Adviniacare Pawtucket Pleasant Rehab Center, LLC

Inspectors wroteBased on clinical record review and staff interviews the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for 1 of 1 resident reviewed with a physician's order for fluid restrictions, Resident ID #1.

Inspectors wroteBased on surveyor observation, record review, and staff and resident interviews, it has been determined that the facility failed to provide treatment and care in accordance with professional standards of practice for 2 of 3 residents reviewed relative to skin conditions, Resident ID #s 111 and 3.

Inspectors wroteBased on record review, staff and resident interview, it has been determined that the facility failed to provide specialized rehabilitation services such as physical therapy and occupational therapy, that are required per the resident's comprehensive plan of care for 2 of 2 residents reviewed with a decline in activities of daily living (ADL) functional abilities, Resident ID #s 8 and 42.

Inspectors wroteBased on surveyor observation, and staff and resident interviews, it has been determined that the facility failed to have sufficient nursing staff with the appropriate competencies and skill sets to help prevent the transmission of communicable diseases and infections for 3 of 4 nursing staff, Staff IDs K, L, and M, interviewed regarding contact precautions (infection control measures which require specific personal protective equipment (PPE)); Resident ID #2 requires the use of infection control measures of donning a gown and gloves when entering the resident's room.

Inspectors wroteBased on surveyor observation, record review, and resident and staff interviews, it has been determined that the facility failed to ensure that a resident received adequate supervision for 1 of 1 resident reviewed who was assessed to be at risk for elopement and failed to ensure that a resident is provided assistive devices to prevent accidents relative to smoking for 1 of 1 resident reviewed, Resident ID #31.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to maintain an infection prevention and control program to help prevent the transmission of communicable diseases and infections, relative to staff wearing the appropriate personal protective equipment (PPE) for 1 of 1 resident reviewed with an order for contact precautions (infection control measures which require donning a gown and gloves upon entering the resident's room) for Extended-spectrum beta-lactamase producing bacteria (ESBL- an antibiotic resistant bacteria), Resident ID #2.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure that services being provided meet professional standards of practice for 1 of 3 residents reviewed for wound treatment orders, Resident ID #2.

Inspectors wroteBased on surveyor observation, record review and staff interview, it has been determined that the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, relative to 3 of 3 units observed for the condition of resident bathrooms and shower rooms.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents are free of any significant medication errors for 1 of 1 resident reviewed for antibiotic use, Resident ID #1.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to provide appropriate treatment and services for 2 of 2 residents reviewed for an indwelling catheter (foley; a flexible tube that drains urine from the bladder), Resident ID #s 1 and 2.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that the assessment accurately reflected the resident's status for 4 of 4 residents reviewed for tobacco use, Resident ID #s 26, 40, 44, and 86 and 1 of 3 residents reviewed for limited range of motion, Resident ID #16.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to maintain an infection prevention and control program to help prevent the transmission of communicable diseases and infections for 2 of 2 residents reviewed relative to Multi-drug Resistant Organisms (MDRO), Resident ID #s 17 and 86, 1 of 1 resident reviewed for enhanced barrier precautions Resident ID #38, 2 of 2 residents reviewed for humidified oxygen storage, Resident ID #s 45 and 58, and 1 of 2 residents reviewed for Bilevel positive airway pressure (BiPAP; a treatment that uses mild air pressure to keep your airways open while you sleep) cleaning schedule, Resident ID #11.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to provide treatment and care in accordance with professional standards of practice for 1 of 1 resident reviewed for assistance with meals, Resident ID #42.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to provide appropriate treatment and services for 1 of 1 resident reviewed with an indwelling foley catheter (a flexible tube that collects urine from the bladder and empties the urine into a drainage bag), Resident ID #11.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure residents that are fed through a feeding tube receive the appropriate treatment and services to prevent complications for 1 of 1 resident reviewed receiving nutrition and medications via a gastrostomy tube (g-tube; (a tube that provides direct access to the stomach for supplemental feeding, hydration or medication), Resident ID #38.

Inspectors wroteEach resident must receive and the facility must provide the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Behavioral health encompasses a resident's whole emotional and mental well-being, which includes, but is not limited to, the prevention and treatment of mental and substance use disorders Based on record review and staff interview it has been determined that the facility failed to provide the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the plan of care. [...]

Inspectors wroteBased on surveyor observation, record review, and staff interview it has been determined that the facility failed to ensure each resident's medication regimen is free from a medication error rate of 5% or greater. Based on 30 opportunities for errors observed during the medication administration task, there were 5 errors resulting in an error rate of 16.67% relative to enteral medication administration via gastrostomy tube (g-tube; (a tube that provides direct access to the stomach for supplemental feeding, hydration or medication).

