Life Care Center Of North Glendale

Based on documentation, staff interviews, and the facility policy and procedures, the facility failed to ensure that residents are free from abuse from other residents.

Findings include:

Resident #11 was admitted to the facility on September 15, 2022 with diagnoses that included unspecified dementia, chronic kidney disease, liver disease, atherosclerotic heart disease, and other specified disorders of bone density and structure unspecified site. .

The minimum data set (MDS) dated June 18, 2024 included a brief interview for mental status score of 14 indicating the resident was cognitively intact.

A progress note dated August 13, 2024 revealed that this writer was at the nurse station at 6:40 p.m. when a certified nursing assistant (CNA) yelled out, "no don't hit her," while rushing toward the
incident. The CNA noticed the resident #37 with left hand balled onto a fist hitting the resident #11 by her left forearm. Nursing staff were immediately present at the incident, and both resident were separated. The Executive Director, Director of Nursing, medical doctor, the power of attorneys, and authorities were notified. This writer didn't notice any injuries upon the initial assessment of both residents. Nursing will continue to follow up with a psych assessment and present medication orders. Safety measures were put in place, both residents are in their rooms resting, and watching TV. Call-lights and bedside tables are within reach.

The care plan dated August 14, 2024 revealed that the resident is/has the potential to be verbally/physically aggressive related to dementia, ineffective coping skills. Interventions included to analyze key times, places, circumstances, triggers, and what de-escalates behavior and document.

-Resident #37 was admitted to the facility on February 9, 2024 with diagnoses that included Alzheimer's disease, anxiety disorder, and depression unspecified.

The minimum data set (MDS) dated August 13, 2024 revealed that the resident is not able to complete a brief interview for mental status.

A progress note dated August 13, 2024 revealed that the resident got in verbal argument with another resident and punched her in the arm. Residents were separated, and the medical doctor and family made aware.

The progress note dated August 13, 2024 revealed that the resident is to move rooms. The resident's son is aware and in agreement. New orders for labs were received.

A progress note dated August 15, 2024 revealed that at approximately 6:43 p.m. a CNA witnessed this resident and another resident raising voices in the hallway. The CNA walked quickly to separate them both and before she could get to them, the CNA witnessed this resident took her left fist and hit the other resident in her left arm. The other resident grabbed this resident's hand and CNA got to them and separated them immediately. Residents were separated immediately, no injuries bruises/redness noted to this resident's arm. The Executive Director, Director of Nursing, medical doctor, and the family were notified. This resident was moved to station 4, and the family was notified of the transfer.

The care plan dated August 16, 2024 revealed that the resident is/has the potential to be physically aggressive related to anger, dementia. Interventions included that the resident needs personal space. The resident reacts to touch. When the resident becomes agitated: intervene before agitation escalates; guide away from source of distress; engage calmly in conversation; if response is aggressive, staff to walk calmly away, and approach later.

Review of a written statement dated August 13, 2024 by a certified nursing assistant (CNA/staff #7), revealed that resident #11 was in the hall and resident #37 stopped her and they started arguing. Resident #37 took left fist and struck resident #11 on the left forearm. Resident #11 grabbed resident #37's arm and when the CNA got to the residents, resident #11 let go of resident #37's arm.

Review of a written statement dated August 13, 2024 revealed that a licensed practical nurse (LPN/staff #41) revealed that she heard the two residents raising their voices in the hallway. A (CNA) went to separate the residents, but before she could get to them, resident #37 raised her hand and grabbed/hit the other resident #11 in the arm. The CNA separated them right away, and no injuries were noted on either resident. Then resident #37 was moved to the fourth floor.

Review of a written statement dated August 13, 2024 revealed that (CNA/staff #54) was standing by room #228 when she saw resident #37 hit resident #11's chair and says something to resident #11 in her language, while making gestures with her hands. Resident #11 had resident #37's right arm very tightly, because she could see the force that resident #11 was exerting on resident #37's arm and then (CNA/staff #7) screams, "they are fighting." Staff #54 stated that they all know that resident #11 doesn't share her space with anyone, and since resident #37 hit her chair, she was angry and became aggressive with resident #37.

