Crown Rehab and Healthcare Center

Inspectors wroteBased on interview and record review, the facility failed to notify the resident or the resident's representative of meetings for care plan development, review, and revision, for three sampled residents (Resident #13, #32 and #40) out of 20 sampled residents. The facility census was 99 residents. Review of the facility policy titled Care Planning dated 10/24/22 showed: -The facility would develop a baseline and/or a comprehensive care plan for the residents. -The facility would provide a written summary of the baseline and/or comprehensive care plan to the resident and/or the resident's representative when the care plan was completed. -The medical record must contain evidence that the summary was given to the resident and/or the resident's representative. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete annual evaluations for two sampled Certified Nursing Assistants (CNA),(CNA N and CNA P); and failed to provide the annual twelve hours of annual education to nursing assistants, based on their performance review for four sampled CNAs (CNA L, CNA N, CNA O, CNA P) out of five CNA's reviewed for annual evaluations and training's. The facility census was 99 residents. A policy for CNA Evaluations was requested and not provided by the date of exit. Review of the facility's undated policy titled Regular In-service Education showed: -All certified nursing personnel was required to complete at least 12 hours of in-service education annually from their date of hire. -Certified staff members who do not meet this requirement will be removed from the schedule. 1. Review of the education documentation showed: [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure residents were provided food that was at a safe and appetizing temperature for three sampled residents (Resident #14, #25, and #34) out of 20 sampled residents. The facility census was 99 residents. Review of the facility policy titled food temperatures dated 10/24/22 showed: -Insert the thermometer into the center of the product. -Wait until there is no movement for 15 seconds. Several readings may be needed to determine hot and cold spots. -Take the temperature of each pan of product before serving. -Acceptable serving temperatures were: --Hot cereal and gravy should be 135 degrees Fahrenheit (F). --Casseroles, Meat entrees, potatoes, pasta, soup, pureed food, vegetables, coffee, and eggs should be greater than 135 degrees F. --Hazardous salads, desserts, milk, and juice should be less than 41 degrees F. [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain the cleanliness in the kitchen by not removing rust and grime from one shelf in the walk-in cooler; failed to clean and maintain four ceiling vent covers over the hot drink preparation area and the hand washing sink dish washing areas. This practice potentially affected all residents who ate food from the kitchen. The facility census was 99 residents. Review of the facility's Cleaning Schedule policy, dated 10/24/22, showed: -The dietary staff maintained a sanitary environment by complying with routine cleaning schedules developed by the Dietary Manager. 1. Observation on 3/18/25 from 9:26 A.M. to 11:14 A.M. of the kitchen showed: -Two ceiling vent covers over the hot beverage preparation area were discolored with dark brown or black grime, dust or debris. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure accurate and timely tuberculosis (TB - a communicable disease that affects especially the lungs, that is characterized by fever, cough, difficulty in breathing, abnormal lung tissue and function) testing was completed for three sampled residents (Residents #79, #246, and #196) out of five residents sampled for tuberculosis screening/testing; and failed to ensure appropriate hand hygiene and infection control practices during incontinence care for three sampled residents (Resident #73, #246, and #21) out of 20 sampled residents. The facility census was 99 residents. Review of the facility Tuberculosis - Screening policy dated 10/24/22 showed: -Residents are to be screened for tuberculosis upon admission, readmission, and as indicated. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure completion, submission and retention of a Level I Nursing Facility Pre-admission Screening for Mental Illness, Intellectual Disability or Related Condition (PASRR-a federally mandated screening process for individuals with serious mental illness and/or intellectual disability/developmental disability related diagnosis who apply or reside in Medicaid (program that helps with medical costs for some people with limited income and resources) certified beds in a nursing facility regardless of the source of payment. The screening assures appropriate placement of persons known or suspected of having a mental impairment(s) and that the individual needs of mentally impaired persons can be and are being met in the appropriate placement environment) for one sampled resident (Resident #4) out of 20 sampled residents. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure bathing/showers were completed twice weekly and with the resident's preference considered for two sampled residents (Resident #4 and #79) out of 20 sampled residents. The facility census was 99 residents. A policy for showers/bathing was requested and was not received at the time of exit. 1. Review of Resident #4's admission Record showed he/she was admitted on [DATE] with the following diagnoses: -Hemiplegia and Hemiparesis (muscle weakness or partial paralysis on one side of the body) affecting left non-dominant side 3/4/20. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure communication and coordination of care with a resident's hospice (end of life care) provider for one sampled resident (Resident #73) out of 20 sampled residents. The facility census was 99 residents. Review of the facility's End of Life Care policy dated 10/24/22 showed no instructions on how the hospice provider and the facility will communicate with one another to ensure coordination of care. 1. Review of Resident #73's Face Sheet showed he/she was admitted on [DATE] and was receiving hospice services. Review of the resident's quarterly Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff for care planning) dated 1/21/25 showed the resident: -Was severely cognitively impaired. -Was receiving hospice services. [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain audiological (science and medicine concerned with the sense of hearing) health by not following up with the audiologist recommendations for one sampled resident (Resident #28) out of 20 sampled residents. The facility census was 99 residents. 