Lakewood Post Acute and Rehabilitation

Inspectors wroteBased on record review and interviews, the facility failed to complete a performance review of every nurse aide at least once every 12 months and provide regular in-service education based on the outcome of these reviews for five of five certified nurse aides (CNA). Specifically, the facility failed to complete annual performance reviews for CNA #2, CNA #4, CNA #5, CNA #6 and CNA #7 in order to determine potential training needs.

Inspectors wroteBased on observations and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of diseases and infection. Specifically, the facility failed to: -Ensure staff wore the appropriate personal protective equipment (PPE) in contact and/or droplet precaution resident rooms; -Ensure housekeeping staff cleaned resident rooms in a sanitary manner: and, -Ensure disinfectant dwell times were followed.

Inspectors wroteBased on record review and interviews, the facility failed to provide training to their staff that at a minimum educated staff on activities that constitute abuse, neglect, exploitation and misappropriation of resident property as set forth, procedures for reporting incidents of abuse, neglect, exploitation or misappropriation of resident property and resident dementia abuse prevention. Specifically the facility failed to: -Provide annual resident abuse prevention training to 17 out of 74 staff members; and, -Provide annual dementia management training for 15 out of 74 staff members.

Inspectors wroteBased on record review and interviews, the facility failed to ensure consent was obtained for the use of psychotropic medications for one (#4) of five residents reviewed for unnecessary medications out of 17 sample residents. Specifically, the facility failed to ensure informed consents, which included the risks associated with taking a psychotropic medication, were obtained for Resident #4 prior to the administration of a psychotropic medication.

Inspectors wroteBased on record review and interviews, the facility failed to develop and implement a comprehensive care plan for two (#18 and #15) of three residents reviewed for care plans out of 17 sample residents. Specifically, the facility failed to: -Ensure Resident #18's comprehensive care plan addressed his use of oxygen; and, -Ensure Resident #15 had a care plan for the use of splint and contractors.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#15) of two residents received care and services according to acceptable standards of clinical practice out of 17 sample residents. Specifically, the facility failed to ensure residents had a physician review and order for the use of specialized medical devices for Resident #15.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#18) of three residents who required respiratory care received the care consistent with professional standards of practice out of 17 sample residents. Specifically, the facility failed to: -Obtain a physician`s order for oxygen therapy was in place for Resident #18. -Ensure Resident #18`s portable oxygen tank was operating when in use.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#75) of one resident reviewed for dialysis care out of 17 sample residents received dialysis services consistent with professional standards of practice. Specifically, the facility failed to consistently complete the pre-dialysis facility assessment section on dialysis communication form for Resident #75.

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents diagnosed with mental disorder or psychosocial adjustment difficulty received appropriate treatment and services to attain the highest practicable mental and psychosocial wellbeing for one (#78) of three residents out of 17 sample residents. Specifically, the facility failed to: -Ensure Resident #78, who had a history of suicide attempts and trauma, was monitored for signs and symptoms of suicidal ideation; and, -Ensure Resident #78, who had a diagnosis of depression and requested to see a therapist, was provided with mental health services.

Inspectors wroteBased on record review and interviews, the facility failed to ensure two (#15 and #11) of five residents were free from unnecessary psychotropic medications out of 17 sample residents. Specifically, the facility failed to: -Document resident specific care plan approaches, to include medication specific target behaviors and person-centered interventions for Resident #15 and Resident #11's psychotropic medications; -Document behaviors for Resident #15 and Resident #11 to justify the use of psychotropic medications; and, -Ensure non-pharmacological interventions were offered to Resident #11 prior to the administration of an as needed (PRN) psychotropic medication.

Inspectors wroteBased on observations, record review and interviews the facility failed to ensure for one (#5) of two residents reviewed received foods in the appropriate form as prescribed by the physician and/or assessed by the interdisciplinary team to support the treatment and plan of care. Specifically, the facility failed to consistently follow the physician's order for a renal diet for a Resident #5.

Inspectors wroteBased on record review, observations and staff interviews, the facility failed to ensure one (#6) of three residents reviewed out of 28 sample residents, was provided the care and services necessary to meet their nutrition needs to maintain their highest level of physical well-being. Resident #6, age [AGE], was admitted on [DATE] with diagnoses of fractured right femur (thigh bone), NPO (no food or fluids by mouth), type two diabetes, anemia, dysphagia (difficulty swallowing), and vitamin D deficiency. Resident #6 sustained a weight loss of 7.7 % (8.3 lbs) from 8/22/23 to 9/12/23, and a weight loss of 11.6 % ( 12.0 lbs) from 8/22/23 to 9/19/23, which was considered significant. Resident #6's weight was not obtained on 9/26/23, and not requested on 9/27/23 or 9/28/23. [...]

