Autumn Care of Portsmouth

Inspectors wroteBased on interviews, observations, facility document review, and policy review, the facility failed to honor the food choices for 11 of 98 facility residents (Resident (R) R5, R15, R94, R93, R103, R120, R84, R63, R49, R8, and R22). This failure had the potential to lead to dissatisfaction with meals, malnutrition or weight loss, or feelings of helplessness among resident whose preferences were not honored.

Inspectors wroteBased on interviews, record review and facility policy review, the facility failed to implement their abuse policy, and protect three out of 38 sampled residents, (Resident (R123) R112 and R111) from a resident-to-resident encounter. Encounters involved R123 & R122; R112 and R26, and R111 and R121. R123 expressed fear to staff and did not feel safe after R122 threatened R123 with physical violence. This resulted in the potential for mental harm for R123 and had the potential to affect other residents.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure allegations of resident-to-resident abuse involving four of six residents (Resident (R) 111, R121, R122, and R123) reviewed for abuse were reported to the State Agency (SA) within required time frames. The failure had the potential to allow potential abuse without recognition or regulatory follow-up to prevent recurrence.

Inspectors wroteBased on observations, facility document review, and policy review, the facility failed to ensure staff followed the menus for mechanical soft and puree diets for 14 residents who received these diet textures (five residents on puree diets and nine residents on mechanical soft diets) out of a census of 98. This failure placed those residents at risk of malnutrition, weight loss, or dissatisfaction with meals.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to follow infection control guidelines during the medication administration observation by touching pills prior to being administered to two of four residents (Resident (R)84 and R119) and failed to don appropriate personal protective equipment for two of four residents in transmission-based precautions (R50 and R63) out of 38 total sampled residents. These failures had the potential to expose R84, R119, R50, and R63 to infections in an already vulnerable population.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to provide written information on how to formulate an Advance Directive for one of five residents (Resident (R)30) reviewed for Advance Directives out of a total of 38 sampled residents. This failure has the potential for R30 not to be able to make her desires known if she was unable to speak for herself.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to implement their abuse policy and thoroughly investigate an allegation of resident-to-resident abuse for two of five residents (Resident (R) 122, R123) reviewed for abuse out of 38 sample residents. This had the potential to affect residents in the facility who were at risk for abuse.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure a written transfer notice that contained all required information and the bed hold notice was provided for one of seven residents (Resident (R) 74) and/or their responsible party (RP) reviewed for hospital transfer out of 38 sampled residents. This failure had the potential to result in the resident and their RP not having the knowledge of where and why a resident was transferred, the bed holds policy, and/or how to appeal the transfer, if desired.

Inspectors wroteBased on interviews and record review, the facility failed to ensure the Minimum Data Set (MDS) accurately reflected the status for two of 38 sampled residents (Resident (R) 34 and R76). Specifically, the MDS did not accurately assess presence of pressure ulcers for R34 and the use of oxygen for R76. These failures placed the residents at risk for unmet care needs related to pressure ulcers for R34 and oxygen for R76.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure that an accurate Preadmission Screening and Resident Review (PASARR) Level I assessment was completed for two residents (Resident (R) 102 and R9) out of 38 sampled residents. This had the potential to affect all residents who were admitted to the facility.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to develop a care plan for three of four residents (Resident (R) 64, R30, and R5) that included targeted behaviors for the use of anxiety medication out of a total sample of 38 residents. This failure had the potential for residents to experience adverse effects of an anxiety medication which was not specifically monitored.

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure timely review and revision of care plans for one resident (Resident (R) 42) of four reviewed for care plan revisions out of a total sample of 38 residents. The facility failed to ensure R42's care plan was updated to reflect the resident's current smoking status. Failure to ensure care plan accuracy had the potential for the residents who smoke to be at risks for accidents/hazards during smoke breaks by not reflecting accurate smoking assessments for all residents who smoke.

