Laurel Convalescent Hospital

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure potentially hazardous foods were maintained at or above 140 degrees Fahrenheit (unit of measure) at the time of service to residents, when two of two test trays (test trays of food prepared by the facility for temperature and palatability testing) had hot food items which were served to the residents below 140 Degrees Fahrenheit. This failure had the potential to cause foodborne illness in a vulnerable population of 80 residents who reside in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper and safe infection control practices were followed when:1. Certified Nursing Assistant 3 (CNA 3) removed a set of gloves after providing care for a resident and did not perform hand hygiene prior to putting on a new set of gloves to assist another resident.2. CNA 4 (CNA 4) did not wear a gown when changing linens or providing patient care for Resident 3 who was on enhanced barrier precautions (EBP - an infection control strategy that requires healthcare staff to wear gowns and gloves during high-contact care activities for residents who are known or suspected to be colonized/infected with multidrug-resistant organisms or who have wounds or indwelling devices which place them at increased risk for infection). 3. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that two of two residents (Residents 86 and 47) received food served at an appetizing and palatable temperature when Residents 86 and 47 reported their hot foods were often served cold. This failure had the potential to negatively affect Residents 86 and 47 comfort, appetite, and overall satisfaction with meals due to not receiving food at the preferred temperature.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a dignified dining experience for three of twelve residents (Residents 19, 76 and 1) when a Restorative Nursing Assistant (RNA 1), and two Certified Nursing Assistants (CNA 1 and 5) were standing while assisting them to eat during lunch time. These failures had the potential to negatively impact Resident 19, 76 and 1's dignity and psychosocial well-being by failing to provide a respectful, person-centered approach to their dining experience.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident and/or the representatives (RP) was informed of psychotropic medication (medications that affect the mind, emotions, and behaviors) treatment for one of one resident (Resident 63) when Resident 63's informed consent (document signed by resident or RP to give permission for a proposed psychotropic medication and possible risks and benefits expected) was not updated and signed by a provider and by the resident and/or the RP for Resident 63's order of Divalproex Sodium (Depakote-antiseizure and mood stabilizer) 125 milligram (MG-unit of measurement). This failure resulted in Resident 63 and/or their RP not being informed of the psychotropic medication risks, benefits, adverse reactions, and the right to refuse the administration of medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure implementation of their policy and procedure (P&P) for advance directive (a legal document that states a person's wishes about receiving medical care if that person is no longer able to make medical decisions) was completed for one of 24 residents (Resident 87) reviewed for advance directives. This failure had the potential to result in delay of treatment for the Resident 87 as related to advance directives, or for life sustaining measures to be rendered against what the resident wanted.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff documented the location of a resident's pain as required by the physician's order for 1 of 2 residents ( Resident 18) reviewed for pain management. This failure had the potential to result in inaccurate pain assessment, inadequate monitoring, and unmet pain management needs for Resident 18.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure administered medications were accurately documented according to the facility's policies and procedures (P&P) for two out of 13 residents (Residents 45 and 82) when:1. Registered Nurse 2 (RN 2) did not document Resident 45's administration of Omeprazole (a medication used to treat acid reflex) on the Medication Administration Record (MAR- record for what medication a resident has received). This failure had the potential to result in medication errors, including double dosing and may adversely affect Resident 45's health and safety. 2. RN 2 inaccurately documented the administration time of Resident 82's Famotidine (a medication used to treat acid reflex) as 6:53 AM when the medication was observed to be administered at 5:19 AM. [...]

Inspectors wroteBased on interview, and record review, the facility did not ensure one of one resident (Resident 85) medication order for Ambien (a medication used to help treat insomnia [the inability to maintain or initiate sleep]) had a frequency in which the medication could be administered. This had the potential for Resident 85 to experience an overdose of Ambien medication which can cause severe sedation, cognitive impairment, respiratory arrest or coma.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medication error rate was less than five percent. There were three medication errors observed out of a total of 29 opportunities for errors, affecting three out of 13 observed residents (Residents 27, 45, and 82), resulting in an overall medication error rate of 10.34 percent when:1. Famotidine (a medication to treat acid reflux) was not administered to Resident 82 within 60 minutes of scheduled time (one hour before and one hour after) according to the facility's policy and procedure (P&P).2. Omeprazole (a medication to treat acid reflux) was not administered to Resident 45 before 30 minutes of meal according to a physician order. These failures had the potential to result in unmet health care needs and increased risk of complications related to acid reflux for Residents 45 and 82. 3. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure dietary staff prepared and served the large portion sizes, as specified in the resident's physician order, for one of one sampled resident (Resident 66) when Resident 66's breakfast tray was sent from the kitchen without the required large portions. This failure had the potential for Resident 66 to receive a meal inconsistent with the prescribed dietary order.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure resident's equipment was maintained in safe operating condition for 1 of 2 residents (Resident 86) when Resident 86 bed malfunctioned such that the foot section would not elevate, the head and foot controls were reversed, and normal bed positioning could not be performed as intended. This failure had the potential to affect Resident 86 safety, comfort, and positioning needs, and create risk for confusion, distress, and delayed staff response during care.

