Health inspection·November 12, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation, interview, and record review, the facility failed to promote and treat two of 2 residents (Resident 20 and 83) with respect, privacy and dignity by failing to ensure: Residents Affected - Some 1. Resident 20's nephrostomy bag (a small flexible, rubber tube that is placed through your skin into the kidney to drain your urine) was covered to provide privacy. 2. Resident 83's privacy curtain was drawn close to provide privacy to the resident while Certified Nursing Assistant 1 (CNA 1) rendered care to Resident 83. These deficient practices had the potential to cause a psychosocial (mental and emotional well-being) decline, resident's individuality, self-esteem, and self-worth. Findings: 1. During a review of Resident 20's admission Record, indicated the facility admitted Resident 20 on 9/27/2022 with diagnoses that included chronic obstructive disease (COPD- a long-term exposure to irritants that damage the lungs and airways), epilepsy (a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain), and hydronephrosis with renal and ureteral calculous obstruction (swelling of the kidney from urine build up due to blockage or obstruction). During a review of Resident 20's History and Physical dated 10/13/2022, the record indicated, Resident 20's could make needs known but could not make medical decisions. During a review of Resident 20's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 10/13/2023, the MDS indicated, Resident 20 required total dependence with oral and toileting hygiene, shower/bathe self, upper and lower body dressing, putting on/taking off footwear and personal hygiene. During a concurrent observation on 11/10/2023 at 11:31 AM, with Licensed Vocational Nurse 1 (LVN 1), Resident 20 was lying in bed with nephrostomy bag hanging on the bed frame uncovered without a dignity bag (privacy cover). During an interview on 11/10/2023 at 11:40 AM, with Registered Nurse 1 (RN 1), she stated Resident 20's nephrostomy bag should have a privacy bag to provide Resident 20's with privacy, respect, and dignity. Page 1 of 16 555787 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a record review of the facility's policy and procedure (P&P) titled, Dignity, revised on February 2021, the P&P indicated, staff were expected to promote privacy, respect and dignity by assisting resident's urinary catheter bags covered. b. During a review of Resident 83's admission Record, indicated the facility admitted Resident 83 on 10/31/2022 with diagnoses that included unspecified dementia (memory loss which interferes with daily functioning), difficulty of walking and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with your daily functioning). During a review of Resident 83's History and Physical dated 10/31/2022, the record indicated, Resident 83's could make needs known but could not make medical decisions. During a review of Resident 83's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 11/6/2023, the MDS indicated, Resident 83 required total dependence with eating, oral and toileting hygiene, shower/bathe self, lower body dressing, putting on/taking off footwear and personal hygiene. During a review of Resident 83's Care Plan titled, Functional Abilities/Self Care Deficit, initiated on 10/31/2023, indicated resident had impaired cognition. The interventions indicated the nursing staff will maintain resident's privacy and talk to the resident while providing care and explain procedures even if resident is not responding. During an observation on 11/10/23 at 2:17 PM, Resident 83 was in the room lying in bed with the lower extremities exposed and uncovered. Then CNA 1 came in to Resident 83's room and did not close the privacy curtain to provide Resident 83 privacy while rendering care to the resident. During an observation on 11/10/2023 at 2:17 PM, Resident 83 was in the room, lying in bed exposed wearing incontinent brief with the privacy curtain not drawn closed. During an interview on 11/10/2023 at 2:21 PM, CNA 1 stated Resident 83's privacy curtain should be closed to provide Resident 83 privacy and dignity. During an interview on 11/10/2023 at 2:49 PM, the Director of Nursing (DON), stated the privacy curtain should be drawn closed to maintain Resident 83 a privacy and to provide dignity to resident. During a record review of the facility's policy and procedure (P&P) titled, Dignity, revised on February 2021, indicated, the facility staff will promote, maintain and protect resident's privacy, including bodily privacy during assistance with personal care during treatment procedures. 