Sherman Oaks Health & Rehab

technology, if possible and as soon as practicable.

The facility shall renew the written informed

9/27/2024, the P&P indicated residents (and/or representatives) have the right to decline treatment with psychotropic medications. a.

The staff and physician will review with the resident/representative the risks related to not taking the medication as well as appropriate alternatives.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During an interview on 3/14/2025, at 11:37 a.m., with the Director of Nursing (DON), the DON stated Resident 107's call light should always be within reach so that if there is an emergency on the part of the resident, they can call right away.

The DON stated there is a potential for Resident 107 to fall while reaching for the call light on the floor.

The DON added it is the responsibility of all staff in the facility to ensure resident's call lights are withing reach.

During a review of the facility's recent P&P titled Answering the Call Light, last reviewed on 9/27/2024, the P&P indicated the purpose of this procedure is to ensure timely responses to the resident's requests and needs.

Ensure that the call light is accessible to the resident when in bed, from the toilet, from the shower or bathing facility and from the floor.

During a review of the facility's recent P&P titled Accommodation of Needs, last reviewed on 9/27/2024, the P&P indicated our facility's environment and staff behaviors are directed toward assisting the resident in maintaining and/or achieving safe independent functioning, dignity and well-being. e. installing longer cords or providing remote controlled overhead or task lighting so that they are easily accessible.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During an interview on 3/12/2025 at 10:03 a.m., inside the dining room, seven (7) of 7 resident council group attendees stated they do not know where to examine the most recent survey results.

The attendees pointed at the black metal rack outside the Activity Director's (AD) office where they can locate the binder for the most recent survey results.

During a concurrent observation, upon inspection of the black metal rack, there was no survey binder available.

During a concurrent observation and interview on 3/12/2025 at 10:43 a.m., in the lobby with the AD.

The AD stated the survey binder is placed on the table outside the social services and admissions office.

The AD stated the binder was placed flat and located underneath the tabletop's surface and did not have a visible sign posted.

The AD stated the survey binder was previously placed on top of the counter and corded because some residents take it and at night and write on the papers.

Upon inspection, the survey did not have the most recent recertification survey results from 2024.

During a concurrent observation and interview on 3/12/2024 at 10:46 a.m. in the lobby with the Administrator (Adm), the Adm stated the State inspection results should be available for all residents and/or their representatives, so residents/resident representatives know what the facility is working on.

The Adm stated the survey result should be readily accessible.

During a review of the facility's policy and procedure (P&P) titled, Resident Rights, last reviewed on 9/27/2024, the P&P indicated the resident rights include the resident's right to examine survey results.

The P&P further indicated a copy of the most recent standard survey is maintained in a three-ring binder located in an area frequented by most residents, such as the main lobby or resident activity room.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a concurrent interview and record review on 3/13/2025 at 10:30 a.m., reviewed Resident 97's Preferred Intensity of Care Surrogate Decision Maker Form with Registered Nurse (RN) 1. RN 1 stated Resident 97's Preferred Intensity of Care Surrogate Decision Maker Form did not indicate Resident 97's representative was asked if the resident had an AD and/or was offered assistance in the formulation of an AD. RN 1 stated the SSD is responsible in asking the residents and/or their representative if the resident had executed an AD and will be offered assistance to formulate an AD if needed and documented in the medical record. RN 1 stated the SSD should have asked Resident 97's representative for the presence of an AD and/or offer assistance in the formulation if needed. RN 1 stated it was important for the AD information to be in Resident 97's medical record to ensure there is no delay in the provision of necessary care and services in the event of an emergency and to ensure the facility is honoring Resident 97's wishes in case of an emergency.

During a review of the facility's recent policy and procedure (P&P) titled, Advanced Directives, last reviewed 9/27/2024, the P&P indicated the following: - The resident has the right to formulate an advance directive, including the right to accept or refuse medical or surgical treatment. - Advance directives are honored in accordance with state law and facility policy.

