Oxnard Manor Healthcare Center

In the surveyor’s words

From the most serious findings on record at Oxnard Manor Healthcare Center, in the surveyor’s own words.

• Immediate jeopardy, patternF886Jan 13, 2021

  Based on interview and record review, the facility failed to ensure twice weekly testing for COVID-19 was completed for all staff. This failure created the likelihood for any resident who had not had COVID-19 within the past 90 days to contract and spread [MEDICAL CONDITION] and experience symptoms such as decreased oxygen saturations, fever, cough, [MEDICAL CONDITION], and death. On 01/12/21 at 3:35 PM, the Administrator and Director of Nursing were notified that an immediate jeopardy was identified at F886 for failure to ensure staff were tested for the COVID-19 virus twice weekly as required by county positivity rates with nine staff who missed this requirement subsequently testing positive. […]

• No harm, potential for more than minimal, patternF801Oct 31, 2024

  Based on observation, interview, and record review, the Registered Dietitian (RD) failed to ensure her skill set related to nutrition assessments was current when standards of practice were not implemented as follows: 1. The RD utilized a method to assess the nutritional needs for elderly residents classified as obese that had the potential to promote weight loss, and was not in accordance with professional standards of practice, without obtaining and/or discussing Resident 53's and/or responsible party (RP) weight goal or preference and potential risks of weight loss for informed decision making for one of one sampled residents (Resident 53). 2. […]

• No harm, potential for more than minimal, patternF803Oct 31, 2024

  Based on observation, interview, and record review, the facility failed to follow the planned menu for therapeutic diets (part of the treatment for a disease or clinical condition, to eliminate, decrease, or increase certain substances in the diet or to provide mechanically altered food) when: 1. Resident 9, Resident 40 and Resident 26 received salad when prescribed a mechanical soft diet (to make it easier to chew and swallow foods, reducing the risk of choking) that was not on the mechanical soft diet menu. The Dietary Supervisor (DS) 1 confirmed the error had the potential to affect the following resident's prescribed a mechanical soft diet: Resident's 378, 54, 233, 4, 67, 21, 53, 14, 52, 42, 70, 129, 41, 127, 60, 49, 24, 349, 10, 27, 28, 30). 2. […]

• No harm, potential for more than minimal, patternF584Dec 17, 2021

  Based on observation, interview, and record review, the facility failed to provide a safe, sanitary, and homelike environment for residents when: 1. West Patio exit door could not be shut, as posted, Keep closed at all times. 2. West medication storage room was dirty and in disrepair. 3. Three medication carts were visibly soiled. 4. Resident 4's wall was damaged with a large area of missing plaster, and Resident 4's bed frame was covered with a sticky substance. 5. Resident 63 and Resident 39's room had scratches, peeling paint, and holes in the walls. 6. Windows in the kitchen and dining room had no screens on the windows and a broken window was observed in the dining room. 7. Resident 8's wall was damaged. 8. […]

• No harm, potential for more than minimal, patternF761Dec 17, 2021

  Based on observation, interview, and record review, the facility failed to ensure: 1. Three medications were contained in labeled bottles in two of two sampled medication carts (east nurses' station cart - C1 and west nurses' station cart- C2). 2. A medication was labeled for individual use in one of two sampled medication carts -C2. 3. A medication was labeled with an open date in one of two sampled medication carts - C1. This failure had the potential for residents to receive expired, ineffective, and contaminated medications. […]