Greenup Rehab and Nursing

Inspectors wroteBased on interview and record review the facility failed to complete post fall neurological assessments for 72 hours as directed by the facility's policy for three of three residents (R1, R2, R3) reviewed for accidents in the sample list of eight.

Inspectors wroteBased on interview and record review the facility failed to report an injury of unknown origin to the state survey agency for one of three residents (R1) reviewed for accidents/injuries in the sample list of eight.

Inspectors wroteBased on interview and record review the facility failed to thoroughly investigate an injury of unknown origin for one of three residents (R1) reviewed for accidents/injuries in the sample list of eight.

Inspectors wroteBased on observation, interview and record review the facility failed to report and thoroughly investigate falls and serious injuries and failed to develop/implement fall interventions for two of three residents (R1, R3) reviewed for falls in the sample list of eight.

Inspectors wroteBased on interview and record review the facility failed to protect resident's right to be free from resident-to-resident physical abuse. This failure affected four of five residents (R1, R30, R31, R37) reviewed for resident rights on the sample list of 24 residents.

Inspectors wroteBased on interview and record review the facility failed to submit a final investigation report regarding allegations of abuse to the state surveying agency. This failure has the potential to affect three of five residents (R1, R30, R31) reviewed for abuse on the sample list of 24 residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours per day, seven days a week. This failure has the potential to affect all 36 residents in the facility. Findings Include: The September 2024 Nurse Schedule documents no Registered Nurse coverage on 9/7/24, 9/8/24, 9/21/24, and 9/22/24. On 9/22/24 at 7:55 AM, upon the entrance of the facility's Annual Certification Survey there was no Registered Nurse on duty. On 9/24/24 at 3:18 PM V2 Director of Nurses confirmed the facility only employs two Registered Nurses. V2 stated there are some weekends that the facility does not have eight hours of consecutive Registered Nurse coverage. [...]

Inspectors wroteBased on interview and record review, the facility failed to employ a qualified Director of Food and Nutrition Services. This failure has the potential to affect all 36 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to employ dietary support/staff with the appropriate competencies to carry out the functions of the food and nutrition service. This failure has the potential to affect all 36 residents residing in the facility.

Inspectors wroteBased on observations, interviews, and record review the facility failed to provide a substitute menu, honor resident's preferences, and provide appropriate condiments. These failures have the potential to affect all 36 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide residents breakfast meal in a timely manner. This failure affected all 36 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent the potential for cross-contamination and food-borne illness, by failing to maintain sanitization of a commercial table top can opener, free of grease-like substance, metal fragments, rust and exposed metal, failed to maintain food surface areas in a clean sanitary manner, failed to clean grease build-up on kitchen and food storage room floors, failed to adequately clean grease build- up off the flat top grill, failed to clean commercial ovens and failed to air dry dishware. These failures have the potential to affect all 36 residents residing in the facility.

Inspectors wroteBased on interview and record review the facility failed to establish a water management program, failed to develop a risk assessment ensuring that interventions to monitor control limits are met, develop a method to audit the program to prevent the growth of Legionella and other water borne pathogens in the building's water systems. This failure has the potential to affect all 36 residents that reside in the facility. Findings Include: The facility Long-Term Care Facility Application for Medicare and Medicaid dated 9/22/24 documents that there are 36 residents who reside in the facility. The facility Legionella Policy and Procedure dated 4/20/20 documents that each facility will complete a risk assessment to identify if the entire building or parts of the building are at risk for Legionella growth and spread. [...]

Inspectors wroteBased on observations, interview, and record review the facility failed to maintain kitchen equipment in a safe operable and functional manner. This failure affected all 36 residents in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to honor residents' right to a clean and comfortable homelike environment by failing to repair and maintain the cleanliness of the only two resident-shared shower rooms in the facility. These failures affect all 36 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility repeatedly failed to provide dignity while dining for four of four residents (R15, R17, R27, and R87) reviewed for dignity on the sample list of 28.

Inspectors wroteBased on observation, interview, and record review the facility failed repeatedly to change oxygen tubing and nasal cannula, store oxygen tubing off the floor, and maintain nebulizer breathing treatment equipment and Continuous Positive Airway Pressure (CPAP) equipment in a sanitary fashion. These failures affected two of two residents (R24, R30) reviewed for oxygen in the sample list of 36. Findings Include: 1.) R24's Medical Diagnoses Sheet dated September 2024 document R24 is diagnosed with Congestive Heart Failure and Chronic Obstructive Pulmonary Disease. R24's Physician Order Sheet (POS) dated September 2024 documents R24 is prescribed oxygen at three liters per nasal cannula. The nasal cannula is ordered to be changed every Thursday night. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to serve palatable resident preferred temperature, and pleasant looking food. This failure affected four of four residents (R9, R19, R30, and R32) reviewed for palatability of food on the sample list of 28.