1. Review of Resident #28's quarterly Minimum Data Set (MDS- a federally mandated assessment instrument completed by facility staff for care planning), dated 8/24/24, showed: -The resident was cognitively intact. -The resident's hearing was adequate. Review of the resident's audiology report, dated 9/20/24, showed: -Ear exam results were abnormal in the resident's right ear. -The resident had impacted cerumen (ear wax) in both ears. -Removal of ear wax was attempted via suction. -Due to depth of the cerumen, it was not completely removed. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide necessary treatment and foot care for one sampled resident (Resident #25) out of 20 sampled residents. The facility census was 99 residents. Review of the facility's policy titled Grooming Care of the fingernails and toenails dated as revised 10/24/22 showed: -Toenails were to be trimmed by Certified Nursing Assistants (CNA)s except for residents with the following conditions: --Diabetes or circulatory impairment. --Ingrown, infected, or painful nails. --Nails that are too hard, thick, or difficult to cut easily. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure two sampled Nurse Assistants (NAs) (NA A and NA B) completed the Certified Nurse Assistant (CNA) training program within four months of his/her employment in the facility. The facility census was 99 residents. A policy was requested and was not received by the exit date. 1. Review of the facility spreadsheet for NA training on 3/19/24 showed: -NA A's date of hire was 7/28/24 with a completion deadline of the CNA training by 11/25/24. -He/She had worked on the following days: --3/3/25 on the day shift. --3/4/25 on the day shift. --3/10/25 on the day shift. --3/11/25 on the day shift. --3/12/25 on the day shift. --3/17/25 on the day shift. --3/18/25 on the day shift. -NA B's date of hire was 9/9/24 with a completion deadline of the CNA training by 1/7/25. -He/She had worked on the following days: --3/3/25 on the day shift. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow pre-prepared menus to ensure they met the nutritional adequacy needs of residents, in accordance with established national guidelines and professional standards for food service. This deficient practice potentially affected all residents who ate food from the kitchen. The facility's census was 88 residents with a licensed capacity for 118 residents at the time of the survey. 1. Review of the pre-prepared menus for the current month provided by the Dietary Manager (DM) showed the following: -The menus had the facility's food vendor name at the top left. -The lunch for Monday the 17th was listed as bacon wrapped beef, country mashed potatoes, and mixed vegetables. -The lunch for Tuesday the 18th was listed as a hot dog on a bun, crispy French fries, cucumber salad, and a cottage cheese/pineapple salad. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to keep the Dry Storage (DS) room, walk-in refrigerator, and walk-in freezer floors clean; to maintain sanitary beverage dispensers; to maintain plastic plate covers and utensils in good condition to avoid food safety hazards (cross-contamination); and failed to separate damaged foodstuffs, in accordance with professional standards for food service safety. These deficient practices had the potential to affect all residents, visitors, volunteers, and staff who ate food from the kitchen. The facility's census was 88 residents with a licensed capacity for 118 residents at the time of the survey. 1. Observation on 7/17/23 between 8:29 A.M. and 9:26 A.M. during the initial kitchen inspection showed the following: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the narcotic count sheet was signed by both the on-coming and the off-going nurses to verify the correct count of narcotics. The facility census was 88 residents. Review of the facility's policy, Controlled Medication Storage, dated 11/2017 showed: -Medications included in the Drug Enforcement Administration (DEA) classification as controlled substances were subject to special handling, storage, disposal and record keeping in the nursing care center in accordance with federal, state and other applicable laws and regulations. -The Director of Nursing (DON) and the consultant pharmacist monitor for compliance with federal and state laws and regulations in the handling of controlled medications. -The medication nurse on duty maintains possession of the key to the controlled medication storage areas. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were stored securely; failed to ensure other objects were not in with the residents' prescribed medications; failed to ensure refrigerators that store residents' prescribed medications and supplements were kept within the required temperatures; failed to ensure the sink in the medication room was kept clean and hand soap and towels were available to wash hands, and failed to ensure medication carts were not left unlocked while nursing staff was not in attendance of the medication cart. The facility census was 88 residents. Review of the facility's policy, Storage of Medication, dated 1/2021 showed: -Medications and biologicals were to have been stored properly, following the manufacturer's recommendation, to maintain their integrity and to support safe effective drug administration. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their policy to complete testing to screen residents upon admission for tuberculosis (TB- a communicable disease that affects especially the lungs, that is characterized by fever, cough, difficulty in breathing, abnormal lung tissue and function) for two sampled residents (Resident #83, and #75) out of five sampled residents; the facility failed to follow infection control protocols during wound care for three sampled residents (Residents #23, #25 and #35), and to clean/sanitize scissors properly before and after use between residents for two sampled residents (Residents #25 and #35) out of 18 sampled residents. The facility census was 88 residents. Review of the facility's Tuberculosis Screening policy dated 10/24/22 showed: -All residents were to be screened upon admission to the facility. [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure one sampled resident (Resident #64) had a code status upon admission out of 18 sampled residents. The facility census was 88 residents. Review of the facility's policy, Advance Directives, dated October 24, 2022 showed: -The Facility would respect a resident's advance directive and would comply with the resident's wishes expressed in an advance directive. -Upon admission, the admission Staff or designee would obtain a copy of a resident's advance directive. -A copy of the resident's advance directive would have been included in the resident's medical record. -If the resident did not have an Advance Directive, the Facility would have provided the resident and/or resident's next of kin with information about advance directives upon request. [...]

