Fircrest Nursing Facility

Inspectors wroteBased on interview and record review, the facility failed to provide a written bed hold notice at the time of transfer to the hospital for 3 of 4 residents (Residents 1, 2 & 86), and failed to provide a written transfer notice and notify the Office of the State Long-Term Care Ombudsman (an advocate for residents of nursing homes who protect and promote resident rights under federal and state law and regulations) of the transfer, as required for 1 of 4 residents (Resident 2), reviewed for hospitalization. This failure placed the residents at risk for lack of knowledge regarding their right to hold their bed while in the hospital, protection of resident rights during transfers, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accurately assess 4 of 18 residents (Residents 4, 12, 9 & 5), reviewed for Minimum Data Set (MDS-an assessment tool). The failure to ensure resident assessments were completed accurately on the MDS regarding pressure ulcer (injury to the skin caused by prolonged pressure), antipsychotic (medications used to treat symptoms of psychotic [mental health condition characterized by a loss of touch with reality]) medication review, restraint (devices or methods that limit a resident's freedom of movement), and diagnosis placed the residents at risk for unidentified and/or unmet care needs, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure foods were stored and handled in accordance with professional standards of food safety for 1 of 2 kitchen walk-in refrigerators (Kitchen Main Preparation Walk-In Refrigerator), and 2 of 10 staff (Staff M & N), reviewed for food services. The failure to cover and label food items in the kitchen walk-in refrigerator and perform hand hygiene when assisting residents with their meals placed the residents at risk for food borne illness (caused by the ingestion of contaminated food or beverages), cross contamination, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure hand hygiene and proper glove use were followed for 2 of 16 Staff (Staff N & K) and failed to ensure Enhanced Barrier Precautions (EBP- precaution to protect residents from Multidrug-Resistant Organism [MDRO-a germ that is resistant to medications that treat infections]) practices were followed for 2 of 13 Staff (Staff O & I), reviewed for infection control. These failures placed the residents, staff, and visitors at an increased risk for infection and related complications.

Inspectors wroteBased on interview and record review, the facility failed to ensure an informed consent explaining the risks/benefits for psychotropic medication (alters mood, perception, and behavior) was completed prior to medication administration for 1 of 5 residents (Resident 5), reviewed for unnecessary medications. This failure placed the residents and/or their representative at risk of not being fully informed of the risks and benefits before making decisions about medications prior to administration.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement a care plan for 2 of 18 residents (Residents 4 & 86), reviewed for comprehensive care plans. The failure to implement the care plans for tube feeding (a way to deliver liquid nutrition through a flexible tube into the body) and indwelling urinary catheter (a flexible tube inserted into the bladder to drain urine) placed the residents at risk for unmet care needs and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care in accordance with accepted professional standards of practice for 1 of 1 resident (Resident 83), reviewed for respiratory care. The failure to change the AIRVO 2 (a humidifier with an integrated flow generator that delivers warmed, humidified, high-flow air and/or oxygen) chamber placed the resident at risk for respiratory infections, and related complications.

Inspectors wroteBased on interview and record review, the facility failed to provide adequate supervision for 1 of 3 residents (Resident 1), reviewed for accident hazards. This failure placed the resident at risk for serious harm and injury, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure baseline care plan (initial instructions on necessary care until a comprehensive care plan is established) was accurate for 1 of 3 residents (Resident 2), reviewed for resident records. This failure placed the resident at risk for unmet care needs and a diminished quality of care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure timely reporting of an injury of unknown source to the State Agency for 1 of 3 residents (Resident 1), reviewed for abuse/neglect reporting. This failure placed the resident at risk for potential unidentified and ongoing abuse and lack of protection from abuse.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow the plan of care and provide adequate supervision for 1 of 1 resident (Resident 1), reviewed for accident hazards. This failure placed the residents at risk for further fall, injury, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to inform the residents' representatives (RR) about the residents' positive Respiratory Syncytial Virus (RSV-a germ that could easily spread and cause lung infections) test and treatments for 2 of 3 residents (Resident 1 & 2), reviewed for change in condition. This failure placed the residents and/or their representatives at risk of not being provided adequate information to make informed decisions about their medical condition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the nurse staffing information postings were posted on daily basis at the beginning of each shift. In addition, the facility failed to ensure the nurse staffing information postings were in prominent locations readily accessible to residents and visitors for 5 of 5 units ([NAME], Hickory, Elm, Cherry, and Birch), reviewed for Nurse Staffing Information. These failures placed residents and visitors at risk for not being fully informed of current nurse staffing levels and resident census information.

