Other·October 30, 2018

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the California Department of Public Health during the investigation of one facility reported incident during an abbreviated standard survey. Facility Reported Incident: 600215 Representing the Department: 27137, HFES 40577, HFEN The inspection was limited to the specific facility reported incident and does not represent the findings of a full inspection of the facility. Two deficiencies were written as a result of facility reported incident 600215.

F609 SS=D Reporting of Alleged Violations CFR(s): 483.12(c)(1)(4)

F609 11/01/2018 §483.12(c) In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must: §483.12(c)(1) 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 is 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 555517 09/28/2018 KERN VALLEY HEALTHCARE DISTRICT D/P SNF 6412 Laurel Ave Lake Isabella, CA 93240 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. §483.12(c)(4) Report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to report an allegation of abuse for one of one sampled residents (1) to the Department in a timely manner. This had the potential for an allegation of abuse to be unreported and to delay an investigation. Findings: During a review of the SOC 341, dated 8/17/18, from the facility, it indicated the facility learned of a report of possible abuse on 6/15/18 and did not report this alleged episode to the Department until 8/17/18. During a review of the clinical record for Resident 1, the Progress Note dated 6/15/18, at 8:09 AM, indicated Resident 1 complained about a Certified Nurse Assistant (CNA). The document indicated, "Resident has [complained of] that CNA staff, was rough and abused her this morning giving care. Resident appeared irritated last night. Will continue to monitor behavior. Teaching was given to CNA staff in 555517 09/28/2018 KERN VALLEY HEALTHCARE DISTRICT D/P SNF 6412 Laurel Ave Lake Isabella, CA 93240 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE reference to gentle handling of resident, and to maintain a positive attitude with resident at all times." The document was co-signed by Licensed Vocational Nurse 1. During an interview with the Assistant Director of Nursing, on 8/28/18, at 10:56 AM, she stated "the expectation is we are to notify [the Department]. It is drilled into our heads, we know because we are mandated to call. We call the [physician], we notify everyone that needs to be called." The facility policy and procedure titled "Abuse Prevention Program - Reporting," dated 8/16, indicated "There will be prompt reporting of alleged mistreatment, neglect, or abuse including injuries of unknown source and misappropriation of property in accordance with State and Federal Regulations. All employees of Kern Valley Healthcare District are mandated reporters. If an incident or allegation is considered reportable, the licensed nurse will make a report to California Department of Public Health and the Ombudsman within 24 hours."

F610 SS=D Investigate/Prevent/Correct Alleged Violation CFR(s): 483.12(c)(2)-(4)

F610 11/01/2018 §483.12(c) In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must: §483.12(c)(2) Have evidence that all alleged 555517 09/28/2018 KERN VALLEY HEALTHCARE DISTRICT D/P SNF 6412 Laurel Ave Lake Isabella, CA 93240 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE violations are thoroughly investigated. §483.12(c)(3) Prevent further potential abuse, neglect, exploitation, or mistreatment while the investigation is in progress. §483.12(c)(4) Report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to ensure an investigation took place after an allegation of abuse from one of one sampled residents (Resident 1). This had the potential for an allegation of abuse to go uninvestigated. Findings: During a review of the clinical record for Resident 1, the document titled Progress Notes, dated 6/15/18, indicated "Resident has [complained of] that CNA [Certified Nursing Assistant] staff, was rough and abused her this morning giving care. Resident appeared irritated last night. Will continue to monitor behavior. Teaching was given to CNA staff in reference to gentle handling of resident, and to maintain a positive attitude with resident at all times." The document was co-signed by Licensed Vocational Nurse (LVN) 1. During a review of the SOC 341, dated 8/17/18, from the facility, it indicated the facility learned of possible abuse on 6/15/18 and did not report this alleged abuse to the Department until 555517 09/28/2018 KERN VALLEY HEALTHCARE DISTRICT D/P SNF 6412 Laurel Ave Lake Isabella, CA 93240 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE 8/17/18. During an interview with the Assistant Director of Nursing, on 8/28/18, at 10:56 AM, she stated there was no facility investigation done because LVN 1 no longer worked at the facility, and would not return phone calls. The facility policy and procedure titled "Abuse Prevention Program - Reporting," dated 11/16, indicated "The Director of Nursing or designee shall thoroughly investigate all allegations."