Colonial Care Center

During an observation on 2/3/2025 at 10:32 a.m. in Resident 119's room, observed Resident 119 sitting upright at an 80-degree angle in bed, receiving 3 liter(L)/minute(min) of oxygen via (through) nasal cannular (NC). Resident 119 had a bubbling sound in the throat, indicating the presence of secretions. Resident 119's mouth was open, and there was dried, sticky brown buildup between and covering the entire bottom teeth.

During an observation on 2/4/2025 at 4:13 p.m. in Resident 119's room, observed Resident 119 sitting upright at an 80-degree angle in bed, receiving 3 L/min of oxygen via NC. Resident 119 had a bubbling sound in her throat, indicating the presence of secretions. Resident 119's mouth was open.

There was dried and sticky brown buildup between and covering her entire bottom teeth.

During an interview on 2/5/2025 at 9:06 a.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated that Resident 119 is under palliative care, she still requires all nursing care, including oral care.

During a concurrent observation and interview on 2/5/2025 at 10:11 a.m. with LVN 1 in Resident 119's room, observed LVN 1 assessing the buildup inside of Resident 119's mouth.

Upon inspecting Resident 119's mouth, LVN 1 stated that it was light brown, dried, and stuck between the teeth, and stated that's so bad unsure if it was food residue or another buildup. LVN 1 also stated that CNAs are responsible for providing morning care, oral care should be provided as needed, at least in the morning, to prevent aspiration, discomfort, and potential infections, and Resident 119 should not have such build up, as it can lead to aspiration, tooth decay, pain, infections and food fly can go into the resident's mouth because of it.

During an interview on 2/7/2025 at 12:53 p.m. with the Director of Nursing (DON), the DON stated that oral care is essential for maintaining dignity, even in palliative care, and should be considered a necessary aspect of patient care.

During a review of the facility's policy and procedure (P&P) titled, Palliative care, undated, indicated the Resident will be assisted to be a comfortable demise in a dignified manner.

During a review of the facility's P&P titled, mouth care, dated 2001, indicated that the purposes of this procedure are to keep the resident's lips and oral tissues moist, to cleanse and freshen the resident's mouth and to prevent oral infection.

The H&P also indicated that Demeaning practices and standards of care that compromise dignity are prohibited.

Staff are expected to promote dignity and assist residents

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of the facility's P&P, titled Social Services, revised 9/2022, the P&P indicated the social worker/social services staff are responsible for assisting residents with advance care planning, including but not limited to completion of advance directives (F-F578, Advance Directives).

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

or physician on call when there had been refusal of treatment or medications two or more consecutive

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During an interview on 2/5/2025 at 4:06 p/m. with the Director of Nursing (DON), the DON stated that staff did not implement necessary safety measures before applying the side rails for Resident 24 and placing a lap tray over Resident 161 and failed to ensure a safe environment for the residents.

The DON stated that staff did not follow fall prevention protocols or properly reassess Resident 24's needs before using the side rails and locking the lap tray over Resident 161.

The DON also stated that this failure had the potential to compromise the resident's dignity and safety, create an unsafe environment and increase the risk of furtherer injury.

During a review of the facility's policy and procedure (P&P) titled, Use of Restraints, revised April 2017, indicated the restraints shall only be used after other alternatives have been tried unsuccessfully for the safety and well-being of the resident(s), when they use of restraints is indicated, the least restrictive alternative will be used for the least amount of time necessary, and the ongoing re-evaluation for the need for restraints will be documented and followings: .

The definition of a restraint is based on the functional status of the resident and not the device. If the resident cannot remove a device in the same manner in which the staff applied it given that resident's physical condition (i.e., side rails are put back down, rather than climbed over), and this restricts his/her typical ability to change position or place, that device is considered a restraint.3.

Examples of devices that are/may be considered physical restraints include leg restraints, arm restraints, hand mitts, soft ties or vest, wheelchair safety bars, geri-chairs, and lap cushions and trays that the resident cannot remove.

• Prior to placing a resident in restraints, there shall be a pre-restraining assessment and review to

determine the need for restraints.

