Valley Palms Care Center

During a review of the facility policy and procedure titled, Psychotropic Medication Use, last reviewed 7/30/2025, the policy indicated a psychotropic medication is any medication that affects the brain activity associated with mental processes and behavior.

Anti-anxiety medications are considered psychotropic medications and are subject to prescribing, monitoring, and review requirements specific to psychotropic medications.

Residents are involved in the medication management process.

Psychotropic medication management includes: A.

Indications for use B.

Dose C.

Duration D.

Adequate monitoring for efficacy and adverse consequences E.

Preventing, identifying and responding to adverse consequences Residents have the right to decline treatment with psychotropic medications.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During an interview on 1/19/2025 at 12:35 p.m., with Certified Nursing Assistant 9 (CNA 9) in the activities room, CNA 9 stated he returned Resident 16 to his room and forgot to place the CL within reach of the resident. CNA 9 stated the CL should be within reach of residents at all times to be able to communicate with staff for any needs the resident may have. CNA 9 stated it was especially important to have the CL within reach in case of an emergency so staff is able to attend to the resident right away.

During a concurrent interview and record review on 1/20/2025 at 9:07 a.m., with the Director of Nursing (DON), the DON reviewed the facility policy and procedure regarding CLs.

The DON stated the CL should be within reach of resident's while in bed or sitting in a wheelchair next to the bed and the resident should know where the CL is located.

The DON stated the importance of the CL is that a resident needs to be able to call for help.

The DON stated when a resident does not have a CL they may feel bad or need help and nobody would be able to address their needs or wants.

The DON stated when staff does not attend to resident needs, it may result in the resident having feelings of frustration.

The DON stated resident frustration may result in behavior issues leading to a negative emotional effect and potentially lead to resident's trying to help themselves leading to a fall or injury from an accident.

The DON stated the facility policy was not followed when Resident 16 didn't have access to the CL.

During a review of the facility policy and procedure (P&P) titled, Call Light, last reviewed 7/30/2024, the P&P indicated residents are provided with a measure to call staff for assistance through a communication system that directly calls a staff member or a centralized work station.

The purpose of the procedure is to ensure timely responses to the resident's requests and needs.

Each resident is provided a means to call staff directly for assistance from their bed and from the floor.

During a review of the facility P&P titled, Falls and Fall Risk, Managing, last reviewed 7/30/2024, the P&P indicated based on previous evaluations and current data, the nursing staff will identify interventions related to resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling.

Resident conditions that may contribute to the risk of falls include cognitive impairment and visual deficits.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During an observation on 1/18/2025 at 9:15 a.m., 1/19/2025 at 10:00 a.m., and 1/20/2025 at 10:50 a.m. outside Resident 247's room, observed Resident 247 screaming for assistance due to pain but declined pain medication when offered by staff stating she was not in pain.

During an interview on 1/20/2025 at 11:10 a.m. with Licensed Vocational Nurse 7 (LVN 7), LVN 7 stated she was made aware Resident 247 was in pain but declined when offered pain medication denying pain.

During a concurrent observation and interview on 1/20/2025 at 11:25 a.m., inside Resident 247's room with Registered Nurse 1 (RN 1), observed Resident 247 lying in bed in supine position. Resident 247 stated she was not in pain and the screaming was just because she wanted to scream and declined to be interviewed further.

During a concurrent interview and record review on 1/20/2025 at 3:30 p.m., reviewed Resident 247's electronic health record including care plans if Resident 247's screaming behavior was addressed with Registered Nurse 2 (RN 2). RN 2 verified there was no care plan developed and implemented addressing Resident 247's screaming behavior. RN 2 stated licensed nurses are responsible in the development of care plans if there is a change of condition or behavior issues with a resident and are reviewed and revised by the MDS Coordinator as needed. RN 2 stated there should have been a care plan developed and implemented addressing Resident 247's screaming behavior so the staff would be aware of the care the resident needed to prevent delay in the delivery of care and services Resident 247 needed.

During an interview on 1/20/2025 at 4:30 p.m. with the Director of Nursing (DON), the DON stated licensed nurses are responsible in the development of care plans if there are issues that needed to be addressed.

The DON stated there should have been a care plan developed and implemented addressing Resident 247's screaming behavior and refusal of any type of care so the necessary care and services can be provided to the resident and prevent a delay.

During a review of the facility's policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered, last reviewed 7/30/2024, the P&P indicated a comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident.

The P&P further indicated - The comprehensive care plan includes: a.

Measurable objectives and timeframes

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

F 0656 b.

