Immanuel Skilled Care Center

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure kitchen personnel had a process in place for documentation of weekly deep cleaning of the ovens; and failed to ensure areas surrounding the fryer and griddle were cleaned daily (end of shift). These deficient practices had the potential to increase the risk of foodborne illnesses for anyone receiving food, or having food prepared, from the facility kitchen.

Inspectors wroteBased on observation, interview, and record review, staff member E failed to uphold infection control precautions for 1 (#29) resident, to include failing to use enhanced barrier precautions (EBP) while performing the treatment to an open skin tear for a resident with a known MDRO; placing wound care supplies onto an unclean surface during wound care; and failing to perform hand hygiene before entering a resident's room and donning clean gloves; failed to ensure staff member J followed EBP while administering medications in a gastrostomy tube for 1 (#66) out of 23 sampled residents. The facility also failed to ensure cleaning and a cleaning log was completed for a CoaguChek XS System for 1 (#10) of 1 resident utilizing the CoaguChek XS System. These deficient practices had the potential to increase the risk of communicable diseases within the facility.

Inspectors wroteBased on interview and record review, the facility failed to identify and implement a care plan for concerns related to a resident's diagnosis of Post Traumatic Stress Disorder (PTSD), and or the triggers for the PTSD, for the provision of trauma-informed care, for 1 (#111) of 23 sampled residents.

Inspectors wroteBased on interview and record review, facility nursing staff failed to document blood pressure readings before administering a blood pressure medication with provider orders to hold the medication, if the resident's blood pressure was under 110/60 mmHg, for 1 (#95) of 23 sampled residents. This deficient practice had the potential to cause the resident to become hypotensive.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure pain medications were offered or given prior to ambulation, and non-pharmacological pain interventions were present and used for 1 (#112) of 23 sampled residents, and the resident stated her pain would sometimes make her cry.

Inspectors wroteBased on interview and record review, the facility failed to report their investigative findings of a facility reported incident to the State Survey Agency in a timely manner for 7 (#s 1, 2, 3, 4, 5, 6 and 7) of 13 sampled residents.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure a resident is free from physical restraints, failed to identify a seatbelt as a restraint, failed to assess for safety for the use of a physical restraint prior to the placement of the restraint, and failed to ensure the use of a physical restraint was used to treat a resident's medical symptoms for 1 (#5) of 13 sampled residents. This deficient practice caused the resident to be restrained to her wheelchair by a seatbelt without a clinical rationale.

Inspectors wroteBased on observation, interview, and record review, the facility: - failed to ensure an enhanced barrier precautions door sign was posted to notify all staff of the infection control precautions, and have gowns readily available for use during a tube feeding, for 1 (#361); - failed to ensure staff member R adhered to standard precautions during medication administration via a tube feeding, by placing medications to be administered on an unclean surface without a protective barrier in place, for 1 (#361); - failed to ensure staff member S and Q adhered to proper infection prevention practices related to hand hygiene during donning and doffing of gloves, for 2 (#s 42 and 370); - failed to ensure staff members G and K adhered to proper hand hygiene prior to entering and exiting resident rooms, for 6 (#s 29, 68, 70, 73, 77, and 88) of 37 sampled residents; [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to develop a person-centered, comprehensive care plan for 6 (#s 9, 10, 32, 52, 53, and 100) of 37 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were safe to self-administer medications before leaving the medications at the bedside, causing an increased potential for medications not being taken as the physician ordered, for 3 (#s 9, 23, and 48) of 37 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that oxygen use was accurately coded on a resident's MDS for 1(#10) of 37 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure the baseline care plan was completed with the staff member signature, title, date of completion, and a copy was given to the resident or resident representative, for 2 (#s 9 and 10) of 37 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to meet professional standards of practice by administering oxygen without a physician's order for 1(#10) of 37 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to coordinate a resident's care with hospice for 1 (#24) of 37 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to sufficiently assess residents for safe smoking, ensure residents were monitored while smoking, and allowed residents to keep smoking paraphernalia in their rooms, for 2 (#s 53 and 77) of 37 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to weigh and document the weight in the resident's record, on intervals designed per the facility policy, after a readmission, for 1 (#10) of 37 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure provider orders were in place for the fluids to be administered during an enteral tube feeding and medication administration, for 1 (#361); and staff member R failed to ensure medications and enteral nutrition were administered in a timely manner, for 1 (#361) of 37 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify and address PTSD, provide trauma-informed care, and meet professional standards that accounted for the resident's experiences and preferences to manage and prevent or minimize PTSD triggers, for 1 (#53) of 37 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to adhere to the advanced directive for 1 (#1) of 8 sampled residents. This deficient practice cause the resident to be transferred to the ER and to receive services the resident did not want.

Inspectors wroteBased on interview and record review, the facility failed to investigate an allegation of staff to resident abuse for 1 (#8) of 8 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to provide the resident or resident's representative, prior to a transfer to the ER, a notice of transfer agreement, for 1 (#1) of 8 sampled residents, and the resident's POLST showed he was not to be sent to the ER. This failure prevented the responsible party of resident #1 from intervening in the transfer prior to it occurring.