Encore at Turf Valley

Inspectors wroteBased on observations and interviews with facility staff, it was determined the facility failed to ensure that foods that were stored in the refrigerator and freezer had a date when prepared and opened. This was found to be evident during an initial tour of the kitchen during the survey.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to promote care in a manner that maintains dignity and respect and failed to ensure that meal trays were appropriately presented to residents requiring assistance. This deficient practice was evident for 2 of 15 residents reviewed (Residents #18 and #29) during the survey.

Inspectors wroteBased on record review and an interview, it was determined that the facility failed to ensure that residents were provided written information regarding their right to formulate an advance directive upon admission This was evident for 2 (Residents #13, #62) out of 6 residents reviewed for Advance Directives.

Inspectors wroteBased on interview and record review it was determined the facility failed to notify the physician of a resident's change in condition in a timely manner. This was evident for 1 (Resident #83) out of 1 resident reviewed for neglect during the survey.

Inspectors wroteBased on observation and staff interview, it was determined that the facility failed to ensure the confidentiality of resident records by allowing protected health information (PHI) to remain visible on an unattended computer screen at the main nursing station. This failure resulted in unauthorized exposure of resident names, insurance payor information, and care levels for 27 residents.

Inspectors wroteBased on record review and interview with facility staff, it was determined that the facility failed to timely report allegations of abuse within the required two-hour timeframe to the Survey Agency, the Office of Health Care Quality (OHCQ). This was evident for 1 (MD00199783) of 2 facility related incident reports reviewed during the survey.

Inspectors wroteBased on observation, medical record review and staff interview, the facility failed to ensure a resident receives the correct diet as ordered by the physician. This was evident for 1 (Resident #133) of 23 residents observed during the survey.

Inspectors wroteBased on interview and record review it was determined the facility failed to ensure accuracy of medical assessment documentation of a resident. This was evident for 1 (Resident #38) out 3 residents reviewed for pressure ulcer/injury during the survey.

Inspectors wroteBased on observations and interviews with facility staff it was determined the facility failed to adhere to infection control practices and procedures to prevent the transmission of dirt and germs when storing dish trays in the kitchen. This was found to be evident during observations made in the kitchen during the survey.

Inspectors wroteBased on record review and interviews with staff, it was determined that the facility failed to ensure the Minimum Data Set (MDS) assessments were accurately coded. This was evident for 1 (Resident #87) out of 25 residents reviewed during the investigative portion of the survey.

Inspectors wroteBased on observation, interview, and documentation review it was determined that the facility staff failed to store, prepare, and maintain a sanitary environment in accordance with professional standards for food service safety by failing to ensure that Dishwasher hot water temperatures are frequently checked to ensure the cleanliness and sanitation of dishware, failing to ensure proper cooking temperatures of food by taking temperatures during food preparation and service and failing to store dishware sanitarily. This practice had the potential to affect all residents that consumed food that was prepared by the kitchen.

Inspectors wroteBased on medical record review and staff interview, it was determined the facility failed to develop and implement comprehensive person-centered care plans with appropriate measurable goals. This was exemplified for 3 (#69, #63, #24) residents out of 46 residents reviewed.

Inspectors wroteBased on medical record review and interviews with staff and a resident, it was determined that the facility failed to ensure an interdisciplinary team, which included the resident and or the resident's representatives, contributed to the resident's comprehensive care plan as evidenced by the failure to conduct a quarterly care plan meeting. Additionally, facility staff failed to document and evaluate each care plan to ensure the interventions continued to be appropriate for the resident's condition. This was found to be exemplified for 6 (Residents #29, #22, #49, #24, #123, #69) out of 46 resident's reviewed during the survey.

Inspectors wroteBased on medical record review and interview it was determined that the facility failed to ensure staff followed physician orders as evidenced by 1) failure to assess a resident's blood sugar level every morning as ordered; ; 2) failed to ensure an orders for safety precautions were communicated to staff and implemented; 3) failure to ensure ordered consults were addressed. This was found to be evident for 4 (Resident #29, # 15, #169, #173) out of 46 residents reviewed during the survey.