555787 Page 2 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide reasonable accommodation of need for three of three sampled resident (Resident 9, 6 and 20) who was at risk for fall, by failing to ensure the residents call light (a device attached to the wall used by residents to call for assistance from the staffs) was within reach as indicated in the facility's policy and procedure, titled Answering the Call Light and resident's Care Plan. Residents Affected - Some This deficient practice had the potential for the resident not to receive or received delayed care to meet the necessary care and services that could result in fall and accident. Findings: 1. During a review of Resident 9's admission Record, indicated the facility admitted Resident 9 on 9/21/2022 with diagnoses that included Parkinson's disease (an age-related degenerative brain condition that causes part of the brain to deteriorate causing slowed movements, tremors, balance problems and more) and lack of coordination. During a review of Resident 9's a Care Plan titled, Falls, revised on 3/1/2023, Resident 9 had impaired balance and at risk for falls. The interventions indicated the nursing staff will keep the call lights and bed controls within easy reach and encourage resident to call for assistance. During a review of Resident 9's History and Physical (H&P), dated 3/9/2023, the record indicated, Resident 9 had fluctuating (varied or changing) capacity to understand and made decision. During a review of Resident 9's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 8/1/2023, indicated, Resident 9 required total dependence with one-person on physical assistance with bed mobility, transfer (how resident moves between surfaces including to or from bed, chair, wheelchair, standing position), dressing, toilet use and personal hygiene. During a review of Resident 9's Fall Risk Assessment (method of assessing a patient's likelihood of falling), dated 8/21/2023, indicated Resident 9 was assessed as at high risk for fall. During a concurrent observation and interview on 11/10/2023 at 11:07 AM, with Registered Nurse 1 (RN 1) Resident 9 was lying in bed with call light hanging on the wall that Resident 9 could not reach. RN 1 stated Resident 9 was unable to reach the call light because it was stuck at the wall. RN 1 stated it was important that call light should be within reach to attend the residents need in timely manner. 2. During a review of Resident 6's admission Record, indicated the facility admitted Resident 6 on 6/27/2023 with diagnoses that included Parkinson's disease and heart failure (heart disease that affects pumping action of the heart muscle). During a review of Resident 6's Care Plan titled, Falls, initiated on 6/27/2023, resident was at risk for falls and had impaired balance. The interventions indicated the nursing staff will keep the call lights and bed controls within easy reach and encourage resident to call for assistance. During a review of Resident 6's History and Physical (H&P), dated 6/29/2023, the record indicated, 555787 Page 3 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0558 Resident 6 was able to make decisions for activities of daily living. Level of Harm - Minimal harm or potential for actual harm During a review of Resident 6's MDS, dated [DATE], the MDS indicated, Resident 6 required total dependence with toileting hygiene, shower/bathe self, upper and lower body dressing and putting on/taking off footwear. Residents Affected - Some During a review of Resident 6's Fall Risk Assessment (method of assessing a patient's likelihood of falling), dated 10/2/2023, indicated Resident 6 was assessed as at high risk for fall. During a concurrent observation and interview on 11/10/2023 at 11:15 AM, with Registered Nurse 1 (RN 1), Resident 6 was lying in bed with call light placed on Resident 6's left lower leg that the resident could not reached. RN 1 stated Resident 6 was unable to reach the call light because it was all the way to her left lower leg. 3. During a review of Resident 20's admission Record, indicated the facility admitted Resident 20 on 9/27/2022 with diagnoses that included Chronic Obstructive Pulmonary Disease (COPD- a long-term exposure to irritants that damage the lungs and airways), epilepsy (a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain) and hydronephrosis with renal and ureteral calculous obstruction (swelling of the kidney from urine build up due to blockage or obstruction). During a review of Resident 20's History and Physical (H&P), dated 10/13/2022, the record indicated, Resident 20's could make needs known but could not make medical decisions. During a review of Resident 20's MDS, dated [DATE], the MDS indicated, Resident 20 required total dependence with oral and toileting hygiene, shower/bathe self, upper and lower body dressing, putting on/taking off footwear and personal hygiene. During a review of Resident 20's Care Plan titled, Falls, initiated on 10/13/2023, resident had impaired balance and was at risk for falls. The interventions indicated the nursing staff will keep call lights and bed controls within easy reach. During a review of Resident 20's Fall Risk Assessment (method of assessing a patient's likelihood of falling), dated 10/13/2023, indicated Resident 20 was assessed as at high risk for fall. During a concurrent observation and interview on 11/10/2023 at 11:34 AM, with Licensed Vocational Nurse 1 (LVN 1), Resident 20 was lying in bed with call light hanging on the wall that the resident could not reach . LVN 1 stated Resident 20 was unable to reach the call light because it was all the way to the wall hanging. During an interview on 11/10/2023 at 2:33 PM with Director of Nursing (DON), DON stated, The call light should be in reach of the residents so that the staffs could attend to the residents needs and to maintain residents' safety. During a record review of the facility's policy and procedure (P&P) titled, Answering the Call Light, revised on March 2021, the P&P indicated to ensure the call light was within easy reach to the residents when the resident was in bed or confined to a chair. 