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. (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: 555388 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 555388 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beach Creek Post-Acute 645 South Beach Blvd. Anaheim, CA 92804 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)