Heritage Health Care Rehabilitation & Skilled Nurs

Inspectors wroteThe facility reported a census of 53 residents. Based on observation, interview and record review, the facility failed to ensure Resident (R) 3 remained free from abuse when he had an unwitnessed fall in his room and Licensed Nurse (LN) G instructed R3 to get onto his hands and knees and lift himself off the floor resulting in feelings of anger and embarrassment for R3.

Inspectors wroteThe facility identified a census of 53 residents. Based on record review, observation, and interview, the facility failed to ensure narcotic reconciliation which included regular narcotic counts of all narcotics, including the narcotics stored as overflow.

Inspectors wroteThe facility reported a census of 59 residents, one main kitchen, and two kitchenettes. Based on observation, record review, and interview, the facility failed to prepare and serve food under sanitary conditions to prevent the potential for foodborne bacteria. This placed the residents at risk of foodborne illnesses.

Inspectors wroteThe facility reported a census of 59 residents. Based on observation, interview, and record review, the facility failed to dispose of garbage and refuse properly by failing to ensure the covers on three of the three dumpsters were kept closed. This deficient practice created a risk of attracting insects and/or rodents.

Inspectors wroteThe facility identified a census of 59 residents with two medication rooms, three medication carts, and two treatment carts. All five carts have a narcotic box. Based on observation, interview, and record review, the facility failed to adequately reconcile the medication cart for controlled substances. This placed the residents at risk for misappropriation.

Inspectors wroteThe facility reported a census of 59 residents, three medication carts, two treatment carts, and two medication rooms. Based on observation, interview, and record review, the facility failed to ensure that drugs and biologicals used in the facility were labeled, stored, and secured adequately. This placed the affected residents at risk for ineffective medication regimens or diversion.

Inspectors wroteThe facility reported a census of 59 residents. The sample included 17 residents, including six residents reviewed for unnecessary medications. Based on interview and record review, the facility failed to ensure informed consent including purpose, risks versus benefits, and expected therapeutic benefits for the use of antipsychotic (a class of medications used to treat major mental conditions that cause a break from reality), anxiolytic (medication used to treat symptoms of anxiety) and other psychotropic medications (drugs that affect the brain and nervous system to treat mental illnesses) for Resident (R) 6. This placed the resident at risk for uninformed treatment decisions.

Inspectors wroteThe facility reported a census of 59 residents. The sample included 17 residents, including one resident reviewed for discharge. Based on interview and record review, the facility failed to provide the Ombudsman (a resident advocate) with a notice of transfer for Resident (R)67 and R69. This placed the residents at risk of impaired residents rights related to discharge.

Inspectors wroteThe facility reported a census of 59 residents. The sample included 17 residents, including four residents who were reviewed for activities of daily living (ADL). Based on observation, interview, and record review, the facility failed to provide the necessary ADL care for one sampled resident, Resident (R)8, who did not get showered. This deficient practice placed the affected resident at risk for impaired quality of life and poor hygiene.

Inspectors wroteThe facility reported a census of 59 residents. The sample included 17 residents, with four residents reviewed for wounds. Based on observation, interview, and record review, the facility failed to provide the necessary wound care and services in accordance with professional standards of practice, including wound assessments at least weekly, including measurements and description, for Resident (R) 58 and R2. This placed R58 and R2 at risk for related complications and delayed healing.

Inspectors wroteThe facility reported a census of 59 residents. The sample included 17 residents. Based on interviews, record reviews and observation, the facility staff failed to implement sanitary storage of breathing treatment devices for Resident (R) 1, R18, and R3, who received nebulized (a device that changes liquid medication into a mist easily inhaled into the lungs) breathing treatments. This deficient practice had the potential to spread infections to the residents in the facility.

Inspectors wroteThe facility reported a census of 52 residents, with 17 sampled, including three residents reviewed for pressure ulcers/injuries. Based on observation, interview and record review, the facility failed to assess and provide preventive pressure ulcer treatment for two of the three residents reviewed. Resident (R) 109 developed unstageable pressure injuries on her bilateral heels, left lateral foot, and left anterior foot. The deficient practice placed R109 and any other resident with potential skin issues, at risk of further pressure injury development.

Inspectors wroteThe facility reported a census of 52 residents. Based on observation, record review and interview, the facility failed to prepare and serve food under sanitary conditions, to the residents of the facility appropriately to prevent the potential for food borne bacteria and the facility failed to utilize pasteurized eggs (gently heated in their shells, just enough to kill the bacteria) for soft cooked eggs for residents.

Inspectors wroteThe facility reported a census of 52 residents. Based on interview and record review, the facility failed to electronically submit to Centers for Medicare and Medicaid Services, (CMS) complete and accurate direct care staffing information, including information for agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format according to specifications established by CMS {i.e., Payroll Base Journal (PBJ)}, related to licensed nursing staff coverage 24 hours a day and excessively low weekend nursing staff.

