Carriage Hill Bethesda

Inspectors wroteBased on interview and record review, the facility failed to ensure that a resident's right to make his/her own decisions, including the right to participate in and direct his/her personal and financial affairs, and the right to refuse services, was honored. The facility also failed to obtain the resident's consent prior to submitting a Medicaid application and inaccurately represented the resident's decision-making capacity. This deficient practice was identified for 1 of 1 resident (Resident #69) reviewed for resident rights.

Inspectors wroteBased on observations and interviews with residents and facility staff it was determined the facility failed to ensure that residents' call lights used to notify staff that assistance is needed were within reach. This was found to be evident for 3 (#60, #107, # 67) of 105 residents observed during the initial tour conducted during the facility's annual Medicare/Medicaid survey.

Inspectors wroteBased on observation and interview, the facility failed to ensure residents were permitted to receive visitors at any time in accordance with resident rights, by imposing facility-wide visiting hours. This deficient practice had the potential to affect all residents residing in the facility.

Inspectors wroteBased on observation, interview and record reviews, it was determined that facility staff failed to:1. Honor residents' rights to file grievances anonymously, and failed to provide blank Grievance forms in prominent locations throughout the facility. This was evident for 4 (#4, #25, #74, #83) out of 6 residents from 3/23/26 Resident Counsel meeting.2. Ensure that residents were provided with prompt follow-up responses to their grievances. This was found to be evident for 1 (Resident # 55) of 2 residents reviewed for care concerns during the facility's annual Medicare/Medicaid survey.

Inspectors wroteBased on record review and interview, the facility failed to ensure psychotropic medication use was supported by a clear, appropriate, and documented clinical indication in accordance with professional standards of practice. This deficient practice was identified for 1 (#21) of 5 residents reviewed for unnecessary medications.

Inspectors wroteBased on interviews and record review, it was determined the facility staff failed to ensure alleged abuse/neglect is reported initially no later than 2 hours to the regulator agency Office of Health Care Quality (OHCQ) after the facility's staff was made aware. This was found evident in 1 (Resident #117) out of 16 residents reviewed for abuse/neglect during an annual survey.

Inspectors wroteBased on observation, medical record review, and staff interview, the facility failed to ensure that a resident received the planned breakfast meal and/or was provided an alternative meal or nutritional supplement after the original meal was not consumed. This deficient practice had the potential to result in inadequate nutritional intake for 1 (Resident #21) of 1 residents reviewed for nutritional status.

Inspectors wroteBased on medical record review and interview, the facility and facility pharmacy services failed to identify incorrect indications/reasons for medications being administered. This was evident for 1 (#50) of 8 residents reviewed for medications during the annual survey.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure the consultant pharmacist identified and reported an irregularity related to an inaccurate and incomplete medication order. This deficient practice was identified for 1 (#21) of 5 residents reviewed for pharmacy services.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to ensure a resident was free from unnecessary medication. This was evident for 1 (#132) of 5 residents reviewed for unnecessary medications during the annual survey.

Inspectors wroteBased on resident medical record review and interview, it was determined that the facility failed to ensure that medications were administered as ordered. This was evident for 1 (#50) of 1 resident reviewed for significant medication errors during the annual survey.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to procure, store, prepare, distribute, and serve food under sanitary conditions and in accordance with professional standards for food safety, thereby placing residents at risk for foodborne illness and contamination. This deficient practice was identified during the annual survey and had the potential to affect all residents receiving meals prepared by the dietary department.

Inspectors wroteBased on observation and staff interview, the facility failed to: 1. Maintain proper infection control practices to prevent the potential for cross-contamination by storing soiled linen in the same room as clean linen. This was evident in 1 (first floor) of 1 linen storage areas observed during environmental rounds and has the potential to affect all residents who rely on clean linen for care and services on the first floor.2. Maintain an infection prevention and control practice to provide a safe and sanitary environment in laundry service area. This was evident by 2 of 4 laundry service areas observed during the annual survey.

