Health inspection·March 21, 2023

F684 § 483.25 Quality of care Quality of care is a fundamental principle that applies to all treatment and care provided to facility Patients. Based on the comprehensive assessment of a Patient, the facility must ensure that Patients receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the Patients’ choices, including but not limited to the following: T22 § 72311. Nursing Service - General. (a) Nursing service shall include, but not be limited to, the following: (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. T22 § 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 2/7/2023 at 10:10 am, the California Department of Public Health (CDPH) conducted an unannounced visit to the facility to conduct a Recertification survey.   As a result of the Recertification Survey, CDPH determined the facility failed to provide care and services to Patient 4 by failing to: 1. Notify Patient 4’s Physician (MD 1) of Patient 4, who had a change in condition (COC, a sudden clinically important deviation from a patient's baseline in physical, cognitive, behavioral, or functional domains), that began on 2/2/2023 as indicated in the facility's “Change in a Patient's Condition or Status” policy and procedure. 2. Assess, treat, and monitor Patient 4's skin rashes. On 2/2/2023 (unidentified time), Treatment Nurse (TN) was aware of Patient 4's skin rashes and did not inform MD 1. The TN notified MD 1 on 2/10/2023 (8 days later,) after the surveyor identified Patient 4's skin rashes. The facility did not have documented evidence that Patient 4's skin rashes and itchiness were assessed, treated, and addressed. As a result, Patient 4 experienced skin rashes on her body, severe itchiness without treatment, and placed Patient 4 at risk for infection and discomfort. A review of Patient 4's Admission Record indicated the facility admitted a sixty-seven-year-old-female (Patient 4) on 5/28/2021, with diagnoses that included diabetes mellitus (a medical condition characterized by the body's inability to regulate blood sugar levels), and dementia (loss of memory and other mental abilities severe enough to interfere with daily life). A review of Patient 4's Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 6/5/2022, indicated the Patient was able to express ideas, wants, and had clear comprehension of understanding of verbal content. The MDS indicated Patient 4 required extensive help with mobility, dressing, personal hygiene, and bathing. A review of Patient 4's "Nursing-Weekly Summary," documents, dated 11/5/2022 to 2/4/2023, there was no indication that Patient 4 had skin rashes on her body. During an observation and interview on 2/10/2023, at 8 am, Patient 4 was vigorously scratching over her buttocks and abdomen with the shirt on as she stood up from her wheelchair in the hallway. Patient 4 stated "Itchy itchy." During an observation and interview on 2/10/2023, at 9:58 am, Patient 4 gave the surveyor permission to observe Patient 4's skin in the presence of the Director of Nursing (DON), the Infection Preventionist Nurse (IPN, nurse who helps prevent and identify the spread of infectious agents like bacteria and viruses in a healthcare environment), the TN, and another surveyor. Patient 4 agreed and removed her clothing (T-shirt and pants). Patient 4's front and back upper trunk (torso, the human body apart from the head, neck, arms, and legs, arms, legs, thighs, and abdomen), were covered with raised red papules (small bumps in the skin), scabs, stretch marks, and excoriation (open sore covered with dried blood). During an interview and a record review of Patient 4' Medical Record on 2/10/2023, at 10:20 am, the TN stated she sent a text message and photos of Patient 4's skin condition to the Physician Assistant (PA 1) on 2/2/2023 (unidentified time), and she (TN) did not receive a response. The TN stated she did not inform MD 1. The TN stated there was no documented evidence that MD 1 was notified regarding the rashes and the skin bleeding from intense itching and scratching. Additionally, the TN was unable to find documented evidence that Patient 4's intense itching and scratching was addressed. After reviewing Patient 4's Medication Records, the TN stated that she would notify MD 1 on 2/10/2023 (8 days later). A review of Patient 4's Dermatology (the branch of medicine concerned with the diagnosis and treatment of skin disorders) telemedicine (video call consult) notes, dated 2/10/2023, timed at 4:49 pm, indicated Patient 4 had a skin rash that started a week ago from 2/10/2023 (unidentified date), and Patient 4 was "very itchy." The notes indicated Patient 4 had erythematous (reddening of the skin) excoriated (damaged skin) papules on the back/buttocks, abdomen, and lower extremities (legs). A review of the facility's policy and procedure titled, "Change in a Patient's Condition or Status," revised 2/21, indicated "Our facility promptly notifies the Patient, his or her attending physician, and the Patient representative of changes in the Patient's medical/mental condition and/or status (e.g., changes in level of care, billing/payments, Patient rights, etc.)." As a result of the Recertification Survey, CDPH determined the facility failed to provide care and services to prevent a fall for Patient 1 by failing to: 1. Notify MD 1 of Patient 4, who had a change in condition, that began on 2/2/2023 as indicated in the facility's “Change in a Patient's Condition or Status” policy and procedure. 2. Assess, treat, and monitor Patient 4's skin rashes. On 2/2/2023 TN was aware of Patient 4's skin rashes and did not inform Patient 4's physician. The TN notified Patient 4's physician 8 days later after the surveyor identified Patient 4's skin rashes. The facility did not have documented evidence that Patient 4's skin rashes and itchiness were assessed, treated, and addressed. As a result, Patient 4 experienced skin rashes on her body, severe itchiness without treatment, and placed Patient 4 at risk for infection and discomfort. The above violation jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Patient 4.