Lakeview Nursing & Rehab

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the deep fryer was clean and free of food particles and the splash guard on side of stove was cleaned routinely. The administrator identified 55 residents resided in facility and received their food from the kitchen.

Inspectors wroteBased on record review and interview, the facility failed to ensure a referral to the LOCEU was made when a resident had a diagnosis of a serious mental illness for one (#30) of 2 sampled residents reviewed for PASARR. The administrator identified 55 residents who resided in the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure an insulin vial was cleaned prior to administration for 1 (#27) of 1 sampled resident observed for insulin administration. The assistant director of nursing identified four residents received insulin.

Inspectors wroteBased on record review, observation, and interview, the facility failed to prepare and distribute food under sanitary conditions. The Resident Census and Conditions of Residents report documented 38 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to assist a resident with ADLs for one (#18) of 12 residents reviewed for activities of daily living. The Resident Census and Conditions of Residents report documented 38 residents resided in the facility.

Inspectors wroteOn 07/06/22 an immediate jeopardy (IJ) situation was determined to exist related to the facility's failure to provide supervision to prevent falls and to consistently identify and implement interventions to prevent falls for Res #15, 24, and #30. Resident #15 fell multiple times including one where the Res had sustained a laceration to the right leg which required sutures and subsequently became infected and required further hospitalization. Res #24 fell multiple times and with one fall received a large bump to the upper right forehead and was later found face down in the floor of another resident's room. Res #24 was not responsive and subsequently sent to the hospital for evaluation. Res #24 continued to fall. Res #30 had fallen multiple times with different injuries including one where the Res had sustained a hematoma to his right eyebrow. [...]

Inspectors wrote2. Res #42 was admitted to the facility with diagnoses which included diabetes mellitus and hypertension. A history and physical note, dated [DATE], documented in part, .Code status: DNR/no CPR . Physician progress notes, dated [DATE], [DATE], [DATE], [DATE], and [DATE], read in parts, .Code status: Do not attempt Resuscitation (DNR/No CPR) . On [DATE] at 9:45 a.m., Res #42's chart was observed with a sticker on the spine of the chart that read DNR. A review of Res #42's medical records revealed no DNR document was in the chart. On [DATE] at 2:13 p.m., the administrator stated a signed DNR form should have been in the medical records. The administrator reported Res #42 would have to be a full code until a DNR document could be obtained. [...]

Inspectors wroteBased on record review and interview the facility failed to provide letters of NOMNC and/or ABN for two (#12 and #21) of three residents reviewed Beneficiary Notices. The Beneficiary Notice - Residents discharged Within the Last Six Months, documented 20 residents were discharged from Medicare covered Part A stay with benefit days remaining in the last six months.

Inspectors wroteBased on record review and interview, the facility failed to ensure three (#24, 30, and #42) of four residents whose PASRR documents were reviewed. The administrator reported 35 residents who resided in the facility required a Level II PASRR.

Inspectors wroteBased on record review, observation, and interview, the facility failed develop a comprehensive care plan which included goals and interventions for three (#15, 30 and #35) of 21 residents whose care plans were reviewed. The facility failed to develop a care plan related to: a. the use of a urinary catheter for Res #15. b. pressure ulcers for Res #30. c. bathing needs for Res #35. The Resident Census and Conditions of Residents documented 50 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to update resident care plans to accurately address the residents' current needs for four (#15, 21, 24, 30, and #40) of 21 residents whose records were reviewed. The facility failed to update resident care plan related to: a. falls for resident #15, 21, 24, and #30. b. code status and use of hypnotic medications for Res #40. The Resident Census and Conditions of Residents form documented 50 residents resided in the facility.

Inspectors wroteBased on record review and interview the facility failed to ensure the consultant pharmacist recommendations were acted on for two (#24 and #40) of five residents reviewed for unnecessary medications. The Resident Census and Conditions of Residents form documented 50 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to monitor for target behaviors and side effects and failed to act on a MRR request for reduction for one (#15) of five sampled residents reviewed for unnecessary medications. The Resident Census and Conditions of Residents form documented 50 resident resided in the facility.

Inspectors wroteBased on observation and interview, it was determined the facility failed to ensure the removal of expired medications and supplies from the medication storage room. This had the potential to affect all 50 residents who resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to complete a significant change assessment after a resident decline for one (#12) of 21 sampled residents whose assessments were reviewed. The Resident Census and Conditions of Residents documented 50 residents resided in the facility.

Inspectors wroteBased on record review and interview, the facility failed to transmit resident assessments to the CMS system within 14 days of completion for one (#2) of two residents reviewed for resident assessments. The Resident Census and Conditions of Residents documented 50 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure a resident with urinary incontinence did not continue to have a urinary catheter after a hospitalization without a clinical condition which documented a catheter was necessary for one (#15) of one resident reviewed for catheterization. The Resident Census and Conditions of Residents report documented four residents had indwelling urinary catheters.

Inspectors wroteBased on record review, observation, and interview, the facility failed to assess and monitor for pain every shift according to the plan of care for one (#26) of one resident reviewed for pain. The Resident Census and Conditions of Residents form documented 27 residents on a pain management program.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure an assessment for risk of entrapment was conducted and an informed consent and physician order was obtained prior to installing side rails for one (#30) of four resident reviewed for accident hazards. The Resident Census and Conditions of Residents form documented 50 residents resided in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to reduce a medication which had been identified by the pharmacist consultant as appropriate for reduction and the physician agreed for one (#15) of five residents reviewed for unnecessary medications. The Resident Census and Conditions of Residents report documented 50 residents resided in the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure meals from the kitchen were prepared, served, and stored, in a sanitary manner for 50 of 50 residents who received their meals from the kitchen.

Inspectors wroteBased on record review, observation, and interview, the facility failed to conduct regular inspections of beds, side rails, and mattresses, to identify any areas of potential entrapment for one (#30) of four residents reviewed for accident hazards. The Resident Census and Conditions of Residents form documented 50 residents resided in the facility.