Healthbridge Children's Hospital - Orange D/P SNF

Inspectors wroteBased on observation, interview, medical record review, document review, and facility P&P review, the facility failed to ensure the necessary care and services were provided to prevent the risk and development of pressure injuries for two of three final sampled residents (Residents 19 and 23) reviewed for pressure injuries. * The facility failed to ensure Resident 19's low air loss mattress setting was accurate and on alternate mode setting. * The facility failed to ensure Resident 23's low air loss mattress settings were accurate and failed to obtain a physician's order specifying the low air loss mattress setting. These failures placed Residents 19 and 23 at risk for the development or worsening of pressure injuries and to not benefit from the therapy provided by the LAL mattress.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure appropriate care and services were provided for six of 19 residents (Residents 1, 6,10, 11, 17, and 22) receiving enteral feeding. * LVN 3 failed to verify GT placement prior to administering medications for Residents 1 and 17. * RN 3 failed to verify GT placement prior to administering medications for Resident 6. * LVN 4 failed to verify GT placement prior to administering medications for Resident 10. * The facility failed to ensure Resident 11's HOB (head of bed) was elevated to a minimum of 30 degrees during NGT feeding. * The facility failed to ensure Resident 22's HOB was elevated to a minimum of 30 degrees during the GT feeding. In addition, LVN 3 did not verify the GT placement prior to administering medications through the tube. [...]

Inspectors wroteBased on observation, interview, medical record review, facility document review, and facility P&P review, the facility failed to ensure three of four licensed nurses observed for medication administration demonstrated competency verifying GT placement prior to administering medications (LVNs 3 and 4 and RN 3). * LVN 3 failed to verify the GT placement prior to administering the medications for Residents 1, 17, and 22. * RN 3 failed to verify the GT placement prior to administering the medications for Resident 6. * LVN 4 failed to verify the GT placement prior to administering the medications for Resident 10. These failures had the potential to place the residents at risk for unsafe and improper care, including aspiration and complications related to incorrect tube placement.

Inspectors wroteBased on observation, interview, facility document review, and facility P&P review, the facility failed to ensure the sanitary conditions were maintained in the kitchen. * The facility failed to ensure the hood over the stove was maintained in a sanitary condition. * The facility failed to ensure the kitchen utensils had a smooth cleanable surface and were kept in good repair. * The facility failed to ensure the kitchenware and kitchen utensils were clean and free of food particles or residue. * The facility failed to ensure the cutting boards were maintained in a sanitary condition and had smooth, cleanable surfaces. These failures had the potential for cross contamination and foodborne illnesses to the two residents consuming the food prepared in the facility's kitchen.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to ensure the garbage was properly stored in three of three garbage dumpsters. * The facility failed to ensure the two garbage dumpster lids had fully closed lids and one dumpster had a lid in place. This failure had the potential to attract pest/rodents that carried diseases.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to implement the infection control practices designed to provide a safe and sanitary environment for four of nine residents (Residents 1, 17, 18, and 22) observed during medication administration observation. * During the medication administration observation for Resident 1, LVN 3 failed to don PPE gown for EBP precautions. In addition, LVN 3 failed to perform hand hygiene in between the glove changes. * During the medication administration observation for Residents 17 and 22, LVN 3 failed to don PPE gown for EBP precautions. * The facility failed to ensure RN 6 donned PPE, including gloves, prior to taking Resident 18's vital signs in an EBP room. These failures posed the risk for transmission of infection to residents, staff, and visitors.

Inspectors wroteBased on interview, medical record review, facility document review, and facility P&P review, the facility failed to ensure the antibiotic stewardship program was monitored, and addressed the use of the antibiotics for two of 12 final sampled residents (Residents 3 and 19) and one nonsampled resident (Resident 9). * The facility failed to monitor and address the use of antibiotics when the resident's condition did not meet McGeer's criteria. This failure had the potential for antibiotics to be used when it was not indicated and the development of antibiotic-resistant bacteria.

Inspectors wroteBased on observation, interview, and medical record review, the facility failed to ensure the resident's dignity was maintained for two of 12 final sampled residents (Residents 3 and 23). * The facility failed to ensure Resident 3 and 23's indwelling urinary catheter drainage bag were covered. These failures had the potential to negatively affect the residents' sense of dignity and well-being.

