Bloomfield Nursing and Rehabilitation Center

Inspectors wroteBased on interview and record review, the facility failed to ensure the Director of Nursing (DON) was not working the floor as a charge nurse when the facility census was over 60 residents. This deficient practice is likely to affect all 72 residents who reside in the facility (facility census provided by the Director of Nursing on 01/05/26). If the DON is working as a charge nurse, they may be unable to complete their DON responsibilities, indicating low staffing levels and impacting all residents.

Inspectors wroteBased on record review and interviews, the facility failed to complete an annual performance review of Certified Nursing Assistants (CNAs) for 3 (CNAs #6, #7, and #8) of 5 (#6, #7, #8, #9, and #10) CNAs randomly reviewed. If the facility is not completing a performance review of every CNA at least once every 12 months, then residents are likely to not receive the appropriate care and services, and the CNAs may not meet the needs of all residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident's right to retain his personal property for 1 (R #16) of 1 (R #16) resident reviewed when: Facility staff removed containers, a backpack, a small box, and other reuseable bags filled with resident's items from his room. The facility did not give R #16 consistent access to his personal belongings stored in a conference room. If staff do not respect a resident's right to personal property, then the resident may become angry, frustrated, and feel disrespected.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Minimum Data Set (MDS; a federally mandated comprehensive assessment of a resident's functional, medical, psychosocial and cognitive assessment completed by facility staff) was accurate for 1 (R #66) of 1 (R #66) resident reviewed for MDS accuracy. This deficient practice could result in failure to provide adequate care and treatment of the resident's needs.

Inspectors wroteBased on observations and interviews, the facility failed to ensure the environment was free of accident hazards when a portable electric space heater was plugged in and operating in a common hallway accessible to residents. This deficient practice is likely to affect all residents that walk by the front entrance of the facility and could place residents at risk for burn injuries, particularly residents with impaired cognition or limited safety awareness (inability to recognize or avoid the hazard).

Inspectors wroteBased on observation and interview the facility failed to: Lock a medication cart (a movable piece of equipment used in healthcare facilities to store, transport, and dispense medications) while staff were away from the cart. Ensure all medications were not expired in the medication storage room. These deficient practices are likely to result in resident injury, through dosing with medications that have been improperly stored, having access to medications not prescribed for them, and possible overdose.

Inspectors wroteBased on record review, observation, and interview, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 4 (R #7, R #36, R #50, and R #62) of 10 (R #7, R #10, R #32, R #36, R #50, R #62, R#67, R #74, R#76,and R #77 ) residents reviewed for medication administration and infection prevention when: The facility stored R #7's oxygen (O2) concentrator (medical device that provides continuous O2) inappropriately on the floor. Facility nursing staff administered R #62's topical eye medication while touching the eyelid of R #62 with ungloved hands. Facility nursing staff did not sanitize their hands before and/or after medication administration for R #s 36, 50 and 62. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure the resident's current advance directive (a document which provides an individual's wishes for emergency and lifesaving care) was available in the resident's Electronic Health Record (EHR) and/or available in physical form for the facility staff for 1 (R #43) of 1 (R #43) resident reviewed for advance directives. This deficient practice is likely to cause confusion and delay potentially lifesaving procedures.

Inspectors wroteBased on record review, observations, and interviews, the facility failed to notify the physician and obtain appropriate medical orders for 1 (R #25) of 1 (R #25) residents reviewed who experienced a significant change in condition, requiring oxygen (O2) therapy. If the facility fails to notify the physician and obtain a medical order when a resident experiences a significant change in condition, it may result in delayed or inadequate treatment.

Inspectors wroteBased on record review and interview, the facility failed to create a Baseline Care Plan (minimum healthcare information necessary to properly care for a resident immediately upon their admission to the facility) within 48 hours of admission for 1 (R #25) of 1 (R #25) resident reviewed for Baseline Care Plans. This deficient practice could likely result in the residents' preferences and care needs not being met.

