Autumn Care of Suffolk

Inspectors wroteFacility staff failed to ensure that residents and/or resident representative had the opportunity to develop an Advanced Directive for 19 of 24 residents reviewed. These requirements include provisions to inform and provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment and, at the resident's option, formulate an advance directive. This includes a written description of the facility's policies to implement advance directives. Facility policy does not meet requirement for advance planning, affecting all residents including a number of residents in the survey sample. During record review, surveyors noted difficulty locating documentation concerning advance care planning in resident records. [...]

Inspectors wroteBased on resident interview, staff interview, clinical record review, and facility document review, the facility staff failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team, and/or failed to involve the resident and/or resident representative in planning care, for 5 of 35 sampled residents. Resident #28, Resident #61, Resident #83, Resident #40, and Resident #206.

Inspectors wroteBased on staff interview, clinical record review, and facility document review the facility staff failed to follow physician's orders for the administration of medications for 5 of 35 residents, Resident #33, Resident #207, Resident #100, Resident #357, and Resident #20.

Inspectors wroteBased on staff interview, clinical record review and facility document review the facility staff failed to ensure one of 24 residents was clinically appropriate for self-administration of medications, Resident #87.

Inspectors wroteBased on staff interview, clinical record review, and facility document review, the facility staff failed to screen for a mental disorder and/or intellectual disability prior to admission for 2 of 24 sampled residents. Resident #20 and Resident #61.

Inspectors wroteBased on staff interview, clinical record review, and facility document review, the facility staff failed to develop and/or implement a person-centered, comprehensive, activity care plan for 1 of 24 sampled residents, Resident #83.

Inspectors wroteBased on staff interview, clinical record review, and facility document review, the facility staff failed to provide an ongoing, person-centered activity program to support resident choice, interests and physical, mental, and psychosocial well-being for 1 of 24 sampled residents, Resident #83.

Inspectors wroteBased on staff interview, clinical record review and facility document review the facility staff failed to maintain an accurate accounting of narcotics for one of 24 residents, Resident #18.

Inspectors wroteBased on staff interview, clinical record review and facility document review, the facility staff failed to review and/or act upon pharmacist recommendations for 3 of 24 residents, Resident #4, #51, #48.

Inspectors wroteBased on staff interview, clinical record review and facility document review the facility staff failed to ensure 3 of 35 residents was free of significant medication errors, Resident #33, Resident #87, and Resident #206.

Inspectors wroteBased on staff interview, clinical record review, and facility document review the facility staff failed to obtain lab testing as ordered by the medical provider for 2 of 35 sampled residents. (Resident #51 and #357).

Inspectors wroteBased on interviews, document review, and clinical record review facility staff failed to notify the medical provider and/or a responsible party for related to residents' medication regime for 2 of 35 sampled residents (Resident #100 & #206). 1. For Resident #100, facility staff failed to notify the physician when an anti-hypotensive medication was held. Resident #100 was admitted to the facility with diagnoses which included end stage renal disease with hemodialysis, diabetes mellitus, anemia, septicemia, peripheral vascular disease, deep vein thrombosis, orthostatic hypotension, and malnutrition. On the most recent Minimum Data Set assessment the resident scored 15/15 on the brief interview for mental status and was assessed as without signs of delirium, psychosis, or behaviors affecting care. [...]

Inspectors wroteBased on staff interviews, clinical record review, and facility document review, the facility staff failed to ensure communication with hospice staff allowed for the timely implementation of resident orders for one (1) of 35 sampled residents (Resident #206).

Inspectors wroteBased on observations, clinical record reviews, staff, resident and family interviews, the facility staff failed to ensure two residents were free from abuse; one resident (R#185) who was intentionally restricted from movement by a tucked in top bed sheet on each side with the two top corners tied at the junction of the side rail and bed frame, and the bottom two corners of the top sheet tied to the bedframe; and, a second resident (R#47) to be free of mental and verbal abuse as evidenced by threatening a 30 day notice of discharge. The treatment of Resident #185 constituted harm.

Inspectors wroteBased on record review and staff interviews the facility staff failed to provide one resident (Resident #85) in the survey sample of 35 residents with a notice of transfer to the office of the state Long-Term Care Ombudsman.

Inspectors wrote2. The facility staff failed to provide Resident #85 with a bed-hold policy prior to transferring to a hospital. Resident #85 was admitted to the facility on [DATE] with diagnoses which included anemia, coronary artery disease, heart failure, hypertension, diabetes, hyperlipdemia, manic depression, end stage renal disease, and bipolar disorder. The facility staff failed to provide Resident #85 with a bed-hold policy prior to transferring to a hospital. A 3/3/21 Quarterly Minimum Data Set (MDS) assessed this resident in the area of Cognitive Patterns - Brief Interview for Mental Status as a (10). In the area of Daily Living this resident was coded as requiring minimum assist with supervision in the areas of dressing, toileting, and eating. Resident #85 was continent of bowel and bladder. A 3/18/21 Care Plan indicated: [...]

