Advanced Health Care of Paradise

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure a resident received the medication as ordered for 1 of 4 sampled residents for medication pass observation (Resident 51); and a resident's follow-up appointment in one to two weeks with Neurology, per the hospital discharge instructions, was facilitated for 1 of 12 sampled residents (Resident 16). The deficient practice had the potential for the resident not to receive the maximum therapeutic effect of the medication and identify neurological issues.

Inspectors wroteBased on interview, record review, and document review, the facility failed to ensure a resident was appropriately discharged for 1 of 6 sampled residents (Resident (R) 6). This failure could potentially lead to medical complications or adverse events which could result in rehospitalization.

Inspectors wroteBased on record review and interview, the facility failed to ensure proper Medicare Notice of Medicare Non-Coverage letter was completed and provided for 1 of 3 unsampled residents selected for beneficiary notification review. The deficient practice resulted in non-compliance with Medicare requirements, that could hinder the resident's ability to make informed decisions regarding their coverage and care.

Inspectors wroteBased on observation, interview, medical record review, and document review, the facility failed to implement care plan interventions for 4 of 13 sampled residents and one unsampled resident (Resident #11), for pressure reducing device (Resident #92), intravenous midline care (Residents #17 and 21), feeding assistance (Resident #11 and 21), and constipation care (Resident #39). The deficient practice had the potential to compromise the quality of care, disrupt continuity in treatment, and may lead to negative outcomes, including deterioration in residents' overall health.

Inspectors wroteBased on observation, record review, interview, and document review, the facility failed to ensure care not provided to residents, were not documented in the medical record as completed for the application of antimicrobial wipes for 1 of 13 sampled residents (Resident #92), and for wound care and intravenous midline dressing change for 2 of 13 sample residents (Resident #17 and 21). Failure to accurately document care in the medical record had the potential to compromise patient safety by leading to gaps or errors in care, delay necessary interventions, and hinder continuity of treatment that could lead to deterioration of resident's health due to unmet care needs.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure assistance was provided for residents who were assessed or evaluated to require one-on-one (1:1) feeding assistance for 1 of 13 sampled residents (Resident 21) and one unsampled resident (Resident 11). The deficient practice placed the residents at risk for significant weight loss and malnutrition.

Inspectors wroteBased on observation, record review, interview, and document review, the facility failed to ensure prescribed antimicrobial wipes were used for the treatment of a multidrug resistant fungal infection for 1 of 13 sampled residents (Resident #92). The deficient practice had the potential to increase the risk of complications for the affected resident, compromise the overall quality of care, lead to further spread of the infection, and jeopardizing the health and safety of other residents and staff within the facility.

Inspectors wroteBased on observation, interview, medical record review, and document review, the facility failed to ensure a physician order for an air mattress was followed for 1 of 13 sampled residents (Resident #92), and wound care treatment was provided as per physician's order for 2 of 13 sampled residents (Residents #17 and 21). The deficient practice placed the residents at risk to develop new pressure ulcers and had the potential to worsen or delay healing of the existing pressure ulcer and increase patient pain and discomfort.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure the facility's bowel protocol was followed for a resident who was constipated for 1 of 13 sampled residents (Resident 139). The deficient practice placed the resident at risk for bowel complications such as fecal impaction.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure physician's orders to provide one-on-one (1:1) feeding assistance were followed for 1 of 13 sampled residents (Resident 21) and one unsampled resident (Resident 11). The deficient practice placed the residents at risk for significant weight loss and malnutrition.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure a justification for a midline (a type of peripheral intravenous catheter inserted into a large vein in the upper arm for longer therapy) was obtained and midline dressing changes were administered as ordered for 2 of 13 sampled residents (Residents 17 and 21). The deficient practice placed the residents at risk for midline complications such as occlusion and infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure infection control measures were implemented according to the plan of care for a resident with indwelling urinary catheter and intravenous midline catheter (Resident 26). The deficient practice had the potential to increase the risk of healthcare-associated infections, compromise the resident's safety, and placed other residents and staff at risk by undermining the facility's overall infection prevention protocols.

Inspectors wroteBased on observations, interviews, record reviews, and document reviews, the facility failed to ensure: 1) dialysis intercommunication or post-dialysis treatment information was obtained or maintained for 2 of 2 sampled residents (Residents 28 and 27), 2) the resident's infection status was communicated to transportation staff or to the dialysis center for 1 of 2 sampled residents (Resident 28), and 3) the resident's arteriovenous fistula (AVF) was identified, care orders, and management were obtained, transcribed, and implemented for 1 of 2 sampled residents (Resident 27). The deficient practices could have led to potential cross-contamination among staff members and other residents, increased the risk of infection, and compromised the health and safety of the residents.

Inspectors wroteBased on observations, interviews, record reviews, and document review, the facility failed to ensure a physician order was obtained for the use of a splint, care orders on how to manage the resident's splint were transcribed and implemented, and a care plan was initiated for 1 of 16 sampled residents (Resident 7). The deficient practice could have the potential to result in improper healing, increased pain, or further injury.

Inspectors wroteBased on observations, interviews, record reviews, and document review, the facility failed to ensure a physician's order for peripheral intravenous (IV) insertion and care orders were obtained, transcribed, and implemented for 1 of 16 sampled residents (Resident 138). The deficient practice could have led to potential complications such as infection, incorrect medication administration, or inadequate treatment.

Inspectors wroteBased on observations, interviews, record reviews, and document review, the facility failed to ensure the Oxygen (O2) flow rate was followed as ordered or the titration rate and frequency of the administration were clarified for 1 of 16 sampled residents (Resident 137). The deficient practice could have led to potential respiratory distress, inadequate oxygenation, or exacerbation of the resident's underlying health conditions.

Inspectors wroteBased on observations, interviews, record reviews, and document review, the facility failed to ensure the medication error rate was below five (5) percent (%) when two errors, and were identified with 32 opportunities observed, calculating an error rate of 6.25%. Failure to follow physician orders and timely administer medications posed a potential risk of injury or harm to the resident.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure resident personal information was visible and not accessible to anyone passing by in the hallway, and the medication cart was locked and not left unattended for 2 of 2 medication carts. The deficient practice placed resident confidentiality at risk and could have facilitated unauthorized access to medications in the cart.

Inspectors wroteBased on observation, interview, and document review, the facility failed to: 1) discard five expired thickened orange juice containers stored in the nourishment room [ROOM NUMBER]) ensure a [NAME] was not eating next to the food tray line 3) ensure a Dietary Aide was not touching their face and nose with gloved hands while handling food during tray line and 4) ensure 1 of 4 soap dispensers in the kitchen was refilled timely. The deficient practices could have led to contamination of kitchen surfaces and food borne illness.

Inspectors wroteBased on observations, interviews, record reviews, and document reviews, the facility failed to ensure: 1) transmission based precautions (TBP) was implemented during transportation and personal protective equipment (PPE) was donned as required before entering the TBP room for 1 of 16 sampled residents (Resident 28); and 2) hand sanitizer dispensers were refilled for resident rooms (rooms [ROOM NUMBER]). The deficient practices could have the potential to result in the spread of infection, an increased risk of cross-contamination, and compromised safety for other residents and staff members.

Inspectors wroteBased on interview the facility failed to ensure: -A written record of resident council meetings was kept documenting any responses to concerns raised by the Resident Council group, and a report of actions taken and the rationale to the Resident Council. -A written record of grievances was kept documenting any responses and the rationale for responses to grievances regarding resident issues or grievances concerning care and life in the facility. The deficient practice had the potential to adversely affect outcome of issues concerning resident care and life in the facility.