Health inspection·December 15, 2022

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure restorative nursing (care to improve or maintain the functional ability of the resident) was conducted per the physician's order for one of seven sampled residents reviewed for limited mobility (7). As a result, there was a potential for Resident 7 to experience a decrease in mobility. Findings: Resident 7 was re-admitted to the facility on [DATE] with diagnoses which included osteoporosis (decrease in bone mass) per the facility's Profile Face Sheet. On 12/14/22 at 2:10 P.M., a concurrent interview and record review was conducted with RNA 1. The physician order dated 10/12/22 indicated RNA ambulation program 5x/wk (times/week), Monday to Friday through 1/12/23 for Resident 7. RNA 1 stated if the order was 5x/wk on Monday to Friday, then it has to be followed. RNA 1 stated the consequence of not conducting the RNA per physician's order would be Resident 7 may lose the ability to walk and that was not good. Resident 7's RNA program's chart indicated in 2022: week of 10/24, Resident 7 had RNA 3x/wk week of 10/31, Resident 7 had RNA 4x/wk week of 11/7, Resident 7 had RNA 4x/wk week of 11/14, Resident 7 had RNA 4x/wk week of 11/21, Resident 7 had RNA 4x/wk week of 11/28, Resident 7 had RNA 4x/wk week of 12/5, Resident 7 had RNA 4x/wk On 12/14/22 at 2:35 P.M., an interview with the DON was conducted. The DON stated if the physician's order for Resident 7's RNA program was not being consistently followed, then there was a potential decline for a resident in activities of daily living [walking]. Page 1 of 7 555146 555146 12/15/2022 Redwood Terrace Health Center 710 W 13th Ave Escondido, CA 92025

F 0688 Level of Harm - Minimal harm or potential for actual harm Per the facility's policy and procedure titled, Restorative Nursing Services, dated 2001, Policy Statement Residents will receive restorative nursing care as needed to help promote optimal safety and independence. Residents Affected - Few 555146 Page 2 of 7 555146 12/15/2022 Redwood Terrace Health Center 710 W 13th Ave Escondido, CA 92025

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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** 2a. Resident 30 was admitted to the facility on [DATE] with diagnoses which included glaucoma (vision loss), per the facility's Profile Face Sheet. On 12/12/22 at 8:25 A.M., Resident 30 was observed during the initial tour of the facility. There were two bottles of eye drops on the overbed table. Resident 30 stated she used artificial tears four times a day and the other eye drop at bedtime. A review of Resident 30's medical record was conducted. There was no evidence that Resident 30 could self-administer eye drops. 2b. Resident 16 was admitted to the facility on [DATE] with diagnoses which included hypertension (abnormal blood pressure), per the facility's Profile Face Sheet. On 12/12/22 at 10:16 A.M., during the initial tour of the facility, it was observed that Resident 16's bedside drawer was opened, and there were two large bottles of over-the-counter (OTC) medicine. Resident 16 stated the staff knew about her medications at the bedside and It's fine!. A review of Resident 16's medical record was conducted. There was no evidence Resident 16 had an order from the physician for the OTC or approval for self-administration of medications. 2c. Resident 27 was admitted to the facility on [DATE] with diagnoses which included congestive heart failure (heart problem), per the facility's Profile Face Sheet. On 12/12/22 at 10:33 A.M., during the initial tour of the facility. Resident 27 had a nasal spray bottle on the overbed table. Resident 27 stated he had difficulty squeezing the bottle, so he had to drip the solution into his nose. A review of Resident 27's medical record was conducted. There was no evidence Resident 27 had an order from the physician for the nasal spray or approval for self-administration of medications. 2d. Resident 32 was admitted to the facility on [DATE] with diagnoses which included severe obesity, per the facility's Profile Face Sheet. On 12/12/22 at 10:49 A.M., during the initial tour of the facility, Resident 32's bathroom was observed. On the countertop was a medicine cup with a pink-color cream inside. Resident 32 stated the LN applied the cream last night on her bottom. On 12/13/22 at 3:24 P.M., an interview was conducted with LN 1. LN 1 stated residents who wish to keep their medication at the bedside should have an assessment and an order from the physician. LN 1 further stated the cream on Resident 32's bathroom was a medicated cream. A review of Resident 32's medical record was conducted. There was no evidence Resident 32 had a physician's order for the cream or approval for self-administration of medications. 555146 Page 3 of 7 555146 12/15/2022 Redwood Terrace Health Center 710 W 13th Ave Escondido, CA 92025

