Laurels of Steubenville the

Inspectors wroteBased on review of medical records and interview with facility staff, the facility failed to administer medications as ordered for Resident #531. This affected one (Resident #531) of three records reviewed during the complaint survey. The facility census was 81.

Inspectors wroteBased on closed medical record review, review of hospice records, review of a facility soft file, interview, and policy review the facility failed to implement an effective pain management program, including the administration of scheduled and as needed opioid medication to effectively manage Resident #86's pain. Actual Harm occurred beginning on [DATE], when Resident #86, who was identified with chronic pain and a new onset of end of life care for pain management, did not receive scheduled or as needed Oxycodone (narcotic pain medication), resulting in uncontrolled pain affecting the resident's end of life care requiring increasing and changing the residents pain medication to re-gain control of the resident's pain. This affected one resident (#86) of three residents reviewed for pain.

Inspectors wroteBased on medical record review and interview the facility failed to ensure narcotic medication was not misappropriated. This affected one resident (#86) of three residents reviewed for pain management.

Inspectors wroteBased on observation and interview, the facility failed to maintain a sanitary, clean and comfortable environment for all residents. This affected residents residing in 10 of 13 rooms observed, involved one of two resident shower/bathing rooms and had the potential to affect all 81 residents residing in the facility.

Inspectors wroteBased on observations, medical record review, and interview, the facility failed to ensure orders were implemented for fall interventions for one (Resident #1) of three residents reviewed for falls.

Inspectors wroteBased on observations, policy review, and interview, the facility failed to implement appropriate infection control practices during medication administration and incontinence care. This affected one (Resident #9) of seven residents observed for medication administration and one (Resident #84) of one resident observed for incontinence care.

Inspectors wroteBased on record review, observation, interview and facility policy review, the facility failed to ensure over the counter medication had clearly labeled expiration dates. This was identified in two of four medication carts and had the potential to affect 18 residents (Residents #1, #9, #12, #25, #32, #37, #39, #47, #52, #54, #55, #59, #71, #73, #184, #285, #293, #296) of 24 residents with orders for aspirin 81 milligrams (mg). In addition, the facility failed to ensure medications were secured for Residents #289 and #292. This affected two residents (#289 and #292) of three residents reviewed for medication storage. The facility census was 86.

Inspectors wroteBased on observation, record review, interview and facility policy review, the facility failed to ensure Resident #289's catheter bag was covered to ensure privacy. This affected one resident (#289) of three residents reviewed for dignity. The facility identified five residents (#2, #11, #70, #289 and #297) as using catheters in the facility. The facility census was 86.

Inspectors wroteBased on record review and interview, the facility failed to ensure that advanced directives were consistent within the medical record. This affected two of two residents (#138 and #139) sampled for advanced directives. The facility census was 86.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure a clean, sanitary environment for a resident with a wound. This affected one resident (#64) of 24 residents' environments which were observed. The facility census was 86.

Inspectors wroteBased on observation, medical record review, facility policy review and interview, the facility failed to timely address reports of intense itching for one (Resident #60) of three residents reviewed for non-pressure-related skin impairment and failed to make timely notification of indicators of congestive heart failure for one (Resident #60) of 24 residents observed for edema. The facility census was 86.

Inspectors wroteBased on observation, record review, review of manufacturer information and interview, the facility failed to implement interventions to address identified risk factors for pressure ulcers and failed to implement physician orders for treatment of pressure ulcers. This affected two (Residents #49 and #139) of three residents reviewed for pressure ulcers. The facility census was 86.

Inspectors wroteBased on observation, record review, staff interview and facility policy review, the facility failed to ensure Resident #21, who was incontinent of bladder, received appropriate treatment and services to prevent urinary tract infections (UTI) and failed to ensure Resident #21, who was incontinent of bowel, received appropriate treatment and services to restore as much normal bowel function as possible. This affected one resident (#21) of one resident reviewed for bowel and bladder incontinence and UTI. The facility census was 86.

Inspectors wroteBased on observation, record review, interview and facility policy review, the facility failed to ensure oxygen was administered as ordered by the physician for Resident #289 and failed to ensure oxygen tubing was dated when changed for Residents #289 and #292. This affected two residents (#289 and #292) of three residents reviewed for oxygen administration. The facility identified 18 residents (#1, #3, #15, #16, #21, #34, #44, #62, #70, #71, #139, #235, #284, #285, #289, #292, #295 and #297) who utilized oxygen. The facility census was 86.

