Health inspection·October 6, 2023

F 0572 Give residents a notice of rights, rules, services and charges. 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 provide one of two sampled residents (Resident 12), a copy of the Resident [NAME] of Rights. This failure had the potential for new residents to be unaware of their rights that maintain quality of life while undergoing care in the skilled nursing setting. Residents Affected - Few Findings: A review of an admission record was done. Resident 12 was admitted on [DATE] with diagnoses which included severe protein-calorie malnutrition, major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest), weakness and difficulty walking, and lumbar disc degeneration. A concurrent interview and record review was conducted on 10/05/23 11:54 am, with the admission Coordinator (AC) who stated that the admission process was completed using an iPad device and residents signed the California Standard admission Agreement for Skilled Nursing Facilities electronically. In her estimation, half of residents requested a printed copy of the e-documents they sign which she prints and provides. AC was asked to print a completed admission packet for Resident 12, it was noted that the Resident [NAME] of Rights had not printed, and AC was unable to explain why that particular section had not printed. A review of a California Standard admission Agreement for Skilled Nursing Facilities (AKA admission packet) was made. Attachments A through F were listed in the table of contents, with Attachment F designated for the Resident [NAME] of Rights. Section iv, Your Rights as a Resident, specified as follows, Residents of this Facility keep all their basic rights and liberties as a citizen or resident of the United States when, and after, they are admitted . Because these rights are so important, both federal and state laws and regulations describe them in detail, and state law requires that a comprehensive Resident [NAME] of Rights be attached to this agreement. Attachment F, entitled 'Resident [NAME] of Rights,' lists your rights, as set forth in State and Federal law, and further directs, You should review the attached Resident [NAME] of Rights very carefully. A review of Attachment F, the Resident [NAME] of Rights, was made. Attachment F consisted of 31 pages detailing rights that relate to quality of life and care in the following categories: privacy and confidentiality, participation in the plan of care and in groups and activities, living accommodations, the protection of money and possessions, visitors, self-determination in how to spend one's time, addressing grievances, refusal/participation in medical care and treatment, and freedom from abuse and restraints, among others. A review of Resident 12's admission packet dated 8/30/22 was done. The signature was done Page 1 of 6 555776 555776 10/06/2023 Gridley Post Acute 246 Spruce Street Gridley, CA 95948

F 0572 electronically. Attachment F was not among those documents. Level of Harm - Minimal harm or potential for actual harm In an interview on 10/05/23 12:50 pm, the Administrator stated that the facility's Information Technologist (IT) had discovered that Attachment F, Resident [NAME] of Rights, had not been selected during the initial set-up of the electronic records process and therefore, Attachment F did not print out with the admission forms when residents requested a copy of their admission documents. This was confirmed with IT, who was present. Residents Affected - Few 555776 Page 2 of 6 555776 10/06/2023 Gridley Post Acute 246 Spruce Street Gridley, CA 95948

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a care plan for one of 16 sampled residents (Resident 46), was revised and updated to reflect current individual needs for feeding assistance required. This failure resulted in the resident's individual care needs to go unrecognized, and the potential for a further decline in resident's physical, mental, and psychological status. Findings: During a review of the facility's policy, not dated, titled, Care Plans, Comprehensive Person-Centered, indicated, The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. Each resident's care plan is consistent with the resident's rights to receive the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psycho-social wellbeing. This facility's policy also indicated, Assessments of residents are ongoing and care plans are revised as information about the residents' condition changes. A review of Resident 46's clinical record indicated Resident 46 was admitted to the facility on [DATE] for diagnoses that included high blood pressure, Palliative Care (a program appropriate with any serious medical condition with the primary goal to improve quality of life while providing comfort), Dyspnea (medical term for shortness of breath), and chronic pain. A review of the most recent Minimum Data Set, (MDS, a resident assessment tool), for Resident 46 dated 9/1/23, indicated Resident 46 had a brief interview for mental status (BIMS) score of 13 of 15, no noted cognitive impairment and was her own responsible party. A review of a care plan revised 9/20/23 indicated Resident 46 was admitted to Hospice Services (end of life care), and to coordinate plan of care with hospice agency and to update with any changes. Resident 46's care plan dated 9/20/23 also indicated, Establish a plan of care and update/revise plan frequently. During a concurrent observation and interview on 10/5/23 at 8:15 am, Resident 46 was unable to reach water and yogurt left on the bedside table. Resident 46 stated, Yes, I am hungry, but I need help please. During an interview on 10/5/23 at 8:25 am, Registered Nurse (RN) A confirmed Resident 46 had a recent decline and needs assistance from staff with eating and drinking. During an interview on 10/5/23 at 8:32 am, Certified Nursing Assistant (CNA) H stated, I know [Resident 46] needs help with feeding now, that changed sometime last week. I told the nurse, and I have been helping [Resident 46]. During an interview on 10/5/23 at 8:40 am, CNA G stated, Yes, I was told by CNA H [Resident 46] needs help with feeding assistance, she cannot do it herself now. 555776 Page 3 of 6 555776 10/06/2023 Gridley Post Acute 246 Spruce Street Gridley, CA 95948

