Alpine Nursing and Rehabilitation Center

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record review, staff interview, review of Self-Reported Incidents (SRIs), and review of the facility policy, the facility failed to prevent the misappropriation of resident medications. This affected one (Resident #35) of three residents reviewed for misappropriation. The facility census was 72 residents.

Inspectors wroteBased on observation, staff interview, and review of the facility policy, the facility failed to ensure foods were labeled and dated properly. This had the potential to affect all of the residents residing in the facility. The facility census was 69 residents.

Inspectors wroteBased on medical record review, observation, staff interview, and review of the facility policy, the facility failed to ensure medications were dated upon opening and discarded on or before the expiration date. This affected eight (Residents #6, #8, #10, #24, #28, #44, #49, and #122) and had the potential to affect all of the residents residing in the facility. The facility census was 69 residents.

Inspectors wroteBased on record review, staff interview, and review of the facility policy, the facility failed to complete significant change Minimum Data Set (MDS) assessments in a timely manner. This affected one (Resident #7) of 17 residents reviewed for MDS assessments. The facility census was 69 residents.

Inspectors wroteBased on record review and staff interview, the facility failed to submit Minimum Data Set (MDS) assessments in a timely manner. This affected one (Resident #59) of 17 residents reviewed for assessments. The facility census was 69 residents.

Inspectors wroteBased on medical record review, staff interview, and review of the facility policy, the facility failed to ensure Minimum Data Set (MDS) assessments were coded accurately. This affected one (Resident #66) of 17 residents reviewed for MDS assessments. The facility census was 69 residents.

Inspectors wroteBased on medical record review, staff interview, and review of the facility, the facility failed to ensure staff monitored tube feeding residuals. This affected one (Resident #40) of one resident reviewed for tube feeding. The facility census was 69 residents.

Inspectors wroteBased on review of the medical record review, observation, staff interview, and review of manufacturer's guidelines, the facility failed to ensure the medication error rate was below five percent (%). There were two errors out of 29 medication opportunities resulting in a medication error rate of 6.9%. This affected one (Resident #17) of seven residents reviewed for medication administration. The facility census was 69 residents.

Inspectors wroteBased on review of the medical record review, observation, staff interview, and review of manufacturer's guidelines, the facility failed to ensure residents were free from significant medication errors. This affected one (Resident #17) of seven residents reviewed for medication administration. The facility census was 69 residents.

Inspectors wroteBased on medical record review, observation, staff interview, and review of the facility policy, the facility failed to ensure staff completed proper hand hygiene during medication administration. This affected one (Resident #30) of seven residents observed for medication administration. The facility also failed to ensure staff cleaned glucometers as appropriate after use. This affected one (Resident #3) of one resident with orders for blood sugar checks. Based on medical record review, observation, staff interview, review of the facility policy, and review online guidance per the Centers for Disease Control (CDC) the facility also failed to ensure staff disposed of personal protective equipment (PPE) properly. This affected one (Resident #123) of 15 residents with orders for enhanced barrier precautions (EBP.) The facility census was 69 residents.

Inspectors wroteBased on medical record review, observation, resident interview, staff interview, and policy review, the facility failed to ensure resident rooms were free from pests. This affected one (Resident #23) of 17 residents reviewed for the physical environment. The facility census was 69 residents.

Inspectors wroteTHIS DEFICIENCY REPRESENTS AN INCIDENCE OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on record review, review of physician standing orders, review of hospital records, staff interview, and policy review, the facility failed to ensure residents were free from constipation and had interventions to prevent constipation on the care plan. This resulted in Actual Harm when Resident #75 did not have a bowel movement for five days before a stool softener was prescribed and was transferred out to the hospital and diagnosed with a fecal impaction. This affected one (Resident #75) of three residents reviewed for constipation. The census was 73.

