Adviniacare Providence Dodge Rehab Center, LLC

Inspectors wroteBased on clinical record review, and resident and staff interviews, the facility failed to keep a resident free from physical abuse for 1 of 2 residents that was involved in a physical altercation that resulted in the victim sustaining injuries to his/her face, Resident ID #6.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to provide appropriate treatment and services for a resident who sustained a fall in the facility, was treated with antibiotics for a urinary tract infection (UTI), and subsequently fell again and later was admitted to the hospital with sepsis (a life threatening, emergency response to infection where the immune system triggers widespread inflammation, leading to potential organ failure, shock, and death) for 1 of 2 residents reviewed for falls, Resident ID #12.

Inspectors wroteBased on clinical record review and staff interview, it has been determined that the facility failed to ensure that a resident who requires dialysis (a medical treatment that filters waste products, toxins, and excess fluid from the blood when kidneys have failed) receive such services consistent with professional standards of practice, for 1 of 1 resident reviewed who was prescribed the medication Sevelamer (a medication prescribed primarily to treat elevated phosphorus levels in the blood for individuals with chronic kidney disease and are on dialysis) to treat his/her elevated blood phosphorus levels. This failure resulted in Resident ID #6's blood phosphorus level to further rise.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to establish an Infection Prevention and Control Program (IPCP) that must include, at a minimum, an antibiotic stewardship program which includes antibiotic use protocols and a system to monitor antibiotic use to ensure that residents who require an antibiotic, are prescribed the appropriate antibiotic for 1 of 2 residents reviewed for antibiotic use, Resident ID #12.

Inspectors wroteBased on surveyor observation and staff interview, it has been determined that the facility failed to ensure that food is stored and distributed in accordance with professional standards for food service safety, relative to the main kitchen and two of three kitchenettes.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to implement and revise the comprehensive care plan for 1 of 3 residents reviewed for weight loss, Resident ID #119 and 1 of 1 resident reviewed for fluid restriction, Resident ID #7.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that a resident receives treatment and care in accordance with professional standards of practice relative to the facility's failure to schedule appointments for physician specialists, for 1 of 6 residents reviewed, Resident ID #1, and for wound care for 1 of 3 residents reviewed, Resident ID #57.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to provide respiratory care consistent with professional standards of practice for 1 of 4 residents reviewed for oxygen therapy, Resident ID #105.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents are free from any significant medication errors for 1 of 1 resident reviewed relative to insulin order changes, Resident ID #6.

Inspectors wroteBased on record review and resident and staff interviews, it has been determined that the facility failed to ensure residents are free from any significant medication errors for 1 of 3 residents reviewed for psychotropic medications, Resident ID #1.

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, relative to following physician's orders for 1 of 1 resident reviewed with parameters for weights, Resident ID #2.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to accurately document in the resident's medical record for 3 of 4 residents reviewed for weekly skin checks, Resident ID #s 2, 3 and 4.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to protect the residents' right to be free from abuse for 2 of 2 residents reviewed who sustained injuries as a result of a resident-to-resident altercation, Resident ID #s 1 and 3.

Inspectors wroteBased on surveyor observation, record review, resident and staff interview, it has been determined that the facility failed to provide respiratory care consistent with professional standards of practice for 1 of 1 resident reviewed for tracheostomy (trach; an opening that surgeons make through the front of the neck and into the windpipe. A tube is placed into the opening for breathing) suctioning, Resident ID #114.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that the resident's drug regimen is free from unnecessary drugs for 1 of 1 resident reviewed for blood pressure medications with parameters, Resident ID #80.

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 1 of 3 residents reviewed relative to Multi-drug Resistant Organisms (MDRO), Resident ID #30 and 1 of 1 resident reviewed for an indwelling catheter (a flexible tube inserted into the bladder to drain urine), Resident ID #91.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure the resident's medical record includes documentation that the resident either received the pneumococcal vaccination or did not receive the vaccination due to medical contraindications or refusal, for 4 of 7 residents reviewed, Residents ID #s 17, 63, 73, and 106.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to establish an Infection Prevention and Control Program (IPCP) that must include, at a minimum, an antibiotic stewardship program which includes antibiotic use protocols and a system to monitor antibiotic use to ensure that residents who require an antibiotic, are prescribed the appropriate antibiotic for 2 of 2 residents reviewed for antibiotic use, Resident ID #s 17 and 54.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility has failed to ensure that residents are free of any significant medication errors for 1 of 3 residents reviewed, Resident ID #1.

Inspectors wroteBased on record review, resident and staff interview, it has been determined that the facility failed to ensure that all alleged violations involving abuse are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or no later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to other officials (Department of Health), in accordance with State law for 1 of 1 resident reviewed, Resident ID #1.

Inspectors wroteBased on record review and staff interview it has been determined that the facility failed to provide evidence that all alleged violations were thoroughly investigated for 1 of 1 resident reviewed for an allegation of abuse, Resident ID #1.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure that food is stored, served and distributed, in accordance with professional standards for food service safety, relative to the main kitchen.

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 meal tickets matching what the resident received for a meal.

Inspectors wroteBased on record review, surveyor observation, resident and staff interview, it has been determined that the facility failed to ensure a resident received a therapeutic diet as ordered by the physician for 8 of 8 residents reviewed for therapeutic diets, Resident ID #s 34, 62, 66, 79, 106, 109, 367 and 417.

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 7 of 23 residents reviewed for a Brief Interview for Mental Status (BIMS) Assessment, Resident ID #s 2, 8, 17, 30, 85, 98, and 90.

Inspectors wroteBased on surveyor observation, record review and staff interview, it has been determined that the facility failed to assure that services being provided meet professional standards of quality related to following physician's orders for 1 of 1 residents, Resident ID #69.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that a resident receives treatment and care in accordance with professional standards of practice for 1 of 1 resident reviewed for the use of geri sleeves and limb elevation, Resident ID #35, 1 of 1 resident reviewed relative to podiatry recommendations, Resident ID # 35, and 1 of 2 residents reviewed relative to surgical wounds, Resident ID #109.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure that the resident environment remains as free of accident hazards as possible relative to 1 of 4 residents who had access to smoking materials in his/her room, Resident #15. Additionally, the facility failed to ensure that the resident is provided assistive devices to prevent accidents relative to smoking for 1 of 4 residents reviewed, Resident ID #16.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that the residents are free from significant medication errors for 1 of 5 residents reviewed who was not administered a psychotropic medication according to the physician order, Resident ID #8.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to provide food prepared in a form designed to meet individual needs for 2 of 2 residents reviewed for puree textured diets, Resident ID #s 17 and 73.

Inspectors wroteBased on surveyor observation and staff interview, it has been determined that the facility failed to provide eating equipment and utensils for residents as ordered by the physician for 1 of 1 resident reviewed for adaptive equipment, Resident ID #73.

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 1 of 2 residents reviewed for accuracy of documentation relative to the Medication Administration Record (MAR) for Resident ID #109 and 1 of 4 residents reviewed related to an accurate smoking evaluation, Resident ID #15.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to follow standard precautions to prevent the spread of infections for 2 of 4 wound dressings observed, Resident ID #s 39 and 102.