555787 Page 4 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to assess, monitor, inform the physician and provide necessary care and services in accordance with the facility's policy and procedure titled, Anticoagulation (medication for blood thinner) - Clinical Protocol and the resident's care plan for one (1) of one sampled resident (Resident 82), who was observed with bruises (skin discoloration due to bleeding underneath) while receiving Aspirin (a medication used to treat pain and reduce formation of blood clots). Residents Affected - Few This deficient practice resulted in Resident 82's development of new bruises and skin tear that was undetected which could result in blood loss, infection and other side effects (unwanted effects of medication) and a decline in the resident's well being. Findings: During a review of Resident 82's admission Record, indicated the facility admitted Resident 82 on 11/7/2023 with diagnoses that included anemia (lack of red blood cells to carry adequate oxygen to the body's tissues) and myocardial infarction cerebral infarction (occurs because of disrupted blood flow to the brain and deprives the brain cells with oxygen and vital nutrients which leads to brain cells death) During a review of Resident 82's Care Plan titled, Anticoagulant, initiated on 11/7/2023, indicated Resident 82 had a potential for bleeding due to anticoagulant therapy and was at risk for bruising and/or skin discoloration. The interventions indicated the nursing staff will monitor resident for bruising or bleeding every shift and notify Medical Doctor (MD) of signs of bleeding. During a review of Resident 82's Care Plan titled, Anticoagulant, initiated on 11/7/2023, indicated Resident 82 was at risk for easy bruising and bleeding related to Aspirin therapy. The interventions indicated the nursing staff will monitor/assess signs and symptoms of bleeding such as in stool, urine or vomitus and notify the MD, and will monitor injection sites for bruising. The interventions indicated the nursing staff will assess Resident 82 for other possible causes of bruising like blood draws. During a review of Resident 82's Physician Order, dated 11/7/2023, indicated to administer Eliquis (blood thinner - a medication that thins the blood and could cause bruising or bleeding) oral tablet 2.5 milligrams (mg) one tablet by mouth, twice daily for cerebral vascular accident (CVA or brain attack due to interruption in the flow of blood to cells in the brain) prophylaxis (prevention) or MI (Myocardial Infarction or heart attack due to lack of blood flow to the arteries in the heart) prevention. During a review of Resident 82's Physician Order, dated 11/7/2023, indicated to administer Aspirin (medication used a pain reliever and fever reducer, non-enteric coated formulation used to prevent blood clots during a heart attack) 81 mg one tablet given by mouth, once daily for CVA prevention. During a review of Resident 82's Physician Order, dated 11/7/2023, indicated to monitor Resident 82 for bleeding, bruising and skin discoloration every shift and notify MD if present. During a review of Resident 82's History and Physical, dated 11/9/2023, indicated Resident 82's had the fluctuating (varied or changing) capacity to understand and made decision. 555787 Page 5 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent observation and interview on 11/10/2023 at 11:21 AM, with Registered Nurse 1 (RN 1), Resident 82 was lying in bed with multiple sites of purplish discoloration on the right forearm. Resident 82 stated she got the multiple discolorations from previous injections at General Acute Hospital (GACH) and did not know where she sustained the other skin bruises and other skin discolorations. During a concurrent observation and interview on 11/11/2023 at 10:29 AM, with Licensed Vocational Nurse 2 (LVN 2), LVN 2 stated Resident 82 was not assessed and monitored for skin discoloration on the forearm. LVN 2 stated there was no other clinical documentation to indicate that Resident 82 was assessed and monitored for skin discoloration on the right forearm. During a concurrent observation and interview on 11/11/2023 at 10:29 AM, with LVN 2, Resident 82's had multiple purplish discoloration on the right forearm with the following measurements: 1. Three (3) centimeter (cm, unit of measurement) x two (2) cm 2. 2.5 cm x 1.5 cm 3. 2.5 cm x 1.5 cm 4. 4 cm x 2.5 cm LVN 2 stated Resident 82 was receiving anticoagulant and Aspirin. LVN 2 states, it was important to monitor and assess Resident 82 for signs and symptoms of bleeding and bruising which is the side effects (unwanted effects of medication) of Aspirin. During an interview on 11/12/2023 at 11:50 AM, the Director of Nursing (DON) stated, it was important to assess and monitor residents who were receiving anticoagulants or Aspirin for signs and symptoms of bleeding because the residents skin could easily get discoloration or bleed. A review of the undated facility's policy and procedure titled, Anticoagulation - Clinical Protocol, indicated the facility will assess residents for any signs and symptoms related to adverse drug reactions due to medication. 