Heisinger Bluffs Rehab and Healthcare Center

Inspectors wroteBased on observation, interview and record review, the facility staff failed to store food in a manner to prevent potential contamination and out-dated use. Facility staff also failed to properly wash, sanitize and air-dry mechanically washed dishes to prevent cross-contamination and the growth of foodborne pathogens. This has the potential to affect all residents. The facility census was 55. 1. Review of the facility's Receiving and Storage of Food Policy, dated 10/2023, showed: -Foods shall be received and stored in a manner that complies with safe food handling practices; -Food in designated dry storage areas shall be kept off the floor (at least 18 inches); -Dry foods that are stored in bins will be removed from original packaging, labeled and dated (use by date). Such foods will be rotated using a first in-first out system; [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to serve food in accordance with the nutritionally calculated menus to 33 of 55 residents (Residents #3, #4, #5, #6, #7, #8, 10, #11, #12, #13, #14, #15, #16, #17, #18, #19, #20, #22, #23, #28, #29, #30, #32, #34, #36, #37, #40, #42, #45, #46, #48, #51 and #58). The facility census was 55. 1. Review of the facility's Food and Nutrition Services Policy, dated 04/30/24, showed: -Each resident is provided with a nourishing, palatable, well-balance diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to use enhanced barrier precautions (EBP) (an infection control practice that requires staff to wear personal protective equipment (PPE) (protective equipment such as gowns, gloves, goggles, and masks used to prevent or minimize exposure to hazards) for the care of residents) for four residents (Resident #59, #7, #33 and #13) of seven sampled residents and failed to ensure two residents' catheter (indwelling tube placed directly in the bladder to drain urine) bags did not touch the floor for two residents (Resident #48 and #7) out of three sampled residents. The facility census was 55. 1. Review of the facility policy titled Enhanced Barrier Precautions, undated, showed EBP that employs targeted gown and glove use during high contact resident care activities. [...]

Inspectors wroteBased on interview and record review, facility staff failed to provide the appropriate Center for Medicare and Medicaid Services (CMS) Notice of Medicare Non-Coverage (NOMNC) for three residents (Residents #1, #60, and #61) out of three sampled residents whom the facility-initiated discharge from Medicare Part A Services when benefit days were not exhausted. The facility census was 55. 1. Review of the facility's policy titled Transfer/Discharge Notice Appeal, dated 11/24/24, showed residents have the right to appeal transfer or discharge notices. Should the resident who received a notice of transfer or discharge disagree with the reasons for the transfer or discharge, the resident and/or their representative my file an appeal. [...]

Inspectors wroteBased on interview and record review, facility staff failed to refund resident funds within 30 days of discharge from the facility for three residents (Resident #1 and #3) out of three sampled residents. The facility census was 49. 1. The facility did not provide a policy for refunding monies owed to a resident or his/her representative after a resident discharges from the facility. 2. Review of the Resident #1's Discharge Assessment Minimum Data Set (MDS), a federally mandated assessment tool, dated 02/06/24, showed staff assessed the resident as: -Moderate cognitive impairment; -admission date 10/25/23; -discharge date [DATE]. Review of the resident's Transfer/Discharge report, undated, showed the resident admitted to the facility on [DATE] and discharged from the facility on 02/06/24. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to perform hand hygiene as often as necessary, using approved techniques to prevent cross-contamination. The facility census was 54. 1. Review of the facility supplied policies and procedures, showed the records did not contain a food service hand hygiene policy. Observation on 03/19/24 at 10:00 A.M., showed dietary aide (DA) G washed soiled dishes in the mechanical dishwashing station and then, without performing hand hygiene, the DA put away sanitized dishes from the clean side of the station. Observation on 03/19/24 at 10:32 A.M., showed DA G washed soiled dishes in the mechanical dishwashing station. [...]

Inspectors wroteBased on interview and record review, facility staff failed to use appropriate infection control procedures to prevent the spread of bacteria or other infectious causing contaminants when staff failed to ensure all residents were screened for Tuberculosis (TB), a potentially serious infectious bacterial disease that mainly affects the lungs, when staff failed to ensure a two-step Mantoux test (a skin test to determine whether a person in infected with determining whether a person is infected with tuberculosis) was completed and documented in accordance with their policy for three (#4, #6, and #9) out of six sampled residents. The facility census was 54. 1. Review of the facility's Tuberculosis Testing for Residents, Employees, and Volunteers policy, dated 11/22/23 showed: [...]

