Health inspection·August 3, 2023

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop a personalized comprehensive care plans for one of three sample residents (Resident 1) when the facility failed to develop care plans with interventions for Resident 1 ' s urinary catheter and infection. This failure had to potential to result in Resident 1 not receiving interventions to promote the resident ' s optimal level of function. Findings: A review of Resident 1 ' s admission record indicated the resident was admitted to the facility on [DATE] with diagnoses which included sepsis, pneumonia, urinary tract infection and benign prostatic hyperplasia with lower urinary tract symptoms. A review of Resident 1 ' s Brief Interview for Mental Status (BIMS) dated May 22, 2023, indicated the resident had a score of 15 (no cognitive impairment). A review of Resident 1 ' s MDS (Minimum Data Set- an assessment) section I dated June 12, 2023, indicated Resident 1's medical condition included septicemia, urinary tract infection, and pneumonia. A review of Resident 1 ' s MDS section H dated June 12, 2023, indicated Resident 1 had an indwelling catheter (including suprapubic and nephrostomy tube). A review of Resident 1 ' s care plan indicated no entry to address Resident 1 ' s infection nor indwelling catheter. On July 20, 2023, at 3:40 p.m., during an interview with the Director of Nursing (DON), he stated the facility develops care plans for issues like infections. He further stated care plan entries are developed for resident conditions that require interventions. The DON reviewed the care plan for Resident 1 and acknowledged the absence of care plans for Resident 1 ' s urinary tract infection and suprapubic catheter. He stated there should be care plans for Resident 1 ' s infection and urinary catheter. A review of the facility ' s policy and procedure titled, Care Plans, Comprehensive Person-Centered revised December 2016 indicated, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident ' s physical , psychosocial and functional needs is developed and implemented for each resident .The comprehensive, person-centered care plan will: a. Page 1 of 6 555775 555775 08/03/2023 Bayshire Rancho Mirage 72-201 Country Club Drive Rancho Mirage, CA 92270

F 0656 Level of Harm - Minimal harm or potential for actual harm include measurable objectives and timeframes; b. Describe the services that are to be furnished to attain or maintain the resident ' s highest practicable physical, mental, and psychosocial well-being .Incorporate identified problem areas .reflect treatment goals, timetables and objectives in measurable outcomes .Identifying problem areas and their causes, and developing interventions that are targeted and meaningful to the resident. Residents Affected - Few 555775 Page 2 of 6 555775 08/03/2023 Bayshire Rancho Mirage 72-201 Country Club Drive Rancho Mirage, CA 92270

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to follow their policy and procedure for one of three sampled residents (Resident 1) when the facility did not implement interventions to control Resident 1 ' s pain. Residents Affected - Few This failure resulted in Resident 1 experiencing pain for 4 hours. Findings: A review of Resident 1 ' s admission record indicated the resident was admitted to the facility on [DATE] with diagnoses which included sepsis, pneumonia, urinary tract infection and benign prostatic hyperplasia with lower urinary tract symptoms. A review of Resident 1 ' s Brief Interview for Mental Status (BIMS) dated May 22, 2023 indicated the resident had a score of 15 (no cognitive impairment). A review of Resident 1 ' s physician orders indicated orders for the following: oxycodone-acetaminophen (oxycodone w/ acetaminophen- a medication for pain) oral tablet 5-325 mg (milligrams- a unit of measure) 1 tablet by mouth every 6 hours for moderate to severe pain 4-10 dated May 19, 2023. acetaminophen (pain medication) tablet 325 mg, give two tablets every 4 hours as needed for mild pain 1-3. Do not exceed 3000 mg in 24 hrs (hours) dated May 19, 2023. A review of Resident 1 ' s nursing progress note by Licensed Vocational Nurse (LVN1) dated June 11, 2023 at 3:36 p.m. indicated Resident 1 had pain rated by the resident at a level 10 (using a scale of 0-10 with 10 being the highest level of pain). A review of Resident 1 ' s June 2023 Medication Administration Record (MAR) indicated the resident received oxycodone-acetaminophen oral tablet 5-325 mg tablet June 11, 2023 at 3:36 p.m. by LVN1. The MAR further indicated the resident rated his pain at a level of 10. A review of Resident 1 ' s nursing administration note by LVN1 dated June 11, 2023 at 3:36 p.m. indicated Resident 1 received oxycodone-acetaminophen oral tablet 5-325 mg tablet. The note further indicated, Resident verbalized pain at level 10 to upper/lower back areas bi-lat (bilaterally- left and right sides). Lower extremities A review of Resident 1 ' s nursing administration note by LVN1 dated June 11, 2023 at 4:52 p.m. indicated, PRN (as needed) Administration was: Effective, Follow-up pain scale was: 8 No other documentation indicating notification of physician noted. On July 20, 2023, at 3:25 p.m, during an interview with LVN2, she stated the facility ' s practice for administering as needed pain medication is it ask the resident their level of pain or assess for pain. She stated she would then review the resident's physician orders and inform the resident of the medication prescribed for their pain. She stated she would administer the medication and reassess the resident's pain level 30 minutes after the medication administration. She stated she would 555775 Page 3 of 6 555775 08/03/2023 Bayshire Rancho Mirage 72-201 Country Club Drive Rancho Mirage, CA 92270