Prior to or upon admission of a resident, the social services director or designee inquires of the resident, his/her family members and/or his or her legal representative, about the existence of any written advance directives. - The resident or representative is given the option to accept or decline assistance, and care will not be contingent on either decision. - Information about whether or not the resident has executed an advance directive is displayed prominently in the medical record in a section of the record that is retrievable by any staff.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a concurrent interview and observation on 3/11/2025 at 12:15 p.m. with CNA 3, CNA 3 entered Resident 70's room and assessed the baseboard and windowsill. CNA 3 stated she was assigned to care for Resident 70 and CNA 3 was not previously aware of the broken baseboard and pieces of concrete. CNA 3 assessed Resident 70's wall and stated there were the red letters F-L-A-I on the wall above the resident's head. CNA 3 stated she did not know why the red letters were on the wall.

CNA 3 exited Resident 70's room.

During a concurrent interview and observation on 3/12/2025 at 7:56 a.m., with the Assistant Director of Staff Development (ADSD), the ADSD entered Resident 70's room and assessed the baseboard and windowsill.

The ADSD stated the window baseboard was broken with two nails sticking out and there was broken concrete pieces behind the baseboard.

The ADSD stated the broken baseboard and windowsill did not look safe and should not be like that.

The ADSD stated the nails could be a danger to any resident passing by.

During a concurrent observation and interview on 3/12/2025 at 8 a.m., with the Maintenance Director (MD), the MD entered Resident 70's room and stated a week prior to 3/12/2025 the MD was replacing the baseboards in Resident 70's room and discovered the concrete needed to be repaired.

The MD stated he left the broken board with two nails sticking out, broken windowsill, and pieces of concrete in the resident's room for about one week while waiting to do the repairs.

The MD stated the MD did not think the environment was unsafe for the resident.

During a concurrent observation and interview on 3/12/2025 at 8:05 a.m., with the Director of Nursing (DON), the DON reviewed the facility policy regarding homelike environment and resident supervision.

The DON stated a homelike environment should be safe and homelike with pictures on the wall that the resident would like.

The DON observed Resident 70's room and stated the DON was not aware of the broken baseboard with nails, broken windowsill, and pieces of broken concrete at the resident's bedside.

The DON stated the resident's room had hazards and was not homelike.

The DON stated there was a potential that Resident 70 could get an abrasion from the nail on the board while transferring to the wheelchair.

The DON observed the red letters F-L-A-I on the wall above the resident's head and stated the letters had nothing to do with Resident 70 and should not be there.

The DON stated the red letters created an environment that was not homelike.

The DON stated the letters on the wall and window should have been reported and corrected immediately and they were not.

The DON stated it was important to provide a homelike environment for the resident's spirit and to stimulate the resident.

The DON stated the facility policy was not followed and could have potentially resulted in affecting Resident 70's psychosocial and emotional wellbeing.

During a review of the facility P&P titled, Homelike Environment, last reviewed 7/25/2024, the P&P indicated residents are provided with a safe, clean, comfortable, and homelike environment.

The facility staff and management maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting.

These characteristics include clean and sanitary environment and inviting colors and décor.

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Sherman Oaks, CA 91423

equipment attached or adjacent to the resident's body that the individual cannot remove easily, which

-

Restraints may only be used if/when the resident has a specific medical symptom that cannot be addressed by another less restrictive intervention. - Prior to placing a resident in restraints, there shall be an assessment and review to determine the need for restraints. - Restraints shall only be used upon the written order of a physician and after obtaining consent from the resident and/or representative. - Residents and/or surrogate/sponsor shall be informed about the potential risks and benefits of all options under consideration, including the use of restraints, not using restrains, and the alternatives to restraint use. - Care plans for residents in restraints will reflect the interventions that address not only the medical symptom(s), but the underlying problems that may be causing the symptom(s). - Care plans shall also include the measures taken to reduce or eliminate the need for restraint use.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

resident can come back to the facility if they wish.

reviewed on 9/27/2024, the P&P indicated residents and/or representatives are informed (in writing)

written information regarding the facility bed-hold policies, which address holding or reserving a resident's bed during periods of absence (hospitalization or therapeutic leave).

