Health inspection·February 25, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on interview and record review, the facility failed to follow their policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered, for one of three sampled residents (Resident 1) when: Residents Affected - Few 1. Care plan for refusal of care was not developed and implemented. This failure resulted in Resident 1 not receiving showers or baths for 13 days. 2. Respiratory Care plan was not developed and implemented. This failure had the potential for Resident 1's respiratory signs and symptoms to go unnoticed. Findings: 1. During a concurrent interview and record review on 2/25/25 at 3:01 p.m. with Director of Nursing (DON), Resident 1's Shower Sheets, dated 2/6/25, 2/10/25, 2/13/25, and 2/17/25 were reviewed. DON confirmed Resident 1 refused all showers and baths offered. Resident 1's care plans were reviewed. DON confirmed no care plan was developed or implemented for Resident 1's refusals for showers and baths. DON confirmed a refusal care plan should have been developed and implemented for Resident 1's refusals for showers and baths. 2. During a review of Resident 1's admission Record, (AR) dated 2/5/25, the AR indicated, Resident 1 had a diagnosis of asthma (chronic lung disease caused by inflammation and muscle tightening around the airways, which makes it harder to breathe), interstitial pulmonary disease (group of chronic lung conditions that cause inflammation and scarring of the lungs; scarring leads to stiff and thickened lungs, making it difficult for oxygen to enter the bloodstream), chronic obstructive pulmonary disease (group of lung diseases that cause airflow obstruction and breathing difficulties), respiratory disorders, and atelectasis (a condition where part or all of a lung collapses, leading to a reduction in oxygen exchange). During a concurrent interview and record review on 2/25/25 at 3:01 p.m. with DON, Resident 1's AR was reviewed. DON confirmed Resident 1 had five diagnoses affecting the respiratory system. Resident 1's care plans were reviewed. DON confirmed no respiratory care plan was developed or implemented for Resident 1. DON stated a respiratory care plan should have been developed and implemented for Resident 1's respiratory care. During a review of the facility's P&P titled, Care Plans, Comprehensive Person-Centered, revised March 2022, the P&P indicated, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's needs is developed and implemented for each resident. Page 1 of 3 555912 555912 02/25/2025 Kern River Transitional Care 5151 Knudsen Drive Bakersfield, CA 93308

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. 7. The comprehensive, person-centered care plan: . b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including: (1) services that would otherwise be provided for the above, but are not provided due to the resident exercising his or her rights, including the right to refuse treatment; . 9. Care plan interventions are chosen only after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making. 555912 Page 2 of 3 555912 02/25/2025 Kern River Transitional Care 5151 Knudsen Drive Bakersfield, CA 93308

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to obtain physician's order and document the removal of midline intravenous catheter (midline IV - a thin, flexible tube inserted into a vein in the upper arm; used to administer medications, fluids, or draw blood over a longer period) for one of three sampled residents (Resident 1). These failures had the potential for Resident 1 to have retained piece of the catheter, blood loss and incomplete medical record. Residents Affected - Few Findings: During a review of Resident 1's Medication Administration Record, (MAR) for February 2025, the MAR indicated Resident 1 was administered Meropenem (used to treat infections caused by bacteria) intravenous .every 6 hours for C-Diff (Clostridium difficile - a bacteria that cause inflammation of the large intestine) for 6 Days -Start Date-02/5/2025 1800 (6 pm). The MAR indicated Resident 1's last dose of meropenem was administered on 2/11/25 at 12pm. During a review of Resident 1's Infection Note, (IN) dated 2/12/25, the IN indicated, (Resident 1) is no longer on strict single room isolation . During a review of Resident 1's Medication Administration Note, (MAN) dated 2/13/25, the MAN indicated, No IV line access . During a concurrent interview and record review, on 2/25/25 at 3:01 p.m. with Director of Nursing (DON), DON stated a physician must give orders to remove the midline IV catheter. DON stated once the midline IV is removed the nurse should measure the length of the catheter, ensure the tip was intact, assess resident bleeding, and document in a progress note. Resident 1's physician's orders were reviewed. DON confirmed Resident 1 had no order for midline IV removal. Resident 1's Progress Notes, were reviewed. DON stated there was no documentation of the removal of midline IV in the progress notes. DON stated the removal of the midline IV should have been documented. During a review of the facility's policy and procedure (P&P) titled, Guidelines for Preventing Intravenous Catheter-Related Infections, revised August 2014, the P&P indicated, Replacement of IV Catheters 1. Promptly obtain physician order for the removal of any peripheral or central IV catheter that is no longer essential. 9. Removal of a midline or any central line is to be performed upon the order of a Physician or authorized prescriber in accordance with State Nurse Practice Act. Documentation The following information should be recorded in the resident's medical record: . 2. Any interventions that were done . 4. Communication with Physician, Supervisor, oncoming shift. 555912 Page 3 of 3