Lorien Nursing & Rehab Ctr - Elkridge

Inspectors wroteBased on observations and interviews, it was determined that the facility failed to maintain residents' dignity while dining as evidenced by 1) not serving meals at the same time to residents sitting together and 2) facility staff standing while assisting residents with feeding. This was found to be evident in 1) 6 of 10 residents observed while dining and 2) 2 (Residents #21 and #64) of 2 residents observed with feeding assistance.

Inspectors wroteBased on administrative record review and staff interviews, it was determined that facility staff failed to ensure that newly hired geriatric nursing assistants (GNA) have the knowledge necessary to provide resident care. This deficient practice was evident for 5 of 5 GNA training files reviewed during the annual survey.

Inspectors wroteBased on administrative record review and staff interview, it was determined that the facility failed to ensure staff received Quality Assurance and Performance Improvement Training (QAPI) for new and existing staff. This deficient practice was evident for 6 of 10 employee files reviewed during the annual survey.

Inspectors wroteBased on administrative record review and staff interview, it was determined that the facility failed to ensure Geriatric Nursing Assistants (GNAs) received the required annual in-service training. This deficient practice was evident for 4 of 4 GNA employee files reviewed during the annual survey.

Inspectors wroteBased on interviews and record review, it was determined that the facility failed to permit the resident's representative to speak directly with state surveyors. This was evident for 1 (Resident #14) out 1 resident in the recertification survey.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to notify residents and representatives of transfers or discharges in writing. This was evident in 2 (Resident #1 and #5) out of 2 residents reviewed for hospitalization.

Inspectors wroteBased on medical record review and interview, it was determined that the facility failed to perform appropriate revision to care plan goals and interventions as resident care needs became apparent or changed over time. This was found to be evident in 1 (Resident #33) of 35 residents reviewed during the investigation phase of the survey.

Inspectors wroteBased on interviews and record reviews, it was determined that the facility failed to ensure a resident who required assistance with activities of daily living (ADLs) received assistance in a timely manner. This deficient practice was evident for one resident (#14) reviewed for ADL care during the annual survey.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide and document individualized activities in accordance with the resident's assessed preferences for 1 of 1 resident (Resident #9) reviewed for activities.

Inspectors wroteBased on observation, clinical record review, and interview, it was determined that the facility failed to ensure that enteral nutrition (tube feeding) and hydration canisters were labeled and dated to ensure safety and sanitation. This deficient practice was evident for 1 (Resident #7) out of 1 resident reviewed for tube feedings.

Inspectors wroteBased on medical record review, observation, and interview, it was determined that the facility failed to maintain a medical record in the most accurate form. The was found to be evident for 1 (Resident #33) of 35 residents reviewed during the investigation phase of the survey.

Inspectors wroteBased on administrative record review and staff interview, it was determined that the facility failed to ensure staff received training on abuse, neglect, and exploitation training. This deficient practice was evident for 1 of 5 employee files reviewed during the annual survey.

Inspectors wroteBased on administrative record review and staff interview, it was determined that the facility failed to ensure staff received required compliance and ethics training. This deficient practice was evident for 3 of 5 employee files reviewed during the annual survey.

Inspectors wroteBased on medical record review and interview, the facility staff failed to thoroughly investigate a complaint of missing personal items (Resident #6). This was evident for 1 out of 12 residents reviewed during a complaint survey.

Inspectors wroteBased on medical record review and interview, the facility failed to accurately document medical information in a resident's medical record (Resident #7). This was evident for 1 out of 12 residents reviewed during a compliant survey.

Inspectors wroteBased on review of medical records, facility investigative file, and interviews it was determined that the facility failed to adequately assess and assist a dependent resident during Activity of Daily Living (ADL) care, which led to a resident's fall from bed causing actual harm to Resident #70. This was evident for 1 of 4 (#70) residents reviewed for accidents.

Inspectors wroteBased on record review, and interviews, it was determined that the facility failed to provide a Resident's Representative/guardian the right to be involved in the initial care planning process. This was found evident in 1 (Resident #162) of 5 residents reviewed for rights.

Inspectors wroteBased on record review, and interview with residents and staff, it was determined that the facility failed to answer call bells timely to attend to the needs of dependent residents. This was evident for 1 (Resident #19) on the Second Floor Nursing Unit.

Inspectors wroteBased on record review, and interview, it was determined that the facility failed to offer to help formulate or obtain a Resident ' s Advanced Directive. This was found to be evident in 2 (Resident #54, & #162) of 16 Residents reviewed for Advanced Directives during an annual survey.

Inspectors wroteBased on record review, and interview, it was determined that the facility failed to inform the Resident ' s Responsible Party (RP) of the need to alter treatment. This was found evident of 1 (Resident #70) of 3 residents reviewed for notifications.

Inspectors wroteBased on review of Facility Reported Incidents (FRIs) and interviews with staff, it was determined that the facility failed to maintain documentation that a FRI was thoroughly investigated. This was evident for 1 (Resident #12) out of 13 residents investigated for FRIs during the annual survey.

Inspectors wroteBased on medical record review, and interview with and staff, it was determined that the facility failed to accurately assess and complete a Significant Change in Status Minimum Data Set (MDS) assessment within 14 days of the resident's enrollment into a hospice program. This was evident for 1 (Resident #50) out of 1 resident investigated for hospice during the annual survey.

