Health inspection·October 25, 2023

F609 §483.12(c) In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must: §483.12(c)(1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. 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. An unannounced visit was conducted by California Department of Public Health on 9/12/2023 at 11:05 AM to investigate a complaint regarding an allegation of resident neglect (the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress). The facility failed to identify and report an unobserved/unexplained injury requiring transfer to a hospital for examination and/or treatment to the California Department of Public Health (CDPH), law enforcement agency, and Ombudsman (an official appointed to investigate individuals' complaints against the facility) for Patient 1. This deficient practice had the potential to result in unidentified abuse in the facility and failure to protect residents from abuse. A review of Patient 1's Admission Record indicated the patient is 88- year- old- female patient who was originally admitted to the facility on 11/23/09 and readmitted on 5/20/20 and 8/11/23 with diagnoses which included fracture of fifth metacarpal bone on the left hand, osteoporosis (a bone diseased that occurs when the body loses too much bone, makes too little bone or both which result to bones becoming weak, and osteoarthritis (is a degenerative joint disease, in which the tissues in the joint break down over time). A review of Patient 1's Minimum Data Set (MDS, a standardized assessment and care-screening tool), dated 8/24/23, indicated the patient had severe cognitive impairment (mental action or process of acquiring knowledge and understanding). The MDS also indicated Patient 1 required total dependence (full staff performance every time during entire seven-day period) for bed mobility, transfer, dressing, toilet use, and personal hygiene and extensive assistance (patient involved in activity; staff provide weight-bearing support) for toilet use. A review of the facility document titled, “Progress Notes,” dated 8/11/23 with an entry time of 9:20 p.m., indicated Registered Nurse (RN) body check assessment noted Patient 1 with left hand discoloration. The document also indicated Patient 1 retracted her hand immediately when the RN attempted to assess residents left hand closer. A review of the report dated 8/12/23 on the Xray of Patient 1’s left hand done on 8/11/23 indicated, acute (sudden) mildly displaced fracture (pieces of the bone moved so much that a gap formed around the fracture when the bone broke) base of proximal phalanx of fifth digit (first bone from the hand of the little finger). During an interview on 9/12/23 at 1:45 p.m., the Licensed Vocational Nurse (LVN) stated incidents where the residents (patients) developed a fracture and injury is of unknown origin needs to be reported right away to CDPH, Ombudsman, and the Police since someone might have abused the patient that the facility was not aware of. The LVN also stated, an injury of unknown origin should have been reported and an investigation should have been done to prevent potential abuse from happening again. During an interview on 9/12/23 at 2:20 p.m., the Director of Nursing (DON) stated if the patient sustained a fracture with unknown origin or cause, it is reportable to CDPH, Ombudsman, and to the law enforcement since it could have been a result of an abuse situation. The DON also stated, a report should be made to prevent further incidents of potential abuse. The DON further stated, the facility did not report to CDPH, Ombudsman, and law enforcement agency Patient 1’s fracture on the left hand with an unknown origin from 8/12/23 to 9/12/23. A review of the facility's policy and procedure titled, "Reportable Injuries of Unknown Source," revised June 2022, indicated that the facility is to comply with reportable suspicions of abuse. The policy also indicated, reportable injuries of unknown source included unobserved/unexplained fractures, unobserved/unexplained injury requiring transfer to a hospital for examination and/or treatment. The policy further indicated that the facility is responsible for reporting occurrences involving injuries of unknown source to CDPH (state survey agency), Ombudsman and law enforcement agency. The facility failed to identify and report an unobserved/unexplained injury requiring transfer to a hospital for examination and/or treatment to the California Department of Public Health (CDPH), law enforcement agency, and Ombudsman (an official appointed to investigate individuals' complaints against the facility) for Patient 1. This deficient practice had the potential to result in unidentified abuse in the facility and failure to protect residents from abuse. The above violation had a direct or immediate relationship to the health, safety, or security of Patient 1.