Health inspection·August 29, 2023

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** Based on observation, interview and record review, the facility failed to follow the skin assessment care plan and monitor the skin condition for one of 3 sample Residents (Resident 1). This failure resulted in Resident 1 did not have skin assessment and wound care treatment until 2 days after his re-admission and had the potential to contribute to wound infection. Residents Affected - Few Findings: A review of Resident 1's admission record, indicated he was admitted to the facility on [DATE] with diagnoses which included metabolic encephalopathy (a problem in the brain. It is caused by a chemical imbalance in the blood), Alcoholic Cirrhosis (Cirrhosis is scarring of the liver caused by long-term liver damage after many years of heavy drinking. The scar tissue prevents the liver working properly) of Liver with ascites (the build-up of fluid in the space between the lining of the abdomen and abdominal organs), diabetes (elevated blood sugar), and difficulty in walking. Resident 1 was transferred to the local hospital on 7/31/2023 for vomiting blood, he was readmitted to the facility on [DATE] with diagnoses which included esophagitis (Inflammation that damages the tube running from the throat to the stomach) with bleeding, and abdominal pain. He was his own health care decision maker. A review of the facility's policy titled, Care Plans, Comprehensive Person-Centered , revised 3/2022, indicated that The comprehensive, person-centered care plan reflects currently recognized standards of practice for problem areas and conditions , and Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change . A review of Resident 1's care plan, initiated on 5/26/2023, revised on 8/4/2023, indicated that the skin plan was to anticipate skin breakdown secondary to: generalized weakness, liver cirrhosis, diabetes . , and the interventions/tasks included Daily skin inspection during care: Notify Licensed Nurse (LN) of skin integrity impairments . A review of Resident 1's progress note, dated 8/2/2023 at 4:20 pm, indicated that Resident 1 was readmitted to the facility at 3:30 pm from the hospital. There's no note indicated that Resident 1 had skin issue on his left big toe. A review of Resident 1's Weekly Skin Alteration Report , dated 8/4/2023 at 12:16 pm, indicated that Resident 1 had a new Non-pressure area on the left great toe with discoloration , and the Date of First Observance was on 8/4/2023. The size of wound was 1 centimeter x 1.2 centimeter . The Assessment/Care plan Summary indicated that Patient returned from hospital and was noted to have a new area of concern on the left great toe that was no noted prior. The tip of the left great toe is black in Page 1 of 2 555356 555356 08/29/2023 Quartz Hill Post Acute 2120 Benton Drive Redding, CA 96003

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few color with surrounding erythema noted. MD notified and ordered bilateral lower leg arterial dopplers (an imaging test to check the blood flow in the arteries in the legs) . A review of Resident 1's Skin/Wound progress note, dated 8/4/2023 at 12:20 pm, indicated that Resident 1 was noted to have a new area of concern on the left great toe that is black in color with surrounding area blanching erythema . there's no Skin/wound assessment on the day, 8/2/2023, Resident 1 was readmitted back to the facility. A review of Resident 1's physician order, Left great toe: Paint with betadine every day on every dayshift , dated 8/4/2023, started on 8/5/2023, 3 days after the resident was readmitted . During a concurrent observation and interview on 8/9/2023, at 3:03 pm, Resident 1's left great toe appeared to be swollen with redness, and a 1 cm x 1 cm black area presented at the tip of the toe. Resident 1 stated that he bumped himself but could not recall where and when it happened. During a concurrent interview with the Administrator (ADMIN) and Assistant of Director of Nursing (ADON) and record review on 8/9/2023 at 3:27 pm, ADMIN stated that Resident 1 was re-admitted with a skin abrasion on his left big toe. ADON admitted that there's no skin assessment record could be located on the day Resident 1 was readmitted and she stated that The admitting nurse should do the entire assessment, including skin assessment . It should be done on 8/2/2023 . 555356 Page 2 of 2