Lewis County General Hospital-Nursing Home Unit

Inspectors wroteBased on observation, record review, and interviews (iQIES Intake 3009492) the facility failed to ensure intravenous (through a vein) medications were administered consistent with professional standards of practice and in accordance with physician orders for two of two residents (Residents #122 and #124) reviewed. Specifically, Resident #124's intravenous Zosyn (antibiotic) was not administered timely; their vancomycin (antibiotic) was administered at an incorrect concentration and rate; the provider was not notified of an infiltration (leakage into surrounding tissue) of the resident's intravenous vancomycin; and their intravenous line was not capped when the resident left the facility for an appointment. [...]

Inspectors wroteBased on record review and interviews during the abbreviated surveys (NY00341596, NY00353814, NY00354138, and NY00354190) the facility failed to ensure residents were free from verbal, physical, and mental abuse for 4 of 16 residents reviewed (Resident #1, #3, #4, and #5). Specifically: - Resident #4 was forced to ambulate against their will by several staff members; - Resident #5 was physically restrained by Registered Nurse #9 and Certified Nurse Aide #8 when the registered nurse attempted to obtain a nasal swab for COVID-19 testing from the resident. - Resident #1 was physically and verbally abused by Certified Nurse Aide #6 who was not immediately removed from resident access; [...]

Inspectors wroteBased on record review and interviews during the abbreviated survey (NY00341596, NY00353814, NY00354138, and NY00354190) the facility did not ensure it was administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Specifically, the administration failed to ensure policies and procedures were properly identified, communicated, and consistently implemented for abuse and dementia care. The administration was not aware of the extent of the deficient practices and Immediate Jeopardy was identified on 9/25/2024 in the area of abuse (refer to F 600).

Inspectors wroteBased on observation, record review, and interviews during the abbreviated (NY00348034, NY00353814, NY00354138) surveys, the facility did not ensure a resident who displays or is diagnosed with dementia receives the appropriate treatment and services to attain and or maintain their highest practicable physical, mental, and psychosocial well-being for 3 of 16 residents (Residents #4, #5, and #16) reviewed. Specifically, Residents #4, #5, and #16 had diagnoses of dementia and resided on the dementia unit in the facility and were not cared for in a dementia-informed manner. Resident #4 was forced to ambulate against their will by several staff members after refusing to go to the dining room; Resident #5 was physically restrained by a registered nurse and a certified nurse aide while a nasal swab was obtained; [...]

Inspectors wroteBased on observation, record review, and interview during the recertification and abbreviated (NY00308041 and NY00343021) surveys conducted 7/24/2024-7/31/2024 the facility did not ensure each resident received adequate supervision and the environment remained as free of accident hazards as possible for 2 of 4 resident units (Units 1 and 3) observed and for 1 of 4 residents (Resident #77) reviewed. Specifically: - Unit 1 (dementia unit, also known as the Rainbow Community) had environmental accident hazards readily accessible to residents. - Resident #77, who resided on Unit 1, had a history of wandering throughout the unit and ingesting inedible items, including bar soap. Resident room [ROOM NUMBER] was observed with multiple bars of soap on the sink counter. [...]

Inspectors wroteBased on observation and interview during the recertification survey conducted 7/24/2024-7/30/2024, the facility did not ensure each resident received food and drink that was palatable, flavorful, and at an appetizing temperature for 2 of 2 meal test tray reviewed (the 7/26/2024 lunch meal on Unit 3 and the 7/29/2024 lunch meal on Unit 2). Specifically, food was not served at palatable and appetizing temperatures during the lunch meals on 7/26/2024 and 7/29/2024. Additionally, Resident #26 stated the food did not taste good.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 7/24/2024 - 7/30/2024, the facility did not ensure food was stored, prepared, distributed, and served in accordance with professional standards for food service safety in the main kitchen. Specifically, 7 individual serving size portions of moist and minced fish were stored in cardboard containers dated 2/21 with ice buildup inside the containers; 1 cardboard box of cooked chicken was stored on top of 2 packages of flatbreads; the ice cream cooler contained an employee's personal 20-fluid ounce frozen bottle of water; and the tray line preparation cooler contained 10 sheet pans of uncovered coleslaw, and uncovered 4-ounce servings of strawberries with whipped topping.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 7/24/2024-7/30/2024, the facility did not ensure a resident's ability to safely self-administer medications was clinically appropriate for 1 of 1 resident (Resident #85) reviewed. Specifically, Resident #85 had 6 medications left in a medication cup in their room and there was no documented evidence the resident was assessed to determine their ability to safely self-administer medications or had a physician order for self-administration of medications.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted 7/24/2024-7/30/2024, the facility did not ensure residents were provided appropriate assistive devices and appropriate assistance to maintain or improve their ability to eat and or drink independently for 1 of 1 resident (Resident #29) reviewed. Specifically, Resident #29 was not served food or drinks at meals as planned.

