Health inspection·January 5, 2026

F 0580 Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure nursing staff immediately notified the physician for physical and mental health change of condition for one of three residents, Resident 1, when on 4/8/25 Registered Nurse (RN) 1 did not recognize the physical and mental health decline of Resident 1 brought to her attention by Resident 1's daughter who was at the bedside. RN 1 did not provide the necessary medical notification for the altered mental status of Resident 1, symptoms included inability to swallow medications which prompted RN 1 to perform an oral sweep with her fingers, Resident 1's inability to verbally respond, refused breakfast, lunch and dinner which were all changes to Resident 1's baseline condition. RN 1 did not provide a full accurate description and assessment to the physician when the physician was notified of Resident 1's change of condition.These failures resulted in further decline of Resident 1's clinical status until the evening of 4/8/25 when RN 2 notified the physician of the decline, an emergency transport was ordered to transfer Resident 1 to the nearest general acute care hospital (GACH A) emergency department where Resident 1 was diagnosed with intracranial hemorrhage (brain bleed a type of stroke), coma, and required immediate intubation (someone who has a breathing tube placed through their mouth or nose into their windpipe to keep the airway open, support breathing) for life support. Resident 1 was then transferred to GACH B for a higher level of care to support the care of the evolving brain bleed and then passed away on 4/16/25 at 4:29 a.m.During a review of Resident 1's admission Record (document containing resident demographic information and medical diagnoses) dated 12/17/25, the admission record indicated Resident 1 was admitted to the facility on [DATE] for physical and occupation rehabilitation due to recent motor vehicle accident. Resident 1's diagnosis included but not limited to idiopathic peripheral autonomic neuropathy (nerve damage affecting automatic body functions such as heart rate and digestion), diabetes mellitus II (a chronic metabolic disease where the body either does not produce enough insulin or does not use insulin effectively) constipation (a condition in which there is difficulty in emptying the bowels and possibly causing hard stools), hypertension (high blood pressure), and muscle weakness (a general lack of strength), multiple fractures of ribs, left side, fracture of right lower leg, neuromuscular dysfunction of bladder (nerve damage disrupts normal bladder control, causing issues with storing or emptying urine), hypothyroidism (does not produce enough essential hormones, causing your body's functions to slow down), atrial fibrillation (an irregular and often very rapid heart rhythm) and muscle spasms (a sudden, involuntary, and often painful contraction of one or more muscles).During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool used to identify cognitive [mental processes] and physical functional level assessment), dated 3/31/2025, the MDS, indicated, Resident 1 had a Brief Interview for Mental Status (BIMS - a test given by medical professionals to determine cognitive understanding on a scale of 1-15 ) score of 13 (a score of 0-7 suggests severe cognitive impairment, 8-12 suggests moderately Page 1 of 8 555652 555652 01/05/2026 Willow Creek Healthcare Center 650 W. Alluvial Clovis, CA 93611

F 0580 Level of Harm - Actual harm Residents Affected - Few impaired, 13-15 suggests cognitively intact) indicating Resident 1 was cognitively intact.During a review of Resident 1's Admission/re-admission Summary Note dated 3/28/25 at 4:40 p.m., the Admission/re-admission Summary Note indicated, .Resident was admitted from [GACH A] due to frontal car collision. resident is alert and oriented [person, place, time], able to make her needs known.During a review of Resident 1's Nurses Notes dated 3/28/25 at 3:52 p.m., the Nurses Notes indicated, .writer received report from RN at [GACH A], per report resident full code (when a patient wants all possible life-saving measures taken), Glasgow Coma Scale 15 (GCS - score of 15 means a person has a fully normal level of consciousness: they are awake, alert, oriented, and responsive, with no neurological deficits, representing the highest possible score on the scale).Physical examination: General: Awake and alert, cooperative, no distress.Pain.currently well controlled Oxycodone (pain reliever used to treat moderate to severe pain) HCL oral tablet 5 (milligrams-mg units of measurement).dosage must be closely managed to prevent neurologic/cognitive problems.During a review of Resident 1's Weekly