Childrens Hc Org No Ca -Pediatric Hospital D/P SNF

Inspectors wroteBased on interview and record review, the facility failed to provide services in accordance with professional standards of practice for one of three sampled residents (Resident 1) when license nurses did not accurately complete Resident 1's Skin Assessments. This failure had the potential to compromise the facility's ability to provide resident-centered interventions based on assessment data.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services in accordance with professional standards of practice for four of 12 sampled residents (Resident 125, 9, 16, and 19) when: 1. There were no Identification (ID) bracelets for Resident 125 and 9, 2. Licensed nurses documented medication administration completed before administering the medication for Residents 16 and 19. The failures had the potential to compromise residents' health and well-being.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain sanitary conditions in the kitchen when: 1. Two dietary aides (DA) did not cover their hair completely with hairnets; 2. Temperature logs of a free-standing side-counter refrigerator and freezer had missing temperatures entries; 3. An undercounter refrigerator temperature log for clients' use had missing temperatures entries; 4. A daily dishwasher temperature log had missing temperatures entries, and a chlorine water strip check log had missing results, and 5. One opened bottle of ranch dressing inside the undercounter refrigerator lacked an open date. These failures had the potential to cause food-borne illness for the residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure infection control practices were implemented for three of 12 sampled residents (Residents 14, 19 and 1) when: 1. A white plastic garbage can by the bathroom inside Resident #14's room was overflowing with used yellow disposable gowns and gloves, 2. Licensed Nurses did not change gloves bewtween tasks, nor did they perform hand hygiene during glove changes, 3. Three medications were not kept clean in two medication carts. These failures could result in the spread of infection and cross-contamination for residents in the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of 12 sampled residents (Residents 16) was free from unnecessary psychotropic (drug that affects brain activities associated with mental processes and behavior) medications when there was no documentation indicating the facility obtained informed consent before the medication start date. This failure had the potential to result in unnecessary use of medications.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain a safe environment for one resident (Residents 9) out of 12 sampled residents, when the front vent cover of an air-conditioning unit was loosely ajar. This failure had the potential to cause injury to staff and residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was stored and prepared in accordance with professional standards for food safety when expired foods and unlabeled food items were found in the refrigerator, freezer, dry storage area and the storage cabinets for plastic containers were unsafe. These failures had the potential to cause the growth of microorganisms which could cause foodborne illness (illness caused by food or water contaminated with bacteria, viruses, parasites or toxins) and cross-contaminated food for the 25 residents residing at the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement their infection control practices and precautions when: 1. Staff did not wear N95 (a type of respirator mask) while caring for Coronavirus 2019 (COVID-19, an infectious disease caused by the SARS-CoV-2 virus) exposed residents; 2. A nurse did not change gloves after touching a contaminated object; 3. A nurse did not perform hand hygiene after removing gloves and before donning new gloves. These failures have the potential to spread infection in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide care and services in accordance with professional standards or practice for one of six residents observed for medication administration (Resident 1) when Resident 1 did not have Systane (lubricant eye gel) overnight therapy. This failure had the potential to compromise the resident's health and well-being to meet the therapeutic needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain one of one dishwasher when the dishwasher temperature was below the manufacturer's water requirements of 120 to 140 degrees Fahrenheit (F, temperature scale that bases the boiling point of water at 212 and the freezing point at 32). This failure could cause improper sanitation of the feeding bottles and potentially cause illness in the residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure: 1. two residents (Residents 8 and 9) care plan was implemented related to elevation of the head of bed during tube feedings, and 2. the care plan was developed for a bruise for one resident (Resident 10). These failures resulted in less then optimal care for three out of 12 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to review and revise the care plan (provides direction on the type of nursing care the individual, family may need) for one of 24 residents (Resident 23), when the interventions did not reflect the current tube feeding order, and the positioning of the head of the bed (HOB) did not reflect the current information in the [NAME] (a medical information system used by nursing staff to communicate important information on their patients). This failure could affect outcomes in the residents' care.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure enteral (delivers liquid nutrition through a catheter inserted directly into the gastrointestinal tract) tube feedings were labeled with the recipe of the contents of the formula for six residents (Residents 6, 8, 9, 15, 22, and 25) out of 12 sampled residents. This failure had the potential for all the residents to receive an inaccurate formula as ordered by the physician.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure psychotropic medications (medications that are capable of affecting the mind, emotions, and behavior) ordered as PRN (as needed) for one of six residents (Resident 18), was limited to 14 days and if extended would indicate the duration for the PRN order. This failure could potentially create an unnecessary medication for the resident.

Inspectors wroteBased on observation, interview, and record review, the facility had a medication error rate of 11.54% when the facility failed to ensure the enteral feeding tube was flushed as ordered by the physician prior to administration of medications for three out of nine residents (Residents 3, 14, and 21) observed during a medication pass. This failure had the potential to compromise the residents' medical health.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the kitchen staff were safely performing their functions when the dishwasher's temperature was below the manufacturer's specifications for the water temperature. This failure could cause unsanitary cleaning of the feeding bottles and could cause illnesses in the residents.