The assessment shall be used to determine possible underlying causes of the problematic medical symptom and to determine if there are less restrictive interventions (programs, devices, referrals, etc.) that may improve the symptoms.

• Restraints shall only be used upon the written order of a physician and after obtaining consent from

the resident and/or representative (sponsor).

The order shall include the following: a.

The specific reason for the restraint (as it relates to the resident's medical symptom);

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

F 0604 b.

c.

The type of restraint, and period of time for the use of the restraint.

• The following safety guidelines shall be implemented and documented while a resident is in

restraints: a.

Restraints shall be used in such a way as not to cause physical injury to the resident and to insure the least possible discomfort to the resident. b.

Physical restraints shall be applied in such a manner that they can be speedily removed in case of fire or other emergency.

Restraints with locking devices shall not be used. c.

A resident placed in a restraint will be observed at least every thirty (30) minutes by nursing personnel and an account of the resident's condition shall be recorded in the resident's medical record.

• Residents and/or surrogate/sponsor shall be informed about the potential risks and benefits of all

options under consideration, including the use of restraints, not using restraints, and the alternatives to restraint use.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of Resident 55's PASRR Level I Screening dated 1/9/2025, the section that indicated whether an individual has a serious diagnosed mental disorder such as depressive disorder, anxiety disorder, schizoaffective disorder, or psychosis, and/or mood disturbance, the PASRR indicated Resident 55 did not have a serious mental illness.

During a concurrent interview and record review of the PASRR Level I on 2/6/2025 at 3:56p.m. with ADON, ADON stated Resident 55 was admitted to the facility on [DATE] with has a diagnosis of psychosis and dementia and Resident 16 has a diagnosis of schizoaffective disorder (bipolar type), and MDD ADON stated Resident 55's and 16's PASRR Level I was incorrectly documented. does.

ADON stated the purpose of the PASRR is so that the resident is referred accordingly based on their needs and ensure the residents' psychological and mental health needs are being addressed.

During a review of the facility's policies and Procedures (P&P), titled Preadmission Screening and resident Review (PASRR), revised 6/2024, the P&P indicated each resident with serious mental illness (SMI) and/or intellectual/developmental disability/related conditions (ID/DD/RD) will have the appropriate setting, as well as specialized services and/or rehabilitative services would be needed.

The facility will submit a new Level I PASRR if: any error/discrepancy in the previous PASRR screening.

The facilities designated staff will review the available information from the PASRR Online System regularly .and document and maintain the records.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During an interview on 2/8/2025 at 5:29 p.m., the assistant director of nursing (ADON) stated the PASRR was an assessment that determined if a resident needed anything for their mental health needs.

The ADON stated the PASRR level 2 determination informs the facility what services the resident would benefit from.

The ADON stated he oversaw PASRRs in the facility but did not create individualized care plans based on their PASRR recommendations.

The ADON stated it would be important to create a care plan for PASRR recommendations because it would sure all departments (social services, activities, nursing, etc.) would be on the same page and ensure the residents were meeting their goals and receiving all necessary care.

During a review of the facility's P/P titled Care Plans, Comprehensive Person-Centered dated 3/2022, the P/P indicated a comprehensive, person-centered care plan that included measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs was developed and implemented for each resident.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of AHA's article titled 11 things to know to save a life with CPR, published [DATE], the article indicated according to research, each minute of delayed CPR, there was a decreased chance of survival by about 10%.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of the facility's P&P, titled Interdepartmental Notification of Diet (Including Changes and Reports revised 10/2017, the P&P indicated nursing services shall notify the physician and dietician when a nutritional problem (e.g., weight loss, pressure ulcer, eating problem, etc.) has been identified and shall collaborate with the dietician and physician to initiate an appropriate process of clinical review for causes of the nutritional problem.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

independence.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During an interview on 2/8/2025 at 3:26 p.m., the medical director (MD 2) stated the physician needed to be informed as soon as weight loss was identified. MD 2 stated any significant weight fluctuations needed to be addressed. MD 2 stated continued weight loss was not good and affected a resident's well-being, could lead to malnutrition and slow pressure sore healing.

