Elizabeth City Health and Rehabilitation

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code the Minimum Data Set Assessment (MDS) for 1 of 31 sampled residents (Resident #42) reviewed for MDS accuracy.

Inspectors wroteBased on observations of the meal service tray line, record review, interviews with the Registered Dietitian and staff, the facility failed to ensure residents on the 900 hall received the correct portion sizes based on the menu. This failure had the potential to affect 1 out of 9 halls.

Inspectors wroteBased on record review, staff interviews, and Ombudsman interview, the facility failed notify the Ombudsman in writing of the resident's transfer to the hospital for 3 of 4 residents reviewed for hospitalization (Resident #92, Resident #94, and Resident #349).

Inspectors wroteBased on record review, staff interviews, and Ombudsman interview, the facility's Quality Assessment and Assurance (QAA) Committee failed to maintain implemented procedures and monitor the interventions the committee put into place following the 1/27/23 recertification and complaint investigation survey. This was for two recited deficiencies on the current recertification and complaint investigation survey of 4/05/24 in the areas of Notice Requirements Before Transfer/Discharge (F623) and Accuracy of Assessments (F641). The continued failure during two federal surveys of record shows a pattern of the facility's inability to sustain an effective QAA program.

Inspectors wroteBased on record review, staff interviews, and Medical Director interview the facility failed to notify the physician of administering long-acting insulin to Resident # 1 who had not consumed dinner and had a blood glucose level of 89 mg/dL (milligrams per deciliter). The facility failed to notify the physician after significant changes in condition for Resident #1 which included: obtaining a blood glucose level of 29 mg/dL (a normal blood glucose level range is 70 to 99 mg/dL) requiring the administration of glucagon (a manmade version of a hormone made by the pancreas that raises blood glucose levels); and obtaining a blood glucose level of 27 mg/dL, and the inability to administer glucagon to the Resident during a medical emergency. Resident #1 was one of one resident reviewed for notification of the physician. [...]

Inspectors wroteBased on record review, staff interviews, Pharmacy Nurse Consultant interview, Pharmacist interview, and Medical Director interview, the facility gave long-acting insulin to Resident #1 who had a blood sugar reading of 89 milligrams/deciliter (mg/dL) and had not eaten the dinner meal; failed to monitor the resident for any signs and symptoms of hypoglycemia (low blood glucose) after insulin administration; failed to monitor and complete ongoing thorough assessments by rechecking a blood glucose level as ordered after a hypoglycemic event requiring the intervention of glucagon (used to treat very low blood glucose); and failed to effectively respond to a medical emergency of hypoglycemia for one (Resident #1) of three residents reviewed for diabetes care. Emergency Medical Services (EMS) was contacted to take Resident #1 to the emergency room on [DATE] for hypoglycemia. [...]

Inspectors wroteBased on record review, staff, Pharmacist, Pharmacy Nurse Consultant, and Medical Director interviews the facility failed to demonstrate competency knowing what effective immediate interventions needed to be implemented for treatment of hypoglycemia (low blood glucose) and competency in obtaining life-saving medication from an automated medication dispensing system for one (Resident #1) of one resident reviewed for nursing competency. Emergency Medical Services (EMS) was contacted to take Resident #1 to the emergency room on [DATE] for hypoglycemia. EMS treated Resident #1 with 1 mg glucagon intermuscular. [...]

Inspectors wroteBased on record review and staff interview, the facility failed to accurately document a blood glucose reading as ordered for one (Resident #1) of one resident reviewed for accuracy of medical records.

Inspectors wroteBased on record review, and interviews with Medical Director, Pharmacy Nurse Consultant, Pharmacist, and staff, the facility's Quality Assessment and Assurance (QAA) Committee failed to maintain implemented procedures and monitor the interventions the committee put into place following the focused infection control and complaint investigation survey of 1/19/21 and the recertification and complaint investigation survey of 1/27/23. This was for 3 deficiencies recited on the current complaint investigation survey of 11/22/23 in the areas of: Notification of Changes (F580), Quality of Care/Professional Standards (F684), and Complete and Accurate Medical Records (842). The continued failure during two federal surveys of record shows a pattern of the facility's inability to sustain an effective QAA program.

