Health inspection·December 14, 2018

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 observation, interview, and record review, the facility failed to follow medication administration policy for 1 of 8 residents (Resident 9), when the nurse did not hold the feeding tube before administering Phenytoin (medication used to treat and control seizure/epilepsy.). This failure had the potential to result in Phenytoin subtherapeutic blood levels (a dosage less than the amount required for a therapeutic effect), which could put Resident 9 at risk for seizures. Residents Affected - Few Findings: During a medication administration observation and concurrent interview on 12/12/18, at 10:30 a.m. for Resident 9, Licensed Staff C was preparing to administer medications that would go into the J-tube (Jejunostomy tube - a soft, plastic tube placed through the skin of the abdomen into the midsection of the small intestine). Resident 9's nutritional supplement, via the feeding tube (medical device used to provide nutrition to people who cannot obtain nutrition by mouth, unable to swallow safely, or need nutritional supplementation), was running at 45 milliliter per hour (ml/hr). At 10:45 a.m., Licensed Staff C verified the feeding tube was running. Licensed Staff C stated staff held the feeding tube at 8 a.m., and restarted it at 10:30 a.m. At 10:48 a.m., Licensed Staff C turned off the feeding tube machine. At 10:55 a.m., Licensed Staff C administered the medications, including Phenytoin 350 mg via the J-tube. At 11:21 a.m., Licensed Staff C turned on the feeding tube machine. Licensed Staff C stated the feeding tube would be held for 50 minutes before it restarted running at 45 ml/hr, automatically. During an interview on 12/12/18, at 2:57 p.m., Administrator A stated the feeding tubes were held before administering Phenytoin. The facility policy and procedure titled, Medication Administration through a Feeding Tube, dated 11/16, indicated, Phenytoin. Administration with continuous tube feeding may result in subtherapeutic blood levels. Discontinue tube feeding 2 hours before and after phenytoin administration. Page 1 of 3 555590 555590 12/14/2018 Healdsburg Hospital D/P Snf 1375 University Avenue Healdsburg, CA 95448

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to provide respiratory care for 1 of 8 residents (Resident 7), when Resident 7's corrugated aerosol tubing was disconnected from the oxygen source. This failure had the potential to result in respiratory distress for Resident 7. Residents Affected - Few Findings: During an observation on 12/10/18, at 9:05 a.m. Resident 7 had a tracheostomy (an opening in the neck used to deliver oxygen to the lungs). Resident 7's corrugated aerosol tubing was disconnected from the oxygen source and humidifier (medical devices used to humidify supplemental oxygen to provide long-lasting moisture for patients' comfort during oxygen therapy, especially in drier climates). During an observation and concurrent interview on 12/10/18, at 9:12 a.m., Licensed Staff B noticed Resident 7's corrugated aerosol tubing was disconnected from the oxygen source. Licensed Staff B stated the aerosol tubing came off. Licensed Staff B stated if the Respiratory Therapists from Night and Day shift did a walking round (giving reports at resident bedside); the disconnected aerosol tubing would have been noticed. Licensed Staff B stated he would replace the corrugated aerosol tubing and reconnect it to Resident 7. The facility policy and procedure titled, Respiratory Care Equipment, dated 7/18, indicated, The Respiratory Care Service is responsible for providing respiratory equipment in conjunction with respiratory care modalities and to assure safe and effective services to the patient. 555590 Page 2 of 3 555590 12/14/2018 Healdsburg Hospital D/P Snf 1375 University Avenue Healdsburg, CA 95448

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to follow infection control practices when: Residents Affected - Few 1. The staff did not dispose of the suction catheter right away after suctioning Resident 1's airway; and 2. Condensation collected from Resident 7's corrugated aerosol tubing was touching the floor. These failures had the potential to spread infection among residents and staff. Findings: 1. During an observation and concurrent interview on 12/10/18, at 10:19 a.m., Resident 1 was sitting in his wheelchair by the nurse station with a suction catheter laying on top of his pillow. When the suction catheter was pointed out, Licensed Staff D stated, I think it's suction. Licensed Staff D disposed of the suction catheter. Review of the Resident 1's Minimum Data Set (an assessment tool) dated 9/9/18, indicated the facility was providing oxygen therapy, suctioning and tracheostomy care (an opening in the neck in order to place a tube into a person's windpipe, requiring care to keep the tube clean to prevent a clogged and decreased risk of infection.). During an interview on 12/13/18, at 4:15 p.m., Licensed Staff E stated the suction catheter was to be thrown away after use. The facility policy and procedure titled, Tracheal Suctioning and Sterile Technique, dated 4/17, indicated, Disconnect the catheter and fold it inside your gloves while removing them. Discard the catheter, gloves, rinsing solution and container into a waster container. 2. During an observation on 12/10/18, at 9:05 a.m., the condensation collector of the corrugated aerosol tubing connected to Resident 7, was touching floor. Review of the Resident 7's Minimum Data Set (an assessment tool) dated 10/17/18, indicated the facility was providing oxygen therapy. During an observation on 12/11/18, at 1:05 p.m., the condensation collector of the aerosol tubing connected to Resident 7, was touching the floor. During an observation on 12/13/18 at 3:36 p.m., the condensation collector of the aerosol tubing connected to Resident 7, was touching the floor. When pointed out, Licensed Staff C stated the condensation collector was not supposed to touch the floor. Licensed Staff C stated she fixed the aerosol tubing that morning but it moved. During an interview on 12/13/18, at 3:15 a.m., when asked about the condensation collector of the aerosol tubing touching the floor, Administrator F stated, Totally unacceptable, nothing should be on the floor. 555590 Page 3 of 3