Santa Paula Post Acute Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview the facility failed to ensure nursing staff implemented one of four sampled residents (Resident 1) gastrostomy/Jejunostomy feeding tube (G-tube-surgically placed tube that delivers nutrition, fluids, and medications directly into the stomach, bypassing the mouth and esophagus), care recommendations and Physician's orders regarding flushing of the tube. The facility's failure resulted in Resident's G-tube getting clogged frequently. Finding: Review of [NAME] and [NAME], 7th Edition, Mosby's Fundamentals of Nursing, page 419 in the section titled, Legal Implications in Nursing Practice indicates, Nurses are obligated to follow physician order unless they believe the orders are in error or would harm patients (residents) A complaint was submitted to the California Department of Public Health (CDPH) on 3/3/25 alleging a Resident has presented to the hospital multiple times because the staff at the facility are . clogging the resident's feeding tube. During an onsite visit to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to: 1. Ensure one of four sampled residents (Resident 1) gastrostomy/Jejunostomy feeding tube (G-tube-surgically placed tube that delivers nutrition, fluids, and medications directly into the stomach, bypassing the mouth and esophagus), was managed properly. 2. Ensure licensed nursing staff was educated on the management of G-tube. The facility's failures resulted in Resident 1's G tube having problems for six (6) months without any resolution to the tube problem and staff education regarding G-tube management was not provided to licensed nursing staff. Findings: 1. A complaint was submitted to the California Department of Public Health (CDPH) on 3/3/25 alleging a Resident has presented to the hospital multiply times because the staff at the facility are breaking, pulling and clogging the resident's feeding tube. During an onsite visit to facility on 3/5/25, a record review for Resident 1 was conducted. Record review indicated Resident 1 is a [AGE]…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to ensure an employee working as a certified nursing assistant (CNA- a healthcare professional who provides basic patient care and support)) at the facility held a valid and up-to-date license. This failure had the potential to result in an unlicensed CNA providing direct care to residents without proper certification and put residents' safety at risk. Findings: During a review of the facility's Employee Spreadsheet Roster (ESR) dated 3/17/25, indicated CNA 1 was hired on 7/7/23 with a job title of CNA. No CNA license number was documented on the ESR. During a review of facility's Nursing Assistant (CNA/RNA (restorative nursing assistant)) job description dated 11/21/23, indicated in part, Education and Work Experience Requirements .Must have current state certification. During a review of the facility's policy and procedure (P&P), titled Background Screening Investigations, dated March 2019, the P&P indicated, in part, 3. For any individual applying for a position as a Certified Nursing Assistant, the state nurse aide…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to ensure Resident 1's assessments were performed by a registered nurse (RN) to meet professional scope of practice and standards of practice. This facility failure had the potential to place Resident 1 at risk of not being assessed appropriately and potentially resulting in harm to resident. Findings: 1.According to the Nursing Practice Act, Business & Professions Code, Chapter 6, Nursing Section 2725 indicates, .(b) The practice of nursing within the meaning of this chapter means those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill . RN is accountable for an ongoing comprehensive assessment that includes data collection (LVN data collection contribution), analysis, and drawing conclusions/making judgments in order to: formulate diagnoses and update diagnoses, formulate or change the plan of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility failed to follow physician orders for one of three sampled residents (Resident 1), as evidenced by: 1. Oxygen set at a flow rate of 3 liters per minute instead of 2 liters per minute. 2. Missing entries for G-tube (flexible hollow tube that is inserted into the stomach through abdomen used for nutrition and medication administration) 3. Dispensed blood pressure medication outside of the health parameters specifications. This failure had the potential for Resident 1's physical state to decline. Findings: 1. During an observation on 8/20/24 at 10:12 a.m., in Resident 1's room, Resident 1 was observed sleeping with a continuous flow of oxygen via nasal canula (mask) at a flow rate of 3 liters per minute. During a review of Resident 1's Physician's Orders, dated 8/19/24, the orders indicated Oxygen to be set at 2 liters per minute. During a concurrent observation and interview on 8/20/24 at 12:15 p.m., with Director of Nursing (DON) and Administrator in Resident 1's room, DON and Administrator confirmed the Oxygen set at 3…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to follow physician orders and a care planned intervention for supplemental oxygen, for one of two sampled