Baptist Health & Rehab

Inspectors wroteBased on review of a facility reported incident (FRI) investigation, record review, policy review, and staff interview, the facility failed to provide appropriate respiratory care for 1 of 1 closed resident record (Resident #1) who required respiratory support from a ventilator. Failure to provide care consistent with professional standards of practice and the physician's orders may have resulted in or contributed to Resident #1's death and placed all other ventilator-dependent residents at risk of injury or death. This citation is considered past non-compliance based on review of the corrective action the facility implemented immediately following discovery of the incident. [...]

Inspectors wroteBased on observation, record review, review of facility policy, and staff interview, the facility failed to provide appropriate treatment/services to prevent complications from a gastrostomy tube (G-tube) (a tube inserted through the abdomen that brings nutrition directly to the stomach) for 1 of 1 sampled resident (Resident #47) observed with a G-tube. Failure to flush the tube with water before and after medications may lead to dehydration and G-tube occlusion.

Inspectors wroteBased on observation, record review, and review of facility policy, the facility failed to follow standards of infection control and prevention for 3 of 6 sampled residents (Residents #49, #73 and #436) on enhanced barrier precautions (EBP) and observed during cares. Failure to follow EBP during tracheostomy (an opening through the neck into the windpipe) and percutaneous gastrostomy (PEG) tube (feeding device inserted into the stomach through the abdomen) care for Resident #49, tracheostomy care (cleaning the airway tube and surrounding skin) for Resident #436, and wound care for Resident #73 has the potential to spread infection throughout the facility.

Inspectors wroteBased on observation, record review, review of the facility reported incident, review of the facility policy, and staff interview, the facility failed to ensure a resident received adequate supervision and assistive devices to prevent accidents for 1 of 1 sampled resident (Resident #1) investigated for a fall. Failure to ensure staff used a mechanical lift properly and verified proper installation of attachments to the Broda chair (specialized wheelchair) resulted in a fall from the mechanical lift.

Inspectors wroteBased on record review, review of the facility reported incident, review of facility policy, and staff interview, the facility failed to report an incident of abuse within 24 hours to the State Survey Agency (SSA) for 1 of 1 sampled resident (Resident #2) who experienced an injury. Failure to report an event of potential abuse in the required time frame does not comply with regulations established to protect residents. This citation is considered past noncompliance based on review of the corrective action the facility implemented.

Inspectors wroteBased on record review, review of the facility reported incident, investigation documents, and review of the facility policy, the facility failed to ensure a resident received adequate supervision and assistive devices to prevent accidents for 1 of 1 sampled resident (Resident #1) investigated for falls. Failure to ensure staff use a gait belt during transfers resulted in a fracture and hospitalization. This citation is considered past non-compliance based on review of the corrective actions the facility implemented immediately following the incident.

Inspectors wroteBased on observation, record review, review of facility policy, and staff interview, the facility failed to assess the use of a wheelchair seatbelt and vest straps as a possible restraint for 1 of 2 sampled residents (Resident #2) observed with a wheelchair seat belt and vest straps . Failure to assess the wheelchair seatbelt and vest straps as possible restraints, monitor their use, and evaluate the need for continued use placed Resident #2 at risk for an unnecessary restraint and injury related to their use.

Inspectors wroteBased on observation, record review, review of facility policy, and staff interview, the facility failed to review and revise the comprehensive care plan to reflect the current status for 3 of 28 sampled residents (Resident #2, #63, and #99). Failure to review and revise the care plan limited staff's ability to communicate needs and ensure continuity of care.

Inspectors wroteBased on observation, record review, review of facility policy, review of professional reference, and staff interview, the facility failed to follow professional standards of nursing practice for 1 of 1 supplemental resident (Resident #135) observed during medication administration. Failure of staff to ensure residents swallowed medications, reported behaviors during medication administration, and re-administered unswallowed or refused medications may lead to adverse health conditions.

Inspectors wroteBased on observation, record review, review of facility policy, and family interview, the facility failed to provide an ongoing program of meaningful activities designed to meet the interests and physical, mental, and psychosocial well-being for 1 of 5 sampled residents (Resident #60) dependent on staff for activities. Failure to provide meaningful activities for residents limited Resident #60's ability to reach her highest practicable level of physical, mental, and psychosocial well-being.

Inspectors wroteBased on observation, record review, review of professional reference, review of facility policy, and family interview, the facility failed to offer fluids to 1 of 3 sampled residents (Resident #60) who were observed during cares and required staff assistance for fluid intake. Failure to provide assistance with fluid intake may result in dehydration, constipation, and urinary tract infections (UTIs).

Inspectors wroteBased on record review, policy and procedure review, professional reference review, and resident and staff interviews, the facility failed to provide the care and services consistent with professional standards of practice for 2 of 3 sampled residents (#79 and #99) on hemodialysis with an arterial-venous fistula (vascular access for hemodialysis). Failure to assess the hemodialysis vascular access site (fistula) may result in complications and adverse effects, such as clotting and possible loss of the access site.

Inspectors wroteBased on observation, record review, facility policy review, and staff interview, the facility failed to follow standards of infection control for 3 of 10 sampled residents (#60, #124, and #131) observed during cares. Failure to follow infection control standards during perineal cares and with transmission-based precautions (TBP) has the potential to transmit infections to residents, staff, and visitors.

Inspectors wroteBased on record review, review of the facility reported incident investigation, review of facility policy, and staff interview, the facility failed to ensure an environment free of hazards for 1 of 2 sampled residents (Resident #1) injured while consuming a hot beverage. Failure to provide the appropriate adaptive drinking aids with a mug for hot beverages contributed to Resident #1's injuries This citation is considered past non-compliance based on review of the corrective action the facility implemented immediately following the incident.