Hillcrest Commons Nursing & Rehabilitation Center

Inspectors wroteBased on interviews and record review, the facility failed to offer and/or administer updated Pneumococcal immunizations, according to Centers for Disease Control (CDC) recommendations to 14 Residents (#83, #18, #55, #148, #158, #207, #78, #191, #114, #108, #143, #186, #79, and #134) of 25 applicable residents for vaccinations, out of a total sample of 35 residents, placing the residents at risk for to develop pneumococcal infections. Specifically, the facility failed to: 1. Administer an updated Pneumococcal Vaccine to Residents #83, #18, #55, #148, #158, #207, #78, #191, #114, #108, and #143, when the Residents were eligible for the vaccine and consented to receive an updated Pneumococcal Vaccine. 2. Offer an updated Pneumococcal Vaccine to Residents #186, #79, and #134, when the Residents were eligible to receive an updated Pneumococcal Vaccine.

Inspectors wroteBased on observation and interview, the facility failed to ensure that resident rights were honored for one Resident (#182) out of a total sample of 35 residents, when the Resident had a specific request relative to medication administration. Specifically, for Resident #182, the facility staff failed to honor the Resident's request to take his/her morning medications with a meal when the Resident notified the Nurse that he/she was experiencing stomach discomfort and expressed a preference to take his/her morning medications with the breakfast meal.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide appropriate accommodation of needs for one Resident (#6), out of a total sample of 35 residents. Specifically, for Resident #6, the facility failed to provide a wheelchair that accommodated the Resident's physical needs for use while he/she was out of bed, and the Resident's preference was to get out of bed and his/her bedroom, placing the Resident at risk for decreased mobility and psychosocial wellbeing.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to notify the Physician/Nurse Practitioner (NP) of consistent refusal of a weekly prescribed medication for one Resident (#11) out of a total sample of 35 residents. Specifically, for Resident #11, the facility failed to notify the Physician/NP of the Resident's refusal of his/her weekly medication order for Methotrexate (anti-inflammatory, pain-reducing medication used to treat certain cancers, severe psoriasis, and autoimmune diseases), placing the Resident at risk of disease progression and discomfort.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure nutritional interventions were implemented per the Registered Dietitian (RD) recommendation to address unanticipated, unplanned weight loss for one Resident (#9), of seven applicable residents reviewed for nutrition care and services, out of a total sample of 35 residents. Specifically, for Resident #9, the facility failed to ensure fortified ice cream (Magic Cup) was added to the Resident's lunch tray per the RD's recommendation when the Resident experienced ongoing significant weight loss (weight loss greater than or equal to 5 percent (%) over one month, 7.5% over three months, 10 % over 6-month period) and was determined to be at increased nutritional risk.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the facility main kitchen was maintained in a clean and sanitary manner to prevent contamination and the spread of foodborne illnesses. Specifically, the facility staff failed to ensure: -food for resident consumption was stored appropriately and were labeled and dated. -equipment used for meal preparation were clean and free of debris when not in use. -fans utilized in the kitchen remained dust free preventing potential physical contamination. -an issue with the facility dish machine was identified when the minimum wash temperatures were not obtained, as required.

Inspectors wroteBased on interview, and record review, the facility failed to provide therapeutic diets as ordered by the health care Provider for nutrition and hydration management for four Residents (#163, #89, #125, and #40) out of a total sample of 36 residents. Specifically, 1. For Resident #163, the facility failed to ensure a nutritional supplement was administered as ordered by the Physician after the Resident had a significant weight loss potentially resulting in a further weight decline. 2. For Resident #89, the facility staff failed to establish an accurate fluid plan as ordered by the Physician and inconsistently recorded the total daily fluid intake, placing the Resident at risk for fluid volume overload and related complications when more than the fluid restricted limit was consumed. 3. [...]

