Health inspection·September 1, 2023

42 CFR §483.10(f)(4)(vi) A facility must meet the following requirements: (A) Inform each resident (or resident representative, where appropriate) of his or her visitation rights and related facility policy and procedures, including any clinical or safety restriction or limitation on such rights, consistent with the requirements of this subpart, the reasons for the restriction or limitation, and to whom the restrictions apply, when he or she is informed of his or her other rights under this section. (B) Inform each resident of the right, subject to his or her consent, to receive the visitors whom he or she designates, including, but not limited to, a spouse (including a same-sex spouse), a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time. (C) Not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability. (D) Ensure that all visitors enjoy full and equal visitation privileges consistent with resident preferences. 42 CFR §483.25(d) Accidents. The facility must ensure that – §483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and §483.25(d)(2) Each resident receives adequate supervision and assistance devices to prevent accidents. 42 CFR §483.20(f)(5) Resident-identifiable information. (i) A facility may not release information that is resident-identifiable to the public. (ii) The facility may release information that is resident-identifiable to an agent only in accordance with a contract under which the agent agrees not to use or disclose the information except to the extent the facility itself is permitted to do so. §483.70(i) Medical records. §483.70(i)(1) In accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are— (i) Complete; (ii) Accurately documented; (iii) Readily accessible; and (iv) Systematically organized §483.70(i)(2) The facility must keep confidential all information contained in the resident’s records, regardless of the form or storage method of the records, except when release is— (i) To the individual, or their resident representative where permitted by applicable law; (ii) Required by Law; (iii) For treatment, payment, or health care operations, as permitted by and in compliance with 45 CFR 164.506; (iv) For public health activities, reporting of abuse, neglect, or domestic violence, health oversight activities, judicial and administrative proceedings, law enforcement purposes, organ donation purposes, research purposes, or to coroners, medical examiners, funeral directors, and to avert a serious threat to health or safety as permitted by and in compliance with 45 CFR 164.512. §483.70(i)(3) The facility must safeguard medical record information against loss, destruction, or unauthorized use. §483.70(i)(4) Medical records must be retained for— (i) The period of time required by State law; or (ii) Five years from the date of discharge when there is no requirement in State law; or (iii) For a minor, 3 years after a resident reaches legal age under State law. §483.70(i)(5) The medical record must contain— (i) Sufficient information to identify the resident; (ii) A record of the resident’s assessments; (iii) The comprehensive plan of care and services provided; (iv) The results of any preadmission screening and resident review evaluations and determinations conducted by the State; (v) Physician, nurse, and other licensed professionals progress notes; and (vi) Laboratory, radiology and other diagnostic services reports as required under §483.50. 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. On 7/19/2023, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a report of a resident with possession of a gun at bedside. The facility failed to provide a safe environment when a gun was identified in possession of Resident 1 on 7/18/2023. The facility failed to: 1. Implement its Admission Agreement rights when they did not account for Resident 1’s personal belongings. Resident 1’s first inventory form (record of resident’s personal belongings brought in the facility) dated 7/23/2020 had no signature from Resident 1 or his representative to confirm the resident had “No belongings.” Resident 1’s second inventory form was blank and undated. Resident 1’s third inventory form had a date that was not recognizable to read; Resident 1 did not countersign the form to confirm the belongings. 2. Implement the facility’s policies and procedures titled, “Resident’s Personal Property,” “Safety of Residents,” “Resident Rights Under Federal Law,” and “Weapons.” As a result, a gun was identified in possession of Resident 1 on 7/18/2023 placing an increased threat for injury and death to the facility’s residents, visitors, and staff. Police Officer 1 (PO 1) picked up Resident 1’s unloaded gun along with seven bullets on 7/18/2023. A record review of Resident 1’s Admission Record indicated an admission date of 7/22/2020 for this 64 year-old male with diagnoses that included dysphagia (having difficulty in swallowing), end stage renal disease (long term loss of kidney function when kidneys can no longer support the body’s needs), and difficulty in walking. A record review of Resident 1's Minimum Data Set (MDS - a standardized assessment and screening tool) dated 7/7/2023, indicated the resident was fully alert