Hickory Heights Health and Rehab, LLC

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure proper storage of meats to prevent cross contamination, that stored foods were properly covered, and expired food items were promptly removed and discarded on or before the expiration or use by date, for one of one kitchen observed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure opened food items in the walk-in refrigerator and walk-in freezer were covered , sealed, and dated to maintain freshness and prevent potential cross-contamination, and lemon juice was stored in the dry storage area in accordance with the manufacturer's instructions for residents who receive meal from 1 of 1 kitchen, failed to ensure dietary staff practiced good and washing techniques to prevent potential cross-contamination of food and clean dishes, failed to ensure hot food items were maintained at the required temperatures on the steam table while awaiting service to prevent potential food borne illness for the residents who received meals from 1 of 1 kitchen. These failed practices had the potential to affect 103 residents who received meals from the Kitchen.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dignity was maintained for 2 (Residents #10 and #90) and privacy was maintained for 1 Resident #90 when caring for the Residents.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure personal hygiene as related to proper nail care was provided for 3 of 3 Residents (Resident #2, #42, #73) reviewed for activities of daily living. A. Resident #2's Care Plan identifies Resident #2 to have an ADL (Activity of Daily Living) self-care performance deficit r/t Dementia, Limited Mobility, weakness Date Initiated: 03/13/2023. Intervention/task: Personal Hygiene: substantial/max. Date Initiated: 12/07/2023. B. Resident #2 has impaired cognitive function BIMS (Brief Interview for Mental Status) score related to dementia. Date Initiated: 03/13/2023. C. MDS (Minimum Data Set) dated March 07, 2024, reflects Resident's has a BIMS of 3. BIM scores of 00 - 07 Severely Impaired.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication error rate of less than 5%. Observations revealed there were 5 of 26 medications not administered in accordance with physician's orders for 3 (Residents #3, #10 and #35) of 4 residents, resulting in a medication error rate of 19.23%.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that meals were prepared and served according to the planned written menu to meet the nutritional needs of the residents for 1 of 1 meal observed. This failed practice had the potential to affect 9 residents who received pureed diets from 1 of 1 kitchen, according to a list provided by the Administrator on 04/30/2024 at 11:05 AM

Inspectors wroteBased on observation and interview, the facility failed to ensure that pureed food items were blended to a smooth, lump free consistency to minimize the risk of choking or other complications for those residents who required pureed diets for 2 of 2 meals observed. The failed practice had the potential to affect 9 residents who received pureed diets, as documented on the list provided by the Administrator on 05/01/2024 at 11:05 AM

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff performed hand hygiene between changing gloves and before leaving a room after assisting with care for 1 (Resident #10) of 1 sampled resident who was reviewed for infection control; failed to ensure staff performed hand hygiene before and between passing meal trays to residents and before and between administering medications to residents.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure resident with limited range of motion (ROM) received care and services to prevent any further decrease in ROM for one (Resident #19) who was reviewed for position/mobility.

Inspectors wroteBased on observations and record review the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public.

Inspectors wroteBased on record review and interview, the facility failed to ensure the plan of care was revised to reflect the current needs of the resident and updated to include fall interventions and injuries for 2 Residents (Resident #4, and #7) sample mix residents. Review of Resident #4's Care plan dated 03/13/2023 documented, .high risk for falls r/t Incontinence, requires staff assist with ADL; 04/19/23- actual fall without injury; 04/21/23 - actual fall without injury; 05/30/23 - actual fall without injury; Anticipate and meet the resident's needs, bolster on bed related to (r/t) history (hx) of multiple falls; On 06/04/23 it notes - actual fall without injury; 08/12/23- actual fall without injury; 11/26/23- actual fall without injury. Interventions/ Tasks *fall interventions* 04/19/23- fall mat; 04/21/23- air mattress changed to concave mattress; 05/30/23 - apply [named supply] to mattress; [...]

