Astoria Place Living & Rehab

Inspectors wroteBased on interview and record review the facility failed to promote wound healing in one resident (R3); failed to follow their policy to prevent new pressure ulcers from developing in two residents (R1 and R3) and failed to document skin monitoring and/or frequency to observe for skin impairments. This failure resulted in R1 and R3 developing new unstageable pressure ulcers.

Inspectors wroteBased on observation, interview, and record review the facility failed to practice infection control measures during a wound care dressing change on a resident. This failure affected 1 (R2) of 3 residents reviewed for wound care.

Inspectors wroteBased on interview and record review, the facility failed to implement their abuse prohibition policy by failing to immediately report an allegation of staff to resident sexual abuse to the abuse the coordinator. The facility also failed to report suspicion of a crime to local law enforcement. These failures affect 1 resident (R1) of 5 reviewed for abuse.

Inspectors wroteBased on interview and record review the facility failed to ensure that a resident's medications were documented as administered, as ordered by the physician. This failure affects one resident (R1) out of three residents reviewed for quality of care.

Inspectors wroteBased on interview and record review, the facility failed to provide pain management in accordance with the resident's comprehensive care plan, the resident's goals for care and preferences. This failure affects one (R1) resident of four residents reviewed for pain in the sample of seven.

Inspectors wroteBased upon observation, interview, and record review the facility failed to follow facility polices and procedures, failed to ensure that residents are assessed for signs/symptoms of pain, failed to obtain physician orders, failed to follow physician orders, and failed to ensure that physician orders are transcribed on the MAR (Medication Administration Record). The facility also failed to administer pain medication timely to three of four residents (R1,R2, R4) reviewed for pain. These failures resulted in R2 crying due to experiencing excruciating pain.

Inspectors wroteBased upon interview and record review the facility failed to follow policy procedures, failed to ensure that floor stock medication was available, failed to ensure that floor stock medication was transcribed on the MAR (Medication Administration Record), failed to ensure that prescribed medication was transcribed correctly, and/or failed to administer medication as ordered for four of four residents (R1, R2, R3, R4) reviewed for medication administration.

Inspectors wroteBased on interviews and record review, the facility failed to ensure the safety of one resident (R3) as two Certified Nurse Assistants prepared to transfer resident from chair to bed. This failure resulted in R3 falling and sustaining a laceration to the forehead requiring hospitalization and stitches.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure prepared foods stored in the walk-in cooler were properly dated, labeled and discarded on the use by date. These failures have the potential to affect 154 residents in the facility who are receive an oral diet. Findings Include: On 11/19/24 at 9:08 AM during the initial kitchen tour in the kitchen with V23 (Cook), there was a food cart with trays of prepared foods such as ham sandwich, vanilla pudding, chocolate pudding, cups of fruits, and pitchers of lemonade. The prepared foods on the tray had no labels when they were prepared. The plastic cover covering the food cart had no label. V23 called V22 (Dietary Aide) and entered the main cooler. V22 stated that the plastic cover should have a date labeled when they were made to know when the food should be discarded. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to follow R95 and R110's care plans by not administering the ordered oxygen flow rates, label R40's oxygen tubing, store R86's oxygen tubing while not in use and have oxygen signage for R399 for five out of a total sample of 31 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to properly date opened multi-dose respiratory inhalers and nasal spray, failed to store unopened multi-dose eye drop solution and discard expired multi dose medications for 6 residents (R38, R58, R75, R103, R111, R125) from 3 of 6 medication carts reviewed for medication storage and labeling.

Inspectors wroteBased on observation, interview and record review the facility failed to follow their infection prevention and control policy by failing to don proper personal protective equipment, failing to handle soiled linen properly and failing to perform hand hygiene after handling soiled linen. These failures have the potential to affect all 45 residents residing on the one residental floor at the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide privacy and promote dignity for one of one resident [R105] reviewed for urinary catheter use on the sample list of 31.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a low air loss mattress device was on the correct weight setting for one dependent resident (R105) of two residents with pressure ulcers on a sample list of 31 residents. Findings Include: R105's clinical records show an admission date of 10/27/24 with included diagnoses not limited to Multiple Sclerosis and Stage 4 Pressure Ulcer. R105's physician orders read: Low Air Loss (LAL) Mattress ordered on 10/27/24. R105's skin care plan date initiated on 10/27/24 reads in part: R105 has a pressure injury on the sacral area with one intervention that reads, Check air mattress if functioning properly every shift and prn [as needed]. R105's weight shows 180 lbs dated 11/15/24. R105's Skin Risk assessment dated [DATE] shows a score of 10 (High Risk in developing a pressure ulcer). [...]

Inspectors wroteBased on observation, interview and record review the facility failed to distinguish between a behavior slide versus a fall, and failed to follow their fall occurrence policy for one [R119] resident reviewed for falls on the sample list of 31 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medication was administered and not left at bedside for 1 (R113) resident reviewed for medication administration in a sample of 31.

