Lighthouse Rehabilitation & Healthcare Center

Inspectors wroteBased on interviews, review of Resident Identifier (RI) #32's medical record, the facility's policy and procedures for abuse, and the facility's investigation file, the facility failed to ensure RI #32 was free from abuse perpetrated by Employee Identifier (EI) #10, a Certified Nursing Assistant (CNA). On 7/4/2019 around 6:30 PM/4:40 PM, the CNA, EI #10, in the presence of two Licensed Practical Nurses (LPNs), slapped the resident across the left side his/her face with an open hand. This deficient practice affected RI #32, one of three residents reviewed for abuse and placed RI #32 in immediate jeopardy of serious injury, harm, impairment or death. [...]

Inspectors wroteBased on interviews, review of Resident Identifier (RI) #32's medical record, the facility's investigation file and policy with a subject of Abuse, Neglect and Exploitation, the facility failed to ensure RI #32 was protected from potential further abuse after Employee Identifier (EI) #11 and EI #12, both Licensed Practical Nurses (LPNs) witnessed EI #10, a Certified Nursing Assistant (CNA) slap the resident across the left side of his/her face with an open hand. The LPNs did nothing and left the room. EI #10 later returned to the resident's room twice, once to clean water off the floor and another time around 9:30 PM to check on the resident; however, the resident was asleep. The facility further failed to ensure EI #10, EI #11 and EI #12 reported the physical abuse to the Administrator/Abuse Coordinator of the facility. [...]

Inspectors wroteBased on observation, interviews, review of Resident Identifier (RI) #29's medical record and the facility's policy with a subject of Standard Precautions, the facility failed to ensure Employee Identifier (EI) #5, the Licensed Practical Nurse (LPN) Treatment Nurse removed her gloves, sanitized her hands, and applied new gloves after cleaning RI #29's sacral pressure ulcer, before applying Santyl ointment, skin prep and a clean dressing to the pressure ulcer during wound care. This deficient practice affected RI #29, one of two sampled residents observed for wound care.

Inspectors wroteBased on interviews and review of Resident Identifier (RI) #47's medical record and Mosby's 2017 NURSING DRUG REFERENCE 30TH EDITION, the facility failed to provide medical justification for the use of antipsychotic medication, Risperdal, for RI #47. This deficient practice affected RI #47, one of five sampled residents reviewed for unnecessary medications.

Inspectors wroteBased on observation, interview and review of facility policy titled, FOOD STORAGE LABELING, the facility failed to ensure: 1. a container of pureed slaw in the refrigerator was labeled with identifying label, date and use by date, 2. sliced ham in a zip lock bag in a second reach in refrigerator had an identifying label on it; and 3. kitchen staff while plating mixed vegetables did not rake vegetables that had spilled out of the pan on the side of the steam table back into the pan of mixed vegetables. This had the potential to affect 51 of 51 residents receiving meals from the kitchen. Findings Include: A review of a facility policy titled FOOD STORAGE LABELING with a revised date of 10/17 revealed: POLICY: The facility will ensure the safety and quality of food by following good storage and labeling procedures. PROCEDURE: . 2. [...]

Inspectors wroteBased on record review, interview and review of a facility policy titled, Resident Assessment Instrument, the facility failed to ensure a timely Minimal Data Set (MDS) assessment was completed for Resident Identifier (RI) #3. This affected one of four residents whose MDS assessments were reviewed for timely submission. Findings Include: A review of a facility policy titled, Resident Assessment Instrument, with a revised date of 10/2013 revealed: .PROCESS: . V. MDS Version 3.0 Quarterly Assessment . b) Quarterly assessments are due at least every 92 days, . RI #3 was admitted to the facility on [DATE] with a diagnosis of Cerebral Infarction due to unspecified occlusion or stenosis of right mid cerebral artery. A review of RI #3's MDS 30 day E assessment, with an Assessment Reference Date of 9/28/18, revealed: . [...]

