Health inspection·July 31, 2025

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure non-pharmacological interventions (NPIstreatments that do not involve medications) were documented prior to the administration of Ativan (antianxiety medication used to treat anxiety which is the feeling of fear, dread, and uneasiness) for one of six sampled Residents (Resident 5).This deficient practice had the potential to result in Resident 5's cause of anxiety induced behaviors being unaddressed being managed only with medication.Findings:During a review of Resident 5's admission Record (Face Sheet), the Face Sheet indicated Resident 5 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included anxiety disorder, schizophrenia (a mental illness that is characterized by disturbances in thought), and bipolar disorder (sometimes called manic-depressive disorder; mood swings that range from the lows of depression to elevated periods of emotional highs). During a review of Resident 5's Minimum Data Set (MDS- a resident assessment tool), dated 6/18/2025, the MDS indicated Resident 5's cognition (process of thinking) was moderately impaired. The MDS indicated Resident 5 had delusions (misconceptions or beliefs that are firmly held, contrary to reality) and had verbal behavioral symptoms directed at others (such as threatening, screaming, or cursing at others). The MDS indicated Resident 5 required moderate assistance (helper does less than half the effort) with oral hygiene, toileting, bathing, and dressing. The MDS indicated Resident 5 took antianxiety medication.During a review of Resident 5's History and Physical (H&P), dated 6/13/2025, the H&P indicated Resident 5 did not have the capacity to understand and make decisions. During a review of Resident 5's Order Summary Report, dated 6/30/2025, the Order Summary Report indicated to give Ativan 1 milligram (mg, a unit of measurement), every six hours as needed for increased anxiety and agitation, for 14 days.During a review of Resident 5's Order Summary Report, dated 7/15/2025, the Order Summary Report indicated to:1. Give Ativan 1 mg, every six hours as needed for anxiety manifested by angry outbursts, packing, and throwing things on the floor and walls, for 14 days.2. Monitor target behaviors (specific behavior identified) for Ativan for anxiety due to angry outbursts, pacing, and throwing things on the floor and walls. Indicate the number of behaviors followed by the NPI and whether the NPI was effective.During a review of Resident 5's Order Summary Report, dated 7/31/2025, the Order Summary Report indicated to:1. Give Ativan 1 mg, every six hours as needed for anxiety manifested by angry outbursts, packing, and throwing things on the floor and walls, for 14 days.2. Monitor target behaviors for Ativan for anxiety due to angry outbursts, pacing, throwing things on the floor and walls. Indicate the number of behaviors followed by the NPI and whether the NPI was effective.During a review of Resident 5's Care Plan titled, Uses Anti-Anxiety Medications, revised 11/15/2024, the Care Plan's interventions indicated to monitor [and] record occurrences of target behavior symptoms of pacing, wandering, disrobing, inappropriate response to verbal communication, violence/aggression towards staff [and] others, and document per facility protocol.During a review of Resident 5's Care Page 1 of 3 555099 555099 07/31/2025 Lakewood Healthcare Center 12023 Lakewood Blvd. Downey, CA 90242