Inspectors wroteBased on record review, review of hospital records, staff interview, and review of facility policy, the facility failed to ensure residents were treated timely for a urinary tract infections (UTI). This resulted in Actual harm when Resident #75 developed signs and symptoms of a UTI and wasn't treated for the UTI for six days. She transferred out to the hospital and it was discovered the resident had a significant distention in the bladder with renal pelvictasis, (renal pelviectasis, is when urine gathers in the center of the kidney, called the pelvis. This makes the kidney larger than normal. This condition can affect one or both kidneys.) This affected one (Resident #75) of one resident reviewed for UTI. There were no other residents in the facility with a UTI. The census was 73.

Inspectors wroteBased on observations, staff and resident interviews and policy review, the facility failed ensure meals were palatable. This affected three (Residents #31, #59 and #57) of three residents reviewed for food. The facility identified two residents who couldn't eat anything by mouth. The census was 73.

Inspectors wroteBased on record review, observation, interviews, and policy / procedures the facility failed to perform incontinence care in a sanitary manner. This affected one (#19) out of three residents reviewed for incontinence care. The facility census was 67.

Inspectors wroteBased on employee record review, review of the facility Bureau of Criminal Investigation (BCI) log, staff interview, and policy review, the facility to implement their abuse policy to ensure an employee had a background check completed with the results received timely. The had the potential to affect all 67 residents residing in the facility. The facility census was 67.

Inspectors wroteBased on observations and staff interviews, the facility failed to provide a safe environment for the residents when a window air-conditioning unit in the dining room had exposed wires and coils. This had the potential to affect 41 residents (#102, #107, #109, #110, #112, #116, #118, #119, #120, #122, #125, #126, #127, #128, #129,#130, #131, #134, #135, #136, #138, #139, #142, #143, #144, #145, #146, #147, #149, #151, #152, #153, #154, #156, #158, #159, #161, #162, #163, #164, and #167) who the facility identified who were cognitively impaired and mobile. The facility census was 71.

Inspectors wroteBased on observation, record review, review of the facility policy, and resident and staff interview the facility failed to ensure the residents had access to their call light. This affected one (Resident #200) of two residents reviewed for call light accessibility and functioning. The facility census was 71.

Inspectors wroteBased on medical record review, staff interviews, and policy review, the facility failed to complete an assessment and implement a treatment for a newly developed pressure ulcer. This affected one (#43) out of three residents reviewed for pressure ulcers. The facility census was 65.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to ensure personal protective equipment was worn in resident areas to prevent the potential spread of infection. In addition, the facility failed to ensure contaminated linens and trash were handled to prevent the potential spread of infection. This had the potential to affect all 63 residents at the facility. 1. Observation and interview on 08/22/22 at 8:52 A.M. State Tested Nurse Aide (STNA) #563 walked out of Resident #213 room. The STNA was wearing a N95 mask, eye protection, and an isolation gown. She walked down the walkway along the common area with no residents present and turned left out of view. The STNA returned within minutes carrying bath linens. The STNA #563 stated when she was given report at 6:00 A.M. [...]

Inspectors wroteBased on medical record review, review of the Preadmission Screening and Resident Review, and staff interview, the facility failed to update a resident's Preadmission Screening and Resident Review (PASARR) when a new diagnosis of schizophrenia was added. This affected one resident (#28) out of three residents reviewed for PASARR. The facility census was 63. Review of Resident #28 medical record revealed he was admitted to the facility on [DATE]. Diagnoses included dizziness and giddiness, history of traumatic brain injury, vascular dementia with behavioral disturbance, type II diabetes, post traumatic stress disorder, depression, phobic anxiety disorder, acquired absence of right leg below knee, hypertension, and epilepsy. On 08/07/19 a new diagnosis of schizophrenia was added to his diagnosis. [...]

Inspectors wroteBased on medical record review, review of the Agency on Aging determinations, review of the hospital exemption form, and staff interview, the facility failed to complete the Preadmission Screening and Resident Review. This affected two residents (#19 and #42) out of three residents reviewed for Preadmission Screening and Resident Review. The census was 63.

