Bella Terra Elmhurst

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to provide feeding assistance to dependent residents. This failure applies to 2 of 7 (R8, R12) residents reviewed for activities of daily living. Findings Include: 1. R12 is a is an [AGE] year-old female with diagnoses of history of Dementia, Major Depressive Disorder, Partial Paralysis due to Stroke, Dysphagia, Anemia, Seizures, and COPD who was admitted to the facility 01/19/2020. R12's Current Physician Orders include an active order effective 03/19/2024 for recommendation for one-to-one feeding assistance during all meals to ensure safety during oral intake per the most recent treatment course and active orders effective 10/22/2024 and 10/29/2024 for one-to-one feeding assistance with strict adherence to precautions. [...]

Inspectors wroteBased on interview and record review, the facility failed to assess and monitor a resident who had no recorded bowel movement for eight consecutive days who was experiencing abdominal discomfort. This failure resulted in R1 having acute rectal bleeding, requiring hospitalization for a blood transfusion and emergency intravenous medication administration to reverse the effects of her blood thinner. R1 also required the insertion of a rectal tube for the management of her fecal impaction. This applies to 1 out of 3 (R1) residents reviewed for constipation.

Inspectors wroteBased on interview and record review, the facility failed to consult with a resident's physician when the resident had unrelieved acute gastrointestinal symptoms for 24 hours. This failure resulted in a resident calling the emergency paramedics herself for transfer to the hospital, and R6 was hospitalized for treatment of sepsis (a life-threatening complication of an infection) related to acute enterocolitis and aspiration pneumonia. This applies to 1 out of 3 (R6) residents reviewed for change in condition.

Inspectors wroteBased on interview and record review the facility failed to follow its policy to immediately consult with a resident's physician and notify a resident's representative when a resident had a change in condition requiring resident to be transferred to the hospital. This applies to 2 of 6 residents (R1 and R2) reviewed for change in condition.

Inspectors wroteBased on interview and record review the facility failed to respond after being notified of a concern of missing items. This applies to 1 of 6 residents (R1) reviewed for grievances.

Inspectors wroteBased on interview and record review the facility failed to administer the ordered oxygen to a resident complaining of shortness of breath. This applies to 1 of 1 (R2) resident reviewed for respiratory care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide perineal and indwelling catheter care in a manner that would prevent urinary tract infection (UTI) and failed to ensure that an indwelling catheter is secured to the resident. This applies to 4 of 4 residents (R21, R63, R93, and R102) reviewed for catheter and bowel and bladder care in the sample of 22.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow standard infection control practices related to hand hygiene and gloving during provisions of peri-care and wound care. This applies to 4 of 22 residents (R21, R63, R93, R102) reviewed for infection control in the sample of 22.

Inspectors wroteBased on interview and record review, the facility failed to hold a care plan conference with the resident. This applies to 1 of 1 resident (R11) reviewed for care planning in the sample of 22.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide grooming to a resident that is dependent on staff for care. This applies to 1 of 3 residents (R40) reviewed for ADL (activities of daily living) care in the sample of 22.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow manufacturer's instructions for a pressure relieving mattress. This applies to 1 of 6 residents (R4) reviewed for pressure ulcers in the sample of 22.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide lunch meal and assistance with feeding to a resident with weight loss. This applies to 1 of 5 residents (R40) reviewed for nutrition in the sample of 22.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow their policy to attempt a gradual dose reduction for a resident on psychotropic medications. This applies to 1 of 5 residents (R14) reviewed for unnecessary medications in the sample of 22.

Inspectors wroteBased on interview and record review, the facility failed to hold care plan conferences with residents and their representatives and failed to invite residents and their representatives to participate in the care planning process. This applies to 5 of 5 residents (R1, R3, R5, R7, and R8) reviewed for policy and procedures in the sample of 8.

Inspectors wroteBased on interview and record review, the facility failed to follow their policy to immediately notify a resident's representative when a resident had a change in condition requiring transfer to the local hospital. This applies to 1 of 3 residents (R1) reviewed for change in condition notification in the sample of 8.

