Anoka Rehabilitation and Living Center

Inspectors wroteBased on observation, interview, and record review the facility failed to identify, treat, monitor, and manage 1 of 3 residents (R1) reviewed for pain to the extent possible in accordance with R1's care plan, goals, and preferences. R1 stated pain and was observed having pain. R1 had available morphine sulfate every two hours as needed (PRN), which was not administered to him for his breakthrough pain.

Inspectors wroteBased on interview and document review the facility failed to ensure services were provided in a dignified manner to promote quality of life during incontinence care for 1 of 1 resident (R10) reviewed for dignity

Inspectors wroteBased on interview and record review the facility failed to ensure a psychotropic medication ordered as needed (PRN) was limited to 14-days or extended to a specific date with supporting rationale provided by the medical provider for 1 of 2 residents (R2) reviewed for psychotropic medication use.

Inspectors wroteBased on interview and record review the facility failed to maintain a complete, accurately documented and, readily accessible medical record in accordance with accepted professional standards of practice for 3 of 5 residents (R25, R9, R2) reviewed for advanced directives documentation. This deficient practice gave staff access to inaccurate information.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure appropriate personal protective equipment (PPE) was worn to prevent the spread of infection for for 2 of 2 residents (R8, R9) observed for COVID-19 transmission based precautions (TBP) and for 1 of 2 residents (R10) observed for enhanced barrier precautions (EBP), (an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and glove use during high contact resident care activities). This deficient practice had the potential to affect all 112 residents who resided in the facility. Findings Include: [...]

Inspectors wroteBased on observation, interview and document review, the facility failed to maintain proper holding food temperatures for 18 of 19 residents observed to receive the noon meal on the Reflections unit. Further, the facility failed to maintain the ice machine in a sanitary manner to prevent potential food-borne illness for 39 residents who currently received ice from the ice machine in the Transitional care unit and Cardiac care unit area, and 36 residents who currently received ice from the ice machine in the Riverbend and cornerstone unit area.

Inspectors wroteBased on interview and record review the facility failed to include a resident discharge summary that included a reconciliation of all pre-discharge medications with resident's post-discharge medication (both prescribed and over-the-counter) at discharge for seven of ten residents (R1, R2, R5, R6, R7, R9, and R12). R1 received R2's Mirtazapine (a medication to treat depression) at discharge.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure 1 of 2 unit ice and water dispensers for resident use were maintained in a clean and sanitary manner on the Cornerstone unit kitchenette. In addition, the facility failed to ensure 1 of 2 unit refrigerators were maintained in a clean and sanitary manner. This had the potential to effect 60 residents served by the Cornerstone unit kitchenette.

Inspectors wroteBased on observation, interview, and document review the facility failed to ensure food was properly stored, labeled, dated, and failed to maintain a clean and sanitary kitchen to reduce and/or prevent the risk of food borne illness this practice had the potential to affect all 112 residents, staff and guests who consumed foods from the facility kitchen.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure residents were comprehensively assessed for self-administration of medications for 5 of 5 residents (R3, R14, R74, R36, and R95), reviewed and observed for self-administration of medications.

Inspectors wroteBased on interview and document review, the facility failed to complete care conferences for 5 of 7 residents (R14, R16, R24, R29 and R69) reviewed for care planning.

Inspectors wroteBased on interview and document review the facility failed to ensure 4 of 5 residents (R24, R56, R80, and R102) were offered, educated and/or provided the pneumococcal vaccination series as recommended by the Centers for Disease Control (CDC), who were reviewed for immunizations.

Inspectors wroteBased on document review and interviews, the facility failed to ensure the Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN-CMS-10055) was provided to 1 of 3 residents (R86) reviewed for beneficiary notification.

Inspectors wroteBased on interview, and document review the facility failed to ensure a written notification of transfer was sent to the office of the Ombudsman for long term care for 2 of 2 residents (R106, R107) with the potential to affect all residents transferred to the hospital.

Inspectors wroteBased on interview, and document review the facility failed to complete neurological assessments following falls for 1 of 1 resident (R85) who had unwitnessed falls.

Inspectors wroteBased on interview and document review the facility failed to ensure coordination of dialysis care for 1 of 1 resident (R14) who required dialysis (treatment to filter blood when kidneys are no longer able).

Inspectors wroteBased on interview and document review, the facility failed to assure the use of PRN (as needed) psychotropic medications (a drug which affects mood/behavior) were limited to 14 days, or had a physician specified, time limited order for 2 of 2 residents (R74 and R85) reviewed for Hospice.

Inspectors wroteBased on interview and record review, the facility failed to assist in obtaining routine dental services for 1 of 1 resident (R56) reviewed for dental services.

Inspectors wroteBased on observation, interview and document review the facility failed to ensure enhanced barrier precautions were used for 1 of 3 residents (36) reviewed for infection control.

Inspectors wroteBased on document review and interviews the facility failed to ensure the required staffing information was posted daily. This had the potential to affect all 112 residents residing in the facility and their visitors who may wish to view the information.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure assessed and/or care-planned interventions for pressure ulcer care were implemented for 1 of 3 residents (R3) reviewed for heel pressure ulcers, who were at risk for additional, and/or worsened, pressure ulcers.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure comprehensive assessments were consistently completed, provide and implement interventions to prevent recurrent pressure ulcers (PU) for 1 of 1 residents (R13) who had a history of facility acquired stage 3 pressure ulcers. The facility's failures resulted in actual harm when R13 developed a recurrent pressure ulcer to the right heel.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a dignified living experience was maintained for 2 of 3 residents (R1 and R13) reviewed for dignity.

Inspectors wroteBased on observation, interview, and record review the facility failed to develop and implement the toileting care plan for 1 of 2 residents (R13) reviewed for toileting.

Inspectors wroteBased on observation, interview, and document review the facility failed to use mechanical standing lifts in accordance with manufacturer recommendations for 2 of 3 residents (R1, R13) reviewed for accidents. Additionally, failed to ensure the wander-guard system was operational to prevent elopement for 3 of 4 residents (R9, R14, R12) reviewed for elopement.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure foods stored in the refrigerator were labeled and dated when opened. These failures had the potential to affect all 109 residents in the facility who consumed food from the kitchen.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to follow physician's orders for 2 of 2 Residents (R41 and R73) reviewed for nutrition. The facility failed to obtain and document weights for both residents according to the physician's orders.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure two of two residents (Resident (R)53 and R73) who were unable to carry out activities of daily living (ADLs) received the necessary services to maintain good personal hygiene out of a total sample of 50 residents. Based on observation, interview and record review, the facility failed to provide necessary care for 2 of 2 residents (R53 and R73) reviewed for dependant for assistance with activities of daily living (ADL).

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure respiratory equipment was maintained and stored appropriately for 1 of 1 residents (R53) reviewed for respiratory care. The facility's deficient practice increased the resident's risk of respiratory complications.

Inspectors wroteBased on interview and record review the facility failed to ensure staff had competency in skills and techniques necessary to care for residents. There were no continuing on-going education credits since 02/02/22 or competency evaluations available for review for 1 of 5 employees (registered nurse (RN-B)) reviewed for training competencies.

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish a system of records of receipt and disposition of all controlled medications, for 1 of 4 nursing units. This failure prohibits the prompt identification of loss or potential diversion of controlled medications.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure a medication error rate of less than five percent. A total of 14 errors were made during medication administration for 2 of 5 residents (R40 and R77) observed for medication administration. The facility's medication error rate was 56%.