Summary Notes (WSN), dated 4/3/25 at 6:18 p.m., the WSN indicated, .Basic Activities of Daily Living (ADL)/mobility:. Bed mobility: limited supervision.transfer: limited assistance.Dressing: limited assistance. [Resident 1] ate 75% on average for meals. Alert: yes.oriented: person place time situation.During a review of Resident 1's Physicians Progress Note, dated 4/7/25 at 1:35 p.m., the Physicians Progress Note indicated, .Chief complaint: Mobility and [Activities of Daily Living] dysfunction secondary to right ankle fracture.now with improving endurance and safety.no falls, vital signs stable, no new issues reported. Participating well in therapy.During a review of Resident 1's Physical Therapy Treatment Encounter Notes (PTTEN), dated 4/7/25 and 4/8/25, the Physical Therapy Treatment Encounter Notes, indicated date of service 4/7/25. Resident 1 required moderate cueing for body mechanics and education on importance otherwise engaged. Resident 1 fatigues easily and requires prolonged rest between sets and interventions as session progresses. PTTEN indicated Resident 1was agreeable to therapy. PTTEN indicated Resident 1 instructed to stand and to transfer from bed to wheelchair minimum assistance required minimum cueing for hand/foot sequencing. PTTEN indicated Resident 1 instructed in and completed multiple stand pivot transfer with minimum assistance using parallel bars in order to facilitate safe transfers. PTTEN indicated date of service 4/8/25, Resident 1 encountered semi-Fowlers, daughter at bedside. PTTEN indicated [Resident 1] and daughter stating that they don't feel (Resident 1) can do therapy today as she's having a lot of bowel movements as she was given a suppository.During an interview on 12/17/25 at 8:45 a.m., with Resident 1's daughter (RD), RD stated she came to visit her mother on the morning of 4/8/25 approximately a little after 10 a.m. and her mother was not her normal self. RD stated her mother was usually excited to see her and have a conversation with her as well as being eager for her therapy sessions. RD stated her mother was working to get back home as soon as possible, but on this particular day, her mother did not want to talk at all and told her she had an excruciating headache. RD stated her mother refused therapy that morning and refused to eat due to her headache. RD stated her mother fell asleep around lunch time and the daughter stayed with her at bedside until Registered Nurse (RN) 1 came into her mother's room on that day before 2 p.m. to give her mother her scheduled sodium medication. RD expressed her concerns about her mother, but RN 1 did not seem at all concerned and continued to attempt at waking up my mother. RD stated her mother was barely awake when RN 1 gave her medication. RN 1 tried to get her mother to drink soda from a straw, but her mother was not able to drink. RD stated she again expressed her concerns to RN 1, but RN 1 stated that because Resident 1 had responded to her commands she was fine. RD stated once RN 1 realized her mother was not swallowing the pill, RN 1 stuck her hand in her mother's mouth to find the pill, but she could not find it. RD stated RN 1 left the room unconcerned 555652 Page 2 of 8 555652 01/05/2026 Willow Creek Healthcare Center 650 W. Alluvial Clovis, CA 93611

F 0580 Level of Harm - Actual harm Residents Affected - Few about the changes in her mother's condition. RD stated her mother went back to sleep. RD stated she called the administrator to voice her concerns about her mother's current change in condition and interaction with RN 1. During an interview on 12/17/25 at 10:50 a.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated he does not recall working with Resident 1. LVN 1 stated it was communicated to him by other nursing staff that Resident 1 was sent out for further evaluation to the local hospital and did not return back to the facility. LVN 1 stated that when there is a change of conditions for a resident, the nursing staff is expected to document in the Situation, Background, Assessment and Recommendation (SBAR), change in condition (CIC) and progress nursing (PN) notes, the assessment conducted, communication provided to the responsible party, the primary physician and recommendations made. LVN 1 stated a change of condition can include any of following: change in baseline that could include mental status, physical status, behavioral status; meal consumption and medication administration. LVN 1 stated licensed nurses are trained to document the change of condition accurately and notify the appropriate personnel as indicated in our nursing job descriptions. LVN 1 stated by notifying and providing a complete clinical description of the resident the physician