**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to: 1. Maintain comfortable and acceptable room temperature (ambient air temperature) ranging from 71 to 81 degrees Fahrenheit (°F, unit of temperature). 2. Maintain the compressor (the driving unit of a chiller system) for one of two chillers in working condition. A chiller is a cooling water circulation device that is connected to the air conditioning (A/C) system. 3. Monitor room temperatures and retain records of temperature checks. These deficiencies affected the entire 4th floor of the facility, where 27 of 27 Sub-Acute (a medical facility that provides medical care to chronically ill patients who are medically stable) residents were residing. As a result, Residents 3, 6 and facility staff complained the room temperatures were hot and uncomfortable. This deficient practice placed Residents 3, 6 and other severely ill residents (Residents 1, 2, 4,5, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27) at risk for dehydration (excessive loss of body water) and/or heat stroke (internal body heat with complications involving the central nervous system that occur after exposure to high temperatures). On 7/25/2023, at 6:29 p.m., an Immediate Jeopardy (IJ, a situation in which the provider's non-compliance with one or more requirements of participation has caused or is likely to cause serious injury, harm, impairment, or death of a resident or residents) was declared. The facility's Chief Nursing Officer (CNO), Director of Plant Operations (DPO), and Lead Maintenance of Engineering (LME) were notified of the facility's failure to maintain the compressor for one of two chillers in working condition, monitor and record room temperatures, and provide comfortable and acceptable room temperature for all residents. On 7/27/2023 at 4:23 p.m., the CNO provided an acceptable IJ removal plan that included the following summarized actions/items: A. Procurement of portable chiller to provide acceptable temperature in the facility. B. Obtain emergency authorization from the Department of Health Care Access and Information (HCAI, previously known as the Office of Statewide Health Planning and Development - OSHPD) for the installation of portable chiller. C. Temporary transfer of residents from 4th floor sub-acute unit to 1st floor acute rehabilitation unit (ARU, an institution that provides restorative treatment for instance physical, occupational or speech therapy, to patients with physical injury, dysfunction or disability over a short period of time) and intensive care unit (ICU, a unit in a hospital where severely ill patients are treated and kept under constant medical observation). D. Submit program flexibility request for the use of the ARU and the ICU beds. E. Notification to family members/residents for the temporary location. F. Hourly temperature monitoring of resident rooms. G. In-services performed to staff regarding utilization of temperature log, precautionary measure during heat, and proper use and maintenance of portable cooling devices. On 7/27/2023, at 6:18 p.m., after verifying satisfactory implementation of the facility's immediate corrective actions noted in the IJ Removal Plan (interventions to correct the deficient practice), the Immediate Jeopardy was removed in the presence of the CNO. Findings: A review of the facility's Certification Information indicated that the facility was recommended for certification on 2/3/2023. A review of the facility's census dated 7/25/2023 indicated that there were 27 sub-acute residents in the facility. A review of Resident 3's Face Sheet indicated the facility admitted the resident on January 1, 2023, with diagnoses including respiratory failure (a condition where the lungs fail to perform their normal gas exchange function resulting in too much carbon dioxide or too little oxygen in the blood). Other diagnoses include chronic hypoxemic respiratory failure (a condition where the lungs are not functioning adequately to keep oxygen exchange at acceptable levels), pneumonia (an infection in the lungs that causes them to fill up with fluid or pus) and hypothyroidism (A condition in which the thyroid gland doesn't produce enough thyroid hormone) and chronic cough (a persistent cough that last longer than 8 weeks). Resident 3's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated June 18, 2023, indicated the resident has no cognition deficient (ability to think and process information). Resident 1 required extensive assistance (resident involved in activity, staff provide weight-bearing support) for toilet use, personal hygiene and dressing. Resident 1 required limited assistance (resident highly involved in activity, staff provide guided maneuvering of limbs or other weight -bearing assistance) for bed mobility and walking. A review of Resident 6's Face Sheet indicated the facility admitted the resident on January 1, 2023, with diagnoses including respiratory failure. Resident 6's MDS, dated [DATE], indicated the resident has intact cognition. Resident 6 requires extensive assistance for bed mobility, transfer, toilet use, personal hygiene and dressing. Resident 6 requires supervision for eating. A review of Resident 7's Face Sheet indicated the facility admitted the resident on January 1, 2023, with diagnoses including chronic hypoxemic respiratory failure. Other diagnoses include traumatic brain injury (a sudden injury that causes damage to