Inspectors wroteBased on observation, resident and staff interviews and clinical record review the facility staff failed to ensure 1 of 35 residents (Resident #24) in the survey sample who were unable to carry out activities of daily living (ADL) receives the necessary services.

Inspectors wroteBased on information gleamed during a complaint investigation, resident, family and staff interviews, and clinical record review, the facility's staff failed to ensure a resident's emotional well being was managed to attain the highest practicable mental and psychosocial well-being for a resident with an anxiety disorder and a major depressive disorders for 1 of 35 residents (Resident #80), in the survey sample.

Inspectors wroteBased on resident interview, staff interviews, facility documentation review and clinical record review the facility staff failed to ensure 2 of 35 residents in the survey sample (Resident #67 and #16) received physician ordered medications.

Inspectors wroteBased on observation, resident interview and staff interviews the facility staff to ensure reasonable accommodation of need for 1 of 35 residents (Resident #24) in the survey sample.

Inspectors wroteBased on record review and staff interviews, the facility staff failed to assist one resident (Resident #85) in the survey sample of 35 residents to obtain his Federal Internal Revenue Service Stimulus funds.

Inspectors wroteBased on medical record review, facility document review and staff interviews the facility staff failed to ensure that 2 of 35 residents in the survey sample were afforded the opportunity to formulate an Advance Directive upon admission, Residents' #63 and #84.

Inspectors wroteBased on family interview, facility document review and clinical record review, it was determined that facility staff failed to notify the responsible party of new order and a change in condition for one of 35 residents in the survey sample; Resident # 38.

Inspectors wroteBased on observation, resident interview and staff interviews the facility staff failed to provide reasonable care for the protection of residents' property from loss for 1 of 35 residents (Resident #53) in the survey sample.

Inspectors wroteBased on observation, staff interview, facility document review, and clinical record review, it was determined that facility staff failed to report a suspected abuse allegation within the required time frame after the allegation was made for 1 of 35 residents in the survey sample, Resident #16.

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 for two residents (Resident #76 and Resident #38) after being transferred to the hospital.

Inspectors wroteBased on resident interview, staff interview, facility document review, and clinical record review, it was determined that facility staff failed to provide evidence that one out of 35 sampled residents was invited to attend a care plan meeting on 5/18/21, Resident #54.

Inspectors wroteBased on resident interview, staff interviews, facility documentation review and clinical record review the facility staff failed to ensure medication order was correctly transcribed for 1 resident (Resident #67) and the facility staff failed to follow physician orders for Neurontin (Gabapentin) for 1 resident (Resident #16) of 35 residents in the survey sample. Resident #16 should have received Neurontin 100 mg TID (Three Times a Day) but was given Neurontin 300 mg TID.

Inspectors wroteBased on medical record review, facility document review and staff interviews the facility staff failed to ensure that a physician order for daily weights was carried out for 1 of 35 residents in the survey sample, Residents' #63.

Inspectors wroteBased on observation, staff interviews and clinical record review the facility staff failed to ensure 1 of 35 residents (Resident #24) in the survey sample who were unable to carry out activities of daily living (ADL) receives the necessary services to maintain toenail care.

Inspectors wroteBased on information gleamed during a complaint investigation, observation, resident interview, staff interviews, and clinical record review, the facility's staff failed to ensure the resident was not left in fecal matter for extended periods of time for 1 of 35 residents (Resident #80) surveys, in the survey sample.

Inspectors wroteBased on facility documentation, the facility staff failed to staff a Registered Nurse (RN) for at least 8 consecutive hours a day, 7 days a week.

Inspectors wroteBased on staff interview, facility documentation review and clinical record review, and in the course of a complaint investigation, the facility staff failed to ensure the physician reviewed pharmacy recommendation for 1 of 35 residents in the survey sample, Resident #18.

Inspectors wroteBased on observation, staff interview, and facility document review, it was determined that the facility staff failed to serve food at a palatable temperature.

Inspectors wroteBased on observation, staff interview, facility document review, and clinical record review, it was determined that facility staff failed to maintain infection control practices during incontinence care observation for one of 35 sampled residents; Resident #37.

Inspectors wroteBased on observation, staff interview, and a review of facility documents, the facility staff failed to designate at least one qualified Infection Preventionist.

Inspectors wroteBased on observation, staff interview, and facility document review, it was determined that the facility staff failed to maintain an effective pest control program for the facility kitchen.