residents (Resident 1). These failures had the potential for Resident 1 to experience resipiratory complications and lack of oxygen throughout the body. Findings: During a review of Resident 1's admission Record, undated, the admission Record indicated in part, Resident 1 had diagnoses including chronic respiratory failure (a condition that occurs when the lungs cannot get enough oxygen into the blood or eliminate enough carbon dioxide from the body) with hypoxia (low levels of oxygen in body tissues). During a concurrent observation and interview, on 8/14/24, starting at 1:15 p.m., with the Director of Staff Development (DSD 1), Resident 1 was observed wearing a nasal cannula (a medical device that provides supplemental oxygen through the nose). The DSD 1 confirmed Resident 1 was wearing a nasal canula and verbalized Resident 1 was receiving supplemental oxygen between two to three liters per minute.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure two medication carts were locked, when left unattended. These failures had the potential for residents, staff, visitors, and vendors, to have unauthorized access to medications and the potential for drug diversion. Findings: During a concurrent observation and interview, on 8/14/24, at 12:35 p.m., with Licensed Nurse (LN 1) an IV (intravenous) cart containing antibiotics was unlocked and unattended. The LN 1 verbalized the IV cart should have been locked while it was left unattended. During a concurrent observation and interview, on 8/14/24, starting at 3:29 p.m., with Licensed Nurse (LN 2) a medication cart was unlocked and unattended from 3:29 p.m., to 3:34 p.m. The LN 2 verbalized the medication cart should have been locked while it was left unattended. During a review of the facility's policy and procedure (P&P) titled, Security of Medication Cart dated 4/07, the P&P indicated in part, Medication carts must be securely locked at all times when out of the nurse's view.

Based on record review and interview the facility failed to ensure nursing staff notified the physician and the responsible party (RP) of Resident 1's change of condition (COC) within 24 hours per their policy and procedure. The facility's failure resulted in the resident's RP and physician not being notified of resident's COC in a timely manner placing the resident at risk of deterioration and causing harm to resident. Finding: A review of Resident 1's medical record was conducted on 6/13/24. The document titled SBAR/COC , dated 5/29/24 at 3:51 p.m., indicated resident had a change of condition due to having loose stools which was discovered on 5/29/24. However, the nursing staff (LVN) did not notify the physician and RP of resident's condition until 6/3/24 at 9:00 a.m., which was 5 days after the COC occurred. During a concurrent review of the SBAR/COC document and interview with the DON on 6/13/24 at 3:15 p.m., the DON acknowledged and confirmed the licensed vocational nurse (LVN) did not follow their policy regarding notification to physician and RP when there's a change of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to ensure Resident 1's assessments were performed by a registered nurse (RN) to meet professional scope of practice and standards of practice. The facility's failures place resident at risk of not being assessed appropriately and potentially resulting in harm to resident. Finding: 1.According to the Nursing Practice Act, Business & Professions Code, Chapter 6, Nursing Section 2725 indicates, .(b) The practice of nursing within the meaning of this chapter means those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill . RN is accountable for an ongoing comprehensive assessment that includes data collection (LVN data collection contribution), analysis, and drawing conclusions/making judgments in order to: formulate diagnoses and update diagnoses, formulate or change the plan of care, decide on specific…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure staff monitor Resident 1's intake and output and evaluated resident's hydration status as ordered by the physician. The facility's failure places the resident at risk of dehydration without staff identifying it. Finding: A review of Resident 1's medical record was conducted on 6/6/24 and 6/13/24. Resident 1 was a [AGE] year-old male readmitted to facility after have a cholecystectomy (gallbladder removal). The March, April, and May Order Summary Report (Physician's Orders) document indicated Initiate intake/output (I/O) for hydration every shift. Nursing Progress Note, dated 3/20/24 at 7:31 p.m., indicated, Resident had diarrhea X 4 (episodes) today. Nursing Progress Note, dated 3/21/24 at 2:53 p.m., indicated, Monitoring for having diarrhea X 3. The March ADL- Bowel Continence flow chart documentation indicated resident had loose bowel movements daily from 3/20/24 to 3/30/24. The April ADL- Bowel Continence flow chart documentation indicated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to follow a physician order, and a care planned intervention, for ensuring a wheelchair tab alarm was in place, for one of two sampled residents (Resident 1). This failure had the potential to lead to negative outcomes for Resident 1. Findings: During a review of Resident 1's admission Record