Pih Health Good Samaritan Hospital D/P SNF

In the surveyor’s words

From the most serious findings on record at Pih Health Good Samaritan Hospital D/P SNF, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF851Oct 4, 2024

  Based on interview and record review, the facility failed to submit their Payroll Based Journal (PBJ, information of the provider's daily staffing hours for the appropriate care of the residents) report to Center for Medicare Services (CMS) in a complete and accurate manner. This deficient practice prevented the provision of complete and accurate direct care staffing information to the public. Findings: A review of the CMS PBJ Staffing Report indicated during the first fiscal quarter of 2024 dated 10/1/2023 to 12/31/2023, there was excessively low weekend staffing data triggered. During the second fiscal quarter of 2024 dated 1/1/24 to 3/31/2024, the PBJ report indicated no Registered Nurse (RN) hours were triggered (four or more days within the quarter with no RN hours). […]

• No harm, potential for more than minimal, widespreadF636Oct 6, 2023

  Based on interview and record review, the facility failed to complete and/or submit the Minimum Data Sets (MDS - a comprehensive standardized assessment and screening tool) within the required time frame for six of 19 sampled residents (Residents 8, 10, 13, 57, 110 and 111). This deficient practice had the potential to negatively affect the provision of necessary care and services for Residents 8, 10, 13, 57, 110 and 111. Findings: a. A review of Resident 8's admission record indicated the facility admitted the resident on 9/2/2023. A review of Resident 8's admission nursing assessment, dated 9/2/2023, indicated the resident was alert and oriented to person place and time, also that Resident 8 denied pain and was using oxygen. […]

• No harm, potential for more than minimal, patternF656Oct 4, 2024

  Based on interview and record review, the facility failed to ensure comprehensive, resident -centered care plans were developed for four of ten sampled residents (Residents 111, 115, 163 and 166). For Resident 111 the facility failed to develop a care plan to address the resident's non-compliance to take medications. -For Resident 115 the facility failed to develop a care plan with person centered interventions for psychotropic medication (medications that affect brain activities associated with mental processes and behavior) use. -For Resident 163 the facility failed to develop a care plan including measurable goals and interventions to monitor oxygen use. […]

• No harm, potential for more than minimal, patternF732Oct 6, 2023

  Based on observation, interview and record review, the facility failed to post daily actual hours or projected hours worked by the licensed and unlicensed staff providing direct care to the residents per shift and failed to complete the Direct Care Service Hours Per Patient Day (DHPPD - refers to the actual hours of work performed per patient day by a direct caregiver) for 9/3/2023 to 10/4/2023. As a result, staffing information of the unit was not complete and accurate for residents and visitors. Findings: During an interview on 10/5/2023 at 10:53 AM, Clinical Director (CD) stated she was also the unit's Director of Staff Development. […]

• No harm, potential for more than minimal, isolatedF604Dec 4, 2025

  Based on observation, interview, and record review, the facility failed to document the removal or release of mittens and wrist restraints (any manual method, physical or mechanical device, material or equipment that is attached or adjacent to the resident's body that he or she cannot easily remove that restricts freedom of movement or normal access to one's body) for one out of one sampled resident (Resident 46). There was no evidence in Resident 46's record indicating that the restraints were removed or released for monitoring or assessment during the shift. […]