Inspectors wroteBased on observation, record review and interview during the recertification and abbreviated surveys (NY00292492) conducted 6/28/22-7/6/22, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 6 residents (Resident #37) reviewed. Specifically, Resident #37 was at risk for falls, was not using their wheeled walker and was not assisted when ambulating as planned and sustained a fall with a pelvic fracture. Additionally, the resident was observed using a bassinet as an assistive device for ambulating and did not have non-skid floor strips in place in their room as planned. This resulted in actual harm to Resident #37 that was not Immediate Jeopardy.

Inspectors wroteBased on interview, and record review during the recertification survey conducted 6/28/22-7/5/22, the facility failed to operate and provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes, Specifically, there was no documented evidence of a carbon monoxide (CO) policy and procedure including staff education on responding to a CO activation.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 6/28/22-7/6/22, the facility failed to ensure that all alleged violations involving abuse and neglect were reported to The New York State Department of Health (NYS DOH) as required for 1 of 4 residents (Resident #37) reviewed. Specifically, Resident #37 required limited assistance of one for ambulation, sustained a fall with a fracture while ambulating independently and the incident was not reported to the NYS DOH as required.

Inspectors wroteBased on record review and interview during the recertification and abbreviated (NY00282162) surveys conducted 6/28/22 to 7/6/22, the facility failed to ensure all alleged violations of abuse, neglect, or mistreatment were thoroughly investigated for 1 of 9 residents reviewed (Resident #4). Specifically, Resident #4 sustained a burn from coffee, a timely assessment was not completed by the registered nurse (RN) which lead to confusion as to which arm sustained the burn.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted 6/28/22-7/6/22, the facility failed to ensure a resident with an indwelling catheter received the necessary care and services to prevent urinary tract infections for 1 of 3 residents (Resident #104) reviewed. Specifically, Resident #104's catheter bag was observed multiple times in contact with the floor without a barrier or protective cover.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted 6/28/22 - 7/6/22, the facility failed to store drugs and biologicals in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 4 medication rooms (Unit 3) reviewed. Specifically, in the Unit 3 medication refrigerator, multiple tetanus booster vaccines were expired and one purified protein derivative (ppd, for tuberculosis skin test) multidose vial was dated as opened 5/12/22 and was not discarded after 28 days. The facility policy Nursing Home Medication Management-Consultant Pharmacy Services created 4/2020 and reviewed 11/2021 documented: [...]

Inspectors wroteBased on observation and interview during the recertification survey the facility did not ensure results of the most recent Federal/State survey were posted in a place readily accessible to residents, family members and legal representatives of residents, for 4 of 4 anonymous residents in attendance at the Resident Council Meeting. Specifically, survey results were not in an area that was readily accessible to residents or visitors and where individuals wishing to examine survey results did not have to ask to see them.

Inspectors wroteBased on observation, record review and interview during the recertification survey, the facility did not ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 4 of 4 medication carts reviewed for medication storage and labeling. Specifically, multiple insulin pens and vials were opened and undated. The facility policy, Nursing Home - Pharmacy Services, dated 11/2019, documented the following: - Labeling of Medication- medication labels are to be clean and legible, and may not be defaced, altered or revised. [...]