Residents are provided written information about these policies at least twice: a. well in advance of any transfer (e.g., in the admission packet); and b. at the time of transfer (or, if the transfer was an emergency, within 24 hours).

The written information regarding bed-holds provided to the residents/representatives explains in detail: a. the duration of the state bed-hold policy, if any, during which the resident is permitted to return and resume residence in the facility; b. the reserve bed payment policy as indicated by the state plan (for Medicaid residents); c. the facility policies regarding bed-hold periods; d. the facility per diem rate required to hold a bed (for non-Medicaid residents), or to hold a bed beyond the state bed-hold period (for Medicare residents); and e. the return policy.

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Sherman Oaks, CA 91423

056250 03/14/2025

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of Resident 16's admission Record, the admission Record indicated the facility admitted the resident on 9/20/2024 with diagnoses including type II diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest), and hypertension (HTN-high blood pressure).

During a review of Resident 16's History and Physical (H&P), dated 10/1/2024, the H&P indicated the resident had the capacity to understand and make decisions.

During a review of Resident 16's MDS, dated [DATE], the MDS indicated in section Z0500B, dated 1/13/2025, the registered nurse (RN) assessment coordinator signed the assessment as complete.

During a concurrent interview and record review on 3/12/2025 at 1:56 p.m. with MDS Nurse (MDSN) 1, the Final Validation Report (facility's documentation of successful MDS file submission), dated 1/15/2025 was reviewed.

The Final Validation Report indicated Resident 16's MDS assessment was completed late. MDSN 1 stated the Final Validation Report indicated the assessment completion date was more than 14 days after the assessment reference date of 12/27/2024. MDSN 1 stated this was Resident 16's MDS Quarterly Assessment which should have been completed on 1/10/2025 and if after this date is considered late.

During an interview on 3/14/2025 at 2:49 p.m. with the Director of Nursing (DON), the DON stated the MDS Assessments should be completed timely and should reflect the patient's health status at that time.

The DON stated when the MDS Assessments are not completed timely there could be a delay in reporting of the resident's health status and reporting of the quality measures.

During a review of the facility's policy and procedure (P&P) titled, MDS Completion and Submission Timeframes, last reviewed 9/27/2024, the P&P indicated Timeframes for completion and submission of assessments is based on the current requirements published in the Resident Assessment Instrument Manual.

During a review of the Centers for Medicare &Medicaid Services (CMS, a federal agency that administers major healthcare programs) Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, dated 10/2024, the RAI manual indicated the MDS Completion Date (Item Z0500B) no later than assessment reference date (ARD) + 14 calendar days.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a concurrent interview and record review on 3/12/2025 at 2:22 p.m., Resident 49's MDS, Section A0310 Type of Assessment, Section A2000 discharge date , and Section A2105 dated 1/8/2025 was reviewed with MDSN 1. MDSN 1 stated the MDS Assessment Section A0310 indicated the type of assessment was a 5-day scheduled assessment for Medicare Part A stay and the assessment was not an entry/discharge type of assessment. MDSN 1 stated Section A2000 did not indicate Resident 49's discharge date from the facility, and Section A2105 did not indicate location of discharge status. MDSN 1 stated Resident 49's MDS assessment Sections A2000 and A2105 should have indicated Resident 49's discharge date from the facility and discharge return not anticipated.

MDSN 1 stated Resident 49's MDS assessment was not coded accurately, and it can potentially cause confusion with regards to Resident 49's status in the facility which could lead to a delay in the care and services the resident needed.

During an interview on 3/14/2025 at 2:47 p.m. with the DON, the DON the stated the MDS assessment are signed by the MDSN 1 as complete and accurate prior to submission to reflect the resident's current status for billing purposes and quality to prevent delay in the delivery of care and services the residents need.

The DON stated Resident 49's MDS assessment should have indicated the resident was discharged with return as not anticipated to prevent confusion with Resident 49's current status if still in the facility or not which may lead to delay in providing the care and services Resident 49 needed.

