Oxnard Manor Healthcare Center

F 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

the risks it can cause to the AVF site.During a review of the facility's policies and procedures (P&P) titled, Dialysis Management, dated 3/24, the P&P indicated, The facility should assure that each resident receives care and services consistent with professional standards of practice. 3. A pre and post dialysis evaluation will be completed by the licensed nurse. 4. Vascular Access Site.b. Assessing, observing and documenting care of access sites daily, as applicable, such as.iii. Skin integrity (waxy skin, ulcerations, drainage from incisions) .vii. Evidence of infection at the surgical site, such as drainage, redness, tenderness at incision site, fever.During a review of the facility's P&P titled Arteriovenous Shunt Care, revised 01/12, indicated, . I.

Observe for signs of inflammation, infection and obstruction.Inspect total shunt site area for color, warmth, redness, edema and drainage, once per shift

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/29/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oxnard Manor Healthcare Center

1400 West Gonzales Road Oxnard, CA 93036

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, the facility failed to ensure licensed nurses (LNs) were competent in providing quality of care for one of three sampled residents (Resident 1) when a comprehensive assessment and individualized care plan was not completed related to Resident 1's change of condition (new onset of infection).This failure had resulted in Resident 1's signs and symptoms of infection not monitored by staff and had the potential to develop complications. During a review of Resident 1's admission Record (AR), dated 1/29/26 the AR indicated Resident 1 was admitted to the facility on [DATE REDACTED] with diagnoses that included End Stage Renal Disease (ESRD - final stage of permanent kidney failure whereby requiring regular dialysis or a transplant for survival) and dependence on renal dialysis (procedure done by a trained professional to remove waste and excess fluids from the body when the kidneys stop working properly).

During a review of Resident 1's Order Summary (OS) dated 2/12/25, the OS indicated Resident 1 had hemodialysis on Mondays, Wednesdays, and Fridays. During a review of Resident 1's OS dated 3/24/24,

the OS indicated, If bleeding occurs at AV shunt arteriovenous fistula (AVF- a surgical connection between

an artery and a vein used for dialysis) RUA (Right Upper Arm) any time after dialysis, apply pressure with clean gauze for 5-10 minutes.repeat until bleeding stops. If this intervention does not control the bleeding, notify MD.During a review of Resident 1's medical record titled Microbiology Report (a report that help identify bacteria, fungi, or viruses from clinical specimens to diagnose infections and guide treatment) result date of 1/24/26 indicated, Culture Wound.Access Site.Collected 1/19/26.Organism Pseudomonas aeruginosa (a major opportunistic pathogen, frequently causing severe, antibiotic-resistant), heavy growth and Staphylococcus aureus (a germ found on people's skin), moderate growth. In addition, the physician ordered Vancomycin and Ceftazidime (both antibiotics). During a review of Resident 1's medical record, there was no documentation to show a comprehensive assessment and an individualized care plan with interventions was done for Resident 1's new onset of infection on the dialysis access site and that it had been monitored for signs and symptoms of infection/complication since the start of a new antibiotic therapy.

In addition, there was no documentation on Resident 1's change of condition related to the infection. During

a concurrent phone interview and record review on 2/3/26 at 2:19 p.m. with Licensed Nurse (LN 2), LN 2 confirmed there was no change of condition in the Resident 1's medical record for the positive growth result and antibiotic therapy. LN 2 stated a change of condition should have been initiated but was not. During a concurrent phone interview and record review on 2/3/26 at 3:34 p.m. with Licensed Nurse (LN 3), LN 3 confirmed to have been assigned and was familiar with Resident 1. LN 3 acknowledged that the receiving nurse did not initiate a change of condition when dialysis staff communicated that the resident had positive bacterial cultures and was receiving antibiotics. During a review of the facility's policy and procedure titled, Change in Condition, dated 08/22, indicated, .2. The Licensed Nurse will assess the change of condition and determine what nursing interventions are appropriate. a.i Notification to the Physician/APP will include

a summary of the condition change and an assessment of the resident's vital signs and system review focusing on the condition and/or signs and symptoms for which the notification is required utilizing a SBAR format (situation, background, assessment, recommendation) .4. Reporting Information to the Physician/APP.b. Reporting Laboratory and Diagnostic results .

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