La Jolla Post-Acute

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure the dumpster area was clean and the dumpster lid was closed. This had the potential to affect all 140 residents who resided in the facility.

Inspectors wroteBased on interview, record review, document review, and facility policy review, the facility failed to complete a quarterly Minimum Data Set (MDS) for 10 (Residents #7, #21, #24, #27, #44, #55, #83, #94, #102, and #130) of 11 sampled residents reviewed for resident assessment.

Inspectors wroteBased on interview, record review, document review, and facility policy review, the facility failed to complete an annual Minimum Data Set (MDS) for 1 (Resident #33) of 11 sampled residents reviewed for resident assessment.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure the accuracy of the Minimum Data Set (MDS) for 2 residents (Resident #55 and Resident #71) of 27 sampled residents.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure a Level I preadmission screening and resident review (PASRR) was timely resubmitted after a resident remained in the facility longer than 30 days for 2 (Resident #120) of 6 sampled residents reviewed for PASRR. The facility further failed to ensure the accuracy of the Level I PASRR for 1 (Resident #108) of 6 sampled residents reviewed for PASRR.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to properly dispose of medication for 1 (Resident #71) of 27 sampled residents.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure medications were not left at the bedside of 2 (Resident #55 and Resident #71) of 27 sampled residents

Inspectors wroteBased on interview and record review, the facility failed to ensure POLST (Physician Orders for Life-Sustaining Treatment- a medical order that outlines a patient's preferences for end-of-life care) was correctly documented into Resident 1's medical record. As a result, Resident 1's POLST signed by the physician to a full code status was changed to a Do Not Resuscitate (DNR) status. This failure had the potential for Resident 1 to not receive the full medical treatment in the event of a medical emergency.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure three of six residents' (Resident 1, 2, and 3) medications were stored securely when: -Resident 1's medications were observed at the resident's bedside. -Resident 2 and 3 reported their medications were left at their bedsides. These failures had the potential for residents to receive the wrong medication and/or incorrect dosage which may cause clinically significant adverse consequences.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of four residents' (Resident 3) routine medication was available to be administered to the resident. As a result, Resident 3 was not consistently administered her daily thyroid medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to supply a physician prescribed condom catheter (an external apparatus that fits on the outside of the penis and drains urine into an external bag) for one of one resident (Resident 1). As a result, the facility placed an indwelling catheter (sterile flexible tube placed inside the penis, to drain urine from the bladder into an external bag). When the indwelling urinary catheter was removed, Resident 1 experienced pain, bleeding, and verbalized fear of possible future indwelling urinary catheter placements.

Inspectors wroteBased on interview and record review, the facility failed to ensure staff were competent upon hire for Licensed Nursing (LN) skills, such as the insertion of a urinary catheter for one of one staff reviewed (LN 1) for nursing competency. As a result, an indwelling urinary catheter (a sterile flexible tube placed inside the penis, to drain urine from the bladder into an external bag), was improperly inserted into Resident 1, resulting in bleeding when the catheter was removed the following day.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow infection control standards of practices when: 1. The Treatment nurse 1 (Tx LN 1) did not disinfect hands after removing gloves three out of six times while providing wound care for Resident 6. 2. Tx LN 1 did not disinfect scissors for two of two wound dressing changes for Resident 6. 3. One of three common resident shower rooms (shower between Station 1 and Station 2) was not cleaned after use. 4. Oxygen tubing was undated and was in contact with the floor for one of one resident (Resident 7). 5. A breathing treatment mouthpiece was exposed to the environment while lying on a tabletop for one of one resident (Resident 7). As a result, there was the potential for cross contamination and the spread of infection.

Inspectors wroteBased on observation, interview and record review, the facility failed to consistently monitor and document a low air loss (LAL-a mattress designed to prevent and treat skin issues) mattress, for prevention of skin injuries as ordered by the physician and listed as an intervention in the care plans for three of three residents (Resident 1, 2, and 3), reviewed for plan of care in order to maintain skin integrity. As a result, Residents 1, 2, and 3 had the potential for worsening skin injuries.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently provide wound treatments as ordered by the physician for two of three residents (Resident 1 and Resident 3) reviewed for Quality of Care. As a result, Residents 1 and 3 had the potential for delayed healing and worsening of wounds.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently implement their infection control program when: 1. Certified Nursing Assistant (CNA) 41 did not perform hand hygiene in between residents. 2. Certified Nursing Assistant (CNA) 41 did not clean and disinfect the Blood Pressure (BP) cuff in between resident use. 3. Laundry Staff (LS) 41 and LS 42 did not follow hand hygiene and gloving policy during collection of soiled linens. 4. Certified Nursing Assistant (CNA) 42 did not wear Personal Protective Equipment (PPE) in a Clostridium Difficile (C-Diff - a spore forming bacterium causing intestinal inflammation and infectious diarrhea. C- Diff infection can spread from person to person on a contaminated equipment and by contaminated hands of healthcare workers) isolation room and did not perform handwashing after contact with Resident # 265's environment. [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure policy and procedures to access resident records included verbal requests for one of twenty-three residents, Resident 15. This failure has the potential for Resident 15 to not have access to her records.

Inspectors wroteBased on observation, interview, and record review, the facility failed to protect a resident's confidential medical information for one of 23 sampled residents (80). This failure had the potential for residents' confidential medical information to be visible to unauthorized people.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for one of 23 sampled residents (15). This failure had the potential to not meet the goals of the treatment and the needs of Resident 15.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow a physician's dialysis (a treatment for people whose kidneys are failing) order for fluid restriction for one of two sampled residents (63). This failure had the potential for Resident 63 to have fluid overload (a condition of having more fluids than what a dialysis patient can tolerate).

