Boyd Nursing and Rehabilitation

Inspectors wroteBased on interview, document review, and facility policy review, the facility failed to ensure health department recommendations were followed to test the facility water two times weekly for legionella. This deficient practice had the potential to affect all 57 residents who currently resided in the facility.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure their medication error rate was not greater than 5 percent (%). There were seven errors out of 28 opportunities, which resulted in a mediation error rate of 25% for 2 of 3 residents observed for medication administration, Resident (R) 18 and R19.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to notify the physician when medications were not administered for 2 of 5 sampled residents reviewed for unnecessary medications, Resident (R) 4 and R20.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure the route of medication administration was accurate for 1 of 14 sampled residents, Resident (R) 7.

Inspectors wroteBased on interview, review of the facility staffing sheets, review of the facility assessment, review of the payroll-based journal staffing information, and review of resident grievances, the facility failed to have adequate nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident, considering the number, acuity, and diagnoses of the facility's resident population in accordance with the facility assessment.

Inspectors wroteBased on interview, record review, and review of facility's policy, the facility failed to treat each resident with respect and dignity and care in a manner that promoted maintenance of his or her quality of life for 1 of 1 sampled residents (Resident (R) 62). R62's religious beliefs prohibited cutting of women's hair and R62 was given a haircut without consulting the resident's guardian.

Inspectors wroteBased on observation, interview, and review of facility's policy, the facility failed to follow an infection prevention and control policy to prevent the development and transmission of communicable diseases and infections for 1 of 8 sampled residents receiving blood glucose monitoring (Resident (R) 55). Observation on 10/23/2024 at 11:00 AM revealed Licensed Practical Nurse (LPN) 1 placed R55's glucometer on top of the treatment cart without a barrier prior to obtaining a blood glucose reading. Following the glucose reading, LPN1 cleaned the glucometer for two minutes and placed the glucometer on top of the treatment cart to dry without a barrier between the cart top and the glucometer.

Inspectors wroteBased on observation, interview, and record review it was determined the facility failed to develop and implement a Baseline Care Plan for each resident that includes the instructions needed to provide effective and person-centered care for one (1) of sixteen (16) sampled residents (Resident #207). Resident #207 was admitted to the facility on the evening of 09/23/19 at approximately 8:00 PM, with diagnoses to include Fracture of Shaft of Humerus, Left Arm. However, there was no documented evidence the Baseline Care Plan dated 09/23/19, was developed and implemented to address the resident's Left Arm Fracture and associated pain. Upon admission, Physician's Orders were received for Percocet 10-325 milligrams (mg), one (1) tablet by mouth three (3) times a day PRN (as needed) related to the Left Humerus Fracture. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined the facility failed to ensure pain management was provided to residents who require such services for one (1) of sixteen (16) sampled residents (Resident #207). Resident #207 was admitted to the facility on [DATE] at approximately 8:00 PM, and Physician's Orders were obtained for Oxycodone/Acetaminophen (Percocet) 10-325 milligrams (mg), one (1) tablet PO TID (by mouth three (3) times a day) PRN (as needed) related to a Closed Fracture of the Left Humerus. However, there was no documented evidence the resident received any pain medication until 09/24/19 at 8:44 PM, after orders were received for a one (1) time dose of Percocet 5-325 mg, two (2) tablets. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility policy, it was determined the facility failed to ensure pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident for two (2) of sixteen (16) sampled residents (Resident #32, and Resident #207). Although the facility admitted Resident #207 on 09/23/19 at approximately 8:00 PM, and Physician's Orders were obtained for Oxycodone/Acetaminophen (Percocet) 10-325 milligrams (mg), one (1) tablet PO TID (by mouth three (3) times a day) PRN (as needed) related to a Closed Fracture of the Left Humerus, there was no documented evidence the resident received any pain medication until 09/24/19 at 8:44 PM, when the resident received a one (1) time dose of Percocet 5-325 mg, two (2) tablets. [...]

Inspectors wroteBased on observation, and interview, it was determined the facility failed to ensure the resident has a safe, clean, comfortable and homelike environment for two (2) of sixteen (16) sampled residents (Resident #7 and Resident #54). Observation of Resident #7's air conditioning unit on 10/02/19, revealed the unit was set to seventy-nine (79) degrees Fahrenheit (F), and when the resident attempted to lower the temperature on the air conditioning unit, the air conditioner remained in the seventy-nine (79) degree position. Interview with Resident #7, during the observation, revealed he/she had complained of the air conditioning not working properly six (6) months ago, and he/she was uncomfortable and hot during the summer months. [...]

Inspectors wroteBased on interview, record review, and review of the Centers for Medicare and Medicaid Services, Resident Assessment Instrument (RAI) Manual 3.0, it was determined the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for two (2) of sixteen (16) sampled residents (Resident #32 and Resident #57). Resident #57's Comprehensive Care Plan, dated 02/15/19, was not implemented related to administering oxygen as ordered. [...]

Inspectors wroteBased on observation, interview, record review, review of the facility's Policy, and review of the Kentucky Board of Nursing (KBN), Advisory Opinion Statements (AOS) #14, revised October 2015, Roles of Nurses in the implementation of Patient Care Orders, it was determined the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for one (1) of sixteen (16) sampled residents, (Resident #16).

Inspectors wroteBased on interview, record review, and review of the Emergency Preparedness Manual utilized by the facility, it was determined the facility failed to ensure that a resident who needs respiratory care is provided such care for one (1) of sixteen (16) sampled residents (Resident #57). The facility failed to ensure appropriate measures were in place for Resident #57, in order to provide adequate respiratory services when the electricity/power went out on 08/12/19. (Refer to F-656 and F-849)

Inspectors wroteBased on observation, interview, and review of facility Policy, it was determined the facility failed to ensure proper storage of drugs and biologicals. Observation of the medication refrigerator, on [DATE], revealed an expired vial of Tubersol dated [DATE], accessible for use.

Inspectors wroteBased on observation, interview, record review, and review of the facility's Hospice Agreement, dated 08/30/19, it was determined the facility failed to designate a member of the facility's interdisciplinary team who is responsible for working with Hospice representatives to coordinate care to the resident provided by the Long Term Care (LTC) facility staff and Hospice staff. In addition, the facility failed to have an effective communication process between the LTC facility and the Hospice representative to ensure the needs of the resident are addressed and met twenty-four (24) hours per day. This affected two (2) of two (2) sampled residents reviewed for Hospice services out of a total of sixteen (16) sampled residents (Resident #32 and #57). [...]

Inspectors wroteBased on observation, interview, and record review, it was determined the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Observation of the medication refrigerator, on [DATE], revealed the only vial of Tubersol was dated as opened [DATE], revealing it was expired. Interviews revealed this vial may have been used to administer Purified Protein Derivative (PPD) Skin Tests to State Registered Nurse Aides #3 and #4. In addition, observation of wound care on [DATE], performed by Licensed Practical Nurse (LPN) #2, revealed the nurse failed to perform hand hygiene between glove changes during wound care.