Inspectors wroteBased on record review, observations, and interviews, the facility failed to ensure nursing services were provided in accordance with professional standards of practice for 1 (R #25) of 1 (R #25) resident reviewed, when: The facility nursing staff administered oxygen (O2) without physician orders. The facility nursing staff did not document R #25's O2 use. The facility did not notify the physician when R #25 experienced O2 desaturation (a drop in a person's oxygen level in the blood below normal, meaning the body is not getting enough oxygen). If nursing staff initiate and continue O2 therapy for a resident without a physician order, fail to document oxygen use, and do not notify the physician when a resident experiences O2 desaturation, then residents are at risk for receiving unauthorized treatment without appropriate medical oversight. [...]

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure the accuracy and completeness of the electronic health record (EHR) for 1 (R #66) of 1 (R #66) resident reviewed for accuracy of resident information by: Inaccurately documenting R #66's communication and hearing impairments. This deficient practice is likely to create the potential for inaccurate or incomplete documentation within the electronic health record, which may negatively impact the resident's ability to receive the care and services needed.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide wound care as ordered by the physician for 1 (R #25) of 1 (R #25) resident reviewed for wound care. This deficient practice could likely cause wounds to worsen or become infected which could lead to sepsis (a serious condition in which the body responds improperly to an infection) and hospitalization.

Inspectors wroteBased on observation, interview, and record review; the facility failed to accurately record (document what actually occurred) the wound care for 1 (R #25) of 1 (R #25) resident reviewed for wounds. This deficient practice is likely to cause confusion about wound care, when wound care documentation is inaccurate and indicates wound care treatments as being completed when they were not.

Inspectors wroteBased on interviews and record review, the facility failed to ensure a resident's Level 1 Preadmission Screening and Resident Review (PASRR; a federal requirement to help ensure individuals with a mental disorder or intellectual disabilities are not inappropriately placed in nursing homes for long term care) were reviewed for accuracy and completion for 1 (R #1, R #2 and R #3) of 3 (R #1, R #2 and R #3). If the facility fails to review PASRR screenings for accuracy and completion, then residents with serious mental illness or intellectual disability may receive inappropriate placement and care.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for 1 (R #5) of 5 ( R #'s 1, 2, 3, 4 and 5) residents when they failed to administer anti-seizure medication (medication used to prevent or stop seizures [sudden burst of electrical activity in the brain]) as ordered. This deficient practice likely resulted in the resident experiencing seizures requiring hospitalization.

Inspectors wroteBased on interview and facility policy review, the facility failed to ensure they had a certified infection prevention nurse hired at least part time onsite. This failure has the potential to increase infection rates due to the lack of active surveillance and staff education.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to provide one of two residents (Resident (R)79) reviewed for hospital transfers out of a total sample of 30 residents a written bed hold when R79 was transferred to the hospital.

Inspectors wroteBased on observations, record review, and interview, the facility failed to provide services based on acceptable standards of practice by specifically failing to accurately check a finger stick glucose level for three of three residents (Resident (R)14, R49, and R 52) reviewed for professional standards of 30 sample residents. This failure had the potential to affect the blood glucose levels for three of three residents reviewed.

Inspectors wroteBased on interview and record review, the facility failed to send a referral for a barium swallow study within an appropriate time frame for one of 30 sampled residents (Resident (R) 76). This failure placed the resident at risk of not having pleasurable items.

Inspectors wroteBased on observation, interview, record review, facility policy review, and review of manufacturer's instructions, the facility failed to provide respiratory care in accordance with professional standards for two of two residents (Residents (R) 16, R18 and R31) reviewed for respiratory care out of 30 sampled residents. This failure has the potential for the residents to be subjected to contaminated respiratory equipment and to not receive proper airflow.

Inspectors wroteBased on observations, record review, interviews, and facility policy review, the facility failed to ensure an appropriate diagnosis for the use of an anti-depressant was clarified by the Medical Director for one of five residents (Resident (R) 64) reviewed for unnecessary medications in a total sample of 30 residents. This failure resulted in the Medical Director and/or his nurse practitioner not responding to the consultant pharmacist recommendations for Gradual Dose Reduction (GDR) for psychotropic medications and providing clarification of diagnoses for an anti-depressant.