Inspectors wroteBased on interview and record review, facility staff failed to follow professional standards when staff did not ensure one resident (Resident #6) out of one sampled residents received the required Prothrombin and International Normalized Ratio ((PT/INR) blood test that shows how long it takes to form a blood clot) blood test for the use of Warfarin (medication to thin blood and prevent blood clots). The facility census was 54. 1. Review of the facility's Medication and Treatment Order policy, dated 11/22/23 showed: -Orders for anticoagulants (blood thinning medications) will be prescribed only with appropriate clinical and laboratory monitoring; -The attending physician/practitioner must periodically record in the progress notes the results of the laboratory monitoring and the review for potential complications. Review of the Warfarin prescribed infromation located on www.accessdata.fda. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide an ongoing program of activities designed to meet the residents' interests for fourdependent residents with dementia (Resident #4, #7, #22, and #45) out of 18 sampled residents. The facility census was 54. 1. Review of the facility's activities program policy, dated 07/19/23, showed the activities programs are designed to meet the interests of and support the physical, mental, psychosocial well-being of each resident. Review showed activities offered are based on the comprehensive resident-centered assessment and the preferences of such resident. Review showed the residents' participation are documented in the residents' medical record. Review of the facility's scheduled activities calendar, dated March 2024, showed: -On the 19th at 10:00 A.M., catholic service and 02:00 P.M., Easter Door Crafts; [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to ensure multi-dose medications were dated when opened, including inhalers, insulin pens, and a nose spray. The facility census was 54. 1. Review of the facility's Storage of Medication policy, dated 01/12/07, showed facility staff were directed as follows: -Insulin (helps your body turn food into energy and manages your blood sugar levels) products should be stored in the refrigerator until opened. Note the date on the label for insulin vials and pens when first used. The opened insulin vial may be stored in refrigerator or at room temperature. Opened insulin pens must be stored at room temperature; [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to serve food in accordance with the nutritionally calculated recipes and menus to four of four residents (Residents #11, #18, #27 and #42) who received pureed diets. The facility census was 54. 1. Review of the facility provided policies and procedures, showed the records did not contain policies and procedures for resident food service. Review of meal tray tickets for Residents #11, #18, #27 and #42, showed the tickets directed staff to serve the residents a pureed diet. Review of the facility lunch menus and recipes dated 03/19/24 (Week 3, Day 17), showed the facility staff were directed to provide the residents who received pureed diets with: -A #8 (four ounce) scoop of pureed orange-rosemary pork loin or pureed lemon pepper tilapia; -A #8 scoop of mashed potatoes with two ounces of gravy; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to complete the Employee Disqualification List (EDL) check, the Family Care Safety Registry (FCSR), and/or Criminal Background Check (CBC) upon hire for two current employees (Employee O and Licensed Practical Nurse (LPN) N) as directed in their policy and failed to periodically check the employee disqualification list for one of ten sampled current employees (Housekeeper M). In addition, the facility failed to complete the required Certified Nurse Aide (CNA) Registry checks upon hire for two of the ten sampled employees (Employee O and LPN N). The facility census was 48. 1. Review of the facility's Background Checks Policy and Procedure, undated, showed the following: Policy: The facility has a responsibility to ensure the safety of our residents. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to maintain professional standards of care by not following physician's orders for four residents (Resident #3, #20, #24, and #39). The facility census was 48. 1. Review of the facility's policies, showed staff did not provide a policy for following or obtaining physician's orders. 2. Review of Resident #3's Quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by staff, dated 1/10/23, showed facility staff assessed the resident as follows: -Severe cognitive impairment; -Required extensive assistance from staff for mobility, transfers, and toileting; -Always incontinent of urine; -Frequently incontinent of bowel; -At risk for developing pressure ulcers. [...]

Inspectors wroteBased on interview and record review facility staff failed to ensure medication regimens were free from unnecessary medications when staff failed to obtain an appropriate diagnosis for the use of psychotropic medications (a chemical substance that changes brain function and results in alterations in perception, mood, consciousness or behavior) for three residents (Resident #11, #25, and #40). The facility census was 46. 1. Review of the facility's Medication Administration Safety Program (MASP) -High Alert Medications, not dated, showed antipsychotics may be used with appropriate supporting diagnosis. 2. Review of Resident #11's quarterly Minimum Data Set (MDS), a federally mandated assessment tool to be completed by facility staff, dated 12/22/22, showed facility staff assessed the resident as follows: -Severe cognitive impairment; -No behaviors directed towards others; [...]

Inspectors wroteBased on observation, interviews, and record review, the facility staff failed to ensure the ice bin drained through an air gap, to maintain the kitchen environment in a clean and sanitary manner, to perform hand hygiene as often as necessary, and to properly store open food to prevent cross contamination and outdated usage. This had the potential to affect all facility occupants. The census was 48. 1. Review of the facility's policies showed the facility did not have a policy for the ice machine. Observation on 3/1/23 at 10:40 A.M., showed the ice machine, located in the kitchen, did not drain through an air gap, and the bottom ¼ inch of the drain pipe contained a black substance. Further observation showed staff used the ice machine for resident meal service. [...]

Inspectors wroteBased on interview and record review, the facility staff failed to document collaboration of care with hospice providers for development and implementation of a coordinated plan of care and communication between the facility and two local hospice providers (Hospice A and Hospice B) for four residents (Resident #3, #24 #36, and #40) receiving Hospice services. The facility census was 48. 1. Review of the facility's Hospice A Hospice and Respite Care Service Agreement, dated 1/26/23, showed: -Plan of Care: a written plan prepared for each Hospice patient, containing an assessment of the patient's needs, identification of services to be provided, and a detailed description of the scope and frequency of services needed to meet the patient's and his or her family's needs; [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to use appropriate infection control procedures to prevent the spread of bacteria or other infectious causing contaminants when staff failed to maintain proper infection control practices for two resident's (Resident #5 and #12) catheters, failed to perform hand hygiene and change soiled gloves during incontinent care and/or care for three residents (Resident #5, #17, and #39), and failed to clean wound care equipment for one resident (Resident #39). [...]

Inspectors wroteBased on observation, interview, and record review staff failed to implement procedures to ensure schedule IV (drugs with a low potential for abuse and low risk of dependence) medications were monitored for one resident (Resident #4) and failed to ensure medications were stored in a safe and effective manner. The facility census was 48. 1. Review of the facility policies showed staff did not provide a policy for controlled medication monitoring. 2. Review of Resident #4's Minimum Data Set (MDS), a federally mandated assessment completed by staff, dated 12/15/22, showed staff assessed the resident as follows: -Moderate cognitive impairment; -Diagnosis of dementia, and seizure disorder/epilepsy. Observation on 3/1/23 at 10:10 A.M., showed a vial of Ativan (anti-anxiety medication), 3 milligram (mg)/milliliter (ml), in a locked box in a refrigerator in the medication storage room. [...]