Kula Hospital

Inspectors wroteBased on interviews, observation, record and document review, the facility failed to report two incidents that met criteria to the Department of Human Services, Adult Protective Services (APS) as required by law. P1 was found to have two large forearm lacerations/skin tears, and P2 was diagnosed with a broken finger. Both injuries did not have a known origin. P2 alleged his injury was caused by actions of a Certified Nursing Assistant (CNA)2. As a result of the is deficient practice, the State Agency, was not aware of the incidents and did not conduct external investigations.

Inspectors wroteBased on observation, interviews, record and document review, the facility failed to protect the rights of two Resident's (R )1 and R2 to be free from abuse. R1 suffered physical injuries on 06/11/2024 when a Certified Nurse Assistant (CNA)1 did not react and respond appropriately to R1's aggressive behavior. CNA1 did not leave the room, but willfully continued to interact and react with unnecessary physical contact which resulted in R1 suffering harm. R1 had bruising to the Left (L) forehead, L temple and scratch type injury to his chest. The injuries are not justifiably explained. In addition, on 08/10/2024, staff witnessed non-consensual sexual contact when R3 was observed with his hand inside R2's blouse. R2 does not have the capacity to consent. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide a Director of Nursing (DON) on a full-time basis. The same staff member covers the long-term care (LTC), the Critical Access Hospital (CAH), and the Intermediate Care Facility for the Intellectually Disabled (ICF/IID) facilities as the DON.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store food in accordance with professional standards for food service safety. Residents (R) risk serious complications from foodborne illness as a result of their compromised health status. Unsafe and/or unsanitary food storage/handling practices represent a potential source of pathogen exposure for all residents at the facility who consume food or drink prepared at the facility.

Inspectors wroteBased on observations and staff interview, the facility failed to secure storage rooms located on the second and fourth floors where hazardous chemicals were kept. As a result of this deficient practice, the residents of the facility were placed at risk for accident hazards. 1) On 06/05/24 at 01:06 PM, observed the door to the clean utility room on the second floor was not locked. On the wall outside the clean utility room door was a small keypad lock container. Asked Registered Nurse (RN) 1 what was being kept in the room. RN3 said they keep some of the enteral feeding supplies and nourishments for the residents in the room. Inspected contents of the cabinets with RN3. An opened container of liquid bleach and liquid dish soap were found in one of the cabinets. RN3 notified Nurse Supervisor (NS) 1 who checked the small keypad lock container outside the clean utility room. [...]

Inspectors wroteBased on interviews and record review, the facility failed to assure two residents (Resident (R) 27 and R46) were treated with dignity and respect and provided care in an environment that enhances their quality of life. This deficient practice has a negative effect on maintaining and enhancing both resident's self-esteem and self-worth and has the potential to cause psychosocial harm.

Inspectors wroteBased on interviews and record review, the facility failed to promote the participation for one of the sampled residents (R) 9 and her representative for the development and review of the resident's care plan. This failed practice has the potential to affect all the residents in the facility. Findings Include: R9 is a [AGE] year-old female admitted on [DATE]. Interview was conducted with R9 in her room on 06/04/24 at 08:33 AM. R9 stated that she has not attended a care conference meeting for months. She does recall having meetings in the past but does not recall having one this past year. R9 also added that if a notification was sent to her son, he would have been present at the conference. Record review was done of R9's medical records. Documentation was found on a care conference meeting that was held on 02/22/24. A list of the staff present for the meeting was noted in the document. [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure interventions to prevent or improve pressure ulcers or injuries were implemented for one of the three residents (Resident (R) 50) sampled. Staff did not ensure R50's left heel was offloaded and documented in the medical record every shift. This deficient practice has the potential to affect all residents that are dependent on staff for repositioning in bed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure nurse competency in medication administration as evidenced by Registered Nurse (RN)5 administering a laxative/stool softener to Resident (R)36 despite documentation of a large loose bowel movement that morning. In addition, medications were not documented as administered in a timely manner. This deficient practice places residents at risk for avoidable declines in health status and has the potential to affect all residents at the facility receiving staff-administered medications.

Inspectors wroteBased on record review and interviews, the facility failed to ensure adequate monitoring was done for one resident (Resident (R) 27) sampled for anticoagulant (medication to treat and prevent blood clots) use. The facility was not documenting if R27 was being monitored for signs and symptoms of bleeding. As a result of this deficient practice, R27 was put at risk for avoidable adverse health complications related to her health condition and the use of anticoagulants. This has the potential to affect all residents in the facility taking anticoagulants.

Inspectors wroteBased on observation, interviews and record review, the facility failed to ensure the staff followed the proper use gloves and performed hand hygiene procedures during wound dressing change for Resident (R) 50. This deficient practice placed the residents at risk for the potential spread of infectious and communicable diseases.

