Health inspection·January 17, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a resident centered care plan to address functional assistance needed with Activities of Daily Living (ADL) for one of two sampled residents (Resident 1) in accordance with the facility policy. This failure had the potential for Resident 1 not to receive interventions specific to the residents needs, which could result in injury and fall. Findings: A review of Resident 1's admission Record indicated the resident was initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident 1's diagnoses included dementia (the impaired ability to remember, think or make decisions that interferes with doing everyday activities), difficulty in walking and fracture (break in the bone) of the right femur (thigh bone). A review of Resident 1's History and Physical Examination, dated 3/15/23, indicated Resident 1 does not have the capacity to understand and make decisions. A review of Resident 1's Minimum Data Set (MDS, a standardized resident assessment care screening tool), dated 12/13/23, indicated the resident was severely impaired with cognitive (difficulty with or unable to make decisions, learn, remember things) skills for daily decision making. Resident 1 needed substantial/maximal assistance (helper does more than half the effort; helper lifts or holds trunk or limbs and provides more than half the effort) with walking, transfers (how resident moves to and from bed, chair, wheelchair, standing position), dressing and personal hygiene & required setup or clean-up assistance with eating. During an interview on 1/17/24 at 2:13 PM with Restorative Nursing Assistant (RNA), RNA stated that Resident 1 needed two-person assistance with walking. During a concurrent record review of Resident 1's ADL Function Care Rehab Care Plan and interview on 1/17/24 at 3:46 PM with Physical Therapist (PT), Resident 1's care plan indicated Resident 1 needed Substantial assist with walking. PT stated, I understand substantial assist as the resident only needing one person assist with ambulation (walking). PT also stated care plan should have indicated that the resident was max assist to totally dependent with two people for ambulation. PT stated, It is not safe for the resident to ambulate with only one person since she might fall and sustain further injury. Page 1 of 2 555272 555272 01/17/2024 Atherton Baptist Home 214 South Atlantic Blvd. Alhambra, CA 91801

F 0656 Level of Harm - Minimal harm or potential for actual harm During an interview on 1/17/24 at 4:04 PM with Care Plan Coordinator (CPC), CPC stated, I inputted substantial assist with ambulation in Resident 1's care plan since that is what is reflected on the resident's MDS. CPC stated, I should have made the care plan entry more specific, clear, and easy to understand by facility staff especially since I believe that the resident should ambulate with two-person assistance for her safety and to prevent her from falling. Residents Affected - Few During a record review of Resident 1's Interdisciplinary Team (IDT) Conference Record, dated 1/12/24, IDT Conference Record indicated that the resident required up to extensive to total assistance with ADLs. A review of Resident 1's Falls Care Plan, dated 1/8/24, indicated, Consult with therapy regarding current functional status and follow all recommendations and the restorative programs. A review of the facility's policy and procedure titled, Care Area Assessments, revised November 2019 indicated to Include specific interventions, including those that address common causes of multiple issues. A review of the facility's policy and procedure titled, Care Plans, Comprehensive Person-Centered, revised March 2022, indicated, The care plan interventions are derived from a thorough analysis of information gathered as part of the comprehensive assessment. 555272 Page 2 of 2