Health inspection·May 25, 2023

F 0551 Give the resident's representative the ability to exercise the resident's rights. 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 ensure one of four sampled residents ' (Resident 1) rights were upheld when it failed to honor an agreement made with Resident 1 ' s health care agent (FM 1) regarding his choice of excluding involvement of Licensed Staff A in Resident 1 ' s care. This failure resulted in FM 1 to experience anger, distrust, and undermined his confidence in the nursing care rendered to Resident 1 for 14 months, from the agreement date of 1/17/22, until her discharge from the facility on 3/11/23. Residents Affected - Few Findings: A review of Resident 1 ' s admission Record (a summary of important information about a patient) indicated she was admitted to the facility on [DATE] with diagnoses that included dementia (a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life). A review of Resident 1 ' s Advance Health Care Directive, dated 3-13-2015, designated FM 1 as her health care agent. During an interview on 5/24/23 at 2:40 p.m., FM 1 stated he met with facility staff back in January 2022 to express his concerns regarding Licensed Staff A. FM 1 stated he had been assured by the facility that Licensed Staff A would no longer be involved in Resident 1 ' s care per his request. FM 1 stated it was not until March 2023, 14 months after the agreement was made, when he found out that Licensed Staff A had continued to be part of Resident 1 ' s care, after noting numerous Progress Notes (records of the medical care a patient receives, along with details of the patient's condition) in 2022 and 2023, that were authored by Licensed Staff A. FM 1 stated the facility knew of the agreement but had broken its word. Upon discovery of the Progress Notes, FM 1 stated he was angry and distrustful of the facility and added that it had undermined his confidence in the nursing care that Resident 1 had received in the past year. A review of Resident 1 ' s Progress Notes revealed an IDT Note, dated 01/17/2022, which indicated, IDT had conference call with [FM 1] to discuss his concerns . [FM 1] mentions a specific nurse he wishes to not be involved in his mother ' s care and [FM 1] was reassured this nurse would no longer be involved at his request . Further review of Resident 1 ' s Progress Notes indicated 26 entries authored by Licensed Staff A throughout Resident 1 ' s facility admission until her discharge date on 3/11/23, with majority of the notes as IDT (Interdisciplinary Team) Note type. During an interview on 5/25/23 at 9:50 a.m., Licensed Staff A stated the IDT was a team that met to identify and discuss resident concerns and collaborated on interventions that could be done for them. Licensed Staff A stated the IDT included members from nursing, therapy, Social Services, and other departments involved in the resident ' s care. Licensed Staff A stated part of her role as the Page 1 of 2 555222 555222 05/25/2023 Lakeport Post Acute 1291 Craig Avenue Lakeport, CA 95453

F 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Quality Assurance Nurse included involvement with the IDT. Licensed Staff A stated she had been part of Resident 1 ' s IDT and confirmed she had authored IDT entries on Resident 1 ' s Progress Notes during the past year. Licensed Staff A stated while she was aware of FM 1 having issues with her, she was not aware of any restriction to her involvement with Resident 1 ' s care. During an interview and concurrent review of Resident 1 ' s Progress Notes on 5/25/23 at 11:11 a.m., Licensed Staff B confirmed she authored the IDT Note dated 1/17/23 and identified Licensed Staff A as the nurse indicated on the note. Licensed Staff B stated FM 1 mentioned how he did not want Licensed Staff A to be involved with Resident 1 ' s care during the meeting and she had reassured FM 1 that Licensed Staff A will not be providing direct care to Resident 1. When asked if Licensed Staff A was notified of this agreement, Licensed Staff B stated she told Licensed Staff A, For your safety, distance yourself [from Resident 1]. Licensed Staff B stated Licensed Staff A was part of Resident 1 ' s IDT but had not been providing direct care to Resident 1 since the meeting. During an interview and concurrent record review on 5/25/23 at 11:31 a.m., the Administrator stated he was present during the meeting with FM 1 and Licensed Staff B on 1/17/23. The Administrator stated Licensed Staff A was only writing on Resident 1 ' s records as an IDT member and maintained that Licensed Staff A had not provided any direct care to Resident 1 since the 1/17/23 meeting. When queried if FM 1 had been notified of the extent of Licensed Staff A ' s inclusion in Resident 1 ' s IDT after the 1/17/23 meeting, the Administrator did not respond. When asked if Licensed Staff A ' s presence in the IDT for Resident 1 could be taken as involvement in care, the Administrator stated, That ' s reaching. A review of the facility policy titled, Resident Rights, dated February 2021, indicated, Employees shall treat all residents with kindness, respect, and dignity . These rights include the resident ' s right to . self-determination . be informed of, and participate in, his or her care planning and treatment . 555222 Page 2 of 2