Glenwood Center

Inspectors wroteBased on observation, interview, the facility's Diet Type Report, the 2022 Food Code, the facility's Labeling and Dating Inservice, and the facility's policies for Food Storage: Cold Foods and Meal Distribution; the facility failed to ensure thawed nutritional shakes had Use By dates, two shelves in the Walk-in Freezer were at least six inches from the floor, cups being used for Dinner service on 02/25/2024 were not placed rim down directly atop a cart with spillage upon it, and two gallons of milk, with a manufacturer's date of 02/26/2024, were not labeled with a Use By date of 02/29/2024, This had the potential to affect 117 of 117 residents receiving meals from the facility kitchen.

Inspectors wroteBased on observation, interview, the facility's Diet Type Report, the 2022 Food Code, and the facility's maintenance work orders; the facility failed to maintain the Walk-in Freezer door in working order. This had the potential to affect 117 of 117 residents receiving meals from the facility kitchen.

Inspectors wroteBased on observation, interview, the facility's Diet Type Report, the facility's Tuesday, Week 2 Menu, the facility's Portion Control Chart, and the facility's policy, Menus; the facility failed to ensure 4-ounce portions of Applesauce were prepared for service to the Dysphagia Advanced Diets and the Pureed Diets prior to Lunch on 02/27/2024. This had the potential to affect 35 of 117 residents receiving meals from the kitchen.

Inspectors wroteBased on observations, interviews, and a facility document titled RESIDENT RIGHTS UNDER FEDERAL LAW the facility failed to provide necessary maintenance services to maintain Resident Identifier (RI) #26's bathroom and a chair in the sitting area of the 300 hall in good repair. This had the potential to affect RI #26 one of 24 sampled residents and residents residing on the 300 hall.

Inspectors wroteBased on resident record review, interview, and review of a facility policy titled Person-Centered Care Plan, the facility failed to develop a care plan specific for Urinary Tract Infection (UTI), when Resident Identified (RI) #16 was admitted to the facility with a UTI and antibiotic treatment. This had the potential to affect RI #16, one of three residents sampled for UTI.

Inspectors wroteBased on interviews and review of resident records, and a facility policy titled Skin Integrity and Wound Management, the facility failed to ensure Licensed Practical Nurse (LPN) #21 did not apply an Opti-foam dressing to Resident Identifier (RI) #13's sacral wound without a physician's order. On 02/27/2024 an Opti-foam dressing was observed being removed from RI #13's sacrum. The physician's order for wound care directed staff to apply moisture barrier cream to the wound. This had the potential to affect RI #13, one of two residents observed for wound care.

Inspectors wroteBased on observations, interviews, resident record review, and review of a facility policy titled Activities of Daily Living (ADLs), the facility failed to provide a shower and clean clothes for Resident Identifier (RI) #26, as observed during the survey. RI #26 was observed wearing the same clothing on 4 of 4 days of the survey, 02/25/2024 through 02/28/2024. This had the potential to affect one of ten residents sampled for activities of daily living.

Inspectors wroteBased on observations, interviews, resident record review, and review of Fundamentals of Nursing Tenth Edition and review of facility procedures titled CATHETER: INDWELLING URINARY-CARE OF and PERINEAL CARE, the facility failed to ensure Resident Identifier (RI) #73, a resident with a history of Urinary Tract Infection (UTI), had a urinary catheter and drainage bag maintained in a manner to prevent infection and received incontinent care in a manner to prevent infection. On 02/27/2024, RI #73's catheter tubing was observed twisted and touching the bottom of the overbed table and bed; and on 02/28/2024 Certified Nursing Assistant (CNA) #12 and CNA #13 left bowel movement on RI #73's perineum after care had been provided. This had the potential to affect RI #73, one of five residents sampled for catheter use.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure Resident Identifier (RI) #90's nebulizer mouthpiece was stored in a covering on three of four days of the survey. This deficient practice had the potential to affect one of one resident sampled for nebulizer administration.

Inspectors wroteBased on observation, interviews and review of a facility policy titled Linen Handling, the facility failed to ensure a Certified Nursing Assistant (CNA) #11 did not place soiled linens on the floor while providing morning care and pericare. This was observed on 02/28/2024 and had the potential to affect Resident Identifier (RI) #44 one of 24 sampled residents.

Inspectors wroteBased on interview, the facility's Diet Type Report, the 02/27/2024 Resident Council Meeting, and the facility's Meal Times schedule; the facility failed to ensure the period of time between Dinner and Breakfast did not exceed 14 hours. This had the potential to affect 117 of 117 residents receiving meals from the facility's kitchen.

Inspectors wroteBased on observations, interview, review of facility documents titled, Use By Dating Guideline and Cleaning Procedure Mixer, the facility failed to ensure: 1. outdated thickened apple juice was not stored in the emergency food supply and 2. the food mixer was clean and free from food particles between uses. These failures had the potential to affect 108 of 108 residents who received meals from the kitchen. Findings Include: 1)The facility policy titled, Use By Dating Guidelines, dated 05/01/11, . The manufacturer's expiration date, when available, is the use by for unopened items . On 01/21/20 at 02:19 p.m., the surveyor and Employee Identifier (EI) #1, Dietary Account Manager, observed the following food items in the emergency food supply five honey like consistency thickened apple juice 46 ounce boxes with a use by date of 12/25/19. [...]

Inspectors wroteBased on interview, medical record review and review of a facility policy titled, Person-Centered Care Plan, the facility failed to ensure Resident Identifier (RI) #61 and RI #65's care plans regarding code status were revised to reflect RI #61 and RI #65's DNR (Do Not Resuscitate) decision. This affected RI #61 and RI #65, two of 32 residents whose care plans were reviewed for code status. Findings Include: A review of a facility policy titled, Person-Centered Care Plan, with a Revision Date 03/01/18, documented: .7. Care plans will be: .7.2 Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments, and as needed to reflect the response to care and changing needs and goals; . 1.) RI #61 was readmitted to the facility on [DATE]. [...]

Inspectors wroteBased on observation, interview, medical record review and review of Potter and [NAME], Fundamentals of Nursing, the facility failed to ensure Resident Identifier (RI) #27's physician's order was followed to change his/her oxygen tubing weekly. This affected RI #27, one of 32 residents whose orders were reviewed. Findings Include: A review of Potter and [NAME], Fundamentals of Nursing, Ninth Edition, Chapter 23, Legal Implications in Nursing Practice, page 311, revealed: .Health Care Providers' Orders .Nurses follow health care providers' orders unless they believe that the orders are in error . RI #27 was readmitted to the facility on [DATE] with diagnoses including, Dependence on Supplemental Oxygen. A review of RI #27's physician's orders revealed: .11/2/2017 Change oxygen circuit weekly every night shift every Sunday . [...]

Inspectors wroteBased on observation, interview and review of a facility policy titled, Storage and Expiration Dating of Medications, Biologicals, Syringes and Needles, the facility failed to ensure expired medications and medical supplies were not stored in a medication room on the long term care unit. This deficient practice affected one of three medication storage rooms in the facility. Findings Include: A review of a facility policy titled, Storage and Expiration Dating of Medications, Biologicals, Syringes and Needles, with a Revision Date 10/31/16, revealed: .4. Facility should ensure that medications and biologicals that: (1) have an expired date on the label; (2) have been retained longer than recommended by the manufacturer or supplier guidelines; .are stored separate from other medications until destroyed or returned to the pharmacy or supplier. [...]