Hazard Health and Rehabilitation Center

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to maintain and ensure recording of the reconciliation of controlled medication was occurring as required for 8 of 8 medication carts.

Inspectors wroteBased on observation, interview, record review, and review of the facility's policies, the facility failed to maintain an effective infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 5 of 41 sampled residents (Resident (R)4, R77, R28, R42 and R50).

Inspectors wroteBased on observation, interview, and facility policy review, it was determined the facility failed to provide housekeeping services to ensure a clean and sanitary environment for 5 of 41 sampled residents, (Resident (R)3, R36, R51, R100, R181).

Inspectors wroteBased on interview, record review, and review of facility policies, the facility failed to ensure residents had the right to privacy in their use of electronic social [NAME] communication for 1 of 41 residents (Resident (R)151).

Inspectors wroteBased on observation, interview, record review, and review of facility policies, the facility failed to develop and implement a comprehensive, person-centered care plan for each resident to include measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs and describe the services to be furnished to attain or maintain a resident's highest practicable physical, mental, and psychosocial well-being for 3 of 41 sampled residents, (Resident (R)90, R138 and R24).

Inspectors wroteBased on interview, record review, and review of facility documentation and policy, the facility failed to revise the comprehensive person-centered care plan for 1 of 41 sampled residents, (Resident (R)24)

Inspectors wroteBased on observation, interview, record review, document review and policy review, the facility failed to ensure the kitchen was maintained in a sanitary condition to minimize the risk of food borne illness to all 151 residents residing in the facility and who received meals from the kitchen. Specifically, the water temperature in three out of four handwashing sinks in the kitchen was not hot; sanitizer solutions were too strong; microwave ovens were soiled; individual cartons of shakes were not labeled with expiration dates, and the refrigerator/freezers on the units were not monitored and/or were not functioning properly.

Inspectors wroteBased on observation, record review, interview and facility document review, the facility was to follow Enhanced Barrier Precautions (EBP) when performing direct care to one of 36 residents (Resident (R)108) and failed to update infection control policies annually. This failure has the potential to spread infection to residents, staff are administering direct care to.

Inspectors wroteBased on observation and interview, the facility failed to ensure that two corridors were equipped with firmly secure handrails on each side of the hallway which has the potential to affect all ambulatory residents in the facility. Failure to have handrails could affect residents' ability to safely ambulate down the hallways.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to provide written hospital transfer notices for four of six residents (Resident (R) 9, 14, 35, and R58) reviewed for hospitalization out of a total sample of 36 and failed to inform the Ombudsman of the hospital transfers. The failure had the potential to cause residents to not fully understand the purpose of the hospital transfer and the Ombudsman to not be aware of resident transfers to the hospital from the facility.

Inspectors wroteBased on interviews, record review, and policy review the facility failed to ensure that one resident (Resident (R) R119) out of a total sample of 36 residents, was protected from abuse, when R148 slapped R119 on the cheek of her face.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to provide written information regarding the facility's bed-hold daily pricing for three of six residents (Resident (R)14, 35, and R58) reviewed for hospitalization out of a total sample of 36. The failure had the potential to cause confusion for residents planning on returning to the facility.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure that one out of two residents (Resident (R)147) reviewed for activities of daily living (ADLs) received services to help her maintain her ability to ambulate (walk) after the discontinuation of physical therapy (PT). This created the potential for R147 to decline in her ability to ambulate which could impact her goal of discharge to the community.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure that it provided an ongoing program to support residents in their choice of activities, both facility sponsored and group activities for one resident (Resident (R)49) of 36 sampled residents.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure that one out of three residents (Resident (R)147) reviewed for range of motion (ROM) received services to prevent further declines in ROM after the discontinuation of therapy. Physical therapy (PT) and occupational therapy (OT) recommended R147 to wear right foot and hand splints, and that staff provide ROM exercises. The failure to implement these interventions created the potential for R147 to decline in ROM which could impact her goal of discharge to the community.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain the cleanliness of the nebulizer mouthpiece when not in use for one of 36 residents in the survey sample (Resident (R)133). This deficient practice increases the risk of infection for a resident requiring nebulizer therapy.

Inspectors wroteBased on observation, interview, record review, policy review, and review of the admission packet, the facility failed to ensure two out of five residents (Resident (R)78 and R131) reviewed for unnecessary medications with dementia diagnoses had medication regimens free of unnecessary psychotropic medications. Failures included lack of adequate indication and identification of behaviors warranting the use of antipsychotic medications; duplicate therapy, lack of explaining risks versus benefits prior to the initiation of the medications, and a lack of qualitative and quantitative monitoring of behaviors and side effects. This created the potential for overmedication.

Inspectors wroteBased on observation, staff interview, record review and facility policy review, the facility failed to secure medications in a locked medication cart when left unattended on one of four units (300 Hallway). Resident (R)80's insulin was left on top of the medication cart and was left unattended in the hallway where visitors were present. This failure had the potential for an unauthorized person to take this insulin causing harm to themselves or others.

Inspectors wroteBased on observation, interview, and review of the facility policy, it was determined the facility failed to ensure the call light was accessible to one (1) of thirty-five (35) sampled residents. Observation of Resident #157's call light on 06/18/19 and 06/19/19 revealed it was located on the floor, under a bedside chair, during three (3) observations. Review of the facility policy, Protocol for Answering Call Lights, undated, revealed the resident call system was utilized by residents to alert staff of the need for assistance.

Inspectors wroteBased on interview, record review, and review of the facility's advance directive form, it was determined the facility failed to protect the rights of one (1) of thirty five (35) sampled residents (Resident #240). The facility failed to ensure Resident #240's right to formulate an advance directive was honored.

Inspectors wroteBased on observation, interview, record review, and facility contract review, it was determined the facility failed to coordinate care with outside resources that provided services to one (1) of thirty-five (35) sampled residents (Resident #130). Resident #130 required outpatient hemodialysis treatments two (2) times a week due to end stage renal failure. However, there was no documented evidence that the facility coordinated care with the certified dialysis center. Resident #130 had received twenty-four (24) dialysis treatments from 02/16/19 through 06/15/19. However, Resident #130's medical record revealed no evidence that communication had occurred between the facility and the dialysis for eighteen (18) of the visits.

Inspectors wroteBased on observation, interview, record review, and review of the facility policy, it was determined the facility failed to maintain an effective infection control and prevention program for one (1) of thirty-five (35) sampled residents (Resident #157). Observation of Resident #157 revealed staff provided catheter care and bowel incontinence care for the resident and then turned/repositioned the resident, straightened the resident's linens, and touched the resident's call light with the same dirty/soiled gloves.