Four Corners Regional Care Center

Inspectors wrote2. Resident 52 was admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease with dyskinesia, dementia, insomnia, monoplegia of upper limb, dysphagia, myalgia, and muscle spasms. Resident 52's medical record was reviewed on 1/6/25 through 1/9/25. A care plan Focus initiated on 7/31/19, documented [Resident 52] is High risk for falls r/t Parkinson's disease, poor safety awareness, impaired balance, impaired mobility, impulsiveness frequently taking all of his clothing out of the closet and drawers and throwing them on the floor. The Focus was revised and canceled on 12/27/23. No new fall interventions were implemented in 2023. An annual MDS assessment dated [DATE], revealed resident 52 had a BIMS score of 3, indicating significant cognitive impairment. [...]

Inspectors wroteBased on observation and interview, the facility did not have the nurse staffing information posted. The facility must post the following information on a daily basis: Facility name, the current date, the total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: Registered Nurses, Licensed Practical Nurses, Certified Nursing Assistant, and resident census. The facility must post the nurse staffing data on a daily basis at the beginning of each shift and maintain the posted daily nurse staffing data for a minimum of 18 months. Specifically, the nurse staffing data was not posted on a daily basis and the nurse staffing data was not complete.

Inspectors wroteBased on interview and record review, the facility did not ensure that alleged violations involving abuse were reported immediately but not later than two hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, or not later than 24 hours if the events that caused the allegation did not involve abuse and did not result in serious bodily injury to officials including the State Survey Agency (SSA) and Adult Protective Services (APS). Specifically, for 6 out of 39 sampled residents, allegations of resident to resident abuse and injuries of unknown origin were not reported timely to the SSA or APS. In addition, allegations of resident to resident sexual abuse and neglect were not reported to the SSA or APS. Resident identifiers: 13, 17, 31, 36, 49, and 53.

Inspectors wroteBased on interview and record review, the facility in response to allegations of abuse, neglect, or mistreatment did not have evidence that all alleged violations were thoroughly investigated. Specifically, for 13 out of 39 sampled residents, allegations of resident to resident sexual abuse, injuries of unknown origin, and neglect were not investigated or the allegations were not investigated thoroughly. Resident identifiers: 13, 17, 32, 36, 46, 47, 48, 49, 50, 52, 51, 54, and 55.

Inspectors wroteBased on observation, interview, and record review, the facility did not provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biological's) to meet the needs of each resident. Specifically, the facility staff were taping narcotic medications back into the medication cards.

Inspectors wroteBased on observation and interview, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. Specifically, food items in the walk-in freezer, walk-in refrigerator, and dry food storage room were open to the air and several areas throughout the kitchen had floor tiles that were damaged.

Inspectors wroteBased on observation and interview, the facility did not maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, for 5 out of 39 sampled residents, a residents feeding tube was not capped when not in use, staff did not wear Personal Protective Equipment (PPE) while providing high contact care for residents on Enhanced Barrier Precautions (EBP), staff were not performing hand hygiene between resident care, and the Hoyer lift was not sanitized between resident use. Resident identifiers: 5, 19, 23, 29, and 348.

Inspectors wroteBased on interview and record review, the facility did not ensure that residents maintained acceptable parameters of nutritional status unless the resident's clinical condition demonstrated that this was not possible. Specifically, for 1 out of 39 sampled residents, a resident who had experienced a significant weight loss did not have recommendations from the Registered Dietitian (RD) implemented. Resident identifier: 4.

Inspectors wroteBased on interview and record review, the facility did not ensure that the pharmacist reported irregularities to the attending physician, the facility's Medical Director (MD), and the Director of Nursing (DON) were acted upon. Specifically, for 1 out of 39 sampled residents, a pharmacy recommendation to discontinue hydroxyzine was not acted upon timely. Resident identifier: 17.

Inspectors wroteBased on interview and record review, the facility did not ensure that each resident's drug regimen was free from unnecessary drugs. An unnecessary drug was any drug when used in excessive dose; or for excessive duration; or without adequate monitoring; or without adequate indication for its use; or in the presence of adverse consequences which indicated that the dose should be reduced or discontinued. Specifically, for 1 out of 39 sampled residents, a resident's medication was not discontinued per pharmacy and provider recommendations. Resident identifier: 17.

Inspectors wroteBased on interview and record review, the facility did not ensure that residents who used psychotropic drugs received gradual dose reductions (GDR) unless clinically contraindicated, in an effort to discontinue these drugs. A GDR must be attempted in two separate quarters, with at least one month between attempts, within the first year in which an individual was admitted on a psychotropic medication or after the facility had initiated such medication, and then annually. Specifically, for 1 out of 39 sampled residents, a resident taking an anticonvulsant medication for behavioral disturbance had not received a GDR on that medication since 2023, and the medication was not clinically contraindicated. Resident identifier: 24.

Inspectors wroteBased on observation and interview, the facility did not label all drugs and biological's used in the facility in accordance with currently accepted professional principles, and include appropriate accessory instructions and the expiration date when applicable. Specifically, two vials of insulin were open and available for use past the expiration date.

