Graham Healthcare and Rehabilitation Center

Inspectors wroteBased on record review and staff, Visitor, Police Sergeant, and Nurse Practitioner interviews, the facility failed to protect a cognitively impaired resident's right to be free from staff to resident physical and verbal abuse when Agency Nurse #1 yelled at Resident #1 loudly in a common area of the facility utilizing language that was vulgar and demeaning in a volume that was loud enough for a visitor in a nearby room to hear. Agency Nurse #1 also pushed Resident #1 down into her wheelchair when she attempted to stand up, shook the wheelchair violently, propelled the resident down the hall in her wheelchair in an aggressive manner, and hit Resident #1 in the back with a closed fist multiple times. Resident #1 was crying following the incident and stated to staff that she was afraid. Agency Nurse #1 was charged with assault on a handicapped person. [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure staff implemented their abuse policy in the areas of protecting and reporting for 1 of 3 residents reviewed (Resident #1) for abuse. On [DATE] at approximately 7:05 PM, Agency Nurse #2 and Agency Nurse Aide #1 witnessed Agency Nurse #1 use inappropriate language to speak to Resident #1, aggressively push Resident #1 down the hall in her wheelchair in an erratic and aggressive manner, hit Resident #1 in the back with a closed fist multiple times, and did not effectively intervene and immediately report the incident to the Administrator. On [DATE] at approximately 6:00 AM, Agency Nurse #2 reported the incident to the Director of Nursing. [...]

Inspectors wroteBased on record review and interviews with staff and the physician, the facility failed to monitor and document a resident's pulse and blood pressure for a resident who had physician ordered hold parameters for digoxin (a cardiac glycoside used to strengthen heart contractions) and losartan (antihypertensive medication) for 1 of 5 residents reviewed for unnecessary medications (Resident #52).

Inspectors wroteBased on record review, staff, Nurse Practitioner (NP) and Medical Director interviews, the facility failed to complete a Medical Orders for Scope of Treatment (MOST) form with a required signature for 1 of 3 residents reviewed for advance directive (Resident #26).

Inspectors wroteBased on record review, staff and Medical Director interviews, the facility failed to submit a request for a Level II Preadmission Screening and Resident Review (PASRR) evaluation for a resident diagnosed with intellectual disability for 1 of 2 residents reviewed for PASRR (Resident #15).

Inspectors wroteBased on record review and staff, Consultant Pharmacist, Supervisor Consultant Pharmacist, and Physician interviews, the Consultant Pharmacist failed to identify and report the lack of documented monitoring for a resident who had hold parameters for digoxin (a cardiac glycoside used to strengthen heart contractions) and losartan (an antihypertensive medication). This failure affected 1 of 5 residents reviewed for unnecessary medications (Resident #52).

Inspectors wroteBased on record reviews and staff interviews, the facility failed to submit a request for an evaluation of updated Pre-admission Screening and Resident Review (PASARR) determination for 1 of 3 residents reviewed (Resident #11).

Inspectors wroteBased on observations and staff and Consultant Pharmacist interviews, the facility failed to discard expired medications from 2 of 2 medication rooms (North and South medication rooms), and 1 of 2 medication carts (South medication cart). The facility also failed to date an eye drop after opening in 1 of 2 medication carts (South medication cart).

Inspectors wroteBased on record reviews, observations, and staff interviews, the facility failed to implement their infection control policy when 3 staff members (Nurse Aides #1, #2, and #3) failed to sanitize their hands in between resident contacts and contact with surfaces in the dining room during meal service. In addition, Nurse #1 failed to don Personal Protective Equipment (PPE) including a gown when providing urinary catheter care and failed to perform hand hygiene before applying gloves and after removing gloves during catheter care for Resident #4. This involved 4 of 5 staff members observed for infection control practices (Nurse Aides #1, #2, #3 and Nurse #1).

Inspectors wroteBased on record reviews and resident and staff interviews, the facility failed to include documentation in the medical record of education regarding the benefits and potential side effects of the COVID-19 immunization for 3 of 6 residents reviewed for infection control (Resident #2, Resident #11, and Resident #18).

Inspectors wroteBased on record review, staff and physician interviews, the facility failed to protect residents' rights to be free from misappropriation of controlled medications for 1 of 1 resident (Resident #1) reviewed for misappropriation of residents' property.

Inspectors wroteBased on record review and staff interviews the facility failed to provide completed Notice of Medicare Non-Coverage (NOMNC) and/or Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF-ABN) to 3 of 3 residents reviewed for Beneficiary Notification (Residents #102, #103, and #104).

Inspectors wroteBased on observations and interviews with staff, the facility failed to secure a loose metal plate and place a cover over the telephone jack leaving the cutout in the wall and the metal plate exposed (room [ROOM NUMBER]-A), failed to repair areas of missing and discolored caulk and replace floor tiles with a buildup of a black colored substance around the base of the toilet in a shared bathroom (rooms [ROOM NUMBERS]) with odors resembling urine and failed to secure the light fixture located over the head of the bed (room [ROOM NUMBER]-B) for 4 of 4 rooms on 2 of 2 halls reviewed for environment.

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code Minimum Data Set (MDS) assessments in the areas of hospice and tobacco use for 2 of 3 sampled residents reviewed for hospice and smoking (Residents #47 and #22).

Inspectors wroteBased on record review and staff interviews, the facility failed to develop a comprehensive care plan that addressed hospice care for 1 of 1 sampled resident reviewed for hospice (Resident #47).

Inspectors wroteBased on observations, record review, and staff interviews, the facility's Quality Assessment and Assurance (QAA) Committee failed to maintain implemented procedures and monitor the interventions the committee put into place following a recertification and complaint investigation survey completed on 12/02/21. This failure was for one deficiency originally cited in the area of Develop/Implement Comprehensive Care Plan that was subsequently recited during a recertification and complaint investigation completed 07/20/23. This continued failure during two federal surveys of record showed a pattern of the facility's inability to sustain an effective QA Program.