Health inspection·March 7, 2024

Title 22 CFR §72527. Patients' Rights. (a)Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy or these policies available to the patient and to any representative of 1he patient. The policies shall be accessible to the public upon request. Patients shall have the right: (12) To be treated with consideration. respect and full recognition ion or dignity and individuality. including privacy in treatment and in care or personal needs. F550 §483.10(a) Resident Rights. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section. §483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident’s individuality. The facility must protect and promote the rights of the resident. An unannounced visit for recertification survey was conducted by California Department of Public Health (CDPH) from 1/23/24 to 1/26/24. During the course of the survey investigation, it was determined that the facility failed to ensure Patient 1 was treated with respect and dignity as indicated in the facility's policy and procedure, by failing to: 1. Provide privacy and honor Patient 1’s preference to keep gown and incontinent brief on before going to the shower room. This failure resulted in Patient 1's emotional distress manifested by crying, reported feeling embarrassed and frustrated which could potentially result in the patient not able to enhance her sense of well-being, level of satisfaction with life, and feeling of self-worth and self-esteem. A review of Patient 1's "Admission Record," dated 1/1/22, indicated Patient 1, 89 years old female, born 5/1/1935, was admitted to the facility on 1/25/19, and readmitted on 8/3/21, with diagnoses that included dementia [the loss of cognitive functioning (thinking, remembering, and reasoning) to such an extent that it interferes with a person's daily life and activities], diabetes type 2 (condition that results in too much sugar circulating in the blood), schizophrenia (a severe mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), and generalized muscle weakness. A review of Patient 1's Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 11/3/23, indicated, Patient 1 was usually able to express ideas and wants (difficulty communicating some words or finishing thoughts but is able if prompted or given time), and was usually able to verbally understand others (misses some part/intent of message but comprehends most conversation). The MDS also indicated, Patient 1 required supervision or touching assistance (helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity, assistance may be provided throughout the activity or intermittently) with shower and personal hygiene. A review of Patient 1's care plan, initiated on 2/7/19 and revised on 3/31/23, indicated Patient 1 had self-care deficit that require assistance with activities of daily living because of difficulty walking, muscle weakness. The care plan interventions included to assist Patient 1 with shower/bathing as scheduled, and the staff will maintain her privacy and respect her rights. A review of Patient 1's care plan, initiated on 5/13/20 and revised on 3/31/23, indicated Patient 1 had some confusion and forgetfulness, and some difficulty communicating her needs at times because of dementia, schizophrenia. The care plan intervention included to have consistent care giver and have choices of care, clothes, and activity as capable. During an observation on 1/25/24 at 10:55 a.m. in the hallway in front of Patient 1's room, Patient 1 was observed sitting on a wheelchair crying while Certified Nursing Assistant (CNA) 2 was pulling Patient 1's wheelchair backwards going to the shower room. Patient 1 was observed continuing to cry while holding her head with her right hand. The Director of Staff Development (DSD) who was walking behind the surveyor, passed by the surveyor, and pushed Patient 1's wheelchair further inside the shower room while speaking to Patient 1 in a foreign language, then closed the shower room door. During a concurrent observation and interview on 1/25/24 at 10:56 a.m. in the hallway in front of the shower room, the DSD was observed walking out of the shower room and closed the door while Patient 1 and CNA 2 remained inside the room. When the DSD was asked by the surveyor why Patient 1 was crying, the DSD stated, it was because Patient 1 was not comfortable with CNA 2. The DSD stated, she would call another CNA that was familiar with Patient 1 to come and assist her. During an interview on 1/25/24 at 11:23 a.m. with Patient 1 (with a translator that spoke the patient's language) in her room, Patient 1 was asked why she was crying as she went to the shower room with CNA 2, Patient 1 replied, she was crying because "the nurse (CNA 2) wanted to take me naked, she was taking off my clothes and wanted to cover me with a blanket." Patient 1 stated, she became upset because she did not want to go naked with only a blanket to cover her while being wheeled in the hallway to the shower room. Patient 1 stated, she preferred to have her clothes and diaper removed in the shower room, not in her room which was how other CNAs have always assisted her with. Patient 1's stated, CNA 2 insisted on taking her gown and diaper off while in her room and not in the shower room, which made her feel that she was being asked to take off her clothes against her will and feel embarrassed being wheeled down the hallway without underwear on when everyone was present. Patient 1 stated, when the DSD came to talk to her in the shower room, in the presence of the CNA 2, she told the DSD that she was not comfortable with CNA 2, the DSD told her to give CNA 2 a chance. During an interview on 1/25/24 at 2:08 p.m. with CNA 2 outside of Patient 1's room, CNA 2 stated when she was gathering Patient 1's belongings in the room and assisting the patient to remove her gown and diaper, the patient got frustrated and started to cry. CNA 2 stated, Patient 1 got frustrated because she wanted certain belongings and was pointing at her things. CNA 2 stated, she did not speak the language that Patient 1 spoke, so she was just following the patient's hand gestures. CNA 2 stated, when assisting the patient, she observed that Patient 1 was holding on to her gown and diaper, so she told Patient 1 that her gown and diaper needed be off before going to the shower room. CNA 2 stated, Patient 1 cried and spoke to her in a foreign language that she did not understand so she just continued to transfer Patient 1 to the shower room in her wheelchair. CNA 2 stated, she should have stopped and asked for help from a staff who spoke the patient's language. During an interview on 1/25/24 at 3:52 p.m. with the DSD, the DSD stated, CNA 2 should have stopped when Patient 1 started crying in her room and asked the nurses for help to find out why Patient 1 was crying, because it could be some distress going on and the patient was not happy with the care. The DSD stated. CNA 2 should not continue when Patient 1 was already upset with the care. A review of the facility's Policy and Procedure (P&P) titled, "Patient Rights," dated February 2021, indicated that Federal and state laws guarantee certain basic rights to all patients of this facility. These rights include the patient's right to: -self-determination. -be treated with respect, kindness, and dignity. -be free from abuse, neglect, misappropriation of property, and exploitation. A review of the facility's P&P titled, "Dignity," dated February 2021, indicated the following information: The facility culture supports dignity and respect for patients by honoring patient goals, choices, preferences, values and beliefs. -When assisting with care, patients are supported in exercising their rights. For example, patients are encouraged to dress in clothing that they prefer; groomed as they wish to be groomed. -Patients' private space and property are respected at all times. Staff do not handle or move a patient's personal belongings without the patient's permission. -Staff promote, maintain and protect patient privacy, including bodily privacy during assistance with personal care and during treatment procedures. -Staff are expected to treat cognitively impaired patients with dignity and sensitivity, for example, not challenging or contracting the patient's beliefs or statements." The facility failed to ensure Patient 1 was treated with respect and dignity as indicated in the facility's policy and procedure. The above violation had a direct or immediate relationship to the health, safety or security of Patient 1.