Health inspection·November 6, 2023

F 0825 Provide or get specialized rehabilitative services as required for a resident. 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 occupational therapy (OT, rehabilitative profession that provides services to increase and/or maintain a person ' s capability to participate in everyday life activities) and/or physical therapy (PT, a rehabilitation profession that restores, maintains, and promotes optimal physical function) treatments based on the physician ' s order and therapy treatment plan for three of four sampled residents (Residents 1, 2, and 4). Residents Affected - Some These deficient practices had the potential to delay recovery and discharge planning for Residents 1, 2, and 4. Findings: a. A review of Resident 1 ' s Registration Record indicated Resident 1 admitted to the facility on [DATE] for right hip replacement (procedure to replace diseased part of the hip with an artificial part). A review of Resident 1 ' s Resident Care Team Meeting notes dated 11/1/23 and updated on 11/6/23 indicated Resident 1 required moderate assistance with bed mobility, maximum assistance with transfer training, minimal assistance with gait (walking). It also indicated Resident 1 was here for pain management and rehab[ilitation]. Will continue with PT and OT. During an interview on 11/6/23 at 2:15pm, the Clinical Director of Nursing (CDN) stated there was no Minimum Data Set (MDS, a standardized assessment and care-screening tool) assessment completed for Resident 1 yet due to the recent admission. A review of Resident 1 ' s Order Sheet indicated an order for OT evaluation and treatment on 10/31/23. The order sheet indicated an order dated 11/2/23 for OT treatment Monday, Tuesday, Wednesday, Thursday, and Friday for two (2) weeks. A review of Resident 1 ' s OT Inpatient Evaluation dated 11/1/23 indicated Resident 1 required substantial or maximal assistance with toileting hygiene and lower body dressing. The OT evaluation indicated an OT treatment plan frequency for Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. A review of Resident 1 ' s OT Inpatient Daily Treatment documentation indicated there was no OT treatment provided on Thursday 11/2/23. During an observation on 11/6/23 at 10:45 am in Resident 1 ' s room, Resident 1 was wearing a Page 1 of 4 555599 555599 11/06/2023 Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505

F 0825 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some hospital gown and sitting up in the bed. Resident 1 stated she received a little bit of PT and OT. Resident 1 stated she did not receive any OT on Thursday (11/2/23) or on the weekend. During an interview and concurrent record review of Resident 1 ' s medical records on 11/6/23 at 11:30 am, the Rehabilitation Services Manager (RSM) stated Resident 1 admitted to the facility on [DATE] for PT and OT. RSM confirmed the OT evaluation dated 11/1/23 indicated a treatment frequency plan of Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. RSM confirmed a physician ' s order dated 11/2/23 for OT treatment Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. RSM confirmed that no OT treatment was provided on Thursday 11/2/23. RSM reviewed the therapy staffing schedule and stated an OT staff was sick and not able to work so the OT staff was short that day. RSM stated there was no other OT staff to replace the sick OT staff. b. A review of Resident 2 ' s Registration Record indicated Resident 2 admitted to the facility on [DATE] for recent cerebral vascular accident (CVA, blood flow stops to a part of the brain, brain damage due to blocked blood flow). A review of Resident 2 ' s Order Sheet indicated an order dated 10/9/23 for OT evaluation and treatment. The Order Sheet also indicated an order dated 10/11/23 for OT treatment Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday for 2 weeks. The Order Sheet also indicated an order dated 10/25/23 for OT treatment Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday for 2 weeks. A review of Resident 2 ' s MDS dated [DATE] indicated Resident 2 had no cognitive impairments, had functional limitation in range of motion on both sides of the lower extremities. The MDS also indicated Resident 2 required dependence in toileting hygiene, lower body dressing, supervision with eating and oral hygiene. A review of Resident 2 ' s Occupational Therapy Evaluation dated 10/10/23 indicated Resident 2 required maximal assistance with bed mobility, total assistance with toileting, lower extremity dressing, and moderate assistance with upper extremity dressing. The OT evaluation indicated an OT treatment plan frequency for Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday for 2 weeks. A review of Resident 2 ' s OT Inpatient Daily Treatment documentation indicated no OT treatments were provided on Saturday 10/21/23, Friday 10/27/23, Wednesday 11/1/23, and Friday 11/3/23. During an observation and interview on 11/6/23 at 2:43 pm, Resident 2 was sitting up in bed with the head of bed up about halfway. Resident 2 was wearing a hospital gown and drinking a yogurt drink with the right arm. Resident 2 ' s had a visitor in the room. Resident 2 stated the therapists were all very good, but they did not have enough staff. Resident 2 stated sometimes they were short of therapy staff. During an interview and concurrent record review of Resident 2 ' s medical records on 11/6/23 at 11:52 am, RSM stated Resident 2 admitted to the facility on [DATE] for PT and OT. RSM confirmed the OT evaluation dated 10/10/23 indicated a treatment frequency plan of Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday for 2 weeks. RSM confirmed a physician ' s order dated 10/11/23 for OT treatment Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday for 2 weeks and a physician ' s order dated 10/25/23 for OT treatment Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday for 2 weeks. RSM confirmed that no OT treatment was provided on Saturday 10/21/23, Friday 10/27/23, Wednesday 11/1/23, and Friday 11/3/23. RSM reviewed the Rehab staffing calendar and stated on 10/21/23 and 10/27/23 only one OT staff was scheduled to work that day and on 11/1/23 and 11/3/23 one OT staff 555599 Page 2 of 4 555599 11/06/2023 Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505