Inspectors wrote- On 12/11/23 at 03:36 PM, during a tour of the residents' beauty shop with Activity Staff Z the following concerns were identified: 1. A collection of various hair was built-up in the sink drain. 2. The countertop around the sink had various multiple hair clippings. 3. The top drawer of the sink counter held nail clippers with visible white debris, an unlabeled hair pick with hair in the teeth, and two unlabeled combs with hair in the teeth. On 12/11/23 at 03:36 PM, Activity Staff Z, verified the above findings and stated the beautician comes to the facility one time a week and should clean the beauty and the personal care items before leaving. Personal care items should be labeled and not used between residents to prevent cross contamination and prevent infections. On 12/11/23 at 03:46 PM, Administrative Staff A, verified the above findings, and stated the beauty shop was used weekly. [...]

Inspectors wroteThe facility reported a census of 52 residents with 17 residents sampled, including two residents reviewed for dignity. Based on observation, interview and record review, the facility failed to show respect and dignity to one Resident (R)14, when staff failed to close the window blinds in the resident's room while performing catheter care.

Inspectors wroteThe facility reported a census of 52 residents with 17 residents sampled. Based on observation, interview and record review the facility failed to complete an individualized plan of care, regarding Activities of Daily Living (ADL) for one dependent Resident (R)46, regarding facial shaving.

Inspectors wroteThe facility reported a census of 52 residents with 17 selected for review. Based on observation, interview and record review, the facility failed to review and revise the care plan for two of the 17 residents. Resident (R)8 for decline in eating, and R4 for intervention for use of anipsychotic medication use.

Inspectors wroteThe facility reported a census of 52 residents with 17 residents sampled including four residents reviewed for Activities of Daily Living (ADL). Based on observation, interview and record review the facility failed to provide appropriate assistance with personal hygiene needs for two dependent Residents (R)46 regarding facial shaving and R 21 regarding bathing.

Inspectors wroteThe facility reported a census of 52 residents with seventeen selected for review which included four residents reviewed for accidents. Based on observation, interview and record review, the facility failed to ensure staff followed the care plan interventions for one Resident (R)8 of the four residents reviewed for accidents. R8 sustained two falls without the use of interventions with nonskid socks/slippers when in bed as care planned.

Inspectors wroteThe facility reported a census of 52 residents with 17 residents sampled including two residents reviewed for bowel and bladder. Based on observation, interview and record review, the facility failed to use a leg anchor to prevent the tubing from being tugged on for dependent Resident (R)14's indwelling urinary catheter (a closed sterile system with a catheter and retention balloon that is inserted into the bladder to drain urine).

Inspectors wroteThe facility reported a census of 52 residents with 17 selected for review which included seven residents reviewed for nutrition. Based on observation, interview and record review, the facility failed to ensure the Registered Dietician assessed three of the seven residents reviewed for nutritional needs in a timely manner. The facility failed to evaluate and implement strategies for optimal nutritional intake for Resident(R)107 following esophagus surgery, R 109 with a post operative wound and multiple pressure ulcers and R8 to maintain weight.

Inspectors wroteThe facility reported a census of 50 residents. Based on observation, interview and record review, the facility failed to provide sanitary food preparation, storage and serving to prevent the spread of food borne illness to the residents of the facility.

Inspectors wroteThe facility reported a census of 50 residents with 15 selected for review which included one resident reviewed for choices. Based on observation, interview and record review, the facility failed to ensure encouragement for the one sampled resident (R)100, to voice preferences choices for beverages and food.

Inspectors wroteThe facility reported a census of 50 residents with 15 selected for review. Based on observation, interview and record review, the facility failed to review and revise the plan of care for two of the 15 residents. Resident (R)33 to prevent further bruising following a large bruise on her hand and R15 with implementation of hospice services.

Inspectors wroteThe facility reported a census of 50 residents with 15 residents sampled including three residents reviewed for Activities of Daily Living (ADL). Based on observation, interview, and record review, the facility failed to provide Resident (R)147 with adequate bathing opportunities to maintain good personal hygiene.

Inspectors wroteThe facility reported a census of 50 residents with 15 selected for review which included two residents reviewed for skin issues. Based on observation, interview and record review, the facility failed to develop interventions to prevent bruising for one of the two sampled residents (R)33 who had extensive bruising on the top of her right hand that extended into her fingers.

Inspectors wroteThe facility reported a census of 50 residents with 15 residents sampled, including one resident reviewed for pressure ulcers (PU). Based on observation, interview, and record review, the facility failed to ensure staff implemented the planned pressure reducing seat cushion to the wheelchair for the one Resident (R)147, who admitted with PUs and was at risk for further development of PUs.

Inspectors wroteThe facility reported a census of 50 residents with 15 residents sampled, including three residents reviewed for bowel and bladder. Based on observation, interview, and record review, the facility failed to properly anchor the catheter tubing and keep the catheter tubing from coming into direct contact with the floor for two of the three sampled residents, Residents (R)147 and R 19.

Inspectors wroteThe facility reported a census of 50 residents with 15 selected for review, which included six residents reviewed for unnecessary medication use. Based on interview and record review, the facility failed to obtain physician ordered lab tests to monitor PT/INR, (international normalized ratio, a blood test use to determine clotting time of the blood) to ensure two of the six sampled residents had no adverse effects of these medications. Residents (R) 36 and R102, received Coumadin (blood thinning medication).