Health inspection·May 10, 2023

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to monitor for side effects of psychotropic medication (medication given to cause changes in mood, feelings or behavior) for one of three sample residents (Resident 1). The facility also failed to obtain informed consent before administering psychotropic medication to Resident 1. Failure to monitor for psychotropic medicaion side effects had the potential to compromise Resident 1's health. Failure to obtain informed consent had the potential to compromise Resident 1's ability to make informed decisions regarding his treatment. Findings: 1. Review of Resident 1's medical record indicated he was admitted on [DATE] and had the diagnosis of bipolar disorder (a mental health condition that causes extreme mood swings). Review of Resident 1's Order Summary Report indicated he had a physician's order, dated 11/23/22, for divalproex sodium (a seizure medication often used as a mood stabilizer) 250 milligrams (mg, unit of dose measurement) one tablet by mouth at bedtime for bipolar disorder. Review of Resident 1's medicaion administration record (MAR) indicated he was receiving divalproex sodium 250 mg at bedtime for bipolar disorder from 11/23/22 until 3/14/23 (except when he refused the medication). Further review of the medical record indicated there was no documentation that the facility monitored Resident 1 for side effects of divalproex sodium. During an interview and concurrent record review with the director of nursing (DON) on 5/10/23 at 11:42 a.m., she stated for residents taking psychotropic medication, the nurses should monitor for side effects every shift and document this on the MAR. The DON reviewed Resident 1's medical record and confirmed there was no documentation that the nurses monitored him for side effects of divalproex sodium. Review of the facility's policy titled Psychotropic Medication Management, revised 10/24/17 indicated, Medication effects will be monitored and documented on the medication administration record, to include target behavior monitoring, and monitoring for adverse effects when the medications are used. 2. Review of Resident 1's Order Summary Report indicated he had a physician's order, dated 10/15/22, for lorazepam (medication used to treat anxiety) 0.5 mg one tablet by mouth every 6 hours as needed for anxiety. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 555060 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555060 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor the Ridge Rehabilitation Center 350 Iris Drive Salinas, CA 93906 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)