M I Nursing & Restorative Center

Inspectors wroteBased on observation and interview, the facility failed to 1. provide a dignified dining experience on the 4A nursing unit and 2. ensure staff did not speak in a foreign language while providing care on the nursing units.

Inspectors wroteBased on observation, record review and interview the facility failed to develop and implement a comprehensive person-centered plan of care for five Residents (#171, #4, #11, #3 and #14) out of a total sample of 38 Residents. Specifically,1. For Resident #171 the facility failed to implement heel booties (specialty booties utilized to relieve pressure on the heels). 2. For Resident #4 the facility failed to implement bilateral lower extremity ace wraps.3. For Resident #11 the facility failed to implement bilateral lower extremity compression stockings.4. For resident #3 the facility failed to implement bilateral fall mats while the Resident was in bed.5. For Resident #14 the facility failed to develop a comprehensive plan of care for a pacemaker.

Inspectors wroteBased on observations and interviews the facility failed to ensure staff stored drugs and biologicals in accordance with State and Federal requirements. Specifically,For one Resident (#23) the facility failed to ensure medications were not unsecured and stored at the bedside, out of a total sample of 38 residents. The facility failed to ensure that treatment and medication carts were locked when unattended on two units (2B and 3A) out of six units. The facility failed to ensure medications were not left unattended at the nurse's station.

Inspectors wroteBased on record review and interview, the facility failed to ensure Advance Directives (written documents that instruct health care providers of the decisions for specific medical treatment if a person was unable to speak or lacked the capacity to make decisions for themselves) were able to be located in the medical record for one Resident (#28) out of a total sample of 38 residents.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure staff implemented physician orders for on Resident (#87) out of a total of 38 sampled residents. Specifically, for Resident #87, the facility failed to implement physical therapy and occupational therapy services per the physician orders.

Inspectors wroteBased on observation, record review and interview the facility failed to provide one Resident (#7), who is unable to carry out activities of daily living, nail care out of a total sample of 38 residents.

Inspectors wroteBased on observation, interviews and records reviewed, the facility failed to ensure treatment and care in accordance with professional standards for one Resident (#74) out of a total sample of 38 residents. Specifically, the facility failed to ensure Resident #74 received appropriate assessment, monitoring, treatment, and care planning for multiple skin integrity issues, in accordance with the resident's assessed needs and hospice status.

Inspectors wroteBased on observations, interviews and records reviewed, the facility failed to provide necessary treatment and services consistent with professional standards of practice, to promote healing, and prevent new pressure ulcers from developing for three Residents (#74, #3, and #48), out of a total sample of 38 residents. Specifically,1. For Resident #74 who has a history of and is at risk for the development of pressure ulcers, the facility failed to implement an air mattress as recommended by nurse practitioner resulting in the development of a Stage 2 Pressure Injury and failed to implement treatment orders for the newly developed Stage 2 Pressure Injury.2. For Resident #3, who has a pressure ulcer on his/her left heel the facility failed to implement a skin intervention of implementing Prevalon (off-loading) boots as ordered.3. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure nursing implemented a splinting device as ordered for contracture prevention for one Resident (#187) out of a total sample of 38 residents. Specifically, the facility failed to ensure Resident #187 was utilizing a resting hand splint as ordered and recommended by the therapy department.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide respiratory care services in accordance with professional standards of practice for one Resident (#74) out of a total sample of 38 residents. Specifically, the facility failed to ensure oxygen tubing was changed/dated as necessary, the oxygen concentrator filter was cleaned weekly and b.) ensure oxygen therapy was implemented as ordered by the physician. Review of the facility policy titled Equipment [NAME]/Disinfection undated, indicated:d. Oxygen Concentrators: Rinse and dry the external filter weekly and PRN when visibly dusty. Wipe compressor down for soiling PRN (as needed). -Nebulizers, Aerosols/Humidifiers: Every 7 days / PRN for soiling. [...]

Inspectors wroteBased on record review and interviews, the facility failed to provide necessary behavioral healthcare services for one Resident (#68) out of a sample of 38 Residents. Specifically, the facility failed to timely approve or deny psychiatric recommendations.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that recommended specialist appointments were scheduled for one Resident (#14) out of a total sample of 38 residents. Specifically, the facility failed to follow up with Resident #14's cardiologist to schedule a pacemaker check as indicated in physician's orders.