undated, indicated in part, Resident 1 was admitted to the facility on [DATE], with diagnoses including a lack of coordination, difficulty in walking, and repeated falls. During a concurrent observation and interview, on 5/16/24, starting at 4:40 p.m., with the Assistant Director of Nursing (ADON 1), outside the facility's main entrance, Resident 1 was seated in a wheelchair, at a table. The Resident 1's wheelchair was observed without a wheelchair tab alarm. The ADON 1 examined Resident 1's wheelchair and confirmed there was no wheelchair tab alarm. The ADON 1 verbalized there should have been a wheelchair tab alarm on Resident 1's wheelchair. During…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interviews, review of staffing data reports, and facility policy review, the facility failed to ensure staffing data based on payroll data was submitted to the Centers for Medicare and Medicaid Services (CMS) for 1 (fourth quarter) of 4 quarters reviewed for fiscal year (FY) 2023. Additionally, the facility failed to ensure accurate and valid staffing data was submitted to CMS for 1 (first quarter) of 1 quarter reviewed for FY 2024. Findings included: Review of a facility policy titled, Reporting Direct Care Staffing Information (Payroll-Based Journal), revised in August 2022, revealed, Direct care staffing information is reported electronically to CMS through the Payroll-Based Journal system. The policy indicated, 1. Complete and accurate direct care staffing information is reported electronically to CMS through the Payroll-Based Journal (PBJ) system in a uniform format specified by CMS. The policy also indicated, 9. Direct care staffing information is submitted on the schedule specified by CMS, but no less frequently than quarterly. 10. Staffing information is collected…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interviews, and facility policy review, the facility failed to resubmit a Level I Preadmission Screening and Resident Review (PASRR) for 1 (Resident #73) of 2 sampled residents reviewed for PASRR requirements when the resident received new mental illness diagnoses. Findings included: A review of a facility policy titled, admission Criteria, revised in March 2019, revealed, 9. All new admissions and readmissions are screened for mental disorders (MD), intellectual disabilities (ID) or related disorders (RD) per the Medicaid Pre-admission Screening and Resident Review (PASARR) process. a. The facility conducts a Level I PASARR screen for all potential admissions, regardless of payer source, to determine if the individual meets the criteria for MD, ID, or RD. A review of an admission Record revealed the facility admitted Resident #73 on 03/21/2023 and most recently readmitted the resident on 11/29/2023. According to the admission Record, the resident had a medical history that included…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review, the facility failed to maintain complete and accurate medical records for one of three sampled residents (Resident 1), when Resident 1 with a diagnosis of Dementia (a decline in cognitive ability, including memory loss and thinking difficulties) was asked to sign their own medical record accounting for the personal belongings brought into the facility upon admission. This failure had the potential for medical records being inaccurate as Resident 1 was deemed to not have the capacity to understand, further questioning the accuracy of the document and items brought to facility. Findings: During a review of Resident 1's History and Physical (H&P), dated 9/8/23, the H&P indicated, Resident 1 had a diagnosis of Dementia and does not have the capacity to understand and make decisions. During a review of Resident 1's Inventory of Personal Effects (document used to log a Residents personal belongings brought into the facility), dated 9/8/23, the inventory had an illegible signature that is claimed to be that of Resident 1. During an interview on 9/25/23…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure one of four sampled residents (Resident 1), documentation was accurate when Resident 1's, Fall Risk Assessments, did not reflect Resident 1's accurate status. This facility failure resulted in Resident 1's medical record not reflecting accurate fall assessments and had the potential for Resident 1 to not receive adequate care. Findings: During a review of Resident 1's, admission Record, the record indicated, Resident 1 was admitted with diagnoses including, paralysis affecting left side following a cerebral infarction (stroke), end stage renal disease that required hemodialysis (a process of purifying the blood of a person whose kidneys are not working normal), osteoporosis (condition in which bones become weak and brittle), and fractures (broken bones). During a review of Resident 1's, Fall Risk Assessment, dated 8/2/23, the assessment indicated, Resident 1 had 1-2 falls in past 3 months, requires use of assistive devices, is on…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review the facility failed to provide an adaptive call light button device for one of 27 sampled residents (Resident 9). This failure had the potential for the resident to not receive care in a timely manner. Findings: During the tour of the facility on 4/13/2021 