Inspectors wroteBased on observation, staff interview, record review, and review of equipment service manual, the facility failed to follow routine maintenance cleaning of the cabinet filter, based on the manufacturer's recommendation. This deficient practice put one Resident (R) 8 at risk for the development and transmission of communicable diseases and infections.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to update their facility assessment as required annually or when there is a change that would require a substantial modification to any part of the assessment (i.e. staffing shortage, COVID-19 outbreak). The facility assessment provides a comprehensive inventory of resources that are necessary to care for its residents competently during day-to-day operations and during emergencies. This deficient practice renders the administrative and management staff the inability to assess for potential system failure(s).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate protective and preventive measures for COVID-19, linen is processed as to prevent the spread of communicable diseases and infections. This is evidenced by the facility failing to ensure staff followed transmission-based precautions (TBP) by wearing the proper personal protective equipment (PPE), as well as follow standard precautions by consistently performing hand hygiene. In addition, the facility failed to track and monitor that staff's COVID-19 testing was consistently conducted to minimize the risk of continued transmission of COVID-19 during a facility outbreak. These deficient practices have the potential to affect all residents in the facility, as well as all healthcare personnel, and visitors at the facility.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure a comprehensive person-centered care plan was developed and/or implemented for three of nineteen residents (Resident (R)34, R27, and R21) sampled. An intervention to apply compression stocking to reduce swelling in R34's lower extremities was not implemented as documented in the comprehensive care plan. Behavioral and skin care interventions were not implemented for R27. R21's chronic joint pain and refusals of care were not addressed. As a result of this deficient practice residents are at risk of negative outcomes and a potential for harm.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure there was sufficient nursing staff to provide nursing and related services to meet the residents' needs safely and in a manner that promotes each resident's rights, in addition to their physical, mental, and psychosocial well-being. As a result of this deficient practice, the residents were placed at risk of a decreased quality of life and were unable to attain their highest practicable well-being.

Inspectors wroteBased on observation and interview, the facility failed to ensure a resident's right to a dignified existence for Resident (R)79. While providing care, Staff(S)45's interaction included verbal taunting which elicited a stressed response from R79. As a result of this deficient practice, residents are at risk for the potential of psychosocial harm.

Inspectors wroteBased on observation, interview and record review, the facility failed to formulate an advance directive for two of three residents sampled. The deficient practice disregards the residents right to make important decisions about end-of-life treatment when the individual may be incapacitated.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the resident's right to be free from physical restraints was being followed for three of three residents (Resident (R)82, R33, and R193) sampled. Observed positioning wedges placed at the (lower end) of both bedrails, adjacent to the resident's body which restricted the resident's willful movements and confine the residents to their bed. Interviews with staff verified the wedges were used to prevent the residents from exiting the bed. The resident's medical record (MR) did not include any information in the assessment, physician orders, or care plan related to the use of wedges for positioning. As a result of this deficient practice, residents are at risk for potential or physical and psychosocial harm and/or serious injury.

Inspectors wroteBased on observation, interview, and record review (RR), the facility failed to develop a baseline care plan that provided effective and person-centered care for one Resident (R)41 of 19 residents in the sample. Specifically, despite identifying the residents' immediate needs, the facility failed to develop and implement resident-specific interventions that addressed those needs. This deficient practice has the potential to affect all newly admitted residents at the facility.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure a resident who is unable to carry out Activities of Daily Living (ADLs) received the necessary services to maintain good personal hygiene for one Resident (R)12 sampled. R12 is dependent on staff for showers, did not receive a shower for two weeks and reported feeling unkept and unclean. As a result of this deficient practice, dependent residents are at a potential risk of psychosocial harm and potential physical harm because of unmet needs.

Inspectors wroteBased on observation and interview, the facility failed to ensure its nurse staffing information posted on the third floor contained the required data elements. Specifically, the posted nurse staffing information did not contain the facility name, unit census, and actual hours worked, on any of the survey days, and did not contain the date on the first day of the survey.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to provide a complete and accurately documented medical record of one resident (R), R21, out of a sample of 19 residents. Rehabilitation Services Supervisor (RSS)22 did not document that R21's referral for an occupational therapy (OT) evaluation for R21's complaint of pain was received and the reasons for the delay of services. This deficient practice could potentially have R21 be lost to appropriate follow up of necessary services.

Inspectors wroteBased on observation and interviews, the facility failed to implement an effective pest control program so that the facility is free of pest. As a result of this deficient practice, residents are at risk for potential harm related to disease spread by pest.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff conducting point-of-care (POC) COVID-19 outbreak testing on themselves conducted the testing in a manner consistent with current standards of practice for conducting COVID-19 tests. As a result of this deficient practice, the facility placed the residents and staff at an increased risk of COVID transmission. This deficient practice has the potential to affect all residents in the facility, as well as all healthcare personnel, and visitors at the facility.

Inspectors wroteBased on interview and record review, the facility failed to protect one resident's right to be free from abuse from other residents. As a result of this deficient practice, Resident (R)22 was observed by staff hitting R23 in the left temple, without provocation. This deficient practice has the potential to affect all residents in the facility.

Inspectors wroteBased on observations, record review and interview with staff members, the facility failed to assure that each resident receives an accurate assessment, reflective of the resident's status at the time of the assessment for two (Residents 4 and 37) of 18 residents in the sample

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure a comprehensive person-centered care plan that includes measurable objectives and timeframe to meet the resident's medical, nursing, and psychosocial needs identified on the comprehensive assessment was developed for one of 18 residents sampled, Resident (R)62.

Inspectors wroteBased on observations, record review and interview with staff members, the facility did not provide necessary services for a resident who is unable to carry out activities of daily living to maintain good grooming.

Inspectors wroteBased on observations and record review, the facility failed to provide adequate supervision while a resident wandered on the unit. Resident (R)12 was observed wandering on the unit and entered another residents' room. This has the potential to be unsafe as it may lead to an altercation.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure a resident was assessed for risk of entrapment from bed rails, review of the risk and benefits of bed rails with the resident representative, and obtain an informed consent for the use of bed rails for one resident (Resident (R)24) sampled.

Inspectors wroteBased on observation and interviews, the facility failed to ensure infection control practices were implemented for a resident (Resident (R)62) with an indwelling catheter.