Altercare of Louisville Ctr for Rehab & Nsg Care

Inspectors wroteBased on observation, interview, and policy review the facility failed to ensure proper hand hygiene was maintained during medication administration for Resident #46 and Resident #61 and during incontinence care for Resident #59. This affected three residents (#46, #59, #61) out of six residents reviewed for hand hygiene practices. The facility census was 78.

Inspectors wroteBased on observation, record review, and interview, the facility did not ensure the call light was kept within reach for Resident #27. This affected one resident (Resident #27) of 23 residents reviewed for accommodation of needs. The facility census was 77.

Inspectors wroteBased on record review, interview and review of facility policy, the facility failed to immediately notify the physician and responsible parties of a fall incident involving Resident #8. This affected one resident (Resident #8) of five residents reviewed for accidents. The facility census was 77.

Inspectors wroteBased on observation, record review, interview and review of facility policy, the facility failed to ensure personal privacy and confidentiality of records for Resident #42 and #85. This affected two residents (Residents #42 and #85) of 23 residents reviewed for privacy/confidentiality. The facility census was 77.

Inspectors wroteBased on observation, record review, interview and review of facility policy, the facility failed to ensure a physician order was obtained for Resident #7's right lower arm skin tear. This affected one resident (#7) of one resident reviewed for general skin conditions. The facility census was 77.

Inspectors wroteBased on observation, record review, interview and review of facility policy, the facility failed to ensure Resident #5's left lower leg/foot dressing was administered as ordered. This affected one resident (Resident #5) of three residents reviewed for pressure ulcers/injury. The facility census was 77.

Inspectors wroteBased on observations, record review, interview and review of facility policy, the facility failed to ensure fall interventions were in place for Resident #27. This affected one resident (Resident #27) of five residents reviewed for accidents. The facility census was 77.

Inspectors wroteBased on observation, record review, interview, and review of facility policy, the facility failed to ensure Resident #7's percutaneous endoscopic gastrostomy (PEG) tube dressing was administered as ordered. This affected one resident (Resident #7) of one resident reviewed for tube feeding. The facility identified one resident (#7) as ordered a tube feeding. The facility census was 77.

Inspectors wroteBased on observation, record review, interview, and review of facility policy, the facility failed to ensure Resident #17's oxygen therapy was administered as ordered and Residents #55 and #87's aerosol masks were stored in a protective barrier to prevent cross contamination of the masks. This affected three residents (Resident#17, #55 and #87) of four residents reviewed for respiratory care. The facility census was 77.

Inspectors wroteBased on record review and interview the facility did not ensure pre and post dialysis assessments were completed as required for Resident #5. This affected one resident (Resident #5) of one resident reviewed for dialysis services. The facility identified one resident (#5) as receiving dialysis services. The facility census was 77.

Inspectors wroteBased on record review and interview, the facility did not ensure Resident #81 was administered medication according to physician orders. The affected one resident (#81) of five residents reviewed for medication administration. The facility census was 77.

Inspectors wroteBased on record review, interview and review of facility policy, the facility did not ensure gradual dose reduction recommendations pertaining to anti-anxiety medications for Resident #58 were addressed by the physician. This affected one resident (Resident #58) of five residents reviewed for unnecessary medications. The facility census was 77.

Inspectors wroteBased on observations, interview and review of facility policy, the facility failed to ensure staff performed hand hygiene during medication administration for Resident #21. This affected one resident (Resident #21) of five residents (Resident #7, #21, #22, #30, and #71) observed for medication administration. The facility census was 77.

Inspectors wroteBased on medical record review, resident interview, and staff interview, the facility failed to ensure Resident #29's pain medication was reordered timely. This affected one resident (#29) out of three (Resident #18, Resident #29, and Resident #54) reviewed for medication administration. The facility census was 64.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on record review, self-reported incident review (SRI), interview, and facility policy review the facility failed to ensure Resident #21 was free from staff-to-resident physical abuse. This finding affected one resident (#21) of five residents reviewed for Abuse, Neglect and Misappropriation of Resident Property. The facility census was 70.

Inspectors wroteBased on observation, record review, interview, and facility policy review the facility failed to ensure Resident #46 was provided timely incontinence care. This finding affected one resident (#46) of three residents reviewed for incontinence care. The facility census was 70.

Inspectors wroteBased on observation, record review, staff interview, and review of the facility policy the facility failed to ensure smoking assessments were completed with a quarterly according to the facility's smoking policy. This affected three residents (#10, #25, and #29) of three residents reviewed for smoking. The facility identified six residents (#10, #25, #26, #29, #36, and #37) who smoked at the facility. The facility census was 65.

