Harris Health Care Center North

Inspectors wroteBased on clinical record review and staff interview, the facility failed to maintain a resident's right to be free from involuntary seclusion for 1 of 1 resident reviewed, Resident ID #1.

Inspectors wroteBased on surveyor observation, clinical record review, and staff and resident interviews, the facility failed to inform residents how to file a grievance or complaint. Additionally, the facility failed to implement the grievance policy to ensure the prompt resolution of all grievances, for 9 of 9 residents reviewed during the Resident Council meeting, Resident ID #s 4, 6, 9,14, 20, 22, 24, 26, and 29.

Inspectors wroteBased on surveyor observation, clinical record review, and staff interview, the facility failed to ensure that food is stored and distributed in accordance with professional standards for food service safety, relative to the main kitchen.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to develop, implement, and maintain an effective, comprehensive, data-driven Quality Assurance and Performance Improvement (QAPI) program that focuses on indicators of the outcomes of care and quality of life relative to making a good faith attempt to correct deficiencies related to trauma informed care and the cleanliness of the kitchen.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to maintain an infection prevention and control program to help prevent the transmission of communicable diseases and infections relative to the storage of staff insulin in the main kitchen, failed to clean with an Environmental Protection Agency (EPA) approved disinfectant, failed to prevent the spread of infection during 1 of 1 wound observation for Resident ID #5, and failed to report a cluster of scabies to the Rhode Island Department of Health affecting Resident ID #'s 11, 14, 23, 28 and 30. [...]

Inspectors wroteBased on surveyor observation, clinical record review, and resident and staff interviews, the facility failed to ensure a resident's dignity was maintained relative to privacy of personal needs for 5 of 5 residents reviewed for the use of adult protective underwear, Resident ID #s 3, 16, 24, 28, and 31.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure psychotropic drug usage is based on the comprehensive assessment of a resident, and that residents who use psychotropic drugs (medications that are prescribed to affect behavior, mood, thoughts, or perception) receive gradual dose reductions (GDR) and behavioral interventions unless clinically contraindicated for 1 of 1 resident reviewed for a GDR, Resident ID #31.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to provide appropriate treatment and services for 1 of 1 resident reviewed with a urostomy (a surgical procedure that creates an opening in the abdominal wall to allow urine to exit the body bypassing an injured or non functioning bladder), Resident ID #2.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that residents who are trauma survivors, receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents experiences, and preferences, in order to eliminate, or mitigate triggers that may cause re-traumatization of the resident for 2 of 3 resident reviewed with a history of trauma, Resident ID #s 3 and 16.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure the medical care of each resident is supervised by a physician for 1 of 1 resident reviewed following an admission from home, Resident ID #2.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that the resident's drug regimen is free from unnecessary drugs for 1 of 1 resident reviewed for antibiotics, Resident ID #7.

Inspectors wroteBased on surveyor observation, clinical record review, and staff interview, the facility failed to ensure each resident's medication regimen is free from a medication error rate of 5% or greater. Based on 25 opportunities for errors observed during the medication administration task, there were 4 errors resulting in an error rate of 16% affecting Resident ID #s 2, 5, and 10.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure residents are free from any significant medication errors for 1 of 1 resident reviewed with a hospital recommendation, Resident ID #1.

Inspectors wroteBased on surveyor observation, clinical record review, and staff interview, the facility failed to provide sufficient support personnel with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, taking into consideration the individual needs of 2 of 2 residents reviewed for modified diets, Resident ID #s 13 and 15, and to safely and effectively carry out the functions of the food and nutrition service for all residents.

Inspectors wroteBased on surveyor observation, clinical record review, and staff interview, the facility failed to ensure that services provided meet professional standards of quality and practices relative to 1 of 1 resident observed during wound care, Resident ID #5.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to provide appropriate treatment and services for 2 of 2 residents reviewed for a change in condition related to bleeding, Resident ID #s 5 and 16.

Inspectors wroteBased on surveyor observation, clinical record review, and staff interview, the facility failed to provide respiratory care consistent with professional standards of practice for 1 of 1 resident reviewed for oxygen therapy, Resident ID #1.

Inspectors wroteBased on surveyor observation and staff interview, the facility failed to store drugs and biologicals in accordance with currently accepted professional principles relative to 1 of 2 medication carts observed and 1 resident observed with medication at the bedside, Resident ID #1.

Inspectors wroteBased on clinical record review and staff interview, the facility continues to fail to maintain complete and accurately documented medical records for 1 of 3 residents reviewed for medication administration, Resident ID #1.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure the resident's medical record includes documentation that the resident either received the pneumococcal vaccination or did not receive the vaccination due to medical contraindications or refusal, for 2 of 5 residents reviewed, Resident ID #s 6 and 27 Additionally, the facility failed to have updated policies regarding immunizations.

