Other·October 20, 2022

F908 §483.90(d)(2) Maintain all mechanical, electrical, and patient care equipment in safe operating condition. § 72657. Mechanical Systems. Heating, air conditioning and ventilating systems shall be maintained in normal operating conditions to provide a comfortable temperature and shall meet the requirements of Section T17-105, Title 24, California Administrative Code. Note: Authority cited: Sections 208(a) and 1275, Health and Safety Code. Reference: Section 1276, Health and Safety Code. The facility failed to maintain the HVAC (Heating, Ventilation and Air Conditioning; The HVAC system is essential for maintaining environmental temperatures within safe and acceptable ranges. This includes the air conditioning unit as well as the ventilation systems) system in a safe operating condition. Two air conditioning compressors (mechanical devices that maintains the facility’s environmental temperature at a cool, comfortable level ranging from 71 to 81 degrees Fahrenheit [°F, unit of temperature]) were malfunctional and not maintaining the facility at a cool, comfortable temperature for 79 residents residing in the facility. As a result, residents’ room temperatures were hot and uncomfortable with temperatures ranging from 86-89°F. This deficient practice increased the residents’ risk of dehydration (excessive loss of body water) and/or heat stroke (a complication when a person’s body overheats due to the inability to regulate normal body temperatures) where conditions may be life threatening. Additionally, this deficient practice resulted in the residents’ increased level of discomfort which can negatively impact the residents’ quality of life. On September 7, 2022, at 2:15 p.m., a complaint investigation was conducted regarding an alleged malfunction air conditioner and above normal temperatures in the facility. At the time of the investigation, environmental and clinical surveys were conducted. During the environmental portion of the survey, the following was observed: A review of the facility’s floor plan indicated there were 22 resident rooms on the first floor and 32 resident rooms on the second floor. A total of 54 resident rooms are in the facility. A review of the facility's census report, dated September 6, 2022, indicated there were 79 residents residing in the facility. (The facility’s bed capacity is 99 beds.) On September 7, 2022, at 2:30 p.m., an interview was conducted with the administrator regarding hot room temperatures in the facility. The administrator stated that the facility’s air conditioning system was not cooling properly due to the malfunction of two of three compressors. The Administrator stated the compressors have not been functioning since September 5, 2022. Since the discovery of the malfunctioning air compressors, the facility has contacted one air conditioning company for the cost of repairs but was waiting to hear back from another company to compare prices. No actions have been taken to facilitate the initiation of compressor repairs. On September 7, 2022, between 2:45 p.m. and 3:30 p.m., a general observational tour was conducted with the maintenance supervisor. The following room temperatures were observed: 1. Room 126 = 86°F 2. Room 131 = 86°F 3. Room 108 = 86°F 4. Room 208 = 88°F 5. Room 217 = 88°F 6. Room 226 = 87°F 7. Room 231 = 89°F Outside temperature = 99°F On September 7, 2022, at 3:45 p.m., during an observation and interview in the presence of the DON, Patient 2 was observed lying in bed. During an interview with Patient 2, he stated it was warm in his room and wished he had a fan. On September 7, 2022, at 3:55 p.m., during an interview, Patient 2 stated that the facility has been hot for the last 4 to 5 days. The staff provided Patient 2 with an electric fan, but it was still warm in his room. On September 7, 2022, at 3:55 p.m., during an observation and interview in the presence of the Director of Nursing (DON), Patient 1 was observed lying in bed, awake with a fan in the room. During an interview with Patient 1, he stated it had been very warm in his room the last four to five days. Patient 1 further stated, “It’s okay as long as the fan is on.” On September 7, 2022, at 4:10 p.m., during an interview, Patient 1 stated that it had been hot in the facility for the last 4 days and said he wished he had an electric fan in his room. On September 7, 2022, at 5:54 p.m., during an observation and interview in the presence of the Director of Staff Development (DSD), Patient 3 was observed lying in bed, with a white sheet covered on top of her up to her knees. During an interview, Patient 3 stated she was warm and her room was "hot” and wanted a fan or AC (air conditioning, system used to cool down the temperature in an inside space by removing the existing heat and moisture from the room) in her room. On September 7, 2022, at 6:15 p.m., during an interview, the maintenance supervisor stated that the facility did not have or maintain room temperature logs or a written policy for maintaining environmental temperatures. On September 7, 2022, between 6:30 p.m. and 7:15 p.m., another general observational tour was conducted with the maintenance supervisor. The following room temperatures were obtained: 1. Room 208 = 85°F 2. Room 226 = 84°F 3. Room 231 = 83°F 4. Room 217 = 83°F 5. Room 126 = 82°F 6. Room 131 = 80°F 7. Room 108 = 82°F A record review of Patient 1's Admission Record indicated the patient was admitted to the facility on 08/08/22 with diagnoses that included in cerebral infarct (a blockage of blood flow to the brain) and gout (sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, often the joint at the base of the big toe). A review of Patient 1’s Minimum Data Set (MDS- a comprehensive assessment and screening tool), dated 08/15/22, indicated the patient’s cognitive patterns (mental action or process of acquiring knowledge and understanding) were intact. The MDS also indicated Patient 1 required extensive assistance (resident was involved in activity, but staff provided weight bearing support) from staff for bed mobility, transfer, and dressing. A record review of Patient 2 's Admission Record indicated the patient was re-admitted to the facility on 12/15/21 with diagnoses that included encephalopathy (a disease damaged the functions of the brain) and Type two diabetes mellitus (a disease in which your blood sugar levels are too high). A review of Patient 2’s MDS assessment, dated 08/26/22, indicated the patient’s cognitive patterns were intact and required total dependence (full staff performance every time) from staff for transfer and required extensive assistance from staff for bed mobility, toilet, and personal hygiene. A record review of Patient 3’s Admission Record indicated the patient was readmitted to the facility on 09/11/21 with diagnoses that included hypertensive (high blood pressure) and pneumonia (infection that inflames air sacs in one or both lungs, which may fill with fluid). A review of Patient 3’s MDS assessment, dated 07/20/22, indicated the patient was assessed with severe cognitive impairment in cognitive skills for daily decision making. The MDS indicated the patient required total dependence from staff for transfer, locomotion (movement) on and off the unit and toilet use. On September 7, 2022, from 5:15 p.m. to 8:35 p.m., during a general observation of the facility, the DSD checked Patients 1, 2 and 3's room temperature and 38 other rooms using the facility's laser temperature thermometer. Patient 1’s room temperature was 84-degree Fahrenheit (°F), Patient 2’s room temperature was 83-degree Fahrenheit (°F), Patient 3’s room temperature was 84-degree Fahrenheit (°F), and 38 other rooms had a temperature ranging from 83 °F to 87 °F. On September 7, 2022, at 6:50 p.m., during an interview, the DSD stated the residents' room temperatures should be between 73 °F and 80 °F. On September 7, 2022, at 7:02 p.m., during an interview, DON stated regarding residents’ room temperature, facility would follow the regulation which was to maintain a temperature of not less than 71 °F or more than 81 °F. A review of the facility’s policy and procedure titled, “Emergency Generator or Alternate Energy Source,” revised April 2019, indicated that during an emergency event, the temperature regulation for resident health, safety, comfort, as well as to protect supplies and subsistence need, will be maintained by the alternate power source (the emergency generator). In this document, it indicates that the acceptable temperature range is between 71 – 81 °F. This violation had a direct relationship to the health, safety, and security of all residents.