Enniscourt Nursing Care

Inspectors wroteBased on closed medical record review, interview, review of the emergency medical services (EMS) run report, and facility policy review, the facility failed to provide timely, necessary and adequate care and services following an acute change in condition. Resident #45 had a recent hospitalization and a significant cardiac history including cardiac coronary disease, history of a heart attack, atrial fibrillation, and congestive heart failure. The facility failed to ensure changes in the resident's medical condition were adequately assessed, failed to have documented evidence of notification to the physician and that adequate care and services were implemented for Resident #45 when the resident had repeatedly complained of chest pain and tightness. [...]

Inspectors wroteBased on the medical record review, review of the emergency medical services (EMS) run report, facility policy and procedure review and interview, the facility failed to report an allegation of neglect to the State agency. This affected one (Resident #45) of three residents reviewed for change in condition. The facility census was 42.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on observation, interview, record review, review of facility self-reported incidents (SRI) and facility policy review, the facility failed to ensure Resident #4 was free from misappropriation. This affected one resident (#4) of three residents reviewed for abuse, neglect and misappropriation of property. The facility census was 44.

Inspectors wroteBased on record review, interview and review of the facility policy, the facility failed to correctly transcribe and record oxygen orders upon admission to ensure oxygen was administered properly. This affected one resident (#43) of three residents reviewed for oxygen. Facility census was 40.

Inspectors wroteBased on interviews, review of the Payroll Based Journal (PBJ) staffing report, review of facility staffing schedules and timecard punches revealed the facility failed to submit accurate staffing information to the Centers for Medicare and Medicaid Services (CMS). This had the potential to affect all 39 residents residing in the facility.

Inspectors wroteBased on record review, observation and interview, the facility did not ensure private and confidential handling of resident medical information for Residents #14, #15, #19, #20, #29 and #31. This affected six residents ( #14, #25, #19, #20, #29 and #31) of six residents reviewed for weights and had the potential to affect all residents living in the facility. The facility census was 42.

Inspectors wroteBased on record review, observation and interview, the facility failed to ensure adequate and sufficient documentation of residents' weights in the medical record for the monitoring of residents at nutrition risk and identification and assessment of significant weight changes. This affected six residents (#14, #15, #19, #20, #29, and #31) of six reviewed for nutrition. The facility census was 42.

Inspectors wroteBased on observation, record review, staff and resident interviews, and policy review, the facility failed to ensure call lights were within reach and accessible. This affected two residents (#5 and #31) of two residents reviewed for call light placement. The facility census was 42. Findings Include: 1. Review of the medical record for Resident #5 revealed she was admitted to the facility on [DATE] with diagnoses including dementia, dysphagia and difficulty walking. Review of the annual, Minimum Data Set (MDS) assessment, dated 07/16/23, revealed Resident #5 had a Brief Interview for Mental Status (BIMS) score of 10 indicating she was alert and oriented with long-term and short-term cognition impairment. Review of the MDS assessment revealed Resident #5 was a one-person extensive assist for activities of daily living (ADLs). [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure a physician order was written for dialysis treatments, a dialysis contract was in place between the facility and the dialysis center, and also failed to ensure assessments before and after dialysis treatments were completed for Resident #145. This affected one resident (#145) of one resident reviewed for dialysis services. The facility census was 42.

Inspectors wrote2. Review of Resident #43's medical record identified admission to the facility occurred on 01/17/22 with medical diagnoses including stroke, dementia, alzheimer's, skin cancer, and depression. The record identified Resident #43 discharged to the hospital on [DATE] and did not re-enter the facility. Review of both the electronic medical record and hard chart revealed no evidence Resident #43 and/or representative received notification in writing for transfer to the hospital dated 07/12/23. Interview on 09/07/23 at 9:30 A.M. with Registered Nurse (RN) #964 revealed he was responsible for notifying the ombudsman of discharges and transfers to the hospital and did so via email. [...]

Inspectors wroteBased on medical record review, review of facility bed hold policy and staff interviews, the facility failed to ensure Resident #40 and #43 were provided bed hold notices. This affected two residents (#40 and #43) of two residents reviewed for hospitalization and had the potential to affect all residents living in the facility. The facility census was 42.

Inspectors wroteBased on record review and staff interview the facility failed to ensure the pre admission screen and resident review status was coded correctly on the Minimum data set (MDS) assessment. This affected two (Residents #1 and #2) of two residents with a level two mental illness currently residing at the facility. The facility census was 42. Findings Include: 1. Record review revealed Resident #1 was admitted to the facility on [DATE] with diagnoses that included schizoaffective disorder, type two diabetes and hypothyroidism. Review of the pre-admission screen and resident review (PASRR) level two evaluation from the state department of mental health dated 11/06/97 revealed Resident #8 had level two mental illness. [...]

