Avir at Bay City

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions in accordance with professional standards for 4 of 8 medication carts reviewed for medication storage in that: Medication Carts #1, #2, #3 and #4 contained medications that did not have an open date written on the bottles. The failure to date opened medications placed residents at risk for receiving expired, contaminated, or ineffective medications which could result in medication errors, infection, delayed treatment or adverse drug outcome.

Inspectors wroteBased on interviews and record review, the facility failed to document evidence of receiving or refusal of influenza or pneumococcal immunization for 5 of 5 residents reviewed for immunizations (Resident#12, Resident #2, Resident #39, Resident #7, and Resident #5). The facility failed to document evidence in the electronic medical record the offering or the refusal of the influenza and pneumococcal immunization status for Resident #12 and Resident #2. The facility failed to document evidence in the electronic medical record the offering or the refusal of the pneumococcal immunization status for Resident #7, Resident #39, and Resident #5. The failures could place residents at risk of contracting viral illness, influenza or pneumococcal disease, or of not being informed of the benefits and risk which could cause respiratory complications and lead to potential adverse health outcomes. [...]

Inspectors wroteBased on interview and record reviews, the facility failed to implement their policy to ensure residents were offered, received, or refused Covid-19 immunization, for 3 of 5 residents who were reviewed for immunization compliance. (Resident #12, Resident #7, and Resident#2). The facility failed to document in Resident #12, Resident #7, and Resident #2's electronic medical records for having received or having had not received the Covid-19 immunization due to medical contraindication or refusal. This failure could place residents at risk of not being informed of complications and potential adverse health outcomes. [...]

Inspectors wroteBased on interview and record the facility failed to review and revised the person-centered comprehensive care plan for 1 (Resident #22) of 5 residents reviewed for comprehensive care plan revisions. The facility failed to update Resident #22's care plan to reflect the status of Resident #22's NPO status. This failure could place residents at risk of not receiving the appropriate care and interventions they need. [...]

Inspectors wroteBased on interview and record review, the facility failed to use the services of a registered nurse for at least 8 consecutive hours 7 days a week reviewed for RN coverage for 5 of 30 days reviewed for nursing services. (11/9/24, 11/10/24, 11/23/24, 11/24/24 and 11/30/24). The facility failed to have an RN for 8 consecutive hours 7 days a week for 5 days from November 9, 2024, through November 10, 2024, November 23, 2024, through November 24, 2024, and November 30, 2024. This failure could place residents at risk of lack of nursing oversight and a higher level of care.

Inspectors wroteBased on interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 2 (Resident #11 and Resident #45) of 25 residents reviewed for pharmacy services. The facility failed to ensure Resident #11's medications were reordered timely to prevent the medications being unavailable for administration to the resident. The facility failed to administer two doses of Hydrocodone-acetaminophen- Schedule II tablet; 10-325 mg; oral on 12/04/2024 at 1 AM and 7 AM for Resident #11. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for the kitchen. The facility failed to ensure on 12/03/2024 at 8:15 AM that a container of bacon grease, chicken noodle soup and French toast were labeled and dated with the preparation date and expiration date. The facility failed to ensure a bag of open tortillas was sealed. The facility failed to ensure the label on the ground beef in the freezer was legible. These failures had the potential to place residents at risk of serious complications from foodborne illness because of their compromised health status. Record review of Food Receiving and Storage policy dated November 2022 read in part . Foods shall be received and stored in a manner that complies with safe food handling practices. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the coordination of assessments with the Pre-admission Screening and Resident Review (PASRR) program was provided for 1 of 4 residents reviewed for PASRR screenings (Resident #49). The facility did not correctly identify Resident #49 as having mental illness in his PASRR Level 1 Screening. This failure could place residents with documented mental illness diagnoses at risk of not receiving needed care and services in the appropriate setting.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that the medication error rate was not five percent (%) or greater. The facility had a medication error rate of 7% based on 2 errors out of 28 opportunities, which involved 1 of 4 residents (Residents #45) reviewed for medication errors. 1. The facility failed to ensure MA A administered the correct dose of Clonazepam to Resident #45. 2. The MA failed to administer Methimazole to Resident #45 according to physician orders and administered the medication after meal instead of before meal. These failures could place residents at risk of not receiving the intended therapeutic benefits of prescribed medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection for 1 (Resident #69) of 5 resident reviewed for infection control. The facility failed to ensure that CNA A, used appropriate PPE during urinary catheter care to Resident #69. These failures could place residents at-risk for infection due to improper care practices. Findings Included: Record review of Resident #36's face sheet dated 12/03/2024 revealed resident was admitted to the facility on [DATE], age [AGE] years old. Resident #69 had a diagnosis of Malignant neoplasm of liver (a cancerous tumor that can start in the liver or spread to the liver from another part of the body). [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet the resident's medical, nursing, mental, and psychosocial needs and describes the services to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 6 residents (Resident #1) reviewed for comprehensive care plans. The facility failed to develop a comprehensive person-centered care plan for Resident #1 as identified in the Care Area Assessment of the admission MDS assessment. This failure could place residents at risk of not having personalized plans developed to address their specific care needs.

