Health inspection·September 24, 2024

F 0697 Provide safe, appropriate pain management for a resident who requires such services. 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 administer pain medication for the appropriate pain scale as indicated by the physician ' s orders for one of two residents (Resident 1) reviewed for pain management. Residents Affected - Few This deficient practice had the potential to cause Resident 1 further discomfort and pain. Findings: A review of the facility ' s admission Record indicated Resident 1 was admitted on [DATE] with diagnoses which included a fracture of the right humerus (a broken right upper arm bone), lack of coordination, and muscle weakness. A review of the Minimum Data Set (MDS, an assessment tool) dated 9/21/24, indicated Resident 1 was cognitively intact with a BIMS (assessment of cognition) score of 14. A review of the physician ' s orders dated 9/20/24 indicated, Oxycodone HCL Oral Tablet 5mg Give 1 tablet by mouth every 4 hours as needed for moderate pain . and Oxycodone HCl Tablet 10mg Give 1 tablet every 4 hours as needed for Severe Pain Score 7-10 for 7 days . On 9/24/2024 at 12:37 P.M., an observation was conducted in Resident 1 ' s room. Resident 1 was sitting in her wheelchair, and her right arm was placed in a sling. Resident 1 was observed with facial grimacing, quietly moaning, with the left hand placed over the right shoulder. Resident 1 stated she was in pain and wanted pain medication. During a medication pass observation on 9/24/24 at 12:47 P.M., Licensed Nurse (LN 1) asked Resident 1 to rate her pain on a scale of one to ten, with ten being the worst pain. Resident 1 stated she had 8/10 pain to the right arm. LN 1 was observed reviewing Resident 1 ' s Medication Administration Record. LN 1 took a medication out of the narcotic drawer and placed one pill into a medication cup, and administered it to Resident 1. LN 1 stated [Resident 1] can have Oxycodone 5mg for severe pain, but if her pain is less than 7, I give her Tylenol . On 9/24/24 at 1:10 P.M., a concurrent interview and record review was conducted with LN 1. A review of the physician ' s orders dated 9/20/24 indicated, Oxycodone HCL Oral Tablet 5mg Give 1 tablet by mouth every 4 hours as needed for moderate pain . and Oxycodone HCl Tablet 10mg Give 1 tablet every 4 hours as needed for Severe Pain Score 7-10 for 7 days . LN 1 stated .(Resident 1) is allowed to have 10mg for severe pain .but I didn ' t see it . LN 1 stated since Resident 1 reported severe pain, Oxycodone 10mg should have been administered. LN 1 stated it was important to manage pain .to make Page 1 of 2 555158 555158 09/24/2024 El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243

F 0697 sure the resident is comfortable, its important for healing also . Level of Harm - Minimal harm or potential for actual harm A review of Resident 1 ' s EMAR (Electronic Medical Administration Record) indicated Resident 1 received Oxycodone 5mg with a severe pain level instead of Oxycodone 10mg, on the following days: Residents Affected - Few -9/21/24 at 3:09 A.M. for a pain level of 9/10 -9/21/24 at 12:24 P.M. for a pain level of 7/10 -9/21/24 at 4:50 P.M. for a pain level of 7/10 -9/22/24 at 5:45 A.M. for a pain level of 9/10 -9/24/24 at 1:13 P.M. for a pain level of 8/10 On 9/24/24 at 2 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated her expectation was .for the resident to maintain a manageable pain level . The DON stated Resident 1 should have been given Oxycodone 10mg for a pain level of 7 or above, instead of Oxycodone 5mg. The DON stated by not administering the appropriate dose to address Resident 1 ' s pain, Resident 1 was at risk for further discomfort and a delay of healing. A review of the facility policy titled Pain—Clinical Protocol revised 10/22 indicated, .The staff and physician will identify the characteristics of pain such as location, intensity, frequency, pattern, and severity .staff will use a consistent approach and a standardized pain assessment instrument appropriate to the resident ' s cognitive level .Staff will provide the elements of .appropriate physical .interventions . 555158 Page 2 of 2