Health inspection·October 5, 2023

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 record review and interview, the facility failed to ensure physician orders for Lactulose (a medication that helps prevent complications of liver disease and relieves constipation) were adhered to, for one of two sampled residents (Resident 1) when: Residents Affected - Few 1. Resident 1 did not receive a scheduled dose of Lactulose due to a family outing. 2. Nursing staff did not notify Resident 1's physician, when Resident 1 had less than three bowel movements a day, on four separate occasions. This failure placed Resident 1 at risk to have irregular bowel moements and other adverse reactions. Findings: 1.During a concurrent interview and record review, on 10/3/23, starting at 12:57 p.m., with the Assistant Director of Nursing (ADON 1), Resident 1's Medication Administration Record (MAR) was reviewed. Resident 1's MAR indicated on 10/9/22, an active order for Lactulose Solution 10 GM (grams)/15 ML (milliliters) Give 30 ml by mouth three times a day for Alcoholic liver cirrhosis (a condition where a person's liver is scarred and permanently damaged). Resident 1's MAR indicated on 10/9/22, at 1:00 p.m., Resident 1 did not receive the prescribed dose of Lactulose. The ADON 1 verbalized Resident 1 had not received the scheduled dose of Lactulose on 10/9/22, due to Resident 1 being outside of the facility, on a family outing. The ADON 1 further verbalized, when residents leave the facility, such as for family outings, the nursing staff can sometimes provide the family with the scheduled medications, or nursing staff can call the physician to obtain a one-time order for the scheduled medication to be administered, when the resident returns. When asked if the facility could provide documentation indicating the nursing staff provided Resident 1's family with the medication, or that Resident 1's physician was contacted to obtain a new one time order or instructions for the medication, post Resident 1's return to the facility, the ADON stated No documentation found. The ADON 1 acknowledged facility records indicated Resident 1 received two doses of Lactulose on 10/9/22, instead of the prescribed three doses. 2. During a concurrent interview and record review, on 10/3/23, starting at 12:57 p.m. with the ADON 1, Resident 1's medication record was reviewed. Resident 1's Plan of Care Note dated 10/18/22, indicated in part, Resident 1's physician (MD 1) had given a verbal order wherein ADON 1 wrote Lactulose 60 ml to be given until 3 stools have been reached. I (ADON 1) explained to [MD 1] that per pharmacy max dose is to be 180 ml. MD 1 stated that MD 1 was overriding pharmacy and it was okay to start giving (Resident 1) 60 ml of lactulose q (every) 6 hours to achieve three stools (bowel movements)/day if not we will notify him and increase the times that it is being administered. Resident 1's MAR (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 555830 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555830 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lompoc Skilled Nursing & Rehabilitation Center 1428 West North Avenue Lompoc, CA 93436 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)