Avalon Care Center at Northpointe

Inspectors wroteBased on interview and record review, the facility failed to implement their Abuse and Neglect Prohibition Policies to include not reporting allegations of abuse to facility administration and the State Agency (SA) within the required timeframe, and completing thorough investigations, for 5 of 7 sampled residents (Resident 5, 38, 69, 117, and 131), reviewed for abuse/neglect. This failure placed the residents at risk for unidentified abuse/neglect.

Inspectors wroteBased on observation and interview, the facility failed to maintain a clean, comfortable, and homelike environment for 1 of 3 units (Unit 1 - North Unit), observed for environment. This failure resulted in residents being unable to have a clear view to the outside through several windows.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that lorazepam liquid (a controlled anti-anxiety medication with potential for abuse) was monitored adequately to minimize risk of loss or diversion, in 2 of 3 medication rooms inspected (Med room [ROOM NUMBER] - East and Med room [ROOM NUMBER] - West). Additionally, the facility failed to discard 2 vials of an expired Tuberculin PPD (a solution injected under the skin to test for exposure to tuberculosis, a contagious respiratory disease) in 1 of 3 medication rooms inspected (Med room [ROOM NUMBER] - West). These failures placed the facility at risk of diversion of controlled medications and residents at risk of receiving expired test solution, inaccurate test results and possible adverse health consequences.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff implemented Enhanced Barrier Precautions (EBP, use of gowns and gloves during high contact resident care activities) during 3 of 5 resident care observations (Resident 112, 144, 15) and failed to ensure gloves were worn during an insulin injection for 1 of 3 medication administration observations. These failures placed residents and staff at risk of spreading infectious bacteria, and exposure to blood or body fluids.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was evaluated to safely self-administer their medication for 1 of 6 sampled residents (Resident 3) reviewed for medication administration. This failure placed the resident at risk for unintended health consequences.

Inspectors wroteBased on interview and record review, the facility failed to ensure Pre-admission Screening and Resident Review (PASRR) Level II evaluations were completed timely for 1 of 5 sampled residents (Resident 7) reviewed for PASRR. This failure placed the resident at risk for unmet care needs and a decline in condition.

Inspectors wroteBased on observation, interview and record review, the facility failed to revise comprehensive care plans for 1 of 3 sampled residents (Resident 65) whose care plan was reviewed for accident hazards. This failure placed the resident at risk for burns and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a peripherally inserted central catheter (PICC, a long flexible intravenous [IV] tube inserted into a vein that was advanced to a large vein near the heart, also called a central line) was maintained as ordered for 1 of 1 sampled residents (Resident 144) reviewed for antibiotic use. Additionally, the bowel management protocol was not implemented when indicated for 1 of 5 sampled residents (Resident 11) reviewed for medication regimen reviews. These failures placed the residents at risk of unintended health consequences and decreased quality of life.

Inspectors wroteBased on observations, interview and record review, the facility failed to maintain a pressure- reducing mattress on the ordered setting, for 1 of 3 residents (Resident 5) reviewed for pressure ulcer/injury (wounds from unrelieved pressure). This failure placed residents at risk of worsening pressure ulcers and possible delayed wound healing.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement interventions to prevent weight loss for 2 of 8 sampled residents (Residents 11 and 62) reviewed for nutrition. This failure resulted in the residents being at risk for further weight loss and a decline in their health.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medications were administered as ordered for 2 of 5 sampled residents (Residents 5 and 11) reviewed for medication administration. Specifically, medications were not held or administered when indicated, according to parameters ordered by the provider. This failure placed residents at risk for adverse health complications and diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to routinely encode and transmit resident assessment data to the Centers for Medicare & Medicaid Services (CMS) within the required timeframe for 2 of 25 sampled residents (Residents 132 and 41), reviewed for timeliness in encoding and transmission of Minimum Data Set (MDS, a required assessment tool). This failure affected federal health information data gathering and placed residents at risk for inaccurate monitoring of the residents' progress over time, untimely comprehensive review of residents' health data/information, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to administer methadone consistent with the dosage prescribed by Opioid Treatment Program provider and as a part of medications for opioid use disorder (MOUD) for 1 of 8 residents (Resident 1) reviewed for medication administration. This failure placed the resident at risk for medical complications, unintended health consequences and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to coordination with the opioid treatment program provider to change dosage of medications for opioid use disorder (MOUD) for 1 of 1 sampled residents, (Resident 1), reviewed for MOUD. This failure placed the resident at risk for medical complications, unintended health consequences and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure acceptable parameters of nutrition were maintained for 2 of 2 sampled residents (Residents 4 and 14) reviewed for nutrition. Resident 4 experienced harm when they had a significant weight loss of 7.9% in approximately three months and 14.29% in six months. Resident 14 experienced harm when they had a significant weight loss of 8.51% in one month and their weight loss was not reported to the dietician. This failure placed the residents at risk for further decline in their weight, unintended consequences of poor nutrition, and decreased quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to store, discard and distribute food, and monitor temperatures of foods being served in accordance with professional standards for food safety for 1 of 1 facility kitchens, reviewed. This failure placed residents at risk for food borne illness and diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to ensure the resident and/or the resident's representative was informed of and consented to a new medication for 2 of 3 sampled residents (Residents 54 and 90), reviewed for care planning. This failure disallowed the resident and/or the resident representative to make an informed decision regarding treatment and placed the resident at risk of diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to ensure the Office of the State Long-Term Care Ombudsman (a person who acted as an advocate for residents that lived in long-term care) received written notification of a hospital transfer and/or discharges, as required for 5 of 6 sampled residents (Resident 4, 30, 46, 71 and 90), reviewed for hospitalization and discharge. This failure placed residents at risk of not having access to additional advocacy services from the State Long-Term Care Ombudsman, unmet needs, and diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to provide a bed-hold notice, a notice that informed the resident of their right to pay the facility to hold their room/bed while they were hospitalized , to the resident and/or their representative at the time of discharge or within 24 hours of transfer to the hospital for 5 of 5 sampled residents (Resident 4, 30, 46, 71 and 90), reviewed for hospitalization. This failure placed residents at risk for a lack of knowledge regarding the right to a bed-hold while they were hospitalized .