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2e. Resident 88 was admitted to the facility on [DATE] with diagnoses which included a fracture of the left femur (broken thigh bone) per the facility's Profile Face Sheet. On 12/12/22 at 3:20 P.M., during the initial tour of the facility, Resident 88 was observed. Resident 88 had two single-use vials of eye drops inside a medicine cup on the overbed table. Resident 88 stated she used the eye drops four times a day. A review of Resident 88's medical record was conducted. There was no evidence Resident 88 could self-administer eye drops. On 12/13/22 at 3:24 P.M., an interview was conducted with LN 1. LN 1 stated residents who wish to keep their medication at the bedside should have an assessment and an order from the physician. LN 1 further stated no residents in the facility had approval from the physician to self-administer. On 12/14/22 at 3:55 P.M., an interview was conducted with the DON. The DON stated no residents had approval from the physician to self-administer medications. The DON stated the LNs should not leave the medications unattended to ensure residents' safety. 2f. Resident 194 was re-admitted to the facility on [DATE] with diagnoses which included mild cognitive (thinking ability) impairment per the facility's Profile Face Sheet. On 12/13/22 at 8:28 A.M., an observation of medication administration to Resident 194 was conducted. LN 1 prepared six medications for Resident 194, placed it in the medicine cup, left the medications on the breakfast tray, and then left the room without observing Resident 194 take the medications. On 12/13/22 at 9 A.M., an interview with LN 1 was conducted. LN 1 stated she knew she should not have left Resident 194's medications without observing her take them. LN 1 stated she should have watched Resident 194 take the medications for patient safety or not take the medications. On 12/13/22 at 10:13 A.M., an interview with the DON was conducted. The DON stated the staff should have taken the medications with her if she had to leave the resident's room prior to the resident taking the medications. The DON stated without observation, the staff would not know what the resident did with the medications. 2g. Resident 200 was admitted to the facility on [DATE] per the facility's Profile Face Sheet. On 12/14/22 at 4:34 P.M., during an observation of medication administration with LN 7 and LN 8, a bottle of vitamin and mineral supplements were found inside Resident 200's drawer inside his room. LN 7 stated Resident 200 may take more than what was prescribed if the medications were kept in his room. On 12/14/22, an interview with LN 2 was conducted. LN 2 stated Resident 7 should not have the medication inside his room. LN 2 stated the medication was in Resident 200's drawer since admission. LN 2 stated Resident 7 may overdose on the medication if it was kept in his room. A record review was conducted. There was no self-administration assessment conducted for Resident 200 prior to 12/14/22. On 12/15/22 at 8:06 A.M., an interview with the DON was conducted. The DON stated if a resident did 555146 Page 4 of 7 555146 12/15/2022 Redwood Terrace Health Center 710 W 13th Ave Escondido, CA 92025

