Health inspection·November 26, 2024

§ 72637. General Maintenance. (a) The facility, including the grounds, shall be maintained in a clean and sanitary condition and in good repair at all times to ensure safety and well-being of patients, staff and visitors. (b) Buildings and grounds shall be free of environmental pollutants and such nuisances as may adversely affect the health or welfare of patients to the extent that such conditions are within the reasonable control of the facility. § 72311. Nursing Service - General. (a) Nursing service shall include, but not be limited to, the following: (1) Planning of patient care, which shall include at least the following: (A) Identification of care needs based upon an initial written and continuing assessment of the patient's needs with input, as necessary, from health professionals involved in the care of the patient. Initial assessments shall commence at the time of admission of the patient and be completed within seven days after admission. (B) Development of an individual, written patient care plan which indicates the care to be given, the objectives to be accomplished and the professional discipline responsible for each element of care. Objectives shall be measurable and time limited. (C) Reviewing, evaluating and updating of the patient care plan as necessary by the nursing staff and other professional personnel involved in the care of the patient at least quarterly, and more often if there is a change in the patient's condition. (2) Implementing of each patient's care plan according to the methods indicated. Each patient's care shall be based on this plan. F689 Free of Accident Hazards/Supervision/Devices §483.25(d) Accidents. The facility must ensure that – §483.25(d)(1) The Patient environment remains as free of accident hazards as is possible; and §483.25(d)(2) Each Patient receives adequate supervision and assistance devices to prevent accidents. On 10/21/2024 at 8:30 AM, an unannounced visit was conducted by the California Department of Public Health (CDPH) at the facility to conduct an annual recertification survey. During the investigation CDPH determined that the facility failed to implement the facility’s policy and procedure (P&P) titled, “Smoking Policy-Patients," dated 8/2022 for eight patients (Patients 1, 2, 3, 4, 5, 6, 7 and 8) who smoked cigarettes by failing to: 1.Provide supervision while smoking to Patients 1, 2, 3, 4, 5, 6, 7 and 8 when Patients 1, 2, 3, 4, 5, 6, 7 and 8 were assessed by the facility as unsafe smokers, and when Patient 3’s smoking assessment was not completed by the facility. 2. Ensure Patient 3 was assessed for the level of supervision while smoking. 3. Ensure Patient 2 did not store cigarettes and lighters in Patient 2’s drawer. 4. Ensure Patient 4, who was assessed by the facility as “unable to light tobacco [a preparation of the nicotine (a toxic colorless or yellowish oily liquid that is the chief active constituent of tobacco) rich leaves of an American plant, which are cured by a process of drying and fermentation for smoking or chewing safely,”did not pass/share cigarettes with Patients 3, 6 and 8, and used Patient 7’s lighter to light cigarettes. 5. Ensure Receptionist (REC) 1 did not provide lit cigarettes and allowed Patients 3 and 4 to smoke unsupervised?during nonscheduled smoking time. 6. Identify Patients 1, 3, 4, 5 and 9 as noncompliant with the facility’s smoking policy when Patients 1, 3, 4, 5 and 8 smoked during nonscheduled smoking time. 7. Ensure Patients 2, 6 and 7 who were identified as non-compliant with facility’s smoking policy, were not allowed by the facility to continue to keep cigarettes and lighters in Patient 2, 6 and 7’s possession. 8. Ensure a designated staff was scheduled to supervise the smoking patio area during the scheduled and nonscheduled smoking time. 9. Ensure the facility has a plan of care in place on how to care for patients who did not comply with the facility’s smoking policy. As a result, Patients 1, 2, 3, 4, 5, 6, 7 and 8 were at risk for accidental burn, fire hazards that could affect the health, safety, wellbeing of patients, staffs, visitors and result in serious injuries, hospitalization, and death. a. A review of Patient 2's “Admission Record (AR),” the AR indicated the facility admitted Patient 2 on 6/23/2016 and readmitted on 12/16/2023 with diagnoses that included chronic obstructive pulmonary disease (COPD, a lung disease characterized by long-term poor airflow) and nicotine dependence, cigarettes (occurs when the Patient needed nicotine and could stop using it). A review of Patient 1’s “History and Physical (H&P, a comprehensive physician’s note regarding the assessment of the Patient’s health status),” dated 12/29/2023, the H&P indicated, Patient 1 did not have the capacity to understand and make decisions. A review of Patient 1’s “Order Summary Report (OSR),” the OSR indicated on 12/16/2023, Patient 1 had a physician order that Patient 1“may smoke cigarette per preference with staff supervision in designated smoking area and in accordance with facility’s smoking policy.” A review of Patient 1’s“Minimum Data Set (MDS, a federally mandated Patient assessment tool),”dated 8/15/20274, the MDS indicated Patient 1’s cognition (ability to think, remember, and reason) was severely impaired, and Patient 1 needed supervision in walking 150 feet in