Life Care Center of Port Townsend

Inspectors wroteBased on interview and record review, the facility failed to screen residents for mental health conditions prior to admission for 2 of 5 sampled residents (Resident 12 and 47) residents reviewed for Preadmission Screening and Resident /review (PASRR). This failure placed residents at risk for unidentified mental health conditions, lack of appropriate mental health care and a decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure psychotropic medications (any drug that affects the brain activities associated with mental processes and behavior) were regularly monitored for side effects and target behaviors and provided justification for use of the psychotropic medications and non-pharmaceutical interventions were used prior to utilizing psychotropic medications for 3 of 5 sampled residents (Resident 22, 47 & 12) reviewed for unnecessary medication. This failure placed residents at risk of unnecessary medication usage, increase in side effects without interventions, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to coordinate and follow-up on a preadmission screening and resident review (PASRR, a mental health screening tool) level 2 evaluation for residents diagnosed with a significant mental illness for 2 of 5 residents (3 and 4) reviewed for PASRR. This failure placed the residents at risk for unmet care needs and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary services for a dependent resident for 1 of 2 sampled residents (3) reviewed for activities of daily living (ADL). This failure placed the resident at risk for a decline in health status and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to prevent facility acquired pressure ulcers (injury to skin and underlying tissue resulting from prolonged pressure) from developing for 1 of 3 sampled residents (Resident 6) reviewed for pressure ulcers. This failure placed residents at risk for developing pressure ulcers, worsening pressure ulcers, increased pain, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to reassess current nutritional interventions and implement new nutritional interventions for 1 of 1 sampled residents (Resident 6) reviewed to weight loss. This failure placed residents at risk for continued weight loss, malnutrition, medical complications and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that potential restraints were appropriately assessed for safety, care planned, and/or documented on for 3 of 3 residents (Residents 14, 16, & 29) reviewed for physical restraints. This failure placed residents at risk for unidentified risks and care needs, of the potential for restraint, and for a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to provide non-pharmacological interventions (health interventions/approaches used instead of medication), to implement and/or follow parameters for medications, and/or to reassess necessity of medication when vitals were abnormal for 3 of 6 sampled residents (Residents 19, 23 & 16) when reviewed for unnecessary medications and/or pain management. This failure placed the residents at risk for receiving unnecessary medications, avoidable medication side effects, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to obtain an updated preadmission screening and resident review (PASRR, a mental health screening tool) when a diagnosis of significant mental illness was identified for 2 of 5 residents (Resident 4 & 1) reviewed for PASRR. This failure placed the residents at risk for unmet care needs and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the comprehensive care plan included resident specific interventions for 5 of 12 sampled residents (Residents 42, 14, 16, 26 & 29) reviewed for care plans. This failure to establish care plans that were individualized, accurately reflected assessed care needs and provided direction to staff, placed residents at risk to receive inappropriate and inadequate care to meet their individual needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure services provided met professional standards of practice related to performing daily weights and accurate documentation of side effects for 1 of 5 residents (Resident 23) reviewed for unnecessary medications, failed to follow hospice (end of life care) recommendations for 1 of 1 resident (Resident 28) reviewed for hospice, and failed to monitor after a change in status for 1 of 2 residents (Resident 29) reviewed for hospitalization. These failures placed residents at risk for unmet care needs,the provider not being aware of resident conditions, and potential negative outcomes.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dependent residents were provided with oral care for 2 of 3 residents (Resident 42 & 14) reviewed for dental care related to activities of daily living. This failure placed residents at risk for poor oral hygiene, worsening dental condition, and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper storage and labeling of medications in 1 of 2 medication carts (B Hall medication cart) and 1 of 1 medication rooms when reviewed for medication storage. This failure placed residents at risk for receiving expired medications, ineffective treatment, and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure dishwasher temperatures were maintained within required ranges for 1 of 1 dishwasher and failed to ensure appropriate personal protective equipment (PPE) was worn for 1 of 4 (Staff I) kitchen staff observed. These failures placed residents at risk of food-borne illness, unsanitary conditions, and a diminished quality of life.

Inspectors wroteBased on observations, interviews and record review, the facility failed to properly store oxygen equipment for 1 of 1 sampled resident (Resident 39) reviewed for oxygen, and to ensure staff performed hand hygiene for 1 of 1 dining room reviewed for dining services. The facility also failed to use personal protective equipment (PPE) in accordance with the Centers for Disease Control (CDC) guidelines when caring for residents on enhanced barrier precautions (EBP, a set of infection control measures that use gowns and gloves to reduce the spread of multidrug-resistant organisms (MDROs)) for 1 of 3 sampled residents (Resident 26), and 1 of 3 kitchen staff members (Staff I) reviewed for infection control. Additionally, the facility failed to handle, store, and transport linens appropriately for laundry services reviewed for infection control. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure nursing assistants were screened through the nurse aide registry prior to providing care to residents for 1 of 2 staff (Staff B) reviewed for staff qualifications. This failure placed residents at risk for abuse and unmet care needs.

Inspectors wroteBased on observation and interview the facility failed to ensure appropriate personal protective equipment (PPE) was doffed (taken off) for 1 of 4 sampled rooms (room [ROOM NUMBER]) observed for Transmission Based Precautions. The facility also failed to ensure proper signage was placed in front of the entry doors to residents' rooms (room [ROOM NUMBER]A, 127B, 112, 103 & 101) for 2 of the 4 days. These failures placed residents at risk for facility acquired or healthcare associated infections and related complications and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure Pre-admission Screening and Resident Review (PASRR) Level II evaluation treatment recommendations were incorporated into a resident's plan of care for 1 of 3 residents (Resident 16) who were reviewed for Level II PASRRs. This failure placed residents at risk for unmet mental health and psychosocial needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure dental services were provided for 1 of 2 Medicaid residents (Residents 17) reviewed for dental services. Failure to follow up on dental referrals and timely assistance with appointment scheduling extended the time residents had to use ill-fitting dentures and/or go without dentures. These failures placed residents at risk for difficulty chewing, oral pain, decreased self-image, and diminished quality of life.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to maintain and document refrigerator temperatures for 1 of 3 facility refrigerators (snack refrigerator) reviewed for food service. These failures placed residents at risk of food-borne illness, unsanitary conditions, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from accident hazards when staff provided a one-person transfer with toileting assistance instead of the care planned two-person transfer with toileting assistance for 1 of 3 sampled residents (Resident 1) reviewed for accident hazards. This failure placed residents at risk for injury and a diminished quality of life. Resident 1 experienced harm when he was assisted with one staff rather than two and sustained three rib fractures and subsequent pleural effusion (a build-up of excess fluid between the layers of the pleura outside the lungs), pain, and bruising.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents' comprehensive plans of care were developed, implemented, and/or accurately reflected residents' care needs for 1 of 3 residents (Resident 1) reviewed for care planning. This failure to accurately update the comprehensive care plan and review for discrepancies placed the resident at risk for inconsistent or inadequate care, injury, and a diminished quality of life.