Health inspection·November 21, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on observation, interview, and record review, the facility failed to notify the Responsible Party (RP, a person responsible for a resident) for one of three sampled residents (Resident 1), when Resident 1 sustained skin tears (a wound that happens when the layers of skin peel back) to her right forearm and left lower leg. This failure to notify prevented the RP from being able to advocate for the resident's best interest. Resident 1 was admitted mid-2023 with diagnoses which included heart disease, difficulty breathing, and anemia (a condition where the blood does not have enough healthy red blood cells). Resident 1's Minimum Data Set (MDS, an assessment tool) indicated severe cognitive (thinking, knowing) impairment. Resident 1's children are listed as the RPs. During an observation on 11/20/23 at 11:37 a.m., in Resident 1's room, Resident 1 had a dry linear shaped scab to her right forearm. It was not covered with a bandage. During an observation on 11/20/23 at 11:45 a.m., in Resident 1's room, Resident 1 had six thin adhesive bandages placed over a wound to her right outer lower leg, and a foam bandage on her left outer lower leg. During an interview on 11/20/23 at 12:49 p.m., with Resident 1's RPs (RP 1and RP 2), the RP 1 stated when they came to visit Resident 1 they noticed a bandage on her left leg. RP2 stated, .we immediately went up to the nurse on duty and she said she had changed them [bandages], but she did not know who had put the first bandage on, so she didn't know what happened. Nobody recorded it so it took three days to find out the story behind it . During a concurrent interview and record review on 11/20/23 at 1:27 p.m., with the Director of Nursing (DON), the DON reviewed Resident 1's Progress Note (PN): Skin/Wound Note, dated 11/6/23 at 8:06 a.m., the PN indicated, .While repositioning resident a bandaid (sic) was noted to L [left] shin area with dark purple bruising to most of the shin area. Bandaid (sic) removed and presents with a small s/t [skin tear] with complete tissue loss . The DON stated she would expect staff to know what happened if a resident had a bandage. During a concurrent interview and record review on 11/21/23 at 11:09 a.m., with the Treatment Nurse (TN), the TN reviewed Resident 1's Progress Notes (PN): Skin/Wound Note dated 11/3/23 at 9:32 a.m., the PN indicated, Into see Pt [patient] to evaluate S/T [skin tear] to R [right] forearm, injury was sustained 11/02/2023 during PM [evening] shift . The TN confirmed there was no documentation of RP Page 1 of 4 555744 555744 11/21/2023 Siena Skilled Nursing and Rehabilitation Center 11600 Education Street Auburn, CA 95603

F 0580 notification, and stated she would expect family to be notified. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's policy and procedure (P&P) titled, Change in a Resident's Condition or Status, dated 4/2007, the P&P indicated, Our facility shall promptly notify the resident .and representative .of changes in the resident's medical/mental condition .the Charge Nurse will notify the resident's family or representative .when .the resident is involved in any accident or incident that results in an injury including injuries of an unknown source . Residents Affected - Few 555744 Page 2 of 4 555744 11/21/2023 Siena Skilled Nursing and Rehabilitation Center 11600 Education Street Auburn, CA 95603

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on observation, interview, and record review, the facility failed to ensure comprehensive care plans (plans that summarize specific care needs and treatments) were developed for one of three sampled residents (Resident 1), when skin tears (a wound that happens when the layers of skin peel back) to both legs and right forearm were identified, and care plans were not created. This failure had the potential to result in inadequate care being provided for Resident 1. Findings: Resident 1 was admitted mid-2023 with diagnoses which included heart disease, difficulty breathing, and anemia (a condition where the blood does not have enough healthy red blood cells). During an observation on 11/20/23 at 11:37 a.m., in Resident 1's room, Resident 1 had a dry linear shaped scab to her right forearm. It was not covered with a bandage. During an observation on 11/20/23 at 11:45 a.m., in Resident 1's room, Resident 1 had six thin adhesive bandages placed over a wound to her right outer lower leg, and a foam bandage on her left outer lower leg. During a review of Resident 1's Progress Notes (PN): Skin/Wound Note, dated 11/3/23 at 9:32 a.m., the PN indicated, Into see Pt [patient] to evaluate S/T [skin tear] to R [right] forearm, injury was sustained 11/02/2023 during PM [evening] shift . During a review of Resident 1's PN: Skin/Wound Note, dated 11/6/23 at 8:06 a.m., the PN indicated, .While repositing resident a bandaid (sic) was noted to L [left] shin area with dark purple bruising to most of the shin area. Bandaid (sic) removed and presents with a small s/t [skin tear] with complete tissue loss . During a review of Resident 1's SBAR Communication Form (form to notify physician of change in condition), dated 11/15/23, the communication form indicated, . Was called into Pt [patient] room to evaluate opening in skin after shower .skin tear to anterior [near the front] right lower extremity was noted . During an interview on 11/20/23 at 1:39 p.m., with the Director of Nursing (DON), the DON was asked to review the Care Plans for Resident 1's three separate skin tears. The DON was unable to locate any Care Plans and confirmed there were none created for any of Resident 1's skin tears. The DON stated her expectation was there should have been Care Plans created. During a concurrent interview and record review on 11/21/23 at 11:28 a.m., with the Treatment Nurse (TN), the TN reviewed Resident 1's chart and confirmed that no care plans had been created for the three skin tears. The TN stated there should have been care plans created. During a review of facility policy and procedure (P&P) titled, Care Plans-Comprehensive, dated 8/2006, the P&P indicated, An individualized Comprehensive Care Plan that includes measurable objectives and timetables to meet the resident's medical, nursing .needs is developed for each resident .Each resident's Comprehensive Care Plan has been designed to .reflect treatment goals and objectives 555744 Page 3 of 4 555744 11/21/2023 Siena Skilled Nursing and Rehabilitation Center 11600 Education Street Auburn, CA 95603

F 0656 .Care Plans are revised as changes in residents condition dictate . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 555744 Page 4 of 4