Inspectors wroteBased on observation, interview and review of facility policies titled, Hand Washing and Perineal Care, the facility failed to ensure a Certified Nursing Assistant (CNA) washed or sanitized her hands between glove changes during the provision of incontinent care for Resident Identifier (RI) #46. This was observed on 2/27/19 and affected one of one resident observed for incontinent care. Findings Include: A review of a facility policy titled, Hand Washing with a revised date of 3/2006 revealed: PURPOSE: To provide guidelines to employees for proper and appropriate hand washing techniques that will aid in the prevention of the transmission of infections. STANDARD: Handwashing should be performed between procedures with residents. A review of a second facility policy titled, Perineal Care with a revised date of 02/2014 revealed: PURPOSE: Proper perineal care helps prevent infection . [...]

Inspectors wroteBased on observation, interview and review of facility Hand And Single Use Gloves Sanitation Practices policy, the failed to ensure the sanitation of handling of foods in the kitchen by: (1) dietary staff washing their hands after touching their face with bare hands prior to handling resident plates after they had been plated with food and (2) dietary staff not placing a bag of chicken strips on the floor while storing after a food delivery. This had the potential to affect all residents in the facility.

Inspectors wroteBased on observation, interview and review of facility Daily Dumpster Monitoring policy, the facility failed to ensure the two outside dumpsters were maintained in a manner to prevent potential attraction of rodents and bugs to the dumpster site. This had the potential to affect all residents in the facility.

Inspectors wroteBased on observation and interview, the facility failed to ensure residents were cared for in a manner to maintain dignity. During the lunch meal on 1/09/2018, (Resident Identifiers) #s 5, 6, 213 and 32 were seated at the same table. RI #5 was provided with his/her meal tray. Employee Identifier (EI) #10 immediately began assisting RI #5 with eating. RI #s 6, 213 and 32 was not provided their meal tray until approximately 10 minutes later. This deficient practice affected 3 of 6 residents observed during the dining room observation.

Inspectors wroteBased on interviews, record review and review of the facility's Notice of Transfer form, the facility failed to honor a resident's desire not to move from her/his room when informed by the facility that she/he was being moved to another room. This affected Resident Identifier (RI) #31, one of one resident who expressed dissatisfaction with her/her room change.

Inspectors wrote3. RI #3 was readmitted to the facility with diagnoses including End stage renal disease, hypertension and muscle weakness. RI #3's Physician's orders for September 2017 revealed the resident received Hemodialysis on Tuesdays, Thursdays and Saturdays. RI #3's MDS was not coded to reflect the resident received Dialysis. On 01/11/2018 at 4:23 p.m., an interview was conducted with Employee Identifier/EI #15, Unit manager, RN (Registered Nurse). EI #15 reviewed RI #3's Quarterly MDS with a ARD of 09/18/2017 and was asked did that assessment reflect RI #3 receiving Dialysis. EI #15 said no. EI #15 was also asked why should Dialysis have been coded to reflect the resident's Dialysis treatment. EI #15 explained due to the resident receiving Dialysis the MDS should have been coded to reflect the treatment. 2. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure RI (Resident Identifier) #44's care plan was revised to reflect the discontinuation of the Antipsychotic medication. This deficient practice affected RI #44, one of 16 residents whose care plans were reviewed. Findings Include: RI #44 was admitted to the facility on [DATE], with diagnoses to include Dementia with Behavioral Disturbance and Unspecified Psychosis. A review of RI #44's Physician Order List dated 07/01/2017 through 07/31/2017, revealed Risperdal was discontinued on 07/27/2017. A review of RI #44's care plans revealed: .Problem Onset: 05/30/2014 Resident is at risk for side effects from antipsychotic (antipsychotic) drug use . Resident will maintain a normal/therapeutic blood drug range 3/07/18 .Approaches Administer Resident's medication as ordered by physician .Reviewed-09/18/2017 . [...]

Inspectors wroteBased on record reviews, observation and interviews, the facility failed to ensure Resident Identifier (RI) #3, a visually impaired resident, was provided an adaptive device (plate guard) as indicated on his meal tray card. This affected one of one sampled resident who required an adaptive device when eating.