Elderwood of Uihlein at Lake Placid

Inspectors wroteBased on observation, record review, and interviews conducted during the recertification survey, the facility did not ensure drugs and biologicals were labelled and stored in accordance with professional standards of practice. Specifically, (a.) an opened medication bottle had an expired date; (b.) opened medication bottles had no open dates (c.) opened insulin pens were labeled with incorrect expiration dates; (d.) a pre-poured medication cup was noted at a resident's bedside. This was evident for 2 out of 3 medication carts reviewed. This is evidenced by: The facility's Policy and Procedure titled, Medications Administration Methods, date last modified: [DATE] documented under PRODCEDURE #5: Medications may not be pre-poured/pre-punched. #6: Medication expiration dates are checked prior to administration. [...]

Inspectors wroteBased on observation and interviews during the recertification survey, the facility did not ensure food was stored, prepared, distributed or served in accordance with professional standards for food service safety for the main kitchen and one of 3 resident unit kitchenettes. Specifically, appliances and surfaces were not clean. This is evidenced by: During observations on 09/24/2024 at 11:04 AM, in the main kitchen, the following appliances or surfaces were soiled with food particles or oily dust: • Slicer • Cooking line drawers • Bulk food bins • Cupboard doors • 2 exterior windows (windows, windowsills, window screens) • 2 exterior window fan grills • ABC-rated fire extinguisher During observations on 09/24/2024 at 11:56 AM, in the Unit Four Resident Kitchenette, the following was soiled with food particles: [...]

Inspectors wroteBased on observation and interviews during the recertification survey, the facility did not dispose of garbage and refuse properly. Specifically, the side doors to the two outdoor garbage dumpsters were not closed, the sides of the dumpsters below the doors were soiled with food drips, and the grounds around dumpsters were littered. This is evidenced by: During observations on 9/30/2024 at 12:02 PM, litter was found in the outdoor employee break area, around the dumpsters, and the loading dock area. During an interview on 9/30/2024 12:27 PM, Administrator #1 stated that they would have the areas outside cleaned, and staff would be in-serviced on keeping the break area and dumpster area pick-up. 10 New York Codes, Rules, and Regulations 415.14(h)

Inspectors wroteBased on observation, record review, and interview conducted during the recertification survey, the facility did not ensure treatment with respect, dignity, and care for each resident in a manner and in an environment that promoted maintenance or enhancement of their quality of life, recognizing each resident's individuality for 3 (Resident #s48, 100 and 113) of 32 residents reviewed for dignity. Specifically, (a.) Resident #48 was administered an insulin shot in the resident common area during lunch; (b.) Resident #100 had their shirt on inside and backwards, and (c.) Resident #113 was seen in their room removing their pants with their room door open and in full view of the resident common area. This is evidenced by: A facility policy titled Dignity date modified 8/01/2019, documented that each resident had the right to be treated with dignity and respect. [...]

Inspectors wroteBased on observation, record review, and interviews during a recertification survey, the facility did not ensure a resident was assessed by the interdisciplinary team to determine a resident's ability to safely administer their own medications if clinically appropriate for 1 (Resident #73) of 32 residents reviewed. Specifically, Resident #73 was observed with topical pain medications in their room and there was no assessment and/or physician order for the resident to self-administer the medications. This is evidenced by: The Policy and Procedure titled, Self- Administration of Medication, revised 4/10/2018, documented residents who desired to self-administer medication were permitted to do so upon review and approval by the interdisciplinary care planning team members and with an order from the attending physician. [...]

Inspectors wroteBased on observation, record review, and interviews during the recertification survey, the facility did not provide necessary maintenance services to maintain a clean, sanitary, comfortable, and homelike environment relative to building #1. Specifically, the roof leaked. This is evidenced by: During observations on 09/27/2024 at 10:18 AM, evidence of roof leaks was found in the following areas: • Unit One data room had a large tarp hanging from the ceiling. • Unit One janitor closet had water-stained ceiling tiles. • Activities room had a water-stained ceiling tile. • Core area had 2 areas with drain hoses attached to ceiling tiles draining into catch-buckets. During an interview on 09/30/2024 at 2:02 PM, Administrator #1 stated that the facility is looking to secure a contractor and have the roof leaks repaired before winter. 10 New York Codes, Rules, and Regulations 415.5(h)(4)