Inspectors wroteBased on record review, interview and facility policy review, the facility failed to ensure pre and post dialysis assessments were consistently completed for Resident #66. This affected one resident (#66) of one resident reviewed for hemodialysis services. The facility census was 86.

Inspectors wroteBased on record review, interview and facility policy review, the facility failed to ensure parameters were in place for the administration of pain medication and failed to ensure nonpharmacological interventions were attempted prior to administering narcotic pain medication to Resident #3. In addition, the facility failed to ensure insulin was given according to the physician's orders for Resident #21. This affected two residents (#3 and #21) of five resident reviewed for unnecessary medications. The facility census was 86.

Inspectors wroteBased on review of the medial record and interview with staff, the facility failed to ensure a physician's order was written for laboratory tests obtained and laboratory tests were obtained immediately (STAT) as ordered by the physician for Resident #2. This affected one resident (#2) of five residents reviewed for antibiotic stewardship. The facility census was 86.

Inspectors wroteBased on review of the medical record, interview with staff, review of information from the PneumoRecs Vax Advisor application and facility policy review, the facility failed to ensure the pneumonia vaccine was up to date for Resident #19. This affected one resident (#19) of five residents reviewed for vaccination status. The facility census was 86.

Inspectors wroteBased on observations, medical record review, policy review, and interview, the facility failed to adequately address residents' complaints of pain for two (Residents #29 and #326) of five residents reviewed for pain. Actual Harm occurred to Resident #326 on 11/13/22 after staff assessed her with pain which was almost constant with a severity of nine on a scale of zero to ten with acknowledgment Resident #326 had no pain interventions in place, but did not pursue attempts to provide pain relief. Actual Harm occurred to Resident #29 on 11/14/22 after she was noted crying with interview revealing she was having pain from a fractured shoulder and requested ordered pain medication which the nurse refused to administer stating Resident #29 had been medicated earlier.

Inspectors wroteBased on review of schedules and interviews, the facility failed to ensure the Director of Nursing (DON) did not work as a charge nurse when the facility census was greater than 60. This had the potential to affect all 79 residents residing in the facility.

Inspectors wroteBased on observation, record review, staff interview, and facility policy review revealed the facility failed to ensure staff waited for permission to enter a resident's room while she was sleeping. This affected one resident (Resident #177) of three reviewed for dignity. The facility census was 79.

Inspectors wroteBased on observation, record review, staff interview, and facility policy review the facility failed to ensure the call light was within reach for Resident #177. This affected one resident (Resident #177) of 24 residents observed for call lights within reach. The facility census was 79.

Inspectors wroteBased on observation, record review, and staff interview the facility failed to ensure privacy was maintained during a medical treatment for Resident #176. This affected one resident (Resident #176) of one reviewed for privacy. The facility census was 79.

Inspectors wroteBased on record review and interview, the facility failed to ensure a comprehensive bowel and bladder assessment was completed for Resident #67. This affected one (Resident #67) of nine residents reviewed for assessments. The facility census was 79.

Inspectors wroteBased on record review, review of the Centers for Medicare and Medicaid Services' (CMS) Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, and staff interview, the facility failed to ensure Minimum Data Set (MDS) Assessments were completed as required. This affected one (Resident #5) of three residents closed records reviewed. The census was 79.

Inspectors wroteBased on observations, review of the medical record, review of activity calendars, review of activity attendance sheets, and staff interviews revealed the facility failed to provide activities to Resident #68. This affected one (Resident #68) of two residents reviewed for activities. The facility census was 79.

Inspectors wroteBased on review of the medical record and staff interview the facility failed to ensure daily weights for Resident #176 were obtained as ordered. This affected one (Resident #176) of 24 resident records reviewed. The facility census was 79.

Inspectors wroteBased on review of a medical record, observations, and staff interviews the facility failed to ensure a deep tissue injury (DTI) was assessed and an order was obtained timely for Resident #176. This affected one (Resident #176) of two residents reviewed for pressure ulcers. The facility census was 79.

Inspectors wroteBased on observation, medical record review, and interview the facility failed to implement appropriate care plan interventions and/or orders for fall prevention for two (Residents #29 and #63) of five residents reviewed for accidents. The facility census was 79.

