Homestead Health Center

Inspectors wroteBased on observation, interview, and record review the facility failed to employ a full-time certified dietary manager for the residents who resided in the facility and received meals from the facility kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prepare and serve food under sanitary conditions to prevent potential food borne bacteria.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure adequate infection control practices related to Enhanced Barrier Precautions, EBP (a infection control measure using gowns and gloves during high-contact care) and cleaning of the Hoyer lift (mechanical device used to transfer individuals between surfaces) and proper handwashing between clean and soiled during resident care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to have a scale to obtain resident weights that was operational.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services to ensure acceptable parameters of nutritional status for Resident (R) 5 when the facility failed to identify weight loss, implement interventions and recommendations to prevent further loss, notify the registered dietician or the physician of the weight loss, and failed to ensure working scales in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow methods that conserve nutritive value, flavor, and appearance of pureed foods for Resident (R) 33.

Inspectors wrote- Resident (R) 35's Electronic Health Record (EHR) revealed diagnoses of unspecified dementia (progressive mental disorder characterized by failing memory, confusion) and Alzheimer's disease (progressive mental deterioration characterized by confusion and memory failure). The 06/20/24 admission Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. R35 had a total mood severity score of 03, indicating minimal depression and there were no behaviors. She was independent with activities of daily living (ADLs), with toileting hygiene, dressing, personal hygiene, ambulation, and transfers. R35 required set up for meals and moderate assistance with bathing. The MDS indicated R35 experienced no falls since admission. [...]

Inspectors wroteThe facility reported a census of 43 residents with 13 residents selected for review. Based on observation, interview, and record review, the facility failed to accurately revise four resident's care plans after falls experienced by Residents (R)37, R35, R21, and R12. Additionally, R9's hearing bilateral hearing aides were not addressed on the resident's care plan. This placed the residents at risk for uncommunicated care needs.

Inspectors wroteThe facility reported a census of 43 residents with 12 residents sampled. Based on observation, interview, and record review, the facility failed to ensure one of two medication carts observed were locked while unattended. This deficiency had the potential to affect 21 residents located on the North Unit.

Inspectors wroteThe facility reported a census of 43 residents, with 12 residents sampled, including one resident sampled for advanced directives (a written document which indicated the medical decisions for health care professionals when the person could not make their own decisions). Based on interview and record review, the facility failed to ensure Resident (R) 35 who was cognitively intact sign a completed Do Not Resuscitate (DNR- or no code, a legal document or order that means the person does not desire CPR in the event of cardiac arrest), instead they had a family member sign the directive.

Inspectors wroteThe facility reported a census of 43 residents. Based on observations, interviews, and record review, the facility failed to maintain effective infection control measures when Certified Medication Aide (CMA) H poked a straw through a potentially contaminated plastic film on the top of a cup containing a house supplement shake and then assisted a resident in drinking part of the shake. This deficient practice had the potential to contaminate the shake and lead to food-borne illness.

Inspectors wroteThe facility reported a census of 43 residents with 12 residents sampled. Based on interview and record review, the facility failed to provide the pneumococcal vaccine (vaccine designed to prevent pneumonia [inflammation of the lungs which can be debilitating or lethal in the elderly]) declination form to two of the five residents reviewed, Resident (R) 37 and R38.

Inspectors wroteThe facility reported a census of 42 residents with two reviewed for urinary catheter (insertion of a catheter into the bladder to drain the urine into a collection bag) management. Based on observation, record review, and interview the facility failed to ensure appropriate indwelling urinary catheter care for Resident (R)1. On 12/24/23 at approximately 08:30 PM Licensed Nurse (LN) G flushed R1's indwelling urinary catheter, without a physician order, and used a non-sterile 60 milliliter (ml) syringe from R1's bathroom, which possibly contained some bleach and water mixture (used to clean R1's dependent drainage bag). R1 complained of burning pain immediately upon injecting the flush and LN G realized she performed the flush on the wrong patient. [...]

