Bear Hill Healthcare and Rehabilitation Center

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide quality of care in accordance with professional standards for four Residents (#154, #40, #118, and #58) out of a total sample of 31 residents. Specifically,1. For Resident #154, the facility failed to document and assess the alteration of the skin on his/her lower extremities to determine if the areas were healing or worsening and failed to report the condition of Resident 154's lower extremities to the medical provider. 2. For Resident #40, the facility failed to implement an order for a diuretic after a significant weight gain for Resident #40, who has congestive heart failure and edema.3. For Resident #118, the facility failed to label wound dressings after changing Resident #118's dressing.4. For Resident #58, the facility failed to complete weekly skin checks as ordered.

Inspectors wroteBased on observation, record review and interview, the facility failed to identify and assess the use of a geri-chair (a high back chair on wheels with the ability to recline) as a potential restraint for one Resident (#118) out of a total of 31 sampled Residents.

Inspectors wroteBased on record review and interview, the facility failed to develop an activities care plan for one Resident (#40) out of a total sample of 31 residents.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to ensure for one Resident (#145), out of a total sample of 31 residents, that services were provided to maintain his/her hearing abilities. Specifically, for Resident #145 the facility failed to assist with providing his/her's left hearing aid and ensuring it was working to support the Resident's hearing.

Inspectors wroteBased on record review, interview and observation, the facility failed to ensure physicians orders for the care of pressure ulcers were implemented for one Resident (#86) out of a total sample of 31 residents. Specifically, for Resident #86, the facility failed to ensure that the wound physician's recommendations for treatment to Resident #86's sacrum were followed.

Inspectors wroteBased on record review and interview, the facility failed to accurately document in the electronic medical record for two Residents (#12 and #84), out of a total sample of 31 residents. Specifically, 1. For Resident #12, nursing staff documented a right arm sling as being provided when it was not. 2. For Resident #84, the facility failed to accurately record the Resident's oxygen saturation percentages in the medication administration record.

Inspectors wroteBased on record review and interviews, the facility failed to issue a Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN) (a form issued by SNFs to notify Medicare beneficiaries of potential financial liability for certain services) for 2 applicable residents, out of a sample of 3 residents. Specifically, the facility failed to issue SNF ABN notices after skilled services ended.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to provide assistance with Activities of Daily Living (ADLs), for two Residents (#61 and #241) out of a total sample of 30 residents. specifically 1. For Resident #61 the facility failed to provide supervision with meals. 2. For Resident #241 the facility failed to provide incontinent care or hygiene care. Findings Include: Review of the facility policy titled Activities of Daily Living (ADL's), Supporting, undated, indicated the following: Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Policy Interpretation and Implementation 1(c). The refusal and information are documented in the resident's clinical record. 2. [...]

Inspectors wroteBased on record review and interview, the facility failed to accurately document in the clinical record for 4 Residents (#18, #43, #241 and #110) out of a total sample of 30 residents. Specifically: 1. for Resident #18 the facility failed to accurately document the changing of the oxygen tubing. 2. For Resident #43 the facility failed to accurately document the sex of the Resident. 3. For Resident #241 the facility failed to accurately document the Activities of Daily Living (ADL) care provided. 4. For Resident #110, the facility failed to ensure staff accurately documented the completion of wound treatments provided.

Inspectors wroteBased on record review and interview the facility failed to develop a plan of care for two Residents (#43 and #241) out of a total sample of 30 residents. Specifically; 1. For Resident #43 the facility failed to develop a plan of care for suicidal ideation's. 2. For Resident #241 the facility failed to ensure a call light was accessible.

Inspectors wroteBased on observation, record review and interviews, the facility failed to provide respiratory care services in accordance with professional standards of practice for one Resident (#18) out of a total sample of 30 residents.

Inspectors wroteBased on observation, record review and interview, the facility failed to follow the fall plan of care for 1 Resident (#124) out of a total of 36 sampled Residents. Subsequently, Resident #124 sustained a fall requiring hospitalization and was diagnosed with subdural hematoma, (bleeding that occurs within the skull but outside the actual brain tissue).

Inspectors wroteBased on observations, record reviews and interviews, the facility 1) failed to implement personalized care plans for 3 Residents (#128, #52, and #94) and 2) failed to develop a behavior care plan for 1 Resident (#81) out of a total sample of 36 residents.