An interview was conducted on August 27, 2024 at 12:16 p.m. with a licensed practical nurse (LPN/staff #23), who stated that she has received training on abuse and physical abuse includes striking, grabbing, and pulling. She stated that resident #11 needs supervision because she wanders. She stated that she did not witness the altercation, but knows that one of the residents was transferred to the fourth floor.

An interview was conducted on August 28, 2024 at 9:05 a.m. with the Director of Nursing (DON/staff #1), who stated that abuse occurs when harm is inflicted on a resident and can be physical, mental, misappropriation, isolation, restrained, and sexual. She stated that a 5-day investigation was completed and the allegation of abuse was substantiated. The two residents didn't like each other, which only became apparent during the incident.

The facility policy, "Abuse Prevention" revised June 17, 2024 states that it is the policy of this facility to prevent and prohibit all types of abuse, neglect, misappropriation of resident property, and exploitation.

Based on observation, interviews, and records review the facility failed to ensure the physician was notified of a change of condition for one resident (#5). The deficient practice could result in delayed treatment.

Findings include:

Resident #5 was initially admitted to the facility on November 17, 2019 with diagnoses of muscle weakness, anemia, chronic kidney disease and paroxysmal atrial fibrillation.

The care plan initiated on July 12, 2021 revealed that resident #5 was on anticoagulant therapy. The goal was that the resident will be free from discomfort or adverse reactions related to anticoagulant use. Interventions included to administer anticoagulant medications as ordered by physician, monitor for side effects and effectiveness, observe for and report, as needed, adverse reactions of anticoagulant therapy including mental status and significant or sudden changes in vital signs.

A progress note dated August 2, 2021 revealed the resident was sent to the hospital for a CT (Computerized Tomography) scan due to increase pain.

The clinical record review revealed the resident was readmitted at the facility on August 9, 2021.

A physician order dated August 10, 2021 included an order for warfarin sodium (anticoagulant) give 2.5 milligram (mg) by mouth at bedtime every Monday, Tuesday, Wednesday, Friday, and Sunday.

The physician order summary for August 2021 revealed an order to monitor for signs and symptoms of bleeding including black tarry stools, bleeding gums, bruising/nose bleed related to anticoagulant use every shift, to document positive (+) if signs and symptoms were present and negative (-) if not present.

A progress note dated August 10, 2021 at 11:44 A.M. revealed the resident was alert and oriented to situation and surrounding, was pleasant, and was not in acute distress. It was also noted that the resident was readmitted to the facility for coagulopathy and elevated INR.

Review of the progress note dated August 10, 2021 at 5:18 P.M. revealed resident had a fall and was found sitting on the floor next to her bed. The documentation included that neuro checks were started per policy; and that, the physician and family member were notified.

The progress note dated August 10, 2021 at 11:32 P.M. revealed resident was alert and oriented x 3 with confusion and was able to verbalize need. Further, it included neuro checks were continued status post of unwitnessed fall; and that, the resident was very "confusing" at night and "weak while night."

The Fall Risk Evaluation dated August 10, 2021 revealed that the resident had 1-2 falls and had no cognitive change in the last 90 days. There was no documented response for questions on resident behaviors such as easily distracted, periods of altered perception or awareness of surroundings, episodes of disorganized speech, periods of restlessness, periods of lethargy, mental function varies over the course of the day, wanders, abusive and resists care.

However, in another Fall Risk Evaluation dated August 10, 2021 documented that the resident had no falls and had a cognitive change in the last 90 days. The documentation also included that the resident was easily distracted, had periods of altered perception or awareness of surroundings, had episodes of disorganized speech, had periods of restlessness, had periods of lethargy; had mental function that varied over the course of the day, wanders; was abusive and resisted care.

Review of the clinical record revealed that Neurological Checks were completed; and the initial neurological check was August 10, 2021 at 4:45 P.M. Subsequent assessments were conducted on every 15-, 30-, and up to 60-minute intervals; and, the documentation revealed the resident had clear speech.

