Laurel Ridge Rehab and Skilled Care Center

Inspectors wroteBased on record review and interviews, the facility failed to inform the responsible party in advance, of the risks and benefits of proposed care, and treatment for one Resident (#22) out of a sample of 24 Residents. Specifically, the facility failed to inform Resident #22's responsible party of the risks and benefits of psychotropic medications and obtain consent prior to administering psychotropic medications.

Inspectors wroteBased on record review and interviews, the facility failed to develop a person-centered care plan for one Resident (#43) out of a sample of 24 residents. Specifically, the facility failed to develop a person-centered substance use care plan.

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure Residents at risk for developing pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to prevent new pressure ulcers from developing and worsening for one Resident (#15) out of a total sample of 24 Residents. Specifically, the facility failed to ensure a physician's order for an air mattress was complete resulting in the Resident's air mattress to be set to an incorrect pressure setting.

Inspectors wroteBased on observations, record review, policy review and interviews, the facility failed to provide assistance with Activities of Daily Living (ADLs), for four Residents (#39, #163, #32, #100) out of a total sample of 27 residents. Specifically, 1a. For Resident #39, the facility failed to provide assistance with meals as per the plan of care; 1b. For Resident #163, the facility failed to provide assistance with meals as per the plan of care; 1c. For Resident #32, the facility failed to provide assistance with meals as per the plan of care; 2. For Resident #100, the facility failed to provide supervision with meals as per the plan of care.

Inspectors wroteBased on record review, interview and policy review, the facility failed to ensure services consistent with professional standards were provided for 3 Residents (#44, #263, #51) who required dialysis (a procedure to remove waste products and excess fluid from the body when the kidneys stop working properly), out of total sample of 27 residents. Specifically, the facility failed to follow physician's orders to ensure that blood pressure readings were not taken on the arm where the dialysis shunt (an access point from the dialysis machine to a blood artery) is located.

Inspectors wroteBased on observation, policy review and interview, the facility failed to ensure staff stored all drugs and biologicals in accordance with accepted professional standards of practice. Specifically, 1. The facility failed to ensure nursing stored medications in accordance with State and Federal Laws. 2. The facility failed to properly secure medication carts on two of three units and ensure that medication carts were kept clean on one out of three medication carts reviewed. Findings Include: Review of facility policy titled Medication Storage in The Facility, dated January 2021, indicated the following: -Policy: Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. [...]

Inspectors wroteBased on interviews, observations, and policy review, the facility failed to ensure staff treated residents in a dignified manner during the dining experience. Specifically, for residents who were dependent on staff for assistance with meals, staff were standing over the residents while providing assistance with feeding, on the third floor unit.

Inspectors wroteBased on observations, interviews, record review, and policy review, the facility failed to identify and assess the use of pillows tucked underneath a fitted sheet below the side rails on both sides of the bed as a potential restraint for one Resident (#97) out of a total sample of 27 residents.

Inspectors wroteBased on record review, review of the Resident Assessment Instrument (RAI) manual and interview, the facility failed to ensure the Minimum Data Set (MDS) assessments were accurately completed to reflect the status of three residents (#100, #86 and #13) out of a total sample of 27 residents. Specifically, 1. For Resident #100, the facility failed to indicate on the MDS assessment that the resident had a fall with major injury; 2. For Resident #86, the facility failed to indicate on the MDS assessment that the resident had vision impairment; 3. For Resident #13, the facility failed to indicate on the MDS assessment that the resident was a) not on an antibiotic and b) had an alteration in skin integrity that required a wound dressing. Findings Include: [...]

Inspectors wroteBased on observations, record review, interview and policy review, the facility failed to develop and implement a comprehensive and person-centered care plan for two Residents (#86 and #76) out of a total sample of 27 residents. Specifically, 1. For Resident #86, the facility failed to develop a plan of care for his/her vision impairment; 2. For Resident #76, the facility failed to implement a plan of care for a wander guard (part of a system to prevent resident elopement). Findings Include: 1. Resident #86 was admitted to the facility in September 2023 with diagnoses that include dementia, diabetes and hypertension. Review of Resident #86's most recent Minimum Data Set (MDS) Assessment, dated 3/14/24, indicated a Brief Interview for Mental Status (BIMS) score of 3 out of a possible 15, indicating that the Resident has severe cognitive impairment. [...]

Inspectors wroteBased on record review, observations and interviews, the facility failed to ensure a physician's order was implemented for one Resident (#35) out of a total sample of 27 residents. Specifically, for Resident #35, the facility failed to implement off-loading his/her heels as ordered by the Physician.

Inspectors wroteBased on record review, interview and policy review, the facility failed to ensure recommendations from the Monthly Medication Review conducted by the pharmacist were addressed and acknowledged by the physician in a timely manner for one Resident (#16) out of a total sample of 27 Residents.

Inspectors wroteBased on observation, record review, interview and policy review, the facility failed to ensure the call light was accessible for two Residents (#5, #16) out of a total of 27 residents. Specifically, the facility failed to ensure that the call lights were within reach of Residents #5 and #16 while they were in bed.

Inspectors wroteBased on observations and interviews, the facility failed to post nursing staff data daily, at the start of each shift, relative to licensed and unlicensed nursing staff directly responsible for resident care per shift. Specifically, the facility failed to ensure they consistently posted the staffing and the posting failed to include staffing data including the total number and hours for Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nurse Aides (CNAs), as required.

Inspectors wroteBased on record review, interview and observation the facility failed to ensure they provided supervision and assistance with meals for 3 Residents (#51, #83, #106 ) out of a total sample of 23 Residents.

Inspectors wroteBased on record review and interview the facility staff failed to inform 3 out of 3 Residents or their representatives with potential liability for payment for non-covered services including estimated cost of services.