555787 Page 6 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to prevent unnecessary use of medication for one of one sampled resident (Resident 24) who was not monitored for bruising and bleeding while receiving Aspirin (acetylsalicylic acid [ASA], a medication used to treat pain and reduce formation of blood clots). Residents Affected - Few This deficient practice increased the risk of Resident 48 to experience adverse effects (unwanted and dangerous side effects of medication) that could lead to health complications, such as bleeding and bruising in the intestines and stomach, other parts of the body. Findings: A review of Resident 24's admission Record indicated an admission to the facility on 8/14/2023 with diagnoses of contracture (condition of shortening and hardening of muscles, tendons, or other tissue) to right and left knee, type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), and transient cerebral ischemic attack (a stroke due to temporary blockage of blood flow to the brain). A review of Resident 24's History and Physical, dated 8/14/2023, indicated Resident 24 could make needs known but cannot make medical decisions. A review of Resident 24's latest comprehensive Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 8/22/2023, indicated the resident had moderately impaired cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses). A review of Resident 24's Physician Order Summary indicated on 8/14/2023, indicated the physician prescribed Aspirin Oral (by mouth) tablet Delayed Release 325 milligrams (mg, unit of measure for mass) give one (1) tablet by mouth one time a day for cerebrovascular accident (CVA or stroke) prophylaxis (PPX, action taken to prevent disease). There was no physician's order written for Resident 24 to be monitored for the adverse effects of Aspirin. During a concurrent interview and record review of Resident 24's Physician Order Summary with Licensed Vocational Nurse (LVN) 1 on 11/12/2023 at 10:42 AM, indicated no physician order was written to monitor Resident 24 for the adverse effects of Aspirin. The LVN 1 stated it was important to monitor for the residents for discoloration of the skin, bleeding and bruising in the body. During a concurrent interview and record review of Resident 24's Medication Administration Record (MAR) with LVN 1 on 11/12/2023 at 11:43 AM, LVN 1 stated he could not find documented evidence in the MAR for the month November 2023 that licensed nurses monitored Resident 24 for bleeding/bruising. During a concurrent interview and record review of Resident 24's MAR with Director of Nursing (DON) on 11/12/2023 at 11:50 AM, the DON stated she could not find documented evidence in the MAR for the month of October and November 2023, that licensed nurses monitored the resident for adverse reaction of ASA such as bleeding/bruising. A review of the facility's undated policy and procedure titled Anticoagulation- Clinical Protocol, indicated the physician and staff will assess residents for any signs or symptoms related to adverse 555787 Page 7 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0757 drug reactions of medications due to the medication alone or in combination with other medications. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 555787 Page 8 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure three (3) opened bottles of Enulose (also known as Lactulose-medication used to treat chronic constipation) solution stored in the medication cart which belonged to 3 of 3 residents (Resident 9, 8, and 21) were marked with the date that the bottles were first opened in accordance to the facility's policy and procedure for medication storage. This deficient practice had the potential to result in the loss of efficacy of medication due to unsafe storage of the medications. Findings: 1. During a review of Resident 9's an admission Record, indicated the facility admitted Resident 9 on 9/21/2022 with diagnoses that included Parkinson's disease (an age-related degenerative brain condition that causes part of the brain to deteriorate causing slowed movements, tremors, balance problems and more) and metabolic encephalopathy (an alteration in consciousness caused due to brain dysfunction (due to impaired cerebral metabolism). During a review of Resident 9's History and Physical (H&P), dated 3/9/2023, the record indicated, Resident 9 had fluctuating capacity to understand and made decision. During a review of Resident 9's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 8/1/2023, indicated, Resident 9 required total dependence with one-person physical assistance on bed mobility, transfer dressing, toilet use and personal hygiene. During a review of Resident 9's physician order , dated 9/1/2023, indicated to administer Lactulose Oral Solution 20 gm/30 ml (milligrams-unit of measurement) give 30 ml via gastrostomy tube (GT, a tube inserted into the stomach to deliver nutritional formula, fluids and medications) two times a day for bowel management. During a medication cart observation on 11/12/2023, at 9:58 AM, together with Licensed Vocational Nurse 2 (LVN 2), an open bottle of Enulose prescribed to Resident 9 had no label or marked with the date when the bottle was first opened. 