Other·July 26, 2018

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the California Department of Public Health during the investigation of a Facility Reported Incident Facility Reported Incident Number: CA00583231 Representing the California Department of Public Health: Surveyor ID: 37379, HFEN The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility. One deficiency was issued for facility reported incident number CA00583231

F689 SS=G Free of Accident Hazards/Supervision/Devices F689 CFR(s): 483.25(d)(1)(2) §483.25(d) Accidents. The facility must ensure that §483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and §483.25(d)(2)Each resident receives adequate supervision and assistance devices to prevent accidents. 555522 06/19/2018 COMMUNITY HOSPITAL OF SAN BERNARDINO D/P SNF 1805 Medical Center Dr San Bernardino, CA 92411 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE This REQUIREMENT is not met as evidenced by: Based on observation, interview, and record review, the facility failed to ensure that staff were trained to use transfer equipment properly in accordance with the manufacturer's recommendations during a sling scale lift (a mechanical device used to assist residents and staff during transfers) transfer affecting one of three sampled residents (Resident 1). This failure resulted in a fall that caused a fracture to Resident 1's left lower leg. Findings: During an observation on April 20, 2018, at 2:14 PM, with Registered Nurse 2 (RN 2) Resident 1 was lying on the bed, connected to a ventilator (a device used to help with breathing). During a concurrent interview with RN 2, she stated Resident 1 did not have the ability to communicate or to move. A review of Resident 1's "Face Sheet" (a record that provides the demographic data of the Patient) indicated, Resident 1 was readmitted to the facility on March 30, 2005. She was admitted with diagnoses that included, chronic respiratory failure and mental retardation (characterized by below-average intelligence or mental ability and a lack of skills necessary for day-to-day living). A review of Resident 1's "Change of Condition" (COC) dated April 16, 2018, written by Registered Nurse 1 (RN 1) titled, "Change of Condition" indicated "while weighing the patient (Resident 1) using the sling scale by two staffs 555522 06/19/2018 COMMUNITY HOSPITAL OF SAN BERNARDINO D/P SNF 1805 Medical Center Dr San Bernardino, CA 92411 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE (Certified Nurse's Aide 1, {CNA 1} and Licensed Vocational Nurse 1{ LVN 1) pt's (patients) sliding out of sling and LVN 1 assisted patient to the floor." A record review of Resident 1's CT (Computed Tomography, a form X' ray) of the pelvis report dated, April 16, 2018, at 10:04 PM, indicated " an acute intertrochanteric fracture (a hip fracture).The anatomic (body parts) site of this type of hip fracture is the proximal or upper part of the femur (thigh bone) of the left femur with fracture involvement of the greater & lesser trochanter (parts of the thigh bones) approximately 5 mm (millimeter, a unit of measurement) of displacement is noted." A review of the facility's "Incident /Accident Investigation Report" dated April 16, 2018, indicated " Interviewed CNA 1/LVN 1, stated that sling scale was not applied properly (was not crisscross) to the hooks." A review of manufacturer's recommendations provided by the facility for "Liko Sling," indicated that the sling sleeves had to be crisscross and attached to the sling bar securely while lifting the resident. A review of Registered Nurse 1's (RN 1) "Investigation Statement" dated April 16, 2018, indicated that " ...I asked CNA (CNA 1) if he applied the sling scale correctly, and told me, he did not apply sling scale properly as how it should be, it was not crisscross to the lower part of the sling to the hook ..." A review of the "Post-fall Debriefing" dated April 16, 2018, under section, "What Happened" indicated that "While weighing pt. [Resident 1] using sling scale, pt's (patients)sliding out of sling. LVN (LVN 1) assisted pt. to the floor. While interviewing CNA 555522 06/19/2018 COMMUNITY HOSPITAL OF SAN BERNARDINO D/P SNF 1805 Medical Center Dr San Bernardino, CA 92411 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE (CNA 1) and LVN (LVN 1), they stated they did not apply sling scale properly. They did not crisscross the sling scale to the hook" This document was signed by Manager 1. During a telephone interview with CNA 1, on May 22, 2018, at 4:26 PM, he stated that during the process of weighing Resident 1, on April 16, 1028, around 12:30 AM, he stated, while transferring Resident 1, using the sling scale, he did not make sure the proper application of sling (crisscross the slings). He stated that made the Resident 1 to fall. A review of the facility policy and procedure titled "Safe Patient Handling" revised September, 2016, indicated " ...As assessed and appropriate to patient's [Resident] condition, handling equipment and patient assist device will be used to ensure safety ..."