Allen Health and Rehabilitation

Inspectors wroteBased on record review, interviews, a facility policy titled Care Plans, the facility failed to update the care plan with interventions for Resident Identifier (RI) #87's decline in food and fluid intake. This affected RI #87 one of one residents reviewed for decline in nutritional and fluid intake. Findings Include: A review of a facility policy titled Care Plans with an effective date of 5/2018 revealed: . PROCESS: . b. Comprehensive Plan of Care - .The person centered care plan should be reviewed . with significant change of condition, or whenever a change is needed. RI #87 was admitted to the facility on [DATE] with diagnoses to include Dysphasia, oropharyngeal phase and Unspecified dementia without behavioral disturbance. A review of a facility form titled Oral Intake monitor Roster dated 1/27/2020 thru 2/15/2020 revealed Oral Intake Measurement . Breakfast . [...]

Inspectors wroteBased on an observation and interviews the facility failed to ensure that a locked narcotic box in one of the medication room refrigerators was affixed and permanently attached to prevent removal. This was observed on 2/20/20 and affected one of three medication rooms observed. Findings Include: On 2/20/20 at 4:34 PM, the surveyor made an observation, along with the unit nurse, of the locked narcotic medication box on the east unit. The surveyor observed in the locked medication room the locked narcotic medication box within the locked refrigerator. The narcotic box was attached to a shelf in the refrigerator that was not anchored or permanently affixed. The whole shelf containing the locked narcotic medications box could be removed from the refrigerator. The locked box contained 11 vials of 2 milligrams /1 milliliter Ativan. [...]

Inspectors wroteBased on observations, interview, and review of the 2017 U.S. (United States) Public Health Service Food Code, the facility failed to ensure: 1) the flour bin had a date of when the flour was placed in the bin and a date to be used by on. This was observed on 01/28/19, during the initial tour of the facility. 2) food particles were not left on the meat slicer, as observed on 01/31/19. These deficient practices had the potential to affect 86 of 86 residents receiving meals from the kitchen. Findings Include: 1) On 01/28/19 at 5:33 p.m., during the initial tour of the kitchen, the surveyor observed the flour bin to not have a date or use by date on the bin. On 01/28/19 at 5:42 p.m., the surveyor asked the Dietary Manager (DM), Employee Identifier (EI) #4, when was the flour placed in the flour bin. EI #4 said on the 24 th of January, last Thursday. [...]

Inspectors wroteBased on interview, record review and review of a facility policy titled Disposal of Medications Non-Controlled Medication Destruction, the facility failed to ensure the Non-Controlled Packet Medication Destruction forms contained the required signatures. This affected four of 11 months (January, February, May, and November of 2018) of the Non-Controlled Packet Medication Destruction forms reviewed. Finding Include: A facility policy titled Disposal of Medications Non-Controlled Medication Destruction, dated 03/11, revealed: . Procedures . 3. The registered nurse and/or pharmacist witnessing the destruction, or their preparation for environmental service pickup, ensures that the following information is entered on the Record of Medication Destruction form . : J. Signatures of witnesses, two witnesses required for non-controlled substances . [...]

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure: 1) Resident Identifier (RI) #9 was accurately assessed under Section M 0100 on RI #9's 11/06/18 Significant Change (SC) MDS (Minimum Data Set) assessment as having Pressure Ulcers (PU); and 2) RI# 77 was accurately assessed under Section M 0100 on RI #77's 01/11/19 admission MDS assessment as having a PU. These deficient practices affected RI #9 and #77, two of 25 sampled residents whose MDS assessments were reviewed. Findings Include: 1) RI #9 was admitted to the facility on [DATE], with a diagnosis of Multiple Sclerosis. RI #9's admission body audit, dated 07/09/18, revealed RI #9 was admitted with PU's to the left and right scapula, back of the right arm and the sacrum area. [...]

Inspectors wroteBased on observations, interview, and review of a facility policy titled, JOB DESCRIPTION, the facility failed to ensure the following were not observed during the survey: 1) uncapped rusted toilet bolts in RL (Room Locator) #s: 1, 2, 3, 4, 6, 7, 8, 9, 12, 13, 14, and East Unit resident bathroom, found on 2 of 3 Units; 2) dry green substance observed on pipes behind toilet in resident bathrooms in RL #s: 6, 8, and 1; 3) a loose faucet appliance in RL #14; 4) broken tiles in tubroom on East Unit; 5) a shower room on East Unit had black substance on the faucet plate; there was a black, green, and pink substance on the shower floor/wall; and pieces of white plastic bag was tied on the handrail in the shower; 6) an area of sheetrock was broken above the baseboard outside the East Unit shower; [...]

Inspectors wroteBased on record reviews, interviews, and review of a facility policy titled, Policy: Catheters, Urinary: Catheterization., the facility failed to obtain a physician's order for use of a urinary catheter. This affected RI (Resident Identifier) #66, one of twenty-one residents whose orders were reviewed. Findings Include: A review of a facility policy titled, Policy: Catheters, Urinary, with an effective date of 11/16, revealed: . Policy: Catheters, Urinary: Catheterization, . STANDARD: a physician's order should be obtained for the use of any catheter. A review of RI #66's medical record revealed a re-admission date of 9/12/17 with diagnoses to include Retention of Urine, Type II Diabetes Mellitus, and Congestive Heart Failure. [...]

Inspectors wroteBased on record reviews, interview, and review of a facility document titled, PHYSICIAN RECOMMENDATIONS, the facility failed to ensure a pharmacy recommendation of dose reduction form was completed by the medical doctor or designee. This affected RI (Resident Identifier) #4, one of six residents whose psychotropic meds were reviewed. Findings Include: A review of a facility document titled, PHYSICIAN RECOMMENDATIONS, revealed the following directions for completion: . Please evaluate the current dose and consider a gradual taper to ensure this resident is using the lowest possible effective/optimal dose. The comments below may assist you in the documentation process. Please check the appropriate response and add additional information as requested: . [...]

Inspectors wroteBased on record reviews, interview, and review of the facility policy titled, Medication Monitoring Medication Management, the facility failed to provide evidence of monitoring of the efficacy and potential side effects of psychotropic drugs. This affected RI (Resident Identifier) #s 4, 50, and 83, three of six residents whose psychotropic medications were reviewed. Findings Include: A review of the facility policy titled, Medication Monitoring Medication Management, with a copyright date of 2007, revealed: . In order to optimize the therapeutic benefit of medication therapy and minimize or prevent potential adverse consequences, facility staff, the attending physician/prescriber, and the consultant pharmacist perform ongoing monitoring for appropriate, effective, and safe medication use. [...]