Denver North Care Center

Inspectors wroteBased on observations and interviews, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in the main kitchen. Specifically, the facility failed to ensure:-Staff performed hand hygiene was conducted during dishwashing, and, -The food preparation area was clean and sanitary.

Inspectors wroteBased on observations and interviews, the facility failed to remove medications and biologicals that were stored and labeled properly according to professional standards in two of two medication rooms, two of four medication carts and two of four vaccination refrigerators. Specifically, the facility failed to ensure expired medications were removed from the medication room, medication carts, vaccination refrigerator and medication refrigerator.

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 one of two units. Specifically, the facility failed to:-Ensure housekeeping staff cleaned resident rooms in a hygienic manner;-Ensure housekeeping staff disinfected high-touch areas (call lights, door handles and handrails) when cleaning residents' rooms;-Ensure dwell times were followed during room cleaning;-Ensure staff wore personal protective equipment (PPE) while providing wound care to residents;-Ensure hand sanitizer was not expired;-Ensure staff performed hand hygiene while providing wound care to residents;-Ensure a clean field was created for wound care supplies; and,-Ensure staff performed hand hygiene during meals.

Inspectors wroteBased on record review and interviews, the facility failed to provide response, action and rationale to residents involved in group grievances. Specifically, the facility failed to effectively address, resolve and demonstrate the facility's response to grievances identified during resident council.

Inspectors wroteBased on record review and interviews, the facility failed to inform two (#14 and #27) of four residents reviewed for beneficiary notices and appeal rights out of 38 sample residents of changes in their services covered by Medicare in a timely manner. Specifically, the facility failed to provide written notification of a Medicare Non-Coverage letter (NOMNOC) to the resident's representative that Medicare-covered services were ending for Resident #14 and Resident #27 in a timely manner.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#24) of five residents were free from chemical restraints and were receiving the least restrictive approach for their needs out of 34 sample residents. Specifically, the facility failed to ensure evidence was present that indicated Resident #24 had an increase in behaviors that warranted an increase in antipsychotic medication increases.

Inspectors wroteBased on record review and interviews, 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 (#39) of two residents reviewed for PASRR out of 38 sample residents. Specifically, the facility failed to arrange and incorporate recommendations from the PASRR Level II notice of determination (NOD) for Resident #39.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#24) of five residents received medically related social services out of 38 sample residents. Specifically, the facility failed to:-Assist Resident #24 with obtaining a designated representative who could assist the resident with making choices; and,; -Ensure Resident #24 had the ability to give informed consent to psychoactive medications.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents were provided adequate hydration for one (#11) of two residents reviewed for hydration out of 38 sample residents. Specifically, the facility failed to provide drinks during meal time and provide fluids throughout the day for Resident #11.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure two (#6 and #9) of three residents reviewed for abuse out of 11 sample residents were kept free from abuse. Specifically, the facility failed to protect Resident #6 and Resident #9 from physical and verbal abuse from Resident #7.

Inspectors wroteBased on record review and interviews, the facility failed to provide the necessary behavioral health care and services to attain and maintain the highest practicable physical, mental and psychosocial well-being for one (#1) of two residents reviewed out of 11 sample residents. Specifically, the facility failed to implement person centered interventions to address Resident #1's pattern of escalating behaviors.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to ensure food was stored, prepared and served under sanitary conditions in one kitchen. Specifically, the facility failed to ensure: -Cutting boards were free from deep scratches and stains; -Frozen food thawing process was followed; and, -Beard restraints were worn in kitchen areas while preparing food.

Inspectors wroteBased on observations and staff interviews, the facility failed to maintain a sanitary, orderly and comfortable environment for residents in 14 of 40 resident rooms in six hallways. Specifically, the facility failed to ensure walls, floors, baseboards, doors and ceilings were properly maintained and rooms were free of trash and floors deep cleaned.

Inspectors wroteBased on record review and interviews, the facility failed to ensure five (#56, #34, #3, #45 and #128) of six residents were free from unnecessary psychotropic medications out of 27 sample residents. Specifically, the facility failed to: -Implement effective individualized behavior monitoring in the medical record and follow physician orders to determine the efficacy of psychoactive medications for Residents #56, #34, #3 and #128; -Track behaviors of sexual aggression for Resident #128; and, -Update behavior tracking to reflect an increase in an antipsychotic medication for Resident #45.

Inspectors wroteBased on observation and staff interviews, the facility failed to provide a safe, 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 in the shower on the 100 hall, increasing the risk of contamination to the facility's main water supply.

Inspectors wroteBased on interviews and record review, the facility failed to ensure each resident was being screened for a mental disorder prior to admission or that residents identified with a mental disorder were evaluated to receive care and services in the most integrated setting to meet their needs for one (#9) of four residents reviewed out of 27 sample residents. Specifically, the failed failed to: -Notify the State Mental Health Agency Resident #9 had exceeded the 60 day convalescent preadmission screening and resident review (PASRR) period; and, -Submit a new PASRR to the State Mental Health Agency for Resident #9 to determine if a level II evaluation was needed.

Inspectors wroteBased on interviews and record review, the facility failed to notify the state mental health agency promptly after a significant change in the mental condition of two (#45 and #128) of five residents out of 27 sample residents. Specifically, the facility failed to: -Notify the State Mental Health Agency of Resident #128 necessity for inpatient psychiatric hospitalizations; and, -Notify the State Mental Health Agency of Resident #45's suicide attempt and physical aggression towards others.

