Health inspection·March 3, 2022

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that preventative maintenance was performed by the due date as detailed on one out of five oxygen concentrators (an electrically powered medical device that uses environmental air and delivers it to a patient in the form of supplemental oxygen) being used within the facility. Residents Affected - Few This failure had the potential to cause harm to residents due to inadequate oxygen levels being produced by the machine. Findings: During an observation on February 28, 2022, at 1:18 PM, in resident room [ROOM NUMBER]-B, an oxygen concentrator was noted to be present with a label detailing that preventative maintenance was last performed on [DATE], and was due by April, 3, 2021. During an interview on [DATE], at 3:22 PM, with a certified nursing assistant (CNA 1), she stated that preventative maintenance should have been completed by [DATE]. During an interview on [DATE], at 3:28 PM, with a licensed vocational nurse (LVN 1), she stated that she did not know why the machine was in use when the preventative maintenance should have been completed before [DATE]. During an interview on [DATE], at 4:23 PM, with the Director of Staff Development (DSD), she stated that the machine should not be in use with expired preventative maintenance. During a record review of a facility provided document titled, [Name of manufacturer, undated, it outlines the following, Chapter 6: Maintenance .6.0.4 Oxygen concentration verification, [Name of manufacturer] recommends verifying the oxygen concentration level a minimum of every two (2) years . Page 1 of 2 555108 555108 03/03/2022 Inland Christian Home 1950 S Mountain Ave Ontario, CA 91762

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure: 1. Expired intravenous (IV) fluids (solution given through a vein) for one (1) expired resident (Resident 104) were removed from the medication refrigerator. 2. Four (4) expired over-the-counter (OTC) medication bottles and one (1) expired IV start kit were removed from the medication room. 3. Three (3) expired over-the-counter (OTC) medication bottles were removed from two (2) of two (2) medication carts. These failures had the potential for the distribution/use of expired medication(s)/ IV solutions which could cause an adverse reaction resulting in serious harm. Findings: 1. During a concurrent observation and interview, on [DATE], at 12:48 PM, with the Director of Nursing (DON), in the medication room, the medication refrigerator had three (3) IV fluid bags containing a potassium chloride solution with an expiration date of February 10, 2022. The DON stated the IV fluid bags were for a resident who expired. The DON further stated the expired IV fluid bags should have been discarded. 2. During a concurrent observation and interview, on [DATE], at 12:48 PM, with the DON, in the medication room, the medication cabinet had four (4) expired OTC medications and one (1) expired IV start kit: (1) Loratadine 10 milligrams (mg - unit of measurement) expired [DATE]; (2) Magnesium 500 mg expired February 2022; (3) Low dose aspirin 81 mg expired February 2022; and (4) Docusate sodium 100 mg expired February 2022. The IV Start Kit expired on February 13, 2022. The DON confirmed the expiration dates for four (4) OTC medications and one (1) IV start kit and stated they will be removed from the medication room. 3. During a concurrent observation and interview, on [DATE], at 1:00 PM, with a Licensed Vocational Nurse 2 (LVN 2), medication cart #2 had two (2) expired OTC medications: (1) Vitamin B6 50 mg, expiration date [DATE], opened date [DATE], 81 tablets left out of 100 tablets; and (2) Zantac 75 mg, expiration date [DATE] tablets left out of 30 tablets. LVN 2 stated the medications will be discarded. During a concurrent observation and interview, on [DATE], at 1:20 PM, with LVN 3, medication cart #1 had one (1) expired OTC medication: (1) Magnesium 500 mg, expiration date February 2022, opened date [DATE]. LVN 3 stated the medication will be discarded. The facility's policy and procedure (P&P) titled, Discarding and Destroying Medications, dated [DATE], indicated, Policy Interpretation and Implementation . 2. Non-controlled and Schedule V (non-hazardous) controlled substances will be disposed of in accordance with state regulations and federal guidelines regarding disposition of non-hazardous medications . 555108 Page 2 of 2