Desert Regional Medical Center D/P SNF

Inspectors wroteBased on observation and interview, the facility failed to ensure food was served at temperatures and with palatability consistent with resident preferences for four of 21 residents reviewed for food service (Residents 11, 18, 39, and 40). This failure resulted in residents receiving meals that were not served at expected temperatures and had the potential to diminish resident satisfaction with meals and adversely affect residents' enjoyment of dining and food intake.

Inspectors wroteBased on interview and record review, the facility failed to notify the physician when blood glucose (sugar) levels were below 70 mg/dL (milligram per deciliter) as ordered by the physician, for two of three residents reviewed for notification of change (Residents 36 and 39). This failure had the potential to delay physician evaluation, treatment, and modification of medical interventions related to hypoglycemia (a blood sugar level below normal).

Inspectors wroteBased on interview and record review, the facility failed to develop a person-centered baseline care plan for one of three residents reviewed for unnecessary medications (Resident 39) when interventions related to anticoagulation therapy were not included in the resident's baseline care plan. This failure had the potential to result in staff not consistently implementing and monitoring interventions related to anticoagulation therapy (treatment with blood-thinning medication), including monitoring for adverse effects and changes in the resident's condition.

Inspectors wroteBased on interview and record review, the facility failed to ensure physician ordered hypoglycemia management (treatment for low blood glucose [blood sugar]) was implemented and documented for two of three residents reviewed for diabetic management (Residents 36 and 39). This failure had the potential to result in inadequate management of hypoglycemic episodes (an episode of low blood glucose) and negatively affect residents' health and well-being.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure safe and sanitary food preparation and storage practices in the kitchen when: 1. One bag containing a yellow and orange colored liquid was stored in the walk-in refrigerator unlabeled and undated. 2. One package of small, round and brown dessert item was stored in the portable walk-in freezer unlabeled and undated. 3. One sandwich was stored in the resident's refrigerator inside the nourishment room unlabeled, undated, and readily available for use. These failures had the potential to cause foodborne illness (stomach illness acquired from ingesting contaminated food) in a medically vulnerable population of 23 residents who receive food in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper disposal of garbage when multiple debris items were found on the ground outside of the designated container and not stored in the appropriate container. This failure had the potential to attract pests and cause infection control issues.

Inspectors wroteBased on interview and record review, the facility failed to ensure for six of 11 residents reviewed for Advance Directive (AD - written statement of a person's wishes regarding medical treatment) (Residents 1, 5, 10, 29, 32 and 39) that: 1. Resident 5's AD was accessible in the resident's chart; and2. The facility followed up with Residents 1, 20, 29, 32 and 39 and/or Resident Representative (RP) regarding formulation of an AD.This failure had the potential to result in the ADs for Residents 1, 5, 10, 29, 32 and 39 not being readily accessible to staff and physicians, which could lead to the residents' wishes regarding medical treatment being unknown and ultimately not honored.

Inspectors wroteBased on interview and record review, the facility failed to ensure the physician's orders for fluid restriction were followed for two of two residents (Residents 29 and 40) reviewed for nutrition and hydration. These failures had the potential to:1. cause further electrolyte (minerals that help with water balance in the body) imbalance for Resident 29, and2. exacerbate heart failure for Resident 40.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure safe medication administration practices were implemented to meet the needs of the residents when: 1. One nurse was observed to not use the pill cutter to cut a medication tablet in half and instead, by hand to prepare and administer for one of four residents (Resident 10) 2. One nurse was observed to leave the resident's room before the resident finished one medication solution for one of four residents (Resident 42) 3. One blood pressure medication with hold parameters was administered not in accordance with the physician order and without clarification of the order for one of five residents reviewed (Resident 32) These failures had the potential for residents to receive inadequate medication therapy.1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide food with appetizing taste according to residents' preferences for four of 23 sampled residents (Residents 10, 23, 40, and 41). This failure had the potential to decrease the nutritional intake and negatively affect the nutrition status of Residents 10, 23, 40 and 41.

Inspectors wroteBased on interview and record review, the facility failed to develop a comprehensive, person-centered care plan to address a physician-ordered fluid restriction for one of one resident (Resident 40) reviewed. This failure resulted in Resident 40's fluid restriction not being incorporated into the plan of care, which had the potential to exacerbate resident's congestive heart failure (a condition which causes fluid buildup in the body) and compromise his overall health status.

