Admiral at the Lake, the

Inspectors wroteBased on observation, interview and record review the facility failed to label and date opened food stored in the refrigerator and freezer, failed to discard expired food, failed to use hair nets while working in the kitchen. Failed to store food off the floor. This failure has the potential to affect all residents that receive oral diets.

Inspectors wroteBased on observation, interview and record review the facility failed to perform hand hygiene between passing dining trays, failed to clean multi use equipment after use for two residents (R2 and R11), failed to perform hand hygiene after caring for one resident (R6), failed to wear PPE (Personal Protective Equipment) while caring for one resident (R17) on EBP (Enhanced Barrier Precautions), failed to perform hand hygiene during resident ADL (activities of daily living) care for one resident (R20), failed to store clean and soiled linen in a way to prevent the spread of infection. This failure affected five residents (R2, R6, R11, R17, R20) and has the potential to affect all residents that reside in the facility.

Inspectors wroteBased on observations, interviews and record review, facility failed to follow their policy and failed to properly label and marked open medications with opened date and failed to remove expired insulin from the medication cart. These failures affected five residents (R2, R9, R19, R28 and R30) residing on the 8th floor of the facility and have the potential to affect all 14 residents residing on the 8th floor unit of the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to identify, document, and report a new skin alteration (bruise) which affected one resident (R20) reviewed for skin conditions in the total sample of 30 residents.

Inspectors wroteBased on observations, interviews and record review, facility failed to implement their policy and failed to ensure that oxygen equipment was properly contained when not in use for two residents (R8 and R24); Failed to properly label and date one resident's (R13) oxygen equipment and failed to discard/replace unused expired oxygen tubing for one resident (R8). These failures affected three residents reviewed for respiratory care in the final sample of 30 residents.

Inspectors wroteBased on observations, interviews and record review, facility failed to follow their policy and federal regulations and failed to ensure the Daily Nurse Staffing Posting information forms were posted daily in a prominent place readily accessible to residents, staff and visitors. These failures have the potential to affect all 30 residents residing in the facility.

Inspectors wroteBased on interview, and record review facility failed to perform accurate fall risk assessment for a resident with a known fall history, develop and implement post fall interventions to prevent future falls and failed to monitor, document, and send resident to hospital in a timely manner post fall incident for one resident (R2) out of four residents reviewed for accident and supervision. This failure led to R2 falling in the facility sustaining multiple acute fractures. Findings Include: R2's Minimum Data Set (MDS) dated [DATE] shows he is cognitively impaired. [...]

Inspectors wroteBased on interviews, and record reviews, the facility failed to review and revise the comprehensive resident-centered care plan for one resident (R2) out of four residents reviewed for care plan revision. Findings Include: R2's Minimum Data Set (MDS) dated [DATE] shows he is cognitively impaired. R2's electronic medical record (EMR) revealed R2 was initially admitted to the facility on [DATE] and was [AGE] years old with diagnoses of, but not limited to unspecified fall, subsequent encounter, malignant neoplasm of bladder, heart failure, unspecified atrial fibrillation, hypertension, unsteadiness on feet, muscle weakness generalized, chronic kidney disease, diverticulitis of intestine with perforation and abscess with bleeding. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to follow their policies and implement safe food preparation and services to ensure the food conserves a safe temperature. This failure has the potential to affect all residents that receive nutrition from the kitchen.

Inspectors wroteBased on observation, interview, and record review the facility failed to store and label food items in accordance with professional standards for food service safety and follow proper sanitation and food handling. This failure has the potential to affect all residents that receive nutrition from the kitchen.

Inspectors wroteBased on observation, interview, and record review the facility failed to observe proper PPE (Personal Protective Equipment) protocols. This failure has the potential to affect all residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a safe, hazard free environment for 15 residents residing on the eighth floor of the 29 residing in the facility.

Inspectors wroteBased on interview and record review the facility failed to have a person-centered care plan that is consistent with the resident's current condition, goals, and services for one (R3) resident reviewed in a total sample of 12 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their restorative care policy and provide restorative therapy for one (R18) in a total sample size of 12 resident.

Inspectors wroteBased on observation, interview, and record review the facility failed to accurately secure controlled substance medications for two residents (R7 and R14) in a sample of 12 reviewed for medication/controlled substance storage.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to a.) ensure kitchen staff wore beard covering in the kitchen during meal preparation, b.) food items were properly labeled, dated, and stored, c.) discard expired foods. These failures have the potential to affect all 31 residents receiving food prepared in the facility's kitchen.

