Health inspection·November 8, 2023

F 0656 Level of Harm - Potential for minimal harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review, the facility failed to develop the comprehensive person-centered care plan for one of four sampled residents (Resident 1). * Resident 1 consistently refused showers and hygiene care. The facility did not develop a care plan problem to address the refusal of care. This failure put Resident 1 at risk of not having their care needs met. Findings: Closed medical record review for Resident 1 was initiated on 11/7/23. Resident 1 was readmitted to the facility on [DATE], and transferred to the acute care hospital on [DATE]. Review of Resident 1 ' s Shower Day Skin inspection forms dated 10/6/23 and 10/28/23, showed Resident 1 refused to shower on her scheduled shower days. Review of Resident 1 ' s plan of care failed to show a care plan problem addressing Resident 1 ' s refusal to shower. On 11/7/23 at 1223 hours, an interview was conducted with LVN 1. LVN 1 was asked about care and services provided to Resident 1, specifically hygiene care. LVN 1 stated Resident 1 often refused treatments and showers. On 11/7/23 at 1243 hours, an interview was conducted with CNA 1. CNA 1 stated Resident 1 would often refuse hygiene and would not let the staff change the linens on the bed. On 11/7/23 at 1420 hours, a telephone interview was conducted with CNA 2. CNA 2 stated Resident 1 would usually refuse everything, including hygiene care. CNA 2 stated he informed the charge nurse of the resident ' s refusal. On 11/7/23 at 1426 hours, an interview and concurrent closed medical record review was conducted with RN 1. RN 1 was asked about the process regarding a resident refusing care and services, RN 1 stated part of the process included to update the plan of care. RN 1 stated any licensed nurses could update the plan of care. RN 1 was asked to review Resident 1 ' s closed medical record and show evidence a care plan problem was developed for Resident 1 ' s refusal of care, including showers. RN 1 stated there was no care plan problem to address the refusal of care. Page 1 of 4 555688 555688 11/08/2023 Anaheim Point 3415 W Ball Road Anaheim, CA 92804

F 0656 Level of Harm - Potential for minimal harm On 11/8/23 at 1415 hours, a telephone interview was conducted with CNA 3. CNA 3 stated she was normally assigned to care for Resident 1 on the PM shift (1500 to 2300 hours). CNA 3 stated Resident 1 was assigned to have showers on the PM shift, but only accepted one time. CNA 3 stated she informed the charge nurse of the refusals. Residents Affected - Some 555688 Page 2 of 4 555688 11/08/2023 Anaheim Point 3415 W Ball Road Anaheim, CA 92804

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and facility P&P review, the facility failed to ensure one of four sampled residents (Resident 1) received the pain medication as prescribed in accordance with physician ' s orders. Residents Affected - Few * Resident 1 had a physician ' s order for oxycodone-acetaminophen (a narcotic medication used to treat pain) 5-325 mg two tablets by mouth every four hours as needed for moderate pain; however, Resident 1 received the medication on multiple occasions outside of the ordered parameters. This failure had the potential for Resident 1 to not have their pain adequately addressed and adverse effects. Findings: Review of the facility ' s P&P titled Pain Management revised date 11/2016showed the following: - The licensed nurse will administer pain medication as ordered; and - The licensed nurse will assess the resident for pain and document results on the Medication Administration Record (MAR) each shift using the 0-10 pain scale. Closed medical record review for Resident 1 was initiated on 11/7/23. Resident 1 was readmitted to the facility on [DATE], and transferred to the acute care hospital on [DATE]. Review of Resident 1 ' s Order Summary Report showed an order dated 10/4/23, for oxycodone-acetaminophen oral tablet 5-325 mg two tablets by mouth every four hours as needed for moderate pain. Review of Resident 1 ' s MAR dated October 2023 showed Resident 1 received oxycodone-acetaminophen 5-325 mg with the pain level outside of the parameters set by the physician on several occasions. For example, Resident 1 reported pain as follows: - On 10/5/23 at 0130, 0950, and 1400 hours, Resident 1 reported a pain level of 9 on a 0-10 pain scale (with 0 = no pain and 10 = worst pain). - On 10/6/23 at 0930 and 1342 hours, Resident 1 reported a pain level of 9. - On 10/9/23 at 0030 hours, Resident 1 reported a pain level of 9. - On 10/10/23 at 0630 and 1940 hours, Resident 1 reported a pain level of 9. - On 10/20/23 at 1743 hours, Resident 1 reported a pain level of 10. - On 10/30/23 at 0653 hours, Resident 1 reported a pain level of 10. On 11/7/23 at 1406 hours, an interview was conducted with LVN 2. LVN 2 was asked the facility ' s pain scale used to assess pain. LVN 2 stated they used a 0-10 numerical scale with 0 being the least level of pain and 10 beingthe highest. LVN 2 stated pain was classified as mild, moderate, or severe. When asked which numerical indicators were used for each group, LVN 2 stated mild pain was 1-4, moderate 5-7, and severe was 8-10. 555688 Page 3 of 4 555688 11/08/2023 Anaheim Point 3415 W Ball Road Anaheim, CA 92804

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 11/7/23 at 1409 hours, an interview and concurrent closed medical record review was conducted with RN 1. RN 1 was asked about the pain scale used to assess the residents ' pain levels. RN 1 stated the facility used a numerical scale of 0-10. RN 1 stated mild pain was 1-3, moderate was 4-6, and severe 7-10. When asked aboutthe process if a resident reported pain outside of the physician ' s ordered parameters, RN 1 stated the physician should be called and the order was clarified. RN 1 was asked to review Resident 1 ' s closed medical record. RN 1 reviewed Resident 1 ' s MAR and verified the above occasions when Resident 1 received the pain medication outside of the physician ' s orders. 555688 Page 4 of 4