Inspectors wroteBased on observation, medical record review, and staff interview, it was determined that the facility staff failed to code the resident's status accurately on the Minimum Data Set (MDS) assessment. This was found to be evident for 2 (#7, #41) out of 42 residents reviewed during the annual survey.

Inspectors wroteBased on record review, and interviews, it was determined that the facility failed to include and review all initial healthcare information and goals in the baseline care plan. This was found evident of 1 (resident #49) of 3 residents reviewed for care planning.

Inspectors wroteBased on record review, and interview with staff, it was determined that the facility failed to facilitate timely care plan meetings after a resident's quarterly assessment to allow the resident and resident representative to participate in the care planning process. This was evident for 1 (Resident #38) of 3 residents investigated for care planning during the annual survey.

Inspectors wroteBased on observation, record review, and interview with resident and staff, it was determined that the facility failed to evaluate and provide documentation that activities occurred that meet the needs of each resident. This was evident for 2 (Resident #38 & #54) of 2 residents investigated for activities during the annual survey.

Inspectors wroteBasedonrecordreview andinterview itwasdeterminedthatthefacilityfailedtohavephysicianorderswrittentoassurepropercareandtreatmentswereinplaceforfoleycare Thiswasfoundevidentin1 (Resident#41) of3 residentsreviewedforurinarycatheterandUrinaryTractInfection(UTI duringthesurvey Thefindinginclude On9/12/24 at10:16 AM thesurveyorreviewedResident#41' s medical record. The review revealed that Resident #41 was readmitted to the facility in of late August of 2024 after a hospital stay and had a past medical history, including but not limited to, sepsis (body's overreaction to an infection) due to Methicillin Resistant Staphylococcus Aureus (MRSA), urinary tract infections, and obstructive uropathy (obstruction of urinary tract). The surveyor next reviewed the admission assessment dated [DATE] for Resident #41. [...]

Inspectors wroteBased on observation, record review, and interviews, it was determined that the facility failed to ensure that a resident received services to promote healing of a pressure ulcer. This was found evident in 1 (Resident #49) out of 5 residents reviewed for pressure ulcers.

Inspectors wroteBased on record review, and interview, it was determined that the facility failed to provide treatment for constipation and maintaining bowel continence. This was found evident of 1 (Resident #41) of 3 residents reviewed for bladder and bowel during the survey.

Inspectors wroteBased on record review, and interviews, it was determined that the facility failed to provide education for application of a device after the knowledge deficit was identified. This was evident in 1 (Resident #70) of 1 resident reviewed for devices.

Inspectors wroteBased on interview and review of pertinent facility documentation it was determined that the facility staff failed to obtain appropriate certification for a Nurse Aide in Training (NAIT) in the required time frame. This was determined to be evident for 3 (#24, #25, and #26) of 6 NAIT's reviewed for certification.

Inspectors wroteBased on record review, and interview, it was determined that the facility failed to obtain radiology services in a timely manner. This was found evident in 1 (Resident #70) out of 1 resident reviewed for radiology services.

Inspectors wroteBased on observations, interviews with staff, and record reviews, it was determined that the facility failed to store food, dishes and monitor temperatures in a manner that maintains professional standards of food service safety. This practice had the potential to affect all residents eating food prepared in the facility's kitchen.

Inspectors wrote2a) Maryland Medical Orders for Life-Sustaining Treatment (MOLST) is a form which includes medical orders for emergency medical services or other medical personnel regarding CPR (cardiopulmonary resuscitation) and other life-sustaining treatment options. Do Not Intubate (DNI) is an order placed in a person's medical record by a doctor informs the medical staff that chest compressions and cardiac drugs may be used, but no breathing tube will be placed. On [DATE] at 12:22PM, during a review of Resident #38's current paper medical record, the Surveyor discovered an incomplete MOLST form. Page 1 of the MOLST form was completed, signed and dated with a code status of Do Not Intubate (DNI). Page 2 was incomplete and signed and dated. On [DATE] at 12:25PM, the Surveyor informed Second Floor Supervisor #33 that Resident #38's MOLST form was incomplete. [...]

Inspectors wroteBased on observation, and interviews, it was determined that the facility failed to maintain practices to help prevent the transmission of infections. This was found evident on 3 random observations made on the survey.

Inspectors wroteBased on observation and staff interviews it was determined that the facility staff failed to ensure that food was stored and prepared in a sanitary manner. This practice had the potential to affect all residents in the facility.

Inspectors wroteBased on medical record review, the facility failed to provide the hospital with a copy of the comprehensive care plan goals upon resident's transfer. This was evident for 2 out of 2 residents (#11 and #59) reviewed for hospitalization.

Inspectors wroteBased on medical record review, the facility failed to notify Resident #11 or his/her responsible party in writing as to why the resident was transferred to the hospital. This was evident for 1 out of 2 residents reviewed for hospitalization.

Inspectors wroteBased on medical record review, the facility failed to provide the resident or responsible party with a copy of the bed hold policy. This was evident for 1 out of 2 residents (#11) reviewed for hospitalization.

Inspectors wroteBased on review of medical records and interview with facility staff, it was determined that the facility failed to ensure that residents who receive treatment for disruptive or inappropriate behaviors have documentation of the nature and extent of those behaviors when residents exhibit them. This was evident for 1 (Resident #62) of 2 residents reviewed for behaviors.