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F0695
E

Failure to Follow Oxygen Administration Policies for Two Residents

El Monte, California Survey Completed on 06-27-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to implement its policies and procedures for oxygen administration for two residents. For one resident with chronic obstructive pulmonary disease (COPD) and heart failure, surveyors observed that the nasal cannula tubing was touching the floor while in use. Both the LVN and the DON confirmed that this practice was not in accordance with facility policy and posed an infection control risk. The facility's policy required that oxygen tubing be used in a manner that prevents it from touching the floor. For another resident with dementia and anemia, surveyors found that the nasal cannula tubing was not labeled and the oxygen was set at 1.5 L/min, which did not match the physician's order of 2 L/min. The LVN acknowledged that the tubing should have been labeled for infection control and that the oxygen flow rate should have matched the physician's order. The DON confirmed that oxygen tubing should be labeled and that oxygen must be administered as ordered by the physician. The facility's policy required weekly changes of oxygen tubing with labeling and administration of oxygen as ordered.

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