Health inspection·December 8, 2022

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to meet professional standards during medication administration when physician orders were not followed for two of five sampled residents (Resident 28 and Resident 30). This failure had the potential to result in adverse drug interactions. Residents Affected - Few Findings: During an observation on 12/6/22, at 8:41 AM, in Resident 28's room, Registered Nurse (RN) 2 gave Resident 28 the following medications: Cholecalciferol (also known as Vitamin D3-made by the skin when exposed to sunlight) 25 mcg (microgram-unit of measurement), Cyanocobalamin (also known as Vitamin B12) indicated for Vitamin B12 deficiency 1000mcg, Finasteride (medication given for enlarged prostate) 5mg (milligram-unit of measurement), Famotidine (medication used for acid reflux) 20mg, Acidophilus (probiotic-taken for stomach health) , Calcium Carbonate (dietary supplement used when calcium in the diet is not enough) 1250mg. All medications were given through Resident's Gastric Tube (A tube inserted through the wall of the abdomen directly into the stomach). No water flushes were given in between these medications. During a concurrent interview and record review, on 12/6/22, at 8:45 AM, with RN 2, Resident 28's Medication Administration Record (MAR), dated November 2022 was reviewed. The MAR indicated, Flush with a minimum of 15ml [milliliter-unit of measure] H2O [water] in between each medication given. RN 2 stated, Resident 28 should have gotten the flushes. During an observation on 12/6/22, at 8:57 AM, in Resident 30's room, RN 2 gave Resident 30 Carvedilol (medication used to treat high blood pressure) 6.25 mg (mg-unit of measurement), Senna (medication to treat constipation) 8.6mg, and Vitamin B12 2,000U (U-Unit of measurement) through his gastric tube. No water flushes were given in between these three medications. During a concurrent interview and record review, on 12/6/22, at 9 AM, with RN 2, Resident 30's MAR, dated November 2022 was reviewed. The MAR indicated, Flush with a minimum of 15ml H2O in between each medication given. RN 2 stated, she did not do this and should have followed the MAR. During a review of the facility's policy and procedure (P&P) titled, Medication Administration-DP/SNF [Distinct Part-Skilled Nursing Facility], (undated), the P&P indicated, Purpose: to assure the most complete and accurate implementation of physicians' medication orders and to optimize drug therapy for each resident by providing for administration of drugs in an accurate, safe, timely, and sanitary manner. Tube administration (Gastric). 12. Flush tube with minimum of 15 ml of water after each medication. Page 1 of 5 555766 555766 12/08/2022 Sierra View Medical Center 465 W Putnam Ave Porterville, CA 93257

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure a comprehensive activities assessment was conducted and activities care plan developed specific to the preferences of four of 33 sampled Residents (Resident 334, Resident 29, Resident 28, and Resident 30). This failure resulted in Resident 334, Resident 29, Resident 28, and Resident 30 not receiving activities specific to their preference or choice. Residents Affected - Some Findings: During a concurrent interview and record review on 12/8/22, at 10:47 AM, with Certified Nurse Assistant (CNA) 1, the individualized Patient Care Plan for Activities located in the activities binder on the activity cart were reviewed. Resident 334, Resident 29, Resident 28, and Resident 30, did not have a copy of the Patient Care Plan for Activities in the activities binder. CNA 1 stated, she has been helping in activities since 8/22, while the Activity Director (AD) was on leave. CNA 1 stated, she used the activity binder when providing activities to the residents to know what each resident's specific likes and dislikes are. CNA 1 stated, each resident has a copy of their individualized Patient Care Plan for Activities with their specific likes and/or dislikes in the binder (e.g., likes the Los Angeles Dodgers baseball team, or likes country music, or likes books from a favorite author being read). CNA 1 confirmed Resident 334, Resident 29, Resident 28, and Resident 30 did not have a copy of the Patient Care Plan for Activities in the activities binder. CNA 1 stated, she did not know where to find the Activity care plan or who makes the care plans, but AD is responsible for updating the activities binder. During an interview on 12/8/22, at 12:52 PM, with Clinical Manager (CM), CM stated, the facility's AD had been on leave since 5/21/22, and the position had not been replaced. The CM stated, CNA's and Licensed Vocational Nurses had filled in, but there had been no AD since 5/21/22. During an interview on 12/8/22, at 2:42 PM, with Registered Nurse (RN) 1, RN 1 stated, no one has been doing the Activities Assessment since the AD has been on leave. During an interview on 12/8/22, at 4:05 PM, with CM, CM stated, the full activities assessment, that has resident specific likes or dislikes, has not been completed for residents that have been admitted since the AD went on leave (on 5/21/22). CM stated, Yes, the care plan should be specific to the interests of the residents. During a review of the facility's Job Description for Activities Director, revised 7/20, indicated, Responsibilities and Essential Functions: 2 * Completes assessment and care plan for each resident within (7) days after admission, with initial assessment accomplished within 24 hours. 555766 Page 2 of 5 555766 12/08/2022 Sierra View Medical Center 465 W Putnam Ave Porterville, CA 93257

