La Salle County Nursing Home

Inspectors wroteBased on interview, and record review the facility failed to follow their emergency menu. This applies to 4 of 6 (R1, R4, R5, R6) in the sample of 6.

Inspectors wroteBased on observation, interview, and record review the facility failed to identify a severe weight loss and put interventions in place for one (R33) of one resident reviewed for nutrition in the sample of 27. This failure resulted in R33 having a continued severe weight loss of 10.2% in one month and 12.9% loss in six months.

Inspectors wroteBased on observation, interview, and record review the facility failed to date opened food items, use items within the opened date timeframe, and failed to implement the cleaning schedule of equipment. This has the potential to affect all 59 residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure all required staff attended the facility's Quality Assurance Meetings. This has the potential to affect all 59 residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure that the Antibiotic Stewardship Program was complete, accurate and done monthly for residents who are receiving antibiotics or have any type of infection. This failure has the potential to affect all 59 residents residing in the facility. Findings Include: The facility policy, named Antibiotic Stewardship-Infection Control Program, no date, documents the following: It is the policy of the facility is to monitor and maintain an Antibiotic Stewardship Program that monitors the use of antibiotics and their order specifics to decrease the amount antibiotic resistant organisms following the procedure: A.) Utilize the antibiotic tracking form to monitor reason for antibiotics and; B.) Identify the use of antibiotics and the appropriateness of the situation. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure resident call devices were in reach for one (R8) of 15 reviewed for call devices in a sample of 27.

Inspectors wroteBased on interview and record review the facility failed to perform a PASRR (Pre-admission Screening & Resident Review) rescreen after a severe mental illness diagnosis was added for one (R22) one resident reviewed for PASRRs in a sample of 27.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a respiratory assessment was completed pre and post nebulizer treatment for one (R5) of one resident reviewed for nebulizer treatments in a sample of 27.

Inspectors wroteBased on interview and record review, the facility failed to ensure a rationale was documented by the physician for a pharmacy recommendation for one (R53) of five residents reviewed for Medication Regimen Review in a sample of 27.

Inspectors wroteBased on record review and interview the facility failed to document the rational for the continued use of an antibiotic for two of three residents (R16 and R51) reviewed for unnecessary medications in a sample of 27. Findings Include: The facility's Antibiotic Stewardship-Infection Control policy, undated, documents the following: Procedure of Core Elements, D.) Action-Implementing at least one policy or practice to improve antibiotic use this facility will implement a stricter policy (s) on antibiotic order specifics including, but not limited to identifying clinical situations in which inappropriate antibiotics are used such as asymptomatic urinary tract infections, treating a colonized asymptomatic resident, prophylaxis, and guidelines for treating infections. The key element involved is control over antibiotic use which will reduce the threat of antibiotic resistance. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper diagnoses and targeted behaviors were in place for psychotropic medications for two residents (R53 and R49) of three residents reviewed for psychotropic medications in a sample of 27.

Inspectors wroteBased on interview and record review the facility failed to implement fall interventions for a resident at risk for falls for one of three residents (R1) reviewed for falls in a sample of three. This failure resulted in R1 experiencing an unwitnessed fall, subsequently sustaining a left hip fracture requiring surgical repair.

Inspectors wroteBased on observation, interview and record review the facility failed to develop behavior care plans for four residents (R1, R3, R5, R6) of six residents reviewed for care plans.

Inspectors wroteBased on observation, interview and record review the facility failed to revise the comprehensive care plan for two residents (R2, R4) of six residents reviewed for resident-to-resident altercations.

Inspectors wroteBased on observation, interview, and record review the facility failed to monitor refrigerated medication storage temperatures. This failure has the potential to affect all 59 residents in the facility. The facility also failed to ensure refrigerated controlled medications were double locked for four residents (R27, R29, R40, R45) during review for medication storage.

Inspectors wroteBased on observation, interview and record review the facility failed to provide meals according to the menu. This failure has the potential to affect all 59 residents in the facility who receive meals from the kitchen.

Inspectors wroteBased on interview and record review the facility failed to provide/offer bedtime snacks to nine residents (R5, R8, R11, R12, R23, R28, R42, R46, R50) of nine residents who attended a group meeting in the sample of 27.

Inspectors wroteBased on observation, interview, and record review, the facility failed to administer medications without touching with bare hands, cleanse a glucometer, perform handwashing between glove changes, cleanse a bedside table to prevent cross contamination, and change gloves with cares for five (R11, R29, R40, R42, R45) out of 24 residents reviewed for infection control in a sample of 27.

Inspectors wroteBased on interview and record review the facility failed to provide consents for influenza vaccinations and provide documentation of vaccination education/potential side effects for five residents (R10, R16, R40, R45, R50) of five residents reviewed for immunizations in the sample of 27.

Inspectors wroteBased on observation, interview, and record review, the facility failed to have a bedside table for one (R49) of 24 residents reviewed for room furnishings in a sample of 27.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received scheduled showers for one resident (R49) of two residents reviewed for ADLs/Activities of Daily Living in a sample of 27.

Inspectors wroteBased on observation, interview and record review, the facility failed to prevent the development of bilateral, unstageable, pressure wounds to the right malleolus and left calf area for one of three residents (R4), reviewed for pressure wounds, in a sample of 31.

Inspectors wroteBased on observation, interview, and record review, the facility failed to perform perineal care utilizing a front to back technique and failed to change gloves during incontinence care for one of three residents (R20) reviewed for urinary tract infection in the sample of 31.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a current dialysis agreement was in place and failed to ensure a dialysis resident received a morning meal, prior to dialysis, for one of one resident (R31) reviewed for dialysis in the sample of 31. Findings Include: The facility policy, Policy and Procedure for Dialysis, dated 2008 directs staff, To provide quality care and treatment services to the resident who requires dialysis. The SNF (Skilled Nursing Facility) will have an agreement, in writing, with a dialysis provider. General Communication and Coordination of Care. The (facility) dietary staff, the Dietary Director and Consultant RD (Registered Dietician) participate with other disciplinary team members to visit and observe resident's food and fluid intake and preferences. [...]