Health inspection·August 13, 2024

42 CFR §483.25(c) Mobility (1) The facility must ensure that a resident who enters the facility without limited range of motion does not experience reduction in range of motion unless the resident’s clinical condition demonstrates that a reduction in range of motion is unavoidable; and (2) A resident with limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion. (3) A resident with limited mobility receives appropriate services, equipment, and to maintain or improve mobility with the maximum practicable independence unless a reduction in mobility is demonstrably unavoidable. 42 CFR §483.10(g)(14) Notification of Changes (i) A facility must immediately inform the resident; consult with the resident’s physician; and notify, consistent with his or her authority, the resident representative(s) when there is— (A) An accident involving the resident which results in injury and has the potential for requiring physician intervention. (B) A significant change in the resident’s physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications). (C) A need to alter treatment significantly (that is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment) 22 CCR §22 72315 Nursing Services – Patient Care (e) Each patient shall be encouraged and/or assisted to achieve and maintain the highest level of self-care and independence. Every effort shall be made to keep patients active, and out of bed for reasonable periods of time, except when contraindicated by orders of a licensed health care practitioner acting within the scope of his or her. professional licensure. (f) Each patient shall be given care to prevent formation and progression of decubiti, contractures, and deformities. Such care shall include: (3) Maintaining proper body alignment and joint movement to prevent contractures and deformities (g) Each patient requiring help in eating shall be provided with assistance when served and shall be provided with training or adaptive equipment in accordance with identified needs, based upon patient assessment, to encourage independence in eating. 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 § 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: (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. (3) Notifying the attending licensed healthcare practitioner acting within the scope of his or her professional licensure promptly of: (B) Any sudden and/or marked adverse change in signs, symptoms or behavior exhibited by a patient. (G) The facility's inability to obtain or administer, on a prompt and timely basis, drugs, equipment, supplies, or services as prescribed under conditions which present a risk to the health, safety, or security of the patient. On 6/28/2024, the California Department of Public Health (CDPH) conducted a standard annual Recertification Survey of the facility. The facility failed to: 1. Monitor and assess Resident 61’s range of motion ([ROM] full movement potential of a joint {where two bones meet})in each joint of both arms and legs during the quarterly Rehab Screening (brief assessment of a resident’s abilities) from 11/5/2021 to 6/12/2022 in accordance with the facility’s policy titled, “Resident Mobility and Range of Motion,” which indicated the facility will identify the resident’s ROM of the joints as part of the resident’s comprehensive assessment. 2. Provide Resident 61 with passive range of motion ([PROM] a movement of joint through the ROM with no effort from the person) to the left arm from 2/2/2022 to 6/11/2022, as ordered by Resident 61’s physician on 3/26/2019, and in accordance with the Resident 61’s request documented in Resident 61’s Rehab Screening, dated 2/2/2022. 3. Monitor and assess Resident 61’s ROM in each joint of both arms and legs quarterly from 9/2/2022 to 4/2/2024 in accordance with the facility policy titled, “Resident Mobility and Range of Motion” after Resident 61’s discharge from Occupational Therapy ([OT] profession that provides services to increase and/or maintain a person’s capability to participate in everyday life activities) on 9/2/2022. 4. Perform PROM exercises on 6/25/2024 to Resident 61 left elbow, wrist, hand, and ankle and the right leg in accordance with the physician’s orders, dated 1/23/2024, to provide PROM to the left arm and both legs as tolerated. As a result Resident 61 developed limitations in ROM of the left elbow, forearm, and wrist on 6/12/2022, causing Resident 61 to develop contractures (condition of shortening and hardening of muscles, tendons, or other tissue, often leading to joint stiffness) in the left elbow, forearm, and wrist, experienced pain with movement of the left arm, and prevented Resident 61 from participating in activities of daily living ([ADL], tasks related to personal care including bathing, dressing, hygiene, eating, and mobility), including dressing in normal clothes and getting out of bed. A review of Resident 61’s Admission Record, indicated Resident 61, a 68 year old female, was admitted to