Beach Creek Post-acute

Review of the facility's P&P titled Oxygen Administration revised 6/5/23, showed oxygen is administered to residents who need it, consistent with professional standards of practice, the comprehensive person-centered care plans, and the resident's goals and preferences.

Oxygen is administered under orders of a physician.

Medical record review for Resident 13 was initiated on 1/6/25. Resident 13 was admitted to the facility on [DATE].

Review of Resident 13's H&P examination dated 11/7/24, showed Resident 13 had a diagnosis of COPD.

Review of Resident 13's physician's orders showed an order dated 1/4/25, to administer supplemental oxygen at a rate of two liters per minute, to keep Resident 13's oxygen saturation at 92% or greater.

On 1/6/25 at 0750 hours, an observation was conducted of Resident 13. Resident 13 was observed lying in bed with continuous oxygen being administered through an oxygen concentrator, at a rate of four and a half liters per minute via nasal cannula.

On 1/6/25 at 0833 hours, an observation, and concurrent interview was conducted with LVN 8. Resident 13 was observed lying in bed with continuous oxygen being administered through an oxygen concentrator, at a rate of four and a half liters per minute via nasal cannula. Resident 13 stated she received oxygen for shortness of breath. LVN 8 verified Resident 13 was receiving continuous oxygen at a rate of four and a half liters per minute, however, the physician's order showed to administer continuous oxygen at a rate of two liters per minute (to maintain Resident 13's oxygen saturation at 92% or greater). LVN 8 obtained Resident 13's oxygen saturation, while Resident 13 was receiving continuous oxygen at a rate of four and a half liters per minute, which yielded a result of 92%. LVN 8 then lowered Resident 13's oxygen rate to two liters per minute (as per the physician's order) and obtained Resident 13's oxygen saturation, which yielded a result of 86%. LVN 8 stated he would notify Resident 13's physician of Resident 13's change of condition (Resident 13's oxygen saturation of 86% on two liters per minute of continuous oxygen).

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

• LVN 6 acknowledged and verified the above findings. LVN 6 stated the CNAs document the

On 1/9/25 at 1408 hours, an interview and concurrent medical record review was conducted with the

documenting the resident's fluid intake on the Documentation Survey Report for CNAs for Fluid Intake in regards to the fluid consumed by the resident from the water pitcher at bedside, nourishments and the fluids served with the meals.

The DON further stated the licensed nurses were expected to collaborate with the CNAs to calculate the resident's total intake, including the fluid intake alloted for nursing per the physician's order.

The DON verified the inconsistency of the documentation of the resident's intake from the MAR by the licensed nurses and Documentaion Survey Report by the CNA.

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

Review of Resident 118's H&P examination dated 7/3/24, showed Resident 118 had the capacity to understand and make decisions.

Review of Resident 118's Order Summary Report showed a physician's order dated 7/2/24, to administer buprenorphine HCI (schedule III narcotic analgesic medication to treat opioid or narcotic dependence or addiction) 8 mg one tablet sublingually (under the tongue) in the morning for opioid use disorder.

On 1/7/25 at 1035 hours, a controlled medication count review for Resident 118 was conducted with the TRC DON and LVN 2.

Review of 118's buprenorphine HCI sublingual tablet 8 mg Narcotic and Hypnotic Record showed the medication was given routinely in the morning at 0700 hours.

However, review of Resident 118's Narcotic and Hypnotic Record for the buprenorphine HCI medication did not show the documentation the medication was signed out on 1/5/25 at 0700 hours.

The TRC DON verified the above finding. TRC DON stated he would investigate who was assigned on 1/5/25. LVN 2 checked Resident 118's MAR and stated LVN 3 administered the medication.

The TRC DON stated the protocol for administering a narcotic or controlled medication was to pour, pass, and sign the narcotic record sheet then the MAR.

On 1/8/25 at 1051 hours, an interview was conducted with LVN 3. LVN 3 verified she worked on 1/5/25 and was assigned to administer the medication to Resident 118 at 0700 hours. LVN 3 stated she recalled administering the buprenorphine medication to Resident 118 but did not document in the Narcotic and Hypnotic Record sheet after administering the medication. LVN 3 stated she was supposed to document in the Narcotic and Hypnotic Record sheet right after administering the medication.

