Health inspection·December 28, 2023

F 0552 Ensure that residents are fully informed and understand their health status, care and treatments. 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, the facility failed to notify the resident ' s family member of changes in the resident ' s condition when laboratory results were received with abnormal findings for one of three sampled residents (Resident 1). This failure prevented Resident 1 and his family to express concerns, raise questions, and participate in the plan of care for Resident 1. Residents Affected - Few Findings: A review of Resident 1 ' s admission Record (AR- a document containing basic information of a resident), dated December 28, 2023, indicated Resident 1 was admitted to the facility on [DATE], with diagnoses that included acute (sudden in onset) respiratory failure, adult failure to thrive (decline in older adults ' health and ability), and pancytopenia (having low levels of all three blood cell types: red blood cells, white blood cells and platelets) among others. The AR further indicated nieces, son, sister, and brother as contact persons. A review of Resident 1 ' s Physician Order, with order date December 15, 2023, indicated, May do CBC (Complete Blood Count), CMP (Complete Metabolic Panel), uric acid (a chemical created when the body breaks down substances called purines) one time only until 12/19/2023 . A review of Resident 1 ' s laboratory results for CMP and CBC, with test reported date December 19, 2023, indicated the following blood test results are outside of normal ranges: a. Glucose (amount of sugar in blood). b. Creatinine (waste product that comes from the digestion of protein in your food). c. Chloride (an electrolyte that helps maintain acid-base balance in your body). d. Carbon dioxide (measures the amount of carbon dioxide in the blood). e. AST/SGOT (aspartate aminotransferase/serum glutamic-oxaloacetic transaminase- a blood test that looks for liver damage). f. Alkaline Phosphatase (commonly used to diagnose liver damage or bone disorders). g. BUN/Creatinine ratio (an indicator of kidney health). h. WBC (White Blood Cells- cells involved in protecting the body against both infectious disease Page 1 of 2 555108 555108 12/28/2023 Inland Christian Home 1950 S Mountain Ave Ontario, CA 91762

F 0552 and foreign invaders). Level of Harm - Minimal harm or potential for actual harm i. RBC (Red Blood Cells-component of blood responsible for the transportation of gases and nutrients throughout the human body). Residents Affected - Few j. Hemoglobin (a protein in red blood cells that carries oxygen). k. Hematocrit (the percentage by volume of red cells in your blood). l. MCV (mean corpuscular volume- blood test measures the average size of your red blood cells). m. MCH (Mean corpuscular hemoglobin- blood test measures the amount of hemoglobin within red blood cells). n. RDW (red cell distribution width- test measures the differences in the volume and size of your red blood cells). o. Platelet count (measures the number of platelets in your blood. Platelets are cells that help your blood clot). p. MPV (mean platelet volume- measures the average size of your platelets). q. Absolute monocytes (a measurement of a particular type of white blood cell). r. Absolute eosinophils (a measurement of a particular type of white blood cell). s. Absolute basophils (a measurement of a particular type of white blood cell). During a concurrent interview and record review on December 28, 2023, at 10:43 AM with the Assistant Director of Nursing (ADON), Resident 1 ' s Progress Notes were reviewed. The ADON stated there was no documentation on the Progress Notes that indicated Resident 1 ' s family were notified of the abnormal laboratory results done on December 19, 2023. The ADON stated Resident 1 was transferred to the hospital per family request after finding out about the abnormal results on December 22, 2023, three days after the test results were received. The ADON further stated Resident 1 ' s family should have been notified of the laboratory results promptly after the results were received. During a concurrent interview and record review on December 28, 2023, at 1:00 PM with the Director of Nursing (DON), the facility ' s policy and procedure (P&P) titled, Change in a Resident ' s Condition or Status, revised February 2021 was reviewed. The P&P indicated, .Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident ' s medical/mental condition and/or status . The DON stated Resident 1 ' s family should have been notified of the lab results promptly after receiving the results. 555108 Page 2 of 2