The neurological check dated August 11, 2021 at 2:00 A.M. the speech evaluation section was left blank. At 8:00 A.M. and 2:00 P.M., the documentation included that the resident had slurred speech.

Review of the Fall Risk Evaluation dated August 11, 2021 revealed that resident had 1-2 falls and had no cognitive change in the last 90 days. The documentation also included that the resident was not easily distracted, had no periods of altered perception or awareness of surroundings, had no episodes of disorganized speech, periods of restlessness, no periods of lethargy, had a mental function that varied over the course of the day, did not wander, was not abusive and did not resist care.

The physician order with a start date August 12, 2021 included for warfarin 1.5 mg by mouth at bedtime every Thursday and Saturday.

However, there was another physician order with a start date of August 12, 2021 to continue to hold coumadin (brand name for warfarin) and recheck INR in the morning one time only until August 12, 2021.

The neurological check dated August 12, 2021 at 6:00 A.M. revealed the resident had clear speech. At 8:00 A.M, the resident was documented to have slurred speech.

Review of a progress note dated August 12, 2021 at 3:14 P.M. revealed resident was laying in a recliner chair with eyes closed holding a cellphone to ear talking to the air and had slurred slow speech, nonsensical, and was not able to be redirected; and that, a family member was in the room with the resident. It also included that the resident was lethargic, confused, and was hitting, kicking, and pulling at oxygen tubing, screaming without cause in a high-pitched manner. The documentation also included that all narcotics had been discontinued due to the resident's mental status.

Despite documentations that the resident had slurred speech on August 11 and August 12, 2021, there was no evidence found that the physician was notified.

The physician orders for warfarin sodium was transcribed in the Medication Administration Record (MAR) for August 2021. The documentation in the MAR revealed that warfarin 2.5 mg was held on August 10, 2021 and given on the August 11, 2021.

Despite the hold order for warfarin, the MAR documentation for August 12, 2021 revealed that warfarin was administered to the resident.

Review of a progress note dated August 13, 2021 revealed that a registered nurse (RN) contacted the resident's family member regarding the resident's increasing confusion and the medication changes to include the discontinuation of all narcotics. Further, the documentation included that the family member requested to contact the doctor.

A physician order with a start date of August 13, 2021 included to continue to hold coumadin and recheck INR in the morning one time only until August 13, 2021 at 10:59 A.M.

Another progress note dated August 13, 2021 revealed that a nurse practitioner (NP) saw the resident and ordered for the resident to be sent the hospital for a CT scan of the head without contrast second to altered mentation. It was further noted that the resident was transported to the Emergency department at approximately 12:00 P.M.

An interview was conducted on June 14, 2024 at 12:44 P.M. with a licensed practical nurse (LPN/staff #85) who stated that if a resident had an unwitnessed fall or was found on the floor and it was unknown whether the resident hit their head, the RN would perform a neurological assessment and notify the physician and family. The LPN stated that the doctor will also be notified that the resident was on a blood thinner; and, the doctor would give instructions. The LPN said it was the doctor's decision to send the resident who fell to the hospital for a CT scan. Further, the LPN stated that it was a change in condition and the doctor would be notified if a resident who had clear speech prior to a fall then developed slurred speech after the fall. The LPN said the resident who was on coumadin (anticoagulant) and had a fall would be at risk for a brain bleed; and that, not notifying the physicia

Based on observation, interviews, and records review the facility failed to ensure that the physician was notified of a significant change of condition for one resident (#5).

Findings include:

Resident #5 was initially admitted to the facility on November 17, 2019 with diagnoses of muscle weakness, anemia, chronic kidney disease and paroxysmal atrial fibrillation.

The care plan initiated on July 12, 2021 revealed that resident #5 was on anticoagulant therapy. The goal was that the resident will be free from discomfort or adverse reactions related to anticoagulant use. Interventions included to administer anticoagulant medications as ordered by physician, monitor for side effects and effectiveness, observe for and report, as needed, adverse reactions of anticoagulant therapy including mental status and significant or sudden changes in vital signs.

A progress note dated August 2, 2021 revealed the resident was sent to the hospital for a CT (Computerized Tomography) scan due to increase pain.