the brain) and status-post motor vehicle accident. Resident 7's MDS dated [DATE], indicated the resident had severe impairment in cognition. Resident 7 has total dependence (full staff performance every time during the entire 7-day period) for all activities of daily living. According to https://www.nia.nih.gov/health/hot-weather-safety-older-adults National Institute on Aging, under Hot Weather Safety for Older Adults, dated September 2, 2022, indicated older people can have a tough time dealing with heat and humidity. The temperature inside or outside does not have to reach 100°F to put the residents at risk for a heat-related illness. Headache, confusion, dizziness, or nausea could be a sign of a heat-related illness. High environmental temperatures can be dangerous to the body. In the range from 90 F to 105 F, residents can experience heat cramps (painful, involuntary muscle spasms that usually occur during heavy exercise in hot environments) and exhaustion (a state of extreme physical or mental fatigue). During an interview on 7/27/2023, at 2:15 p.m., with registered nurse (RN) 2, RN 2 stated that residents may suffer from dehydration, sweating and heat rash (an itchy skin condition presenting as red blisters caused by blocked sweat ducts and trapped sweat under the skin) due to extreme heat. 1. During an interview on 7/25/2023, at 11:53 a.m., with Resident 3, an oxygen-dependent tracheostomy (a curved hollow tube made of rubber or plastic placed into the trachea of a person to enable mechanical ventilation or to relieve airway obstruction) resident, Resident 3 stated that the room gets very hot, and the facility offered a portable box fan, but it blows hot air and that makes her cough more. Resident 3 also added that other residents on the other side of the unit must get even hotter as the sun rises from that side of the building. During an interview on 7/25/2023, at 12:31 p.m., with certified nursing assistant (CNA)1, CNA 1 stated it was very hot and uncomfortable to clean patients while wearing personal protective gear (PPE). The facility practices enhanced standard precautions (an infection prevention intervention adopted by some nursing home facilities to reduce transmission of multidrug-resistant organisms) and staff must wear PPE to enter each resident's room. During an interview on 7/25/2023, at 1:23 p.m., Resident 6 stated that it was too hot in her room. During an interview on 7/27/2023, at 2:15 p.m., with registered nurse (RN) 2, RN 2 stated it was completely miserable being inside the resident's room with PPE due to the extreme heat that made staff feel uncomfortable inside the resident's room. During an interview on 7/25/2023, at 1:59 p.m., the RN Sub-Acute Manager (SAM) stated that the whole building is warm because of the A/C problem. During an interview with the LME and DPO on 7/25/2023, at 3:17 p.m., the DPO stated that 74°F to 75°F was the maximum room temperature and 68°F is the lowest room temperature required according to the facility's policy. A review of The Weather Channel's forecast indicated the highest temperature for the day of 7/25/2023 was 99°F for the facility's zip code. During concurrent observations and interviews on 7/25/2023, the LME measured resident room temperatures using a temperature gun (a non-contact thermometer [temperature-sensing instrument], also called infrared thermometer). The following temperatures were obtained: A. At 4:20 p.m., in Resident 1 and Resident 9's room, the LME measured the room temperature, and it was measured at 84°F. B. At 4:21 p.m., in Resident 2's room, the LME measured the room temperature, and it was measured at 84°F. C. At 4:21 p.m., in Resident 3's room, the LME measured the room temperature, and it was measured at 83 to 84°F. D. At 4:25 p.m., in Resident 4's room, the LME measured the room temperature, and it was measured at 83°F. E. At 4:25 p.m., in Resident 5's room, the LME measured the room temperature, and it was measured at 82 to 83°F. During an interview on 7/26/2023, at 2:17 p.m., the CNO stated that the past few days had been unbearable, I think it was 100[°F] in the valley. A review of The Weather Channel's forecast indicated the highest temperature for the day of 7/26/2023 was 99°F for the facility's zip code. The forecast also indicated a Heat Advisory (a period of hot temperatures is expected) for the facility's zip code. During concurrent observations and interviews on 7/26/2023, the LME measured resident room temperatures using a temperature gun. The following temperatures were obtained: A. At 5:31 p.m., in Resident 1 and Resident 9's room, the LME measured the room temperature, and it was measured at 86°F. The LME stated that it's hot in the room. B. At 5:33 pm, in Resident 2's room, the LME measured the room temperature, and it was measured at 84 to 87°F. C. At 5:33 p.m., in Resident 3's room, the LME measured the room temperature, and it was measured at 85 to 86°F. The LME stated, it's hotter here because of the heat from the sun. D. At 5:36 p.m., in Resident 5's room, the LME measured the room temperature, and it was measured at 84°F. A review of The Weather Channel's forecast indicated the highest temperature for the day of 7/27/2023 was 99°F for the facility's zip code. The forecast also indicated that the highest temperature recorded for 7/25/2023 and 7/26/2023 was 101°F. A review of the facility's policy and procedure (P&P) titled, Air