Inspectors wroteBased on interview and record review, the facility failed to provide a resident with an Advance Beneficiary Notice (ABN), at the termination of a Medicare Part A covered stay, thereby nullifying the resident's right to continue therapy services at their own expense or decline therapy services. This failure affects one resident (R187) out of a sample of three reviewed for Beneficiary Notices on the sample of 28.

Inspectors wroteBased on record review and interview, the facility failed to issue a written bed hold notice to a resident's family member when the resident was transferred to the hospital. This failure affects one of one resident (R2) reviewed for hospitalization on the sample list of 28.

Inspectors wroteBased on interview and record review the facility failed to closely monitor a resident's weight loss, notify the physician of significant weight loss, and implement nutritional supplement recommendations to slow/prevent weight loss. This failure affected one of one resident (R13) reviewed for nutrition on the sample list of 28. Findings Include: R13's Medical Diagnoses sheet dated September 2024 documents R13 is diagnosed with Dementia and Depression. R13's Minimum Data Set, dated [DATE] documents R13 is severely cognitively impaired and requires partial/moderate assistance for eating. R13's Weight charting on 8/23/24 documented a weight of 239 pounds. R13's Dining Manager note dated 8/25/24 documents R13 was a re-admit from the hospital and weighed 237 pounds. R13 requires assistance during meals and typically eats less than 50%. A house supplement two times per day is recommended. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to label and document expiration dates for medications for two residents (R7, R25) and failed to lock the convenience box after removing medication for one resident (R33) during medication storage and labeling review on the sample list of 28.

Inspectors wroteBased on interview and record review, the facility failed to appropriately assess, evaluate, and document a resident's behaviors after administering medications for behaviors for one resident (R29) of five resident reviewed for Unnecessary Medications in the sample list of 28.

Inspectors wroteBased on interview and record review, the facility failed to ensure complete and accurate controlled medication records. This failure has the potential to affect one resident (R1) of three reviewed for medications.

Inspectors wroteBased on interview and record review, the facility failed to complete a comprehensive Plan of Care with fall interventions for one (R3) of three residents reviewed for Care Plans in the sample of three.

Inspectors wroteBased on interview and record review, the facility failed to form fall interventions and implementation of safety measures to prevent a resident (R3) from falling. R3 is one of three residents reviewed for falls in the sample of three.

Inspectors wroteBased on interview and record review, the facility failed to have RN (Registered Nurse) coverage for 8 hours/day, 7 days/week for one day, 12/3/23 of 15 days reviewed for nursing coverage. This failure has the potential to affect all 36 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent the potential for cross-contamination of disposable plates and failed to maintain sanitary kitchen and pantry floor areas. These failures have the potential to affect all 36 residents in the facility.

Inspectors wroteBased on interview and record review the facility failed to ensure that controlled substances were accounted and reconciled for seven (R2, R3, R4, R10, R15, R16, and R23) of seven residents reviewed for controlled substance accounting and reconciliation from a total sample list of 26 residents.

Inspectors wroteBased on observation, interview and record review the facility failed to store and secure controlled medications behind a separately locked compartment for four (R10, R22, R36 and R193) of four residents reviewed for medication storage from a total sample list of 26 residents.

Inspectors wroteBased on interview and record review the facility failed to notify the Physician of missed medication for one of one resident (R38) reviewed for Physician notification in the sample list of 26.

Inspectors wroteBased on observation, interview, and record review the facility failed to complete a restraint/enabler assessment for two residents (R12, R21) and failed to release a restraint during lunch for one resident (R12) of two residents reviewed for restraints in a sample list of 26.

Inspectors wrote2.) R27 Order Summary Report dated 12/12/23 documents diagnoses including Unspecified Dementia with Agitation and Depression. This Order Summary documents an order for Citalopram HBR (Hydrobromide) (antidepressant) 20 mg (milligrams) one tablet one time a day related to Depression. R27's Care Plan dated 3/24/23 documents R27 has a history of signs and symptoms of depression and is currently being treated. This Care Plan documents interventions of administering medications as ordered. R27's medical record documents one Psychotropic medication assessment dated [DATE]. R27's medical record does not document any other Psychotropic medication assessments for 2023. On 12/11/23 at 12:22 PM, V3 Minimum Data Set Nurse confirmed V3 is responsible to complete the Psychotropic medication assessments. [...]

Inspectors wroteBased on interview and record review the facility failed to administer an anticoagulant medication as ordered for one resident. This failure resulted in a significant medication error for one of one resident (R38) reviewed for medication errors in the sample list of 26.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent the potential for chemical cross-contamination in the kitchen dishwashing sinks. This failure has the potential to affect all 37 residents residing in the facility.

Inspectors wroteBased on record review and interview the facility failed complete the recapitulation of stay, discharge summary and failed to implement a discharge plan of care for one (R37) resident out of one resident reviewed for discharge in a sample list of 22 residents.

Inspectors wroteBased on observation, interview and record review facility staff failed to prevent cross contamination during urinary catheter care for 1 (R6) of 1 resident reviewed for urinary catheter care in a sample of 22 residents.