Cadia Rehabilitation Renaissance

Inspectors wroteBased on observation, interview and review of facility documents it was determined that the facility failed to ensure dishes and utensils were cleaned under sanitary conditions. Additionally, the facility failed to ensure cleanliness of food storage areas and properly store items in facility unit refrigerators.

Inspectors wroteBased on interview, and record review it was determined that for two (R118 and R120) out of nine residents sampled for discharge and hospitalization the facility failed to send the required notification to the Ombudsman of transfer discharge.

Inspectors wroteBased on record review and interview it was determined that for one (R123) out of four residents reviewed for abuse the facility failed to ensure an allegation of misappropriation of resident property was reported to the state agency within the required time frame.

Inspectors wroteBased on interview, and record review it was determined for one (R10) out of four residents sampled for PASARR review the facility failed to ensure a referral for a new PASARR Level I and II screening occurred by or before the sixth (60) day. R10 remained in the facility beyond the authorization time frame.

Inspectors wroteBased on observation, interview and record review it was determined for one (R37) out of two residents sampled for care plans the facility failed to develop and implement a comprehensive person-centered care plan to address R37's refusal to wear a splint/brace for right hand/wrist contractures. A review of R37's clinical record revealed: 1/2/24 - R37 was admitted to the facility with diagnoses including but not limited to stroke and right-side weakness. 1/3/24 - A review of R37's orders documented splint/brace/device see RNP task for details. 10/8/24 - A review of R37's care plan for actual contractures and potential for further contractures related to decreased mobility, right spastic hemiplegia (stiff muscles and poor motor control) following stroke revealed the intervention resting right hand splint initiated 2/19/24. [...]

Inspectors wroteBased on observation, interview, and record review it was determined that for one (R37) out of four sampled residents reviewed for ADL(s) the facility failed to provide nail care.

Inspectors wroteBased on observation, interview, and record review it was determined for one (R37) out of three residents sampled for range of motion and mobility, the facility failed to provide a right wrist splint to prevent contractures for R37.

Inspectors wroteBased on record review and interview it was determined that the facility failed to ensure accuracy of the medication reconciliation documentation for a controlled drug.

Inspectors wroteBased on interview and record review, it was determined for two (R20 and R61) out of five sampled residents for unnecessary medications, the facility failed to document a rationale for disagreeing on a monthly medication regimen review (MRR) recommendations.

Inspectors wroteBased on observation and interview it was determined that for two out of three medication carts reviewed the facility failed to ensure opened medications were labeled with an open date. For one out of three medication carts reviewed the facility failed to ensure that insulin was stored in accordance with manufacturer's instructions regarding temperature. Lastly, the facility failed to ensure that medications in the facility were labeled in accordance with currently accepted professional principles when they accepted and stored unidentifiable medications then failed to ensure safe and secure storage of those medications.

Inspectors wroteBased on record review and interview, it was determined that for one (R106) out of one resident reviewed for lab services, the facility failed to promptly notify the ordering medical practioner of abnormal laboratory results.

Inspectors wroteBased on interview and record review, it was determined that the facility failed to report an allegation of abuse to the state agency for one of one resident (R15) reviewed for abuse.

Inspectors wroteBased on observation, interview, and record review, it was determined that for one (R15) out of one resident reviewed for abuse, the facility failed to protect residents by not suspending the accused staff member pending the outcome of the investigation.

Inspectors wroteBased on observation, interview, record review, and review of the facility's resident rights, the facility failed to ensure 1. residents were provided a homelike environment during meals for eight of eight residents (Resident (R) 46, R8, R25, R32, R36, R83, R111, R32, and R168) during dining; 2. privacy bags covered urinary catheter bags for R51; 3. and privacy with shower schedules was maintained. This failure placed the residents at risk of an undignified dining experience.

