Grafton County Nursing Home

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify personal humidifiers in their Water Management Plan in which Legionella and other opportunistic waterborne pathogens could grow and spread. There were humidifiers on 3 of 4 units observed. (Granite, Profile and Maple Units).

Inspectors wroteBased on interview and record review it was determined that the facility failed to report allegations of abuse to the state survey agency for 2 allegations of abuse reviewed residents. (Resident identifiers are #11, #29, #55, and #82).

Inspectors wroteBased on interview and record review, the facility failed to ensure that 2 of 2 allegations of abuse were investigated and reported to the State Agency. (Resident identifiers are #11, #29, #55, and #82).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that a resident with limited mobility receives appropriate services and equipment to maintain or improve mobility for 1 of 2 residents reviewed for position and mobility in a final sample of 27 residents. (Resident identifier is #4).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that medications were removed from use from 2 of 4 medication carts observed and failed to ensure that medication carts were secured/locked when unattended on 1 of 4 units observed. (Resident identifiers are #23 and #55).

Inspectors wroteBased on observation, interview and record review the facility failed to maintain a safe/clean equipment for 3 of 3 residents reviewed for environment in a final sample of 27 residents. (Resident identifiers are #41, #63 and #100.)

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to offer the residents a nourishing snack at bedtime while having more than 14 hours between the evening meal and the breakfast meal for 4 of 4 units reviewed and without Resident Council consent.

Inspectors wroteBased on observation, record review, and interview, it was determined that the facility failed to determine if a device was a restraint for 1 of 1 resident reviewed for restraints in a final sample of 24 residents (Resident identifier is #58).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to provide appropriate adaptive equipment to maintain their ability to carry out Activities of Daily Living (ADL's) for 2 of 2 residents reviewed for ADL's in a final sample of 24 residents. (Resident identifiers #5 and #58)

Inspectors wroteBased on interview and record review, it was determined that the facility failed to identify resident preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident for 1 of 3 residents reviewed for behavioral-emotional in a final sample of 24 residents. (Resident identifier is #38.)

Inspectors wroteBased on interview and record review, it was determined that the facility failed to ensure that a resident obtained routine dental care for 2 of 2 residents reviewed for dental in a final sample of 24 residents (Resident identifiers are #25 and #63).

Inspectors wroteBased on record review, interview, and policy review, it was determined that the facility failed to follow standards of practice for the complete medical records as it related to the pronouncement of death in 1 out of 1 record reviewed for death documentation and for the incorrect documentation of weights for 1 resident out of a final sample of 24 residents. (Resident identifier is #120 and Resident #42)

Inspectors wroteBased on record review and interview, it was determined the that the facility failed to ensure that the Minimum Data Set (MDS) assessment accurately reflected the residents' status for 2 out of 2 residents reviewed for dental in a final sample of 24 residents (Resident Identifiers are #25 and #63).

Inspectors wroteBased on interview and record review, it was determined that the facility failed to conduct annual reviews of it's infection prevention and control programs policies and procedures which had the potential to effect the facility census of 118 residents.

Inspectors wroteBased on interview and record review, it was determined that the facility failed to complete a Preadmission Screening and Resident Review (PASARR) for an individual who required greater than 30 days of nursing services (Resident identifier is #26) and failed to follow up with a PASARR Level II to determine if additional services were required for 3 of 4 residents reviewed for PASARR in a final survey sample of 25 residents (Resident Identifiers #9 and #33).

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to provide an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities to meet the interests of and support the physical, mental, and psychosocial well-being for 3 out of 3 residents reviewed for activities in a final sample of 25 residents (Resident Identifiers #89, #19, and #40).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to provide services or assist a resident in making appointments to maintain good foot health for 1 of 2 residents reviewed for foot care in a final survey sample of 25 residents (Resident Identifier is #26).

Inspectors wroteBased on interview and record review, it was determined that the facility failed to obtain laboratory services as ordered by a physician for 1 resident in a final sample of 25 residents. (Resident identifier is #58.)

Inspectors wroteBased on interview and record review, it was determined that the facility failed to provide the Notice of Medicare Non-Coverage (NOMNC) prior to the last covered day of Medicare services for 2 out of 3 residents reviewed for advanced beneficiary protection notification (Resident Identifiers #58, and #69).

Inspectors wroteBased on observation interview, and record review, it was determined that the facility failed to post the nurse staffing information in a prominent place readily accessible to visitors. The facility also failed to ensure that the nurse staffing information was accurate and had the actual hours worked by licensed and unlicensed nursing staff per shift for 31 out of 31 days of nurse staffing postings.