Health inspection·August 14, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to implement its policy and procedure on Medication Ordering and Receiving from Pharmacy by failing to reorder and refill one of three sampled residents (Resident 1) Alprazolam (a medication used to treat anxiety disorder [a condition in which a person has excessive worry and feelings of fear, dread, and uneasiness]) timely (five days in advance of anticipated need). This deficient practice resulted in delay in the delivery of medication for Resident 1's and may result to Resident 1 having anxiety attacks. Findings: During a review of Resident 1's admission Record indicated the facility originally admitted Resident 1 on 6/8/2024 and re-admitted on [DATE], with diagnoses that included chronic obstructive pulmonary disease (a common lung disease causing restricted airflow and breathing problems), hypertension (elevated blood pressure), and anxiety disorder. During a review of Resident 1's History and Physical dated 6/21/2024 indicated Resident 1 has the capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set (MDS - a comprehensive assessment and screening tool) dated 6/27/2024, indicated Resident 1's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the sense) was intact. Resident 1 required supervision with eating, and oral hygiene. The MDS indicated Resident 1 required moderate assistance with toileting hygiene, lower body dressing and personal hygiene. During a review of Resident 1's Physician's Order dated 7/31/2024, indicated to administer Alprazolam one milligram (mg- unit of measure), give one tablet by mouth every four hours as needed for anxiety manifested by hyperventilation (a type of abnormal breathing that involves rapid and deep breaths) leading to shortness of breath (SOB). During a review of Resident 1's Medication Administration Record (MAR - a report detailing the medications administered to a resident by a healthcare professional) dated 8/2024, indicated that on 8/11/2024 Resident 1 received Alprazolam one mg tablet at 12:27 a.m., 6:48 a.m., 11:31 a.m., and 3:31 p.m. During an interview on 8/13/2024 at 8:35 a.m. with Resident 1, Resident 1 stated that she (Resident (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 056412 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 056412 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northridge Care Center 7836 Reseda Blvd Reseda, CA 91335 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)