Future Care Cold Spring

Inspectors wroteBased on observations and interviews, the facility failed to store food in accordance with professional standards for food service and safety. This was evident in 2 of 3 kitchen observations and 2 of 2 nourishment room observations during an annual survey.

Inspectors wroteBased on observations, interviews, and record review, it was determined that the facility failed to maintain medical records in accordance with acceptable professional standards and practices by keeping complete and accurate documentation. This was found evident in 3 (Resident #124, #127 and #137) out of 51 residents reviewed during the recertification survey.

Inspectors wroteBased on observations and interviews, the facility failed to maintain practices to help prevent the transmission of infections. This was evident in 1 (Resident #137) of 9 residents reviewed for indwelling medical devices/wounds and observations of the laundry area during the recertification survey.

Inspectors wroteBased on observations and interview it was determined that the facility failed to maintain adequate conditions of equipment. This was evident during 2 of 3 observations of ice machines and 1 of 1 of the laundry room.

Inspectors wroteBased on observations and interviews, the facility failed to provide a resident with a reasonable accommodation of need, as evidenced during one (Resident #138) random observation on the survey.

Inspectors wroteBased on record review and interviews, it was determined that the facility failed to determine if a Resident had an Advanced Directive and/or offer to help formulate one if determined not to have one. This was evident in 2 (Resident #138 & #4) of 3 residents reviewed for Advanced Directives during an annual survey.

Inspectors wroteBased on record review and interviews it was determined that the facility staff physically/verbally abused a resident. This deficient practice was evidenced in 1 (#126) of two facility reported incidents reviewed for alleged abuse during the recertification survey.

Inspectors wroteBased on record review and interview it was determined that the facility failed to appropriately prescribe psychotropic medication for a resident without documented need for one. This was found evident in 1 (Resident #4) out of 5 residents reviewed for unnecessary medications.

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on record review and interviews it was determined that the facility staff failed to notify the state agency within the two-hour allotted time frame. This deficient practice was evidenced in 2 (#124 & #126) of 3 facility reported incident investigations reviewed during the recertification survey.

Inspectors wroteBased on record reviews and interviews, it was determined that the facility failed to develop and implement patient-centered comprehensive care plans to meet the needs of residents. This was evident for 2 (Residents #1 and #4) out of 51 residents reviewed during the annual survey.

Inspectors wroteBased on record review and interviews it was determined that the facility staff failed to follow the standard of practice for nurses as evidenced that a nurse failed to notify the physician when a resident refused a treatment and a nurse completed a Change in Condition Evaluation 11 days after the change occurred. This deficient practice was evidenced in 2 (#124 & #125) of 5 resident records reviewed during the recertification survey.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to provide necessary services to maintain good personal hygiene for dependent Residents. This was evident in 1(Resident #4) out of 2 Residents reviewed for Activity of Daily Living (ADL) care.

Inspectors wroteBased on staff interviews and record reviews, the facility failed to maintain acceptable parameters of nutrition for residents and address significant weight gain. This was evident for 1 (Resident #8) out of 5 residents reviewed for nutrition during the annual survey. Significant weight change is defined as a gain or loss of 5% of a person's weight within 30 days, 7.5% within 90 days, or 10% within 180 days. Significant weight change requires clinical evaluation and, if the change is not beneficial, intervention.

Inspectors wroteBased on observations, staff interviews and clinical record review, it was determined that the facility staff failed to ensure that a tube feeding bag was labeled. This was evident for 1 resident ( #89) of 3 residents reviewed for tube feedings during the annual survey.

Inspectors wroteBased on interviews and record review, it was determined that the facility's physician failed to acknowledge and/or address recommended interventions for a resident with significant weight gain. This was evident in 1 (Resident #8) out of 5 residents reviewed for nutrition.

