Casa De Ramana Rehabilitation Center

Inspectors wroteBased on interview, and record review, the facility failed to ensure that information to file a grievance or complaint was readily available to residents during their facility stay, for seven Residents out of 13 residents. Specifically, for seven residents attending the Resident Council group meeting during the facility survey, the facility failed to ensure residents had access to grievance/concern/complaint forms so the residents could formulate grievances anonymously, should they choose not to alert a staff member of their concern(s).

Inspectors wroteBased on record review, and interview, the facility failed to accurately complete a Level I Preadmission Screening and Resident Review (PASARR- screen to determine if a resident had an intellectual or developmental disability (ID or DD) and/or serious mental illness (SMI) and needed further evaluation) for one Resident (#87), out of a total sample of 22 total residents. Specifically, for Resident #87, the facility failed to accurately complete a Level I PASRR indicating that the Resident had a diagnosis of Bipolar Disorder, and received emergency psychiatric services while hospitalized within the last two years in the community, resulting in a Level II PASRR Evaluation (an evaluation conducted to determine if an individual who screened positive for an SMI or ID/DD requires specialized services) not being completed as required.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide Activities of Daily Living (ADLs: fundamental skills required to independently care for oneself, such as eating, bathing, and mobility) care and services pertaining to mobility for one Resident (#106), out of a total sample of 22 residents. Specifically, the facility failed to provide care and services that would maintain and/or improve Resident #106's functional mobility when the Resident was discontinued from Physical Therapy (PT) services and required the assistance of one staff member with ambulation.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide assistance with activities of daily living (ADLs- fundamental skills required to independently care for oneself, such as eating, bathing, and mobility) for one Resident (#1) out of a total sample of 22 residents. Specifically, the facility failed to ensure Resident #1 was provided personal hygiene assistance for nail trimming and cleaning.

Inspectors wroteBased on record review and interview the facility failed to complete the required Minimum Data Set (MDS) tracking record for one Resident (#84) out of a total sample of 22 records. Specifically, the facility failed to complete the MDS entry tracking record for Resident #84 when the Resident was readmitted to the facility after a discharge to an acute care hospital, with return anticipated.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that Minimum Data Set (MDS) Assessments were accurately coded to reflect the Residents' status for one Residents (#87) out of a total sample of 22 residents. Specifically, for Resident #87, the facility failed to ensure that the MDS assessment was accurately coded for the use of limb restraints while in his/her wheelchair and out of bed and not while in bed.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1) who was moderately cognitively impaired, with behaviors that included unsafe rising and disrobing, the Facility failed to ensure Resident #1 was free from the use of a physical restraint imposed for the purpose of staff convenience when on 08/14/24 during the overnight shift, sometime between 5:30 A.M. and 6:00 A.M. (exact time unknown), Certified Nurse Aide (CNA) #1 and CNA #2 transferred Resident #1 into his/her a tilt back wheelchair, CNA #1 then placed a blanket across Resident #1's torso/lap area, then tied the blanket behind his/her wheelchair securing it snuggly in place, and then both CNA's left the room to care for other residents. [...]

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had moderate cognitive impairment, the Facility failed to ensure staff implemented and followed their Abuse Policy when on 08/14/24 sometime between 5:30 A.M. and 6:00 A.M. (exact time unknown), after witnessing Certified Nurse Aide (CNA) #1 put a blanket across Resident #1's lap/torso and secure it in place by tying it behind his/her wheelchair, CNA #2 did not report the incident to Nurse #1 or Administration, and Resident #1 remained in his/her room, unattended by staff, secured in his/her wheelchair for at least three hours before another staff member discovered and released it.

Inspectors wroteBased on observations, record reviews, policy review and interview the facility failed to ensure a dignified dining experience for two Residents (#61 and #103) out of a total sample of 22 residents. Specifically, the facility staff did not promote dignity for Residents #61 and #103, by standing over both residents rather than sitting at eye level, while assisting them with their meals.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide necessary activities of daily living (ADLs-bathing, dressing, grooming) for one Resident (#80), out of a total sample of 22 residents. Specifically, the facility staff failed to provide grooming pertaining to facial hair removal for Resident #80, who was unable to carry out his/her own ADLs.

Inspectors wroteBased on observation, document review and interview, the facility failed to ensure the environment remained as free of accidental hazards for one Resident (#77), out of a total sample of 22 residents. Specifically, the facility staff failed to ensure that Resident #77 did not maintain smoking materials on his/herself as agreed by his/her signing the facility smoking policy.

Inspectors wroteBased on record review and interview, the facility failed to provide Dialysis (a treatment use to clean the blood when the kidneys are not able remove waste and extra fluids in the blood) care and services for one Resident (#36), out of two applicable residents, in a total sample of 22 residents. Specifically, for Resident #36, the facility failed to ensure that post dialysis weights were documented as ordered by the Physician.