Legacy at Boca Raton Rehabilitation and Nursing Ce

Inspectors wroteBased on review of policy and procedures, observation, record review and interview, the facility failed to ensure that a resident was treated in a dignified manner for 2 of 2 sampled residents observed with Foley Catheters, (Resident #31 and Resident #122).

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide assistance to a resident who was unable to carry out with Activities of Daily Living (ADLs) for 1 of 9 sampled residents (Resident #110) reviewed for ADLs.

Inspectors wrote1). Based on observations, interviews and record review, the facility failed to identify the need for skin care and treatment for 1 of 2 sampled residents reviewed for skin conditions (Resident #14); and 2). Based on observation, record review and interview, the facility failed to follow physician orders for 2 of 4 sampled residents observed during medication administration (Resident #137 and Resident #59).

Inspectors wroteBased on review of policy and procedures, observation, record review and interview, the facility failed to ensure professional standards were followed for 1 of 1 sampled resident observed for Foley catheters (Resident #31).

Inspectors wroteNumber of residents sampled: Number of residents cited: Review of the un-dated facility policy titled Oxygen Administration provided by the Director of Nursing (DON) documented in the Policy Statement. The purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation: 1. Verify that there is a physician's order for this procedure. Review the physician's order or facility protocol for oxygen administration. Documentation: After completing the oxygen setup or adjustment, the following information should be recorded in the resident's medical record: 1. The date and time that the procedure was performed. 2. The name and title of the individual who performed the procedure. 3. The rate of oxygen flow, route, and rationale. 4. The frequency and duration of the treatment. 5. The reason for p.r.n. (as needed) administration. 6. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow doctors' orders for 2 of 4 sampled residents during the Medication Administration Observation. (Resident #59, Resident #137). There were 2 errors for 27 opportunities which resulted in an error rate of 7.41%.

Inspectors wroteBased on interview and record review, the facility failed to appropriate services to a resident who is incontinent of bladder, to prevent urinary tract infections for 1 of 3 sampled residents reviewed for incontinence (Resident # 1).

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide a clean environment free of offensive odor in 1 of 3 units (Berkshire Unit). As evidenced by a foul urine like odor, noted during a tour of the facility.

Inspectors wroteBased on record review, observations and interviews, the facility failed to identify and treat resident's skin redness/rash for 1 of 3 sampled residents (Resident #3). As evidenced by a redness area observed on Resident #3's chest, right upper arm and left upper arm, with no documented treatment in place.

Inspectors wroteBased on observation and interview, it was determined that the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety.

Inspectors wroteBased on observation and interview, it was determined that the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior on the B Wing (1 of 33 rooms), C Wing (17 of 33 rooms) and D Wing (1 of 39 rooms).

Inspectors wroteBased on observation, interview and review of policy and procedure, the facility failed to: 1) ensure that residents medications were properly stored, as evidenced by over the counter medications being left in the resident's room for 5 of 5 sampled residents (Resident #119, #474, #473, #475, and #476); 2) ensure that residents prescription medication were properly stored at the B-wing, as evidenced by medications being left in a medication cup in the resident's room (Resident #129) 3) ensure that resident's medication were stored properly, as evidenced by an opened bottle of Nitroglycerin tablets being left in a drawer at the C-wing nurses station. 4) ensure that it secured 2 of 3 wound care supply carts, located in the C and D wing.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to follow the approved menu for physician ordered Regular Diets for 133 residents ( including sampled Resident's #112, #162, #119), Mechanical Altered Chopped Diets for 24 residents (including sampled Residents #14, #17, #29, and 97), Mechanical Altered Ground Diets for 3 residents (including sampled Resident #116) , and Pureed Diets for 10 residents (including sampled Residents #7 and #92).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to prepare food by methods that conserve methods that conserve nutritive value, flavor, and appearance for 10 physician ordered pureed diets(including sampled Residents #7 and #92), 24 physician ordered Mechanically Altered Chopped Diet (including sampled Residents #14, #17, #29, #29, and #97), and 3 physician Mechanically Altered Ground Diet (including sampled Resident #116).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to prepare food in a proper pureed form to meet the needs of 10 facility residents with physician ordered Pureed Diet which included Sampled Resident's #7 and #92.

