Health inspection·October 10, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medicalrecord review, and facility P&P review, the facility failed to ensure the controlled substance medications (medications with high risk for abuse andaddiction) were appropriately accounted for one of two sampled residents (Resident 1). This failure had the potential to negatively affect the health and safety of the resident. Findings: Review of the facility's P&P titledControlled Medications dated 8/2014 showed the medications included in the Drug Enforcement Administration (an agency which enforces the United States' controlled substance laws and regulation) classification as controlled substances are subject to special handling, storage, disposal, and recordkeeping in the facility, in accordance with federal and state laws and regulations. When a controlled medication is administered, the license nurse administering the medication immediately enters the following information on the accountability record and the medication administration record (MAR): A. Date and time of administration B. Amount administered C. Signature of the nurse administering the dose on the accountability record at the time the medication is removed from the supply. D. Initials of the nurse administering the dose on the MAR after the medication is administered. Medical record review for Resident 1 was initiated on 10/6/23. Resident 1 was admitted to the facility on [DATE]. Review of Resident's 1 Order Summary Report showed a physician's order dated 9/14/23,to administer hydrocodone-acetaminophen (a narcotic pain medication) oral tablet 10-325 mg one tablet by mouth every four hours as needed for moderate to severe pain, not to exceed three grams of acetaminophen per 24 hours. Review of Resident's 1 Antibiotic or Controlled Drug Record showed one tablet of hydrocodone-acetaminophen 10-325 mg was signed out on the following dates and times: - 9/17/23 at 1000 hours; Page 1 of 2 555329 555329 10/10/2023 LA Palma Nursing Center 1130 LA Palma Ave Anaheim, CA 92801

F 0755 - 9/18/23 at 1000, 1400, and 2100 hours; Level of Harm - Minimal harm or potential for actual harm - 9/21/23 at 1000 hours; - 9/22/23 at 0900 and 1430 hours; Residents Affected - Few - 9/23/23 at 0930 hours; - 9/25/23 at 2100 hours; - 9/27/23 at 1700 and 2100 hours; - 9/28/23 at 0200 hours; and - 9/29/23 at 0930 and 1330 hours. However, review of Resident's 1 Medication Administration Record dated September 2023 failed to show documented evidence hydrocodone-acetaminophen 10-325 mg was administered to Resident 1 on the above dates. During an interview and concurrent medical record review with the DON and Administrator on 10/6/23 at 1455 hours, the DON and Administrator verified Resident 1's hydrocodone-acetaminophen 10-325 mg tablets were removed but not documented as administered to Resident 1 for the above dates. 555329 Page 2 of 2