Denton Nursing and Rehab

Inspectors wroteBased on observations, interviews and record reviews it was determined that the facility failed to store food in a manner that maintains professional standards of food service safety in the kitchen and the resident refrigeration units. This practice had the potential to affect all residents that eat food prepared by the facility's kitchen and stored food in the refrigeration units.

Inspectors wroteBased on observations, interviews and record reviews it was determined that the facility failed to ensure essential equipment was in safe operating condition. This was found to be evident in the kitchen. This practice has the potential to affect all residents.

Inspectors wroteBased on medical record reviews and staff interview, it was determined that the facility failed to ensure that residents were offered written information regarding advance directives. This was evident for 4 (Residents #8, #10, #47, and #86) out of 6 residents reviewed for advance directives during the recertification and complaint survey process.

Inspectors wroteBased on observation, record review, and interview, it was determined that the facility failed to ensure services were provided in accordance with professional standards for quality of care. This was evident for 6 (Resident #28, #5, #47,#90, #91, and #44) out of 6 Residents reviewed for professional standards during the medication administration facility task conducted as part of the annual/complaint survey.

Inspectors wroteBased on record reviews and interviews, it was determined that the facility failed to ensure Staff were competent in their skills. This was found to be evident for 4 (GNA #1, #2, #8, & #9) out 5 Geriatric Nursing Assistants reviewed for skill competency evaluations during the recertification and complaint survey.

Inspectors wroteBased on record review and interview, it was determined that (1) the facility failed to ensure residents were offered and educated on COVID-19 vaccinations and (2) the facility failed to maintain staff documentation of COVID-19 screening, education, offering, and current vaccination status. This was evident for 5 of 5 residents reviewed (Resident #15, #5, #47, #7, and #81) and 5 of 5 staff reviewed (Geriatric Nursing Assistants #1, #2, #6, #7, and Registered Nurse #10) for COVID-19 immunization status.

Inspectors wroteBased on interviews, observations and record reviews it was determined the facility failed to ensure a functioning call bell system was available for all residents. This was found to be evident for 4 (Resident's #75, #51, #58 and #98) of 18 Residents review for call bell access during the recertification survey.

Inspectors wroteBased on record reviews and interviews it was determined that the facility failed to ensure that residents remained free of neglect. This was evident for 1 (Resident #75) of 1 Resident reviewed for neglect during the recertification survey.

Inspectors wroteBased on record reviews and interviews, it was determined that the facility failed to thoroughly investigate allegations of neglect. This was evident for 1 (Resident #75) of 1 Resident reviewed for neglect during the recertification survey.

Inspectors wroteBased on interviews and medical record reviews it was determined that the facility failed to ensure 1) quarterly care plan meetings with the interdisciplinary team were held and 2) a Residents care plan intervention was implemented. This was found to be evident for 2 (Resident #75 and #1) out of 18 Residents reviewed for care plans during the recertification and complaint survey.

Inspectors wroteBased on observations, record reviews and interviews it was determine that the facility failed to provide Residents with quality of care. This was found to be evident for 5 (Resident #88, #39, #41, #47 and #90) out of 18 Residents reviewed for quality of care during the recertification and complaint survey.

Inspectors wroteBased on observations, interviews and record reviews it was determined that facility failed to ensure a Resident was provided with supervision. This was found to be evident for 1 (Resident #1) out of 1 Resident reviewed for supervision during the recertification and complaint survey.

Inspectors wroteBased on interviews and record reviews it was determined that the facility failed to ensure that the individual designated as the Kitchen Manager was certified for food service management and safety. This had the potential to affect all residents.

Inspectors wroteBased on observation and interview, it was determined that the facility failed to ensure 1) measures were in place to prevent and monitor the growth of Legionella and other opportunistic waterborne pathogens in the building water system. This deficiency has the potential to affect all residents who utilize the facility's water system and 2) staff perform appropriate hand hygiene. This was found to be evident for 1 Licensed Practical Nurse (LPN #4) of 2 LPNs observed for infection control during the recertification and complaint survey.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to provide influenza and/or pneumococcal immunizations as required or appropriate for residents. This was found to be evident for 4 (Resident #15, #47, #7, and #81) out of 5 Residents reviewed for influenza and pneumococcal immunizations during the Infection Control facility task conducted as part of the annual/complaint survey.

