Health inspection·June 16, 2024

F 0584 Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Level of Harm - Immediate jeopardy to resident health or safety Based on observation, interview, and record review, the facility failed to: Residents Affected - Many 1. Maintain acceptable room temperature ranging from 71 to 81 degrees Fahrenheit (°F, unit of temperature) for 51 of 51 residents (Resident 1 to Resident 51) in the Sub-Acute (a medical facility that provides medical care to chronically ill patients who are medically stable) Unit. 2. Maintain the chiller (a cooling water circulation device that is connected to the air conditioning [A/C] system) for two of two chillers in working condition. 3. Monitor and record room temperatures in accordance with facility's policy and procedures, titled Daily Maintenance Log and Out of Range Temperatures, and Temperature Monitoring of Patient Room. 4. Ensure the rental chillers, which were used temporarily to replace the broken chillers of the air conditioner, were working properly. These deficient practices placed the 51 residents on the Sub-Acute Unit at risk for dehydration (excessive loss of body water) and/or heat stroke (internal body heat with complications involving the central nervous system that occur after exposure to high temperatures). On 6/15/2024 at 7:25 p.m., the Department called an Immediate Jeopardy (IJ, a situation in which the facility's non-compliance with one or more requirements of participation has caused, or is likely to cause serious injury, harm, impairment, or death of a resident) situation for the facility's failure to provide a safe environment to the residents by failing to maintain an acceptable residents' rooms temperature range of 71 to 81 degrees Fahrenheit in the presence of the Chief Nursing Officer (CNO) 1. On 6/16/2024 at 2:16 p.m. and 3:45 p.m., the facility submitted an IJ Removal Plan (immediate action that includes all actions the entity has taken or will take to immediately address the noncompliance that resulted in or made serious injury, serious harm, serious impairment, or death likely), which was not accepted. On 6/16/2024 at 4:12 p.m., the survey team conducted an exit conference with CNO 1 and exited the facility, with the IJ situation not removed. 6/18/2024 at 2:46 p.m., the facility submitted an IJ Removal Plan, which was not accepted. Findings: Page 1 of 3 555217 555217 06/16/2024 Pacifica Hospital of the Valley Dp Snf 9449 San Fernando Road Sun Valley, CA 91352