The clinical record review revealed the resident was readmitted at the facility on August 9, 2021.

A physician order dated August 10, 2021 included an order for warfarin sodium (anticoagulant) give 2.5 milligram (mg) by mouth at bedtime every Monday, Tuesday, Wednesday, Friday, and Sunday.

The physician order summary for August 2021 revealed an order to monitor for signs and symptoms of bleeding including black tarry stools, bleeding gums, bruising/nose bleed related to anticoagulant use every shift, to document positive (+) if signs and symptoms were present and negative (-) if not present.

A progress note dated August 10, 2021 at 11:44 A.M. revealed the resident was alert and oriented to situation and surrounding, was pleasant, and was not in acute distress. It was also noted that the resident was readmitted to the facility for coagulopathy and elevated INR.

Review of the progress note dated August 10, 2021 at 5:18 P.M. revealed resident had a fall and was found sitting on the floor next to her bed. The documentation included that neuro checks were started per policy; and that, the physician and family member were notified.

The progress note dated August 10, 2021 at 11:32 P.M. revealed resident was alert and oriented x 3 with confusion and was able to verbalize need. Further, it included neuro checks were continued status post of unwitnessed fall; and that, the resident was very "confusing" at night and "weak while night."

The Fall Risk Evaluation dated August 10, 2021 revealed that the resident had 1-2 falls and had no cognitive change in the last 90 days. There was no documented response for questions on resident behaviors such as easily distracted, periods of altered perception or awareness of surroundings, episodes of disorganized speech, periods of restlessness, periods of lethargy, mental function varies over the course of the day, wanders, abusive and resists care.

However, in another Fall Risk Evaluation dated August 10, 2021 documented that the resident had no falls and had a cognitive change in the last 90 days. The documentation also included that the resident was easily distracted, had periods of altered perception or awareness of surroundings, had episodes of disorganized speech, had periods of restlessness, had periods of lethargy; had mental function that varied over the course of the day, wanders; was abusive and resisted care.

Review of the clinical record revealed that Neurological Checks were completed; and the initial neurological check was August 10, 2021 at 4:45 P.M. Subsequent assessments were conducted on every 15-, 30-, and up to 60-minute intervals; and, the documentation revealed the resident had clear speech.

The neurological check dated August 11, 2021 at 2:00 A.M. the speech evaluation section was left blank. At 8:00 A.M. and 2:00 P.M., the documentation included that the resident had slurred speech.

Review of the Fall Risk Evaluation dated August 11, 2021 revealed that resident had 1-2 falls and had no cognitive change in the last 90 days. The documentation also included that the resident was not easily distracted, had no periods of altered perception or awareness of surroundings, had no episodes of disorganized speech, periods of restlessness, no periods of lethargy, had a mental function that varied over the course of the day, did not wander, was not abusive and did not resist care.

The physician order with a start date August 12, 2021 included for warfarin 1.5 mg by mouth at bedtime every Thursday and Saturday.

However, there was another physician order with a start date of August 12, 2021 to continue to hold coumadin (brand name for warfarin) and recheck INR in the morning one time only until August 12, 2021.

The neurological check dated August 12, 2021 at 6:00 A.M. revealed the resident had clear speech. At 8:00 A.M, the resident was documented to have slurred speech.

Review of a progress note dated August 12, 2021 at 3:14 P.M. revealed resident was laying in a recliner chair with eyes closed holding a cellphone to ear talking to the air and had slurred slow speech, nonsensical, and was not able to be redirected; and that, a family member was in the room with the resident. It also included that the resident was lethargic, confused, and was hitting, kicking, and pulling at oxygen tubing, screaming without cause in a high-pitched manner. The documentation also included that all narcotics had been discontinued due to the resident's mental status.

Despite documentations that the resident had slurred speech on August 11 and August 12, 2021, there was no evidence found that the physician was notified.

The physician orders for warfarin sodium was transcribed in the Medication Administration Record (MAR) for August 2021. The documentation in the MAR revealed that warfarin 2.5 mg was held on August 10, 2021 and given on the August 11, 2021.

