Harmony Healthcare & Rehab Ctr

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement effective fall precaution interventions for a resident (R2) identified as a fall risk for 1 (R2) of 3 residents reviewed for fall precautions. Findings Include:R2's Facesheet documents that R2 has diagnoses not limited to: unspecified dementia, carcinoma in situ of bladder, essential hypertension, chronic kidney disease, orthostatic hypotension, mild cognitive impairment of unknown etiology, cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery, repeated falls, anxiety disorder, unspecified, age related osteoporosis without current pathological fracture, adult failure to thrive, hyperlipidemia, Alzheimer's disease with late onset, anemia, unsteadiness on feet, history of falling. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that one resident (R3) received the necessary treatment and care for R3 to maintain the highest level of functioning. Failed to identify and treat symptoms of altered cardiovascular status in a patient with CHF, hypertension and stage 3 kidney disease. This failure resulted in R3 having a weight gain of 53.4 pounds, 48% weight gain in 6 months. This failure affected one resident (R3) out of two residents reviewed for death. This failure resulted in R3's hospitalization with a diagnosis of acute decompensated heart failure and diuresing 15 pounds of fluid.

Inspectors wroteBased on interview and record review, the facility failed to access EMS (Emergency Medical Services) for one of one residents (R1) reviewed for change in condition in a total sample of three residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents participated in care planning conferences for 5 (R14, R4, R136, R20, R59) out of 5 residents reviewed in a final sample of 33. Findings Include: On 9/4/24 at 9:52 AM, interviewed R14 and stated admitted in the facility four months ago. R14 stated has not attended any care plan meeting to discuss R14's plan of care. R14's electronic health records show R14 was admitted in the facility on 4/30/24 with diagnoses included but not limited to acute and chronic respiratory failure with hypoxia, dysphagia, major depressive disorder, generalized anxiety, and schizoaffective disorder. R14 had a completed quarterly Minimum Data Set (MDS) assessment with assessment reference date (ARD) of 7/22/24. R14's Brief Interview for Mental Status (BIMS) was coded as 13, which means R14 is cognitively intact. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure resident individualized diet order and food plan was followed affecting one resident (R159) out of 6 residents reviewed for nutrition. The facility also failed to ensure the diet spreadsheet and recipes were followed for pureed food preparation affecting all 22 residents receiving pureed diets in the facility's kitchen. Findings Include: On 09/03/24 at 10:41 AM, R159 said, all my meals are pureed, and I get mashed potatoes at almost all my meals which I am really sick of. I don't know why they cannot puree other things for me, so I don't get the same thing every day. R159 stated R159 is not allowed any liquids except water and is only allowed to have ice cream once a day. R159 said, it's because of my swallowing. Sometimes thin liquids go into my lungs instead of into my stomach. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to (a) ensure staff handled medications in a sanitary manner and performed hand hygiene for 4 (R53, R99, R114, R153) of 5 residents reviewed during the medication administration; (b) post Enhanced Barrier Precautions (EBP) signage for 2 (R30 and R64) residents with an indwelling medical device, and (c) wear proper PPE (Personal Protective Equipment) during high contact resident care activities. These failures have the potential to affect 55 residents residing on 3rd floor and 59 residents residing on 4th floor as of census dated 9/3/24.

Inspectors wroteBased on observation, interview, and record review, the facility: failed to ensure staff did not stand while feeding 2 (R34, and R95) residents that are dependent on staff for assistance with eating and Failed to treat one resident (R417) with respect and dignity by not passing out meals to all residents sitting at the same table at the same time during dining observation in a sample of 33.

Inspectors wroteBased on observation, interview, and record review the facility failed to determine self-administration of medication was appropriate for one resident (R70) in a sample of 33.

Inspectors wroteBased on interview and record review the facility failed to obtain a Physician order and update the resident record with the correct code status for 1 (R85) resident reviewed for Advance Directives in a sample of 33. Findings Include: [...]

Inspectors wroteBased on interview and record review the facility failed to ensure a resident's Advance Directives care plan was revised after three hospitalizations and readmissions to the facility for 1 (R85) resident reviewed for Advance Directives in a sample of 33. Findings Include: [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure oxygen tubing was properly labeled for 1 (R136) resident, and to ensure residents received the correct oxygen flow rate as ordered by the physician for 2 (R50, R136) out of 2 residents reviewed for respiratory care. Findings Include: 1. On 9/3/24 at 10:51 AM, R136 was lying in bed alert and able to verbalize needs. R136 was using oxygen via nasal cannula. R136's oxygen concentrator flow rate was set to 3.5 liters per minute (LPM). R136's oxygen tubing was not labeled when it was last changed. R136 stated R136 has Chronic Obstructive Pulmonary Disease (COPD) and nursing staff sets R136's oxygen. R136 denied changing the flow rate of the oxygen concentrator. At 10:53 AM, interviewed V21 (Registered Nurse) and stated oxygen tubing is changed weekly and as needed. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure adaptive eating equipment was provided to 2 (R96 and R135) residents to facilitate self-feeding. This failure affected 2 (R96 and R135) of 2 residents reviewed for assistive device during mealtime in the sample of 33 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement fall precaution interventions for one (R2) resident identified as a fall risk out of three residents reviewed for fall precautions.

