Barnes-Jewish Extended Care

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were provided with care in accordance with professional standards of practice when staff failed to obtain and follow physician orders for indwelling device use, care, and/or removal, and/or wound care for five residents (Residents #3, #4, #6, #8, and #11), and failed to follow-up with the surgeon's office for further instruction after identifying concern of wound infection for one resident (Resident #4). The sample size was 12. The census was 76. Review of the facility's Central Vascular Access Device (CVAD, devices inserted through a vein to enable administration of fluids, medications, and other therapies to the blood stream) removal policy, updated 06/01/21, showed:-To be performed by Licensed Nurses according to State law and facility policy. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their policy regarding visitation and failed to ensure residents could receive visitors when the facility locked the front door entrance at 8:30 P.M. and did not allow resident families/visitors to freely enter and exit the facility. The census was 69. Review of the facility's Resident Right to Access and Visitation policy, reviewed 9/22, showed:-Purpose: To outline resident's rights regarding visitation practices within the communities to see that proper compliance with CMS (Centers for Medicare and Medicaid Services) guidelines exists;-Responsibility: It is the responsibility of the Administrator to see that all staff members follow the visitation guidelines within this policy;-Policy: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to accommodate the needs of one resident (Resident #30) by failing to ensure the resident's call light was plugged in and accessible to the resident. The sample was 18. The census was 69. Review of the facility's Call Lights: Accessibility and Timely Response policy, revised 8/2024, showed:-Purpose: To establish a procedure to which the community adequately equips call lights at each residents' bedside, toilet and bathing areas to allow residents to call for assistance. Call lights will directly relay to a staff member or centralized location to ensure appropriate response;-Policy: Each resident shall have access to summon assistance lights are answered timely;-Practice: Special accommodations will be identified on the resident's person-centered plan of care and provided accordingly. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure services provided met professional standards when staff failed to identify one resident's burn on admission which resulted in the treatment orders not being obtained for four days (Resident #101) and staff failed to identify/document one resident's wound on admission (Resident #53). The sample was 18. The census was 69. Review of the facility's admission of a Resident policy, date revised 2/26, showed:-The nurse should interview and assess the resident upon admission to determine high risk areas based on the resident's admission diagnosis. Assessment findings will be used to provide appropriate equipment or monitoring required. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide care and services in accordance with professional standards when the facility staff failed to complete/document neurological checks (neuro-checks, an assessment completed by nursing staff to monitor for changes in the resident's neurological (nervous system) status) post fall per the facility's policy for four out of six residents sampled for falls (Residents #14, # 16, #10 and #15). In addition, staff failed to follow a physician order to monitor one resident's blood pressure (B/P) and notify the physician per the physician's order (Resident #14). The sample size was 16. The census was 63. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident with a pressure wound/injury (skin or soft tissue injury that develops with prolonged periods of pressure over specific areas of the body) had necessary treatments and services to promote healing (Resident #30). The sample size was 18. The census was 69. Review of the facility's Wounds: Treatment of Pressure and Non-Pressure policy, revised 6/25/25, showed:-Purpose: To provide guidelines for use in wound assessment, treatment, and documentation;-Policy: The facility's Wound Product Selection Guide will be used as guidelines to determine appropriate treatments. A physician's order is required for all wound treatment; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to evaluate and address the hydration needs for one of 18 sampled residents (Resident #30). The census was 69. Review of the facility's Nursing Policy-A.M. and P.M. Care, revised 10/22, showed the procedure during A.M. and P.M care to be sure water is within reach. Offer and encourage fluid intake with care. Review of Resident #30's Comprehensive Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 3/2/26, showed:-Cognitively intact-Diagnoses included paranoid schizophrenia (serious mental illness that affects how a person thinks, feels, and behaves), anxiety disorder, and benign prostatic hyperplasia (enlarged prostate gland);-Independent of eating. Review of most current care plan, showed:-Focus: Resident is at risk for weight loss;-Goal: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure two residents were free from significant medication errors when staff failed to administer medications per physician orders and failed to notify the physician when the medications were not administered (Resident #10 and #30). The sample was 18. The census was 69. Review of the facility's Medication Administration Policy, dated revised on 6/23, showed: -Only a licensed nurse or Certified Medication Technician (CMT) may prepare, administer and/or record the administration of medications. Medications must be administered in accordance with a physician's orders (i.e., the right resident, the right medication, the right dosage, the right route and the right time). [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure drugs and biologicals were stored in accordance with acceptable standards of practice. The facility identified two medication rooms, six medication carts, and six treatment carts. Both medication rooms, five medication carts and one treatment cart were checked for medication storage. Issues were found in one medication room and two medication carts. Staff failed to double-lock the emergency kit for controlled substances. In addition, staff failed to dispose of expired over-the-counter (OTC) medications. The census was 69. Review of the facility's Delivery, Receipt, Storage, and Inventory of Facility Products policy, reviewed 8/2022, showed:-Subject and Addendum: [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to provide choices for meals and to offer substitutions for two residents (Residents #2 and #128). The sample was 18. The census was 69. Review of the facility's Menu Posting and Menu Substitution policy, dated 1/2025, showed: -Menu Posting:-Menus should include daily choices available for each meal;-An always available or a la carte menu is posted or made available to all residents;-Menu Substitutions:-Menu changes or substitutions for situations such as an emergency event, food unavailability or special dining events will be posted or otherwise communicated prior to meal service;--Menu substitute should be consistent with the usual and/or ordinary food items provided. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow acceptable infection control standards by not implementing Enhanced Barrier Precautions (EBP, an infection control intervention designed to reduce the transmission of multidrug-resistant organisms (MDROs) that employs targeted gown and glove use during high contact resident care activities as recommended by the Centers for Disease Control and Prevention (CDC) and required by the Centers for Medicare and Medicaid Services (CMS)), for one resident who required EBP for Intravenous (IV) medications (Resident #59) and when staff positioned one resident's urinary drainage bag (a medical device designed to collect urine from a catheter (a tube that is inserted into the bladder, allowing your urine to drain freely) on the rim of the trash can (Resident #39). [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to provide treatment and care in accordance with professional standards of practice, for six of twelve residents sampled. Two residents (Residents #5 and #8) did not have orders for wound care, three residents (Residents #6, #7, #9) wound care orders were not followed, and five residents (Residents #4, #6, #7, #8, #9) wound dressings were not dated or initialed per facility policy. The facility census was 62. Review of the facility's policy and procedure for Physician Order, revised 4/2025, showed:-Purpose: To establish guidelines for properly obtaining physician orders and processing these orders;-Policy: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide appealing meal options of similar nutritive value to residents who choose not to eat food that is initially served or who request a different meal choice, by failing to provide alternate meals per resident preference (Residents #10, #11, and #12). The sample size was 12. The facility census was 62. Review of the facility's menu for the week of 7/7/25 through 7/13/25, showed:-Breakfast for 7/7/25: Oatmeal, scrambled eggs, pancake with maple syrup;-Lunch for 7/7/25: Tomato Florentine soup, maple glazed ham, rice pilaf, green beans, blonde bar;-Breakfast for 7/8/25: Grits, scrambled eggs, bacon strips, biscuit;-Lunch for 7/8/25: Garden vegetable soup, beef sirloin steak, green peas, wheat roll, chocolate pudding;-Breakfast for 7/9/25: Oatmeal, scrambled eggs, orange bread;-Breakfast for 7/10/25: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program when staff failed to wear appropriate personal protective equipment (PPE), in accordance with the facility's policy, during high-contact activities with residents on enhanced barrier precautions (EBP, precautions for use during high-contact resident care activities for residents infected with a multidrug-resistant organism (MDRO, microorganisms that are resistant to one or more classes of antimicrobial agents) or any resident who has a chronic wound and/or indwelling medical device) (Residents #295, #301, #6, #200, #249, and #9). The sample was 17. The census was 69. Review of the facility's Enhanced Barrier Precautions (EBP) policy, revised February 2024, showed: -Purpose: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident's care plan accurately reflected the residents' needs and medical conditions upon admission. This failure was noted in 5 of 17 sampled residents, including Resident #199, whose gastrostomy tube (g-tube, a surgical opening made in the stomach to feed nutrition directly into the stomach) was not included on the care plan, Resident #299 whose continuous positive airway pressure (CPAP, used to treat sleep apnea) was not included on the care plan, Resident #298 whose urinary catheter was not included and Resident #301, whose intravenous (IV) line was not included on the care plan, and for Resident #248 when a foot wound was not included on the care plan. The census was 69. Review of the facility's Care Planning policy, revised 11/22 showed: [...]