Inspectors wroteBased on interview, medical record review, facility document review, and facility P&P review, the facility failed to implement their abuse P&P for one of 12 final sampled residents (Resident 19). * The facility failed to assess Resident 19 when the resident reported an allegation of abuse against a staff member. In addition, the facility failed to monitor Resident 19 after Resident 19 reported an allegation of abuse. These failures posed the risk for the delay of identifying the negative outcomes to the resident and implementation of the necessary interventions after a report of an allegation of abuse.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to develop a care plan for two of 12 final sampled residents (Residents 5 and 19). * The facility failed to develop a care plan to address Resident 5's use of anticoagulant medication. * The facility failed to develop a care plan to address Resident 19's use of bilateral side rails. These failures had the potential for the resident needs not being communicated to the IDT, placing the residents at risk of not being provided with appropriate, consistent, and individualized care.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to provide the necessary care and services to ensure one nonsampled resident (Resident 17) was free from accident hazards. * The facility failed to provide padded side rails for seizure (a sudden, uncontrolled electrical disturbance in the brain which can cause uncontrolled jerking, blank stares, and loss of consciousness) precautions per the physician's order for Resident 17. This failure placed Resident 17 at risk for serious injury.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to provide the necessary respiratory care services for two of 12 final sampled residents (Residents 4 and 10) reviewed for respiratory care. * The facility failed to ensure Resident 4 and 10's oxygen tubing were stored in a sanitary condition when not in use. These failures had the potential to negatively affect the respiratory health and well-being of the residents in the facility.

Inspectors wroteBased on interview, observation, medical record review, and facility P&P review, the facility failed to provide pharmaceutical services to meet the resident's need for one of nine residents observed during the medication administration observation. * LVN 3 failed to ensure Resident 22's eye medications were administered per the physician's order. This failure had the potential to negatively affect Resident 22's well-being.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to ensure the accuracy of the medical record for one nonsampled resident (Resident 18) was accurate. * Resident 18's medical record contained behavior and side-effect monitoring for the use of the quetiapine (antipsychotic) medication; however, there was no physician's order for the quetiapine medication. This failure had the potential for the resident's care team having inaccurate information.

Inspectors wroteBased on interview, observation, medical record review, and facility P&P review, the facility failed to ensure the comprehensive plan of care was revised to reflect current care needs and interventions for three of 12 final sampled residents (Residents 3, 11, and 23) and one nonsampled resident (Resident 17). * The facility failed to revise Resident 11's care plan to address Resident 11's hospitalization on 3/9/26. * The facility failed to revise Resident 17's care plan for seizure precautions to include padded side rails. * The facility failed to ensure Resident 23's care plan for wound care management was revised to include the use of the low air loss mattress. * The facility failed to ensure Resident 3's care plan for bilateral side rails was revised to remove the intervention of padded side rails. [...]

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to implement their abuse P&P for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150 B of the Social Security Act for one nonsampled resident (Resident 12) as evidenced by: * The facility failed to ensure the reporting of Resident 12's sexual abuse allegation to the local State and Federal agencies in a timely manner. This failure posed the risk for the abuse allegation going unreported and uninvestigated.

Inspectors wroteBased on interview, medical record review, and the facility P&P review, the facility failed to implement their abuse P&P related to the investigation of sexual abuse for one nonsampled resident (Resident 12). This failure had the potential for not taking all the necessary corrective actions to protect Resident 12 and other residents from abuse.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to develop and implement the individualized care plans for two of 12 sampled residents (Residents 4 and 19) and one nonsampled resident (Resident 12). * The facility failed to develop a care plan problem to address the resident's family member education regarding the use of gown and glove during high-contact interactions with the resident. This failure posed the risk for Resident 4 to be infected and spread the infection. * The facility failed to ensure the care plan problem for the use of the mechanical lift was implemented when Resident 12 was tansferred by one staff using the mechanica lift instead of two staff assistance. This failure posed the risk of Resident 12 for injury or fall. [...]