Inspectors wroteBased on interview and record review, the facility failed to accurately assess 6 of 22 residents (Residents 348, 82, 45, 35, 97, & 12), reviewed for Minimum Data Set (MDS-an assessment tool). The failure to ensure accurate assessments regarding capturing occurrences during the look-back period for anticoagulant (medication that helps to prevent blood clots from forming) use, tracheostomy (an opening into the trachea (windpipe) from outside the neck) care, timing of MDS sections completion, completion of a discharge assessment, placed the residents at risk for unidentified and/or unmet care needs, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to develop and/or implement comprehensive care plans for 5 of 22 residents (Residents 44, 88, 45, 24, & 77), reviewed for care planning. The failure to develop/implement care plans for antidepressant medication use, pressure ulcer (bed sore) care, antibiotic (medication to treat infection) use, refusal of care and use of antipsychotic medication (to treat symptoms of certain mental health disorders) placed the residents at risk for unmet care needs and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure expired medication was disposed of timely and a controlled substance (a drug or chemical that is regulated by the government because it can be addictive or harmful if misused) medication was handled and accounted appropriately for 1 of 3 medication carts ([NAME] Building), reviewed for medication storage. This failure placed the residents at risk for receiving compromised and/or ineffective medications and for potential diversion or misappropriation of controlled substance medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure foods were handled appropriately in accordance with professional standards of food safety for 2 of 3 refrigerators (Walk-in Produce/Milk Refrigerator and Walk-in Preparation Salad Refrigerator), 1 of 1 dry storage room (Commissary Dry Storage Room), and for 3 of 8 staff (Staff NN, OO & PP), reviewed for food services. The failure to date and discard food items past the use by/discard date, perform hand hygiene and handle kitchen equipment appropriately placed the residents at risk for food borne illness (caused by the ingestion of contaminated food or beverages), cross contamination, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff were fit tested (a test protocol conducted to verify that a respirator provides the wearer with the expected protection) timely for N95 (a device/mask designed to protect the wearer against particles and help prevent the spread of germs) masks and used correctly for 2 of 6 staff (Staff EE & Staff FF), reviewed for infection control. In addition, the facility failed to ensure hand hygiene practices and/or proper use of gloves were followed before, during, and after resident care for 5 of 14 staff (Staff Z, L, JJ, Q & R), failed to disinfect medical equipment for 2 of 2 staff (Staff II & U), and failed to ensure that infection control practices were implemented with storage of sharp containers for 3 of 3 medication rooms (Cherry, Birch & Hickory). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services in a manner that maintained and promoted dignity while assisting with a meal for 1 of 18 residents (Resident 29), reviewed for dining observation. This failure placed the resident at risk for a diminished self-worth and over all wellbeing.

Inspectors wroteBased on observation, interview, and record review, the facility failed to inform residents and/or their representatives of risks and benefits before application of a restraint for 2 of 5 residents (Residents 41 & 12), reviewed for physical restraint. This failure placed the residents and/or their representatives at risk for not being fully informed before making decisions regarding their health care, alternative treatment options, and the right to refuse care.

