Health inspection·January 23, 2025

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, for one of three sampled residents (Resident 2), the facility failed to: Residents Affected - Some 1. Follow up and ensure that a physician ordered oxycodone-APAP (controlled medication used to manage moderate to severe pain). 2. Administer Oxycodone-APAP to Resident 2 for 18 of 54 days, The facility was aware Resident 2 had verbalized and was experiencing eight out of 10 (8/10 - numerical pain assessment tool where 0 is no pain and 10 being the worst pain) pain level in both shoulders, neck, and the back. As a result, Resident 2 experienced pain, frustration, and was unable to attend/participate in activities. Findings: During a review of the admission record for Resident 2 indicated Resident 2 was initially admitted to the facility on [DATE] and was readmitted on [DATE] with diagnoses including cervical disc disorder at cervical 6 (C6-neck bone) to C7 level with radiculopathy (also known as pinched nerve is a condition that results in radiating pain, weakness and/or numbness caused by compression of any of the nerve roots in your neck), non-Hodgkin lymphoma (a type of cancer that affects the lymphatic system [immune system] that grow out of control and can form tumors throughout the body), rotator cuff tear of left shoulder (rupture of tendons tough, fibrous, cord-like tissue that connects muscle to bone or another structure). During a review of a history and physical (a term used to describe a physician's examination of a patient) for Resident 2 dated 10/1/2024 indicated, Resident 2 was alert and oriented to person, place, and time and mental status was at baseline. The H&P indicated Resident 2 had chronic (ongoing) neck pain . During a review of a physician order dated 10/1/2024 indicated to administer to Resident 2, oxycodone-Acetaminophen Oral Tablet 5-325 MG (Oxycodone with Acetaminophen) Give 1 tablet by mouth every 4 hours as needed for Moderate Pain 4-7 NTE (not to exceed) 3gms (grams - a unit of measurement for the weight of medicine in a tablet or capsule)/APAP (acetaminophen, medication for pain and fever) 24hrs, and Hold for RR (respiratory rate) <(less than) 12. During a review of the Minimum Data Set (MDS - a resident assessment tool) dated 1/8/2025, Page 1 of 4 555039 555039 01/23/2025 Fireside Health Care Center 947 3rd Street Santa Monica, CA 90403

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some indicated Resident 2 had moderate cognitive impairment (a stage of cognitive decline that affects short-term memory and the ability to complete complex tasks). The same MDS indicated Resident 2 required between setup or clean assistant and substantial/maximum assistance for his Activities of Daily Living such as: (ADLs- routine tasks/activities such as eating, oral hygiene, toileting hygiene, shower/bathe self, personal hygiene, lower/upper body dressing, putting on/taking off footwear). The same MDS indicated Resident 2 experienced occasional moderate pain. During a review of a physician order dated 1/23/2025 indicated the facility to monitor and assess level of pain before, during, and after administration of treatment using pain scale as follows: zero (0)- No pain; 1-3 mild pain; 4-7 moderate pain; and 8-10 sever pain every shift. During an interview on 1/23/2025 at 11:18 am, Resident 2 stated that nursing staff had not consistently given him pain medication. Resident 2 stated he had 3/10 pain level in both his shoulders, neck, and the back. Resident 2 stated there were several occasions where he so much pain (8/10) and needed to take the oxycodone-APAP but the nursing staff would tell him that the pharmacy did not have the oxycodone-APAP in stock. Resident 2 stated he felt frustrated because the doctor ordered the oxycodone-APAP, but the pharmacy did not have it. Resident 2 stated that he had suggested to the nursing staff to take his prescription for the oxycodone-APAP to another pharmacy, but the nurses did not heed his suggestion. Resident 2 stated that he was able to sleep well but was unable to participate in activities due to the pain. During a concurrent interview and record review of the Medication Administration Record (MAR) for 12/ 2024 and 1/2025 for Resident 2 with Licensed Vocational Nurse (LVN) 1 on 1/23/25 at 1:57 pm, LVN 1 confirmed and stated that the pharmacy did not send the oxycodone/APAP for 18 out of 54 days because the pharmacy had not receive authorization from the ordering physician. LVN 1 stated medications must be ordered before the current medication stock runs out. LVN 1 stated nursing must also call the physician ordering the medication to ensure that authorization for the ordered medication is completed and refilled promptly/timely. LVN 1 confirmed and stated there was no documented evidence that the a physician was informed that Resident 2 had run out of oxycodone-APAP which required urgent attention to have the authorization completed. LVN 1 confirmed and stated that Resident 2 was not administered oxycodone-APAP on the following days: 12/2/24, 12/3/24, 12/4/24, 12/5/24, 12/6/24, 12/11/24, 12/12/24, 12/23/24, 12/24/24, 555039 Page 2 of 4 555039 01/23/2025 Fireside Health Care Center 947 3rd Street Santa Monica, CA 90403

