Health inspection·January 25, 2024

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility neglected to provide goods and services when they did not obtain and administer a medication ordered that was necessary to avoid physical harm and psychosocial distress to one of three sampled Residents (Resident 1) when Resident 1 was ordered an antiviral medication upon admission which was not acquired by the facility nor administered for seven days. This failure resulted in Resident 1 being neglected by staff and experienced psychosocial harm and anxiety which prompted Resident 1 to leave the facility against medical advice (AMA) for fear of physical harm due to the gap in the administration of his medication regimen and potential for risk of a worsening viral infection. Findings: During a review of Resident 1 ' s History and Physical (H&P), dated 2/21/23, the H&P indicated, Resident 1 had history of a [virus - Viruses are microscopic organisms that can infect humans, a virus that attacks the body's immune system]. During a review of Resident 1 ' s Minimum Data Set (MDS – an evaluation of a resident's cognitive [ability to process and comprehend information] and functional status), dated 2/25/23, the MDS indicated the Brief Interview for Mental Status (BIMS) score (an assessment of a resident's cognitive status for memory recall) was 12 (a score of 13 – 15 indicated the resident is cognitively intact, 8 – 12 indicated moderately impaired, and 0 – 7 indicated severe impairment). During a review of Resident 1 ' s Order Summary Report (OSR), dated 2/28/23, the OSR indicated, [brand name] oral tablet 200-25 MG (milligrams – unit of measurement) (anti-viral medication) Give 1 tablet by mouth one time a day for [virus]. Order date 2/20/23. Start date 2/21/23. During a review of Resident 1 ' s Medication Administration Record (MAR), dated 2/1/23 – 2/28/23, the MAR indicated, on 2/21/23, 2/22/23, 2/23/23, 2/24/23, 2/25/23, 2/26/23, and 2/27/23, Resident 1 was not administered [brand name] oral tablet 200-25 MG. During a review of Resident 1 ' s Progress Notes (PN), dated 2/21/23, 2/22/23, 2/23/23, 2/24/23, 2/25/23, 2/26/23, and 2/27/23, the PN indicated, [brand name] oral tablet 200-25 MG was on order and waiting for pharmacy to deliver. During an interview on 11/28/23 at 1:08 p.m. with Resident 1, Resident 1 stated he was admitted to the facility on [DATE] through 2/27/23. Resident 1 stated, he was not administered his anti-viral Page 1 of 5 555118 555118 01/25/2024 Almond Vista Healthcare 2030 Evergreen Avenue Modesto, CA 95350

F 0600 Level of Harm - Actual harm Residents Affected - Few medication as ordered from 2/20/23 through 2/27/23. Resident 1 stated he asked staff for the anti-viral medication daily and each time he was informed that the anti-viral medication was on its way from the pharmacy. Resident 1 stated he went one week without the anti-viral medication and it was hazardous (harmful) to his health and safety to miss doses of his medications. Resident 1 stated that not taking his medication daily would worsen his viral infection and this worried him greatly. During an interview on 11/30/23 at 4:50 p.m. with Director of Nursing (DON), DON stated it was standard of practice to notify the physician when a medication was unavailable according to policy and procedure in order to ensure medications were administered as ordered. DON stated there was an increased risk for worsening Resident 1 ' s viral infection if the anti-viral medication was not administered as ordered. During an interview on 1/2/24 at 5 p.m. with Resident 1, Resident 1 stated he was disgusted with the situation at the facility where he went to get physical therapy. The physician ordered his antiviral medication for him through the [name of hospital] pharmacy which was not picked up by the facility. The medication was returned to stock and then it was refilled for pick up. Resident 1 stated the medication was never picked up so it was restocked again. Resident 1 stated he was at the facility for 7 days and never got his medication, so he left against medical advice AMA). He stated, If I don ' t take my medications, I risk my long term health. Resident 1 stated this was neglect. During an interview on 1/10/24 at 2:37 p.m. with Licensed Vocational Nurse (LVN) 3, LVN 3 stated she was assigned to provide care to Resident 1 on 2/21/23, 2/23/23, 2/24/23, and 2/25/23. LVN 3 stated [brand name] oral tablet 200-25 MG was unavailable at the facility since the medication was expensive and required pharmacy verification for approval. LVN 3 stated the verification was given to the Director of Nursing at the time. LVN 3 stated it was standard of practice to notify the physician when a medication was unavailable according to policy and procedure in order to ensure medications were administered as ordered. LVN 3 stated there was an increased risk for worsening Resident 1 ' s viral infection if the anti-viral medication was not administered as ordered. During an interview on 1/11/24 10:08 a.m. with the Administrator (ADM), ADM stated it was standard of practice to notify the physician when a medication was unavailable according to policy and procedure in order to ensure medications were administered as ordered. ADM stated if a medication was unavailable, the medication can be delivered from another pharmacy the facility was contracted with. ADM stated facility staff and pharmacy staff were expected to communicate with one another to ensure residents received their medications as ordered. During an interview on 1/23/24 at 12:55 p.m. with Resident 1, Resident 1 stated he spoke to nursing, the doctor, and the administrator on a daily basis to follow up on his medication. Resident 1 stated he was told the medication was being sent to the facility and he should speak to the doctor. Resident 1 stated he spoke to the doctor but the doctor was very vague. Resident 1 stated he felt a sense of helplessness and wasn ' t being cared for. Resident 1 stated it was depressing and exasperating, then became angry and furious after going a week without his antiviral medication. Resident 1 stated he knew it would be hazardous to his health if he went any longer without his medication. Resident 1 stated he felt discriminated against due to his diagnosis. During a review of the facility ' s P&P titled, Abuse, Neglect, Exploitation and Misappropriation Prevention Program, dated April 2021, indicated, Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. 555118 Page 2 of 5 555118 01/25/2024 Almond Vista Healthcare 2030 Evergreen Avenue Modesto, CA 95350

