Hot Springs Health & Rehabilitation Center

Inspectors wroteBased on interview and record review, the facility failed to develop comprehensive care plans that included resident-specific care items and or accurate levels of care required for ADLs for 4 (#s 2, 11, 22, and 28) of 19 sampled residents. The deficient practice placed residents at risk for unmet care needs and at risk for not maintaining their highest practicable level.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a clean bathroom for the resident(s) to use for 1 (#5) of 19 sampled residents. This deficient practice caused the facility to be odorous of urine.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess a resident for the risk of entrapment from bed rails and failed to obtain consent from the resident's POA, prior to installation of grab bars for 1 (#38) of 19 sampled residents. The deficient practice had the potential to cause an entrapment risk for the resident.

Inspectors wroteBased on observation, interview, and record review, the facility failed to update and maintain current individualized care plans, to include when a change to the resident's care occurred, for activity preferences, or ensure staff were aware of how to use/find the individualized comprehensive care plans for use, for 6 (#s 1, 3, 6, 10, 20, and 22) of 19 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff followed safe food handling practices and ensure staff used proper hair and beard coverings while meals were prepared and served, which may affect any resident receiving meals or meal services from the staff or kitchen.

Inspectors wroteBased on interview and record review, the facility governing body failed to ensure the facility implemented and operationalized policies and procedures related to Advance Directives, PASARR Screenings, Care Plans, and Accidents/Hazards. This failure increased the risk of any resident in the facility being negatively affected due to the lack policies and procedures. Surveyors identified deficient practices for resident #s (6, 20, 30, and 32.) of 19 residents sampled, and for these specific residents, the facility did not have policies or procedures for the facility or staff to utilize.

Inspectors wroteBased on interviews and record review, the facility failed to take actions aimed at performance improvement, and after implementing those actions, measure its success, and track performance to ensure that improvements were realized and sustained: failed to identify and develope policies and procedures that direct staff on resident care expectations. This deficient practice had the potential to affect all residents within the facility who required complete medical records for medical review, residents who fall, residents who were cared for without accurate comprehensive care plans, and staff direction for resident care.

Inspectors wroteBased on interviews and record review, the facility failed to ensure advanced directives were complete for 4 (#s 1, 9, 16, and 30) of 19 sampled residents. This deficiency increased the risk of of the resident's wishes not being met or followed.

Inspectors wroteBased on interview and record review, the facility physician failed to document resident assessments or physician visits for 4 (#s 1, 4, 6, and 20) of 19 sampled residents. This failure increased the risk of others not having the pertinent medical information available, when needed, to address resident care needs.

Inspectors wroteBased on observation and interview, the facility staff failed to remove expired medications, and allowed the expired items to remain in the same location as the unexpired medications, which increased the risk of misuse.

Inspectors wroteBased on interviews and record review, the facility failed to complete a PASARR level I or II for 1 (#6) of 19 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to implement a comprehensive, resident centered care plan, which identified the resident's physical and psychological needs and wishes, for 1 (#32) of 19 sampled residents.

Inspectors wroteBased on observations and interviews, the facility failed to ensure residents who were unable to carry out activities of daily living for oral care received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene, for 1 (#10) of 19 sampled residents.

Inspectors wroteBased on observations and interviews, the facility failed to ensure a resident's environment was addressed for safety related to hazards, and the resident had dementia, and misused the call light/cord, and a staff member reported a concern related to the resident's use of a pillow, for 1 (#20) of 19 sampled residents.

Inspectors wroteBased on interview and record review, facility staff failed to ensure a resident's medical condition remained confidential for 1 (#1) of 5 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to properly identify, document, and implement physicians' orders and appropriate interventions to treat the resident's conditions in a timely manner. This included a skin condition on the entire buttocks of a resident, which was found to be related to sepsis and UTI due to incontinence, and required IV antibiotics and catheter placement during hospitalization for 1 (#32) of 15 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to provide scheduled medication, as ordered by the physician, to 1 (#26) of 15 sampled residents. This deficient practice resulted in undue physical symptoms for the resident.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff used appropriate hand hygiene during medication administration for 4 (#s 9, 26, 29, and 31) of 15 sampled residents; and failed to dispose of a moldy, rotten pumpkin, resulting in foul odor and a dusty fly covered fly tape trap in the common area.

Inspectors wroteBased on interview and record review, facility staff failed to respect the dignity of residents when they were talking about them at the nursing station, and a resident overheard them and filed a grievance, for 1 (#24) if 15 sampled residents, and this had the potential to affect others.

Inspectors wroteBased on interview and record review, the facility failed to notify the physician of medication errors for 1 (#26) of 15 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to protect the resident's right to be free from verbal abuse by staff for 1 (#12) of 15 sampled residents, resulting in the resident feeling scared.

Inspectors wroteBased on interview and record review, the facility failed to report an allegation of verbal abuse from staff to resident, during the appropriate time frame, for 1 (#12) of 15 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide an ongoing activities program, meeting the individual needs of the resident, for 1 (#26) of 15 sampled residents.