Inspectors wroteBased on surveyor observation, record review, resident and staff interview, it has been determined that the facility failed to accommodate residents' food preferences for 1 of 1 resident reviewed, Resident ID #42.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that services being provided meet professional standards of practice related to notifying the physician of a change in condition and implementing hospice recommendations without physician approval for 1 of 1 hospice residents reviewed, Resident ID #1.

Inspectors wroteBased on record review, surveyor observation and staff interview, it has been determined that the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, relative to 4 of 5 units observed for the condition of floors, ceilings, and walls.

Inspectors wroteBased on surveyor observation, record review and staff interview, it has been determined that the facility failed to maintain a safe, clean, comfortable, and homelike environment relative to resident air conditioners for 11 of 19 air conditioners observed on 3 of 3 floors.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to assure residents who have authorized the facility in writing to manage any personal funds have ready and reasonable access to those funds, relative to petty cash.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to address pharmacy recommendations in a timely manner for 3 of 6 months reviewed, January, February, and April of 2023.

Inspectors wroteBased on surveyor observation and staff interview it has been determined the facility failed to provide food that is prepared by methods that conserve nutritive value, flavor and appearance for 7 residents on puree textured diets as evidenced by observations of a cook not following a standardized recipe for the preparation of pureed turkey for 7 residents, Resident ID#'s 11, 24, 61,73, 75, 92 and 106.

Inspectors wroteBased on surveyor observations and staff interview, it has been determined that the facility failed to comply with the appropriate requirements of the Rhode Island Food Code.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to implement and maintain an effective, comprehensive, data-driven, Quality Assurance and Performance Improvement (QAPI) program that focuses on indicators of the outcomes of care and quality of life. Additionally, the facility failed to make a good faith attempt to correct the identified concern of pharmacy recommendations not being addressed.

Inspectors wroteBased on record review, surveyor observation, resident and staff interview, it has been determined that the facility failed to ensure the services provided meet professional standards of quality for 2 of 2 residents reviewed for offloading heels, Resident ID #s 6 and 174; 1 of 1 resident reviewed for chemotherapy treatments and precautions, Resident ID #45; 1 of 6 residents reviewed for blood glucose monitoring, Resident ID #46; 1 of 1 resident reviewed for receiving expired insulin, Resident ID #48; 1 of 4 residents reviewed for contact precautions for Clostridium Difficile (C-Diff - an infectious bacterium causing diarrhea and inflammation of the colon), Resident ID #111; and 1 of 6 residents reviewed for a completed Abnormal Involuntary Movement Scale (AIMS) assessment, Resident ID #374; 1 of 3 residents reviewed for dialysis and medication administration, Resident ID #52.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents who require dialysis receive such services consistent with professional standards of practice for 2 of 3 residents reviewed for dialysis, Resident ID #s 90 and 35.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed, upon a resident's death, to convey within 30 days the resident's funds and a final accounting of those funds to the individual or probate jurisdiction administering the resident's estate, in accordance with state law for 2 of 5 residents reviewed for personal needs funds handled by the facility, Resident ID #s 425 and 426.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan, for 1 of 1 residents reviewed with a surgical wound infection, Resident ID #109.

Inspectors wroteBased on surveyor observation, record review, and staff interview it has been determined that the facility failed to meet professional standards of practice for care related to a peripherally inserted central catheter (PICC) for 1 of 2 residents reviewed for PICCs, Resident ID #109.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure residents who use psychotropic drugs receive gradual dose reductions (GDR) unless clinically contraindicated for 1 of 6 residents reviewed for antipsychotic medications, Resident ID #92.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to maintain medical records that are accurately documented in accordance with professional standards and practices for 2 of 2 residents reviewed for inaccurate documentation relative to medication administration, Resident ID #s 45 and 109.

Inspectors wroteBased on surveyor observation, record review, resident and staff interview, it has been determined that the facility failed to post the results of the most recent survey conducted by federal or state surveyors and failed to protect identifying information for 8 residents listed in the facility survey results binder.

Inspectors wroteBased on record review and staff interview it has been determined the facility failed to provide written information to the resident or resident representative that specifies the facility's bed-hold and reserve bed payment policy before and upon transfer to a hospital or when taking a therapeutic leave of absence from the facility for 7 of 7 residents transferred to the hospital, Resident ID #s 16, 35, 75, 78, 89, 106, and 123.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to properly provide notice to residents and/or representatives informing where changes in coverage are made to items and services covered by Medicare and/or the medical state plan related to the Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNFABN) for 2 of 5 residents discharged from Medicare Part A Services, Resident ID #s 72 and 107.