Inspectors wroteBased on review of Geriatric Nursing Assistant personnel files and staff interview, it was determined that the facility failed to complete required annual performance reviews for Geriatric Nursing Assistants (GNAs) at least once every 12 months. This finding was identified for 2 of the 3 GNA staff members (GNA #22 and #23) reviewed during the annual survey.

Inspectors wroteBased on observations, record reviews, and interviews, the facility staff failed to 1) obtain and administer medications according to procedures and, 2) failed to accurately and safely to conduct and apply before each meal's insulin sliding scale. This was evident for two residents (#133 and #43) out of 10 reviewed for medications.

Inspectors wroteBased on a review of the medical record and interviews with facility staff, it was determined that the facility failed to respond to recommendations made by consulting pharmacists. This was evident for 1 (#12) of 51 residents reviewed during the annual survey.

Inspectors wroteBased on a record review and interviews, the facility failed to obtain laboratory services in a timely manner. This was found evident of 1 (Resident #2) of 1 resident reviewed for laboratory services reviewed during the annual survey

Inspectors wroteBased on record reviews and interviews it was determined that the facility staff failed to ensure two Geriatric Nursing Assistants (GNA) received Dementia training upon hire and failed to complete an annual employee evaluation. This deficient practice was evidenced in three GNA records reviewed during the recertification survey.

Inspectors wroteBased on observation, record review, and interview it was determined that the facility failed to ensure resident #92 received adequate supervision and failed to prevent elopement. This was evident for 1 of 2 residents reviewed for accidents during the facility's recertification survey. The Maryland Office of Health Care Quality (OHCQ) determined that this concern met the Federal definition of Immediate Jeopardy. After the incident, the facility developed, initiated, and completed a plan of correction to prevent further elopement of residents. Therefore, this deficiency will be cited as past non-compliance. The date of correction was 1/28/2022.

Inspectors wroteBased on interview and record review it was determined that the facility failed to ensure the amount of the surety bond was comparable to the amount of the resident funds entrusted to the facility. This was evident during a review of Personal Funds during the recertification survey.

Inspectors wroteBased on observation and interview of facility residents and staff it was determined the facility failed to ensure food was palatable and served at a safe and appetizing temperature. These deficient practices have the potential to affect all residents.

Inspectors wroteBased on observations of the facility's kitchen, review of kitchen records and interviews of dietary staff, it was determined that the facility: 1.) failed to ensure sanitary practices were followed in accordance with professional standards for food service safety; 2.) failed to store food in accordance with professional standards for food service safety, 3.) failed to store, label, and monitor expiration, of food in accordance with professional standards for food service safety, and 4.) failed to ensure monitoring and oversight of kitchen equipment and environment. These deficient practices have the potential to affect all residents.

Inspectors wroteBased on observation, staff interviews and record reviews, it was determined that the facility 1.) failed to utilize appropriate infection control process with the hanging of a urinary bag (Resident #51) 2.) failed to ensure that the Infection Prevention Control program (IPCP) policy was reviewed and updated annually and 3.) failed to assure that staff were educated to handle and process dirty laundry in a manner to prevent the spread of infection. This was evident during the annual recertification survey.

Inspectors wroteBased on observation, medical record review, and interview, it was determined the facility staff failed to failed to assure that each resident receives an accurate assessment, reflective of the resident's status at the time of the assessment, and ensure Minimum Data Set (MDS) assessments were accurately coded. This was evident for 3 (Resident #128, #93, #291) of 5 residents reviewed for MDS accuracy, and 1 (Resident #89) of 10 residents reviewed for pressure ulcers.

Inspectors wrote2) On 2/23/2024 at 9:00 AM, in an interview with Resident #57, the resident stated that s/he had facility acquired right buttocks bed sores and a right leg wound. Resident #57 further stated that the wounds were improving, and dressings changed daily. During a review of Resident #57's medical record conducted on 2/29/2024 at 8:45 AM, surveyor noted active physician orders dated 2/6/2024 for right buttock and right calf wounds to Cleanse with NSS (normal saline solution). Apply Calcium Alginate with Medi-honey cover with a border gauze daily, every day shift for wound care. On 2/29/2024 at 11:35 AM, a review of Resident #57's care plan was completed: A Plan of Care was developed for Resident #57 for Actual impaired skin integrity to right lower calf and bilateral buttocks r/t declined mobility as evidenced by pressure injury created on 2/5/2024 with revision on 2/5/2024. [...]