Inspectors wroteBased on record review and interviews during a recertification survey, the facility did not ensure a Significant Change Minimum Data Set assessment was completed for 1 (Resident #128) of 1 resident reviewed. Specifically, a Significant Change Minimum Data Set assessment was not completed for Resident #128, when the resident was diagnosed with a left arm fracture on 4/11/2024, and the resident was no longer able to stand or walk on 4/12/2024. This is evidenced by: Cross-referenced to: F684: Quality of Care Resident #128 was admitted to the facility with diagnoses of rheumatoid arthritis, muscle weakness, and difficulty walking. The Minimum Data Set (an assessment tool) dated 8/7/2024, documented the resident was cognitively intact. The resident was able to make themselves understood and understand others. [...]

Inspectors wroteBased on record review and interviews during a recertification survey, the facility did not ensure patient centered care plans were reviewed and revised by the interdisciplinary team after each assessment in a timely manner for 2 (Resident #'s 128 and 2) of 32 residents reviewed. Specifically, the facility did not ensure A) Resident #128's care plan was reviewed and revised timely following a fall on 4/6/2024 and fracture diagnosed on [DATE] and B) Resident #2's care plan was reviewed and revised following resident-to-resident altercations on 7/01/2024, 7/08/2024 and 8/03/3024. This is evidenced by: Cross-referenced to: F684: Quality of Care, F637: [...]

Inspectors wroteBased on observations, interviews, and record review during the recertification survey, the facility did not ensure a dependent resident was provided with appropriate treatment and services to maintain or improve their language and communication for 1 of 1 resident (Resident #118) reviewed for Activities of Daily Living. Specifically, nursing staff did not provide Resident #118 with adequate, consistent interpreter services in accordance with professional standards of care. This is evidenced by: Resident #118 was admitted with diagnosis of stenosis of small artery (the walls of the small arteries in the heart aren't working properly); cervicalgia (pain in or around your spine beneath your head) and history of falls. The Minimum Data Set (an assessment tool) dated 9/2024, documented a Brief Interview for Mental Status indicated resident was cognitively intact. [...]

Inspectors wroteBased on record review and interviews during a recertification survey, the facility did not ensure a resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan and the resident's choices for 1 (Resident #128) of 1 resident reviewed for hospitalization. Specifically, the facility did not ensure Resident #128 received an assessment by a qualified person when they returned to the facility on 4/11/2024, following diagnosis and treatment of a left upper arm fracture in the Emergency Department. This is evidenced by: Resident #128 was admitted to the facility with diagnoses of rheumatoid arthritis, muscle weakness, and difficulty walking. The Minimum Data Set (an assessment tool) dated 8/7/2024, documented the resident was cognitively intact. [...]

Inspectors wroteBased on observations, record review, and interviews conducted during the recertification survey, the facility did not ensure that each resident received the necessary respiratory care and services that were consistent with professional standards of practice, for 2 (Resident #'s 29 and 35) of 2 residents reviewed for oxygen administration. Specifically, for Residents #29 and 35, their supplemental oxygen tubing was not dated and labeled to reflect when the tubing was changed. This is evidenced by: A review of the facility's policy and procedure titled Oxygen Therapy, Concentrator, last revised on 3/26/2018, documented that oxygen would be administered by licensed nurses with a physician's order. As part of the procedure nursing staff would label and date the tubing and all tubing would be changed at least weekly (7 days), or more often if soiling with secretions occurs. [...]

Inspectors wroteBased on observation, interview, and record review during the recertification survey, the facility did not ensure infection prevention control practices were followed to help prevent the spread, development, and transmission of communicable diseases and infection for all residents and staff on 4 of 4 units (Units #1, 2, 3, and 4) during the recertification survey. This is evidenced by: The facility's policy titled Infection Prevention Control Program dated 7/15/2024, documented that all department heads would ensure that the following procedures would be followed: 1. Staff were responsible for washing their hands frequently, especially after handling soiled or contaminated objects; before and after coming into contact with residents or handling possessions of resident, and handling equipment. 2. [...]

Inspectors wroteBased on interviews and record review conducted during recertification and abbreviated survey, the facility did not ensure that the development and implementation of comprehensive person-centered care plans included measurable objectives and timeframes to meet residents' medical, nursing, mental and psychosocial needs for 1 (Resident #42) of 31 residents reviewed for comprehensive care plans. Specifically, for Resident #42 , Certified Nurse Aide did not implement the intervention of geri sleeves prior to care which resulted in skin tear to resident's right forearm. This is evidenced by: [...]