Inspectors wroteBased on interviews, record review, and review of the facility arbitration agreement, the facility failed to thoroughly explain the binding arbitration agreement to residents or their representative and provide an arbitration agreement that granted the resident or their representative the right to rescind the agreement within 30 days of signing it and communicate with federal, state, local officials and the ombudsman for three (Residents (R)11, R43, and R89) of three residents reviewed for arbitration in a sample of 34. This failure denied residents the opportunity to fully understand what the agreement meant and the ability to rescind the agreement within 30 days of signing.

Inspectors wroteBased on interviews and record review, the facility failed to ensure the arbitration agreement provided for the selection of a neutral arbitrator without stipulations and the selection of a venue that is convenient for three (Residents (R)11, R43, and R89) of three residents reviewed for arbitration in a total sample of 34 residents. This placed residents at risk not having the opportunity to choose an arbitrator or venue.

Inspectors wroteBased on observation, interview, document review, and policy review, the facility failed to develop and implement infection control protocols for 1. failed to ensure COVID19 infection control processes were followed by facility staff within a secured unit and soiled PPE was not kept out of reach for resident (Resident (R) 89); and 2. infection control was maintained during wound care for R104. These failures had the potential to affect all 116 residents in the facility.

Inspectors wroteBased on interview, record review, and review of the facility's resident rights, the facility failed to honor a resident's right to 1. choose their preferred method of transferring for one of 34 sampled residents (Resident (R) 43) and 2. choose to go outside for one of 34 sampled residents (R42). This failure placed the residents at risk for psychosocial harm by diminishing their independence.

Inspectors wroteBased on interview, record review, and review of the facility's policy, the facility failed to ensure residents were free from physical restraints by applying a Wanderguard to prevent leaving the facility for one of 34 sampled residents (Resident (R) 43). R43 was outside in the facility's parking lot when the nursing staff physically pulled the resident back into the facility against his will while he was in his wheelchair. This deficient practice had the potential to cause psychosocial and physical harm to the resident.

Inspectors wroteBased on interview, record review, and review of the facility's policy, the facility failed to develop and implement person centered comprehensive care plans for side rails and weight monitoring for palliative care for two (Resident (R) 62 and R51) of 34 sampled residents. This placed the residents at risk for decreased quality of life and quality of care and further exacerbation of an illness.

Inspectors wroteBased on observation, interview, record review and review of facility policy, the facility failed to ensure the Comprehensive Care Plan was accurate and updated for one resident (Residents (R)265) in a total resident sample of 34 whose Care Plans were reviewed. This failure placed the residents at risk for unmet care needs and a diminished quality of life.

Inspectors wroteBased on observations, interview, and record review, the facility failed to provide assistance with dining for one of three residents (Resident (R) 106) reviewed for activities of daily living (ADLs) of 34 sampled residents. This failure increased the potential for R106 to have a significant weight loss.

Inspectors wroteBased on observation and interview, the facility failed to provide a safe toilet for one of two residents (Resident) R 42) reviewed for accident hazards out of a total sample of 34 residents creating the potential for a fall or skin injuries.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess the need for side rails and obtain informed consent for one (Resident (R)62) of one resident reviewed for side rails out of a total sample of 34 residents. This failure increased the risk that residents would have side rails without evaluation for the need and without making an informed decision knowing the risks and benefits.

Inspectors wroteBased on observations, interviews, record review, and review of facility policy, the facility failed to ensure one of one resident (Resident (R)80) reviewed for a diagnosis of with post-traumatic stress disorder (PTSD) out of a total sample of 34 residents, received appropriate treatment and services to attain his highest practicable mental and psychosocial well-being. This failure placed the resident at risk of unmet needs and a diminished quality of life.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to contact the pharmacy to ensure medications were available for administration for one of seven residents (Resident (R) 92) reviewed for medication administration out of a sample of 34 residents.