Inspectors wroteThe facility staff failed to provide adequate supervision and failed to ensure heated beverage was served in a manner to prevent an avoidable accident for 1 of 59 residents in the survey sample (Resident #83), with known behaviors of throwing objects, food and beverages resulting in harm, a second degree burn, to Resident #74. The staff served Resident #83 a cup of hot coffee without a lid. Resident #83 threw the hot coffee onto Resident #74 resulting in a second degree burn to the resident's left upper thigh requiring physician intervention, medication and treatment. A second degree burn involves the first two layers of the skin. These may present as deep reddening of the skin, pain, blisters, glossy appearance from leaking fluid, and possible loss of some skin. Referenced from http://www.bt.cdc.gov/masscasualties/burns.asp

Inspectors wroteBased on resident record review, staff interviews and facility document review the facility staff failed to ensure that comprehensive care plan goals were sent upon transfer to the hospital for 4 of 59 Residents in the survey sample, Resident #89, #112, #74 and #101.

Inspectors wroteBased on resident record review, staff interviews and facility document review the facility staff failed to ensure that the bed hold policy was provided to the resident or resident representative upon transfer to the hospital for 6 of 59 Residents in the survey sample, Resident #89, #112, #74, #1, #101 and #461.

Inspectors wroteBased on staff interviews, clinical record review and documentation review, it was determined that facility staff failed to complete and implement a baseline care plan within 48 hours of admission for three of 59 residents (Resident #27, #66 and #92) in the survey sample.

Inspectors wroteBased on observations, resident interview, staff interview, facility documentation review and clinical record review it was determined that facility staff failed to revise the comprehensive care plan for 4 residents ( Resident #3, Resident #74, #83, #31) of 59 residents in the survey sample.

Inspectors wroteBased on resident interview, family member interview, staff interviews, clinical record review and facility documentation review, the facility staff failed to provide foot nail care and/or podiatry services for four of 59 residents in the survey sample (Resident #27, #66, #43 and #12 ).

Inspectors wroteBased on observation, staff interview, facility documentation review, and in the course of a complaint investigation, the facility staff failed to ensure food was labeled and dated in the kitchen refrigerator.

Inspectors wroteBased on observation, staff interview, facility documentation and clinical record review, it was determined that facility staff failed to ensure annual review of the antibiotic stewardship and infection control policies; and failed to ensure staff wear the appropriate PPE (Personal Protective Equipment) for contact precautions for one of 59 residents in the survey sample, Resident #12.

Inspectors wroteBased on observation, staff interviews, clinical record review, documentation review, and complaint investigation, it was determined that facility staff failed to maintain an effective pest control program as evidenced by insects, including roaches and ants, in the kitchen, resident rooms and hallways. The findings Included: 1. The facility staff failed to store, prepare and serve food in an insect free environment. On 07/24/19, at approximately 11:00 AM during the initial inspection of the kitchen, the dietary staff were asked if they had roaches in the kitchen. Dietary Staff #10, stated Yes. No live cock roaches were seen in the kitchen by surveyor. On 07/25/19, day 2 of the kitchen inspection, at approximately 11:00 AM., while inspecting the dry storage area, seven (7) dead cockroaches were seen on the floor located underneath the shelving in the dry storage area. [...]

Inspectors wroteBased on observation, resident interview and staff interviews the facility staff to ensure reasonable accommodation of need and preferences for the use of a bariatric shower bed for 1 of 59 residents (Resident #100) in the survey sample.

Inspectors wroteBased on observation, resident interview, staff interview and facility document review, it was determined that facility staff failed to ensure a clean comfortable and homelike environment for 2 of 59 residents in the survey sample, Resident #12 and #56.

Inspectors wroteBased on staff interviews, facility documentation review and clinical record review the facility staff failed to complete each required section of an MDS (Minimum Data Set) assessment for 1 out of 59 residents (Resident #41) in the survey sample.

Inspectors wroteBased on observations, staff interview, and facility documentation review, the facility staff failed to follow physician orders for blood sugar monitoring on 07/05/19 for 1 (Resident #27) of 59 residents in the survey sample.

Inspectors wroteBased on observation, staff interview, facility documentation, and clinical record review, it was determined that facility staff failed to maintain respiratory equipment in a sanitary manner for two of 59 residents in the survey sample (Residents #31 and #89); and failed to administer oxygen per physician's order for Resident #31. 1. Resident #31 was admitted to the facility on [DATE] with diagnoses that included but were not limited to pneumonia, muscle weakness, and Alzheimer's disease. Resident #31's most recent MDS (Minimum Data Set) assessment was a quarterly assessment with and ARD (assessment reference date) of 5/10/19. Resident #31 was coded as being intact in cognitive function scoring 15 out of possible 15 on the BIMS (Brief Interview for Mental Status) exam. Review of Resident #31's clinical record revealed that he was diagnosed with pneumonia on 7/20/19. [...]

Inspectors wroteBased on observations, resident record review, staff interviews and facility document review the facility staff failed to ensure an ongoing communication and collaboration with the dialysis facility regarding dialysis care and services for 1 of 59 resident in the survey sample, Resident #73.