Alpine Skilled Nursing and Rehabilitation

Inspectors wroteBased on record reviews and interview, the facility failed to ensure there was a sufficient number of skilled licensed nurses, nurses aides, and other nursing personnel to provide care and respond to each resident's basic needs. The facility failed to provide the minimum required staffing hours for 2 of 13 weekends during Fiscal Year Quarter 4 2025.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure that licensed nurses have the specific competencies, and skill sets necessary to care for resident needs by: 1.) S9LPN leaving prescription medications at Resident #80's bedside unattended and failing to remain with the resident until the medications had been taken and 2.) failing to have documentation of Resident #55's Lasix medication being administered as ordered for 2 (#80 and #55) of 3 residents reviewed for competent nursing staff.

Inspectors wroteBased on observations and interviews the facility failed to store, prepare and distribute food in accordance with professional standards for food safety. This had the potential to affect the 117 residents served meals from the kitchen.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment by 1) failing to follow EBP and infection control practices during urinary catheter care and bathing and 2) failing to store unused respiratory equipment in a sanitary manner when not in use for 3 (#10, #61, #91) of 4 residents reviewed for infection control.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to assess residents for self-administration of medications for 1 (#1) of 1 sampled residents observed for medications available at the bedside.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure a resident's tube feeding bag had documentation including the resident's identifying information, type of formula, and date and time it was started for 1 (#61) of 1 resident reviewed for tube feeding.

Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure an accurate assessment was completed to reflect a resident`s condition. The failed practice was evidenced by 1 (#316) of 5 (#50, #62, #80, #102, and #316) residents reviewed for pressure ulcers not having an accurate wound assessment completed by a Registered Nurse (RN) upon discovery of skin breakdown.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure that a resident who needs respiratory care was provided such care, consistent with professional standards of practice by not having signage on the outside of the residents' room door to indicate oxygen was in use for 3 (#29, #104, #316) of 5 (#17, #29, #67, #104, #316) residents reviewed for oxygen.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to ensure residents were assessed for the risk of entrapment from side rails prior to the installation of side rails for 5 (#22, #40, #50, #55, #104) of 5 (#22, #40, #50, #55, #104) residents reviewed for side rails. The facility failed to complete the Side Rail Utilization Assessment and consent for side rails prior to implementation for resident #22.

Inspectors wroteBased on record review and interview, the facility failed to conduct Quality Assessment and Assurance meetings at least quarterly.

Inspectors wroteBased on record review and interview, the pharmacist failed to identify and report irregularities to the attending physician and the facility's medical director and director of nursing for 1 (#22) of 5 (#4, #17, #22, #55, and #78) residents reviewed for unnecessary medications.

Inspectors wroteBased on record review and interview, the facility failed to ensure resident's drug regimens were free from unnecessary psychotropic medications for 1 (#22) of 5 (#4, #17, #22, #55, and #78) residents reviewed for unnecessary medications. The facility failed to ensure a psychotropic medication was used only when there was an acceptable diagnosis documented in the medical record for resident #22.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that licensed nurses have the specific competencies and skill sets necessary to care for a resident's need by not having a controlled medication available and administered in accordance with physician orders for 1 (#8) of 5 (#7, #8, #34, #72, and #86) residents reviewed for unnecessary medications.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure routine medications were administered to each resident for 3 (#18, #34, and #69) of 4 (#18, #34, #69, and #101) residents reviewed for pharmceutical services. The facility failed to have documented evidence as to the reason why the residents were not administered their medications in accordance with the physician's orders.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure an entry in the Emergency (ER) Transfer Log was completed and the Ombudsman was notified of the transfer for 1 (#64) of 1 (#64) residents reviewed for Notice Requirements Before Transfer/Discharge. The failed practice was made evident by the facility failing to ensure emergency transfer logs were completed and the ombudsman was notified when resident #64 was transferred to the emergency room on the dates of 07/05/2023 and 11/03/2023.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide assistance for residents who were unable to carry out activities of daily living (ADL) by failing to maintain good grooming and personal hygiene for 3 (#7, #29, and #39) of 4 (#7, #29, #39, and #72) residents reviewed for activities of daily living.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure that residents receive care, consistent with professional standards of practice, to prevent pressure ulcers for 1 (#83) of 1 residents reviewed for pressure ulcers. The facility failed to provide a pressure relieving device while in the wheelchair for resident #83.

Inspectors wroteBased on record review and interview, the facility failed to ensure a performance review was completed at least once every 12 months for 3 (S4 Certified Nursing Assistant (CNA), S6CNA, S8CNA ) of 5 (S4CNA, S5CNA S6CNA, S7CNA, and S8CNA) personnel records reviewed.