Health inspection·May 10, 2023

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that staff treated one of two sampled residents (Resident 1) with respect and dignity while providing care and responding to concerns. This resulted in increased emotional distress including hopelessness, anxiety, tearfulness, and depression for Resident 1. Residents Affected - Few Findings: Resident 1 was admitted to the facility on [DATE], with diagnosis which included an infection and inflammatory (immune system) response from an implanted post-surgical fixation device (surgical hardware). Review of a Minimum Data Sets (resident assessment tool) dated 9/11/22, 12/10/22, and 3/10/23 indicated that Resident 1 was consistently cognitively (normal thought process) intact and was able to make her own decisions. A review of and undated facility policy titled Promoting and Maintaining Resident Dignity indicated that staff would respond to a resident's request for assistance in a timely manner, speak respectfully, respect their living space/personal possessions and that the resident's former lifestyle/ personal choices are considered when providing care and services. During an interview on 3/3/23, at 10:00 AM, Resident 1 stated, the staff treats me different than my roommate, one of the Certified Nursing Assistants (CNA 1) is rude . Resident 1 explained CNA 1 was rude to her; first, when she requested a soda and then responded with an attitude after Resident 1 pushed her call light to request help for her roommate (Resident 2). Resident 1 explained that CNA 1 took a long time to get the soda and when she came in the room next, she had put her hands on her hips and stated, what do you need now, I was just in here . Resident 1 indicated that CNA 1 had been rude to her before and that she felt she was being singled out because CNA 1 treated her roommate (Resident 2) differently. Resident 1 explained, a Licensed Nurse (LN 1) was passing medications, had been cussing, and slamming the medication cart drawers in the hallway just outside her door. Resident 1 explained that she had asked LN 1 if everything was alright, and that the nurse seemed upset and rushed off to retrieve a medication. Resident 1 confirmed that LN 1 had not been in her room since. Resident 1 explained, the Chief Clinical Officer (CCO) and the Director of Quality and Risk Management (DQRM) came into her room to discuss a request to change her diet preferences when the CCO used a loud voice and was confrontational. Resident 1 stated, after requesting a change in diet, the interactions with staff felt confrontational. Resident 1 was observed tearful, and requested the door be closed. Resident 1 indicated that interactions with facility staff had affected her ability to participate in needed therapies and that she felt more tearful, depressed, and anxious than before. Page 1 of 6 555588 555588 05/10/2023 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 1 stated, Sometimes I feel like ending it all. Resident 1 indicated that she would not harm herself, had no plan to harm herself and felt safe but the interactions with staff had made her feel bad. During an interview on 3/3/23, at 10:40 AM, Resident 2 stated, the nurses are busy, and short staffed, but they are nice to me; I did notice staff treated me differently than my roommate (Resident 1), and they had a second person standing at the door like she was in trouble or something. Resident 2 indicated CNA 1 was rude to her roommate (Resident 1) several times, even when Resident 1 had pushed the call light because she needed help from staff and could not reach her own. Resident 2 explained she had witnessed the CCO and DQRM speaking loudly at Resident 1. Review of a Progress Note dated 2/17/22, DQRM documented that Resident 1 notified staff that she had a personality clash with CNA 1 who provided her care during the previous shift and reported LN 1 had loudly slammed the medication cart drawers and cursed just outside her room. Review of a Nursing Note dated 2/23/23 at 11:07 AM, DQRM documented that while at bedside with CCO discussing Resident 1's diet requests, the resident became upset and stated that she had felt like that CCO had been confrontational and used a loud voice. During an interview on 3/3/23 at 12:15 AM the CCO stated, this resident has had multiple complaints about many of the staff, even me. CCO stated, the resident told me she felt I was yelling at her and being confrontational . CCO confirmed that she used a loud voice when she was in Resident 1's room. CCO confirmed that the staff had been instructed to enter Resident 1's room two at a time and that Resident 1 expressed this caused her to feel more emotional. CCO explained the relationship with Resident 1 became too friendly and needed more professional boundaries. Review of a Facility document titled Job Description and Chief Clinical Officer (CCO), dated 5/1/17, indicated that the CCO would cultivate, advocate, demonstrates and understands the importance of respect for the rights, dignity, and individuality of each Resident in all interactions. Review of a Facility document titled Job Description and Competencies Director of Nursing (DON), dated 11/1/18, indicated that the DON would cultivate, advocate, demonstrates and understands the importance of respect for the rights, dignity, and individuality of each Resident in all interactions. 