Inspectors wroteBased on record review and interview, the facility failed to notify resident representatives or Power of Attorney (POA) in writing of the bed hold policy upon a resident's transfer to the hospital and/or discharge as required for 1 Resident (Resident #4) of 1 sampled Resident who was transferred and/or discharged from August 03, 2023, through August 07, 2023.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure foods stored in the freezer and dry storage area were covered, sealed, and dated to minimize the potential for food borne illness for residents who received meals from 1 of 1 kitchen; failed to ensure the ice machine and ice scoop holder were free of debris and maintained in clean and sanitary condition to prevent potential growth of harmful bacteria that could be transferred to the residents' food, failed to ensure opened food items in the freezer and storage area were covered and dated to maintain freshness and prevent potential cross contamination, failed to ensure dietary employees washed their hands or changed gloves before handling food items to minimize the potential for food borne illnesses and failed to ensure ceiling air vents were free of debris, stains, rust and dirt. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the call light was within reach for 2 (Residents #20 and #164) of 12 (Residents #5, #15, #20, #21, #22, #31, #55, #58, #68, #70, #78 and #164) sampled resident who were able to use their call lights.

Inspectors wroteBased on observation, and interview, the facility failed to ensure doors were maintained in good condition in 1 (room [ROOM NUMBER]) of 5 (Rooms #301, #303, #304, #306 and #317) resident rooms and failed to ensure a broken towel rack was repaired in 1 (room [ROOM NUMBER]) of 5 (Rooms #301, #303, #304, #306 and #317) resident rooms.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure oxygen was consistently administered at the flow rate ordered by the Physician to minimize the potential for hypoxia or other respiratory complications for 3 (Residents #21, #47 and #164) of 11 (Residents #20, #21, #31, #47, #55, #76 #84, #90, #102, #163 and #164) sampled residents who had Physician's Orders for oxygen therapy, and failed to ensure a nasal cannula was stored in a bag or other closed container when not in use to prevent potential contamination or infection for 1 (Resident #164) of 11 (Residents #20, #21, #31, #47, #55, #76, #84, #90, #102, #163 and #164) sampled residents who required oxygen therapy. The failed practices had the potential to affect 20 residents who had Physician's Orders for oxygen therapy according to a list provided by the Assistant Administrator on 03/23/23 at 10:52 AM.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure meals were prepared and served according to the planned written menu to meet the nutritional needs of the residents for 2 of 2 meals observed. This failed practice had the potential to affect 8 residents who received pureed diets from 1 of 1 kitchen according to the list provided by the Dietary Supervisor on 03/21/23 at 11:42 AM.

Inspectors wroteBased on observation, and interview, the facility failed to ensure pureed food items were blended to a smooth, lump-free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 2 of 2 meals observed. This failed practice had the potential to affect 8 residents who received pureed diets as documented on the Diet List provided by the Food Service Supervisor on 03/21/23 at 11:45 AM.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure laundered linens and personal clothing were kept free from possible contamination and failed to ensure the dirty and clean areas of the laundry area had a separational barrier to help prevent the potential of cross contamination and spread of infection for 119 residents whose linens were laundered by the facility and 89 residents whose personal clothing was laundered by the facility as documented on the laundry list provided by the Assistant Administrator on 03/23/23.

Inspectors wroteBased on interview, and record review, the facility failed to ensure Pneumococcal immunizations were administered to eligible residents and failed to ensure Influenza and Pneumococcal immunization records were accurate for 3 (Residents #22, #68 and #84) of 5 (Residents #21, #22, #68, #84 and #105) sampled residents to help protect against pneumococcal bacteria and influenza which can cause serious infections and are potentially fatal. This failed practice had the potential to affect 107 residents as documented on the list of residents eligible for immunizations and not receiving hospice services provided by the Assistant Administrator on 03/23/23.

Inspectors wroteBased on interview, and record review, the facility failed to ensure COVID-19 immunizations were administered to eligible residents and the immunization records were accurate for 3 (Residents #21, #68 and #105) of 5 (Residents #21, #22, #68, #84 and #105) sampled residents to help protect against COVID-19 disease which can cause serious illness and is potentially fatal.

Inspectors wroteBased on observation, and interviews, the facility failed to ensure resident personal hygiene items and wash basins were stored in a sanitary manner for 3 (Rooms 301, 303, 304) of 5 (Rooms 301, 303, 304, 306 and 317) resident bathrooms observed.