Inspectors wroteBased on closed record review and interview, the facility failed to provide adequate assistance to Resident #63, who had cognitive impairment and required two staff to transfer using a mechanical (Hoyer) lift to prevent an injury. Actual Harm occurred on 10/06/23 when State Tested Nursing Assistant (STNA) #804 failed to ensure a second staff member was present (as care planned) to reposition and then transfer Resident #63 from her wheelchair to bed using a Hoyer lift. At the time of the transfer, STNA #804 identified the Hoyer lift pad was not properly under the resident and instead of obtaining a second staff member to properly reposition the resident, required the resident to push up and scoot herself in the wheelchair. The resident complained of pain to her arm during this time. [...]

Inspectors wroteBased on closed record review and interview, the facility failed to timely notify Resident #63's family representative and physician of the resident's complaints of pain in the left arm. This finding affected one resident (#63) of three residents reviewed for notification.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure Resident #40's lidocaine pain patch was administered as ordered. This finding affected one resident (#40) of six residents reviewed for medication administration.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure central catheter access lines were removed in a timely manner, as ordered by the physician. This affected one (Resident #70) of three residents reviewed for central catheter access lines. The facility census was 72.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure laboratory testing was completed as ordered by the physician to monitor for medication side effects. This affected one (Resident #70) of three residents reviewed for laboratory testing. The facility census was 72.

Inspectors wroteBased on medical record review, review of facility investigation, observation, interview, and policy review the facility failed to ensure a resident was safely transferred with a mechanical lift and resident smoking materials were stored in a secure area. This affected one (Resident #23) of three residents reviewed for falls and six (#22, #29, #37, #41, #43, and #52) of six residents reviewed for smoking.

Inspectors wroteBased on record review, review of facility reported incident (FRI) investigation, review of the controlled drug receipt form, interview, and policy review the facility failed to ensure a thorough investigation was completed and documented for misappropriation of narcotics. This affected one (Resident #52) of one resident reviewed for abuse.

Inspectors wroteBased on record review, interview and facility policy review the facility failed to ensure Pre-admission Screening and Resident Review (PASARR) documentation was updated when resident diagnoses changed. This affected three residents (#23, #24, and #32) of three residents reviewed for PASARR.

Inspectors wroteBased on record review and interview, the facility failed to ensure smoking care plans were updated in a timely manner. This affected three (Residents #22, #41, and #43) of six residents reviewed for smoking. The census was 67.

Inspectors wroteBased on medical record review, observation, and interview the facility failed to ensure Resident #23 received assistance with placement of hearing aids and changing hearing aid batteries. This affected one (Resident #23) of one resident reviewed for hearing.

Inspectors wroteBased on medical record review, interview, and policy review revealed the facility failed to ensure duplicate treatments were not applied to the same area. This affected one (Resident #34) of one resident reviewed for skin conditions.

Inspectors wroteBased on record review, observation, interviews, and policy review the facility failed to follow Resident #34's dietary orders for supplements, ensure the resident was encouraged to get up to eat, and substitutes were offered if less then 50 percent of meal was consumed. This affected one (Resident #34) of three residents reviewed for nutrition.

Inspectors wroteBased on record review and interview, the facility failed to ensure pharmacy recommendations were addressed timely. This affected three (#9, #23, and #32) of four residents reviewed. The census was 67.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident #9's order for as needed Trazodone was re-assessed within the required 14-day time frame, Resident #23 had a gradual dose reduction attempted or evidence of a clinical indication why it was not attempted, and Resident #56 had a clinical indication for the continued use of Seroquel. This affected three of five residents reviewed for unnecessary medication. The census was 67.

Inspectors wroteBased on record review, observation, interview, and policy review the facility failed to ensure residents received timely dental services. This affected two residents (#12 and #34) of four residents reviewed for dental.

Inspectors wroteBase on observation and interview the facility failed to ensure staffing levels were posted daily as required. This had the potential to affect all residents. The facility census was 67.

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner. This affected 76 of 77 residents who received meals from the dietary department. Resident #5 was NPO (nothing by mouth) and did not receive meals prepared by dietary staff. The facility census was 77.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to maintain a clean and sanitary environment. This had the potential to affect all 77 residents residing in the facility.

Inspectors wroteBased on record review, observation and interview, the facility failed to ensure an accurate assessment of resident's signs/symptoms of possible infection was documented. This affected two residents (Resident #50 and Resident #79) of three residents reviewed for infection. The facility census was 77.