Health inspection·July 19, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of two sampled residents' (Resident 1) physician was notified of a change in Resident 1's skin condition. This failure had the potential to negatively impact Resident 1's well-being. Residents Affected - Few Findings: Review of the facility's P&P titled Wound Treatment Management dated 12/19/22, showed to promote wound healing of various types of wounds, it is the policy of the facility to provide evidence-based treatment in accordance with the current standards of practice and physician order. The P&P further showed in the absence of treatment orders, the licensed nurse will notify physician to obtain treatment orders. On 7/18/23 at 1032 hours, a telephone interview was conducted with the Resident Representative. The Resident Representativestated when he visited Resident 1 around the end of May 2023, and noticed Resident 1's fingers on the right hand were white in color and looked like it had a fungal infection. The Resident Representative stated another family member visited Resident 1 on 7/11/23, and noticed the fingers of the Resident 1 ' s right hand were worse and sent a picture of the wound to the Resident Representative. The Resident Representativestated the picture showed Resident 1's nails looked long and had thick yellow whitish substance. The Resident Representative stated the facility did not take care of the Resident 1's right hand fingers. Medical record review for Resident 1 was initiated on 7/18/23. Resident 1 was admitted to the facility on [DATE],and was readmitted to the facility on [DATE]. Review of Resident 1's History and Physical Examination dated 2/17/23, showed Resident 1 did not have the capacity to understand and make decisions. Review of Resident 1's MDS dated [DATE], showed Resident 1 had cognitive impairment and required extensive assistance for her ADL care. Review of Resident 1's Progress Notes dated 7/18/23 at 1147 hours, showed Resident 1 had a change in skin color and condition. The progress notes further showed Resident 1 was assessed to have hard thick fingernails. Resident 1's physician was notified and ordered to apply ciclopirox (medication to treat fungal skin infection) external solution 8% daily. Review of Resident 1's Surgical Note dated 7/18/23, showed Resident 1 was assessed with a lesion on Resident 1's right fourth and fifth fingernails. The physician described the condition of the Page 1 of 2 555021 555021 07/19/2023 The Grove Post Acute 12332 Garden Grove Blvd. Garden Grove, CA 92843

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few fingernails as thickened yellow nails with severe mycosis (fungus infection) of right fourth and fifth nails. Nails were yellow thick and dystrophic (abnormal changes in shape, color, texture, and growth). Further review of the document showed Resident 1's wound had a duration of more than four weeks. Further review of Resident 1's medical record failed to show Resident 1 received any treatment for the changes in her fingernails prior to 7/18/23. Furthermore, there were no documented assessments performed regarding the change in Resident 1's skin prior to 7/18/23. On 7/18/23 at 1448 hours, a concurrent interview and medical record review was conducted with LVN 1. LVN 1 verified above findings and stated she noticed Resident 1 had hard and thick fourth and fifth fingernails of her right hand around 2 weeks ago. When asked if she notified Resident 1's physician when she first noticed the change in Resident 1's skin condition, LVN 1 stated she did not notify the physician. LVN 1 added Resident 1's DO came to see the Resident 1 on 7/18/23 (approximately two weeks after the change in Resident 1's skin condition was identified by LVN 1), and addressed the above change in Resident 1's skin condition. LVN 1 stated she should have documented the change in Resident 1's skin condition and notified Resident 1's physician when the change was first identified. LVN 1 acknowledged Resident 1's wound treatment was delayed for two weeks. On 7/18/23 at 1655 hours, a concurrent observation and interview was conducted with LVN 1. Resident 1 was observed laying in the bed, Resident 1's right fourth fingernail was observed grown outward with thick yellowish deposit and fifth fingernail was observed with thick yellowish deposit. LVN 1 was observed measuring right fourth fingernail which showed 1.7 cm in length and 3 cm round thick deposit. LVN 1 verified the above observation. On 7/19/23 at 1217 hours, a concurrent interview and medical record review was conducted with the ADON. The ADON verified and acknowledged above findings. The ADON stated LVN 1 should have notified thephysician and started treatment as soon as possible after the skin issue was identified. On 7/20/23 at 1441 hours, a telephone interview was conducted with the DO. The DO stated he was notified of the Resident 1 ' s skin issue of her right-hand fourth and fifth fingernails on 7/18/23. The DO stated based on his clinical judgement, he thought Resident 1 had the fungal infection on her right fourth and fifth fingernails for more than four weeks. 555021 Page 2 of 2