Park Avenue Healthcare & Wellness Center
PARK AVENUE HEALTHCARE & WELLNESS CENTER in POMONA, CA — inspection on January 16, 2025.
Found 5 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
During an interview on 1/15/2025 at 4:21 pm, with the DON, the DON stated a flu vaccine tracking
status.
The DON stated when there was no tracking system or log in place, residents who were medically eligible to receive the flu vaccine would not be offered the vaccine because of the facility's disorganization [lack of tracking].
During a review of the facility's P&P titled, Completion and Correction, revised 1/1/2012, the P&P indicated the purpose was to ensure that medical records were complete and accurate, and that the facility would work to complete and correct medical records in a standardized manner to provide the highest quality and accuracy in documentation.
The P&P indicated entries would be complete, legible, descriptive, and accurate.
The P&P indicated an event was never supposed to be documented before it occurred.
During a review of the facility's P&P titled, Influenza Prevention and Control revised 9/10/2020, the P&P indicated residents were to be offered the influenza immunization every year during flu season, unless medically contraindicated, or the resident had already been immunized during the current flu season.
The P&P indicated the resident's medical record would include documentation that indicated, at a minimum, the resident or the resident's representative was provided education regarding the risk and benefits and potential side effects of the influenza vaccination and whether the resident received the influenza vaccine, could not receive the vaccine due to a medical contraindication or refused the vaccine.
The P&P indicated the vaccine type, dose, route, and nurse administering the vaccine would be documented on the medication administration record.
The P&P indicated the vaccine lot number would be recorded on the immunization log.
555852 01/16/2025
Park Avenue Healthcare & Wellness Center 1550 North Park Avenue Pomona, CA 91768
During a review of the facility's P&P titled, Enhanced Barrier Precautions (EBP), revised 7/5/24, the P&P indicated, When Transmission-based precautions (TBP- a set of infection control measures used in healthcare to prevent the spread of infection) are not appropriate and in addition to Standard Precautions, EBP will be used for novel (new) or targeted MDROs in the facility, based on the Centers for Disease Prevention and Control (CDC) guidance.
The P&P indicated, Purpose . To reduce the risk of transmission of epidemiologically important microorganisms by direct or indirect contact.
The P&P indicated, Many residents in nursing homes (skilled nursing facilities) are at increased risk of becoming colonized (infected) and developing infections with MDROs.
The P&P indicated, .EBP is employed when performing the following high-contact resident care activities .: a.
Dressing, b.
Bathing/showering, c.
Transferring within the resident room, d.
Providing hygiene e.
Changing linens, f.
Changing briefs or assisting with toileting, g.
Device care or use: ( .tracheostomy/ventilator).
The P&P indicated, Required PPE . gloves and gown prior to the high contact care activity .
555852 01/16/2025
Park Avenue Healthcare & Wellness Center 1550 North Park Avenue Pomona, CA 91768
During a review of the facility's undated Centers for Disease Control and Prevention Vaccine Information Statements (CDC VIS), the CDC VIS indicated people 65 years and older, and people with certain health conditions such as heart disease, cancer, diabetes, or a weakened immune system were at greater risk of flu complications.
The CDC VIS indicated flu could cause fever and chills, sore throat, muscle aches, fatigue, cough, headache, and runny or stuffy nose.
The CDC VIS indicated flu vaccine prevented millions of illnesses and flu-related visits to the doctor each year.
During a review of the facility's P&P titled, Influenza Prevention and Control revised 9/10/2020, the P&P indicated to prevent and control the spread of influenza in the facility, the facility would follow infection prevention and control policies and procedures to minimize the risk of residents acquiring, transmitting or experiencing complications from influenza.
The P&P indicated the CDC considered the flu season to be between October 1st and March 31st.
The P&P indicated residents were to be offered the influenza immunization every year during flu season, unless medically contraindicated, or the resident had already been immunized during the current flu season.
The P&P indicated the resident's medical record would include documentation that indicated, at a minimum, the resident or the resident's representative was provided education regarding the risk and benefits and potential side effects of the influenza vaccination and whether the resident received the influenza vaccine, could not receive the vaccine due to a medical contraindication or refused the vaccine. P&P indicated the vaccine type, dose, route, and nurse administering the vaccine would be documented on the medication administration record.
The P&P indicated the vaccine lot number would be recorded on the immunization log.
During a review of Resident 1's Admission Record (AR), the AR indicated the facility admitted Resident 1 on 5/25/2022 with diagnoses that included immunodeficiency (decreased ability of the body to fight infections and other diseases), and personal history of COVID -19 (Coronavirus -19, highly contagious virus that can affect lungs and airways and spreads form person to person).
During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 11/9/2024, the MDS indicated Resident 1's cognition (ability to think and process information) was severely impaired.
The MDS indicated Resident 1/RP 1 was offered and declined the flu vaccine (on 10/20/2023).
The MDS indicated Resident 1 did not receive the flu vaccine while at the facility.
