Bella Terra Wheeling

Inspectors wroteBased on interviews and record review, the facility failed to follow its abuse policy to ensure one resident (R1) remained free from physical abuse by another resident (R2) in a sample of three reviewed. This failure resulted in R1 sustaining lacerations to the forehead and swelling to the left eye.

Inspectors wroteBased on the interview and record review, the facility failed to provide appropriate assistive devices and staff supervision while walking to two cognitively impaired, high-risk falls residents (R1, R2) out of 3 residents reviewed for incidents/accidents. These failures resulted in R1 bumping R1's nose on the hallway countertop and sustained a nasal fracture. Findings Include: R1's clinical records show an initial admission date of 11/30/22 with included diagnoses but not limited to Unspecified Dementia Without Behavioral Disturbance, Unspecified Psychosis, History of Falling, and Altered Mental Status. R1's Minimum Data Set (MDS) dated [DATE] shows R1 has severe cognitive impairment and requires supervision or touching assistance with walking. R1's fall risk evaluation dated 9/09/24 shows R1 is at high risk for falls. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were administered as scheduled per physician orders to 3 (R3, R4, R5) out of 3 residents reviewed for medication administration. Findings Include: On 1/12/25 at 9:13 AM, I interviewed R3. R3 stated that yesterday (1/11/25), R3 received [R3's] 9:00 AM medications closed to lunch time. R3 stated they were two hours late. On 1/12/25 at 10:26 AM, the Surveyor observed V8 (Agency Registered Nurse) enter R4's room and administer two insulin injections and medication pills to R1. The Surveyor asked what [V8] had just given to R4 and stated that those were R4's 9:00 AM medications. On 1/12/25 at 10:31 AM, R4 stated that sometimes on weekends, [R4] would get [R4's] medications late, sometimes one hour to two hours late. [...]

Inspectors wroteBased on interview and record review the facility failed to notify the residents Power of Attorney (POA) of an abnormal labororatory results and change in medication/treatment to 1 of 3 residents (R1) reviewed of notification of change in the sample of 3.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure a resident's right to be free from physical harm and mental abuse for 1 (R1) of 4 residents reviewed for abuse in the sample of 5. This failure resulted in R1 being verbally and physically assaulted by staff causing bruising and lacerations during an unprovoked altercation.

Inspectors wroteBased on interviews and record review, the facility failed to keep a severely cognitively impaired resident at high risk for falls and with history of falls from a mechanical fall while providing routine ADLs (activities of daily living care) and failed to follow fall prevention protocols for 1 (R2) of 3 residents reviewed for accidents/hazards in the sample of 5. This failure resulted in R2's transfer to the hospital Emergency Department and diagnosis of comminuted displaced intertrochanteric right femur fracture.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure food containers are stored off the floor and ensure staff are employing hygienic practices during food handling in the dining room. This deficiency has the potential to affect all 165 residents receiving food from the kitchen.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement appropriate transmission-based precaution and to provide the necessary personal protective equipment (PPE) supplies readily accessible for use by staff and visitors for 3 of 3 residents (R153, R47, R131) reviewed for transmission-based precaution in a sample of 37.

Inspectors wroteBased on interviews and record reviews, the facility failed to follow its intravenous therapy policy and accurately assess and monitor resident's signs/symptoms/change of condition, which resulte in delay of care and resulted in MRSA spread causing decline in resident's health, with infection to knee and MRSA pneumonia for one resident's (R422) PICC (peripherally inserted central catheter) out of three reviewed for change in condition in a sample of 37. This failure resulted in R422 developing chills, elevated white blood cell count, and malaise. R422 was transported to the hospital and diagnosed with MRSA infection of PICC line causing MRSA infection of right knee and MRSA pneumonia.

Inspectors wroteBased on observation, interview and record review the facility failed to identify supervision needs and implement measures to reduce fall risk for a confused resident at risk for falls, failed to implement plan of care interventions and falls policy to prevent resident's fall and injury. This failure affects 1 (R1) of 3 residents reviewed for accidents/incidents in the sample and resulted in R1 being emergently transferred to the hospital for hip fracture with surgical intervention.

Inspectors wroteBased on interview and record review, the facility failed to have effective interventions in place to keep residents free from physical abuse. This failure applied to two (R4 and R5) of three residents reviewed for abuse.

Inspectors wroteBased on observation, interview and record review, the facility failed to discard expired medications from two of five medication carts and one of two medication rooms. This deficiency could potentially affect all 162 residents in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain sanitizer levels in the three-compartment sink and two sanitizer buckets. This failure has the potential to affect 160 residents receiving meals from the facility's kitchen.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a privacy cover on urinary drainage bag and failed to knock on the door and ask permission before going inside the room for three (R64, R115, R135) of 13 residents reviewed for dignity in a sample of 32.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement the comprehensive care plan for existing interventions to prevent falls for 1 of 5 residents (R122) for fall prevention and failed to implement a comprehensive care-plan for 1 of 1 resident (R135) reviewed for communication in a sample of 32.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow standards of practice by failing to ensure that the head of the bed was elevated while infusing enteral tube feeding for one resident (R150) out of three residents reviewed for enteral feeding in the sample of 32. Findings Include: On 3/14/2023, at 10:15 am, surveyor observed R150 with V5 (Certified Nurses' Aides) CNA, lying almost flat while receiving an enteral feeding. V5 said that the resident's head of the bed should be higher. On 03/14/23 at 10:18 am, V3 ( Registered Nurse) came in resident's room and when asked how low was the resident lying in bed, V3 stated close to being flat Further, V3 said that the resident needs to be positioned at 45 degrees to prevent aspiration that may cause pneumonia. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the oxygen prong was properly placed on one resident (R150) out of one resident reviewed for supplemental oxygen in a sample of 32.

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident is free from unnecessary antibiotic treatment for one (R115) of four residents reviewed for antibiotic use in a sample of 32.

Inspectors wroteBased on interview, and record review, the facility failed to ensure that 2 residents (R135, R138) out of five residents reviewed for pneumococcal immunizations received their second dose of the pneumococcal immunization in the sample of 32.