Inspectors wroteBased on record review and interviews, the facility failed to consistently provide pain management services for one (#14) of one resident reviewed for pain out of 28 sample residents. Resident #14 was admitted on [DATE]. He had a surgical procedure on 9/25/23 to scrape infected bone out of his left foot and ankle region as a result of osteomyelitis (bone infection). Resident #14 had pain from the recent surgical procedure and phantom pain from a previous right leg above-knee amputation. He had orders for as-needed (PRN) Oxycodone which relieved his pain when given, but it was not administered in a timely manner. The facility failed to ensure Resident #14 had enough pain medication on hand to manage his pain and when it ran out failed to provide it from the facility emergency kit. [...]

Inspectors wroteBased on record review, observations and interviews, the facility failed to ensure proper storage of medications for two of three medication storage carts. Specifically, the facility failed to: -Ensure a medication cart that was no longer in use did not contain medications from residents who had discharged and over the counter medications were kept locked; and. -Ensure medication was properly labeled with open dates.

Inspectors wroteBased on observations, record review and interviews, the facility failed to store, prepare and serve food in a sanitary manner. Specifically, the facility failed to: -Ensure a system was in place to monitor the internal temperature of the dish machine and ensure proper functioning of a high temperature dish machine; -Ensure staff washed and dried hands appropriately while plating and serving resident meals; and, -Ensure proper bistro refrigerator temperatures were maintained in two of two resident snack refrigerators that contained ready to eat perishable food.

Inspectors wroteBased on record review and interviews, the facility failed to ensure each resident had the right to formulate an advanced directive based on the residents wishes for five (#23, #181, #6, #233 and #14) of five residents reviewed out of 28 sample residents. Specifically, the facility failed to ensure: -Resident #23's physician order matched his Medical Orders for Scope of Treatment (MOST) advance directives form; -Resident #181 and Resident #233 had the MOST form completed upon admission; -Resident #6's physician order matched his MOST form and was readily accessible to nursing staff; and, -Resident #14 had a MOST form completed upon admission and reviewed with him.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure two (#183 and #14) of three residents reviewed out of 28 sample residents were provided services that meet professional standards of quality. Specifically, the facility failed to: -Document narcotic medication on the narcotic sheet and in the medication administration record (MAR) at the time of administration for Resident #183; and, -Document narcotic medication on the narcotic sheet and in the MAR at the time of administration and have physician order prior to administering the narcotic for Resident #14.

Inspectors wroteBased on staff interviews and record review, the facility failed to ensure certified nurse aides and licensed nurses were able to demonstrate competency skills and techniques necessary to care for residents' needs. This placed all residents at the facility at risk of receiving inadequate care. Specifically, the facility failed to conduct staff competency evaluations for certified nurse aides (CNAs), licensed practical nurses (LPNs) and registered nurses (RNs). Cross-reference F658, professional standards for failure to sign out narcotic medications at the time of administration. Cross-reference F692, nutrition/hydration for failure to administer bolus tube feedings and water flushes per physician orders resulting in significant weight loss. Cross-reference F695, respiratory care for failure to ensure physician orders and baseline care planning for tracheostomy care. [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infection. Specifically, the facility failed to provide isolation signage, appropriately apply and remove (donning and doffing) personal protective equipment (PPE) and assure the resident's door remained closed for Resident #232 on isolation precautions.

Inspectors wroteBased on record review and staff interviews, the facility failed to implement policies and procedures related to pneumococcal immunizations for four (#232, #230, #16 and #229) of seven residents reviewed for immunizations out of 28 sample residents. Specifically, the facility failed to: -Offer Resident #232 and #16 the pneumococcal vaccine upon admission; and, -Offer additional doses of the pneumococcal vaccine to Resident #229 and #230.

Inspectors wroteBased on record review, interviews, and observations the facility failed to develop a comprehensive care plan for two (#6 and #131) of eight residents out of 28 sample residents for services to attain or maintain the residence highest practical physical, mental and psychosocial well-being that included measurable objectives and timeframes. Specifically, the facility failed to: -Ensure the comprehensive care plan for Resident #6 included a focus care plan for catheter care; and, -Ensure the comprehensive care plan for Resident #131 included a focus care plan for antidepressant and antipsychotic medication use.