the facility on 3/21/2019 with diagnoses including cerebral infarction (brain damage due to a loss of oxygen to the area) due to embolism (blood vessel blockage) of the right middle cerebral artery (largest of the major blood vessels in the brain), hemiplegia (paralysis of one side of the body) and hemiparesis (weakness of one side of the body), hypertensive (abnormally high blood pressure) heart disease, type 2 diabetes mellitus (high blood sugar), and major depressive disorder (depression, a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with daily functioning). A review of Resident 61’s OT Evaluation and Plan of Treatment, dated 3/22/2019, indicated Resident 61’s ROM in the right arm was within functional limits ([WFL] sufficient movement without significant limitation) and the left arm was impaired. The OT Evaluation indicated Resident 61’s left arm ROM impairments included left shoulder flexion (lifting the arm upward) 30 to 90 degrees (30-90 degrees, normal 0-180 degrees), left elbow flexion (bending the elbow) 40-140 degrees (normal 0-150 degrees), left wrist (unspecified ROM), and left-hand ring finger and small finger had flexion (bending) contractures. The OT Evaluation indicated Resident 61 had limited strength in both arms with weakness in the left arm. Resident 61’s OT Plan of Treatment indicated an OT Evaluation only (no OT intervention) with recommendations for Resident 61 to receive a Restorative Nursing Aide ([RNA] a certified nursing aide program that helps residents to maintain their function and joint mobility) program to provide PROM to the left shoulder, elbow, and hand, five times per week. A review of Resident 61’s Physical Therapy ([PT] profession aimed in the restoration, maintenance, and promotion of optimal physical function) Evaluation and Plan of Treatment, dated 3/22/2019, indicated Resident 61’s both legs were WFL except for left ankle stiffness. Resident 61’s PT Plan of Treatment indicated a PT evaluation only. A review of Resident 61’s Physician’s Orders, dated 3/26/2019, indicated for the RNA to provide PROM to the resident’s left arm in all available planes (movement side-to-side, front, and back, or rotational), five times per week as tolerated. Another physician’s order, dated 3/26/2019, indicated for the RNA to provide Resident 61 with active assistive range of motion ([AAROM] use of muscles surrounding the joint to perform the exercise but required some help from a person or equipment) exercises to both legs and sit to stand transfers with one siderail use, five times per week as tolerated. A review of Resident 61’s Physician’s Orders, dated 10/29/2021, indicated for the RNA to provide PROM to the resident’s left leg, five times per week as tolerated. A review of Resident 61’s Rehab Screening, dated 11/5/2021, indicated Resident 61’s ROM in the right arm and right leg were WFL. The Rehab Screening indicated Resident 61’s ROM in the left arm and left leg were impaired (unspecified). A review of Resident 61’s Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 11/9/2021, indicated Resident 61 had intact cognitive (ability to think, understand, learn, and remember) skills for daily decision making. The MDS indicated Resident 61 had ROM limitations in one arm and one leg. A review of Resident 61’s Rehab Screening, dated 2/2/2022, and 5/2/2022 indicated Resident 61’s ROM in the right arm and right leg were WFL. The Rehab Screening indicated Resident 61’s ROM in the left arm and left leg were impaired (unspecified). The Rehab Screening indicated Resident 61 had left-sided hemiplegia with noted hypertonicity (increased tightness in the muscles). The Rehab Screening indicated Resident 61 verbalized a wish to continue with the RNA program for PROM to both arms and both legs. The Rehab Screening indicated Resident 61 was receiving RNA for PROM to the left arm and left leg, five times per week as tolerated. A review of Resident 61’s Documentation Survey Report (record of nursing assistant tasks) for RNA, dated for the month of 2/2022, 3/2022, and 4/2022, indicated Resident 61 received RNA for PROM to the left leg, five times per week as tolerated. The Documentation Survey Report did not include documentation from 2/2022 thru 4/2022 RNA for PROM to the left arm as ordered by Resident 61’s physician (3/26/2019) and as indicated in the Rehab Screening, dated 2/2/2022. A review of Resident 61’s Documentation Survey Report (record of nursing assistant tasks) for RNA, dated for the months 5/2022 and 6/2022, indicated Resident 61 received RNA for PROM to the left leg, five times per week as tolerated. The Documentation Survey Report did not include documentation from 5/2022 thru 6/2022 RNA for PROM to the left arm as ordered by Resident 61’s physician (3/26/2019) and indicated in the Rehab Screenings, dated 2/2/2022 and 5/2/2022. A review of Resident 61’s Rehab Screening, dated 6/12/2022, indicated Resident 61 required an OT Evaluation. A review of Resident 61’s OT Evaluation and Plan of Treatment, dated 