Inspectors wroteBased on record reviews and interviews during a recertification survey, the facility did not develop and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that met professional standard of quality care for 3 (Resident #'s 2, 32, and #57) of 11 residents reviewed for baseline care plans. Specifically, for Resident #'s, 32 and #57, the facility did not ensure a baseline care plan was developed or completed within 48 hours of the residents' admission. This is evidenced by: The facility Policy and Procedure titled Care Plan - BASELINE last revised 2/15/2018, documented that the interdisciplinary team will develop a baseline care plan within 48 hours of admission which provides instructions for the provision of effective and person-centered care to each resident. Resident #2: [...]

Inspectors wroteBased on observation, interview and record review during the recertification survey and an abbreviated survey (Case #NY00280258), the facility did not ensure residents who were unable to carry out activities of daily living (ADLs) received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 2 (Resident #'s 37 and 40) of 3 residents reviewed for ADL's. Specifically, for Resident #'s 37 and 40, who were dependent on staff for ADL care, the facility did not ensure incontinence care was provided in accordance with the resident's care plan. This is evidenced by: The Policy and Procedure (P&P) titled ADL Assistance and Supervision dated 1/8/2018, documented the Unit Manager/designee would ensure that a plan of care for receiving ADL assistance and/or supervision was incorporated into the daily nursing care of each residents, if needed. [...]

Inspectors wroteBased on observation, record review and interviews during the recertification survey and an abbreviated survey (Case #NY00280271), the facility did not ensure a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice for 1 (Resident #8) of 3 residents reviewed for pressure ulcers. Specifically, for Resident #8, the facility did not ensure an open area on the resident's coccyx was assessed upon discovery and did not ensure that a timely treatment plan was initiated. This is evidenced by: The facility Policy & Procedure titled Skin Care Program, last modified on 5/8/2018 documented: [...]

Inspectors wroteBased on record review and interviews during the recertification survey, the facility did not ensure the resident's environment remained as free of accident hazards as possible for 1 (Resident #37) of 1 resident reviewed for falls. Specifically, for Resident #37, who had 19 falls from 9/21/2021 - 11/10/2021 resulting in 2 fractures (collarbone and hip), the facility did not ensure the resident's fall risk was consistently re-assessed and did not conduct a root cause analysis after the resident fell, did not consistently identify, implement, or revise resident specific interventions in a timely manner to reduce the resident's risk to fall and did not consistently monitor care planned interventions for effectiveness. This is evidenced by: [...]

Inspectors wroteBased on observation and staff interview during the recertification survey, the facility did not provide effective housekeeping and maintenance services. Specifically, the facility did not ensure floors were clean on 3 of 3 resident units. This is evidenced as follows. Resident rooms and common areas were spot-checked on 11/17/2021 at 12:05 PM. The floors were soiled next to walls and/or door thresholds in resident room #'s 216, 221, 223, 224, 352, 355, 360, 361, 368, 369, 373, 378, and #380; the Units 1, 3, and 4 common areas and corridors; and the core area. The Housekeeping Supervisor stated in an interview on 11/17/2021 at 12:25 PM, that housekeeping was aware of the floor cleanliness and has recently hired a floor technician. [...]

Inspectors wroteBased on record review and staff interview during the recertification survey, the facility did not ensure the policy regarding foods brought to residents is in accordance with adopted regulations. Specifically, the policy does not include a procedure to ensure all residents have the necessary assistance in accessing and consuming food brought to them by visitors. This is evidenced is as follows. Record review of the facility policy for food brought in by visitors was reviewed on 11/16/2021. This policy did not include a procedure to assist residents that are unable on their own to access and consume food brought to them by visitors. The Administrator stated in an interview on 11/16/21 at 11:26 AM the policy on food brought in by residents or for residents does not include a provision for helping residents that need assistance in accessing their food, but the policy will be updated. [...]

Inspectors wroteBased on record reviews and interviews during the recertification survey, the facility did not ensure for one (Resident #75) of one resident reviewed for hospitalization received written notice of transfer/discharge with the reason for the transfer/discharge in a language they understand. Specifically, for Resident #75, the facility did not ensure the written notice of transfer/discharge with the reasons for the transfer were provided to the resident or the resident's representative when the resident was transferred to the hospital. This is evidenced by: Resident #75: The resident was admitted to the facility on [DATE], with diagnoses of dementia with behavioral disturbance, coronary artery disease, and congestive heart failure. The Minimum Date Set dated 6/24/19, documented the resident was cognitively intact and able to make her needs known. A policy titled: [...]

