Care Nursing & Rehabilitation

Inspectors wroteBased on observation, interview and record review, the facility failed to have a written agreement with the hospice that is signed by an authorized representative of the hospice and an authorized representative of the LTC facility before hospice care is furnished to any resident and an interdisciplinary team member collaborate with hospice representatives and coordinate the hospice care planning process for each resident receiving hospice services, to ensure quality of care for the resident, ensuring communication with the hospice medical director, the resident's attending physician and others participating in the provision of care for 2 (Resident #10, Resident #60) of 16 residents reviewed for hospice services. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the resident's right to reside and receive services in the facility with accommodation of residents' needs and preferences for 2 (Resident #10, Resident #26) of 24 residents reviewed for resident rights. The facility failed to ensure Resident #10's and Resident #26's call lights were within reach. This failure could place residents at risk of a diminished quality of life and lead to a loss of self-esteem and isolation.

Inspectors wroteBased on interviews and record reviews, the facility failed to not use any individual working in the facility as a nurse aide for more than four months unless that individual had completed a training and competency evaluation program for 3 (SNA A, SNA B, and SNA C) of 6 student nurse aides reviewed for nursing services. The facility failed to ensure SNA A, SNA B, and SNA C were certified within four months of hire. This failure could place residents at risk for receiving inappropriate care from individuals whose skill level was not known.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as possible, in four out of ten resident rooms on 1 of 4 halls (The middle hall) reviewed for accident hazards, in that; The facility failed to ensure that the hot water temperatures in the sinks for 4 resident rooms did not exceed the maximum of 110 degrees Fahrenheit. This failure could place residents at risk for injuries related to hot water temperatures.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure drugs and biologicals are labeled in accordance with professional principals , for 1 of 2 medication rooms (The front medication room) inspected for medication storage. The medication room had opened and undated vial of Tuberculin (TB) medication in the refrigerator. This failure could place residents at risk of receiving medications that were expired and not produce the therapeutic effect.

Inspectors wroteBased on record review and interviews, the facility failed to maintain medical records on each resident that were accurately documented for 1 (Resident #15) of 27 residents reviewed for accuracy of records. The facility failed to ensure LVN A documented in Resident #15's record the holding of Lantus Insulin was because of the resident's request. This failure to place residents of risk of having incomplete and accurate records.

Inspectors wroteBased on observation, interview, and record review, 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 1 (Resident #22) of 2 residents reviewed for infection control. CNA A failed to change her gloves and wash her hands after they became contaminated during incontinent care while assisting Resident #22. This failure could place resident's risk for cross contamination and the spread of infection.

Inspectors wroteBased on interview and record reviews, the facility failed to immediately consult with the resident's physician when there was a need to alter treatment significantly and a decision to discharge the resident from the facility to the hospital for 1 (Resident #1) of 3 residents reviewed for notification of changes. The facility failed to notify Resident #1's physician when Resident #1 was transferred and discharged to the hospital on [DATE]. This failure could place residents at risk of not having their change of condition communicated to their physician, delay of treatment, and a decline in the residents' health and well-being.

Inspectors wroteBased on observations, interviews and record review it was determined the facility failed to provide pharmaceutical services that ensure the accurate administering of drugs for 2 of 3 medication carts and 1 of 1 treatment cart observed for medications stored and properly labeled, in that:. Two of the medication carts had insulin pens that were opened but not dated when placed into use. The treatment cart had an opened undated TB vial. These failures could place residents at risk of receiving medications that were expired and not produce the desired effect.

Inspectors wroteBased on observation, interview and record review the facility failed to store all drugs and biologicals in locked compartments for 1 of 1 treatment cart and 2 of 3 nurse carts reviewed for medication storage and security. The treatment medication cart was left unlocked and unsupervised. The nurse medication carts were left unlocked and unsupervised. These failures could place clients at risk for drug diversion or accidental ingestion.

Inspectors wroteBased on observation, interview, and record review, 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 two (Resident #42 and #29) of 4 residents reviewed for infection control in that; LVN C closed the faucet with her bare hands after she had washed her hands after assisting Resident #42. CNA E failed to perform incontinent care to Resident #29's peri-area after the resident used the urinal. These failures could place resident's risk for cross contamination and the spread of infection.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 3 residents (Resident #42) reviewed for accident hazards in that: LVN C and CNA D did not demonstrate appropriate transfer techniques for Resident #42. This failure could put residents at risk of accidents and serious injuries which could result in a reduced quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents who received nutrition by enteral means received the appropriate treatment and services for 1 of 1 resident (Resident #2) reviewed for enteral feeding. The facility failed to ensure that Resident #2's enteral feeding bag was correctly labeled and dated. This failure could result in the resident receiving formula that is not appropriate for the treatment/service for the resident.

Inspectors wroteBased on observations, interview, and record review the facility failed to ensure that 3 of 4 (Residents #32, #34, and #47 ) residents reviewed for respiratory care were provided care consistent with professional standards of practice in that: Resident #32 did not have her SVN mask bagged when not in use. Resident #34 did not have her CPAP mask bagged when not in use. Resident #47 did not have his nebulizer bagged when not in use. This deficient practice could place residents who received oxygen treatments at risk of respiratory infection.

Inspectors wroteBased on observation, interview and record review, the facility failed to establish and maintain a resident environment that is free of accident hazards for shower room [ROOM NUMBER] of 4 shower rooms. The South Hall shower room was unsecured and unattended, leaving razors, shampoo, denture cream, shaving cream, and fingernail clippers accessible to residents. Residents could injure themselves or ingest materials, placing them at risk of harm.

Inspectors wroteBased on interview and record review the facility failed to ensure that residents are not given psychotropic drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record for one (Resident #32) of 5 residents reviewed for unnecessary medications. Resident #32 was placed on the antipsychotic Olanzapine without an appropriate indication for use. Resident #32's antipsychotic Olanzapine was increased without indicator documented supporting the increased dosage. These failures put residents at increased risk of side effects as a result of being administered an unnecessary antipsychotic.