Life Care Center of Coeur D'alene

Inspectors wroteBased on observation, review of records and interviews, it was determined the facility failed to ensure residents consistently received necessary care to prevent pressure ulcers and infection from developing. This was true for 1 of 1 resident (Resident #9) reviewed for pressure ulcer. This deficient practice caused harm to Resident #9 when he developed pressure wound and infection to his right palm which required use of antibiotics.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure medication refrigerator temperatures were routinely monitored and documented. This was true for 2 of 2 medication refrigerators (A-Wing and D-Wing Refrigerator) whose temperature logs were reviewed. This deficient practice created the potential for harm if residents received vaccines or medications which had reduced potency and safety from improper storage.

Inspectors wroteBased on observation, review of the FDA Food Code, and staff interview it was determined the facility failed to provide employee hand hygiene, remove ice build-up in the freezer, and clean dust from the air condensing units. This was true for 75 of 76 residents who received food prepared by the facility's kitchen. This deficient practice created the potential for harm by placing residents at risk for potential foodborne illnesses and adverse health outcomes.

Inspectors wroteBased on observation and staff interviews, it was determined the facility failed to ensure infection control practices were followed for donning and doffing PPE during an Influenza-A outbreak, compromising safe infection control practices. This failure affected all residents who received care and services, and the potential for adverse outcomes related to cross contamination when staff created an environment where Influenza-A spread to multiple resident's on different halls.

Inspectors wroteBased on observation and staff interview, it was determined the facility did not ensure resident shower areas were maintained in a clean and sanitary condition. This failure affected 1 of 1 shower rooms observed and created the potential for harm if residents were exposed to black microbial substances on the grout of the shower walls.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure residents were treated with dignity and respect. This was true for 1 of 1 residents (Resident #15) observed during cares. This deficient practice placed residents at risk of embarrassment and diminished sense of worth.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure residents were provided with an appropriate adaptive call light due to inability to use the push button call light. This was true for 1 of 1 residents (Resident #15) observed for accommodations. This deficient practice had the potential to cause harm when Resident #15 was not able to call for assistance when needed or experienced an adverse medical event that required attention.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure residents received information and assistance to formulate an Advance Directive. This was true for 1 of 4 residents (Resident #74) reviewed for Advance Directive. This deficient practice created the potential for harm should residents' wishes regarding end of life or emergent care not be honored if they were incapacitated.

Inspectors wroteBased on record review and staff interview, it was determined the facility did not ensure provider notification was completed according to the physician's order for 1 of 2 residents (Resident #1) whose record was reviewed for provider notification. This failure created the potential for harm when elevated blood glucose levels were not communicated to the attending physician as required.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure a grievance was thoroughly investigated. This was true for 1 of 1 residents (Resident #52) reviewed for grievance investigations. This deficient practice created potential for psychosocial harm if residents' concerns were not investigated completed to avoid future occurrences.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure residents and/or their representatives were provided written notice of the facility's bed-hold policy. This was true for 3 of 6 residents (#5, #39, and #98) whose records were reviewed for discharges. This failure placed the residents at risk for psychosocial harm and possible financial distress when they were not provided documentation of the cost of holding their bed or their right to return to the facility.

Inspectors wroteBased on record review and staff interview, it was determined the facility did not ensure residents assessments were accurately documented. This was true for 2 of 3 residents (#4 and #39) reviewed for MDS accuracy. This failure resulted in inaccurate transmission of assessment data, as Resident #4's MDS assessment documented the use of physical restraints, and Resident #39 did have a PASRR level II.

Inspectors wroteBased on observation, policy review, and staff interviews, it was determined the facility failed to provide a PASRR level II to the designated state agency. This was true for 1 of 2 residents (Resident #79) whose record was reviewed for PASRR documentation. This deficient practice created the potential for harm if Resident #79's coordination of care was not completed between the facility and the designated state agency, with interventions appropriately documented in Resident #79's care plan.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to revise residents care plans and to provide care conferences. This was true for 4 of 18 residents (#10, #69, #79, and #91) whose care plans were reviewed. This deficient practice created the potential for harm if resident's care plans were not updated to direct staff with appropriate care interventions for Resident #10, Resident #69, and Resident #91, and a potential for harm for Resident #79 when quarterly care conferences were not completed with the resident and/or their representative.

