Careone at Teaneck

Inspectors wroteBased on record review, observation, staff interviews, and facility policy review, the facility failed to ensure initial and weekly weights were implemented for two out three residents (Resident (R) 26 and R92). This lack of monitoring of residents' weight loss/gain can delay in identifying potential nutritional problems.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to make choices about their life including interacting with family members in the community for one of 25 sampled residents (Resident (R) 78). Specifically, R78 had an outing in the community scheduled with her son; however, the resident was denied her right to leave the facility with her son. This failure violated the resident's rights, placed the resident at risk for psychosocial decline, and placed the resident at risk for a diminished quality of life.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to protect one of two residents (Resident (R) 93) from misappropriation of property. This failure has the potential to affect all residents who choose to keep money and/or private property in their rooms.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to include in the physician's order a 14-day limit for an as needed psychotropic medication for one (Resident (R)1) of five residents reviewed for unnecessary medication. This had the potential to place the resident at a higher risk for falls, injury, and confusion.

Inspectors wroteBased on interviews, record review, and review of the facility's policy, the facility failed to complete a thorough investigation of an allegation of misappropriation for one (Resident (R) 93) of two residents reviewed for abuse out of 40 sampled residents. The facility's failure to complete a thorough investigation placed residents at risk of being unprotected from misappropriation.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to obtain wound treatment orders, upon admission, to provide treatment for one of two residents (Resident (R) 93) and failed to implement wound prevention measures upon admission. This failure had the potential to lead to infection and worsen the pressure ulcer.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medication orders were followed and administered through a feeding tube according to standard of practice for one (Resident (R)103) of five residents reviewed for medication administration. This practice had the potential to alter the drug release, absorption, and/or effectiveness as well as causing discomfort.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that food preferences were honored for one out of two sampled residents (Resident (R) 26). The facility failed to ensure the resident was given dinner that she had ordered and strawberry ice cream.

Inspectors wroteBased on observation and interview, the facility failed to ensure one of one resident (Resident (R) 26) reviewed for assistive devices during dining out of a total sample of 40. This had the potential to cause a decrease in the resident's dietary intake.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure the clinical records were complete for one of three residents (Resident (R) 26) reviewed for tube feeding orders out of a total sample of 40 residents. This had the potential for the resident not to receive accurate care.

Inspectors wroteBased on observation, interview, record review, the facility failed to ensure residents' care equipment was maintained in safe operating condition for one of 25 sampled residents (Resident (R) 107). Upon admission, R107 was provided a bed that was broken and in need of repair or replacement. This failure placed the resident at risk of a diminished quality of life from not having a homelike environment and placed the resident at risk for accidents and hazards to occur.

Inspectors wroteBased on record review, observations, and interviews the facility failed to ensure one Certified Nursing Assistant (CNA) 1 was effectively trained in understanding misappropriation. As a result, money was exchanged from one of one resident (Resident (R) 93) to CNA1. This had the potential for staff not to recognize a gift could be viewed as misappropriation, when a resident was dependent on the caregiver for personal needs.

Inspectors wroteBased on document review, interview, and review of facility policy, the facility failed to ensure that the quality assessment and assurance (QAA) committee met at least quarterly. This had the potential to affect the care and services for each of the 83 residents in the facility.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to maintain professional standards of nursing practice for not following physician orders for 3 of 21 residents reviewed (Resident # 19, #197, and #72) and b.) failed to document for accountability of medications and treatments administered for 3 of 21 residents reviewed (Resident #72, #196, and #197). The deficient practice was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45, Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: The practice of nursing as a licensed practical nurse is defined as performing tasks and responsibilities within the framework of case finding; [...]

Inspectors wroteBased on the interview and record review, it was determined that the facility failed to code the Minimum Data Set (MDS), an assessment tool used to facilitate the management of care of all residents, accurately for 1 of 21 residents reviewed (Resident # 89). The deficient practice was evidenced by the following: The surveyor reviewed Resident # 89's records. The resident was discharged from the facility and according to the Discharge Return Anticipated MDS, an assessment tool used to facilitate the management of care, dated 11/21/23, the resident was assessed as being discharged to home or lesser care. A review of Resident # 89's progress notes dated 11/21/23 revealed that the resident had a transfer to hospital, as the resident had an increase in respiratory distress, chest congestion which started on 11/20/23 and the symptoms had gotten worse. [...]

Inspectors wroteBased on interview, and record review, it was determined the facility failed to follow professional standards and practices to accurately document in the medical record the status of a resident's progress or changes in his/her condition. The resident was transferred from the facility to the hospital. The concern was cited for 1 (Resident #199) of 21 residents reviewed and is evidenced by the following: Resident #199 is not in the facility and will investigate the closed record and conduct interviews. §483.70(i)(1) In accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are (ii) accurately documented. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to a.) clarify a physician order with regard to fluid consistency for 1 of 21 residents (Resident#23) and b.) label and date the enteral feeding (method of supplying nutrients directly into the gastrointestinal tract) and water flush bottle for 1 of 1 resident (Resident #69) in accordance with facility policy and procedure and professional standards of practice. This deficient practice was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45. Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to a.) provide wound treatment consistent with professional standards of practice to an existing pressure injury and b.) implement an element of the facility policy and procedure concerning a wound dressing, for 1 of 1 Resident (Resident#46) observed during wound treatment observation. This deficient practice was evidenced by the following: On 11/15/21 at 10:40 AM, the surveyor was informed by Resident #46 that there was a pressure wound on their coccyx area that I was not sure if 100% healed. On 11/16/21 at 9:48 AM, the surveyor interviewed the Registered Nurse (RN) who informed the surveyor that Resident#46 was cognitively intact with periods of forgetfulness. The RN stated that the resident had a pressure wound to the sacrum and I will get back to you with the stage of the wound. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to properly label, store and dispose of medications in two (2) of two (2) medication refrigerators that were inspected. This deficient practice was evidenced by the following: On [DATE] at 9:50 AM, the surveyor inspected the 2nd floor medication room refrigerator in the presence of a Registered Nurse (RN). The surveyor observed two opened vials of Protein Purified Derivative (PPD) that were opened and not dated. The surveyor also observed an opened vial of PPD that had an opened date of [DATE] and was expired. The surveyor interviewed the RN who stated that once a vial of PPD is opened that it should be dated because an opened vial of PPD only have a 30-day expiration date. [...]