Country Manor La Mesa Healthcare Center

Inspectors wroteBased on observation, interview, and record review, the facility failed to coordinate resident's care needs with the rehabilitation (help residents regain strength and independence) services for one of three sampled residents (1) when Resident 1's weight-bearing status (amount of weight that can be put on an injured body part) was changed from NWB (no weight-bearing, not allowed to put any weight) to WBAT (weight-bearing as tolerated, may put weight on affected injured body parts). As a result, the physical therapist (PT- helps residents regain function and manage pain and disabilities through various treatments) was not able to promptly address Resident 1's needs, which could lead to a slower recovery.

Inspectors wroteBased on record review and interview, the facility failed to notify one (Resident 8) of four resident ' s representative reviewed for resident rights when: 1. The resident ' s representative was not notified of new orders for lab and a medication, 2. The resident ' s representative was not notified of a new order for insulin, 3. The resident ' s representative was not notified that the insulin was not administered according to the Nurse Practitioner ' s (NP-a registered nurse with advanced training and education qualified to treat certain medical condition without the direct supervision of a doctor) order, 4. The resident ' s representative was not notified of the NP ' s order for a medication. This failure resulted in the resident ' s representative to not be informed of Resident 8 ' s condition and the plan of care.

Inspectors wroteBased on interview and record review the facility failed to provide a medication for an elevated blood sugar for one of four residents (Resident 8) reviewed for quality of care. This failure had the potential for further decline in Resident 8 ' s medical condition.

Inspectors wroteBased on interview and record review, the facility failed to promptly notify the registered dietitian (RD) and physician when one of four residents, (Resident 1), with a compromised medical status, consumed less than 50% of his meals for more than three consecutive days, according to facility policy and standards of practice. This failure led to further decline in Resident 1's nutrition and medical status and contributed to the resident's severe unintentional weight loss of 16 pounds (7.83%) in 16 days.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure three of six residents, who were unable to carry out activities of daily living (ADL-self- care activities such as grooming, bathing, and toileting), received assistance with nail care (cleaning, trimming and/or filing of nails) and shaving. (Resident 21, 57 and 67) This failure resulted in residents having long, dirty fingernails, a thick beard and moustache which had the potential to negatively impact the residents' self-esteem and comfort.

Inspectors wroteBased on observation and interview, the facility failed to ensure the kitchen staff followed a recipe during food preparation. As a result, there was a potential the taste of the food was affected.

Inspectors wroteBased on interview and record review the facility's Quality Assessment and Assurance Committee (QAA-facility group that monitors concerning trends in a facility) failed to identify and include in the facility's Quality Assurance Performance Improvement plan (QAPI-plan developed by QAA to help improve conditions in the facility) deficient trends found by surveyors during the recertification survey concerning grooming/hygiene and the management of residents with Post Traumatic Stress Disorder (PTSD- a mental health condition that's caused by an extremely stressful or terrifying event - either being part of it or witnessing it). This failure had the potential for facility to overlook trends in resident care that might have affected residents' health and quality of life. Cross Reference:

Inspectors wroteBased on observation and interview, the facility failed to maintain a resident's electric fan filled with gray dust for one of 18 residents reviewed for home like environment. (Resident 57) This failure had the potential to affect the resident's self-esteem living in an unkempt environment and the risk for respiratory issues from inhaling dust from the electric fan.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure two of three residents (Resident 26 and 46) reviewed for Trauma Informed Care (TIC - an intervention and organization approach that focuses on how trauma may affect an individual's life and his or her response to behavioral health), received care and services in accordance with professional standards when Resident 26's and 46's diagnosis of PTSD (Post-traumatic stress disorder - a disorder that may occur in people who have experienced or witnessed a traumatic event) were not identified and addressed by the facility. [...]

Inspectors wroteBased on interview and record review, the facility failed to indicate the appropriate indication for the use of anticoagulant (blood thinner) medication for one of three residents (Resident 51) reviewed for unnecessary medications. This failure had the potential for unnecessary medication use and had the potential to negatively impact the resident's well-being.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to indicate the appropriate and measurable target behavior of antipsychotic (medication used to treat the symptoms of mental illness) medication and psychotropic (mind-altering medications) medication for two of six residents reviewed for unnecessary psychotropic medication use (Resident 6 and Resident 52). This failure had the potential for unnecessary psychotropic medication use, its side effects, and a decline for residents psychological and mental well-being.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure provision of hospice services (a special kind of care that focuses on a person's quality of life and dignity as they near the end of their life) for one of two residents (Resident 67) reviewed for hospice when: 1. The facility did not have documentation of hospice staff visits, 2. There was no schedule when a resident will be visited by hospice staff, 3. The facility did not have an agreement with the hospice agency. This failure had the potential to put Resident 67 at risk for uncoordinated medical care between the facility and the hospice agency. In addition, Resident 67's ADL need for grooming was not met.