Inspectors wroteBased on record reviews and interviews during the recertification survey, the facility did not ensure one (Resident #75) of one resident reviewed for hospitalization recieved a bed hold policy notice upon transfer. Specifically, for Resident #75, the facility did not ensure that the resident and/or the residents' representative was notified in writting of the bed hold policy when the resident was transfered to the hospital. This is evidenced by: Resident #75: The resident was admitted to the facility on [DATE], with diagnoses of dementia with behavioral disturbance, coronary artery disease, and congestive heart failure. The Minimum Date Set dated 6/24/19, documented the resident was cognitively intact and able to make her needs known. A policy titled: Hospitalization (Bed Reservations, Readmission, Notifications) with a date last modified of 7/11/19 documented: [...]

Inspectors wroteBased on observation, record review, and staff interview during a recertification the facility did not ensure that based on the comprehensive assessment of a resident, residents receive treatment and care in accordance with professional standards of practice to maintain the highest practicable physical well-being for one (Resident #44) of twenty-one residents reviewed. Specifically, Resident #44 was not assisted out of bed for care, services and activities at the facility for more than two months. This is evidenced by: Resident #44: This resident was admitted to the facility on [DATE], with diagnoses of multiple sclerosis, stage IV pressure ulcer and contracture of multiple sites. The Minimum Data Set (MDS- an assessment tool) dated 5/20/19, documented the resident was without cognitive impairment and had the ability to understand and be understood. [...]

Inspectors wroteBased on observation, record review and interviews during the recertification survey the facility did not ensure each resident was free from accident hazards for 1 (Resident #54) of 21 residents reviewed. Specifically, for Resident #54, who had difficulty swallowing, the facility did not ensure the resident was sitting fully upright in bed while eating. This is evidenced by: Resident #54: The resident was admitted to the facility on [DATE], with the diagnosis of dementia, dysphagia and gastroesophageal reflux disease (GERD). The Minimum Data Set (an assessment tool) dated 7/22/19, documented the resident had severe cognitive impairment. The resident was sometimes able to understand others and usually able to be understood. The resident required the supervision of 1 person while eating. [...]

Inspectors wroteBased on observations, record reviews and interviews during a recertification survey, the facility did not ensure residents who use psychotropic drugs received gradual dose reductions, and behavioral interventions, unless clinically contraindicated for 1 (Resident #36) of 5 residents reviewed for unnecessary psychotropic medications. Specifically: For Resident #36, the facility did not ensure the resident received a gradual dose reduction for the use of an antidepressant medication. This is evidenced by: Resident #36: The resident was admitted on [DATE], with diagnoses of cerebral infarction accident with hemiplegia, chronic pain syndrome, and major depressive disorder. The Minimum Data Set (MDS- an assessment tool) dated 5/9/19, assessed the resident was without cognitive impairment. The resident received antidepressant medication daily. [...]

Inspectors wroteBased on observation, record review, and staff interview during the recertification survey, the facility did not store, prepare, distribute or serve food in accordance with professional standards for food service safety. Food preparation and serving areas and equipment are to be kept clean, kitchen equipment is to be kept in good repair, and a test kit is to be provided to measure the parts per million (ppm) concentration of the solution used to sanitize equipment. Specifically, equipment in the main kitchen and unit kitchenettes were not clean, equipment was not in good repair, and an accurate test kit was not provided. This is evidenced as follows. The main kitchen and the kitchenettes were inspected on 07/29/2019 at 10:15 AM. In the main kitchen and unit kitchenettes, the shelving, drawers, mixer, slicer, ABC fire extinguisher, and microwave ovens were soiled with food particles; [...]

Inspectors wroteBased on observation, interview and record review during a recertification survey, the facility did not maintain an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infection for 2 (Resident #'s 13 & 45) of 2 residents. Specifically, for Resident #13, the facility did not ensure infection control standards were maintained during a dressing change, and for Resident #45 the facility did not ensure tracheostomy (a surgically created breathing passage in the neck with an airway applicance) care was provided using standard infection control precautions. This is evidenced by: Resident #13: [...]