Lawrence Hall Health & Rehabilitation

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined that the facility failed to ensure Enhanced Barrier Precautions (EBP) were utilized for 1 (Resident #5) of 4 residents reviewed for pressure ulcers.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure medications were not stored on top of the nurse ' s station counter near residents, to prevent misappropriate use of resident owned medications or accidents affecting 1sampled (Resident #72) resident. The facility also failed to ensure the appropriate temperature range was maintained in the 300 Hall medication refrigerator to ensure flu vaccines were stored at the recommended temperatures.

Inspectors wroteThrough observations, interviews, and policy/procedure reviews, it was determined the facility failed to ensure that essential equipment and appliances were kept clean and free of debris and food items were properly stored and labeled.

Inspectors wroteBased on interviews, record review, and facility policy review, it was determined the facility failed to ensure a written discharge summary and information form was completed for 1 (Resident #90) of 1 resident reviewed for discharge.

Inspectors wroteBased on observations, interviews, record review, and facility document review, it was determined that the facility failed to ensure a resident was in the proper position for consuming a meal while in bed for 1 (Resident #13) of 1 resident reviewed for proper positioning during meal consumption.

Inspectors wroteBased on observations, interviews, record review, and facility document review, it was determined that the facility failed to ensure resident received the correct physician ordered diet for 1 (Resident #13) of 1 resident reviewed for therapeutic diet.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure the 200 Hall Soiled Utility door was locked to prevent resident access to dirty linens and trash, failed to ensure the 200 Hall Linen Closet door was locked to prevent resident access to linens, and failed to prevent clean laundry items from resting against the floor to prevent cross contamination. The facility also failed to ensure appropriate hand hygiene was performed during perineal care for 1 (Resident #20) of 1 sampled resident, and during meal service to prevent cross contamination and the risk for infection.

Inspectors wroteBased on interview and record review, the facility failed to ensure a request for Level ll Preadmission Screening and Resident Review (PASRR) was completed and referred to the appropriate state agency for 2 Residents (Resident's #33 and #67), of 45 residents who had a negative Level 1 pre-screen who was later identified with a newly evident serious mental disorder.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure nail care, and personal hygiene was provided on a regular basis to prevent injury, infection, or cross contamination for 2 Residents (R #17 and R #64). Findings follow: 1. On 11/29/23 at 8:59 AM, the Surveyor observed R #17 fingernails to be approximately 1/4 - 1/2 inch past the fingertips with brown colored substance visible underneath nails on both hands. The Surveyor asked R #17 if he liked his nails, the way they were. R #17 answered, No, they are long and need to be cut. I need a bath. The Surveyor asked R #17 when his last bath was. R #17 answered, I'm not sure but it was a week ago this past Monday (11/27/23). The Surveyor asked if it had been 10 days or more since the last bath. R #17 answered, Yes, I think so. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to date and contain oxygen tubing, nebulizer tubing, and date and contain Continuous Positive Airway Pressure (CPAP) tubing, mask, and connectors for 4 Residents (Resident #17, #33, #60, and #239) receiving oxygen/respiratory therapy to prevent cross contamination and infection.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure 1 of 3 ice scoop holders and 1 of 3 ice machines were maintained in a clean and sanitary condition to prevent potential contamination of residents' beverages for residents who received meals from 1 of 1 kitchen; failed to ensure foods stored in the freezer, refrigerator and dry storage area were covered, sealed, and dated to minimize the potential for food borne illness for residents who received meals from 1 of 1 kitchen; failed to ensure 1 of 3 ice scoops and 1 of 3 ice machines were maintained in a clean and sanitary condition to prevent potential contamination of residents' beverages for residents who received meals from 1 of 1 kitchen; [...]

Inspectors wroteBased on interview and record review the facility failed to ensure an antianxiety medication was discontinued or reevaluated for use after 14 days for 2 (residents #58 and #90) of 13 (#3, #5, #6, #10, #22, #35, #50, #53, #57, #65, #72, #84 and #90) final sample residents who had PRN [as needed] antianxiety medications according to a list provided by The Assistant Director of Nursing on 09/14/22 at 10:56 AM. 1. Resident #58 had diagnosis of Anxiety. A Significant Change MDS [Minimum Data Set] with an Assessment Reference Date (ARD) on 7/28/2022 documented a SAMS [staff assessment for mental status of 1/1 [ short- and long-term memory loss]. Residents Care Plan with an initiated date of 10/21/2021, documented, . The resident uses antianxiety medications (Lorazepam PRN [as needed]) r/t [related to] Anxiety, comfort care protocol, Date Initiated: 08/03/2022 . a. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure meals were prepared and served according to the planned written menu to meet the nutritional needs of the residents for 2 of 2 meals observed. This failed practice had the potential to affect 6 residents who received pureed diets, 7 residents who received mechanical soft diets from 1 of 1 kitchen according to a list provided by the Dietary Supervisor on 9/13/2022.

Inspectors wroteBased on observation and interview, the facility failed to ensure pureed food items were blended to a smooth, lump-free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 2 of 2 meals observed. This failed practice had the potential to affect 12 residents who received pureed diets, as documented on the Diet List provided by the Food Service Supervisor on 9/13/2022 at 2:40 PM.

Inspectors wroteBased on Observation, interview, and record review the facility failed to ensure that during the 8:00 AM medication pass, manufacturers guidelines were consistently followed when administering insulin via a pen insulin device for 1 (Resident #51) resident. This failed practice had the potential to effect 4 (#49, #51, #65 and #91) sample residents who had physician's orders for an insulin pen according to a list provided by the ADON [Assistant Director of Nurses] on 9/14/2022 at 12:00 PM.

Inspectors wroteBased on observation, interview, and record review the facility failed to consistently store prescription, Narcotic and over the counter medications in the 300 Hall locked medication cart, to prevent the potential for self-mobile residents to have access to these medications. This failed practice had the potential to effect 3 (#25, #51 and #94) final sample residents who resided on 300 Hall and were self-mobile according to a list provided by the ADON [Assistant Director of Nursing] on 9/14/2022 at 12:07 PM. a. On 09/14/22 at 08:01 AM, the medication cart on 300 Hall was in the hall, unlocked, outside of room [ROOM NUMBER] with the door to residents' room closed completely. No staff was present. b. On 09/14/22 at 08:03 AM, RN# 1 exited room [ROOM NUMBER] and pushed the medication cart to the side and pushed the latch to lock it. The Surveyor asked if she just locked the cart. [...]