Health inspection·January 23, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure the respiratory services were provided as ordered for two of five sampled residents (Residents 1 and 2). Residents Affected - Few * The facility failed to ensure Resident 1 received oxygen 2 liters per minute via nasal cannula as per the physician's order. In addition, the facility failed to ensure the nebulizer (used to deliver vaporized medicine into the airway) mask was stored properly. * The facility failed to ensure Resident 2's nebulizer mask and BiPAP (bilevel positive airway pressure, a machine used to provide pressurized air into the airways while asleep) mask were stored properly. These failures had the potential to affect the residents' health and well-being. Findings: Review of the facility's P&P titled Administering Medications Through a Small Volume (Handheld) Nebulizer revised October 2010 showed the purpose of this procedure is to safely and aseptically administer aerosolized particles of medication into the resident's airway. Under the Steps in the Procure section showed to rinse and disinfect the nebulizer equipment according to facility protocol, or: (a) wash pieces with warm water, soapy water; (b) rinse with hot water; (c) place all pieces in a bowl and cover with isopropyl (rubbing) alcohol and soak for five minutes; (d) rinse all pieces with sterile water (not tap, bottled, or distilled); and (e) allow to air dry on a paper towel. When equipment is completely dry, store in a plastic bag with resident's name and the date on it. 1. On 1/23/24 at 0827 hours, Resident 1 was observed with the following: - The oxygen nasal cannula tubing was on top of the mattress and connecting to the oxygen concentrator machine with the flow meter set at five liters per minute; and, - The nebulizer mask was on the back of the nebulizer machine without a storage bag. Medical record review for Resident 1 was initiated on 1/23/24. Resident 1 was admitted to the facility on [DATE]. Review of Resident 1's Order Summary Report dated 1/23/24, showed a physician's order dated 11/2/23, to administer ipratropium-albuterol solution (breathing treatment medication) 0.5-2.5 mg/3 ml via nebulizer four times a day for shortness of breath. Page 1 of 3 555388 555388 01/23/2024 Beach Creek Post-Acute 645 South Beach Blvd. Anaheim, CA 92804

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 1's MAR for January 2024 showed the physician's order dated 11/13/23, to administer oxygen at two liters per minute via nasal cannula continuously to maintain oxygen saturation level greater than or equal to 94%. In addition, the MAR showed Resident 1 was receiving ipratropium-albuterol solution breathing treatments four times a day via nebulizer mask. On 1/23/24 at 0830 hours, an observation and concurrent interview for Resident 1 was conducted with LVN 1. LVN 1 verified Resident 1's oxygen nasal cannula was on top of the mattress. LVN 1 was then observed placing the oxygen nasal cannula into Resident 1's nose. LVN 1 verified the oxygen concentrator flow meter was set at five liters per minute. LVN 1 stated Resident 1's oxygen treatment was ordered continuously at two liters per minute. LVN 1 was then observed changing the flow meter on the oxygen concentrator to two liters per minute. On 1/23/24 at 0835 hours, an observation, follow up interview, and concurrent medical record review was conducted with LVN 1. LVN 1 verified Resident 1's oxygen treatment was ordered continuously at two liters per minute. LVN 1 verified Resident 1's nebulizer mask was stored uncovered on the back of the nebulizer machine. LVN 1 stated the nebulizer mask should be stored inside a plastic storage bag. 2. On 1/23/24 at 0853 hours, Resident 2 was observed with the following: - The nebulizer mask was inside a plastic storage bag containing two Vitamin A&D (used as a moisturizer) ointment sachets, one lip balm; and another plastic storage bag contained one comb, one toothbrush, and one lip balm; - Multiple droplets of clear liquid inside the plastic storage bag containing the nebulizer mask; and, - The uncovered BiPAP facemask and tubing were on top of the BiPAP machine. Medical record review for Resident 2 was initiated on 1/23/24. Resident 2 was readmitted to the facility on [DATE]. Review of Resident 2's Order Summary Report dated 1/23/24, showed the following physician's orders: - dated 12/9/23, to administer ipratropium-albuterol solution 0.5-3 mg/3 ml orally via nebulizer every six hours as needed for SOB; - dated 11/17/23, to apply BiPAP on at bedtime for sleep apnea (sleep disorder in which breathing repeatedly stops and starts); and, - dated 11/17/23, to remove BiPAP in the morning. Review of Resident 2's MAR for January 2024 showed Resident 2 was administered ipratropium-albuterol solution via nebulizer on 1/4 at 1357 hours, 1/5 at 1634 hours, 1/7 at 0951 hours, 1/8 at 1638 hours, 1/10 at 0919 hours, and 1/17/24 at 1047 hours. The MAR also showed Resident 2 received the BiPAP at bedtime and the BiPAP was removed in the morning at 0700 hours. On 1/23/24 at 0909 hours, an observation and concurrent interview for Resident 2 was conducted with LVN 2. LVN 2 verified the above findings and acknowledged Resident 2's nebulizer mask should be 555388 Page 2 of 3 555388 01/23/2024 Beach Creek Post-Acute 645 South Beach Blvd. Anaheim, CA 92804

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stored inside a clean plastic storage bag separate from the resident's toiletries. LVN 2 stated the BiPAP mask should also be stored inside a plastic storage bag. On 1/23/24 at 1320 hours, an interview was conducted with the DON. The DON was informed and acknowledged the above findings. The DON stated the licensed nurses were expected to store the nebulizer mask and BiPAP mask inside a clean plastic set up bag labeled with the resident's name and date. When asked, the DON stated the licensed nurses were responsible to monitor the residents receiving oxygen treatment per the physician's order. 555388 Page 3 of 3