Health inspection·March 27, 2024

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on interview, observation, and record review, the facility failed to meet this requirement when a blood draw tourniquet (a device that is used to apply pressure to a limb or extremity in order to stop the flow of blood) remained on a resident (Resident 1 ' s) for an estimated six hours unnoticed and unattended to. This resulted in Resident 1 ' s hand being swollen and red, and had the potential for serious injury. Residents Affected - Few Findings A review of Resident 1's clinical record, indicated Resident 1 was admitted to the facility with diagnoses including dementia (memory and mental function loss), diabetes, communication deficits (inability to speak), and muscle weakness. On 3/27/24 at 1:45 PM, Resident 1 was observed to have a phlebotomy (blood draw) tourniquet around his wrist, tied tightly in a slip knot. The tourniquet was observed to be pressing deeply into Resident 1 ' s skin; his fingers were red and swollen. There were no staff present in Resident 1 ' s room. No staff were observed to come into his room by 1:50 PM. In a concurrent interview and observation on 3/27/24 at 1:50 PM, Licensed Vocational Nurse (LVN) A, who was assigned to Resident 1 that day, stated that she had not placed the tourniquet there, and it had likely been placed in the morning for a blood draw. LVN A confirmed that she had been in Resident 1 ' s room several times that morning and had not noticed the tourniquet. LVN A confirmed that Resident 1 ' s fingers were swollen and red, particularly the ring finger, and that there was a deep indentation in his skin around his wrist. In an interview on 3/27/24 at 1:55 PM, LVN B concurrently assessed Resident 1 ' s condition: I see a pressure indentation around his wrist from the tourniquet, it ' s swollen and red. LVN B stated that the tourniquet was placed there by an outside mobile phlebotomy service that morning, around 6-7:00, to draw a blood test on Resident 1. The time the tourniquet was placed on Resident 1 ' s arm, until it was brought to LVN A ' s attention, was more than six hours. LVN B further stated that there were several opportunities that day when staff interacted closely with Resident 1 and opportunities to notice the tourniquet, stating that medications were given to him by LVN A at 8:00 that morning, and that a CNA took his blood pressure around that time as well, which would have required him to sit up. He also received RNA (restorative nursing assistance; help with eating) around noon, and there had been a chance for it to be seen at that point. Review of Resident 1's Minimum Data Set (a standardized assessment of a resident's abilities) dated 3/3/24 indicated that Resident 1 was totally dependent on staff for most aspects of daily care, and Page 1 of 2 555535 555535 03/27/2024 River Valley Care Center 9000 Larkin Road Live Oak, CA 95953

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few mobility and that he needed maximal assistance for moving from one surface to another or moving from side to side in bed. Review of Resident 1's Brief Interview of Memory Status (BIMS) on 3/3/24 indicated that his score was 11, moderately impaired. Review of Resident 1 ' s electronic medication administration record (eMAR), dated 3/27/24, indicated that LVN B had administered medication to Resident 1 at or around 8:00 AM, providing an opportunity for assessing Resident 1; and again at 9:00 AM. The record further indicated that Resident 1 ' s blood pressure was taken before he received his morning medication, which provided yet another opportunity for assessing Resident 1 ' s arm. Review of the facility ' s record titled, Assisting the Nurse in Examining and Assessing the Resident, Revised September 2010, indicated that While only licensed nurses can conduct a full assessment, non-licensed staff obtain important information about the resident in their daily observations and interactions. Review of the Nursing Practice Act Business & Professions Code, Chapter 6, Nursing Section 2725, indicated that a Registered Nurse (RN) is accountable for an ongoing comprehensive assessment that includes data collection, analysis, and drawing conclusions/making judgments in order to formulate or change the plan of care and to advocate for the patient as needed RN uses scientific knowledge and experience to make clinical judgments about observed abnormalities and changes based on a series of complex, independent and collaborative decision making activities. 555535 Page 2 of 2