a corridor or similar space. A review of Patient 1’s “Smoking and Safety (S&S),” dated 8/15/2024, the form indicated Patient 1 was a tobacco user. A review of Patient 1’s CP, titled “Smoking,” dated 8/27/2024, the CP indicated Patient 1 was at risk for hazard/injury (burns) related to smoking cigarettes. The CP interventions included for facility staff to provide frequent monitoring to Patient 1 during smoking times. b. A review of Patient 2's AR, the AR indicated the facility admitted Patient 2 on 10/10/2017 and readmitted on 5/6/2024 with diagnoses that included hemiplegia [a condition that causes half of the body to be paralyzed (or unable to move)]and hemiparesis (weakness or the inability to move on one side of the body)following cerebral infarction (or a stroke, which is a medical emergency that occurs when blood flow to the brain is cut off)affecting right dominant side, and COPD. A review of Patient 2’s OSR, the OSR indicated on 5/6/2024, Patient 2 had a physician order that Patient 2 “may smoke cigarette per preference with staff supervision in designated smoking area and in accordance with facility’s smoking policy.” A review of Patient 2’s H&P, dated 5/8/2024, the H&P indicated Patient 2 had the capacity to understand and make decisions. A review of Patient 2’s MDS, dated 9/6/2024, the MDS indicated Patient 2’s cognition was intact. The MDS indicated Patient 2 was a tobacco user, and able to independently (Patient completes the activity by themselves with no assistance from a helper) utilize the wheelchair to manually wheel at least 50 feet, make two turns or at least 150 feet in a corridor or similar space. A review of Patient 2’s S&S, dated 9/6/2024, the S&S indicated Patient 2 had “balance problems while sitting or standing,” and required supervision during smoking breaks. The form indicated the goal was for Patient 2 to adhere to the facility’s Tobacco/Smoking Policies. A review of Patient 2’s CP titled, “Smoking,” dated 10/2024, the CP indicated Patient 2 was at risk for discomfort, shortness of breath (SOB, the feeling of not get enough air into the lungs) and injury related to smoking. The interventions included for facility staff to provide frequent monitoring, remind Patient 2 of smoking schedule, and reorient Patient 2 to the smoking area. A review of Patient 2’s CP, tilted “Non-Compliance with Smoking,” dated 10/2024, the CP indicated Patient 2 was not following smoking schedule and was keeping/hiding smoking paraphernalia such as lighters, matches and at risk for injury related to smoking and non-compliance behavior. The interventions included for staff to conduct an IDT conference with Patient 2 and for facility staff to supervise designated smoking area. c. A review of Patient 3's AR, the AR indicated the facility admitted Patient 3 on 6/24/2019 with diagnoses that included COPD, and arthritis [the swelling and tenderness of one or more joints (places where two bones meet, such as the elbow or knee)]. A review of Patient 3’s OSR, indicated on 7/11/2019, Patient 3 had a physician order that Patient 3 “may smoke cigarette per preference with staff supervision in designated smoking area and in accordance with facility’s smoking policy.” A review of Patient 3’sMDS,dated 9/1/2024, the MDS indicated Patient 3’s cognition was intact, and Patient 3 was able to wheel the wheelchair at least 150 feet in a corridor or similar space. A review of Patient 3’s S&S, dated 6/3/2024, the S&S indicated Patient 3 was a tobacco user and the CP’s goal was for the Patient to adhere to the facility’s Tobacco/Smoking Policies. d. A review of Patient 4's AR, the AR indicated the facility admitted Patient 4 on 1/13/2020 and readmitted on 9/7/2023 with diagnoses that included COPD, and “nicotine dependence, cigarettes.” A review of Patient 4’s OSR, dated on 5/30/2014, the OSR indicated Patient 4 had a physician order that Patient 4 “may smoke cigarette per preference with staff supervision in designated smoking area and in accordance with facility’s smoking policy.” A review of Patient 4’s MDS, dated 8/22/2024, the MDS indicated Patient 4’s cognition was intact, and Patient 4 needed supervision in walking 150 feet in a corridor or similar space. A review of Patient 4’s S&S, dated 8/22/2024, the S&S indicated Patient 4 was a tobacco user. The form indicated Patient 4 was unable to light tobacco safely, and Patient 4 required supervision during smoking breaks. e. A review of Patient 5's AR, the AR indicated the facility admitted Patient 5 on 7/6/2017 and readmitted on 4/7/2023 with diagnoses that included COPD, and “nicotine dependence, cigarettes.” A review of Patient 5’s OSR, dated 4/7/2023, the OSR indicated Patient 5 had a physician order that Patient 5 “may smoke cigarette per preference with staff supervision in designated smoking area and in accordance with facility’s smoking policy.” A review of Patient 5’s MDS, dated 8/10/2024, the MDS indicated Patient 5’s cognition was intact. The MDS indicated Patient 5 was a tobacco user and was able to utilize the wheelchair with supervision to wheel at east 150 feet in a corridor or similar space. A review of Patient 5’s H&P, dated 4/4/2024, the H&P indicated Patient 5 had the capacity to understand and make decisions. A review of Patient 5’s S&S, dated 8/14/2024, the S&S indicated Patient 5 was a tobacco user, and Patient 5 had “balance