Inspectors wroteBased on interview and record review it was determined that the facility failed to ensure that care plan meetings were conducted as required. This was evident for 4 (Resident #33, #82, #91 and #98) out of 67 residents reviewed for resident care, and one complaint (MD00178503) of 16 complaints reviewed during the recertification survey.

Inspectors wrote3) A review of Resident #98's monthly Medication Regimen Review (MMR) on 2/28/24 at 12:49 PM revealed that the pharmacist recommendations were made on 7/14/23, 8/15/23, 9/07/23, 10/05/23, 11/08/23, 12/08/23, 1/05/24, and 2/09/24 with details: On 7/14/23, the pharmacist recommended changing the hydrocortisone (for anti-itching) cream to PRN (as needed) or discontinuing it. On 8/15/23, the pharmacist commented that to clarify directions as either one tablet or two tablets for resident has a new order for Oxycodone 5mg give two tabs every 6 hours PRN for give one tab every 6 hours PRN for pain 7-10. On 9/07/23, the pharmacist recommended clarifying the same order as last month (8/15/23). On 10/05/23, the resident ordered Bio-freeze gel twice a day for the back and Menthyl 5% patch for the lower back twice a day. [...]

Inspectors wroteBased on review of administrative documents, and interviews of residents and staff it was determined that the facility failed to ensure that grievances and concerns from the resident (group) council were documented, reviewed, and responses provided to the group in writing. This was evident in a review of 9 of 9 resident council meeting minutes reviewed.

Inspectors wroteBased on interview and record reviews it was determined that the facility failed to maintain safe, clean, comfortable and homelike environment. This was evident on 2 of 4 nursing units reviewed during both the Infection Control facility task and the Resident Council facility task.

Inspectors wroteBased on medical record review and staff interviews, it was determined that the facility failed to notify the resident/resident's representative in writing of the bed-hold policy upon transfer of a resident to an acute care facility. This was evident for 2 (R#118, R#12) of 5 residents reviewed for hospitalization during the recertification/complaint survey.

Inspectors wroteBased on medical record review and interview, it was determined that the facility failed to meet professional standards of practice as evidenced by 1) failing to ensure nursing staff documenting opioid use on the Medication Administration Record (MAR) and Controlled Drug Administration Record (also known as control sheet). This was evident for 2 (Resident #88 and #124) out of 3 residents reviewed for administration of narcotic medication, and 2) failing to ensure that a licensed nurse had specific competencies and skill sets necessary to care for a dialysis resident. This was evident during a review of a complaint incident during an annual survey.

Inspectors wroteBased on observation, record reviews and staff interviews, it was determined that the facility failed to: 1) to maintain safety by allowing the bed of a resident at risk for fall to be in the up position when care was not being provided thereby placing resident at high risk for injury. This was evident for 1 (#51) of 6 residents reviewed for accidents; 2) to assess residents' fall risk after the fall incident occurred. This was evident of 1 (Resident #98) out of 6 residents reviewed for falls; 3) ensure resident's outside consult appointment had follow-up. This was evident for 1 (Resident #292) out of 67 residents reviewed for following appointments during this recertification/complaint survey.

Inspectors wroteBased on medical record review, staff interview, and observation, it was determined that the facility failed to provide appropriate treatment and services for the care of a resident with a urostomy upon admission. This was evident for 1 (Resident #88) of 1 resident reviewed for urostomy care during the survey.

Inspectors wroteBased on observation, medical record review, and interview, it was determined that the facility staff failed to provide required care to the residents' percutaneous endoscopic gastrostomy (PEG) sites. This was evident for 1 (Resident #290) out of 2 residents reviewed for PEG site management during the survey.

