Life Care Center of Littleton

Inspectors wroteBased on interviews and record review, the facility failed to ensure three (#89, #59 and #67) of three residents out of 41 sample residents received adequate supervision to prevent accidents. Resident #89, who had a history of falls, was admitted to the facility on [DATE] after sustaining multiple pelvic fractures related to a fall sustained at home. The facility initiated a fall care plan on 11/15/23 which identified the resident was at risk for falls due to a gait imbalance (unsteady gait), poor cognition and a history of falls. The care plan documented generalized fall interventions which were not specific to the resident. The facility completed an initial fall risk assessment on 11/15/23 which was not consistent with the resident's care plan and inaccurately documented the resident had no history of falls, was independent and ambulated without problems using an assistive device. [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure food was prepared, distributed and served under sanitary conditions in the main kitchen and three of three nourishment rooms. Specifically, the facility failed to: -Ensure ready-to-eat foods were handled in a sanitary manner to prevent cross contamination in the main kitchen; and, -Ensure safe and appropriate storage of food items in the nourishment room refrigerators.

Inspectors wroteBased on observations and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of diseases and infection on one of three units. Specifically, the facility failed to: -Ensure housekeeping staff disinfected high-touch areas (call lights, door handles and handrails) when cleaning residents' rooms; and, -Ensure staff followed appropriate infection control practices when providing catheter care.

Inspectors wroteBased on observations, record review and interviews, the facility failed to honor resident choices for one (#201) of one resident out of 41 sample residents. Specifically, the facility failed to ensure Resident #201's rehabilitation therapy was scheduled per her preference.

Inspectors wroteBased on record review and staff interviews, the facility failed to incorporate the recommendations from the PASRR (preadmission screening and resident review) Level II determination and evaluation report into the assessment, care planning and transition of care for one (#39) of five residents reviewed for PASRR out of 41 sample residents. Specifically, the facility failed to ensure Resident #39 was followed by a psychiatrist for medication management, per the resident's PASRR Level II recommendations.

Inspectors wroteBased on observations, record review and interviews the facility failed to ensure one (#66) of one resident with limited range of motion received the appropriate treatment and services out of 41 sample residents. Specifically, the facility failed to ensure Resident #66's hand brace, used for his left hand contracture, was included in the restorative program to include how often and duration for donning (putting on) and doffing (taking off), had a physician's order in place and was included in the comprehensive care plan.

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents with indwelling catheters received the appropriate care and services according to professional standards for one (#205) of one resident reviewed for catheters of 41 sample residents. Specifically, the facility failed to obtain physician's orders and documentation for catheter care and maintenance for Resident #205.

Inspectors wroteBased on observations, record review, and interviews the facility failed to ensure residents with percutaneous endoscopic gastrostomy (PEG) tubes received treatment and services to prevent complications for one (#21) of one resident reviewed for enteral feeding management (the delivery of nutrients through a PEG tube directly into the stomach, also called tube feeding) out of 41 sample residents. Specifically, the facility failed to: -Ensure Resident #21 received his tube feeding as ordered by the physician; and, -Label Resident #21's tube feeding containers with the residents' names, room number, date, start time, formula type, feeding rate and nurse initials.

Inspectors wroteBased on observations, record review and interviews, the facility failed to use a person-centered approach when determining the use of a grab bar/bed rail for one (#59) of one resident reviewed for grab bars/bed rails out of 41 sample residents. Specifically, for Resident #59, the facility failed to: -Assess the resident for risk of entrapment prior to installing a grab bar/bed rail; -Obtain consent, which included the risks versus benefits of grab bars/bed rails, from the resident and/or the resident's representative prior to grab bar/bed rail installation; -Identify alternatives to using grab bars/bed rails; and, -Conduct routine assessments and maintenance of the resident's grab bar/bed rail to evaluate the continued safety and/or the continued need for the grab bar/bed rail.

Inspectors wroteBased on record review and interviews, the facility failed to ensure two (#66 and #56) of five out of 41 sample residents were as free from unnecessary medications as possible. Specifically, the facility failed to: -Ensure consent was obtained for Risperdal (antipsychotic medication) prior to administering the medication to Resident #66; -Ensure behavior tracking was in place for Resident #66's use of Risperdal; and, -Monitor Resident #56 for antipsychotic medication side effects.

Inspectors wroteBased on observations and interviews, the facility failed to ensure that all drugs and biologicals were properly stored and labeled according to professional standards of practice in two of six medication carts. Specifically, the facility failed to: -Label medications to facilitate safe medication administration; and, -Ensure medications were labeled and dated appropriately.

Inspectors wroteBased on observations, record review and interviews, the facility failed to implement their policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling and consumption on two of three units. Specifically the facility failed to ensure safe and appropriate storage of food items in Resident #51 and Resident #42's personal refrigerators. A. Professional reference The Colorado Retail Food Establishment Regulations, (3/16/24), were retrieved on 11/13/24 from https://cdphe.colorado.gov/environment/food-regulations. [...]

