Other·February 1, 2018

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the California Department of Public Health during the investigation of a complaint investigation during an Abbreviated survey. Complaint number: CA00555634 Complaint number: CA00557245 Representing the Department of Public Health: Health Facilities Evaluator Nurse ID: 36331 The inspection was limited to the specific complaints/ERIs investigated and does not represent the findings of a full inspection of the facility. One deficiency was issued for complaint number CA00555634 and CA005557245

F323 SS=G FREE OF ACCIDENT HAZARDS/SUPERVISION/DEVICES CFR(s): 483.25(d)(1)(2)(n)(1)-(3)

F323 01/16/2018 (d) Accidents. The facility must ensure that (1) The resident environment remains as free from accident hazards as is possible; and (2) Each resident receives adequate supervision and assistance devices to prevent accidents. (n) - Bed Rails. The facility must attempt to use appropriate alternatives prior to installing a side or bed rail. If a bed or side rail is used, the 055287 01/02/2018 VALLEY PALMS CARE CENTER 13400 Sherman Way North Hollywood, CA 91605 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE facility must ensure correct installation, use, and maintenance of bed rails, including but not limited to the following elements. (1) Assess the resident for risk of entrapment from bed rails prior to installation. (2) Review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation. (3) Ensure that the bed’s dimensions are appropriate for the resident’s size and weight. This REQUIREMENT is not met as evidenced by: Based on interview, and record review, the facility staff failed to check the temperature of the hot bowl of soup being served to one of 3 sample residents (Resident 1). This deficient practice resulted in Resident 1 spilling the hot soup on the resident's thighs and groin area. Resident 1 was transferred to the acute care hospital where treatment was provided for the resident by making an incision (cut open) in a blister that was located in the resident's right inner thigh area. Findings: On 10/19/2017, an unannounced visit was made at the facility to conduct a complaint investigation regarding a burn that occurred involving Resident 1 . Resident 1's admission record indicated the resident was admitted to the facility on 12/3/2015, with diagnosis that included Parkinson's disease (a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement), and lack of coordination, generalized weakness, and dementia (a term 055287 01/02/2018 VALLEY PALMS CARE CENTER 13400 Sherman Way North Hollywood, CA 91605 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities). The Minimum Data Set (MDS- an assessment and care planning tool, dated 9/25/2017, indicated Resident 1 had clear speech, able to express ideas and wants, and impaired vision. The resident was also assessed as needing extensive assistance with eating requiring one person to assist the resident. A review of Resident 1's progress note, dated 10/1/ 2017, at 3:22 p.m., indicated at 11:45 a.m., Resident 1 was sitting in the dining room for lunch when CNA 1 placed hot bowl of soup on top of the dining table. Resident 1 grabbed the bowl of soup spilling the soup on the resident's lap. CNA 1 immediately brought the resident back to bed where LVN 1 administered Tylenol to the resident (Tylenol is a pain medication). LVN 1 assessed the resident where the resident was assessed with a burn , reddish in color, open skin, and blisters to both inner thighs. A review of Resident 1's change of condition form, dated 10/1/2017 at 12:00 p.m., indicated Resident 1 had a tissue burn, right and left thigh redness, with top layer of skin peeling off. The change of condition indicated the physician was made aware. The physician ordered to apply silvadene cream to the resident's thigh area (Silver sulfadiazine cream or silvadene cream is used to prevent and treat wound infections in patients with second- and thirddegree burns). The resident was transferred to the acute care hospital. A review of Resident 1's transfer sheet dated 10/1/17, indicated the resident was being transferred to the acute care hospital with 055287 01/02/2018 VALLEY PALMS CARE CENTER 13400 Sherman Way North Hollywood, CA 91605 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE blisters, redness and open skin to both thigh area. A review Resident 1's history and physical from the acute hospital dated 10/1/2017, indicated Resident 1 was brought to the acute care hospital with a second degree burn to the inner thigh from pouring hot soup on the resident from the facility. A review of Resident 1's Operative Note, dated 10/5/2017, at 10:13 a.m., indicated an incision and drainage was done on Resident 1's right thigh blister. A review of Resident 1's discharge summary from the acute hospital indicated the resident was discharged from the acute hospital on 10/5/17 from an acute burn to the resident's right inner thigh secondary to a hot beverage. On 11/2/17, at 10:50 a.m., an interview was conducted with CNA 1 who stated she did not check the temperature of the soup prior to giving the soup to the resident. A review of the Food Temperature Record for 10/1/17 for lunch hour indicated the temperature of the soup was measured at 170 degrees Fahrenheit. The facility policy and procedure titled, Food Service Temperature Control, revised date 2017, indicated for stewing- use more liquid than when braising. Add just enough liquid to cover meat and cook in a covered pan at a temperature slightly below boiling . A review of the facility's policy and procedure for meal service indicated the cook and dietary service supervisor will take food temperatures prior to service of the meal. Soup and hot beverage should be measured at 170-190 055287 01/02/2018 VALLEY PALMS CARE CENTER 13400 Sherman Way North Hollywood, CA 91605 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE degrees Fahrenheit (F). Cream soup should be measured at 160-170 degrees Fahrenheit. Recommended temperature at delivery to resident for soup is greater than 140 degrees .