During a review of the facility's policy and procedure (P/P) titled Nutritional Assessment dated 10/2017, the P/P indicated as part of the comprehensive assessment, the nutritional assessment was to be a systematic, multidisciplinary process that included gathering and interpreting data and using that data to help define meaningful interventions for the resident at risk of impaired nutrition.

During a review of the facility's P/P titled Weight Assessment and Intervention dated 3/2022, the P/P indicated weights were to be recorded in each unit's weight record chart and in the individual's medical record.

Any weight change of 5% or more since last weight assessment was retaken the next day for confirmation and if the weight is verified, the nursing team was to immediately notify the RD in writing.

Residents were to be weighed at an interval determined by the IDT.

The threshold for significant unplanned and undesired weight loss was to be based on the following criteria [ where percentage of body weight loss = (usual weight - actual weight)/ (usual weight) x 100]: a. 1 month - 5% weight loss is significant; greater than 5% is severe. b. 3 months- 7.5% weight loss is significant; greater than 7.5% is severe. c. 6 months - 10% weight loss is significant; greater than 10% is severe.

Care planning for weight loss or impaired nutrition is a multidisciplinary effort and includes the physician, nursing staff, the dietitian, the consultant pharmacist, and the resident or resident's legal surrogate (RP).

Individualized care plans shall address to the extent possible: the identified causes of weight loss; goals and benchmarks for improvement; and time frames and parameters for monitoring and reassessment.

During a review of the facility's P/P titled Change in Resident's Condition or Status dated 3/2022, the P/P indicated the nurse was to notify the physician and RP when there has been a significant change in the resident's physical condition.

Notifications were to be made within 24 hours.

The nurse was to record information relative to changes in the resident's record.

During a review of the facility's Registered Dietician (RD) Consultant job description dated 4/2022, the job description indicated the RD was to work with the ADM, nursing, and other department heads on planning resident care issues, and quality assessment monitoring and reporting.

The RD was responsible for evaluating the nutritional needs of the residents and documenting in the nutritional record.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a concurrent observation and interview on 2/3/2025 at 3:36 p.m., with Licensed Vocational Nurse 2 (LVN 2), LVN 2 stated Resident 37's tubing for the tube feeding was wrapped around the right side of the residents side rails and the tube was taught. LVN stated he changes tube feeding within 48 hrs and is in the facility policy. LVN 2 stated Resident 37's tube feeding that is hanging was dated 2/2/2025 at 5:00 a.m. and indicated it should have been replaced as the feeding can go bad and is a safety concern. LVN 2 stated the water bag does not have a label on it, and they would normally label it. LVN 2 stated the water bag should have been replaced as it is replaced every 24 hours.

During a review of the facility's policies and Procedures (P&P), titled Enteral Feedings-Safety Precautions, revised 11/2018, the P&P indicated the facility will remain current in and follow accepted best practices in enteral nutrition.

Change administration sets for open-system enteral feedings at least every 24 hours, or as specified by the manufactured.

Change administration sets for closed-system enteral feeds in according the manufacturer's instructions.

During a review of Jevity 1.5 Cal Complete, Balanced Nutrition with Fiber manufacturer guideline, updated 7/22/2024, the manufacturer guideline indicated unless a shorter hang time is specified by the set manufacturer, hand product for up to 48 hours after initial connection when clean technique and only one new set are used.

Otherwise hang for no more than 24 hours.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of the facility's P/P titled Change in Resident's Condition or Status dated 3/2022, the P/P indicated the nurse was to notify the physician and RP when there has been a significant change in the resident's physical condition.

Notifications were to be made within 24 hours.

The nurse was to record information relative to changes in the resident's record.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of Resident 52's order summary sheet, an order was placed 1/29/2025 for Zinc Sulfate capsule 220 mg, give 1 capsule by mouth one time a day for supplement/ wound healing for 1 month.

During an interview on 2/5/2025 at 9:07 a.m., licensed vocational nurse (LVN 3) stated she had not previously noticed Resident 52's physician order for Zinc Sulfate was incorrect. LVN 3 stated Resident 52 was unable to swallow anything by mouth and the order should have indicated the Zinc Sulfate was to be given by GT. LVN 3 stated nurses were to follow the medication administration rights (Right Person, Right Medication, Right Dose, Right Time, Right Route, Right Reason, and Right Documentation) when administering medications to residents and it was for resident safety. LVN 3 stated she had been giving the medication via GT because Resident 52 could not swallow but if someone did follow the order, Resident 52's safety was at risk, and he could choke and aspirate.