Inspectors wroteBased on observation, medical record review, and interview, it was determined that the facility failed to place a physician's order for the indication of Oxygen administration and develop and implement a person-centered comprehensive care plan with resident-centered goals for respiratory care to include oxygen therapy. This was evident for 1 (Resident #302) of 1 resident reviewed for respiratory care during the survey.

Inspectors wroteBased on record review and staff interview, it was determined that the nurse failed to do a timely assessment on a resident post dialysis, this was evident during a review of a complaint MD00200471 during the survey.

Inspectors wroteBased on record reviews and staff interviews, it was determined that the facility failed to ensure that a licensed nurse was competent to care for a dialysis resident. This was evident during a review of a complaint incident MD00200471 during an the survey.

Inspectors wroteBased on a review of the medical record and interview with staff, it was determined the facility staff failed to monitor and/or document the resident's inappropriate behavior related to mental health. This was evident for 1 (Resident #24) of 5 residents who were reviewed for behavioral-emotional issues during the survey.

Inspectors wroteBased on a review of the medical record and interview with staff, it was determined that the facility staff 1) failed to ensure narcotics removed from the resident's supply were administered to the resident, as evidenced by staff documenting the removal of narcotics without documentation of the need for the narcotic or documentation that the narcotic was administered to the resident. This was evident for 3 (#88 and #124) of 3 residents reviewed for Controlled drug administration and medication administration records reviewed during the survey, and 2) failed to timely provide medication to meet the needs of the residents. This was evident for 1 (#116) of 5 residents reviewed for medications during the recertification/complaint survey.

Inspectors wroteBased on medical record review and interview, it was determined the facility staff failed to follow physician orders by administering as needed (PRN) pain medication outside the prescribed parameters. By failing to follow the prescribed parameters for the medication administration, the resident was given an unnecessary medication. This was identified for 2 (#116, #57) of 67 residents reviewed for medications during a recertification/complaint survey.

Inspectors wroteBased on record review and interview it was determined the facility failed to implement a gradual dose reduction (GDR) for a resident receiving a psychotropic medication. This was evident for 1 of 1 resident reviewed for psychiatric medications during the facility's recertification survey.

Inspectors wroteBased on observations and interviews it was determined that the facility failed to remove expired medications and properly store medications. This was evident found on 1 of 2 medication storage rooms, and 1 of 3 medication cart, and 1 medication cart left unattended by nursing staff.

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to ensure residents received needed dental services. This was evident for 1 resident (Resident #101) of 2 residents reviewed for dental services during the recertification survey.

Inspectors wroteBased on observation, record review, and interview it was determined the facility failed to: 1.) ensure certification for medical ineffectiveness of treatment documentation was complete (Resident #102), and 2.) ensure the accuracy of a medical order (Resident #39). This was evident for one out of one certification of medical ineffectiveness of treatment form reviewed by the surveyor, and one out of one medical order for insulin reviewed by the surveyor.

Inspectors wroteBased on record review and interview it was determined that the facility failed to obtain the proper information for residents who received hospice services. This was evident for 1 (Resident #47) of 1 residents reviewed for hospice services during the recertification survey.

Inspectors wroteBased on observation and staff interview it was determined the facility failed: 1) to maintain 2 bathtubs in operating condition. This was evident during environmental rounds of the facility for 2 of 2 bathtubs found out of 4 observed bathing areas of the facility; 2) ensure lift equipment utilized for resident care was maintained in a safe condition for use. This was evident for 2 out of 2 lift devices observed during the survey.

Inspectors wroteBased on documentation review and interview, it was determined that the facility failed to maintain an effective training program for new and existing staff. This was evident for Geriatric Nursing Assistant (GNA #50) and Registered Nurse (RN #53) of 8 employees' training records reviewed during this recertification survey.