with understanding questions, thought process, and with capacity for decision-making tasks. The MDS also indicated Resident 1 required extensive assistance for bed mobility (how resident moves from lying position, turns side to side, or positions body) and with transfers (how resident moves from surfaces including to or from bed, chair, or wheelchair to bed). On 7/19/2023 at 12:55 p.m., upon entrance to the facility, there were no noted postings to identify that the facility does not allow the possession of firearms, knives, or any other dangerous weapons within the property. On 7/19/2023 at 1:13 p.m., during an interview, Resident 1 confirmed having had a gun present in the facility. Resident 1 stated, “I used to buy and sell guns before coming here. All my guns are loaded (with bullets).” Resident 1 stated that the staff never accounted for his inventory of personal belongings. On 7/19/2023 at 2:06 p.m., during a phone interview, Certified Nurse Assistant 1 (CNA 1) stated that on the morning of 7/18/2023 around 6:30 a.m., CNA 1 went to check on Resident 1 and lifted the resident’s blanket, only to find a gun on the right side of the resident facing the door. CNA 1 stated having gloves on, lifted the gun not knowing it was real, but it was heavy. On 7/19/2023 at 2:47 p.m., during an interview, Social Services Assistant (SSA) stated that upon a resident’s admission, the inventory form is done by CNAs. The assigned CNA is to sign the inventory form, then it is countersigned by the resident if the resident is alert, or by a family member if one is present. If a family member is not present and the resident is not alert, the Registered Nurse supervisor or Licensed Vocational Nurse can countersign with the CNA to validate the belongings. SSA further stated that for Resident 1’s case, if the inventory was done, staff could have identified the gun sooner, separated the gun from Resident 1, and notified the police. On 7/19/2023 at 3:09 p.m., during an observation and interview, in the presence of the Director of Staff Development (DSD), observed Resident 1’s belongings around his bedside. Observed one luggage to the left of the resident. Resident 1 was wearing a necklace and noted with a cellular phone. Resident 1 stated having a charger for the phone. Other present belongings included a tablet computer present on the top drawer of the bedside cabinet and a second luggage inside Resident 1’s closet. Resident 1 stated never refusing the staff to have the inventory of his belongings done. On 7/19/2023 at 3:53 p.m., during an interview and record review, Registered Nurse 1 (RN 1) indicated Resident 1 is alert and was admitted on 7/22/2020. RN 1 indicated that Resident 1 has not been out of the facility or discharged to hospital since being admitted and confirmed that Resident 1 does have a lot of belongings. RN 1 stated, “On inventory and screening, it should be done during screening of visitors or family members in what they bring. We really don’t know if there was a visitor the day before, maybe he had other days there could be a time someone visited him. I have worked here since 6/6/1996, working four days a week now during 7-3 shift (7 a.m. to 3 p.m. shift). For this resident, I have never seen any visitor for him before this event. If inventory was being done during any visits, maybe the gun could have been identified sooner. For having a gun in the facility, it could bring harm to himself, other residents, visitors, and the staff. Harm can include death.” On 7/19/2023 at 4:44 p.m., during an interview, the Director of Nursing (DON) stated that since finding the weapon on Resident 1, an update of inventory screening for all the present residents including Resident 1 has not been completed. The DON stated Resident 1 never refused to have his inventory checked. On 7/20/2023 at 2:35 p.m., during an interview, Resident 1 stated, “I have had that gun here for days, weeks, months. I know I told the psychiatrist earlier it’s been 3 years, but I really don’t know how long I’ve had it or who brought it in.” Resident 1 was presented the Admission Agreement packet and asked if he had ever received a copy for himself, Resident 1 denied ever seeing a copy. On 7/20/2023 at 4:54 p.m., during an interview, Licensed Vocational Nurse 3 (LVN 3) stated that the possibility of harm with a gun is large and that most residents within the facility are elderly and sick. LVN 3 stated, “I don’t see a reason for having a gun in the facility. It would be catastrophic (great damage or suffering) and could be fatal if used.” LVN 3 indicated that a couple Sundays ago, there was a woman and a little girl visiting Resident 1 and that Resident 1 disclosed to LVN 3 that the little girl was a granddaughter. During record review of visitors’ screening log, there were no noted visitors recorded for Resident 1 during previous weekends. On 7/21/2023 at 12:51 p.m., during a phone interview, Police Officer 1 (PO 1) stated picking up a gun at the facility from Resident 1 on 7/18/2023, that the model of the weapon was a Glock 36, and that the caliber or measurement of the size of the bullets was 45 (0.45 inches [unit of measure] from side to side of bullet). PO 1 indicated collecting seven bullets along