at 3:40 p.m., Resident 9 was observed in his bed, wearing a splint on both upper extremities (arms and hands), to keep the hands from closing due to contractures (a decrease in passive range of motion (ROM) at a joint). The call light button was placed beside the resident. During an interview on 4/15/2021 at 9:31 a.m., with the licensed nurse (LN2), LN2 stated the resident is non-verbal and has limited range of motion and contractures of the upper extremities. The resident understands when spoken to and is able to nod and shake his head in response to yes and no questions. LN2 stated Resident 9 has a regular call light but is not able to use a regular call light due to contractures of the upper extremities. During an interview on 4/15/2021, at 11:10 a.m., with the director of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview, and observation, the facility failed to ensure laundry staff wore appropriate personnel protective equipment (PPE) when cleaning a dryer lint trap. This facility failure had the potential for laundry staff to contaminate clean linen. During a concurrent interview and observation on 4/16/21, at 11:47 a.m.,with laundry staff (LS1), in the laundry room, LS1 verbalized the lint traps in the dryers were to be cleaned out every two hours. LS1 then demonstrated how the lint traps were cleaned. LS1, with an unprotected uniform, got a broom, opened the lint trap door, and proceeded to clean out the lint trap. The assistant administrator (Admin1) and infection preventionist (IP1) both confirmed LS1 should have worn a protective gown to cover her uniform while cleaning the lint trap. During a review of the facility policy and procedure (P&P) titled, Laundry and Bedding, Soiled, dated 8/09, the P&P indicated in part, Soiled laundry/bedding shall be handled in a manner that prevents gross microbial contamination of the air and persons handling the linen .Anyone who handles…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review the facility failed to monitor and report signs and symptoms of depression as indicated in the care plan for one of 27 sampled residents, (Resident 47). This facility failure has the potential to decrease the resident's quality life. Findings: During an observation and concurrent interview on 4/13/2021 at 3:09 p.m., with the certified nursing assistant (CNA1) in Resident 47's room in the resident's room, the resident was lying in bed. Resident 47 is Spanish speaking only and CNA1 was translating for the resident. During the interview the resident was observed on the verge of crying multiple times. CNA1 stated the resident is known to do this behavior. During a review of Resident 47's Care Plan for depression related to tearfulness and crying the care plan indicated an intervention to monitor/document/report to the nurse or physician signs and symptoms of depression. During a concurrent record review and interview, on 4/15/2021 at 11 a.m., with licensed nurse (LN1), Resident 47's electronic medical record (EMR) was reviewed. There was…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to follow professional standards for one of 23 sampled residents (Resident 44) and one unsampled resident (Resident 71) when: 1. Physician orders were not followed for oxygen administration for Resident 71. This failure resulted in Resident 71 not receiving oxygen per physician orders and had the potential for the resident to have breathing difficulties. 2. Physician orders and facility policy and procedures (P&P) for input and output (I&O) were not followed for Resident 44 who was dependent on a feeding tube (a flexible tube passed into the stomach for introducing fluids and liquid food and medications into the stomach). This failure had the potential for Resident 44 to become malnourished and dehydrated. Findings: Resident 71 1. During an observation on 4/13/21, at 10:25 a.m., in Resident 71's room, Resident 71 was lying supine in bed, receiving oxygen through a nasal cannula (tubing with two prongs which are placed in the nostrils to deliver supplemental oxygen) at two liters per minute (LPM). During an…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review the facility failed to address dental services for one of 23 sampled residents (Resident 1). This failure resulted in Resident 1's inability to eat regular textured foods and had the potential for unintended weight loss. Findings: During a concurrent interview and observation on 4/13/21, at 10:40 a.m., with Resident 1, Resident 1 verbalized having no bottom teeth and meals had to be soft and the meat had to be minced. Resident 1 verbalized minced meat is not appetizing. Resident 1's mouth was visualized and the bottom teeth were missing. Resident 1 stated, They are supposed to be making me some dentures. It would be nice to eat regular food. During a concurrent record review and interview on 4/16/21, at 9:40 a.m., with the director of social services (DSS1), Resident 1's Dental Evaluation, dated 12/14/20, was reviewed. The dental evaluation indicated the treatment plan was for partial upper dentures and full lower dentures. The dental evaluation further indicated the findings and treatment plan were discussed with Resident 1. DSS1…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure medication