Inspectors wroteThe facility reported a census of 42 residents with two reviewed, Resident (R)1 and R2, for urinary catheter (insertion of a catheter into the bladder to drain the urine into a collection bag) management. Based on observation, record review, and interview the facility failed to ensure nursing staff competency when LN G flushed R1's indwelling urinary catheter, without a physician order, and used a non-sterile 60 milliliter (ml) syringe from R1's bathroom, which possibly contained some bleach and water mixture (used to clean R1's dependent drainage bag) on 12/24/23 at approximately 08:30 PM. R1 complained of burning pain immediately upon injecting the flush and LN G realized she performed the flush on the wrong patient. LN G then flushed the catheter again with the same non-sterile 60 ml syringe using tap water from the sink to take out whatever was making it burn. [...]

Inspectors wroteThe facility reported a census of 41 residents. All residents received meals prepared in the main kitchen. Based on observation, interview and record review, the facility failed to store foods safely and sanitary by the staff's failure to date and reseal opened food items, failure to discard expired food items, and the failure to handle plates appropriately in the kitchen, to prevent the spread of food borne illnesses to the residents of the facility.

Inspectors wroteThe facility reported a census of 41 residents. Based on record review and interview, the facility failed to conduct Quality Assessment and Assurance (QAA) committee meetings with the required members present that included the Director of Nursing Services (DON), the Medical Director, the Nursing home administrator, owner, board member, or other individual in a leadership role, the Infection Preventionist and two other staff members, when the facility failed to have a DON present at the meetings. This had the potential to affect all residents.

Inspectors wroteThe facility reported a census of 41 residents, with 12 residents sampled, including one resident sampled for advanced directives (a written document which indicated the medical decisions for health care professionals when the person could not make their own decisions). Based on interview and record review, the facility failed to clarify Resident (R)32's advanced directives to ensure the resident had the right to formulate the wishes in the event the resident's heart stopped beating or the resident stopped breathing.

Inspectors wroteThe facility reported a census of 29 residents with 12 sampled, including one resident for bladder and bowel incontinence. Based on observation, interview, and record review, the facility failed to provide appropriate treatment and services to prevent possible urinary tract infections for Resident (R) 41.

Inspectors wroteThe facility reported a census of 41 residents with 12 residents sampled, including two residents reviewed for respiratory care. Based on observations, record reviews, and interviews, the facility failed to obtain a physician order to appropriately administer oxygen to Resident (R)24, who used oxygen. In addition, the facility failed to properly store the resident's oxygen tubing, to prevent possible contamination of the tubing, to prevent possible respiratory complications.

Inspectors wroteThe facility reported a census of 41 residents, with 12 sampled, including one resident sampled for dialysis care. Based on observation, interview, and record review, the facility failed to provide Resident (R) 19 treatment consistent with professional standards of practice by not monitoring dialysis treatments appropriately by not sending or collecting the dialysis communication forms.

Inspectors wroteThe facility census totaled 41 residents, with 12 sampled, including five residents for unnecessary medications. Based on interview and record review the facility failed to act upon irregularities identified by the pharmacy consultant for one of the five residents reviewed, regarding pantoprazole (proton pump inhibitor medication, used to decrease the amount of acid produced by the stomach and to promote healing of tissue) for Resident (R) 30, regarding decreasing the dose of this medication. This failure placed the resident at risk for adverse effects related to medication use. Findings Included: [...]

Inspectors wroteThe facility census totaled 41 residents, with 12 sampled, including five residents for unnecessary medications. Based on interview and record review, the facility failed to ensure adequate monitoring for one of the five residents reviewed, regarding pantoprazole (proton pump inhibitor medication, used to decrease the amount of acid produced by the stomach and to promote healing of tissue) for Resident (R) 30, by not decreasing the dose of this medication as ordered. This failure placed the resident at risk for adverse effects related to medication use. Findings Included: [...]