Countryside Care & Rehabilitation

Inspectors wroteBased on observation, interview, policy review, and review of the Idaho Food Code, the facility failed to ensure staff wore beard nets in the kitchen and appropriately stored, distributed, and labeled foods. This deficient practice had the potential to affect all residents who received meals prepared in the facility's kitchen. This placed residents at risk for potential contamination and use of spoiled foods, and adverse health outcomes including food-borne illnesses.

Inspectors wroteBased on observation, interview, Department of Health and Welfare - Idaho Administrative rules, and U.S. Food and Drug Administration 2022 Food Code review, the facility failed to ensure garbage cans were properly closed with lids to minimize attracting pests and rodents into the kitchen. This deficient practice had the potential to affect all residents and staff in the facility. This placed residents and staff at risk of potential food contamination from bugs and rodents that may enter the kitchen due to the open garbage containers.

Inspectors wroteBased on record review, State Operations Manual Appendix PP-Guidance to Surveyors for Long Term Care Facilities, and staff interview, it was determined the facility failed to ensure residents and their representatives received assistance to exercise their right to formulate an Advance Directive. This was true for 1 of 12 Residents (Resident #3) whose records were reviewed for Advance Directive. This deficient practice created the potential for harm or adverse outcomes if residents' wishes were not followed or documented regarding their advance care planning.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to provide the Advance Beneficiary Notice (CMS-10055 form) for 1 of 3 residents (Resident #1) whose medical records were reviewed for beneficiary protection notification. This deficient practice had the potential to cause financial harm or distress for residents when they were not informed of their potential liability for payment when their Medicare Part A benefits ended.

Inspectors wroteBased on facility standing orders, record review and staff interview, it was determined the facility failed to follow facility bowel care standing order of delivering specific medications when residents do not have BM within 24, 48, and 72 hours for 4 of 7 Residents (#1, #18, #24, and #26) who records were reviewed for bowel and bladder care. This failed practice created the potential for residents to experience discomfort when medications were not administered according to the physician's order.

Inspectors wroteBased on observation, policy review, record review, and interviews, it was determined the facility failed to provide respiratory services as ordered by the physician. This was true for 4 of 5 residents (#4, #13, #19, and #26) whose records were reviewed for respiratory services. This failure created the potential for residents to experience respiratory related infections, increased fatigue, and low oxygen levels.

Inspectors wroteBased on policy review, record review, observation, and staff interview, it was determined the facility failed to ensure that prior to the placement of bed rails, alternatives to bed rails were attempted and how the alternatives failed to meet the resident's assessed needs. This was true for 4 of 6 residents (#6, #7, #8, and #32) reviewed for bed rails. This failure created the potential for harm due to the risk for injury, entrapment and/or death.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure controlled medications were tracked and kept secure from potential theft and/or diversion. This was true for 1 of 1 medication cart reviewed. This failure created the potential for undetected misuse and/or diversion of controlled medications and had the potential to affect all residents who received controlled medication in the facility.

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to properly sanitize the thermometer used to take temperatures of the food. These failures had the potential to increase the risk of foodborne illnesses and infection for all residents receiving food from the facility kitchen.

Inspectors wroteBased on record review, interviews, and policy review, the facility failed to thoroughly investigate an injury of unknown origin for one resident (Residents (R)20) out of two residents reviewed for abuse out of a total sample of 14 residents. This failure created the potential for residents to be, or to continue to be, abused/neglected.

Inspectors wroteBased on record review, observations, interviews, and review of the National Institute of Health (NIH) guidance, the facility failed to ensure professional standards of care were met for one resident (Residents (R)14) of one resident observed receiving medication through a gastrostomy (G) tube out of a total sample of 14 residents. This failure created the potential for R14 to have unwanted complications related to administration of her medication.

Inspectors wroteBased on record review, interviews, and review of facility policy, the facility failed to ensure one resident (Resident (R) 14) of seven residents reviewed for accidents had been assessed for the use of side rails, had risk and benefits discussed with her representative, and/or obtained informed consent for the use of side rails out of a total sample of 14 residents This failure created the potential for the resident to experience negative effects/risks associated with the use of the rails unnecessarily.

Inspectors wroteBased on policy review, observation, and staff interview, it was determined the facility failed to ensure measures were in place to prevent possible cross-contamination of dirty to clean areas in the kitchen. This had the potential to affect the 39 residents residing in the facility who consumed food prepared by the facility. This failure created the potential for contamination if residents contracted food-borne illnesses.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure resident records included an Advance Directive. This was true for 4 of 12 residents (#5, #9, #10, #25) whose records were reviewed for Advance Directives. This failed practice created the potential for harm if residents' wishes regarding end of life or emergent care were not honored if they became unable to make their wishes known.

Inspectors wroteBased on staff interview, record review, and policy review, it was determined the facility failed to ensure as needed psychotropic medications had a physician evaluation or documented rationale when the medication order extended beyond 14 days, and documentation of consent from the resident before administering the psychotropic medications. This was true for 4 of 6 residents (#3, #10, #12, and #139) who were reviewed for unnecessary medications. This deficient practice created the potential for harm if residents experienced adverse effects from unnecessary psychotropic medications.

Inspectors wroteBased on policy review, record review, and resident and staff interview, it was determined the facility failed to ensure a bed hold notice was provided to residents and their representatives upon transfer to the hospital. This was true for 1 of 1 resident (Resident #12) who was reviewed for transfer. This deficient practice created the potential for harm if residents and their representatives were not informed of the residents' rights to return to their former bed/room at the facility within a specified time.

Inspectors wroteBased on record review, policy review and staff interview, it was determined the facility failed to ensure professional standards were met for bowel care. This was true for 1 of 4 residents (Resident #8) who were reviewed for bowel and bladder incontinence. This failed practice had the potential to place residents at risk for fecal impaction when orders were not followed regarding bowel management.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to securely store controlled medications. This was true for 1 of 2 medication rooms, observed during the inspection of the medication storage areas. This failed practice created the potential for harm if the controlled medication was diverted or contaminated.

Inspectors wroteBased on observation, policy review and staff interview, it was determined the facility failed to ensure the nurse staffing information was posted daily per shift in a clear and easy to understand format. This failed practice had the potential to affect all residents in the facility and their representatives, visitors, and others who wanted to know the facility's staffing levels.