Inspectors wroteBased on complaint, reviews of a closed and active medical record, reviews of all pertinent administrative records, and staff interviews, it was determined that the facility failed to have a system in place to ensure clinical records were complete and accurately documented. This was found to be evident for 2 (Residents #8, #9) of 9 residents reviewed during the complaint survey.

Inspectors wroteBased on a review of a complaint, medical record review, facility documentation review, and staff interviews, it was determined the facility failed to keep a dependent resident free from injury while transferring the resident from the bed to the chair via a Hoyer lift, which resulted in actual harm to Resident (R) #11. The failure of facility staff to follow the plan of care while transferring a resident resulted in bilateral sacral fractures and a L2 fracture. This was evident for 1 (#11) of 3 residents reviewed for falls.

Inspectors wroteBased on medical record review, facility documentation and interview, it was determined the facility failed to provide a safe and functional environment resulting in psychosocial and physical harm to a resident (Resident #9). This was evident for 1 of 79 residents in the facility on 1/24/25 and reviewed during the complaint survey.

Inspectors wroteBased on observation, interview, and medical record review, it was determined the facility failed to ensure that the resident's call light was within reach, per the individualized care plans, to allow access to assistance when needed. This was evident for 1 (#13) of 14 residents reviewed during a complaint survey.

Inspectors wroteBased on medical record review, facility documentation and interviews, it was determined the facility staff failed to notify a physician promptly when a resident had a change of condition (Resident #12) and failed to notify a resident's representative when a resident had medication changes (Resident #6). This was evident for 2 of 14 residents reviewed during a complaint survey.

Inspectors wroteBased on review of facility reported incidents, record review, and interview, it was determined the facility failed to report an injury of unknown origin within 2 hours of becoming aware of the injury, to the regulatory agency, the Office of Health Care Quality (OHCQ). This was evident for 1 (#1) 9 residents reviewed for 10 facility reported incidents during a complaint survey.

Inspectors wroteBased on review of facility reported incidents, documents, and staff interview, it was determined the facility failed to provide documentation that allegations of misappropriation of property were thoroughly investigated. This was evident for 1 (#2) of 9 residents reviewed for facility reported incidents during a complaint survey.

Inspectors wroteBased on medical record review and interview, it was determined that the facility staff failed to have quarterly care plan meetings for residents (Resident #9). This was evident for 1 of 14 residents reviewed during a complaint survey.

Inspectors wroteBased on medical record review and staff interview it was determined the facility failed to keep a resident's drug regimen free from unnecessary drugs by failing to follow physician ordered blood pressure and heart rate parameters for administering a blood pressure medication. This was evident for 1 (#6) of 13 residents reviewed during a complaint survey.

Inspectors wroteBased on medical record review and interview, it was determined the facility failed to maintain complete and accurate medical records in accordance with accepted professional standards (Resident #5). This was evident for 1 of 14 residents reviewed during a complaint survey.

Inspectors wroteBased on record review and staff interviews, it was determined that the facility failed to correct and monitor quality deficiencies identified on the previous survey. This was evident for 3 out of 19 deficiencies reviewed in the revisit survey.

Inspectors wroteBased on observations, staff and resident interviews, record reviews, and facility policy review, the facility failed to ensure sufficient staffing was scheduled to meet the needs of the 81 residents in the facility. Five residents (Resident (R) 55, R48, R15, R44, and R48) and staff members, Geriatric Nurse Aide (GNA 11, GNA4, GNA9, GNA6, GNA3, GNA8, GNA5, GNA7, and GNA10), Registered Nurse (RN1), the Administrator, the Director of Nursing (DON), and the Regional Director of Labor Management voiced concerns regarding sufficient staffing, and the facility exhibited multiple failures related to a lack of sufficient staffing throughout the survey.

Inspectors wroteBased on interviews and personnel files review, the facility failed to ensure a performance review was completed for five of five Geriatric Nurse Aides (GNA)5, GNA7, GNA13, GNA4, GNA 14) once every 12 months. The failure to ensure annual performance reviews were completed had the potential to impact all 80 residents in the facility related to safety, person-centered environment, and the number of adverse events or other resident complications.

Inspectors wroteBased on interviews, document review and observations, the facility failed to ensure food was served at a palatable and appetizing temperature for two of two meal tray observations. This deficient practice had the potential to affect the meal consumption for all 80 of 80 residents who consumed food prepared from the facility's kitchen.

