Avante at St. Cloud Inc

Inspectors wroteBased on observation, interview, and record review, the facility failed to conduct a medication self-administration assessment to ensure safety for 1 of 1 resident reviewed for self-administration of medications, of a total sample of 53 residents, (#1).

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the resident was free from physical restraint for 1 of 1 resident reviewed for restraints, of a total sample of 53 residents, (#65). Findings Resident #65, an [AGE] year-old- female was admitted to the facility on [DATE] and readmitted on [DATE]. The resident was admitted to Hospice Services on 1/17/24. Her diagnoses included convulsions, cerebral atherosclerosis, repeated falls, major depressive disorder, and generalized muscle weakness. Review of the resident's physician orders revealed an order dated 3/12/21 for bilateral upper grab bars to enable positional changes, bed mobility or to determine bed perimeters. [...]

Inspectors wroteBased on interview and record review, the facility failed to report allegations of abuse to State agencies as required for 2 of 5 residents reviewed for abuse, of a total sample of 53 residents, (#110 and #276).

Inspectors wroteBased on interview and record review, the facility failed to provide written Notification of Transfer or Discharge forms to the residents or their representative for 2 of 2 residents reviewed for hospitalizations, of a total sample of 53 residents, (#121 and #123).

Inspectors wroteBased on interview and record review, the facility failed to ensure the Minimum Data Set (MDS) assessments were accurate for tracheostomy care for 1 of 1 resident, (#86), failed to accurately assess for insulin administration for 1 of 1 resident, (#15), and failed to ensure assessment accurately reflected oxygen (O2) therapy for 2 of 2 residents reviewed for O2 therapy, (#64, and #95), of a total sample of 53 residents.

Inspectors wroteBased on interview and record review, the facility failed to refer residents with a newly evident mental disorder for Level II Preadmission Screening and Resident Review (PASARR) evaluation and determination for 1 of 4 residents reviewed for PASARR, of a total sample of 53 residents, (#97).

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services in accordance with professional standards of practice related to the collection of an urine specimen for 1 out of 5 residents reviewed for abuse, (#276), and for limited range of motion and contracture care, for 1 of 2 residents reviewed for limited range of motion and positioning, (#42), out of a total sample of 53 residents.

Inspectors wroteBased on interview observation and record review, the facility failed to implement accident intervention for 1 of 5 residents reviewed for accidents, of a total sample of 53 residents, (#22)

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a physician's order was obtained prior to the administration of oxygen (O2) therapy for 1 of 1 resident, (#64), and failed to ensure the flow rate for O2 therapy was administered as per physician's order for 1 of 1 resident, (#95) reviewed for O2 therapy, of a total sample of 53 residents.

Inspectors wroteBased on interview and record review, the facility failed to accurately document administered medications in the Medication Administration Record (MAR) for 1 of 6 residents reviewed for choices, of a total sample of 53 residents, (#279).

Inspectors wroteBased on observation, interview and record review, the facility failed to provide timely assessment, treatment, and management of pain to the extent possible for 1 of 2 sampled residents, (#42), and failed to ensure pain management was provided consistent with professional standards of practice for 1 of 2 sampled residents reviewed for pain management, (#274), of a total sample of 53 residents.

Inspectors wroteBased on interview, and record review, the facility failed to ensure notification to provider for elevated blood glucose, and failed to ensure orders were received and implemented timely for treatment of elevated blood glucose levels for 1 of 1 resident reviewed for quality of care, of a total sample of 50 residents, (#382).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the Quality Assurance and Performance Improvement (QAPI) committee developed and implemented effective Performance Improvement Plans (PIPs) to correct and monitor identified deficiencies.

Inspectors wroteBased on interview, and record review, the facility failed to ensure Quarterly Minimum Data Set (MDS) assessments were completed within fourteen calendar days of the Assessment Reference Date (ARD) for 4 of 6 residents reviewed for Resident Assessment of a total sample of 50 residents, (#119, #29, #99, #105).

Inspectors wroteBased on interview, and record review, the facility failed to develop, implement, review, and provide a copy of a baseline care plan within 48 hours for 2 of 6 newly admitted residents, of a total sample of 50 residents, (#379, #381).

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive care plan for Continuous Positive Airway Pressure (CPAP) therapy for 1 of 4 residents reviewed for respiratory care and services, out of a total sample of 12 residents, (#381).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure physician orders were obtained and entered correctly in the electronic medical record for Continuous Positive Airway Pressure (CPAP) therapy for 1 of 4 residents reviewed for respiratory care, (#381); failed to ensure Oxygen (O2) therapy was administered per physician orders for 1 of 4 residents reviewed for respiratory care, (#379); and failed to ensure oxygen concentrators were maintained in clean and safe condition for 1 of 4 residents reviewed for respiratory care, of a total sample of 50 residents, (#93).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure ongoing communication, coordination and collaboration between the nursing home and the dialysis center for 1 of 1 resident reviewed for dialysis of a total sample of 50, (#8).

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure foods were correctly stored in the walk-in cooler and walk-in freezer to prevent contamination, failed to ensure staff members had appropriate hand hygiene/grooming, and failed to ensure the walk-in cooler was in good repair.

Inspectors wroteBased on record review and interview, the facility failed to maintain the survey book with all surveys over the past three years.