Kearny County Hospital Ltcu

Inspectors wroteThe facility reported a census of 25 residents with 12 residents selected for review. Based on observation, interview, and record review, the facility failed to identify, implement, and reevaluate fall prevention interventions to prevent falls for six residents. Resident (R) 21 experienced a fall which resulted in multiple sinus fractures (broken bone) and R18's fall resulted in a hip fracture, which required hospitalization and surgery. Additionally, the facility failed to implement new interventions to prevent falls for R12, R17, R20 and R23, placing the residents at risk for falls with injury.

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents reviewed for person-centered care plan development. Based on observation, interview, and record review, the facility failed to develop and implement a person-centered comprehensive care plan for three residents, Resident (R) 74 related to psychotropic (any class of medications that alter mood or thought) medication use, opioid (a class of medications used to treat moderate to severe pain) medication use, diuretic (a class of medication to promote the formation and excretion of urine) medication use and nebulized (a device which changes liquid medication into a mist easily inhaled into the lungs) medication use. [...]

Inspectors wrote- R74's Electronic Health Record (EHR) revealed diagnoses of anxiety disorder (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear), chronic obstructive pulmonary disease (COPD - a progressive and irreversible condition characterized by diminished lung capacity and difficulty or discomfort in breathing), congestive heart failure (CHF-a condition with low heart output and the body becomes congested with fluid) and Alzheimer's disease (a progressive mental deterioration characterized by confusion and memory failure) The admission Minimum Data Set (MDS) dated [DATE], documented a Brief Interview for Mental Status (BIMS) score of 12, which indicated moderately impaired cognition. The assessment documented R74 utilized a walker and/or a wheelchair for locomotion. [...]

Inspectors wroteThe facility had a census of 25 residents. Based on observation, record review, and interview, the facility failed to provide Registered Nurse (RN) coverage eight hours a day, seven days a week, placing all residents who reside at the facility at risk of lack of assessments and inappropriate care.

Inspectors wroteThe facility reported a census of 25 residents. Based on observation, interview, and record review, the facility failed to store, prepare, and serve food in a sanitary manner to prevent possible food-borne illness to the residents of the facility.

Inspectors wroteThe facility reported a census of 25 residents. Based on observation, interview, and record review, the facility failed to maintain and/or dispose of garbage and refuse properly, and in a sanitary condition, ensuring the lids were down to cover the disposed waste and prevent the potential harboring/feeding of pests.

Inspectors wroteThe facility reported a census of 25 residents. Based on observation, interview, and record review the facility failed to provide administrative services in a manner to effectively and efficiently use resources to attain/maintain each resident's highest physical, mental, and psychosocial well-being, for all 25 residents that resided in the facility.

Inspectors wroteThe facility had a census of 25 residents. Based on observation, record review, and interview, the facility failed to accurately complete a Payroll Based Journal (PBJ- a required detail information submitted by nursing homes of staffing information that is required by the Centers of Medicare and Medicaid Services [CMS]) reports for Registered Nurse (RN) coverage eight hours a day, seven days a week and failed to accurately complete a PBJ report for Licensed Nursing Coverage 24 hours/day. Which placed all residents who reside at the facility at risk of lack of assessments and inappropriate care.

Inspectors wroteThe facility reported a census of 25 residents. Based on observation, interview, and record review, the facility failed to ensure the Quality Assessment and Assurance (QAA) program (a management process for long-term care (LTC) facilities that ensures care practices are consistently applied and quality standards are met) conducted at least one performance improvement project annually, that focused on high-risk or problem prone areas, identified by the facility, through data collection and analysis. This failure has the potential to affect all 25 residents.

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents. Based on observation, interview, and record review, the facility failed transport clean linens in a method to protect clean linens from dust or soiling when staff left the clean linen cart uncovered during transport. The facility further failed to maintain an effective infection control program related to the maintaining an annually reviewed Infection Prevention and Control Program (IPCP) (a practical, evidence-based approach preventing patients and health workers from being harmed by avoidable infections). [...]