Despite the hold order for warfarin, the MAR documentation for August 12, 2021 revealed that warfarin was administered to the resident.

Review of a progress note dated August 13, 2021 revealed that a registered nurse (RN) contacted the resident's family member regarding the resident's increasing confusion and the medication changes to include the discontinuation of all narcotics. Further, the documentation included that the family member requested to contact the doctor.

A physician order with a start date of August 13, 2021 included to continue to hold coumadin and recheck INR in the morning one time only until August 13, 2021 at 10:59 A.M.

Another progress note dated August 13, 2021 revealed that a nurse practitioner (NP) saw the resident and ordered for the resident to be sent the hospital for a CT scan of the head without contrast second to altered mentation. It was further noted that the resident was transported to the Emergency department at approximately 12:00 P.M.

An interview was conducted on June 14, 2024 at 12:44 P.M. with a licensed practical nurse (LPN/staff #85) who stated that if a resident had an unwitnessed fall or was found on the floor and it was unknown whether the resident hit their head, the RN would perform a neurological assessment and notify the physician and family. The LPN stated that the doctor will also be notified that the resident was on a blood thinner; and, the doctor would give instructions. The LPN said it was the doctor's decision to send the resident who fell to the hospital for a CT scan. Further, the LPN stated that it was a change in condition and the doctor would be notified if a resident who had clear speech prior to a fall then developed slurred speech after the fall. The LPN said the resident who was on coumadin (anticoagulant) and had a fall would be at risk for a brain bleed; and that, not notifying the physician of any changes can put the resident at ris

Based on observation the facility failed to maintain two special locking exit doors located in the facility. Failing to ensure the correct amount of force needed to release of the exit doors could cause harm to patients and/or staff in an emergency

NFPA 101 Life Safety Court, 2012, Chapter 19, Section, 19.2.2.2.4 "Doors within a required means of egress shall not be equipped with a latch or lock that requires the use of a tool or key from the egress side." Exception No. 2 "Delayed-egress locks complying with 7.2.1.6.1 shall be permitted, provided that not more than one such device is located in any egress path. Section 7.2.1.6.1 "Special Locking Arrangements" " (c) An irreversible process shall release the lock within 15 to 30 seconds upon application of a force to the release device required in 7.2.1.5.4 that shall not be required to exceed 15 lbs nor be required to be continuously applied for more than 3 seconds. The initiation of the release process shall activate an audible signal in the vicinity of the door. Once the door lock has been released by the application of force to the releasing device, relocking shall be by manual means only."

Findings include:

Observations made while on tour on July 5, 2023, revealed the following;

1) the rehabilitation room door #1 delayed egress door exit door failed to open with a force of less than 15 lbf. The panic bar was pushed and and set off the irreversible process at 45 lbft for the left door and 20 lbft for the right door
2) the rehabilitation room door #2 delayed egress door exit door failed to open with a force of less than 15 lbft. The panic bar was pushed and and set off the irreversible process at 30 lbft for the left door and 70+ lbft for the right door. The left door took 55lbft to open the door to the public way

During the exit conference on July 5, 2023, the above findings were again acknowledged by the management team.

Based on observation behind the kitchen cook top rags were seen on the gas line and floor. Failing to inspect and clean the kitchen hood baffles from cleaning rags, oil, grease will allow a build-up of grease and provide fuel for a fire. A fire in the kitchen may cause harm to patients and/or staff.

Findings include:

NFPA 101 Life Safety Code, 2012 Edition, Chapter 19, Section 19.3.2.5, "Cooking Facilities." "Cooking facilities shall be protected in accordance with 9.2.3." Section 9.2.3, "Commercial Cooking Equipment" "Commercial cooking equipment shall be in accordance with NFPA 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations.... Chapter 11, Section 11.2 Inspection and Testing, and Maintenance of Fire extinguishing Systems. Section 11.6 Cleaning of Exhaust Systems. Upon inspection, if the exhaust system is found to contaminated with deposits from grease-laden vapors, the contaminated portions of the exhaust system shall be cleaned by a properly trained, qualified, and certified person(s) acceptable to the authority having jurisdiction. Section 11.6.2* Hoods, grease removal devices, fans, ducts and other appurtenances shall be cleaned to remove combustible contaminants prior to the surfaces becoming heavily contaminated with grease or oily sludge.