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure one (#229 ) of two residents reviewed out of 28 sample residents who required respiratory care were provided such care and services consistent with professional standards of practice. Specifically, the facility failed to: -Ensure Resident #229 had physician orders to care for tracheostomy care; and, -Ensure the tracheostomy was included in the baseline care plan.

Inspectors wroteBased on resident and family interviews, staff interviews and record review, the facility failed to ensure one (#180) of 28 sample residents was free from a significant medication error that involved an intravenous (IV) antibiotic. Specifically, the facility failed to ensure the IV antibiotics administered to Resident #180 were prescribed to her and that it was the correct medication was ordered for Resident #180.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to ensure food was stored, prepared, and served under sanitary conditions in four of four kitchens. Specifically, the facility failed to ensure: -Appropriate hand hygiene by food service staff.

Inspectors wroteBased on observations and staff interview the facility failed to maintain a sanitary, orderly, and comfortable environment for residents in eight of 108 resident rooms and on 12 of 12 hallways. Specifically, the facility failed to ensure: -Walls, carpets, and door threshold were repaired, painted and properly maintained.

Inspectors wroteIV. Resident #39 A. Resident status Resident #39, age [AGE], admitted on [DATE]. According to the February 2020 computerized physician's orders (CPO) diagnoses included metabolic encephalopathy, chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease (COPD) and dementia without behavioral disturbance. According to the 2/6/2020 minimum data set (MDS) assessment the resident had moderate cognitive impairment with a brief interview of mental status (BIMS) score of nine out of 15. He was identified as receiving oxygen therapy while a resident. B. Observations On 2/19/2020 at 1:44 p.m. the resident was in his room awake and lying in bed. He was wearing oxygen and it was set at 4.5 liters per minute (LPM). He said he had been using oxygen for six years and he was on 3LPM. His oxygen tubing was labeled with a piece of tape and dated 2/9/2020. On 2/19/2020 at 3:23 p.m. [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure drugs and biologicals were labeled and stored properly for two out of four medication storage rooms and one out of eight medication carts. Specifically, the facility failed to ensure: -Injectable medications were dated when opened in order for the staff to identify when the medications should be removed from service; -An insulin vial, retrieved from the emergency drug unit (Omnicell) had the proper resident identifier; and, -Discontinued medications were removed from medication carts in a timely manner.

Inspectors wroteBased on record review and resident and staff interviews, the facility failed to treat residents with dignity and respect while providing assistance and care for one (#110) of six out of 27 sample residents. Specifically, the facility failed to ensure: -Resident #110 was treated with dignity and respect; and, -The facility failed to demonstrate a thorough investigation was conducted to determine why the resident was upset.

Inspectors wroteBased on observation and interviews the facility failed to have the last three years of recertification survey results, complaints and plans of correction posted in a public area accessible to residents, visitors and staff, without having to ask for them. Specifically, the facility failed to have the state survey results available to residents without asking as well as including the past three years of survey results, complaints and plans of correction.

Inspectors wroteBased on observations, record review and interviews, the facility failed to meet professional standards of quality for one (#50) of five residents reviewed for unnecessary medications of 27 sample residents. Specifically, the facility failed to follow physician orders for the administration of anti-anxiety medication and pain medication for Resident #50.

Inspectors wroteBased on resident, family interviews and record review, the facility failed to ensure the resident received treatment and care in accordance with professional standards of practice, their comprehensive, person centered care plan and the residents choice for one (#50) of three residents reviewed for skin issues non pressure related out of 27 sample residents. Specifically, the facility failed: -To ensure tubigrips were placed on lower extremities for Resident #50 according to physician order.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#39) of five residents reviewed out of 27 residents were as free from unnecessary medications as possible. Specifically, the facility failed to: -Identify, monitor and care plan resident specific targeted behaviors for psychotropic medication use, and side effects of Seroquelfor Resident #39; and, -Document and implement resident specific care plan approaches to include non-pharmacological interventions and non-pharmacological interventions were tried before restarting the resident back on Seroquel.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that the medical record was complete and accurate in keeping with accepted standards of practice for one (#57) of 27 total sampled residents. Specifically, Resident #57's skin assessment were not accurately documented.