Health inspection·November 17, 2023

Gilroy Health Care F609 §483.12(b) The facility must develop and implement written policies and procedures that: §483.12(b)(5) Ensure reporting of crimes occurring in federally-funded long-term care facilities in accordance with section 1150B of the Act. The policies and procedures must include but are not limited to the following elements. (i)Annually notifying covered individuals, as defined at section 1150B(a)(3) of the Act, of that individual's obligation to comply with the following reporting requirements. (A)Each covered individual shall report to the State Agency and one or more law enforcement entities for the political subdivision in which the facility is located any reasonable suspicion of a crime against any individual who is a resident of, or is receiving care from, the facility. (B)Each covered individual shall report immediately, but not later than 2 hours after forming the suspicion, if the events that cause the suspicion result in serious bodily injury, or not later than 24 hours if the events that cause the suspicion do not result in serious bodily injury. The facility failed to follow its policy and procedure for one of three sampled residents (Resident 1), when the facility failed to report an injury of unknown source with serious bodily injury (injury requiring medical intervention such as surgery) to the California Department of Public Health (CDPH) within 2 hours after the facility known about the injury of Resident 1. This failure had the potential for Resident 1's injury of unknown source to not be investigated thoroughly and be at risk for continued injury. During a review of Resident 1's "Facility Admission Record", undated, Admission Record indicated, Resident 1 had diagnoses of Metabolic Encephalopathy (disorder that affects brain function), Unspecified Dementia (mild memory disturbance due to known physiological condition), Psychotic Disturbance (Psychotic disorders that affect brain function by altering thoughts, beliefs or perceptions), Muscle Weakness, and Personal History of Other Mental and Behavioral Disorders. During a review of Resident 1's "Minimum Data Set Section C (MDS-assessment tool used to determine care needed for residents)", dated 8/29/23, the MDS Section C indicated, Resident's Brief Interview for Mental Status (BIMS-tool used to screen mental cognitive status) was scored of 4, indicating severe cognitive impairment. During a review of Resident 1's MDS "Section G", dated 9/26/23, the MDS indicated Resident 1 required for staff total dependence with transfer, locomotion on unit, locomotion off unit-how resident moves to and returns from off-unit, and personal hygiene. During a review of Resident 1's "Facility's Progress Note", dated 9/26/23, Progress Note indicated, Resident 1 was transferred on a gurney via ambulance to acute care hospital. It was also indicated the reason for transfer: Abnormal Pulse Oximetry [method of measuring oxygen in the blood]". During a review of Resident 1's Acute Hospital Record titled "Operation Note", dated 9/28/23, the Operation Note indicated, "Workup with CT [computerized tomography-series of x-rays] to scan with rectal contrast revealed a colovaginal fistula [an abnormal hole between the vagina and colon-large intestine] . At surgery on vaginal vault [expanded region of vaginal canal at the end of the vagina] there was also a palpated [felt] a foreign material, which was able to be removed. This appeared to be partially through the fistula and once removed, this foreign object wa a plastic fork with one tine missing. It had penetrated into the superficial posterior [rear side of body] wall of the vagina and was being held in place due to the scar tissue around the tines." During an interview on 10/17/23 at 1:40 p.m. with Director of Nursing (DON), DON stated she was aware Resident 1 had a foreign body removed from rectal area via surgical procedure at the local hospital. DON stated she was informed by the acute hospital staff and Resident 1 was unable to state how the foreign body got there. DON stated the acute hospital staff believed it was in there for months. During a concurrent interview and record review on 10/23/23, at 12:59 p.m., with DON, the DON reviewed the facility's policy and procedure (P&P) titled "Abuse Prevention, Intervention, Investigation & Crime Reporting Policy" dated November 2016. The DON stated the P&P indicated in response to allegations of abuse, neglect, exploitation or mistreatment, the facility would ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately but not later than 2 hours after the allegation was made, if the events that cause the allegation involve abuse or result in serious bodily injury; or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury; to the administrator of the facility and to other officials (including State Survey Agency) and adult protective services. It was also indicated the injury of unknown source was an injury that was not observed by any person, or the source of the injury could not be explained, and the injury was suspicious." DON stated, the facility did not observe the injury, the source of the injury could not be identified, and it was a suspicious injury. DON stated, the facility did not report the incident to the California Department of Public Health (CDPH State Survey Agency). During an interview with Administrator (abuse coordinator) on 10/23/23 at 1:05 p.m., Administrator stated, Resident 1's injury was not reported to CDPH. This violation had a direct or immediate relationship to the health, safety, or security of the patients.