On 1/9/25 1437 at hours, an interview was conducted with the DON and Administrator.

The DON and Administrator were informed and acknowledged the above findings.

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

multi-vitamin tablet to Resident 63, however, the physician's order showed to administer a

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

During the medication administration for Resident 4, LVN 10 was observed having applied a nicotine 21 mg transdermal patch to Resident 4's lower back.

On 1/8/25 at 0946 hours, an interview and concurrent medical record review was conducted with LVN

• LVN 10 reviewed Resident 4's active physician's orders. LVN 10 verified Resident 4 did not have

an order for a nicotine 21 mg transdermal patch.

The package which contained the nicotine 21 mg transdermal patches was observed without a label.

The label had been pealed from the box.

The package which contained the nicotine 21 mg transdermal patches was not labeled with a resident's name, prescribing physician's name, prescription number, prescribed dose, or the appropriate instructions and precautions. LVN 10 verified the findings. LVN 10 stated the label should include a resident's name to identify which resident to apply the nicotine patch.

Cross reference to F-F759, example #1.

• Medical record review for Resident 63 was initiated on 1/6/25. Resident 63 was admitted to the

facility on [DATE].

On 1/8/25 at 1030 hours, a medication administration observation for Resident 63 was conducted with LVN 6.

During the medication administration for Resident 63, LVN 6 was observed having held Resident 63's scheduled morning (0900 hours) carvedilol (antihypertensive medication) 3.125 mg tablet. LVN 6 stated Resident 63's systolic blood pressure was 101 and the physician's order showed to hold the medication if Resident 63's systolic blood pressure was less than 110.

The bubble pack (packaging) which contained the carvedilol 3.125 mg tablets showed instructions to hold the medication if Resident 63's systolic blood pressure was less than 100. LVN 6 verified the findings and stated she needed to clarify the discrepancy specific to the hold parameters for the medication.

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

According to the USDA Food Code 2022, Section 4-601.11 Equipment, Food- Contact Surfaces,

clean to sight and touch.

On 1/6/25 at 0800 hours, an observation and concurrent interview was conducted with the DSS.

One of three residents' meal tray drying rack was observed with a brown residue, which resembled rust and had peeling paint.

The DSS verified the finding and stated he will order a new rack today.

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

According to the US Food Code 2022, Section 5-501.113, Covering Receptacles, receptacle units for refuse shall be kept covered with tight fitting lids after they are filled.

Review of the facility's P&P titled Dispose of Garbage and Refuse reviewed/revised 12/19/22, showed the refuse containers and dumpsters kept outside the facility shall be designed and constructed to have tightly fitting lids, doors, or covers.

On 1/6/25 at 0926 hours, an observation of trash disposal with DSS was conducted.

Two of three dumpsters were observed located outside of the facility with lids not completely close.

The DSS stated one of the dumpster lid was bent, and the other dumpster had too much trash in it.

The DSS verified the trash was exposed, and the lids of the two dumpsters were not fully closed.

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

Based on interview and facility document review, the facility failed to conduct and document a

during both day-to-day operations and emergencies.

This failure posed the risk of the facility not being able to evaluate its resident population and identify the resources needed to provide the necessary care and services the residents required.

Findings

On 1/6/25 at 0830 hours, an entrance conference was conducted with the Administrator and DON.

When the Entrance Conference Worksheet items needed within four hours were read, the Facility Assessment was requested.

On 1/6/25 at 1600 hours, an interview was conducted with the Administrator.

The Administrator stated the Facility Assessment had not been completed.

On 1/7/25 at 0730 hours, the Administrator submitted a Facility Assessment to the survey team.

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

Wednesday, Thursday, Friday, and Saturday for enhance pulmonary function and mucociliary airway

minimal harm - dated 1/6/25, to administer the oxygen at two liters per minute via nasal cannula.

May titrate up to

of breath related to COPD.

On 1/8/25 at 1210 hours, a concurrent interview and medical record review was conducted with LVN

• Resident 51's Pulmonary administration record for January 2025 was reviewed with LVN 5. LVN 5

verified the missing initials by the licensed nurses to show for the administration of the above physician's orders for Resident 51 on the following dates: - 1/3/24, for incentive spirometer treatment; - 1/3/24, for chest physiotherapy via Acapella; - 1/3-1/6/25, to clean outside surface of devices; - 1/5-1/6/25 at 0900 hours, to administer Anoro Ellipta Inhalation 1 inhalation inhale orally one time a day for COPD; - 1/5-1/6/25, for pulmonary demonstration; and - 1/6/25, for the administration of oxygen at two liters per minute via nasal cannula as needed.