will provide a plan of care specific for that resident. LVN 1 stated an inaccurate resident clinical assessment that is communicated to a physician would be unsafe and potentially harm the resident.During an interview on 12/18/25 at 8:15 a.m., with the certified nursing assistant (CNA) 1, CNA 1 stated she had previously cared for Resident 1 and the resident required extensive to moderate assistance with her activities of daily living (ADL) and set up assistance with eating. CNA 1 stated if a resident change of condition could include going from a high energy to a low energy, refusing meals, refusing care or having behaviors and it should all be reported to the charge nurse immediately. CNA 1 stated Resident 1 was usually wide awake, up in her wheelchair and able to communicate to staff about any issues, concerns, wants, needs and pain. I do not recall this resident being sleepy or groggy while caring for her, she was very alert and able to use the call light for assistance.During a concurrent interview and record review on 12/18/25 at 9 a.m., with the Assistant Director of Nurses (ADON) 1, the facility's document titled PN for Resident 1, dated 4/8/25 at 12:16 p.m. was reviewed. The PN indicated, .[ADON] was notified by charge nurse to accompany to residents' room to take a look at resident. Resident [1] had eyes closed and was responsive. Resident [1] was asked by [RN 1] to squeeze [RN 1's] hands 4 times. Resident responded with 4 squeezes. Resident nodded her head with yes and no questions answered appropriately. ADON 1 stated RN 1 asked her to help check on Resident 1 with her since Resident 1's daughter was concerned because her mother was so sleepy. ADON 1 stated I only made visual observations as [RN 1] assessed [Resident 1] .I never checked on [Resident 1] physically myself. ADON 1 stated the daughter was concerned about her mother's well-being since it was a change from her norm. ADON 1 stated she is a licensed vocational nurse and her scope of practice only allows her to collect data and not assess, so she observed RN 1 assessment of Resident 1. During a concurrent interview and record review on 12/18/25 at 9:10 a.m., with the ADON 1, the facility's document titled PN for Resident 1, dated 4/8/25 at 3:50 p.m. was reviewed. The PN indicated, .Writer tried waking up [Resident 1] and she was able to nod her head yes and no and open her mouth. She took her medicine and sucked on it. Writer wore a glove felt in her mouth until resident swallowed her medication. ADON 1 stated that is not normal practice to place a gloved hand in a resident's mouth unless you are doing a mouth sweep for someone who is unconscious or choking. ADON 1 stated we have never taught that in this facility so I do not understand where [RN 1] would have learned that from.During a concurrent interview and record review on 12/18/25 at 9:15 a.m., with the ADON 1, the facility's document titled Situation, Background, Assessment and Recommendation (SBAR) for Resident 1, dated 4/8/25 at 3:31 555652 Page 3 of 8 555652 01/05/2026 Willow Creek Healthcare Center 650 W. Alluvial Clovis, CA 93611

F 0580 Level of Harm - Actual harm Residents Affected - Few p.m. was reviewed. ADON 1 stated documentation on the SBAR did not have the full documented assessment for Resident 1. The SBAR did not indicate Resident 1 had difficulty swallowing requiring a mouth sweep with a gloved hand by RN 1, changes in resident verbal baseline responses and meal refusals. ADON stated the full assessment was not communicated to the primary physician for clinical recommendations appropriate for Resident 1. ADON 1 stated by not providing an accurate description of Resident 1's current condition, the physician only made recommendations based on the information provided by RN 1.During a review of the facility's document titled Documentation Survey Report, for Resident 1, printed on 12/18/25, the Documentation Survey Report indicated, Resident Refused her breakfast, lunch and dinner meals for 4/8/25. The Documentation Survey Report indicated, on 4/6/25, Resident 1 ate 26-50 % for breakfast, 76-100% for lunch and 51-75% for dinner and on 4/7/25, Resident 1 ate 26%-50% for breakfast and lunch and 51-75% for dinner.During an interview on 12/18/25 at 9:30 a.m., with the Medical Director (MD) for the facility, the MD stated it is the expectation for licensed nurses to provide physicians with a full and accurate description of a resident's assessment and their current condition. The MD stated based on Resident 1's SBAR records versus what was documented in the nurse's progress notes, the full assessment was not accurately communicated to the primary physician for Resident 1. The MD stated it is important and expected for