Health inspection·April 4, 2023

F 0791 Provide or obtain dental services for each resident. 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 follow-up with the dental services for one (Resident 1) of three residents when Resident 1's tooth was avulsed. Residents Affected - Few This failure resulted in Resident 1's tooth not reimplanted for 11 months or not having the replacement tooth for 11 months. Findings: Review of Resident 1's clinical record indicated he was admitted to the facility on [DATE] with diagnoses including anoxic brain injury, persistent vegetative state and dependence on respirator. Review of Registered Nurse's (RN A) notes, dated 3/31/22, indicated resident 1 banged his tooth to side rail during activity of daily living (ADLs) while being turned. Review of the facility dentist (DT) notes, dated 4/3/22, indicated Resident 1 sustained avulsion injury of a permanent tooth after hitting his tooth on the bed side rail. Further review of the DT notes indicated Resident 1's responsible party (RP; person who makes all care decisions for the resident) was to pursue a dental implant to restore the empty space in the mouth where a tooth was. Review of Licensed Vocational Nurse's (LVN B) notes, dated 4/16/22, indicated Resident 1 was approved for dental referral for consultation. Review of the inter-disciplinary team care conference, dated 4/25/22, did not indicate how the tooth reimplantation will pursue. During an interview with the facility dentist (DT), on 1/30/23 at 3:00 p.m., the DT indicated for an implant Resident 1 would need hospitalization and anesthesia (use of medications to prevent pain during surgery). Review of Resident 1's clinical record did not indicate Resident 1 was hospitalized for the reimplantation. During an interview with the Social Services Director (SSD), on 1/30/2023 at 2:15 p.m., the SSD confirmed the RP wanted Resident 1 to have an implant. She stated the Administrator was hesitant to pay for services and to only find a place that took the RP's insurance. The SSD stated the burden fell Page 1 of 2 555204 555204 04/04/2023 Childrens Hc Org No CA Saratoga Pediatric Subacute 13425 Sousa Lane Saratoga, CA 95070

F 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few onto the RP to cover with her insurance. The SSD stated she left her position at the facility, in part, because of the handling of this incident. She stated the previous administer did not want to cover it. She indicated she provided to the RP the state agency (SA) contact information along with the ombudsman's contact information so the RP could file a complaint with the SA. She stated she had a meeting with the owner of the facility who indicated the facility should pay for expenses. She stated she returned to working for the facility after the previous administrator left employment. During an interview with the ombudsman (OMB), on 1/30/2023 at 2 p.m., the OMB indicated her understanding was the facility said no on the implant and she indicated she believed the facility was responsible for the implant given it happened while Resident 1 was under their care. Review of the facility's email sent to the surveyor, dated 2/24/23, indicated the facility's plan was to reimburse for any dental expenses. Review of the facility's policy Dental Services, reviewed 10/2021, indicated if dental services cannot be provided at the facility, the facility will assist in making appointments and arranging for transportation to and from the service location. 555204 Page 2 of 2