Inspectors wroteBased on interview and record review the facility failed to routinely encode and transmit resident assessment data to the Centers for Medicare & Medicaid Services (CMS) within the required timeframe for 4 of 11 sampled residents (Residents 7, 12, 86 and 90), reviewed for timeliness in encoding and transmission of Minimum Data Set (MDS - an assessment tool). This failure affected federal health information data gathering and placed residents at risk for inaccurate monitoring of the residents' progress over time, untimely comprehensive review of residents' health data/information, and a diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to routinely timely and accurately complete Minimum Data Sets (MDS - an assessment tool) for 9 of 11 sampled residents (Residents 3, 12, 14, 39, 82, 83, 90, 109, and 510), reviewed for timely MDS assessment completion. This failure affected federal health information data gathering and placed residents at risk for inaccurate monitoring of the residents' progress over time, untimely comprehensive review of residents' health data/information, and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to consistently monitor and provide bowel care timely for 7 of 7 sampled residents (Residents 23, 36, 54, 62, 4, 39, and 46) reviewed for constipation. This failure placed the residents at risk for medical complications and unmet care needs.

Inspectors wroteBased on interview and record review the facility failed to ensure falls were investigated, safety interventions implemented, and residents monitored after falls were sustained for 4 of 6 sampled residents (Residents 4, 14, 30,and 90), reviewed for falls. In addition, the facility failed to assess residents for risks associated with a substance use disorder (SUD) and their ability to safely smoke for 2 of 3 sampled resident (Resident 46 and 110), reviewed. This failure placed residents at risk of potentially avoidable accidents, unmet care needs, and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure respiratory treatments had provider orders, that provider orders were carried out, and care plan goals and interventions were developed for 3 of 3 sampled residents (Residents 71, 358 and 359), reviewed for respiratory care. These failures placed residents at risk for respiratory complications and a diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to complete annual staff performance reviews yearly as required and provide education based on the outcome of these reviews for 2 of 5 sampled staff (Staff P and Y), reviewed for performance reviews. This failure placed residents at risk of receiving care from inadequately trained and/or underqualified care staff, and diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to ensure residents were not given psychotropic medications (medication that affected the mind, emotions, and behaviors) unless the medication was necessary to treat specific conditions documented in the clinical record, residents received non-medication behavioral interventions, and behavior and adverse side effect monitoring was consistently done for 3 of 6 sampled residents (Residents 22, 23 and 90), reviewed for unnecessary medications. This failure placed residents at risk of being chemically restrained, unmet care needs, and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure 3 of 5 sampled residents (Residents 22, 46 and 71), reviewed for medication administration, received medication as ordered by the physician. Failure to administer insulin, a medication used to treat diabetes, and consistently monitor blood sugar levels, a test done that checked the level of sugar in the blood stream, and failure to follow the parameters for holding a blood pressure medication created significant medication errors, and placed the residents at risk for medical complications, unintended health consequences and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure medications were stored under proper temperature controls in 2 of 3 sampled medication rooms (East and West) and in 1 of 3 medication storage refrigerators (East), reviewed for medication storage. This failure placed residents at risk of receiving less than the optimum dose of their medications, adverse side effects, and diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide appetizing and palatable food for 5 of 9 sampled residents (Residents 18, 23, 36, 48 and 54) reviewed for food. This failure placed the residents at risk for decreased nutritional intake, and a diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to ensure arbitration (a procedure used to settle a dispute using an independent person mutually agreed upon by both parties) agreement was reviewed and explained in a form, manner, and/or language understood by the resident and/or their legal representative for 3 of 3 sampled residents (Residents 14, 60, 90), reviewed for arbitration. This failure placed residents at risk of being uninformed of their rights, loss of legal protection, loss of right to pursue legal action and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure enhanced barrier precautions were implemented when indicated for 2 of 4 sampled residents (Residents 46 and 54 ) reviewed that had draining wounds and that hand hygiene was completed when indicated during 1 of 2 dining observations and 1 of 2 wound treatments observed. Additionally, N95 respirator-style masks were not donned correctly in accordance with the Centers for Disease Control (CDC) guidelines by 7 Staff (R, HH, II, JJ, X, T, and KK) when reviewing infection control practices, infection prevention and control policies were not reviewed yearly as required and a water management plan was not fully developed. These failures put residents and staff at risk of becoming ill with contagious viral and bacterial infections and spreading those illnesses to others.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was evaluated to self-administer their medications for 1 of 5 sampled residents (Resident 74) reviewed for medication administration. This failure placed the resident at risk for missed medication doses or unintended health consequences.

