Health inspection·November 29, 2024

The following reflects the findings of the California Department of Public Health (CDPH) during an abbreviated standard survey. Recertification Survey: 7D3Q11 The inspection was limited to the specific Recertification Survey investigation and does not represent the findings of a full inspection of the facility. A Class B Citation was issued for the Recertification Survey: 7D3Q11 §483.24 Quality of Life §483.24(a)(2) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. §483.55 Dental services. The facility must assist residents in obtaining routine and 24-hour emergency dental care. §483.55(a) Skilled Nursing Facilities A facility- §483.55(a)(1) Must provide or obtain from an outside resource, in accordance with §483.70(f) of this part, routine and emergency dental services to meet the needs of each resident. §483.55(a)(4) Must if necessary or if requested, assist the resident. (i) In making appointments. §483.55(a)(5) Must promptly, within 3 days, refer residents with lost or damaged dentures for dental services. If a referral does not occur within 3 days, the facility must provide documentation of what they did to ensure the resident could still eat and drink adequately while awaiting dental services and the extenuating circumstances that led to the delay. 22 CCR § 72301. Required Services. (a) Skilled nursing facilities shall provide, but shall not be limited to, the following required services: physician, skilled nursing, dietary, pharmaceutical and an activity program. (d) Written arrangements shall be made for obtaining all necessary diagnostic and therapeutic services prescribed by the attending physician, podiatrist, dentist, or clinical psychologist subject to the scope of licensure and the policies of the facility. If the service cannot be brought into the facility, the facility shall assist the patient in arranging for transportation to and from the service location. 22 CCR § 72315. Nursing Service--Patient Care. (d) Each patient shall be provided care which shows evidence of good personal hygiene, including care of the skin, shampooing, and grooming of hair, oral hygiene, shaving or beard trimming, cleaning, and cutting of fingernails and toenails. The patient shall be free of offensive odors. On 11/8/2024, the California Department of Public Health (CDPH) made an unannounced visit to the facility to conduct annual recertification survey. The facility failed to: 1. Provide oral care for Resident 28. On 11/10/24 at 7:48 a.m., Resident 28 was observed in bed with his mouth wide open and crusty buildup of yellow-brown dried secretions in this oral cavity. 2. Provide dental care services to Resident 28, who had a physician's orders, dated 9/23/24 which indicated dental evaluation/consult was not done. These failures have the potential to result in infection, illness and effect Resident 28's self-esteem and quality of life. During a review of Resident 28's "Admission Record" dated 11/10/24 indicated, Resident 28 was admitted to the facility on 8/21/24, with diagnosis including; Alzheimers disease (a disease characterized by a progressive decline in mental abilities), disorder of the muscles, Parkinsonism (a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movements), gastrostomy tube (Gtube - a surgical opening fitted with a device to allow feedings to be administered directly to the stomach common for people with swallowing problems) and dysphagia (difficulty swallowing). During a review of Resident 28's Minimum Data Set (MDS- a federally mandated resident assessment tool) dated 10/15/24, indicated the resident was rarely/never understood, with severely impaired cognition rarely/never made decisions, had short- and long-term memory problems, was unable to eat by mouth, and was dependent on staff for oral hygiene, toileting, showering/bathing, dressing, personal hygiene, and bed mobility. During observation with concurrent interview with the facility administrator (ADM) on 11/10/24 at 7:48 a.m., Resident 28 was observed in bed with his mouth wide open and crusty buildup of yellow-brown dried secretions in this oral cavity. The AMD stated the resident does mouth-breath and has buildup in his mouth of the dried secretions quickly shift to shift, the CNA should have done oral care on the night shift. During observation with concurrent interview on 11/10/24 at 8:17 a.m. with CNA 3. Resident 28's mouth was observed wide open with the same crusty buildup of yellow-brown dried secretions in this oral cavity CNA 3 was providing oral care and stated the buildup in his mouth was tarter. The CNA was unable to clear the mouth of the crusty buildup with the oral sponge on a stick and toothbrush and toothpaste. She further stated she didn't know if the resident had been seen by a dentist. During a concurrent interview and record review with Registered Nurse (RN) 1 on 11/10/24 at 10:06 a.m., Resident 28's physician's orders, dated 9/23/24 were reviewed. The orders indicated dental evaluation/consult as needed, RN 1 stated she did not know if the resident had a dental evaluation. RN 1 stated Social Services usually dealt with dental evaluations. During an interview with Social Services Director (SSD) on 11/10/24 at 10:20 a.m., the SSD stated Resident 28 had not been seen by a dentist at the facility. The SSD confirmed there was a dentist that went to the facility and was able to perform all dental services. During a review of the facility's policy and procedures (P&P) titled "Mouth Care" revised January 2024 indicated, the purpose of this procedure are to keep the resident's lips and oral tissues moist, to cleanse and freshen the resident's mouth and to prevent oral infection. During a review of the facility's P&P titled "Dental Services" revised 1/2024, indicated routine and emergency dental services were available to meet the resident's oral health services in accordance with the resident's assessment and plan of care. The facility failed to: 1. Provide oral care for Resident 28. On 11/10/24 at 7:48 a.m., Resident 28 was observed in bed with his mouth wide open and crusty buildup of yellow-brown dried secretions in this oral cavity. 2. Provide dental care services to Resident 28, who had a physician's orders, dated 9/23/24 which indicated dental evaluation/consult was not done. These failures have the potential to result in infection, illness and effect Resident 28's self-esteem and quality of life. This violation, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Resident 28.