Inspectors wroteBased on interview, and record review, the facility failed to implement corrective and preventive actions and re-evaluate a performance improvement plan (PIP) when the identified interventions were no longer making progress toward the identified goal for reducing the amount of food allergens that were sent to residents on meal trays. Specifically, the facility failed to ensure that an effective system was maintained for implementing changes and monitoring performance putting residents in the facility at risk for significant harm relative to ingesting a food allergen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement infection control practices in accordance with professional standards of practice to prevent the potential spread of infection for one Resident (#209), out of a total sample of 36 residents, and on four units (Unit 1, Unit 2, Unit 3 and Unit 4) out of five units. Specifically, the facility failed to: -ensure the appropriate precautions were initiated timely when Resident #209 was identified with gastrointestinal symptoms (nausea and vomiting) increasing the risk for the spread of infection to other residents and staff. -initiate norovirus outbreak monitoring timely resulting in the spread of infection to Unit's 1, 2, 3, and 4.

Inspectors wroteBased on record review, observation, and interview, the facility failed to assess self-administration of medication for one Resident (#135), out of a total sample of 36 residents. Specifically, for Resident #135, the facility failed to: -ensure an IDT (Interdisciplinary Team) assessment was completed for the Resident to self-administer Albuterol Sulfate Inhaler (bronchodilator medication) and Trelegy Ellipta Inhaler (combination beta-agonist/anticholinergic/ corticosteroid medication) medications prior to allowing the Resident to have the inhalers in his/her possession. -ensure that the medication was safely and appropriately stored when the Resident was observed to store an inhaler in their clothing, on his/her bedside table, and in an unlocked bedside drawer.

Inspectors wroteBased on interview, and record review, the facility failed to ensure written notification was provided for two Residents (#40 and #199) out of a total of 36 residents, who experienced room and/or roommates changes. Specifically, 1. For Resident #40, the facility failed to provide written notification when the Resident had several roommate changes after his/her roommate/ significant other (SO) passed away. 2. For Resident #199, the facility failed to notify and provide written notification to the Resident when two separate room changes occurred within a timeframe of less than one week.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accurately code Minimum Data Set (MDS) Assessments for ten Residents (#132, #171, #53, #158, #229, #10, #155, #123, #226 and #47), out of a total sample of 36 residents. Specifically: 1) For Resident #132, the facility failed to accurately code the Resident as having a feeding tube in use. 2) For Resident #171, the facility failed to accurately code medication administration relative to the Resident receiving Insulin medication when the Resident was prescribed and administered a Diabetes medication that was non- Insulin. 3) For Resident #53, the facility failed to ensure that the most recent comprehensive MDS Assessments was coded accurately relative to upper extremity limited range of motion (ROM). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide Activities of Daily Living (ADL) care in accordance with assessed needs, goals for care, preferences, and recognized standards of practice for one Resident (#155) out of a total sample of 36 residents. Specifically, for Resident #155, the facility failed to: -provide consistent ADL assistance relative to dressing, nail and hand hygiene care when the Resident had bilateral hand contractures and was dependent on staff for bathing, dressing and personal hygiene increasing the risk for skin breakdown and resulting in development of a fungal infection in his/her left hand that required medical treatment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that one Resident (#215) out of a total sample of 36 Residents received quality of care in accordance with professional standards of practice. Specifically, for Resident #215, the facility failed to: -apply ACE bandages on the day shift as ordered to the Resident's bilateral legs to manage swelling and treatment of bilateral leg edema. -provide care and services that reflected the Resident's preference for application of the ACE bandages when the Treatment Administration Record (TAR) indicated the ACE bandages were applied to the Resident's lower extremites and the Resident was observed without the ACE bandages in place.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide appropriate treatment to prevent further decrease in range of motion (ROM) for one Resident (#123) with limited ROM, out of a total sample of 36 residents. Specifically, the facility failed to implement a passive ROM (PROM) program to Resident #123's lower extremities when the Resident had bilateral lower extremity contractures and was unable to perform his/her own lower extremity ROM, which increased the Resident's risk for progression of lower extremity contractures and pain.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one Resident (#40) received dialysis care in accordance with professional standards of practice for three applicable residents receiving dialysis, out of a total sample of 36 residents. Specifically, the facility failed to ensure nursing assessments, including assessment of the dialysis access site, vital signs and blood sugar levels, were performed when Resident #40 returned from dialysis.

