Hartwell Health and Rehabilitation

Inspectors wroteBased on observations, staff interviews, and review of facility policy titled, Food Preparation and Distribution, the facility failed to ensure dietary staff properly washed hands in the dish room to prevent cross contamination. The facility census was 85 and all residents were receiving an oral diet. The deficient practice had the potential to affect all facility residents.

Inspectors wroteBased on record review, staff interviews, and review of the facility policy titled, Abuse Prohibition-Screening, Hiring, And Training Practices, the facility failed to complete and receive satisfactory background check screenings for one of 11 nursing staff reviewed. The deficient practice had the potential for staff with criminal backgrounds to care for vulnerable residents.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policy titled, Foot Care, the facility failed to adequately provide Activities of Daily Living (ADL) care pertaining to foot treatment for one of 36 sampled residents (R) (R11). The deficient practice had the potential to place R11 at risk for unmet needs and a diminished quality of life.

Inspectors wroteBased on staff and resident interviews and record review, the facility failed to follow physician orders and to contact the physician for a change in condition for one of 16 residents (R) (R13) sampled with physician orders for daily weights. The deficient practice had the potential to place R13 at risk for medical complications, unmet needs, and a diminished quality of life.

Inspectors wroteBased on observations, record review, staff interviews, and review of the facility's policy titled, Patient Smoking Guidelines, the facility failed to keep facility free of accident hazards for one of three sampled residents (R) (R22) who smoked. Specifically, smoking materials were not kept away from R22's bedside. This deficient practice had the potential to result in choking, aspiration, oral injury, and other avoidable harm to facility residents.

Inspectors wroteBased on observations, record review, staff interviews and review of the facility policies titled, Infection Prevention Plan and Transmission-Based Precautions, the facility failed to maintain effective infection control practices concerning contact precautions standards for one of 39 sampled residents (R) (R78). Additionally, the facility failed to prevent the risk of cross-contamination for one of 39 sampled residents (R) (R16). The deficient practices had the potential for cross-contamination of pathogens to other residents and staff.

Inspectors wroteBased on observations, record review, staff interviews, and review of the facility's policy titled Medication Beyond-Use and Expiration Dates, the facility failed to remove expired insulin pens from two of three medication carts observed. This failure had the potential for residents to be administered expired medications.

Inspectors wroteBased on observations, staff interviews, record review, review of facility's policy titled, , Housekeeping, review of the documents titled, Patient Room Cleaning Standard and 10 Step Patient Room Cleaning, the facility failed to maintain clean exhaust fans for six shared bathrooms out of 35 bathrooms. This had the potential to compromise the hygiene and safety of the shared bathroom environments, increasing the risk of infection and negatively impacting the health and well-being of residents. The facility census was 84. Findings Include: A review of the facility's policy titled Housekeeping, dated 12/29/2023, under the section titled Intent revealed, It is the intent of this center to maintain a clean and sanitary center that is free from odor and other environmental factors that may affect the quality of life of our patients. [...]

Inspectors wrote3. Review of the EMR for R32 revealed she was admitted to the facility on [DATE]. R40 had diagnoses that included but not limited to, unspecified dementia (moderate) with other behavioral disturbance, personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits, unspecified sequelae of cerebral infarction, other lack of coordination, pain (unspecified). Review of R32's quarterly Minimum Data Set (MDS) dated [DATE] documented in Section C (Cognitive Patterns) a Brief Interview for Mental Status (BIMS) of 13, which indicated the resident was cognitively intact. [...]

Inspectors wroteBased on observations, resident and staff interviews, record reviews, and review of the facility's policy titled, Skilled Nursing Services Use of Oxygen Therapy, the facility failed to ensure one of 11 residents (R) (R33) receiving oxygen therapy, was administered oxygen in accordance with the physician order. Specifically, R33 did not receive oxygen at the accurate flow rate prescribed by the physician. The deficient practice had the potential to cause respiratory complications for R33.

Inspectors wroteBased on observations, record review, staff interview, and review of the facility's policy titled Oral Inhalation and Nebulizer Administration, the facility failed to properly administer an oral steroid inhaler for one of nine residents (R) R6 observed during medication administration. This failure had the potential to reduce the efficacy of the medication.

Inspectors wroteBased on observation, record review, resident and staff interviews, and review of facilities policies titled, Fall Management and Documentation in the Medical Record revealed, the facility failed to maintain accurately documented resident record in accordance with accepted professional standards and practices regarding falls for one Resident (R) R32 out of 29 sampled residents. The facility census was 84. Findings Include: A review of the policy titled, Fall Management dated 12/29/2023 under the section titled Overview revealed, Each patient is assisted in attaining/maintaining his or her highest practicable level of function by providing the patient adequate supervision, assistive devices and/or functional programs as appropriate to minimize the risk for falls. Each patient's risk for falls is evaluated by the interdisciplinary team (IDT). [...]

Inspectors wroteBased on observations, staff interviews and review of the facility's policy titled, Guidelines for Eyewash Stations and Emergency Showers, the facility failed to maintain one of one eyewash station observed in a safe, functional manner by ensuring proper drainage. Specifically, water flowed from an open pipe below the eyewash station onto the floor and onto the feet of staff using the sink. This deficiency had the potential to cause falls and injury to staff utilizing the eye wash station.

Inspectors wroteBased on record review and interviews, the facility failed to ensure a level two Pre-admission Screening and Resident Review (PASRR) was completed after a change in mental health status for one resident (R) (R#29) reviewed for Pre-admission Screening and Resident Review (PASRR). The sample size was 21.