Embassy of Lebanon

Inspectors wroteBased on observation, staff interview and policy review, the facility failed to ensure that residents had the appropriate signage, Personal Protective Equipment (PPE), and orders for being in Enhanced Barrier Precautions (EBP). This affected two Residents (#28 and #40) of three residents sampled for enhanced barrier precautions. The facility census was 55.

Inspectors wroteBased on review of staffing schedules. staff and resident interviews and policy review, the facility failed to ensure a registered nurse (RN) was present in the facility for eight consecutive hours a day as required. This had the potential to affect all 59 residents residing in the facility. The facility census was 59.

Inspectors wroteBased on record review, review of facility self-reported incidents (SRI's), staff interviews and policy review, the facility failed to timely report an allegation of verbal abuse to the survey agency as required. This affected one (#53) of three residents reviewed for abuse. The facility census was 59.

Inspectors wroteBased on record review, review of facility self-reported incidents (SRI), staff interviews and facility policy, the facility failed to have documented evidence that an allegation of abuse was thoroughly investigated for Resident #53. This affected one (#53) of three residents reviewed for abuse. The facility census was 59.

Inspectors wroteBased on record review, observations, staff and resident interviews and policy review, the facility failed to ensure two (#22 and #21) dependent residents were assisted in a timely manner for meal assistance. Additionally, the facility failed to provide care and services for one (#46) dependent resident with facial hair. This affected three (#22, #21 and #46) out of three residents reviewed for activities of daily living. The facility census was 59.

Inspectors wroteBased on record review, staff interview, and policy review, the facility failed to ensure medications were administered to the correct resident resulting in significant mediation errors. This affected one (#60) of three residents reviewed for medication administration. The facility census was 59.

Inspectors wroteBased on record review, observations, staff interviews and policy review, the facility failed to ensure prescribed medications were not left in residents room unsecured and unsupervised. This affected three (#29, #10 and #45) out of three residents reviewed for medication storage. The facility census was 59.

Inspectors wroteBased on review of facility water management plan documents, staff interview, and review of the Centers for Disease Control and Prevention (CDC) website, the facility failed to develop a comprehensive water management plan. This had the potential to affect all 59 residents residing in the facility. The facility census was 59.

Inspectors wroteBased on record review, observation, staff interview, and facility policy review, the facility failed to ensure the medication error rate did not exceed five percent (%). Two medication errors occurred within 25 opportunities for an error rate of eight percent. This affected one (Resident #32) of two residents observed during medication administration. The facility census was 55.

Inspectors wroteBased on medical record review, staff interview, and resident interview, the facility failed to ensure residents were free of significant medication errors. This affected one (Resident #27) of three residents reviewed for medication administration. The census was 58 residents.

Inspectors wroteBased on medical record review, observations, interviews and policy reviews the facility failed to ensure urinary catheter care was provided in a dignified manner. This affected one (#19) out of three residents reviewed for resident rights. The facility census was 63.

Inspectors wroteBased on medical record review and staff interviews, the facility failed to ensure urinary catheter care was completed and documented as ordered. This affected one (#64) of three residents reviewed for catheter care. The facility census was 63.

Inspectors wroteBased on medical record review, observation, staff interview and policy review, the facility failed to follow the physician orders for medication administration. This affected two (#30 and #64) of four residents reviewed for medication administration. The facility census was 63.

Inspectors wroteBased on medical record review, observation, staff interview, review of medication manufacturer instructions, and review of facility policy, the facility failed to ensure a staff member primed (performed a safety test) when using an insulin pen-injector, resulting in a significant medication error. This affected one (#2) of five residents observed for medication administration. The facility census was 63.

Inspectors wroteBased on medical record, staff interviews and policy review, the facility failed to ensure staff accurately documented dietary intake of meals. This affected one (#64) of three residents reviewed for staff assistance with dietary intake. The facility census is 63.

Inspectors wroteBased on observation, record review and staff interview the facility failed to ensure medication error rates were less than 5% when they gave Resident #39 the wrong medication and Resident #38 blood pressure medication was not held for low blood pressure. This affected two (Resident #38 and #39) of four residents observed for medication administration. There were two errors out of 25 opportunities for a medication error rate of 8 %. The facility census was 58.

Inspectors wroteBased on medical record reviews, observations, staff interviews, and policy review, the facility failed to follow infection control procedures. This affected two (#10 and #13) residents out of the three residents reviewed. The facility census was 58.

Inspectors wroteTHIS IS AN INCIDENCE OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record review, staff interview, resident interview, and review of the facility ' s smoking policy, the facility failed to ensure Resident #34 did not smoke while wearing oxygen. This resulted in Immediate Jeopardy and the potential for serious life-threatening harm and/or injuries when agency State Tested Nursing Assistant (STNA) #10 took Resident #34 outside for a smoke break and lit the resident ' s cigarette while Resident #34 was wearing oxygen per nasal cannula. The oxygen ignited, resulting in burns to both nostrils and singed the nose hairs. This affected one (Resident #34) of four residents reviewed for smoking. [...]