Inspectors wroteBased on interview, and record review, the facility failed to ensure that triggers relative to a past trauma were identified to create an individualized trauma care plan for one Resident (#199) out of a total sample of 36 residents. Specifically, for Resident #199, the facility failed to ensure that an individualized care plan addressed Resident #199's triggers so they could be reduced in his/her environment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide appropriate medical care and supervision for one Resident (#224) out of a total sample of 36 Residents. Specifically, for Resident #224, the facility failed to ensure that the Provider was aware of the Resident's weight loss and oversaw his/her nutritional status.

Inspectors wroteBased on interview, and record review, the facility failed to ensure that appropriate competencies related to medication administration was completed for one Licensed Nurse (Nurse #9) out of 5 staff records reviewed. Specifically, the facility failed to provide documentation that Nurse #9 had completed the appropriate nursing competencies for medication administration and controlled substances (a drug or chemical that the government regulates for its manufacture, possession and use, that are classified into schedules based on their potential for abuse) documentation.

Inspectors wroteBased on record review, and interview, the facility failed to maintain accurate documentation of controlled substance (a drug or chemical that the government regulates for its manufacture, possession and use, that are classified into schedules based on their potential for abuse) for two units (Unit 2, side one and Unit 2, side two) out of five units reviewed. Specifically, the facility failed to maintain accurate documentation in the controlled substance register (Narcotic Book Documentation).

Inspectors wroteBased on record review, interview, and observation, the facility failed to provide routine dental services for two Residents (#47 and #186) out of a total sample of 36 residents. Specifically, 1. For Resident #47, the facility staff failed to follow through on a Doctor of Medicine in Dentistry (DMD) recommendation to have the Resident seen by an Oral Surgeon for a tooth extraction resulting in delayed dental care and services. 2. For Resident #186, the facility failed to assist the Resident in making an appointment for recommended dental extractions in a timely manner which resulted in a delay in dental care and increased risk for oral pain and infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident received food and drink that was palatable and served at an appetizing temperature on two (Unit One and Unit Four) out of four units, where test trays were conducted. Specifically, the facility failed to ensure: 1. Pureed (food prepared as a smooth, pudding-like texture) asparagus was served consistent with pureed texture and at an appetizing temperature for Residents requiring pureed food on Unit One. 2. For Unit Four, the facility failed to serve palatable food at an appetizing temperature.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide safety and awareness related to resident's food allergies for two Residents (#163 and #215) out of a total sample of 36 residents. Specifically, 1. For Resident #163, the facility failed to ensure that the Resident with a chocolate allergy was not provided with food that included the documented allergen. 2. For Resident #215, the facility failed to maintain Resident safety relative to a coconut allergy putting him/her at risk for anaphylaxis (a life-threatening allergic reaction).

Inspectors wroteBased on record review, and interview, the facility failed to provide a Pneumococcal Immunization to one Resident (#25) of five applicable residents, out of a total sample of 36 residents. Specifically, the facility failed to administer an updated Pneumococcal Immunization to Resident #25 within the appropriate timeframe as indicated by CDC (Centers for Disease Control and Prevention) guidelines placing Resident #25 at increased risk for complications associated with Pneumococcal infection.

Inspectors wroteBased on record review, and interview, the facility failed to provide Notice of Medicare Non-Coverage (NOMNC) to two Residents (#531 and #532) out of three residents reviewed, prior to discharge from the facility in accordance with Federal Regulations. Specifically, 1. For Residents #531, the facility discharged the Resident following services provided under a Medicare payor source with days remaining in the benefit period without a NOMNC issued. 2. For Resident #532, the facility discharged the Resident following services provided under a Medicare payor source with days remaining in the benefit period without a NOMNC issued.

