Life Care Center at Inverrary

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to provide double portions for 2 of 2 sampled residents (Resident #6 and #107) reviewed for dining observations, and for 1 of 1 tray line observations in the kitchen. This has the potential to affect 8 residents with double portions orders. The facility failed to provide fortified foods during observations in the kitchen, that has the potential to affect 12 residents who are to be served fortified foods.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to provide the correct diet consistency for pureed diets, for 5 of 5 sampled residents (Resident #20, Resident #45, Resident #108, Resident #33 and Resident #15) observed on pureed diets. This has the potential to affect 10 residents receiving pureed diets.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide a weekly menu to a resident on contact precautions for Clostridium Difficile (C. Diff) for 1 of 1 sampled resident reviewed for contact precautions for C. Diff (Resident #6).

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to follow physician orders for oxygen therapy care and management for 2 of 4 sampled residents (Resident #23 and Resident #40), and failed to follow its own policy to ensure the respiratory care and services are in accordance with professional standards of practice by: failing to properly disinfect and store nebulizing masks for 2 of 4 sampled residents (Resident #45 and Resident #100); failed to have an order for a required tracheostomy tube size, and failed to maintain sterility during tracheostomy care for 1 of 2 sampled residents (Resident #1). The facility also failed to provide a readily available tracheostomy inner canula for immediate care for 2 of 2 observations and for 1 out of 2 sampled residents reviewed for tracheostomy care (Resident #9).

Inspectors wroteBased on record reviews and interviews, the facility failed to follow the professional standards of practice and doctor's order regarding taking blood pressure (BP) on the dialysis access site for 1 of 1 sampled resident (Resident #5) reviewed for dialysis.

Inspectors wroteBased on record review and interviews, the facility failed to ensure a resident's medication regimen for psychotropic (antipsychotic) medication was monitored appropriately, as evidenced of the lack of written documentation of behavior monitoring for 1 of 5 sampled (Resident #3) residents reviewed for Unnecessary medications.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to provide food that meets residents' preferences, for 3 out of 22 sampled residents observed during dining. (Resident #21, Resident #55, Resident #62).

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to follow their own policy for Clostridium Difficile Infection (CDI) regarding meal tray removal for 1 sampled resident (Resident #6) and failed to follow their policy for disinfection of machine and equipment after residents' use during 2 observations.

Inspectors wroteBased on review of policy and procedure, observation, interview and record review, the facility failed to follow physicians' orders for medication parameters for an antihypertensive medication; and for a vitamin supplement for 1 of 6 sampled residents, Resident #51, located on the [NAME] wing.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to initiate care plans for the use of bed rails/side rails and accurately assess 5 of 5 sampled residents reviewed for the use of side rails, (Residents #25, #46, #89, #258 and #259); failed to honor a resident's representative declining the use of bed rails/side rails for 1 of 5 sampled residents reviewed for side rails/bed rails, (Resident #258); failed to obtain orders for the use of side rails/bed rails for 1 of 5 sampled residents reviewed for side rails/bed rails, (Resident #259); and failed to assess for the potential risks associated with the use of side rails for 5 of 5 sampled residents reviewed for side rails/bed rails, (Resdents #25, #46, #89, #258 and #259).

Inspectors wroteBased on the interview, observation, and records review, the facility failed to ensure that 1 of 5 sampled residents (Resident #42) was free from unnecessary medications by failing to timely relay recommendations made by the Consulting Pharmacist to decrease Resident #42's psychotropic medication, to Resident #42's Psychiatrist.

Inspectors wroteBased on review of policy and procedure, observation, interview and record review, the facility failed to ensure that it secured 1) over-the-counter (OTC), prescription pill medications; and 2) one (1) Nebulizer treatment medication solution for 1 of 6 sampled residents (Resident #51) observed during a Medication Administration Observation, in 1 of 3 units; the facility's Locked Dementia Unit.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to clean and disinfect the glucometer per manufacturer's instructions for 4 out of 4 sampled residents reviewed for blood glucose monitoring (Resident #29, #70, #80, and #93). The facility failed to properly perform hand hygiene during medication administration observation for 4 out of 6 sampled residents reviewed for medication administration (Resident #52, #76, #77, and #78). In addition, the facility failed to implement proper signage for Contact Precautions as per Physician's orders for 1 out of 2 sampled residents reviewed for Transmission-Based Precautions (Resident #311).

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, serve, and distribute food in accordance with professional standards for food safety that include: ensure that the dish machine is sanitizing as per regulation, maintenance of ceiling panels to ensure food borne illness does not occur, cleaning of dish room walls to prevent mold growth, on-going preventive maintenance on refrigeration units, and ensure that food storage containers are being cleaned on a regular basis.

Inspectors wroteBased on observation and interview, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 1 (Second Floor) of 2 resident living areas.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to follow the approved resident menu for physician ordered Pureed Diet, Mechanical Soft Diet, and Easy to Chew Diet for 31 residents that included 8 of 8 sampled residents (Resident #96, #83, #11, #42, #37, #60, #58 and #35).

Inspectors wroteBased on observations, interviews and record review, the facility failed to treat residents with dignity during dining for 5 of 5 sampled residents (Resident #58, #67, #83, #96 and Resident #352); and failed to avoid the use of labels such as feeders when addressing residents.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to address weight loss and provide nutritional interventions in a timely manner for 3 of 8 sampled residents reviewed for nutrition (Residents #96, #58, and #36).

Inspectors wroteBased on observations, interviews, and chart review, the facility failed to follow the practitioner's orders for tube feeding for 1 of 2 sampled residents reviewed for tube feeding (Resident #4).

Inspectors wroteBased on observation, interviews and record review, the facility failed to provide Tracheostomy care using a sterile technique for 1 of 1 sampled residents (Resident #4) reviewed for Respiratory Care.

Inspectors wroteBased on observations, interviews and record review, the facility failed to: 1) secure/lock the non-controlled substance e-kit located in the 2- [NAME] unit's medication storage room; 2) failed to remove an IV (intravenous) start kit with an expiration date on [DATE]; 3) failed to remove a Gastrostomy tube feeding with an expiration date of 09/2017 in the 1- [NAME] unit's medication storage room; and 4) failed to secure/lock 1 of 3 treatment carts located in the 2-East unit.

Inspectors wroteBased on interview, record review and review of policy and procedure, it was determined that the facility failed to ensure that it exercised due diligence with regard to not promptly addressing, reporting and following-up on the resident's dental concerns, in a timely manner for 1 of 2 sampled residents observed ( Resident #48).