During a review of Resident 1's eINTERACT/Change in Condition Evaluation (CIC, a change in the resident's health or functioning that requires further assessment and intervention) form, dated 12/27/2024, timed at 3:25 pm, the CIC indicated Resident 1 was noted with increased fatigue (extreme tiredness) and slept more than usual.
During a review of Resident 1's Progress Notes (PN), dated 12/27/2024, timed at 10:50 pm, the PN indicated Resident 1 was being monitored for increased fatigue and fever.
During a review of Resident 1's Order Summary Report (OSR), dated 12/28/2024, the OSR indicated for Resident 1 to be transferred to General Acute Care Hospital (GACH) 1 for evaluation and treatment.
During a review of Resident 1's CIC, dated 12/28/2024, timed at 2:54 pm, the CIC indicated Resident 1 had episodes of vomiting and Resident 1's oxygen saturation [O2 sats, the percentage (%) of hemoglobin (a red protein responsible for transporting oxygen) in the blood] dropped (% was not indicated).
The CIC indicated Resident 1 was put on 02 via nasal cannula (NC, a small plastic tube which fits into the person's nostrils for providing supplemental oxygen).
The CIC indicated Resident 1 was sent to GACH 1.
555852
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 555852 B.
Wing 01/16/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Park Avenue Healthcare & Wellness Center 1550 North Park Avenue Pomona, CA 91768
During a review of Resident 4's AR, the AR indicated Resident 4 was admitted to the facility on [DATE] with diagnoses that included atherosclerotic heart disease (a type of heart disease that occurs when plaque
potential for actual harm heart) without angina pectoris (chest pain), and immunodeficiency.
the MDS indicated Resident 4 had moderately impaired cognition (ability to think, reason, and understand).
The MDS indicated Resident 4/RP 4 was offered the flu vaccine and declined (on 11/8/2023).
During a review of Resident 4's eINTERACT/Change in Condition notification (CIC- a change in the resident's health or functioning that requires further assessment and intervention) dated 12/25/2024 at 9:21 pm, the CIC indicated Resident 4 had a fever of 102.3 degrees Fahrenheit [ F, unit of temperature (a normal body temperature is generally considered to be 98.6 F)], oxygen saturation [O2 sats, the percentage (%) of hemoglobin (a red protein responsible for transporting oxygen) in the blood]of 83% (normal level of oxygen saturation level is between 95% and 100%)on room air (no supplemental oxygen) and was tachycardic (fast/increased heart rate) at 117 beats per minute, (BPM, a normal resting heartbeat/heartrate should be between 60 to 100 BPM) The CIC indicated Resident 4's attending physician recommended to transfer Resident 4 to GACH 1 via 9-1-1 (phone number used to contact emergency services in the event of a medical emergency) for further evaluation.
During a review of Resident 4's GACH 1 Emergency Department Physician Note (EDPN), dated 12/26/2024, timed at 12:18 am, the EDPN indicated Resident 4 presented to the ED with shortness of breath (the feeling of not being able to breathe deeply enough or getting enough air into your lungs), productive cough [a type of cough that produces mucus (phlegm or sputum)], and fevers of 103 F for two days.
The EDPN indicated Resident 4 needed to be admitted to GACH 1 for treatment of Influenza A, PNA, and sepsis.
During a review of Resident 4's CDII dated 1/13/2025, the CDII indicated IP 1 spoke to Resident 4's RP via telephone, who verbally declined the flu vaccine due to fear of side effects.
During a concurrent interview and record review on 1/14/2025 at 5:08 pm. Resident 4's MDS, dated [DATE] was reviewed, the MDS indicated Resident 4/RP 4 was offered the flu vaccine and declined. IP 1 stated the flu vaccine was last offered to Resident 4/RP 4 on 11/8/2023.
During a concurrent interview and record review on 1/15/2025 at 11:39 am, with IP 1, Residents 4's CDII was reviewed. IP 1 stated the process for obtaining flu vaccine consent from a RP was to verify the name of the RP called, provide a verbal vaccine information statement (VIS- information sheet that explains the benefits and risks of a vaccine) including the risks and benefits, indicate on the CDII if the RP consents or declines, and cosign the CDII with a licensed nurse witness. IP 1 stated the cosigner should be present during the call to ensure accuracy. IP 1 stated on 1/13/2025, IP 1 documented IP 1 spoke to RP 4 regarding the flu vaccine for Resident 4. IP 1 stated IP 1 documented and signed RP 4 declined the flu vaccine for Resident 4. IP 1 stated IP 1 did not speak to RP 4 but left a voicemail.
During a telephone interview on 1/15/2025 at 4:51 pm, with RP 4, RP 4 stated facility staff did not call RP 4 to offer the flu vaccine for Resident 4 (for the current flu season). RP 4 stated RP 4 would not decline the flu vaccine for Resident 4.
555852
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 555852 B.
Wing 01/16/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Park Avenue Healthcare & Wellness Center 1550 North Park Avenue Pomona, CA 91768
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.