Inspectors wroteBased on record review and interviews, the facility failed to meet all the requirements for the provision of hospice care for one (#38) of one resident reviewed for hospice services out of 41 sample residents. Specifically, the facility failed to ensure hospice notes were readily accessible and the comprehensive care plan was developed with a delineation of care responsibilities established between the facility and hospice for Resident #38.

Inspectors wroteBased on record review and interviews, the facility failed to implement an antibiotic stewardship program that included antibiotic use protocols and a system to monitor antibiotic use for one (#69) of one resident reviewed for antibiotic use out of 41 sample residents. Specifically, the facility failed to effectively track and monitor the use of long-term antibiotics for Resident #69.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure it was free of a medication error rate of five percent (%) or greater. Specifically, the medication administration observation error rate was 40% or 10 errors out of 25 opportunities for error. Cross-reference F760 failure to prevent significant medication errors.

Inspectors wroteBased on interviews, observations and record review the facility failed to ensure that each resident received food and drink that is palatable, attractive and at a safe and appetizing temperature. Specifically, the facility failed to: -Ensure food was palatable and attractive when delivered to residents; and, -Ensure cold food items were served at the appropriate safe temperature.

Inspectors wroteBased on observations and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of diseases and infection for one out of two units at the facility. Specifically, the facility failed to: -Ensure housekeeping staff were following the proper cleaning techniques for cleaning resident rooms and disinfecting high frequency touched areas (call lights, door handles and hand rails); -Ensure surface disinfectant times were followed; and, -Ensure housekeeping staff mixed chemicals in accordance with manufacturer recommendations.

Inspectors wroteBased on record review and interviews, the facility failed to ensure the neurological assessment accurately reflected the resident's status for one (#248) out of five residents reviewed out of 49 sample residents. Specifically, the facility failed to ensure Resident #248 received thorough neurological assessments for post fall follow up for five separate dates and times to accurately reflect the resident's vital signs and level of consciousness following an unwitnessed fall.

Inspectors wroteBased on record review and interviews, the facility failed to prevent a significant medication error for two (#251 and #252) of five residents reviewed out of 49 sample residents. Specifically, the facility failed to ensure antibiotic medications were administered in a timely manner for Residents #251 and #252.

Inspectors wroteBased on facility observations and staff interviews, the facility failed to provide services necessary to maintain a sanitary, orderly and comfortable environment for its residents in two out of four units. Specifically, the facility failed to: -Store and label resident's personal items such as hair brushes and toothbrushes separately in a double occupancy room and shower rooms; and, -Ensure the towels in a double occupancy room were separated in a way for staff/residents to know which one was used by each resident.

Inspectors wroteBased on record review and interviews, the facility failed to ensure registered nurses (RNs) and certified nurse aides (CNA) were able to demonstrate competencies in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care. Specifically, the facility failed to ensure nursing staff had completed competencies prior to providing skilled services as ordered by the physician for three out of three nurses reviewed for competencies.

Inspectors wroteBased on record review and interviews, the facility failed to ensure five (#47, #69, #9, #57, and #20) of six residents reviewed for unnecessary medications of 38 sample residents was free from unnecessary drugs. Specifically, the facility: -Failed to re-evaluate the use of an as needed (PRN) psychotropic medication by a physician within 14 days for Resident #47, -Failed to have signed consent forms and provided education for the use of psychoactive medications for Residents #47, #69, #9, and #20. -Failed to have an effective system to monitor behaviors associated with psychoactive medications for Residents #69 and #57. I. Facility policy The Psychotropic Medication Use policy, provided by the nursing home administrator (NHA) on 3/23/22 at 8:47 a.m. included; [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to maintain an effective pest control program so the environment was free of pests in seven resident rooms and one hallway out of three hallways. Specifically, the facility failed to prevent and take adequate measures to eliminate an ant infestation.

Inspectors wroteBased on record review and interviews, the facility failed to ensure all staff had current abuse and dementia care training. Specifically, the facility failed to: -Ensure 13 certified nurse aides (CNAs) in total, 10 agency CNAs and three facility CNAs reviewed received dementia management training, and that 10 agency CNAs received abuse prevention training.

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents were fully informed of their total health status, informed of proposed care and/or treatments for one (#344) of five residents reviewed for medications out of 38 sample residents. Specifically, the facility failed to accurately and fully inform and educate Resident #344 of the five medications with a black box warning he was being administered as part of his medication regimen.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that the hospice services provided met professional standards and principles that applied to individuals providing services in the facility for one (#47) of two residents reviewed for hospice services out of 38 sample residents. Specifically, the facility: -Failed to have facility staff orientate hospice staff to the facility including the policies and procedures; and, -Failed to develop a system to effectively ensure hospice visit notes were integrated to ensure residents had a complete medical chart for Resident #47 and care was provided accordingly. I. Facility policy The Hospice Program policy, provided by the nursing home administrator (NHA) on 3/22/22 at 1:28 p.m. included; The written agreement must set out at least the following: [...]