Inspectors wroteBased on observation, interview, and medical record review, the facility failed to revise the care plan for one of 12 final sampled residents (Resident 17) and one nonsampled resident (Resident 12). * Resident 12's plan of care was not revised to reflect an abuse allegation reported. * Resident 17's plan of care was not revised to reflect the resident's use of bilateral afo to lower extremity. These failures posed the risk of the residents to not receive the appropriate care.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of 12 final sampled residents (Resident 1) received the appropriate treatment and services to prevent the occurrences of complications from the GT feeding. * The facility failed to ensure Resident 1's head of bed was positioned safely at 30 to 45 degrees during the GT feeding to reduce the risk of aspiration. In addition, the facility failed to ensure Resident 1's tube feeding formula was properly labeled. These failures posed the risk for developing complications related to GT feedings, which had the potential to negatively impact the resident's well-being.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to provide the necessary respiratory care and services for two of 12 final sampled residents (Residents 7 and 9). * The facility failed to ensure Resident 7's cool aerosol therapy (treatment that uses mist of medicine to help relieve upper airway issues by loosening phlegm) plastic bag was dated as per the facility's P&P. * The facility failed to ensure Resident 9's suction canister (bottle connected to suction machine to collect the secretions like phlegm, mucous during suctioning ) was dated when it was installed and hooked to the suction machine (medical device that removes obstructions from a patient's airway by clearing from secretions). These failures had the potential for increased risk of infection.

Inspectors wroteBased on observation, interview, medical record review, and facility's P&P review, the facility failed to ensure one of 12 final sampled residents (Resident 273) were free from the unnecessary psychotropic medications. * The facility failed to monitor the episodes of OMS as one of the behavior manifestations and side effect monitoring for alprazolam (anxiety medication) and sertraline (antidepressant medication) medications for Resident 273. In addition, both medications had the same indication. This failure had the potential for inaccurate behavior and side effects monitoring, which might cause the physician for not having the necessary information to determine the effectiveness of the medications for Resident 273.

Inspectors wroteBased on observation, interview, medical record review, facility document review, and facility P&P review, the facility failed to ensure the residents' medications and biologicals were properly stored and labeled for two of 12 final sampled residents (Residents 4 and 273). In addition, the facility failed to ensure three of six medication carts had no expired supplies and medication. * Resident 4 had a six ounce tube of Triad hydrophilic wound dressing (used to provide a moist wound healing environment) with CMC (cellulose gum) at the bedside table. * Resident 273 had a 22-gram tube of mupirocin (used to treat skin infections) 2% ointment and a 60-gram tube of Venelex wound dressing (used to cover wounds) on the bedside table. * Medication Cart 2 had eight packets of SurePrep protective wipe (skin protectant) with an expiration date of [DATE]. [...]

Inspectors wroteBased on interview and facility document review, the facility failed to submit the complete and accurate direct care staffing information to CMS. This failure posed the risk of inaccurate auditable data reporting.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to ensure the resident care equipment was kept in safe operating condition as evidenced by: * The facility's mechanical lift stopped working during the transfer for one nonsampled resident (Resident 12). * The ice buildup was observed in the enteral feeding refrigerator. These failures posed the risk for equipment hazards or unsafe practices which could affect the residents' well-being in the facility.

Inspectors wroteBased on observation, interview, and medical record review, the facility failed to ensure one nonsampled resident (Resident 12) was assisted with her meals in a timely manner. This failure had the potential for Resident 12 not enjoying her meals at an appetizing temperature.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to provide a safe, clean, homelike environment for one of 12 final sampled residents (Resident 8). * Resident 8 was residing in Room A. Room A had a supply cabinet drawer that was difficult to pull open and with thin wood material coming out from the face of the drawer. In addition, the wall near the call light system had chipped off blue paint. These failures had the potential to negatively impact the resident's quality of life.