During an interview on 2/8/2025 at 2:52 p.m., the Director of Nursing (DON) stated the medication administration route needed to be verified against physician orders, but the nurses also needed to assess the resident to see if the order was correct for their condition.

The DON stated it was important for physician's orders to indicate the correct route because the medication could have accidentally been given by mouth and the resident might aspirate.

The DON stated the nurses needed to take the time to get a clarification of physician's orders if something was not correct.

During a review of the facility's policy and procedure (P/P) titled Medication and Treatment Orders dated 7/2016, the P/P indicated orders for medications must include the route of administration.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of Resident 188's admission record, the admission record indicated Resident 188 was admitted to the facility 12/6/2024 with diagnoses of gastrostomy tube (GT, a feeding tube), muscle wasting, non-Hodgkin lymphoma (cancer), tracheostomy tube (an opening surgically created through the neck into the trachea (windpipe) to allow air to fill the lungs), and multiple pressure ulcers. Resident 188's admission record did not indicate Resident 188 had any diagnosis related to mental health issues or psychosis.

During a review of Resident 188's minimum data set (MDS, a resident assessment tool) dated 12/13/2024 indicated Resident 188 had severe cognitive impairment (a significant decline in cognitive abilities that significantly impact daily functioning and independence).

The MDS indicated Resident 188 did not have any indicators for psychosis nor did he exhibit any behavioral symptoms.

The MDS indicated Resident 188 did not have any psychiatric or mood disorders.

The MDS indicated Resident 188 was receiving antipsychotic medication.

During a review of Resident 188's Order Summary Report, the report indicated an order was placed 2/3/2025 for Seroquel (antipsychotic medication) oral tablet 25 mg, give 1 tablet via GT at bedtime for anti-psychosis.

During an interview on 2/8/2025 at 3:16 p.m., the Assistant Director of Nursing (ADON) stated there must be an actual diagnosis for antipsychotic usage and the physician's order needed to be full and complete including the manifestation (m/b, what symptoms is resident exhibiting.

The ADON stated he reviewed Resident 188's chart and he did not have any diagnosis for psychosis or mental health issues.

The ADON also stated that the order for Seroquel was not complete because it did not contain the m/b statement informing which behaviors Resident 188 had that warranted the use of Seroquel.

The ADON stated Resident 188 was at risk of medication side effects and Seroquel had a black box warning (is an added label to drugs or drug products by the Food and Drug Administration (FDA) when serious adverse reactions or special problems occur, particularly those that may lead to death or serious injury) which was, increased risk of death.

During a review of the facility's policy and procedure (P/P) titled Antipsychotic Medication Use dated 7/2022, the P/P indicated residents would not receive medications that were not clinically indicated to treat a specific condition.

Residents who were transferred from the hospital and were already receiving antipsychotics would be evaluated for the appropriateness and indications for use.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

Based on interview and record review the facility failed to follow their policy and procedure (P/P)

184) had complete physicians orders for psychotropic medications (any drug that affects behavior, mood, thoughts, or perception) including a specific diagnosis.

This deficient practice placed Resident 184 at risk for receiving unnecessary medications (medications without adequate indication for use).

Findings

During a review of Resident 184's admission Assessment, the admission Assessment indicated Resident 184 was admitted to the facility 9/16/2024 with diagnoses of unspecified dementia (a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain) with behavioral disturbance, unspecified mood disorder (a mental health condition that primarily affects your emotional state), and unspecified psychosis (a severe mental condition in which thought and emotions are so affected that contact is lost with external reality).

During a review of Resident 184's minimum data set (MDS, a resident assessment tool) dated 12/20/2024, the MDS indicated Resident 184 had severe cognitive impairment (problems with your thinking, communication, understanding or memory).

The MDS indicated Resident 184 had no behavioral symptoms or indicators of psychosis.

The MDS indicated Resident 184 was receiving antipsychotics.

