Guest House Nursing and Rehabilitation

Inspectors wroteBased on record reviews and interview the facility failed to ensure each resident received the care and treatment in accordance with professional standards of practice for 2 (#1, #2) of 3 sampled residents. The facility failed to assess, monitor, and document edema in accordance with the physician's orders and/or the comprehensive plan of care.

Inspectors wroteBased on observations and interviews, the facility failed to maintain a safe, clean, comfortable and homelike environment for 2 (#38, #100,) of 2 (#38, #100) sampled residents reviewed for environmental concerns. The facility failed to ensure that residents' wheelchairs were maintained in good repair.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident was free from misappropriation of personal property for 1 (#11) of 1 resident reviewed for personal funds.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure residents were free from physical restraints imposed for the purpose of discipline or convenience for 1 (#16) of 1 residents reviewed for restraints. The facility failed to have documented evidence of releasing the lap tray every two hours for range of motion.

Inspectors wroteBased on interview and record review, the facility failed to ensure a thorough investigation was completed for an allegation of misappropriation of property/exploitation for 1 (#7) of 1 resident reviewed for personal funds.

Inspectors wroteBased on record reviews and interviews, the facility failed to notify the state-designated mental health disability authority promptly for a review when a resident with Mental Disorders or Intellectual Disorders experienced a change in mental or physical status for 1 (#7) of 2 (#7 and #8) residents reviewed for Pre-admission Screening and Resident Review (PASARR).

Inspectors wroteBased on record reviews and interviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment for 1 (#89) of 2 (#63 & #89) sampled residents reviewed for mood/behavior.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident was as free of accident hazards as is possible by failing to ensure an appropriate intervention was attempted for 1 (#71) of 8 (#2, #4, #9, #10, #18, #36, #71, #89) residents reviewed for accidents.

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure respiratory care was provided consistent with professional standards of practice for 1 (#61) of 1 (#61) residents reviewed for respiratory care. The facility failed to ensure there was signage indicating oxygen in use was posted outside the entrance of Resident #61's room.

Inspectors wroteBased on record review and interview, the facility failed to ensure each resident's medication regimen was free from unnecessary medications by failing to monitor for any active bleeding or bruising for a resident who received an anticoagulant for 1 (#1) 3 (#1, #61, #71) reviewed for general concerns.

Inspectors wroteBased on observation, review of the policy, and interviews, the facility failed to ensure that all drugs and biologicals are stored in locked compartments by having an unlocked, open medication room that was not being monitored by licensed nursing staff.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure that before allowing an individual to serve as a nurse aide, a facility must receive receive registry verification that the individual has met competency evaluation requirements for 1 Certified Nursing Assistant (S5CNA) of 3 (S5CNA, S6CNA, and S7CNA) personnel files reviewed. The facility allowed an employee to work as a CNA with an expired and out of State certification.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure the assessment accurately reflected the resident's status for 1 (#1) of 2 (#1 and #2) resident records reviewed, by assessing that bed rails were not indicated for a resident who was identified as having bed rails in use.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure residents were assessed for the risk of entrapment from bed rails prior to installation for 2 (#1 and #2) of 2 (#1 and #2) residents reviewed for accident hazards. The facility failed to have documented evidence of an assessment for the risk of entrapment from bed rails for residents identified as having ¼ bed rails in use.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure nursing staff was competent in providing nursing and related services to assure resident safety and maintain resident's highest practicable physical, mental, and psychological well-being for each resident. The facility failed to ensure: 1) the Certified Nursing Assistants (CNAs) conducted a walk through round and provided a report on residents during shift change and 2) CNAs rounded on residents every 2 hours for 2 (#1, #2) of 3 (#1, #2, #3) sampled residents.

Inspectors wroteBased on record review and interview the facility failed to electronically transmit encoded, accurate and complete Minimum Data Set (MDS) data to Centers for Medicare and Medicaid (CMS) in a timely manner for 3 (#43,#48, and #94) of 3 (#43,#48, and #94) residents reviewed for the completion of a fourteen day discharge assessment.

Inspectors wroteBased on observation, record review, and interview the facility failed to develop and implement a comprehensive person-centered care plan for 1 (#66) of 1 (#66) residents identified with a skin rash.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide respiratory care consistent with professional standards of practice for 2 (#25, #71) of 2 (#25, #71) sampled residents reviewed for respiratory care. The facility failed to ensure: 1) a resident's oxygen (O2) was administered as ordered, the O2 tubing was dated, and the nebulizer was dated/stored properly (#25); and 2) a resident's O2 concentrator was clean (#71).

Inspectors wroteBased on record review and interviews the facility failed to ensure that the pharmacist reported any irregularities to the physician and director of nursing for 1 (#15) of 5 (#15, #23, #37, #51, #59) residents reviewed for unnecessary medications. The pharmacist failed to identify that resident #15 was receiving as needed (prn) doses of the psychotropic medication clonazepam beyond 14 days without a documented rationale and duration date for administration.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that each resident was free from unnecessary medication use for 1 (#15) of 5 (#15, #23, #37, #51, #59) residents reviewed for unnecessary medications. The facility failed to have a documented rationale in the resident's medical record to indicate the duration of an as needed (prn) psychotropic medication to be extended beyond 14 days of use for resident #15 who received the prn medication clonazepam.

Inspectors wroteBased on record reviews and interview, the facility failed to ensure the State Adverse Actions Website checks were completed for Certified Nursing Assistants (CNA) monthly for 4 (S3CNA, S8CNA, S10CNA, and S11CNA) of 5 (S3CNA, S8CNA, S10CNA, S11CNA and S12CNA) personnel files reviewed.

Inspectors wroteBased on record review and interview, the facility failed to ensure it was in compliance with state laws by failing to obtain criminal history checks upon hire for 1 (S8Certified Nursing Assistant) (CNA) of 5 (S3CNA, S8CNA, S10CNA, S11CNA and S12CNA) personnel files reviewed.

Inspectors wroteBased on record review and interviews the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment witnessed by staff are reported immediately to their supervisor or the Director of Nursing for 1 (#1) of 3 (#1, #2, #3) residents reviewed for abuse.

Inspectors wroteBased on record review and interviews the facility failed to have documented evidence that allegations of verbal abuse were thoroughly investigated for 1 (#1) of 3 (#1, #2, and #3) sampled residents reviewed for abuse.

Inspectors wroteBased on observation and interviews the facility failed to ensure expired medications were not available for use and administered to residents as evidenced by expired medications being stored in the facility's 2 of 2 medication rooms. This deficient practice had the potential to affect any of the facility's 92 residents as listed on the Resident Census and Condition of Residents Report.