Inspectors wroteBased on observation, interview, and record review the facility failed to communicate with hospice (end of life) services provided for two of 23 sampled residents (27,80). This failure had the potential to prevent residents from receiving coordinated hospice care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow up on an optometrist appointment for one of one sampled resident (80). As a result, Resident 80 wore broken eyeglasses since admission to the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide assistance device to 1 of 23 residents (Resident 28) when a grab bar (a safety assistive device to hold in the bathroom) was not provided in Resident 28's bathroom for safety. This failure had the potential for Resident 28 to have accident and fall that could lead to injury.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an oxygen nasal cannula (device used to deliver oxygen to a person) was changed per the facility's oxygen policy on seven of 23 sampled residents 5,14,27,28,41,60, 64) reviewed for oxygen use. This failure had the potential for residents to be placed at risk for infection.

Inspectors wroteBased on interview and record review, the facility failed to post their actual staffing hours when the facility only posted anticipated staffing for the day. As a result, the staffing information may not have been accurate.

Inspectors wroteBased on interview and record review, the facility failed to ensure the monthly MRR was completed, and the pharmacist recommendations were acted upon monthly. This failure had the potential for medications to be continued unnecessarily.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate indication for a psychotropic medication (A drug that affects emotions, mental processes, and behavior) for one of five sampled residents (27). This failure put Resident 27 at risk for receiving unnecessary medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure; 1. The disposal of two opened vials of antibiotics (medication to treat infection) per facility policy and, 2. Medication storage room was locked. These failures had the potential for all residents to receive ineffective medications and access by unauthorized personnel to medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the menus were followed when: 1. Consistent Carbohydrate (CCHO) diets were not followed for two of two residents (15,51). 2. Large portion diets were not followed for three of three residents (52,53, 54). These failures had the potential for 112 residents receiving food prepared in the kitchen to not meet their nutritional needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents' food preferences were followed for 3 of 23 final sampled residents (7, 11, 15). This failure caused the resident to not receive food they preferred.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the sanitary requirements were followed in the kitchen: a. The inside of the ice machine was not clean, and manufacturer's instructions were not followed for the ice machine cleaning and sanitizing b. A cutting board surface was heavily marred. c. Brooms and mop were stored on the floor. d. The inside of the dining bowls was not clean. e. The ice machine and three compartment sink drain did not have an air gap. f. Kitchen equipment were not air dried. These deficient practices had the potential to cause food borne illnesses for 112 residents.

Inspectors wroteBased on interview and record review the facility failed to ensure that two of 23 sampled residents (7, 48) had a completed POLST in their clinical record. The failure had the potential the residents end of life wishes may not have accurately been followed in an emergency.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure dialysis (a process to remove waste from the blood for residents with kidney disease) assessments were consistently and accurately completed for four of four sampled dialysis residents (97, 32, 39, 64). These failures had the potential for miscommunication between the facility and dialysis center and to affect the continuity and quality of care of these residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently implement their infection control program when the ice scoop was not stored in a sanitary manner. This failure had the potential to increase the risk of infection and illness to residents in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess one of 29 sampled residents (52), for safe self-administration of medication. This failure had the potential to put Resident 52 at risk for improper medication administration, and did not ensure safe storage of the self-administered medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Notify the physician of a high blood sugar reading for one of 14 sampled residents (39) receiving insulin (a medication to control high blood sugar); and, 2. Ensure three of six sampled residents (36, 49, 1) with identified nutritional concerns and weight loss were monitored with weekly weights as indicated by their care plans. As a result, Resident 39 may not have received treatment for high blood sugar, and there was the potential for Resident's 36, 49, and Resident 1 to be at risk of further weight loss.

Inspectors wroteBased on interview and record review the facility failed to ensure a resident's care plan was revised after falls for one of 29 sampled residents (16). This failure had the potential to put Resident 16 at increased risk for further falls or injury.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure nutritional recommendations by the registered dietician were not implemented for one of six sampled residents (1) with identified nutritional concerns and weight loss. This failure had the potential to contribute to further weight loss for the resident.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of two residents (308) with a peripherally inserted central catheter (PICC line- to provide access to a large vein for administration of medication for long-term use), was monitored per the physician's order. This failure had the potential to affect Resident 308's care and delay the identification of catheter-related complications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the medication error rate was less than five percent. Thirteen medication errors out of 28 opportunities were identified during medication administration, when nursing: 1. Administered nine crushed medications via PEG (Percutaneous endoscopic gastrostomy tube - a tube that is placed directly into the stomach through an abdominal wall incision for administration of food, fluids, and medications) at the same time to Resident 87. 2. Omitted one medication for Resident 87. 3. Administered the incorrect form of a medication to Resident 87. 4. Administered the incorrect form of a medication to Resident 74. 5. Omitted one oral medication for Resident 38. 6. Omitted one topical medication for Resident 38. This failure resulted in the medication error rate of 46.43%.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure; 1. Medications were stored properly. 2. Expired biological's were discarded in two of four medication carts and, 3. Medication Refrigerator temperatures were monitored for two of two medication refrigerators. This failure had the potential for unsafe storage and administration of resident medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food production was implemented in a manner that mitigated the risk for food borne illness by the lack of an air gap in the food preparation (prep) sink. This failure had the potential to place residents at risk for food borne illnesses, which could have resulted in gastrointestinal distress and weight loss.

Inspectors wroteBased on interview and record review, the facility failed to ensure hospice documentation and the hospice plan of care were up to date for one of three sampled residents on hospice services (12). As a result, the facility did not have a record of the current care the hospice agency was providing to the resident.