2. During a review of Resident 8's admission Record, indicated the facility admitted Resident 8 on 5/19/2023 with diagnoses that included hepatic encephalopathy (loss of brain function occurs when the liver is unable to remove toxins from the blood), and paraplegia (paralysis of the legs and lower body). During a review of Resident 8's Physician Order, dated 5/19/2023, indicated Lactulose Oral Solution 10 gm/15 ml give 45 ml by mouth three times a day for hepatic encephalopathy. During a review of Resident 8's History and Physical (H&P), dated 5/20/2023, the record indicated, Resident 8's did not have the capacity to understand and made decisions. During a review of Resident 8's MDS dated [DATE], indicated, Resident 8 required extensive 555787 Page 9 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0761 Level of Harm - Minimal harm or potential for actual harm assistance with one person assist for bed mobility and personal hygiene. MDS indicated Resident 8 required total dependence with one person assist for transfer, dressing and toilet use. During a medication cart observation on 11/12/2023, at 9:59 AM, with LVN 2, an open bottle of Enulose prescribed to Resident 8 was not dated as to when the bottle was first opened. Residents Affected - Some 3. During a review of Resident 21's admission Record, indicated the facility admitted Resident 9 on 9/8/2021 with diagnoses that included hepatic failure (Liver failure occurs when your liver isn't working well enough to perform its functions) and hypertension (high blood pressure). During a review of Resident 21's MDS, dated [DATE] indicated, Resident 9 required total dependence with one person physical assistance with bed mobility, transfer (how resident moves between surfaces including to or from bed, chair, wheelchair, standing position), dressing, toilet use and personal hygiene. During a review of Resident 21's Physician Order, dated 9/1/2023, indicated Lactulose Oral Solution 10 gm/15 ml give 45 ml by mouth one time a day for hepatic encephalopathy. During a medication cart observation on 11/12/2023, at 9:58 AM, with LVN 2, an open bottle of Enulose prescribed to Resident 21 was not dated as to when the bottle was first opened. During an observation and concurrent interview on 11/12/2023 at 10:01 AM, the LVN 2 stated, the Enulose bottles in the medication cart were stored in the medication cart without the date on when it first was opened. LVN 2 stated, it was important to label or mark the medication bottles when the bottles were first opened to know ensure the medication were still effective when used. During an interview on 11/12/2022 at 11:52 AM, the Director of Nursing (DON), stated it was important that the staff should labels the medications with the date the bottle was first opened to know the medication's effectivity. During a record review of the facility's undated policy and procedure (P&P) titled, Date Open Procedures, the P&P indicated, it will be the responsibility of the Nursing Staff to enter the opening date on all manufacturers' labels or blank pharmacy labels, . P&P indicated, on for the containers that do not have a space to record the opening date on the manufacturers' label, the pharmacy will affix a blank Date Opened sticker to the container. 555787 Page 10 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, facility failed to follow the facility's policy and procedure titled Confidentiality of Information and Personal Privacy by ensuring the resident's identifiable, personal and medical information were not exposed on the computer screens and left unattended while in view of unauthorized persons and access two out of 2 residents (Resident 16 and 17) confidential information without the resident's consent or knowledge. This deficient practice resulted in Resident 16 and 17's violation of resident's right for privacy to keep their personal and medical records confidential and not readily observable and accessible by others. Findings: A review of Resident 16's Face Sheet (a document that gives a patient's information at a quick glance) indicated the facility admitted the resident on 9/7/2023 with diagnoses including Parkinson's disease (a progressive disorder that affects the nervous system and the part of the body controlled by nerves), epilepsy (a brain condition that causes recurring seizures), and encephalopathy (brain disease that alters brain function or structure). A review of Resident 16's History and Physical assessment dated [DATE], indicated Resident 16 had the fluctuating (changing or varied) capacity to understand and make decisions. A review of Resident 17's Face Sheet indicated the facility admitted the resident on 11/24/2022 with diagnoses including chronic obstructive pulmonary disease (COPD, group of diseases that cause airflow blockage and breathing-related problems), type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), morbid obesity (when one weighs 100 pounds over their recommended weight). A review of Resident 17's History and Physical Assessment, dated 8/28/2023, indicated Resident 17 had the fluctuating capacity to understand and make decisions. During an observation of the facility's nursing station 11/10/2023 at 1:23 