F 0600 During a review of the facility ' s policy and procedure (P&P) titled, Resident Rights, dated 2/2021, the P&P indicated, Policy Level of Harm - Actual harm Residents Affected - Few Statement: Employees shall treat all residents with kindness, respect, and dignity . 1. Federal and State laws guarantee certain basic rights to all residents of this facility. These rights include the resident ' s right to: c. be free from abuse, neglect, misappropriation of property, and exploitation . During a review of the facility ' s P&P titled, Unavailable Medications, dated 8/2014, the P&P indicated, Policy .The facility must make every effort to ensure that medications are available to meet the needs of each resident . Procedures. B. Nursing staff shall: 1). Notify the attending physician of the situation and explain the circumstances, expected availability and optional therapy(ies) that are available. a. If the nurse is unable to obtain a response from the attending physician, the nurse should notify the nursing supervisor and contact the Facility Medical Director for orders and/or direction . During a review of the facility P&P titled, Pharmacy Services Overview, dated 4/2019, the P&P indicated, Policy Interpretation and Implementation. 1. Pharmaceutical (a variety of medicines used to prevent, diagnose, treat or cure disease) services consists of: a. The processes of receiving and interpreting prescriber ' s orders; acquiring, receiving, storing, controlling, reconciling, compounding (the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient [e.g., intravenous antibiotics]), dispensing, packaging, labeling, distributing, administering, monitoring responses to, using and/or disposing of all medications . 2. The facility shall contract with a licensed consultant pharmacist to help it obtain and maintain timely and appropriate pharmacy services that support residents ' needs, are consistent with current standards of practice, and meet state and federal requirements. 3. Pharmacy services are available to residents 24 hours a day, seven days a week. 4. Residents have sufficient supply of their prescribed medications and receive medications (routine, emergency or as needed) in a timely manner. 5. Nursing staff communicate prescriber orders to the pharmacy and are responsible for contacting the pharmacy if a resident ' s medication is not available for administration . During a review of the professional reference titled, HIGHLIGHTS OF PRESCRIBING INFORMATION, dated 1/2022, the information reviewed indicated, Dosage Recommendations for Treatment of [viral] Infection. Inform [viral] infected patients that it is important to take [brand name] with other antiretroviral drugs for the treatment of [viral] on a regular dosing schedule with or without food and to avoid missing doses as it can result in development of resistance . How should I take [brand name]? Take [brand name] exactly as your healthcare provider tells you to take it. If you take [brand name] to treat [viral] infection, you need to take [brand name] with other [viral] medicines. Your healthcare provider will tell you what medicines to take and how to take them. Take [brand name] 1 time each day with or without food . Do not change your dose or stop taking [brand name] without first talking with your healthcare provider. Stay under a healthcare provider ' s care when taking [brand name]. Do not miss a dose of [brand name] . 555118 Page 3 of 5 555118 01/25/2024 Almond Vista Healthcare 2030 Evergreen Avenue Modesto, CA 95350