Inspectors wroteBased on record review and interview, the facility failed to ensure a clinical assessment was completed before and after each dialysis session for Resident #51. This affected one (Resident #51) of one resident reviewed for dialysis. The census was 79.

Inspectors wroteBased on record review and staff interview the facility failed to ensure non-pharmacological interventions were attempted prior to the administration of pain medication, for Residents #34 and #58. This affected two (Residents #34 and #58) of six residents reviewed for unnecessary medication use. The facility census was 79.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident #42's recommendation for a gradual dose reduction (GDR) was addressed by the physician. This affected one (Resident #42) of six residents reviewed for unnecessary medications. The facility census was 79.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure evening snacks were provided to all residents. This affected ten residents (#20, #41, #48, #75, #192, #51, #46, #8, #33 and #35) and had the potential to affect all 95 residents residing in the facility.

Inspectors wroteBased on record review and staff interview the facility failed to ensure Preadmission Screening and Resident Reviews (PASARRs) were completed and accurate to capture changes in diagnosis warranting a reassessment. This affected four residents (#9, #24, #34 and #51) of four residents reviewed for PASARR.

Inspectors wroteBased on observation, medical record review, policy review and interview the facility failed to maintain Resident #59's dignity related to the use of an indwelling urinary catheter. This affected one resident (#59) of two residents observed with an indwelling urinary catheter.

Inspectors wroteBased on observation, record review and interview the facility failed to provide a dining table at an appropriate height to accommodate Resident #57's needs. This affected one resident (#57) of one resident reviewed for accommodation of needs.

Inspectors wroteBased on record review and interview the facility failed to ensure Minimum Data Set (MDS) 3.0 assessments were accurately completed for Resident #53 and Resident #86. This affected two residents (#53 and #86) of 31 residents whose MDS assessments were reviewed.

Inspectors wroteBased on record review and staff interview the facility failed to develop, implement and provide residents/representatives with a baseline plan of care as required. This affected two resident (#58 and #284) of eight residents reviewed for baseline plans of care.

Inspectors wroteBased on observation, medical record review and interview the facility failed to ensure Resident #7, who was dependent on staff for personal care was provided timely care and care according to the resident's preferences. This affected one resident (#7) of five residents reviewed for activities of daily living (ADL). The facility identified 28 residents dependent on staff for bathing. The facility census was 95.

Inspectors wroteBased on record review and interview the facility failed to ensure Resident #27's hearing aids were in proper working order and failed to obtain hearing aids for Resident #34. This affected two residents (#27 and #34) of three residents reviewed for hearing.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure Resident #14, who was at risk for falls was provided fall safety interventions as care planned. This affected one resident (#14) of two residents reviewed for accidents.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure adequate and necessary care and treatment was provided for Resident #42 related to the use of an indwelling urinary catheter. The facility also failed to ensure a bowel program was initiated for Resident #58 after a noted decline in bowel function. This affected one resident (#42) of three residents reviewed for UTI/catheters and one resident (#58) of one resident reviewed for bowel function.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure physician orders were in place for the administration of oxygen, failed to ensure humidification was properly used and/or failed to ensure respiratory equipment was maintained in a clean/sanitary manner for Resident #25, #37, and #56. This affected three residents (#25, #37 and #56) of four residents reviewed for respiratory care.

Inspectors wroteBased on medical record review and interview the facility failed to ensure Resident #51 received behavior health services to assist the resident to attain or maintain her highest level of well-being. This affected one resident (#51) of four residents reviewed for Preadmission Screening and Resident Review (PASARR) Identification Screen.

Inspectors wroteBased on record review and interview the facility failed to ensure the justified use of narcotic pain medication for Resident #284 and Resident #58. The facility failed to ensure parameters were in place related to medication administration, failed to ensure medication was administered only after a comprehensive pain assessment had been completed and/or failed to ensure evidence of non-pharmacological interventions prior to the medication administration. This affected two residents (#58 and #284) of five residents reviewed for unnecessary medication use. The facility identified five residents on a pain management program.

Inspectors wroteBased on record review and interview the facility failed to ensure Resident #190's medical record was complete and accurate related to infection and antibiotic use. This affected one resident (#190) of 31 residents whose medical records were reviewed.

Inspectors wroteBased on record review and interview the facility failed to implement a comprehensive antibiotic stewardship program to monitor and prevent the unnecessary/inappropriate use of antibiotics. This affected two residents (#58 and #195) of five residents reviewed for infections.