555588 Page 2 of 6 555588 05/10/2023 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review the facility failed to employ a full time, 40 hour a week, dedicated, Director of Nursing (DON) who was responsible for the oversight of the delivery of nursing care services for residents. This had the potential to affect the quality of care and life of all residents in the facility. Findings: A review of a facility policy titled Job description and Competencies Director of Nursing revised November 2018, indicated; the Director of Nursing was responsible for the administration of nursing services in the Skilled Nursing Facility/Transitional Care Unit. Directs, plans, and coordinates service activities of professional nursing and auxiliary nursing personnel in rendering customer care. Interprets facility policies and regulations to all nursing personnel and ensures compliance, as well as analyzes and evaluates nursing and related services rendered to improve quality of customer care and to better utilize staff time and abilities. Also ensures the provision of in-service training programs for nursing personnel. Ability to identify and implement components of the nursing process. Identify learning needs and teach patients and families. Ability to communicate and collaborate with a variety of teams and individuals. Working knowledge and ability to apply professional standards of practice in job situations. Coordinates and monitors all patient care services. Responsible for all activities relevant to patient care services. Assures compliance with all local, state, and federal laws regarding licensure and certification of staff. During an interview on 3/3/23 at 12:15 PM, the Chief Clinical Officer (CCO) for the Long-Term Acute Care (LTAC) hospital which had a 50-bed capacity. CCO explained that she was also working as interim Director of Nursing (DON) for the Skilled Nursing Facility (SNF) which had a 32-bed capacity. CCO stated she was unable to dedicate 40 hours a week to her DON role at the SNF due to her role as CCO in the LTAC. CCO stated the DON job position was posted and the last applicant interviewed was in October 2022. CCO stated the SNF did not have a dedicated fulltime (40 hours a week) DON for at least a year. 555588 Page 3 of 6 555588 05/10/2023 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide medically related social services to maintain the highest practicable physical, mental, and psychosocial well-being for one of two Residents (Resident 1). This resulted in Resident 1 to experience increased emotional distress including hopelessness, anxiety, tearfulness, and depression. Residents Affected - Few Findings: Resident 1 was admitted to the facility on [DATE], for infection and inflammatory (immune system) response from an implanted post-surgical fixation device (surgical hardware). Review of Minimum Data Set (MDS, resident assessment) dated 9/11/22, 12/10/22, and 3/10/23 indicated that Resident 1 was consistently cognitively intact (normal though process) and was able to make her own decisions. Review of the MDS Section D (mood assessment) dated 9/11/22, 12/10/22, and 3/10/22 indicated that Resident 1 was rarely or never understood, and because of this the depression screening interview was not completed with her. Licensed staff performed the depression screening interview and documented that she had no indicators of depression. A review of policy titled Abuse Prevention and Management , revised on 5/1/18, indicated residents would be free of abuse including incidents of verbal abuse, that the facility staff would investigate any allegations of abuse, will ensure the Social Worker evaluates the resident to determine if there are any psychosocial affects following the incident. A review of a policy titled Resident Rights , revised on 3/1/18, indicated that Social Services would continue to monitor adherence to resident's individual rights, as necessary, throughout the resident's stay, as well as promote their rights and assure they are upheld; and monitor and intervene with staff, residents and family members with complaints and grievances. He/she will mediate differences, problems, or issues as they arise or are referred to the department. Review of a Job Description and Competencies - Social Worker, dated 6/1/17, indicated that a Licensed Clinical Social Worker (LCSW) would provide patient assessment, counseling, and discharge planning and act as a liaison between the patient, family, and hospital. During an interview on 3/3/23, at 10 AM, Resident 1 stated, after requesting a change in diet, the interactions with staff felt confrontational . Resident 1 was observed tearful, and requested the door be closed. Resident 1 indicated that interactions with staff had affected her ability to participate in needed therapies and that she felt more tearful, depressed, and anxious than before. Resident 1 stated, Sometimes I feel like ending it all . Resident 1 indicated that she would not harm herself, had no plan to harm herself and felt safe but the interactions with staff had made her feel bad. Review of Care Plan Notes dated 1/31/23, a Student Social Worker (SSW 1) documented that Resident 1 had a depressed affect, expressed worry and concern related to her care and continued to struggle with anxiety. 