PM, two computer screens were observed unattended and logged on, exposing resident identifiable, personal, and medical information of Resident 16 and 17. During a concurrent observation and interview with the Licensed Vocational Nurse (LVN) 2 on 11/10/2023 at 1:23 PM, LVN 2 returned to the nursing station and stated the computer screen should not have been left open because other people might see Resident 17's information. LVN 2 stated it was a violation of HIPAA (Health Insurance Portability Accountability Act, a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge). During a concurrent observation and interview with the Registered Nurse Supervisor (RNS) on 11/10/2023 at 1:26 PM, RNS returned to the nursing station and stated she usually closes the Window application when walking away from the computer. RNS stated she forgot my screen was open and the computer screen was exposing Resident 16's information. RNS stated it was important to keep resident's 555787 Page 11 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0842 information confidential for privacy. RNS stated exposing resident information was a violation of HIPAA. Level of Harm - Minimal harm or potential for actual harm During an interview with the Director of Nursing (DON) on 11/10/2023 at 2:46 PM, the DON stated the purpose of logging out of the computer was to protect resident's information and the computer screen should never be left unattended. Residents Affected - Some A review of facility's policy and procedure titled Confidentiality of Information and Personal Privacy dated 10/2017 indicated, the facility will safeguard the personal privacy and confidentiality of all resident personal and medical records. The policy indicated access to resident personal and medical records will be limited to authorized staff and business associates. 555787 Page 12 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide safe and sanitary environment to prevent the development and transmission of infections by ensuring the oxygen tubing or Nasal Cannula (NC-a device with two prongs inserted below the nose used to deliver supplemental oxygen directly into the nostrils or nares [opening of the nose]) was kept clean to prevent contact with disease causing organisms for for two of two residents (Resident 20 and 137) as indicated in the facility's policy and procedure by failing to ensure: Residents Affected - Some 1. Resident 20's NC tube was not touching the floor. 2. Resident 137's NC was not touching the humidifier bottle (a bottle connected to the oxygen machine that moisturizes the air in the NC before breathing in the air) when not in use. These deficient practices had the potential for Residents 20 and 137 to contract infection when the NC when inserted into their nostrils which could increase the risk of the spread of infection to the residents, staff, and other visitors in the facility. Findings: 1. During a review of Resident 20's admission Record, indicated the facility admitted Resident 20 on 9/27/2022 with diagnoses that included Chronic Obstructive Pulmonary Disease (COPD- a long-term exposure to irritants that damage the lungs and airways), epilepsy (a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain) and hydronephrosis with renal and ureteral calculous obstruction (swelling of the kidney from urine build up due to blockage or obstruction). During a review of Resident 20's History and Physical (H&P), dated 10/13/2022, the record indicated, Resident 20's could make needs known but could not make medical decisions. During a review of Resident 20's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 10/13/2023, the MDS indicated, Resident 20 required total dependence with oral and toileting hygiene, shower/bathe self, upper and lower body dressing, putting on/taking off footwear and personal hygiene. A review of Resident 90's Physician Order's, dated 9/1/2023, indicated to administer oxygen at two (2) liters per minute (L/min) via nasal cannula as needed for shortness of breath or wheezing (a high-pitched whistling sound made while breathing) or oxygen saturation (a percent of blood cells carrying oxygen in the body) is below 92% ( normal level 90-100%). During an observation on 11/10/2023 at 11:31 AM, with Licensed Vocational Nurse 1 (LVN 1) Resident 20 was awake lying in bed with oxygen NC on the floor. LVN 1 stepped on to the NC . LVN 1 stated NC should not be touching the floor because the floor was dirty, and the could get contaminated (soiled or stained) with germs and resident might possibly get infection . During an interview on 11/12/2023 at 11:53 PM with the facility's Director of Nurses (DON), stated oxygen tubing should not be touching the floor because the floor was dirty and could cause cross contamination (the process by which bacteria or other microorganisms are unintentionally transferred 555787 Page 13 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0880 from one substance or object to another, with harmful effect). Level of Harm - Minimal harm or potential for actual harm During a review of the undated facility's policy and procedure (P&P) titled, Respiratory Therapy Prevention of Infection Level 1, P&P indicated, keep oxygen tubing from touching the floor. Residents Affected - Some 2. A review of