Brunswick Cove Nursing Center

Inspectors wroteBased on record review and interviews with the staff, Consultant Pharmacist, Nurse Practitioner (NP), and Medical Director, the facility failed to prevent a significant medication error when Nurse #1 administered Resident #2 Haldol (an antipsychotic medication used to treat severe behavioral issues) IM (intramuscular) (delivered via injection) 20 milligrams (mg) instead of the ordered 2 mg. This deficient practice affected 1 of 3 residents reviewed for significant medication errors.

Inspectors wroteBased on observations, record review, staff and physician and pharmacist technician specialist interviews, the facility failed to obtain an order to flush a percutaneous intravenous central catheter (PICC) with normal saline and heparin (blood thinning agent) flushes for 1 of 1 resident (Resident #129) reviewed for intravenous (IV) antibiotics.

Inspectors wroteBased on record review, and resident, staff, Nurse Practitioner, and Wound Physician interviews, the facility failed to provide treatment for surgical wound as specified in the hospital discharge summary (Resident #48) and failed to offload a neck/shoulder contracture as ordered (Resident #6). This was for 2 of 3 residents reviewed for skin integrity (Resident #48 and Resident #6).

Inspectors wroteBased on observations, record review and staff and Wound Physician interviews, the facility failed to follow a physician order for a wound treatment for 1 of 3 residents (Resident #16) observed for pressure ulcers.

Inspectors wroteBased on observation, record review, and resident, staff and Nurse Practitioner (NP) interviews, the facility failed to provide supervision and ensure a smoking apron was worn for 1 of 1 resident identified as requiring supervision with smoking reviewed for smoking (Resident #99). Resident #99 was admitted into the facility on 9/30/20 with diagnoses of nontraumatic subdural hemorrhage (bleeding between the brain and its tough outer covering), syncope (a temporary loss of consciousness) and collapse (fall). A diagnosis of narcolepsy (a chronic condition where the brain cannot regulate sleep-wake cycles, causing overwhelming daytime sleepiness and sudden sleep during activities) was added on 12/9/22. Resident #99's quarterly Minimum Data Set, dated [DATE] revealed she was cognitively intact and had no impairment of her upper extremities. [...]

Inspectors wroteBased on record review, observations, and staff and Nurse Practitioner interviews, the facility failed to administer oxygen at the prescribed rate for 1 of 4 residents reviewed for respiratory care (Resident #72).

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to follow their infection control policy and procedures for Enhanced Barrier Precautions (EBP) during high contact care for a resident (Resident #105) with a pressure ulcer wound when the Wound Treatment Nurse was providing resident care without wearing the required personal protective equipment (PPE) for 1 of 4 staff observed for infection control.

Inspectors wroteBased on record review and staff interviews, the facility failed to code the Minimum Data Set (MDS) assessments accurately in the areas of medication, dental and continence for 4 of 30 residents whose MDS assessments were reviewed (Resident # 283, Resident #99, Resident #76 and Resident #115).

Inspectors wroteBased on record review, staff, Nurse Practitioner and Physician interviews, the facility failed to ensure a resident had an ophthalmology appointment scheduled as ordered on 1/11/24, 2/13/24 and 3/26/24 resulting in the resident not seen until 4/19/24 and failed to obtain the retinol specialist appointment recommended by the ophthalmologist for 1 of 1 resident (Resident #101) reviewed for vision.

Inspectors wroteBased on record review, staff interviews and Consultant Pharmacist interview the facility failed to ensure the facility staff reviewed pharmacy recommendations and documented any action taken or a rationale for no action taken on the pharmacy request for 1 of 5 residents reviewed for drug regimen review (Resident #115).

Inspectors wroteBased on record review and staff and Consulting pharmacist interviews, the facility failed to complete an AIMS (Abnormal Involuntary Movement Scale) assessment for 1 of 5 residents (Resident #11) reviewed for unnecessary medications who received psychotropic medications.

Inspectors wroteBased on record review, Physician interview, Nurse Practitioner (NP) interview, staff interviews, and Responsible Party (RP) interview, the facility failed to notify the resident's (Resident #89) Responsible Party (RP) and the facility Physician of the resident's fall and change in condition for 1 of 4 sampled residents reviewed for change of condition.

Inspectors wroteBased on record review and staff interviews, the facility failed to provide a Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) (form 10055) prior to discharge from Medicare Part A skilled services for 2 of 3 (Resident #112 and Resident #115) residents reviewed for beneficiary protection review.

Inspectors wroteBased on record reviews, observation, resident and staff interviews the facility failed to develop a comprehensive person-centered care plan for the focus areas of antidepressant and antiplatelet medications, continence and indwelling catheter for 3 of 30 residents (Resident #76, Resident #99 and Resident #283) reviewed for comprehensive care plans.

Inspectors wroteBased on record review, observations, staff and physician interviews, the facility failed to apply signage indicating the use of oxygen outside the resident's room for 2 of 2 residents reviewed for oxygen use (Resident #11 and Resident #112).

Inspectors wroteBased on observation and staff interviews, the facility failed to date foods stored for use in one of one kitchen walk-in refrigerator.

Inspectors wroteBased on observations, record review, and staff interviews, the facility ' s Quality Assurance and Performance Improvement (QAPI) committee failed to maintain implemented procedures and monitor these interventions that the committee put into place in February of 2022. This was for one recited deficiency in the area of food and nutrition services. The continued failure of the facility during the two federal surveys of record shows a pattern of the facility ' s inability to sustain and effective QAPI program.

Inspectors wroteBased on record review, staff and Responsible Party (RP) interviews, the facility failed to invite the RP to the care plan meeting for 1 of 1 resident (Resident #81) reviewed for care plans.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to complete a smoking assessment for 1 of 1 resident (Resident #51) reviewed for smoking.

Inspectors wroteBased on record review and Administrator interview, the facility failed to submit the Payroll Based Journal (PBJ) data for the 3rd, and 4th quarters in fiscal year (FY) 2022 and 1st quarter in fiscal year 2023.