Harmony Hall Nursing and Rehabilitation Center

Inspectors wroteBased on observation, record review and staff, Nurse Practitioner, and Pharmacy Consultant interviews, the facility failed to administer insulin prior to the manufacturer's recommended expiration date for 1 of 1 resident reviewed for professional standards (Resident #4). Resident #4 was admitted to the facility on [DATE] with diagnoses which included type 2 diabetes mellitus. Review of Resident #4's quarterly Minimum Data Set (MDS) dated [DATE] revealed he was cognitively intact and coded for the use of insulin. Review of Resident #4's care plan dated 1/12/26 revealed a focus for diabetes mellitus with interventions which included finger stick blood sugars as ordered by physician, medication as ordered by physician, and monitoring for signs and symptoms of hypoglycemia. [...]

Inspectors wroteBased on observation, record review, resident and staff interviews, the facility failed to secure smoking materials (cigarettes/lighters) for 1 of 9 residents sampled for smoking (Resident #57).

Inspectors wroteBased on observations, manufacturer's instructions, staff and Pharmacy Consultant interviews, the facility failed to remove one (1) multi-dose insulin injector pen that was expired in 1 of 5 medication carts reviewed for medication storage and labeling (Station 2 medication cart #1). The manufacturer's instructions dated 3/2026 for insulin glargine injector pen stated it should be discarded 28 days after opening. Observation of Station 2 medication cart #1 on 2/26/26 at 10:14 am revealed one (1) open insulin glargine injector pen with a handwritten opened date of 1/20/26 and a handwritten expiration date of 2/17/26. During an interview and observation conducted on 2/26/26 at 10:14 a.m. the Medication Aide #1 who was assigned to Station 2 medication cart #1 stated she did not administer insulin injections; [...]

Inspectors wroteBased on observation, record review and staff interview the facility failed store a plastic tube feeding syringe with the plunger separate from the barrel which created a potential for bacterial growth. This deficiency was for 1 of 1 resident reviewed for enteral tube feeding management (Resident #2). Resident #2 was admitted to the facility on [DATE] with diagnoses that included dysphagia (trouble swallowing) following cerebral infarction (stroke). A quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #2 was severely cognitively impaired and was admitted with a gastrostomy tube (g-tube: a surgically placed tube that provided direct access to the stomach for nutrition, hydration and medication). [...]

Inspectors wroteBased on observations, record review and staff interview the facility failed to attempt alternative interventions, assess for entrapment risk, review the risks and benefits of the use of side rails, and/or obtain consent from the resident or resident representative before use of bilateral quarter length side rails. This deficient practice affected 1 of 1 resident (Resident #4) reviewed for side rails.

Inspectors wroteBased on record review, observations, and resident interview and staff interviews, the facility failed to assess the ability of a resident to self-administer medications prior to leaving the resident's medications on the bedside table in the resident's room for 2 of 2 residents observed with medications at bedside (Resident #25 and Resident #62).

Inspectors wroteBased on record review and staff interviews, the facility failed to provide a complete Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) (form 10055) prior to discharge from Medicare Part A skilled services by omitting the options checked section indicating a resident's decision to continue part A Medicare services and by omitting the resident's signature on the form for 2 of 3 residents (Resident#170 and Resident #7) reviewed for beneficiary protection review.

Inspectors wroteBased on observations, record review, and resident and staff interviews, the facility failed to secure smoking materials (cigarettes/lighters) for 2 of 4 residents sampled for smoking (Resident #23, Resident #106).

Inspectors wroteBased on observations, staff interviews, and facility record reviews, the facility failed to keep a urinary catheter bag from touching the floor to reduce the risk of infection for 2 of 4 residents (Resident #87 and Resident #91) reviewed with urinary catheters.

Inspectors wroteBased on record review and staff and physician interviews, the facility failed to provide incontinence care safely to a dependent resident for 1 of 1 residents reviewed for falls. Resident #307 fell out of bed during incontinence care provided by Nursing Assistant (NA) #1 resulting in an upper lip laceration which required to 7 sutures, a laceration to the left side of the head that required 12 staples and a small laceration to the 2nd digit on the left foot.