Resident 137's Face Sheet (a document that gives a patient's information at a quick glance) indicated a readmission to the facility on 4/26/2023 with diagnoses that included chronic obstructive pulmonary disease (COPD, lung disease causing restricted airflow and breathing problems), pneumonia (infection that inflames the air sacs in one or both lungs), and metabolic encephalopathy (alteration in consciousness caused due to brain dysfunction). A review of Resident 137's History and Physical assessment dated [DATE], indicated Resident 137 had the capacity to understand and make decisions. A review of Resident 137's Order Summary Report dated 9/29/2023, indicated a physician order for Oxygen therapy at 2 liters (L-unit of measurement) via nasal cannula when in bed every shift for shortness of breath when lying flat in bed may remove when resident is up. During an observation in Resident 137's room on 11/11/2023 at 3:32 PM, Resident 137's nasal cannula was observed outside of the clean bag and exposing nasal cannula prongs touching the humidifier bottle. During a concurrent observation and interview in Resident 137's room with the Registered Nurse (RN) 1 on 11/12/2023 at 3:40 PM, the RN 1 confirmed Resident 137's nasal cannula was not in the clean bag and the nasal cannula prongs were exposed and touching the humidifier bottle connected to the oxygen machine. RN 1 stated the nasal cannula should be in the clean bag to control infection or contact with disease causing organism. During an interview with the infection prevention nurse (IPN) on 11/12/2023 at 3:58 PM, the IPN stated the nasal cannula should be placed in the bag when not in use to keep it clean and for infection control. The IPN stated when the nasal cannula or tubing is not in the clean bag or found touching the floor, it should be replaced with a new one. 555787 Page 14 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide a minimum of 80 square feet (sq. ft., unit of measurement) per resident area for fourteen (14) out of eighteen (18) resident rooms (Rooms 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 13, 14, 15, and 16). The 14 resident rooms consisted of 14 -two (2) bed capacity rooms. This deficient practice had the potential to impact the ability to provide safe nursing care and privacy to the residents. Findings: During an interview with the Administrator (ADM) on 11/11/2023 at 12:44 PM, the ADM stated the facility would like to request a room waiver (a document recording the waiving of a right or claim) this year. A review of the facility's letter to request for additional room waiver dated 11/11/2023 indicated the size of the rooms caused no negative outcome with regards to the health, safety, and welfare of all the residents in the facility. The request indicated the following resident bedrooms were: room [ROOM NUMBER] (2 beds) 2 residents 146.52 sq. ft. 73 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 146.52 sq. ft. 73 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 143.88 sq. ft. 71.5 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 143.88 sq. ft. 71.5 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 149.16 sq. ft. 74.5 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 141.21 sq. ft. 70.5 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 133.32 sq. ft. 62.6 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 133.32 sq. ft. 62.6 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 147.84 sq. ft. 73.5 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 147.84 sq. ft. 73.5 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 147.84 sq. ft. 73.5 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 133.32 sq. ft. 62.6 sq. ft. room [ROOM NUMBER] (2 beds) 2 residents 133.32 sq. ft. 62.6 sq. ft room [ROOM NUMBER] (2 beds) 2 residents 147.84 sq. ft. 73.5 sq. ft. 555787 Page 15 of 16 555787 11/12/2023 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some During an interview with the ADM on 11/12/2023 at 4:40 PM, the ADM stated there have been no complaints from residents, resident families, and staff about the room size. During an observation from 11/10/2023 to 11/12/2023, Rooms 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 13, 14, 15, and 16 had adequate space, nursing care, comfort, and privacy to the residents. The residents residing in the affected rooms were observed to have enough space for the residents to move freely inside the rooms. Each resident inside the affected rooms had beds and bedside tables with drawers. There was an adequate room for the operation and use of the wheelchairs (a chair fitted with wheels for use as a means of transport by a person who is unable to walk as a result of illness, injury, or disability), walkers (is a device that gives additional support to maintain balance or stability while walking,), or canes. The room size did not affect the care and services provided to the residents when nursing staff were observed providing care to the residents. A review of the facility's policy and procedure titled Accommodation of Needs, dated 1/1/2020 indicated the facility's environment and staff behaviors are directed toward assisting the resident in maintaining and/or achieving safe independent functioning, dignity and well-being. 555787 Page 16 of 16