Inspectors wroteBased on interviews, record reviews, and policy review, the facility failed to ensure that one of seven residents reviewed for unnecessary medications (Resident (R) 16) out of a total sample of 34 residents received antibiotics with diagnoses of tooth abscess and moderate protein-calorie malnutrition. This failure had the potential to increase the risk of infection, pain, and weight loss.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure: 1. an insulin pen was not expired when used for one resident (Resident (R) 66) of four insulin pens reviewed on three medication carts and This failure increased the risk of insulin not being effective.

Inspectors wroteBased on observation, interview, and record review, the facility failed to have menu extensions for finger foods for one (Resident (R)89) of three residents reviewed for diets in a total sample of 34 residents. The failure had the potential to cause R89 to lose weight by not receiving foods easy to eat.

Inspectors wroteBased on interview, record review and review of other facility documentation, it was determined that for two (R1 and R2) out of two residents reviewed for abuse, the facility failed to ensure the protection of all residents from alleged sexual abuse. The facility's failure placed all residents at risk for a serious adverse outcome, by not immediately protecting the resident and allowing the CNA to continue providing care for other residents. An IJ was identified on 6/17/24 and due to the facility's corrective measures this is being cited as past non-compliance with a compliance date 6/14/24.

Inspectors wroteBased on record review, interviews, facility reportable incidents (FRIs), and facility policy review, the facility failed to ensure two of four residents (Resident (R) 2 and R6) reviewed for abuse and neglect were free from abuse. Specifically, R2 was involved in a resident-to-resident altercation initiated by R1, and R6 was verbally abused by Registered Nurse (RN) 1.

Inspectors wroteBased on interviews, facility document review, and facility policy review, the facility failed to ensure that an allegation of abuse for one of one resident (Resident (R) 6) reviewed for an allegation of verbal abuse, was reported to the State of Delaware, Department of Health and Social Services, Division of Health Care Quality within two hours of the allegation of abuse being identified.

Inspectors wroteBased on observation and interview, it was determined that the facility failed to maintain essential kitchen equipment in safe operating condition.

Inspectors wroteBased on observations, interview and record review, it was determined that for one (R18) out of twenty-two residents reviewed for care plans, the facility failed to develop a care plan for the use of oxygen.

Inspectors wroteBased on observation, interview and record review, it was determined that for one (R66) out of one resident reviewed for pressure ulcers the facility failed to ensure that the resident received the necessary treatment and services to promote healing and prevent new pressure ulcers from developing. For R66, a dependent resident with a pressure ulcer the facility failed to ensure that R66 was turned and repositioned every two hours. Findings Include: National Pressure Ulcer Advisory Panel (NPUAP), Prevention and Treatment of Pressure Ulcers: Quick Reference Guide, second edition, published 2014, stated Do not position an individual directly on a pressure ulcer .Continue to turn and reposition the individual regardless of the support surface in use .No support surface provides complete pressure relief. [...]

Inspectors wroteBased on observation, interview and record review, it was determined that for one (R18) out of one resident reviewed for respiratory care, the facility failed to provide professional standards of practice by ensuring the oxygen tubing was changed weekly.

Inspectors wroteBased on record review, interview and review of facility documentation, it was determined that for one ( R262) out of twenty-one (21) sampled residents, the facility failed to ensure accurate and complete records. 1. Review of R262's clinical record revealed: 3/6/23 - admission to facility. 8/7/23 - 9:03 AM- A review of R262's Medication Administration Record (MAR) lacked documentaion of the administration of Zosyn (antibiotic medication) on 3/16/23 and 3/23/23. R262 was receiving his antibiotic through a PICC (peripheral inserted central catheter) line. 8/7/23 10:01 AM - An interview with E4 (LPN) revealed that if a medication is unavailable, staff would notify the pharmacy and the on-call provider to get a hold order. Also, if there is an issue with the PICC line staff would notify the IV team. [...]

Inspectors wroteBased on interview and record review, it was determined that the facility failed to ensure that the state survey inspection results were available for residents to read.