During a review of the facility's P&P titled, Certifying Accuracy of the Resident Assessment, dated 9/27/2024, the P&P indicated: - Any person completing a portion of the MDS must sign and certify the accuracy of that portion of the assessment. - The information captured on the assessment reflects the status of the resident during the observation period for that assessment.

During a review of the facility's P&P titled, Resident Assessment, last reviewed on 9/27/2024, the P&P indicated:

• The resident assessment coordinator is responsible for ensuring that the interdisciplinary team

conducts timely and appropriate resident assessments and reviews according to the following requirements:

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Sherman Oaks, CA 91423

F 0641 a.

minimal harm (7) Discharge Assessment (return anticipated and return not anticipated).

• All persons who have completed any portion of the MDS resident assessment form

must sign the document attesting to the accuracy of such information.

During a review of the facility's P&P, titled Adverse consequences and Medication Errors, last reviewed 9/27/2024, the P&P indicated:

• Residents receiving any medication that has a potential for an adverse consequence will be monitored

to ensure that any such consequences are promptly identified and reported.

• An 'adverse consequence' is defined as an unpleasant symptom or event that is due to or associated

with a medication, such as an impairment or decline in an individual's mental or physical condition or functional or psychosocial status. An adverse consequence may include: a.

Adverse drug/medication reaction b.

Side effect

• The staff and practitioner shall strive to minimize adverse consequences by:

a.

Following relevant clinical guidelines and manufacturer's specifications for use, dose, administration, duration, and monitoring of the medication.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

the P&P indicated a purpose to provide guideline for the safe administration of insulin to residents

-

Select an injection site: a.

Insulin may be injected into the subcutaneous tissue of the upper arm and the anterior or lateral areas of the thighs and abdomen.

Avoid the area approximately 2 inches around the navel. b.

Injection sites should be rotated, preferably within the same general area (abdomen, thigh, upper arm).

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of the facility's P&P titled, Do Not Resuscitate Order, last reviewed 9/27/2024, the P&P indicated the facility will not use cardiopulmonary resuscitation and related emergency measures to maintain life functions on a resident when there is a Do Not Resuscitate Order in effect.

The P&P indicated Do Not Resuscitate orders must be signed by the resident's attending physician on the physician's order sheet maintained in the resident's medical record.

The P&P indicated DNR orders will remain in effect until the resident (or legal surrogate) provides the facility with a signed and dated request to end the DNR order.

During a review of the facility's P&P titled, POLST, last reviewed 9/27/2024, the P&P indicated Just because POLST is offered does not mean the resident or legal representative must complete one. No one is required to complete a POLST form as it is 100% voluntary.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of the facility's recent policy and procedure (P&P) titled Acute Condition Changes- Clinical Protocol, last reviewed on 9/27/2024, the P&P indicated the physician will help identify individuals with a significant risk for having acute changes of condition during their stay; for example, an individual with an indwelling urinary catheter who has had recurrent symptomatic urinary tract infections, or someone with unstable vital signs or recurrent pneumonia. In addition, the nurse shall assess and document/report the following baseline information: a.

Vital signs; b.

Neurological status; c.

Current level of pain, and any recent changes in pain level; d.

Level of consciousness; e.

Cognitive and emotional status; f.

Resident's age and sex; g.

Onset, duration, severity; h.

Recent labs; i.

History of psychiatric disturbances, mental illness, depression, etc.; j.

All active diagnoses; and k.

All current medications.

Before contacting a physician about someone with an acute change of condition, the nursing staff will collect pertinent details to report to the physician; for example; the history of present illness and previous and recent test results for comparison. a.

Phone calls to attending or on-call physicians should be made by an adequately prepared nurse who has collected and organized pertinent information, including the resident/patient's current symptoms and status.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

on 9/27/2024, the P&P indicated our facility strives to make the environment as free from accident

Implementation Guide, undated, the National Falls Toolkit indicated furniture near the head of the bed should be placed with care and sharp edges should be padded for persons likely to fall from bed.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a concurrent observation and interview on 3/12/2025, at 8:35 a.m., with Certified Nursing Assistant (CNA) 1, inside Resident 371's room, observed Resident 371's urinary catheter tubing coiled not promoting proper drainage. CNA 1 stated Resident 371's urinary catheter tubing should not be coiled to prevent backflow of urine to the bladder causing infection.