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 10/5/23 at 8:45 am, Director of Staff Development (DSD) confirmed the change in condition for Resident 46's self-feeding ability was not updated on the care plan. A review of Resident 46's clinical record dated 10/5/23 at 13:22, titled, General Note, indicated, Resident 46 was noted to have a decline in ability to self-feed, Hospice notified of change, Medical Doctor (MD), updated and resident agrees with needing assistance During an interview on 10/5/23 at 2:55 pm, MDS Coordinator (MDS) stated, I cannot believe no one told me about this decline with [Resident 46], but I will make sure it is added to the care plan. During an interview on 10/5/23 at 3:45 pm, Interim Director of Nursing (IDON) confirmed all changes should be added to the care plan as soon as staff is aware to meet the individual needs of all residents in a timely manner. IDON confirmed the care plan was not revised or updated for Resident 46 in a timely manner. 555776 Page 4 of 6 555776 10/06/2023 Gridley Post Acute 246 Spruce Street Gridley, CA 95948

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain consistent placement of hearing aids for one (Resident 27), of six sampled residents. This resulted in difficult communication between Resident 27 and others and had the potential to lead to misidentification of the resident and resulting errors, for example, administration of incorrect medications or treatments. Residents Affected - Few Findings: A review was made of a facility policy titled, Sensory Impairments - Clinical Protocol, undated, wherein was directed that staff will try to minimize complications of sensory impairments. A review of an admission record was done. Resident 27 was admitted with diagnoses which included major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest), adult failure to thrive (a state of decline due to poor nutrition, weight loss, inactivity, depression and decreasing functional ability), heart failure (the heart muscle does not pump sufficiently), and hearing loss. On 10/3/23 2:50 pm, a concurrent observation and interview was conducted with Resident 27, who was not wearing her hearing aids. Close proximity to her left ear and speaking loudly was required for Resident 27 to be able to hear questions. A physician's order dated 6/30/23, for the use of hearing aids for Resident 27 was reviewed and instructed staff to apply right and left hearing aids each morning and to remove them at bedtime and place them on the charger at the patient's bedside. A care plan for a hearing deficit for Resident 27 was reviewed which instructed staff to ensure hearing aids were in place to both ears. A Medication Administration Record (MAR) for Resident 27, dated October 2023 was reviewed wherein on 10/5/23 at 8 am, Registered Nurse (RN) A documented having applied Patient 27's hearing aids. An observation was made on 10/05/23 9:47 am, of Resident 27 who did not have hearing aids in either ear; aids were in the charger on a stand across from the foot of her bed. In an interview conducted 10/5/23 9:50 am, RN A was asked how she communicated with Resident 27. RN A stated she leans next to her ear and that the resident can hear when she talks loudly to her. When asked why Resident 27 did not have hearing aids in when there was a physician's order to place hearing aids each morning, and that RN A had already documented placing the hearing aids nearly two hours previously, RN A stated that she had documented placing the hearing aids in and had meant to go back and actually put the hearing aids in, but she had been busy doing her morning medication pass, and had forgotten. In an interview conducted dated 10/5/23 12:42 pm, the Interim Director of Nursing stated it was her expectation that hearing aids be placed in residents' ears first thing in the morning. 555776 Page 5 of 6 555776 10/06/2023 Gridley Post Acute 246 Spruce Street Gridley, CA 95948

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, distribute and serve food in accordance with professional standards for food service safety when a case of Glucerna (a sugar-free nutritional supplement protein shake), had expired on 8/1/23, and was still on the shelf and available for use. This failure had the potential to result in health and safety concerns for individual residents that consumed the shake for nutritional supplement. Findings: During a concurrent observation and interview on 10/3/23 at 09:30 am with the Dietary Manager (DM) in the dry storage food pantry, a case of Glucerna that expired on 8/1/23, was available for use. DM stated, I see the date, yes, they are expired. I will get rid of them immediately. During a review of the facility's policy and procedure titled, Receiving HCSG Policy 017, dated 9/2017, indicated, safe food handling procedures for time .will be practiced in storage of all food items. During a review of the United States (U.S.) Food and Drug Administration (FDA) Food Code 2022, indicated, regarding commercially processed food requirements .processed .foods that exceed the use-by date or manufacturer's pull date .must be disposed of in a proper manner. 555776 Page 6 of 6