Bingham Memorial Skilled Nursing & Rehabilitation

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure professional standards of nursing practice were followed for 3 of 4 residents (#5, #11, and #28) reviewed for quality of care. Residents were at risk for adverse outcomes when they did not have Physician orders for medications that residents received or Physician orders did not document all the required elements to prevent adverse drug reactions. These failed practices had the potential to adversely affect residents whose care and services were not followed according to accepted standards of practice.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure medications available for residents were stored appropriately, this was true for 1 of 2 nurses observed for medication pass and 1 of 1 medication carts audited for labeling and storage of medication. This failure created the potential for residents to have missed doses of medication and created the potential for harm to a resident if they were to obtain medications which were left unattended and unsecured by staff.

Inspectors wroteBased on observation, document reviews, and staff interview, it was determined the facility failed to ensure infection control prevention practices were maintained to provide a safe and sanitary environment. These failures had the potential to impact all residents in the facility by placing them at risk for cross contamination and infection.

Inspectors wroteBased on observation, staff interview, and policy review, it was determined the facility failed to ensure resident's privacy was protected for 1 of 1 medication carts reviewed for privacy and confidentiality. This deficient practice placed residents at risk of embarrassment and loss of control over their personal information.

Inspectors wroteBased on Appendix PP of the State Operations Manual, record review, and staff interview, it was determined the facility failed to refer residents for further evaluation when residents were diagnosed with a major mental illness, intellectual disability, or a related condition. This was true for 1 of 3 residents (Resident #4) reviewed for PASARR level II evaluations. This deficient practice had the potential to cause harm if an appropriate state-designated authority did not evaluate a resident's mental health needs.

Inspectors wroteBased on policy review, record review, and staff interview it was determined the facility failed to include necessary healthcare information for 2 of 4 residents (#1 and #2) on resident's baseline care plans. This failure created the potential for resident specific needs to go unrecognized due to lack of information for caregivers.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to ensure care plans were comprehensive and individualized for 1 of 2 residents (Resident #1) whose comprehensive care plans were reviewed. This placed residents at risk for adverse outcomes if care and services were not provided due to care plans being incomplete and not person-centered.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure controlled medications were tracked and kept secure from potential theft and/or diversion. This was true for 1 of 1 medication carts reviewed. This failure created the potential for undetected misuse and/or diversion of controlled medications and had the potential to affect all residents who received controlled medication in the facility.

Inspectors wroteBased on observation, policy review and interviews, it was determined the facility failed to ensure all call light buttons or pads were easily accessible to residents. This was true for 2 of 19 residents (#14 and #15) whose rooms were observed for call light device locations. This failure had the potential for harm if residents were not able to summon staff for assistance.

Inspectors wroteBased on observation, interview, policy review, and review of the Idaho Food Code, the facility failed to appropriately store, distribute, and label foods. This deficient practice had the potential to affect 17 of 17 residents who received meals prepared in the facility's kitchen. This placed residents at risk for potential contamination and use of spoiled foods, and adverse health outcomes including food-borne illnesses.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure residents' care plans were revised to reflect current needs and interventions. This was true for 3 of 6 residents (#1, #4, and #15) whose care plans were reviewed. This failure placed residents at risk of adverse outcomes if care and services were not provided due to care plans not being revised as residents' needs changed.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure residents were given treatment and services to maintain or improve their ability to carry out activities of daily living. This was true for 3 of 6 residents (#1, #4, and #15) reviewed for restorative nursing services. This failure placed residents at risk for decreased range of motion, functional ability, and decreased quality of life.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure adherence to infection control and prevention practices to provide a safe and sanitary environment when staff did not offer or encourage residents hand hygiene prior to meals served in their rooms. This failure had the potential to impact 2 of 3 residents (#12 and #15) observed during meal service for hand hygiene, placing them at risk for cross-contamination and infection.

Inspectors wroteBased on observation and resident and staff interviews, it was determined the facility failed to ensure residents were provided with a safe and clean, homelike environment that did not pose any safety or infection risks. This was true for 1 of 17 residents (Resident #22) whose rooms were observed. This deficient practice created the potential for diminished quality of life and psychosocial distress for Resident #22 when the flooring in her room was not cleaned daily and a portion of the floor tile was missing.

Inspectors wroteBased on observation, interview, and record review, it was determined the facility failed to ensure the MDS assessment accurately reflected the resident's status. This was true for 1 of 4 residents (Resident #225) whose MDS, care plan, and nursing assessments were reviewed. This deficient practice had the potential for negative outcomes if the resident was not assessed and cared for or monitored due to inaccurate assessments.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure medications available for residents were dated when opened and not expired. This was true for 1 of 1 medication storage rooms inspected. This failure created the potential for residents to receive expired medications with decreased efficacy.

Inspectors wroteBased on observation, interview, and policy review, it was determined the facility failed to ensure residents were provided evening snacks. This was true for 2 of 2 resident's (#19 and #22) who attended the Resident Council meeting. This failure created the potential for residents to experience hunger between meals, increased fatigue, weight loss, and poor quality of sleep.

Inspectors wroteBased on review of the facility's admission agreement, record review, and staff interview, it was determined the facility failed to ensure residents and/or their representatives were not explicitly informed of their right to not sign the agreement as a condition of their admission or that they had the right to revoke the agreement. This was true for 12 of 12 residents (#3, #4, #5, #7, #9, #14, #15, #16, #17, #18, #19, and #20) who were newly admitted to the facility. This failure had the potential to cause significant psychosocial distress to residents and/or their representatives by not clearly knowing their rights.

Inspectors wroteBased on observation, policy review, review of manufacture instructions for use, and staff interview, it was determined the facility failed to ensure infection control and prevention practices were maintained to provide a safe and sanitary environment when staff did not perform proper hand hygiene, properly sanitize and disinfect equipment, and follow proper handling of equipment. This was true for 3 of 11 residents (#1, #2, and #10) observed during medication pass and this was true for 1 of 1 (Resident #9) observed during wound care. These failures had the potential to impact all residents in the facility by placing them at risk for cross contamination and infection.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents' care plans were revised and updated as needed. This was true for 1 of 16 residents (Resident #1) whose care plans were reviewed. This created the potential for harm if cares and/or services were not provided appropriately due to inaccurate information in the care plan.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure residents were monitored appropriately and offered non-pharmacological interventions while receiving opioid pain medications. This was true for 2 of 5 residents (#9 and #12) reviewed for unnecessary medications. This failure created the potential for residents to experience adverse reactions due to a lack of appropriate monitoring or experienced increased pain due to not offering non-pharmacological interventions.

Inspectors wroteBased on record review, staff interview, and facility policy review, it was determined the facility failed to ensure residents' potential side effects of antidepressant medications were routinely monitored for 1 of 5 residents (Resident # 1) reviewed for unnecessary medications. This created the potential for residents to experience adverse reactions from unnecessary antidepressant medications.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure food items were dated and labeled. This failure had the potential to affect the 21 residents residing in the facility who consumed food prepared by the facility at risk of adverse health outcomes, including food-borne illnesses.