On 1/8/25 at 1500 hours, an interview was conducted with the DON.

The DON was asked regarding the documentation after administration of the medication and ordered monitoring or assessment.

The DON stated the licensed facility staff must document or chart after the administration of the medications and completing any assessments or pulmonary treatments before the shift ended.

On 1/9/25 1437 at hours, the DON and Administrator were informed and acknowledged the above findings.

entrance to Resident 50's room, a sign was posted which showed enhanced barrier precautions were required.

The sign showed providers must wear gloves and a gown when bathing and changing Resident 50. Resident 50 was observed inside of her room lying on her bed. CNA 6 was observed providing care to Resident 50. CNA 6 was observed bathing and changing Resident 50's adult brief.

CNA 6 was observed only wearing gloves while providing care to Resident 50, however, CNA 6 failed to don a gown while she was bathing and changing Resident 50's adult brief. CNA 6 verified in accordance with the ordered enhanced barrier precautions, she should have donned a gown while bathing and changing Resident 50, for infection control.

On 1/7/25 at 1642 hours, an interview was conducted with the IP.

The IP verified in accordance with the EBP, the staff members were required to don gloves and a gown while bathing and changing Resident 50's adult brief, for infection control.

• On 01/07/25 at 1028 hours, during the initial observation of Room A, there was no receptacle to

dispose of the used gowns readily available.

Room A was designated as an enhanced barrier precautions room.

When asked about any receptacle readily available to dispose of the used gowns, LVN 1 initially was unable to explain, but then stated the used gown would be placed in a bin located outside Room A, approximately 15 feet away.

555388 01/09/2025

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

Review of Resident 13's H&P examination dated 11/7/24, showed Resident 13 had a diagnosis of COPD.

Review of Resident 13's physician's orders showed an order dated 1/4/25, to administer supplemental oxygen at a rate of two liters per minute, to keep Resident 13's oxygen saturation at 92% or greater.

On 1/6/25 at 0750 hours, an observation was conducted of Resident 13. Resident 13 was observed lying in bed with continuous oxygen being administered through an oxygen concentrator, at a rate of four and a half liters per minute via nasal cannula.

On 1/6/25 at 0833 hours, an observation, and concurrent interview was conducted with LVN 8. Resident 13 was observed lying in bed with continuous oxygen being administered through an oxygen concentrator, at a rate of four and a half liters per minute via nasal cannula. Resident 13 stated she received oxygen for shortness of breath. LVN 8 verified Resident 13 was receiving continuous oxygen at a rate of four and a half liters per minute, however, the physician's order showed to administer continuous oxygen at a rate of two liters per minute (to maintain Resident 13's oxygen saturation at 92% or greater). LVN 8 obtained Resident 13's oxygen saturation, while Resident 13 was receiving continuous oxygen at a rate of four and a half liters per minute, which yielded a result of 92%. LVN 8 then lowered Resident 13's oxygen rate to two liters per minute (as per the physician's order) and obtained Resident 13's oxygen saturation, which yielded a result of 86%. LVN 8 stated he would notify Resident 13's physician of Resident 13's change of condition (Resident 13's oxygen saturation of 86% on two liters per minute of continuous oxygen).

555388

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 555388 B.

Wing 01/09/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804

During the medication administration for Resident 63, LVN 6 was observed having held Resident 63's scheduled morning (0900 hours) carvedilol (antihypertensive medication) 3.125 mg tablet. LVN 6 stated Resident 63's systolic blood pressure was 101 and the physician's order showed to hold the medication if Resident 63's systolic blood pressure was less than 110.

The bubble pack (packaging) which contained the carvedilol 3.125 mg tablets showed instructions to hold the medication if Resident 63's systolic blood pressure was less than 100. LVN 6 verified the findings and stated she needed to clarify the discrepancy specific to the hold parameters for the medication.

555388

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 555388 B.

Wing 01/09/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Beach Creek Post-Acute 645 South Beach Blvd.

Anaheim, CA 92804