Observations made while on tour on July 5, 2023, revealed three (3) cleaning rags behind the cook top. Two (2) cleaning rags were on the main gas line to the cook top and the third was on the floor. Staff said the rags appeared to have been from the hood cleaning company. The last hood cleaning was in May 2023.

During the exit conference on July 5, 2023, the above findings were again acknowledged by the management team.

Based on observation the facility failed to maintain several doors in the building. Failing to maintain doors in the facility could allow heat and/or smoke to transfer which will cause harm to the patients and/or staff.

NFPA 101, Life Safety Code, 2012 edition, Chapter 19, Section 19.3.6.3.5. "Doors shall be provided with a means for keeping the door closed that is acceptable to the authority having jurisdiction."

Findings include:

Observations made while on tour on July 5, 2023, the following;

1) 3rd floor "C" hall rated door, failed to latch secure
2) 3rd floor fireplace lounge, rated door failed to latch secure
3) 2nd floor "A" hall rated door, failed to latch secure
4) room 207 failed to latch secure
5) 2nd floor soiled linen rated door, failed to latch secure
6) 2nd floor "C" hall rated door, failed to latch secure
7) room 232 rated door, failed to latch secure
8) room 101 had excessive gap, 1/2 inch on the lower handle side of the door
9) the door between the kitchen and laundry in the service hall failed to latch secure.

During the exit conference conducted on July 5, 2023, the above findings were again acknowledged by the management team.

Based on observation the facility failed to ensure a protected covering over exposed wires. Failure to have the appropriate protection around exposed wires could cause harm to patients and/or staff. .

NFPA 101, 2012 Edition Chapter 19. "19.5.1 Utilities. 19.5.1.1 Utilities shall comply with the provisions of Section 9.1" " 9.1 Utilities. 9.1.2 Electrical Systems. Electrical wiring and equipment shall be in accordance with NFPA 70, National Electrical Code, unless such installations are approved existing installations, which shall be permitted to be continued in service.

NFPA 70, 2011 Edition Chapter 1 General "110.27(A) Live Parts Guarded Against Accidental Contact. Except as elsewhere required or permitted by this Code, live parts of electrical equipment operating at 50 volts or more shall be guarded against accidental contact by approved enclosures or by any of the following means: (1) By location in a room, vault, or similar enclosure that is accessible only to qualified persons. (2) By suitable permanent, substantial partitions or screens arranged so that only qualified persons have access to the space within reach of the live parts. Any openings in such partitions or screens shall be sized and located so that persons are not likely to come into accidental contact with the live parts or to bring conducting objects into contact with them. (3) By location on a suitable balcony, gallery, or platform elevated and arranged so as to exclude unqualified persons. (4) By elevation of 2.5 m (8 ft) or more above the floor or other working surface."

Findings include:

Observations made while on tour on July 5, 2023, revealed exposed electrical wiring under the disposal in the kitchen. Two (2) flex conduit were seen, pulled away from the disposal. The exposed wiring was approximately shin height.

During the exit conference on July 5, 2023, the above findings were again acknowledged by the management staff. .

-Resident #92 was admitted to the facility on 03/09/2023 with diagnoses that included sepsis, bipolar disorder and depression.

Review of the Level I PASRR dated 3/09/2023 included the diagnoses of bipolar disorder and depression. Per the documentation, the resident had not exhibited any interpersonal symptoms or behaviors (not due to a medical condition) and she received antidepressant medication daily.

However, review of the physician's orders dated 03/09/2023 included:
-Risperidone (antipsychotic) 2 milligrams (mg). Give 1 tablet via G-tube at bedtime for bipolar disorder with a target behavior of striking out.
-Sertraline HCL (antidepressant) 50 mg. Give 1 tablet daily for depression with a target behavior of lack of motivation.

A risk for change in mood or behavior care plan dated 03/10/2023 related to her medical condition had a goal to allow staff to assist her with basic needs. Interventions included a psychiatric consult as indicated.

