Aperion Care Midlothian

Inspectors wroteBased on observation, interview and record review, the facility failed to protect a resident's right to be free from physical abuse by a staff member. This failure affected one (R1) of three residents reviewed for abuse. R1 sustained redness and bruising on his left eye after he was hit by staff while providing care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to make water available for residents in between meals to maintain residents' hydration and failed to make water pitchers available for residents. These failures affected five residents R2, R9, R10, R11, and R12, reviewed for water availability in between meals. On 5/11/26 between 11:45am and 12pm, during observation of residents on the units with V14(CNA/Certified nurse assistant), and later with 15(CNA), and V16(LPN/Licensed Practical Nurse Supervisor), several residents including R2, R9, R10, R11, and R12, were observed without water or water pitchers at the bedside. Other residents were observed with empty water pitchers. The Surveyor asked V14(CNA/Certified nurse assistant) why residents did not have any water pitchers or water available at their bedside to drink when needed before lunch is served. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents' bed frames have functioning manual lift mechanism to raise or lower the bed and failed to ensure that a resident's electric bed was in good repair. These failures affected five residents, R3, R4, R5, R6, and R7, reviewed for functional beds that was in good repair.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow the medical patient rights act which requires staff members to wear a visible name badge that discloses the employee's first name, licensure status, if any, and staff position of the person examining or treating the patient or resident. This has the potential to affect all 43 residents residing on Unit 1 at the facility.

Inspectors wroteBased upon observation, interview, and record review the facility failed to ensure that sufficient nursing staff were available to meet the needs for 36 of 40 dependent residents (R2, -R6, R10, R12, R18, R20, R21, R28, R29, R32, R33, R34, R36, R38 - R40, R44, R51, R54, R56 - R59, R61, R67, R68, R74, R75, R80 - R82, R85, R96) in the sample reviewed for staffing.

Inspectors wroteBased upon observation, interview, and record review the facility failed to follow policy procedures, failed to ensure that IV (Intravenous) medication was labeled properly, failed to ensure that medication rooms are locked, failed to ensure that medication refrigerators are maintained within the required range, and failed to store refrigerated medications at required temperatures. These failures have the potential to affect 87 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the outside dumpster was closed. These failures have the potential to affect all 87 residents residing at the facility.

Inspectors wroteBased upon observation, interview, and record review the facility failed to follow policy procedures, failed to implement care plan interventions, and/or failed to ensure that ADL (Activities of Daily Living) care was provided to four of forty dependent residents (R3, R4, R6, R59) in the sample.

Inspectors wroteBased upon observation, interview, and record review the facility failed to ensure that (R4's) IVPB (Intravenous Piggyback) was infusing at the correct rate and failed to ensure that prescribed medications were administered within regulatory requirements for 32 of 40 residents (R2, R3, R4, R5, R10, R18, R20, R21, R28, R29, R32, R33, R34, R36, R38, R39, R40, R44, R51, R54, R56, R57, R58, R59, R61, R67, R68, R74, R75, R81, R82, R85) in the sample. These failures have the potential to affect 87 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to conduct hand hygiene prior to passing meal trays , and before providing meal time assistance. This affected 4 residents (R12, R22, R72 and R76) reviewed for hand hygiene in the sample of 40 residents.

Inspectors wroteBased on interview and record review, the facility failed to refer residents with possible serious mental disorders for Screening and Resident Review to the appropriate state-designated authority for further assessment as required. This failure affects 2 residents (R5 and R79) reviewed for pre-admission screening in the sample list of 54 residents.

Inspectors wroteBased on interview and record review, the facility failed to have a pain management care plan with resident's goals and preferences for two residents who receive pain medications (R20 and R59) reviewed for care planning in a sample of 54 residents.

Inspectors wroteBased upon observation, interview, and record review the facility failed to ensure they (facility) have a LALM (Low Air Loss Mattress) policy, failed to ensure that staff are aware of required LALM settings, failed to ensure that LALM settings were correct, and/or failed to ensure that the LALM was used correctly for three of 40 residents (R2, R4, R6) in the sample.

Inspectors wroteBased upon observation, interview, and record review the facility failed to ensure that residents are assessed properly for restorative care needs, failed to ensure that residents are assessed properly for restorative device needs, failed to ensure that required restorative care was provided to (R44, R67) as directed and failed to provide restorative devices to two of 40 residents (R59, R67) in the sample.

Inspectors wroteBased upon observation, interview, and record review the facility failed to implement required care plan interventions and failed to provide a urinary catheter leg strap to prevent tension/trauma for one of 40 residents (R4) in the sample reviewed indwelling urinary catheters.