Inspectors wroteBased on interview and record review, the facility failed to follow physician orders to weigh residents daily, and to check systolic blood pressure readings prior to administering cardiac/blood pressure medications. This applies to 3 of 3 residents (R1, R4, and R7) reviewed for improper nursing care in the sample of 8.

Inspectors wroteBased on interview and record review, the facility failed to provide physical therapy (PT) services to a resident with ordered rehab services. This applies to 1 of 3 residents (R1) reviewed for physical therapy.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide personal hygiene assistance to meet the needs of residents dependent on staff. This applies to 4 of 8 residents (R7, R27, R56, R61) reviewed for ADLs (Activities of Daily Living) in a sample of 27 residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to properly secure medications; sign controlled substances count form and resident's narcotic sheet; have two nurses sign off on the narcotic sheet when wasting narcotic medication; remove expired medication and double-lock narcotic medication. This applies to 15 of 15 residents (R16, R25, R28, R29, R46, R50, R53, R54, R56, R58, R60, R63, R66, R71, R295) reviewed for medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow infection control procedures during medication administration, equipment cleaning, incontinence care, and while providing direct care of residents under EBP (Enhanced Barrier Precautions). This applies to 7 of 8 residents (R23, R31, R54, R59, R67, R95, R346) reviewed for infection control in a sample of 27.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all staff were fully vaccinated for COVID-19. This has the potential to affect all 87 residents residing in the facility.

Inspectors wrote4. R26's face sheet showed that R26 is 49 years-old with multiple medical diagnoses which includes: Polyneuropathy, Fibromyalgia, Spinal Stenosis, Ataxia, and lack of coordination. R26's Minimum Data Set (MDS) dated [DATE] indicates that R26 is alert and oriented and requires extensive assistance with grooming/hygiene. R26's Care Plan showed that R26 is alert and oriented and requires assistance with Activities of Daily Living (ADL) care such as bed mobility, transfer, dressing, walking, personal hygiene, and toileting. On 5/03/22 at 9:38 AM, R26 was resting in bed displaying overgrown facial hair in the cheeks, upper lip, chin and below chin/upper neck. R26 stated that she would like it shaved. She appeared anxious and tearful. On 5/03/22 at 12:29 PM, V25 (CNA) stated that R26 wants her family to shave for her. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide incontinence care in a manner that would prevent Urinary Tract Infection (UTI) and failed to ensure that an indwelling urinary catheter tubing is anchored/secured to prevent from pulling. This applies to 4 of 6 residents (R26, R47, R124, R125) reviewed for incontinence and catheter care in the sample of 19.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow manufacturer's and/or pharmacy recommendation with regards to medication storage and labeling and failed to ensure that a narcotic medication is not taped in the blister pack. This applies to 5 of 6 residents (R34, R39, R52, R68, R126 ) reviewed for medication storage and labeling.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow standard infection practices with regards to hand hygiene and gloving during provisions of care, failed to don a gown when entering an isolation room, and failed to ensure that there is a posted sign on a door for transmission-based precaution. This applies to 5 of the 19 (R26, R47, R125, R329, R330) residents reviewed for infection control in the sample of 19.

Inspectors wroteBased on interview and record review the facility failed to review and update the care plan with interventions for pain management after a resident had a fall with a fracture. This applies to 1 of 2 residents (R14) reviewed for pain medication.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow guidance of no straws for residents that had an order for the same. This applies to 2 of 3 residents (R123 and R223) for order of no straws during review of hydration.

Inspectors wroteBased on interview and record review the facility failed to provide assistance to a resident with obstructive Sleep Apnea in using a Sleep Apnea machine. This applies to 1 of 1 residents (R173) reviewed for respiratory equipment in a sample of 19.

Inspectors wroteBased on interview and record review the facility failed to evaluate and justify the continued use of a narcotic pain medication. The facility also failed to assess a resident for Abnormal Involuntary Movements prior to starting a medication with a black box warning and failed to justify continued use of the medication longer than twelve weeks. This applies to 2 of 6 residents (R14 and R44) reviewed for unnecessary medication in a sample of 19.