Health inspection·July 31, 2024

F 0697 Provide safe, appropriate pain management for a resident who requires such services. 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 pain medication was administered, in accordance with the resident ' s comprehensive care plan, and the resident ' s goals for care and preferences for one of three residents (Resident 1) who were sampled for pain management. This failure caused Resident 1 to experience increased pain and discomfort with the potential to experience a decline in her health condition. Residents Affected - Few Findings: The facility ' s policy titled Pain Policy undated, indicated The Center [facility] evaluates for, and attempts to manage/minimize, pain in residents. The facility ' s policy titled Medication Administration undated, indicated Medications are administered in accordance with written orders of the prescriber [Physician]. Medications are to be administered within 60 minutes of scheduled time A review of Resident 1 ' s undated Face Sheet indicated that Resident 1 was admitted on [DATE] with diagnoses including a broken leg, muscle weakness, lung disease, and pain. A review of Resident 1 ' s admission Minimum Data Set (MDS, a clinical assessment), dated 4/9/24, indicated Resident 1 had pain frequently and the pain occasionally disturbed her sleep and activities. Resident 1 was able to understand and make her own health care decisions and participate in her treatment plan. A review of Resident 1 ' s Care Plan, titled Acute [severe]/chronic [constantly recurring] pain r/t [related to] left femoral neck intertrochanteric fracture [broken left leg], chronic back pain, and arthritis dated 4/3/24, indicated interventions included Anticipate the resident ' s need for pain relief and respond immediately to any complaint of pain. A review of Resident 1 ' s Care Plan titled The resident is on pain medication therapy . dated 4/3/24, indicated interventions included, Administer ANALGESIC [painkilling] medication as ordered by physician. A review of Resident 1 ' s Physician ' s Orders dated 4/23/24, indicated Resident 1 had an order for Norco (a narcotic with two medications mixed into one tablet to treat pain) Tablet 10-325 mg (10 mg of Hydrocodone [a strong pain medication that acts on the central nervous system] and 325 mg of Acetaminophen [a milder pain medication]). The order read to give 1 tablet by mouth every four hours for pain. The scheduled times for this medication was: midnight, 4:00 am, 8:00 am, 12:00 pm, 4:00 pm, (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 555281 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555281 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oroville Hospital Post-Acute Center 1000 Executive Parkway Oroville, CA 95966 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)