Inspectors wroteBased on a review of employee file documentation and interviews, it was determined that the facility failed to have a process to ensure all Geriatric Nursing Assistants (GNAs) have no less than 12 hours of education per year, and the education included annual dementia management training and resident abuse prevention training. This is evident for 1 (GNA #52) of 5 GNA employment files reviewed during this recertificate survey.

Inspectors wroteBased on observations, review of daily staffing records, and staff interview it was determined that the facility failed to consistently post the nurse staffing data at the beginning of each shift, the ratio of licensed and unlicensed staff to residents, and failed to retain the posted daily nurse staffing data for a minimum of 18 months. This was evident on 4 of 4 nursing units and in the facility lobby during the recertification/complaint survey.

Inspectors wroteBased on medical record reviews, staff interviews and observations, it was determined that the facility failed to accommodate resident's need and preferences. This was evident for 1 (R#33) of 5 residents reviewed for personal property during the survey.

Inspectors wroteBased on the review of facility self-report investigation records, observation, and interview, the facility staff failed to provide a safe/secure storage space for resident's personal belongings. This was evident for 1 (Resident #279) out of 16 residents reviewed for facility self-reported incidents.

Inspectors wroteBased on medical record review and interview, it was determined that the facility staff failed to timely report an allegation of abuse/harassment and resident elopement to the State Agency, the Office of Health Care Quality, immediately but not later than 2 hours after the allegation is made. This was evident for 2 (Resident #279 and Resident 392) out of 2 residents reviewed for elopement and abuse during survey.

Inspectors wroteBased on review of facility reported incident investigations and interview and record review, it was determined the facility failed to thoroughly investigate allegations of: 1.) misappropriation of resident property, and 2.) elopement. This was evident 2 out of 4 residents reviewed for personal property (Resident #116 and Resident #99) and 1 out of 2 residents reviewed for elopement (Resident #92) during the facility's recertification/complaint survey.

Inspectors wroteBased on record review and interview, facility staff failed to provide correct notice to pay for (or to have paid under Medicare or Medicaid) a stay at the facility and to provide sufficient skilled rehabilitation treatment, and to assure the safe discharge of a resident. This was evident for 1 (Resident #282) out of 1 resident reviewed for proper notice of stay and safe discharge during the survey.

Inspectors wroteBased on medical record review and interview of facility staff it was determined the facility failed to: 1) ensure physician ordered wound treatments are performed and receive timely wound consultation and 2) provide accurate ongoing assessment of skin and wounds and receive timely wound consultation. This was evident for 2 ( #295, #293) out of 10 residents reviewed for wounds during the facility's recertification survey.

Inspectors wroteBased on record review and interviews it was determined that the facility failed to ensure resident's care was directed by a physician. This was evident for 1 facility reported incident (MD00203534) of 27 facility reported incidents reviewed during the recertification survey.

Inspectors wroteBased on observation, resident interview, and staff interview it was determined that the facility staff failed to ensure a cord used to turn on/off a call light was attached to the call system. This was evident for 3 of 5 call lights in the 3A central bathing room.

Inspectors wroteBased on medical record review, observation and interview, it was determined the facility staff failed to provide Resident (#36 and #50) with showers and failed to provide Resident (#63) with food preferences. This was evident for 3 of 3 residents selected for review of choices during the survey process and 3 of 47 residents selected for review during the annual process.

Inspectors wroteBased on medical record review, observation and interview, it was determined the facility staff failed to provide Residents (#44, #90, #118 and #326) with care that promoted the highest practicable well-being. This was evident for 4 of 47 residents selected for review during the survey process.

Inspectors wroteBased on medical record review and interview it was determined the facility staff failed to thoroughly assess the need for pain medication for Residents (#63 and #90). This was evident for 2 of 2 resident selected for pain assessment and 2 of 47 residents selected for review during the annual survey.