Inspectors wroteBased on observations, record reviewed and interviews the facility failed to maintain complete and accurate medical records for two Residents (#74 and #14) out of a total sample of 38 residents. Specifically, 1. For Resident #74 the facility failed to accurately document the application of Geri-Sleeves to bilateral arms as ordered by the physician. 2. For Resident #14 the facility failed to accurately document the location of a wander guard device (part of a system to ensure the safety of residents who are at risk for elopement).

Inspectors wroteBased on interviews and records reviewed, the facility failed to ensure coordination of hospice care and services in accordance with a written agreement with a Medicare-certified hospice provider for one Resident (#74) out of a total sample of 38 residents. Specifically, the facility failed to ensure a current hospice plan of care was present in the Resident's medical record and failed to notify and consult with the hospice provider regarding significant changes in the Resident's physical condition.

Inspectors wroteBased on observations and interview the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically,1. On the 3A Rehab Unit, the facility failed to ensure the shared vitals machine was disinfected after each resident. 2. On the 2B Unit, staff failed to maintain infection control practices around the disposal of soiled linen.

Inspectors wroteBased on observations, interviews and record review, for one of one sampled residents (Resident #1) who required assistance of two staff members with bed mobility and incontinence care, the facility failed to ensure Resident #1 was free of incidents/accidents resulting in serious injury when care was rendered by one staff, resulting in a humeral (upper arm bone) fracture that required surgical repair.

Inspectors wroteBased on observation, record review and interview, the facility failed to develop and implement the plan of care for two Residents (#140, #65) out of a total sample of 35 residents. Specifically: 1. For Resident #140, the facility failed to develop a plan of care to address a diagnosis of post-traumatic stress disorder. 2. For Resident #65, the facility failed to implement a physician's order for the use of shin guards.

Inspectors wroteBased on observation, record review and interview, the facility failed to implement the treatment orders for a pressure ulcer as recommended by the wound physician for one Resident (#4) out of a total sample of 35 residents. Specifically, the facility failed to implement updated recommendations to leave a pressure area on the right ischium (lower hip area) open to air for Resident #4.

Inspectors wroteBased on observations, interview and record review, the facility failed to develop and implement care plans for three Residents (#99, #69, #121) out of a total sample of 39 residents. Specifically, 1a) for Resident #99, the facility failed to implement a history of elopement care plan and 1b) failed to implement a mood care plan addressing the resident's weepiness. 2) for Resident #69, the facility failed to develop and implement a dementia care plan, and 3) For Resident #121, the facility failed to develop and implement an edema management care plan.

Inspectors wroteBased on observations, record review and interviews the facility failed to revise a care plan, specifically for use of geri sleeves and hand gloves for one Resident (#3) out of a total sample of 39 residents. Findings Include: Review of facility policy titled 'Care Planning' last reviewed September 2017, indicated the following but not limited to: Policy: *The care plan is revised when appropriate to reflect the resident's current needs based on the evaluation of progress towards goals, response to care and treatment, and significant changes in the resident's status. Resident #3 was admitted to the facility in September 2021 with diagnoses including, dementia and anxiety. [...]

Inspectors wroteBased on interview, record review and policy review the facility failed to ensure Activity of Daily Living (ADL) assistance was provided to one dependent Resident (#128), out of a total sample of 39 residents. Specifically, the facility failed to provide showers to Resident #128.

Inspectors wroteBased on observations, record review and interview the facility failed to provide respiratory care services in accordance with professional standards of practice. Specifically the facility failed to change and clean the oxygen filter for one Resident (#8) out of a total sample 39 residents.

Inspectors wroteBased on observations, record review, policy review, and interviews, the facility failed to ensure it was free from a medication error rate of greater than 5% when one out of two nurses observed made seven errors out of 31 opportunities, resulting in a medication error rate of 22.58%. Those errors impacted one (Resident #84) out of three residents observed.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure staff adhered to infection control practices by performing adequate hand hygiene during a medication pass.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), whose diagnoses included diabetes mellitus and had Physician's orders for insulin to manage the condition, the Facility failed to ensure he/she was free from significant medication errors, when on 09/07/23, after the Physician wrote a new order for insulin, nursing misread and did not clarify the order, and it was transcribed incorrectly onto his/her Medication Administration Record. As a result, from 09/08/23 to 09/11/23, nursing administered 30 units (10 x the dose ordered) of insulin to Resident #1 instead of the 3 units as ordered by his/her Physician. On 09/12/23, Resident #1 was noted to be lethargic, unresponsive, was hypoglycemic (low blood sugar), was transferred to the Hospital Emergency Department for evaluation and was admitted to the Hospital for treatment. Findings Include: [...]