all aspects of the assessment including changes in vital signs, verbal responses, difficulty with arousal, changes in appetite, and medication refusals to be communicated to all primary physicians. The MD stated physicians depend on information provided by the nursing staff in order to make the necessary recommendations and decisions for a plan of care, evaluation and treatment. During a concurrent interview and record review on 12/18/25 at 10 a.m., with RN 1, the facility's document titled PN for Resident 1, dated 4/8/25 at 3:50 p.m. was reviewed. The PN indicated, .Writer tried waking up [Resident 1] and she was able to nod her head yes and no and open her mouth. She took her medicine and sucked on it. Writer wore a glove felt in her mouth until resident swallowed her medication. RN 1 stated CNA staff failed to communicate to her that Resident 1 had refused breakfast and lunch. RN 1 stated it is her normal practice to place a gloved hand in a resident mouth as she was taught this in nursing school. RN 1 stated Resident 1 pockets (holding medication or food in their cheek instead of swallowing) medication but could not identify anywhere in the medical record that this was documented as a previous concern. RN 1 stated Resident 1 was sucking on her medication, and she had not swallowed it. RN 1 was concerned Resident 1 would choke on the medication so she made the decision to place a gloved hand into Resident 1's mouth to verify Resident 1 had swallowed her medication. RN 1 stated based on her documented progress notes, Resident 1's inability to swallow was a change in the resident baseline condition which should have been communicated to the primary physician and reflected on the SBAR.During a concurrent interview and record review on 12/18/25 at 10:22 a.m., with RN 1, the facility's document titled Situation, Background, Assessment and Recommendation (SBAR) for Resident 1, dated 4/8/25 at 3:31 p.m. was reviewed. RN 1 stated the SBAR did not indicate on the summary detail that a full assessment was reported at 3:26 p.m. to the primary physician for the change of condition signs and symptoms. RN 1 stated she did not notify the primary physician regarding concerns of choking or pocketing medications during assessment, or that she placed a gloved hand in Resident 1's mouth. RN 1 stated she did not communicate Resident 1's meal refusals, to the primary physician, and should have. RN 1 stated the primary physician makes their recommendations based on the information she provides them for residents. RN 1 stated it is the expectation of all licensed nurses to chart accurately and completely. RN 1 stated based on the nursing facility's job description she signed, all documentation, and communication should be precise and accurately depicting what was assessed by the nursing staff. RN 1 555652 Page 4 of 8 555652 01/05/2026 Willow Creek Healthcare Center 650 W. Alluvial Clovis, CA 93611

F 0580 Level of Harm - Actual harm Residents Affected - Few stated on 4/8/25 this did not occur.During an interview on 12/18/25 at 10:47 a.m., with the Director of Nursing (DON), the DON stated in reviewing the documentation the action of RN 1 placing a gloved hand into Resident 1's mouth is not standard of practice. The DON stated RN 1 should have initially asked and documented permission for Resident 1 to open her mouth and to check for medication if she had concerns Resident 1 did not swallow the medication. The DON stated there should have been documentation why a gloved hand was placed inside Resident 1's mouth. The DON stated Resident 1 had two missed meals, breakfast and lunch which should have been reported to the licensed charge nurse. The DON stated it is the expectation of the facility that all meal refusals are communicated to the charge nurse. The DON stated RN 1's SBAR did not reflect that she had communicated the complete clinical assessment to the primary physician. The DON stated based on the information provided and reviewed by the primary physician, the physician could not make the appropriate plan of care and treatment for Resident 1 which could have potentially included transporting Resident 1 to a GACH.During a review of the facility's document titled Situation, Background, Assessment and Recommendation (SBAR) for Resident 1 dated 4/8/25 at 7:34 p.m., the SBAR indicated, . [Resident 1] lethargic during [morning] shift. Report of difficulty swallowing medications. Lab results show critically low potassium level. Order obtained for potassium supplement. Resident difficult to arouse or give response from just before dinner served to after dinner time. Became responsive to sternal rub only. [Vital signs] unchanged except oxygen saturation which ranged from 