F 0697 12/25/24, Level of Harm - Minimal harm or potential for actual harm 12/26/24, 12/27/24, Residents Affected - Some 12/28/24, 12/29/24, 1/7/25, 1/8/25, 1/17/25, and 1/20/25. LVN 1 stated that same MAR indicated Resident 2 experienced pain levels range between four out of 10 (4/10-numerical pain assessment where 0 is no pain and 10 is severe pain) and 8/10 on the days Resident 2 received/administered oxycodone-APAP. There was no documented evidence that Resident 2 was assessed for pain on the aforementioned dates and that Resident 2 did not receive pain Oxycodone-APAP for pain. LVN 1 admitted and stated that not ordering and having oxycodone-APAP in stock could lead to Resident 2 experiencing unnecessary pain. LVN 1 admitted that Resident 2 did not participate in activities when he was in pain. During an interview with Registered Nurse Supervisor (RNS) 1 on 1/23/25 at 2:15 pm, RNS 1 stated that in addition to calling in the medications at the pharmacy, nursing staff must reach out to the prescribing physician to ensure prompt authorization of the prescribed medication to avoid medication administration disruption which can result in unnecessary pain. During a concurrent interview and record review of Resident 2's MARs for December 2024 and January 2025 with the Director of Nursing (DON) on 1/23/25 at 4 pm, the DON confirmed and stated the facility did not administer oxycodone-APAP for pain to Resident 2. on the following dates: 12/2/24, 12/3/24, 12/4/24, 12/5/24, 12/6/24, 12/11/24, 12/12/24, 12/23/24, 12/24/24, 12/25/24, 12/26/24, 12/27/24, 12/28/24, 12/29/24,1/7/25,1/8/25,1/17/25, and 1/20/25. The DON stated medications must be ordered from the pharmacy before the medication completely runs out. The DON stated nursing must follow up with the pharmacy on the status for medication/s refill and contact the prescribing physician immediately if the issue is related to medication authorization. The DON stated that failure to administer pain medication to a resident experiencing pain can result in the resident suffering unnecessary pain. The DON was unable to provide the oxycodone-APAP pharmacy medication delivery receipts. As of 1/31/2025, the facility did not provide documented evidence/receipts that the pharmacy delivered oxycodone-APAP for Resident 2. During a review of a Policy and Procedures (P&P) titled Pain Management. Reviewed on 10/16/24 indicated, To ensure accurate assessment and management of the resident's pain. A Licensed Nurse will assess residents for pain on admission and routinely as indicated by the resident's health and functional status. Facility Staff is responsible for helping the resident attain or maintain the highest 555039 Page 3 of 4 555039 01/23/2025 Fireside Health Care Center 947 3rd Street Santa Monica, CA 90403

F 0697 Level of Harm - Minimal harm or potential for actual harm level of well-being while working to prevent or manage the resident's pain. The same P&P indicated under pain management which included the following: -The Licensed Nurse will administer pain medication as ordered and document al medication administered on the Medication Administration Record (MAR). Residents Affected - Some -The Licensed Nurse will assess the resident for pain and document results on the MAR each shift using the 1-10 pain scale. i. The shift pain score will indicate the highest pain level that occurred on that shift. During a review of the facility P&P titled, PREPARATION AND GENERAL GUIDELINES, reviewed on 10/16/24 indicated, if a medication with a current, active order cannot be located in the medication cart/drawer, other areas of the medication cart, medication room, and facility (e.g., other units) are searched, if possible. If the medication cannot be located after further investigation, the pharmacy is contacted, or medication removed from the night box/emergency kit. 555039 Page 4 of 4