Advena Living at Fountainview

Inspectors wroteThe facility reported a census of 47 residents. Based on observation, interview, and record review, the facility failed to conduct annual performance reviews for five of five direct care staff reviewed, to ensure the residents received adequate cares.

Inspectors wroteThe facility identified a census of 47 residents. The facility identified residents on Enhanced Barrier Precautions (EBP-infection control interventions designed to reduce transmission of resistant organisms that employ targeted gown and glove use during high contact care). Based on record review, observations, and interviews, the facility failed to ensure the gait belts were sanitized after each resident's use and further failed to ensure staff followed the protocols when a nurse provided a tube feeding for a resident. These deficient practices placed the residents at risk for infectious diseases.

Inspectors wroteThe facility reported a census of 47 residents with 14 residents sampled. Based on observations, interviews, and record review, the facility failed to ensure that one Resident (R) 6 had a current and valid Preadmission Screening and Annual Resident Review (PASARR).

Inspectors wroteThe facility had a census of 47 residents and the sample included 14 residents. Based on observation, record review, and interview, the facility failed to ensure a safe environment free from accident hazards for Resident (R) 25 who had a medication located in her room that was not secured. This failure placed the affected residents at risk for preventable accidents and related injuries.

Inspectors wroteThe facility reported a census of 47 residents, which included one resident sampled for respiratory care. Based on observation, interview, and record review, the facility failed to provide appropriate respiratory care in maintaining respiratory equipment to prevent the spread of infection, for one Resident (R) 35. The facility failed to ensure safe storage of oxygen nasal cannula and oxygen tubing when not in use to prevent cross contamination and the spread of infection.

Inspectors wroteThe facility identified a census of 47 residents. The sample included 13 residents. Based on observation, record review, and interviews, the facility failed to provide adequate pharmaceutical services to ensure Resident (R) 25 had their prescribed medications available in a timely manner for administration. This deficient practice placed both R25 and R38 at risk of delayed treatment, which could have adverse consequences.

Inspectors wroteThe facility reported a census of 44 residents with seven residents selected for review, including two residents reviewed for allegations of abuse. Based on observation, interview, and record review, the facility failed to ensure staff provided a safe environment, free from abuse for Resident (R)1 and R7. During cares on 10/26/23, Certified Nurse Aide (CNA) M grabbed R1 by the arm, which resulted in an injury to R1's left arm near her wrist, which required steri-strips (thin adhesive bandage used to close wounds or cuts) for wound closure. During cares for R7, CNA M was verbally rude and physically forced a shirt on him, which he voiced he did not want to wear.

Inspectors wroteThe facility reported a census of 44 residents with seven residents selected for review including two residents reviewed for allegations of abuse. Based on interview and record review, the facility failed to report allegations of abuse to the State Survey Agency when an allegation was made by Resident (R)1 and R7 against Certified Nurse Aide (CNA) M on 10/26/23. R1 reported CNA M tried to get her out of bed forcefully, grabbed her by the arm and hurt her and R7 reported CNA M forced a long sleeve shirt on him when he wanted a short sleeve shirt on and CNA M treated R7 with verbal abuse by being rude.

Inspectors wroteThe facility had a census of 42 residents. Based on observation, interview, and record review the facility failed to employ a full time certified dietary manager for the 42 residents who resided in the facility and received meals from the facility kitchen. This deficient practice placed the 42 residents at risk for receiving inadequate nutrition.

Inspectors wroteThe facility had a census of 42 residents. Based on observation, interview, and record review the facility failed to ensure foods remained at a safe, hot, holding temperature during the meal service. This deficient practice placed the 42 residents who received meals from the facility at risk for food borne illness.

Inspectors wroteThe facility had a census of 42 residents. Based on observation, interview, and record review the facility failed to store, prepare, and serve food to the residents of the facility in a safe, sanitary manner. This deficient practice placed the 42 residents of the facility who received their meals form the kitchen at risk for food borne illnesses.

Inspectors wroteThe facility had a census of 42 residents. Based on record review and interview, the facility failed to ensure the staff person designated as the Infection Preventionist, who was responsible for the facility's Infection Prevention and Control Program, completed the specialized training in infection prevention and control. This placed the residents at risk for lack of identification and treatment of infections.

Inspectors wroteThe facility had a census of 42 residents. Based on observation, interview, and record review the facility failed to ensure drugs were in locked storage when unattended by licensed staff. This deficient practice placed residents at risk for missing or tampered with medications.