supplies were stored in a safe and sanitary manner when five (1 milliliter[1ml]) syringes were open and out of protective packaging. This facility failure had the potential to result in contamination of supplies and spread infection to residents. Findings: During a concurrent observation and interview on 4/14/21, at 10:57 a.m., with licensed nurse (LN3), at the east medication storage cart, LN3 confirmed five (1 ml) syringes were open and out of protective packaging. LN3 stated, she did not know if the syringes were clean or dirty. LN3 3 further stated, the syringes should be covered in manufacturer's packaging and then removed the syringes from the medication storage cart. During a review of the facility's policy and procedure (P&P) titled, Administering Oral Medications dated 10/2010, indicated in part . The purpose of this procedure is to provide guidelines for the safe administration of oral medications .steps in the procedure: 3. Maintain medication administration supplies, clean and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure documentation on the cool down log for egg salad in the refrigerator. This facility failure had the potential for residents to acquire a food borne illness. Findings: During a review of The California Department of Education, Temperature Controls of Potentially Hazardous Food, Nutrition Services Division Management Bulletin dated October 2018, indicated in part: Subject: The Importance of Maintaining Proper Time and Temperature Controls of Potentially Hazardous Foods Time and Temperature. Time and temperature are two of the most important factors to control in the prevention of a food borne illness . Some foods, known as PHFs (potentially hazardous foods), are at higher risk for growing harmful microorganisms; it is these microorganisms that cause a food borne illness. The following foods are considered PHF and require proper control of time and temperature: Eggs. During a review of the facility document titled, In service Topic: Cool down Log dated 3/17/21, indicated in part: Learning Objectives:…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure a container of margarine was stored at proper temperature to retain integrity of ingredients. This facility failure resulted in separation of ingredients, unpalatable appearance and had the potential for loss of flavor. Findings: During a review of the facility's policy and procedure (P&P) titled, Storage of Food and Supplies, dated 2020, the P&P indicated: Policy: Food and supplies will be stored properly and in a safe manner. During an initial tour of facility kitchen on 04/13/21, at 09:16 a.m., with the dietary supervisor (DS), a large clear container with a saran wrapped top labeled butter was on a steel counter. The container had a one-inch layer of a thick whitish ingredient on bottom, then a four inch layer of a yellow liquid, and a two inch layer of a lighter yellow liquid above that with a three inch solid yellow substance on top. The DS confirmed the container had butter in it, ingredients are separated, and contents unappealing. During an interview on 4/15/21, at 9:53 a.m. in the kitchen…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility failed to maintain a clean and sanitized kitchen when kitchen shelves had food debris and were lined with rubber liners. This facility failure resulted in an unsanitary kitchen and had the potential to attract pests and rodents. Findings: During a review of the facility's policy and procedure (P&P) titled, Storage of food and supplies, dated 2020, the P&P indicated in part: Policy: food and supplies will be stored properly and in a safe manner. 4. All shelves and storage racks or platforms should be in accordance with state and federal regulations to facilitate air circulation and promote easy and regular cleaning. Shelves and cupboards will not be lined with shelf paper or other liners. 5. Routine cleaning and pest control procedures should be developed and followed. During a concurrent observation and interview on 4/15/21 at 11:45 a.m., with the Registered Dietician (RD) and the dietary supervisor (DS) at the serving prep table in the far right corner of kitchen, the shelf below was dirty and scrunched up shelf liner.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure an effective pest control program when ants were observed in one of 23 sampled residents rooms (Resident 1's room [ROOM NUMBER]-A). This facility failure resulted in an unsanitary environment for Resident 1. Findings: During an observation on 4/13/21, at 11:00 a.m., in Resident 1's Room (room [ROOM NUMBER]-A), the wall next to Resident 1's bed had a trail of ants crawling up toward the heating vent. During a concurrent observation and interview on 4/13/21, at 12:30 p.m., with Resident 1, in room [ROOM NUMBER]-A, Resident 1 was eating lunch. Resident 1 looked up at the wall and stated, Oh, there are those ants. They come and they go. Resident 1 took her hand and wiped off some ants with her hand. Resident 1 further stated, One time they were crawling on me and in my bed. I reported it. During a concurrent observation and interview on 4/13/21, at 2:30 p.m., with the director of nursing (DON1), in Resident 1's Room (room [ROOM…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.