Life Care Center of Lewiston

Inspectors wroteBased on interview, record review, and review of facility procedure, the facility failed to ensure the Minimum Data Set (MDS) accurately reflected medications received for three residents (Resident (R)6, R4, and R22) out of a total sample of 19 residents. These failures created potential for an incomplete or ineffective plan of care related to medication effectiveness and side effects.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure one of three residents (Resident (R) 11) reviewed for falls was assessed for injury by a licensed nurse prior to being moved by the Certified Nurse Aides (CNAs). This failure had the potential to contribute to exacerbated injury upon movement prior to assessment.

Inspectors wroteBased on record review, staff interview, and policy review, the facility failed to ensure there was no delay in treatment of a newly identified pressure ulcer for one of two residents (Resident (R) 10) reviewed for pressure ulcers. This failure had the potential to slow healing or lead to wound infection.

Inspectors wroteBased on record review, interview, and manufacturer's instructions for use of the resident bed, the facility failed to ensure the brakes on the bed were locked for one of three residents (Resident (R) 11) reviewed for falls. This failure caused a fall with minor injury for R11 and had the potential to cause injury from falls.

Inspectors wroteBased on interview, record review, and review of facility procedure, the facility failed to ensure a medication was available to administer as ordered for one resident (Resident (R)6) out of a total sample of 19 residents. This failure created potential for the resident to have side effects.

Inspectors wroteBased on observations, interviews, record review, and policy review, the facility failed to ensure staff donned (put on) the appropriate personal protective equipment (PPE) required for contact isolation precautions for one of three residents reviewed for transmission-based precautions (Resident (R) 16) as well as failed to ensure one out of one resident (R53) catheter bag was not resting on the floor. This failure had the potential to lead to spread of infection throughout the facility.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility's Quality Assessment and Performance Improvement (QAPI) committee failed to implement actions and resolve systemic problems which were identified for tracking and monitoring of controlled substances (narcotics). This failure placed residents at risk for pain to experience increased and/or uncontrolled pain levels should they not receive their narcotic medication due to misappropriation.

Inspectors wroteBased on record review, policy review, and resident representative, 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 27 residents (Resident #13) 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 observation, policy review, and staff interview, it was determined the facility failed to ensure expired medications and stool culture kits were not available for use or administration to residents. This was true for 1 of 4 medication storage rooms reviewed for expired medications and biological products. This failed practice had the potential to effect 22 of 22 sampled residents (#1, #2, #4, #8, #13, #15, #17, #22, #40, #48, #49, #52, #53, #59, #62, #65, #66, #70, #72, #74, #231, #233) who resided in the facility, who could receive expired medications and/or biological products. This failed practice created the potential for harm should residents receive expired medications and/or biological products with decreased efficiency.

Inspectors wroteBased on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure residents were assisted to perform standard hand hygiene measures, staff performed hand hygiene, and catheter tubing was kept off the ground to reduce the risk of infection. This was true for 5 of 21 (#2, #4, #26, #36, and #131) residents sampled for infection control. This failure created the potential for more than minimal harm by exposing residents to the risk of infection and cross-contamination.

Inspectors wroteBased on observation, record review, facility policy review, and staff interview, it was determined the facility failed to maintain an environment that enhanced residents' dignity and respect when staff placed clothing protectors on residents without their permission and when staff did not address residents by their preferred name. This was true for 3 of 3 (#2, #40 and #42) residents sampled for dignity and had the potential to affect all residents who resided in the facility's Special Care Unit. This practice created the potential for psychosocial harm if residents experienced embarrassment or a lack of self-esteem due to their appearance or how they were addressed.

Inspectors wroteBased on staff interview and record review, it was determined the facility failed to ensure appropriate information was documented in the resident's record and provided to the resident upon discharge. This was true for 1 of 3 residents (#80) reviewed for discharge from the facility. This failure created the potential for harm and inappropriate care due to incomplete documentation related to the resident's discharge.

Inspectors wrote2. The facility's Interdisciplinary Team Approach from the Wound Care Resource Manual, dated 2/25/15, documented All disciplines focus on assessment, planning, and implementing, and documenting care. The facility's Evaluations, Screenings, and Assessments from the Wound Care Resource Manual, dated 11/2017, documented the following: * All residents receive a weekly skin check by licensed staff. * Appropriate disciplines are notified of skin breakdown or the resident's risk of skin breakdown. * Nursing coordinates the response to resident's skin needs by the following means: implementing appropriate prophylactic measures when there is an identified risk, referring the resident to restorative and therapeutic programs when medically directed, and medically directed treatment for existing skin problems. [...]

Inspectors wroteBased on observation, staff interview, policy and procedure review, and resident record review, it was determined the facility failed to ensure adequate supervision of residents to prevent falls and that fall prevention measures were followed. This was true for 1 of 4 sampled residents (#70) reviewed for falls when a resident experienced multiple falls in the facility. This failure created the risk for harm should residents sustain injuries from falling.

Inspectors wroteBased on observation, resident and staff interview, and record review, it was determined the facility failed to ensure a method for evaluating the effectiveness of residents' pain management plans was in place for 2 of 3 residents (#1 and #231) sampled for pain. This failure created the potential for harm if residents experienced ongoing severe pain or increased pain and the facility did not identify it.

Inspectors wroteBased on observation, record review, and staff interview, it was determined the facility failed to ensure residents receiving a psychoactive medication had an appropriate indication for use of the medication. This was true for 1 of 5 (#1) sampled residents who received psychoactive medications. This deficient practice created the potential for harm if residents received medications that may result in negative outcomes without clear indication of need.