at least 80 square feet per resident for residents who occupied the following multiple resident bedrooms: Rooms A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y, Z, AA, and BB This failure had the potential to result in a lack of sufficient space for the provision of care by facility staff and a lack of sufficient space for residents to have personal belongings at the bedside. Findings: During random interviews and observations of care and services from 11/14/22 to 11/17/22, there was sufficient space for the provision of care for the residents in all rooms. There was no heavy equipment kept in the rooms that might interfere with residents' care, and each resident had adequate personal space and privacy. There were no complaints from residents regarding insufficient space for their belongings. There were no negative consequences attributed to the decreased space and/or safety concerns in the identified rooms. During a record review of the Client Accommodations Analysis, dated 1/14/22, the following multiple resident rooms were identified having below the required 80 square feet requirement per resident: Room A had 3 beds and 75.75 sq.ft/bed Room B had 3 beds and 75.56 sq.ft/bed Room C had 3 beds and 76.23 sq.ft/bed Room D had 3 beds and 75.93 sq.ft/bed Room E had 3 beds and 75.33 sq.ft/bed Room F had 3 beds and 75.33 sq.ft/bed Room G had 3 beds and 78.00 sq.ft/bed Room H had 3 beds and 75.86 sq.ft/bed Room I had 2 beds and 78.56 sq.ft/bed Room J had 2 beds and 79.73 sq.ft/bed Room K had 3 beds and 76.77 sq.ft/bed Room L had 3 beds and 78.35 sq.ft/bed Room M had 3 beds and 76.76 sq.ft/bed 056381 Page 8 of 9 056381 11/18/2022 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0912 Room N had 2 beds and 79.76 sq.ft/bed Level of Harm - Potential for minimal harm Room O had 2 beds and 79.76 sq.ft/bed Room P had 3 beds and 73.84 sq.ft/bed Residents Affected - Some Room Q had 3 beds and 73.70 sq.ft/bed Room R had 3 beds and 72.36 sq.ft/bed Room S had 3 beds and 70.26 sq.ft/bed Room T had 3 beds and 73.44 sq.ft/bed Room U had 3 beds and 72.83 sq.ft/bed Room V had 3 beds and 73.39 sq.ft/bed Room W had 3 beds and 73.39 sq.ft/bed Room X had 3 beds and 73.39 sq.ft/bed Room Y had 3 beds and 73.39 sq.ft/bed Room Z had 3 beds and 73.08 sq.ft/bed Room AA had 3 beds and 73.39 sq.ft/bed Room BB had 3 beds and 73.39 sq.ft/bed 056381 Page 9 of 9