Laurels Peak Health Care, LLC

Inspectors wroteBased on observation, interview, and document review, the facility failed to provide the necessary assistance with activities of daily living (ADL) to maintain oral hygiene for 1 of 1 resident (R36) reviewed for ADL assistance.

Inspectors wroteBased on observation, interview, and document review the facility failed to provide appropriate services to ensure 1 of 1 resident (R10) reviewed for abuse maintained his highest practicable psychosocial well-being, specifically dignity.

Inspectors wroteBased on interview, and record review the facility failed to ensure all staff were competent with transferring and walking residents that required transfer assistance for 1 of 3 residents (R1). This deficient practice resulted in R1 falling and fracturing the facial bone. The facility had put corrective measure in place, prior to the start of the survey and therefore, this was issued at past non-compliance.

Inspectors wroteBased on observation, interview, and document review, the facility failed to assess and determine safety for self-administration of medications (SAM) for 5 of 5 residents (R68, R25, R28, R11 and R66) who were observed to have medications at bedside.

Inspectors wroteBased on observation, interview, and document review, the facility failed to maintain the physical environment in good repair to ensure a safe and homelike setting for resident's when baseboard heating register covers were detached or not repaired for 6 of 23 resident rooms (R29, R34, R5, R14, R25, and R49) reviewed for environment.

Inspectors wroteBased on observation and interview, the facility failed to ensure basic infection control practices were followed when 1 of 1 resident (R38's) urinary drainage bag was observed resting on the floor, failed to ensure enhanced barrier precautions (EBP) were implemented for 1 of 1 resident (R68) when staff failed to wear personnel protective equipment (PPE) to empty urinary drainage bag, and failed to ensure proper glove use and hand hygiene was performed during wound care for 1 of 2 residents (R5) reviewed for pressure ulcers. Furthermore, the facility failed to ensure proper infection control practices were followed for 1 of 1 resident (R66) whose nebulizer machine and tubing were left on the floor.

Inspectors wroteBased on observation, interview and document review, the facility failed to follow their grievance process for 1 of 1 resident (R28) who reported missing property.

Inspectors wroteBased on observation, interview and document review, the facility failed to address urinary catheter/drainage bag/leg bag, and CPAP (continuous positive airway pressure) machine in the care plan for 1 of 3 residents (R68) reviewed for care plans.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assist with oral care as directed by the plan of care for 1 of 4 resident (R65) reviewed for activities of daily living (ADLs).

Inspectors wroteBased on interview, observation and record review the facility failed to complete a comprehensive skin assessment and monitoring of impaired skin integrity for 1 of 2 residents (R65) reviewed for skin care.

Inspectors wroteBased on observation, interview, and document review, the facility failed to follow up on a resident's request for vision care and failed to ensure timely scheduling of an eye appointment, resulting in a delay in care for 1 of 1 resident (R44) reviewed for vision services.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure proper cleaning and storage of respiratory equipment (nebulizer and CPAP/BiPAP) resulting in improperly maintained respiratory devices, potential for cross-contamination, and increased risk for respiratory infection for 3 of 4 residents (R12, R44, R68) reviewed for respiratory equipment use.

Inspectors wroteBased on interview, observation, and document review, the facility failed to serve menu items as listed and planned for 1 of 3 residents (R37) reviewed for nutrition services.

Inspectors wroteBased on interviews and document review the facility failed to accurately document a resident's verbal and physical abuse towards staff, and rejection of cares for 1 of 3 residents (R2) reviewed when the Minimum Data Set (MDS) indicated the resident did not have any behaviors or rejection of cares during an evaluation period over seven days. The nursing progress notes for the same period documented daily rejections of care and yelling at staff when they tried to provide hygiene and incontinent care.

Inspectors wroteThe facility failed to develop and revise a person centered behavior care plan, document the risk verse benefit associated with refusing care, identify root cause analysis, and determine what triggered her anxiety and agitation, and provide ordered psychiatric follow up care for 1 of 3 residents (R2) reviewed, when she was found to have maggots on her body because she refused to accept help to change soiled clothing and bed linen, and let housekeeping clean her room.

Inspectors wroteBased on interview and document review, the facility failed to clarify medication orders for 1 of 3 residents (R3) reviewed for medication errors.

Inspectors wroteBased on observations, interview and documents review the facility failed to ensure enhanced barrier precautions (EBP-where gown and gloves used for high contact resident care activities) was used for 2 of 2 resident (R3 and R5).

Inspectors wroteBased on interview and observation, the facility failed to ensure all residents were consistently offered and provided a nutrient and/or calorie-substantive snack after the dinner meal and before bedtime for 19 of 19 residents (R43, R2, R5, R37, R39, R34, R16, R25, R10, R29, R7, R19, R42, R6, R31, R99, R22, R202, R4) who voiced a concern. This had the potential to affect all 51 residents who resided in the facility.

Inspectors wroteBased on observation, interview and document review, the facility failed to consistently monitor and assess a resident for potential complications related to dialysis treatment post treatment, failed to monitor fluid restrictions, failed to notify the provider of refusal of dialysis, and failure to complete dialysis treatment and monitor daily weights per order for 1 of 1 resident (R99) reviewed for dialysis.

Inspectors wroteBased on observation, interview, and document review the facility failed to label insulin pens with opened and expiration dates for 3 of 3 residents (R10, R253, and R24). Further, the facility failed to label an insulin pen with clear, concise, and viewable resident identification for 1 of 1 resident (R10). Finally, the facility failed to dispose of expired eye drop medication for 1 of 1 resident (R4).

Inspectors wroteBased on observation, interview, and document review the facility failed to maintain a clean field, use clean supplies and scissors when performing wound care treatments to reduce the risk and/or prevent infections for 1 of 1 resident (R99) whose treatments were observed for venous ulcer wound care and treatment.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure the kitchen ceiling tiles, tracks, lights and kitchen ceiling vents were kept in a clean and sanitary manner and free of dust and debris. This had the potential to affect all 51 residents residing in the facility.

Inspectors wroteBased on observations, interview, and document review the facility failed to ensure the required nursing staffing information was posted daily. This had the potential to affect all 51 residents residing in the facility and the visitors who may wish to view the information.

Inspectors wroteBased on observation, interview, and document review the facility failed to follow physician orders related to weight gain, and monitor and assess edema (a condition characterized by an excess of watery fluid collecting in the cavities or tissues of the body) for 1 of 1 resident (R2) reviewed for fluid overload.

Inspectors wroteBased on observation, interview, and document review the facility failed to maintain a system to analyze monthly surveillance data for trends and patterns to reduce the spread of illness, infections, control transmission of infections and communicable diseases present in the facility, failed to implement measures to prevent the spread of infection when the facility failed to ensure personal protective equipment (PPE) of N95 masks were worn, and failed to wear appropriate PPE when sorting and handling soiled laundry. This had the potential to affect all 48 residents who resided in the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure meals were served in a timely manner for 5 of 5 residents (R25, R45, R100, R28, R16) reviewed for dining. This deficient practice had the potential to affect all 48 residents residing within the facility.