Louisa Health & Rehabilitation Center

Inspectors wroteBased on staff interview, facility document review and clinical record review, the facility staff failed to notify the family/responsible party of a fall with injury for one of eight residents in the survey sample (Resident #5).

Inspectors wroteBased on staff interview, clinical record review, and facility document review, the facility staff failed to ensure a complete and accurate clinical record for one of eight residents in the survey sample (Resident #3, R3).

Inspectors wroteBased on observations, clinical record review, and staff interview, the facility staff failed to develop a baseline care plan for the immediate care needs identified upon admission for three of 24 residents.

Inspectors wroteBased on staff interview, clinical record review and during a complaint investigation, the facility staff failed to ensure wound care orders were in place for one of 24 residents in the survey sample, Resident #75. Resident #75 did not have wound care orders for the treatment of two unstageable pressure ulcers that were present upon admission to the facility (06/20/22); physician orders for wound care were not obtained until 06/28/22, eight days after admission.

Inspectors wroteBased on family interview, resident council interview, staff interview and facility document review, the facility staff failed to promptly respond to call bells on one of two units (Residential unit). Residents and a family member reported extended wait times for staff response to call bells on the Residential unit.

Inspectors wroteBased on staff interview and clinical record review, the facility staff failed to ensure an as needed (prn) psychotropic medication was limited to 14-day use for one of twenty-four residents in the survey sample. Resident #44 had an order for the anti-anxiety medication lorazepam in use beyond 14 days without a documented rationale for the extended use or a designated duration for the order.

Inspectors wroteBased on staff interview, clinical record review, and facility document review, the facility staff failed to notify the physician and the RP (responsible party) of a change in resident status for one of 24 residents, Resident #79.

Inspectors wroteBased on staff interview, clinical record review, and facility document review, the facility staff failed to follow their abuse policies for reporting injuries of unknown origin (bruises) for one of 24 residents, Resident #79.

Inspectors wroteBased on staff interview, clinical record review and facility document review, the facility staff failed to report an injury of unknown origin to the administrator for one of 24 residents (Resident #79). Bruising that was observed on Resident #79's abdomen, hip, and arms by several nursing staff was not reported to the administrator or the DON (director of nursing) until the day of discharge from the facility.

Inspectors wroteBased on staff interview, facility document review and clinical record review, the facility staff failed to act upon pharmacy recommendations for two of twenty-four residents in the survey sample. Pharmacy recommendations for Residents #44 and #24 were not responded to and/or implemented.

Inspectors wroteBased on observation, staff interview, and facility document review, the facility staff failed to ensure expired medications were not available for administration on one of two medication carts inspected: Residential unit. A vial of expired Lantus insulin was observed in the medication cart.

Inspectors wroteBased on staff interview, clinical record review and facility document review, the facility staff failed to ensure a complete and accurate clinical record for one of 24 residents in the survey sample (Resident #23). The Findings Include: Resident #23 had incomplete documentation of the Treatment Administration Record (TAR) for several days in the month of January 2023. Diagnoses for Resident #23 included; Urinary tract infection, Osteomyelitis, multiple pressure ulcers and wounds, and quadriplegia. The most current MDS (minimum data set) was a quarterly assessment with an ARD (assessment reference date) of 12/28/22. Resident #23 was assessed with a cognitive score of 14 out of 15, indicating cognitively intact for daily decision making. On 1/25/23, Resident #23's physician orders were reviewed. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility policies, the facility failed to develop comprehensive and individualized care plans that included person-centered interventions to meet the residents' medical needs for 3 of 17 sampled residents, (Resident (R) 6, R60 and R171). The facility failed to include individualized interventions on the care plan for R60 to prevent falls and potential for injury when the resident had a history of repetitive falls prior to admission. The facility failed to include individualized interventions on the care plans for R6 and R171 of the necessary respiratory care interventions, consistent with physicians' orders and professional standards of practice, for the prevention of respiratory infections resulting from the residents' oxygen tubing resting on the floor.

Inspectors wroteBased on observation, interview, record review, review of facility policy, and review of disinfectant instructions for use, the facility failed to ensure the staff appropriately disinfected blood glucose (sugar) monitors between resident use for one of two residents (Resident (R) 38), and failed to prevent the potential for cross-contamination for two of two residents (R38 and R12) when the staff placed wax paper barriers on the potentially contaminated surfaces of two medication carts and on surfaces in resident rooms. The facility had 18 residents who received blood glucose monitoring.

Inspectors wroteBased on observation, interview and facility policy review, the facility failed to ensure one resident (Resident (R) R21) was able to have her desired personal property. R21 was unable to have a television of the size she wanted in her room. This failure effected one of 36 sampled residents.

Inspectors wroteBased on observation, interview, record review, and review of facility policies, the facility failed to update the comprehensive care plan with person-centered interventions to prevent additional falls for 1of 17 sampled residents, (Resident (R) 60), who had a history of falls prior to admission and subsequently sustained a fall after admission to the facility.

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to conduct an effective post-fall root-cause analysis per facility policy to develop appropriate person-centered fall prevention measures for one resident (Resident (R) 60) with repeated falls out of a sample of 17 residents. The failed practice put R60 at risk for further falls and injury.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to provide necessary respiratory care consistent with the physicians' orders, professional standards of practice, and the residents' care plans for two of two residents observed for oxygen use, (Resident (R) 6 and R171). The staff failed to date and initial R6's and R171's oxygen tubing and humidifiers, failed to ensure the residents' oxygen tubing did not come into contact with the contaminated floor, and failed to ensure that R171's humidifier bottle was replaced when empty.

Inspectors wroteBased on interview, record review, facility policy review, and review of the Centers for Disease Control and Prevention (CDC) guidelines, the facility failed to obtain physician orders for and offer two of five residents (Resident (R) 66 and R169) and/or their representative, reviewed for influenza/pneumonia vaccinations, the opportunity for the resident to be vaccinated in accordance with nationally recognized standards. The facility failed to offer R169 the opportunity to be vaccinated with PCV13 (pneumococcal vaccine) in accordance with CDC guidelines and failed to obtain a physician order for or offer the resident the influenza vaccine in accordance with the facility policy. The facility also failed to obtain a physician order for or offer R66 the opportunity to be vaccinated with the influenza vaccination in accordance with the facility policy. [...]

Inspectors wroteBased on observation and staff interview, the facility staff failed to follow proper handwashing technique during a medication pass and pour observation. Staff touched the motion-activated paper towel dispenser after washing their hands.

Inspectors wroteBased on observations, clinical record review, resident interview, and staff interview, the facility staff failed to ensure residents had ready access to petty cash in their Resident Fund Account. Resident withdrawals of petty cash from the Resident Fund Account could only be made Monday through Friday.

Inspectors wroteBased on resident record review and staff interview the facility failed to notify the state ombudsman's office and the responsible party in writing for discharge to hospital for one of 21 Resident's, Resident #2 . The Findings Include: Resident #2 was admitted to the facility on [DATE]. Diagnoses for Resident #2 included: Alzheimer's disease, dementia with behaviors, breast cancer, and sundowner syndrome. The most current MDS (minimum data set) was an initial assessment with an ARD (assessment reference date) of 4/8/18. Resident #2 was assessed with have long and short-term memory loss with a cognitive status of moderately impaired. Resident #2's medical record was reviewed on 10/3/18. A progress note dated 4/8/18 documented that Resident #2 was admitted to the hospital due to treatment of fractured left hip. Resident #2 did not return to the facility. [...]