On 03/28/2023 a PASRR Level I screening was completed. The screening revealed the resident's diagnoses included bipolar disorder, depression and anxiety disorder. The assessment included that she had exhibited no interpersonal symptoms or behaviors, including difficulty interacting with others and that she had displayed no symptoms related to adapting to change such as physical violence and or excessive irritability. The screening indicated that no Level II referral was necessary.

The admission MDS assessment dated 04/04/23 revealed the resident was rarely/never understood and scored 99 on the BIMS assessment, indicating severely impaired cognition. According to the assessment the resident displayed no behaviors.

Review of the April 2023 Medication Administration Record (MAR) revealed medications were administered in accordance with the physician's orders. According to the record, the resident displayed no symptoms of depression and she had 2 episodes of striking out.

The May 2023 MAR indicated the resident received medications per physician's orders. Review of the MAR revealed the resident displayed no symptoms of depression. According to the MAR, she displayed behaviors of striking out on 5 occasions.

According to the June 2023 MAR, the resident was administered medications as ordered. Per the MAR, the resident displayed symptoms of depression on 1 occasion and she displayed behaviors of striking out on 5 occasions.

However, despite the resident's escalated behaviors, the resident was not referred to the State authority for PASRR Level II evaluation and determination.

On 06/30/2023 at 12:29 PM, an interview was conducted with Social Service Director (staff #99). After review of resident #92's Level I PASRR, she stated that based on the resident diagnosis of bipolar and the prescribed antipsychotic medication, a Level II evaluation was needed. She stated the risk to the resident would include not identifying the resident's needs and getting services in place.

-Resident #92 was admitted to the facility on 03/09/2023 with diagnoses that included sepsis, bipolar disorder and depression.

Review of the Level I PASRR dated 3/09/2023 included the diagnoses of bipolar disorder and depression. Per the documentation, the resident had not exhibited any interpersonal symptoms or behaviors (not due to a medical condition) and she received antidepressant medication daily.

However, review of the physician's orders dated 03/09/2023 included:
-Risperidone (antipsychotic) 2 milligrams (mg). Give 1 tablet via G-tube at bedtime for bipolar disorder with a target behavior of striking out.
-Sertraline HCL (antidepressant) 50 mg. Give 1 tablet daily for depression with a target behavior of lack of motivation.

A risk for change in mood or behavior care plan dated 03/10/2023 related to her medical condition had a goal to allow staff to assist her with basic needs. Interventions included a psychiatric consult as indicated.

On 03/28/2023 a PASRR Level I screening was completed. The screening revealed the resident's diagnoses included bipolar disorder, depression and anxiety disorder. The assessment included that she had exhibited no interpersonal symptoms or behaviors, including difficulty interacting with others and that she had displayed no symptoms related to adapting to change such as physical violence and or excessive irritability. The screening indicated that no Level II referral was necessary.

The admission MDS assessment dated 04/04/23 revealed the resident was rarely/never understood and scored 99 on the BIMS assessment, indicating severely impaired cognition. According to the assessment the resident displayed no behaviors.

Review of the April 2023 Medication Administration Record (MAR) revealed medications were administered in accordance with the physician's orders. According to the record, the resident displayed no symptoms of depression and she had 2 episodes of striking out.

The May 2023 MAR indicated the resident received medications per physician's orders. Review of the MAR revealed the resident displayed no symptoms of depression. According to the MAR, she displayed behaviors of striking out on 5 occasions.

According to the June 2023 MAR, the resident was administered medications as ordered. Per the MAR, the resident displayed symptoms of depression on 1 occasion and she displayed behaviors of striking out on 5 occasions.

However, despite the resident's escalated behaviors, the resident was not referred to the State authority for PASRR Level II evaluation and determination.

On 06/30/2023 at 12:29 PM, an interview was conducted with Social Service Director (staff #99). After review of resident #92's Level I PASRR, she stated that based on the resident diagnosis of bipolar and the prescribed antipsychotic medication, a Level II evaluation was needed. She stated the risk to the resident would include not identifying the resident's needs and getting services in place.