Pacific Care Nursing Center

symptoms.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During a review of Residents 65 admission Record (Face Sheet), the admission Record indicated Resident 65 was initially admitted to the facility on [DATE] with diagnoses that include but not limited to quadriplegia (a form of paralysis that affects all four limbs plus the torso), muscle weakness (lack of muscle strength), osteoarthritis unspecified (degenerative joint disease in which the tissue in the joint break down over time), neuromuscular dysfunction of bladder (lack of bladder control due to brain or spinal cord injury).

During a review of Resident 65's History and Physical (H&P), dated 5/7/2024, the H&P indicated Resident 65 had the capacity to understand and can make decisions.

During a review of Resident 65's Minimum Data Set ([MDS] a specialized resident screening and assessment tool), dated 4/5/2024, the MDS indicated Resident 65 was able to understand and be understood by others.

The MDS indicated Resident 65 had impairments (the state of function being weakened or damaged) on both sides of his upper extremities (upper part of the body that includes the shoulder, elbow, wrist, and hand) and on both sides of the lower extremities (lower part of the body that includes the hip, knee, ankle, and foot).

The MDS indicated that Resident 65 was dependent on staff for toileting, bathing, dressing, and personal hygiene.

Section D and E were not completed and there were missing signatures on the MDS.

During an interview on 7/24/2024 at 1:00 p.m. with the Minimum Data Set (MDS) Nurse, the MDS nurse stated completing MDS assessment withing a week of admission or during the quarterly due date allows for optimal care to be given for the resident and for billing to take place.

The MDS nurse stated that MDS assessments should be completed upon admission, quarterly, and if there is a change in condition.

The MDS nurse stated that all parts of the MDS assessment should be finished and completed by the date stated completed on the document.

The MDS nurse stated if an assessment was not completed in a timely manner direct care of the resident was affected.

During an interview on 7/25/2024 at 11:00 a.m. with the Director of Nursing (DON), the DON stated that all dates should match when the MDS assessment was completed, and records updated.

The DON stated all sections of the MDS must be completed by the two-week mark, after admission or the 3-month mark for quarterly submissions.

The DON stated that residents are at an increased risk of decreased care quality when MDS assessments are delayed.

A review of the facility's policy and procedure (P&P) titled, Minimum Data Set, revised 3//2021, the P&P indicated, Providing evidence-based assessments and management of common conditions ensure timely assessments, contacts with providers and transfers to hospital in a timely update to residents care record.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During an interview on 7/24/2024 at 10:45 a.m.

Registered Nurse Supervisor (RNS), the RNS stated

RNS stated this was the best way to communicate with the team about care.

The RNS stated every person on a care team were responsible to help and update care records.

During an Interview with the Director of Nursing (DON) on 7/24/24 at 2.00 p.m., the DON stated for any patient that has limitation non-pharmacologic interventions are a must.

The DON stated staff works as a group to keep medical records updated.

A review of the facility's policy and procedure (P&P) titled, Comprehensive care planning, revised 10/2017, the P&P indicated, A Comprehensive Care Plan will be developed for each resident.

The Care Plan will include measurable objectives and timetables to meet a resident's medical, nursing, mental, and psychosocial needs.

Cross Reference F-F695.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During an interview on 7/25/2024 at 2:17 p.m., with the Director of Nursing (DON), the DON stated CNA's were responsible for performing personal hygiene and residents' fingernails were cleaned as needed and trimmed once a week.

During a concurrent interview on 7/25/2024 at 2:17 p.m., with the Assistant Director of Nursing (ADON), the ADON stated that if CNA's were not cleaning the residents' fingernails daily and as needed, it could lead to an infection if he nails were left dirty.

The ADON stated if staff were not trimming the residents' fingernails, the residents could scratch themselves and end up with cuts.

During a review of the facility's policy and procedure (P&P) titled, Activities of Daily Living, Quality of Care, Routine Resident Monitoring, and Scope of Services, dated June 2022, the P&P indicated, it is the policy of the facility that each resident receive, and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being consistent with the resident's assessment and plan of care.

The P&P indicated staff will ensure that ADLs are monitored, assisted with, and provided for those residents who are unable to perform ADLs.

The P&P indicated if a resident is unable to carry out ADLs, they are to be provided services to maintain the food nutrition, grooming and personal and oral hygiene.

The P&P indicated the facility will provide care consistent with progressional standards for residents to prevent pressure injuries and not develop pressure injures unless they are unavoidable.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During an interview on 7/25/2024 at 12:46 p.m., with the Director of Nursing (DON), the DON stated Resident 15 could develop respiratory problems if the resident was not wearing the oxygen as ordered by the physician.

During a review of the facility's policy and procedure (P&P) titled, Oxygen Administration, revised 3/2017, the P&P indicated to verify that there was a physician's order for oxygen administration and review the resident's care plan for any special needs of the resident.