Care plan interventions are chosen after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making. - Interventions address the underlying source(s) of the problem area(s), not just symptoms or triggers.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During an interview on 1/20/2025 at 5:30 p.m the Director of Nursing (DON) stated if a resident is

resident with eating.

The DON stated the staff has to offer an alternate menu and request in the kitchen and/or provide assistance with eating.

The DON stated CNA 9 should have provided assistance to Resident 242 with eating or tried to assist if Resident 242 did not seem to want to eat or touch the food by offering the food.

The DON stated if Resident 242 was not eating, it placed the resident at risk for malnutrition, weight loss, dehydration, worsening of pressure ulcer.

During a review of the facility's policy and procedure (P&P) titled, assistance with Meals, last reviewed 7/30/2024, the P&P indicated residents shall receive assistance with meals in a manner that meets the individual need of each resident.

The P&P further indicated residents who cannot feed themselves will be fed with attention to safety, comfort and dignity.

During a review of the facility's P&P titled, Activities of Daily Living (ADL), Supporting, last reviewed 7/30/2024, the P&P indicated residents will be provided wit8h care, treatment, sand services as appropriate to maintain or improve their ability to carry out ADLs.

The P&P further indicated appropriate care, and services will be provided for residents who are unable to carry out ADLs independently including appropriate support and assistance with dining (meals and snacks).

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During a review of the facility's policy and procedure (P&P) titled, Seizures and Epilepsy - Clinical Protocol, last reviewed 7/30/2024, indicated the nurse shall assess and document/report the resident's last blood level of any anticonvulsants being given.

During a review of the facility's P&P titled, Lab and Diagnostic Test Results - Clinical Protocol, last reviewed 7/30/2024, indicated the staff will process requisitions and arrange for tests.

The P&P indicated a nurse will try to determine whether the test was done as a routine screen or follow-up; to assess a condition change or recent onset of signs and symptoms; or to monitor drug level.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During a review of Resident 26's Order Summary Report dated 1/3/2025, the Order Summary Report

skin erosion caused by prolonged exposure to a source of moisture such as urine, stool, sweat, wound drainage, saliva or mucus): cleanse with NS, pat dry, apply antifungal, zinc oxide (type of topical treatment) and cover with dry dressing every day shift for 30 days.

During an observation on 1/18/2025 at 11:42 a.m., observed Resident 26's LALM was turned off.

During a concurrent observation and interview on 11/18/2025 at 11:59 a.m. with RN 3, RN 3 stated Resident 26's LALM should have been turned on. RN 3 stated the LALM for Resident 26 was not plugged in as there were no more electrical outlets. RN 3 stated having LALM turned off can be a potential for Resident 26 to develop a pressure injury and to cause pain and discomfort.

During an interview on 1/22/2025 at 12:47 p.m. with the DON, the DON stated LALMs are used for residents with skin breakdown or at risk for developing pressure ulcers.

The DON stated Resident 26 has an order for LALM which should have been turned on.

The DON stated if the LALM was not turned on, Resident 26 can be at risk to develop a pressure ulcer and/or for the pressure ulcers to get worse.

During a review of the facility's policy and procedures (P&P) titled, Support Surface Guidelines, last reviewed on 7/30/2024, the P&P indicated redistribution support surfaces are to promote comfort for all bed or chairbound residents, promote circulation and provide pressure relief or reduction.

Individuals at risk for developing ulcers should be placed on redistribution support surface, such as foam, gel, static air, alternating air, or air-loss or gel when lying in bed.

During a review of LALM 1 Manual with a date of 2024, the Manual indicated pressure redistribution and alternating pressure therapy have been demonstrated to reduce the risk of pressure injuries and as being a valuable aid in the treatment of pressure injuries. In the powered alternating pressure mode, the Pressure Redistribution Optimization (P.R.O) mat plus adds the benefit of cyclic offloading for advance treatment of uncomplicated stage 3 or 4 pressure injuries for resident where such therapy may improve pressure redistribution and circulation.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During a review of the facility provided manufacturer's guideline on Floor Mat 1 (FM 1), dated 11/2017, the manufacturer's guideline indicated to check to ensure the bedside matt does not pose a tripping hazard to residents or staff.

During a review of the facility's policy and procedure (P&P) titled, Safety and Supervision of Residents, last reviewed 7/30/2024, the P&P indicated: - Individualized, resident-centered approach to safety addresses safety and accident hazards for individual residents. - Implementing interventions to reduce accident risks and hazards shall include the following: a.

Communicating specific interventions to all relevant staff. b.

Ensuring the interventions are implemented c.

