Haines City Rehabilitation and Nursing Center

Inspectors wroteBased on observation, interview and record review the facility failed to start a medication timely for one resident (#1) of three residents sampled.

Inspectors wrote5. On 11/18/2024 at 11:01 a.m., Resident #39 was observed laying in bed under the covers, dressed in a gown, groomed and sleeping. The resident was receiving nutrition via tube feeding. A verbal attempt was made to wake the resident up by calling her name, however, the resident opened her eyes and immediately closed her eyes. No visitors or staff were observed in the room. On 11/19/2024 at 10:27 a.m., Resident #39 was observed laying in bed under the covers, dressed in her personal clothing, groomed and awake. An attempt at verbal communication with the resident was made by calling out her name, however, the resident continued to stare and did not verbalize a response. No visitors or staff were observed in the room. On 11/21/2024 at 3:30 p.m., Resident #39 was observed laying in bed under the covers, dressed in her personal clothing, groomed and awake. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility's Quality Assurance Performance Improvement Program (QAPI) failed to implement an effective plan of action to correct deficient practice identified during the recertification survey and complaint survey originally conducted 11/18/2024 through 11/21/2024 as evidenced by: [...]

Inspectors wroteBased on observation, interview, and medical record review, the facility failed to ensure call light cords and buttons were placed within reach for three (#61, #34, and #24) of forty-eight sampled residents.

Inspectors wroteBased on observation, staff interview, and medical record review, the facility failed to ensure one (#36) of forty-eight sampled residents was offered and assisted to scheduled activities that met his interest.

Inspectors wroteBased on record review and interview, the facility did not ensure medications were administered in a timely manner for two (#815, #763) of forty eight residents and failed to ensure wounds were monitored for signs and symptoms of infections and deterioration, and treatment orders were obtained and implemented for one (#64) of two residents sampled for pressure wounds, surgical incisions, and other skin conditions. Findings Included: 1. Review of the admission Record for Resident #815 revealed she was admitted to the facility on [DATE] with diagnoses which included Chronic Diastolic Heart Failure, Non-St Elevation Myocardial Infarction, Paroxysmal Afibrillation and Pulmonary Hypertension. Review of November 2024 Physician orders for Resident #815 revealed an order dated 11/4/24 for : [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure medications were administered at the correct dose for one (Resident #90) out of 26 residents sampled. Findings Included: During an observation on 11/18/2024 at 9:49 a.m. Resident #90 was observed in bed, she was not able to answer questions regarding her care. Review of Resident #90's admission record revealed resident #90 was admitted to the facility on [DATE] with diagnoses that included anxiety disorder and depression. Review of Resident 90's admission Minimum Data Set (MDS) dated [DATE] revealed Section C. Cognitive Patterns, Brief Interview for Mental Status (BIMS) of 04 out of 15 showing severe cognitive impairment. Review of Section N. Medications revealed Antipsychotic and antidepressant. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the medication error rate was less than 5.00%. Thirty-four medication administration opportunities were observed, and three errors were identified for two (#13 and #11) of four residents observed. These errors constituted an 8.82% medication error rate.

Inspectors wroteBased on observation, record review and interview, the facility failed to coordinate dental services for one resident (#18) out of eight residents sampled.

Inspectors wroteBased on resident meal observation and staff interview, it was determined the facility did not ensure one (Resident #816) of three residents observed during a lunch meal received food presented in an attractive and appealing manner.

Inspectors wroteBased on observation, record review, and interview, the facility failed to implement an effective infection control program related to 1. the use of Personal Protective Equipment (PPE) for one (#88) of one sampled resident for transmission-based precautions, 2. failed to ensure fingernails of staff were kept in a manner that prohibited the growth of microorganisms and allowed for sufficient hand hygiene, and 3. failed to ensure the storage of personal hygiene equipment for one resident (#91) out of ten sampled residents related to oral hygiene.

