Health inspection·January 17, 2024

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Actual harm Based on interview and record review, this requirement was not met when the facility failed to provide pain medication as ordered to one of five sampled residents (Resident 1). This caused Resident 1 to have significant back pain, interrupted his sleeping patterns, and had the potential to negatively affect his health. Residents Affected - Few Findings A review of Resident 1's admission Record, dated 1/12/24, indicated he was admitted to the facility after being hospitalized for pneumonia (an infection of the lungs), and he had a history of back pain. A review of Resident 1's discharge medication list from an acute care hospital on 1/12/24 indicated that Resident 1 should continue to receive pain medication Norco (a narcotic pain medication) Oral Tablet 5-325 MG (milligrams, a unit of measure), give 1 tablet by mouth every 6 hours as needed for pain 4-10 (a scale from zero to ten, used to measure pain) for 14 days. Begin 1/13/24 11:15 AM. A review of the facility's policy titled Pain Management, Dated 11/24/17, indicated, Pain medication is to be given before pain becomes severe. Response to pain is to be documented on the Medication Administration Record. Review of that record for Resident 1 for 1/13/24 indicated Resident 1 reported a back pain level of 7, or Severe. A review of the facility's medication administration record (MAR) for Resident 1, dated 1/12/24 to 1/16/24, indicated Norco Oral Tablet 5-325 MG, give 1 tablet by mouth every 6 hours as needed for pain 4-10 for 14 days. Begin 1/13/24 11:15 AM. No administrations of this medication were recorded up to and including Resident 1's discharge, on 1/16/23. During an interview on 1/16/24 at 3:30 PM, Resident 1's family member (FAM 1) stated, [Resident 1] didn't get hydrocodone so he was in pain for most of the weekend, Friday to Monday. He was so miserable that I had to bring in his medications from home on Sunday night 1/14/23 so that he would have them. He was so uncomfortable that he couldn't sleep. During a concurrent interview on 1/17/24 at 10:45 AM, with the facility's administrator (ADMIN A) and director of nursing (DON B) on 1/17/23 at 10:45 AM, ADMIN A stated that they were aware of pharmacy issues and were working to resolve them. ADMIN A indicated that earlier that day he had sent a letter to the pharmacy being used, terminating their contract. DON B stated that the facility was aware some medications were not being delivered, and staff had been educated to replace the meds through various means such as checking emergency drug kits. DON B reviewed the MAR and confirmed that the Norco had not been given to Resident 1 as needed, as ordered. Page 1 of 4 555625 555625 01/17/2024 California Park Post Acute 2850 Sierra Sunrise Terrace Chico, CA 95928

F 0697 During an interview on 1/17/24 at 11:15 AM, licensed vocational nurse (LVN C) confirmed problems with the pharmacy, They say they are going to deliver them, then we don't receive them for a few days. Level of Harm - Actual harm Residents Affected - Few During an interview on 1/18/24 at 12:09 PM, Resident 1 stated that he was unable to explain how the facility's nursing staff recorded his pain rating as 0 on 1/14/24 and 1/15/24, up until discharge, since he was in pain, I was having pain in my back starting from when I first got there. I'd ask for something and they'd give me Tylenol which is nothing for me. I'd ask for something stronger-- I take hydrocodone (generic name for Norco) at home which I've been taking for years for chronic pain. The nurses would tell me that it was ordered the day before and they were waiting for it to come later in the morning. Then it never came, the next day and so on. The pain in my back would keep me up all night, just lying there wide awake. Finally, my wife had to bring some of my prescription in from home. 555625 Page 2 of 4 555625 01/17/2024 California Park Post Acute 2850 Sierra Sunrise Terrace Chico, CA 95928

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, this requirement was not met when the facility failed to be free of significant medication errors when a necessary heart medication was not provided to one of five sampled residents (Resident 1) after it was ordered by a physician. This had the potential to put Resident 1 at risk of heart failure, further hospitalization, or death. Residents Affected - Few Findings Resident 1 was admitted to the facility after being hospitalized for pneumonia, and severe peripheral artery disease following a history of heart surgery. During his hospitalization, he was diagnosed with atrial fibrillation (Afib, a heart condition that causes the heart chambers to be chaotically and out of rhythm, dysrhythmia) and he was prescribed digoxin, an important medicine to correct this dysrhythmia, to be continued by the long-term care facility. Review of the facility's policy titled, Medication Administration, dated 11/24/17, indicated that licensed nurses must administer medications in accordance with physician orders. Review of Resident 1's record titled Discharge Summary dated 1/12/24, indicated that the acute care hospital had diagnosed Resident 1 with atrial fibrillation (chaotic, disorganized heart beats) and ventricular ectopy, (missed or extra heartbeats), which was new, from Resident 1's baseline. The record further noted that Resident 1 was then started on digoxin for better rate control. (Digoxin is a medicine that improves heart contractions, lowers heart rate, and decreases strain on the heart). Review of Resident 1's hospital Discharge summary dated [DATE] also indicated that Resident 1 had a CHA2DS2-VASc score more than two. (CHA2DS2-VASc score is a point-based system used to determine the risk of stroke and death in heart patients. Resident 1's score of more than two indicated that he was a High risk patient. Review of the hospital discharge summary also indicated that Resident 1 was to continue to take Digoxin, 125 micrograms, 1 tablet by mouth daily, start date 1/13/24. Review of the facility's Medication Administration Record (MAR) for Resident 1 indicated that Resident 1 did not receive digoxin on 1/13/24 or 1/14/24 per the prescriber's order, a period of two days. Review of The American Journal of Cardiology dated 7/15/07, indicated that discontinuation of digoxin is associated with worsening heart failure (HF) symptoms and that outcomes improved with continued therapy of digoxin. In an interview on 1/16/24 at 3:30 PM, Resident 1's family member (FAM1), stated, [the facility] was having pharmacy issues and told me they ordered his medication, but the bottom line is that he was not supposed to interrupt his digoxin, it's for his heart, and he could have gone into Afib again. In an interview on 1/17/24 at 10:45 AM, the facility's administrator (ADMIN A) and director of nursing (DON B) both acknowledged that the facility's current pharmacy had been having delivery issues since they were contracted with, in December 2023, and provided written evidence that the facility is withdrawing its contract with that pharmacy and were working to resolve them. ADMIN A indicated 555625 Page 3 of 4 555625 01/17/2024 California Park Post Acute 2850 Sierra Sunrise Terrace Chico, CA 95928

F 0760 that previously that day he had sent a letter to the pharmacy being used, terminating their contract. Level of Harm - Minimal harm or potential for actual harm In an interview on 1/17/24 at 11:25 AM, LVN D further acknowledged the facility's issues with its pharmacy and that the record showed that doses of Resident 1's digoxin were missed on 1/13 and 1/14/24. LVN D further stated that one of the meds was digoxin, a really important heart medication. LVN D stated, I'm not sure what they could have done, but they could have found a way to get it. LVN D added that digoxin is not in the facility's emergency kit, and she would have called an outside community pharmacy for the commonly prescribed medication and had someone pick up the missing doses. Residents Affected - Few In an interview on 1/18/24 at 12:09 PM, Resident 1 acknowledged that he had not received all his medication, including digoxin. 555625 Page 4 of 4