Crowley County Nursing Center

Inspectors wroteBased on observations and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of diseases and infection on two of four halls and in one of one dining room. Specifically, the facility failed to:-Ensure staff donned (put on) the appropriate personal protective equipment (PPE) for a resident requiring enhanced barrier precautions (EBP) when obtaining vital signs; -Ensure vital signs equipment was sanitized between resident use; and,-Ensure staff performed hand hygiene while providing meal assistance.

Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure that residents received proper treatment and assistive devices to maintain hearing abilities for one (#31) of four residents reviewed for hearing services out of 23 sample residents. Specifically, the facility failed to ensure Resident #31's missing hearing aids were replaced in a timely manner.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#6) of five residents out of 23 sample residents received the nutritional care and services necessary to maintain their highest practicable level of well-being. Specifically, the facility failed to implement effective, person-centered interventions for Resident #6 who was experiencing weight loss.

Inspectors wroteBased on record review, observations and interviews, the facility failed to ensure one (#21) of six residents diagnosed with a mental disorder or psychosocial adjustment difficulty received appropriate treatment and services to attain the highest practicable mental and psychosocial wellbeing out of 23 sample residents. Specifically, the facility failed to identify, implement and care plan interventions for Resident #21 who had a history of trauma and suicidal ideation.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#7) of four residents reviewed, out of 23 sample residents received timely dental services. Specifically, the facility failed to ensure Resident #7 received replacement of missing dentures in a timely manner.

Inspectors wroteBased on observation, record review and staff interviews, the facility failed to provide a safe, sanitary, functional and comfortable environment for residents, staff and the public. Specifically, the facility failed to: -Ensure a backflow prevention device was installed on the hand held shower hose in the shower room on B hall, increasing the risk of contamination to the facility's main water supply; and, -Ensure necessary kitchen equipment was maintained in safe, sanitary and working condition.

Inspectors wroteBased on record review and interviews, the facility failed to complete a performance review of every nurse aide at least once every 12 months and provide regular in-service education based on the outcome of these reviews for four of four certified nurse aides (CNAs) reviewed. Specifically, the facility failed to: -Provide inservice education plans based on the outcome of the performance reviews for CNA #2, #3, #4, and #5; and, -Ensure CNAs received 12 hours of training annually for CNA #2, #3 and #4.

Inspectors wroteBased on record review and interviews, the facility failed to ensure in-service training for certified nurse aides (CNA) consisted of annual training for dementia management and/or annual abuse training for four of four CNAs reviewed. Specifically, the facility: -Failed to ensure CNAs #2, #3, #4, and #5 received annual dementia management training; and, -Failed to ensure CNAs #2, #3, and #4 received annual abuse training.

Inspectors wroteBased on interviews and record review, the facility failed to ensure consent was obtained for the use of psychotropic medications for two (#25 and #30) of five residents reviewed for unnecessary medication of out 17 sample residents. Specifically, the facility failed to ensure consents were obtained for the usage of psychotropic medications for Resident #25 and Resident #30.

Inspectors wroteBased on interviews and record review, the facility failed to incorporate recommendations from the preadmission screening and resident review (PASRR) level II determination and evaluation from the State Mental Health Agency in the case of residents with serious mental illness or a related condition for one (#25) of three residents reviewed for PASRR out of 17 sample residents. Specifically, the facility failed to arrange and incorporate recommendations from the PASRR level II notice of determination for Resident #25.

Inspectors wroteBased on observation, record review and interviews, the facility failed to develop and implement a comprehensive person-centered care plan, consistent resident rights, that included measurable objectives and timeframes to meet medical, nursing, mental and psychosocial needs for one (#23) of 12 residents reviewed for activities of daily living (ADL) out of 17 sample residents. Specifically, the facility failed to revise Resident #23's person-centered, resident-specific care plan to addressed the resident's refusal of a physician ordered one-on-one for meal supervision.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that the hospice services provided met professional standards and principles that applied to individuals providing services in the facility for one (#38) of two residents receiving hospice services. Specifically, the facility failed to orient hospice aides to the facility, including the policies and procedures.

Inspectors wroteBased on observation, record review and interviews, the facility failed to take timely and sufficient steps to implement interventions to prevent the development of pressure injuries, affecting one (#29) out of one resident reviewed for pressure injuries out of 29 sample residents. Resident #29 admitted to the facility with a stage 2 pressure ulcer to her left buttock and was identified as being at risk for pressure ulcer development related to multiple comorbidities including post-polio syndrome, adult failure to thrive, spinal stenosis, and fibromyalgia. Record review revealed Resident #29's pressure ulcer to her left buttock healed over three times. The facility failed to have a system in place to identify and review residents at risk for pressure ulcer development and pressure ulcer re-development. [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure an effective quality assurance program to identify and address facility compliance concerns was implemented, in order to facilitate improvement in the lives of nursing home residents, through continuous attention to quality of care, quality of life, and resident safety. Specifically, the quality assurance performance improvement (QAPI) program committee failed to: -Identify systemic issues in its management for residents at risk for pressure ulcers to ensure they were consistently reviewed and appropriate interventions implemented to prevent the redevelopment of pressure ulcers; -Ensure residents were reviewed consistently as an interdisciplinary team (IDT) to prevent unintended weight loss and activities of daily living (ADL) decline; -Perform proper hand hygiene prior to, during, and after wound care treatment; [...]

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to ensure food was served under sanitary conditions during meal services. Specifically, the facility failed to ensure: -Prevention of potential cross-contamination of food contact surfaces; and -Appropriate use of gloves when handling ready-to-eat foods.

Inspectors wroteBased on record review and interviews, the facility failed to ensure prompt efforts to resolve all resident grievances. Specifically, the facility failed to ensure: -Call light wait times were resolved for Resident #35; and -Call light wait times were resolved for a group of individual residents.

Inspectors wroteBased on observations, record review and interviews the facility failed to ensure residents maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range, as evidenced by significant weight loss for one (#4) of two residents reviewed for nutrition of 29 sample residents. Specifically, the facility failed to: -Follow the dietary consultant's recommendation to increase a supplement if Resident #4 had continued weight loss; -Notify the physician timely of Resident #4's continued weight loss; -Consistently review Resident #4's significant weight loss as an interdisciplinary team; and -Implement additional nutritional interventions which contributed to Resident #4's unintended weight loss and further activities of daily living (ADL) decline.

Inspectors wroteBased on observations and interview, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary environment to help prevent the development and potential transmission of communicable diseases and infections. Specifically, the facility failed to: -Perform proper hand hygiene prior to, during, and after wound care for Resident #29.

Inspectors wroteBased on record review and staff interviews, the facility failed to develop and implement an antibiotic stewardship program that included antibiotic use protocols and a system to monitor antibiotic use for one (#18) of one residents out of 29 sample residents. Specifically, the facility failed to: -Ensure clinical signs and symptoms of an infection were identified for Resident #18 prior to administering antibiotics; and -Report culture and sensitivity (C&S) results timely to the physician.