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure for the two-step tuberculosis (TB - an infectious disease which affects the lungs or other parts of the body) screening, a requirement for the annual health examinations, for two of eight staff members reviewed. This failure had the potential to place staff and vulnerable residents at risk for exposure to infection.

Inspectors wroteBased on interview and record review, the facility failed to notify the resident ' s representative, of a transfer to the Emergency Department (ED) for further evaluation of agitation for one of three residents (Resident 1). This failure resulted in Resident 1 ' s Representative not being informed of the transfer to the ED, limiting their ability to participate in the resident's medical care decisions to the extent deemed possible.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure dementia (memory loss) training was provided to one of two sampled employees (CNA1). This failure had the potential to result in staff lacking the necessary skills to manage and care for residents with dementia effectively.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, and serve food in a sanitary manner, in accordance with professional standards for food service safety, as evidenced by: 1. Rodent droppings and evidence of nesting (collection of clutter, trash, and debris) was found in the cooking line area of the kitchen, as well as an accumulation of grease and black grime and food, this had the potential to transmit disease to patients by contaminating food and food contact surfaces. In addition, a convection oven (oven that has fans to circulate air around food), a steamer, three ovens, one fryer and a broiler had an accumulation of grease and food grime build-up. This had the potential to attract pests and for microorganism (a microscopic organism, especially a bacterium, virus, or fungus) growth that could be inadvertently transferred to food. 2. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the lunch menu served on February 27, 2024, met the nutritional need of 15 out of 16 residents in accordance with established national guidelines. This failure had the potential for residents not to receive the caloric intake needed, when the established menu was not followed, which could result in poor nutrition and further compromise the residents' medical status.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program to keep the facility free of pests and rodents when: 1. There were rodent droppings and evidence of nesting found in the cooking line; 2. There was not a set schedule for the pest control company to service the kitchen; and 3. Recommendations made by the pest control company were never implemented. These failures created an environment attracting rodents and the potential contamination of food and kitchen equipment used to supply meals to 15 out of 16 vulnerable residents, who are put at risk for food-borne illness (caused by food contaminated with bacteria, viruses, parasites, and toxins).

Inspectors wroteBased on observation, interview, and record review, the facility failed, for two employees observed, to ensure infection control policy and procedures for hand hygiene and personal protective equipment (PPE) were implemented when: 1. RN 2 did not perform hand hygiene before donning gloves on two occasions. In addition, RN 2 did not remove gloves after direct patient care and exited the room to enter another resident's room. 2. One Certified Nursing Assistant (CNA 1) did not perform hand hygiene upon entering and exiting a resident's room and after providing direct patient care. These failures had the potential to spread infection and compromise the overall health of residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain essential kitchen equipment in a safe operating condition, as evidenced by multiple pieces of equipment out of service and not being clean or maintained. These failures led to harborage conditions in the kitchen that was attracting pest and the potential for cross contamination and foodborne illness in 15 out of 16 medically compromised residents who received food from the kitchen.

Inspectors wroteBased on interview and record review, the facility failed to ensure the pharmacist recommendation to reduce the number of anticoagulants (medications to reduce or prevent blood from clotting) from two medications to single medication was acted upon by providing a rationale for not reducing the number of anticoagulants (medications that reduce or prevent blood from clotting), for one of five residents reviewed for unnecessary medications (Resident 76). This failure had the potential to result in adverse consequences related to anticoagulant therapy.

Inspectors wroteBased on interview and record review, the facility failed to designate a person to serve as the Director of Food and Nutrition Services (DFANS), who meets the State requirements for food service managers or dietary managers. This failure resulted in a lack of oversight in the kitchen which led to unsanitary conditions being present and an Immediate Jeopardy being called because of the presence of evidence of pests (cross reference F812). This facility failure had the potential to affect 15 out of 16 medically compromised residents who receive food from the kitchen.

Inspectors wroteBased on interview and record review, the facility failed to report an allegation of verbal abuse within 2 hours to California Department of Public Health (CDPH) after the allegation was made, for one of four residents reviewed (Resident 1). This failure had potential to result in further abuse for Resident 1, affecting the resident's physical, emotional, and psychosocial well-being.