with the gun. PO 1 stated, “The possibilities of having a gun in a hospital includes death. If he went rogue (having destructive behavior) and used the weapon, it can kill someone unexpectedly. We recommended for the facility to have camera inside the lobby. We advised having a security guard, and to have better recording of the visitation log of who is entering as it was unorganized. They didn’t even have dates on their visitor logs when we reviewed it. I have family members that work in nursing homes like that. I know young children visit their loved ones in places like that. Who’s to say a kid can’t grab at the gun and use it? Kids run in and out of those places. So, I would hate to find out that something bad happened in there.” On 7/21/2023 at 1:52 p.m., during an observation, able to enter facility with computer bag without having its contents searched for weapons or prohibited items. On 7/21/2023 at 2:53 p.m., during an interview with the Social Services Director (SSD) and a concurrent record review of Resident 1’s Inventory of Personal Effects (record of resident’s personal belongings brought in the facility), the SSD stated that Resident 1 is fully alert without episodes of forgetfulness. The SSD stated that Resident 1’s first inventory on file was dated 7/23/2020, but no signature from Resident 1 or representative to confirm resident had “No belongings” as Resident 1 was alert. The SSD also stated that the second inventory form on file was blank, including not having a date written. The SSD stated the third inventory form for Resident 1 had a date that was not recognizable to read; Resident 1 did not countersign the form to confirm the belongings. The SSD stated that based on the facility’s “Admission Agreement,” the inventory should be done upon admission and semiannually (twice a year). The SSD stated that anytime someone brings inventory to the residents, it should be counted to track items coming in and going out to account for personal belongings. The SSD indicated that the residents or responsible party should be allowed a copy of the Admission Agreement but was unsure if Resident 1 received a copy. A record review of Resident 1’s “Inventory of Personal Effects,” with completion date 7/19/2023, indicated no record of a copy or receipt of the Admission Agreement. On 7/21/2023, at 4:49 p.m., during an interview, Resident 1 confirmed the current date, time, day of the week, and the current U.S. President. Resident 1 stated, “A gun was found here. An automatic. It was a Glock 36.” Resident 1 stated not knowing how long the weapon has been in his possession inside facility. Resident 1 stated, “The reason you’re not seeing any of my visitors on the sign in is because when they visit me, my visitors come in after hours, or no one is screening them. They tell me no one was at the front to screen them or check into their bags. The staff think my visitors are delivering food. I know this because I see a lot of other visitors still in the hallways after hours. I don’t know which of my visitors brought the gun and I don’t know when, but I always ask them why they’re carrying a bag up here when they have a license to drive and leave the bag in the car." A review of the facility-provided admission agreement titled, “California Standard Admission Agreement For Skilled Nursing Facilities And Intermediate Care Facilities,” with date of 5/2011, contained the topic “California Personal Property Regulation,” with date 1/1/2017, which indicated, “A written patient personal property inventory is established upon admission and retained during the resident’s stay in a long-term health care facility. A copy of the written inventory shall be provided to the resident or the person acting on the resident’s behalf. Subsequent items brought into or removed from the facility shall be added or removed from the personal property inventory by the facility at the written request of the resident, the resident’s family, a responsible party, or a person acting on behalf of a resident.” The Admission Agreement also indicated that the signed Admission Agreement should have a “White” copy on the Financial File, a “Yellow” copy to the Resident, and a “Pink” copy in the Medical Chart. A review of the facility policy and procedures titled, “Resident’s Personal Property,” with effective date of 8/25/2021 indicated, “Personnel will identify and record the Resident belongings upon admission to a Facility.” The policy’s procedure indicated “All items brought into the Facility will be listed on the Inventory of Personal Effects form and kept in the Resident clinical chart. Any additional items brought into the facility after admission must be added to this list.” The procedures also indicated for staff to obtain the following signatures on the Inventory of Personal Effects as indicated, “3.1.1 Resident or resident representative/date, 3.1.2 Employee/date.” A review of the facility-provided policy and procedures titled “Safety of Residents” with effective date 6/27/2022, indicated the purpose statement, “To provide a safe environment for residents and Facility Staff.” A review of the facility policy and procedures titled, “Resident Rights Under Federal Law,” with revision date of 2/1/2023, in