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure one (#3) of six residents reviewed for medication administration received treatment and care in accordance with professional standards of practice out of of 27 sample residents. Specifically, the facility failed to ensure that Resident #3 was not administered an expired inhaler as identified by the manufacturer's directions.

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide appropriate treatment and services to maintain or improve the ability to perform activities of daily living (ADLs) for one (#3) of two residents reviewed for ADLs out of 27 residents. Specifically, the facility failed to provide supervision, oversight, encouragement and cueing with personal hygiene for Resident #3.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure three (#60, #25 and #3) out of 27 sample residents remained free of accident hazards and received adequate supervision to prevent accidents. Specifically, the facility failed to: -Assess Resident #60 and #25's bolstered mattresses to ensure they remained free of accident hazards; and, -Provide supervision to Resident #3, who was a supervised smoker.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents who needed respiratory care were provided such care, consistent with professional standards of practice for one (#33 and #62) of three residents reviewed for the use of supplemental oxygen of 27 sample residents. Specifically, the facility failed to: -Have an oxygen order in place for an individual requiring supplemental oxygen to include correct liter flow for Resident #33; and, -Ensure oxygen was provided as ordered for Resident #62.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#45) of three 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 27 sample residents. Specifically, the facility failed to ensure Resident #45 who expressed suicidal ideations was assessed and provided psychosocial support.

Inspectors wroteBased on interview and record review, the facility failed to test residents, facility staff, and individuals providing services under arrangement and volunteers, for COVID-19. This had the potential to affect all 77 residents residing in the facility at the time of the survey. Specifically, the facility failed to ensure: -Rapid point-of-care (POC) tests for COVID-19 were consistently conducted and documented on staff prior to the start of their shift, based on the facility's county positivity rate and outbreak status; and -Polymerase chain reaction (PCR) testing was conducted on all staff based on the county positivity rate and outbreak status. Cross reference F888 (COVID-19 staff vaccination matrix) and F880 (Infection control).

Inspectors wroteIII. Resident #41 A. Resident status Resident #41, age [AGE], was admitted on [DATE]. According to the September2022 computerized physician orders (CPO), the diagnoses included type two diabetes mellitus, history of stroke, weakness on the right side, dysphagia (swallowing difficulty) and dementia with behavioral disturbance. The 8/4/22 minimum data set (MDS) assessment revealed the resident was cognitively impaired, he was rarely understood, and a brief interview for mental status score was not conducted. He required extensive assistance for most activities of daily living (ADLs). B. Record review The code status for Resident #41 was not listed on the front page of the electronic medical record. The binder at the nurses station contained a paper copy of the MOST form for Resident #41. The form read no CPR for the resident and only selective treatments. [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure six (#47, #27, #30, #41, #43, and #50) of eleven residents were free from unnecessary psychotropic medications out of 36 sample residents. Specifically, the facility failed to: -Identify and monitor targeted behaviors for psychotropic medications for Resident #47, #27, #30, #41, #43, and #50; and, -Ensure consents were obtained and contained black box warnings for the usage of psychotropic medications for Resident #47, #27, #30, #41 and #43.

Inspectors wroteBased on observations, interviews, and record review the facility failed to store, prepare, distribute, and serve food in a sanitary manner in the main kitchen. Specifically, the facility failed to: -Ensure food was labeled and dated; and, -Ensure holding temperatures of food were within the safe range.

Inspectors wroteBased on observations, record review and interviews, the facility failed to develop and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infection for three out of four units. Specifically, the facility failed to: -Ensure proper hand hygiene was offered to residents prior to meals; and, -Ensure proper wearing of masks for staff.

Inspectors wroteBased on observations, record review and interviews, the facility failed to develop and implement a COVID-19 staff vaccination process to address all facility staff, including agency staff who provided care, treatment and other services to facility and/or residents. Specifically, the facility failed to obtain the vaccination status of other outside providers. The facility did not have the vaccination status for all of the outside providers. The facility was unable to provide a listing of the vaccination status of all contracted providers/staff who enter the facility on a regular basis and provide direct care to residents. Cross-reference F886 (COVID-19 testing), and F880 (Infection control).

Inspectors wroteBased on observations and interviews, the facility failed to ensure care for residents was provided in a manner and in an environment that maintained or enhanced the residents' dignity and respect in full recognition of their individuality for two (#3 and #274) residents of five residents reviewed for dignity out of 36 sample residents. Specifically, the facility failed to: -Ensure Resident #3 had the right to a dignified existence and the ability to exercise self-determination by neglecting to support and honor the resident's status as a transgender female; and, -Assist Resident #274 with the organization of his personal items. Two weeks after admission, the resident's television (TV) was not properly mounted and he was not able to use it. In addition, he was not offered any linens for his mattress, and slept on top of the uncovered mattress.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to provide necessary care and services for residents who were unable to carry out activities of daily living for two (#41 and #275) of six residents reviewed for activities of daily living of 36 sample residents. Specifically, the facility failed to: -Establish an effective communication system for Resident #41 in order to provide him with services; and, -Provide nail care to Resident #275.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#274) out of 36 sample residents reviewed for fecal incontinence and constipation received appropriate treatment and services to maintain normal bowel function as much as possible. Specifically, the facility failed to follow bowel protocol for Resident #274 who was at risk for constipation.

Inspectors wroteBased on observation, record review and interviews, the facility failed to establish a communication process with the hospice provider, including how the communication would be documented between the facility and the hospice provider for one (#274) resident reviewed for hospice care and services out of 36 sample residents. Specifically, the facility failed to collaborate with hospice for the development, implementation and revision of the coordinated plan of care for Resident #274.