During an interview on 3/13/2025, at 11:20 a.m., with RN 1, RN 1 stated there should be no loops on Resident 371's urinary catheter tubing to prevent backflow of urine that can cause UTI.

During an interview on 3/14/2025, at 11:37 a.m., with the Director of Nursing (DON), inside the facility's conference room, the DON stated Resident 371's urinary catheter tubing should not have loops on them because it can cause urine reflux or backflow to the bladder causing UTI.

During a review of the facility's recent P&P titled Catheter Care, Urinary, last reviewed on 9/27/2024, the P&P indicated the purpose of this procedure is to prevent urinary catheter-associated complications, including urinary tract infections.

Check the resident frequently to be sure he or she is not lying on the catheter and to keep the catheter and tubing free of kinks.

Check drainage tubing and bag to ensure that the catheter is draining properly.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of the facility's P&P titled, Snacks (Between Meal and Bedtime), Serving, last reviewed on 9/27/2024, the P&P indicated the purpose of this procedure is to provide the resident with adequate nutrition.

The P&P indicated the person performing this procedure should record the following information in the resident's medical record including the date and time the snack was served, the name and title of the person who served the snack, the amount of snack eaten by the resident, if the resident refused the snack, the reason(s) why and the intervention taken, and the signature and title of the person recording the data.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

dated 2016, the manufacturer's guideline indicated the DCS is:

cover between line accesses. - The cap will disinfect the needleless connector one (1) minute after application and protect from contamination between accesses for up to 7 days if not remove. - New cap should be placed on needleless connector after each use.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During an interview on 3/13/2025 at 8:02 a.m. with RN 1, RN 1 stated oxygen is considered medication because it requires a doctor's prescription.

During an interview on 3/14/2025 at 2:45 p.m. with the DON, the DON stated PRN oxygen is given when the resident really needs it and if the resident does not need it, they place it in storage.

The DON stated if they administer oxygen, they should document it on the MAR.

During a review of the facility's P&P titled, Oxygen Administration, last reviewed 9/27/2024, the P&P indicated the purpose of the procedure is to provide guidelines for safe oxygen administration.

Verify that there is a physician's order for this procedure.

Review the physician's orders.

Review the resident's care plan to assess for any special needs of the resident.

Before administering oxygen, and while the resident is receiving oxygen therapy. assess for the following:

• Signs or symptoms of cyanosis (i.e., blue tone to the skin and mucous membranes)
• Signs or symptoms of hypoxia (i.e., rapid breathing, rapid pulse rate, restlessness, confusion)
• Signs or symptoms of oxygen toxicity (i.e., tracheal irritation, difficulty breathing, or slow, shallow

rate of breathing).

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Sherman Oaks, CA 91423

F 0695 4.

• Lung sounds

After completing the oxygen setup or adjustment, the following information should be recorded in the resident's medical record:

• The date and time that the procedure was performed.
• The name and title of the individual who performed the procedure.
• The rate of oxygen flow, route, and rationale.
• The frequency and duration of the treatment.
• The reason for PRN administration.
• All assessment data obtained before, during, and after the procedure.
• How the resident tolerated the procedure.

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Sherman Oaks, CA 91423

Cognitive status

ii.

Vital signs iii.

Access site (central line, shunt, graft site) iv.

Document presence or absence of bruit and/or thrill v.

Bleeding at _site_ vi.

Breathing patterns / breathing sounds b) Complete post-dialysis assessment on return from treatment. c) Complete additional comments for any significant information. d) Follow up on any dialysis center recommendations. e) Notify MD of any significant change in condition upon return from dialysis center.

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Sherman Oaks, CA 91423

c. grab/assist bars.