Inspectors wroteBased on medical record review, staff interview, review of the facility incidents, and policy review, the facility failed to ensure a fall investigation was completed and root cause was identified post resident fall. This affected one resident (#15) out of 20 sampled residents. The facility census was 63. Review of the medical record for Resident #15 revealed an admission date of 11/03/21. Diagnosis included obstructive and reflux uropathy, pseudobulbar affect, personal history of Covid-19, dementia, and adult failure to thrive. Review of the quarterly minimum data set (MDS) assessment dated on 06/23/22 revealed Resident #15 had severe cognitive impairment. Resident #15 required total dependence for bed mobility, dressing, bathing, and personal hygiene. Resident was setup assistance for all meals. Resident #15 required extensive one-person assistance for toilet use, and transfers. [...]

Inspectors wroteBased on medical record review, staff interview, and policy review, the facility failed to ensure weights were monitored per recommendation. This affected one resident (#42) out of seven residents reviewed for nutrition. The census was 63.

Inspectors wroteBased on medical record review, staff and resident interview, and policy review, the facility failed to comprehensively document care provided for residents. This affected two residents (#54 and #61) of 24 resident record reviews. The census was 63.

Inspectors wroteBased on medical record review, observation, staff interview and review of medication storage policy, the facility failed to properly label drugs and biological's used in the facility and the facility failed to ensure medication carts were secure. This directly affected two Residents (#70 and #62) of two whose medication were observed opened and undated. This had the potential to affect all residents. The facility also failed to ensure medication carts on the memory impaired unit were locked. Facility census was 67.

Inspectors wroteBased on observation, staff interview, and review of facility policy on cleaning glucometers and facility policy the facility failed to maintain an infection program. The facility failed to ensure a glucometer was cleaned between resident use. This directly affected three Residents (#15, #48 and #54) of three observed. The facility also failed to follow their Legionella plan. This had the the potential to affect all residents that resided in the facility. Facility census was 67.

Inspectors wroteBased on review of the infection control book, staff interview and review of facility policy the facility failed to ensure they had an infection prevention and control program (IPCP) that included antibiotic use and a system to monitor antibiotic use. This had the potential to affect all the residents that resided in the facility. Facility census was 65.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure, gradual dose reductions (GDR) were made and responded to and acted upon timely. This affected three Residents (#2, #41, and #67) of five reviewed for unnecessary medication use. The facility census was 67.

Inspectors wroteBased on observation, staff interview and review of facility policy the facility failed to properly and safely store food items. This had the potential to affect all residents who consumed meals from the facility kitchen. The facility identified one resident (Resident #11) who did not consume food prepared by the kitchen staff. The facility census was 67.

Inspectors wroteBased on medial record review, observation and staff interview the facility failed to provide meals to all of the residents at a table at the same time. This affected one Resident (#24) of 17 residents observed eating in the dining area on the secured unit. The facility census was 67.

Inspectors wroteBased on medical record review, personal funds statement review, staff interview and review of facility policy the facility failed to provide a spend down letter to residents and/or the resident's representative when the resident's personal trust fund account was $200 less than Social Security Income (SSI) resource limit. This affected one Resident (#11) of five reviewed for personal funds accounts. The facility census was 67.

Inspectors wroteBased on medical record review, facility record review and staff interview, the facility failed to provide the required Beneficiary Protection Notifications (BPN) when Medicare Part A residents were discharged from services with skilled days remaining. This affected three Residents (#16, #323 and #324) of four residents reviewed for BPN during the annual survey. The facility census was 67.

Inspectors wroteBased on medical record review, staff and resident interviews, review of concern forms, review of facility self-reported incidents (SRI), and review of facility policy, the facility failed to implement their abuse and misappropriation policy when they failed to report to the state agency. This affected one Resident (#10) of 24 residents reviewed. The facility census was 67.