F 0825 was out sick and stated there was no other OT staff to replace the sick OT staff. Level of Harm - Minimal harm or potential for actual harm c. A review of Resident 4 ' s Registration Record indicated Resident 4 admitted to the facility on [DATE] for pseudomonas bacteremia (type of infection in the body). Residents Affected - Some A review of Resident 4 ' s Order Sheet indicated an order dated 10/20/23 for OT evaluation and treatment and an order dated 10/20/23 for PT evaluation and treatment. The Order Sheet also indicated an order dated 10/23/23 for OT treatment Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks and an order dated 10/23/23 for PT treatment Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. A review of Resident 4 ' s MDS dated [DATE] indicated Resident 4 was severely impaired in cognitive skills (mental processes involved in gaining knowledge and comprehension, includes thinking, knowing, remembering, judging, problem-solving) for decision making. The MDS also indicated Resident 4 required dependence in toileting hygiene, oral hygiene, and moderate assistance with dressing. The MDS also indicated the activities of walking and chair transfers did not occur. A review of Resident 4 ' s Occupational Therapy Evaluation dated 10/21/23 indicated Resident 4 required dependent assistance with toileting hygiene, maximal assistance with lower body dressing, and moderate assistance with upper body dressing. The OT evaluation indicated an OT treatment plan frequency for Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. A review of the OT Inpatient Daily Treatment documentation indicated no OT treatments were provided on Monday 10/23/23, Friday 10/27/23, Wednesday 11/1/23 and Thursday 11/2/23. A review of Resident 4 ' s PT Evaluation dated 10/21/23 indicated Resident 4 required moderate assistance for bed mobility and Resident 4 did not stand. The PT evaluation indicated an PT treatment frequency plan for Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. A review of the PT Inpatient Daily Treatment documentation indicated no PT treatments were provided on Tuesday 10/24/23 and Thursday 10/26/23. During an observation and interview on 11/6/23 at 10:59 am, Resident 4 was wearing a hospital gown and sitting up in bed with the head of bed up more than halfway. Resident 4 had difficulty hearing and could not answer specific or general questions regarding therapy services. On 11/6/23 at 12:30 pm, during an interview and record review of Resident 4 ' s medical records, RSM stated Resident 4 admitted to the facility on [DATE] for PT and OT. RSM confirmed the OT evaluation dated 10/21/23 indicated a treatment frequency plan of Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. RSM confirmed a physician ' s order dated 10/23/23 for OT treatment Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. RSM confirmed OT treatments were not provided on Monday 10/23/23, Friday 10/27/23, Wednesday 11/1/23, and Thursday 11/2/23. RSM reviewed the therapy staff schedule and stated on 10/23/23 and 10/27/23 there were only 2 OTs scheduled because one OT was on vacation and on 11/1/23 and 11/2/23 one OT staff was out sick. In the same interview and record review, RSM confirmed the PT evaluation dated 10/21/23 indicated a treatment plan frequency of Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. RSM confirmed a physician ' s order dated 10/23/23 for PT treatment Monday, Tuesday, Wednesday, Thursday, and Friday for 2 weeks. RSM confirmed PT treatments were not provided on Tuesday 10/24/23 and Thursday 555599 Page 3 of 4 555599 11/06/2023 Torrance Memorial Med Ctr Snf/Dp 3330 West Lomita Blvd Torrance, CA 90505

F 0825 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 10/26/23. RSM reviewed the therapy staff schedule and stated on 10/24/23 and 10/26/23 there were only three PTs on staff that day, one PT was on vacation and another PT was on a leave of absence. In the same interview, RSM stated residents were usually admitted to this unit because they needed rehabilitation such as PT and OT so that residents could improve their functional mobility and their independence with activities of daily living (basic activities such as eating, dressing, toileting) and get them close to maximum functioning before they move to the next level of care. It was important for residents to receive their therapy treatments as ordered because therapy services was to help residents get better and stronger and get to the next level of care. RSM stated that therapy was not a skill or profession that could be replaced by nursing or activities. RSM stated if residents did not receive their therapy as ordered and per the treatment plan, then it could delay and take longer for residents to get better, and they may have to stay longer at the facility. During an interview with Physical Therapist (PT 1) and RSM on 11/6/23 at 2:31 pm, PT 1 stated she was responsible for scheduling therapy staff at the unit. PT 1 stated PT and OT staff were scheduled to treat about eight residents a day. PT 1 stated sometimes if a treatment was missed on a weekday, she would try to make it up and schedule the resident on a Saturday. PT 1 stated the last couple weeks was unusual and they had a lot of staffing issues and that it did not happen often. RSM stated the rehabilitation unit did not use registry or have a float pool and that the facility should look at back up options for staffing so that all residents received their therapy treatments as ordered and based on their therapy treatment plan. A review of the facility ' s policies and procedures dated 1/31/20, titled, Rehabilitation orders and treatment/intervention plan indicated the therapist will provide services for specific rehabilitation orders. 555599 Page 4 of 4