Inspectors wroteBased on interview, observation, and record review, the facility failed to develop a comprehensive care plan within seven days after completion of the comprehensive assessment, for 1 of 6 residents (Resident #1) reviewed for comprehensive care plans. The facility failed to develop a comprehensive person-centered care plan for Resident #1 within 7 days of the completed admission MDS assessment and no more than 21 days after admission. This failure could place residents at risk for not receiving the required person-centered care.

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive care plan, and the residents' choices for 1 resident of 17 residents (Resident #1) reviewed for quality of care. The facility failed to assess Resident #1, who was prescribed daily anticoagulant medication, before lifting her up off the floor when she had an unwitnessed fall and sustained facial injuries and a bleeding hematoma to the back of her head. An Immediate Jeopardy (IJ) was identified on 02/22/2024. The IJ template was provided to the facility on [DATE] at 3:22 p.m. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one resident (Resident #2) of five residents reviewed for physician orders received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices. -Resident #2 was given supplements for colonoscopy preparation but had no order for them. -The colonoscopy preparation supplement had been ordered for a different resident. The deficient practice could place residents at risk of ingesting medications not prescribed resulting in severe abdominal distress and diarrhea.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as possible for one (Resident #1) of five residents reviewed on the secured unit for adequate supervision to prevent accidents. The facility failed to ensure resident safety, as evidenced by: -The door of the nurses' office on the secured unit was open and accessible to residents. -Resident #1, a confused resident, was in close proximity to a bag of medications on the nurses' desk, with no staff within line of sight of the nurses' office. The deficient practice placed residents at risk for ingesting medications that could be detrimental to his or her health, resulting in illness or hospitalization.

Inspectors wroteBased on interview and record review the facility failed to ensure the services of a registered nurse for at least eight consecutive hours a day, seven days a week for 10 days in April 2023 and two days in May 2023 of 60 days reviewed for RN coverage. The facility failed to ensure RN coverage for all Saturdays and Sundays in April 2023 and one Saturday and one Sunday in May 2023. This failure placed the residents at risk for not having decisions made that would have required an RN to make in the management of the residents' healthcare needs and in managing and monitoring of the direct care staff.

Inspectors wroteBased on interview, and record review, the facility failed to ensure that licensed nursing staff have the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care for 1 of 18 residents (Resident #52) reviewed for nursing competency, in that: -The facility failed to ensure LVN C was competent in medication administration skills by failing to perform pre and post treatment vital signs, observing resident while administering Handheld nebulizer treatment, and documenting that the medication was administered and completed. These failures could put residents at risk for inadequate care, result in ineffective treatment, worsening of symptoms and/or medical complications.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide pharmaceutical services to include administering of medications to meet the needs of 1 resident (Resident #52) of 18 residents reviewed for pharmacy handheld nebulizer treatments, in that: -Resident #52's scheduled medication was not administered timely and according to facility policy. -The facility failed to change Resident #52's HHN equipment weekly per policy. This deficit practice could affect the resident by not receiving a therapeutic dose and could prevent the resident from receiving the highest possible benefit from their medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure in accordance with State and Federal laws, all drugs and biologicals were stored securely in locked compartments for one (Nurse medication cart 500 Hall) of 7 medication carts observed for storage of medications. The facility failed to ensure the nurse 500 hall medication cart was secured when unattended. This failure could place residents at risk for loss of medications, resident's safety, and drug diversion.

Inspectors wroteBased on interview and record review, the facility failed to maintain accurate and complete medical records in accordance with accepted professional standards of practice. The facility did not maintain medical records that were accurately documented for 1 of 3 (Resident #6) residents reviewed for DNR status, in that: -The facility failed to ensure Resident #6's electronic records were correctly updated and complete with a Full Code/DNR status. -The facility failed to ensure Resident #6s DNR/Full Code status was correctly verified based on the order in the electronic medical record (EMR). This failure could place residents at risk for inaccurate clinical records regarding effective Full Code and/or DNR status.