Inspectors wroteBased on record review, observation, staff interview, resident interview, physician interview, physician assistant interview, and family interview the facility failed to prevent intentional inappropriate touching for one of three residents reviewed for resident-to-resident abuse. Resident #1 was observed by Resident #3 touching the breasts of Resident #2 under her shirt after the conclusion of a planned activity event with a gathering of the residents. Resident #2 did not have the cognition to express an adverse outcome, inappropriate touching of their breasts would have traumatized a reasonable female person. A family member of Resident #2 confirmed Resident #2 would have been devastated, furious, and mad at being touched inappropriately by a man if she was not cognitively impaired.

Inspectors wroteBased on record review and staff interview the facility failed to identify resident to resident abuse and failed to immediately report resident to resident abuse to the Administrator and Director of Nursing per facility policy for one of three abuse investigations reviewed.

Inspectors wroteBased on record review and staff interviews, the facility failed to provide care safely when a resident (Resident #295) was provided with incontinence care. Resident #295 fell from the bed during care and sustained a 2.5-centimeter (cm) laceration to her head with bleeding and she reported pain in her back and head post fall. Resident #295 was sent to the hospital and required 3 staples to close the laceration. This was for 1 of 8 residents reviewed for accidents (Resident #295).

Inspectors wroteBased on record review, staff interviews, and Responsible Party (RP) interview, the facility failed to provide an ongoing resident centered activities program that include one on one (1:1) activities to meet the interests of a resident that did not participate in group activities for 1 of 2 residents reviewed for activities (Resident #110).

Inspectors wroteBased on observation and staff interviews, the facility failed to remove expired medications stored in 1 of 2 medication rooms observed (Sycamore Medication Room).

Inspectors wroteBased on record review, staff, and the facility ' s Quality Assessment and Assurance (QAA) Committee failed to maintain implemented procedures and monitor interventions the committee put into place following the 1/19/21 focused infection control and complaint investigation survey and the 11/18/21 recertification survey. This was for 2 recited deficiencies on the current recertification and complaint investigation survey of 1/27/23 in the areas of infection control (F880) and label/store drugs and biologicals (F761). The continued failure during two or more federal surveys of record shows a pattern of facility ' s inability to sustain an effective QAA committee.

Inspectors wroteBased on observation, record review, and staff interviews, the facility failed to implement infection control policies and procedures (1) when Nurse Aide (NA) #1 failed to remove isolation gown and gloves and perform hand hygiene before exiting a COVID-19 isolation room, (2) Nurse #1 failed to replace oxygen tubing that was on floor before placing in residents' nose (Resident #87), and (3) failed to perform hand hygiene between 4 of 4 residents when passing meal trays (Resident #101, Resident #70, Resident #62, Resident #115).

Inspectors wroteBased on record review and staff interview the facility failed to code the Minimum Data Set assessment accurately for 1 of 5 sampled residents (Resident #51) reviewed for nutrition.

Inspectors wroteBased on observations, record review, resident and staff interview the facility failed to provide Activities of Daily Living (ADL) care for 1 of 3 residents (Resident #30) who was dependent on facility staff for ADL care.

Inspectors wroteBased on record review, resident interview, staff interviews, and physician interviews, the facility failed to provide the care for ear wax removal as recommended by a physician for 1 of 1 resident reviewed for communication (Resident #123).

Inspectors wroteBased on record review and staff interview, the facility failed to provide a surety bond which named the residents of the facility as the obligee for 43 of 43 residents who had personal funds accounts with the facility.

Inspectors wroteBased on observations, resident and staff interviews, the facility failed to inform the residents of the location and availability of the facility's survey results. This failure affected all residents in the facility.

Inspectors wroteBased on record review and staff interviews, the facility failed to notify the Ombudsman in writing when 6 of 6 residents (Residents #1, #143, #55, #110, #51, and #102) transferred to the hospital.