Health inspection·October 17, 2019

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the skilled nursing facility did not provide the necessary care to to maintain a resident's ability to effectively communicate with staff for one of 19 sampled residents (Resident 68). Facility staff did not address Resident 68's hearing loss. Residents Affected - Few This failure resulted in Resident 68 expressing feelings of frustration. Findings: A record review on 10/15/19 of the document Resident Face Sheet, showed the facility admitted Resident 68 on 9/20/19. Diagnoses included kidney failure and lung disease. A review of the document MDS 3.0 (resident assessment), dated 9/27/19, showed Resident 68 understood what others said to him and had, Minimal Difficulty hearing with Difficulty in some environments (e.g., when person speaks softly or setting is noisy. In an interview on 10/14/19 at 8:40 a.m., Resident 68 stated he could not understand this surveyor's question because he could not hear. Resident 68 stated he did not have a hearing aide, could Sometimes understand what staff were saying to him. He stated he was Frustrated and would like to get a hearing aide At some point. In an interview on 10/15/19 at 12:50 p.m., Certified Nursing Assistant 1 (CNA 1) confirmed Resident 68 had a difficult time hearing and she needed to Speak louder to him. In an interview on 10/15/19 at 1:02 p.m., the facility's Social Services Director (SSD) confirmed Resident 68 had difficulty hearing. The SSD stated when a resident had anything other than adequate hearing documented on the resident assessment form, they needed to be placed on the audiologist (hearing specialist) referral list so the hearing loss can be addressed. The SSD stated Resident 68's name had not been placed on the list. A review of the document Referral to Outside Agencies, dated 6/2008, showed it was the facility's policy to, Establish guidelines for making referrals to outside agencies that will meet the psychosocial and/or concrete needs of a resident . Referrals can be made by the, Social Service Director, licensed nurse, or a member of the IDT (Interdisciplinary Team) based on a resident's individualized, specific needs identified through interviews, evaluations, and assessments. Page 1 of 3 056447 056447 10/17/2019 Hayward Hills Health Care Center 1768 B Street Hayward, CA 94541

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 failed to ensure the medication error rate was not five percent (5%) or greater. Medication pass observation on 10/16/19 and on 10/17/19 revealed two errors out of 33 opportunities resulting in an error rate of 6.06%. Residents Affected - Few 1. For Resident 19, staff administered one capsule of Cranberry (used to prevent Urinary Tract Infections) instead of two capsules as ordered by the physician. 2. For Resident 66, staff did not administer Prednisone (medication used as an anti-inflammatory or an immunosuppressant that treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders) according to the manufacturer's specifications. These failures had the potential to result in Resident 19 and Resident 66 not getting the full therapeutic benefit of the medications and could result in undesired health outcomes. Findings: 1. Review of Resident 19's Face Sheet on 10/15/19 indicated she was admitted with multiple diagnoses that included Urinary Tract Infection, site not specified. During a medication pass observation with Licensed Vocational Nurse (LVN 1) on 10/15/19, LVN 1 prepared and administered Lactulose syrup 15 ml (ml, a unit of measurement) and seven tablets (Aripiprazole 1 tab, Vitamin D3-2 tabs, Keppra 1 tab, Multivitamin with Minerals 1 tab, Oscal 1 tab and Cranberry 1 cap) to Resident 19 at 9:10 a.m. During the medication reconciliation with the 2019 Physician Order Report on 10/15/19, the order indicated Cranberry extract capsule 425 mg (mg, a unit of measurement) take 2 caps (850 mg) by mouth every day for UTI prophylaxis. (prophylaxis: prevention) During an interview on 10/15/19 at 12:36 p.m., LVN 1 checked the order and stated she thought she gave Resident 19 two capsules of the Cranberry extract. LVN 1 agreed that she only gave the Resident 19 a total of seven pills during medication pass. LVN 1 stated the order was for 2 caps of cranberry, It was an error. 2. Review of Resident 66's Face Sheet on 10/15/19 indicated she was admitted with multiple diagnoses that included Myasthenia gravis (a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs). During a medication pass observation on 10/15/19 at 9:35 a.m., Registered Nurse 1 (RN 1) prepared and administered 14 oral medications (Iron 1 tab, Vitamin C 1 tab, Aspirin 1 tab, Lorazepam 1 tab, Gabapentin 2 caps, Metoprolol 1 tab, Multivitamin 1 tab, Prednisone 1 tab, Mycophenolate 4 caps and Senna 1 tab). During the medication pass observation, the Prednisone medication card indicated Take with food/meal. 056447 Page 2 of 3 056447 10/17/2019 Hayward Hills Health Care Center 1768 B Street Hayward, CA 94541

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Drug manufacturer's specification for Prednisone indicated Take this medicine with food or milk to avoid stomach irritation. During an interview on 10/15/19 at 1:15 p.m., RN 1 stated breakfast was served at 7 am and she gave the Prednisone to Resident 66 at 9:35 a.m. When RN 1 checked the medication card, RN 1 acknowledged the medication card's instructions was to give Prednisone with meals. RN 1 stated the medication should be given with meals for better absorption. RN 1 confirmed the drug specification stated Must be given with food/meals. During an interview on 10/16/19 at 9:10 a.m., the Registered Pharmacist (RPh) stated the Prednisone should be taken with meals. The RPh stated the manufacturer's specifications required the prednisone be taken with food and not doing so was an error. The facility policy and procedure titled Medication Pass Guidelines effective 3/00 indicated Purpose: To assure the most complete and accurate implementation of physician's medication orders and to optimize drug therapy for each resident by providing for administration of drugs in an accurate, safe, timely and sanitary manner. 056447 Page 3 of 3