Health inspection·January 30, 2024

F 0551 Give the resident's representative the ability to exercise the resident's rights. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record review, the facility failed to ensure residents' rights were honored when the facility limited Resident 1's legal representative's visitation to one hour a day. Residents Affected - Few This failure had violated Resident 1's visitation rights by not honoring exercising the resident's rights to designate visitors of his/her choosing. Findings: During a review of Resident 1's History and Physical (H&P), dated 09/26/2019, the H&P indicated, Resident 1 was admitted to the facility for continued tracheostomy (a surgically created hole in the windpipe (trachea) that provides an alternative airway for breathing) care, anti-aspiration ( to avoid food or fluids getting into the airway) measures, and pulmonary toilet ( exercises and procedures that help to clear the airways of mucus and other secretions). During a review of Resident 1's physician's progress note (PPN), dated 1/29/2024, the PPN indicated, Resident 1 had past medical history including, but not limited to. respiratory failure (a condition when blood does not have enough oxygen or too much carbon dioxide), severe encephalopathy (disease that affects the whole brain and alters how it works causing changes in mental function), dysphagia (difficulty swallowing), percutaneous endoscopic gastrostomy ( PEG)( a procedure to place a feeding tube into the stomach) placement and tube feeding (a liquid form of nutrition provided through a flexible tube). During an interview, on 1/30/2023, at 9:24 a.m., with RR 1, the RR1 stated, the facility limited RR1's visitation hours to a one hour a day as of December 2023. The RR1 stated, the RR1 is Resident 1's conservator ((a court arrangement where a judge appoints a responsible person (a conservator) to care for another adult who cannot care for themselves [conservatee]) was not notified of the imposed restrictions and the facility only kept in contact with the Resident 1's second conservator (RR 2). The RR1 stated, the facility violated Resident 1's rights by attempting to implement unreasonable visitation hours disregarding that the RR1 is Resident 1's conservator for Resident 1. The RR 1 further stated, the RR1 is not always allowed to participate in Interdisciplinary Treatment (IDT) meetings (an essential part of collaborative care, where physicians, nurses, therapists, social workers, and other professionals work together to plan and coordinate patient care) and is not regularly updated about Resident 1's treatment plan. During an interview on 1/30/2023 at 2:15 p.m., with the director of nursing (DON), the DON stated, Resident 1 was admitted to the facility in 2019. The DON further stated, during Resident 1's stay at the facility, there were multiple disturbing events involving Resident 1's Representative 1(RR1). The DON further stated, the RR1 witnessed and documented disturbing behavior included, but no limited Page 1 of 3 555380 555380 01/30/2024 Encino Hospital Medical Center D/P Snf 16237 Ventura Blvd Encino, CA 91436

F 0551 Level of Harm - Minimal harm or potential for actual harm to, yelling and threatening staff, physical assault to a charge nurse, disturbing other residents by looking for staff in their rooms and playing loud music at night, verbal assaults and name calling, throwing objects at staff, interfering with patient care and medication administration and physician's orders, not following infection control rules, and closing the Resident 1's door when asked by nursing staff to keep the door open for visual observation. Residents Affected - Few During a further interview on 1/30/2023, at 2:15 p.m., with the DON, the DON stated, the facility attempted to address RR 1's behavior many times. The DON stated, the facility's manager (FM) received numerous staff complaints about RR1's behavior and some staff resigned, as a result. The DON stated, management addressed the RR1 inappropriate behavior many times by attempted educational sessions with RR1 and there were instances when the security was called to the unit, but RR1's threats, outburst, and interruptions in provision of Resident 1's care nevertheless continued. During an interview on 1/30/2023, at 2:15 p.m., with Director of Nursing Services (DON), the DON stated, on 12/05/2023, the facility restricted RR 1's visitation hours to a one-hour visitation time a day. The DON stated, the facility determined that the presence of RR1 may present danger to the health and safety of Resident 1 and the facility's staff. The DON further stated, the RR1 is no longer included in email correspondence regarding Resident 1's health status and the facility only interacts with RR2 due to RR 1's challenging behavior that is causing emotional distress to staff and interference with Resident 1's care. During an interview on 1/30/2023, at 2:19 p.m., with the DON, the DON stated, on 9/20/2023, the facility held an arranged meeting with RR1, RR2, and the ombudsman, to address disruptive behavior of RR1. The DON stated, during the meeting, the resolution was achieved when RR1 agreed to improve the behavior toward staff and not to interfere with Resident 1's treatments and care. The DON further stated, the behavior of RR 1 did not improve as per conditions placed by the facility, to which RR1 and RR2 mutually agreed to during the meeting held on 9/20/2023. The DON stated, on 12/4/2023, the RR 1's visitation hours were reduced to one hour a day. The DON also stated, the email was sent to the RR2, and RR1 was not notified of restricted visitation time. During a further interview on 1/30/2023, at 2:21 p.m., with DON, the DON stated, during the meeting held on 9/20/2023, the facility and RR2 came to an agreement, that all communication and email correspondence regarding Resident 1's health status and treatment plan shall occur only between the facility and RR 2 and no longer involved any communication with RR 1. The DON further confirmed, RR 1 is a legal, appointed by the court, Resident 1's representative since 7/8/2023 and this status is current. During a record review, on 1/30/2023, at 2:30 p.m., a copy of a document, titled Petition for Appointment of Probate Conservator of the Person, (a court arrangement where a judge appoints a responsible person (a conservator) to care for another adult who cannot care for themselves (conservatee) (Resident 1) dated 7/8/2021 was reviewed. The document indicated; two (2) representatives were appointed as conservators for Resident 1 on 7/8/2021. The facility failed to provide legal evidence indicating RR 1 is no longer obligated to be communicated with regarding Resident 1's health status; the facility also failed to provide evidence report indicative RR 1 was informed of restricted visitation hours. During a review of the facility's policy and procedure (P&P) titled Visitation, dated 8/2023, the P&P indicated, Any clinically necessary or reasonable restrictions or limitations imposed by the 555380 Page 2 of 3 555380 01/30/2024 Encino Hospital Medical Center D/P Snf 16237 Ventura Blvd Encino, CA 91436

F 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility on a patient's visitation rights will be necessary to provide safe care to the patient or other patients. A justified clinical restriction may include, but not limited to: Court order, behaviors presenting direct risk or threat to the patient, facility staff, or others in the immediate environment, behavior disruptive of the functioning of the patient care unit, patient risk of infection by the visitor . During a review of the facility's policies and procedures (P&P) titled, Resident's Rights, dated 4/21/2023, the P&P indicated, Patients' rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient. 555380 Page 3 of 3