88-91% on room air. Notified provider of level of consciousness and vital signs. Order obtained to send resident to [general] acute hospital for evaluation. During a concurrent interview and record review on 1/5/26 at 11:55 a.m., with the DON, the facility's document titled, Standards of Practice in Nursing for removal of meds from a patient mouth if patient in unable to swallow, dated 1/5/26 at 11:48 a.m. was reviewed. The DON stated the nursing standard of practice involved removing the medication if safely possible and then withholding the dose. The document also indicated the healthcare provider should be notified immediately based on the assessment that a resident is unable to swallow the medication and the nurse had to retrieve the medication or assess for the medication in the mouth. The DON stated this did not occur with RN 1. The DON stated RN 1, failed to provide full and accurate assessment to the primary physician on the day of the 4/8/25. The DON stated the primary physician did not have documented knowledge of the swallowing difficulties Resident 1 was experiencing at the time of notification from RN 1.During an interview on 1/5/26 at 12:25 p.m., with RN 2, RN 2 stated she recalled she was the PM nurse for Resident 1 on 4/8/25. RN 2 stated when she had previously cared for Resident 1, Resident 1 was alert, oriented, able to voice her requests with more than yes or no answers, feed herself with tray assistance and required limited to extensive assistance depending on the ADL. RN 2 stated on 4/8/25, RN 1 indicated Resident 1 was lethargic and required extra work in order for her to swallow her medications on her shift. RN 2 stated at no time did RN 1 state that Resident 1 required a finger sweep of the mouth because she was pocketing medications or was at risk for choking during her shift. RN 2 stated it is not a normal standard of practice in the facility for a nurse to place a gloved hand in any resident's mouth to make sure they swallow their medications. RN 2 stated when it comes to a full neurological assessment, that would include vital signs, checking pupils, assessing range of motion and strength, assessing gait balance, sensation as well as level of consciousness. RN 2 stated assessment findings should have been reported in detail to the primary physician overseeing the resident. RN 2 stated after her assessment of Resident 1 she called the primary physician to report Resident 1's change in condition and Resident 1 was sent to GACH A.During an interview on 1/5/26 at 12:35 p.m., with the Physical Therapist (PT)1, PT 1 stated she was Resident 1's primary therapist during her stay. PT 555652 Page 5 of 8 555652 01/05/2026 Willow Creek Healthcare Center 650 W. Alluvial Clovis, CA 93611

F 0580 Level of Harm - Actual harm Residents Affected - Few 1 stated Resident 1 was working hard and making progress in multiple aspects as she was eager to go back home with her daughter. PT 1 stated normally Resident 1 was very vocal, spoke in complete sentences, was out of bed in her wheelchair often and was fully aware of her condition, status and environment. PT 1 stated Resident 1 was a very motivated individual.During an interview on 1/5/26 at 12:40 p.m., with the DON, the DON stated Resident 1's baseline included Resident 1 being able to speak in complete sentences, including voicing concerns of pain. The DON stated Resident 1 was able to eat independently with tray set up and prior to 4/8/25, Resident 1 did not have any documented incidents of pocketing medications or food in the medical record. The DON stated Resident 1 was showing progress in occupation and physical therapy notation. The DON stated Resident 1 had acute changes from her baseline. The DON stated RN 1 failed to communicate all information from initial assessment to the primary physician and failed to conduct and document a full neurological assessment that would have included assessing mental status and level of consciousness, pupillary response, motor strength, sensation and gait. During a review of Resident 1's Electronic Medication Administration Record (EMAR), dated 4/8/25 at 2 p.m., the EMAR indicated, . Sodium Chloride Oral (oral medication or supplement containing the chemical compound for salt that functions as an electrolyte replenisher) tablet 1 gram (gm- unit of measurement) . administered by Registered Nurse (RN) 1.During a review of the facilities document titled Nurses Notes for Resident 1 dated 4/8/25 at 8:30 p.m., the Nurses Notes indicated, .Ambulance transported [Resident 1] . to [GACH A] for [Altered Mental Status] .During a review of Resident 1's Emergency Department Provider Notes (GACH A), dated 4/8/25 at 9:17 p.m., the Emergency Department Provider Notes