Health inspection·July 10, 2024

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to follow its policy and procedure when a care plan was not developed for a suprapubic catheter (is a hollow flexible tube that is used to drain urine from the bladder through a cut in the abdomen) for one of two sampled residents (Resident 1). This failure had the potential to delay Resident 1's care and treatment needed. Findings: During a review of Resident 1's Baseline Admission/readmission Screen (BARS), dated 9/25/23, the BARS indicated, Resident 1 was admitted on [DATE] due to septic shock (serious condition when body respond poorly to an infection) and had a suprapubic catheter (an organ that stores urine). During a review of Resident 1's History & Physical (H&P), dated 9/26/23, the H&P indicated, Resident 1 had diagnoses including, status post (s/p) septic shock, suprapubic abscess (a pocket of infected fluid and pus), urinary tract infection (an infection in any part of the urinary system) and pressure ulcer (an injury that breaks down the skin and underlying tissue). During a review of Resident 1's Minimum Data Set (MDS - a tool used to assess and plan care of residents in a nursing facility) dated 9/30/23, the Urinary Incontinence (loss of bladder control) and Indwelling Catheter in the MDS Care Area Assessment Summary was triggered. During a concurrent interview and record review of Resident 1's Care Plans (CP), with the Treatment Nurse (TN), Resident 1's CPs were reviewed. The CPs did not include a CP for Resident 1's suprapubic catheter. TN confirmed there was no care plan initiated for Resident 1's suprapubic catheter since admission. During an interview on 7/29/24 at 10:53 a.m. with the Director of Nursing (DON), the DON confirmed there was no CP for Resident 1's suprapubic catheter and the CP should have been initiated on admission and was not. During a review of the facility's policy and procedure (P&P) titled, Care Plans - Baseline, dated 3/2022, the P&P indicated, A baseline plan of care to meet the resident's immediate health and safety needs is developed for each resident within forty-eight hours of admission. 1. The baseline care plan includes instructions needed to provide effective, person-centered care of the resident that meets professional standards of quality care and must include the minimum healthcare information necessary to properly care for the resident including, but not limited to the following: a. Initial goals Page 1 of 4 555876 555876 07/10/2024 Alta Healthcare Center of Camarillo 6000 Santa Rosa Road Camarillo, CA 93012

F 0655 Level of Harm - Minimal harm or potential for actual harm based on admission and discussion with the resident/representative; b. Physician's orders; c. Dietary orders; d. Therapy services; e. Social services ., if applicable. 2. The baseline care plan is used until the staff can conduct the comprehensive assessment and develop an interdisciplinary person-centered comprehensive care plan . The baseline care plan is updated as needed to meet the resident 's needs until a comprehensive care plan is developed. Residents Affected - Few 555876 Page 2 of 4 555876 07/10/2024 Alta Healthcare Center of Camarillo 6000 Santa Rosa Road Camarillo, CA 93012

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. Based on record review and interview, the facility failed to complete an individualized care plan for a pressure ulcer (an injury that breaks down the skin and underlying tissue) on the sacrum (tail bone) for one of two sampled residents (Resident1). This failure had the potential for health, safety and care needs to go unmet if Resident 1's condition changed. Findings: During a review of the facility's policy and procedure (P&P) titled, Care Plans - Baseline, dated 3/2022, the P&P indicated, A baseline plan of care to meet the resident's immediate health and safety needs is developed for each resident within forty-eight hours of admission. 1. The baseline care plan includes instructions needed to provide effective, person-centered care of the resident that meets professional standards of quality care and must include the minimum healthcare information necessary to properly care for the resident including, but not limited to the following: a. Initial goals based on admission and discussion with the resident/representative; b. Physician's orders; c. Dietary orders; d. Therapy services; e. Social services ., if applicable. 2. The baseline care plan is used until the staff can conduct the comprehensive assessment and develop an interdisciplinary person-centered comprehensive care plan . The baseline care plan is updated as needed to meet the resident 's needs until a comprehensive care plan is developed. During a review of Resident 1's History & Physical (H&P), dated 9/26/23, the H&P indicated, Resident 1 had a diagnoses including, Status Post (S/P) septic shock and pressure ulcer. During a review of the Minimum Data Set (MDS - a tool used to assess and plan care of residents in a nursing facility), dated 9/30/23, the Pressure Ulcer in the Care Area Assessment Summary was triggered. During a review of the Resident 1's Wound Consult (WC), dated 9/27/24, the WC indicated, Resident 1 had a stage 4 pressure injury (full thickness tissue loss with exposed bone, tendon, or muscle) on the sacrum. During a review of Resident 1's admission plan of care for sacral pressure injury, dated 9/26/23, the plan of care intervention (action taken) indicated, the use of low air loss mattress (special bed to prevent further skin breakdown), wound treatment, wound monitoring for signs and symptoms of infection, and reporting to the doctor. During a concurrent interview and record review on 7/24/24 at 3:12 p.m. with the treatment nurse (LN 1), Resident 1's care plan for sacral pressure injury was reviewed. LN 1 verbalized nursing interventions includes the use low air loss mattress, gel cushion (special pad placed on a wheelchair), turning and repositioning every two hours, good peri care (perineal - cleaning of private areas), dietician consult, daily monitoring for signs and symptoms of infection. LN 1 further verbalized the plan of care was not person-centered and does not reflect Resident 1's plan of care for the sacral wound. During an interview on 7/29/24 at 10:53 a.m. with the Director of Nursing (DON), the DON verbalized 555876 Page 3 of 4 555876 07/10/2024 Alta Healthcare Center of Camarillo 6000 Santa Rosa Road Camarillo, CA 93012

F 0656 the plan of care must be customized and individualized according to the Resident 1's needs. The DON further verbalized Resident 1's plan of care for the pressure sore was not. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 555876 Page 4 of 4