F 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure a qualified professional directed the activities program from 5/21/22 through the recertification survey, which concluded on 12/8/22 (six and a half months). This failure resulted in 34 of 34 sampled residents (Resident 1, Resident 2, Resident 3, Resident 4, Resident 5, Resident 6, Resident 7, Resident 8, Resident 9, Resident 10, Resident 11, Resident 12, Resident 13, Resident 14, Resident 15, Resident 16, Resident 17, Resident 18, Resident 19, Resident 20, Resident 21, Resident 22, Resident 23, Resident 24, Resident 25, Resident 26, Resident 27, Resident 28, Resident 29, Resident 30, Resident 31, Resident 32, Resident 33, Resident 334) not receiving activities directed by a qualified professional. Residents Affected - Many Findings: During an interview on 12/6/22, at 8:20 AM, with Clinical Manager (CM], CM stated, the facility has not had an Activity Director (AD) since April 2022. CM stated, facility's AD was out on leave, and the facility has not yet replaced the AD. CM stated, the facility has been using Certified Nursing Assistants (CNAs) and Licensed Vocational Nurses (LVNs) to fill in and provide activities to all the residents since April 2022. CM stated, CNA 1 had been providing activities to the residents for the last several weeks. During an interview on 12/6/22, at 8:45 AM, with CNA 1, CNA 1 stated, she has been helping provide activities to the residents of the facility. She is not the facility's Activities Director, her title is Certified Nursing Assistant. During an interview on 12/8/22, at 12:52 PM, with CM, CM stated, CNA 2 had filled in for the AD through 5/21/22 through 8/5/22. CM stated, CNA 2 does not have the required training or certification to be an AD. CM stated, CNA 1 filled in for the AD when CNA 2 went on leave 8/5/22. CM stated, [CNA 1] is not the Activity Director. During an interview on 12/8/22, at 2:42 PM, with Registered Nurse (RN) 1, RN 1 stated, no one has been doing the activities assessment since the AD has been on leave [since 5/21/22]. During a review of the facility's Job Description for Activities Director, revised 7/20, the Job Description indicated, Position Summary: Under the direction of the Department Director, The Activities Director assumes responsibility for planning and carrying out social and other purposeful independent or group activities to meet the patients' individual needs. Education/Training/Experience: Completion of 36 hours Activities Program Course Training and Certification of such. 555766 Page 3 of 5 555766 12/08/2022 Sierra View Medical Center 465 W Putnam Ave Porterville, CA 93257