Inspectors wroteBased on interview and record review, the facility failed to reassess the effectiveness of individualized resident care and interventions by not reviewing and revising resident care plans (a document that specified health care and supported needs and outlined how the facility met resident requirements) for one sampled resident (Resident #23) out of 18 sampled residents. The facility census was 88 residents. Review of the facility's Care Planning policy, dated 10/24/22, showed: -The purpose of the policy was to ensure a comprehensive person-centered care plan was developed for each resident based on their individual needs. -The care plan served to help the resident move toward resident-specific goals which addressed the resident's medical, nursing, mental and psychosocial needs. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete labs as ordered for one sampled resident (Resident #31) out of five residents sampled for unnecessary medications. The facility census was 88 residents. Review of the facility's laboratory, diagnostic and radiology services policy dated 10/24/22 showed: -The facility was to ensure they provided laboratory services to meet the residents' needs. -The facility would coordinate lab services based on orders from an appropriate practitioner. -The facility was responsible for the timeliness of the lab services. 1. Review of Resident #31's quarterly Minimum Data Set (MDS-a federally mandated assessment tool completed by facility staff for care planning) dated 5/15/23 showed the following staff assessment of the resident: -Moderately cognitively impaired. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide nail care for one sampled resident (Resident #83) and failed to respond promptly to one supplemental resident's (Resident #27) call bell/light out of 18 sampled residents. The facility census was 88 residents. Review of the facility's policy titled Communication - Call System dated 10/24/22 showed: -The call system was used to provide a mechanism for residents to promptly communicate with nursing staff. -The facility would provide a call system to enable residents to alert the nursing staff from their beds and toileting/bathing facilities. -Nursing staff should answer call bells promptly. -When answering a request, nursing staff will return with the item or reply promptly. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure two sampled residents (Residents #13 and #16) received dental services out of 18 sampled residents. The facility census was 88 residents. Review of the facility's dental policy showed: -The facility would assist residents with referrals for dental services, including coordinating transportation within three business days or less from the time of damage or loss to dentures. -If a referral was not made within three days, the facility had to provide documentation of they did to ensure the resident could still eat and drink adequately while awaiting dental services. 1. Review of Resident #16's entry tracking form showed he/she admitted to the facility on [DATE]. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide restorative care (a program to maintain a person's highest level of physical, mental, and psychosocial function in order to prevent declines that impact quality of life) following discharge from therapy services for one sampled resident (Resident #77) out of 18 sampled residents. The facility census was 88 residents. Review of the facility's Restorative Nursing Program Guidelines policy, dated 10/24/2022, showed: -The program focused on achieving and maintaining physical, mental and psychosocial functioning. -Residents were started on the Restorative Nursing Program: --Upon admission to the facility with restorative needs, but was not a candidate for formalized rehabilitation therapy; --When restorative needs arose during the course of a longer-term stay; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure they completed a check of the Employee Disqualification List (EDL) and/or Criminal Background Check (CBC) and/or the Nurse Aide (NA) Registry to ensure they did not have a Federal Indicator (a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents) prior to hire for six sampled staff out of 10 staff sampled. The facility census was 86 residents. Record review of the facility's employment screening policy dated 2/1/22 showed: -Check the EDL at least two days prior to scheduled resident contact on all newly employed individuals. -Check the CBC through the use of the Family Care Safety Registry at least two days prior to scheduled resident contact on all newly employed individuals. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide regular bathing assistance for seven sampled residents (Residents #7, #49, #65, #276, #31, #226, and #73) that were dependent upon staff assistance for bathing assistance out of 18 sampled residents. The facility census was 86 residents. Record review of the facility's policy titled Activities of Daily Living (ADLs-bathing, grooming, hygiene, etc.), Supporting dated March 2018 showed ADLs should be provided for residents who are unable to carry out their own ADLs independently. 1. Record review of Resident #7's undated face sheet showed: -The resident was admitted to the facility on [DATE]. -Some of his/her diagnoses included heart disease and kidney failure. Record review of the resident's interdisciplinary notes dated 9/24/21 to 3/3/22 showed no documentation regarding the resident's bathing/showering. [...]