Inspectors wroteBased on observations and interviews with facility staff it was determined the facility failed to ensure that a resident has access to a phone and a working television (TV) remote control in their room. This was found to be evident for 1 (#109) of 62 residents reviewed during the facility's annual Medicare/Medicaid survey.

Inspectors wroteBased on observation, resident interviews, and staff interviews, it was determined that the facility failed to maintain a sanitary, pest-free environment to ensure residents reside in a safe and comfortable setting. This deficient practice affected 1 out 2 floors reviewed during the annual survey.

Inspectors wroteBased on administrative record reviews and staff interviews it was determined that the facility failed to provide evidence that part-time and PRN geriatric nursing assistants (GNA) received education on abuse prevention, neglect, and exploitation training annually. This was evident for 7 (#17, # 21, #22, #24, #30, #39, #40) of 8 GNA employee and education files reviewed during the annual survey.

Inspectors wroteBased on review of employee human resource records, education training records, spreadsheets, and interviews it was determined that the facility failed to have a system in place to ensure that PRN and part-time geriatric nursing assistants (GNAs) received at least 12 hours of clinical in-service training annually. This was found to be evident for 7 (#17, # 21, #22, #24, #30, #39, #40) of 8 part time or PRN GNAs employee files and educational files reviewed during the annual survey.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to complete and transmit the Minimum Data Set (MDS) assessments. This was evident for 27 (Residents #4, #6, #9, #11, #22, #23, #30, #32 #46, #62, #64, #65, #71, #72, #76, #78, #81, #87, #91, #93, #94, #95, #96, #99, #101, #102 and #109) of 33 residents reviewed for resident assessments during the annual survey.

Inspectors wroteBased on observations and interviews it was determined that the facility failed to ensure a safe environment. This was found to be evident during random observations conducted of the facility's environment during the recertification survey. This deficient practice has the potential to affect all Residents.

Inspectors wroteBased on observations, staff interview and record review, it was determined that the facility failed to ensure a homelike environment for residents and accommodate the needs of residents. This was found to be evident for 8 (Resident #209, #210, #212, #213, #215, #216, #217, and #357) out of 15 Residents reviewed for homelike environment and accommodation of needs.

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to complete comprehensive MDS (Minimum Data Set) assessments within the required timeframe. This was evident for 6 (Resident #4, #6, #11, #71, #94, and #405) out of 34 Residents reviewed for resident assessments during the annual survey.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to complete the Quarterly MDS (Minimum Data Set) assessments within the required timeframe. This was evident for 18 (Residents #9, #11, #22, #30, #32, #46, #62, #64, #65, #76, #78, #81, #87, #96, #99, #101, #102 and #109) of 33 residents reviewed for resident assessments during the annual survey.

Inspectors wroteBased on observation, interview and medical record review it was determined that the facility failed to provide an invitation to residents for care plan meetings, failed to provide residents with care plan meetings and failed to revise resident care plans. This was found to be evident in 5 (Resident #1, #58, #62, #158 and #164) out of 10 Residents reviewed for care plan timing and revision.

Inspectors wroteBased on observations, clinical record reviews and interviews, it was determined that the facility failed to ensure that medical records maintained for residents reflect an accurate representation of the care and services provided across all disciplines and failed to ensure the accuracy of the Medical Orders for Life-Sustaining Treatment (MOLST) order form. This was evident for 8 (Resident #94, #158, #166, #255, #256, #455, #1 and #10) out of 74 residents sampled during the annual survey.

Inspectors wroteBased on observations and interviews it was determined that the facility failed to ensure the dignity of the residents as evidenced by the nursing staff not knocking on resident room door before entering resident room, and nursing staff not wearing a name tag. This was found to be evident for 2 (Resident #35 and #58) out of 3 residents reviewed for dignity and resident rights.

Inspectors wroteBased on record review and interview, it was determined the facility failed to ensure a resident was free of neglect. This was found to be evident for 1 (Resident #165) out of 1 Resident reviewed for neglect during the recertification survey.

