El Dorado Care and Rehab

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a vegetarian diet to meet the resident's nutritional needs and failed to initiate weight loss interventions for R31, to prevent a significant weight loss of 16.30 percent (%) in 19 days. Additionally, the facility failed to provide R2 with a breakfast meal on scheduled dialysis (procedure where impurities or wastes were removed from the blood) treatment days, to meet R2's nutritional needs.

Inspectors wroteBased on record review and interview, the facility failed to submit complete and accurate staffing information through the Payroll Based Journal (PBJ) as required. This deficient practice placed the residents at risk for unidentified and ongoing inadequate nurse staffing.

Inspectors wroteBased on interviews, observation, and record review, the facility failed to utilize Enhanced Barrier Precautions (EBP-infection control interventions designed to reduce transmission of resistant organisms which employ targeted gown and glove use during high contact care) when providing wound care to a Resident (R) 2 with a Foley catheter (tube inserted into the bladder to drain urine into a collection bag), colostomy (surgical creation of an artificial opening on the stomach wall to excrete feces from the body), and a hemodialysis port (a subcutaneous vascular access device placed under the skin to provide long-term access for hemodialysis {procedure where impurities or wastes were removed from the blood}). The facility further failed to ensure adequate hand hygiene during care for R43, R31 and R8.

Inspectors wroteBased on observation, interview and record review the facility failed to store and label biologicals adequately when staff failed to date an insulin (medications used to treat high blood glucose levels) pen when opened and failed to remove or dispose of four expired bottles of stock medications. This deficient practice placed the residents at risk to receive expired, ineffective insulin and other residents at risk to receive expired ineffective stock medications.

Inspectors wroteBased on observation, record review, and interview the facility failed to prepare and serve food under sanitary conditions to prevent the potential for food borne bacteria and illness.

Inspectors wroteBased on observation and interview, the facility failed to promote dignity for one resident, Resident (R) 36, whose were exposed to other residents when his pants started to fall.

Inspectors wroteThe facility reported a census of 43 residents; 14 residents were sampled for advanced directives (a written document, which indicates the medical decisions for health care professionals when the person could not make their own decisions). Based on interview and record review, the facility failed to ensure one resident's advanced directives were honored. Resident (R) 8's completed do not resuscitate (DNR- or no code, a legal document or order that means the person does not desire resuscitative measures) order was discontinued on [DATE].

Inspectors wroteBased on observation, interview, and record review the facility failed to identify, monitor, and respond to an injury of unknown origin/skin condition identified as and abrasion and redness on Resident (R) 8's forehead.

Inspectors wroteBased on record review and interviews, the facility failed to provide written notification of a bed hold for a facility-initiated transfer for Resident (R) 5 when they were transferred to the hospital and failed to notify the State Long Term Care Ombudsman (LTCO) of facility-initiated transfers/discharges for R5.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide consistent bathing for two residents, Resident (R) 22 and R37. The facility failed to provide grooming for R43, who had facial hair and dirty fingernails.

Inspectors wroteBased on interview and record review, the facility failed to ensure dependent Resident (R) 43 received staff assistance in placing his hearing aids, which placed the resident at risk for social isolation, mental decline, and loss of independence.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide adequate supervision to ensure a safe environment for one resident, Resident (R) 22, who had multiple falls in the facility dining room, and failed to follow her plan of care.

Inspectors wroteBased on observation, record review and interview, the facility failed to facilitate the necessary dental care services for Resident (R)1.

Inspectors wroteThe facility had a census of 43 residents. The sample included 14 residents. Based on observation, record review, and interview, the facility failed to meet the nutritional needs of residents in accordance with established national guidelines, placing the residents at risk for unmet nutritional needs.

Inspectors wroteThe facility reported a census of 37 residents. The sample included eight residents who were reviewed for misappropriation. Based on observation, interview, and record review, the facility failed to ensure Resident (R)1, R2, and R3 remained free from misappropriation when staff wrote checks and forged signatures to cash the checks without appropriate authorization.

Inspectors wroteThe facility reported a census of 34 residents with 14 residents selected for review, which included one resident reviewed for self-determination. Based on observation, interview, and record review, the facility failed to ensure one Resident (R)5, received appropriate preparations for his scheduled surgery.

Inspectors wroteThe facility reported a census of 34 residents. The sample of 14 residents included three residents reviewed for respiratory care. Based on observation, interview, and record review, the facility failed to provide two Residents (R), R27 and R 3, who required respiratory care, including tracheostomy (opening through the neck into the trachea through which an indwelling tube may be inserted) care and tracheal suctioning, provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals and preferences related to the storage of suctioning cannulas/tubing to when not in use to prevent infection and cross contamination to prevent infection.

