Arlington Rehabilitation & Healthcare Center

Inspectors wroteBased on interviews, record review, and the facility's policy titled Behavior Management Program the facility failed to ensure staff implemented Resident Identifier (RI) #3's behavioral care plan approaches. RI #3 had care planned behaviors of being combative and resisting care with an approach to leave the resident alone and return later when the resident resisted care. On 03/31/2023 staff continued to provide care to RI #3 after staff observed the resident was agitated and the resident asked to be left alone. This deficient practice affected RI #3, one of 12 sampled residents whose plan of care was reviewed.

Inspectors wroteBased on interview, record review and review of the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) 3.0 User's Manual, the facility failed to accurately code the resident's status on the completed Minimum Data Set (MDS) Assessment for three (3) residents (Resident #21, #25 and #94) out of 21 sampled residents.

Inspectors wroteBased on interview, record review and facility policy review, the facility failed to accurately document the code status of two (2) out of 24 sampled residents (Resident #17 and #94). The facility failed to properly transcribe the correct code status of Resident #17 and #94 to the Physician's Order.

Inspectors wroteBased on observation, interview, record review and review of a facility policy titled, Resident Privacy, the facility failed to ensure Resident Identifier (RI) #147's Foley catheter bag was in a privacy bag and not visible from the hallway on 03/21/19. This deficient practice affected RI #147, one of two residents sampled with a Foley catheter. Findings Include: A facility policy titled, Resident Privacy, dated 12/04, revealed the following: It is the policy of Ball HealthCare Services, Inc. (BHS) . that all residents have the right to personal privacy, including privacy in . medical treatment . RI #147 was admitted to the facility on [DATE] with diagnoses to include Hypertension and Pressure Ulcer of Sacral Region, Unspecified Stage. On 03/21/19 at 9:11 a.m., the surveyor observed RI #147's Foley catheter bag did not have a covering and could be seen from the hallway. [...]

Inspectors wroteBased on observations, interview and record review, the facility failed to ensure Resident Identifier (RI) #146 had a Physician's Order for the use of Oxygen and suctioning. RI #146 was observed utilizing Oxygen at 2 liters via (by way of) nasal cannula and having suction set up at the bedside on three of four days of the survey. This deficient practice affected RI #146, one of 37 sampled residents whose Physician Orders were reviewed. Findings Include: RI #146 was admitted to the facility on [DATE], with a diagnoses of Personal History of Recurrent Pneumonia. RI #146's Problem/Need care plan titled, (RI #1) is at risk for difficulty breathing related to HX (history) of Pneumonia and diagnosis Asthma with a Problem Onset date of 03/07/19, revealed the following approaches: . * O2 (Oxygen) per NC (Nasal Cannula) as ordered *Suction as ordered . [...]

Inspectors wroteBased on observations, interview and record review, the facility failed to ensure Resident Identifier (RI) #146's suction machine and Yankauer (oral suctioning tool) were covered while not in use on three of four days of the survey. This deficient practice affected RI #146, one of three residents sampled requiring suctioning. Findings Include: RI #146 was admitted to the facility on [DATE], with a diagnoses of Personal History of Recurrent Pneumonia. On 03/19/19 at 2:27 p.m., the surveyor observed a suction machine on top of RI #146's dresser. A Yankauer, which was connected to the suction machine was observed to be lying on the inside of the dresser drawer. Neither the suction machine nor Yankauer were in a covering. On 03/20/19 at 9:23 a.m., RI #146's suction machine and Yankauer, which remained on the insider of the dresser drawer, remained uncovered. [...]

Inspectors wroteBased on observation, interview, the 2013 Food Code, and the facility's policy on Waste Disposal, the facility failed to ensure the area around the outside oil refuse receptacle was free from food related garbage and trash, so as to discourage attracting vermin. This had the potential to affect all residents in the facility, 109 of 109 residents. Findings Include: 2013 Food Code by the United States Public Health Service and Food and Drug Administration documented the following: . 5-501.15 Outside Receptacles. (B) Receptacles and waste handling units for REFUSE . shall be installed so that accumulation of debris and insect and rodent attraction and harborage are minimized and effective cleaning is facilitated around and . under the unit. 5-501.115 Maintaining Refuse Areas and Enclosures. A storage area . for REFUSE . shall be maintained free of unnecessary items, as specified under . [...]

Inspectors wroteBased on observation, interview, medical record review and review of a facility policy titled, Resident Privacy, the facility failed to ensure licensed staff provided privacy during suctioning and Tracheostomy care for Resident Identifier (RI) #89. This deficient practice affected RI #89, one of one resident observed during Tracheostomy care. Findings Include: A review of a facility policy titled, Resident Privacy, revealed: It is the policy .that all residents have the right to personal privacy, including privacy in accommodations, medical treatment . RI #89 was admitted to the facility on [DATE] with diagnoses including, Respiratory Failure Unspecified With Hypoxia or Hypercapnia and Tracheostomy Status. On 03/15/18 at 10:45 a.m., Employee Identifier (EI) #2, a Respiratory Therapist, was observed suctioning and providing Tracheostomy care for RI #89. [...]

Inspectors wroteBased on interview, medical record review, and review of facility documents titled, ADMINISTRATIVE POLICY, the facility failed to ensure a care plan was developed for the use of a psychoactive medication for Resident Identifier (RI) #16. This deficient practice affected one of 28 residents reviewed for care plans. Findings Include: A review of a facility document titled, ADMINISTRATIVE POLICY with a revised date of 09/2009, revealed: SUBJECT: Care Plans PURPOSE: Plans of Care are developed . to coordinate and communicate the plan of care for the resident. A review of a facility document titled, ADMINISTRATIVE POLICY with a revised date of 02/2013, revealed: SUBJECT: Psychoactive Medications . PROCESS: I. Unnecessary Drugs . (f)Nursing service, social service and other members of the interdisciplinary team will address behavior symptoms . in the plan of care . [...]

Inspectors wroteBased on observation, interview, medical record review, review of a facility policy titled, Oral and Nasal Inhalation Administration and Fundamentals of Nursing the facility failed to ensure: 1.) a Licensed Nurse remained with Resident Identifier (RI) #53 during administration of a nebulizer treatment, and 2.) Licensed Nurses followed physician's orders for flushes between medications for Resident Identifier (RI) #3 and RI #25. These deficient practices affected RI #53, RI #3 and RI #25, three of eight residents and three of seven nurses observed during medication administration observation. Findings Include: A review of a facility policy titled, Oral and Nasal Inhalation Administration, dated 8-2007 revealed: PURPOSE: To administer oral, nasal and aerosol inhalation medications in a safe and accurate manner. .III. Aerosol/Hand Held/Mask Nebulizer Therapy .d. [...]

Inspectors wroteBased on observations, interviews, medical record reviews and review of a facility document titled, Standard Precautions, the facility failed to ensure licensed staff: 1. changed gloves after gastrostomy tube medication administration for Resident Identifier (RI) #3 before rinsing, drying and storing RI #3's syringe, 2. did not manipulate a paper towel dispenser lever while wearing gloves during RI #3's medication administration, and 3. rinsed and dried both pieces of RI #25's piston syringe before storing them in a plastic bag, These deficient practices affected RI #3 and RI #25, two of eight residents and two of seven nurses observed during medication pass observations. Findings Include: A review of a facility document titled, Standard Precautions revised 12/2009 revealed: [...]