Emerald Healthcare & Rehab of Dublin

Inspectors wroteBased on observation, resident and staff interviews, and record review, the facility failed to ensure the resident's right to privacy during shower care for one of 29 sampled residents (R) (R36). This deficient practice had the potential to diminish the resident's quality of life and contribute to emotional distress and reduced trust in facility staff.

Inspectors wroteBased on observations, resident and staff interviews, and record review, the facility failed to ensure one of 29 sampled residents (R) (R40) did not have unauthorized and unsecured medications at the bedside. This failure had the potential to result in medication errors, improper use, and adverse drug events for the residents.

Inspectors wroteBased on staff interviews, record reviews, and review of the facility's Advance Directives policy, the facility failed to ensure residents/representatives/guardians were informed of and provided written notice of the right to accept or decline medical and surgical treatments and their right to formulate an advance directive for two of two sampled residents (R) reviewed (R9 and R42).

Inspectors wroteBased on observations, staff interviews, and review of the facility's policy titled Quality of Life - Homelike Environment, the facility failed to maintain a safe, clean, and comfortable environment for residents on two of five halls. Specifically, tripping hazards in front of resident toilets, drawers with chipped and missing paint, and uneven, bulging baseboard tiles along the walls of the shower room on one hall. These conditions created an environment that was not safe or homelike and had the potential to negatively affect residents' safety, dignity, and overall quality of life.

Inspectors wroteBased on staff interview, record review, and review of the Centers for Disease Control and Prevention (CDC) website and Clinical Laboratory Improvement Amendments of 1988(CLIA) regulations, the facility failed to ensure a current Centers for Medicare & Medicaid Services (CMS) CLIA Certificate of Waiver. The facility census was 56.

Inspectors wroteBased on staff interviews and facility document review, the facility failed to employ a qualified dietitian. This deficient practice had the potential to place the 56 residents residing in the facility at risk of unmet nutritional needs and a diminished quality of life.

Inspectors wroteBased on staff interviews and record review, the facility failed to employ a qualified Social Service Worker on a full-time basis to provide services for the residents in the facility. The facility was licensed for 126 beds.

Inspectors wroteBased on staff interviews and review of the facility-provided document titled CNA/STNA (Certified Nursing Assistant/State Tested Nursing Assistant), the facility failed to provide the required in-service training for the CNAs employed by the facility. This deficient practice had the potential to adversely affect the 56 residents residing in the facility.

Inspectors wroteBased on resident and staff interviews, record review, and review of the facility policy titled, Bed Hold, the facility failed to provide the resident or representative with written information that included the duration of the bed hold policy and the reserve payment amount at the time of transfer to an acute care hospital for one of three residents (R) (R30) reviewed. This failure had the potential to place R30 at risk of denial of re-admission and loss of their room following hospitalization.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policy titled, Oxygen, Administration-Nasal Canula, the facility failed to follow a physician order for oxygen (O2) therapy for one of 11 residents (R) (R1) receiving O2 therapy. The deficient practice had the potential to place R1 at risk of medical complications and unmet needs.

Inspectors wroteBased on observations, staff and resident interviews, and record reviews, the facility failed to ensure respiratory equipment was maintained in a sanitary manner for one of 11 residents (R) (R25) receiving oxygen (O2) therapy. This deficient practice had the potential to place R25 at risk of respiratory complications and a diminished quality of life.

Inspectors wroteBased on staff interviews and record review, the facility failed to notify the physician of a significant change in condition for one of seven sampled residents (R) (R1) related to respiratory distress and the need for further medical treatment. On [DATE], R1 exhibited shortness of breath, tripoding (leaning forward to maximize lung expansion), and a decreased oxygen saturation of 83 percent. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had the likelihood to cause serious injury, harm, impairment, or death to residents. The facility's Administrator, Director of Nursing (DON), and Corporate [NAME] President of Compliance and Regulatory Services were informed of the Immediate Jeopardy (IJ) on [DATE] at 4:18 pm. The noncompliance related to the IJ was identified to have existed on [DATE]. [...]

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled Freedom of Abuse, Neglect, and Exploitation; Abuse Prevention: Fast Alerts, the facility failed to protect the resident's right to be free from neglect by staff for one of seven sampled residents (R) (R1). Specifically, R1 had a significant change of condition while in respiratory distress and required further medical treatment. R1 expired less than four hours after being placed in his bed by staff. On 7/11/2024, a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had the likelihood to cause serious injury, harm, impairment, or death to residents. [...]

Inspectors wroteBased on staff interviews, record reviews, and review of the Administrator and Director of Nursing (DON) job descriptions titled Title: License Nursing Home Administrator and Title: Director of Nursing, the facility Administration failed to ensure that one of seven sampled residents (R) (R1) was free from neglect by staff when R1 was in respiratory distress asking for help. In addition, the facility Administration failed to provide oversight and monitoring of care and services to R1 for further medical treatment. This failure resulted in R1 expiring in his room alone and gripping the handrails. On [DATE], a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had the likelihood to cause serious injury, harm, impairment, or death to residents. [...]

Inspectors wroteBased on staff interviews, record review, and review of the facility documents titled Resident Fund Management Service and Burial Account, the facility failed to ensure that one of seven sampled residents (R) (R2's) burial account funds were not used to pay the care cost balance. This deficient practice had the potential to affect all residents who had a trust funds account with the facility.

Inspectors wroteBased on staff interviews and record review, the facility failed to ensure vital signs were obtained as ordered for two of seven sampled residents (R) (R1 and R3). This deficient practice had the potential to negatively affect R1 and R3's physical health and well-being.

Inspectors wroteBased on staff interviews, record reviews, and review of the facility policy titled Clinical Documentation, the facility failed to ensure clinical records contained complete and accurate documentation for one of seven sampled residents (R) (R1).

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled Clinical Staffing Standard, the facility failed to ensure that a Registered Nurse (RN) other than the Director of Nursing (DON) was assigned to direct nursing care of the residents for 27 of the 28 days reviewed. The facility census was 77 residents. This failure had the potential to negatively impact all residents residing at the facility.

Inspectors wroteBased on observation, staff interviews, and review of the facility document titled CNA/STNA (Certified Nursing Assistant/State Tested Nursing Assistant), the facility failed to ensure that one resident (R) (R11) of 16 sampled residents was provided perineal care. This failure placed R11 at risk for unmet needs and a diminished quality of life.

Inspectors wroteBased on observation, staff interview, and review of the facility-provided document titled Licensed Nursing Home Administrator, the facility failed to ensure that a Licensed Administrator was present in the facility to oversee daily operations and management on four of four days observed. The facility census was 77 residents.

Inspectors wroteBased on observations, staff interviews, and review of the facility policies titled Cleaning and Sanitizing Dietary Areas and Equipment, and Deep Fryer Cleaning, the facility failed to ensure that the kitchen equipment was kept clean and sanitary and failed to ensure pureed food was prepared in a manner to prevent foodborne illness. These deficient practices had the potential to place 11 of 11 residents who received a pureed diet, and all residents who received an oral diet at risk of contracting a foodborne illness. The census was 81 residents.