Advanced Health Care of Reno

Inspectors wroteBased on observation, clinical record review, interview, and document review, the facility failed to ensure the Baseline Care Plan for 1 of 12 sampled residents (Resident #30) included monitoring and care instructions for an indwelling drainage tube. This deficient practice had the potential to result in the resident not receiving the care and services necessary to manage the drainage device.

Inspectors wroteBased on observation, clinical record review, interview and document review, the facility failed to ensure the Comprehensive Care Plan included a care plan for the monitoring and care of an indwelling drainage tube for 1 of 12 sampled residents (Resident # 30), and for the administration and monitoring of insulin for 1 of 12 sampled residents (Resident #9). This deficient practice had the potential to result in the residents not receiving the care and services necessary to manage the affected care areas.

Inspectors wroteBased on observation, clinical record review, document review, and interview, the facility failed to ensure medications were administered in a timely manner resulting in a medication error rate of 12%. This deficient practice had the potential to result in residents not receiving medications as prescribed, potentially compromising the effectiveness of treatment, and placing residents at risk for adverse health outcomes.

Inspectors wroteBased on observation, record review, interview, and document review, the facility failed to ensure medications were stored according to the manufacturer's instructions in 1 of 2 inspected medication carts and failed to ensure medications were not left unattended on top of a medication cart. This deficient practice had the potential to result in medication contamination, diversion, or administration errors, placing residents at risk for receiving compromised or incorrect medications.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure the thermometer used to take temperatures of food in holding trays was disinfected and sanitized between uses for each food item. The deficient practice had the potential to expose residents to foodborne illnesses due to cross-contamination.

Inspectors wroteBased on interview and document review, the facility failed to ensure nursing services were provided in accordance with the facility's own assessment of resident needs and resources. This deficient practice had the potential to affect the delivery of care and services by direct care staff to the entire facility census, potentially compromising residents' health, safety and well-being.

Inspectors wroteBased on observation, interview, and document review, the facility failed to maintain the drainage pipe under a handwashing sink in the kitchen, allowing water to leak onto the kitchen floor. The deficient practice had the potential to pose a safety risk to staff working in the kitchen.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure medications were not left unattended and unsecured in the dining room during a medication pass, creating a potential accident when a licensed nurse left the medications at a resident's table and walked away, resulting in the medications out of the nurse's line of sight for supervision for 12 of 12 residents in the dining room.

Inspectors wroteBased on personnel record review, document review and interview, the facility failed to ensure a Certified Nursing Assistant (CNA) had an annual performance evaluation completed timely and identified and addressed areas of weakness for 3 of 3 sampled CNAs employed greater than one year, selected for personnel record review (Employee #21, #22, and #23).

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure a medication cart and medications left on top of a medication cart were secured for 1 of 3 medication carts.

Inspectors wroteBased on interview, observation, and document review, the facility failed to 1) ensure all residents residing in the same hall were tested for Covid-19 (Covid) during a Covid outbreak, 2) ensure all staff in contact with a confirmed Covid positive resident were tested for Covid-19, 3) ensure staff were fit-tested for the use of N95 respirators prior to donning and in accordance with the facility's Covid Emergency Plan, and 4) ensure a resident's urinary catheter bag was not laying on the ground for 1 of 12 sampled residents (Resident #350). The lack of Infection Control related to Covid had the potential to affect the 42 resident census.

Inspectors wroteBased on interview, observation, and document review, the facility failed to ensure a resident maintained a dignified existence when a resident's catheter bag was visible with urine while the resident was in the dining room and communal area of facility for 1 of 12 sampled residents (Resident #147).

Inspectors wroteBased on interview, clinical record review, and document review the facility failed to modify interventions to prevent future injuries from falls for 1 of 12 sampled residents (Resident #350).

Inspectors wroteBased on observation, interview, clinical record review, and document review the facility failed to ensure a resident's indwelling urinary catheter bag was kept off the floor while the resident was seated in a recliner for 1 of 12 sampled residents (Resident #350).

Inspectors wroteBased on interview, clinical record review and document review the facility failed to administer oxygen therapy per a physician's order and include dosage parameters on the physician's order for 1 of 12 sampled residents (Resident #347).

Inspectors wroteBased on observation, interview, clinical record review and document review, the facility failed to ensure medication was administered with an error rate of less than five percent (%). There were 26 opportunities and five medication errors. The medication error rate was 19.23%.

Inspectors wroteBased on observation, interview and document review, the facility failed to remove expired laboratory's supplies from the medication storage rooms and ensure expired medications were removed from 2 of 3 sampled medication carts.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure clean dishes were handled in a sanitary manner after exiting the dishwasher.