Health inspection·January 10, 2024

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure there was an adequate indication for the use of permethrin cream (a medication used to treat scabies [a condition caused by tiny insects called mites] that infest and irritate a person's skin) and ivermectin (a medication that treats infections caused by roundworms, threadworms, and other parasites [organism that lives on or in a host organism and gets its food from or at the expense of its host]) for one of three sampled residents (Resident 1). Residents Affected - Few This deficient practice had the potential to result in the use of unnecessary medication and cause adverse side effects (an undesired harmful effect resulting from a medication or other intervention) such as burning, itching, numbness, rash, redness, stinging, swelling of the skin, weakness, uncontrollable shaking of a part of the body, and chest discomfort. Findings: A review of Resident 1's admission Record indicated the facility readmitted Resident 1 on 3/22/2023 with diagnoses that included chronic obstructive pulmonary disease (refers to a group of diseases that cause airflow blockage and breathing-related problems), personal history of other diseases of the digestive system, and schizoaffective disorder (is a mental health condition with symptoms of both schizophrenia [a disorder that affects a person's ability to think, feel, and behave clearly] and mood disorders [described by marked disruptions in emotions]). A review of Resident 1's Minimum Data Set (MDS- a standardized assessment and screening tool) dated 6/9/2023 indicated Resident 1's cognitive (knowledge and understanding through thought, experience, and senses) skills for daily decision making was intact. The MDS also indicated Resident 1 was independent with bed mobility, transfer, locomotion on and off unit, dressing, eating, toilet use, and personal hygiene. A review of Resident 1's Dermatology (branch of medicine dealing with the skin) Note dated 5/23/2023, indicated a diagnosis of dermatitis (a common condition that causes swelling and irritation of the skin) unspecified. A review of Resident 1's physician's orders dated 5/23/2023, indicated an order for permethrin cream 5%, apply to neck to toes topically one time a day for dermatitis unspecified for four weeks. Apply from neck to toes at 9 p.m. Leave on for 12 hours then shower at 9 a.m. A review of Resident 1's physician's orders dated 5/23/2023, indicated an order for ivermectin oral tablet, give 15 milligrams (mg- unit of measurement) by mouth one time a day every Wednesday for dermatitis unspecified for four weeks. Page 1 of 2 555519 555519 01/10/2024 The Care Center on Hazeltine, LLC 6835 Hazeltine Ave. Van Nuys, CA 91405

F 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of Resident 1's Lab Results Report, reported date 6/8/2023, indicated scabies exam result: no sarcoptes scabei (itch mite that causes scabies) seen. During a concurrent interview and record review on 12/14/2023 at 11:00 a.m., with the Infection Preventionist (IP), reviewed Resident 1's Treatment Administration Record (TAR) for 6/2023, Medication Administration Record (MAR) for 5/2023 and 6/2023, and progress notes and dermatology notes for 5/2023. The IP stated that there was no documented evidence that Resident 1 had a diagnosis of scabies. The IP stated the facility administered permethrin cream to Resident 1 on 6/2/23 and administered ivermectin 15 mg on 5/24/2023, 5/31/2023, and 6/7/2023. The IP stated that both medications were ordered by the dermatologist (physician who specializes in treating the skin, hair, and nails) which is why the medications were administered. The IP stated Resident 1 was diagnosed with dermatitis and stated permethrin is a medication used for scabies. During an interview on 12/14/2023 at 11:22 a.m., with the Director of Nursing (DON), the DON stated that Resident 1 had a rash, which is why the dermatologist prescribed the permethrin cream and the ivermectin. The DON stated that Resident 1 did not have a diagnosis of scabies. A review of the facility's policy and procedure titled, Unnecessary Drugs, revised 3/2023, indicated each resident shall be free of unnecessary drugs. Under guidelines: Unnecessary drugs include but not limited to medications used: b. For excessive duration; d. without adequate indications; f. any combinations of the aforementioned reasons. A review of an article in MedlinePlus titled, Permethrin Cream, copyrighted 2023, indicated permethrin is used to treat scabies (mites that attach themselves to the skin) in adults and children 2 months of age and older. A review of an article in MedlinePlus titled Ivermectin, copyrighted 2023, indicated ivermectin is used to treat strongyloidiasis (threadworm; infection with a type of roundworm that enters the body through the skin, moves through the airways and lives in the intestines). Ivermectin is also used to control onchocerciasis (river blindness; infection with a type of roundworm that may cause rash, bumps under the skin, and vision problems including vision loss or blindness). 555519 Page 2 of 2