Lewiston Transitional Care of Cascadia

Inspectors wroteBased on observation, review of the Food, Drug, Administration (FDA) Food Code, and staff interview, it was determined the facility failed to ensure staff food and physical therapy ice packs were stored separately from resident food in a freezer, resident food was not dated correctly, and pest control measures were not followed. This was true for the 66 residents who consumed food stored and prepared by the facility. This placed residents at risk for potential contamination of food and adverse health outcomes, including food-borne illnesses.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to update a resident's care plan for 1 of 17 residents (Resident #54) reviewed for care plan accuracy. This deficient practice created the potential for harm if resident's care plan was not current for health care interventions.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to follow a dietary restriction related to a food allergy. This was true for 1 of 1 resident (Resident #14) whose medical record was reviewed for food allergies. This deficient practice had the potential to cause harm or death related to anaphylaxis (a severe, potentially life-threatening allergic reaction) when staff failed to follow dietary restrictions related to food allergies.

Inspectors wroteBased on record review, and resident and staff interviews, it was determined the facility failed to ensure resident's pain was effectively managed and treated. This was true for 1 of 3 residents (Resident #31) reviewed for pain management. This deficient practice created the potential for harm should residents not receive effective pain management.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to ensure significant medication errors were prevented. This was true for 1 of 6 residents (Resident #14) reviewed for significant medication errors. This failed practice had the potential for harm if medications were not administered according to physicians orders.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure infection prevention standards were followed. This was true for 1 of 1 resident (Resident #40) whose intravenous (IV) medication administration was observed. This failure created the potential for harm if infectious pathogens (any organism that causes disease) were introduced to his peripherally inserted central catheter (PICC- a thin tube placed in a vein in the arm passed through to the large vessels near the heart).

Inspectors wroteBased on policy review, observation, and staff interview, it was determined the facility failed to ensure food was not expired and the stove hood was cleaned in 1 of 1 kitchen. These deficiencies had the potential to affect 69 residents residing in the facility who consumed food prepared by the facility. This placed residents at risk for potential contamination of food and adverse health outcomes, including food-borne illnesses.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure a Level I Preadmission Screening and Resident Review (PASARR) was updated to include a diagnosis of Post-Traumatic Stress Disorder (PTSD). This was true for 1 of 1 resident (Resident #29) whose PASARR record was reviewed. This deficient practice had the potential to cause harm if residents' specialized services for mental health needs were not provided due to a lack of updated screening.

Inspectors wroteBased on record review, policy review, and resident and staff interview, it was determined the facility failed to ensure residents were provided with bathing consistent with their needs. This was true for 1 of 3 residents (Resident #6) reviewed for activities of daily living. This failure created the potential for residents to experience embarrassment, isolation, decreased sense of self-worth, and skin impairment due to a lack of personal hygiene.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure resident records included an advanced directive, or documentation of an advanced directive being offered. This was true for 3 of 7 residents (#2, #50, and #52) whose records were reviewed for advanced directives. This failed practice created the potential for harm if residents' wishes regarding end of life or emergent care were not honored if they became incapacitated.

Inspectors wroteBased on observation, staff interview, manufacturer's instructions, and policy review, it was determined the facility failed to ensure a vial of Tuberculin Purified Protein Derivative (PPD- a solution that is injected under the skin and used to help diagnose tuberculosis) was discarded 30 days after the open date. This was true for 1 of 2 medication storage rooms reviewed for outdated medications. This failed practice had the potential to result in decreased potency of the PPD, resulting in a false tuberculosis (TB) test readings, and had the potential to affect all residents who resided on the A wing and received the PPD.

Inspectors wroteBased on observation, policy review, and resident and staff interview, it was determined the facility failed to ensure residents' room temperatures were maintained at a comfortable level. This was true for 2 of 17 residents (#41 and #46) whose environment was observed. This deficient practice created the potential for harm if residents became too cold or hot and it compromised their health status.

Inspectors wroteBased on record review, policy review, and resident representative and staff interview, it was determined the facility failed to ensure transfer notices were provided in writing to residents and their representatives. This was true for 1 of 2 residents (Resident #50) reviewed for transfers. This created the potential for harm if residents were not made aware of or able to exercise their rights related to transfers.

Inspectors wroteBased on staff interview, record review, and policy review, it was determined the facility failed to ensure resident MDS assessments were accurate regarding falls and anticoagulant use. This was true for 2 of 16 residents (#36 and #57) whose MDS assessments were reviewed. This deficient practice created the potential for harm if residents received inappropriate care related to inaccurate MDS assessments.

Inspectors wroteBased on record review, policy review, and resident and staff interview, it was determined the facility failed to ensure care conferences were held after each assessment, including the comprehensive and quarterly assessments. This was true for 1 of 16 residents (Resident #2) whose care plans were reviewed. These failures created the potential for harm if residents and/or their representative were not included in making decisions regarding residents' care, and if care was not provided or care decisions were made based on inaccurate information.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure medication was not left unattended at a resident's bedside. This was true for 1 of 6 residents (Resident #21) who were observed during medication pass. This failure created the potential for harm if residents did not ingest the medication as ordered by the physician resulting in a decrease or change in their health status.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to consistently implement a restorative nursing program (RNP). This was true for 1 of 3 residents (#36) reviewed for restorative nursing services. The failure created the potential for harm if residents experienced a decline in Range of Motion (ROM).

Inspectors wroteBased on staff interview, record review, and policy review, it was determined the facility failed to ensure an as needed psychotropic medication had a physician evaluation or documented rationale when the medication order extended beyond 14 days . This was true for 1 of 5 residents (Resident #32) reviewed for unnecessary medications. This deficient practice created the potential for harm if residents experienced adverse effects from unnecessary psychotropic medications.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure staff performed appropriate hand hygiene during blood gluocse (BG) testing. This was true for 1 of 2 nurses (LPN #1) observed during medication pass, and had the potential to affect 2 of 6 residents (#3 and #10) observed during medication pass. This failed practice had the potential for harm due to cross contamination.

Inspectors wroteBased on observation, review of daily staff posting, policy review, and staff interview, it was determined the facility failed to ensure the posted staffing information was maintained daily, and the posted information was in an easily readable format. This failure had the potential to effect the 65 residents living in the facility, their family members, and visitors who wanted to know the facility's staffing levels.