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many During an interview on 6/15/2024, at 2:11 p.m., with CNO 1, CNO 1 stated the chillers for the hospital went out yesterday on 6/14/2024 with no time identified. The hospital had vendors come and installed 2 rental chillers to use. The staff engineer checked the rental chillers after installation and the staff engineer stated everything was to be ok. The staff engineer did not check the temperature of the residents' rooms to confirm the temperature range was safe for patient care. During an interview on 6/15/2024, at 2:30 p.m., with House Supervisor (HS) 1, HS 1 stated, It feels very hot in the hospital. The engineer staff have been working on it today. During an interview on 6/15/2024, at 2:39 p.m., with Engineer Staff (ES) 1, ES 1 stated he was on duty today and the vendors were checking on the two rental chillers. The two rental chillers were running fine when ES 1 left the hospital at 1:15 pm today. ES 1 stated he told staff if they had issues with the temperature to call the on-call engineer staff. ES 1 stated 68 to 74 degrees Fahrenheit was a normal comfortable temperature range for the Sub Acute Unit. ES 1 did not know at this time if the two rental chillers were down. ES 1 stated it is important to keep the residents' rooms in running cool temperature. ES 1 stated he did not do a temperature log for today. ES 1 stated he did not have time to do the temperature log. During an interview on 6/15/2024, at 2:39 p.m., with Director of Operations (DO) 1, DO 1 stated the following: two rental chillers were installed at 4 am this morning and at 9 am, both rental chillers were running fine. DO 1 stated the engineer staff should be checking the chillers and temperature of the Sub Acute Unit daily. DO 1 stated the engineer staff should be checking and monitoring the temperature of the Sub Acute Unit after installation of the rental chillers. During an observation on 6/15/2024, at 3:34 p.m., on Sub Acute Unit on the 3rd Floor, rooms 340 to 344 were noted to have a hot temperature. During an interview on 6/15/2024, at 3:36 p.m., with Registered Nurse (RN) 2, RN 2 stated, Yesterday, called engineering department because temperature was hot, and they came. Today I called engineering department for the temperature, and they did not come. It has been hot today on the Sub Acute Unit. Did not provide cooling measures to the residents today. Not safe for residents to be in high temperature condition, they can have serious complications. During an observation on 6/15/2024, at 4:03 p.m., with Engineer Staff (ES) 1 on Sub Acute Unit on the 3rd Floor, ES 1 used a handheld thermometer (a non-contact thermometer temperature-sensing instrument) to obtain the temperature of rooms 340 to 344. The rooms had a temperature range of 77 to 82 degree per reading on the handheld thermometer. During an observation on 6/15/2024, at 4:46 p.m., with Engineer Staff (ES) 1 on the Sub Acute Unit 2nd Floor, ES 1 used a handheld thermometer to obtain temperature of rooms 340 to 344. The rooms had a temperature range of 77 to 82 degree per reading on the handheld thermometer. During an observation on 6/15/2024, at 5:50 p.m., with Engineer Staff (ES) 1 on Sub Acute Unit on 3rd Floor, ES 1 used a handheld thermometer to obtain temperature of rooms 340 to 344. The rooms had a temperature range of 77 to 82 degree per reading on the handheld thermometer. During an interview on 6/15/2024, at 5:57 p.m., with Licensed Vocational Nurse (LVN) 1, LVN 1 stated, Today at 11 a.m., it started to be hot. The temperature feels hot. It is important for the temperature to be cool for residents, they can have problems if the rooms are very hot. 555217 Page 2 of 3 555217 06/16/2024 Pacifica Hospital of the Valley Dp Snf 9449 San Fernando Road Sun Valley, CA 91352

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many During an interview on 6/15/2024, at 6:01 p.m., with Licensed Vocational Nurse (LVN) 2, LVN 2 stated, Nursing station temperature is really bad and felt really hot the whole start of my shift. The hospital air conditioning has always been a problem, we alerted the engineering department about the AC problem, but I think there are limited staff to get it done. Today is obvious hot on this Sub Acute Unit floor. It is not safe for residents to be in this hot air condition, they can have problems. During an interview on 6/15/2024, at 6:19 p.m., with CNO 1 and Engineer Staff (ES) 1, CNO 1 and ES 1 stated, The reason why the facility had problems with the two rental chillers because the vendor installed it incorrectly. Informed by the current vendor onsite who does not want to touch the work of another vendor. The water hoses of the rental chillers (was) installed incorrectly by the vendor. There is no estimated time for the vendor, who installed the chillers incorrectly, will be here. They are on their way as soon as possible to fix the issue. During a review of the facility's census dated 6/15/2024, the census indicated that there were 51 sub-acute residents in the facility. During a review of the facility's policy and procedure (P&P) titled, Contingency Plan for Failure of Air Conditioning System, revised on 2/2024, the P&P indicated, The Engineering Department shall have a contingency plan in place in the event of failure of the air-conditioning system. During a review of the facility's P&P titled, HVAC System, revised on 2/2024, the P&P indicated, Engineering Department personnel shall be trained in the preventative maintenance, location and safe operation of the HVAC system. During a review of the facility's P&P titled, Daily Maintenance Log and Out of Range Temperatures, revised on 2/2024, the P&P indicated, Engineering Department personnel will conduct daily rounds and monitor patient room temperatures that drop below or exceed above normal comfortable room temperature ranges. The facility was unable to provide records of residents' rooms temperature monitoring for the sub-acute. During a review of the facility's P&P titled, Temperature Monitoring of Patient Room, dated 10/2023, the P&P indicated, Purpose: This policy is to provide instructions on how to monitor and document temperatures that are required for assuring optimal conditions for patient rooms. Frequency: Temperatures of room air are monitored and documented each day manually by the Engineering Department. Acceptable Temperature Room Ranges 71 to 81 degrees 555217 Page 3 of 3