Discovery Rehabilitation and Living

Inspectors wroteBased on observation, interview, policy review, and review of the Idaho Food Code, the facility failed to appropriately store, distribute, and label foods. This deficient practice had the potential to affect all residents who received meals prepared in the facility's kitchen. This placed residents at risk for potential contamination and use of spoiled foods, and adverse health outcomes including food-borne illnesses.

Inspectors wroteBased on record review, policy review, and interview, it was determined the facility failed to ensure a baseline care plan was developed within 48 hours of resident's admission. This was true for 1 of 3 residents (Resident #36) reviewed for baseline care plan. This failure created the potential for harm when the care plan failed to provide direction for care.

Inspectors wroteBased on observation, record review, and interviews, it was determined the facility failed to provide respiratory services as ordered by the physician. This was true for 2 of 4 residents (#5 and #15) whose records were reviewed for respiratory services. This failure created the potential for residents to experience increased fatigue and low oxygen levels.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure medications available for residents were stored appropriately and not expired, this was true for 1 of 1 for medication carts audited and 1 of 1 treatment carts audited for labeling and storage of medication. This failure created the potential for residents to have missed doses of medication, created the potential for harm to a resident if they were to obtain medications which were left unattended and unsecured by staff, and to receive expired medications with decreased efficacy.

Inspectors wroteBased on observation, interview, and U.S. Food and Drug Administration 2022 Food Code review, the facility failed to ensure garbage cans were properly closed with lids to minimize attracting pests and rodents into the kitchen. This deficient practice had the potential to affect all residents and staff in the facility.

Inspectors wroteBased on observation, document reviews, and staff interview, it was determined the facility failed to ensure infection control prevention practices were maintained to provide a safe and sanitary environment. These failures had the potential to impact all residents in the facility by placing them at risk for cross contamination and infection.

Inspectors wroteBased on observation, staff interview, and policy review, it was determined the facility failed to ensure food was stored in a safe and sanitary manner. This deficient practice had the potential to affect the 31 residents residing in the facility who consumed food prepared by the facility. This placed residents at risk for potential contamination of food and adverse health outcomes, including food-borne illnesses.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure residents were provided with a safe, clean, and homelike environment. This was true for 1 of 1 shower/tub room observed. This deficient practice created the potential for harm if: a) the holes in the floors caused a resident to fall and b) cross-contamination from spread of microorganisms.

Inspectors wroteBased in policy review, observation, and staff interview, it was determined the facility failed to ensure respiratory equipment was changed and stored as indicated. This was true for 1 of 2 residents (Resident #2) observed for respiratory equipment. This created the potential for respiratory infections due to growth of pathogens (organisms that cause illness) in respiratory treatment equipment.

Inspectors wroteBased on observation, policy review, and resident and staff interview, it was determined the facility failed to ensure resident meals were palatable and maintained their correct temperature. This directly impacted 7 residents (#2, #3, #5, #8, #14, #16, and #28) who were interviewed about food services, and had the potential to affect all 31 residents who dined in the facility. This failed practice had the potential to negatively affect residents' nutritional status and psychosocial well-being.

Inspectors wroteBased on observation, policy review, and staff interview, the facility failed to ensure adherence to infection control and prevention practices to provide a safe and sanitary environment when, 1. staff did not clean resident's equipment properly, 2. perform hand hygiene, 3. change gloves when going from dirty to clean areas, and 4. hairnet and glove use in the kitchen.

Inspectors wroteBased on policy and record review, and staff interview it was determined the facility failed to ensure pertinent health information was provided to the receiving hospital for 1 of 1 resident (Resident #20) reviewed for transfers/discharge. This deficient practice had the potential to result in adverse outcomes if residents were not treated in a timely manner due to a lack of information provided upon transfer.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to ensure a bed hold notice was provided to residents or their representatives upon transfer to the hospital. This was true for 1 of 1 resident (Resident #20) reviewed for transfer/discharge. This deficient practice created the potential for harm if residents were not informed of their right to return to their former bed/room at the facility within a specified time.

Inspectors wroteBased on observation, record review, and staff interview, the facility failed to follow physician's orders for 1 of 4 residents (Resident #8) for Occupational Therapy (OT), Physical Therapy (PT), and Speech Therapy (SP) to evaluate and treat as needed. This failure created the potential for harm, adverse outcomes, and reduced opportunity for independence when residents did not receive ordered specialized therapy treatment.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure resident's care plans were revised to reflect current needs and interventions. This was true for 2 of 13 residents (Resident #5 and #8) whose care plans were reviewed. This placed residents at risk of adverse outcomes if care and services were not provided due to care plans not being revised as residents' needs changed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain physician's orders for 1. diabetic toenail and fingernail checks and 2. follow care plan for wound care for 1 of 4 residents (Resident #8). This deficient practice created the potential for harm or adverse outcomes related to diabetic skin and nail infection, skin breakdown, and development of pressure ulcers.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure medications available for residents were labeled and had not expired. This was true for 1 of 1 medication carts inspected. This failure created the potential for residents to receive medication used for another resident, presenting a risk for cross-contamination or to receive expired medications, with decreased efficacy.

Inspectors wroteBased on observation and interviews, it was determined the facility failed to ensure all call light strings in resident restrooms were proper length and easily accessible to residents. This issue was observed for 1 of 12 residents (Resident #8) call lights. This failure had the potential for harm if residents were not able to summon staff for assistance.