Inspectors wroteBased on observations, staff interview and policy review, the facility failed to ensure foods were labeled and dated and failed to ensure expired foods were discarded in resident refrigerators. Additionally, the facility failed to ensure kitchen equipment was maintained in sanitary condition. This had the potential to affect 56 out of 58 residents who received food from the kitchen, the facility identified two (#3 and #53) residents who do not receive their food/meals from the kitchen. The facility census was 58.

Inspectors wroteBased on medical record review, observations, and staff interviews, the facility failed to complete repairs to ensure a safe and comfortable environment for two (Residents #24 and #12) of four residents reviewed for environment. The facility census was 58.

Inspectors wroteBased on medical record review and staff and resident interview, the facility failed to ensure residents received timely assistance to transfer out of bed. This affected one (#33) of five residents sampled for activities of daily living (ADL) assistance. The facility census was 58.

Inspectors wroteBased on medical record review, observations and staff interview, the facility failed to ensure a residents indwelling urinary (Foley) catheter bag was timely emptied and not being stored on the floor. This affected one (#12) of five residents reviewed for urinary catheter care. The facility census was 58. Findings Include: Record review of Resident #12 revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #12 included osteomyelitis left ankle and foot, diabetes, and neuromuscular dysfunction of bladder. Review of the Minimum Data Set, (MDS) comprehensive assessment dated [DATE] revealed the resident had moderately impaired cognition and was receiving medications insulin, Aquaphor, Zofran, and mirtazapine. The resident was currently receiving Macrobid antibiotic for urinary tract infection and had an order for a urinary catheter. [...]

Inspectors wroteBased on medical record review, observation, staff and resident interviews and policy review, the facility failed to ensure residents had mediations available as ordered. This affected one (#33) of five residents reviewed for medication administration. The facility census was 58.

Inspectors wroteBased on record review, observation, and interview the facility failed to ensure a resident was accurately assessed and interventions were put into place to prevent fluid overload. The resulted in actual harm when Resident #12 became short of breath and requested to be sent out to the hospital where he required a procedure to remove 5.3 liters of fluid off of his abdomen. This affect one (Resident #12) of three residents reviewed for hospitalization. The faciltiy also failed to complete wound treatments as ordered. This affected one (Resident #13) of four residents reviewed for skin related conditions. The facility census was 64.

Inspectors wroteBased on record review, observation, staff interview, resident interview, staff training, and policy review the facility failed to ensure a resident properly transferred with a slide board and with the assistance of two staff. This resulted in actual harm for Resident #53 when she was transferred via slide board with only one staff member assisting; during the transfer, the resident felt her knee pop, the knee became swollen and she had a decline in transferring. This affected one (Resident #53) of 25 sampled residents. The facility census was 64.

Inspectors wroteBased on record review, observation, staff interview, consultant dietician interview, and policy review, the facility failed to assess and timely implement interventions to prevent significant weight loss. This resulted in actual harm to Resident #33, who had a significant weight loss and the facility failed to implement nutritional interventions to prevent further weight loss. This affected one (Resident #33) of five residents reviewed for nutrition. The facility census was 64.

Inspectors wroteBased on interview, record review and observation, the facility failed to ensure residents with broken or decayed teeth were provided dental services. This involved three (Residents #12, #39, #46) of three residents reviewed for dental care.

Inspectors wrote2. During observation on 10/28/19 at 12:19 P.M., Resident #61 was sitting at the dining room table sleeping. There were 13 other residents in the dining room eating their lunch except for Resident #61. Some of the residents were finishing up their meal or leaving the dining room. Resident #61 had a cup of coffee and a cup of lemonade in front of her. STNA #23 was feeding Resident #17 and STNA #24 was feeding Resident #32. Both STNA's were sitting behind Resident #61. During interview on 10/28/19 at 12:25 P.M. STNA #23 and #24 stated Resident #61 had not eaten and was waiting for her meal. At 12:30 P.M., STNA #23 served the resident her meal. During interview on 10/28/19 at 2:00 P.M., the Director of Nursing stated all meals should be served to all residents in the dining room before staff assist with feeding. [...]

Inspectors wrote2. Resident #27 was admitted to the facility on [DATE]. Diagnoses included history of falling, dementia, major depression and muscle weakness. Review of the MDS assessment dated [DATE] documented impaired cognition, required extensive assistance of one person for bed mobility, transfer, and used a wheelchair to move about the facility on her own. During observation on 10/28/19 at 11:07 A.M., the resident was being assisted to get into her room. The roommate's wheelchair was up against Resident #27's bed, preventing her from wheeling over to her bed or being able to get in it. There were several pieces of equipment on the roommate's side including an over bed table and an oxygen concentrator. during observation on 10/28/19 at 11:16 A.M., Resident #27 could not navigate around her room as there was too much equipment cluttered throughout her room. [...]