Inspectors wroteBased on record review, staff interview, and facility policy review, the facility failed to implement a 14 day stop date for the as needed (PRN) use of an anti-anxiety medication and/or provide a rationale for the continued use of the medication for one of two residents reviewed for anti-anxiety medications (Resident (R) 69), out of a total sample of 30 residents. The facility also failed to implement a gradual dose reduction (GDR) for one of five reviewed for an antipsychotic GDR (R 16). Failure to provide evidence of the physician rationale for continued use of the medication had the potential to result in unnecessary medication use.

Inspectors wroteBased on interview and record review, and the facility policy review, the facility failed to assist one of one (Resident (R) 54) reviewed for dental services in obtaining routine dental services out of a sample of 30 residents.

Inspectors wroteBased on observations, record review, interviews, and facility policy review, the facility failed to ensure food preferences were honored for two of two residents (Residents (R) 29 and R44) out of a sample of 30 residents. By not ensuring food preferences are being honored, residents may be at risk for potentially adverse effects such as weight loss and preferring not to eat what is being served.

Inspectors wroteBased on observations, interviews and review of facility policy, the facility failed to ensure staff used a protective barrier for blood glucometer supplies while preparing to check blood glucose readings at the resident's bedside for four or four residents (Resident (R)14, R37, R49 and R52) and failed to wear personal protective equipment (PPE) while administering medications through a gastrostomy tube for one of one resident (R38). The facility staff also failed to only take the needed supplies into each room. Failure to use a protective barrier and taking all resident supplies into each room can lead to cross contamination. Failure to use appropriate PPE for residents on enhanced barrier precautions (EBP) could contribute to the spread of microorganisms.

Inspectors wroteThis is a past noncompliance. Based on record review and interview, the facility failed to ensure nursing staff demonstrated competency in skills and techniques necessary to safely administer medications to residents for 1 [Licensed Practical Nurse (LPN #1)] of 4 [LPN #1, LPN #2, Registered Nurse (RN) #1, and Certified Medication Assistant (CMA) #1] employees sampled for training. This deficient practice likely resulted in R #1 receiving another resident's medication, which resulted in R #1 being admitted to the hospital on [DATE] for accidental overdose and hypotension (low blood pressure).

Inspectors wroteThis is past noncompliance. Based on record review, observation, and interview, the facility failed to ensure residents are free of any significant medication errors for 1 (R #1) of 7 (R #1, R #3, R #4, R #5, R #6, R #7, and R #8) residents reviewed for neglect, when nursing staff failed to administer medication to the correct resident. This deficient practice likely resulted in R #1 experiencing adverse (unwanted, harmful, or abnormal) side effects and admission to the hospital.

Inspectors wroteBased on record review and interview, the facility failed to provide resident care that met acceptable standards of professional practice for 3 (R #3, R #6 and R #7) of 3 (R #3, R #6 and R #7) residents by not conducting weekly skin checks and weekly skin evaluations. This deficient practice could likely result in residents not receiving all the appropriate care needed to ensure they reach or maintain their optimal well-being.

Inspectors wroteBased on interview and record review, the facility failed to notify the resident's representative when the resident was discharged from the facility for 1 (R #4) of 2 (R #4 and R #5) residents reviewed for discharges. This deficient practice could likely result in the resident's representative being unable to provide assistance with coordinating care and/or making medical decisions as needed.

Inspectors wroteBased on interview and record review, the facility failed to conduct a MDS assessment (minimum data set - a standardized assessment tool that measures health status in nursing home residents) following a significant change in condition for 1 (R #2) of 1 (R #2) reviewed for hospice (a type of health care that focuses on the quality of life of person with a serious illness who is approaching the end of life). This deficient practice could likely result in residents not receiving the appropriate care and services they need.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure staff maintained accurate medical records for 1 (R #3) of 1 (R #3) resident reviewed for quality of care and discharges. This deficient practice could likely result in residents not receiving the care and services they need.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure the nutritional needs and preferences were met for all 81 residents list on the resident census list provided on 07/17/23 by the facility Administrator by: 1. Not following the posted menu 2. Not providing an alternative meal These deficient practices could prevent residents from eating well, meeting their nutritional needs, and lead to weight loss.