indicated .Patient [arrived to Emergency Department at 8:48 pm] with Altered mental status from [Skilled care facility], staff said [last seen normal] at 2 p.m., decreasing mental status all day, [Emergency Medical Services] found her [Glasgow Coma Scale] of 3 (a score of 3 on the Glasgow Coma Scale, the lowest possible, indicating a patient is in the deepest coma, completely unresponsive).per daughter, patient has been altered since 10 am . [Computer Tomography (medical imaging technique using X-rays and a computer to create detailed cross-sectional slices of the body to diagnose illness, injury, or plan treatments)] of head performed at 9:05 pm .intraparenchymal hemorrhage (bleeding that occurs directly within the brain's functional tissue).intubation (someone who has a breathing tube placed through their mouth or nose into their windpipe to keep the airway open, support breathing) conducted at 9:15 pm.transfer to (GACH B) intubated due to intracranial bleed and Neuro consult.During a review of Resident 1's Emergency Department (ED) Disposition (GACH B), dated 4/8/25 at 11:54 p.m., the ED disposition indicated, . 81 [year old] [female] prior medical history of atrial fibrillation, hypertension, diabetes mellitus present to [offsite hospital] from skilled nursing facility for [Altered mental status] patient has Glasgow Coma Scale of 3 (a score of 3 on the Glasgow Coma Scale, the lowest possible, indicating a patient is in the deepest coma, completely unresponsive). on scene [last known well] was [2 pm], imaging at [offsite hospital] shows a large right sided temporal parietal [intraparenchymal hemorrhage (bleeding that occurs directly within the brain's functional tissue)] . Case and imagining [discussed with] attending, this is a devastating brain bleed, surgical interventions for any meaningful recovery very unlikely.During a review of Resident 1's Expiration Discharge summary, dated [DATE], the Expiration Discharge Summary indicated, .81 [year old] .arrived to [GACH B] on 4/8[2025] as a transfer from [GACH A] for higher level of care after having been found to have a large right side intraparenchymal hemorrhage (bleeding that occurs directly within the brain's functional tissue) in the right temporoparietal region (bleeding that occurs in the area of the brain or skull involving both the temporal and parietal bones or lobes) greater than 1 centimeter (cm-unit of measurement) of leftward midline shift. Reportedly had 555652 Page 6 of 8 555652 01/05/2026 Willow Creek Healthcare Center 650 W. Alluvial Clovis, CA 93611

F 0580 Level of Harm - Actual harm Residents Affected - Few gradual decline in her exam throughout the day on 4/8/25, last seen awake/talking [at] 2pm. Found by nursing staff in evening as [Glasgow Coma Scale] of 3. Intubated (someone who has a breathing tube placed through their mouth or nose into their windpipe to keep the airway open, support breathing) at sending facility [GACH A]. Found to have hemorrhage leading to transfer. Family opting to transition to comfort measures. admitted to Neurocritical unit for ongoing supportive care.During a review of the facility's policy and procedure (P&P) titled, Change in a Resident's Condition or Status, revised dated 2/2021, the P&P indicated, .the nurse will notify the resident 's attending physician or physician on call when there has been a .significant change in the resident 's physical/emotional/mention condition .refusal of treatment.A significant change of condition is a major decline or improvement in the resident 's status that : . will not normally resolve itself without intervention by staff or by implement standard disease related clinical interventions. impact more than once area of the residents health status. ultimately is based on the judgment of the clinical staff .prior to notifying the physician or healthcare provider, the nurse will make detailed observations, gather relevant and pertinent information for the provider. the nurse will record in the resident ' s medical record information relative to changes in the resident ' s medical/mental condition or status .During a review of the facility's policy and procedure (P&P) titled, Staffing, Sufficient and Competent Nursing, revised dated 8/2022, the P&P indicated, .Licensed nurses and nursing assistants are trained and must demonstrate competency in identifying, documenting and reporting changes of condition consistent with their scope of practice and responsibilities.During a review of the facility's Job description titled, Registered Nurse (RN), signed by RN 1 dated 10/17/22, the job description indicated, .consult with the resident, his/her family, and the residents physician in planning the residents care, treatment.Review