Arrowhead Senior Living Community

Inspectors wroteBased on observation, interview, and record review, facility staff failed to follow appropriate infection control practices during perineal care for one resident (Resident #39) out of 18 sampled residents and during wound care for three residents (Resident #27, #28 and #1) of four sampled residents with wounds. Facility staff also failed to develop and implement complete policies and procedures for the inspection, testing and maintenance of the facility's water systems to inhibit the growth of waterborne pathogens and reduce the risk of an outbreak of Legionnaire's Disease, a serious type of pneumonia (lung infection) caused by Legionella bacteria. This failure has the potential for the failure of staff to identify and mitigate the presence of waterborne pathogens, which places all residents of the facility at risk of exposure which could lead to illness. The facility census was 51. 1. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to ensure two residents (Resident #1 and #39) out of four sampled residents with wounds, received the necessary treatment and services in accordance with professional standards when staff failed to ensure pressure wounds were identified, assessed appropriately and provided adequate pressure relief. The facility census was 51. 1. Review of the National Pressure Injury Advisory Panels (NPIAP) definitions of staging showed: -Stage 1 Pressure Injury: Non-blanchable erythema of intact skin Intact skin with a localized area of non-blanchable erythema. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury. -Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis Partial-thickness loss of skin with exposed dermis. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to obtain physician orders for oxygen use for three residents (Resident #1, Resident #2, and Resident #3) out of three sampled residents. The facility census was 54. 1. Review of the facility's Oxygen Safety and Management policy, dated 03/22/2019, showed oxygen will be provided to residents based on their physicians' orders. Physician orders for oxygen use should include the rate of oxygen flow, the route of administration, and frequency of administration. Review of the facility's standing oxygen order showed the Medical Director is responsible to provide standing orders, and if oxygen is less than 90% staff is to administer oxygen at two to five liters per minute via nasal cannula. May titrate oxygen to maintain oxygen at greater than or equal to 90%. 2. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to reconcile narcotics at the change of shift when the medication cart changed from one staff member to another, and to ensure medications were secured. The facility census was 46. 1. Review of the facility's policy titled Controlled Medication Storage, dated 01/2021, showed the Director of Nursing (DON) and the consultant pharmacist maintain facility compliance with handling of controlled mediations. The medication nurse on duty maintains possession of the key to the controlled medication storage areas. There should be a system of medications records that enables accurate reconciliation and accounting of controlled medications. At change of custody, a physical inventory of all controlled medications is conducted and documented by two licensed staff. 2. [...]

Inspectors wroteBased on interview and record review, facility staff failed to follow their policy as directed to check the Certified Nurse Assistant (CNA) Registry for all staff to ensure they did not have a Federal Indicator (a marker given by the federal government to individuals who have committed abuse and/or neglect) for two of six sampled employees (Licensed Practical Nurse (LPN) C and The Infection Preventionist) as directed in their policy. The facility census was 38. 1. Review of the facility's policy, titled Abuse, Neglect, Exploitation, undated, showed staff were directed to conduct employee reference checks and perform Certified Nursing Assistant CNA and Certified Medication Aide (CMA) registry, licensing board, and state approved background checks. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to accurately complete entrapment assessments and obtain physician orders for bed rails for four residents (Resident #5, #28, #30 and #32). The facility census was 38. 1. Review of the facility's Bed Mobility Device, revised November 28, 2017, directed staff as follows: -All residents will be evaluated for the need for bed mobility devices; -The bed mobility device assessment will be completed on admission, readmission, quarterly and with a significant change in status. The assessment form will be completed prior to utilization of any such device, including: short side rails containing bed control, bed cane, transfer pole, trapeze, other adaptive equipment utilized to aid in repositioning. 2. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the arbitration agreement was explained to two residents (Resident #9, and #29) and/or to their representative in a form and manner that he/she understood. The census was 38. 1. Review of the facility's policies showed staff did not provide a policy for Arbitration Agreements. Review of the facility's admission Agreement showed page 8 the Arbitration Agreement as a single paragraph that did not contain a place to decline, or agree to the arbitration. Further review showed there was one signature page at the end of the agreement used to sign for everything listed in the admission agreement. 2. Review of the Resident's #9's Quarterly Minimum Data Set (MDS), a federally mandated assessment tool completed by facility staff, dated 08/24/23 showed the resident was cognitively intact. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to document collaboration of care with hospice providers for development and implementation of a coordinated plan of care and communication between the facility and their two hospice providers for two out of three residents (Resident #27, and #31) receiving Hospice services. The facility census was 38. 1. Review of the facility's Hospice Services Agreement, undated, showed: -Plan of Care. Hospice will collaborate with Facility on a coordinated Plan of Care developed jointly between Hospice and Facility. -Resident Chart. Facility and Hospice will prepare and maintain complete medical records for Hospice Patients receiving Facility services in accordance with this Agreement and will include all treatments, progress notes, authorizations, physician orders and other pertinent information. [...]