Inspectors wroteBased on observation, record review, and interview, the facility failed to: 1. Ensure cold foods were served at the appropriate temperature 2. Ensure food trays were served at posted meal times 3. Ensure food trays were served at the same time to all residents sitting at the same table 4. Ensure food items are labeled These deficient practices are likely to result in residents being served food not at the appropriate temperature and not being served in a timely manner causing residents frustration and feeling as if they do not matter.

Inspectors wroteBased on observation and interview, the facility failed to deliver meals consistently and timely to all 81 residents that receive room trays or eat in the dining room. This deficient practice is likely to cause frustration and hunger.

Inspectors wroteBased on observation and interview, the facility failed to store and serve food under sanitary conditions by not: 1. Ensuring records of the refrigerator and freezer temperatures not pre-documented 2. Ensuring 5 gallon buckets of sanitizer were not stored on the bare floor. 3. Ensuring cold food/beverages being served for lunch were on ice and at appropriate temperature (40 degrees or below). These deficient practices are likely to affect all 81 residents listed on the resident census list provided by the Administrator on 07/17/23, and are likely to cause foodborne illnesses in residents if food is not being stored properly and safe food handling practices are not adhered to.

Inspectors wroteBased on record review and interview, the facility failed to provide an ongoing activity program for 1 (R #7) of 1 (R #7) resident reviewed for activities. If the facility does not ensure that all residents are receiving an ongoing activity program, documenting resident refusals, and making in-room activity accommodations, then residents are likely to demonstrate an increase in isolation and depression.

Inspectors wroteBased on observation and interview, the facility failed to: 1. Ensure that medications were not expired and were labeled as to when they were opened 2. Ensure Medication carts were locked and not left unattended. These deficient practices are likely to result in residents receiving medications that have lost their potency and effectiveness leaving them vulnerable to acquiring infections. Leaving medication carts unlocked and unattended gives residents access to potentially dangerous medications kept in the unlocked medication carts.

Inspectors wroteBased on observation and interview, the facility failed to provide food that accommodates resident allergies, intolerances, and preferences for 1 (R #26) of 1 (R #26) resident observed for food allergies. This deficient practice is likely to result in weight loss due to residents not eating or experiencing allergic reactions.

Inspectors wroteBased on record review and interview, the facility failed to ensure that 1 (R #26) of 1 (R #26) resident's New Mexico Medical Orders For Scope of Treatment (MOST) reviewed was completed to reflect medical interventions (Advanced Directives-legal documents that allow you to spell out your decisions about end-of-life care ahead of time). This deficient practice is likely to affect residents' fulfillment of their end-of-life medical care choices and could result in unnecessary suffering for the resident.

Inspectors wroteBased on interview and record review, the facility failed to complete the Minimum Data Set (pertinent resident health information) (MDS) quarterly for 1 (R #42) of 1 (R #42) resident reviewed for current comprehensive assessment. This deficient practice is likely to result in residents not receiving the optimal care needed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that the resident's care plan had been revised for 1 (R #26) of 1 (R #26) resident reviewed by not updating the care plan to include a food allergy. This deficient practice is likely to result in residents' care and needs not being addressed if care plans are not updated.

Inspectors wroteBased on record review and interview, the facility failed to complete an annual performance/competency review for two Certified Nurse Assistants (CNA)'s (CNA #2 and #3) of 3 (CNA #1, CNA #2, and CNA #3) CNA's randomly reviewed for annual performance/competency trainings. This deficient practice is likely to result in staff not maintaining the competencies to perform their daily tasks needed to provide the care and service to meet the needs of all residents.

Inspectors wroteBased on observation and interview, the facility failed to provide proper infection control practices by not: 1. Ensuring that the door between the soiled utility room, containing clothing items that were soiled with body fluids, and the clean laundry room (where clothing items are cleaned and laundered) was kept closed. 2. Ensuring alcohol wipes were readily available for use in the facility kitchen to wipe thermometer probe used to take temperature of prepared food items before food service. 3. Ensuring that sanitizer buckets used to clean food preparation areas had sanitizer in them. These deficient practices are likely to cause the spread of infections and illness to residents and staff within the facility.