Inspectors wroteBased on interview and record review, the facility did not provide or obtain laboratory services to meet the needs of its residents. Specifically, for 1 out of 39 sampled residents, a resident had a urinalysis (UA) ordered and the urine was not collected for five days after the order was given. Resident identifier: 17.

Inspectors wroteBased on interview and record review, the facility did not maintain medical records on each resident that were accurately documented. Specifically, for 2 out of 39 sampled residents, a resident's medical record contained another resident's appeal discussion. Resident identifiers: 246 and 247.

Inspectors wroteBased on interview and record review, it was determined, the facility did not ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infections (UTI). Specifically, for 1 out of 23 sampled residents, facility staff did not: promptly respond with the resident presented with signs and symptoms of a UTI; ensure the resident received an antibiotic susceptible to organism causing the UTI; and, obtain antibiotic order clarification when a disparity existed. Resident identifier: 10.

Inspectors wroteBased on observation, interview, and record review, it was determined, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, for 2 out of 23 sampled residents, a staff member was observed to touch resident medications with bare hands with each medication administration. Resident identifiers: 2 and 22.

Inspectors wroteBased on observation, interview, and record review, it was determined, the facility did not ensure that the residents environment remains as free of accident hazards as was possible. Specifically, for 1 out of 23 sampled resident, a resident fell in the transportation vehicle during a transport. Resident identifier: 21. Findings Included: Resident 21 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which include end stage renal disease, vascular dementia, pulmonary fibrosis, essential hypertension, type 2 diabetes, dependence on renal dialysis, atherosclerotic heart disease, benign prostatic hyperplasia, gastro-esophageal, hyperkalemia, incontinence without sensory awareness, presence of coronary angioplasty. On 3/14/23, resident 21's medical record was reviewed. A significant change Minimum Data Set (MDS) assessment dated [DATE], was reviewed. [...]

Inspectors wrote2. Resident 15 was admitted to the facility on [DATE] with diagnoses which included late onset Alzheimer's disease, dementia, narcolepsy, obstructive sleep apnea, restless leg disorder, mood disorder, essential hypertension, wandering, and spinal stenosis. A review of resident 15's physician's orders revealed the following: a. Haloperidol lactate concentrate 2 milligrams/milliliter (mg/ml), administer 2.5 ml (milliliters)by mouth every 12 hours PRN for agitation. The medication was initiated on 12/24/22, with an end date documented as indefinite. b. Haloperidol lactate 5 mg/ml, inject 2.5 ml intramuscularly every 12 hours PRN for agitation and aggression. The medication was initiated on 1/4/23, with an end date documented as indefinite. A review the MAR for December 2022, January 2023, and February 2023 revealed haloperidol was administered to resident 15 numerous times. [...]

Inspectors wroteBased on interview and record review, it was determined, the facility did not ensure that each resident's medical record included documentation that indicated that the resident or resident's representative was provided education regarding the benefits and potential side effects of the influenza and pneumococcal immunizations; and that the resident either received the influenza and pneumococcal immunizations or did not receive the influenza and pneumococcal immunizations due to medical contraindications or refusal. Specifically, for 1 out of 23 sampled residents, a resident was not offered the pneumococcal immunization and the resident or the resident's responsible party was not provided information including the risks, benefits, and potential side effects of the pneumococcal immunization. Resident identifier: 15.

Inspectors wroteBased on record review and interview the facility did not develop and implement a comprehensive person-centered care plan for 3 of 18 sample residents, that included measurable objectives and timeframes to meet the residents' medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment. Specifically, a resident's care plan regarding assisting with dining was not implemented as written, and two residents did not have care plans developed regarding their need for assistance with dining. Resident identifiers: 9, 14, and 33.

Inspectors wroteBased on observation, interview and record review, the facility did not provide services to maintain good nutrition, grooming, and personal hygiene for 4 of 18 sample residents where were unable to carry out those activities of daily living. Specifically, residents were not provided timely assistance with meals. Resident identifiers: 9, 14, 16, and 33.

Inspectors wroteBased on interview, record review, and observation, the facility did not review and revise 1 of 18 sample resident's care plans after each assessment. Specifically, one resident had 12 falls with the care plan updated 4 times. Additionally, staff did not implement the resident's care plan effectively. Resident identifier: 22.

Inspectors wroteBased on observation, interview, and record review it was determined for 1 of 18 sample residents that the facility failed to ensure a resident with limited range of motion received appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion. Resident identifier 16.

Inspectors wroteBased on observation, interview and record review it was determined for 1 of 18 sample residents, that the facility did not ensure that the resident's environment remained as free of accident hazards as was possible; and that the resident received adequate supervision and assistance devices to prevent accidents. Specifically, one resident had multiple falls without interventions. Resident identifier: 22.

Inspectors wroteBased on interview and record review, the facility did not ensure that 1 of 18 sample residents saw a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter. Specifically, a resident had not been seen by the physician for approximately 6 months. Resident identifier: 33.

Inspectors wroteBased on interview and record review, the facility did not ensure that 2 of 18 sample residents who had not used psychotropic drugs were not given these drugs unless the medication was necessary to treat a specific condition as diagnosed and documented in the clinical record. Resident identifiers: 30 and 33.