Lake Hamilton Health and Rehab

Inspectors wroteBased on observations, interviews, record review, and facility policy review, it was determined that the facility failed to ensure that privacy was provided while providing care to maintain dignity for 2 (Resident #8 and #57) of 2 sampled residents observed for personal care.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure 1 of 1 ice machine was maintained in a sanitary condition; expired food items were promptly removed / discarded on or before the expiration or use by date; food stored in the freezer was covered; the refrigerator temperature and cold dairy products were maintained at 41 degrees Fahrenheit or below; and dietary staff washed their hands between tasks for 1 of 1 meal observed.

Inspectors wroteBased on observations, interviews, record review, and facility policy review, it was determined that the facility did not ensure Enhance Barrier Precautions (EBP) were implemented and followed; that staff used proper hand hygiene during incontinence care; and/or that staff wore proper Personal Protective Equipment (PPE) when care was provided, for 3 (Resident #8, #42, and #226) of 3 residents reviewed for EBP or Transmission Based Precautions (TBP).

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined that the facility did not ensure there was a device in place to prevent further contracture and/or skin breakdown for 1 (Resident #59) of 1 resident sampled for mobility.

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure food items stored in the freezer were covered, sealed, and dated to minimize the potential for food borne illness for residents who received meals from 1 of 1 kitchen, manufacturer specification was followed to prevent the potential for borne illness for residents who received meals from 1 of 1 kitchen, and dietary staff washed their hands before handling clean equipment or food items to prevent potential food borne illness for residents who received meals from 1 of 1 kitchen; These failed practices had the potential to affect 73 residents who received. meals from the kitchen, (total census:74).

Inspectors wroteBased on observation, interview and record review, the facility failed to develop care plans to address a resident receiving antibiotics for prevention of recurring urinary tract infections for 1 (Resident #34) sampled resident, a resident was receiving anticoagulants for 1 (Resident #22) sampled resident, and a resident was receiving insulin for 1 (Resident #68) sampled resident to ensure appropriate coordination of care. This failed practice had the potential to affect 3 residents that were receiving antibiotics for prevention of recurring urinary tract infections, 27 residents that were receiving anticoagulant medication and 10 residents that received insulin.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure stock narcotics were counted, and accurately documented when received from the pharmacy to ensure the correct count was on hand and to prevent misappropriation of resident medications and ensure accurate documentation in the narcotic book to prevent the potential for medication errors. This failed practice had the potential to affect 74 residents receiving medications in the facility.

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to ensure the medication error rate was less than 5%. Physician orders were not followed for 2 (Resident #67 and #229) of 3 residents reviewed for Medication Administration. Medications were observed with 2 errors in 34 opportunities, resulting in a medication error rate of 5.88%.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medications were not stored at the bedside for residents without self-administration rights approved by the Interdisciplinary team. This failed practice had the potential to affect 3 (Residents #22, #26, #68) sampled residents and 23 residents that ambulate and/or self-propel on 100 and 200 Halls. The facility failed to ensure licensed staff remained at the bedside during updrafts to ensure residents received the complete dose affecting 1 (Resident #226) of 3 sampled on 100 Hall getting updrafts. The facility failed to ensure refrigerated narcotics were stored in a permanently affixed storage box to ensure no misappropriation of resident medications affecting all 74 residents in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure meals were served in a method that maintained the appearance of cold products and at temperatures that were acceptable to the residents to improve palatability and encourage good nutritional intake during 1 of 1 meal observed. This failed practice had the potential to affect 15 residents who received meal trays in their rooms on the 100 Hall, 25 residents who received meal trays on the 200 Hall, 17 residents who received meal trays in their room on the 300 Hall, and 17 residents who received meal trays on the 400 Hall.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff were sitting face to face with residents during meal service to promote dignity for 1 (Resident #41) of 3 sampled residents requiring feeding assistance during dining.

Inspectors wroteBased on observation, interview and record review, the facility failed to protect 1 (Resident #231) sampled resident ' s privacy by leaving medication cards with identifiable resident information facing out towards passersby on an unattended medication cart on the 100 Hall.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the unlocked public bathroom near a common resident area was equipped with a pull cord on the call light to ensure resident safety and to prevent falls. This failed practice had the potential to affect 9 (Residents #8, #22, #26, #27, #30, #63, #68, #325, #326) of 42 sampled residents who ambulated and/or self-propelled in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure only licensed nursing staff provided oxygen as ordered by the physician via concentrator, and/or portable oxygen tank to prevent possible respiratory complications for 1 (Resident #45) on who received oxygen with 1 of 1 observation.

Inspectors wroteBased on observation, and interview, the facility failed to ensure staff washed their hands or changed gloves between residents while serving beverages for the lunch meal on the 200 Hall to prevent the potential for food borne illness. The failed practice had the potential to affect 24 residents who resided on the 200 Hall as documented on the Census List provided by the Administrator on 04/24/23.

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain a Physician's Order for supplemental oxygen before administering it to a resident for 1 (Resident #31) of 9 (Residents #2, #30, #31, #39, #45, #56, #67, #70 and #74) sampled residents who received oxygen as documented on a list provided by the Administrator on 04/28/23 at 9:10 AM, and failed to store nebulizer tubing and mask in a sanitary manner for 1 (Resident #70) of 2 (Residents #31 and #70) sampled residents who received respiratory care services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure safe staffing levels were maintained for 2 (Residents #1 and #10) of 30 (Residents #1, #2, #3, #4, #7, #10, #20, #21, #22, #26, #28, #30, #31, #33, #34, #38, #39, #42, #43, #45, #49, #53, #56, #61, #67, #70, #71, #74, #76 and #77) sampled residents who relied on the facility to provide safe staffing ratios and to ensure sufficient staff were present to avert the use of restraints for 1 (Resident #71) of 9 (Residents #3, #7, #20, #31, #34, #39, #43, #53 and #71) sampled residents who resided in the facility and used a seatbelt and/or pressure alarm restraints.

Inspectors wroteBased on observation, and interview, the facility failed to ensure resident personal hygiene items were stored in a sanitary manner 2 (rooms [ROOM NUMBERS]) of 5 (Rooms 211, 213, 215, 217 and 303) resident bathrooms.

Inspectors wroteBased on observation, record review and interview, the facility failed to document the medical symptoms that required the use of a restraint; failed to demonstrate ongoing monitoring and evaluation for the use of the restraint and failed to demonstrate attempts of other less restrictive interventions prior to the initiation of the restraint for 1 (Resident #71) of 1 sampled resident who was required to wear a seatbelt while in his wheelchair.

Inspectors wroteBased on observation, interview, and record review, the facility failed to complete a Comprehensive Care Plan to include care for indwelling catheters for 1 (Resident #74) of 4 (Residents #10, #70, #71 and #74) sampled residents with indwelling catheters as documented on a list provided by the Administrator on 04/28/23 at 9:10 AM.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide activities designed to meet the interests and support the physical, mental and psychosocial wellbeing of each resident for 1 (Resident #3) of 30 (Residents #1, #2, #3, #4, #7, #10, #20, #21, #22, #26, #28, #30, #31, #33, #34, #36, #39, #42, #43, #45, #49, #53, #56, #61, #67, #70, #71, #74, #76 and #77) sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who received antibiotics did not receive them for an excessive duration, without adequate monitoring and indication for their use for 1 (Resident #20) of 30 (Residents #1, #2, #3, #4, #7, #10, #20, #21, #22, #26, #28, #30, #31, #33, #34, #36, #39, #42, #43, #45, #49, #53, #56, #61, #67, #70, #71, #74, #76 and #77 ) sampled residents.