Documenting interventions - Monitoring the effectiveness of interventions shall include the following: a.

Ensuring the interventions are implemented correctly and consistently. - Certain resident risk factors and environmental hazards are addressed in dedicated policies and procedures which include bed safety and falls.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During a review of the facility's policy and procedure (P&P) titled, Renal Dialysis, Care of Residents, last reviewed 7/30/2024, the P&P indicated that it is the facility's policy to follow standards of care for residents receiving renal dialysis.

The P&P indicated the access site care will be provided by a licensed nurse, with physician's order; access site care is checked for condition and patency every shift; and physician/s are notified immediately of any apparent complications.

The P&P indicated resident's care documentation including recording of date, time, access site conditions, patency after dialysis and access site care in the Dialysis Communication Form.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During a review of the facility's P&P titled, Controlled Medications, last reviewed 7/30/2024, the P&P indicated medications included in the controlled substances are subject to special handling, storage, disposal, and record keeping in the facility in accordance with the federal and state laws and regulations.

The P&P further indicated: - When a controlled medication is administered, the licensed nurse administering the medication immediately enters the following information on the accountability record and the MAR:

• Date and time of administration
• &n[TRUNCATED]

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

Based on observation, interview, and record review, the facility failed to properly label the open date

Medication Carts (Medication Cart 2 [MC 2]).

This deficient practice had the potential for the medication to be ineffective.

Findings

During a concurrent observation and interview during a review of the medication storage on 1/20/2025 at 10:18 a.m. with Licensed Vocational Nurse 7 (LVN), MC 2 was observed with Senna 8.6 mg with expiration date of 9/2027 with no open date observed. LVN 7 stated opened Senna container today and did not label it with an open date. LVN 7 stated must put open date on medications so that the facility knows when the medication was opened.

During an interview on 1/22/2025 at 12:54 p.m., the Director of Nursing (DON) stated over the counter medication should have an open date.

The DON stated medications should have open date because we should not follow expiration date, medications should be discarded three months after opening.

During a review of the facility's Policy and Procedures (P&P) titled, Medication Storage in the Facility, last reviewed on 7/30/2024, 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 P&P titled, Medication ordering and receiving from Pharmacy, last reviewed on 7/30/2024, the P&P indicated floor stock medications are labeled as floor stock or house supply and kept in the original manufacturer's container.

The manufacturers or pharmacy's label should include the following:

• expiration date.

During a review of the facility's recipe titled, Breakfast (BRK) Omelet, with a date of 2024, the recipe indicated, ingredients: margarine, all-purposed flour, salt, black pepper, low fat milk (contains lower calories and fat), and liquid eggs.

During a review of the facility's recipe titled, Scrambled Egg, with no date, the recipe indicated, ingredients: liquid eggs, whole milk (contains more calories and fat), salt, margarine, and black pepper.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During a review of the facility's recipe titled, Breakfast (BRK) Omelet, with a date of 2024, the recipe indicated, ingredients: margarine, all-purposed flour, salt, black pepper, low fat milk (contains lower calories and fat), and liquid eggs.

During a review of the facility's recipe titled, Scrambled Egg, with no date, the recipe indicated, ingredients: liquid eggs, whole milk (contains more calories and fat), salt, margarine, and black pepper.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

required for a meal.

During a review of the recipe Bread Slice for Cycle 4 2024, the recipe indicated it is recommended to serve puree or gelled bread for dysphagia diets, but if the SLP of the facility signs and approves regular breads on an individual basis, chop regular portions.

Make sure all particles are no more than 15 millimeters (mm, a unit of measurement) x 15 mm (1/2 inches [in, a unit of measurement]) in size.

The recipe indicated to use puree bread mix.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During an interview on 1/22/2025 at 12:41 p.m. with the Director of Nursing (DON), the DON stated

issue.

During a review of the facility's policy and procedures (P&P) titled, Food Receiving and Storage, last reviewed on 7/30/2024, the P&P indicated food shall be received and stored in a manner that complies with safe food and handling practices.

• Foods that are prepared off site will only be accepted from institutions that are subject to federal,

state, or local inspection.

• All foods stored in the refrigerator or freezer will be covered, labeled and dated (use by date).

f.

Partially eaten food may not be kept in the refrigerator.