Inspectors wroteBased on observations, interviews, document review, policy review and review of the Federal and Drug Administration (FDA) Food Code, the facility failed to ensure food was served and prepared under sanitary conditions. The facility failed to ensure floors, baseboards, walls, appliances, hood vent and ice machine were kept clean and in good working condition. The facility also failed to ensure dietary staff adhered to sanitary requirements related to hair restraints. The deficient practice has the potential to affect 80 of 80 residents who received meals prepared in the facility kitchen.

Inspectors wroteBased on observations, interviews, document review, and policy review, the facility failed to ensure garbage and refuse was properly disposed of in that the facility did not ensure dumpsters were maintained in a sanitary condition. This deficient practice had the potential to affect all residents in the facility

Inspectors wroteBased on observations, interviews, record review and facility policy review, the facility failed to wear the appropriate PPE when providing catheter care for one of one resident (Resident (R) 65) observed during catheter care out of a total sample of 31 residents. In addition, the facility failed to ensure that one resident (R65) had personal protective equipment (PPE) readily available to use during catheter care that was on enhanced barrier precautions (EBP) and failed to ensure that staff used EBP for two of three residents (R11, and R33) during care. This failure has the potential to place R65, R11 and R33 at risk for infection to the urinary tract. In addition, the facility failed to have a water management program. This failure has the potential to place all 80 residents residing in the facility at risk for Legionella.

Inspectors wroteBased on interviews, personnel files review and policy review, the facility failed to ensure 12 hours of required in-service training for five of 5 Geriatric Nurse Aides (GNA)5, GNA7, GNA13, GNA4, GNA14) was provided to ensure continuing competencies. The failure to ensure an effective training program was in place had the potential to impact 80 residents in the facility related to safety, person-centered environment, and the number of adverse events or other resident complications.

Inspectors wroteBased on review of complaints, observation of resident rooms and equipment, and resident and staff interview, it was determined the facility staff failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior. This was evident on 3 of 4 nursing units observed.

Inspectors wroteBased on review of the facility's investigations, medical record reviews, interviews, and policy review, the facility failed to fully implement their abuse policy for an allegation of physical abuse and verbal abuse and misappropriation of property three of five residents (Resident (R) 233, R11, and R232) reviewed for abuse out of a total sample of 31 residents. This failure to fully implement the abuse policy, including timely and thorough investigations and and timely reporting, increased the risk of continued abuse to residents.

Inspectors wroteBased on review of the facility's investigations, medical record reviews, interviews, and policy review, the facility failed to investigate allegations of physical abuse, verbal abuse, and misappropriation of property timely and thoroughly for 4 of 31 residents (Resident (R) 233, R11, R232, and R65) reviewed for abuse.

Inspectors wroteBased on observations, interviews, record review, and facility policy review, the facility failed to ensure that two of five residents (Resident (R) 14 and R65) were treated with dignity and respect, out of a total sample of 31 residents. This failure has the potential to negatively affect all residents residing in the facility by affecting a resident's psychosocial well-being.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to allow one of one resident (Resident (R) 15) reviewed from a sample of 31 residents for self-determination to make their own choice on the size of incontinent briefs to wear. This failure has the potential to affect R15 and other residents residing at the facility by not allowing the residents to make choices about aspects that affect their daily lives.

Inspectors wroteBased on medical record review and staff interview it was determined the facility failed to notify a resident's responsible party (RP) when a new treatment was started for a pressure ulcer. This was evident for 1 (#65) of 4 residents reviewed for pressure ulcers.

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to ensure one of 31 sample residents (Resident (R) 4) reviewed for Resident Council grievances was promptly resolved. Specifically, the facility failed to ensure a grievance voiced by R4 during a resident council meeting on 09/24/24 was investigated, resolved, and followed up by staff. This failure had the potential to cause further grievances to be unresolved for residents throughout the facility.

Inspectors wroteBased on interviews, record reviews, and review of the facility's policy, the facility failed to protect the resident's right to be free from physical abuse for one of six residents (Resident (R) 39) reviewed for abuse out of a total sample of 31.

Inspectors wroteBased on the facility's investigations, medical record reviews, interviews, and policy review, the facility failed to timely report allegations of physical abuse and verbal abuse for 5 (Resident (R) 233, R32, R28, R65, R62) of 31 residents reviewed for abuse. This failure increased the risk of continued abuse to these residents.