Inspectors wroteBased on record review, observation, staff interview, resident interview, family interview, hospital record review and outside clinical staff interview, the facility failed to ensure a resident could timely see a provider of their choice; and failed to ensure a resident was assisted to the bus on his outside workshop days. This affected two (Residents #36 and #62) of 25 sampled residents. The facility census was 64.

Inspectors wroteBased on record review and staff interview the facility failed to identify the Preadmission Screening and Resident Review (PASRR) captured a resident's mental illness diagnosis. This affected one (Resident #42) of 25 sampled residents. The facility census was 64.

Inspectors wroteBased on observation, record review and staff and resident interview, the facility failed to implement a care plan for impaired vision. This affected one (Resident #47) of one resident reviewed for vision. The facility census was 64.

Inspectors wroteBased on record review, observation, and staff interview, the facility failed to ensure residents were dressed during the day, clean, and had oral care completed. This affected one (Resident #33) of 25 sampled residents. The facility census was 64.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure a nurse did not touch medications with her bare hands, failed to ensure a multi-dose inhaler was sanitized when it fell on the floor and failed to ensure an leg strap for an indwelling urinary catheter was changed when it became soiled. This affected one (Resident #12) of two residents reviewed.

Inspectors wroteBased on resident interview, staff interview and review of the local post office business hours, the facility failed to ensure mail was delivered on Saturdays. This affected eight (Residents #2, #8, #13, #37, #50, #53, #57 and #65) residents interviewed during the resident council meeting and had the potential to affect all 64 residents in the facility. Facility census was 64.

Inspectors wroteBased on observations, record reviews and staff interviews, the facility failed to ensure residents receiving oxygen therapy had clean disposable oxygen supplies for six residents (#32, #45, #27, #261, #48, #30) residents and failed to ensure to post signage on doors of residents receiving oxygen therapy. This affected four residents (#32, #27, #261, and #4) of 12 residents (#33, #23, #29, #57, #52, and #211) receiving oxygen therapy within the facility. The facility census was 62.

Inspectors wroteBased on record review, observation, resident and staff interviews, the facility failed to assess residents for their preferences for a dignified existence. This affected two, (#8 & #49) of five residents reviewed for choices. Facility census was 62.

Inspectors wroteBased on record review, staff interview , Self-Reported Incident (SRI) review and policy review, the facility failed to report an allegation of staff to resident abuse to the administrator and the state agency when a resident expressed a staff member threatened her with physical harm. This affected one (Resident #49) of 24 residents reviewed in the initial pool process. Facility census was 62.

Inspectors wroteBased on record review, staff interview, Self-Reported Incident (SRI) review and policy review, the facility failed to implement their abuse policy and report an allegation of staff to resident abuse to the administrator and state agency. This affected one (Resident #49) of 24 residents reviewed in the initial pool process. Facility census was 62.

Inspectors wroteBased on record review and staff interview, the facility failed to notify a resident, the resident's representative or the Ombudsman of a resident's transfer and the reasons for the resident's transfer to the hospital. This affected one (#62) of three closed records reviewed. The facility census was 62.

Inspectors wroteBased on record review and staff interview, the facility failed to provide written bed hold information to residents upon transfer to the hospital. This affected one (#62) of three closed records reviewed. The facility census was 62.

Inspectors wroteBased on record review and staff interview, the facility failed to accurately assess one resident's contractures. This affected one (#13) of two residents reviewed for accuracy of resident assessments. The facility census was 62.

Inspectors wroteBased on observation, record review, resident and staff interview, the facility failed to provide an adequate and accurate care plan for one (Resident #45) of twenty residents reviewed during the investigation phase. The facility identified one resident (Resident #45) receiving dialysis. The facility census was 62.

Inspectors wroteBased on record review and staff interview, the facility failed to revise one resident's care plan to address the care of the resident's contractures. This affected one (#13) of 20 residents reviewed during the investigation stage. The facility census was 62.

Inspectors wroteBased on observation, resident and staff interview and record review the facility failed to provide adequate dialysis care, including the monitoring of the dialysis access site, to one resident (Resident #45). Resident #45 is the only resident at the facility receiving dialysis. The facility census is 62.

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure a resident's drug regimen was free from unnecessary medications by not adequately monitoring the resident and by not attempting non-pharmalogical interventions prior to administration of pain medication. This affected one resident (#30) of five residents reviewed for unnecessary medications. The facility census was 62.

Inspectors wroteBased on observation, medical record review, staff interview and review of Medscape Medication information, the facility failed to use antipsychotic medication to treat an appropriate specific diagnosed condition. This affected one (Resident #19) of five residents reviewed for unnecessary medications. The facility census was 62.

Inspectors wroteBased on record reviews and staff interview, the facility failed to ensure outside resources were provided when a urology consultation was ordered and an appointment was not made. This affected one resident (#23) of one resident reviewed for urinary catheters. The facility census was 62.