Inspectors wroteThe facility reported a census of 34 residents. The sample of 14 residents included five residents reviewed for unnecessary medications. Based on observations, interviews, and record review, the facility failed to ensure medications monitored and administered to treat Resident (R)19's heart failure.

Inspectors wroteThe facility reported a census of 34 residents. Based on observation, record review, and interview, the facility failed to ensure foods were stored, prepared, and distributed in a manner to prevent foodborne illness to the residents.

Inspectors wroteThe facility reported a census of 34 residents with 14 residents selected for review. Based on observation, interview, and record review, the facility failed to ensure staff provided incontinence care in a manner to prevent the spread of infection for one Resident (R)13 with an open wound on her sacrum (large triangular bone between the two hip bones).

Inspectors wroteThe facility reported a census of 34 residents. Based on observation and interview, the facility failed to maintain patient care equipment in safe operating conditions to ensure two residents, Resident (R)82 and R2's commode grab bars and over the toilet commode.

Inspectors wroteThe facility reported a census of 37 residents. The sample included four residents sampled for quality of care. Based on observation, interview, and record review, the facility failed to ensure that three Residents(R)2, R 3, and R 4, received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and/or the residents' choices, related to skin treatments for ostomies (an artificial opening in an organ created during an operation as ordered by the physician.

Inspectors wroteThe facility reported a census of 37 residents. The sample included four residents sampled for procedures of following physician orders. Based on observation, interview, and record review, the facility failed to ensure three Residents(R)2, R 3, and R 4, received treatment and care in accordance with physician's orders related to skin treatments for ostomies (an artificial opening in an organ created during an operation as ordered by the physician).

Inspectors wroteThe facility reported a census of 35 residents. Based on observation and interview the facility failed to ensure a safe, clean, and homelike environment for the residents in the facility beauty shop, a resident hallway, the quiet room, and in the dining room.

Inspectors wroteThe facility reported a census of 35 residents. Based on observation and interview, the facility failed to ensure an environment as free of accident hazards as possible when the facility failed to ensure portable oxygen tanks were kept in a secure upright position.

Inspectors wroteThe facility reported a census of 35 residents with 16 residents sampled. The facility failed to complete a baseline care plan to include the need for assistance with oral hygiene needs for one (R)137 sampled resident.

Inspectors wroteThe facility reported a census of 35 residents with 16 residents sampled, including four residents reviewed for Activities of Daily Living (ADL). Based on observation, interview, and record review, the facility failed to provide adequate hygiene cares for two fo the four sampled residents including: dependent Resident (R)137, regarding oral hygiene cares and R31 with grooming of facial hairs.

Inspectors wroteThe facility reported a census of 35 residents with 16 residents sampled, including one resident reviewed for wheelchair positioning. Based on observation, interview, and record review, the facility failed to provide adequate body alignment of foot support for the one sampled dependent Resident (R)20, while in her wheelchair.

Inspectors wroteThe facility reported a census of 35 residents with 16 selected for review which included four residents reviewed for urinary catheter/urinary tract infection. Based on observation, interview and record review, the facility failed to ensure secure placement of a urinary catheter for one Resident (R)31 of the four residents reviewed.

Inspectors wroteThe facility reported a census of 35 residents with 16 residents sampled, including one resident reviewed for tube feeding and weight. Based on observation, interview and record review, the facility failed to ensure staff gave the correct higher calorie physician ordered formula to the one sampled tube feeding Resident (R)137, which resulted in a 4.07% (percent) weight loss.

Inspectors wroteThe facility reported a census of 35 residents with 16 residents sampled, including one resident reviewed for respiratory. Based on observation, interview, and record review, the facility failed to ensure a clean, sanitary storage of the one sampled Resident's (R)11 bilevel positive airway pressure mask (BIPAP-a device that helps with breathing), to prevent respiratory infections.

Inspectors wroteThe facility reported a census of 35 residents with 16 selected for review which included six residents reviewed for unnecessary medications. Based on observation, interview and record review, the facility failed to ensure staff followed medication administration holding parameters for one of the six sampled residents, Resident (R)25.

Inspectors wroteThe facility reported a census of 35 residents with 16 selected for review which included six residents reviewed for unnecessary medications. Based on observation, interview and record review, the facility consulting pharmacist failed to identify the lack of the facility following physician order parameters for holding the administration of antihypertensive medications for one Resident (R)25, of the six residents reviewed for unnecessary medications.

Inspectors wroteThe facility reported a census of 35 residents. Based on observation and interview the facility failed to post actual hours worked by the nursing staff as required.