Heritage House Nursing Center

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure Resident #5's right to reasonable accommodation of her physical limitations by not maintaining a call light within reach and not providing a call light she could independently activate to request assistance, for one (1) of nineteen (19) residents sampled.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure a resident was evaluated for continued need of a PRN (as needed) psychotropic medication after fourteen (14) days for one (1) of five (5) residents reviewed for unnecessary medications, Resident #9.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure a Minimum Data Set (MDS) assessment was coded accurately to reflect a resident's tobacco use for one (1) of nineteen (19) residents whose MDS assessments were reviewed, Resident #46.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to implement a comprehensive care plan intervention for one (1) of 19 sampled residents (Resident #5).

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure staff maintained competency in food safety practices by failing to properly calibrate a food thermometer prior to checking food temperatures for one (1) of three (3) kitchen observations.

Inspectors wroteBased on observation and staff interview the facility failed to ensure sanitary food handling practices were maintained by failing to sanitize a food thermometer between checking temperatures of multiple food items on the steam table for one (1) of three (3) kitchen observations.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to implement Enhanced Barrier Precautions (EBP) as required during wound care for one (1) of two (2) wound care observations, Resident #18.

Inspectors wroteBased on observation, staff interview and facility policy review the facility failed to ensure linen barrels did not block fire doors on one of two halls for one (1) of four (4) days of survey. This had the potential to affect 56 residents residing in the facility. Findings Include Record review of the facility policy titled, Safety and Security Plan with a revision date of 4/23 revealed #19 .Arrange equipment such as wheelchairs, tables, linen carts, etc., so as not to block aisles, exits, fire fighting equipment, alarm boxes, electric lighting, or power panels, etc .FIRE DOORS MUST BE KEPT CLEAR AT ALL TIMES . An observation on 03/11/24 at 6:45 PM, revealed the double fire doors leading to Hall 200 were open with two linen barrels propped against one of the doors. [...]

Inspectors wroteBased on observation, staff interview, record review and facility policy review the facility failed to secure electronic health records as evidenced by an Electronic Medication Record (EMAR) was visible on an unattended medication cart on the 200 hall for one (1) of 56 residents residing in the facility during survey.

Inspectors wroteBased on observation, staff interview and facility policy review the facility failed to provide resident rooms that are in good repair as evidenced by broken blinds, missing base molding and peeling sheetrock for two (2) of 36 resident rooms observed during survey. Findings Include. A review of the facility policy with a last revision date of 06/13, titled Repair Requisition revealed, .Procedure: 1. When a resident, staff member, or family member recognizes the need for maintenance services, a Repair Requisition form (AD-022) will be completed by a resident, a family member, or a staff member. 2. The completed form will be placed in a mailbox or other designated place for maintenance personnel. 3. Maintenance personnel will review all Repair Requisitions daily and prioritize work to be done .All Repair Requisitions will be followed up on . [...]

Inspectors wroteBased on staff interview, record review, and facility policy review, the facility failed to transmit a discharge Minimum Data Set (MDS) Assessment for one (1) of two (2) residents reviewed for discharge MDS assessments. Resident #10 Findings Include Review of the facility policy titled, CH (Chapter) 5: Submission and Correction of the MDS Assessments dated October 2023 revealed, 5.2 Timeliness Criteria .Encoding Data: For a .Discharge .assessment, encoding must occur within 7 days after the MDS Completion Date (Z0500B + 7 days). Record review of Resident #10's Face Sheet' revealed an admit date of 7/17/23 and a discharged date of 10/24/23 with a Discharge Status of Return not anticipated. [...]

Inspectors wroteBased on staff interviews, record review, and facility policy review, the facility failed to develop a care plan related to resident facial hair for Resident #3 and Resident #40 or implement a care plan for Resident #43 related to administering medications one at a time, with a flush between each medication through a percutaneous endoscopic gastrostomy (PEG) tube for three (3) of 18 resident care plans reviewed. Findings Include Record review of the facility policy titled Care Plan Process with a revision date 08/17, revealed Regulations require facilities to complete, at a minimum and at regular intervals, a comprehensive standardized assessment of each resident's functional capacity and needs, in relation to a number of specified areas (e.g., customary routine, vision, and continence . [...]

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to follow professional standards of practice for a feeding tube as evidenced by crushing and administering multiple medications at once without the use of gravity and failure to follow physician orders for water flushes for one (1) of five (5) residents observed during medication administration.

Inspectors wroteBased on observations, staff interview, record review, and facility policy review, the facility failed to provide personal hygiene to residents as evidenced by unshaven facial hair for two (2) of 18 sampled residents. Resident #3 and Resident #40. Findings Include Record review of the facility policy titled, A.M. Care with a Latest Review date of 01/24, revealed Purpose: To prepare the resident for their day .To maintain the resident's desired physical appearance . Procedure . 12. Assist the resident with grooming according to their preferences . shaving and hair removal . Resident #3 An observation on 03/12/24 at 08:07 AM and again at 12:05 PM, revealed Resident #3 had facial hair approximately one-half (1/2) inch long to her chin area and beside her mouth. [...]

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to ensure the medication error rate was not five (5) percent (%) or greater for (5) of (29) medication opportunities. The medication error rate was 17.24%. Resident #43 Findings Include: Review of the facility policy titled Administering Medications Through Nasogastric or Gastrostomy Tube with a revision date of 03/2018 revealed .Procedures: . 7. After verifying proper placement of tube, flush it with a least 30 cc [cubic centimeters] of water before administering medications. Administer each medication separately, mix crushed medication with 5 cc [cubic centimeters] of water and flush the feeding tube with at least 5 cc of water between medications unless fluids are restricted .Points To Remember: . 8. [...]

Inspectors wroteBased on observation, resident and staff interview, record review, manufacturers instruction and facility policy review the facility failed to instruct a resident to rinse their mouth and spit following the administration of an inhaler and failed to utilize a spacer during administration of an inhaler for one (1) of six (6) residents observed during medication pass. Resident #49.

Inspectors wroteBased on observation, staff interview, record review and facility policy review the facility failed to prevent the likelihood of the spread of infection as evidenced by failure to clean a pulse oximeter and blood pressure cuff between use for one (1) of six (6) residents observed during medication pass. Resident #49.