Inspectors wroteBased on interview and record review, the facility failed to prevent one of three sampled residents (Resident 1), who was diabetic, obese, and immobile and at risk for skin breakdown develop pressure injuries (pressure on body prominence causes breakdown to tissue) as follows: a. Left heel, left great toe and 1st metatarsal developed a deep tissue injury (DTI). And right medial foot fluid blister. b. Acquired an open wound to left elbow and sacral (tailbone) c. No family notification of left elbow and sacral open wound and wound treatment. This failure had the potential to result in a clinically compromised resident, (Resident 1) to be placed at risk for unnecessary pain, infection and death due to wounds not being identified and treated to prevent progressing.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure the kitchen refrigerator temperature was maintained at 40 degrees Fahrenheit (F) or lower. This deficient practice had the potential to affect all residents who received food from the kitchen.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure the residents' fingernails were clean and trimmed for 2 (Resident #2 and Resident #136) of 3 sampled residents reviewed for activities of daily living (ADLs).

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure a resident's catheter was secured using a securement device for 1 (Resident #52) of 2 sampled residents reviewed for urinary catheters.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow their Policy when the nursing staff failed to provide care for 2 of 3 sampled Residents (Resident 1 and 2). This failure had the potential to place two clinically compromised Residents (Resident 1 and 2) psychosocial health and safety at risk. When facility staff failed to provide Resident ' s 1 and 2 with requested care and services.

Inspectors wroteBased on interview and record review the facility failed to prevent for one of three sampled residents Resident 1, two pressure injuries from reopening and an physician order placed a Computed tomography (CT) to right foot, instead of left foot. This failure placed a clinically compromised Residents (Resident 1) health and safety at risk and could have delayed treatment.

Inspectors wroteased on interview and record review, the facility failed to protect against physical and verbal abuse for one of three sampled residents (Resident 1) when Resident 1 fell out of bed and a Certified Nursing Assistant (CNA 1) pulled Resident 1 by one arm back onto the bed and Resident 1 ' s hip rubbed against the footrest. The CNA 1 stated to Resident 1 Stop that! you ' re being annoying! This failure caused Resident 1 to suffer physical and verbal abuse.

Inspectors wroteBased on interview and record review the facility failed to follow their policy when staff did not notify the physician and alternative physician promptly for a change of condition for one of four sampled residents (Resident 1). This failure had the potential to result in a delay of treatment for redness, swelling and tender to touch of the left foot of Resident 1.

Inspectors wroteBased on interview and record review the facility failed to ensure one of four clinically compromised residents (Resident 1) was provided transportation for his dialysis treatment appointment. This failure had the potential to result in a delay of treatment that could adversely affect and further compromise Resident 1 ' s health.

Inspectors wroteBased on interview and record review the facility failed when the Licensed Vocational Nurse (LVN 1) failed to assess, notify the physician and the responsible party of a change of condition for one of three sampled residents (Resident 1) according to facility policy. This failure placed a clinically compromised Resident (Resident 1) health and safety at risk by causing a delay in treatment, and transfer to acute hospital for evaluation.

Inspectors wroteBased on interview and record review the facility failed to continually document blood sugar results in the medical record for one of three sampled residents (Resident 1). This failure placed a clinically compromised Resident (Resident 1's) health and safety at risk when the facility was not able to track blood sugar patterns and results.

Inspectors wroteBased on interview and record review the facility failed to ensure one of three sampled residents (Resident 1) received intravenous antibiotic medications as prescribed by the physician. This failure had placed a clinically compromised Resident (Resident 1) health and safety at risk by causing a delay in treatment when IV antibiotic medication were not given as ordered by a physician.

Inspectors wroteBased on interview, and record review, the facility failed to ensure staff reported an allegation of abuse to outside agencies in the timeframe specified by the facility's policy and procedures (P&P) and as required by federal regulations. This failure resulted in an allegation of abuse to not be reported timely which had the potential to place Resident 1 at risk for ongoing abuse or mistreatment due to a delay in the reporting and investigation of the alleged incident.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent a serious injury for one of three sampled residents' (Resident 1) who sustained a right distal humeral fracture (a break in lower end of the humerus bone) while Certified Nursing Assistant CNA1 was performing care, for one of three sampled residents (Resident 1). This failure contributed to a clinically compromised Resident 1 having to be transferred to general acute hospital for emergency treatment of fracture.