During a review of the facility's P&P titled, Policies and Practices Infection Control, last reviewed on 7/30/2024, the P&P indicated policies and practices are intended to facilitate maintaining a safe, sanitary, and comfortable environment and to help prevent and manage transmission of disease and infections.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During an interview on 1/19/2025 at 10:51 a.m. with Registered Nurse 1 (RN 1), RN 1 entered the Station A Medication Room and stated the blanket was still in the room. RN 1 stated she was not sure if the blanket was used, but blankets should not be left in the medication room for infection control and sanitary reasons. RN 1 stated when a blanket is left in the medication room it can lead to cross contamination (the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect) of bacteria to the resident medications and cause illness of residents.

During a concurrent interview and record review on 1/20/2025 at 9:07 a.m., with the Director of Nursing (DON), the DON reviewed the facility policy and procedures regarding infection control and medication storage.

The DON stated resident, or staff personal belongings should not be in the medication rooms for infection control reasons.

The DON stated any staff member that entered into the medication storage room and saw the blanket should have removed the blanket, but they did not.

The DON stated she has spoken with staff, and nobody wants to own up to who the blanket belonged to.

The DON stated the medication rooms stores medications that are administered to residents and any contamination from the blanket could transfer to the residents and medication carts causing illness.

The DON stated the facility policies were not followed.

During a review of the facility P&P titled, Storage of Medications, last reviewed 7/30/2025, the P&P indicated medications and biologicals are stored safely, securely, and properly.

Medication storage areas are kept clean, and conditions are monitored on a routine basis and corrective action taken if problems are identified.

During a review of the facility P&P titled, Policies and Practices - Infection Control, last reviewed 7/30/2025, the P&P indicated the facilities infection control policies and practices are intended to facilitate maintaining a safe, sanitary and comfortable environment and to help prevent and manage transmission of diseases and infections.

All personnel will be trained on the infection control policies and practices upon hire and periodically thereafter.

055287 01/22/2025

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During an interview on 1/19/2025 at 6:12 a.m., [NAME] 1 stated she made a mistake by making scrambled eggs instead of the breakfast omelet that are on the menu for today (1/19/2025).

During an interview on 1/19/2025 at 7:53 a.m., the Dietary Supervisor (DS) stated [NAME] 1 made scrambled eggs instead of the omelet that was on the menu.

The DS stated it would affect the taste and texture because the scrambled eggs and breakfast omelet are two different foods.

During a review of the Policies and Procedures (P&P) titled, Menus, last reviewed on 7/30/2024, the P&P indicated menus are developed and prepared to meet resident choice including religious, cultural, and ethnic needs while following established national guidelines for nutritional adequacy.

1.

Menus meet the nutritional needs of residents in accordance with the recommended dietary allowance of the Food and Nutrition Board (National Research Council and National Academy of Sciences).

2.

Menus for regular and therapeutic diets are written at least two (2) weeks in advance and are dated and posted in the kitchen at least one (1) week in advance.

During a review of the facility's cook's spreadsheet titled, Cycle 4 2024, Week 2 Sunday, dated 1/19/2025, the spreadsheet indicated residents on regular diet would include the following foods in the tray:

- Apple Juice four (4) ounces (oz- a unit of measurement)

- Hot or cold cereal one (1) serving.

- Breakfast omelet one (1) square.

- Bacon one (1) slice

055287

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 055287 B.

Wing 01/22/2025

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

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605

During an interview on 1/19/2025 at 6:12 a.m., [NAME] 1 stated she made a mistake by making scrambled eggs instead of the breakfast omelet that are on the menu for today (1/19/2025).

During an interview on 1/19/2025 at 7:53 a.m., the Dietary Supervisor (DS) stated [NAME] 1 made scrambled eggs instead of the omelet that was on the menu.

The DS stated it would affect the taste and texture because the scrambled eggs and breakfast omelet are two different foods.

During a review of the Policies and Procedures (P&P) titled, Menus, last reviewed on 7/30/2024, the P&P indicated menus are developed and prepared to meet resident choice including religious, cultural, and ethnic needs while following established national guidelines for nutritional adequacy.

1.

Menus meet the nutritional needs of residents in accordance with the recommended dietary allowance of the Food and Nutrition Board (National Research Council and National Academy of Sciences).

2.

Menus for regular and therapeutic diets are written at least two (2) weeks in advance and are dated and posted in the kitchen at least one (1) week in advance.

During a review of the facility's cook's spreadsheet titled, Cycle 4 2024, Week 2 Sunday, dated 1/19/2025, the spreadsheet indicated residents on regular diet would include the following foods in the tray:

- Apple Juice four (4) ounces (oz- a unit of measurement)

- Hot or cold cereal one (1) serving.

- Breakfast omelet one (1) square.

- Bacon one (1) slice

055287

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 055287 B.

Wing 01/22/2025

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

Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605