Inspectors wroteBased on interview and medical record review, the facility failed to ensure a copy of the Notice of Transfer/Discharge was sent to the LTC Ombudsman for one of one final sampled resident (Resident 19) reviewed for hospitalization. This failure posed the risk of the LTC Ombudsman not being aware of the circumstances should an appeal be filed by the resident or their representative regarding the transfer/discharge and the risk of the residents or their representative not being aware of their rights prior to the transfer/discharge from the facility.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to implement their P&P for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act when the facility did not report an allegation of abuse to the CDPH, L&C program for one of two sampled residents (Resident 1). This failure had the potential for the abuse allegation going unreported and uninvestigated.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to thoroughly investigate an allegation of abuse for one of two sampled residents (Resident 1) when Resident 1 was allegedly abused by an unknown staff on 9/11/24. This failure posed the risk for the potential abuse to remain unidentified and for the residents to go unprotected.

Inspectors wroteBased on interview, facility documemt review, and facility P&P review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe and sanitary environment to help prevent the transmission of communicable diseases and infections. * The facility failed to ensure the water management program was established and implemented to include an assessment of the facility water systems to identify where Legionella (a bacterium commonly found in natural and man-made aquatic environments, warm stagnant water) and other opportunistic pathogens can grow and spread; implementation of measures to prevent the growth of Legionella and other opportunistic pathogens; and a way to monitor the measures they have in place. This failure increased the risk for the spread of infection.

Inspectors wroteBased on observation, interview, medical record review, and facility document review, the facility failed to ensure the residents' entrapment assessments were complete and the measurements were recorded during the bed inspection when identifying areas of possible entrapment with the use of side rails for six of 12 final sampled residents (Residents 1, 7, 9, 10, 17, and 22). These failures had the potential to negatively impact the residents resulting in possible entrapment, serious injury, and death.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of 12 final sampled residents (Resident 21) was free from the physical restraints. * The facility failed to conduct an assessment and implement the least restrictive measures prior to applying a mitten (mitten which look like boxing gloves with a Velcro or tie at the wrist to hold them in place and immobilize the resident's fingers) to Resident 21's hand and abdominal binder. In addition, the facility failed to obtain an informed consent from the responsible party for the use of hand mitten and abdominal binder. These failures posed the risk of compromising the residents' independence and psychosocial well-being.

Inspectors wroteBased on observation, interview, and medical record review, the facility failed to develop the comprehensive person-focused care plans for four of 12 final sampled residents (Residents 1, 8, 10, and 21). * The facility failed to develop a care plan problem for Resident 1's use of lap tray (a removable stable surface which can be attached to the wheelchair designed to lean on for support, provide activity, and feeding surfaces) while in the wheelchair for positioning. * The facility failed to develop a care plan problem for Resident 8's use of tobramycin (antibiotic) medication. * The facility failed to develop a care plan problem for Resident 10's use of side rail in bed. * The facility failed to develop a care plan problem Resident 21's use of the mittens and abdominal binder restraints. [...]

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to provide the necessary care and services to prevent accidents for four of 12 final sampled residents (Residents 4, 7, 11, and 22). * The facility failed to ensure Resident 11's vital signs were taken, and neurological assessment was completed after a fall incident on 2/20/24, to which a care plan problem was only initiated on 2/29/24. In addition, the medical record did not show the facility addressed the causative factors of the fall and consulted the pharmacist and the physical therapist as per the care plan. Furthermore, the medical record did not show an IDT review was conducted as per the facility's P&P on falls. * The facility failed to ensure Resident 4's stroller was strapped while the resident was in the stroller as per the physician's order. [...]

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to provide the necessary care and services to maintain the intravenous accesses for one of 12 final sampled residents (Resident 21). * The facility failed to ensure the CVAD (Central Venous Access Device - a type of intravenous catheter) line external catheter measurements were completed and documented in the medical record for Resident 21. In addition, the facility failed to develop a plan of care for the use of CVAD. These failures had the potential to delay the identification of catheter related complications for the resident.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure the mechanical ventilation tubing setup bag for one of 12 final sampled residents (Resident 9) was labeled in accordance with the facility's P&P. This failure posed the risk for the resident's equipment to be contaminated which had the potential for increased risk of infection.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure the least restrictive alternatives were attempted prior to the use of side rails for one of 12 final sampled residents (Resident 9). This failure had the potential to put the resident at risk for entrapment and serious injury.

