Complete Care at Multi Medical Center LLC

Inspectors wroteBased on medication administration observation, medical record review and staff interview, it was determined that the facility staff failed to ensure a medication error rate of less than 5%. This was evident for 11 out of 41 medications administered during the medication administration facility task which resulted in an error rate of 26.83%.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to ensure that the Ombudsman was notified of resident transfers to the hospital. This deficient practice was evident for 1 (Resident #104) of 1 resident reviewed for hospitalization notification during the recertification survey.

Inspectors wroteBased on review of complaints and residents' medical records, as well as resident, family, and staff interviews, it was determined that the facility failed to ensure dependent residents received necessary activities of daily living (ADL) care, including timely incontinence care, provision of scheduled showers, documentation of care, and provision of oral care as ordered. This was evident for 3 (Residents #17, #116, and #119) of 5 residents reviewed for ADL care during the complaint and annual survey.

Inspectors wroteBased on surveyor observations, medical record review and staff interviews, it was determined that the facility failed to provide adequate care to prevent complications from hand contractures. This was evident for 1 resident (Resident #17) reviewed for mobility.

Inspectors wroteBased on medical record review, staff interviews, and review of facility investigation documents, it was determined that the facility failed to provide adequate supervision to a resident as evidenced by Resident #27 eloping from the facility through the front door. This was evident in one of one resident reviewed during this survey.

Inspectors wroteBased on interview with facility staff and observations, it was determined that the facility failed to store all drugs and biologicals in locked compartments. This was evident for 1 (Resident #57) out of 4 residents observed during the medication administration facility task for the recertification survey.

Inspectors wroteBased on interviews with residents, observations, review of pertinent documentation, and interview with facility staff, it was determined that the facility failed to serve meals according to the predetermined menu and have a system in place to ensure alternative foods and beverages were provided for residents with allergies. This was evident for 1 (Resident #6) out of 3 residents reviewed for food during the facility's recertification survey.

Inspectors wroteBased on observations, facility protocol, and staff interviews, it was determined that the kitchen failed to store food items so as to maintain the integrity of the specific item and failed to ensure that the nourishment refrigerators were maintained at the appropriate temperature. This was evident by the initial tour of the kitchen and the nourishment refrigerators.

Inspectors wroteBased on interviews and record review, it was determined that the facility failed to keep complete and up to date medical records. This was found to be evident in 1 (Resident #80) of 41 residents reviewed during the annual survey.

Inspectors wroteBased on observations and interviews, it was determined that the facility failed to ensure oxygen tubing and humidifier bottles were dated to reflect appropriate change and monitoring in accordance with infection control practices. This deficient practice was evident for 2 (Residents #43 and #60) of 3 residents reviewed for oxygen use.

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on surveyor observations, medical record review and facility staff interviews, it was determined that the facility failed to ensure residents had access to a call device system. This was evident for 2 of 2 resident room observations and 1 of 1 shower room observations.

Inspectors wroteBased on observation and interview, it was determined that the facility failed to post complete and accurate daily nurse staffing information on each resident care unit, including the required staffing ratios for licensed nurses and nurse aides. This deficient practice was evident for 4 of 4 units reviewed (Chesapeake, Evergreen, [NAME], and [NAME]) during the recertification survey.

Inspectors wroteBased on interviews, observations, food temperature testing it was determined that the facility staff failed to ensure meals were palatable and that cold liquids were served at the correct temperatures. This failure had the potential to affect all residents receiving meals from the facility's kitchen.

Inspectors wroteBased on observations and interviews it was determined that the facility staff failed to provide a dignified existence to a resident dependent on ADL care. The deficient practice was evidenced in 1 (#202) of 3 dependent residents assessed for ADL care during the survey.

Inspectors wroteBased on observation and interviews it was determined that the residents who participated in the resident council meeting were unaware meetings could be held without the facility staff being present. This deficient practice was discovered during the survey and impacts residents attending resident council meetings.

Inspectors wroteBased on record review and interviews it was determined that the residents were not notified who the facility Ombudsman was or how to contact them. This deficient practice was discovered during the survey.

Inspectors wroteBased on medical record review and staff interview, it was determined the facility staff failed to ensure that a Minimum Data Set (MDS) assessment was accurately coded. This was evident for 1 (Resident #58) of 6 residents reviewed during the survey.