Inspectors wroteThe facility reported a census of 25 residents. Based on interview and record review the facility failed to ensure staff adhered to the principles of antibiotic stewardship through monitoring for the appropriate use of antibiotics prescribed for residents to prevent antibiotic resistance and spread of multidrug resistant organisms within the facility.

Inspectors wroteThe facility reported a census of 25 residents. Based on interview and record review the facility failed to designate a qualified Infection Preventionist (IP), who had completed specialized training in infection prevention and control, to be responsible for the facility's Infection Prevention and Control Program (IPCP). This failure has the potential to affect all 25 residents.

Inspectors wroteThe facility reported a census of 25 residents. Based on interview and record review, the facility failed to ensure four of the five Certified Nurse Aides (CNA) sampled lacked the required 12 hours per year in-service training. This placed the residents at risk for decreased quality of life and/or inadequate care.

Inspectors wroteThe facility reported a census of 25 residents, with 12 residents sampled and reviewed for advanced directives (a written document, which indicates 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 five resident's advanced directives were thoroughly completed. Resident (R)124 had a Do Not Resuscitate (DNR- or no code, a legal document that means the person does not desire cardiopulmonary resuscitation [CPR is an emergency lifesaving procedure performed when the heart stops beating] in the event of cardiac arrest) form that was only located in the Code Status binder at nurse's station. However, the electronic health record (EHR) lacked a DNR order and lacked the uploaded DNR document for R124. Additionally, R15 had no order for a DNR in the EHR. [...]

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents. Based on observation and staff interviews, the facility failed to promote a clean homelike environment for five residents. Resident (8) had a chair seat repaired with duct tape and R124 had a bureau drawer, which had lacked part of the veneer on the drawer facing and the remaining veneer was loose and brittle. Additionally, R2, R74, R23 and R124 had fall mats, which were cracked and had worn down surfaces all that were identified as non-cleanable surfaces and a non-home-like environment. These deficient practices had the potential to spread possible infections to the residents in the facility.

Inspectors wroteThe facility had a census of 25 residents. The sample included 12 residents with three reviewed for discharge. Based on observation, interview, and record review the facility failed to provide written notice to the resident or resident representative for facility-initiated transfers for Residents (R)18, R12, and R23 when they transferred to the hospital. The facility also failed to send a copy of the notice to the Office of the Long-Term Care Ombudsman (LTCO - a public official who works to resolve resident issues in nursing facilities) of R18, R12, or R23's discharge. This placed the residents at risk of uninformed care choices.

Inspectors wroteThe facility had a census of 25 residents. The sample included 12 residents with three reviewed for discharge. Based on observation, record review, and interviews, the facility failed to provide a written bed hold policy notice to Residents (R)18, R12, and R23, or the resident's representatives, when they transferred to the hospital. This deficient practice had the risk of impaired ability to return to the facility and to the previous room for R18, R12 and R23.

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents. Based on interview and record review, the facility failed to complete a Quarterly Minimum Data Set (MDS) assessment in a timely manner for eight residents, Resident (R) 8, R10, R12, R17, R18, R19, R20 and R21. This placed the residents at risk for unmet care needs and inaccurate assessments.

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents. Based on interview and record review, the facility failed to complete a comprehensive Minimum Data Set (MDS) assessment in a timely manner for ten residents. Resident (R)8, R10, R12, R15, R17, R18, R19, R20, R21 and R124. This placed the residents at risk for unmet care needs and inaccurate assessments.

Inspectors wroteThe facility identified a census of 25 residents, which included 12 residents sampled. Based on interviews, observations, and record review, the facility failed to review and revise the care plans with appropriate interventions for eight of the sampled residents; R23 related to treatment of an area of pressure ulcer/injury and enhanced barrier precautions (EBP - a set of infection control interventions designed to reduce transmission of resistant organisms which employs targeted gown and glove use during high contact cares) related to wound care and urinary catheter (a flexible tube inserted through a narrow opening into a body cavity, particularly the bladder, for removing fluid) care; R19, R15, R20, R21, R17, R12 and R18 related to development and implementation of appropriate interventions to prevent multiple falls. [...]