Inspectors wroteBased on interview and record review the facility failed to ensure a change in condition of one of four sampled residents (Resident 1) was reported to the attending physician and the representative in accordance with the facility's policy and procedure. This failure had potential to result in a delay of diagnosis and early treatment for symptoms of low blood sugar.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement safeguards to prevent accident hazards, for one of three sampled residents (Resident 1) when Resident 1 was struck by an object falling from the roof during facility approved roof maintenance. This failure caused Resident 1 to suffer an injury to her left shoulder after being struck by the object falling from the roof.

Inspectors wroteBased on observation, interview and record review, the facility did not have a policy regarding use and storage of foods brought in for residents by family and other visitors, that indicated how they would ensure safe and sanitary storage, handling, and consumption. This had the potential to lead to unsafe food handling and foodborne illness in a medically compromised population of 83 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to perform preventative maintenance on five out of fifteen oxygen concentrators (an electrically powered medical device that uses environmental air and delivers it to a patient in the form of supplemental oxygen), when preventative maintenance was not completed by the expiration date listed on the machine. This failure had a potential to cause avoidable hazards and accidents to residents due to electrical failure, electric shock, and lack of oxygen due to inadequate levels of oxygen being produced by the machine.

Inspectors wroteBased on interview, and record review the facility failed to provide direct care service hours for the entire patient day when there was a shortage of certified nursing assistant (CNA) hours noted on: October 24, 2021, November 5,6,13,and 14 2021 (Dates reviewed October 15, 2021 to November 14, 2021). This failure had the potential of putting the health and safety of clinically compromised residents residing in the facility at risk.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide two out of 18 sampled residents (Residents 71 and 63) the choice to eat their meals in the dining room when there were not enough staff to accommodate them. This failure had a potential to cause psychological harm due to loss of interaction with other residents and the provision of rights that are conducive to a homelike environment.

Inspectors wroteBased on observation, interview and record review, the facility failed to hold the medication as per physician's orders for one of four residents (Resident 25) when the dialysis center recommendation was not followed. This failure has the potential to place Resident 25 at risk of developing complications such as bone fractures, bone pain and muscle weakness.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a system for the disposition of all controlled drugs was maintained in a universe of 83 residents, when two containers, used for the destruction of expired or discontinued controlled drugs, were not secured in a double locked location and contained non-destroyed drugs. This failure had the potential to cause drug diversion (the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use) and accidental exposure.

Inspectors wroteBased on interview and record review, the facility failed to ensure a drug regimen review system was maintained for one of 18 sampled residents (Resident 56) when the pharmacist's reported irregularities were not acted upon for four months. This failure had the potential to cause Resident 56 to receive too much antidepressant medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to secure a metered dose inhaler (a device used to administer medication by breathing it into the lungs) containing Fluticasone, Proprianate and Salmeterol, (medications commonly used for respiratory conditions) when it was observed on a resident's (Resident 7's) bedside table. This failure had a potential to cause harm to other residents who could access the medication without the appropriate knowledge of its use.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow the menu for the dysphagia mechanical diet (texture-modified diet that restricts foods that are difficult to chew or swallow) when Resident 45 received puree (smooth without any lumps) green beans instead of mash-able chopped green beans. This had the potential to lead to the resident not eating the food because it was a more restrictive texture modification than physician prescribed.

Inspectors wroteBased on observation, interview and record review, the facility did not store, and prepare food in accordance with professional standards for food service safety when: 1. There was no air gap on the food preparation sink (a gap between the water supply outlet and the flood level rim of a plumbing fixture or equipment that prevents contamination that may be caused by backflow) 2. Can opener had residue on the blade 3. Bottom shelf of the refrigerator had debris and food stain 4. Pepperoni was uncovered in the freezer 5. The bulk sugar was contaminated with a bug 6. Floor in the dry storage had food debris and trash This had the potential to lead to food borne illness in an immune-compromised population of 80 residents who received food from the kitchen.

Inspectors wroteBased on observation, interview, and facility record review, the facility failed to maintain infection control practices when: 1. Three of eighty-three residents (Resident 25, 40 and 64) had urinals in their rooms which were not labeled with room/bed number and/or resident's name. 2. Staff was observed not performing hand hygiene after providing care for one resident (Resident 13) and retrieve clean linen from the closet. These failures had the potential to spread infectious disease to other residents and staff in the facility.