Health inspection·May 9, 2024

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure Resident 1's post fall assessment and other assessments were performed by a registered nurse (RN) to meet professional standards of practice. Residents Affected - Few The facility's failure place residents at risk of not being assessed appropriately and potentially resulting in harm to residents. Finding: According to the Nursing Practice Act, Business & Professions Code, Chapter 6, Nursing Section 2725 indicates, .(b) The practice of nursing within the meaning of this chapter means those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill . RN is accountable for an ongoing comprehensive assessment that includes data collection (LVN data collection contribution), analysis, and drawing conclusions/making judgments in order to: formulate diagnoses and update diagnoses, formulate or change the plan of care, decide on specific activities to implement the plan of care, prioritize and coordinate delivery of care, delegate to nursing care competent staff to deliver required care . RN uses scientific knowledge and experience to make clinical judgments/assessments about observed abnormalities and changes based on a series of complex, independent and collaborative decision-making activities Set priorities for implementation of nursing care, priorities regarding urgency of patient concerns . LVN is not prepared by formal education to make RN level nursing judgments/assessments that include independent analysis, synthesis, and decision-making. RN is responsible for collecting (LVN data collection), analyzing, and collaborating with all information sources to ensure a comprehensive written plan of care that is based on current standards of safe practice. According to the Scope of Vocational Nursing Practice, section 518.5 indicates, The licensed vocational nurse performs services requiring technical and manual skills which include the following: (a) Uses and practices basic assessment (data collection), participates in planning, executes interventions in accordance with the care plan or treatment plan, and contributes to evaluation of individualized interventions related to the care plan or treatment plan. The data collection performed by the LVN is integrated to the data collection the RN collects to analyzed, synthesized, and make decisions regarding patient/residents' care as outlined above. During a concurrent review of Resident 1's SBAR Communication Form . dated 04/11/24 and interview with the interim assistant director of nursing (IADON) on 4/18/24 at 1:25 p.m., the IADON was asked if this SBAR communication form on 4/11/24 at 4:43 a.m., was the nursing assessment the patient received prior to being sent to the hospital emergency department ED, were there any other nursing Page 1 of 2 555762 555762 05/09/2024 Samarkand Skilled Nursing Facility 2566 Treasure Drive Santa Barbara, CA 93105

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few assessments documented elsewhere in the record. The IADON confirmed the SBAR Communication form was an assessment and was created by a licensed vocational nurse (LVN). The IADON stated This SBAR form is the nursing assessment done before patient left to the ED. This is the only one (assessment). The SBAR document consisted of resident's assessment of all the body systems. A review of Resident 1's Daily Skilled Progress Note , dated 4/10/24 at 12:37 p.m., was conducted on 4/18/24. This progress note also consisted of the evaluation/assessment of the resident body systems. This assessment was also created by an LVN. During an interview with the IADON and administrator (ADMIN) on 4/18/24 at 2:05 p.m., the ADMIN and IADON were explained Resident 1's assessment dated [DATE] and 4/10/24 were conducted by an LVN without having an RN validate the assessments and/or cosign the assessments. It is not within the LVN scope of practice to perform assessments independently. The ADMIN acknowledged this and stated, I understand we need to look into this and change our practice. 555762 Page 2 of 2