problems while sitting or standing.” A review of Patient 5’s CP titled, “Smoking,” dated 8/16/2024, the CP indicated Patient 5 was “at risk for hazards/injury (burns) related to smoking cigarettes.” The interventions included for facility staff to provide frequent monitoring to Patient 5 during smoking times. f. A review of Patient 6's AR, the AR indicated the facility admitted Patient 6 on 4/10/2024 with diagnoses that included “nicotine dependence, cigarettes,” and psychoactive substance (a drug or other substance that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behavior)abuse. A review of Patient 6’s OSR, dated 4/10/2024, the OSR indicated Patient 6 had a physician order that Patient 6 “may smoke cigarette per preference with staff supervision in designated smoking area and in accordance with facility’s smoking policy.” A review of Patient 6’s H&P, dated 4/10/2024, the H&P indicated Patient 6 was a smoker, and had the capacity to understand and make decisions. A review of Patient 6’s MDS, dated 7/18/2024, indicated Patient 6’s cognition was intact. The MDS indicated Patient 6 needed supervision (helper provides verbal cues and/or touching/steadying and/or contact guard assistance as Patient completes activity) when walking 150 feet in a corridor or similar space. A review of Patient 6’s CP titled, “Smoking,” dated 4/10/2024, the CP indicated Patient 6 was at risk for discomfort, SOB and injury related to smoking. The interventions included for staff to frequent monitoring Patient 6 while smoking, remind Patient 6 of smoking schedule, and to wear smoking apron. A review of Patient 6’s “Activity Participation Notes,” dated 9/23/2024, the notes indicated Patient 6 was noncompliant with Smoking Policy and Procedure. The notes indicated Patient 6 smoked whenever and wherever Patient 6 wanted, and Patient 6 “continued to supply cigarettes to other Patients.” The notes indicated Patient 6 declined to surrender smoking paraphernalia like lighters and cigarettes.” A review of Patient 6’s S&S, dated 10/16/2024, the S&S indicated Patient 6 was a tobacco user and was noncompliant with smoking times. g. A review of Patient 7's AR, the AR indicated the facility admitted Patient 7 on 4/18/2024 with diagnoses that included COPD due to drugs, and “nicotine dependence, cigarettes.” A review of Patient 7’s H&P, dated 7/5/2024, the H&P indicated Patient 7 had a smoking history, and had the capacity to understand and make decisions. A review of Patient 7’s S&S, dated 7/25/2024, the S&S indicated Patient 7 was a tobacco user. The S&S indicated Patient 7 had “balance problems while sitting or standing,” and required supervision during smoking. A review of Patient 7’s CP titled, “Smoking,” dated 7/5/2024, the CP indicated Patient 7 was at risk for discomfort, SOB and injury related to smoking. The interventions included for facility staff to provide frequent monitoring, reorienting Patient 7 to the smoking area, and offering smoking apron. A review of Patient 7’s IDT Care Conference notes, dated 7/30/2024, the notes indicated the IDT met with Patient 7 regarding the smoking P&P. The notes indicated Patient 7 was re-educated and the Patient agreed to comply with the smoking scheduled time. The notes indicated Patient 7 was reminded that any smoking paraphernalia should be surrendered to the activity staff, including cigarettes and lighters for safekeeping. A review of Patient 7’s CP titled, “Noncompliance with Smoking,” dated 8/1/2024, the CP indicated Patient 7 did not follow the facility’s smoking schedule. The CP indicated Patient 7 shared/passed “only one” cigarette and smoked the same cigarette with other Patients. The CP indicated Patient 7 was at “high risk for transmitting infection.” The interventions included for facility staff to supervise designated smoking area, offer smoking apron every schedule smoking time to Patient 7, and notify Patient 7’s Medical Doctor (MD) about Patient 7’s non-compliance. A review of Patient 7’s “Activity Participation Notes,” dated 9/23/2024, the notes indicated Patient 7 was noncompliant with Smoking P&P. The notes indicated Patient 7 smoked whenever and wherever she wanted. The notes indicated Patient 7 “continued to supply cigarettes to other Patients and declined to surrender smoking paraphernalia like lighters and cigarettes.” A review of Patient 7’s MDS, dated 10/14/2024, the MDS indicated Patient 7’s cognition was moderately impaired. The MDS indicated Patient 7, needed supervision in walking 150 feet in a corridor or similar space. h. A review of Patient 8's AR, the AR, indicated the facility admitted Patient 8 on 10/1/2024 and readmitted on 10/17/2024 with diagnoses that included lack of coordination, drug induced secondary parkinsonism (condition that manifested by tremors, muscle stiffness and slow movement), and hypertension (high blood pressure). A review of Patient 8’s H&P, dated 10/2/2024, the H&P indicated Patient 8 had the capacity to understand and make decisions. A review of Patient 8’s MDS, dated 10/8/2024, the MDS indicated Patient 8’s cognition was moderately impaired. The MDS indicated Patient 8 needed partial assistance (helper does less than half the effort) in walking at least 10 feet in a room, corridor, or similar space. A review of Patient 8’s OSR, dated 10/17/2024, the OSR indicated Patient 8 had a physician order that Patient 8 “m