Green House Homes at Mirasol, the

Inspectors wroteBased on record review and interviews, the facility failed to ensure a response, action, and rationale to residents involved in group grievances. Specifically, the facility failed to provide a response, action, and rationale for resident concerns brought up in the resident council meetings, related to staff not making the residents' beds, the type of mattresses provided by the facility and the type of napkins provided during mealtime.

Inspectors wroteBased on interviews and record review, the facility failed to ensure the activities program was directed by a qualified professional. Specifically, the facility failed to employ a qualified activities director in order to provide a program of activities for residents requiring activity and recreational support.

Inspectors wroteBased on observations, record review and interviews, the facility failed to develop an antibiotic stewardship program that promotes the appropriate use of antibiotics and includes a system of monitoring to improve resident outcomes and reduce antibiotic resistance for three (#80, #46 and #2) of three residents out of 37 sample residents. Specifically, the facility failed to: -Ensure clinical signs and symptoms of an infection were identified and/or culture results were obtained prior to the administration of antibiotics for Resident #80; and, -Ensure staff effectively tracked and monitored the use of long-term antibiotics for Resident #46 and Resident #2.

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide needed care and services that are resident centered, in accordance with the resident's preferences, goals for care and professional standards of practice that will meet each resident's physical, mental, and psychosocial needs for two (#10 and #40) of two residents out of 37 sample residents. Specifically, the facility failed to: -Ensure staff provided edema care per physician's order for Resident #10; and, -Ensure staff followed up with the physician regarding high blood levels of iron and the continued use of an iron supplement for Resident #40.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure infection control practices were established and maintained to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility failed to: -Ensure staff donned (put on) the appropriate personal protective equipment (PPE) while providing direct care for Resident #46 and Resident #57, who were on enhanced barrier precautions (EBP); and, -Implement an effective water management plan to monitor for Legionella.

Inspectors wroteBased on interviews, observations and record review, the facility failed to consistently serve food that was palatable and at a safe and appetizing temperature. Specifically, the facility failed to ensure resident food was palatable in taste, texture and temperature.

Inspectors wroteBased on observations and interviews, the facility failed to prepare and serve food in a sanitary manner. Specifically, the facility failed to: -Ensure a system was in place to monitor the internal temperature of the dish machine and ensure proper functioning in one of nine houses; and -Ensure staff washed and dried hands appropriately while plating and serving resident meals in house eight and nine.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure two (#24 and #19) of 10 residents reviewed for activities out of 33 sample residents received an ongoing program of activities designed to meet needs and interests, and promote physical, medical and psychosocial well-being. Specifically, Residents #24 and #19 were not provided opportunities to partcipate in their preferred activities.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#27) of six residents reviewed for accidents out of 28 sample residents remained as free from accident hazards as possible. Specifically, the facility failed to provide adequate supervision, assistance and assistive devices; and failed to assess and implement new interventions after each fall. The resident sustained six falls in the period of three months.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#31) of six residents reviewed for nutritional status of 33 sample residents maintained acceptable parameters of nutritional status. Specifically, the facility failed to assess, identify and implement effective nutritional measures to prevent severe weight loss for Resident #31. Record review, observations and interviews revealed the facility failed to ensure the resident was offered and provided food other than dietary supplements; and failed to assess, identify and encourage the resident to eat her favorite foods for meals and snacks. The resident experienced a severe weight loss of 8.8% in one month, and 7.4 % (6.2 lbs) within eight days. The facility further failed to accurately document the resident's nutritional intake.

Inspectors wroteBased on observations, staff interview and record review, the facility failed to ensure two (#32 and #65) of six out of 33 sample residents received and consumed foods in the appropriate form as prescribed by a physician and/or assessed by the interdisciplinary team to support the treatment and plan of care. Specifically, the facility failed to: -Follow the physician diet order and offer a mechanically soft diet for Resident #32; and -Follow the physician diet order and offer low sodium (2g/day) for Resident #65.

Inspectors wroteBased on observations, interviews and record review, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to prevent the development and transmission of disease and infection in one out of eight homes. Specifically, the facility failed to: -Ensure residents were offered hand hygiene before meals; and, -Ensure that oxygen tubing and nasal cannulas were stored off the floor, in a clean bag and replaced when contaminated.

Inspectors wroteBased on observations, record review and interviews, the facility failed to store, prepare, distribute and serve food under sanitary conditions in four of six kitchens. Specifically, the facility failed to follow accepted food service industry standards to minimize the risk of foodborne illness in a highly susceptible population in the following practices: -Hold ready-to-eat foods at proper hot and cold holding temperatures; and -Ensure proper glove use and hand hygiene.

Inspectors wroteBased on observations and interviews, the facility failed to ensure care for residents was provided in a manner and in an environment that maintained or enhanced the residents' dignity and respect in full recognition of their individuality for one (#2) of two residents reviewed for dignity out of 28 sample residents. Specifically, the facility failed to assist Resident #2 with dignity and respect during meals in the dining room. I. Resident status Resident #2, age [AGE], was admitted on [DATE]. According to the September 2019 computerized physician orders (CPO), pertinent diagnoses included Parkinson's disease, dementia and psychotic disorder with delusions. The 6/26/19 minimum data set (MDS) assessment revealed the resident had severe cognitive impairment; his brief interview for mental status (BIMS) score was not conducted. The resident required extensive assistance for eating. II. [...]

Inspectors wroteBased on record review and interviews, the facility failed to provide notice before transfer/discharge for one (#56) of 28 sample residents. Specifically, the facility failed to: -Obtain a physician order for transfer/discharge; -Provide notice of transfer/discharge; and -Document the reason for the transfer/discharge.

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure the environment remained as free of accident hazards as possible for one (#41) of two residents reviewed out of 28 sample residents. Specifically, the facility failed to act timely when Resident #41's motorized wheelchair malfunctioned.