6/12/2022, indicated Resident 61’s ROM in the right arm was WFL but Resident 61’s left arm ROM was impaired. The OT Evaluation indicated Resident 61’s left arm ROM impairments included shoulder flexion 0-80 degrees, shoulder abduction (lifting the arm up and away from the body) 0-45 degrees (normal 0-180 degrees), elbow positioned in extension (straightened elbow) with 10 degrees of motion, wrist positioned in flexion (bent downward) to 90 degrees, wrist extension (bending the wrist upward) to neutral (wrist straightens but unable to bend further upward), the forearm positioned in increased pronation (rotation of the forearm that results in the palm facing downward), and the left-hand middle, ring, and small fingers were positioned in flexion. The OT Plan of Treatment included to provide therapeutic exercises (movement prescribed to correct impairments and restore muscle function), neuromuscular reeducation (technique used to restore movement patterns through repetitive motion to retrain the brain), therapeutic activities (tasks that improve the ability to perform ADLs), self-care management training, and orthotic (also known as a splint, material used to restrict, protect, or immobilize a part of the body to support function, assist and/or increase range of motion) management and training, five times per week for 30 days. A review on Resident 61’s PT Evaluation and Plan of Treatment, dated 6/11/2022, indicated Resident 61’s ROM in the right leg, left hip, and left knee were WFL. The PT Evaluation indicated Resident 61’s left ankle dorsiflexion (bending the ankle toward the body, normal 0-20 degrees) was impaired and positioned in 10 degrees of plantarflexion (ankle bent away from the body). The PT Plan of Treatment included therapeutic exercise, neuromuscular reeducation, and therapeutic activities five times per week. A review of Resident 61’s OT Discharge Summary, dated 7/29/2022, indicated Resident 61 tolerated wearing the left-hand wrist, hand, finger orthosis ([WHFO], material secured with straps that extends from the fingers to the forearm to properly position the fingers and wrist and prevent contractures) for five hours daily and the RNA (unknown) demonstrated 100 percent (%) good return demonstration of the left arm PROM exercises with prolonged stretch to maintain joint mobility, good hygiene, and prevent contractures. The OT Discharge Summary indicated recommendations for the RNA to provide Resident 61 with AAROM to the right arm, PROM to the left arm, and application of the left-hand WHFO for four to six hours, seven days a week as tolerated. A review of Resident 61’s PT Discharge Summary, dated 7/29/2022, indicated Resident 61 tolerated wearing pressure relief ankle-foot orthosis ([PRAFO] a device worn on the calf and foot to suspend the heel and hold the ankle in neutral [90 degree] position) to the left ankle for two hours five times per week. The PT Discharge Summary indicated recommendations for the RNA to provide Resident 61 with PROM of both legs and to apply the left ankle PRAFO as tolerated with skin checks, five times per week as tolerated. A review of Resident 61’s Physician’s Orders, dated 7/29/2022, the physician’s orders indicated the order for the RNA to perform AAROM to Resident 61’s right arm, PROM to Resident 61’s left arm, and to apply the left-hand WFHO for four to six hours as tolerated, seven days per week. Another physician’s orders, dated 7/29/2022, indicated the order for the RNA to perform PROM to both of Resident 61’s legs and to apply the left ankle PRAFO, five times per week as tolerated. A review of Resident 61’s PT Evaluation and Plan of Treatment, dated 8/19/2022, indicated Resident 61’s ROM in the right leg was WFL but impaired on the left hip, knee, and ankle. The PT Evaluation indicated the ROM in Resident 61’s left leg included left hip flexion 0-60 (bending the leg at the hip joint toward the body, normal 0-120), left knee fixed (immovable) into extension (straightening out the knee, normal 0-135 degrees), and the left ankle was positioned in 10 degrees of plantarflexion. A review of Resident 61’s OT Evaluation and Plan of Treatment, dated 8/20/2022, indicated Resident 61’s ROM in the right arm was WFL but Resident 61’s ROM in the left arm was impaired. The OT Evaluation and Plan of Treatment indicated Resident 61’s left arm ROM impairments included shoulder flexion 0-70 degrees, shoulder abduction 0-45 degrees, elbow positioned in extension with 10 degrees of motion, wrist positioned in flexion to 90 degrees, wrist extension to neutral, the forearm positioned in increased pronation, and left-hand middle, ring, and small fingers were positioned in flexion. The OT Plan of Treatment included to provide therapeutic exercises, neuromuscular reeducation, therapeutic activities, and orthotic management and training, four times per week for two weeks. A review of Resident 61’s PT Discharge Summary, dated 8/25/2022, indicated Resident 61 tolerated wearing the left ankle PRAFO for two