Fort Myers Rehabilitation and Nursing Center

Inspectors wroteBased on observation and staff interviews, the facility failed to follow proper sanitation procedures for the 3-compartment sink, increasing the risk of cross-contamination and foodborne illness with the potential to impact residents receiving cooked food out of the dietary department.

Inspectors wroteBased on observation, review of the clinical record, review of the facility job description of the Activity Director and staff interviews, the facility failed to ensure they provided an ongoing program to support the residents in their choice of activities which are designed to meet the resident's interests and support the resident's physical, mental, and psychosocial well-being for 2 ( Resident #3 and #91 ) of 3 residents reviewed for involvement in the activity programs. The lack of an ongoing activity program could lead to a decline in the residents' self-esteem, physical, mental, and psychosocial well-being.

Inspectors wroteBased on review of the facility job description for the Activity Director and staff interviews, the facility failed to ensure the activities program was directed by a qualified professional who is a qualified therapeutic recreation specialist or an activity professional. This has the potential to affect all 131 current residents residing in the facility.

Inspectors wroteBased on observation, review of facility policy and procedures, record review and staff and resident interviews, the facility failed to ensure urinary catheters were secured to prevent pulling and injury and failed to maintain the catheters in sanitary manner for 3 (Resident #50, #423, and #274) of 3 residents reviewed with an indwelling urinary catheter.

Inspectors wroteBased on observation, review of the clinical record, review of the facility job description of the Activity Director and staff interviews, the facility failed to ensure resident records were maintained in accordance with accepted professional standards and practices, that are complete, and accurately documented for 2 (Residents #3, and #91) of 28 residents records reviewed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a clean, comfortable, homelike environment that allows the resident to use the physical layout to maximize independence and does not pose a safety risk for 4 (#52, #57, #273, #274) of 5 residents reviewed.

Inspectors wroteBased on record review and interview, the facility failed to ensure 1 (Resident #96) of 3 residents with newly evident or possible serious mental disorder, or related condition was referred to the appropriate state-designated mental health or intellectual disability authority for review for a Level II screening.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services to meet the needs for personal hygiene, nail care, assistance with dressing, and toileting for 1 (Residents #28) of 5 dependent residents reviewed.

Inspectors wroteBased on record review, interview and observation, the facility failed to maintain ongoing communication, coordination and collaboration between the nursing home and the dialysis staff for 1 (Resident #87) of 1 sampled resident receiving dialysis services reviewed.

Inspectors wroteBased on observations and staff interviews, the facility failed to establish and maintain an effective infection prevention and control program, which increased the risk of communicable diseases and infections for 3 (Residents #23, #274 and #278) of 3 residents reviewed for catheter care and enhanced barrier precautions.

Inspectors wroteBased on observation, staff and resident interviews, review of facility policy and procedure, and record review, the facility failed to ensure 4 (Residents # 16, #69, #78 and #98) of 5 residents reviewed for accidents were assessed for alternative interventions prior to the use of bed rails. This had the potential to have bed rails installed when alternatives with less chance of negative consequences could be utilized.

Inspectors wroteBased on observation, clinical record review and staff interviews, the facility failed to ensure its medication error rate remains below 5%. Five licensed nurses on two different shifts with 27 opportunities were observed. Four medication errors were observed resulting in a 14.81% error rate.

Inspectors wrote4. Record review of the Minimum Data Set (MDS) with Assessment Reference Date of 8/4/22 indicated Resident #108 had a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. The MDS revealed several active diagnoses for Resident #108 including Non-Alzheimer's Dementia, Depression, Psychotic Disorder, and Schizophrenia. On 8/15/22 at 4:30 p.m., during an observation and interview with Resident #108 she said she keeps her medicine in her chest drawers. Resident #108 stood up from bed, walked to the chest of drawers across from her bed and removed a red, 7-day pill organizer from the top drawer. She opened one section of the pill organizer and placed several pills in her hand, including a large pink pill identified as Depakote 500 milligrams (mg), which is used to treat seizures and mood disorders. [...]

Inspectors wroteBased on observation, record review and resident and staff interviews, the facility failed to implement adequate supervision for 1(Resident #78) of 19 residents reviewed with known unsafe wandering behaviors.

Inspectors wroteBased on observation, resident council, and staff interview, the facility failed to keep the most recent survey results in a place readily accessible to residents, visitors, and the public.

Inspectors wroteBased on observation, policy review and staff interview, the facility failed to follow the manufacturer's specification to clean and disinfect multiuse Evencare G3 blood glucose meters for 5 (Residents #16, #24, #63, #116 and #371) of 5 residents observed with a physician's order for blood glucose monitoring (test that measures the amount of sugar in the blood). The facility failed to apply the disinfectant necessary for the minimum wet contact time per manufacturer's instructions to kill bloodborne pathogens on shared multiuse blood glucose meters. Inadequate disinfection may result in indirect contact transmission (the transfer of an infectious agent through a contaminated inanimate object) of pathogens through the improperly disinfected glucometers. The facility had a total of 12 blood glucose meters used for 42 diabetic residents with orders for blood glucose checks. [...]

Inspectors wroteBased on record review and staff and resident interviews the facility failed to ensure they considered the views of Resident Council and act promptly upon their grievances, concerns, and recommendations for 7 (8/2020, 9/2020, 10/2020, 11/2020, 12/2020, 1/2021 and 2/2021) of 7 months reviewed.

Inspectors wroteBased on interview and staff and resident interviews the facility the facility failed to ensure 10 (#43, #12, #23, #97, #9, #95, #90, #113, #40 and #98) of 14 resident's wheelchairs were clean and kept in a sanitary condition to prevent the spread of disease-causing organisms.

Inspectors wroteBased on observation, resident and staff interview, the facility failed to accommodate the food allergies and offer appropriate alternative for 1 (Resident #28) of 3 residents reviewed for food allergies, intolerances, and preferences.

Inspectors wroteBased on record review and interview the facility failed to maintain complete and accurately documented medical records for 5 (Resident #2, #30, #40, #59, and #122) of 27 residents records reviewed. Accurate and complete records are necessary to document the course of a resident's care provided by the facility.

Inspectors wroteBased on observation and residents and staff interview the facility failed to ensure 4 (Residents #44, #34, #90 and #49) out of 10 siderails checked out of a possible 129 bed with siderails installed were in safe operating condition at all times.

Inspectors wroteBased on record review, resident and staff interview, the facility failed to promote residents right to dignity and provide care and services to maintain self-esteem and self-worth for 2 (Residents #318, and #116) of 3 sampled residents. This has the potential to cause psychological harm, frustration, and discomfort.

Inspectors wroteBased on observation, resident and staff interview, the facility failed to provide private closet space for 2 (Resident #94 and #116) of 2 residents reviewed for physical environment. The failure to provide private closet space inhibits the ability to protect personal effects from casual access by others and allow items to remain clean and accessible to residents.