During a review of Resident 184's Order Summary Report, orders were placed 3/4/2025 for Olanzapine (an antipsychotic medication) oral tablet 5 milligrams (mg, a unit of measurement), give 1 tablet by mouth two times a day for antipsychotics.

During an interview on 3/12/2025 at 2:11 p.m., the assistant director of nursing (ADON) stated he oversaw monitoring antipsychotics for the facility and the facility was cited on their recent recertification survey (exit date 3/8/2025) for unnecessary psychotropic medications and it was part of his duty to ensure all residents had a proper diagnosis and indication for antipsychotic use.

The ADON stated he reviewed Resident 184's current medication orders on 3/12/2025 and noted for antipsychotics was not a proper diagnosis to be prescribed Olanzapine and there was no indication mentioned.

The ADON stated it was important to ensure residents receiving antipsychotic medications had a specific diagnosis for use and an indication as to why the resident was receiving the medication to ensure they were being monitored for the behavior.

The ADON stated the potential risk of residents not having a proper diagnosis or indication for the antipsychotics was the resident does not really need the medication and they could have adverse side effects (unwanted undesirable effects that are possibly related to a drug).

During a review of the facility's P/P titled Antipsychotic Medication Use dated 7/2022, the P/P indicated residents would not receive medications that were not clinically indicated to treat a specific condition.

Residents who were transferred from the hospital and were already receiving antipsychotics would be evaluated for the appropriateness and indications for use.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a concurrent observation and interview on [DATE] at 2:44 p.m., in the Station 1 medication storage room refrigerator with RN 5, there was one opened Tuberculin Purified Protein Derivative (PPD-used in the 2-step process to screen new resident for tuberculosis (TB-an infectious disease that primarily affects the lungs) solution multi-dose vial with the open date of [DATE]. RN 5 stated the PPD solution should be used within 30 days per manufacturer guidelines (until [DATE]).

During an interview on [DATE] at 6:50 p.m. with the Director of Nursing (DON), the DON stated it is important to label medications and follow manufacturer guidelines for storage. It is important to dispose of medications when expired, because the potency of the medication will be affected. It is important to ensure that PPD solution is not expired because it can produce inaccurate TB screening readings potentially placing all residents at risk for tuberculosis.

During a review of the facility's policy and procedure (P&P), titled Medication Storage in the Facility - Storage of Medications, dated [DATE], The P&P indicated Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier .

Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according to procedures for medication disposal, and reordered from the pharmacy if a current order exists.

During a review of the facility's policy and procedure (P/P), titled Preparation and General Guidelines - Vials and Ampules of Injectable Medications, dated [DATE], The P/P indicated the date opened and the initials of the first person to use the vial are recorded on multi-use vials .medication in multi-dose vials may be used until the manufacturer's expiration date or 6 months after opening unless otherwise specified.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a concurrent observation and interview on 2/4/2025 at 11:59a.m. with Regional Registered Dietitian (RRD), RRD was observed grabbing a food thermometer with no hand washing and gloves, grabbed an alcohol swab (clean and disinfect skin or surfaces to prevent infection), swabbed the metal part of the thermometer, and stuck the thermometer into the purred broccoli (cooked food that has been blended to the consistency of a creamy paste). RRD was observed getting another alcohol swab and wiping away the metal part of the thermometer to clean the purred broccoli and attempted to repeat the process without hand hygiene and gloves. RRD stated the cook had already taken the temperature of the food and did not wear a glove because I had asked him to take the temperature of the food.

During an interview on 2/4/2025 at 12:43p.m. with RRD, RRD stated hand hygiene is performed to prevent cross contamination and indicated he was not touching the food when taking the temperature.

During a review of the facility's Policies and Procedures (P&P), titled Sanitation and Infection Control, undated, the P&P indicated hand washing before and after handling foods.

Hands are to be washed when entering the kitchen and before putting on disposable gloves.

Disposable gloves are to be worn when handling food directly with hands when handling ready-to-eat foods.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During an interview on 2/8/2025 at 1:57 p.m., the RD stated she did not attend IDT meetings for weight loss.

The RD stated the IDT discussed Resident 188's case but it was not written down.

The RD stated if it was not documented, it was not done.

