Green Meadows Health & Rehabilitation

Inspectors wroteBased on observation, interview, and policy review, the facility failed to provide food storage in a safe and consistent manner. Specifically, food items were observed open and unlabeled/ undated as to when the package/bottle/bags/boxes was opened. This had the potential to affect 78 of 79 residents who consumed food from the kitchen.

Inspectors wroteBased on observations, interviews and document review, the facility failed to ensure the call light systems annunciator was operating at two of two nurses' stations (Transition and Orchard). This deficient practice could result in residents being unable to obtain assistance with their activities of daily living.

Inspectors wroteBased on observations and interviews, the facility failed to ensure two of two (Transition and Orchard) living room couches used by residents were maintained in a safe manner. The unrepaired couches could be a fall risk and possible risk for physical injury. This deficient practice has the potential to affect all 79 residents and their visitors in the facility.

Inspectors wroteBased on observations, interviews, and facility policy review, the facility failed to properly store medications. Specifically, there were several loose tablets in three of six medication carts (Peach unit, Cherry unit and Maple unit). This failure increased the risk for drug diversion from three of six medication carts.

Inspectors wroteBased on interview, record review, and review of the facility instructions for completion of the Center for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) CMS-10055, revealed that the facility did not provide the SNFABN document to one of one resident (Resident (R)52) who remained in the facility after receiving skilled Medicare part A services. This failure could lead a resident or responsible party to not make an informed decision about remaining in the facility after Medicare A services ended.

Inspectors wroteBased on record review, interviews, and policy review, the facility failed to verbally explain the contents of the binding arbitration agreement for one resident (Resident (R)24) of three residents reviewed for binding arbitration agreements.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to ensure infection control practices had been followed by two of six staff (Licensed Practical Nurse (LPN)2 and LPN4) while dispensing medications for two of 11 residents (Resident (R)59 and R39) observed during medication administration. This deficient practices has the potential to contaminate the medications taken by the residents.

Inspectors wroteBased on observation, interview and review of the facility's policy, it was determined the facility failed to ensure drugs and biologicals were labeled in accordance with currently accepted professional principles. Observations revealed three (3) of five (5) medications carts to contain opened medications without labels or expiration dates.

Inspectors wroteBased on observation, interview and review of the facility's policies, it was determined the facility failed to store foods in accordance with professional standards for food service safety. Observations of the kitchen on 06/29/19 revealed frozen food products, outside original boxes without labels with food names, received dates, or use by dates.

Inspectors wroteBased on interview, record review, and review of the Resident Assessment Instrument (RAI) Manual, it was determined the facility failed to ensure a quarterly Minimum Data Set (MDS) assessment was completed no less than every three (3) months for one (1) of eighteen (18) sampled residents (Resident #5). Review of Resident #5's medical record revealed the facility completed the resident's Quarterly MDS assessment on 01/14/19; however, the facility failed to open a quarterly assessment until 06/25/19 (date of the survey), approximately five (5) months later.

Inspectors wroteBased on interview, record review, and review of the Resident Assessment Instrument (RAI) 3.0 User's Manual, it was determined the facility failed to submit the Minimum Data Set (MDS) assessments to the Centers for Medicare and Medicaid Services (CMS) within the required timeframe for two (2) of eighteen (18) sampled residents (Residents #3 and #5)

Inspectors wroteThe facility failed to ensure each resident's assessment was coordinated by and certified as complete by a registered nurse, to the accuracy of the portion of the assessment he or she completed for two (2) ResidentS (Residents #4 and #55).

Inspectors wroteBased on observation, interview, record review and review of facility Policy, it was determined the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and time frames to meet a resident's medical, nursing, and mental and psychosocial needs for one (1) of eighteen (18) sampled residents (Resident #77). Resident #77 had a urinary catheter; however, review of the Comprehensive Care Plan revealed no documented evidence of a plan of care for the urinary catheter. Review of Resident #77's physician's orders revealed a Physician's Order, dated 6/7/19, to start bladder retraining; however, there was no documented evidence the bladder retraining occurred and no documented evidence of a plan of care for the bladder retraining.

Inspectors wroteBased on observation, interview, record review and review of facility's policy, it was determined the facility failed to revise the Comprehensive Care Plan for one (1) of eighteen (18) sampled residents (Resident #47). Resident #47 had a skin tear to the right upper arm and review of Resident #47's Comprehensive Plan of Care revealed no documented evidence the Care Plan was revised to include the skin tear to the right upper arm.

Inspectors wroteBased on observation, interview, record review and review of facility policy it was determined the facility failed to provide services to meet professional standards of quality for one (1) of eighteen (18) sampled residents (Resident #47). Review of Resident #47's Treatment Administration Record (TAR), for June 2019, revealed no documented evidence of the treatment for which there was a physician order, dated 06/21/19, for treatment to a skin tear to the right upper arm. The Findings Include: Review of the facility policy titled Green Meadows Physician's Orders, date implemented 03/01/19, revealed verbal orders should be received only by licensed nurses, or pharmacists, and confirmed in writing by the physician,on the next visit to the facility. [...]

Inspectors wroteBased on observation, interview, record review and review of facility's Policy, it was determined the facility failed to ensure that a resident who enters the facility without an indwelling catheter was not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary; was assessed for removal of the catheter as soon as possible; and received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for one (1) of eighteen (18) sampled residents (Resident #77). Review of Resident #77's physicians orders, revealed a Physician's Order dated 6/7/19 to start bladder retraining and discontinue the use of a catheter. However, there was no documented evidence the bladder retraining occurred or the urinary catheter was discontinued. [...]

Inspectors wroteBased on interview, record review and review of the facility's policy, it was determined the facility failed to provide routine and emergency drugs and biologicals and failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident, for one (1) of eighteen (18) sampled residents (Resident #49). Per interview on 06/25/19, with the Resident and the resident's representative, Ranitine (Zantac) medication was ordered by an out of facility provider and given to the facility's nursing staff on 06/17/19. Record review of Resident #49's physician's orders revealed no documented evidence of an order on 06/17/19 for Ranitidine. [...]

Inspectors wroteBased on observation, interview, record review and review of the facility's policy, it was determined the facility failed to ensure the medication error rate for the facility was not five (5) percent or greater. Observation of the medication pass revealed twenty-four (24) medication opportunities with five (5) medication errors to result in a twenty-one (21) percent medication error rate.

Inspectors wroteBased on observation, interview, record review and review of the facility's policy, it was determined the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one (1) of eighteen (18) sampled residents (Resident #77). Observation of lunch meal service, on 06/25/19 revealed a nurse entered Resident #77's room without donning PPE, to deliver a meal tray and exit the room without proper hand hygiene. Additionally, observation of wound care, on 6/27/19 revealed a nurse failed to practice proper hand hygiene during a non-sterile dressing change for Resident #77.