Crittenden County Health & Rehabilitation Center

Inspectors wroteBased on interview and record review, the facility failed to ensure the physician acknowledged the pharmacist's recommendation for a resident's monthly medication regime review for one of five sampled residents (Resident (R) 43) reviewed for unnecessary medications.

Inspectors wroteBased on observation, interview, record review, document review, and facility policy review, the facility failed to ensure staff wore a gown when they provided care to residents on enhanced barrier precautions (EBP) for one (Resident 42) of one sampled residents reviewed for tube feeding, one of (Resident 33) of one sampled residents reviewed for pressure ulcer/injury, and one (Resident 42) of five sampled residents reviewed for infection control.

Inspectors wroteBased on observation, interview, and review of facility policy, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Food items in the walk-in freezer were not labeled or dated. Staff failed to completely cover their hair while in the kitchen. Staff failed to cover prepared food on the warming table. A cold food was not at the proper temperature for serving. These failures had the potential to affect all 61 of the facility's residents who consumed food from the kitchen.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to implement multiple interventions on the comprehensive person-centered care plan for one (Resident (R) 37) of two sampled residents reviewed for wound care. Interventions regarding treatment orders, infection control measures, and odor control were not implemented in accordance with the resident's care plan.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide non-pressure wound care in accordance with the resident's care plan and physician orders for one (Resident (R) 37) of two sampled residents reviewed for wounds.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to maintain an infection prevention and control program designed to prevent the development and transmission of communicable diseases and infections for one (Resident (R) 37) of two residents reviewed for wound care. Facility staff failed to perform hand hygiene as indicated before, during, and after ostomy and wound care. Staff failed to use enhanced barrier precautions (EBP) designed to reduce transmission of multidrug-resistant organisms even though the resident had wounds that required EBP. Treatment supplies, including scissors and ointment, were handled in a manner that did not prevent the spread of infection. In addition, hand hygiene was not monitored by supervisory staff as planned as part of the facility's surveillance/monitoring activities.

Inspectors wroteBased on interview, record review, and review of facility policy, it was determined the facility failed to ensure the services provided or arranged by the facility met professional standards of quality for two (2) of three (3) sampled residents (Resident #40 and Resident #41). Although it was not within the Scope of Practice for a Licensed Practical Nurse to declare death or sign the Provisional Report of Death or Death Certificate, review of Resident #40's Provisional Report of Death, dated [DATE], revealed Licensed Practical Nurse (LPN) #3 completed and signed the form. Additionally, review of Resident #41's Provisional Report of Death, dated [DATE], revealed LPN #3 completed and signed the form.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure a resident who is unable to carry out Activities of Daily Living (ADL) receives the necessary services to maintain good personal hygiene related to incontinence care for one (1) of forty (40) sampled residents (Resident #17). Observation on 02/20/2024 at 1:20 PM, revealed a strong odor of urine in Resident #17's room, and the resident was noted to be lying in bed with his/her pants and bed linens soiled with a yellow/brown substance.

Inspectors wroteBased on observation, interview, and facility policy review, it was determined the facility failed to ensure the resident environment remains as free of accident hazards as is possible. Observation on 02/22/2024 at 9:00 AM, revealed lancets (a small needle used to puncture the skin of the finger in order to obtain a small drop of blood to test blood sugar) were left unattended on top of a treatment cart on the 500 hallway.

Inspectors wroteBased on observation, interview, record review and review of the facility policy, it was determined the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one (1) of three (3) sampled residents (Resident #34). Observation on 02/22/2024 at 11:05 AM, revealed Licensed Practical Nurse (LPN) #1 performed a blood glucose finger stick on Resident #34, then doffed his gloves, and failed to perform hand hygiene prior to exiting the room.

Inspectors wroteBased on observation, interview, record review, and review of the facility's Policies, it was determined the facility failed to provide means for resident(s) to directly contact caregivers through a communication system which relays the call directly to a staff member or to a centralized staff work area for three (3) of forty (40) sampled residents (Residents #17, #35, and #36). Observation of Resident room [ROOM NUMBER] on 02/20/2024, revealed the call lights for Residents #17 and #36 did not have a push button on the end resulting in the residents not being unable to call for help if needed. Additionally, Resident 17's call light was hanging on the wall and out of reach.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to have an effective antibiotic stewardship program for one (1) of twenty-two (22) sampled residents (Resident #75). On 11/03/19, Resident #75 was ordered to receive an antibiotic for an infected wound. However, staff interview and review of a Skin McGeer Criteria form (utilized by the facility to determine the eligibility for a resident to receive an antibiotic) revealed the resident did not meet the criteria for antibiotic therapy. However, there was no evidence that Resident #75's physician had been notified that the resident did not meet the criteria for use of an antibiotic.