555588 Page 4 of 6 555588 05/10/2023 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0745 Level of Harm - Minimal harm or potential for actual harm Review of Care Plan Notes dated between 12/13/22 and 2/3/23, indicated SSW 1, provided five counseling sessions to Resident 1 and the last documented session was on 2/23/23. Resident 1's depression and anxiety were discussed during four out of five counseling sessions; one session was declined by Resident 1. Resident 1 had a depressed affect during three of four remaining counseling sessions provided by SSW 1. Resident 1 continued to struggle with coping during for of the counseling sessions provided by SSW 1. Residents Affected - Few During a concurrent interview and record review on 3/3/23 at 12 PM, the Director of Quality and Risk Management (DQRM) confirmed there were no notes in Resident 1's medical record by the Licensed Clinical Social Worker (LCSW 1). DQRM confirmed that there was no telehealth behavioral health (consult through internet) or psychiatric consults in Resident 1's medical record. Review of a progress note dated 3/7/23 at 5:09 PM, LCSW 1 documented that she consulted the SSW 1 over the duration of his treatments, provided assessment screening materials and reviewed the treatment plan in response to Resident 1's increased expressed feelings of being overwhelmed to staff. This was the first note entry since Resident 1's admission on [DATE]. LCSW 1 did not document that she had assessed Resident 1 in person. Review of a progress note dated 3/16/23 at 5:39 PM, LCSW 1 documented a supervisory visit to Resident 1, that she denied having coping issues and was positive in spirits. This was the second LCSW 1 note entry since admission. During an interview on 3/24/23 at 9:20 AM, the Chief Clinical Officer (CCO) for the Long-Term Acute Care (LTAC) hospital which is 50 bed capacity stated she is interim Director of Nursing (DON) for the Skilled Nursing Facility (SNF) which had a 32-bed capacity. CCO stated the facility had one LCSW (LCSW 1), her schedule was Tuesday and Thursday and has student four days a week. CCO stated they both deal with psychosocial issues mainly in the skilled nursing facility. During an interview on 3/27/23 at 11:30 AM, SSW 1 explained he was a student studying marriage and family therapy. SSW 1 stated that he participated in an unpaid internship at the facility and provided counseling services to Resident 1. SSW 1 stated he worked under that supervision of the LCSW 1, who reviewed and cosigned all his notes but did not actively participate in his counseling sessions with Resident 1. SSW 1 confirmed that Resident 1 had expressed worry and concern related to her care and treatment by staff. SSW 1 stated, she has been in the facility a long time; she has the hospital blues. SSW 1 stated that Resident 1 had discussed the interactions with staff get her down sometimes. When asked how the facility had assessed Resident 1 for potential risk of self-harm SSW 1 stated, Resident 1 has not made any statements of self-harm; I personally completed the Columbia Suicide Screening with Resident 1 within the last 2-3 weeks, Resident 1 was non-suicidal. During an interview on 3/28/23 at 9:00 AM, LCSW 1 stated that she had been working part time, typically 16 hours per week. LCSW 1 explained that she splits her hours between SNF and the LTAC. LCSW 1 stated most of her time was spent at the SNF (12-13 hours per week). LCSW 1 explained her other duties included monthly new staff orientation, precepting, and education presentations for staff. LCSW 1 stated she felt she was given adequate time to meet the needs of all the residents in the SNF and LTAC. LCSW 1 stated that typically the SNF residents are higher acuity and require more services. LCSW 1 stated, A student social worker, assists me with my case load; I oversee the student. LCSW 1 explained that she personally participated in all Resident 1's assessments, care plans, and treatment monitoring. LCSW 1 confirmed that she was not present when SSW 1 met with Resident 1 to provide counseling sessions. When asked to explain the process for cosigning notes written by students LCSW 1 555588 Page 5 of 6 555588 05/10/2023 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0745 Level of Harm - Minimal harm or potential for actual harm explained Well-Sky (electronic medical record) was not equipped with a cosign feature. LCSW 1 stated, I read all of the students notes and documented that I agreed with his treatment plans in separate notes. LCSW 1 stated she had assessed Resident 1 in the last 2 weeks and gave her a writing assignment. LCSW 1 stated, I documented under Case Management Notes and my last note was 2-3 weeks ago. Residents Affected - Few 555588 Page 6 of 6