Heritage Health Care & Rehab Inc

Inspectors wroteBased on interviews, record review, and facility procedure review titled, Restorative Nursing Program, the facility failed to update Resident Identifier (RI) #48's care plan with recommendations from the speech therapy department. This deficient practice affected RI #48, one of 25 sampled residents whose care plans were reviewed. Findings Include: A review of a facility procedure titled, Restorative Nursing Program, written in November of 2016 and revised in November of 2017, revealed in part, Those residents on a restorative program will have a care plan developed to reflect the goal(s) of the restorative program. RI #48 was admitted to the facility on [DATE] and had diagnoses to include Dysphagia (difficulty swallowing). [...]

Inspectors wroteBased on observations, interviews, record review, and review of a facility policy titled, Activities of Daily Living (ADLs) the facility failed to provide Resident Identifier (RI) #48 and RI #62 with necessary and appropriate care and services with eating. This deficient practice affected RI #48 and RI #62, two of three residents reviewed for assistance with ADLs. Findings Include: A review of the Activities of Daily Living (ADLs) policy, written in January of 2018 and last reviewed in January of 2020, which was provided by EI #2, revealed, . C. A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. [...]

Inspectors wroteBased on observations and interviews the facility failed to ensure: 1. dietary staff did not take food temperatures by sticking the thermometer through plastic wrap or foil and 2. staff dated resident's food before placing it in the unit refrigerators. This had the potential to affect 140 of 156 residents receiving meals from dietary and two of four unit refrigerators. 1. The following observations were made on 05/15/19 of the lunch tray line service: At 11:15 a.m., of the tray line service. EI (Employee Identifier) #2 was observed taking the temperature of the black forest cake by placing the thermometer through the plastic wrap covering and into the cake. At 12:08 p.m., more cake was brought out and the temperature was taken of the cake by EI #3. EI #3 was observed taking the temperature by sticking the thermometer through the plastic wrap and into the cake. [...]

Inspectors wroteBased on observations, interview, medical record review and a facility's policy titled, COLOR CODES/LABELING, the facility failed to ensure the spine of the medical chart and the end of the bed for RI (Resident Indentifer) #405 had the correct code status label. This deficient practice affected one out of 30 sampled residents.

Inspectors wroteBased on interviews, observations and a facility's document titled FEEDING THE IMPAIRED RESIDENT, the facility failed to ensure Resident Identifier (RI) #406 did not wait thirty minutes to receive assistance with the dinner meal on 05/14/2019. This deficient practice affected one out of five sample residents who required assistance with feedings

Inspectors wroteBased on observations, interviews, record reviews, review of the Potter and [NAME], Fundamentals of Nursing, Ninth Edition, and review of facility policies titled, OXYGEN ADMINISTRATION, METERED DOSE INHALER ADMINISTRATION PROCEDURE and USING GLOVES, the facility failed to ensure: 1. a Certified Nursing Assistant (CNA) did not reapply Resident Identifier(RI) #88's nasal cannula after it was found on the floor under RI #88's bed, 2. a.) RI #89's oxygen tubing was dated, b.) a Licensed Practical Nurse (LPN) cleaned RI #89's inhaler after administration and before storing it in the medication cart, and 3. an LPN changed her gloves and washed her hands after touching potentially contaminated objects when obtaining RI #116's finger stick blood sugar, administering RI #116's nebulizer treatment and during administration of RI #116's medications via gastrostomy tube. [...]

Inspectors wroteBased on interview, medical record review and a review of [NAME] and Perry's FUNDAMENTALS OF NURSING EIGHT EDITION, the facility's policies titled, ADMISSIONS, and Procedure: MEDICATION ADMINISTRATION GUIDELINES, the facility failed to ensure Resident Identifier (RI) #313 received the Mestinon medication upon admission to the facility. The facility further failed to ensure RI #313 did not received an unsampled resident's medication. This affected one of 14 residents admitted to the facility with admission orders within the last 30 days. Findings Include: A review of [NAME] and Perry's FUNDAMENTALS OF NURSING EIGHT EDITION, page 584 -585, Box 31-6 PROCESS FOR MEDICATION RECONCILIATION, revealed the following: . 2. Clarify: Make sure that the list of medications . frequencies is accurate; [...]

Inspectors wroteBased on interview, medical record review and a review of [NAME] and Perry's FUNDAMENTALS OF NURSING EIGHT EDITION, and the facility's policy titled, ADMISSIONS, the facility failed to ensure Resident Identifier (RI) #313's Mestinon medication was available upon admission to the facility. This affected one of 14 residents admitted to the facility with admission orders within the last 30 days. Findings Include: A review of [NAME] and Perry's FUNDAMENTALS OF NURSING EIGHT EDITION, page 584 -585, Box 31-6 PROCESS FOR MEDICATION RECONCILIATION, revealed the following: . 22. Clarify: Make sure that the list of medications . frequencies is accurate; clarify the list with as many people as necessary ( ., patient, caregiver, health care providers. pharmacist) to ensure accuracy . Attitudes To administer medications safely . Standards . Nurses verify medication information . [...]

Inspectors wroteBased on interview, medical record review and a review of the facility's policy titled, CHARTING AND DOCUMENTATION GUIDELINES, the facility failed to ensure licensed staff documented an assessment of Resident Identifier (RI) #313's colostomy and skin status on 05/20/18. This affected one of one sampled resident with a colostomy. Findings Include: A review of the facility's policy titled, CHARTING AND DOCUMENTATION GUIDELINES with a revised date of 04-16, revealed the following: . III. PROCESS: a. Rules for Charting and Documentation 1. Chart all pertinent changes in the resident's condition, . as well as routine observations . 4. Chart sufficient information to identify the resident's assessments, . and services provided. 5. Document . pertinent observations . [...]