Inspectors wroteBased on medical record review, staff and resident interviews, review of concern forms, review of facility self-reported incidents (SRI), and review of facility policy, the facility failed to ensure allegations of misappropriation of property were reported to the state agency. This affected one Resident (#10) of 24 residents reviewed. The facility census was 67.

Inspectors wroteBased on medical record review, staff and resident interviews, review of concern forms, review of facility self-reported incidents (SRI), and review of facility policy, the facility failed to thoroughly investigate allegations of misappropriation of property. This affected one Resident (#10) of 24 residents reviewed. The facility census was 67.

Inspectors wroteBased on record review and staff interview the facility failed to provide a notice of transfer/discharge to the resident's representative upon being transferred to the hospital. This affected two Residents (#10 and #48) of four reviewed for hospitalization. The facility census was 67.

Inspectors wroteBased on record review and staff interview the facility failed to provide a bed hold notice to the resident's representative upon being transferred to the hospital. This affected two residents (#10 and #48) of four reviewed for hospitalization. The facility census was 67.

Inspectors wroteBased on record review and staff interview the facility failed to complete a significant change Minimum Data Set as(MDS) with the required 14 days for residents with a significant change in status. This affected two Residents (#35 and #48) of 20 residents reviewed for MDS assessments during the investigation stage of the annual survey. The facility census was 67.

Inspectors wroteBased on medical record review, review of the Minimum Data Set (MDS) assessment data, and staff and resident interviews, the facility failed to accurately code data on the resident MDS assessment. This affected one (Resident #26) of 24 residents reviewed during the investigation stage of the annual survey. The facility census was 67.

Inspectors wroteBased on record review and staff interview the facility failed to ensure residents had complete and accurate care plans. This affected one Resident (#48) of 20 residents care plans reviewed during the investigation phase of the annual survey. The facility census was 67.

Inspectors wroteBased on medical record review, resident and staff interview, and review of facility policy, the facility failed to complete and revise resident care plans. This affected four Residents (#26, #34, #35 and #57) of 24 reviewed during the investigation stage of the annual survey. The facility census was 67.

Inspectors wroteBased on medical record review, family and staff interview, review of After Visit Summary, review of Medication Error log and review of facility policy the facility failed provide medications with professional standard of quality when a nurse hid medications in food and left the food unattended. This affected two residents (#27 and #60) of 17 residents who received medications on the memory care unit. The facility census was 67.

Inspectors wroteBased on medical record, observation, and staff interview, the facility failed to provide mouth care for a dependent resident. This affected one Resident (#11) of one reviewed for activities of daily living (ADL's). The facility census was 67.

Inspectors wroteBased on medical record review, observations and staff interview, the facility failed to ensure a resident was provided with activities per the plan of care. This affected one Resident (#17) of two reviewed for activities. The facility census was 67.

Inspectors wroteBased on observation, medical record review, family interview, staff interview and review of hospital records, the facility failed to provide timely care for one resident and failed to provide proper positioning for one resident. This affected Resident (#61) reviewed for delay of care and Resident (#40) reviewed for positioning. The facility census was 67.

Inspectors wroteBased on medical record review, and resident and staff interview, the facility failed to ensure a resident was sent for an ophthalmology referral in a timely manner. This affected one Resident (#70) of one reviewed for vision. The facility census was 67.

Inspectors wroteBased on medical record review, observation, resident and staff interview, and review of facility Smoking Policy, the facility failed to ensure a resident assessed to require supervision with smoking was not permitted to possess their own smoking materials. This affected one Resident (#26) of six observed for smoking. The facility census was 67.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure monthly Medication Regimen Reviews (MRR) were performed. This affected three Residents (#2, #41, and #67) of five residents reviewed for unnecessary medications. The facility census was 67.

Inspectors wroteBased on closed and open medical record review and staff interview, the facility failed to maintain residents medical records in a complete and accurate manor. This affected two Resident's #21 and #35) of six reviewed. The facility census was 67.