Inspectors wroteBased on interviews, record review, and review of facility policy, the facility failed to ensure staff maintained professional standards of practice by ensuring one resident (Resident (R) 122) was not administered crushed medications when there was not a clinical indication to do so.

Inspectors wroteBased on observations, record review, interviews, and policy review, the facility failed to administer oxygen in accordance with physician orders for two of four residents (Resident (R) 30 and R76) reviewed for oxygen therapy out of a total of 38 sampled residents. This failure had the potential for the residents not to receive the correct amount of oxygen causing hyperoxia (cells, tissues and organs are exposed to an excess supply of oxygen) or hypoxia (cells, tissues and organs are exposed to a decrease in oxygen).

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to ensure that staff followed physician orders and weighed (Resident #4) prior to and after dialysis for one of one resident reviewed for dialysis, out of a sample of 38 residents. This had the potential to affect all residents who went out for dialysis treatment.

Inspectors wroteBased on staff interviews, clinical record review, and review of facility documents, the facility staff failed to ensure one resident (Resident #38) entering the facility did not develop pressure ulcers unless they were unavoidable. For Resident #38, the facility failed to identify two pressure ulcers prior to being found at an advanced stage (unstageable), which constituted in harm. For Resident #58, the facility staff failed to provide care and services to prevent pressure ulcer development and to identify a left heel pressure ulcer prior to progression to an advanced stage (stage 3) which constituted harm. For Resident #88B, a new stroke victim who required total care for all activities of daily living (ADL), the facility staff failed to provide care and services to prevent development of an unstageable deep tissue injury (DTI) of the right buttock. [...]

Inspectors wroteBased on staff interviews, clinical record reviews and facility documentation review, the facility staff failed to ensure 2 of 38 residents in the survey sample, (Resident #10 and #33) were given the opportunity to formulate an advance directive.

Inspectors wroteBased on employee record review, facility document review and staff interviews the facility staff failed to implement their Abuse/Neglect Prevention Policy for screening of new employees. Criminal Background Checks were not obtained for 5 current employees 2 of which were agency staff within 30 days of their hire date and Sworn Statements were not obtained for 2 current agency staff employees upon hire.

Inspectors wroteBased on a closed record review, staff and family interviews, and a complaint investigation, the facility staff failed to thoroughly investigate an incident of an injury of unknown source for one resident (Resident #89) in the survey sample of 38 residents.

Inspectors wroteBased on staff interviews, clinical record review and facility documentation review the facility staff failed to send a copy of the Resident's Care Plan to include their goals after being transferred and admitted to the hospital for one resident (Resident #35) in survey sample of 38 residents.

Inspectors wroteBased on resident record review, staff interviews and facility document review, the facility failed to notify the Office of the State Long-Term Care Ombudsman in writing of hospital discharges for 1 of 38 residents (Resident #88, a closed record resident) in the survey sample.

Inspectors wroteBased on staff interviews, clinical record review and facility documentation review, the facility staff failed to revise 1 of 38 residents (Resident #10) comprehensive personal-centered care plan in the survey sample.

Inspectors wroteBased on observation, resident interview, staff interview, clinical record review, and review of facility documents, the facility staff failed to obtain weights and labs necessary for management of acute on chronic hypoxic and hypercapnic respiratory failure due to CHF and COPD exacerbations for 1 of 38 residents (Resident #61), in the survey sample.

Inspectors wroteBased on observation, staff interview, and facility document review, the facility staff failed to ensure a Registered Nurse (RN) coverage for 8 hours, 7 days a week. The facility staff failed to ensure RN coverage for 8 consecutive hours for 24 days.

Inspectors wroteBased on record reviews and staff interviews, the facility staff failed to ensure drug regimen of each resident were reviewed monthly for two residents (Resident #44 and #56) in the survey sample of 38 residents.

