Advanced Health Care of Coeur D'alene

Inspectors wroteBased on observation, interview, and policy review, the facility failed to ensure shelves, trash cans, and equipment throughout the kitchen were kept clean and/or in good repair and foods were stored, labeled and dated. The failures had the potential to increase the prevalence and spread of foodborne illness and infection for all 29 of 29 residents who received meals prepared in the facility's only kitchen.

Inspectors wroteBased on interview, record review and policy review, the facility failed to revise one resident's (Resident (R) 46) comprehensive care plan reviewed in the sample of 20 residents to reflect the discontinued TED hose compression stockings and the initiated application of Tubi-Grip support bandage. This failure had the potential to result in inconsistent care and failure to provide staff with accurate guidance regarding the residents' compression treatment needs.

Inspectors wroteBased on interviews, record review, and policy review, the facility failed to ensure safe transportation for one of three residents (Resident (R)25) reviewed for accidents. Specifically, when R25 was transported to an outside appointment in the facility, van the resident slid off her wheelchair onto the van floor during transport, resulting in a laceration/abrasion injury. This failure had the potential to place residents at risk for injury during transportation.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure kitchen equipment was maintained, cleaned, and sanitized. These deficiencies had the potential to affect the 43 residents who consumed food prepared by the facility. This placed residents at risk for potential foodborne illnesses and adverse health outcomes due to contaminated food services equipment.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to ensure a bed hold notice was provided to residents and/or their representatives upon transfer to the hospital. This was true for 1 of 7 residents (Resident #21) reviewed for transfers. This deficient practice created the potential for harm if residents were not informed of their right to return to their former bed/room at the facility within a specified time.

Inspectors wroteBased on policy review, record review, observation, and staff interview, it was determined the facility failed to ensure the baseline care plan included resident's use of oxygen. This was true for 1 of 6 residents (Resident #90) whose baseline care plan were reviewed. This deficient practice created the potential for harm if residents' respiratory needs were not met.

Inspectors wroteBased on record review, review of facility's policy and procedure, review of Incidents and Accidents (I&As) reports, and staff interview, it was determined the facility failed to ensure residents were free from significant medication errors. This was true for 2 of 2 residents (#20 and #141) reviewed for medication errors.

Inspectors wroteBased on facility document review and staff interview, it was determined the facility failed to ensure the activities program was directed by a qualified professional. This failure had the potential to compromise the mental and psychosocial well-being of all 25 residents residing in the facility, including Resident #103, if the activities program was not designed to accommodate specific needs and interests.

Inspectors wroteBased on observation, review of facility documentation, and staff interview, it was determined the facility violated resident rights when they were placed on quarantine unnecessarily. This was true for 14 of 25 residents (#7, #11, #25, #28, #29, #30, #32, #33, #37, #39, #40, #41, #220, and #225) residing in the facility. This had the potential to cause psychosocial distress such as depression, anxiety, and adverse behaviors from being isolated to their rooms for residents who did not require quarantine.

Inspectors wroteBased on record review, policy review, review of facility Incident & Accident (I&A) reports, and staff interview, it was determined the facility failed to ensure their Fall Risk Assessment included all elements to accurately reflect residents' risk for falling. This was true for all 25 residents who currently resided in the facility. This failure increased the potential for harm should a resident receive inappropriate care related to discrepancies in the Fall Risk Assessment.

Inspectors wroteBased on review of facility grievances, review of call light logs, resident and staff interview, it was determined the facility failed to ensure a sufficient number of competent staff to answer call lights in a timely manner. This was true for 5 of 12 residents (#7, #25, #32, 48, and #300) reviewed for staffing concerns and had the potential to affect the other 13 residents in the facility. This deficient practice created the potential for physical and psychosocial harm if residents did not receive appropriate care or received a delay in care.

Inspectors wroteBased on observation, review of facility COVID-19 and infection control documents, and staff interview, it was determined the facility failed to ensure a) staff appropriately donned/doffed (put on/took off) PPE and wore the appropriate PPE b) medical supplies were not reused c) appropriate N95 fit testing for all staff that entered patient care areas and d) documentation of housekeeping daily cleaning logs was maintained for 14 of 25 residents (#16, #25, #28, #29, #31, #32, #37, #39, #41, #44, #105, #107, #120, and #149) who were observed. This deficient practice created the potential for spreading infectious organisms, including, but not limited to COVID-19, from cross contamination. [...]

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to develop and implement a baseline care plan for 1 of 12 residents (Resident #100) whose records were reviewed. This failure placed residents at increased risk of injury and/or medical complications due to the lack of interventions and information in their baseline care plans.

Inspectors wroteBased on observation, resident interview, resident representative interview, and staff interview, it was determined the facility failed to ensure residents received services and meaningful activities to maintain their highest practicable physical, mental and psychosocial well-being. This was true for 1 of 12 residents (Resident #103) who were reviewed. This failure had the potential to result in psychosocial distress if they lost their ability to communicate, cope with stressors, and the potential for residents to experience depression and sadness.

Inspectors wroteBased on resident and staff interview, and record review, it was determined the facility failed to ensure physician orders were followed for blood glucose monitoring for 3 of 5 residents (#7, #39, and #99) who were diabetic and prescribed insulin. These failed practices had the potential to adversely affect residents if higher blood glucose readings that could potentially lead to an increased insulin administration whose services were not delivered according to accepted standards of clinical practices.

Inspectors wroteBased on staff interview and review of annual competency evaluations, it was determined the facility failed to ensure each CNA's performance was evaluated at least once every 12 months and annual evaluations were performed. This was true for 1 of 3 CNAs (CNA #5) whose personnel records were reviewed. This failure created the potential for CNAs providing care who were not competent.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to implement an appropriate treatment and services plan for 1 of 1 resident (Resident #48) who left against medical advice (AMA) and whose record was reviewed. This failure placed residents at increased risk of injury and/or medical complications due to the lack of mental health interventions.

Inspectors wroteBased on policy review, Medication Error Reports review, and staff interview, it was determined the facility failed to ensure the medication error review process was followed to ensure residents were free of medication errors. This was true for 2 of 5 medication error incidents reviewed from June 2021 to August 2021 (Medication Error Reports dated on 7/1/21 and 7/2/21). This failure placed residents at risk for adverse effects due to incorrect medication being administered and/or incorrect doses.