Health inspection·July 10, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 the necessary care and services to ensure one of three sampled residents (Resident 1), who was unable to carry out activities of daily living (ADLs), received services to maintain good oral hygiene as indicated in the care plan by the certified nurse assistant (CNA) 1 after Resident 1 had been assisted and finished with his meal. This deficient practice had the potential to place Resident 1 at risk for diseases of the mouth, gums, and teeth, and aspiration (something other than air gets into your airways) of the food pieces in the mouth could further lead to pneumonia (an infection/inflammation in the lungs). Findings: During a review of Resident 1's admission Record (AR) the AR indicated that the facility originally admitted Resident 1 on 10/3/2024 and readmitted on [DATE], with diagnoses including metabolic encephalopathy (a series of neurological disorders result from systemic illness), dysphagia (difficulty swallowing), and depression (mental health condition that causes a persistent feeling of sadness and changes in how you think, sleep, eat and act.).During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 7/5/2025, the MDS indicated that Resident 1 was severely cognitively impaired (rarely/ never made decisions). The MDS also indicated that Resident 1 was dependent (helper does all the effort) on eating, oral hygiene, and personal hygiene. During a review of Resident 1's Physician Orders dated 6/29/2025, the Orders indicated to provide fortified (extra nutrients added) puree diet with nectar-thick (liquid consistency that helps prevent choking and stop fluid from entering the lungs) liquid. During a review of Resident 1's Care Plan dated 6/29/2025, the Care Plan indicated that Resident 1 had self-care deficits, impaired functional abilities related to metabolic encephalopathy. The Care Plan indicated interventions to anticipate and provide resident's daily needs and dental/ oral care BID (twice daily) and PRN (as needed). During a review of Resident 1's Flowchart for Activities of Daily Living (ADLs Flowchart) dated from 7/1/2025 to 7/10/2025, the ADLs Flowchart indicated that Resident 1 was dependent on oral hygiene. During a concurrent observation and interview on 7/10/2025 at 9:10 AM, Resident 1 was observed sleeping in bed in a semi-Fowler_position (a position in which the individual lies on their back on a bed with the head of the bed elevated at 30-45 degrees), having call light and a television remote control in each hand, mouth open with visible traces of food/ milk on Resident 1's gums. CNA 1 stated Resident 1 was not provided with oral care on that day, 7/10/2025. CNA1 stated she was supposed to provide oral care to Resident 1 after the resident had his breakfast and it was one of her responsibilities to maintain residents in good hygiene. During an interview on 7/10/2025 at 9:40 AM with the licensed vocational nurse (LVN) 1, LVN 1 stated Resident 1 was dependent on nearly all ADLs including oral hygiene. LVN 1 stated Resident 1's dental health will be at risk if not done. During an interview on 7/10/2025 at 11:05 AM with the Director of Staff Development (DSD), DSD stated she was responsible for supervising CNA's and ensuring the CNA's provide proper care and assistance to residents. DSD stated oral hygiene was important and the Residents Affected - Few Page 1 of 2 555787 555787 07/10/2025 Whittier Nursing and Wellness Center, Inc 7926 S Painter Ave Whittier, CA 90602

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few assigned CNA for Resident 1 should have provided oral care once Resident 1 was done with his meal. DSD also stated by not having oral hygiene maintained, the resident could be at risk for bad mouth odor or even aspirate on anything remaining from the gum and that can lead to pneumonia.During a review of the facility's Policy and Procedures (P&P) titled Activities of Daily Living (ADLs), revised 3/2018, the P&P indicated that residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal and oral hygiene. The P&P also indicated that appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: Hygiene (bathing, dressing, grooming, and oral care) 555787 Page 2 of 2