Inspectors wroteBased on a review of facility-reported incident investigation, record review and interview, it was determined that the facility failed to thoroughly investigate an allegation of abuse. This was evident for 1 (Resident #358) of 11 residents reviewed for abuse during the recertification survey.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to accurately code the resident's discharge status on the Minimum Data Set (MDS) assessment. This was evident for 1 (Resident #152) of 4 residents reviewed for hospitalizations during the survey.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to develop and implement a comprehensive care plan for constipation, the use of intravenous (IV) fluids for hydration and Activities of Daily Living (ADLs) for dependent resident. This was evident for 3 (Resident #12, #355 and #356) out of 13 residents reviewed for care planning during the recertification survey.

Inspectors wroteBased on observation, clinical record review and staff interviews, it was determined that the facility staff failed to provide an ongoing activities program to meet the needs and preferences of residents. This was evident for 1 (#94) of 4 residents reviewed for activities during the survey.

Inspectors wroteBased on record reviews and interviews, it was determined that the facility failed to follow up on recommendations for specialty consultations for residents. This was evident for 1 (Resident #12) of 1 resident reviewed for consultations.

Inspectors wroteBased on observation, medical record review and interviews it was determined that the facility failed to follow appropriate respiratory care and services. This was found to be evident in 1 (Resident #145) out of 1 Resident reviewed for respiratory care and services.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to discontinue a medication in a timely manner as ordered by the attending physician. This was evident for 1 (Resident #73) of 2 residents reviewed for unnecessary medications.

Inspectors wroteBased on interview, observation and record review it, was determined that the facility staff failed to promptly provide or obtain/schedule for dental services. This was found to be evident for 1 (Resident #1) out of 3 residents reviewed for dental services during an annual survey.

Inspectors wroteBased on observation, interview and record review the facility failed to 1) ensure a diet met the need of the resident and 2) provide a resident with a lunch meal to accompany resident on scheduled days of dialysis to an outpatient dialysis center. This was found to be evident in 2 (Resident #58 and #169) out of 5 residents reviewed for food and nutrition services.

Inspectors wroteBased on observations, interviews and record review it was determined that the facility failed to adhere to menus and food provided to residents in accordance with resident preferences. This was found to be evident for 3 (Resident #255, #357, and #455) out 21 Resident's reviewed for food and dining during the survey.

Inspectors wroteBased on surveyor observation during the initial kitchen tour it was determined that the facility staff failed to properly store items in a manner consistent with regulatory requirements. The facility prepares all meals in one centralized kitchen.

Inspectors wroteBased on surveyor review of the clinical record and staff interview, it was determined that the facility staff failed to develop a baseline care plan pertinent to the needs of the resident within 48 hours of admission. This finding was evident for 1 of 3 residents reviewed for the pain management care area (Resident #08).

Inspectors wroteBased on surveyor review of the clinical records and facility staff interviews it was determined that the facility staff failed to develop a comprehensive resident centered care plan. This finding was evident for 1 of 22 residents (#26) selected for review during the survey.

Inspectors wroteBased on surveyor observation, the review of the clinical record and staff interviews, it was determined that the facility staff failed to provide appropriate equipment or services to prevent further decrease in range of motion. This finding was evident in 1 of 3 residents selected for review for the limited range of motion care area (Resident #14).

Inspectors wroteBased on surveyor observation and review of the clinical record, it was determined that the facility staff failed to properly secure an indwelling catheter to prevent urinary catheter associated complications. This finding was evident in 1 of 3 residents reviewed for the indwelling catheter care area (Resident #157).

Inspectors wroteBased on surveyor observation, review of the clinical records, staff interview, it was determined that the facility staff failed to administer drugs that are labeled in accordance with acceptable standards of practice, and with Federal laws. This finding was evident for 1 of 22 residents selected for investigation during the survey (Resident #08).

Inspectors wroteBased on facility staff interview and administrative record review, it was determined that the facility staff failed to complete performance review of nurse aides at least once every 12 months. This finding was evident for 3 of 3 GNAs (Geriatric Nursing Assistants) reviewed for annual performance review of nurse aides.