Emerson Health & Rehabilitation

Inspectors wroteBased on interview and record review, the facility failed to ensure the Director of Nursing (DNS) did not serve as a charge nurse when the facility had an average daily occupancy over 60. This failure placed all residents at risk of lack of oversight for care provided, unmet care needs, and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure gloves were changed and hand hygiene was completed when indicated during the lunch meal service, foods were served at the appropriate temperatures and food was labeled and dated as required. The facility further failed to maintain the required dish washing machine temperatures. These failures placed residents at risk for food-borne illnesses.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure interventions developed to prevent the growth of waterborne bacteria or Legionella (a contagious bacteria that caused respiratory illness when water droplets or mist containing the bacteria were inhaled) as part of the Water Management Plan were monitored for completion as required. This failure placed residents and staff at risk of developing severe respiratory illness and unintended health consequences.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an effective system to deliver mail to the residents on the days mail was delivered. This failure placed the residents at risk for feelings of isolation, loneliness, anxiety, and depression.

Inspectors wroteBased on interview and record review, the facility failed to ensure the staff documented the information conveyed to the hospital at the time of 4 of 5 hospital transfers for 1 of 3 sampled residents (Resident 6) whose closed records were reviewed. Additionally, the staff failed to ensure bed hold notices were offered to Resident 6 or their representative in 4 of 5 hospital transfers and failed to notify the Office of the State Long-Term Care Ombudsman (an advocate for residents of nursing homes, adult family homes, and assisted living facilities who protect and promote the resident rights under federal and state law and regulations) of 5 of 5 hospital transfers. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the staff provided required splints and positioning devices and adequately followed up with resident refusals of Restorative Nursing Programs for 3 of 3 sampled residents (Residents 12, 13, and 71) reviewed for Limited Range of Motion (ROM, the full movement potential of a joint) and positioning. These failures placed the residents at risk for worsening contractures (shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints) and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to complete annual staff performance reviews yearly as required and provide education based on the outcome of these reviews for 3 of 8 sampled staff (Staff AA, BB, and CC), reviewed for performance reviews. This failure placed residents at risk of receiving care from inadequately trained and/or under-qualified care staff, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to provide information of potential risks and/or benefits of psychotropic (medications that affect behavior, mood, thoughts, or perception such as antidepressants) medications prior to their use for 1 of 5 sampled residents (Resident 31), reviewed for unnecessary medications. This failure placed residents and/or their representatives at risk of not being fully informed of the risks, benefits or alternative treatment options available before decisions were made regarding medications.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain a clean, sanitary, and homelike environment free of institutional odors for 1 of 4 sampled residents (Resident 31), reviewed for environment. This failure placed residents at risk of lack of dignity, unmet care needs, and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Pre-admission Screening and Resident Review (PASRR, a screening that occurred prior to facility admission that determined if one met nursing home level of care and potentially required services for mental health needs once a resident. If one was expected to be at the facility less than 30 days, they were exempt. After 30 days, if still at the facility, a new referral and screening was required) was completed timely after an exempted hospital stay expired for 2 of 5 sampled residents (Residents 2 and 3) reviewed. This failure placed residents at risk for not receiving timely and necessary services to support their mental health care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently provide shaving and nail care for 2 of 2 sampled residents (Residents 19 and13) reviewed for activities of daily living (ADLS). This failure placed the residents at risk for poor personal hygiene, unmet care needs, and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure care plan goals and interventions were developed and monitoring occurred for 2 of 2 sampled residents (Residents 11 and 22) reviewed for edema (swelling) management. This failure placed the residents at risk for worsening edema, unrecognized changes to their skin, and decreased quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain oxygen saturations per provider orders and failed to ensure respiratory equipment was cleaned and maintained for 1 of 1 sampled residents (Resident 70), reviewed for respiratory care. This failure placed the resident at risk for illness and decreased quality of life.

Inspectors wroteBased on observation and interview, the facility failed to ensure the kitchen floor was maintained and torn linoleum was repaired when indicated. This failure placed staff at risk of potentially avoidable accidents, and infection control issues because the floor was not a cleanable surface.

Inspectors wroteBased on interview and record review the facility failed to consistently monitor tolerance to dialysis (procedure to remove fluid and waste from the body when the kidneys stop working properly) treatments and collaborate care with the dialysis center for 1 of 2 sampled residents (Resident 51), reviewed for dialysis care. These failures placed residents at risk of unrecognized complications, unmet care needs and diminished quality of life.

Inspectors wroteBased on interview and record review the facility failed to timely transcribe provider orders and administer medications as intended by the provider for 1 of 6 sampled residents (Resident 34), reviewed for unnecessary medications. Specifically, Resident 34 was routinely administered pain medication when the provider intended to change the prescription to as needed. This failure placed residents at risk of adverse side effects, unnecessary medications, and diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to accommodate a resident's desire for a larger television that they could better visualize for 1 of 3 sampled residents (Resident 47) reviewed for environment. This failure placed the resident at risk of being unable to participate in their preferred activities and decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a clean, comfortable, homelike environment for 1 of 2 sampled residents (Resident 48), reviewed for environment. This failure placed residents at risk for possible illness from unclean equipment, a lack of dignity, and a decreased quality of life.

