Citizens Medical Center Ltcu

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the required annual performance reviews were completed for four randomly selected nurse aides reviewed.

Inspectors wroteBased on record review and interview, the facility failed to implement a policy to screen potential employees for a history of abuse, neglect, exploitation, or misappropriation when the facility failed to obtain a criminal background check and license verification upon hire of a Licensed Nurse (LN) I.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a 14-day stop date or a specified duration with a rationale for Resident (R) 11's ongoing as-needed (PRN) antianxiety medication (a class of medications that calm and relax people).

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure Resident (R) 2 and R17 and their representatives were provided with a bed hold policy. The facility failed to ensure R2 and R17 and their representatives were provided with a written notification of transfer that included a statement of the right to appeal and the state ombudsman information, upon their transfer to the hospital as soon as practicable upon their transfer to the hospital. The facility failed to ensure the long-term care ombudsman (LTCO) was notified of R2 and R17's transfer to the hospital as soon as practicable.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one resident, Resident (R) 14, maintained skin integrity when she received numerous skin tears (traumatic wounds caused by friction, shear, or blunt force that separate the top layer of the skin from the layer beneath it) during staff-assisted care.

Inspectors wroteThe facility has a census of 43 residents. The sample included 12 residents, with three reviewed for skin conditions, not pressure-related. Based on observation, record review, and interview, the facility failed to revise the care plan for Resident (R) 3 to include the use of protective sleeves to prevent skin injury. This placed the resident at risk for further skin injury due to uncommunicated care needs.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents with one resident reviewed for discharge. Based on record review and interview the facility failed to complete a recapitulation (a concise summary of stay and course of treatment in the facility) of Resident (R) 45's stay in the facility. This placed the resident at risk of unmet care needs.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents, with three reviewed for skin conditions, not pressure-related. Based on observation, record review, and interview, the facility failed to ensure Resident (R) 3, who received anticoagulant (medication that inhibits the coagulation of blood), received the care as required to prevent skin injuries including Dermasaver sleeves (protects fragile skin prone to skin tears and bruises) and sheepskin surface padding. This placed R3 at risk for further skin injury.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents with two residents sampled for pressure ulcers (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction). Based on observation, record review, and interview, the facility staff failed to implement interventions to prevent development and promote healing of pressure ulcers for Resident (R)26, who had a Stage 4 pressure ulcer (a deep pressure wound that reaches the muscles, ligaments, or even bone) when staff did not reposition R26 per the plan of care. This placed R26 at risk for the development of new pressure injuries or delayed healing of the existing pressure ulcer.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents with five reviewed for unnecessary drugs. Based on observation, interview, and record review the facility failed to ensure the Consultant Pharmacist identified and reported to facility administration the lack of a documented physician rationale which included the multiple unsuccessful attempts for nonpharmacological symptom management and risk versus benefits for the continued use of an antipsychotic (class of medications used to treat mental disorder characterized by gross impairment in reality testing) and/or for not attempting a gradual dose reduction (GDR) for psychotropic (alters mood or thought) medications and that staff had not administered the physician ordered as needed (PRN) blood pressure medication when the blood pressure was out of parameters, placing R7 at risk for further issues related to [...]

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents with five reviewed for unnecessary drugs. Based on observation, interview, and record review the facility failed to administer two blood pressure medications based on the blood pressure monitoring per the physician's orders for Resident (R) 7. This placed the resident at risk for unnecessary medication resulting from abnormal blood pressure.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents with five reviewed for unnecessary drugs. Based on observation, interview, and record review the facility failed to obtain a written risk versus benefit rationale from the physician for the continued use of four psychotropic (alters mood or thought) drugs for Resident (R) 7. This placed R7 at risk for unnecessary psychotropic medications and related side effects.

Inspectors wroteThe facility identified a census of 44 residents with three residents reviewed for neglect. Based on record review, observation, and interview, the facility failed to ensure Resident (R) 1 who had a history of respiratory failure and chronic obstructive pulmonary disease (COPD- a progressive and irreversible condition characterized by diminished lung capacity and difficulty or discomfort in breathing) received the required respiratory services. On 05/21/24 at 09:58 AM Certified Nurse Aide (CNA) M failed to provide R1's continuous oxygen at 4 Liters (L) per minute for forty-five minutes, while staff provided R1 a bath. At 10:45 AM CNA M assisted R1 back to his wheelchair after bathing and dressing him; when R1 sat down he became unresponsive. Certified Medication Aide (CMA) R entered the bathhouse and noted R1 had no color and was struggling to breathe. [...]

Inspectors wroteThe facility had a census of 48 residents. The sample included 13 residents, with three reviewed for nutrition. Based on observation, record review, and interview, the facility failed to identify weight loss and involve the Registered Dietician (RD) for weight loss interventions to address the significant unplanned weight loss for one sampled resident, Residents (R) 20. The facility further failed to monitor nutritional supplement intake for R20 after the significant loss to evaluate the effectiveness of the intervention. R20 had a significant unplanned weight loss of 14.06 percent (%) in three months and remained at risk for further loss and impaired nutrition.

Inspectors wroteThe facility had a census of 48 residents. The sample included 13 residents, with two reviewed for urinary catheters (tube inserted into the bladder to drain urine into a collection bag). Based on observation, record review, and interview, the facility failed to cover the urinary catheter bag for one sampled resident, Resident (R) 45. This placed the resident at risk for impaired dignity and respect.

Inspectors wroteThe facility had a census of 48 residents. The sample included 13 residents. Based on observation, interview, and record review, the facility staff failed to report Resident (R) 35 and R32's allegations of abuse to facility administration as required. This deficient practice placed R35, and R32 at risk of ongoing abuse.

Inspectors wroteThe facility had a census of 48 residents. The sample included 13 residents. Based on observation, record review and interview the facility failed to provide the necessary cares and services to ensure appropriate wheelchair posture and positioning for one sampled resident, Resident (R) 34. This placed the resident at risk for pain and skin breakdown.

Inspectors wroteThe facility had a census of 48 residents. The sample included 13 residents, with two reviewed for urinary catheters (tube inserted into the bladder to drain urine into a collection bag). Based on observation, record review, and interview, the facility failed to maintain catheter tubing in a sanitary manner when the catheter tubing touched the floor for one sample resident, Resident (R) 45. This placed the resident at risk for urinary tract infections (UTIs).