Inspectors wroteThe facility reported a census of 25 residents with 12 residents selected for review which included five residents reviewed for respiratory care. Based on observation, interview, and record review, the facility failed to provide respiratory care consistent with professional standards for four residents. The facility failed to ensure staff properly cleaned and stored the nebulizer (a device for administering inhaled medications) for Resident (R)12, R8, and R74. The facility failed to ensure R18's room remained free of used nebulizer equipment (from a prior discharged resident) not required for R18's medical care. Additionally, the facility failed to ensure the nasal cannula (a device to deliver low-concentration, low-pressure supplemental oxygen) were stored appropriately, sanitarily, when not in use for R12 and R8. [...]

Inspectors wroteThe facility census totaled 25 residents on two halls and had two medication carts. Based on observation, interview, and record review, the facility failed to ensure the staff and secured storage of resident medications when observation onsite revealed an unlocked and unattended medication cart, not in the line of vision of the attending staff, containing oral, topical and inhaled medications. This deficient practice placed nine cognitively impaired, independently mobile residents at risk.

Inspectors wroteThe facility reported a census of 25 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]) consent/declination form to five residents reviewed. (Resident (R) 8,12,18,19 and 124). Additionally, the facility failed to provide a second witness signature on R12 and 18's influenza vaccine (a vaccine designed to prevent influenza [highly contagious viral infection]) consent forms.

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents. Based on interview and record review, the facility failed to treat residents in a dignified manner when it charted in the medical record that Resident (R)17 was placed at the feeder table. The facility did not honor resident's rights related to personal food preferences and food choices for Resident (R)124. This deficient practice placed the resident at risk for decreased psychosocial well-being.

Inspectors wroteThe facility reported a census of 25 residents with 12 residents sampled that included two residents reviewed for baseline care plan. Based on interviews, observations, and record review, the facility failed to develop a person-centered baseline care plan for Resident (R) 74 and R124. This deficient practice had the potential to lead to uncommunicated needs.

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents reviewed for person-centered care plan development. Based on observation, interview, and record review, the facility failed to develop and implement a person-centered comprehensive care plan for three residents, Resident (R) 74 related to psychotropic (any class of medications that alter mood or thought) medication use, opioid (a class of medications used to treat moderate to severe pain) medication use, diuretic (a class of medication to promote the formation and excretion of urine) medication use and nebulized (a device which changes liquid medication into a mist easily inhaled into the lungs) medication use. [...]

Inspectors wroteThe facility reported a census of 25 residents with 12 residents selected for review. Based on observation, interview, and record review, the facility failed to accurately assess the nutritional status of cognitively impaired Resident (R)124 on admission, placing the resident at risk for nutritional deficits.

Inspectors wroteThe facility reported a census of 25 residents with 12 residents selected for review. Based on observation, interview, and record review, the facility failed to ensure the Physician documented and conducted the in person admission visit as required for Resident (R)124.

Inspectors wroteThe facility identified a census of 25 residents. The sample included 12 residents with the residents reviewed for dementia (progressive mental disorder characterized by failing memory, confusion) care services. Based on observation, record review, and interviews, the facility failed to support Residents (R)19 and R124 and implement care planned interventions to address dementia care needs. This deficient practice placed the residents at risk for impaired ability to achieve and/or maintain their highest practicable level of functioning and wellbeing. The facility failed to implement individualized interventions, as well as revise the care plan accordingly, to address individualized interventions related to the residents symptomology and rate of progression as evidenced by observation, record review, and/or interview.

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents with six residents reviewed for unnecessary medications. Based on observation, interview, and record review, the facility failed to act upon the pharmacist's monthly medication review (MRR) on 06/30/24 for Resident (R)18. The deficient practice had the potential to lead to the residents receiving unnecessary mediations. - Review of the Electronic Health Record (EHR) for Resident (R)18 included diagnoses of dementia (a progressive mental disorder characterized by failing memory, confusion), epilepsy (a brain disorder characterized by repeated seizures), frontotemporal neurocognitive disorder (a brain disease that affects behavior, language and movement abilities), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). [...]