Inspectors wroteBased on interview, and record review, the facility failed to ensure incidents of potential abuse, such as misappropriation of personal property, were identified as such and reported to the State Survey Agency as required, for 1 of 6 sampled residents (Resident 30) reviewed for abuse. Failure to report allegations/incidents of abuse placed the resident at risk for additional abuse.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a significant change assessment was completed timely when a resident had several areas of decline for 1 of 21 sampled residents (Resident 8) reviewed for declines in activities of daily living (ADLs). This failure placed residents at risk for unrecognized and unmet changes in care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Pre-admission Screening and Resident Review(PASARR) [an assessment used to identify people referred to nursing facilities with mental illness, intellectual disabilities, or related conditions], was completed for 1 of 5 sampled residents (Resident 48), reviewed for PASARR services. This failure placed the residents at risk for inappropriate placement, and/or not receiving timely and necessary services to meet mental health care needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 1 of 1 sampled resident (Resident 48) reviewed for activities of daily living, received assistance with eating and consuming fluids. These failures placed the resident at risk for weight loss, dehydration, and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently monitor and provide bowel care timely for 2 of 2 sampled residents (Resident 48 and 268), reviewed for constipation. This failure placed the residents at risk for medical complications and unmet care needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident that had significant weight loss was reassessed by the Registered Dietician (RD) timely for 1 of 6 sampled residents (Resident 268) reviewed for nutrition. This failure placed residents at risk for further undesired weight loss, and a decline in their health.

Inspectors wroteBased on interview and record review, the facility failed to ensure dietary staff had the proper qualifications. Failure to ensure the dietary manager had the proper certification placed all residents at risk for receiving dietary services from staff without the required competencies.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dietary staff had the required training for 2 dietary staff (S,T). This failed practice had the potential risk for unsafe food handling practices and placed all residents at risk for developing foodborne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store food in accordance with professional standards for food service safety. Failure to ensure expired foods were discarded for 1 of 3 refrigerators and 1 of 1 dry storage areas, and failure to cover food that was stored in 1 of 1 refrigerators. These failures placed residents served from the kitchen at risk for consuming expired food and food-borne illnesses.

Inspectors wroteBased on observations, interview, and record review the facility failed to perform hand hygiene when indicated during meal service in 1 of 3 dining rooms (Meadowood) and 1 of 3 halls (Tuscan Trail), observed during meal service. These failures placed residents at risk for transmission of communicable diseases and/or healthcare associated diseases, and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure staff possessed appropriate competencies and skills to administer medications for 1 of 3 sample residents (Resident 1), reviewed for medication administration. This failure placed residents at risk for adverse medication outcomes and potential medication errors.

Inspectors wroteBased on interview and record review, the facility failed to ensure a qualified Registered Dietician (Staff E) completed nutritional assessments and failed to ensure the Registered Diet Technician (Staff G), received proper supervision in accordance with professional standards related to the care of 3 of 7 sample residents (19, 31, 57), reviewed for nutrition. This failure placed the residents at risk of receiving nutritional care and services from staff without the required competencies and skills, possible weight loss, and a deterioration in their nutritional status.

Inspectors wroteBased on observation and interview, the facility failed to ensure a vegetarian diet menu was in place, recipes were followed, and the high calorie high protein diet parameters were followed in accordance with established national guidelines. This deficient practice placed residents receiving food from the kitchen at risk of a diet lacking variety and adequate nutrient intake.

Inspectors wroteBased on interview and record review, the facility failed to develop comprehensive person-centered care plans, to address a resident with a suprapubic catheter (a surgically created connection between the urinary bladder and the skin used to drain urine), and a resident receiving oxygen, for 2 of 20 sample residents (43, 220), whose care plans were reviewed. This failure placed the residents at risk for unmet needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the food was palatable, attractive, and served at a safe and appetizing temperature for 6 of 6 sample residents (11,19, 31, 51, 522, 523), reviewed for food. This failure caused residents dissatisfaction with their meals and placed them at risk for reduced food intake and possible weight loss.

Inspectors wroteBased on interview and record review, the facility failed to monitor and report a low oxygen saturation reading to the provider for 1 of 4 sample residents (220), reviewed for oxygen use. This failure placed the resident at risk for potential deterioration in their medical condition and unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care-planned restorative interventions for 1 of 3 sample residents (31), reviewed for restorative services (interventions developed to promote the resident's ability to achieve and maintain optimal physical, mental, and psychosocial functioning). This failure placed the resident at risk for a decline in mobility and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement nutritional interventions as per the care plan, or provide the resident with a requested food in a timely manner, for 1 of 3 sample residents (19), reviewed for nutritional status. This failure resulted in the resident losing a significant amount of weight in a short period of time.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 5 sample residents (57), reviewed for unnecessary medication, was free from significant medication errors. Failure to follow the physician's orders for monitoring and administering insulin (a medication used to treat diabetes, a medical condition resulting in the body being unable to produce enough insulin), and contacting the provider when the blood sugar was over 450, placed the resident at risk for health complications.

Inspectors wroteBased on observation and interview, the facility failed to discard undated, opened vials of long-acting and short-acting insulin, and expired vials of two other types of insulin. In addition, the following medications were expired: over-the-counter pain relieving patches, an over-the-counter acid reducer, vitamin B-12 and iron, for 1 of 4 medication carts reviewed (Tuscan hallway). This failure placed the residents at risk for receiving discharged resident's medications and compromised or ineffective medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide food that accommodated food preferences for 1 of 6 sample residents (31), reviewed for preferences. This failure placed the resident at risk for decreased dietary intake and decreased quality of life.