Inspectors wroteBased on observation and interview, the facility failed to ensure the weekly menus and/or alternative menus were provided for 3 of 9 sampled residents (Residents 23, 36 and 48), reviewed for food. This failure denied residents the right to choose their meal preference, had the potential to negatively affect their nutritional needs and create a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to provide information on services and charges for those services not covered under the facility's per diem rate for 2 of 3 sampled residents (Resident 91 and 14), reviewed for advanced beneficiary notices. This failure placed residents at risk of incurring unknown debt, financial hardship and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a homelike environment for 4 of 8 sampled residents (Residents 14, 39, 46 and 83), reviewed for environment. Specifically Resident 14 had a wheelchair that was not maintained in a sanitary manner, Resident 39 had a hole in their drywall in their room, and Residents 39, 46 and 83 had drywall that was in disrepair. This failure did not allow residents to enjoy a homelike environment.

Inspectors wroteBased on observations, interview and record review, the facility failed to thoroughly investigate potential allegations of abuse for 2 of 3 sampled residents (Residents 30 and 83), reviewed for abuse. The facility further failed to investigate falls for 2 of 6 sampled residents (Residents 4 and 14) reviewed for falls. Specifically, Resident 30 had a fall in which they alleged the call light had been removed by staff and the call light concern was not investigated and Resident 83 had a scabbed area on their arm allegedly caused by staff and the cause of the scab was not investigated to rule out abuse. This failure placed residents at risk of further potential abuse and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident's medical record contained documentation of a hospital transfer and/or that the receiving hospital had received information of the resident's condition, for 1 of 4 sampled residents (Resident 4), reviewed for hospitalization. This failure placed the resident at risk for a delay in treatment and unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Pre-admission Screening and Resident Review (PASARR) [an assessment used to identify people referred to nursing facilities with mental illness, intellectual disabilities, or related conditions], was completed after an exempted hospital stay for 1 of 5 sampled residents (Resident 46), reviewed for PASARR services. This failure placed the resident at risk for inappropriate placement, and/or not receiving timely and necessary services to meet mental health care needs.

Inspectors wroteBased on interview and record review the facility failed to prepare a discharge summary that included all the required components, complete a final summary of the resident's status upon discharge, complete a discharge plan of care with all the required components, and convey discharge information to the provider continuing care for 2 of 6 sampled residents (Residents 90 and 110), reviewed for discharge. This failure placed residents at risk of unsafe discharges, unmet care needs and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure a staff member was available to provide assistance to a resident while they were at an appointment with a provider outside the facility and failed to provide bathing as care planned for 2 of 4 sampled residents (Resident 109 and 54) reviewed for activities of daily living.

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify a pressure ulcer and implement treatement timely for the development of a wound for 1 of 2 sampled residents (Resident 54), reviewed for pressure ulcers. This placed the resident at risk for unidentified wounds, worsening pressure ulcers and delayed wound healing.