The RD stated she based her assessment of Resident 188 on the resident's chart and information obtained from nursing but did not assess or speak to the resident himself.

During a review of the facility's P/P titled Weight Assessment and Intervention dated 3/2022, the P/P indicated any weight change of 5% or more since last weight assessment was retaken the next day for confirmation and if the weight is verified, the nursing team was to immediately notify the RD in writing.

Residents were to be weighed at an interval determined by the IDT.

The threshold for significant unplanned and undesired weight loss was to be based on the following criteria [ where percentage of body weight loss = (usual weight - actual weight)/ (usual weight) x 100]: a. 1 month - 5% weight loss is significant; greater than 5% is severe. b. 3 months- 7.5% weight loss is significant; greater than 7.5% is severe. c. 6 months - 10% weight loss is significant; greater than 10% is severe.

Care planning for weight loss or impaired nutrition is a multidisciplinary effort and includes the physician, nursing staff, the dietitian, the consultant pharmacist, and the resident or resident's legal surrogate (RP).

Individualized care plans shall address to the extent possible: the identified causes of weight loss; goals and benchmarks for improvement; and time frames and parameters for monitoring and reassessment.

During a review of the facility's Registered Dietician (RD) Consultant job description dated 4/2022, the job description indicated the RD was to work with the ADM, nursing, and other department heads on planning resident care issues, and quality assessment monitoring and reporting.

The RD was responsible for evaluating the nutritional needs of the residents and documenting in the nutritional record.

During a review of the facility's P&P, titled Dish Washing Procedures-Dish Machine undated, the dish washer will run the dish machine before washing of dishes until temperature and chlorine level is within manufacturer's guidelines.

During a review of the facility's P&P, titled Storage of Canned and Dry Goods undated, the P&P indicated new stock must be placed behind the old stock so oldest items will be used first.

Products should be dated to ensure FIFP-First -in-First-out.

All foods will be dated according to -month, day, and year.

Plastic or metal contained (with fitting lids and NSF approved_, or re-sealable plastic bags will be used for staples and opened packages (like pasta, rice, cereal, flour, etc.).

Food items will be dated and labeled when placed in containers.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a concurrent observation of the garbage area located outside the facility near the kitchen and interview with Dietary Manager (DM) at 2/3/2025 on 9:43a.m., 2 of 3 blue dumpsters were not completely closed and covered.

There were 3 black trash bags between two dumpsters on the floor.

DM stated the trash bin lids were not completely closed, and it could attract pests.

During a concurrent observation of the garbage area located outside the facility near the kitchen and interview with the Maintenance Supervisor (MS) at 2/7/2025 on 12:20 p.m., 1 of 3 blue dumpsters was open.

There was 1 black trash bag, flattened cardboard boxes, and soiled diapers in the walkway next to the dumpsters.

During a review of Food Code 2017, indicated, 5-501.113 Covering Receptacles and waste handling units for refuse, recyclables, and returnable shall be kept covered: (A) Inside food establishment if the receptacles and units: (1) Contain food residue and are not in continuous use; or (2) After they are filled; and 174 (B) With tight-fitting lids or doors if kept outside the food establishment.

During a review of the facility's Policies and Procedures (P&P), titled Waste Control and Disposal, undated, the P&P indicated trash bins should be covered at all times.

Outside garbage bin should be kept closed at all times and surrounding area must be kept clean.

Dispose garbage in a timely manner to prevent build up.

All cardboard boxes will be broken down and disposed of timely.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

the resident's medical, physical, functional, or psychosocial condition, shall be documented in the

complete, and accurate.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During an interview on [DATE] at 7:42 p.m., the administrator (ADM) stated CPR and weight loss were not part of their current QAPI plan and the issues were not identified prior to the recertification survey [DATE]-[DATE].

The ADM stated these issues should have been caught via training and follow through, but they were not.

During a review of the facility's policy and procedure (P/P) titled, Quality Assurance and Performance (QAPI) Program, revised 2/2020, indicated the facility implements and maintains an ongoing, facility-wide Quality Assurance and Performance Improvement (QAPI) Program focused on the indicators of the outcomes of care and quality of life for our residents.

