Cascade Senior Care Center

Inspectors wroteThis citation pertains to intake numbers 3052863 and 3069687. Based on observation, interview and record review, the facility failed to ensure timely revision of the Care Plan for two (R2 and R4) of three reviewed.

Inspectors wroteThis citation pertains to intake 3055356. Based on observation, interview and record review, the facility failed to ensure staff who identified themselves as a Social Worker had the required credentials, according to State Law, for two (R2 and R5) of two reviewed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure tow out of two emergency (ER) crash carts (used to house CPR -Cardiopulmonary Resuscitation equipment) were checked daily and stocked with life sustaining items. Record review of an ER CART AUDIT FORM/CHECK LIST, placed on a crash cart on the Meadows Unit, and another on the Rehab/Nursing Unit, documented all the items required to be on each of the crash carts upon nursing performing a nightly check of the crash carts. The form revealed, Initial when checked at the top of the form. Observation of the Meadows Unit crash cart revealed a one-liter bag of normal saline (NS) that did not have a sticker on it, nor did it have an expiration date. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide assistance with Activities of Daily Living for one resident (R200) of three dependent residents reviewed.

Inspectors wroteBased on interview and record review, the facility failed to safely transfer one (R200) of three residents reviewed, resulting in an injury.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently use required Personal Protective Equipment (PPE).

Inspectors wroteThis citation pertains to intake #2698300 Based on observation, interview, and record review, the facility failed to implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act. Findings Include: Review of the medical record reflected R10 was admitted to the facility on [DATE], with diagnoses that included Alzheimer's disease. The Minimum Data Set (MDS) reflected R10 scored 5 out of 15 (severe impairment) on the Brief Interview for Mental Status (BIMS-a cognitive screening tool). Review of the medical record reflected R30 was admitted to the facility on [DATE], with diagnoses that included Unspecified dementia. The Minimum Data Set (MDS) reflected R30 scored 9 out of 15 (moderately impaired) on the Brief Interview for Mental Status (BIMS-a cognitive screening tool). [...]

Inspectors wroteThis citation pertains to intake #2682852Based on observation, interview, and record review the facility failed to 1) ensure proper medication management, 2) accurate documentation, 3) recognize a change in condition and 4) adherence to physician orders for two (Resident #20, Resident #40) in three reviewed for quality of care.

Inspectors wroteThis citation pertains to intake #2682852Based on observation, interview, and record review the facility failed to maintain required dialysis coordination and communication documentation for two (Resident #20 and Resident #40) out of three reviewed for dialysis.

Inspectors wroteThis citation pertains to intake #2682852 Based on interview and record review, the facility failed to ensure accurate documentation for one (Resident #20) of three reviewed for accurate medical records.

Inspectors wroteBased on interview and record review, the facility failed to assess and monitor respiratory status for one (R51) of one reviewed, resulting in R51 being discovered unresponsive and pronounced deceased .

Inspectors wroteThis citation pertains to intake MI00150737. Based on observation, interview and record review, the facility failed to ensure call lights were responded to in a timely manner for five (R24, R26, R37, R42 and R43), from a census of 54 residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure that the Notice of Medicare Non-Coverage (NOMNC) and Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) were provided accurately and timely to two Residents (R#25 and R#107) of three reviewed.

Inspectors wroteBased on observation, interview, and record review the facility failed to develop and implement comprehensive care plans for one resident (#49) of 14 resident reviewed.

Inspectors wroteDuring observation, interview, and record review the facility failed to provide failed to provide meaningful, individualized activities for one resident (#49) of one resident reviewed for activities.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure proper medication storage of medications for two residents (#2, #3) out of 54 current residents residing at the facility and failed to label mediation in accordance with accepted professional standards, dating of open multi-dose medication, observed in one medication room out of three medication rooms reviewed.

Inspectors wroteThis citation pertains to Intake MI00150266. Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for one (R1) of three reviewed.

Inspectors wroteThis citation pertains to Intake MI00150266. Based on interview and record review, the facility failed to ensure coordination of care and monitoring of a baclofen pump (implanted device that delivers the baclofen, a muscle relaxant medication, directly into the spinal fluid) for one (R1) of three reviewed.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to: (1) effectively clean and maintain food service equipment, (2) date mark all potentially hazardous ready-to-eat food products, and (3) effectively date, label, and store food products effecting 55 residents, resulting in the increased potential for cross-contamination, bacterial harborage, resident foodborne illness, and inadequate mechanical dish machine sanitization final rinse dispersion.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to effectively clean and maintain the physical plant effecting 55 residents, resulting in the increased likelihood for cross-contamination, bacterial harborage, and decreased air quality.