Inspectors wroteBased on interview and record review, the facility failed to affirm the rights of a resident to be free from abuse. This failure affects one (R1) of three residents reviewed for abuse. Findings Include: R1's electronic health records (EHR) documents R1 was initially admitted to the facility on [DATE] with listed diagnoses not limited to but including Unspecified Dementia, Alzheimer's Disease, Dysphagia, Moderate Protein Calorie Malnutrition, Anorexia, Chronic Kidney Disease Stage 4, Repeated Falls, Type 2 Diabetes Mellitus. R1 was admitted under hospice services on 05/04/23 for end-of-life support. R1's Minimum Data Set (MDS) dated [DATE] documents R1 has severely impaired cognition and requires substantial/maximal assistance with Activities of Daily Living (ADLs). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the lids on the outside dumpsters were closed and maintained in a sanitary condition to prevent the harborage and feeding of rodents and pests. This failure has the potential to affect all 150 residents in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that medications were secured in a locked medication and treatment cart which has the potential to affect 48 residents on the second floor and 52 residents on the third floor.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents have a quiet and home like environment while sleeping at night without being disturbed by loud noises from another resident. This failure affected 2 residents (R57 and R115), reviewed for resident's rights to enjoy a quiet homelike environment, in a total sample of 50 residents.

Inspectors wrote2. On 12/10/2023 at 11:36am, R198 was lying on a Low Air Loss (LAL) mattress. The setting of R198's LAL mattress observed at 230 pounds. On 12/10/2023 at 12:30 pm, this surveyor inquired with R198 about R198's weight. R198 stated, I (R198) weigh about 120 pounds. R198's admission Record documents, in part, R198's diagnoses including but not limited to: hypertension, hyperparathyroidism, chronic kidney disease, Hemiplegia and Hemiparesis. R198's Minimum Data Set (MDS), dated [DATE], documents, in part, R198's Brief Interview for Mental Status (BIMS) score is 09, which indicates R198 is moderately cognitively intact. R198's (printed date: 12/12/2023) Monthly Weight Report documented, in part December 114.0 lbs (pounds). R198's Patient Risk Profile, dated 12/07/2023, documents a Braden score of 13 which shows R198 is at moderate risk for developing a pressure ulcer injury. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the G-tube feeding was labeled for one resident (R103). This has the potential to affect all residents receiving enteral feeding on the 2nd floor.

Inspectors wroteBased on observation, interview and record review, the facility failed to label with date: the bag of intravenous (IV) fluids being infused, the IV site on the resident's left wrist, and the IV tubing, during administration of intravenous fluids to a resident. This failure affected one resident (R138), reviewed for IV fluids administration, in a total sample of 50 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that physician ordered oxygen therapy was provided to a resident which affected one resident (R21) in the sample of 50 residents when reviewed for oxygen therapy.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an accurate account of controlled substance record for two residents (R28 and R42) reviewed for controlled substance in a sample of 50 residents.

Inspectors wroteBased on observation, interview and record review the facility failed to properly log refrigerator temperatures for two residents (R 47 and R110); and failed to discard expired food from a resident (R110) refrigerator. These failures affected R47 and R110 in the sample of 50 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to serve meals with an appetizing temperature by providing food with temperatures below 135 degrees F for 2 residents (R37, R104) reviewed in a sample of 47. This deficient practice has the potential to affect all 135 who receive their meals from the kitchen. Finding Include: On 01/03/2022 at 11:08 am, R104 stated, The hot meals that we are served at lunch and dinner time are often cold. It's hard to eat the meal and enjoy it when it's cold. Many times, I could not eat and enjoy the meals because it's cold and not cooked properly. On several occasions when they served us broccoli at mealtimes, the tip of the broccoli was refrigerator cold, and I could not eat it. On 01/03/2022 at 11:11 am, R37 stated, The facility has a problem with serving warm meals. The lunch and dinner that we get are often served cold. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow their call light protocol to ensure dependent residents have accessibility to the call light at all times for four [R50, R70, R95, R100] of 4 residents reviewed for call lights in a sample of 28 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their policy on (a) controlled medication count for 1 resident (R16), (b) failed to securely store controlled medication for 1 resident (R8) and (C) failed to dispose expired medications in 2 of 3 medication carts reviewed. This deficiency has the potential of affecting all 90 residents residing on the 2nd and 4th floors.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow their infection control procedures during an outbreak of COVID-19 by not having the proper isolation signage outside of COVID-19 positive residents and performing proper hand hygiene when doffing gloves from a COVID-19 positive room for 4 (R13, R192, R99 and R129) of 7 residents reviewed for transmission-based precautions in a total sample of 28 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their policy on Self Medication Administration for 1 resident (R76) reviewed for self-medication administration in a sample of 28 residents reviewed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to change oxygen tubing and failed to properly label oxygen tubing for three residents (R57, R42, R129) reviewed for oxygen therapy in a sample of 28 residents.