nurses notes to ensure that they are informative and description of the nursing care being provided, that they reflect the residents response to the care, and that such care is provided in accordance with the resident wishes. Notify the resident's attending physician and next of kin when there is a change in the resident's condition. evaluate each residents physical and emotional status. report problem areas.demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served. knowledgeable of nursing and medical practices and procedures.During a review of a professional reference titled, Change in Mental Status, dated [DATE], retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441973, the professional reference indicated .Altered mental status is a common presentation. It is important to recognize the early signs of altered mental status, identify the underlying cause, and to provide the appropriate care to reduce patient morbidity and mortality. Changes in consciousness can be categorized into changes of arousal, the content of consciousness, or a combination of both. Arousal includes wakefulness and/or alertness and can be described as hypoactivity or hyperactivity, while changes in the content of consciousness can lead to changes in self-awareness, expression, language, and emotions. When eliciting a history from a patient who presents for altered mental status, it is important to obtain information both from the patient and from collateral sources (e.g., parents, children, friends, emergency management services, bystanders, the patient's primary physician). This information can provide more insight regarding the chronicity of the change, precipitating factors, exacerbating or relieving factors, and recent as well as chronic medical history. When performing a physical exam, start with a primary survey (assessing the patient's airway, spontaneous respirations, pulses and heart rate, the level of consciousness). Make sure to expose the patient and check their back and extremities for signs of trauma. or infection. Then, perform a secondary survey, with careful attention to the pupillary and neurologic exam. Patients with a change in mental status are best managed by an 555652 Page 7 of 8 555652 01/05/2026 Willow Creek Healthcare Center 650 W. Alluvial Clovis, CA 93611

F 0580 Level of Harm - Actual harm Residents Affected - Few interprofessional team that includes a neurologist, internist, psychiatrist, a radiologist, and an emergency department physician. Because there are numerous causes of mental status changes, a thorough history is necessary. While the patient is being worked up, the patient with acute mental status changes needs to be monitored by a nurse. The nursing staff should update the team about changes in the condition of the patient. Close communication should be made with the other healthcare professionals so that no serious cause of mental status changes is missed.During a review of a professional reference titled, Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety, dated September 2009, retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC2757754, the professional reference indicated . Clear and complete communication between health care providers is a prerequisite for safe patient management.Communication between healthcare workers accounts for the major part of the information flow in healthcare and growing evidence indicates that errors in communication impact on patient safety.nurse competency and preparedness are key components of nurse-physician communication about patient issues.There is evidence that clear communication is associated with improved quality of care and patient outcomes.During a review of a professional reference titled, Golden hour management in the patient with intraparenchymal cerebral hemorrhage: an Italian intersociety document, dated May 9,2025, retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC12065239/ the professional reference indicated . Spontaneous intracerebral hemorrhage (ICH- bleeding inside the skull without trauma) accounts for 9-27% of all strokes (medical emergency where blood flow to part of the brain is cut off )worldwide and is associated with high mortality (death, especially on a large scale) and disability. The main causes include vascular malformations (abnormality of blood vessels), small- and large-vessel angiopathies (disease affecting the blood vessels), and coagulation disorders (conditions that affect the blood's clotting activities). Mortality rates reach approximately 40% in 1 month and 54% in 1 year, largely influenced by early management decisions. Rapid intervention, particularly within the first hour, is crucial. Early intervention within 555652 Page 8 of 8