Health inspection·November 6, 2024

F 0657 Level of Harm - Potential for minimal harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and medical record review, the facility failed to ensure the comprehensive plan of care was revised to reflect the resident's current wound care treatment and interventions for each individual wound site as ordered for one of seven sampled residents (Resident 3). * Resident 3's care plan was not revised to address the wound site of left foot first metatarsal base and head arterial wounds. This failure posed the risk of not providing the resident with individualized and person-centered care. Findings: Medical record review for Resident 3 was initiated on 11/5/24. Resident 3 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 3's physician's order dated 11/1/24, showed the following: - to provide wound care to sacrococcyx Sites #1 and #2 as follows: cleanse with NS, pat dry, apply Santyl (debridement agent) nickel thick layer and oil emulsion gauze, and cover with a dry clean dressing every day shift for 14 days and as needed for 14 days - to provide wound care to the right knee anterior skin tear as follows: cleanse with NS, pat dry, then apply Xeroform gauze (nonadherent dressing to maintain moist wound environment), and cover with a dry clean dressing every day shift for 14 days and as needed for 14 days. - to provide wound care to left inner/medial knee skin tear as follows: cleanse with NS, pat dry, then apply Xeroform gauze, and cover with a dry clean dressing every day shift for 14 days and as needed for 14 days. - to provide wound care to the left foot first metatarsal head and base arterial wound as follows: cleanse with NS, pat dry, then apply Santyl nickel thick layer, cover with moist gauze followed by a dry clean dressing every day shift for 14 days and as needed for 14 days. - to provide wound care to the left elbow skin tear as follows: cleanse with NS, pat dry, then apply Xeroform gauze and cover with a dry clean dressing Review of Resident 3's plan of care dated 11/1/24, showed wound management goals and interventions for the following wound sites: pressure injury to the sacrum coccyx Sites #1 and #2, right foot Page 1 of 5 555688 555688 11/06/2024 Anaheim Point 3415 W Ball Road Anaheim, CA 92804

F 0657 Level of Harm - Potential for minimal harm Residents Affected - Some fifth metatarsal base and head arterial wounds, skin tear on the left inner knee, and skin tears to the right lower leg anterior and left elbow. However, the care plan failed to show goal and interventions of the left foot first metatarsal head and base arterial wounds. On 11/6/24 at 1530 hours, a concurrent interview and medical record review for Resident 3 was conducted with the DON. The DON verified the findings and stated Resident 3's care plan should be revised to reflect all wound sites currently undergoing treatment and monitoring. 555688 Page 2 of 5 555688 11/06/2024 Anaheim Point 3415 W Ball Road Anaheim, CA 92804

F 0693 Level of Harm - Potential for minimal harm Residents Affected - Some Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and medical record review, the facility failed to provide the necessary tube feeding care and services for one of seven sampled residents (Resident 3). * The facility failed to ensure Resident 3 was positioned safely at 30 to 45 degrees during the enteral feeding via PEG tube. This failure posed the risk for developing complications related to resident's tube feeding and health consequences. Findings: Review of the facility's P&P titled Enteral Tube Management: Nasogastric Tube, Gastrostomy Tube, and Jejunostomy Tube revised on 9/28/23, showed the head of the bed should be elevated 30 degrees during enteral feedings. Medical record review for Resident 3 was initiated on 11/5/24. Resident 3 was initially admitted to the facility on [DATE], and was readmitted on [DATE]. Review of Resident 3's Order Summary Report dated 10/31/24, showed an order to administer Jevity 1.5 at 50 ml per hour for 20 hours = 1000 ml/24 hours via PEG tube and elevate the head of bed at 30 to 45 degrees during the enteral feeding. On 11/6/24 at 1230 hours, Resident 3 was observed lying flat in bed. Resident 3's tube feeding with Jevity 1.5 was observed infusing via a feeding pump at 50 ml per hour. On 11/6/24 at 1232 hours, a concurrent observation and interview for Resident 3 was conducted with LVN 3. LVN 3 verified the finding and stated that the head of the bed should be elevated at 30 to 45 degrees during the enteral feeding. When asked what could happen to Resident 3 if her head of the bed was not elevated during the enteral feeding, LVN 3 stated Resident 3 could aspirate (inhalation of food, saliva, liquids, or vomit into the lungs) if the head of the bed was kept flat during the enteral feeding. On 11/6/24 at 1530 hours, the DON acknowledged the above finding. 555688 Page 3 of 5 555688 11/06/2024 Anaheim Point 3415 W Ball Road Anaheim, CA 92804

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to implement the infection control practices designed to provide the safe and sanitary environment to prevent the transmission of diseases and infections in the facility. Residents Affected - Some * The facility failed to ensure the staff practiced the EBP during high contact-care for one of seven sampled residents (Resident 3). This failure posed the risk for the transmission of diseases and infections. Findings: According to the CDC, EBP promotes the use of PPE to include donning of gown and gloves during high-contact resident care activities that can provide the opportunities for transmission of MDROs to others. Examples of high-contact resident care activities requiring gown and glove use for Enhanced Barrier Precautions include the following: - Dressing - Bathing/showering - Transferring - Providing hygiene - Changing linens - Changing briefs or assisting with toileting - Device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator - Wound care: any skin opening requiring a dressing Review of the facility's EBP signage showed everyone must clean hands before entering and after leaving room. All healthcare personnel must wear gloves and gown for the following high contact resident care activities: - Dressing, bathing/showering - Transferring - Changing linens - Providing Hygiene - Changing briefs or assisting with toileting - Device care or use: central line, urinary catheter, feeding tube, tracheostomy 555688 Page 4 of 5 555688 11/06/2024 Anaheim Point 3415 W Ball Road Anaheim, CA 92804

F 0880 - Wound care: any skin opening requiring a dressing Level of Harm - Potential for minimal harm Medical record review for Resident 3 was initiated on 11/5/24. Resident 3 was admitted to the facility on [DATE], and readmitted on [DATE]. Residents Affected - Some Review of Resident 3's care plan showed Resident 3 was on EBP for presence of the PEG tube, Foley catheter, and wounds. On 11/6/24 at 1240 hours, Resident 3's room was observed with an EBP standard precautions signage posted on Resident 3's door. The signage showed EBP, everyone must perform hand hygiene before entering the room, providers and staff must also wear gloves and gown for high contact resident care activities such as: - Dressing - Bathing/showering - Transferring - Changing linens - Providing hygiene - Changing briefs or assisting with toileting - Device care or use: central line, urinary catheter, feeding tube, tracheostomy - Wound care: any skin opening requiring a dressing. On 11/6/24 at 1241 hours, a concurrent observation of Resident 3 and interview was conducted with CNA 8. CNA 8 was observed handling Resident 3's Foley catheter without proper PPE. CNA 8 verified he should have donned the gloves and gown before handling the Foley catheter for the infection prevention. On 11/6/24 at 1420 hours, a concurrent interview and medical record review was conducted with RN 1. RN 1 verified Resident 3 was on EBP or presence of PEG tube, Foley catheter, and wounds. RN 1 further stated for EBP, the staff should wear the gloves and gown when providing Foley catheter care to prevent the infection. On 11/6/24 at 1530 hours, the DON verified the findings and stated the staff were expected to perform hand hygiene, don gloves and gown when providing high contact resident care activities, including Foley catheter care to prevent the transmission of diseases and infection prevention for the residents on EBP. 555688 Page 5 of 5