The P&P indicated if the resident refused the administration of oxygen, document the reason(s) and ensure that the risks were explained to the resident and documented.

During a review of the facility's P&P titled, Activities of Daily Living, Quality of Care, routine Resident Monitoring, and Scope of Services, dated 6/2022, the P&P indicated the facility would provide care for residents who require respiratory care, so they receive care and treatment in accordance with professional standards of practice, the comprehensive resident centered care plan, as well as the resident's goals and preferences.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During an interview on 7/24/2024 at 9:48 a.m., with Resident 27, Resident 27 stated her left upper arm pain was a little better than yesterday, but she continued to have 7/10 pain.

During an interview on 7/25/2024 at 12:49 p.m., with the Director of Nursing (DON), the DON stated when a routine pain medication was given, the pain must be reassessed to see if the pain medication was affective or if the physician needed to be notified.

The DON stated when residents were experiencing pain, they did not want to participate in activities, the residents cannot sleep or move around.

The DON stated pain could affect a resident's whole life.

During a review of the facility's policy and procedure (P&P) titled, Pain Management Protocol, dated 10/2017, the P&P indicated pain will be considered as the 5th vital sign and the absence or presence of pain will be documented at each nursing note entry that requires full vital signs.

The P&P indicated reassessments will be conducted whenever there is a change in the dose, or the type of medications being utilized.

The P&P indicated to assess effectiveness of pain medication with routine and as needed pain medication approximately 30 minutes after administration.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During a review of the facility's policy and procedure (P&P) titled, Dialysis Care, revised on 9/2020, the P&P indicated, In case of an emergency, at the bedside of a dialysis resident, there should be a clamp, tape, [gauze], and Kerlix.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During an observation on 7/25/2024 at 11:05 a.m., Resident 27's Tramadol 50 mg tablet blister pack

During a concurrent interview and record review on 7/25/2024 at 11:06 a.m., with LVN 3, the Antibiotic or Controlled Substance Drug Record dated 7/2024, was reviewed.

The record indicated Resident 27 last received Tramadol 25 mg on 7/24/2024 at 9:00 p.m., with 49 doses remaining. LVN 3 stated she gave Resident 27's Tramadol 25 mg tablet on 7/25/2024 at 9:07 a.m. but did not document.

During an interview on 7/25/2024 at 11:10 a.m., with LVN 3, LVN 3 stated when administering controlled substances, it should be signed and documented as soon as possible to prevent medication errors.

During an interview on 7/25/2025 at 1:27 p.m., with the Assistant Director of Nursing (ADON), the ADON stated administered controlled substances should be documented right away before it was forgotten to monitor drug effectiveness and to prevent discrepancies.

During a review of the facility's policy and procedure (P&P) titled, Controlled Medications 8/2014, the P&P indicated when a controlled medication was administered, the licensed nurse administering the medication immediately enters the following information on the accountability record and the medication record MAR: a.

Date and time of administration. b.

Amount administered. c.

Signature of the nurse administering the dose on the accountability record at the time the medicine is removed from the supply.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

action and the procedure included wiping the rubber cap of a vial with an alcohol swab.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During a review of Resident 15's admission Record, the admission Record indicated Resident 15 was a [AGE] year-old female originally admitted to the facility on [DATE] and re-admitted on [DATE]. Resident 15's admitting diagnosis included a cerebral infarction (tissue death of the brain from a clot or other obstruction of blood flow) and hypertension (high blood pressure).

During a review of Resident 15's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 6/5/2024, the MDS indicated Resident 15 was severely cognitively impaired (ability to think and reason).

The MDS indicated Resident 15 required total assistance (helper does all the effort) with all activities of daily living (ADLs) such as oral hygiene, toileting hygiene, showering/bathing, dressing, and personal hygiene.

During a review of Resident 15's Physician Orders dated 5/30/2024, the orders indicated Resident 15 was to receive Artificial Tears Solution, one drop in both eyes two time a day for eye dryness.

During a review of the facility's P&P titled Medication Storage in the Facility dated 4/2008, the P&P indicated Outdated, contaminated, or deteriorated medications and those in containers that were cracked, soiled, or without secure closures should be immediately removed from stock, disposed of according to procedures for medication disposal, and reordered from the pharmacy if a current order exists.

The P&P indicated Medication storage conditions are monitored on a routine basis, and corrective action taken if problems are identified.

During a review of the facility's P&P titled Medication Administration dated 5/2019, the P&P indicated The licensed nurse administering the medication must check the label three times to verify the right resident, the right medication, the right dosage, the right time, and route of the administration before giving the medication and medications ordered for a specific resident may not be administered to another resident.

According to 2022 Food Code: U.S.

Food and Drug Administration, dated 1/18/2023, indicated, Food shall be safe, unadulterated (completely pure and has nothing added to it) .