Inspectors wroteBased on interview and record review, the facility failed to 1) ensure two residents (#3 and #37) who had not been deemed incapacitated were acting as their own responsible party; and 2) ensure code status wishes were being honored for one (Resident #37) of two reviewed.

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate coding of Minimum Data Set (MDS) Assessments for two (Resident #37 and Resident #54) of 13 reviewed.

Inspectors wroteThis citation pertains to intake MI00140368. Based on interview and record review, the facility failed to monitor weights according to Physician Orders and prevent significant weight loss for one (Resident #4) of three reviewed for weight loss.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure eight residents (Resident #14, #15, #23, #27, #31, #36, #39, and #47) received skilled nursing services including medication administration and assessments by a licensed nurse, resulting in Immediate Jeopardy when an unlicensed staff member administered medications, performed assessments, and falsified medical records to reflect the skilled nursing services were performed by a Registered Nurse (RN).

Inspectors wroteBreakfast was observed on the Meadow's unit, a dementia care unit, on 3/13/23; the breakfast meal cart was delivered to the unit at 7:43 AM. Seven rooms had droplet precaution signs and isolation kits with personal protective equipment (PPE), including gowns and gloves, on the front of the resident room doors. There were no goggles/face shields or N95 respirator masks noted in any of the 7 isolation kits hung resident doors on the unit. A cart for soiled linen and another cart for trash were noted in the center of hallway, placed next to each other, in front of room [ROOM NUMBER], both carts had lids that were attached. Resident #26 (R26) On 3/13/23 at 7:28 AM, R26's door to his room was open, a Droplet precautions sign was posted on the door, and personal protection equipment kit was hanging on the door that included gloves and gowns. R26 was observed lying in bed on left side. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a Registered Nurse (RN) provided services for at least eight consecutive hours per day, seven days per week resulting in the potential for inadequate coordination of emergent or routine care with negative clinical outcomes affecting all 50 residents in the facility.

Inspectors wroteBased on interview and record review the facility failed to conduct routine Covid-19 testing on all facility employees in accordance with the Center for Disease Control (CDC) and local Public Health Department guidelines during the facilities current Covid-19 outbreak resulting in the potential and likely hood for Covid-19 to spread in the facility and placing the residents at risk for acquiring Covid-19 in a current facility census of 50 residents. Findings Included: In an interview on 03/16/2023 at 09:11 a.m. Director of Nursing (DON) B explained that the facilities most recent outbreak of Covid-19 occurred on February 27, 2023. She explained that on that date four residents and two employees were positive for Covid-19. She further explained that after reviewing the correlating data regarding the outbreak they had made the determination that the outbreak originated with the staff. [...]

Inspectors wroteBased on interview and record review, the facility failed to implement a compliance and ethics program resulting in the potential for criminal, civil, and administrative violations with the potential to affect all 50 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a call light was in place for one (Resident #153) of 13 reviewed, resulting in a missed meal when Resident #153 was not able to call and notify staff that she had not been served breakfast.

Inspectors wroteBased on interview and record review, the facility failed to accurately complete at Minimum Data Set (MDS) assessment for one (Resident #31) of 13 reviewed, resulting in an inaccurate MDS assessment and the potential for unmet care needs.

Inspectors wroteDuring observation, interview, and record review the facility failed to assess pressure ulcers on admission and regularly for one resident (#23) of one resident's reviewed for the assessment and monitoring of pressure ulcers resulting in the potential for resident's pressure ulcers to worsen or be provided proper treatments to promote healing. Finding Included: [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure pain medications were given as ordered for one (resident #157) of one reviewed, resulting in increased pain and the potential for unmanaged pain.

Inspectors wroteBased on observation and interview, the facility failed to ensure that the sole facility medication room and that one facility supply room were free of expired medications resulting in the potential for decreased medication efficacy and adverse side effects in a current facility census of 50 residents.

Inspectors wroteBased on interview and record review, the facility failed initiate antibiotic use protocols and monitor antibiotic use, in one of one reviewed for antibiotic use (Resident #6), resulting in the increased risk for adverse events associated with antibiotic use, including the development of antibiotic-resistant organisms, from unnecessary or inappropriate antibiotic use.

Inspectors wroteBased on interview and record review, the facility failed to notify resident families and representatives of COVID-19 infections in the facility in one of one reviewed for notification (Resident #6), resulting in not fully prepared for status prior to visit and lack of involvement in the resident care plan.

Inspectors wroteBased on interview, and record review, the facility failed to accurately report staffing information, resulting in inaccurate data and the potential for unidentified staffing concerns.