Inspectors wroteBased on medical record review and staff interview it was determined the facility staff failed to have a process to ensure that medication regimen reviews occur monthly for all residents and pharmacist recommendations were timely acted upon and documented in the resident's medical record. This was evident for 3 (#49, #56, #52) of 5 residents reviewed for unnecessary medications. Additionally, the facility failed to develop policies and procedures related to the steps the pharmacist must take when he or she identifies an irregularity that requires urgent action to protect the resident.

Inspectors wroteBased on medical record review and interview it was determined that the facility failed to ensure that medical records were kept in accordance with the professional standards of practice as evidenced by: 1) failure to ensure that orders for CPR were discontinued in the electronic health record when a new MOLST was initiated and new orders for No CPR were instituted; 2) failure to ensure that the advanced directives that were referenced in MOLST forms were kept in the medical record; 3a & 3b) the failure to ensure that old (expired) Maryland Medical Orders for Life-Sustaining Treatment (MOLST) forms were voided when a new MOLST form was initiated; 4a & 4b) residents' immunization consent forms that were obtained without signature and date, and 5) nursing staff documented Foley catheter care for a resident that did not have a catheter. [...]

Inspectors wroteBased on observation, record review, and staff interview, it was determined that the facility failed to maintain strict infection control processes evidenced by: 1) failure to clean reusable medical equipment from resident to resident. This was observed as 2 of 2 staff performed vital sign checks on the long-term care unit, and 2) failure to implement appropriate standard precautions to help prevent the spread of infections. This was found to be true for 1 of 4 nurses observed during the medication administration facility task. This deficient practice has the potential to affect all residents, staff, and visitors in the facility. Standard precautions are the minimum infection prevention and control practices that must always be used for all patients/residents in all situations. [...]

Inspectors wroteBased on medical record review and interview it was determined that the facility failed to have an effective system in place to ensure resident's who were capable to make their own decisions were involved in decisions regarding life sustaining treatment orders; and failed to ensure that a copy of a resident's advance directive was kept in the resident's medical record. This was found to be evident for 3(Resident #29, #15 and #14 ) out of 7 residents reviewed for Advance Directives during the survey.

Inspectors wroteBased on medical record review and interview, the facility failed to notify a resident's responsible party and provider when the resident received a injury that required treatment (Resident #226). This was evident for 1 out of 2 residents reviewed during an annual survey for neglect.

Inspectors wroteBased on medical record review, staff interview, and review of administrative records, it was determined that the facility failed to provide written notification to residents or resident representative when the facility determined that a resident no longer qualified for Medicare part A skilled services. This is identified for 1 (Residents #124) of 2 residents reviewed that remained in the facility after termination of Medicare part A skilled services.

Inspectors wroteBased on observation, interview and review of pertinent documentation it was determined that the faciltiy failed to maintain a safe and clean environment as evidenced by failure: 1) to ensure that needed repairs were reported to maintenance, 2) to ensure that exhaust vents in bathrooms were cleaned on a regular basis, and 3) that hazards were identified and removed from resident care areas. This was found to be evident on two out of the ## units at the facility.

Inspectors wroteBased on medical record review the facility failed to keep resident medication safe and free of misappropriation of resident property. This was evident for 5 (Resident #219, #220, #221, #32, #47) out of 6 residents reviewed for abuse.

Inspectors wroteBased on medical record review and interview it was determined that the facility failed to include a statement of the resident's appeal rights in the written transfer notice provided to residents at the time of discharge, and failed to ensure that staff completed information regarding where a resident was being transferred as well as why the transfer was necessary. This was found to be evident for 3 (Resident #169, #14, #70 ) out of the 5 residents reviewed for hospitalization during the survey.

Inspectors wroteBased on medical chart review, the facility failed to have a baseline care plan for Resident # 55 and Resident # 63. This was evident for 2 out of 2 residents reviewed for pain management.