Inspectors wroteBased on record review, staff and resident interview, it has been determined that the facility failed to provide necessary treatment and services, consistent with professional standards of practice, to promote wound healing and prevent new ulcers from developing for 1 of 1 resident reviewed with a pressure ulcer (a localized injury to the skin and/or underlying skin usually over a boney prominence), Resident ID #26.

Inspectors wroteBased on record review, staff interview and resident interview, it has been determined that the facility failed to develop and implement a comprehensive person-centered care plan for smoking for 2 of 2 residents reviewed who are smokers, Resident ID #s 10 and 23.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents who are trauma survivors, receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents experiences, and preferences, in order to eliminate, or mitigate triggers that may cause re-traumatization of the resident for 1 of 1 resident reviewed with a history of trauma, Resident ID #10.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents are free of any significant medication errors for 2 of 5 residents reviewed for unnecessary medications, Resident ID #s 1. Additionally, the facility failed to follow the pharmacy recommendation for a gradual dose reduction (GDR) (psychotropic medications are required by federal guidelines in skilled nursing facilities) for 1 of 2 residents reviewed, Resident ID #23.

Inspectors wroteBased on record review, staff and resident interview, it has been determined that the facility failed to accurately document bowel movements (BM) in the resident's medical record for 2 of 2 residents reviewed for constipation, Resident ID #s 1 and 5.

Inspectors wroteBased on surveyor observation, record review, staff and resident interview, it has been determined that the facility failed to ensure that services being provided meet professional standards of practice for 1 of 2 residents reviewed relative to wound care, Resident ID #22 and 1 of 1 resident observed receiving medications, Resident ID #16.

Inspectors wroteBased on surveyor observation and staff interview, it has been determined that the facility failed to store and label drugs and biologicals in accordance with currently accepted professional principles for 1 of 1 medication storage rooms observed.

Inspectors wroteBased on record review, staff and resident interview, it has been determined that the facility failed to implement their smoking policy in accordance with federal, state, and local laws for 1 of 2 residents reviewed for smoking, Resident ID #10.

Inspectors wroteBased on record review and staff interview, it is has been determined that the facility failed to assess residents using the quarterly review instrument specified by the State and approved by Centers for Medicare & Medicaid Services (CMS) not less frequently than once every 3 months. According to the, State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities, last revised in February of 2023 states in part, .DEFINITIONS §483.20(c) 'Quarterly Review Assessment' is an OBRA ' 87-required, non-comprehensive assessment that must be completed at least every 92 days following the previous OBRA assessment of any type. It is used to track a resident's status between comprehensive assessments to ensure critical indicators of gradual change in a resident's status are monitored. As such, not all Minimum Data Set (MDS) items appear on the Quarterly assessment . 1. [...]

Inspectors wroteBased on surveyor observation, record review and staff interview, it has been determined that the facility failed to ensure that residents who are trauma survivors, receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents experiences, and preferences, in order to eliminate, or mitigate triggers that may cause re-traumatization of the resident for 2 of 5 residents reviewed for Trauma Informed Care, Resident ID #s 12 and 21.

Inspectors wroteBased on surveyor observation, record review and staff interview, it has been determined that the facility failed to develop and implement a baseline care plan for each resident within 48 hours of a resident's admission, that includes the instructions needed to provide effective and person-centered care for the resident that meets professional standards of quality care relative to bilateral lower extremity edema (swelling caused due to excess fluid accumulation in the body tissues) for 1 of 2 new admissions, Resident ID #179.

Inspectors wroteBased on record review, surveyor observation and staff interview it has been determined that the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan, for 1 of 3 residents reviewed for COVID-19, Resident ID #28, and 1 of 2 residents reviewed for new admissions, Resident ID #179.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that the irregularities identified by the Clinical Consultant Pharmacist during the monthly pharmacist Medication Regimen Review (MRR) were acted upon for 1 of 5 residents reviewed, Resident ID #24.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure each resident's medication regimen is free from a medication error rate of 5% or greater. Based on 25 opportunities observed during the medication administration task, there were 2 errors resulting in an error rate of 8%.

Inspectors wroteBased on record review and staff interview it has been determined that the facility failed to maintain medical records on each resident that are accurately documented for 1 of 3 residents reviewed for COVID-19, Resident ID #28.

Inspectors wroteBased on surveyor observation and staff interview, it has been determined that the facility failed to follow standard precautions (basic level of infection control that should be used at all times, example: hand hygiene) to prevent the spread of infection relative to hand washing during the Medication Administration task for Resident ID #s 3, 5, 18 and 180 and placement of a glucometer supply basket during the morning blood glucose monitoring for Resident ID #s 13, 24, 79 and 129.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to conduct periodic accurate, comprehensive, standardized reproducible assessment of each resident's functional capacity for 3 of 4 residents reviewed, Resident IDs #2, 3, and 4.