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some not pass a self-administration assessment and a medication was kept inside a resident's room, there was always a risk of a resident taking more than what was prescribed which could cause potential harm. Per the facility's policy and procedure, titled Medication Administration Self-Administration by Resident, dated 11/17, .The interdisciplinary team determines the resident's ability to self-administer medications by means of a skill assessment . Per the facility's policy and procedure, titled Medication Storage, dated 9/18, .The medication supply shall be accessible only to licensed nursing personnel . Based on observation, interview, and record review, the facility failed to ensure LN removed an expired medication from the medication cart for one of two medication carts observed. In addition, LN left medications unattended in residents room and allowing residents to self-administer without proper assessment and qualification for two of 13 sampled residents (27 and 88), and five unsampled residents (16, 30, 32, 194 and 200). As a result, there was a potential for staff to administer expired medication. In addition, staff would not have been able to verify the appropriate dose taken by the residents. Findings: 1. On 12/15/22 at 10:21 A.M., an observation of a medication cart was conducted with LN 2. A bottle of calcium citrate tablets was noted to have expired on 8/22. On 12/15/22 at 10:28 A.M., an interview with LN 2 was conducted. LN 2 stated if a resident was given an expired medication, it could have less effectiveness. On 12/15/22 at 10:30 A.M., an interview with LN 6 was conducted. LN 6 stated there should have not been expired medications in the medication cart. On 12/15/22 at 1:45 P.M., an interview with the DON was conducted. The DON stated if there were expired medications in the medication cart, there was a risk it would be given to a resident which could cause potential harm. Per the facility's policy and procedure titled Storage of Medication, dated 9/18, .Procedures .14 .Outdated, .medications .are immediately removed .disposed of . 555146 Page 5 of 7 555146 12/15/2022 Redwood Terrace Health Center 710 W 13th Ave Escondido, CA 92025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure food stored and prepared in the kitchen was in accordance with professional standards for food and service safety when: 1. the walk-in refrigerator had open and undated food, and 2. a box of lemon-glycerin swabsticks (lemon-flavored medical swab sticks that were 4-inch plastic swabs with [NAME] or foam tips) was stored in the residents' reach-in freezer. As a result, there was a potential for the staff to serve contaminated or spoiled food, and swabsticks may accidentally be ingested by a confused resident. Findings: 1. On 12/12/22 at 8:20 A.M., a joint observation and interview were conducted with CK 1. Inside the walk-in refrigerator, there was a tray of cube potatoes spread evenly on the tray with no cover, label, or date, and a tray of small plastic cups containing a yellow-colored substance. The tray had no date or label. CK 1 stated prepared items should have been labeled and dated. On 12/12/22 at 8:40 A.M., an interview was conducted with RDS 1. RDS 1 stated the kitchen staff should label and date the prepared foods. RDS 1 further stated it was essential to date items to ensure the items prepared first should have been served first. Per the facility's policy and procedure, titled Production, Purchasing, Storage, dated 1/22, .Cover, label, and date unused portions and open packages .Date and rotate items . 2. On 12/13/22 at 4:38 P.M., the residents' food refrigerator with freezer in the communal area was observed with the DON. A box of lemon-glycerin swabs was found inside the freezer. The DON stated the ST used the items for treatment and should not be inside the resident's refrigerator. A follow-up interview was conducted with ST 1. ST 1 acknowledged she put the lemon-glycerin swabs in the resident's refrigerator and used the swabs during treatment. Furthermore, ST 1 stated she should not place the swabs with the residents' food. On 12/14/22 at 11:25 A.M., an interview was conducted with RDS 2. RDS 2 stated the lemon-glycerin swabs were not food and should not be inside the resident's refrigerator. Per the facility's policy and procedure, titled Production, Purchasing, Storage, dated 1/22, .All food, non-food items and supplies used in food preparation shall be stored in a manner as to prevent contamination to maintain the safety and wholesomeness of the food for human consumption . 555146 Page 6 of 7 555146 12/15/2022 Redwood Terrace Health Center 710 W 13th Ave Escondido, CA 92025

F 0880 Provide and implement an infection prevention and control program. 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 follow infection control prevention for one of 13 sampled residents (28) when the LN put on new gloves without performing hand hygiene. Residents Affected - Few As a result, there was a potential for cross-contamination. Findings: Resident 28 was admitted to the facility on [DATE] with diagnoses which included diabetes mellitus (abnormal blood sugar) per the facility's Profile Face Sheet. On 12/12/22 at 2:26 P.M., LN 2 was observed conducting a wound dressing change to Resident 28. LN 2 cleansed Resident 28's right foot with gloved hands and then, LN 2 removed her gloves. LN 2 put on new gloves without performing hand hygiene, and proceeded to complete the wound dressing change. After Resident 28's dressing change, an interview was conducted with LN 2. LN 2 stated she did not perform hand hygiene after removing the soiled gloves and applying new ones. LN 2 further stated she should have performed hand hygiene between glove changes. On 12/14/22 at 3:55 P.M., an interview was conducted with the DON. The DON stated the staff should perform hand hygiene between glove changes to prevent cross-contamination. Per the facility's policy and procedure, titled Handwashing/Use of Alcohol-Based Hand Rubs, dated 8/20, .Perform hand hygiene before applying non-sterile gloves .When removing gloves .perform hand hygiene. 555146 Page 7 of 7