Inspectors wroteBased on observation, interview, and record review, the facility failed to post on a daily basis required nurse staffing information that included the actual hours worked by licensed and unlicensed nursing staff and the daily census.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide adequate nutritional care and services for two Residents (#193 and #60), out of a total sample of 36 residents. Specifically, the facility failed to: 1. Re-evaluate Resident #193's nutritional needs, identify a severe weight loss, monitor weights as ordered, and accurately monitor meal intake percentages when the Resident had been identified as having a poor appetite, being at nutritional risk, and had experienced a severe weight loss greater than 7.5 percent (%) in less than three months; and 2. [...]

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure that one Resident (#156) out of a total sample of 36 residents was assessed to self-administer medication prior to allowing self-administration of his/her medications.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to notify the Physician/Non-Physician Practitioner (NPP- Nurse Practitioner) and Dietitian of a severe weight loss of greater than 7.5 percent (%) in less than three months for one Resident (#193) out of a total sample of 36 residents. Specifically, the facility failed to notify the NPP and Dietitian of the Resident's severe weight loss when the Resident had been previously identified as being at nutritional risk.

Inspectors wroteBased on interviews and record reviews the facility failed to provide or arrange for services that accepted standards of practice dictate should have been provided for two Residents (#6 and #193), out of a total sample of 36 residents. Specifically, 1. For Resident #6, the facility staff failed to document where subcutaneous (under the skin) injections of Insulin (medication used to treat Diabetes [chronic, metabolic disease characterized by high blood sugar levels]) was administered on the Resident's body, putting the Resident at risk for lipohypertrophy (a lump of fatty tissue under the skin caused by repeated injections in the same area) development. 2. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide appropriate treatment and services for one Resident (#108) out of a total sample of 36 residents, with limited range of motion (ROM) to prevent further decrease in ROM. Specifically, for Resident #108, the facility staff failed to re-assess the Resident's condition relative to hand contractures upon return from a hospitalization, and resume Occupational Therapy (OT) when the Resident had known bilateral hand contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity, and rigidity of joints), increasing the risk for further decrease in ROM, impaired skin integrity, and infection.

Inspectors wroteBased on observation, interview and record and policy review, the facility failed to notify and solicit the assistance of the appropriate authorities for one Resident (#283), out of four sampled residents, when the Resident left the facility, did not return as indicated, and was unable to be contacted by facility staff. Specifically, the facility staff failed to notify the Police Department when Resident #283 was considered missing for failing to return to the facility from a leave of absence (LOA), and the facility could not verify the Resident whereabouts, care, or safety.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure that the Oxygen flow rate (measurement of how much Oxygen is being administered) was set at the correct liters per minute (LPM - the amount of oxygen flow that is being received) for one Resident (#156), out of a total sample of 36 residents. Specifically, the facility staff failed to ensure that the Resident's oxygen flow rate was maintained at 2 LPM as prescribed by the Physician, putting him/her at risk for adverse outcomes like hypercapnia (failure of the body to remove carbon dioxide in the blood) and Respiratory Failure (condition that results when the blood does not have enough oxygen or too much carbon dioxide).

Inspectors wroteBased on observation, interviews, records reviewed and policy review, the facility failed to accurately complete Minimum Data Set (MDS) Assessments for two Residents (#114 and #232), and failed to ensure timely completion of Section C (Cognitive Patterns) and Section D (Mood) within the required timeframe for four Residents (#113, #173, #167 and #93), out of a total sample of 40 residents (including 36 active and four closed records). Specifically, 1. For Resident #114, the facility failed to ensure that staff coded the use of Oxygen (O2) therapy on a Quarterly MDS Assessment, as required. 2. For Resident #113, the facility failed to ensure Sections C and D were completed during the assessment reference period, as required. 3. Resident #173, the facility failed to ensure Sections C and D were completed during the assessment reference period, as required. 4. [...]