Hillside Village of De Soto Rehabilitation and Nur

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents. Based on observation, record review, and interview, the facility failed to store and prepare food in a sanitary manner for the residents who reside in the facility and receive meals from the facility kitchenette.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents. Based on observation, interview, and record review, the facility failed to maintain a Quality Assessment and Assurance Committee (QA&A) that had the required membership in attendance.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents. Based on interview and record review, the facility failed to notify the State Long Term Care Ombudsman (LTCO) of Resident (R) 1, R3, R20, and R45's facility-initiated discharge to the hospital.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents. Based on observation, interview, and record review, the facility failed to administer Resident (R) 6's medication as prescribed and instructed.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents. Based on observation, record review, and interview, the facility failed to implement acceptable infection control practices when staff failed to properly store Resident (R) 14's oxygen tubing and nasal cannula (a device used to deliver supplemental oxygen or increased airflow to a person in need of respiratory help) in a sanitary manner.

Inspectors wroteThe facility had a census of 41 residents. The sample included 12 residents and five Certified Nurse Aides (CNA) reviewed for performance evaluations and required in-service training. Based on record review and interview, the facility failed to ensure five of the five CNA staff reviewed had the required yearly performance evaluations completed. This placed the residents at risk for inadequate care.

Inspectors wroteThe facility identified a census of 41 residents. Based on observation, record review, and interviews, the facility failed to ensure proper infection control standards were followed related to the implementation of procedures to monitor and prevent Legionella disease (Legionella is a bacterium that can cause pneumonia in vulnerable populations) or other opportunistic waterborne pathogens. These deficient practices placed the residents at risk for complications related to infectious diseases. Findings Included: - A review of the information provided by the facility on the facility's Water Management program revealed the program lacked text and diagrams specific to the building's water flow system. The program did not identify building-specific areas at risk for Legionella or identify specific points within the system checked by the water management program team. [...]

Inspectors wroteThe facility had a census of 41 residents. The sample included 12 residents and five Certified Nurse Aides (CNA) reviewed for in-service training. Based on record review and interview, the facility failed to ensure five of the five CNA staff reviewed had the required 12 hours of in-service education including the required topics per year. This placed the residents at risk for inadequate care.

Inspectors wroteThe facility had a census of 41 residents. The sample included 12 residents of which five were reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure the Consultant Pharmacist (CP) identified and reported the lack of the required stop date for Resident (R) 30's as-needed (PRN) lorazepam (antianxiety-class of medications that calm and relax people). This placed the resident at risk of receiving unnecessary psychotropic (alters mood or thoughts) medications.

Inspectors wroteThe facility had a census of 41 residents. The sample included 12 residents of which five were reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure Resident (R) 30 had a stop date for the use of as-needed (PRN) lorazepam (an antianxiety medication that calms and relaxes people). This placed the resident at risk of receiving unnecessary psychotropic (alters mood or thoughts) medications.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents. Based on observation, record review, and interviews, the facility failed to store, prepare, and serve food in a sanitary condition for 43 residents who received meals from the kitchen, and ate in the dining room placing them at risk for food borne illness.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents. Based on observation, record review, and interview, the facility failed ensure the resident council was able to meet regularly, which placed the residents at risk for unmet concerns related to life in the facility.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents of which six where reviewed for accidents and/or hazards. Based on observation, record review, and interview, the facility failed to update interventions on the care plans to prevent falls and hot beverage spill for Resident (R) 6, R34, R14, and 32. This deficient practice placed the residents at risk for injuries and accidents due to uncommunicated care needs.

Inspectors wrote- The Electronic Medical Record (EMR) for R14 documented diagnoses of hypertension (high blood pressure), dementia without behavioral disturbance (progressive mental disorder characterized by failing memory and confusion), and diabetes mellitus type 2 (when the body cannot use glucose, not enough insulin made, or the body cannot respond to the insulin). The Quarterly Minimum Data Set (MDS), dated [DATE], documented R14 had severely impaired cognition and had only transferred with one staff two or fewer times, did not ambulate, had unsteady balance, and had no functional impairment. The MDS further documented R14 had two or more non injury falls since prior assessment. The Fall Risk Assessment, dated 05/03/22, documented the resident a high risk for falls. [...]

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents. The facility idneitfied two staff members currently positive for COVID-19 (highly contagious, potentially life-threatening respiratory virus). Based on observation, record review, and interview, the facility failed to follow the core principles of infection control for resident surveillance of signs/symptoms of COVID-19 when they failed to complete a respiratory assessment and temperature at least daily for 12 sampled residents, Resident (R) 5, R6, R14, R16, R23, R25, R28, R31, R32, R34, R38, and R142. This deficient practice placed the residents at increased risk for transmission and/or development of COVID-19.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents, with five reviewed for unnecessary medications. Based on observation, record review, and interview, the facility's Consultant Pharmacist (CP) failed to identify and report no blood sugar parameters for Resident (R) 25, who received insulin (hormone used to control blood sugar levels). The facilty further failed to ensure the CP identified and reported the lack of a stop date for Resident (R) 28's as needed (PRN) Ativan (a sedative used to treat anxiety). This placed R25 at risk for hyperglycemic (high blood sugar) or hypoglycemic (low blood sugar) episodes and R28 at risk for side effects from psychotropic (alters mood or thought) medication.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents, with five reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to obtain, from the physician, blood sugar parameters for Resident (R) 25, who received insulin (hormone used to control blood sugar levels) and had her blood sugar taken five times per day. This placed the resident at risk for hyperglycemic (high blood sugar) or hypoglycemic (low blood sugar) episodes.

Inspectors wroteThe facility had a census of 43 residents. The sample included 12 residents with five reviewed for unnecessary medications. Based on observation, record review and interview, the facility failed to ensure Resident (R) 28's as needed lorazepam (an antianxiety medication) had a stop date as required, placing the resident at risk for adverse side effects related to psychotropic (altering mood or mind) medication use.