Inspectors wroteBased on observation, medical record review, and interviews it was determined that the facility staff failed to meet professional standards by documenting that a medication was administered when it was not observed as administered. This was found to be evident for 1 (#106) out of 7 residents reviewed during the survey.

Inspectors wroteBased on record review and interviews it was determined that the facility staff failed to provide showers to a resident who was dependent for ADL care. This deficient practice was evident in 1 (#98) of 1 resident who verbalized not receiving a shower.

Inspectors wroteBased on record reviews and interviews, it was determined that facility staff failed to administer blood pressure medication as ordered by the physician. This deficient practice was evident for 1 of 27 (#18) residents reviewed during the survey.

Inspectors wroteBased on observations and record review it was determined that the facility had a medication error rate greater than 5%. This deficient practice was evidenced in 1 (#204) of 5 residents observed during the medication pass during the survey.

Inspectors wroteBased on observations and interviews, it was determined that facility staff failed to discard expired medications. This deficient practice was evident in 1 out of 4 medication storage rooms assessed during the survey.

Inspectors wroteBased on record reviews and interviews, it was determined that facility staff failed to have a system in place to ensure geriatric nursing assistant (GNA) received dementia training annually. This deficient practice was evident for 4 out of 5 (GNA #18, GNA #41, GNA #42, and GNA #43) GNA files reviewed for training.

Inspectors wroteBased on surveyor observation and resident interview it was determined that the facility failed to provide a safe, clean, comfortable and homelike environment. This deficient practice has the potential to affect all residents.

Inspectors wroteBased on review of employee health records and staff interview the facility staff failed to thoroughly screen for immunity to common childhood diseases, failed to have 2nd step Tuberculosis (PPD) or offer the seasonal vaccination for protection against Influenza completed to those newly hired employees (Employee #10, #11, #12, #13, and #14,). This is evident for 5 of 6 newly hired employees. It was also determined the facility failed to maintain resident care equipment in a manner to prevent the spread of infection and cross contamination (Resident #14). This was evident for 1 of 2 residents reviewed for hydration

Inspectors wroteBased on surveyor observation it was determined that the facility failed to maintain an effective pest control program as evidenced by the presence of flies. This deficient practice has the potential to impact all residents.

Inspectors wroteBased on observation, resident and staff interviews it was determined that the facility staff failed to provide a private space to support residents right to privacy while conducting their monthly resident council meeting.

Inspectors wroteBased on record review, observation and interview, it was determined the facility staff failed to assess the need for 2 full side rails on the bed for Resident (#69) and failed to thoroughly assess and determine if an alarming Self-Release belt was a restraint for Resident (#87). This was evident for 2 of 33 residents selected for review during the survey process.

Inspectors wroteBased on medical record review and interview, it was determined that the facility failed to notify the responsible party in writing of a Resident's (#34) transfer to the hospital. This was evident for 1 of 3 residents sampled for hospitalizations.

Inspectors wroteBased on medical record review, observation and interview it was determined the facility staff failed to review and revise the care plan for Resident (#69) to reflect accurate and current interventions. This was evident for 1 of 33 residents reviewed for care plans during the survey process.

Inspectors wroteBased on a review of nursing staff competencies and staff interview it was determined that facility staff failed to ensure nursing staff received all necessary training's and competency reviews. This was true for 1 out of the 6 nursing staff reviewed.

Inspectors wrote2. The facility staff failed to obtain/document the blood pressure for Resident #69 when parameters were ordered. Medical record review for Resident #69 revealed on 8/30/18 the physician ordered: Metoprolol 12.5 milligrams 2 times a day for high blood pressure/A fib, hold for systolic blood pressure (top number) less than 110 or heart rate less than 60. Atrial fibrillation (AFib) is a quivering or irregular heartbeat (arrhythmia) that can lead to a very fast heart rate and other heart-related complications. Metoprolol belongs to a class of drugs known as beta blockers. These drugs work by slowing down a resident's heart rate and lowering their blood pressure. Review of the Medication Administration Record revealed the facility staff failed to obtain/document the resident's blood pressure or heart rate as ordered; however, documented the administration of the medication from: [...]

Inspectors wroteBased on observation and staff interview it was determined that the facility failed to store and prepare food in accordance with professional standards for food service safety. This deficient practice has the potential to affect all residents.

Inspectors wroteBased on observation and staff interview it was determined that the facility failed to maintain kitchen equipment in safe operating condition. This was evident for 2 pieces of equipment in the main kitchen.