Jones Convalescent Hospital

Inspectors wroteBased on observation, interview, and record review, the facility failed to comply with the Federal regulations related to the oversight of food service operations when: a. the facility did not have a full-time dietitian or a full-time dietetic service supervisor. b. dietary staff did not have competencies and training to carry out to carry out Food and Nutrition Services in a safe and sanitary manner. The lack of a full-time, competent supervisor resulted in Food and Nutrition Services staff not having adequate training and knowledge to carry out Food and Nutrition Services in a safe and sanitary manner placed 23 residents who received food from the kitchen at risk for food borne illnesses (illnesses caused by food contaminated with bacteria, viruses, parasites, and toxins) and/or malnutrition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, and serve food under sanitary conditions when: - stainless steel waste can was dirty; - kitchen floor tiles were dirty; - staff did not adequately check for chemical sanitation of dishwashing machine; - plate warmer was dirty; - plates inside plate warmer was dirty; - pair of thermal gloves was dirty; - moldy and unusable foods were not discarded; - food items stored in the refrigerator was unlabeled; - mounted can opener was dirty; - multiple dented cans were stored; - staff did not follow hand hygiene practices; - ice machine was dirty. These failures placed the facility's 23 residents who received food from the kitchen at risk of foodborne illness.

Inspectors wroteBased on observation, interview, and review of the facility's policies and procedures, the facility failed to: 1) Ensure that all expired or outdated medications were available for administration to 2 sampled residents (2 and 3) of the facility's 19 sampled residents. 2) Ensure that medications which had been discontinued by the resident's physicians, were no longer available for administration to 1 sampled resident (19) and 1 unsampled resident 1, of the facility's 19 sampled residents. 3) Ensure that medications were available for all residents, as needed, including medications which had been prescribed for unsampled resident 2. 4) Ensure that all medications had been administered as ordered by each resident's physician (Resident 3 and 22). [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure garbage and refuse were properly stored in dumpster when the left lid cover of one dumpster was left open. This failure had the potential for pest infestations and spread of diseases in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one out of 10 residents (Resident 5) was treated with respect, dignity, individuality in environment that promotes and enhances the quality of life when Certified Nurse Assistant (CNA) 1 stood over Resident 5 while assisting her with feeding. This failure had the potential to deny Resident 5 dignity, respect, and individuality.

Inspectors wroteBased on observation and interview with facility Nursing and Administrative staff, the facility failed to ensure that 1 sampled resident (10) out of 19 sampled residents had her needs accommodated while using her own wheelchair. This failure resulted in this resident not having a wheelchair which did not accommodate this resident's needs and preferences, which had the potential to result in decline and resident harm.

Inspectors wroteBased on observation, interview, and record review for 2 (Resident 11 and 22,) of 19 sampled residents, the facility failed to ensure that Resident 11 and 22 had received Restorative Nursing Assistance (RNA) treatments as ordered by the resident's physician. This failure had the potential to result in this resident's decline, which could result in the resident's decrease in muscle strength, decreased range of motion, contractures, and possible decline in function. Findings 1: Review of Resident 22's medical record on 1/25/2024 at 8:50 am revealed that this resident had a physician's order for Restorative Nursing Assistance (RNA). The physician order which had been written on 12/15/2023 read: RNA program every day (QD) 3 times per week for 90 days for (bilateral upper extremities) BUE (active assisted range of motion) AAROM as tolerated to maintain current level of function (CLOF). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow the correct serving size to one Resident for a census of 23 (Resident 13). This deficient practice resulted in Resident 13 not receiving the appropriate diet portions to meet each individual needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a homelike environment for two of 14 sampled Residents (Resident 11 and 19). This failure had the potential to make Residents 11 and 19 feel depressed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored appropriately when: 1. Expired medications were stored in the medication cart and medication refrigerator. 2. Expired emergency kit (e-kit, a kit that contain a small quantity of medications that can be dispensed when pharmacy services are not available) were not replaced. 3. Temperature logs for the medication refrigerator were incomplete and there was no thermometer and temperature log for the medication room and the storage shed. 4. A bottle of Acidophilus (supplement to help restore the normal balance of intestinal bacteria) and a bottle of Lorazepam (a psychotropic medicine used to treat anxiety) was not stored in the refrigerator. 5. Food items were stored in the medication refrigerator. 6. [...]

Inspectors wroteBased on observation, interview, and document review, for three (Residents 14,9, and 18) of eight residents prescribed with psychotropic medication (capable of affecting the mind, emotions, and behavior), the facility failed to: 1. For Residents 14, the target behavior for Olanzapine (antipsychotic medication that is used to treat psychotic conditions) use was not monitored 2. For Resident 18, the target behavior for Divalproex Sodium (medication used to treat seizure disorders and certain psychiatric conditions), Melatonin Tablet (supplement for sleep aid) and Quetiapine Fumarate medication used to used to treat certain mental/mood disorders) use was not monitored. 3. For Resident 9, the target behavior for Lexapro (medication used to treat depression and anxiety) use was not monitored. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one of 13 sample residents (Resident 3), was free from significant medication error when higher dose than the physician ordered was administered to Resident 3 for Seroquel (medication used to treat certain mental/mood disorders) This failure placed Resident 3 at risk for adverse effect associated with the medication.

Inspectors wroteBased on observation, staff interviews, and review the facility failed to ensure that open dates were indicated on food items in the kitchen. This failure placed the 13 of 13 sampled residents at risk for food borne illnesses.

Inspectors wroteBased on observation, interview, and document review the facility failed to ensure infection control procedures were followed for handling of clean and dirty laundry and the manufacturer's guideline for using a disinfectant wipe for medical equipment was not followed. These failures had the potential to transmit microorganisms and spread possible infection among the residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain comfortable sound levels for two of 13 sampled residents (Resident 18 and Resident 5), when Residents 18 and 5 complained of the exit door at the end of the hallway making a noise when being closed multiple times a day. This failure had the potential to disrupt a comfortable homelike environment.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide adequate assistance to perform the activities of daily living for one of 13 sampled residents (Resident 17) when two staff assistance was not provided to assist Resident 17 during repositioning. This failure had the potential to harm the resident who had impaired mobility.

Inspectors wroteDuring an observation, interview and medical record review, the facility failed to provide wound treatment for one of one sample residents (Resident 17) when Resident 17's pressure injury to the right lateral thigh was not covered with dressing as ordered by the physician. This failure had the potential to delay healing and worsen the wound condition.

Inspectors wroteBased on observation, interview and document review, the facility failed to provide Resident 19 a functioning call light. This failure resulted in Resident 19 to receive delayed care.

Inspectors wroteBased on observation, interview and document review, the facility failed to provide a safe and functional environment for one of 13 sampled residents (Resident 1) when the sink used by Resident 1 in her bathroom had a water leak and water spilled on to the floor. This failure had the potential for Resident 1, who had a risk for falls, to slip and cause injury.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow safe food practices when: a. Refrigerator 3 had an internal temperature reading of 50 degrees Fahrenheit (°F), and; b. Freezer 2 had two vacuumed sealed packs of meat with no label or date. These failures had the potential to result in foodborne illness.