Inspectors wroteBased on observations, interview, and record review the facility failed to ensure infection control procedures were followed when a Licensed Nurse (LN) 12 did not wear a gown for Resident 55 with enhanced barrier precautions (EBP - involves gown and glove use during high-contact resident care activities for residents [example: residents with medical devices]), and perform hand hygiene (the practice of cleaning hands to remove germs, dirt, or other harmful substances) consistently after removing his gloves while passing medication (med/s) during med pass observation. These failures had the potential for cross contamination, spread of infection and Resident 55's decline of health.

Inspectors wroteBased on interview and record review the facility failed to follow the professional nursing standards of practice when: 1. Nursing staff failed to notify the physician when a blood sugar (the concentration of glucose in the blood) level was over 250 milligrams per deciliter (mg/dl- normal range is 70 -100 mg/dl), for one of four residents (Resident 1), reviewed for following the physician ' s plan of care; and, 2. Nursing staff did not use standard medical abbreviations to describe specific body sites of where a subcutaneous injection (medication administered into the fatty tissue, just under the skin) of insulin (a hormone our body produces to keep our blood glucose levels within the normal range), for two of four residents (Residents 1 and 2), reviewed for services meeting professional standards of practice. As a result: 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to prevent a deep tissue injury (DTI-pressure-related injury of intact skin with non-blanchable {discoloration of the skin that does not turn white when pressed}, redness in a localized area, usually over a bony prominence), from developing after admission for one of four residents (Resident 1) reviewed for skin-related injuries. OR As a result, Resident 1 developed a DTI, measuring 15 centimeters (cm) in length by 17 cm in width in size, which resulted in delayed healing and a delayed recovery process.

Inspectors wroteBased on interview and record review, the facility failed to ensure insulin injection sites were rotated before administration for one of four residents (Resident 1), reviewed for pharmacy services. As a result, there was the potential for Resident 1 to experience increased bruising, pain, and possibly a decreased absorption of medication due to repeatedly used injection sites.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff and visitors followed the protocol for transmission-based precautions for residents under investigation for COVID-19. This failure had the potential to allow COVID-19 to infect staff, visitors, and residents.

Inspectors wroteBased on observation and interviews, the facility failed to ensure food was served in a safe manner when [NAME] 1 (C1) did not use appropriate hand hygiene or change gloves between tasks. As a result, there was a potential to place residents at risk for food borne illness.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 6 out of 78 sampled residents (28, 29, 31, 37, 68 and 97) had access to their call light button when they were not within reach. As a result, there was a potential to put residents 28, 29, 31, 37, 68 and 97 at risk for injury.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement care plans for two of 25 sampled residents (54,10). 1. As a result Resident 54's interventions and goals for self administration of medications was not identified or addressed

Inspectors wrote2. Resident 39 was re-admitted to the facility on [DATE] with diagnosis of Type 2 Diabetes Mellitus (a problem with your body that causes blood glucose (sugar) levels to rise higher than normal), Diabetic Neuropathy (nerve damage that is caused by diabetes). and Peripheral Vascular Disease (a disease that causes restricted blood flow to the arms, legs, or other body parts), per the facility's admission Record. Observations of Resident 39 were conducted: On 9/17/19 at 9:26 A.M. On 9/18/19 at 7:19 A.M. On 9/19/19 at 8:30 A.M. On 9/20/19 at 7:25 A.M. Resident 39 was lying in bed without her Z-flex boots on both feet. Observations of Resident 39 sitting in her wheelchair with one z-flex boot on her left foot and none on her right foot. On 9/18/19 at 11:40 A.M On 9/19/19 at 11A.M. On 9/19/19 at 11:30 A.M. an interview and record review were conducted with LN 1. [...]

Inspectors wroteThe facility failed to ensure 1 of 25 sampled residents' medications were were not locked in a bedside table drawer. As a result there was potential for theft, diversion, and access by other residents, staff or visitors.

Inspectors wroteThe facility failed to provide diet preferences for 4 of 25 sampled residents (12,13, 21,77). As a result substitutions of equal nutritive value were not offered to Residents 12, 13, 21, and 77.