Inspectors wroteBased on staff interview, review of personnel files and the abuse policy and procedure, the facility failed to develop and implement policies and procedures to include screening of all employees against the State of Ohio Nurse Aide Registry to identify if an employee had a finding concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property This affected nine of nine employees whose personnel files were reviewed for screening against the State of Ohio Nurse Aide Registry (Dietary Aide (DA) #587 , Registered Nurse (RN) #570, Maintenance Director (MD) #505, Activities Assistant (AA) #533 and State Tested Nursing Assistants (STNAs) #507, #526, #536, #540, #567). This had the potential to affect all 43 residents residing in the facility.

Inspectors wroteBased on review of Notice of Medicare Non-Coverage (NOMNC) letters and staff interviews, the facility failed to provide the correct Quality Improvement Organization (QIO) information to residents who were completing therapy. This affected three (Resident #22, Resident #243 and Resident #244) of three reviewed for liability notices. The facility also failed to provide 48-hour notice of the non coverage to the residents. This affected two (Resident #243 and Resident #244) of three reviewed for liability notices. The census was 43.

Inspectors wroteBased on record review, policy review and resident interview the facility failed to ensure Resident #5 was free from unnecessary restraint. This affected one (Resident #5) of two residents reviewed for elopement. The facility census was 43. Findings Include: Resident #5 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #5 had a Brief Interview for Mental Status (BIMS) score of 15 indicating no cognitive impairment and exhibited no physical, verbal or wandering behaviors. Review of the physician orders dated 12/17/19 revealed an order for a wanderguard to right wrist and to check placement every shift. A Wanderguard Bracelet triggers alarms and locks monitored doors to prevent the wearer from leaving an area unattended. [...]

Inspectors wroteBased on record review and staff interview the facility failed to ensure Pre admission Screen and Resident Review (PASRR) forms were completed timely as required and addressed all applicable mental health and developmental disability diagnoses. This affected two of three residents reviewed for PASRR compliance. The facility census was 43. Findings Include: 1. Resident #12 was admitted to the facility on [DATE] with diagnoses that included major depressive disorder, overactive bladder and constipation. Further review of the medical record revealed Resident #12 was admitted to the facility on a hospital exemption form which in turn required the completion of the PASRR form within thirty days of admission. Review of the PASRR in the medical record revealed Resident #12's PASRR was completed on 06/16/21. 2. [...]

Inspectors wroteBased on record review and staff interview the facility failed to ensure resident care plans were revised to reflect current resident medical/behavioral conditions. This affected one (Resident #5) of two residents reviewed for elopement. The facility census was 43. Findings Include: Resident #5 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #5 was cognitively intact and exhibited no physical, verbal or wandering behaviors. Review of the physician order dated 12/17/19 revealed an order for a wanderguard to right wrist and to check placement every shift. Review of the elopement/wandering assessment for 12/16/19 revealed Resident #5 was at a high risk for wandering. [...]

Inspectors wroteBased on record review and staff interview the facility failed to ensure physician orders were followed as written and medication was not given without a physician order. This affected two (Residents #5 and #42) of fifteen sampled residents. The facility census was 43. Findings Include: 1. Resident #5 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #5 was cognitively intact and exhibited no physical, verbal or wandering behaviors. Review of the physician order dated 12/17/19 revealed an order for a wanderguard to right wrist and to check placement every shift. Review of both the electronic and paper medical records revealed no evidence of monitoring of the placement of Resident #5's Wanderguard. [...]

Inspectors wroteBased on record review and staff interview the facility failed to ensure a Wanderguard (device used for alerting staff of exit seeking from a resident) was functioning properly. This affected one (Resident #5) of two residents reviewed for elopement. The facility census was 43. Findings Include: Resident #5 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #5 was cognitively intact and exhibited no physical, verbal or wandering behaviors. Review of the physician order dated 12/17/19 revealed an order for a wanderguard to right wrist and to check placement every shift. Observation of Resident #5 ambulating on 06/15/21 at 11:20 A.M. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure accurate resident assessments. This affected two residents (Resident's #14 and #31) of 21 residents reviewed for accurate assessments. The facility census was 40.

Inspectors wroteBased on observation, staff interview, medical record review, review of Centers for Disease Control (CDC) guidelines and policy review, the facility failed to ensure appropriate infection control procedures were enacted for two residents (Resident #194 and Resident #38) of 22 residents reviewed for infection control procedures. The facility census was 40. Findings Include: 1. Review of the medical record revealed Resident #194 was admitted to the facility on [DATE] with diagnoses including post-operative therapy after cervical spinal surgery, a positive test for the Influenza A virus, neuromuscular dysfunction of the bladder (a condition causing difficulty with bladder control), heart disease, chronic obstructive pulmonary disease, and chronic kidney disease. [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the office of the Long-Term Care Ombudsman of resident's transfers to the hospital. This affected two (Resident's #11 and #44) of two residents reviewed for hospitalization. The facility census was 40.