The resident assessment to determine risk of entrapment includes but not limited to: a. medical diagnosis, condition, symptoms, and/or behavioral symptoms; b size and weight; c. sleep habits; d. medication(s) e. acute medical or surgical interventions; f. underlying medical conditions; g. existence of delirium; h. ability to toilet self safely; i. cognition; j. communication; k. mobility (in and out of bed); and l. risk of falling.

056250 03/14/2025

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of Resident 272's admission Record dated 3/12/2025, the admission Record indicated

During a review of Resident 272's Order Summary Report dated 2/25/2025, the Order Summary Report indicated Resident 272 was prescribed pregabalin 75 mg capsule to give by mouth twice a day for neuropathy, starting 3/4/2025.

During a review of Resident 272's MAR for 3/2025, the MAR indicated Resident 272 was prescribed pregabalin 75 mg twice a day for neuropathy to be given at 9 a.m. and 5 p.m., and was administered a dose on 3/12/2025 at 9 a.m.

During a review of the P&P titled Controlled Medication Storage, last reviewed 1/15/2025, the P&P indicated that At each shift change, a physical inventory of all Schedule II ., is conducted by two licensed nurses .and is documented on the CS accountability record During a review of the P&P titled Controlled Medications, last reviewed 9/27/2024, the P&P indicated: Medications included in the Drug Enforcement Administration classification as CS are subject to special handling, storage, disposal, and recordkeeping at the facility, in accordance with federal and state laws and regulations.

A.

The DON and the Consultant Pharmacist maintain the facility's compliance with federal and state laws and regulations in the handling of CMs.

C.

When a CM 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
• Amount administered
• Signature of the nurse administering the dose on the accountability record at the time the medication

is removed from the supply.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of facility P&P titled Lab and Diagnostic Test Results - Clinical Protocol, last reviewed 9/27/2024, the policy indicated:

• The physician will identify, and order diagnostic and lab testing based on the resident's diagnostic

and monitoring needs.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

9/27/2024, the P&P indicated to assess for signs and symptoms related to adverse drug reactions

example, a resident with an above therapeutic level of an anticoagulation medication should be

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

from falls.

The DON stated the facility policy was not followed.

P&P indicated residents will not receive medications that are not clinically indicated to treat a

with mental processes and behavior.

Psychotropic medication management includes adequate monitoring for effi[TRUNCATED]

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of the facility's document, titled Meal Time and Locations and Menus, [undated], the document indicated: Meal Times: Breakfast - 7:15 am Lunch - 12:15 pm Dinner - 5:15 pm

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

of Prescribing Information indicated to rotate injections sites to reduce the risk of lipodystrophy.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of the facility P&P titled, Labeling of Medication Containers, last reviewed 9/27/2024, the P&P indicated all medications maintained in the facility are properly labeled in accordance with current state and federal guidelines and regulations.

Medication labels must be legible at all times.

Labels for individual resident medications include all necessary information, such as the resident's name.

Labels for each single unit dose package include all necessary information, such as the name of the resident.

The names of the resident and physician do not have to be on each unit dose package, but they must be identified with the package in such a manner as to ensure that the drug is administered to the right resident.

During a review of the facility P&P titled, Administering Medications, last reviewed 9/27/2024, the P&P indicated medications are administered in a safe and timely manner.

The individual administering the medication checks the label three times to verify the right resident, right medication, right dosage, right time and right method (route) of administration before giving the medication.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of the facility's policy and procedures (P&P) titled, Test Results, last reviewed 9/27/2024, the P&P indicated the resident's attending physician will be notified of the results of the diagnostic tests.

The P&P indicated Should the test results be provided to the facility; the attending physician shall be promptly notified of the results.

The director of nursing services, or charge nurse receiving the test results, shall be responsible for notifying the physician of such test results.

Signed and dated reports of all diagnostic services shall be made a part of the resident's medical record.

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Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a kitchen observation tour and interview on 3/11/2025, at 10:35 a.m., with the Dietary Manager (DM), inside the facility's kitchen, observed a pitcher of cranberry juice stored in the kitchen refrigerator without the date it was poured on the pitcher.

