Sherman Oaks Health & Rehab

During a review of Resident 13's Admission Record, the Admission Record indicated the facility admitted the resident on 6/26/2016 and readmitted the resident on 9/5/2019 with diagnoses that included dementia, muscle weakness, pressure induced deep tissue damage of the sacral region (region at the bottom of the spine lying and tailbone), and history of falling.

During a review of Resident 13's CP titled, Resident is at risk for falls/injury ., initiated 9/27/2024, the CP indicated to provide the resident with a safe environment.

During a review of Resident 13's H&P, dated 12/9/2024, the H&P indicated the resident did not have the capacity to understand and make decisions.

During a review of Resident 13's MDS dated [DATE], the MDS indicated the resident was rarely/never able to understand others and was sometimes able to make herself understood.

The MDS indicated the resident was dependent on assistance from staff for toileting, dressing, personal and oral hygiene, bathing, and rolling from left to right side.

During a review of Resident 13's CP titled, Falling Star Program ., initiated 1/7/2025, the CP indicated an intervention for a low bed with floor mats to decrease the potential for injury due to unpredictable movement related to dementia.

During a review of Resident 13's Order Summary Report, the Order Summary Report indicated the following orders:

-Low bed with bilateral (both sides) upper (located at the chest and shoulders) half siderails (adjustable rigid plastic bars attached to the bed that may be positioned in various locations) up with floor mat to decrease the potential injury due to unpredictable movement related to dementia, dated 2/17/2024.

- Medi honey wound dressing external gel (topical wound and burn medication made from honey), apply to Sacro coccyx topically everyday shift for pressure injury for 30 days.

Cleanse with normal saline (NS, a mixture of water and salt), pat to dry, and cover with foam dressing, dated 3/3/2025.

- Vitamins A&D external ointment (topical medication for the skin), apply to left heel topically every day shift for skin maintenance cleanse with NS, pat dry, and leave open to air, dated 11/11/2024.

056250

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 056250 B.

Wing 03/14/2025

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

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of Resident 107's Admission Record, the Admission Record indicated the facility admitted the resident on 2/17/2025, with diagnoses including type 2 diabetes mellitus (DM, a disorder characterized by difficulty in blood sugar control and poor wound healing), lack of coordination, and chronic kidney disease stage 3 (when the kidneys have mild to moderate damage and are less able to filter waste and fluid out of the blood).

During a review of Resident 107's History and Physical (H&P), dated 2/19/2025, the H&P indicated the resident was alert and oriented to person, place, and time.

The H&P indicated the resident had the capacity to understand and make decisions.

056250

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 056250 B.

Wing 03/14/2025

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

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of Resident 115's Preferred Intensity of Care (PIC) Authorization/Decisions, dated [DATE], the PIC Authorization/Decisions indicated the resident's representative authorized no CPR and that the resident was not capable of making preferred intensity decisions and requested that the withholding of the above-described medical care was consistent with the views of the resident.

During a review of Resident 115's History and Physical (H&P- a comprehensive assessment that involves a thorough medical history and a physical examination, forming the foundation for resident care and guiding diagnostic and treatment decisions), dated [DATE], the H&P indicated the resident did not have the capacity to understand and make decisions.

The H&P indicated the resident did not want cardiopulmonary resuscitation (CPR-emergency procedure used to restart a person's heartbeat and breathing after one or both have stopped).

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

056250

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 056250 B.

Wing 03/14/2025

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

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of Resident 42's Admission Record (a document containing demographic and diagnostic information,) dated 3/13/2025, the Admission Record indicated the facility originally admitted Resident 42 to the facility on [DATE] and readmitted the resident on 4/20/2024 with diagnoses including epilepsy and paroxysmal atrial fibrillation.

During a review of Resident 42's Order Summary Report, dated 3/13/2025, the Order Summary Report indicated Resident 42 was prescribed the following:

1.

Eliquis 5 mg to give one (1) tablet by mouth once a day for atrial fibrillation, starting 4/25/2024

056250

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 056250 B.

Wing 03/14/2025

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

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of Resident 42's Admission Record (a document containing demographic and diagnostic information,) dated 3/13/2025, the Admission Record indicated the facility originally admitted Resident 42 to the facility on [DATE] and readmitted the resident on 4/20/2024 with a diagnoses including epilepsy and paroxysmal atrial fibrillation.

During a review of Resident 42's Order Summary Report, dated 3/13/2025, the Order Summary Report indicated Resident 42 was prescribed the following:

1.

