Bella Vista Health Center

Inspectors wroteBased on interview and record review, the facility failed to administer medication as ordered for one of four sampled residents (1). As a result, Resident 1 was at increased risk of medication side effects.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the dietary staff were competent on the ambient temperature (the temperature of the surrounding air, room temperature) food cool down process and cooked food cool down process for Time/Temperature Control for Safety Food (TCS- foods that can rapidly spoil and cause illness). These failures placed the facility's residents who consumed food prepared in the kitchen at risk of foodborne illness.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure practices that mitigated the risk of resident food contamination were followed when: Fruit flies were observed flying around the kitchen. An open food thickener container was placed right next to the open trash can. A staff food cart was stored in the kitchen. An expired cream cheese was found in the walk-in refrigerator. Tuna salad sandwiches and hard-boiled eggs were not cooled down (a two-stage method for rapidly cooling food to prevent the growth of bacteria) properly. Washed dishes were stacked wet and with food residue on them. Washed coffee mugs had residue on them. Cooked chicken did not have a temperature taken before being plated and placed in the meal cart. These failures had the potential to cause foodborne illnesses among residents who received food from the kitchen.

Inspectors wroteBased on the observation, interview, and record review, the facility failed to ensure safe storage of resident food brought from outside of the facility when: Resident food was stored in the resident refrigerator for over 72 hours. Resident food containers were not properly labeled. The thermometer located in the resident food refrigerator was broken and the temperatures entered in the log were consistently over 41 degrees F (Fahrenheit). Staff food items were found in the designated resident refrigerator. The facility did not implement its policy titled Food Brought from Outside. As a result, the residents were at risk of consuming potentially contaminated food.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Pre-admission Screening and Resident Review Level II (PASARR II - an evaluation of the resident's psychiatric treatment requirements) was followed up on and completed for two of four residents (Resident 26 and 49) reviewed for PASARR.This failure had the potential for Resident 26 and Resident 49 to not receive necessary mental health care services in an appropriate healthcare setting.

Inspectors wroteBased on interview and record review, the facility failed to provide pharmaceutical services according to acceptable standards of practice when the documentation on the Controlled Drug Record (CDR an accounting of controlled medications, drugs with a high abuse potential) and the Medication Administration Record (MAR documentation in the medical record that a resident received a medication) did not reconcile for one of three randomly selected residents (Resident 14). This failure had the potential for drug diversion (illegal acquisition, misuse, or transfer of prescription medication for an unauthorized purpose) and/or inadequate pain management.

Inspectors wroteBased on interview and record review, the facility failed to provide outside dental resources and services in a timely manner for one resident (Resident 6). As a result, Resident 6 waited over 11 months to be evaluated for a new denture and was at risk for potential issues with the fitting of the new denture caused by the delay in receiving dental care and treatment.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to ensure a Level I Preadmission Screening and Resident Review (PASRR) accurately reflected the presence of a diagnosed mental disorder for 1 (Resident #44) of 5 residents reviewed for PASRR requirements.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure expired medications and/or biologicals were removed from 1 (Station 1) of 2 medication storage rooms and 1 of 1 central supply closet.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary care and treatment to a resident's (1) identified skin issues (redness of the buttocks), for one of three sampled residents, when Resident 1's physician was not informed of the resident's skin condition during admission to the facility. The delayed care and treatment to Resident 1's skin issues had the potential to worsen Resident 1's skin condition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper food handling practices, and sanitation requirements were met when: 1. Kitchen staff (KA 1) did not perform hand hygiene between kitchen tasks, and 2. Dishwashing racks (used for storing dinnerware, cups and glasses) were worn, and covered in a gray residue. These failures had the potential to cause the spread of food borne illness to residents in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide infection control standards of practice when; In the facility's designated Red Zone: 1a. CNA 6 and Maintenance (Mnt 6) staff was observed entering and exiting (clean to dirty area) the Red Zone not donning PPE (personal protective care equipment). 1b. A resident (Resident 58) was observed wandering the halls of the Red Zone without a mask. 1c. Social service (SS 6) staff member was observed exiting an isolation room and entering a clean room without performing handwashing. 1d. CNA 8 was observed entering an isolation room not donning PPEs. 2. During lunch meal service a CNA 7 did not perform handwashing when passing resident meal trays. 3. [...]

Inspectors wroteBased on interview and record review, the facility failed to support four of seven residents (Residents 26, 47, 56, and 254), reviewed for resident rights, when their normal activity of smoking was not permitted. This failure resulted in Residents 26, 47, 56, and 254 to experience increased anxiety and anger.

Inspectors wroteBased on interview and record review, the facility failed to consistently offer snacks to five of six confidential residents (CR 1, CR 2, CR 3, CR 4, CR 5 ) and two unsampled residents (55, 90) reviewed for evening snacks. This failure had the potential for residents to experience hunger between meals.

Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Provide dignity and privacy to one of three residents (Resident 249) reviewed for urinary catheter (a flexible tube that collects urine from the bladder and leads to a drainage bag) care, when a dignity bag, (a solid colored bag, which covers the urine collection bag) was not properly placed over the catheter collection bag and was viewable from the hallway;. and 2. A resident's property was not safeguarded by having the property identified, inventoried and properly secured for one of one sampled residents (Resident 297), when a bag of prescription medications was found in a the residents' room. These failures had the potential to effect Resident 249's self esteem and for Resident 297's property to be lost or stolen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accurately assess and document the dental needs for one of three residents (Resident 32) reviewed for accuracy of MDS assessment. As a result, Resident 32's dental needs went unrecognized and untreated.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop a person-centered care plan regarding refusal of care, for one of eight residents (64) reviewed for individualized care plans. This failure had the potential to deny Resident 64 the care required to meet her daily needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to secure a resident's personal medications, including a controlled substance for 1 of 1 resident (Resident 297), reviewed for accidents. In addition, residents and staff were at risk for injuries related to exposed sharps in one of two shower rooms. This failure puts residents at risk for accidents and hazards.

Inspectors wroteBased on observation, interview, and record review, the facility failed to administer the appropriate amount of oxygen (O2), ordered by the physician and the oxygen was administered when there was no indication of need, for one of two residents (Resident 62), reviewed for oxygen administration This failure had the potential for Resident 62 to experience hypercapnia (high carbon dioxide levels in the blood).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a residents property was properly secured for one of one sampled resident (Resident 297) when a bag of prescription medications including a narcotic was found in a the residents' room. This failure had potential for health and safety risk to other residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents' food brought into the facility from the outside, was dated and discarded timely. This failure had the potential to cause the spread of food borne illness in the facility if residents consumed spoiled food.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accurately record the amount of food consumed by one of eight residents (64), reviewed for meal intake. This failure had the potential to affect Resident 64's health because the RD and physician were unaware of the resident's lack of food intake.