Inspectors wroteBased on staff interview, clinical record review, review of facility documents and during the course of a complaint investigation, the facility's staff failed to accurately document in one residents medical record for 1 of 38 residents (Resident #35), in the survey sample.

Inspectors wroteBased on staff interview, facility document review and clinical record review, it was determined that facility staff failed to practice safe bed mobility for one of 39 residents in the survey sample, Resident #26, resulting in an avoidable fall with a head laceration, that lead to an acute transfer to the hospital which constitutes harm.

Inspectors wroteBased on observations and staff interview it was determined that the facility staff failed to maintain an effective pest control system.

Inspectors wroteBased on staff interviews, clinical record review and facility document review, the facility staff failed to provide the resident or resident's representative education regarding the benefits and potential side effects of influenza immunization for four of 39 residents in the survey sample, (Resident #33, #10, #96, #88).

Inspectors wroteBased on staff interview and facility documentation review, it was determined that the facility failed to replace personal property damaged by facility laundry for one resident out of 39 records reviewed.

Inspectors wroteBased on observation, resident interview, and staff interviews, the facility's staff failed to assure 1 of 39 residents (Resident #59), in the survey sample call bell was within reach at all times.

Inspectors wroteBased on observations, record review and staff interview, the facility staff failed to ensure one of 39 residents in the survey sample, Resident #68, was free from physical restraints. The facility staff had tube socks in use to Resident #68's bilateral arms to prevent scratching of a wound.

Inspectors wroteBased on staff interview, facility document review and clinical record review, it was determined that facility staff failed to send the required documentation upon transfer to the hospital for two of 39 residents in the survey sample, Resident #33 and #26.

Inspectors wroteBased on resident interview, staff interview, facility document review and clinical record review, it was determined that facility staff failed to send written bed hold notification upon transfer to the hospital for one of 39 residents in the survey sample, Resident #33.

Inspectors wroteBased on staff interview, facility document review, and clinical record review, it was determined that facility staff failed to ensure an accurate MDS (minimum data set) assessment for two of 39 residents in the survey sample, Residents # 102 and #59.

Inspectors wroteBased on observations, record review and staff interview the facility staff failed to revise the comprehensive care plan for two of 39 residents in the survey sample, Resident #23 and Resident #68.

Inspectors wroteBased on observations, resident interview, staff interviews, and clinical record review the facility staff failed to ensure 1 of 39 residents (Resident #21), in the survey sample received fingernail care prior to his fingernails becoming long with broken edges and a brownish substance beneath them.

Inspectors wroteBased on observation, resident interview, and staff interviews the facility staff failed to ensure 1 of 39 residents (Resident #21), in the survey sample received foot care prior to the toe nails advancing to painful, long and curvy nails.

Inspectors wroteBased on observation, family interview, staff interview, and clinical record review, the facility staff failed to ensure necessary respiratory care and services were provided for 2 of 39 residents in the survey sample (Residents #97 and #10). For Resident #97, the facility staff failed to ensure resident specific tracheostomy equipment was easily accessible in case of an emergency, failed to provide tracheostomy care without compromising the resident's respiration/airway and failed to administer oxygen (O2) as ordered. For Resident #10, the facility staff failed to administer oxygen as ordered.

Inspectors wroteBased on observations, family interview and staff interviews the facility staff failed to ensure staff was competent in tracheostomy tube care for 1 of 39 residents (Resident #97), in the survey sample.

Inspectors wroteBased on staff interview and facility documentation review, the facility staff failed to ensure there was Registered Nurse (RN) coverage for eight consecutive hours in a twenty-four hour period.

Inspectors wroteBased record review and staff interview the facility staff failed to ensure medications were available for administration for two residents (Resident #68 and Resident #96 ) in the survey sample of 39 residents.

Inspectors wroteBased on observations, resident interview, staff interviews, clinical record review, the facility's staff failed to review food preference with the resident and provide like food alternatives for 1 of 39 residents (Resident #95), in the survey sample.