Inspectors wroteBased on record review, interview, review of the Resident Assessment Instrument (RAI manual and policy review, the facility failed to ensure one resident (Resident (R) 75) out of 31 sampled Minimum Data Set (MDS) assessments was transmitted in a timely manner.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to develop a written care plan with interventions and goals for the use and discontinuation of an indwelling urinary catheter for one of one resident (Resident (R)11) reviewed for urinary catheters out of a sample of 31 residents. This failure resulted in R11 having an indwelling urinary catheter in place for seven months without a written comprehensive plan to discontinue the use of the urinary catheter.

Inspectors wroteBased on record review, interviews, hospice contract review, and facility policy reviews, the facility failed to ensure that one out of one resident (Resident (R) 32) reviewed for hospice had a care plan to include hospice out of a sample size of 31 residents. In addition, the facility failed to ensure that all necessary interdisciplinary team (IDT) members and outside resources were invited to participate in one of one resident (R32) care conferences, out of a sample size of 31 residents. Also, facility staff failed to have quarterly care plan meetings for residents (Resident #19, #45 and #65). This was evident for 3 of 33 residents reviewed during an annual survey. These failures had the potential to affect resident care.

Inspectors wroteBased on record review and interview, the facility failed to ensure that one of one resident (Resident (R) 3) reviewed for weight loss had weekly weights completed as ordered by the physician, out of a total sample of 31 residents. This had the potential to have increased weight loss for R3.

Inspectors wroteBased on observations, interviews, record review and facility policy review, the facility failed to ensure that two of two residents (Resident (R) 15, and R33) reviewed out of 33 sampled residents, for activities of daily living (ADL) received the necessary services to maintain appropriate grooming. This failure has the potential to affect R15 and other residents residing at the facility's highest practicable physical, mental, and psychosocial well-being by not providing necessary ADL care to dependent residents.

Inspectors wroteBased on medical record review and staff interview it was determined the facility failed to provide timely treatment/services to prevent/heal pressures ulcers. This was evident for 1 (#65) of 4 residents reviewed for pressure ulcers.

Inspectors wroteBased on observations, interviews, record review and policy review, the facility failed to ensure that the designated smoking area was safe for one of one resident (Resident (R) 29) reviewed for smoking. R29 was the only smoker in the facility. Specifically, the facility failed to ensure there was an accessible metal container with a self-closing cover where the ashtrays could be emptied, that did not contain trash and there was no protective cover over the smoking area to protect R29 from rain and snow.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to attempt a voiding trial and to discontinue an indwelling urinary catheter after multiple urinary tract infections for one of one resident (Resident (R)11) reviewed for urinary catheters out of a total sample of 31 residents. This failure increased the risk of continued urinary tract infections and antibiotic usage.

Inspectors wroteBased on facility provided staffing documentation and interview, the facility failed to have a Registered Nurse (RN) for at least 8 consecutive hours a day, 7 days week. This was evident for 4 of 56 days reviewed during an annual survey.

Inspectors wroteBased on interview, record review and policy review, the facility failed to ensure medication regimens was free from unnecessary medications. The facility failed to ensure an as needed (PRN) psychotropics were not prescribed beyond 14 days without documented rational, for one (Resident (R)17) of five residents reviewed for unnecessary medications.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to obtain a urology consult timely to assess the continued need for an indwelling urinary catheter for one of one resident (Resident (R)11) reviewed for indwelling urinary catheters out of a total sample of 31 residents. This failure resulted in the continued use of an indwelling urinary catheter without an appropriate indication for the catheter.

Inspectors wroteBased on medical record review and interview, it was determined the facility failed to maintain complete and accurate medical records in accordance with accepted professional standards (Resident #19, #45 and #62). This was evident for 3 of 33 residents reviewed during an annual survey.

Inspectors wroteBased on observation, interviews, document review and record review, the facility failed to ensure a resident's bed was inspected and maintained for one (Resident (R) 2) of 31 residents in the sample.

Inspectors wroteBased on medical record review, interview and observation, it was determined the facility staff failed to promote care for residents in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individuality by labeling a resident as feeder on the July 2019 order summary sheet. This was evident for 1 of 4 residents (Resident #42) reviewed for dignity during the annual survey.

