Health inspection·May 5, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm ***REPEAT Deficiency*** Residents Affected - Few Based on record review and interview, the facility failed to ensure two of two sampled residents' (Resident 1 and Resident 2) assessments were performed by a registered nurse (RN) to meet professional standards of practice. This facility 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 . 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 into the data collection the RN collects to analyze, synthesize, and make decisions regarding patient/residents' care as outlined above. During a concurrent review of Resident 1's assessments and interview with the director of nursing (DON) and administrator (Admin) on 4/17/25 at 1:16 p.m., the document titled SBAR Communication Form . which consist of resident's evaluation of ten body systems was reviewed. The Admin was asked under which category this document was located. The Admin stated The SBAR Communication form is located under the assessments category. On the front page of document indicated Before calling Page 1 of 2 555762 555762 05/05/2025 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 Physician/NP/PA/other healthcare professional: Evaluate the Resident: Complete relevant aspects of the SBAR form below . On the second page of document indicated Resident Evaluation .listed 10 body systems to be evaluated. The DON and Admin confirmed the SBAR form was an assessment of a resident. A review of the resident assessments indicated the following: SBAR Communication forms dated 4/8/25 at 12:05 p.m., and 3/8/25 at 6:00 a.m., were not signed by a nursing staff, the signature area was left blank. SBAR Communication forms, dated 3/31/25 at 11:25 p.m., and 2/26/25 at 12:23 a.m., were signed by an LVN and not an RN. During a concurrent interview and record review on 4/17/25 at 1:16 p.m. with director of nursing (DON) and administrator (Admin) Resident 2's assessments and SBAR (Situation, Background, Assessment, and Recommendation - a tool used to share information about a patient) Communication Form, dated 2/11/25 at 5:59 a.m. were reviewed. The assessment was not signed by a nursing staff, the signature area was left blank. The DON and Admin were informed that the residents' SBAR forms required a signature to indicate who is completing the assessment, and the assessments need to be completed by an RN. If an assessment is completed by a licensd vocational nurse (LVN) then an RN must validate the assessments and/or cosign the assessments. It is not within the LVN scope of practice (activities and duties a healthcare professional is allowed to do) to perform assessments independently. The Admin stated OK . The DON stated OK . 555762 Page 2 of 2