The DM stated the staff should have dated the pitcher of cranberry juice once poured to ensure the cranberry juice was fresh and not passed it best use by date to prevent food-borne illness to residents due to ingestion of potentially expired drinks.

During an interview on 3/14/2025, at 11:37 a.m., with the Director of Nursing (DON), inside the facility's conference room, the DON stated the dietary staff should have labeled the pitcher of cranberry juice with the date it was poured on the pitcher to know how old the cranberry juice is.

The DON stated there is a potential for residents to experience stomach problems such as nausea, vomiting, and diarrhea when they consume the old cranberry juice inside the pitcher.

During a review of the facility's recent policy and procedure (P&P) titled Food Receiving and Storage, last reviewed on 9/27/2024, the P&P indicated foods shall be received and stored in a manner that complies with safe food handling practices.

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

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Sherman Oaks, CA 91423

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 03/14/2025

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During an interview on 3/13/2025 at 8:51 a.m., with the Administrator (ADM), the ADM stated 2 additional LVNs were just called in to assist with medication administration that day (3/13/2025.) During a concurrent observation and interview on 3/13/2025 at 10:05 a.m., LVN 4 was still passing 9 a.m. medications. LVN 4 stated she was still passing 9 a.m. medications and that per facility policy there was a one (1) hour window before and after 9 a.m. to administer medications. LVN 4 stated it was 10 a.m. and that LVN 4 still needed to administer medications to Resident 15, 16, 113, 271 and

• LVN 4 stated with the number of residents assigned to LVN 4 there was not enough time to

complete medication administration by 10 a.m. LVN 4 stated more LVNs are needed to administer medications timely and be compliant with Medication Administration policy.

During a review of Facility Assessment, dated 12/1/2024, the Facility Assessment indicated a staffing need of 1 LVN per 24 residents during the day shift.

During a review of Staffing Assignment between 3/11/2025 and 3/13/2025, the assignment indicated: 3/11/2025 Day Shift 7 a.m. to 3 p.m. LVN 2 - ratio 1:36 3/11/2025 Day Shift 7 a.m. to 3 p.m. LVN 1 - ratio 1:40 3/11/2025 Day Shift 7 a.m. to 3 p.m. LVN 3 - ratio 1:45 3/12/2025 Day Shift 7 a.m. to 3 p.m. LVN 5 - ratio 1:36 3/12/2025 Day Shift 7 a.m. to 3 p.m. LVN 1 - ratio 1:40 3/12/2025 Day Shift 7 a.m. to 3 p.m. LVN 3 - ratio 1:45 3/13/2025 Day Shift 7 a.m. to 3 p.m. LVN 1 - ratio 1:40 3/13/2025 Day Shift 7 a.m. to 3 p.m. LVN 2 - ratio 1:36 3/13/2025 Day Shift 7 a.m. to 3 p.m. LVN 3 - ratio 1:45 During a review of the facility's policy and procedure (P&P,) titled Facility Assessment, last reviewed on 9/27/2024, the P&P indicated: A facility assessment is conducted annually to determine and update our capacity to meet the needs of and competently care for our residents during day-to-day operations.

Determining our capacity to meet the needs of and care for our residents during emergencies is included in this assessment.

056250 03/14/2025

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

F 0838 1.

The facility assessment is intended to help our facility plan for and respond to changes in the needs of our resident population and helps to determine budget, staffing, training, equipment, and supplies needed. It is separate from the Quality Assurance and Performance Improvement evaluation.

• The facility assessment is reviewed and updated annually, and as needed.

Facility or resident changes or modifications that may prompt a reassessment sooner include: c. a significant change in the resident census and/or overall acuity of our residents.

056250 03/14/2025

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

reviewed on 9/27/2024, the P&P indicated:

incidents or accidents involving the resident. - Documentation in the medical record will be objective, complete, and accurate.

056250 03/14/2025

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a concurrent interview and record review on 3/14/2025 at 10:20 a.m. with the Administrator

sample of the R-FAA revised 11/2019.