Inspectors wroteBased upon observation, interview, and record review the facility failed to follow physician orders, failed to ensure that enteral feed orders include required total volume with start/stop times, and failed to ensure that one of 40 residents (R6) in the sample received prescribed enteral nutrition.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure the oxygen humidifier was changed weekly and failed to label with date the nasal canula and failed to contain respiratory equipment for a resident. This affected one of forty (R7) residents reviewed for Respiratory care.

Inspectors wroteBased upon observation, interview, and record review the facility failed to follow policy procedures, failed to re-order prescribed medications, and failed to ensure that prescribed medications were available for one of four residents (R12) reviewed for medication administration.

Inspectors wroteBased upon observation, interview, and record review the facility failed to follow policy procedures, failed to ensure that prescribed medications were available, and failed to ensure that extended-release medications were not crushed therefore failed to maintain a medication error rate below 5%. There were 6 medication errors out of 25 opportunities, resulting in a 24% medication error rate. Three of four residents (R12, R80, R96) in the medication administration sample were affected.

Inspectors wroteBased upon observation, interview, and record review the facility failed to follow policy procedures and failed to ensure residents were free from a significant medication error. This affected three of four residents (R12, R80, R96) reviewed for medication.

Inspectors wroteBased upon observation, interview, and record review the facility failed to follow policy procedures and failed to ensure that dental services for abnormalities of the teeth were provided to one of 40 residents (R67) reviewed for dental care.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure food was stored in a manner that will prevent foodborne illness to the residents. This deficiency has the potential to affect 65 residents receiving food from the kitchen.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure privacy was maintained while obtaining a blood glucose monitor and administering an insulin injection for 1 of 1 resident (R39) reviewed for privacy in a sample of 18.

Inspectors wroteBased on interview and record review, the facility failed to document a significant change in condition for one (R85) of three hospice residents reviewed for significant change in condition in a sample of 18.

Inspectors wroteBased on interview and record review, the facility failed to have a treatment order in place and failed to perform dressing changes to the sacral wound for seven days. This affected one of three residents (R1) reviewed for wound care in a total sample of six. This failure resulted in the sacral wound deteriorating by becoming larger in size, and R1 being diagnosed with osteomyelitis of the sacral wound after being hospitalized for an elevated white blood cell count indicating an infection. Findings Include: R1 is an [AGE] year old with the following diagnosis: adult failure to thrive, dementia, cerebral infarction, type 2 diabetes, stage 4 pressure ulcer of the sacral region, pressure induced deep tissue damage of the left and right heel, stage 3 pressure ulcer of the right upper back, and osteomyelitis of the sacral region. [...]

Inspectors wroteBased on interview and record review the facility failed to prevent and protect a resident with a diagnosis of dementia from physical and verbal abuse by facility staff. This affected one of three residents (R2) reviewed for abuse. This failure resulted in R2 being yanked and tugged by V4 (certified nursing aide) and V4 telling R2, I'm not doing this with you, you're getting on my f****** nerves. Using the reasonable person concept may have resulted in R2 being fearful and displaying anxiety around facility staff.

Inspectors wroteBased on interview and record review, the facility failed to follow their abuse policy by taking a resident's personal food item and sharing with other resident without the resident's consent. This affected one of three (R1) residents reviewed for misappropriation of property.

Inspectors wroteBased on interview and record review, the facility failed to follow their abuse policy by not immediately reporting an allegation of abuse for one resident (R2) for one of ten residents reviewed for abuse.

Inspectors wroteBased on observation, interview and record review the facility failed to review and updated resident's care plan after fall and elopement incidents. This deficiency affects two ( R10 and R67) of three residents in the sample of 22 reviewed for Comprehensive care plan.

Inspectors wroteBased on observation, interview and record review the facility failed to implement its policy on fall prevention and risk for elopement management by failure to provide adequate supervision and monitoring to residents who are at high risk for falls and at high-risk elopement . This deficiency affects all three (R10 , R52 and R67) residents in the sample of 22 reviewed for Resident Safety.

Inspectors wroteBased on observation, interview and record review the facility failed to follow physician order and implement care plan intervention of individual psychotherapy to residents who has diagnosis of psychiatric diagnosis. This deficiency affects all three (R4, R10 and R67) residents in the sample of 22 reviewed for Behavioral Health Services.

Inspectors wroteBased on observation, interview and record review the facility failed to implement infection control protocol by failure to wear gloves when emptying urinal and removing gloves and perform handwashing after emptying urinal. This deficiency affects two (R16 and R72) of three residents in the sample of 22 reviewed for Infection control.