Inspectors wroteOn 2/06/24 at 12:40 PM, V6 (Certified Nursing Assistant) was assisting R20 for lunch in the 9th floor dining room. R20 received pureed soup, pureed meat, pureed cauliflower, mashed potato, and thickened water. R20 did not receive the pureed macaroni salad and pureed cookie that were listed on the menu. On 2/07/24 at 12:16 PM, V39 (Certified Nursing Assistant) was assisting R20 for lunch in the 9th floor dining room. R20 received pureed soup, pureed biscuit, pureed chicken, pureed green beans, and thickened water. At 12:41 PM, R20 finished eating lunch, and did not get any dessert. R20's clinical records show R20 has a diagnosis of Dementia. R20's Minimum Data Set (MDS) dated [DATE] shows R20 has severely impaired cognitive skills for decision making and has short- and long-term memory problems. R20's physician orders show R20's diet order of pureed diet with honey thickened fluids. [...]

Inspectors wroteBased on interview and record reviews, the facility failed to establish an antibiotic stewardship program that includes a protocol and a system to monitor antibiotic use and failed to use an infection assessment tool to determine if the antibiotic is indicated or needs to be adjusted for four (R15, R23, R25, R27) of four residents reviewed for antibiotic use in a sample of 14.

Inspectors wroteBased on interview and record review, the facility failed to provide eligible residents and/or resident representatives education regarding the benefits and potential side effects of all available pneumococcal vaccinations for 5 residents (R10, R23, R25, R27 and R28), Failed to assess eligibility and offer pneumococcal vaccinations to 4 (R10, R25, R27 and R28) residents and Failed to administer Pneumococcal vaccine for one (R23) resident eligible to receive the vaccine. These failures affect 5 (R10, R23, R25, R27 and R28) of eight residents reviewed for immunization.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the residents were treated with respect and dignity by not passing out meals to residents sitting together at the same time for one (R1) resident and standing over a resident while feeding them affecting one (R2) resident on the total sample of 12 residents reviewed for dining services.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow wound doctor's recommendations for a resident with an acquired pressure ulcer for 1 (R184) resident. The facility also failed to ensure that appropriate linen is used on an air loss mattress for one (R29) resident who is at risk in developing pressure ulcer. These failures affect two (R29 and R184) residents reviewed for pressure ulcer in a sample of 14.

Inspectors wroteOn 02/06/24 at 12:30 PM, surveyor observed R14 up in chair, Oxygen tubing and Nebulizer treatment mask were not in a plastic bag when not in use. On 02/07/24 at 12:34 PM, surveyor and V27 (Licensed Practical Nurse) entered R14's room, V27 and surveyor observed R14's Oxygen Nasal Cannula not in a plastic bag and Nebulizer treatment Mask not in a plastic bag. V27 stated having the nebulizer mask and oxygen nasal cannula out makes R14 at risk for breathing in germs like bacteria. The oxygen nasal cannula and mask should have been contained in a plastic bag when not in use. On 2/8/24 at 9:30 AM, V2 (Director of Nursing) stated, it is V2's expectation that nurses will keep oxygen nasal cannula tubing and nebulizer treatment mask in a plastic bag when not in use to maintain good hygiene and prevent infection. R14 Minimum Data Set, dated [DATE] shows R14 is cognitively intact. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to follow their policy and procedure to ensure medications were stored safely and securely for one (R4) resident out of 14 residents reviewed for medication storage in a final sample or 14. Findings Include: On 2/06/24 at 11:19 AM, R4 was sitting on R4's wheelchair in R4's room with V35 (R4's Caregiver) at bedside. Surveyor noted a nebulizer machine and two ampules of Ipratropium-Albuterol solutions on top of R4's nightstand. R4 stated that R4 has not received R4's nebulizer treatment yet. V35 stated that R4 just came back from the hospital for Pneumonia. R4 stated that the nebulizer treatment helps R4 breaths better. At 11:40 AM, V5 (Registered Nurse) stated that there is no resident in the unit that is self-administered with medications. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to prepare and serve mechanical soft food at the appropriate texture. This failure affected 1 (R184) of 4 residents reviewed for mechanical soft diet prepared in the facility's kitchen, in a total sample of 31 residents. Findings Include: R184's diagnoses includes but not limited to Dysphagia Oral Phase, Dysphagia Oropharyngeal Phase, Alzheimer's Disease, Unspecified Dementia. R184's Physician Orders for 02/07/24 document diet order is mechanical soft with nectar thick liquids ordered 01/21/23. R184's MDS (Minimum Data Set) from 12/24/23 BIMS (Brief Interview for Mental Status) was 03 out of 15 indicating severely impaired cognition. R184's nutrition care plan documents in part, R184 is at nutrition risk related to altered texture diet for dysphagia. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to follow facility policy for personal refrigerators by not keeping a temperature log to ensure refrigerator is at proper temperature, labeling items with a date, monitoring food for quality for potential concerns and disposal of items from resident's personal refrigerators for two (R8, R17) residents reviewed in the sample of 4 for safe personal food storage.