Inspectors wroteBased on observation and interview, the facility failed to provide accessible closet doors handles in all resident rooms to meet their physical needs. This was true for 1 of 12 residents (Resident #8) whose closet door handles were 58 inches high, and not accessible from a wheelchair. This deficient practice had the potential to cause harm and distress for residents wanting to remain independent.

Inspectors wroteBased on observation, policy review, and staff interview the facility failed to ensure staff provided meal service according to the facility's posted meal time schedule. This failure resulted in residents in the dining rooms having to wait 30 minutes to an hour before being served, which placed residents at risk for decreased quality of life and potential nutritional issues.

Inspectors wroteBased on policy review, record review, and staff and resident interview, it was determined the facility failed to ensure residents' advance directives were obtained and documented in their records. This was true for 5 of 12 residents (#6, #19, #25, #26, and #179) whose advance directives were reviewed. This deficient practice created the potential for harm or adverse outcomes if the residents' wishes were not followed or documented regarding their advance care planning.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure the medication error rate was less than 5%. This was true for 7 of 24 medications (29.17%) which affected 6 residents. (#6, #14, #18, #23, #26, and #179) whose medication administration was observed. This failed practice placed residents at risk of not receiving the prescribed dosage of their medication.

Inspectors wroteBased on observation, policy review, record review, and resident and staff interview, it was determined the facility failed to ensure residents were treated with dignity and respect. This was true for 2 of the 2 residents (Resident #23 and #26) reviewed for respect and dignity. This deficient practice placed Resident #23 and #26 at risk of embarrassment and diminished sense of self-worth.

Inspectors wroteBased on record review, policy review and staff interview, it was determined the facility failed to ensure a resident's representative was immediately notified when the resident had a significant change in condition. This was true for 1 of 1 resident (Resident #28) reviewed for notification of change in condition. This deficient practice placed Resident #28 at risk for harm due to lack of advocacy and support from their representative.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to complete comprehensive MDS assessments when one resident experienced a significant change in mental health and functional status. This was true for 1 of 12 residents (#13) reviewed for the comprehensive MDS assessment process. This failure had the potential for harm if facility staff did not recognize significant changes in the resident's health status and needs.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure Preadmission Screening and Resident Review (PASRR) were complete when the resident's mental condition changed. This was true for 1 of 2 residents (#13) whose PASRR records were reviewed. This deficient practice had the potential to cause harm if residents' specialized services for mental health needs were not provided due to a lack of updated screening.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents' care plans were revised and updated as needed. This was true for 3 of 12 residents (#10, #19, and #25) whose care plans were reviewed. This created the potential for harm if care and/or services were not provided appropriately due to inaccurate information in the care plan.

Inspectors wroteBased on observation, policy review, record review, and staff interview, it was determined the facility failed to ensure residents were provided with showers and nail care consistent with their needs. This was true for 1 of 3 resident's (Resident #19) reviewed for ADLs. This failure created the potential for residents to experience embarrassment, isolation, decreased sense of self-worth, and skin impairment due to a lack of personal hygiene.

Inspectors wroteBased on observation, policy review, record review, and resident and staff interview, it was determined the facility failed to ensure adequate monitoring for residents with a wander guard (device a resident who wanders and is at risk for elopement wears that actvates an alarm to alert staff if the resident attempts to leave the building unattended). This was true for 1 of 1 resident (Resident #25) reviewed for elopement. This deficient practice placed Resident #25 at risk for harm should the resident elope and have an accident.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure residents who required enteral feeding received appropriate care and services to prevent complications for 1 of 1 resident (Resident #23) reviewed for the use of a feeding tube. This created the potential for complications from improper tube feeding practices.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure a resident received oxygen therapy per physician orders. This was true for 2 of 2 residents (#13 and #15) reviewed for respiratory care. This failure put resident #13 and Resident #15 at risk for hypoxia (below-normal levels of oxygen in the blood) when the physician order was not followed.

Inspectors wroteBased on observation, policy review, record review, and staff interview, it was determined the facility failed to ensure nurse staffing information was posted daily for each shift and kept for review for 18 months. This failed practice had the potential to affect the 30 residents residing in the facility and their representatives, visitors, and others who wanted to review the facility's staffing levels.

Inspectors wroteBased on observation, record review, policy review, and resident and staff interview, it was determined the facility failed to ensure residents were monitored appropriately and offered non-pharmacological interventions while receiving opioid pain medications. This was true for 2 of 5 residents (#10 and #26) reviewed for unnecessary medications. This failure created the potential for residents to experience adverse reactions due to a lack of appropriate monitoring or experienced increased pain due to not offering non-pharmacological interventions.

Inspectors wroteBased on observation, staff interview, and policy review, it was determined the facility failed to ensure a nutritional assessment was completed. This was true for 1 of 2 residents (Resident #179) whose records were reviewed for nutritional assessments. This failure had the potential for residents to experience malnutrition.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to ensure an effective communication plan was established between the Hospice agency and the facility. This was true for 1 of 1 resident (Resident #179) whose record was reviewed for hospice services. This had the potential for inadequate end of life care due to lack of communication and advocacy on behalf of the facility.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure infection control and prevention practices were maintained to provide a safe and sanitary environment when staff did not perform proper hand hygiene and follow proper handling of medications. This was true for 2 of 9 residents (Resident #14 and #23) observed during cares, and medication pass. These failures had the potential to impact all residents in the facility by placing them at risk for cross contamination and infection.