Health inspection·April 5, 2022

F697 §483.25(k) Pain Management. The facility must ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents’ goals and preferences. § 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. On 2/15/2022, the California Department of Public Health (CDPH - or State Survey Agency [SSA]) made an unannounced visit to the facility for the annual recertification survey and Resident 261’s quality of care was investigated. The facility failed to manage Resident 261’s pain due to osteoarthritis (the protective cartilages cushioning the ends of the bones wear down over time resulting in pain), by not administering the resident’s pain medication as ordered by the physician. As a result, on 2/5/2022 and 2/14/2022 Resident 261 endured unnecessary severe pain that caused her to be in tears. A review of Resident 261's Admission Record indicated the facility admitted the resident to the facility on 2/5/2022 with diagnoses including muscle weakness and osteoarthritis. A review of the Physician’s Order for Resident 261, dated 2/5/2022, timed at 10:16 a.m., indicated to administer Norco 5/325 milligrams (a combination of hydrocodone 5 milligrams [mg] and acetaminophen 325 mg; hydrocodone is an opioid [narcotic]; acetaminophen is a less potent pain reliever that increases the effects of hydrocodone), one tablet by mouth every six hours as needed for pain management, for 14 days. A review of Resident 261’s History and Physical exam completed by the attending physician on 2/6/2022, indicated the resident had the capacity to understand and make decisions. A review of Resident 261's Care Plan developed on 2/7/2022 for the resident’s pain risk of pain relates to osteoarthritis indicated the goal for the resident to display a decreased behavior of inadequate pain control. The interventions included administering analgesia (inability to feel pain) as per physician’s order. A review of the Physician’s Order for Resident 1, dated 2/8/2022, indicated to administer the resident Norco 5-325 mg one tablet by mouth every four hours as needed for severe pain. A review of Resident 261’s Physical Therapy (PT) Treatment Encounter Notes, dated 2/14/2022 indicated the physical therapist made multiple visits to the resident to initiate therapy treatment because Resident 261 was complaining of pain. The physical therapist documented the facility was unable to premedicate the resident for pain because prescription of pain medication run out. On 2/16/2022 at 10:29 a.m., during an interview, Resident 261 stated she was admitted to the facility on 2/5/2022 at around 10 a.m. she informed her nurse she was suffering from knee pain and requested Norco. The nurse told her they were waiting for the pharmacy to deliver the Norco. Resident 261 stated she had to wait in pain until the following day, 2/6/2022, before the nurse gave her first dose of Norco. Resident 261 stated she had to endure pain 10 of 10 (10/10, in a pain rating scale from zero [0] to 10, zero indicating no pain and 10 indicating the worst possible pain) and was in tears. Resident 261 stated the same happened on 2/14/2022, before noon, she asked the nurse for Norco but was informed they had run out of her pain medication. Resident 261 stated she once again had to wait for the pharmacy to deliver the medication until around 8 p.m. Resident 261 stated that the prolonged untreated pain caused her to cry out. A review of facility's Pharmacy Delivery Sheet for Resident 261's Norco 5-325 mg dated 2/5/2022, indicated the facility received 28 tablets of Norco on the same day the facility admitted Resident 261 on 2/5/2022 at 11:35 p.m. A review of facility's Pharmacy Delivery Sheet for Resident 261’s Norco 5-325 mg dated 2/14/2022, indicated the facility received 35 tablets of Norco at 7 p.m. A review of Resident 261’s Medication Administration Record for the month of 2/2022 indicated the nurse gave the resident Norco 5-325 mg at 2/6/2022 at 12:06 a.m. for pain level was 6/10 (moderate pain) although Resident 261 said the pain was 10/10. On 2/14/2022 the nurse documented administered Resident 261 at 8 p.m. for pain rated 8/10. On 2/16/2022 at 3:37 p.m., during an interview, Director of Nursing (DON) stated medication refills for residents should be placed when there is around three to four days' worth of remaining medication doses. DON added that if the facility does not have the medication, licensed nurses could call the pharmacy to get authorization to obtain the medication from the facility's automated medication dispensing system (machine that stores medication to be used during emergent situations such as when a significant medication has not yet been delivered to the facility). On 2/17/2022 at 3:32 p.m., during an interview, Licensed Vocational Nurse 8 (LVN 8) stated on 2/5/2022 Resident 261 informed him she was having knee pain but since the resident was a new admission and the pharmacy had not delivered their ordered medication. LVN 8 stated on 2/14/2022 Resident 261 was having knee pain but there was no available Norco. LVN 8 stated did not know the facility utilized an automated medication dispensing system where he could have obtained a dose of Norco 5/325 mg for Resident 261 while the pharmacy delivered the resident's medication. On 2/18/2022 at 8:15 a.m., during an interview, Assistant DON (ADON) stated the facility does carry Norco 3/325 mg in the automated medication dispensing system. On 2/18/2022 at 12:46 p.m., during an interview, Certified Occupational Therapy Assistant (COTA) stated she provides physical therapy exercises to Resident 261. COTA stated that on 2/14/2022 at approximately 10:30 a.m., Resident 261 complained to her of knee pain, but the facility had run out of Norco. COTA stated Resident 261 was breathing heavily, appearing to be overwhelmed by not having any pain medications. COTA stated she informed the nurses Resident 261 needed pain medication. A review of the facility`s undated policy and procedures, titled "Pain Management," indicated staff was responsible for helping the resident attain or maintain their highest level of well-being to prevent or manage the resident’s pain. A review of the facility’s undated policy and procedures, titled "Medication-Administration," indicated medication will be administered by a Licensed Nurse per the order of an attending physician or licensed independent practitioner. A review of the facility’s undated policy and procedures, titled "Medication Ordering and Receiving from Pharmacy," indicated emergency pharmacy service was available on a 24-hour basis. Emergency needs for medication are met by the facility’s emergency medication supply or by special order from the pharmacy. The pharmacy supplies emergency medications including emergency drugs, antibiotics, controlled substances, products for infusion in limited quantities in portable, sealed containers in compliance with applicable state regulations. The facility failed to manage Resident 261’s pain due to osteoarthritis, by not administering the resident’s pain medication as ordered by the physician. As a result, on 2/5/2022 and 2/14/2022 Resident 261 endured unnecessary severe pain that caused her to be in tears. The above violations had a direct relationship to the health, safety, or security of Resident 1.