Park Avenue Healthcare & Wellness Center
PARK AVENUE HEALTHCARE & WELLNESS CENTER in POMONA, CA — inspection on January 16, 2025.
Found 2 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 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