Inspectors wroteBased on medical record review and interview, the facility nursing staff: 1) failed to follow standards of practice by failing to report and obtain an order for treatment of an observed injury (Resident #226). This was evident for 1 out of 3 residents reviewed during a complaint survey. 2) Failed to meet a professional standard of quality as evidenced by Foley catheter care was documented seven times for a resident whose catheter had been already removed. This was evident for 1 (Resident #173) of 6 residents reviewed for Foley catheter during the survey.

Inspectors wroteBased on medical record review, staff interview, and observation, it was determined that the facility failed to follow hospital discharge instructions for a follow-up appointment with a Urologist. The failure of the facility to follow up with a Urologist placed the resident at risk for infection. This was evident for 1 (# 173) of 6 residents reviewed for Foley catheters during the survey.

Inspectors wroteBased on medical record review, interview and observation, the facility's nursing staff failed to administer resident pain medication based on order parameters (Resident #30). This is evident for 1 of 7 residents observed during the medication administration task for the facility's annual survey. On 11/18/21 at 8:29 AM, the surveyor observed Registered Nurse (RN), #9, administering medication to Resident #30 as part of medication administration observation task for the facility's annual survey. Resident #30 self-reported pain level at 8 and requested pain medication. RN#9 gave the resident two 325mg tablets of Tylenol and a 10mg Oxycodone tablet for the resident's self-reported pain level of 8. Review of Resident #30's medical record at 11/18/21 at 10:03 AM revealed that the resident was ordered to have two 325mg Tylenol tablets for mild pain self-reported at a level 1-3. [...]

Inspectors wroteBased on medical chart review, the facility failed to clarify an order for Xanax with behavior health and the resident's physician. This was evident for 1 (#64) out of 4 residents reviewed for mood-behavioral comprehensive assessment.

Inspectors wroteBased on observation and interview, the facility nursing staff failed to ensure that all medications in a medication cart were unexpired. The was found in 1 of 3 medication carts inspected. This deficient practice has the potential to affect all residents. On 11/19/21 at 9:30 AM, the surveyor inspected a medication cart on the Patuxent unit. The surveyor observed that a bottle of liquid protein expired on 9/25/21 and a bottle of MiraLAX expired on 10/20/21. The surveyor interviewed Registered Nurse (RN) #9 to ask about the facility process to ensure that all medications in a medication cart are unexpired and safe to use for all residents. RN#9 stated that all medications are checked daily by each individual nurse assigned to the cart to ensure that medications are unexpired. The surveyor pointed out the two expired medications found on the Patuxent medication cart. [...]

Inspectors wroteBased on record review and staff interview, it was determined that the facility staff failed to document that residents and/or their Responsible Parties (RPs) were provided education on Influenza and Pneumococcal vaccines before requesting consent. This was evident for 4 (Resident #6, #29, #57, and #60) of 5 residents reviewed for Immunizations during the survey.

Inspectors wroteBased on observation and interview, the facility failed to accurately post the total number (licensed and unlicensed) and the actual hours worked for all nursing staff caring for residents. This deficient action has the potential to affect all residents and visitors to the facility. The surveyor reviewed the facility's nursing staff posted hours on 11/23/21 at 7:30 AM. The surveyor observed that the facility failed to list the total number of licensed and unlicensed nursing staff caring for the residents, as well as, the total number of actual hours each nursing staff group worked for that shift. On 11/24/21 at 4:50 PM the surveyor shared concerns about the facility's posted nursing staff hours with the Director of Nursing (DON) and the Administrator. The DON located the regulation about the nursing staff posting requirements and confirmed the surveyor's findings.

Inspectors wroteBased on observation and interviews of facility staff, it was determined that food service employees failed to ensure that equipment was maintained and staff practices were followed to reduce the risk of foodborne illness.

Inspectors wroteBased on staff interviews and review of medical records, it was determined that the facility staff failed to properly document a change in condition for Resident #9. This occurred with 1 resident out of 27 residents surveyed during the investigation stage of the annual facility survey.