Health inspection·November 27, 2024

42 CFR §483.25(h) Parenteral Fluids Parenteral fluids must be administered consistent with professional standards of practice and in accordance with physician orders, the comprehensive person-centered care plan, and the resident’s goals and preferences. 22 CCR §72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. 22 CCR §72313. Nursing Service – Administration of Medications and Treatments (a) Medications and treatments shall be administered as follows: (2) Medications and treatments shall be administered as prescribed. On 10/07/2024, the California Department of Public Health (CDPH) made an unannounced visit to the facility to conduct its annual recertification survey. The facility failed to monitor and provide peripheral (away from the center of the body) intravenous (IV- into a vein) line care to Resident 65 on 10/6/2024 when Resident 65 complained of pain to the IV site on the left forearm. As a result, Registered Nurse 3 (RN 3) continued to use Resident 65's IV site on the left forearm on 10/6/2024 to administer IV medication further causing Resident 65 to experience untreated pain to the IV site. During a review of Resident 65's Admission Record, the Admission Record indicated the facility admitted Resident 65 on 9/4/2024 with diagnoses that included chronic obstructive pulmonary disease (COPD - a progressive group of lung diseases that make it hard to breathe), atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow), transient ischemic attack (TIA - a temporary disruption in the blood supply to part of the brain) and cerebral infarction (a serious condition when blood flow to the brain is blocked, causing brain tissue to die). During a review of Resident 65's History and Physical (H&P- a comprehensive assessment of a resident's medical history and current condition), dated 9/6/2024, the H&P indicated Resident 65 did not have the capacity to understand and make decisions. The H&P also indicated Resident 65 was admitted to the General Acute Care Hospital (GACH) for cholecystitis (inflammation of the gallbladder [a small digestive organ]) status post (s/p- medical term that refers to a patient's condition after a specific event, treatment, or diagnosis) cholecystectomy (surgical procedure to remove the gallbladder). During a review of Resident 65's Minimum Data Set (MDS- a resident assessment tool), dated 9/11/2024, the MDS indicated Resident 65 needed substantial assistance from staff for toileting, dressing, showering, and personal hygiene, and some assistance for eating. During a review of Resident 65's Physician Orders, the Physician Orders indicated the following: 1. Zosyn (antibiotic [a medication used to treat infection caused by bacteria]) 3.375 milligrams (mg - unit of measurement) IV every six hours for seven days for wound infection, ordered 10/3/2024. 2. Vancomycin (antibiotic) one (1) gram (gm - unit of measurement) IV every 12 hours for seven days for wound infection, ordered 10/3/2024. During a review of Resident 65's Type of Line form (documentation form for the insertion of IV lines) undated, the Type of Line form indicated that on 10/3/2024 at 6:00 p.m., Resident 65 had a left forearm IV line inserted. During a review of Resident 65's Type of Line form undated, the Type of Line form indicated that on 10/7/2024 at 10:30 a.m., Resident 65's left forearm IV access site was discontinued (removed) due to the IV line being infiltrated (a complication of IV therapy that occurs when IV fluid or medication leaks out of the vein and into the surrounding tissue causing swelling and pain). During a concurrent observation and interview on 10/7/2024 at 12:20 p.m., with Resident 65's wife (Responsible Party 1 [RP 1]) in Resident 65's room, observed Resident 65's left forearm. RP 1 pointed to Resident 65's left foreman covered with a bandage and stated that the IV that was previously on Resident 65's left forearm was infiltrated from 10/6/2024 and had to be removed. RP 1 stated that RP 1 informed RN 3 on 10/6/2024 about Resident 65's left forearm IV access site having blood and fluid on the outside of the IV insertion site and causing Resident 65 pain, but RN 3 never checked Resident 65's left forearm IV site. RP 1 stated that Registered Nurse 4 (RN 4) removed Resident 65's left forearm IV access on 10/7/2024 because the IV access was causing Resident 65 pain. During an interview on 10/7/2024 at 12:30 p.m., with Resident 65, Resident 65 stated that his (Resident 65) IV access on the left forearm began to cause Resident 65 pain starting on 10/6/2024. Resident 65 stated that he (resident 65) informed RN 3 about the pain to the left forearm IV access site, but RN 3 did not provide any intervention for the pain in Resident 65's left forearm IV access site. Resident 65 stated that RN 3 even continued administering Resident 65's IV antibiotic Zosyn despite the pain at the IV access site on the left forearm. During an interview on 10/7/2024 at 12:35 p.m., with RN 4, RN 4 stated she (RN 4) had to remove the IV access on Resident 65's left forearm on 10/7/2024 during the 7 a.m.-3 p.m. shift because it was painful to Resident 65 and was no longer patent (patency refers to when the IV line is open and not clogged). During an interview on 10/7/2024 at 3:35 p.m., with RN 3, RN 3 stated that on 10/6/2024, Resident 65 complained of pain to the left forearm IV access site. RN 3 stated that he (RN 3) noted that Resident 65's IV access site to the left forearm had blood around the outside of the tubing. RN 3 stated that he (RN 3) did not check the patency of Resident 65's IV access to the left forearm and did not address Resident 65's complaint of pain to the left for arm access site. RN 3 stated that he (RN 3) continued to utilize Resident 65's left forearm IV access on 10/6/2024 at 6 p.m. to infuse the physician ordered antibiotic Zosyn despite Resident 65's complaint of pain; and despite not checking the patency of Resident 65's IV access. RN 3 stated he (RN 3) should have not increased the rate of the Zosyn administration and should have checked for placement and infiltration. During an interview on 10/10/2024 at 11:45 a.m., with the Director of Nursing (DON), the DON stated the licensed nurses must address any pain the residents are experiencing and reporting immediately. During an interview on 10/11/2024 at 2:00 p.m., with the Medical Records Assistant (MRA), the MRA stated the facility does not have a policy regarding IV medication administration and peripheral IVs. The facility failed to monitor and provide peripheral IV line care to Resident 65 on 10/6/2024 when Resident 65 complained of pain to the IV site on the left forearm. As a result, RN 3 continued to use Resident 65's IV site on the left forearm on 10/6/2024 to administer IV medication further causing Resident 65 to experience untreated pain to the IV site. The above violation had a direct or immediate relationship to the health, safety, or security of Resident 65.