Inspectors wroteBased on observation and interview, the facility failed to ensure a clean and comfortable environment by not maintaining and cleaning one (B Hall) of two community shower rooms.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one (#61) of forty-eight sampled residents, was provided with personal hygiene fingernail care during at least three of four days observed (11/18/2024, 11/19/2024, 11/20/2024). It was observed all ten of the fingernails were found with dark debris and were long, cracked/chipped and leaving sharp edges.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure a hazarded free room environment, with (brand name) Air Freshener Spray found in one resident room, Resident (#99) out of eight residents sampled.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide housekeeping and maintenance services to maintain a sanitary and homelike environment related to not maintaining the kitchen ceiling in one of one kitchen, repairing of holes in the walls of three resident rooms (#140, #145 and #181), and a stained floor, walls and privacy curtain and broken furniture in one resident room (room [ROOM NUMBER]) out of a total of 64 resident rooms.

Inspectors wroteBased on observation, record review, and interview, the facility, 1. failed to ensure blood pressures were monitored adequately for a period of three months for one resident (#40) of five sampled residents, and 2. failed to ensure one resident (#98) receiving antibiotic treatment had a diagnosis listed, to indicate the purpose of the treatment of four residents reviewed for a UTI (urinary tract infection) diagnosis.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure comprehensive assessments were accurately documented for one resident (#84) of 50 sampled residents.

Inspectors wroteBased on observation, record review, and interview, the facility failed to develop a care plan related to floor mats for one resident (#15) of fifty sampled residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure Activities of Daily Living (ADLs) related to oral care, were provided for one resident (#91) of five residents sampled.

Inspectors wroteBased on observation, record review, and interview the facility failed to provide supervision for smoking and limited access to smoking materials for three residents (#58, #712, and #715) out of ten smokers as evidence by the observation of the three residents smoking unsupervised and the observation of smoking paraphernalia removed from resident rooms.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide enteral nutrition in accordance with professional standards for one resident (#459) of two residents sampled for enteral nutrition needs.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure the physician order for one resident (#17) out of five residents sampled for unnecessary medications was implemented following the recommendation of the consulting pharmacist.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that the medication error rate was less than 5.00%. Thirty- eight medication administration opportunities were observed, and twenty-three errors were identified for four (#43, #11, #27 and #3) of six residents observed. These errors constituted a 60.53% error rate.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure one of one kitchen was maintained in a clean and sanitary manner, one (Station #2) of two refrigerators in the pantry stations was maintained in a clean and sanitary manner, and temperatures were documented daily for the refrigerators and freezers in two pantry stations (Station #1 and Station #2) of two pantry stations.

Inspectors wroteBased on observation, interview and record review the facility failed to honor the rights to a dignified existence by not ensuring that a resident's environment enhanced the quality of life for one resident (#77) of 43 sampled residents.

Inspectors wroteBased on observations, record reviews, and interviews the facility failed to implement the care plan for two residents (#49 and #94) out of forty-three residents sampled in regards to ensuring the resident (#49) was not isolated in her room and ensuring the resident (#94) had bilateral floor mats as ordered.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to provide restorative services per physician's orders for two residents (#30 and #49) out of the sampled forty-three residents.

Inspectors wroteBased on observations, record reviews, and interviews the facility failed to ensure weekly weights were obtained following weight loss for two residents (#94 and #27) out of four residents sampled for nutrition.

Inspectors wroteBased on observations, policy reviews, and interviews the facility failed to ensure respiratory equipment for two residents (#40 and #94) out of thirty residents who received respiratory treatments was stored in a sanitary manner for three of four days.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to monitor side effects of psychotropic medications for two residents (#30 and #25) and failed to monitor behaviors for one resident (#25) out of the sampled five residents reviewed for unnecessary medications.

Inspectors wroteBased on observations, record reviews, and interviews the facility failed to ensure that drugs and biologicals were stored in a safe, secure, and orderly manner related to not ensuring medications were inaccessible to residents, unauthorized personnel and/or visitors during two of six observations of medication administration and failed to permanently affix two of two refrigerated narcotic boxes.

Inspectors wroteBased on observations, interviews, and record review the facility did not ensure sufficient staff were available to provide meal assistance for five residents (#20, #52, #54, #55, and #66) during dining services, of 102 residents in the facility, on one of four hallways (the B Hall) for two of two days observed.

Inspectors wroteBased on interviews, record review, observations, menu review, and policy review the facility did not ensure cultural food choices were available for one resident (#61) of 43 residents sampled.