Emerald Nursing & Rehab Lakeview

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09Based on record review and interview the facility failed to ensure that the resident choice for Cardiopulmonary Resuscitation (CPR) (a lifesaving attempt combination of rescue breathing and chest compressions when someone's heart has stopped) matched the physician signed advanced directive for 2 of 24 residents reviewed (Residents 47 and 71). This had the potential for the facility to not follow the resident preference for CPR in the event of cardiac arrest. The facility census was 74. The facility Administrator was notified on [DATE] at 5:15PM of an Immediate Jeopardy (IJ) which began on [DATE]. The IJ was removed on [DATE], as confirmed by surveyor onsite verification.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(B)(ii)(1)Based on record review and interview the facility failed to ensure that nurse aides and medication aides completed at least 12 hours of continuing education annually as required for 5 of 5 sampled staff. The facility census was 74.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.19(A)Licensure Reference Number 175 NAC 12-006.19(B) Based on record review, observation, and interview the facility failed to maintain a sanitary, orderly, and comfortable interior and exterior for 16 of 74 residents (Resident 1, 5, 7, 9, 10, 13, 19, 21, 24, 32, 36, 48, 58, 71, 75, and 85.) Facility census was 74.

Inspectors wroteLicensure Reference Number 175 NAC 12-007.04(D) Based on observation and interviews the facility failed to ensure the ventilation system was in working order in 12 resident bathrooms (rooms 501,502,503, 504, 505, 506, 508, 510, 511, 512, 513, 514) of 24 sampled resident rooms.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(S)Based on record review, observation, and interview the facility failed to ensure resident dignity by not storing incontinent products out of public sight and for not ensuring residents' body parts were covered for 2 residents (Resident 2 and Resident 5) of 2 sampled residents. The facility census was 74.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17(E)(ii)Based on record review and interview, the facility failed to notify the local state ombudsman of resident transfers in and out of the facility for 1 resident (Resident 75), and failed to provide the resident or their responsible party written information regarding bed hold at the time of transfer for 1 resident (Resident 75). The facility census was 74.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(i)(2)Based on observation, interview, and record review the facility failed to provide treatment and services to maintain or restore a resident's level of functional ability for 1 (Resident 2) of 1 sampled resident. The facility census was 74.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09Based on record review and interview the facility failed to thoroughly assess a resident after a possible/probable accident/incident and failed to notify a resident's provider after a possible/probable incident/accident that could result in deterioration of health and need to alter treatment for 1 (Resident 83) of 1 sampled resident, and the facility failed to follow practitioner orders of providing medications as prescribed for 1 (Resident 89) of 1 sampled resident. The facility census was 74.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.08(B)(i)Based on record review and interview the facility failed to ensure that the physician performed the resident initial 30 day visit as required for 1 of 3 residents reviewed (Resident 47). The facility census was 74.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18(B)Based on observation, interview, and record review, the facility failed to ensure staff donned (put on) and doffed (took off) the required PPE (personal protective equipment) during cares for a resident that requires staff to wear PPE for EBP (enhanced barrier precautions), to prevent the potential spread of microorganisms. This affected 1 resident (Resident 4) of 1 sampled resident. The facility failed to clean glucometers per manufacturer recommendations after use affecting 1 resident Resident 76 of 2 sampled residents, and failed to change disposable medical care equipment as ordered for 1 resident Resident 2 of 1 sampled residents. The facility census was 74.

Inspectors wroteLicensure Reference Number 175 NAC 1-009.01 Based on observation and interview, the facility failed to ensure the facility was neat clean and in good repair. This affected 11 of 69 facility residents. Facility stated a census of 69.

Inspectors wroteLicense Reference Number 175 NAC 12-006.11 Based on record review, observation, and interviews, the facility failed to ensure the menus were followed as written and that use of the correct size serving spoons were used when meals are served resulting in less than required caloric intake. This affected 13 (Residents 40, 65, 22, 223, 6, 54, 44, 49, 43, 221, 222, 55, and 59) of 15 residents served meals. The facility census was 69.

Inspectors wroteLicensure Reference Number 175NAC 12-006.19(C)(i) Licensure Reference Number 175NAC 12-006.18(B) Based on observation, interview, and record review, the facility failed to ensure that staff performed laundry delivery to residents in a manner to prevent the potential for cross-contamination for 20 of 20 residents observed (Residents 57, 10, 15, 26, 7, 27, 37, 11, 30, 36, 31, 223, 22, 54, 6, 60, 59, 43, 55, and 41). The facility census was 69.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 Based on observation, interview, and record review, the facility failed to provide an assessment by a licensed professional nurse for 1 (Resident 23) of 1 sampled residents with symptoms of a potential respiratory infection. The facility identified a census of 69.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.09(H)(iii)(2) Based off observation, interview, and record review, the facility failed to routinely assess a pressure ulcer (a localized area of damaged skin or tissue that can occur when pressure is applied to an area for a prolonged period) and monitor the effectiveness of the treatment for the wound for 1 (Resident 26) of 1 sampled residents. The facility identified a census of 69.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(h)(v) Based on observation, interview, and record review, the facility failed to implement interventions to prevent the potential worsening of a contractures for 1 (Resident 23) of 1 sampled resident. The facility identified a census of 69.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.10 (D) Based on observation, record review, and interview, the facility failed to ensure a medication error rate of less than 5% with an observed medication error rate of 7.41% (27 administrations and 2 errors). This affected 2 (Residents 14 and 17), of 10 sampled residents. The facility stated census of 69.

Inspectors wroteLicense Reference Number 175 NAC 12-006.119(A)(iv) Based on record reviews, observations, and interviews, facility failed to provide a physician ordered therapeutic diet with increased protein for 1 (Resident 22) of 1 resident sampled. The facility census was 69.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11E Based on observation, interview and record review, the facility failed to store and distribute foods and liquids in accordance with the facility policy and to prevent potential cross contamination and foodborne illness. This had the potential to affect 68 of 69 residents. Findings Are: A record review of the facility policy labeled Nutrition Services Food Storage dated 03/14/2014 revealed dry storage room items should be stored to ensure freshness, in bulk, and in tightly covered containers. The policy revealed all containers must be labeled and dated. In addition, scoops for items stored in bins, such as sugar, flour, rice and other items should be covered in a protected area near the food containers. The policy revealed for refrigerated items to be dated, labeled and tightly sealed. All items should include name of item and a use by date. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18 Based on observation and interview, the facility failed to ensure that the bathroom ventilation vents were free from dirt and dust affecting 10 (Residents 6, 16, 35,19, 44, 51, 53, 119, 120, and 121) of 20 sampled residents. The facility census was 68.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18E3 Based on observation, interview, and record review the facility failed to ensure that hot water temperatures were within a safe range to prevent the potential for resident skin injury for 1 of 24 residents (Resident 64). The facility census was 68.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17 Based on observation, record review, and interview the facility failed to ensure safe and sanitary practices related to changing and labeling disposable medical equipment used for respiratory therapy for 1 resident (Resident #20), and for disposable enteral feeding equipment for 1 resident (Resident #29). This affected 2 of 3 sampled residents. The facility census was 69.