Inspectors wroteBased on observation, record review, policy review, and staff interviews, it was determined the facility failed to ensure residents receive treatment and care in accordance with professional standards of practice and comprehensive person-centered care plan. This was true for 2 of 18 residents (#55 and #103) reviewed for standards of practice. Resident #55 had a wrong route of administration on two medication orders. Resident #103's vitals signs were not checked prior to administration of her anti-hypertensive medication. These failed practices created the potential for these residents to experience adverse effects when their medications were not administered according to physician's orders.

Inspectors wroteBased on record review and staff interview it was determined the facility failed to ensure a resident was provided quality treatment and care in accordance with professional standards of practice related to timely physician response. This was true for 1 of 18 residents (Resident #98) whose record was reviewed for quality of care. This deficient practice created the potential for harm due to delayed medical intervention when Resident #98 experienced a change of condition.

Inspectors wroteBased on observation, review of records, and interviews, it was determined the facility failed to ensure residents received appropriate treatment and services to increase range of motion and/or prevent further decrease in range of motion. This was true for 1 of 1 residents (Resident #9) reviewed for range of motion services. This failure created the potential for Resident #9 to experience a further decrease in mobility and function due to his refusals to participate in the restorative nursing program and to wear his right hand grip orthotic were not addressed accordingly.

Inspectors wroteBased on record review and staff interview, it was determined the facility failed to ensure residents were free from significant medication errors. This was true for 1 of 1 residents (Resident #1) reviewed for physician orders. When the facility failed to administer insulin as ordered and administered an incorrect dose of morphine, creating the potential for uncontrolled blood sugars and overmedication.

Inspectors wroteBased on record review and staff interview, it was determined the facility did not ensure hospice documentation was complete and available in the resident's medical record. This was true for 1 of 1 residents (Resident #1) reviewed for hospice services. The absence of required hospice documents created the potential for delayed or incomplete care due to lack of access to the hospice plan of care and current terminal certification.

Inspectors wroteBased on interview and job description review, the facility failed to ensure a qualified director of food and nutrition services was in place to oversee the dietary department with the potential to effect 82 census residents.

Inspectors wroteBased on observation, interview, and job description review, the facility failed to ensure there was sufficient staff with the appropriate competencies and training to carry out the functions of the dietary department. This failure had the potential to affect the ability of the dietary staff to safely and effectively carry out the functions of the food and nutrition service for 81 of 82 residents consuming food.

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to ensure food was not stored on the floor in the freezer and in the dry storage area, a dirty ice machine was cleaned, and proper handling of food and dishware on the tray line. These failures had the potential to increase the prevalence and spread of foodborne illness and infection for all 82 census residents.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to serve residents consecutively while seated at five of the seven tables (one, two, three, four, and seven) observed during meal service which included one of one resident (Resident (R) 48) reviewed for dignity during meal service of 29 sample resident. This had the potential to affect meal satisfaction for the 17 residents eating meals in the dining room.

Inspectors wroteBased on observation, record review, interview, and policy review, the facility failed to ensure that two out of four residents (Resident (R) 140 and R18) reviewed for abuse were free from sexual abuse from R139 as he was observed placing R140's hand on top of his genitals and on another occasion was observed placing his hand on R18's groin of 29 sample residents. The failure to protect R140 and R18 from R139 resulted in the potential for more than minimal phsychosocial harm from unwanted sexual contact.

Inspectors wroteBased on observation, record review, interview, and policy review, the facility failed to ensure the medication error rate of less than 5% by having a medication error rate of 7.69% for the 26 medication administration opportunities observed for two of five residents (Resident (R) 58 and R78) of 29 sample residents. The facility's failure to administer medications as ordered and placed residents who received medications at risk for medication errors.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure one of three residents (Resident (R) 40) reviewed for insulin use had a medical record that was accurate regarding the treatment of high and low blood sugar (BS) levels of 29 sample residents. This failure created the potential for inadequate treatment of R40's diabetes.