Inspectors wroteBase on observation, interview and record review, the facility failed to ensure two residents' Activities of Daily Living (ADL) needs were met by failing to ensure both residents received at least two showers/bed baths weekly (Residents #248 and #249) . The sample was 17. The census was 69. Review of the facility's AM and PM Care policy, revised 10/2022, showed: -Purpose: to provide grooming and hygiene for each resident, assisting with bathing, dressing and elimination as needed; -Policy: it shall be the policy of Bethesda that each resident receives assistance with ADLs as needed throughout each day. Consideration will be given to making the experience as home-like and individual as possible; -Procedure: on the designated day, assist the resident with their bath or shower. 1. Review of Resident #248's electronic medical record (EMR), showed: -admit date [DATE]; -Cognitively intact; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for one resident (Resident #301). The resident admitted from the hospital on 5/16/24. The facility admission nursing assessment identified an open area on the buttock and a double lumen peripherally inserted central catheter (PICC, a device which delivers fluids directly into a much larger vein) inserted into the right side of the resident's neck. There was no order for the PICC line dressing change, flushing, or care. In addition, facility staff failed to complete treatment orders and apply dressing changes as ordered to the buttocks. The sample was 17. The census was 69. Review of the facility's Central Vascular Access Device (CVAD) Flushing and Locking policy, dated 1/15/2004 and last revision 6/1/21, showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident (Resident #298) who was admitted with a indwelling urinary catheter (thin tube inserted into the bladder to drain urine) had a physicians order to provide care for the catheter. The sample size was 17. The census was 69. Review of the facility's Prescribing and Ordering of Medication/Products policy, dated effective date 4/2002 and last revision 1/24, showed: -To establish guideline for properly obtaining physician orders and processing these orders; -To obtain admission orders from the physician, check the transfer sheet from the discharging facility as a reference; -Enter orders into the resident's medical record. Review of Resident #298's electronic medical record (EMR) and resident information card, reviewed on 5/21/24 at 10:40 A.M., showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one resident maintained acceptable parameters of nutritional status to the extent possible, for one resident (Resident #34) who experienced a significant weight loss (weight loss of 5% or more in the last month, loss of 7.5% or more in the last three months, or loss of 10% or more in the last six months) of -10.35% from July 2023 to January 2024. During this timeframe, the facility's Registered Dietician (RD) completed two nutritional assessments, noted a decline in the resident's meal intake, and did not recommend additional nutritional interventions. The resident was not served fortified cheesy eggs as recommended by the RD, and the RD's recommendation for fortified pudding did not get added to the resident's meal ticket. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure physician orders were obtained for the use of a continuous positive airway pressure (CPAP, machine that keeps the airways open during sleep for persons with sleep apnea) for one resident (Resident #299) and to ensure CPAP masks were properly stored while not in use for infection control purposes for two residents (Residents #299 and #146). The sample was 17. The census was 69. Review of the facility's CPAP/Bilateral Positive Airway Pressure (BIPAP, mechanical breathing device)/Average Volume Assured Pressure Support (AVAPS, mode of non-invasive ventilation)/Trilogy Ventilator (device used to provide pressure support, pressure control, or volume control during breathing support) policy, revised November 2021, showed: -Purpose: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide necessary behavioral health services to maintain the highest practicable psychosocial well-being for one resident (Resident #6) who expressed feelings of being better off dead and thoughts of unplugging his/her left ventricular assist device (LVAD, a device implanted in the chest to help the heart pump blood). The sample was 17. The census was 69. Review of Resident #6's medical record, showed: -admission date 5/11/23; -Diagnoses included history of stroke with residual hemiparesis (weakness on one side of the body), heart disease, heart failure, atrioventricular block (interrupted or delayed heart rate), ischemic cardiomyopathy (heart's decreased ability to pump blood properly), and presence of heart assist device. Review of the resident's physical therapy evaluation, dated 11/9/23, showed: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to store medication and medical equipment in accordance with professional principles, including abiding by the expiration date on stock medications in facility medication rooms and medication carts. Concerns were found in one of two medication rooms and in two of six treatment carts in the facility. The sample size was 17. The census was 69. Review of the facility's LTC Facility's Pharmacy Services and Procedures Manual, revised 12/01/22, showed: -Facility should ensure that medications and biologicals that: (1) have an expired date on the label; (2) have been retained longer than recommended by manufacturer or supplier guidelines; or (3) have been contaminated or deteriorated, are stored separate from other medications until destroyed or returned to pharmacy supplier; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents could safely administer their own medications for three sampled residents (Residents #374, #376 and #186), who had medications left at their bedside. The census was 60. Review of the facility's Self Administering Medication Policy, reviewed 8/2022, showed: -Medications may be self-administered only after the resident has been evaluated by an interdisciplinary team to determine that the resident can safely self-administer medications with administrator/Executive Director Approval; -An evaluation will be completed and documented prior to allowing self-administration of medications; -If the evaluation indicates the resident may self-administer medications, the resident's/community member's physician must also give an order allowing self-administration. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to assure residents who were unable to carry out activities of daily living (ADLs) receive the necessary services to maintain good personal hygiene and grooming by not providing baths or showers at least twice a week, for three sampled residents (Residents #180, #183 and #187). In addition, two sampled residents were observed to have long nails, who preferred to have their nails short and clipped (Residents #7 and #12). The census was 60. Review of the facility's A.M. and P.M. Care Policy, revised on 10/2022, showed: -Purpose: To provide grooming and hygiene for each resident, assisting with bathing, dressing and elimination as needed; -Responsibility: All nursing staff shall be responsible for assisting with ADLs; -Policy: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure adequate amounts of all the necessary items were available for the dinner meal on 11/16/22 and for breakfast on 11/17/22 for two residents (Residents #186 and #370). This practice potentially affected all residents who ate food from the facility kitchen. The facility census was 60 residents. Review of the facility's menu for the week of 11/14/22 through 11/20/22, showed: -The dinner menu for 11/16/22: Chicken and dumplings, baby carrots, roll and peaches; -The breakfast menu for 11/17/22: Oatmeal, scrambled eggs, bacon, pancake with maple syrup. 1. Review of Resident #186's medical record, showed the following: -admission: [DATE]; -No cognitive impairment; -Regular diet; -Diagnoses included malnutrition. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide appealing options of similar nutritive value to residents who choose not to eat food that is initially served or who request a different meal choice, by failing to provide alternate meals (Resident #186). The facility also failed to consistently provide menu tickets for residents to select their meal preferences or serve the items residents selected on their menu ticket (Resident #370). The facility census was 60. 1. Review of the facility's menu for the week of 11/14/22 through 11/20/22, showed: -Breakfast for 11/14/22: Oatmeal, scrambled eggs, pancake with maple syrup; -Breakfast for 11/15/22: Oatmeal, egg scramble, ham, hash brown potatoes; -Breakfast for 11/16/22: Oatmeal, banana, sausage links, chocolate chip muffins; -Breakfast for 11/17/22: Oatmeal, scrambled eggs, bacon, pancake with maple syrup; [...]

Inspectors wroteBased on observation and interview , facility staff failed to store food in a manner to prevent contamination and out-dated use by not covering and dating food items stored in the refrigerator and storing scoops and cups inside bulk bins. These deficient practices had the potential to effect all residents who at the facility. The census was 60. Review of the facility's Storage of Food and Supplies policy, revised 12/7/20, showed; -All food, non-food items and supplies used in food preparation shall be stored in such a manner as to prevent contamination to maintain the safety and wholesome of the food for human consumption; -Refrigerated Foods: Use food grade plastic bags for food storage. Cover foods stored on ladder/seed racks to prevent contamination from airborne contaminants as well as from dripping condensation. [...]

Inspectors wroteBased on interview and record review, the facility failed to assure staff followed the complaint/grievance policy, when staff failed to make prompt efforts to resolve the resident's grievances affecting one resident (Resident #20). The facility also failed to follow the grievance policy by not providing a written method for the residents to file grievances. The facility census was 60. Review of the resident and family concern policy, revised 2/2019, showed: -Purpose: To establish written guidelines for the filing of resident concerns and to assure that appropriate investigation and action is promptly taken. Customer feedback is an important source of information about an organization's performance. The verbal or written resident concerns received by staff, physicians and administrators provide vital information about improvement opportunities; -Responsibility: [...]

Inspectors wroteBased on interview and record review, the facility's admission packet failed to include transportation as a billable, non-covered service not provided by the facility for one sampled resident (Resident #376). This deficiency had the potential to affect all residents who required transportation. The census was 60. Review of the facility's admission policy, date last reviewed 5/20, and showed: -Transportation was not addressed. Review of the facility's admission Packet, undated, showed: -Transportation was not addressed. Review of the List of Covered/Non-Covered Charges, undated, showed: -The list of ancillary services billable by supplying provider, transportation was not addressed. Review of Resident #376's medical record, showed: -admission date of 10/25/22; -The resident was alert and able to make needs and wants known. During interviews on 11/14/22 at approximately 11:30 A.M. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident admitted to the facility with a deep tissue injury (DTI, an injury to underlying tissue below the skin's surface that results from prolonged pressure in an area of the body, usually a dark purple color) received an accurate admission skin assessment, physician notification of the wound and orders for wound care. The nursing staff also failed to ensure treatment orders once obtained four days after admission, were accurately entered onto the treatment administration record (TAR). This affected one of three residents reviewed for pressure injury care (Resident #420). The census was 60. The administrator was notified on 11/17/22, of the past non-compliance. [...]