The P/P indicated the objective of the QAPI program was to provide a means to measure current and potential indicators for outcomes of care and quality of life and establish a system through which to monitor and evaluate corrective actions.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of the facility's P&P, titled Handwashing/Hand Hygiene undated, the P&P indicated this facility considers hand hygiene that primary means to prevent the spread of healthcare-associated infections.

Hand Hygiene is indicated after contact with blood, body fluids, or contaminated surfaces, after touching the resident's environment.

Single-use disposable gloves should be used when anticipating contact with blood or body fluids and when in contact with a resident.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During an interview on 2/8/2025 at 6:50 p.m. with the Director of Nursing (DON), the DON stated the purpose of the antibiotic stewardship program is to ensure antibiotics are used appropriately and prevent overuse or incorrect use of antibiotics.

The DON stated the physician must be notified if a resident does not meet criteria.

During a review of the facility's Infection Control Preventionist Job Description dated 3/19/2024, the job description indicated, the IPN reviews every antibiotic order in the facility to ensure that each medication has proper indication for use and is appropriate for the residents and is responsible for sharing feedback to the physicians.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

Based on observation, interview and record review, the facility failed to offer, educate, and track

This failure had the potential to place all residents at risk for infection of coronavirus.

Findings

During an interview on 2/6/2025 at 2:50 p.m. with the Infection Preventionist Nurse (IPN), the IPN stated the facility does not have a tracking log or retain records of vaccination education, proof of vaccination, or declinations for coronavirus vaccination of facility staff.

During an interview on 2/8/2025 at 6:50 p.m. with the Director of Nursing (DON), the DON stated it is important to educate and document staff coronavirus vaccinations in order to protect residents and staff from the coronavirus.

During a review of the facility's policy and procedure (P/P), titled Covid-19 Policy, dated 8/26/2024, the P/P indicated: A.

The facility will continue to educate residents, responsibility parties, and staff about the benefits of receiving the vaccination and risks of refusals.

B.

Covid-19 2024-2025 vaccination will be offered to residents and staff based on recommendations by Long beach Health Department (LHD) and California Department of Health (CDPH).

C.

The facility will keep copies of the proof of vaccinations.

E.

The facility will continue to educate the resident, responsible party, and employees regarding the benefits of COVID-19 vaccination to keep their vaccination up to date unless it is contraindicated, refused by resident or refused by employees.

G.

If am employee chooses not to be vaccinated, they must provide a written declination that he or she has declined the vaccination.

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Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During an interview on 2/8/2025 at 6:56 p.m. with the Administrator, the ADM stated that currently, there were 18 of RN, 50 of LVN, 20 of RT, and 100 of CNA in the facility.

During a concurrent interview and record review on 2/8/2025 at 7:55 p.m. with the Director of Staff Development (DSD), the facility's in-service logs, for the year of 2024.

The DSD stated that she was unaware that Effective Communications was a mandatory training for direct care staff and stated that the training was not provided in 2024.

The DSD also stated that Effective Communications is important to ensure that staff can communicate effectively with residents, without this training, staff may lack the necessary skills to communicate properly with residents.

During an interview on 2/8/2025 at 8:05 p.m. with the Director of Nursing (DON), the DON stated that effective communication is essential to meet resident's need, particularly for Non-English speaking residents and those requiring specialized care, such as individuals with dementia, traumatic brain injury (TBI), or stroke, who rely on specific communication methods.

The DON also stated that the training should be provided to ensure staff can effectively communicate with these residents, without proper training, resident's needs may not be met, affecting their care.

During a review of the facility's policy and procedure (H&P) titled, In-Service Training, All Staff, revised August 2022, indicated the all staff are required to participate in regular in-service education and primary object of the in-service training is to ensure that staff are able to interact in a manner that enhances the resident's quality of life and quality of care and can demonstrate competency in the topic areas of the training.

The P&P also indicated 'Effective communication with residents and family as a required training topic for direct care staff.

The P&P indicated that training requirement are met prior to staff providing services to residents, annually, and as necessary based on the facility's assessment.

056043 02/06/2025

Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During an interview on 2/8/2025 at 6:56 p.m. with the Administrator, the ADM stated that currently, there were 18 of RN, 50 of LVN, 20 of RT, and 100 of CNA in the facility.

