Apple Valley Village Health Care Center

Inspectors wroteBased on interview and document review, the facility failed to ensure a physician order was processed timely for 1 of 3 residents (R1) who was ordered scheduled tube feeding free water flushes to mitigate the risk of dehydration. This resulted in R1 not being administered these flushes for approximately 48 hours.

Inspectors wroteBased on interview and document review, the facility failed to ensure appropriate side effect monitoring for potential orthostatic hypotension (sudden drop in blood pressure what occurs when a person stands up after sitting or lying down) was completed for 1 of 5 residents (R79) reviewed for unnecessary medication use and who consumed antipsychotic medication.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure activities of interest were consistently offered, provided and documented within the medical record to support ongoing engagement and continuity of care for 2 of 2 residents (R58, R321) reviewed for activities and who resided on the transitional care unit (i.e., TCU).

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure non-pressure related wounds were monitored for signs and symptoms of infection and healing until resolved for 1 of 1 resident (R16) reviewed for skin concerns.

Inspectors wroteBased on observation, interview and document review, the facility failed to effectively communicate with a dialysis center and failed to provide care consistent with professional standards of practice for 1 of 2 residents (R98) reviewed for dialysis.

Inspectors wroteBased on interview and document review, the facility failed to ensure a resident/ resident representative's voiced grievances, were tracked through the facility-established grievance process, and the resident representative was updated on the resolution of the grievance for 1 of 1 residents (R55) who had reported missing clothing items and care concerns.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure routine grooming and personal hygiene care (i.e., nail care) was provided for 1 of 3 residents (R60) reviewed for activities of daily living (ADLs) and who was dependent on staff for such care.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure a developed skin condition was comprehensively assessed and, if needed, acted upon or monitored to ensure healing for 1 of 1 resident (R141) reviewed who had large areas of dry, flaking skin present on their leg.

Inspectors wroteBased on observation, interview, and document review, the facility failed to consistently implement a restorative nursing program (RNP) to prevent a possible decrease in mobility for 1 of 1 residents (R52) reviewed for range of motion.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure an appropriate medical justification was documented for an indwelling catheter and failed to attempt a trial discontinuation without medical justification for continued use for 1 of 1 resident (R35) reviewed for catheter use.

Inspectors wroteBased on interview and document review, the facility failed to assess and reassess what, if any, non-pharmacological pain interventions would be helpful and accepted by 1 of 1 resident (R95) to supplement medication management of chronic pain continually rated severe and described as frequently interfering with sleep and daily activities.

Inspectors wroteBased on interview and document review, the facility failed to ensure identified dental concerns (i.e., loose dentures, need for appointment) were acted upon and, if needed, referred to the appropriate resource in a timely manner for 2 of 2 residents (R106, R65) reviewed who voiced dental complaints during the survey.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure symptoms of respiratory impairment and potential infection were assessed and acted upon for 1 of 1 residents (R44); failed to ensure combative behaviors with personal, intimate care (i.e., pericare) were assessed and, if able, interventions developed to provide comfort during such care for 1 of 1 resident (R77); and failed to ensure interventions to reduce or control developed edema were implemented or re-evaluated for 2 of 2 residents (R44, R31) observed with lower extremity edema.

Inspectors wroteR101's quarterly MDS dated [DATE], indicated R101 was cognitively intact and required extensive assistance with bed mobility, transfers, dressing, toileting and personal hygiene. R101 was non ambulatory and had no locomotion on or off the unit during the look back period. The MDS further indicated R101 had several medical diagnoses including arthritis due to bacteria of the left hip, osteoarthritis of bilateral knees, depression, and stage III pressure injury to left buttock. R101's orders dated 8/2/23, indicated R101 had an order for Lidocaine 2% gel to wounds twice daily prior to wound care. R101's MAR for the month of August indicated an order for lidocaine 2% gel to wound prior to wound care. However, the lidocaine gel had not been administered since the order was received on 8/2/23. [...]

Inspectors wroteBased on interview and record review the facility failed to provide 1 of 1 resident (R343) with timely toileting care to promote a dignified toileting experience.

Inspectors wroteBased on observation, interview, and document review the facility failed to ensure call lights were accessible for 2 of 3 residents (R26, R31). In addition, the facility failed to ensure an electric wheelchair was charged each night to ensure the highest level of independence for 1 of 1 residents (R31).

Inspectors wroteBased on observation, interview, and document review, the facility failed to provide a clean homelike environment for 1 of 1 residents (R63) whose bed linens were soiled.

Inspectors wroteBased on interview and document review, the facility failed to ensure an allegation of resident-to-resident abuse was thoroughly investigated to provide continued protection for 2 of 2 residents (R61, R338) involved in a resident-to-resident altercation.

Inspectors wroteBased on observation, interview and document review, the facility failed to provide routine bathing and hair washing to 1 of 1 residents (R101) reviewed for activities of daily living (ADLs).

Inspectors wroteBased on observation, interview and record review the facility failed to comprehensively reassess a resident for a bowel program while bed bound to ensure continence status was maintained for 1 of 1 residents (R101) reviewed for bowel and bladder status.

Inspectors wroteBased on observation, interview, and document review the facility failed to ensure staff provided cares according to standards of practice and per physician orders for gastrostomy tube for 1 of 1 residents (R96) reviewed for tube feedings.