Eliquis 5 mg to give one (1) tablet by mouth once a day for atrial fibrillation, starting 4/25/2024

2.

Clopidogrel 75 mg to give one (1) tablet by mouth once a day for paroxysmal atrial fibrillation, starting 8/2/2024

3.

Gabapentin 600 mg to give one (1) tablet by mouth three (3) times a day for epilepsy, starting 4/29/2024

056250

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 056250 B.

Wing 03/14/2025

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

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During an interview on 3/11/2025 at 12:50 p.m., with LVN 1, LVN 1 stated LVN 1 was busy with other residents and administered Resident 77's carvedilol at 9:15 a.m. that morning (3/11/2025). LVN 1 stated it was not possible to administer medications between 7 and 7:30 a.m. because LVNs were busy with hand off from previous shift and making resident rounds. LVN 1 acknowledged the physician's order specified to administer carvedilol at 7:15 a.m. with breakfast. LVN 1 stated breakfast is usually delivered around 7:30 a. m. LVN 1 stated, per facility policy, there was a 60-minute window for medication administration and LVN 1 administered carvedilol later than that timeframe. LVN 1 stated the carvedilol was scheduled to be administered at 7:15 a.m. with breakfast to prevent stomach discomfort and increase the absorption of the medication. LVN 1 stated LVN 1 failed to administer carvedilol as prescribed by Resident 77's physician and that a delay in medication administration was considered a medication error.

During an interview on 3/12/2025 at 11:30 a.m., LVN 1 stated LVN 1 did not administer carvedilol at 7:15 a. m. to Resident 21 that morning (3/12/2025) as the resident was sleeping but failed to document as such because LVN 1 was busy that morning with a lot of residents assigned to LVN 1. LVN 1 stated LVN 1 was assigned over 40 residents that day. LVN 1 stated LVN 1's shift started at 7 a.m. and it takes about 30 minutes to take blood pressure measurements from the residents, an additional 20 to 30 minutes for hand off information from previous shift nurse, medication cart checks, and rounding on 40 residents, resulting in LVN 1 failing to administer medications timely specially those scheduled prior to 8 a.m. LVN 1 stated to provide good care to residents there should be less number of residents assigned per LVN.

056250

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 056250 B.

Wing 03/14/2025

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

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of Resident 107's Admission Record, the Admission Record indicated the facility admitted the resident on 2/17/2025, with diagnoses including type two (2) diabetes mellitus (DM - a disorder characterized by difficulty in blood sugar control and poor wound healing), lack of coordination, and chronic kidney disease stage 3 (when the kidneys have mild to moderate damage and are less able to filter waste and fluid out of the blood).

During a review of Resident 107's History and Physical (H&P), dated 2/19/2025, the H&P indicated the resident was alert and oriented to person, place, and time.

The H&P indicated the resident had the capacity to understand and make decisions.

During a review of Resident 107's Minimum Data Set (MDS - a resident assessment tool), dated 2/23/2025, the MDS indicated the resident had the ability to make self-understood and understand others and had intact cognition (a participant who has sufficient judgment, planning, organization, self-control, and the persistence needed to manage the normal demands of the participant's environment).

The MDS indicated the resident was on a high-risk drug class hypoglycemic medication (a group of drugs used to help reduce the amount of sugar present in the blood).

During a review of Resident 107's Order Summary Report, the Order Summary Report indicated an order for:

On 2/17/2025, Insulin Aspart Solution 100 unit per milliliters (unit/ml, a milliliter is a unit of fluid volume equal to one-thousandth of a liter).

Inject 6 unit subcutaneously before meals for diabetes mellitus type 2 (DM2).

Administer before breakfast.

On 2/20/2025, Insulin Glargine Solution 100 unit/ml.

Inject 15 unit subcutaneously every 12 hours for DM2.

During a review of Resident 107's Location of Administration Report of Insulin for 2/2025 to 3/2025, the Location of Administration Report indicated Insulin Glargine Solution 100 unit/ml was administered subcutaneously on:

2/22/2025 at 9:40 a.m. at the Abdomen - Left Lower Quadrant (LLQ)

2/22/2025 at 9 p.m. at the Abdomen - LLQ

2/22/2025 at 10:41 a.m. at the Abdomen - Left Upper Quadrant (LUQ)

2/22/2025 at 4:30 p.m. at the Abdomen - LUQ

056250

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 056250 B.

Wing 03/14/2025

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

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423