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Plan titled, Mood Problem Related to Anxiety, revised 12/20/2024, the Care Plan's interventions indicated to assist the resident in developing/provide the resident with a program of activities that is meaningful and of interest. Encourage and provide opportunities for exercise [and] physical activity.During an interview on 7/31/2025 at 2:58 p.m., with Licensed Vocational Nurse (LVN), LVN 4 stated Resident 5 often became very impatient and anxious where Resident 5 would begin pacing and screaming. LVN 4 stated whenever Resident 5 exhibited anxious behaviors, the nursing staff would try to calm him down by suggesting Resident 5 go to his room where it was quiet, offering him cigarettes or snacks. LVN 4 stated when the NPIs were ineffective, he would administer Resident 5 the Ativan. LVN 4 stated attempting NPIs were essential to determine the cause of the target behaviors and to see if redirection (intervening in or managing inappropriate behavior by diverting their attention) was successful to limit the use of medication. LVN 4 stated Resident 5 had an order for Ativan 1mg to administer if needed to treat specific behaviors. LVN 4 stated when Resident 5 exhibited the target behaviors, the behavior, the successful or unsuccessful NPIs attempted, and the administered medication had to be documented. During a concurrent interview and record review on 7/31/2025 at 3:04 p.m., with Licensed Vocational Nurse (LVN) 4, Resident 5's Medication Administration Record (MAR - a daily documentation record used by a licensed nurse to document medications and treatments given to a resident) and Administration Notes, dated 7/1/2025 through 7/31/2025, were reviewed. The MAR and Administration Notes indicated on the following dates and times Ativan 1mg was administered and no indication of NPIs attempted:- 7/1/2025 at 6:05 p.m.- 7/2/2025 at 6:10 p.m.- 7/4/2025 at 9 a.m.- 7/5/2025 at 6:08 p.m.- 7/6/2025 at 6:03 p.m.- 7/7/2025 at 6:10 p.m.7/8/2025 at 7:17 p.m.- 7/11/2025 at 6:29 p.m.- 7/12/2025 at 6:54 p.m.- 7/13/2025 at 6:21 p.m.- 7/14/2025 at 7:35 p.m.- 7/17/2025 at 7:40 p.m.- 7/18/2025 at 6:08 p.m.- 7/19/2025 at 6:02 p.m.- 7/20/2025 at 6:29 p.m.7/21/2025 at 11:45 p.m.- 7/23/2025 at 7:32 p.m.- 7/24/2025 at 7:10 p.m.- 7/25/2025 at 7:09 p.m.- 7/26/2025 at 7:21 p.m.- 7/29/2025 at 6:15 a.m.- 7/30/2025 at 7:02 p.m.LVN 5 stated the attempted NPIs were not documented and if they were not documented, there was no proof of the NPIs attempted. LVN 5 stated without indicating the NPIs attempt, it appeared Resident 5's anxiety was only treated with medication. LVN 5 stated Resident 5 took other medications to treat other mental illnesses and behaviors, and the use of Ativan should be used when NPIs were ineffective to reduce any adverse reactions (unintended, harmful, or unpleasant reaction to a medication).During an interview on 7/31/2025 at 3:17 p.m., with the Director of Nursing (DON), the DON stated prior to administering Ativan, the licensed nurse was responsible for assessing Resident 5 and determine if administering Ativan was appropriate to treat the target behaviors. The DON stated part of the assessment was initially attempting various NPIs such as socializing with Resident 5, offering snacks and cigarettes, providing activities, redirecting to their room or to listen to music and determining if the NPIs were effective or not. The DON stated if the NPIs were ineffective, the ordered Ativan would be administered. The DON stated the attempted NPIs had to be documented in Resident 5's electronic health record (eHR) to support the appropriate administration of Ativan. The DON stated without documenting the attempted NPIs, there was no proof of NPIs attempted and anyone reviewing Resident 5's eHR would think administering medication was the primary intervention for Resident 5's behaviors.During a review of the facility's Policy and Procedure (P&P) titled, Behavior/Psychoactive Medication Management, revised 4/24/2025, the P&P indicated, The licensed nurse will collaborate with the healthcare practitioner, family, resident, and/or interdisciplinary team members [IDT], to identify the contributing factors related to the resident's mood/behavior and the non-medication interventions to be implemented.During a review of the facility's P&P titled, Resident Rights- Quality of Life, revised 3/2017, the P&P indicated, Each resident shall be cared 555099 Page 2 of 3 555099 07/31/2025 Lakewood Healthcare Center 12023 Lakewood Blvd. Downey, CA 90242

F 0605 Level of Harm - Minimal harm or potential for actual harm for in a manner that promotes and enhances the quality of life, dignity, respect, individuality and receives services in a person-centered manner, as well as those that support the resident in attaining or maintaining his/her highest practicable well-being. Residents Affected - Some 555099 Page 3 of 3