Health inspection·December 30, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** The facility failed to follow their policy and procedure on medication administration when a Licensed Vocational Nurse failed to administer Nifedipine (medication use to lower blood pressure) ordered by physician to one of three sampled Residents (Resident 1). Residents Affected - Few This failure has a potential to place a clinically compromised Resident 1 ' s health and safety at risk. Findings: During a review of Resident 1 ' s admission Record (general demographics), the document indicated Resident 1 was last admitted to the facility on [DATE], with diagnoses that included, cerebral infarction ( damage to tissues in the brain due to a loss of oxygen to the area), hypertension ( High blood pressure), gastroesophageal reflux ( involuntary back flow of stomach contents back into the esophagus or food pipe ), rheumatoid arthritis (chronic autoimmune disease that causes inflammation and damage to the joints), malignant neoplasm of female breast ( a cancerous tumor that develops in the breast tissue ), polyneuropathy (affects nerves that control movement, feeling, or both), depressive disorder ( loss of pleasure or interest in activities for long periods of time), anxiety disorder ( feelings of worry, anxiety, or fear that strong enough to interfere with one ' s daily activities). During an interview with a Licensed Vocational Nurse 2 (LVN2), on December 17, 2024, at 12:30 PM, LVN2, stated on December 3, 2024, at 10:40 AM, LVN2 notified Resident 1 ' s Primary Physician (PMD) regarding a PRN (as situation demands or as needed) order for Hydralazine 60 mg PO (By mouth) every 6 hours PRN for Blood Pressure above 160 systolic. LVN 2 stated Hydralazine 60 mg po was administered on December 3, 2024, at 11:00 AM for a high blood pressure above 160 systolic. LVN 2 stated that Resident 1 verbalized she did not receive her blood pressure medication on December 2, 2024, at 9:00 pm. During a concurrent MEDICATION ADMINISTRATION RECORD (MAR) review and interview with Nursing Office Assistant (NOA), on December 17,2024, at 1:20 PM. NOA stated there is no documentation or signature on MAR, that Nifedipine ER 60 mg po Q HS was administered on November 28, 2024, and November 29, 2024, at 9:00 PM During an interview with Administrator (ADM) on December 22,2024 at 2:35 PM, ADM stated that he did a grievance following a complaint from Resident 1 ' s daughter regarding the missed medication dose on Resident 1 on December 2, 2024, at 9:00 PM. ADM interviewed LVN 1, and he stated that Nifedipine ER 60 mg was not given on December 2, 2024, at 9:00 pm due to blood pressure below110 systolic. ADM stated, upon reviewing the MAR, there is no documentation/Signature that a dose was administered on Page 1 of 2 555251 555251 12/30/2024 Knolls West Post Acute LLC 16890 Green Tree Blvd Victorville, CA 92395

F 0684 November 28, 2024, and November 29, 2024, at 9:00 PM. Level of Harm - Minimal harm or potential for actual harm During a review of Resident 1 ' s admission physician ' s orders on December 30, 2024, at 9:30 AM, dated November 27, 2024, indicated, NIFEDIPINE ER 60 MG PO Q HS ( At bedtime ) , HOLD FOR SYSTOLIC BELOW 110. Residents Affected - Few During a concurrent record review and interview on December 22, 2024, at 2: 40 PM with the ADM, the facility ' s policy, and procedure (P&P) titled, Physician ' s Orders dated October 2014 was reviewed. The P&P indicated, It shall be this facility ' s policy to provide care and services to the resident in accordance with physician orders .1. All aspect of resident ' s care, including but not limited to the following shall only be provided if ordered by the physician: Medications. During a concurrent record review and interview on December 22,2024 at 2:42PM with the ADM, the facility ' s P&P titled, Medication and Treatment Administration dated October 2014 was reviewed. The P&P indicated, It is the policy of this facility to administer medication or treatment, upon order of a person lawfully authorized to give such orders, and within the scope of professional standards of practice .2. Medications and Treatments shall be administered as prescribed . 21. Licensed nurse administering the medication/treatment shall record the date, time, dose of the drug or treatment administered to the resident in the clinical record ( e.g. MAR, treatment record ). 555251 Page 2 of 2