Inspectors wroteBased on interview and record review, the facility failed to ensure a physician ordered foot care referral for a podiatrist was followed for 1 of 2 sampled residents (Resident 54), reviewed for wound care. This failure placed the resident at risk for skin impairment, discomfort, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure consistent, ongoing communication and collaboration with the dialysis facility for 1 of 2 sampled residents (Resident 23) reviewed for dialysis, a treatment that removed waste products and excess fluid from the bloodstream when the kidneys no longer functioned properly. In addition, the facility failed to ensure Resident 23's care plan included accurate goals and interventions related to the care and maintenance of the central venous catheter (CVC: a flexible tube that was inserted into a vein to provide an access site for dialysis).

Inspectors wroteBased on interview and record review the facility failed to ensure the facility had enough staff to provide care according to facility acuity (the level of severity of residents' illnesses, physical, mental, and cognitive limitations, and conditions) and/or care plans for 3 of 8 sampled residents (Resident 83, 90 and 110), reviewed for sufficient staffing. This failure placed all residents at risk for potentially avoidable accidents, unmet care needs, and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure monitoring of potential adverse effects from a blood thinning medication was done consistently for 1 of 5 sampled residents (Resident 22) reviewed for unnecessary medications. This failure placed the resident at risk for medical complications, unmet care needs and adverse side effects.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure resident beds were in safe operating condition for 4 of 26 beds in use on the [NAME] nursing unit observed. Specifically, bed controls had wires exposed and old electrical tape that had peeled off for 4 resident beds. This failure put residents at risk of injury and of being deprived of a home-like environment.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the call bells were in working condition for 2 of 50 residents observed (Residents 4 and 74) housed on the [NAME] nursing unit. This failure placed residents at a safety risk of having their urgent needs unanswered and unintended health consequences.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure resident personal refrigerators were maintained in a clean manner, without expired foods and at the appropriate temperatures for 2 of 5 sampled residents (Residents 74 and 51) reviewed for a homelike environment. This failure placed the residents at risk of eating spoiled foods and having an unclean environment.

Inspectors wroteBased on interview and record review, the facility failed to ensure allegations of potential misappropriation were reported immediately to facility administration and the State Survey Agency as required, for 1 of 5 sampled residents (Resident 9) reviewed for abuse/neglect. This failure placed the resident at risk for abuse.

Inspectors wroteBased on interview and record review the facility failed to provide the necessary care and services for 1 of 4 residents (Resident 3), reviewed for wound care. Failure to perform wound treatments as ordered placed the resident at risk for delayed wound healing, worsening of wounds, and/or potential infection and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from misappropriation of property for 1 of 3 sampled residents (Resident 1), reviewed for misappropriation. This failure placed residents at risk for pain and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to provide supervision for 1 of 3 sampled residents (Resident 1) reviewed for accidents. Resident 1 was harmed when they wandered unassisted in to the hall, intercepted fall (occurs when the resident would have fallen if they had not caught themself or had not been intercepted by another person - this is still considered a fall) and sustained a fractured humerus (the upper arm bone). This failure put residents at risk for injuries and decreased quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide sufficient nursing staff to ensure showers were completed as careplanned and call lights were answered timely for 3 of 4 sampled residents (5, 6, 7) reviewed for activities of daily living (ADLs). This failure put residents at risk for skin breakdown, incontinence episodes, or unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to notify the provider of a change in a resident's oxygen saturations for 1 of 4 sampled residents (Resident 1) reviewed for notification of changes. Failure to notify the provider of low oxygen saturations did not allow for interventions to be put in place prior to the resident's departure to the hospital.

Inspectors wroteBased on observation, interview and record review, the facility failed to assess a resident for removal of an indwelling urinary catheter (a small flexible tube inserted into the bladder to drain urine) for 1 of 3 sampled residents (Resident 9), reviewed for catheter use. Additionally, the facility failed to ensure indwelling urinary catheters were properly secured for 2 of 3 sampled residents (Resident 8 and 9). This failure placed the residents at increased risk of acquiring potentially preventable catheter associated urinary tract infections, pain, and urethral trauma.

Inspectors wroteBased on interview and record review the facility failed to ensure 3 of 5 Licensed Nurses (Staff J, K, and L) were evaluated by the facility for competency with skills and techniques prior to working with residents with indwelling urinary catheters (flexible tube inserted into the bladder to drain urine). This failure placed residents at risk for clinical complications.

Inspectors wroteBased on interview and record review, the facility failed to ensure blood pressure medications were held when indicated for 1 of 3 sampled residents (Resident 1) reviewed for medication administration. This failure put residents at risk for unintended health consequences related to low blood pressures.