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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 meet professional standards of quality when one of three sampled residents (Resident 1) was not administered his anti-viral medication (medication used to help the body fight off harmful viruses which can ease symptoms and shorten the length of a viral infection) for seven days, as ordered on admission and staff did not follow up with the pharmacy or notify the physician as required according to the facility ' s policy and procedure titled, Unavailable Medications. Residents Affected - Few This failure resulted in increasing the risk of worsening Resident 1 ' s viral infection and possibly cause harm and mental and emotional distress (anger and frustration). Findings: During an interview on 11/28/23 at 1:08 p.m. with Resident 1, Resident 1 stated he was admitted to the facility on [DATE] through 2/27/23. Resident 1 stated, he was not administered his anti-viral medication as ordered from 2/20/23 through 2/27/23. Resident 1 stated he asked staff for the anti-viral medication daily and each time he was informed that the anti-viral medication was on its way from the pharmacy. Resident 1 stated he went one week without the anti-viral medication and it was hazardous (harmful) to his health and safety. During a review of Resident 1 ' s History and Physical (H&P), dated 2/21/23, the H&P indicated, Resident 1 had history of a [virus - Viruses are microscopic organisms that can infect humans, a virus that attacks the body's immune system]. During a review of Resident 1 ' s Minimum Data Set (MDS – an evaluation of a resident's cognitive and functional status), dated 2/25/23, the MDS indicated the Brief Interview for Mental Status (BIMS) score (an assessment of a resident's cognitive status for memory recall) was 12 (a score of 13 – 15 indicated the resident is cognitively intact, 8 – 12 indicated moderately impaired, and 0 – 7 indicated severe impairment). During a review of Resident 1 ' s Order Summary Report (OSR), dated 2/28/23, the OSR indicated, [brand name] oral tablet 200-25 MG (milligrams – unit of measurement) (anti-viral medication) Give 1 tablet by mouth one time a day for [virus]. Order date 2/20/23. Start date 2/21/23. During a review of Resident 1 ' s Medication Administration Record (MAR), dated 2/1/23 – 2/28/23, the MAR indicated, on 2/21/23, 2/22/23, 2/23/23, 2/24/23, 2/25/23, 2/26/23, and 2/27/23, Resident 1 was not administered [brand name] oral tablet 200-25 MG. During a review of Resident 1 ' s Progress Notes (PN), dated 2/21/23, 2/22/23, 2/23/23, 2/24/23, 2/25/23, 2/26/23, and 2/27/23, the PN indicated, [brand name] oral tablet 200-25 MG was on order and waiting for pharmacy to deliver. During an interview on 11/30/23 at 4:50 p.m. with Director of Nursing (DON), DON stated it was standard of practice to notify the physician when a medication was unavailable according to policy and procedure in order to ensure medications were administered as ordered. DON stated there was an increased risk for worsening Resident 1 ' s viral infection if the anti-viral medication was not administered as ordered. 555118 Page 4 of 5 555118 01/25/2024 Almond Vista Healthcare 2030 Evergreen Avenue Modesto, CA 95350

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 1/10/24 at 2:37 p.m. with Licensed Vocational Nurse (LVN) 3, LVN 3 stated she was assigned to provide care to Resident 1 on 2/21/23, 2/23/23, 2/24/23, and 2/25/23. LVN 3 stated [brand name] oral tablet 200-25 MG was unavailable at the facility since the medication was expensive and required pharmacy verification for approval. LVN 3 stated the verification was given to the Director of Nursing at the time. LVN 3 stated it was standard of practice to notify the physician when a medication was unavailable according to policy and procedure in order to ensure medications were administered as ordered. LVN 3 stated there was an increased risk for worsening Resident 1 ' s viral infection if the anti-viral medication was not administered as ordered. During an interview on 1/11/24 10:08 a.m. with the Administrator (ADM), ADM stated it was standard of practice to notify the physician when a medication was unavailable according to policy and procedure in order to ensure medications were administered as ordered. ADM stated if a medication was unavailable, the medication can be delivered from another pharmacy the facility ' s pharmacy was contracted with. ADM stated facility staff and pharmacy staff were expected to communicate with one another to ensure residents received their medications as ordered. During a review of the facility ' s policy and procedure (P&P) titled, Unavailable Medications, dated 8/2014, the P&P indicated, Policy .The facility must make every effort to ensure that medications are available to meet the needs of each resident . Procedures. B. Nursing staff shall: 1). Notify the attending physician of the situation and explain the circumstances, expected availability and optional therapy(ies) that are available. a. If the nurse is unable to obtain a response from the attending physician, the nurse should notify the nursing supervisor and contact the Facility Medical Director for orders and/or direction . During a review of the professional reference titled, HIGHLIGHTS OF PRESCRIBING INFORMATION, dated 1/2022, the information reviewed indicated, Dosage Recommendations for Treatment of [viral] Infection. Inform [viral] infected patients that it is important to take [brand name] with other antiretroviral drugs for the treatment of [viral] on a regular dosing schedule with or without food and to avoid missing doses as it can result in development of resistance . How should I take [brand name]? Take [brand name] exactly as your healthcare provider tells you to take it. If you take [brand name] to treat [viral] infection, you need to take [brand name] with other [viral] medicines. Your healthcare provider will tell you what medicines to take and how to take them. Take [brand name] 1 time each day with or without food . Do not change your dose or stop taking [brand name] without first talking with your healthcare provider. Stay under a healthcare provider ' s care when taking [brand name]. Do not miss a dose of [brand name] . 555118 Page 5 of 5