Inspectors wroteThe facility reported a census of 25 residents. The sample included 12 residents with six residents reviewed for unnecessary medications. Based on observation, interview, and record review, the facility failed to ensure Resident (R)74's medication regimen remained free of as needed (PRN) psychotropic (any class of medications that alters mood or thought) medication that lacked the required 14 day stop date or clinical rationale for continued use beyond the initial 14 days. This deficient practice had the potential to lead to the resident receiving unnecessary psychotropic medications. Findings Included: [...]

Inspectors wroteThe facility reported a census of 25 residents with 12 residents selected for review. Based on observation, interview, and record review, the facility failed to accommodate a resident's preferences related to dietary preferences for one Resident (R)124.

Inspectors wroteThe facility reported a census of 25 residents. Based on observation, interview, and record review, the facility failed to ensure the posted daily nurse staffing sheets included the daily census and nursing hours, as required

Inspectors wroteThe facility reported a census of 29 residents. Based on record review and interview, the facility failed to maintain an effective Quality Assessment and Assurance ([QAA] facility meetings to identify issues with care and services in the facility and develop action plans to correct the concerns) program to ensure the problems related to resident care identified and action plans developed through the QAA program to address those concerns. This had the potential to affect all residents.

Inspectors wroteThe facility reported a census of 29 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, 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 did not have at least quarterly meetings. This had the potential to affect all residents.

Inspectors wroteThe facility reported a census of 29 residents, with 12 residents sampled, including one resident sampled for Activities of Daily Living (ADL). Based on observation, interview, and record review, the facility failed to provide appropriate nail care and assistance for Resident (R) 15.

Inspectors wroteThe facility reported a census of 29 residents, with 12 residents sampled, including two residents sampled for position/mobility. Based on observation, interview, and record review, the facility failed to provide care, equipment, and assistance to maintain or improve mobility with the maximum practicable independence for Resident (R) 15 and R2 by the failure to provide the provider ordered finger separator (device used to stretch and separate the fingers) for R15 and the carrots (hand contracture orthosis) for R2.

Inspectors wroteThe facility reported a census of 29 residents with 12 sampled including two residents sampled for indwelling urinary catheter (tube placed in the bladder to drain urine into a collection bag). 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) 2 and R7.

Inspectors wroteThe facility identified a census of 29 residents. The sample included 12 residents, including five sampled residents reviewed for unnecessary medications. Based on observation, record review and interview, the facility failed to ensure the Consultant Pharmacist (CP) identified and reported an inadequate indication for use for Resident (R) 27's anti-psychotic (a class of medications used to treat psychosis and other mental emotional conditions) medication Seroquel. This failure had the potential of unnecessary antipsychotic medication use and related side effects for R27.

Inspectors wroteThe facility identified a census of 29 residents. The sample included 12 residents, including five residents sampled for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure an appropriate diagnosis for an antipsychotic (a class of medications used to treat psychosis and other mental emotional conditions) for Resident (R)27's anti-psychotic (a class of medications used to treat psychosis and other mental emotional conditions) medication Seroquel. This failure had to potential of unnecessary antipsychotic medication use and related side effects for R27.

Inspectors wroteThe facility census totaled 28 residents. Based on observation, interview, and record review the facility failed to ensure safe water temperatures in areas accessible to residents which had the potential to cause serious burns from extremely hot water temperatures in excess of 140 degrees Fahrenheit (F) (acceptable water temperature 120 F or below with a 3 degree variance + or -). The facility failed to monitor and document water temperatures accessible to residents in their personal restroom sink or sinks accessible in public areas, which placed residents who lived on one of two halls in the facility at risk for burns and in immediate jeopardy.

Inspectors wroteThe facility reported a census of 28 residents. The facility had one main kitchen where food was stored and prepared for two dining rooms. Based on observation, interview, and record review the facility failed to properly store food items placed in a refrigerator and dry goods storage room by the failure to ensure food items in opened packages were dated and expired foods were discarded after the expiration date. The facility also failed to ensure staff followed sanitary methods of distributing food to residents. This had the potential to affect all residents in the facility.

Inspectors wroteThe facility reported a census of 28 with two residents reviewed for skin conditions (non-pressure related). Based on observation, interview, and record review the facility failed to ensure nursing staff identified, documented, and followed-up on bruising for Resident (R)9.