Inspectors wroteBased on interview and record review, the facility failed to establish and maintain annual competencies and skill sets of at least 12 hours of education in-services/training of facility licensed nursing staff, Certified Medication Technicians (CMT's), and Certified Nursing Assistants (CNA's). The facility census was 86 residents. Record review of the facility Staffing policy dated October 2017 showed the facility provides sufficient numbers of staff with the skills and competency necessary to provide care and services for all residents in accordance with resident care plans and the facility assessment. 1. Record review of the facility In-Service Training Program, Nursing Assistant dated May 2019 showed: -All nursing assistant personnel participate in regularly scheduled in-service training classes. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staffing information was posted in a prominent place, readily accessible to residents and visitors. This practice had the potential to affect residents and visitors who were inquiring about the facility staffing hours. The facility census was 86 residents. Record review of the facility Posting Direct Care Daily Staffing Numbers dated July 2016 showed: -Within two hours of the beginning of each shift the number of Licensed Nurses [Registered Nurses (RN's), Licensed Practical Nurses (LPN's), and Licensed Vocational Nurses (LVN's)] and the number of unlicensed nursing personnel [Certified Nurse Aides (CNA's) directly responsible for resident care will be posted in a prominent location (accessible to residents and visitors) and in a clear and readable format. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide a bed hold policy at the time of or within 24 hours of the resident's discharge to the hospital for two sampled residents (Resident #3 and #65) out of 18 sampled residents. The facility census was 86 residents. Record review of the facility's bed-holds and returns policy dated 2019 showed that prior to transferring a resident, the facility would inform the resident or the resident's representatives in writing of the bed-hold and return policy. 1. Record review of Resident #3's entry tracking record showed he/she was admitted to the facility on [DATE]. Record review of the resident's general note dated 11/16/21 showed he/she was sent to the hospital due to decreased mental status and a fever. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to administer Levothyroxine (Synthroid used for thyroid hormone replacement) according to manufacturer's instructions for two sampled residents (Resident #11 and # 68) out of 18 sampled residents. The facility census was 86 residents. Record review of the facility's policy titled Medication Administration dated 1/21 showed: -Medications were to be administered as prescribed in accordance with manufacturer's specification. -Personnel authorized to administer medication do so only after they have familiarized themselves with the medication. -If necessary the nurse would contact the prescriber for clarification. -The interaction with the pharmacy and the resulting order clarification would be documented in the nursing notes. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify edema with a weight gain and notify the Physician for one sampled resident (Resident #14) and to provide medication and a treatment for a resident with skin issues that had been prescribed by the physician for one sampled resident (Resident #49) out of 18 sampled residents. The facility census was 86 residents. Record review of the facility's policy titled Medication Administration dated 1/21 showed medications were to be administered as prescribed. Record review of the facility's policy titled Activities of Daily Living (ADLs- bathing, grooming, hygiene, etc.), Supporting dated March 2018 showed ADLs should be provided for residents who are unable to carry out their own ADLs independently. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to follow through with pharmacy recommendations to reduce anti-psychotic medications for one sampled resident (Resident #71) out of 18 sampled residents. The facility census was 86 residents. Record review of the facility's Medication Utilization and Prescribing - Clinical Protocol policy, dated April 2018, showed: -When a medication was prescribed for any reason the physician and staff would identify the indications, considering the resident's age, medical and psychiatric conditions, risks, health status and existing medication regimen. -A diagnosis by itself may not be sufficient justification for prescribing a medication. -The existence of a condition or risk does not necessarily require a treatment and the treatment may be something besides, or in addition to, medication. [...]

Inspectors wroteBased on interview and record review, the facility failed to determine the vaccination status related to a influenza (flu) vaccine for one sampled resident (Resident #126); and to obtain vaccination status for influenza, pneumococcal (pneumonia) and Covid-19 immunizations for one sampled resident (Resident #35) out of five residents sampled for vaccination review. The facility census was 86 residents. Record review of the facility's flu vaccine policy dated August 2016 showed: -Between October 1st and March 31st each year, the flu vaccine would be offered to residents unless the vaccine was medically contraindicated or the resident was already immunized. -Any refusal of a vaccine by a resident would be charted in their medical record. Record review of the facility's pneumococcal (pneumonia) vaccine policy dated August 2016 showed: [...]