During a concurrent interview and record review on 2/8/2025 at 7:55 p.m. with the Director of Staff Development (DSD), the facility's in-service logs, for the year of 2024, were reviewed.

The DSD stated that she was unaware that QAPI was a mandatory training for direct care staff, and she did not provide the training to direct care staff in 2024.

The DSD also stated that QAPI training is important for staff to stay informed what was going on in the facility and could not answer the potential outcomes of not providing the training.

During an interview on 2/8/2025 at 8:05 p.m. with the Director of Nursing (DON), the DON stated that QAPI is ongoing process used to address issues, improve communication among staff, ensure proper resident care.

Without this training, staff may not be aware of updated facility procedures, proper communication protocols, or how to assist residents effectively, potentially impacting resident care and teamwork within the facility.

During a review of the facility's policy and procedure (H&P) titled, In-Service Training, All Staff, revised August 2022, indicated the all staff are required to participate in regular in-service education and primary object of the in-service training is to ensure that staff are able o interact in a manner that enhances the resident's quality of life and quality of care and can demonstrate competency in the topic areas of the training.

The P&P also indicated 'Elements and goals of the facility QAPI program as a required training topic.

The P&P indicated that training requirement are met prior to staff providing services to residents, annually, and as necessary based on the facility's assessment.

056043 02/06/2025

Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

F-F578, Advance Directives).

056043

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 056043 B.

Wing 02/06/2025

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

Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of the facility's policy and procedure (P/P) titled, Quality Assurance and Performance (QAPI) Program, revised ,d+[DATE], indicated the facility implements and maintains an ongoing, facility-wide Quality Assurance and Performance Improvement (QAPI) Program focused on the indicators of the outcomes of care and quality of life for our residents.

The P/P indicated the objective of the QAPI program was to provide a means to measure current and potential indicators for outcomes of care and quality of life and establish a system through which to monitor and evaluate corrective actions.

056043

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 056043 B.

Wing 02/06/2025

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

Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of Resident 188's Minimum Data Set ([MDS] a resident assessment tool) dated 12/13/2024, the MDS indicated Resident 188 had severe cognitive impairment (a significant decline in cognitive abilities that significantly impact daily functioning and independence) for daily decision making.

The MDS indicated Resident 188's current weight as of 12/6/2024 was 119 lbs.

The MDS indicated Resident 188 was receiving a therapeutic (a meal plan that controls the intake of certain foods or nutrients) diet and was receiving 51% or more of his total calories through a feeding tube.

During a review of Resident 188's untitled Care Plan initiated on 12/23/2024, the Care Plan indicated Resident 188 had cancer with an increased risk for weight loss secondary to non-Hodgkin's lymphoma.

The untitled Care Plan indicated Resident 188's goal was not to have a weight loss exceeding 5% per month.

The Care Plan interventions included RD evaluations and to notify the physician and Resident 188's responsible party of any change of conditions.

During a review of a document titled, Weekly-Weights- Station Subacute (a level of care needed by a patient who does not require hospital level acute care but who requires more intensive licensed skilled nursing care than is provided to the majority of patients in a skilled nursing facility) Summary dated 12/2024, the document indicated Resident 188's admitting weight was 119 lbs. and was weighed weekly after admission on 12/6/2024. Resident 188's weight was as follows:

1. On 12/11/2024 Resident 188's weight was 115 lbs.

There was four lbs. weight loss in five days since admission on12/6/2024.

2. On 12/18/2024 Resident 188's weight was 112 lbs.

There was another three lbs. weight loss in a week from 12/11/2024.

3. On 12/27/2024 Resident 188's weight was 110 lbs.

There was another two lbs. weight loss in a week from 12/28/2024.

4. On 1/3/2025 Resident 188's weight was 110 lbs.

The Weekly Weights and Vitals Summary did not indicate the aforementioned weekly weights were recorded and addressed in Resident 188's electronic medical record (EMR) and the resident's weekly weight loss was addressed.

056043

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 056043 B.

Wing 02/06/2025

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

Colonial Care Center 1913 E 5th Street Long Beach, CA 90802