Conditioning (HVAC) System Failure, dated 12/2019, indicated, the comfortable and safe temperature levels range between 71° to 81°F. A review of County of Los Angeles Public Health News Release, dated 7/26/2023, indicated, heat advisory extended - high temperatures for parts of Los Angeles County from 7/25/2023 to 7/27/2023. Public Health reminds everyone to take precautions to avoid heat-related illness, especially older adults, young children, outdoor workers, athletes, and people with a chronic medical condition who are especially sensitive to negative health impacts from extreme heat. 2. During an interview on 7/25/2023, at 11:29 a.m., the LME stated that the compressor for one of two chillers in the penthouse (rooftop) started having problems about two weeks ago and that is affecting the tower. The tower included the resident rooms in the 4thfloor sub-acute. The LME added, four portable A/Cs were installed in the sub-acute unit and fans were provided to the residents. During an interview on 7/25/2023, at 4:47 p.m., the DPO stated that the facility was waiting for parts to be delivered to repair the chiller's compressor. The parts were ordered on Sunday (7/23/2023) and scheduled to be delivered on 7/26/2023. During a concurrent observation and interview on 7/25/2023 at 12:02 p.m., with LME on the rooftop (penthouse), the evaluator observed one of the chillers not working with equipment parts on the floor. The LME pointed to one of the chillers and stated, that is not working and that it's off. The parts on the floor were the chiller's water valve and exhaust. During an interview on 7/25/2023, at 1:12 p.m., the LME stated, the facility has one chiller that is working but not enough to provide cool air because the other chiller is down. During an interview with the LME and DPO on 7/25/2023, at 3:17 p.m., the LME stated that the vendor started working on the non-functioning chiller on Thursday (7/20/2023). The DPO also stated, we know that we are having issues. During a concurrent interview and record review on 7/27/2023 at 2:28 p.m. with Engineering Staff 1 (ES 1), the Penthouse Chiller Room engineering log dated 6/26/2023 was reviewed. The log indicated, OFF, OOC, and called vendor for service. ES 1 explained, that means off, equipment is off, and we let the vendor know. OOC means out of service, because the unit starts to trip and the vendor [was] supposed to look at it. During a concurrent interview and record review on 7/27/2023 at 2:59 p.m. with ES 1, the Penthouse Chiller Room engineering log dated 5/22/2023 was reviewed. The log indicated, 5/23 - chiller #2 - reset oil pressure switch. - still tripping called vendor and #2 chiller not working notify vendor. ES 1 explained, that means the chiller had been shut off and the unit started having issues on 5/23/2023. It was not normal. During a review of the facility's policy and procedure (P&P) titled, Air Conditioning (HVAC) System Failure, dated 12/2019, the P&P indicated, The Engineering Department is responsible for the operation of the HVAC System throughout the hospital. The heating, ventilation, and air-conditioning (HVAC) system is designed, installed, operated and maintained in a manner that is designed to provide a comfortable and safe environment for patients, personnel and visitors. Procedures in the event of HVAC failure included the following procedures: check to ascertain if chillers are operating, if the engineering tech is unable to identify the problem, contact the approved vendor, and notify House Supervisor and Administrator on call. During a review of the facility's policy and procedure (P&P) titled, Utility systems Management Plan, dated 1/2022, the P&P indicated, The Director of Facilities Management has the responsibility of the Utility Equipment Management Plan and will ensure the hospital designs, installs and maintains utility systems that meet patient care and operational needs. The Director of Facilities Management has overall responsibility for the proper maintenance and operation of the utility and mechanical systems in the hospital. These systems include HVAC (heating, ventilation, and air conditioning) systems. 3. During an interview on 7/25/2023, at 12:21 p.m., the LME stated that the engineering staff either checks the thermostat (temperature regulating device) or uses a temperature gun to measure room temperatures. The temperature in resident rooms including the 4thfloor sub-acute should range between 68°F to 72°F according to facility's policy. The LME explained, the engineering staff conducts daily room temperature check in the surgical suite but we don't do sub-acute, on and off I do take temperatures, but I don't do it on a daily basis. The LME also stated that the facility does not keep record of the room temperatures taken in sub-acute. During an interview on 7/26/2023, at 3:18 p.m., the DPO stated that the facility was supposed to have a daily [room temperature] log that is monitored every shift by engineering department. The facility was unable to provide records of room temperature monitoring for the sub-acute. A review of the facility's policy and procedure (P&P) titled, Air Conditioning (HVAC) System Failure, dated 12/2019, indicated, the Engineering Department is responsible for the operation of the HVAC System throughout the hospital. The procedure included maintaining records of inspections and services performed in the Facilities Department.