Inspectors wroteThe facility had a census of 42 residents. The sample included 12 residents of which five were reviewed for immunization status. Based on record review and interview, the facility failed to offer and provide and/or obtain informed refusals for influenza and pneumococcal vaccinations and failed to offer and provide the residents and/or their representative the current years Vaccine Information Statement (VIS-information sheets produced by the CDC [Centers for Disease Control and Prevention] that explained both the benefits and risk of vaccine to vaccine recipients for Resident (R)5, R10, R17, R29 and R35. This placed the affected residents at increased risk for illness and infection.

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with five reviewed for activities of daily living (ADL). Based on observation, interview, and record review, the facility failed to provide dignity during dining for Resident (R) 28 who was brought to the dining room disheveled and then left unassisted while he dropped food all down the front of his shirt. This placed R28 at risk for impaired dignity and decreased psychosocial wellbeing.

Inspectors wroteThe facility had a census of 42 residents. The sample included 12 residents. Based on record review and interview, the facility failed to provide three sampled residents, Resident (R)13, R16 and R146 (or their representative) the completed Skilled Nursing Facility Advanced Beneficiary Notices (ABN) form 10055, (CMS) Centers for Medicare and Medicare Services which placed them at risk to make uninformed decisions about their skilled care

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with one reviewed for hospitalization. Based on observation, interviews, and record review, the facility failed to provide Resident (R) 19 with a bed hold notice upon discharge to the hospital. This placed the resident at risk for impaired rights to return to the facility and in the same room as previously resided.

Inspectors wroteThe facility had a census of 42 residents. The sample included 13 residents with two reviewed for urinary catheter (a flexible tube used to empty the bladder and collect urine in a drainage bag) use. Based on observation, interview, and record review the facility failed to develop a baseline care plan in a timely manner for Resident 93's urinary catheter and R194's activities of daily living (ADL) , hospice and end of life cares. This deficient practice placed at risk for unmet and uncommunicated care needs.

Inspectors wroteThe facility had a census of 42 residents. The sample included 12 residents, with two reviewed for indwelling urinary catheters (tube inserted directly into the bladder to drain urine). Based on observations, interview and record review, the facility failed to develop a care plan for Resident (R) 15's indwelling catheter as well as need for assistance with activities of daily living. This placed R15 at risk for uncommunicated and unmet care needs.

Inspectors wroteThe facility had a census of 42 residents. The sample included 12 residents, with five reviewed for unnecessary medications. Based on observations, interview and record review, the facility failed to revise the care plan to include Resident (R)38 and R32's antipsychotic (a medication used to treat any major mental disorder characterized by a gross impairment in reality testing medication which included targeted behavior and side effects) medication, and failed to revise R19s care plan with her change in mobility status. This placed the affected residents at risk for inadequate care or uncommunicated care needs.

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with one reviewed for discharge. Based on interviews, and record review, the facility failed to establish a discharge plan with goals for Resident (R) 42. This placed R42 at risk for uncommunicated care needs and inappropriate discharge. Findings Included: - R42's Electronic Medical Record (EMR) recorded diagnoses of diabetes mellitus (when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), anxiety (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear), right femur (thigh bone) fracture, and depression (mood disorder characterized by feelings of persistent sadness). [...]

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with one reviewed for discharge. Based on interviews, and record review, the facility failed to complete a recapitulation of Resident (R) 42 stay at the facility. This placed R42 at risk for uncommunicated care needs and missed health care opportunities. Findings Included: - R42's Electronic Medical Record (EMR) recorded diagnoses of diabetes mellitus (when the body cannot use glucose, not enough insulin made or the body cannot respond to the insulin), anxiety (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear), and depression (mood disorder characterized by feelings of persistent sadness). R42's admission Minimum Data Set (MDS) dated [DATE] recorded R42had a Brief Interview for mental Status (BIMS) score of 15 which indicated he was cognitively intact. [...]

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with five reviewed for activities od daily living (ADL). Based on observation interview, and record review the facility failed to provide Resident (R) 28 with the requires personal hygiene and dressing assistance he required. The facility further failed to provide consistent bathing per resident preferences for R28, R35, and R38. This placed the affected residents at risk for impaired dignity increased risk for skin issues and other complications.

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with five reviewed for activities of daily living (ADL). Based on observation, interviews, and record review, the facility failed to ensure appropriate wheelchair positioning for Resident (R) 19 whose feet dangled in an unsupported, dependent position while she sat in her wheelchair. This placed R19 at increased risk for medical complications and/or injuries.