The ADM stated the R-FAA is an alternative means to solve a problem and the R-FAA must comply with certain regulations.

The ADM stated a key element of the R-FAA is to specifically indicate the selection of a neutral arbitrator and the selection of a venue that is convenient to both parties.

The ADM stated the facility R-FAA was updated in 2019 to reflect these key elements.

The ADM stated Resident 3's signed R-FAA did not include those key elements.

The ADM stated when Resident 3's R-FAA did not specify a neutral party and convenient location, it could potentially result in placing the resident in a less favorable position than the facility during the arbitration process.

During a follow-up concurrent interview and record review on 3/14/2025 at 1:19 p.m. with the ADM, the ADM reviewed the R-FAA revised 11/2019 and Information Regarding the Resident-Facility AA Form (AA Info.

Form), undated.

The ADM stated the facility does not have a policy regarding AAs.

The ADM stated the facility uses the R-FAA revised 11/2019 and AA Info.

Form to guide the arbitration agreement process.

The ADM stated the facility process was not followed when Resident 3 entered into an R-FAA that did not provide for the selection of a neutral arbitrator agreed upon by both parties and for the selection of a venue that was convenient to both parties.

During a review of the facility-provided AA Info.

Form, undated, the AA Info.

Form indicated a neutral arbitrator is a professional who is experienced in presiding over arbitration hearings. If the parties agree to arbitration, then the case will not be tried in court and there will be no jury.

During a review of the facility-provided Resident - Facility AA, last revised 11/2019, the R-FAA indicated, . it is understood that any dispute as to medical malpractice, that is as to whether any medical services rendered under this contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration.

Both parties to this contract, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration .

Accordingly, this Agreement is to be governed by the Federal Arbitration Act and the procedural rules set forth in the Federal Arbitration Act (9 U.S.C.

Sections 1-16) shall govern any petition to compel arbitration and the selection of an arbitrator, should the parties be unable to mutually agree upon the appoint of a single neutral arbitrator.

The arbitration shall be venued in a location convenient for all parties .

056250 03/14/2025

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of the facility's policy and procedure (P&P) titled, Hospice Program, last reviewed 9/27/2024, the P&P indicated In order for a resident to qualify for the hospice benefit under Medicare, he or she must be . certified as being terminally ill . hospice providers who contract with this facility . are held responsible for meeting the same professional standards and timeliness of service as any contracted individual or agency associated with the facility . It is the responsibility of the hospice to manage the resident's care as it relates to the terminal illness and related conditions, including the following: a.

Determining the appropriate hospice plan of care.

056250 03/14/2025

Sherman Oaks Health & Rehab 14401 Huston St.

Sherman Oaks, CA 91423

During a review of the facility's Bleach Wipes 1's Safety Data Sheet (SDS), dated 11/22/2022, the SDS indicated recommended for use on hard, non-porous (not porous [material having pores or openings]) surfaces.

During a review of the facility's policy and procedure (P&P) titled, Cleaning and Disinfection of Resident-Care Items and Equipment, last reviewed 9/27/2024, the P&P indicated the resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current Centers of Disease Control (CDC-a national public health agency in the United States) recommendations for disinfection and the Occupational Safety and Health Administration (OSHA-assures safe and healthful working conditions by setting and enforcing standards, and by providing training, outreach, education and assistance) Bloodborne Pathogens Standard.

The P&P indicated semi-critical items consist of items that may come in contact with mucous membranes or non-intact skin such devices should be free from all microorganisms, although small numbers of bacterial spores are permissible.

The P&P indicated reusable items are cleaned and disinfected or sterilized between residents according to manufacturer's instructions.

056250 03/14/2025

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 CPR.

During a review of Resident 115's Minimum Data Set (MDS-a resident assessment tool), dated [DATE], the MDS indicated the resident had clear speech, moderately impaired vision, and was rarely/never makes self understood and rarely/never had the ability to understand others.

The MDS indicated the resident had severely impaired cognitive skills (mental action or process of acquiring knowledge and understanding) for daily decision making.

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 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