Inspectors wroteBased on observation, record review, interview, and Centers for Disease Control (CDC) guidance, the facility failed to implement proper infection control procedures for one of four residents (Resident (R) 78) reviewed for infection control of 29 sample residents. R78 required enhanced barrier precautions (EBP) due to having an invasive device such as a feeding tube or catheter. This failure had the potential to increase the risk of infection.

Inspectors wroteBased on observation, record review, and resident and staff interview, it was determined the facility failed to ensure a resident's bed rails were installed on his bed per his preference and physician order to aid him in repositioning and mobility. This was true for 1 of 1 resident (Resident #50) reviewed for residents' rights. This deficient practice had the potential to cause harm if the Resident #50 experienced decreased mobility and weakness from not having bed rails to assist him with repositioning.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to ensure residents' received information and assistance to exercise their rights to formulate an Advance Directive and this was documented in their record. This was true for 3 of 18 residents (#5, #10, and #18) whose records were reviewed. This failed practice created the potential for harm or adverse outcome if the resident's wishes were not followed or documented regarding their advance care planning.

Inspectors wroteBased on policy review, record review, and staff and resident representative interview, it was determined the facility failed to ensure notification of a medication dosage change to the legal guardian for 1 of 2 residents (Resident #10) reviewed for notification of changes. This deficient practice placed Resident #10 at risk due to lack of information shared and the resident's right to be informed.

Inspectors wroteBased on record review, policy review, and staff interview, it was determined the facility failed to ensure information was provided to the receiving facility for 2 of 3 residents (#51 and #60) reviewed for transfer to the hospital. This deficient practice had the potential to cause harm if the residents were not treated appropriately or in a timely manner due to a lack of information.

Inspectors wroteBased on resident interview, staff interview and record review, it was determined the facility failed to ensure bathing was provided to residents. This was true for 2 of 11 residents (#56, and #277) reviewed for bathing. This failure had the potential for residents to experience embarrassment and compromised skin integrity due to lack of hygiene.

Inspectors wroteBased on policy review, record review, and staff interview, it was determined the facility failed to ensure residents received treatment for constipation as ordered by the physician for 1 of 18 residents (Residents #6) who were reviewed.

Inspectors wroteBased on record review, policy review, and resident and staff interview, it was determined the facility failed to ensure a resident's urinary catheter needs were met in accordance with professional standards of nursing practice. This was true for 1 of 7 residents (#60) reviewed for urinary catheters. This failed practice created the potential for resident's to experience urinary tract infections (UTI's) due to lack of proper catheter care.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure nutritional assistance services were provided. This was true for 1 of 12 residents (Resident #13) reviewed for nutrition assistance. This had the potential for undetected weight loss and nutritional deficits when the facility failed to assist with nutritional needs.

Inspectors wroteBased on observation, staff interview, and record review, it was determined the facility failed to provide oxygen therapy as oredered by the physician and assess resident oxygen needs. This was true for 1 of 6 residents (Resident #56) reviewed for oxygen therapy. This failure placed residents at risk for decline related to shortness of breath due to low oxygen saturation.

Inspectors wroteBased on observation, staff interview, and record review, it was determined the facility failed to ensure post-dialysis assessments were completed. This was true for 2 of 3 residents (#44 and #47) who were reviewed for dialysis. This failure created the potential for harm if dialysis residents experienced complications and/or compromised medical status.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure Nursing Assistants performed tasks which they had the knowledge, skills, and competencies. This was true for 1 of 6 NAs (#1) observed in the facility. This had the potential for adverse effects to residents medical and physical status.

Inspectors wroteBased on observation and staff interview, it was determined the facility failed to ensure food was maintained according to safe practices for refrigerated foods. These failed practices placed the residents who resided in, and dined in the facility, at risk of adverse health outcomes.

Inspectors wroteBased on observation, policy review, and staff interview, it was determined the facility failed to ensure infection control measures were implemented appropriately for 1 of 2 residents (Resident #50) observed during a wound dressing change. These failures resulted in the potential for the introduction of infection due to cross contamination.