Las Estancias by Pure Health

Inspectors wroteBased on interview and record review, the facility failed to coordinate vision services for 1 (R# 1) of 1 (R #1) resident reviewed for outside vision services, when:The facility did not adhere to the care plan and failed to schedule a vision appointment for approximately three months. This deficient practice is likely to result in residents being unable to achieve their full visual potential, thereby diminishing their quality of life.

Inspectors wroteBased on observation and interview, the facility failed to store and serve food under sanitary conditions when staff failed to ensure: 1. All items were labeled and dated in the kitchen refrigerator. 2. The counter tops and shelves were clean. 3. The floors throughout the kitchen were clean. 4. The heated plate dispenser (a device used to heat and store plates prior to use) was clean. These deficient practices are likely to affect all 115 residents listed on the resident census provided by the Administrator on 02/17/25 and are likely to lead to foodborne illnesses in residents.

Inspectors wroteBased on observation, record review, and interview, the facility failed to develop and implement an accurate, person-centered comprehensive care plan for 4 (R #4, R #72, R #109, and R #164) of 9 (R #3, R #4, R #8, R #37, R #46, R #62, R #72, R #109 and R #164) residents reviewed for care plans. This deficient practice is likely to result in staff being unaware of the current and actual needs of the residents.

Inspectors wroteBased on interview, record review, and observation, the facility failed to ensure staff served meals that were attractive and palatable (pleasant to taste) for 8 (R #'s 4, 12, 37, 46, 99, 105, 108, and 165) of 10(R #'s 4, 8, 12, 37, 46, 48, 99, 105, 108, and 165) residents reviewed for meal quality. This deficient practice reduces residents' ability to eat and enjoy meals, may decrease their quality of life, and could likely lose weight.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care (health care discipline specializing in the promotion of optimum cardiopulmonary (promotion of health and wellness in the respiratory system (lungs)) function, that was consistent with professional standards of practice for 2 (R #46 and R #62) of 5 (R #4, R #8, R #46, R #62 and R #72) resident sampled for respiratory care when staff failed to change R #46's and R #62's nasal cannula (medical device to provide supplemental oxygen therapy to through the nose) within seven days of the previous change. This deficient practice could likely cause the nasal cannula to become obstructed, non-functional, and unsanitary and not provide the resident with the oxygen needed.

Inspectors wroteBased on record review and interview, the facility failed to offer COVID-19 (an acute respiratory disease in humans characterized mainly by fever and cough and capable of progressing to severe symptoms and in some cases death, especially in older people and those with underlying health conditions) vaccinations to 1 (R #8) of 5 (R #3, R #4, R #8, R #15, and R #46) residents reviewed for COVID-19 vaccinations. This deficient practice could likely result in residents getting COVID-19.

Inspectors wroteBased on record review and interview, the facility failed to ensure Certified Nurse Aides (CNAs) received the required in-service training of 12 hours per year for 3 (CNA #1, CNA #2, and CNA #3) of 5 (CNA #1, CNA #2, CNA #3, CNA #4, and CNA #5) CNAs reviewed for required in-service training. This deficient practice is likely to result in the CNAs not receiving the necessary training to meet the care needs of the residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Pre-admission Screening and Resident Review (PASRR; a screening to help ensure that individuals are not inappropriately placed in nursing homes for long term care) assessment was accurate for 1 (R #3) of 4 (R #3, R #8, R #37, and R #112) residents reviewed for PASRR accuracy. This deficient practice is likely to result in the residents not receiving the services they need.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure staff revised the care plan for 1 (R # 21) of 1 (R # 21) resident reviewed when staff failed to: 1. Update R 21's plan of care to include fall prevention and interventions. 2. Update R #21's plan of care to include oxygen therapy. 3. Update R #21's plan of care to include vision loss under ADL (activities of daily living) self-care performance deficit. This deficient practice is likely to result in staff not being aware of residents' care needs and preferences, and residents not receiving the needed care.

Inspectors wroteBased on record review and interview, the facility failed to adequately monitor for the stop on the antibiotic for 1 (R #109) of 1 (R #109) resident reviewed for stop date on an antibiotic. This deficient practice could likely lead to overuse of an antibiotic and lead to multi-drug-resistant infections, antibiotic resistance and poor patient outcomes.

Inspectors wroteBased on record review and interview, the facility failed to offer the influenza (for Flu virus, a highly contagious viral respiratory infection that affects the nose, throat, and sometimes the lungs) vaccine for 1 (R #8) of 5 (R #3, R #4, R #8, R #15, and R #46) residents reviewed for immunizations. If residents are not given the opportunity to consent or decline the vaccine as appropriate against the flu, then they have a higher likelihood of contracting the illness and spreading it to other residents in the facility.

Inspectors wroteBased on observation and interview the facility failed to properly store medications in a medication cart. This deficient practice has the likelihood to result in all 36 residents in 100 hall, and all 18 residents in the 300 hall that were identified on the census list provided by the administrator on [DATE], to receive expired or improperly temperature-controlled medications that have either lost their potency or effectiveness.

Inspectors wroteBased on record review and interview, the facility failed to maintain a process of ensuring antipsychotic medications (medications that alter brain chemistry to help reduce psychotic symptoms like hallucinations, delusions and disordered thinking) are prescribed to treat a specific condition as diagnosed and documented in the clinical record for 1 (R #55) of 2 (R #26 and R #55) residents reviewed for the use of psychotropic medication. This deficient practice could likely result in residents receiving a psychotropic medication without a corresponding active diagnosis.

Inspectors wroteBased on observation, record review, and interview, the facility failed to maintain proper infection prevention measures by: 1. Not wearing the proper personal protective equipment (PPE) before entering a resident's room under droplet precautions (set of measures to prevent the transmission of bacteria and viruses that are spread through respiratory liquid). 2. Not performing hand hygiene between residents. This deficient practice could likely result in the spread of infectious agents (viruses and bacteria) between the 36 residents in the 100 hall.