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few notify the physician if the medication was not effective if there was no other pain medication ordered. She further stated, depending on the medications ordered, she would potentially wait to administer a second medication due to concerns of the combined side effects of both pain medications. On July 20, 2023, at 3:40 p.m., during a concurrent interview and record review with the Director of Nursing (DON), he stated the process is to notify the physician if a pain medication was not effective to get an order for another intervention or pain medication more effective. He reviewed Resident 1's administration note dated June 11, 2023, at 4:52 pm. He acknowledged the note indicated the pain medication was effective with a pain rating of eight. He stated a pain level of eight is not effective. He stated the nurse should have called the physician to get another treatment option for the resident's pain. He could not indicate if Resident 1's pain was relieved. A review of Resident 1's care plan entry titled Pain Care Plan, is at risk for pain related to generalized body pain, dated May 19, 2023 indicated interventions including administer pain medication as per orders, anticipate the resident's need for pain relief, provide pain interventions and follow up for effectiveness. A review of the facility's policy and procedure titled, Pain Assessment and Management revised 2020 indicated, Pain management is a multidisciplinary care process that includes .recognizing the presence of pain .developing and implementing approaches to pain management .monitoring for the effectiveness of interventions, and modifying approaches as necessary . Acute pain (or significant worsening of chronic pain) should be assessed, on the onset and reassessed as indicated until relieft if obtained .Report the following information to the physician or practitioner .prolonged, unrelieved pain despite care plan interventions. 555775 Page 4 of 6 555775 08/03/2023 Bayshire Rancho Mirage 72-201 Country Club Drive Rancho Mirage, CA 92270

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the failed to notify the physician of abnormal laboratory results for one of three sampled residents (Resident 1). This failure had the potential to result in Resident 1 not receiving treatment to address abnormal laboratory values. Findings: A review of Resident 1's admission record indicated the resident was admitted to the facility on [DATE], with diagnoses which included fracture of right humerus (arm bone), difficulty walking, hypertension (high blood pressure), & protein-calorie malnutrition. The record indicated the resident was discharged on March 13, 2023. The record further indicated Resident 1 ' s family member as the responsible party and durable power of attorney. A review of Resident 1's Brief Interview for Mental Status (BIMS) dated March 14, 2023, indicated the resident had a score of 14 (little to no cognitive impairment). A review of Resident 1 ' s physician orders indicated an order for suprapubic catheter size Fr# 18/10 ml balloon for urinary obstruction, neurogenic bladder (lack of bladder control due to nerve damage), monitor for placement and functioning qshift (every shift), report abnormal findings to physician every shift for catheter care dated May 19, 2023. A review of Resident 1 ' s urinalysis with culture (a diagnostic test) collected June 5, 2023, and reported June 9, 2023, indicated the resident had abnormal values. The record indicated the values were reviewed by Licensed Vocational Nurse (LVN3) on June 12, 2023. The report further indicated the resident had a yeast infection. A review of Resident 1 ' s nursing progress notes indicated no notification of Resident 1 ' s laboratory results to the physician. On August 1, 2023, at 10:47 am, during a concurrent interview and record review with the Assistant Director of Nursing (ADON), she stated resident's laboratory results are reported to the physician. She stated if there is an order from the physician, it is inputted and carried out. She stated the representative or power of attorney is notified. She stated notification of the provider should be documented. She reviewed Resident 1's urinalysis collected June 5, 2023. She further reviewed Resident 1's progress notes and could not state if the physician was notified of the resident's urinalysis results. A review of the facility's policy and procedure titled, Catheter Care, Urinary, revised September 2014, indicated, Observe the resident for complications associated with urinary catheters .Observe for other signs and symptoms of urinary tract infection or urinary retention. Report findings to the physician or supervisor immediately. A review of the facility's policy and procedure titled, Lab and Diagnostic Test Results- Clinical Protocol revised November 2018 indicated, When test results are reported to the facility, a nurse 555775 Page 5 of 6 555775 08/03/2023 Bayshire Rancho Mirage 72-201 Country Club Drive Rancho Mirage, CA 92270

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few will first review the results .before contacting the physician, the person who is to communicate results to a physician will gather, review, and organize the information .A nurse will identify the urgency of communicating with the Attending Physician based on physician request, the seriousness of any abnormality, and the individual's current condition .Facility staff should document information about when, how, and to whom the information was provided and response. This should be done in the Progress Notes section of the medical record . 555775 Page 6 of 6