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure it was free from a medication error rate of five percent (%) or greater during the medication pass observation. The facility had a cumulative medication rate of 7.14% consisting of two errors in a sample size of 28 opportunities for error. Residents Affected - Few The medication errors consisted of giving two residents (Resident 28 and Resident 30) medications through their Gastric Tubes (Tube going directly into the stomach) without flushing with 15 milliliter (ml-unit of measure) water in between each medication. These failures had the potential to result in adverse drug interactions. Findings: During an observation on 12/6/22, at 8:41 AM, in Resident 28's room, Registered Nurse (RN) 2 gave Resident 28 the following medications: Cholecalciferol (also known as Vitamin D3-made by the skin when exposed to sunlight) 25 mcg (mcg-unit of measurement), Cyanocobalamin (also known as Vitamin B12) indicated for Vitamin B12 deficiency 1000mcg, Finasteride (medication given for enlarged prostate) 5mg (mg-unit of measurement), Famotidine (medication used for acid reflux) 20mg, Acidophilus (probiotic-taken for stomach health) , Calcium Carbonate (dietary supplement used when calcium in the diet is not enough) 1250mg. All medications were given through Resident's Gastric Tube (A tube inserted through the wall of the abdomen directly into the stomach). No water flushes were given in between these medications. During a concurrent interview and record review on 12/6/22, at 8:45 AM, with RN 2, Resident 28's Medication Administration Record (MAR), dated November 2022 was reviewed. The MAR indicated, Flush with a minimum of 15ml H2O [water] in between each medication given. RN 2 stated, Resident 28 should have gotten the flushes. During an observation on 12/6/22, at 8:57 AM, in Resident 30's room, RN 2 gave Resident 30 Carvedilol (medication used to treat high blood pressure) 6.25 mg (mg-unit of measurement), Senna (medication to treat constipation) 8.6mg, and Vitamin B12 2,000U (U-Unit of measurement) through his gastric tube. No water flushes were given in between these three medications. During a concurrent interview and record review, on 12/6/22, at 9 AM, with RN 2, Resident 30's MAR, dated November 2022 was reviewed. The MAR indicated, Flush with a minimum of 15ml H2O in between each medication given. RN 2 stated, she did not do this and should have followed the MAR. During a review of the facility's policy and procedure (P&P) titled, Medication Administration-DP/SNF [Distinct Part-Skilled Nursing Facility], (undated), the P&P indicated, Purpose: to assure the most complete and accurate implementation of physicians' medication orders and to optimize drug therapy for each resident by providing for administration of drugs in an accurate, safe, timely, and sanitary manner. Tube administration (Gastric). 12. Flush tube with minimum of 15 ml of water after each medication. 555766 Page 4 of 5 555766 12/08/2022 Sierra View Medical Center 465 W Putnam Ave Porterville, CA 93257

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to implement infection control practices when Licensed Vocational Nurse (LVN) 1 did not change her gloves and perform hand hygiene before giving eye drop medication and after giving medication through Gastric tube (Tube going directly into the stomach) for one of five sampled residents (Resident 31). This failure had the potential for transmission of infection to Resident 31. Residents Affected - Few Findings: During a concurrent observation and interview on 12/6/22, at 9:50 AM, with LVN 1, in Resident 31's room, LVN 1 put on a pair of gloves and gave Resident 31 Baclofen (medication used for muscle spasms) 20 mg (mg-unit of measurement), Lovenox (medication used to thin blood) 40mg (injected into the abdomen), and Keppra (medication used for seizures[involuntary movements]) 100mg through Resident 31's Gastric tube. LVN 1 then proceeded to give Resident 31 Genteal tears (lubricant for the eyes) one drop to both eyes while wearing the same pair of gloves. LVN 1 stated, she should have washed her hands after administration of medication through the gastric tube and put on a new pair of gloves before instilling eye drops to Resident 31's eyes. During a review of the facility's policy and procedure (P&P) titled, Medication Administration-D/P SNF [Distinct Part-Skilled Nursing Facility] , (undated), the P&P indicated, Tube Administration 16. discard all other supplies appropriately. 17. Wash Hands. Ophthalmic medications: 3. Use a clean gauze pad for each stroke and wipe the eye from inside to outside. 10. dispose of supplies appropriately. 11. Wash Hands 555766 Page 5 of 5