Inspectors wrote3). Resident #256 was admitted to the facility on [DATE] with medical diagnosis that included anorexia and moderate protein-calorie malnutrition. Review of an admission MDS assessment for Resident #256 documented he had moderately impaired cognition. He received a mechanically altered, therapeutic diet and weighed 133 pounds. He was independent with eating and required set up help only. The initial care plan for Resident #256 was in progress beginning on 08/11/23 and included guidance for activities of daily living and personal care. Review of Resident #256 ' s weights revealed an admission weight on 08/11/23 of 132.6 pounds. On 08/23/23 he weighed 130.6 pounds for a total weight loss of 2 pounds between 08/11/23 and 08/23/23. Resident #256 ' s medical record revealed a physician order dated 08/12/23 for Dronabinol Oral 5 MG capsule twice a day for appetite stimulant. [...]

Inspectors wroteBased on observations, record review, and staff interviews the facility failed to a) ensure expired beverages were discarded and not available for use, b) ensure that frozen foods were sealed when stored to prevent freezer burn, c) ensure that foods were labeled, dated, stored, and left to thaw in a safe manner to prevent the potential for food borne illness. These practices had the potential to affect residents in the facility.

Inspectors wroteBased on observations, record review, staff, Regional Pharmacy Services Manager, and Physician interviews the facility failed to protect a resident's right to be free from misappropriation of a resident's controlled hypnotic medication (Ambien) which was prescribed by the physician for insomnia. This resulted in 78 missing doses of Ambien for 2 of 2 residents (Resident #84, Resident #6) reviewed for misappropriation of medications.

Inspectors wroteBased on record review, staff, physician, and Regional Pharmacy Services Manager interviews the facility failed to address drug irregularities noted by the Consultant Pharmacist on six consecutive monthly Medication Regimen Reviews for an antipsychotic medication prescribed by the physician for 1 of 5 residents (Resident #10) reviewed for unnecessary medications.

Inspectors wroteBased on record review, staff, physician, and Regional Pharmacy Services Manager interviews the facility failed to transcribe and administer an antipsychotic medication at a reduced dose per the Consultant Pharmacist recommendation due to a noted increase in abnormal movements. The failure to transcribe the reduced dose resulted in 189 doses administered at a higher dose than ordered for 1 of 5 residents (Resident #10) reviewed for psychotropic medication.

Inspectors wroteBased on record review and staff interviews the facility failed to ensure advanced directive information matched throughout the medical record for 1 of 1 resident (Resident #25) reviewed for advanced directives.

Inspectors wroteBased on record review, staff and Physician interviews the facility failed to obtain daily weights as ordered by the physician and failed to accurately document a weight or obtain a reweigh for 1 of 1 resident (Resident #4) reviewed for nutrition.

Inspectors wroteBased on record review, and interviews with staff, the resident, the Regional Pharmacy Services Manager and the Physician, the facility failed to acquire and administer temazepam, a controlled substance medication used for insomnia, for Resident #31 for a period of 4 days for 1 of 3 residents whose medications were reviewed.

Inspectors wroteBased on record review and staff interview the facility's Quality Assessment and Assurance Committee failed to maintain implemented procedures and monitor interventions that the committee had previously put in place following the recertification and complaint survey of 04/13/22. This was for a recited deficiency in the area of Advance Directives (F578). The continued failure during two federal surveys of record showed a pattern of the facility's inability to sustain an effective Quality Assurance Program.

Inspectors wroteBased on observations, and staff interviews the facility failed to maintain resident rooms in good repair as evidenced by damaged drywall which included visible holes in the walls, scratched walls, and peeling paint which was observed in 12 of 25 resident rooms (Rooms 2203, 2212, 2215, 2218, 2221, 2302, 2315, 3412, 3416, 3418, 3503, 3516) reviewed for the provision of a safe, clean, homelike environment.

Inspectors wroteBased on observations, staff interviews and record review the facility failed to accurately code Minimum Data Set (MDS) assessments to reflect Hospice Services (Resident #26), application of dressings and ointments to a wound (Resident #80), and dental status (Resident #25) for 3 of 26 residents whose MDS assessments were reviewed.