Glendora Grand, Inc

attempts in the clinical record, including discussions with the resident and/or resident representative.

056079 02/26/2025

Glendora Grand, Inc 805 W.

Arrow Hwy.

Glendora, CA 91740

During a review of the facility's P&P titled, Comprehensive Care Plans, undated, the P&P indicated, It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that include measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment.

The P&P indicated, The facility will attempt alternative methods of refusal of treatment and services and document such attempts in the clinical record, including discussions with the resident and/or resident representative.

056079 02/26/2025

Glendora Grand, Inc 805 W.

Arrow Hwy.

Glendora, CA 91740

During a concurrent record review and interview, on 2/26/25 at 3:41 pm, with the DON, the DON could not recall if Resident 4's family was informed of Resident 4's repeated refusals for podiatry care. Resident 4's last 4 Interdisciplinary Team (IDT, CP conferences, a team of health care professions who work together to establish plans of care for residents) were reviewed with the DON, the DON was unable to find documentation indicating Resident 4's family was informed of Resident 4's repeated refusal for podiatry care.

The DON stated after a resident refused treatment three times, the primary physician, the psychologist/psychiatrist, and the family must be informed.

The DON stated licensed nurses were not aware Resident 4 was refusing podiatry care and, probably did not inform (Resident 4's) physicians.

During a review of the facility's P&P titled, Podiatry Services, undated, the P&P indicated, It is the policy of this facility to ensure residents receive proper treatment and care within professional standards of practice and state scope of practice, as applicable, to maintain mobility and good foot health.

The P&P indicated, Employees should refer any identified need for foot care to the social worker or designee.

During a review of the facility's P&P titled, Comprehensive Care Plans, undated, the P&P indicated, It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that include measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment.

The P&P indicated, The facility will attempt alternative methods of refusal of treatment and services and document such attempts in the clinical record, including discussions with the resident and/or resident representative.

During a review of the facility's policy and procedure (P&P) titled, Change in a Resident's Condition or Status, undated, the P&P indicated, The Nurse Supervisor/Charge Nurse will notify the resident's Attending Physician or On-Call Physician when there has been .refusal of treatment or medications .A significant change of condition is a decline or improvement in the resident's status that will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, impacts more than one area of the resident's health status, requires interdisciplinary review and/or revision to the care plan and ultimately is based on the judgment of the clinical staff .Unless otherwise instructed by the resident, the Nurse Supervisor/Charge Nurse will notify the resident's family or representative when .there is a significant change in the resident's physical, mental, or psychosocial status .

056079 02/26/2025

Glendora Grand, Inc 805 W.

Arrow Hwy.

Glendora, CA 91740

During a telephone interview on 2/26/25 at 12:35 pm with RN 2, RN 2 stated when Resident 1 was readmitted on [DATE], Resident 1 was supposed to be readmitted to Station 6, which was an open unit, and Resident 1's RP was aware of it.

During a review of the facility's policy and procedure (P&P) titled, Elopements and Wandering Residents, dated 2/2020, the P&P indicated, the facility ensured residents who exhibited wandering behavior and/or were at risk for elopement received adequate (sufficient/enough) supervision to prevent accidents and receive care in accordance with their person-centered plan of care addressing the unique factors contributing to wandering or elopement risk.

The P&P indicated, the facility established and utilized a systematic approach to monitoring and managing residents at risk for elopement or unsafe wandering, including identification and assessment of risk, evaluation and analysis of hazards and risks, implementing interventions to reduce hazards and risks, and monitoring for effectiveness and modifying interventions when necessary.

The P&P indicated, adequate supervision would be provided to help prevent accidents or elopement.

During a review of Resident 4's History and Physical (H&P, physician's clinical evaluation and examination of the resident), dated 12/10/24, the H&P indicated Resident 4 could make needs known but cannot make medical decisions.

During a review of Resident 4's CP titled, Care Plan Report. dated 12/10/24, the CP indicated Resident 4 was at risk for clinical or social decline due to Resident 4's refusal to shower, refusal of assistance with Activities of Daily Living (ADLs- activities such as bathing, dressing and toileting a person performs daily), and refusal of treatment and medications.

The CP's goal indicated for Resident 4's family members and/or staff to assist in making decisions for health and personal care and to inform Resident 4 of risks and consequences of the choices Resident 4 made daily.

The CP's interventions included for staff (in general) to monitor Resident 4 for episodes of noncompliance and to notify the physician for possible treatment, and to refer Resident 4 for psychological (related to the mental and emotional state of a person) and/or psychiatric (relating to mental illness or its treatment) consultation as ordered by the primary physician.

056079

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 056079 B.

Wing 02/26/2025

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

Glendora Grand, Inc 805 W.

Arrow Hwy.

Glendora, CA 91740

During a review of Resident 4's History and Physical (H&P, physician's clinical evaluation and examination of the resident), dated 12/10/24, the H&P indicated Resident 4 could make needs known but could not make medical decisions.

During a review of Resident 4's CP titled, Care Plan Report. dated 12/10/24, the CP indicated Resident 4 was at risk for clinical or social decline due to Resident 4's refusal to shower, refusal of assistance with Activities of Daily Living (ADLs- activities such as bathing, dressing and toileting a person performs daily), and refusal of treatment and medications.

The CP's goal indicated for Resident 4's family members and/or staff to assist in making decisions for health and personal care and to inform Resident 4 of risks and consequences of the choices Resident 4 made daily.

The CP's interventions included for staff (in general) to monitor Resident 4 for episodes of noncompliance and to notify the physician for possible treatment, and to refer Resident 4 for psychological (related to the mental and emotional state of a person) and/or psychiatric (relating to mental illness or its treatment) consultation as ordered by the primary physician.

056079

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 056079 B.

Wing 02/26/2025

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

Glendora Grand, Inc 805 W.

Arrow Hwy.

Glendora, CA 91740