Mesa Verde Post Acute Care Center
MESA VERDE POST ACUTE CARE CENTER in COSTA MESA, CA — inspection on June 6, 2024.
Found 5 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
The facility failed to ensure the smoking materials for Resident 24 were securely stored.
This posed the risk of fire and serious injuries to the residents who resided in the facility.
Findings:
Review of the facility's P&P titled Smoking Residents revised 7/27/23, showed the IDT will develop an individualized plan of care for safe storage, use of smoking materials, assistance, and/or required supervision, for residents who smoke.
On 6/5/24 at 0415 hours, an observation and concurrent interview was conducted with Resident 24 in his room. A box of cigarettes was observed to be stored inside a bag on the ground.
When asked about the cigarettes, Resident 24 stated the facility did not let him store the cigarettes in his room but kept them because the facility would forget about them.
Medical record review for Resident 24 was initiated on 6/3/24. Resident 24 was readmitted to the facility on [DATE].
Review of Resident 24's H&P examination dated 7/1/23, showed Resident 24 had the capacity to understand and make decisions.
Review of Resident 24's plan of care showed a care plan problem dated 11/24/2, to address Resident 24's tobacco use.
The interventions included for the cigarettes and lighter to be stored in a designated box.
On 6/5/24 at 0425 hours, an observation and concurrent interview was conducted with LVN 4 for Resident 24 in Resident 24's room. LVN 4 acknowledged the above findings. LVN 4 stated the facility allowed Resident 24 to have his own cigarettes and lighter. LVN 4 stated Resident 24 kept his cigarettes in his room and verified the facility did not take his smoking materials for safe storage.
On 6/5/24 at 0448 hours, an observation and concurrent interview was conducted with RN 2. RN 2 verified the above findings. RN 2 stated the cigarettes should not be kept in his room and should be kept in a locked box with his name and room number. RN 2 proceeded to take Resident 24's cigarettes, then placed them into a locked container located in the nurse's station.
056362
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 056362 B.
Wing 06/06/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Mesa Verde Post Acute Care Center 661 Center Street Costa Mesa, CA 92627
The facility failed to apply a cervical collar (c-collar) to Resident 17 as ordered by the physician.
This failure had the potential to negatively affect the Resident 17's health and well-being.
Findings:
Review of the facility document titled Your Path to Recovery After Cervical Spine Surgery revised 11/2015 showed a cervical collar is worn at the discretion of the surgeon.
Under the section titled Spine Precautions, showed a cervical collar is used to provide support and limit movement of the neck.
Your doctor may or may not order a cervical collar.
Typically, the collar should be worn at all times.
Cervical collar is worn at the discretion of the surgeon.
During an initial tour of the facility on 6/3/24 at 0845 hours, Resident 17 was observed lying in bed. A c-collar was observed on the top of Resident 17's bedside drawer. Resident 17 stated he was hit by car a couple weeks ago while he was in his wheelchair.
Medical record review for Resident 17 was initiated on 6/3/24. Resident 17 was admitted to the facility on [DATE].
Review of Resident 17's Psych Progress Note dated 4/24/24, showed Resident 17 had the capacity to understand and make his own medical decisions.
Review of Resident 17's Order Summary Report dated 6/5/24, showed a physician's order dated 4/12/24, for the application of the c-collar on at all times, TLSO for out of bed activities or HOB greater than 30 degrees.
Review of Resident 17's plan of care failed to show the application of the c-collar, TLSO when out of bed, or noncompliance were addressed.
On 6/4/24 at 1138 hours, Resident 17 was observed lying in bed without a c-collar on.
On 6/4/24 at 1534 hours, an interview and concurrent medical record review was conducted with the DOR.
The DOR verified Resident 17 did not wore the c-collar as ordered by the physician.
The DOR stated Resident 17 received a c-collar and a back brace but was non-compliant with wearing both.
The DOR stated Resident 17 should have had a follow up appointment with the orthopedic specialist and the c-collar order could only be addressed by an orthopedic specialist.
On 6/4/24 at 1550 hours, an interview was conducted with RNA 1. RNA 1 verified Resident 17 was currently receiving RNA services. RNA 1 stated Resident 17 did not use a brace and stated she was never instructed to apply a c-collar or back brace on Resident 17.
056362
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 056362 B.
Wing 06/06/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Mesa Verde Post Acute Care Center 661 Center Street Costa Mesa, CA 92627
Review of the binder showed the following confidential resident rosters:
- a confidential resident roster dated 8/31/21, with two residents' names and their identifiers
- a confidential resident roster dated 9/1/21, with two residents' names and their identifiers
- a confidential resident roster dated 9/15/21, with two residents' names and their identifiers
On 6/5/24 at 0937 hours, an interview and concurrent facility document review were conducted with the Administrator.
The Administrator verified three confidential resident rosters were in the CDPH Annual Survey Binder and should not have been there.
39670
2.
Medical record review for Resident 29 was initiated on 6/4/24. Resident 29 was admitted to the facility on [DATE] and readmitted on [DATE].
Review of Resident 29's monthly weights for the past six months, showed the following monthly weights:
- On 1/5/24 = 165.0 lbs
- On 2/1/24 = 169.1 lbs
- On 4/8/24 = 159.9 lbs
- On 5/3/24 = 161.7 lbs
- On 6/1/24 = 70.6 lbs
056362
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 056362 B.
Wing 06/06/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Mesa Verde Post Acute Care Center 661 Center Street Costa Mesa, CA 92627
F-F813.
3. On 6/4/24 at 0803 hours, an ice machine inspection, concurrent interview, and facility document review was conducted with the Director of Maintenance.
The upper inside cabinet layer of the ice machine was wiped with a white paper towel and a yellowish slimy residue was observed on the paper towel.
The Director of Maintenance verified the above findings.
When asked what solutions were used to clean the ice machine, the Director of Maintenance stated he used two solutions, to which he showed a bottle of Hydro Balance H. B. 30 ice machine cleaner nickel-safe, and a green bottle and labeled only with for ice machine only.
Cross-reference to
According to DA Food Code 2022, 4-602.13, Non-Food Contact Surfaces, showed the presence of food debris or dirt on nonfood contact surfaces may provide a suitable environment for the growth of microorganisms which employees may inadvertently transfer to food. If these areas are not kept clean, they may also provide harborage for insects, rodents, and other pests.
Review of the facility's P&P titled Hood and Filter-Operation and Cleaning dated 10/1/14, showed the hood and filter system will be cleaned routinely at least weekly or more often as necessary, and hoods will be kept free of grease and dust.
056362
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 056362 B.
Wing 06/06/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Mesa Verde Post Acute Care Center 661 Center Street Costa Mesa, CA 92627