Inspectors wroteBased on interviews and record reviews the facility failed to maintain a resident's (R2) rights to privacy and confidentiality of personal and medical information for 1 of 3 residents reviewed for residents' rights.

Inspectors wroteBased on interview and record review, the facility failed to ensure that resident belongings were returned after discharge for one (R2) of three residents reviewed for misappropriation of resident property.

Inspectors wroteBased on interview and record review, the facility failed to report and investigate misappropriation of property for one (R2) of three residents reviewed for misappropriation of resident property.

Inspectors wroteBased on interview and record review, the facility failed to provide their bed hold policy, upon discharge to hospital, for one (R2) of three resident reviewed.

Inspectors wroteBasedonobservations interviews andrecordreviews thefacilityfailedtoensure that thelowairlossmattressissetonthe appropriatesettingfor4 residents(R0, R2, R4, andR36) reviewedforpressureulcerpreventioninthetotalsampleof57 residents

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure incoming and outgoing nurses counted the controlled medications during shift change, failed to document dispensing of controlled medication, and failed to follow pharmacy instruction to refrigerate medications. These failures affected 4 residents (R27, R110, R140, and R141) reviewed for pharmacy services and records and have the potential to affect all 44 residents on 2nd floor Team 2 and 3rd floor Team 3.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure medication vials are contained in original packaging for 1 resident (R142), failed to discard expired flu vaccine, failed to check the temperature of vaccine refrigerator at a minimum of two times daily, and failed to ensure the refrigerator was within the required temperature. These failures have the potential to affect all the residents on 3rd floor.

Inspectors wroteBased on observation, interview and record review the facility failed to provide required oxygenation assistance for one resident (R30). This failure has the potential to affect one resident R30 out a sample of 57.

Inspectors wroteBased on observation, interview and record review, the facility failed to label and date oxygen tubing per the facility policy. This failure affected one resident (R90) reviewed for oxygen equipment, in a total sample of 57 residents.

Inspectors wroteBased on observations, interviews and records review, the facility failed to follow their policy on sanitation and food safety by failing to date open food items with open date and use by date. This failure has the potential to affect 151 residents who are on an oral diet.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a.) staff donned the appropriate PPE (Personal Protective Equipment) prior to entering Transmission Base Precaution Rooms and b.) failed to ensure linen was stored on the linen cart to prevent contamination. This deficient practice has to potential to affect all residents residing on the 3rd floor of the facility. Third floor census= 52 residents. Finding Include: On 11/01/2022 at 12:23 pm, V13 (Agency CNA) observed standing inside of R9 and R107's room (identified as a contact isolation room). V13 observed wearing an N95 mask and face shield only while standing inside of R9 and R107's room. V13 states I am supposed to be wearing a gown and gloves while inside of R9 and R107s' room. If I am not wearing proper PPE then I can spread an infection. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to answer a call light in a timely manner for 1 (R309) of 4 residents reviewed for call lights.

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain a physician order for oxygen therapy for one resident (R210). The facility also failed to properly label oxygen tubing with a date for six residents (R3, R310, R64, R312, R313, R127). The facility failed (a) to follow their policy and procedure and comprehensive care plan to ensure the correct oxygen flow rate was received as ordered by the physician for one resident (R123), and (b) to follow their policy and procedure to ensure humidifier bottle had at least an inch of water and was properly labeled for 1 (R123) of 8 residents reviewed for respiratory care.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to (a) properly date opened multi-dose inhalers for 4 residents (R35, R76, R73, R159); (b) properly discard multi-dose insulin pen after 28 days of opening for 1 resident (R104); and properly discard expired house stock medications on expiration date that could potentially affect all 20 residents residing on 4th floor team 1 from three of four medication carts inspected for medication storage and labeling.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess/monitor one resident (R38) for self-administration of medication out of a sample of 31 residents reviewed.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to follow their policy and procedure and the comprehensive care plan to ensure incontinence care was provided for a dependent incontinent resident in a timely manner for 1 (R71) of 4 residents reviewed for ADL (Activities of Daily Living) care in a sample of 31.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide nursing services and care to ensure continuity of care for 1 resident (R309) out of a sample of 31 residents reviewed.

Inspectors wroteBased on interview and record review the facility failed to assess/document a blood pressure assessment and failed to ensure medications were administered as ordered by the residents' physician for one (R309) resident out of a sample of 31 residents reviewed. Findings Include: On 11/01/2022 at 10:35 am, R309 stated I have not received my morning medication and it is almost 11 o'clock. On 11/01/2022 at 12:42 pm, V28 (R309s' family) stated R309 still has not received any medications. On 11/01/2022 at 1:07 pm, V9 (Agency LPN #1) located at the 3rd floor nurses station accessing the electronic medication administration record (eMAR) via computer. Surveyor observed residents' eMARs on V9s' computer and observed R309s' eMAR was red in color. On 11/01/2022 at 1:14 pm, V2 (Director of Nursing/DON) located on the 3rd floor of the facility at the nurses station. [...]

Inspectors wroteBased on observations, interview and records review, the facility failed to follow their policy of diets & diet orders and failed to follow their food menu/mechanical soft diet for one resident (R20) reviewed for diets & diet orders in a sample of 6 residents.

Inspectors wroteBased on observation, interview and record review the facility failed to follow their policy of food from outside for one of six residents (R62) reviewed for food from outside labeling in a sample of 6 residents.