Food packages shall be in a good condition and protect the integrity of the contents so that the food is not exposed to adulteration or potential contaminants.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During a concurrent interview and record review on 7/23/2024 at 2:30 p.m. with the Administrator (ADM) and IPN 2, the QAPI committee meeting minutes and sign in sheets on 4/8/2024, 5/16/2024 and 6/20/2024 were reviewed.

The QAPI committee sign in sheets and minutes indicated the IPN did not sign and did not present any infection control reports or findings to the QAPI committee.

The ADM stated the QAPI committee meets every 30 days.

The ADM stated that she was a new administrator in the facility and the IPN was also new to the facility. IPN 2 stated that she had not attended any QAPI meetings since she was promoted as the IPN.

The ADM agreed that it was mandatory to have an IPN to attend and participate in all QAPI committee meetings and discuss the current infection rate and infection control practices in the facility.

The ADM explained that the previous IPN resigned before a new IPN could be hired.

The ADM stated she received the infection control summary for the month of May 2024, but it was never presented at the QAPI committee meeting.

The ADM stated she was working on improving the QAPI process.

The ADM stated the facility did not have a policy and procedure for their QAPI Program.

During a review of the facility's QAPI Plan, (no date), the QAPI Plan indicated all department heads, the administrator, the director of nursing, infection control and prevention officer, medical director, consulting pharmacist, resident and/or family representatives (if appropriate), and three additional staff will provide QAPI leadership by being on the QAPI Committee.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During an interview on 7/24/2024 at 10:30 a.m., with the IPN, the IPN stated expired food should not be stored, especially in the resident fridge.

The IPN stated storing expired food put the resident at risk for food poisoning if the food was served to them.

During an interview on 7/25/2024 at 8:53 a.m., with the Dietary Supervisor (DS), the DS stated expired food should not be stored and should be disposed of right away.

The DS stated labeling and dating food items was a way to ensure accountability of the expiration dates and to be aware whose food was whose.

The DS stated the residents in the facility were very fragile and many had low immunity, so they were at high risk of food borne illness if the staff were not careful.

During an interview on 7/25/2024 at 11:13 a.m. with the DON, the DON stated the nursing department was responsible for maintaining the resident fridge.

The DON stated when food items were stored in the fridge, the item had to be labeled with the resident's name, the date, and check the expiration date.

The DON stated if a food item was expired, it would need to be discarded.

The DON stated removing expired food was essential in preventing foodborne illnesses that could cause diarrhea and upset stomach.

During a review of the facility's P&P titled, Dietary- Refrigerator for Resident Storage of Food, revised on 1/2017, the P&P indicated, Food will be labeled with the resident's name and the date the food is placed in the refrigerator.

Leftover food will be kept for 72 hours after the date on the container and will be discarded after 72 hours or discarded based on the expiration date if unopened.

056007 07/25/2024

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806

During a telephone interview on 7/24/2024 at 9:48 a.m. with Resident 15's Family Member (FM 1), FM 1 stated when they visited Resident 15, Resident 15 frequently had fingernails that were uncut. FM 1 stated that the fingernails on Resident 15's right hand would pinch his skin and cause a cut to the middle of his palm. FM 1 stated the nurses were notified of Resident 15's long fingernails several times, but Resident 15 continued to have long fingernail during their next visit to the facility. FM 1 stated the family would have to cut Resident 15's nails whenever they visited to prevent the nails from cutting his skin.

During an observation on 7/24/2024 at 3:30 p.m., in Resident 15's room, Resident 15's right hand was contracted (a shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff, preventing normal movement). Resident 15 had long, jagged untrimmed fingernails on both hands. Resident 15's fingernails to the right contracted hand were digging into his palm causing redness to the area.

During a concurrent observation and interview on 7/24/2024 at 3:35 p.m. with Licensed Vocational Nurse (LVN) 3, LVN 3 opened up Resident 15's contracted right hand. LVN 3 stated Resident 15's long fingernails were causing redness to the to the palm of his hand which could lead to injury and cause an infection. LVN 5 stated the certified nursing assistants (CNAs) should cut Resident 15's fingernails every week.

During an interview on 7/24/2024 at 4:27 p.m. with Registered Nurse (RN) 1, RN 1 stated the CNAs were responsible for cutting the residents' fingernails and shaving the resident every Sunday. RN 1 stated that if Resident 15's fingernails were left to grow long, they could break the skin which could lead to infection.

During a review of Resident 15's Admission Record, the Admission Record indicated Resident 15 was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE]. Resident 15's diagnoses included cerebral infarction (damage to tissues in the brain due to a loss of oxygen to the area), dysarthria (a speech disorder where damage to the nervous system causes the muscles that produce speech to become paralyzed or weakened), anarthria (a complete loss of speech), dysphagia (difficulty swallowing), lack of coordination, muscle weakness, hemiplegia (unable to make voluntary movements on one side of the body), and hemiparesis (muscle weakness on one side of the body).

056007

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 056007 B.

Wing 07/25/2024

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

Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806