Delta Grande Skilled Nursing and Rehabilitation

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident that received psychotropic drugs had a gradual dose reduction was not subjected to chemical restraints for 1(#8) of 5 residents reviewed for unnecessary medications. The facility failed to ensure Resident #8 received a dose reduction for an antipsychotic medication in a timely manner.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure a resident maintained acceptable parameters of nutritional status by failing to ensure the resident received his diet as ordered for 1 (#41) of 2 residents reviewed for nutrition.

Inspectors wroteBased on record review, observation and interview, the facility failed to develop and implement a comprehensive person-centered plan of care for each resident by failing to develop a plan of care for 1 (#24) of 3 residents reviewed for Activities of Daily Living.

Inspectors wroteBased on observations, interviews, and record reviews, 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 communicable diseases and infections. The facility failed to implement the EBP policy for 1 (#4) of 3 residents reviewed for EBP.

Inspectors wroteResident #61 Review of the medical record revealed sample resident #61 was admitted to the facility on [DATE] with diagnosis of Alzheimer's disease, heart disease, agitation, pacemaker, and dementia. The resident resided in the locked unit. Review of the quarterly Minimum Data Set assessment dated [DATE] revealed the resident was cognitively impaired and needed assistance with all activities of daily living. Review of the physical restraint section revealed no restraints documented as being used for the resident. Review of the February 2025 physician's orders revealed no order for a lap tray to the wheelchair to aide in trunk control or the monitoring of the lap tray release every two hours. On 02/17/2025 at 1:45 p.m., observation revealed resident #61 had a lap tray on the wheelchair. [...]

Inspectors wroteBased on observation, record review and interview the facility failed to ensure the nurse monitored the resident's oxygen saturation as ordered for 1 (#7) of 1 resident's reviewed with an order to monitor the oxygen saturation every shift. Resident #7 Review of the record for resident #7 revealed diagnoses in part of non-traumatic acute subdural hemorrhage, chronic pain, acute upper respiratory infection, chronic respiratory failure, tracheostomy status, muscle spasm, conversion disorder with seizures or convulsions, flaccid hemiplegia, hemiplegia affecting the left dominant side, and aphasia. Review of the physician orders revealed an order date 08/13/2024 to monitor for signs and symptoms of respiratory distress every shift; if signs and symptoms are positive then notify respiratory therapist and Physician. [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure that nursing staff were able to demonstrate competencies and skills necessary to care for residents needs for 2 (#2 and #41) of 2 sampled residents. The facility failed to have documentation of peg site care and foley catheter care for resident #2, and failed to have documentation of edema monitoring for resident #41.

Inspectors wroteBased on record review and interview the facility failed to ensure a dosage reduction was carried out for 1 (#40) of 5 (#15, #20, #40, #38, #43) residents review for unnecessary medication review. Resident #40 Review of the record for resident#40 revealed diagnoses in part of acute respiratory failure, diverticulitis, dorsalgia, anxiety disorder, idiopathic peripheral autonomic neuropathy, depression, chronic viral hepatitis C, chronic combined systolic and diastolic congestive heart failure, emphysema and spinal stenosis. Review of the February 2025 Physician orders in part revealed an order dated 08/03/2024 for Cymbalta 60 milligrams (mg) - Give 60 mg orally one time a day related to depression, give with 30 mg dose Cymbalta to equal 90 mg. Observation: antidepressant medication- Observe for behavior, observe for side effects: [...]

Inspectors wroteBased on record reviews, observations, policy review, and interviews, the facility failed to implement policies and procedures for enhanced barrier precautions (EBP) for 6 (#7, #19, #21, #25, #42, and #60) of 6 residents reviewed for enhanced barrier precautions.

Inspectors wroteBased on record review, observations, and interviews, the facility failed to ensure activities of daily living (ADL) were performed for 1 (#53) of 1 residents reviewed for activities of daily living. The facility failed to ensure resident #53 received nail care.

Inspectors wroteBased on record reviews and interviews, the Pharmacist failed to identify and report irregularities to the attending Physician, the facility's Medical Director and Director of Nursing (DON) for 1 (#40) of 5 (#15, #20, #40, #38 and #43) residents reviewed for unnecessary medications.

Inspectors wroteBased on observation, record review and interview the facility failed to develop and implement a comprehensive-centered plan of care for 2 (#1, #4) of 2 (#1, #4) residents with indwelling urinary catheters.

Inspectors wroteBased on record review and interview the facility failed to ensure nursing staff communicated a change in status to the responsible party for 1 (#1) of 5 (#1,#2,#3,#4,#5) residents reviewed for notification of change.

Inspectors wroteBased on record review, interviews, and observations, the facility failed to ensure a resident, with an indwelling catheter, received the appropriate care and services to prevent urinary tract infections for 1 (#35) of 1 sampled residents reviewed for urinary catheters. The facility failed to ensure resident #35's urinary catheter tubing was positioned off the floor and the facility failed to obtain complete urinary output documentation.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to ensure that a resident who needs respiratory care was provided such care, consistent with professional standards of practice for 3 (#6, #23, and #37) of 6 (#6, #9, #15, #18, #23, and #37) sampled residents reviewed for respiratory care. The facility failed to ensure: 1.) oxygen (O2) nasal cannula tubing and nebulizer masks/tubing were changed weekly and stored properly for resident #23 & resident #37 and 2.) O2 nasal cannula tubing and humidifier canister were changed weekly for resident #6.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to maintain an infection prevention and control program designed to provide a sanitary environment and to help prevent the development and transmission of communicable diseases and infections. The facility failed to 1) ensure personal items belonging to staff were not stored in the laundry room and available for resident use and 2) ensure that residents on isolation precautions are served meals in disposable containers.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent infection for 1 (#13) of 2 (#13 and #18) residents reviewed for pressure ulcers. S4Assistant Director of Nursing (ADON) failed to ensure a disposable cloth to establish a clean field and to serve as a barrier was provided for a resident (#13) with a pressure ulcer during wound care.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure a resident with limited range of motion received appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion for 1 (#9) of 1 (#9) residents reviewed for limited range of motion. The facility failed to ensure staff placed a hand roll in both of resident #9's hands as directed by the plan of care.