Inspectors wroteBased on interview and record review, the facility failed to promptly resolve resident grievances and provide written grievance decisions for 3 out of 3 sample residents (Resident 2, 6, 7), reviewed for grievances. In addition, the facility failed to establish a grievance policy with all the required components. These failures placed the residents at risk of having unresolved grievances and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to develop a care plan to address assessed risks for accident hazards for 2 of 8 sample residents (Resident 2 and 8) reviewed for care planning. This failure placed residents at risk of unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 3 sampled residents (Resident 2) and/or their representatives, reviewed for quality of care, received timely notification of a transfer to the hospital when the resident's condition declined. This failure placed the resident at risk of delayed access to care, inability to participate in care planning, and diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to assess for and accommodate resident preferences and intolerances for 1 of 3 sampled residents (Resident 2) reviewed for nutrition. This failure placed the resident at risk for dissatisfaction with food, decreased nutritional intake, unplanned weight loss, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure labs were obtained as ordered, for 1 of 4 sampled residents (Resident 5), reviewed for laboratory (lab) services. This failure placed the resident at risk for delayed treatment, and a decline in condition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently monitor and provide bowel care timely for 2 of 3 sampled residents (25, 7, and 50), reviewed for constipation. This failure placed the residents at risk for medical complications and unmet care needs.

Inspectors wroteBased on record review and interview, the facility failed to ensure 6 of 17 sampled residents (7, 13, 19, 45, 57, 72), whose medications were reviewed, received their narcotic medications as ordered, received the appropriate doses of medication, and were free from significant medication errors. These failures placed the residents at risk for uncontrolled pain, over sedation and diminished quality of life.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure resident's preferences for bathing were honored for 1 of 1 sampled residents (43), reviewed for choices. This failure placed the resident at risk for decreased quality of life.

Inspectors wroteBased on record review and interview, the facility failed to inform and provide written information concerning the right of their residents to formulate an advance directive for 2 of 4 sampled residents (22, 76) reviewed. This failure placed residents at risk of not being able to exercise their rights and not having their wishes honored.

Inspectors wroteBased on interview and record review, the facility failed to recognize a reported incident as an allegation of possible abuse/neglect and therefore did not report to the state survey agency in the required timeframe, for 1 of 3 residents, investigated for abuse/neglect. This failure placed the residents at risk for unidentified abuse/neglect.

Inspectors wrote*AMENDED - All Amendments are in bold Based on observation, interview, and record review, the facility failed to implement interventions necessary to prevent the development of a wound for 1 of 5 sampled residents (65), reviewed for pressure ulcers. This placed the resident at risk for developing pressure ulcers and delayed wound healing.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide respiratory care consistent with professional standards for 2 of 3 sampled residents (7 and 22) reviewed. Resident 22 had no orders for the provision of oxygen and care of their nebulizer equipment and Resident 7's orders for their oxygen were not followed and their equipment was not maintained in a clean manner. This failure placed residents at risk for respiratory difficulties and infections.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide person-centered pain management for 1 of 3 sampled residents (131). Resident 131 was not offered non-pharmacological pain interventions, an ordered pain relieving gel was not available, and doses of narcotic pain medications were removed from the narcotic locked drawer, but not documented they were administered. These failures placed residents at risk for increased pain, and decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to identify a resident was taking an ordered medication twice a day, instead of once daily as ordered, for 1 of 5 sampled residents (27), reviewed for unnecessary medications. This failure resulted in the resident receiving twice the intended amount of the medication for 13 days, and placed them at increased risk for side effects such as low blood pressure, fainting and heart issues.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure expired medications were disposed of timely, in accordance with currently accepted professional standards, in 2 of 2 medication storage rooms. The facility failed to maintain temperatures to ensure medications were properly stored. The facility further failed to ensure narcotics were counted and locked in the permanently affixed narcotic containers for 2 of 2 medication rooms. This failure placed residents at risk for receiving compromised or ineffective medication and placed the facility at risk for potential diversion or misappropriation of narcotic medications.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dietary staff had the required qualifications (current Food Worker Cards) for 4 dietary staff (S, T, U and W.) This failed practice had the potential risk for unsafe food handling practices and placed all residents at risk for developing foodborne illness.

Inspectors wroteBased on observation, interview and record review, the facility staff failed to perform hand hygiene when indicated during a dressing change for 1 of 5 sampled residents (Resident 69) reviewed for pressure ulcer management and during one meal observation on the [NAME] Unit. This failure placed residents at risk for contact with contaminated surfaces, contamination of wounds and spread of harmful bacteria.