Inspectors wroteBased on interview, medical record review, and facility P&P review, the facility failed to ensure the Pharmacy Consultant's recommendations from the drug regimen review were acted upon for two of 12 final sampled residents (Residents 4 and 11). * The Pharmacy Consultant's recommendation to add blood pressure monitoring to the Diuril (diuretic) medication order in the MAR for Resident 11 was not acted upon. * The Pharmacy Consultant's recommendation to discuss with the primary physician to evaluate the need for the continuation of the Culturelle (supplement) medication, and to add the word for chronic use to the medication order if it was for chronic use was not acted upon for Resident 4. These failures had the potential to put the residents at risk for adverse consequences related to the medications.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of 12 final sampled residents (Resident 9) were free from unnecessary psychotropic (any drug that affects brain activity) medications. * The facility failed to monitor episodes of crying inconsolably as one of the behavior manifestations for Risperdal (antipsychotic) medication for Resident 9. The facility failed to ensure Resident 9's monthly behavior summary and monthly summary of the side effects monitoring were accurate related to the use of Risperdal medication. In addition, the facility failed to document the implementation of the non-pharmacological interventions prior to the use of the Risperdal medication. Furthermore, the facility failed to ensure there was a monthly summary of the side effects monitoring related to the use of the diazepam (sedative) medication. [...]

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure the staff implemented the proper storage, labeling, and disposal of medications in a safe manner. * The facility failed to dispose of the discontinued medications in Medication Room A. * The facility failed to ensure the medications administered orally were stored separately from the externally used medications inside Medication Cart A. These failures had the potential to result in the unsafe medication administration and cross-contamination of the medications.

Inspectors wroteBased on observation, interview, and facility P&P review, the facility failed to ensure the sanitary requirements were met in the kitchen as evidenced by: * The facility failed to ensure the expired and moldy food items in the refrigerator were discarded. * The facility failed to remove a bag of beef patties with freezer burns. * The facility failed to store a bag of sausage patties properly. * The facility failed to air-dry four cutting boards. * The facility failed to ensure the cutting boards were in sanitary condition. These failures had the potential for food broone illness.

Inspectors wroteBased on interview, medical record review, facility document review, and facility P&P review, the facility failed to implement an accurate antibiotic stewardship program. The facility failed to include the residents on long-term antibiotic in the surveillance listing for two of 21 final sampled residents (Residents 1 and 8). This failure posed the risk of inaccurately identifying residents met the indication of antibiotic use, and inappropriate antibiotic use.

Inspectors wroteBased on interview and medical record review, the facility failed to ensure for an accurate assessment was completed for one nonsampled resident (Resident 14). * The staff failed to complete the comprehensive assessment for discharge. This failure had the potential for a follow-up change in the resident's care needs not being identified.

Inspectors wroteBased on observation, interview, medical record review, and facility P&P review, the facility failed to ensure the comprehensive plan of care for one of 12 final sampled residents (Resident 21) was revised to reflect the resident's current care needs and interventions. * Resident 21's plan of care was not revised to address Resident 21's padded side rails use. This failure posed the risk for not providing Resident 21 with individualized and person-centered care.

Inspectors wroteBased on interview, medical record review, facility document review, and facility P&P review, the facility failed to provide the necessary care and services to attain or maintain the highest practicable well-being for one of six sampled residents (Resident 1). * The facility failed to ensure the licensed nurse used the approved devices to locate Resident 1's vein during the blood draw as per the facility's P&P. Resident 1 sustained a blister to the left foot from the licensed nurse's LED (light emitting diode) flashlight used during the blood draw. This failure had the potential to negatively impact the resident's well-being.

Inspectors wroteBased on interview and medical record review, the facility failed to develop the comprehensive plans of care to reflect the individual care needs for one of six sampled residents (Resident 1). * The facility failed to develop a care plan problem to address Resident 1's neck redness under the tracheostomy [a procedure to help air and oxygen reach the lungs by creating an opening into the trachea (windpipe) from outside the neck] tie, change of condition manifested by elevated temperature, and blister on the left foot. This failure posed the risk of not providing appropriate, consistent, and individualized care to Resident 1.