Inspectors wroteBased on observations, interviews and record review, the facility failed prevent verbal abuse towards a resident from a staff member for 1 of 1 sampled resident, (Resident #54).

Inspectors wroteBased on observations, interviews, and record review, the facility failed to report an injury of unknown origin in a timely manner for 1 out of 1 sampled resident reviewed for skin discoloration (Resident #104).

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide and identify the need for psychosocial assessments in a timely manner for 1 out of 1 sampled resident reviewed for disruptive yelling out behaviors (Resident #104). The facility also failed to follow Physician's orders to report blood sugar readings of 400 and above to the Physician for 1 out of 1 sampled resident reviewed for insulin (Resident #323). In addition, the facility failed to perform a skin assessment in a timely manner for 1 out of 1 sampled resident reviewed for skin condition (Resident #71).

Inspectors wroteBased on record review, observations and interviews, the facility failed to ensure that a resident receives wound care consistent with professional standards of practice for 1of 1 sampled residents reviewed for wound care (Resident #30).

Inspectors wroteBased on review of policy and procedure, observation, interview and record review, the facility failed to ensure that it performed appropriate hand hygiene, care and cleanliness to avoid cross-contamination, per professional standards, during Perineal and Foley Catheter care for 1 of 1 sampled residents observed, (Resident #97).

Inspectors wroteBased on interview and record review, the facility failed to reimburse a resident's representative for monies spent on the resident from the resident's trust fund for 1 of 1 sampled resident, reviewed for personal funds (Resident #3).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to store, prepare, distribute and serve food in accordance with professional standards that include: failure to maintain refrigeration units, failure to ensure washing in the 3-compartment sink, failure to maintain and clean ceiling and light fixtures, and failure to clean and sanitize commercial food preparation equipment.

Inspectors wroteBased on observation, interview and record review, the facility failed to serve residents in a manner to enhance or maintain the dignity of the residents during dining.

Inspectors wroteBased on interview and record review, the facility failed to act on and resolve grievances voiced by the Resident Council, with the potential to effect residents in the facility that prefer meals in the Dining Rooms(s) and the timing of the meals being served.

Inspectors wroteBased on observations and interviews, the facility failed to maintain the facility's laundry services in a clean and sanitary manner.

Inspectors wroteBased on observations, interviews and record review, the facility failed to 1) ensure expired supplements and medical/biologicals supplies were removed from 2 of 3 medications/supplements storage room reviewed (Cambridge Unit, [NAME] Unit, and the Biological Storage Room); 2) keep medications carts free from loose pills/tablets noted in the drawers for 2 of 4 medications carts reviewed; and 3) ensure that 1 of 3 treatment carts (Berkshire Unit) and 1 of 3 respiratory care carts were kept secure/locked.

Inspectors wroteBased on observation, interview, and record review, it was determined that the approved menu was not followed for physician ordered Purred Diet, Chopped Diet, and Ground Diet which effected 8 of 8 sampled (Resident #10, #14, #70, #81, #87, #92, #98, and #213).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to prepare food by methods that conserve nutritive value, flavor, and appearance for physician ordered Pureed Diets which included 13 facility residents (Sampled Resident's #10, #78, #87, and #92).

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess 2 of 2 sampled residents for self-administration of medications for Resident #79 to safely store, transport and administer mediations at dialysis, and for Resident #34 to safely to store, and administer medications in the resident's room.

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide foot care to 2 of 2 sampled residents reviewed for foot care (Resident #39 and #78).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to follow physician ordered Fluid restriction for 1 (Resident #79) 5 sampled residents reviewed for nutrition.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to maintain resident's private health information in a secure manner and the facility failed to follow physician's orders for Resident #415.