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with seven reviewed for accidents and/or falls. Based on observation, record review, and interviews the facility failed to ensure interventions identified to prevent falls were implemented for Resident (R)35 and failed to identify and implement interventions to prevent further falls for R36. This placed the residents at risk for further falls and fall related injuries.

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with five reviewed for unnecessary medication. Based on observation, interviews, and record review, the facility failed to act upon the recommendations of the Consultant Pharmacist (CP) to monitor and report abnormal findings when Resident (R) 19's blood glucose levels were outside acceptable parameters and failure to administer R19's as needed (PRN) insulin (medication used to lower blood glucose levels) for elevated blood glucose levels. This placed the affected residents at risk for medical complications related to the medication regimen.

Inspectors wroteThe facility identified a census of 42 residents. The sample included 13 residents with five reviewed for unnecessary medication. Based on observation, interviews, and record review, the facility failed to monitor and report abnormal findings when Residnet (R) 19's blood glucose levels were outside ordered parameters and further failed to administer R19's as needed (PRN) insulin (medication used to lower blood glucose levels) for elevated blood glucose levels. The facility further failed to monitor bowel movements for R35 and R36. This placed the affected residents at risk for medical complications related to the medication regimen.

Inspectors wroteThe facility had a census of 42 residents. The sample included 12 residents, with five reviewed for unnecessary medications. Based on observations, interview and record review, the facility failed to ensure an appropriate indication for Resident (R)38's, and R32's antipsychotic (a medication used to treat any major mental disorder characterized by a gross impairment in reality testing)medication, failed to ensure a 14- day stop date for R17's received as needed (PRN) psychotropic (an antianxiety medication that calm and relax people with excessive restlessness) that lacked a 14 day stop date or rationale for use. This placed the affected residents at risk for unintended affects related to psychotropic drug medications.

Inspectors wroteThe facility identified a census of 42 residents. The sample included 12 residents with two reviewed for hospice. Based on observation, interviews, and record review, the facility failed to ensure collaboration with the hospice provider to establish a plan for Resident (R)194's care and included shared information regarding R194's care needs, medication and equipment provided by hospice as well as the frequency of nursing visits and nursing care provided by hospice. This placed R194 at risk for uncommunciated or unmet care needs related to end of life cares.

Inspectors wroteThe facility reported a census of 41 residents. The sample contained 14 residents, with five residents reviewed for COVID-19 vaccinations. Based on interview and record review, the facility failed to follow instruction by the legal representative, for refusal of the COVID 19 vaccination for one Resident (R) 5 of the five sampled residents. The facility administered R5 the COVID-19 vaccine and then failed to timely notify the resident's legal representative of the failure to follow the instructions provided.

Inspectors wroteThe facility reported a census of 41 residents. The sample contained 14 residents. Based on observation, interview, and record review, the facility failed to review and revise the plan of cares for two of the sampled residents. This included, Resident (R)1 with failure to include appropriate interventions following falls to prevent further falls and for R1 and R2 who used wheelchairs without foot pedals, propelled by staff, and with their feet touching the floor.

Inspectors wroteThe facility reported a census of 41, the 14 sampled residents included two sampled for discharge. Based on interview and record review, the facility failed to develop a discharge summary that included a recapitulation of the residents stay, a final summary of the residents' status at the time of discharge, for one of the two residents, Resident (R) 39.

Inspectors wroteThe facility reported a census of 41, the sample of 14 included six residents for review regarding Activities of Daily Living (ADL). Based on observation, interview, and record review, the facility failed to provide the necessary services to maintain adequate personal hygiene, related to bathing, for one of the six residents, Resident (R)8.

Inspectors wroteThe facility reported a census of 41 residents. The sample contained 14 residents, with three residents reviewed for accidents. Based on observation, interview, and record review, the facility failed to ensure safety for two of the three sampled residents including, failure to implement planned interventions to prevent further falls for Resident (R)1, and failure to use wheelchair foot pedals when propelling chairs for two cognitively impaired residents, R1 and R5, placing them at risk for falls/accidents.

Inspectors wroteThe facility reported a census of 41 residents, with 14 sampled for review which included five residents reviewed for unnecessary medication monitoring. Based on interview and record review, the facility failed to adequately monitor one of the five residents reviewed, Resident (R)30's orders for notification to the physician when the resident's blood sugar was out of the ordered parameters.