Inspectors wroteBased on record review and interview, the facility failed to: 1. Reconcile medications (to identify active medications and remove discontinued medications) during discharge; 2. Follow physician's order to create a referral. This deficient practice affected 2 (R #265 and R #6) of 5 (R #6, R #13, R #55, R #85, and R #265) residents reviewed for safe discharge and disease management. This deficient practice could likely result in an erroneous administration of medication and residents not feeling well due to a lack of consultation. Findings related to Medication Reconciliation: A. On 11/14/23 at 11:19 am, during an interview, the family member of R #265 said the discharge nurse at the facility gave her the resident's medication in a plastic bag, but the nurse did not tell her what to do with the medications. [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the physician of oxygen saturation levels falling below and failed to notify the physician of a conflict with a residents dialysis schedule and not receiving some medications for 3 (R #156, 161 and 164) of 3 (R #s 156, 161 and 164) residents being looked at for vitals and medications. This deficient practice could likely cause an underlying condition to go untreated and a resident to receive medications inconsistently, causing harm to the residents.

Inspectors wroteBased on record review and interview, the facility failed to develop a baseline care plan within 48 hours after admission to include the minimum healthcare information for 3 (R #'s 161, 162, and 254) of 4 (R #'s 76, 161, 162, and 254 ) residents reviewed for baseline care plans. This deficient practice may likely result in a lack of appropriate and consistent care for any affected resident.

Inspectors wroteBased on record review and interview, the facility failed to develop and implement (put into place) a comprehensive person-centered care plan for 2 (R #63 and #76) of 3 (R #63, #76 and #305) residents reviewed for care plans. This deficient practice could likely result in staff's failure to understand and implement the needs and treatments of the residents.

Inspectors wroteBased on record review and interview, the facility failed to provide medications as per physicians' orders for 2 (R #80 and 255) of 2 (R # 80 and 255) residents noted to have missed ordered doses of medication because the medications were not available to administer at the times that they were scheduled to be given This deficient practice may likely result in residents failing to achieve their highest level of well being.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the medication error rate did not exceed 5% by failing to give ordered medications timely for 2 (R #80 and 255) of 7 (R #'s 52, 80, 85, 93, 154, 158 and 255) residents reviewed for medication administration. This resulted in seven errors out of forty opportunities for error and an error rate of 17.5 percent. If medications are not administered as ordered, residents are likely to experience an exacerbation [sudden worsening] or lack of relief from symptoms that the medication was ordered to prevent.

Inspectors wroteBased on record review and interview, the facility failed to ensure that medical records were complete and accurate for 3 (R #'s 37, 80 and 254) of 3 (R #'s 37, 80 and 255) residents noted to lack the necessary documentation or have inaccurate documentation in their medical records. This deficient practice may likely have a negative impact on the well being of any resident affected as caregivers may not have the information needed to provide optimum care.

Inspectors wroteBased on record review and interview, the facility failed to provide care and treatment in accordance with professional standards of practice 1 (R #60) of 1 (R #60) resident looked at for medication issues. This deficient practice could likely cause confusion with nursing staff around when to give and not give certain medications and cause the resident to receive inconsistent treatment.

Inspectors wroteBased on observation, record review, and interview the facility failed to provide ADL (Activities of Daily Living) with trimming toenails for 1 (R #37) of 1(R #37) resident sampled for ADL care. This deficient practice could likely result in residents becoming depressed (mood disorder that causes a persistent feeling of sadness and loss of interest) anxious (experiencing worry, unease, and nervousness about an uncertain outcome), and lacking self-worth.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that 1 (R #76) of 1 (R #76) resident reviewed for hearing, kept track of proper assistive devices to maintain his hearing. If the facility is not assisting residents in accessing treatment and devices to maintain their hearing, residents are likely to lose their ability to hear and communicate.

Inspectors wroteBased on record review and interview the facility failed to have physician orders for monitoring the shunt site (a hemodialysis shunt, graft, or fistula provides vascular access for hemodialysis, a treatment that cleans the blood by removing wastes and excess water from the body) for 1 (R #16) of 3 (R #16, 161 and 162) residents reviewed for dialysis care. This failed practice could potentially result in staff not being unaware of changes that could occur for a resident on dialysis.

Inspectors wroteBased on record review and interview the facility failed to ensure that 1 (R #63) of 1 (R #63) residents who were diagnosed with Dementia [a group of symptoms that together affect the memory, normal thinking, communicating and reasoning ability of a person] had a comprehensive care plan developed/implemented to address the resident's individual needs. This deficient practice could lead to residents experiencing an avoidable decline in their physical and mental health.

Inspectors wroteBased on record review and interview the facility failed to ensure medically-related social services were provided for 1(R #102) of 1 (R #102) resident that was identified as needing assistance with funding for services repairing his broken electric wheelchair. This deficient practice could likely result in a residents decline in physical functioning and the onset of feelings of depression (mood disorder that causes a persistent feeling of sadness and loss of interest) and isolation (the sense of being alone, separated from others, either socially or emotionally.

Inspectors wroteBased on record review and interview, the facility failed to ensure that the attending physician accurately documented in the resident's medical record his or her rationale for not following the pharmacist recommendations for 1 (R #63) of 1 (R #63) sampled for drug (medication) regimen review (thorough evaluation of the medication regimen of a resident, with the goal of promoting positive outcomes and minimizing adverse consequences [undesirable effects of medication]). This deficient practice could likely result in residents receiving medications that may have adverse consequences, receiving medications longer than needed or at a higher or incorrect dose.