Inspectors wroteBased on medical record review and interview, it was determined the facility staff failed to hold blood pressure medication for Resident (#34 and #123) when the documented blood pressure was below the set parameter as ordered by the physician, failed to document the heart rate and blood pressure for Resident (#36) when the physician ordered parameters, and failed to document the use of a medication (#274). This was evident for 4 of 6 residents selected for un-necessary medication review and 4 of 47 residents selected for review during the annual survey process.

Inspectors wroteBased on observation and interview, it was determined the facility staff failed to provide Resident (#54) with the most dignified existence, failed to honor a resident's right to explore living arrangements in the community (#61), and failed to promote and enhance a resident's dignity and rights by obtaining weights and blood pressures on Resident (#174). This was evident for 3 out of 3 residents investigated for dignity during the survey process and 3 of 47 residents selected for review during the annual survey process.

Inspectors wroteBased on medical record review, resident and staff interview, it was determined that the facility staff failed to ensure that a Minimum Data Set (MDS) Assessment accurately reflected a resident's status (#100). This was evident for 1 out of 1 resident reviewed for skin conditions during the annual survey.

Inspectors wroteBased on review of the medical record and interviews with staff, it was determined that the facility staff failed to develop a comprehensive care plan for a resident (#61, #274, and #123). This was evident for 1 of 2 residents reviewed for presence of a urinary catheter and 2 of 6 residents reviewed for unnecessary medications during the annual survey.

Inspectors wroteBased on medical record review and interview, it was determined the facility staff failed to thoroughly review dental recommendations for Resident (#36) and act upon those recommendations. This was evident for 1 of 3 residents selected for dental review and 1 of 47 residents selected for review during the annual survey.

Inspectors wroteBased on observation and interview, it was determined the facility staff failed to provide services that would allow resident the ability to achieve the greatest independence with performing Activities of Daily Living to Resident (#63). This was evident for 1 of 4 residents selected for review of ADL during the survey process and 1 of 47 residents selected for review during the annual survey.

Inspectors wroteBased on medical record review and interview, it was determined that the nursing staff failed to implement protective measures to prevent a sacral pressure ulcer (#274) from occurring. This was evident for 1 of 6 resident's selected for review of pressure ulcers during the annual survey. A pressure ulcer (also known as pressure sore or decubitus ulcer) is any lesion caused by unrelieved pressure that results in damage to the underlying tissue. Pressure ulcers are staged according to their severity from Stage I (area of persistent redness), Stage II (superficial loss of skin such as an abrasion, blister, or shallow crater), Stage III (full thickness skin loss involving damage to subcutaneous tissue presenting as a deep crater), and Stage IV (full thickness skin loss with extensive damage to muscle, bone, or tendon).

Inspectors wroteBased on observation of medication pass and interview, it was determined the facility staff failed to maintain an environment free from potential accidents for Resident (#19). This was evident for 1 of 4 residents observed for medication observation and 1 of 27 opportunities for error.

Inspectors wroteBased on medical record review, observation and interview, it was determined the facility staff failed to adequately use Provale cups for Resident (#36) with as ordered. This was evident for 1 of 8 residents selected for review of Nutrition during the annual survey process and 1 of 47 residents selected for review during the annual survey process.

Inspectors wroteBased on medical record review and interview, it was determined the physician staff provided contradictory medical information concerning a resident's end of life wishes (#84). This is evident for 1 of 6 residents reviewed for advanced directives during the annual survey.

Inspectors wroteBased on record reviews and staff interviews it was determined that the facility's pharmacist failed to identify and report irregularities in Resident #326's drug regimen. This was evident for 1 (#326) of 10 residents whose medications were reviewed.

Inspectors wroteBased on observation during the initial tour of the kitchen and garbage disposal area, it was determined that facility staff failed to dispose of garbage and refuse properly.

Inspectors wroteBased on medical record review and interview, it was determined the facility staff failed to maintain the medical record in the most complete and accurate form for Residents (#22, #46 and #123). This was evident for 3 of 47 residents selected for medical record review during the annual survey process.