Inspectors wroteBased on observations, policy review and interviews, the facility failed to 1. ensure medications with short expirations dates were dated when opened, expired medications were not available for administration, failed to ensure medication carts were kept clean and 2. failed to ensure medication and treatment carts were locked when unattended on three out of four units.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure practices to prevent the spread of infection were implemented. Specifically, the facility failed to 1. ensure for two residents (#130 and #134) that staff implemented and adhered to enhanced infection precautions, 2. failed provide urinary catheter care in adherence to infection control standards for two residents (#130 and #102), 3. failed to handle clean linen to prevent possible contamination, 4. failed to ensure infection control practices were adhered to with multi-use medical equipment and 5. failed to ensure hand hygiene was preformed after glove use potentially contaminating the resident's environment and 6. failed to ensure a risk assessment was present as part of the overall water management program to prevent the risk of Legionella and other opportunistic pathogens.

Inspectors wroteBased on observation, record review and interview, the facility failed to alert the physician of changes in condition for 1 Resident (#94) and failed to notify the responsible party of a change in condition for 1 Resident (#40) out of a total of 36 sampled Residents. Specifically, the facility failed to: 1.) Alert the physician of a newly developed gangrenous wound for Resident #94 and, 2.) failed to notify the responsible party of a change in condition, resulting in the needs for medical attention. Review of the facility's policy entitled Change is Resident's Condition, undated, indicated the following: *The facility is required to notify a resident's physician when there is a significant change in the resident's health status. The facility is required to make any pertinent information available and provide it to the resident's physician upon request. [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure that services provided met professional standards of quality, for three Residents (#48, #405 and #130) out of a total sample of 36 residents. Specifically, the facility 1. failed to follow physician's orders for maintaining and documenting fluid restriction for Resident #48 and #405 and 2. failed to provide fortified mashed potatoes in accordance with the medical orders.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure staff provided treatment and care in accordance with professional standards of practice for two Residents (#94, #40) out of a total of 36 sampled Residents. Specifically the facility failed to: 1. Identify and address a newly developed gangrenous (dead tissue) skin injury for Resident #94. 2. Implement an antibiotic treatment for cellulitis and implement monitoring of the diagnosis for Resident #40. 1. Review of the facility's Prevention of Pressure Ulcer policy, undated, indicated: *Any resident who has a pressure or stasis ulcer (an skin ulcer related to poor circulation) as well as residents with weight loss/gain are reviewed weekly. *Residents will additionally be re-assessed minimally quarterly and with any chance in condition thereafter. *Resident's will receive necessary service to promote healing. [...]

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to provide respiratory care services in accordance with professional standards of practice. Specifically, the facility failed to 1. have physician orders to administer continuous oxygen for one Resident (#98), and 2. failed to ensure oxygen administration was in accordance with the medical plan of care for one resident (#134) out of a total sample of 36 residents.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure care and services for the provision for hemodialysis was in accordance with professional standards of practice for one out of one applicable resident (#134), out of a total sample of 36 residents. Specifically, the facility failed to 1.) ensure ongoing appropriate assessment of the resident's hemodialysis access site, and 2.) failed to provide equipment and supplies necessary to manage a medical emergency for those. Review of the facility's policy and procedure dated as revised 2/2019, titled Dialysis indicated the following: *Purpose: to ensure that residents receiving outpatient dialysis will have a comprehensive treatment plan. Policy: communication regarding treatment delivery or problems will be comprehensive and ongoing between the dialysis delivery company and the facility's nursing staff. *Procedure: [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure a plan of care was developed for Trauma-Informed Care for one Resident (#136), who was admitted with the diagnosis of Post-Traumatic Stress Disorder (PTSD), out of a total sample of 36 residents.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure licensed nursing staff possessed the appropriate competency and skills to care for one resident (#134) out of one applicable resident, requiring dialysis, out of a total sample of 36 residents. Specifically, 1. nursing staff did not provide appropriate assessment of the dialysis access site and did not know how to implement an emergency plan related to dialysis care and 2. facility staff failed to ensure newly hired licensed nursing staff had a complete orientation including medication pass competency.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure pharmaceutical services met the needs of each resident. Specifically, the facility failed to ensure an antibiotic kit, an emergency kit and an insulin kit were replaced by the pharmacy after being opened.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to ensure it was free from medication error rate of greater than 5 percent. Two out of three nurses observed made two errors out of 27 opportunities on two of two units resulting in a medication error rate of 7.41%. These errors impacted two Residents (#72 and #38), out of four residents observed.

Inspectors wroteBased on record review and interview the facility failed to ensure for one resident (#130), out of five applicable residents, was assessed for the eligibility, received, or declined the pneumonia vaccine, and was provided education of the risk benefits of the pneumonia vaccine timely.

Inspectors wroteBased on record reviews and interviews, the facility failed to provide a written notice of intent to discharge prior to transferring 3 Residents (#37, #98 and #127) to the hospital, out of a total sample of 36 residents.

Inspectors wroteBased on record reviews and interviews, the facility failed to provide a bed-hold notice upon transferring three Residents (#12, #37, and #98) to the hospital, out of a total sample of 36 residents.