Inspectors wroteBased on interview and record review, the facility failed to ensure annual Minimum Data Set (MDS-an assessment tool) was completed within 14 days from the Assessment Reference Date (ARD) for 1 of 22 residents (Resident 24), reviewed for comprehensive assessments. This failure placed the resident at risk for delayed and/or unmet care needs, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Significant Change in Status Assessment (SCSA) Minimum Data Set (MDS - an assessment tool) was completed for 1 of 2 residents (Resident 35), reviewed for SCSA. This failure placed the resident at risk for delayed care planning, unmet care needs, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure services were consistently provided to increase Range of Motion (ROM) and/or to prevent decrease in ROM for 2 of 5 residents (Residents 12 & 81), reviewed for restorative services. This failure placed the residents at risk for a decline in ROM, unmet care needs, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medical supplies used for medication administration were stored properly for 2 of 3 medication rooms (Cherry and Hickory Buildings), reviewed for accident hazards. This failure placed the residents at risk for ingestion or exposure to cleaning chemicals and potential negative outcomes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate treatment and services related to gastrostomy tube (G-tube - a medical device used to provide nutrients through a tube directly into the stomach) were followed for 1 of 3 residents (Resident 9), reviewed for tube feeding management. The failure to check for G-tube placement by visual inspection of aspirated stomach content prior to medication administration placed the resident at risk for medical complications and negative health outcomes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure oxygen tubing were labeled and/or appropriately stored for 2 of 4 residents (Residents 4 & 80), reviewed for respiratory care. This failure placed the residents at risk for unmet care needs and potential negative outcomes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure clinical records were complete and accurate for 1 of 3 residents (Resident 18), reviewed for resident medical records. This failure placed the resident at risk for unmet care needs and medical complications.

Inspectors wroteBased on interview and record review, the facility failed to ensure the pneumococcal vaccine (used to prevent pneumonia [a lung infection]) was offered for 1 of 5 residents (Resident 80) reviewed for immunizations and infection control. This failure placed residents at risk of acquiring, transmitting, and/or experiencing potentially avoidable complications from pneumococcal and disease.

Inspectors wroteBased on interview and record review, the facility failed to ensure timely reporting of abuse allegation to the State Agency for 1 of 1 resident (Resident 1), reviewed for abuse/neglect reporting. This failure placed the resident at risk for potential unidentified and ongoing abuse and lack of protection from abuse.

Inspectors wroteBased on interview and record review, the facility failed to ensure necessary care and services was provided per professional standards of practice for 1 of 1 resident (Resident 1), and failed to prevent an unnecessary replacement of gastrojejunostomy tube (GJ tube, is a feeding tube that is placed through the stomach into the jejunum [small intestine] and that has dual ports to access both the stomach and the small intestine for administration of food, fluids, and medications) for 1 of 1 resident (Resident 2), reviewed for GJ tube replacement. These failures placed the residents at risk of unmet care needs, unnecessary surgical procedure, medical complications, and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to accurately assess 5 of 29 residents (Residents 49, 51, 48, 54, and 42) reviewed for Minimum Data Set (MDS- an assessment tool) assessment. The failure to ensure accurate assessments regarding eating, diagnosis for catheter (a flexible tube placed into the bladder to drain urine) use, falls, and dental condition placed the residents at risk for unidentified or unmet care needs and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure foods stored in the kitchen were discarded on or before use by date. In addition, the facility failed to ensure ready-to-eat food was handled appropriately in accordance with professional standards for food service safety in 1 of 6 dining rooms. These failures placed the residents at risk for food borne illnesses (caused by the ingestion of contaminated food or beverages), cross contamination, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement comprehensive care plans for 1 of 19 residents (Resident 94) reviewed for comprehensive care plans. Failure to develop and implement a comprehensive care plan placed residents at risk for unmet care needs and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents consistently received the appropriate treatment and services related to tube feeding (TF - a medical device used to provide nutrition through a tube directly to the stomach) for 1 of 3 residents (Resident 21) reviewed for tube feeding. Failure to change the TF administration set, formula, and water flush bag placed Resident 21 at risk for adverse consequences and/or complications of feeding via TF.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain, clean and store respiratory (breathing) equipment properly for 1 of 3 residents (Resident 26) and 1 of 10 suction machines (a medical device used to remove mucus/saliva secretions/blood obstruction from a person's airway) (Elm's Suction Machine 2) reviewed for respiratory care. These failures placed residents at risk for infection and a decrease in health maintenance.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure proper hand hygiene practices were followed during stoma (an opening surgically created in the wall of the stomach that allows waste to leave the body) care for 1 of 3 residents (Resident 32) reviewed for tube feeding (a device that delivers liquid nutrition via tube through the stomach). This failure placed the resident at risk for facility acquired or healthcare-associated infections and related complications.