Inspectors wroteBased on observation, medical record review and interview it was determined the facility staff failed to honor residents' right to form advanced directives concerning life sustaining treatments. This was evident for 3 of 4 residents (Resident #25, #52 and #54) selected for review of advanced directives.

Inspectors wroteBased on medical record review and interview with the facility staff, it was determined that the facility failed to provide timely notification to a resident or representative (RP) regarding notification and explanation of their rights regarding a pending discharge from Medicare covered services. This was evident in 3 of 3 residents (Resident #128, #129 and #66), reviewed regarding liability notices.

Inspectors wroteBased on interviews and observation of residents rooms during a tour of the facility on the 300 hundred wing revealed residents' rooms were not being maintained at comfortable temperatures between 71° to 81° Fahrenheit. This was observed in 4 resident rooms.

Inspectors wroteBased on observation, medical record review and interview with facility staff it was determined that the facility failed to have a system in place to identify and assess the side rails on the residents' beds. This was evident on the observation of 3 of 3 beds (Resident #52, #26 and #57) were side rails were covering the length of the bed that could not be lowered by the residents.

Inspectors wroteBased on administrative documentation, medical record review, and staff interview it was determined the facility failed to report an allegation of neglect to the state survey and certification agency in a timely manner. This was found to be evident for 1 out of 1 resident (Resident #228) reviewed during the investigative stage of the survey.

Inspectors wroteBased on medical record review and interview with staff it was determined that the facility failed to have a system in place to ensure the resident, or their responsible party 1.) was notified in writing of the reason a resident's was transferred to the hospital (Resident #69); and 2.) received written notification of a transfer to the hospital, including appeal rights and ombudsman contact information (Resident #45). This was found to be evident for 2 out of 2 residents reviewed for hospitalization during the investigation stage of the survey.

Inspectors wroteBased on medical record review and interview with facility staff, it was determined that the facility staff failed to ensure a resident's Preadmission Screening and Resident Review (PASARR) form was completed correctly on readmission to the facility. This was evident during the review of 1 of 1 resident (Resident #51) reviewed for PASARR screening.

Inspectors wroteBased on medical record review and interview with facility staff, it was determined that the facility failed to develop person-centered individualized comprehensive care plan as evidenced by failure to develop a care plan to address: 1.) three residents identified as having restraints (Resident #52, #25 and #57); 2.) activities (Resident #45). This was evident during the review of 4 of 25 residents during the investigative portion of the survey.

Inspectors wroteBased on medical record review and interview with facility staff, it was determined that the facility failed to revise care plans related to: 1.) a resident's repeated falls; 2.) a resident's visual needs; 3.) pain management and 4.) care plan updates hospitalization. This was evident during the review of 4 of 25 residents (Resident #52, #57, #70, and #43) reviewed during the investigative portion of the survey.

Inspectors wroteBased on observations of residents, review of medical records and staff interview it was determined that the facility staff failed to ensure residents are provided with activities that meet the resident's needs based on their assessment. This was evident for 1 out of 6 residents (Resident #45) reviewed for activity during the investigation stage of the survey

Inspectors wroteBased on medical record review and interview with facility staff, it was determined that the facility attending physician failed to: 1.) document procedural treatments rendered to a resident and 2.) document an updated and complete assessment of a resident's medication for 11 months. This was evident during the review of 2 of 25 residents (Resident #52 and #70) reviewed during the investigative portion of the survey.

Inspectors wroteBased on observation, medical record review and staff interview it was determined the facility staff failed to only administer ordered medications. This was evident for 1 of 6 residents (Resident #5) observed during the medication administration task during the annual survey.

Inspectors wroteBased on observation and staff interview , it was determined that the facility had not properly labeled and dated leftover food that was in the refrigerator. This was true of 1 out 2 observations made in the kitchen's walk-in refrigerator. This deficient practice can impact all residents and the facility's infection control practices.

Inspectors wroteBased on observation and staff interview it was determined the facility staff failed to clean hands between residents during medication pass observation. This was evident for 4 of 6 residents observed during the medication pass task.

Inspectors wroteBased on observation, resident and staff interview and review of facility documentation, it was determined that the facility failed to maintain an effective pest control program. This was evident on 3 out of 4 nursing units and has the ability to impact all residents, staff and visitors in the facility.