Craneville Rehabilitation and Skilled Care Center

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), whose physician's orders included the need to notify family member of changes, the facility failed to ensure nursing notified the family/resident representative when he/she developed an injury to his/her foot and when he/she was referred to Hospice.

Inspectors wroteBased on observations, and interviews, the facility failed to provide a safe, clean, comfortable and homelike environment for one Resident (#10), out of a total sample of 16 residents. Specifically, the facility failed to provide housekeeping and maintenance services related to: -a rubber baseboard that was pulled away from the wall exposing glue, and debris build-up in the Resident's room. -peeling paint behind the toilet in the Resident's bathroom. -gouges on the Resident's bathroom door and the other shared resident's door.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide assistance with personal hygiene care and services for one Resident (#9), out of a total sample of 16 residents. Specifically, for Resident #9, the facility failed to ensure grooming assistance was offered and/or provided relative to nail care when the Resident was dependent on staff for grooming tasks.

Inspectors wroteBased on interview and record review, the facility failed to ensure that nursing staff possessed the competencies and skill sets necessary to provide nursing and related services to meet the residents' needs safely. Specifically, the facility failed to provide documentation and could not verify that three Licensed Nurses (#3, #4, and #5) out of a sample of three Licensed Nurses, had completed orientation training/competencies (Nurse #3), or annual competencies (Nurse #4, Nurse #5) as outlined in the Facility Assessment Tool

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure that food in three unit kitchenettes (Unit 1, Unit 2, and Unit 3) out of three units observed, were labeled and dated as required, and the cleanliness of the refrigerators and freezers were maintained to prevent contamination and the spread of food borne diseases.

Inspectors wroteBased on record review and interview, the facility failed to provide timely Physician and/or Nurse Practitioner (NP) notification of a significant change in condition for one Resident (#61) out of three sampled residents. Specifically, the facility staff failed to notify the Physician and/or NP when the Resident was assessed to have low blood pressure readings, resulting in delayed interventions and transfer to the hospital.

Inspectors wroteBased on interviews and record review, the facility failed to provide the required Discharge/Transfer notices to the Resident and/or his/her Representative and the Office of the Long-Term Care Ombudsman for one Resident (#10) out of a total sample of 15 residents.

Inspectors wroteBased on interviews and record review, the facility failed to provide the required Notice of Bed-Hold Policy to the Resident and/or Resident Representative for one Resident (#10) out of a total sample of 15 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that oxygen care and services were provided per the Physician's prescribing orders for one Resident (#20) out of a total sample of 15 residents. Specifically, for Resident #20, the facility failed to ensure the Resident's Oxygen flow rate was set at the ordered three (3) liters per minute (LPM - the rate at which Oxygen flows over a period of one minute) prescribed by the Physician.

Inspectors wroteBased on interview and record review, the facility failed to ensure that one Resident (#40) out of a total sample of 15 residents, received dialysis care consistent with professional standards of practice. Specifically, the facility staff failed to monitor and track the Resident's fluid intake as ordered.

Inspectors wroteBased on interviews and record review, the facility failed to ensure that Pharmacy Recommendations were reviewed and implemented as agreed to by the attending Physician for one Resident (#20) out of a total sample of five residents. Specifically, the facility failed to ensure that a Pharmacy recommendation was reviewed by the attending Physician within 30 days, and that Pharmacist recommendations agreed to by the attending Physician were implemented.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to adhere to infection control guidelines to prevent contamination and the spread of infection for two Residents (#40 and #47) out of three sampled residents. Specifically, the facility staff failed to: 1) implement the facility infection surveillance program and conduct Covid-19 outbreak testing for Resident's #40 and #47.

Inspectors wroteBased on observation, interview and policy review, the facility failed to maintain laundry equipment in a safe operating condition. Specifically, the facility staff failed to clean the lint traps of the laundry drying machines as scheduled per manufacturer's instructions and facility policy.

Inspectors wroteBased on observation and interview, the facility failed to ensure that its staff: 1) Followed the facility policy for food storage and 2) Properly stored clean steam table pans in the main kitchen. Findings Include: Review of the facility policy titled: Food Storage and Preparation, reviewed on 9/21, indicated the following: -All food items will be wrapped properly and tightly, or stored in clean, covered containers clearly marked, including the preparation date and discard date. 1. The facility failed to ensure staff properly stored a frozen bag of chicken in the walk-in freezer and failed to ensure a frozen bag of cake pieces was dated in the stand-up freezer. On 7/18/22 at 11:23 A.M., during a floow-up tour of the kitchen, the surveyor observed a bag of cake pieces in the stand-up freezer in the main kitchen area that was undated. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that its staff provided supervision, verbal cues, and assistance while eating for one Resident (#56) out of a total sample of 15 residents. Findings Include: Resident #56 was admitted to the facility May 2019 with a diagnosis of Dementia with behavioral disturbance. Review of the facility policy titled: Assisting Resident with Feeding, reviewed 9/21, indicated the following: -Arrange dishes for easy access . -Provide cueing as necessary . Review of the Resident's [NAME] Report (a brief report used by staff to know what a resident's baseline needs are), as of 7/18/22, indicated the following: Eating/Nutrition - .is continual cues and supervision in setting of 1:8 ratio and may be assist of one at times . Review of the Resident's Care Plan titled: [...]

Inspectors wroteBased on interviews and record review, the facility failed to ensure that its staff provided timely psychiatric services for one Resident (#51) out of a total of 15 sampled residents.

Inspectors wroteBased on interviews and record review, the facility failed to ensure that its staff maintained a complete and fully accessible medical record for one Resident (#51) out of a total of 15 sampled residents.

Inspectors wroteBased on interviews and record review, the facility failed to ensure that its staff completed both routine and outbreak Covid-19 surveillance for two (#12 and #17) out of three Residents sampled. Review of the facility policy, Infection Control, Section: Guidelines, dated 3/1/20, revised 6/22/22, included the following: -It is the policy of [NAME] Care facilities to take appropriate actions related to the Novel Coronavirus known as Covid-19. The Centers for Disease Control (CDC) recommended guidelines for infection control practices related to the newly identified Coronavirus 19 will be followed. - The situation regarding Covid-19 is still evolving worldwide and can change rapidly. [...]