Health inspection·January 5, 2024

F 0580 Level of Harm - Potential for minimal harm Residents Affected - Some Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review, the facility failed to notify the resident's representative when there was a change of the POA for one of four sampled residents (Resident 1). * Resident 1's legal representative was changed from Family Member 1 to Family Member 2 without informing Family Member 1. This failure resulted in Family Member 1 being unaware of the change, which had the potential to negatively impact the resident's well-being. Findings: On 1/2/24 at 0816 hours, a telephone interview was conducted with Family Member 1. Family Member 1 stated she was the POA for Resident 1; however, the facility changed the POA to Family Member 2 without informing her. Medical record review for Resident 1 was initiated on 1/2/24. Resident 1 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 1's History and Physical Form dated 2/28/23, showed Resident 1 did not have the capacity to understand and make decisions. Review of Resident 1's History and Physical Form dated 7/13/23, showed Resident 1 did have the capacity to understand and make decisions. Review of Resident 1's Progress Note dated 7/20/23 at 1217 hours, showed Resident 1 was assisted to complete a new Advance Health Care Directive, designating Family Member 2 as his Power of Attorney. There was no documentation showing Family Member 1 was made aware. Review of Resident 1's Progress Note dated 9/26/23 at 1521 hours, showed Family Member 2 was left a voicemail regarding the change in Power of Attorney. On 1/2/24 at 1147 hours, an interview and concurrent medical record review was conducted with the SSA. The SSA verified Resident 1 changed his POA from Family Member 1 to Family Member 2 on 7/19/23, after his physician deemed him capable of understanding and making medical decisions. The SSA stated she called Family Member 1 and left a voicemail to inform her, but forgot to document the call. The SSA was unable to show any documentation Family Member 1 was made aware of the change of POA prior to 9/26/23. Page 1 of 3 555667 555667 01/05/2024 Garden Park Care Center 12681 Haster Street Garden Grove, CA 92840

F 0690 Level of Harm - Potential for minimal harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and medical record review, the facility failed to ensure a physician's order was in place prior to the use of an indwelling urinary drainage catheter for one of four sampled residents (Resident 3). This failure put Resident 3 at risk of complications and not having their care needs met. Findings: On 1/2/24 at 1354 hours, an observation was conducted at Resident 3's bedside. Resident 3 was observed in bed with an indwelling urinary drainage catheter in place. Medical record review for Resident 3 was initiated on 1/2/24. Resident 3 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 3's Order Summary Report failed to show a physician's order for the use of an indwelling urinary drainage catheter. On 1/5/24 at 1137 hours, an observation, interview, and concurrent medical record review was conducted with LVN 1. Resident 3 was again observed in bed with an indwelling urinary drainage catheter in place. LVN 1 was asked about Resident 3's indwelling urinary drainage catheter. LVN 1 stated Resident 3 had the indwelling urinary drainage catheter since his readmission. LVN 1 was asked to show the physician's order for the use of the indwelling urinary drainage catheter. LVN 1 reviewed the medical record and was unable to find a physician's order. LVN 1 stated there should be a physician's order prior to the use of an indwelling urinary drainage catheter. 555667 Page 2 of 3 555667 01/05/2024 Garden Park Care Center 12681 Haster Street Garden Grove, CA 92840

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review, the facility failed to administer the medications as ordered by the physician for one of four sampled residents (Resident 3). * Resident 3 had a physician's order for insulin glargine (a medication used to treat diabetes) to be given at bedtime, with parameters to hold if the blood sugar levels were less than 120 mg/dl. There was no documented evidence the blood sugar level was checked to determine whether to administer or hold the insulin as ordered. This failure put Resident 3 at risk of complications. Findings: Medical record review for Resident 3 was initiated on 1/2/24. Resident 3 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 3's Order Summary Report showed an order dated 12/26/23, for insulin glargine 100 unit/ml 6 units subcutaneously (under the skin) at bedtime for DM and to hold if the blood sugar levels were less than 120 mg/dl. Review of Resident 3's Medication Administration Record showed Resident 3 received insulin glargine as ordered from 1/1 - 1/4/24; however, there was no documented evidence of blood sugar levels. On 1/5/24 at 1137 hours, an interview and concurrent medical record review was conducted with LVN 1. LVN 1 verified Resident 3 had an order for insulin glargine at bedtime with the instructions to hold if the blood sugar levels were less than 120 mg/dl. LVN 1 was asked to show documentation the blood sugar levels were checked prior to the insulin administration and was unable to do so. 555667 Page 3 of 3