Apple Rehab Clipper

Inspectors wroteBased on clinical record review and staff interview, the facility failed to inform the resident's appointed representative, in advance, of the care to be furnished by the physician or other provider, of the risks and benefits of proposed care or treatment alternatives relative to the ordering of, and administration of, antipsychotic medications for 2 of 5 residents reviewed, Resident ID #s 25 and 35.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to develop and implement a baseline care plan for each resident within 48 hours of a resident's admission, that includes the instructions needed to provide effective and person-centered care, including initial goals based on admission orders, for 1 of 1 resident reviewed who was newly admitted to the facility with a Prevena wound vac (a portable, disposable negative pressure therapy system designed to protect and manage surgical incisions by applying continuous suction to promote healing and reduce complications), Resident ID #54.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to meet professional standards of practice for 1 of 1 resident reviewed with a midline catheter (a type of intravenous catheter inserted into a vein in the upper arm often used to deliver antibiotics), Resident ID #59.

Inspectors wroteBased on clinical record review, surveyor observation and staff interview, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment, and to help prevent the development and transmission of communicable diseases and infections, relative to enhanced barrier precautions (EBP; refers to an infection control intervention designed to reduce transmission of multidrug-resistant organisms [MDRO] that employs targeted gown and glove use during high contact resident care activities), for 1 of 1 resident reviewed with a Prevena wound vac (a portable, disposable negative pressure therapy system designed to protect and manage surgical incisions by applying continuous suction to promote healing and reduce complications), Resident ID #54.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure the medical care of each resident is supervised by a physician, relative to the providers failure to reconcile the resident's post and pre hospitalization orders relative to the administration of Aranesp (a medication prescribed to treat anemia caused by chronic kidney disease), for 1 of 1 resident reviewed, Resident ID #3.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents are free of any significant medication errors for 2 of 5 residents reviewed for medication administration, Resident ID #s 3 and 5. Based on record review and staff interview, it has been determined that the facility failed to ensure that residents are free of any significant medication errors for 2 of 5 residents reviewed for medication administration, Resident ID #s 3 and 5.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that a resident with a nephrostomy receives care, consistent with professional standards of practice relative to physician's orders, for 1 of 1 resident who has a percutaneous nephrostomy tube (PCN- an artificial opening created between the kidney and the skin which allows for urinary drainage), Resident ID #4.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to provide a dietary menu that meets the nutritional needs of residents in accordance with established national guidelines.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure that food is stored and distributed in accordance with professional standards for food service safety, relative to the main kitchen and 2 of 2 units observed during meal service.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that a resident with a pressure ulcer (localized damage to the skin and/or underlying soft tissue, usually over a bony prominence) receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing for 1 of 2 residents reviewed with wounds, Resident ID #31.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to maintain acceptable parameters of nutritional status, such as usual body weight, for 2 of 6 resident reviewed, who experienced actual weight loss, Resident ID #s 17 and 23. Additionally, the facility failed to follow it's own policy relative to weight monitoring, for 3 of 6 residents reviewed, Resident ID #s 17, 22, and 23.

Inspectors wroteBased on surveyor observation and staff interview, it has been determined that the facility failed to store and label drugs and biologicals in accordance with currently accepted professional principles for 2 of 2 medication carts observed.

Inspectors wroteBased on record review, and resident and staff interviews, it has been determined that the facility failed to obtain written authorization for residents whom the facility is holding personal funds for 2 of 5 residents reviewed, Resident ID #s 4 and 12.

Inspectors wroteBased on surveyor observation, record review and staff interview, it has been determined that the facility failed to maintain acceptable parameters of nutritional status, such as usual body weight and weight monitoring for 7 of 8 residents reviewed, Resident ID #s 4, 10, 12, 17, 38, 41 and 44.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to complete an annual performance review for every nurse aide (nursing assistant), at least once every 12 months, for 3 of 3 nursing assistants personnel records reviewed, Staff F, G, and H.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to provide appropriate treatment and services for 1 of 2 residents reviewed with an indwelling catheter (a flexible tube that collects urine from the bladder and empties the urine into a drainage bag), Resident ID #4.

Inspectors wroteBased on surveyor observation, record review, and staff interview it has been determined that the facility failed to implement a comprehensive person-centered care plan for each resident to meet a resident's medical and nursing needs that are identified in the comprehensive assessment for 1 of 1 resident reviewed with lower leg edema (swelling), Resident ID #38.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents receive treatment and services in accordance with professional standards of practice, relative to following physician's orders for weekly body audits for 1 of 7 residents reviewed, Resident ID #12.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that the irregularities identified by the Clinical Consultant Pharmacist during the monthly pharmacist Medication Regimen Review (MRR) were acted upon for 2 of 2 residents reviewed, Resident ID #s 10 and 12.

Inspectors wroteBased on surveyor observation and staff interview, it has been determined that the facility failed to store drugs and biologicals in accordance with currently accepted professional principles for 1 of 1 medication room observed.

Inspectors wroteBased on surveyor observation, record review and staff interview, it has been determined that the facility failed to provide a safe and sanitary environment to help prevent the transmission of infections related to disinfecting blood glucose meters (a device used to monitor blood glucose) for 1 of 1 resident observed, Resident ID #28. Additionally, the facility failed to help prevent the transmission of infections related to Enhanced Barrier Precautions (EBP) (an infection control intervention designed to reduce transmission of multidrug-resistant organisms in nursing homes) for 4 of 5 residents reviewed, Resident ID #'s 4, 12, 46, and 152.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to include a part of Quality Assurance Performance Improvement (QAPI) mandatory training, which outlines and informs staff of the elements and goals of the facility's QAPI program for all staff.

Inspectors wroteBased on record review and resident and staff interviews, it has been determined that the facility failed to protect a resident's right to be free from physical and psychological abuse for 3 of 3 residents reviewed for staff to resident abuse, Resident ID #s 1, 2, and 3.

Inspectors wroteBased on record review and resident and staff interviews, it has been determined that the facility failed to ensure that all alleged violations involving abuse are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse, or no later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to other officials (Rhode Island Department of Health-RIDOH) in accordance with State law for 3 of 3 residents reviewed for abuse, Resident ID #s 1, 2, and 3.