Majestic Care of Carmel

Inspectors wroteBased on interview and record review, the facility failed to ensure the State Long-Term Care Ombudsman was notified after a resident was discharged to the hospital for 2 of 3 residents reviewed for hospitalization. (Resident 13 and 6)

Inspectors wroteBased on interview and record review, the facility failed to ensure a Preadmission Screening and Record Review (PASARR) was completed after new psychotropic medications were prescribed for 2 of 3 residents reviewed for PASARR. (Resident 35 and 13)

Inspectors wroteBased on interview and record review, the facility failed to ensure the physician's orders related to medication hold parameters were followed for 3 of 3 residents reviewed for quality of care. (Resident 13, 2 and 4)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was assessed and provided pain management prior to the physician's ordered wound treatment for 1 of 1 resident reviewed for pain. (Resident 4)

Inspectors wroteBased on interview and record review, the facility failed to ensure the Medication and Treatment Administration Records were complete and accurately documented for 3 of 5 residents reviewed for complete and accurate medical records. (Resident 37, 2 and 41)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure catheter tubing was not touching the ground, oral care products were stored properly, and clean laundry and linen were stored and handled appropriately for 12 of 12 residents randomly observed for infection control. (Residents 34, 302, 4, 27, 11, 38, 13, 15, 4, 17, 9 and 30)

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a resident with a call light he was physically capable of activating for 1 of 1 resident reviewed for accommodation of needs. (Resident 40)

Inspectors wroteBased on interview and record review, the facility failed to ensure a new PASARR (pre-admission screening and resident review) level 1 request was submitted when changes in medications and diagnoses occurred for 3 of 3 residents reviewed for PASARR. (Resident 35, 40 and 46)

Inspectors wroteBased on interview and record review, the facility failed to develop a comprehensive care plan for the diagnoses of mental health conditions and the use of antipsychotic medications for 1 of 5 residents reviewed for unnecessary medications. (Resident 19)

Inspectors wroteBased on interview and record review, the facility failed to ensure staff followed the physician ordered hold parameters for a medication and failed to ensure treatments were documented in the Treatment Administration Record for 3 of 3 residents reviewed for quality of care. (Resident B, 34 and 46)

Inspectors wroteBased on interview and record review, the facility failed to have an Infection Preventionist (IP) who was able to fulfill the role at least part-time and was not preforming the duties of the full-time Director of Nursing (DON) for 1 of 1 Infection Preventionist reviewed.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was assessed to self-administer medications for 1 of 2 residents observed for medication administration. (Resident D)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication was administered per the physician's order for 1 of 2 residents observed for quality of care. (Resident B)

Inspectors wroteBased on interview and record review, the facility failed to ensure staff contacted the physician, dietitian, or nurse practitioner to get an order for nutritional formula administration for 1 of 2 residents reviewed for gastronomy tube feedings. (Resident C)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure documentation was correct in the resident record when the administration of a transdermal medication patch found on a resident was dated for 11/9/23 but charted as being changed on 11/12/23 for 1 of 3 residents reviewed for documentation in the medical record. (Resident B)

Inspectors wroteBased on interview and record review, the facility failed to ensure notices were given 48 hours prior to the Medicare benefits ending date and to ensure the residents chose an option for ongoing services for 3 of 3 residents reviewed for beneficiary notices. (Resident 153, 17 and 45)

Inspectors wrote2. During an observation, on 05/16/23 at 12:01 p.m., Resident 35 was on contact isolation for Escherichia Coli (E. coli) and ESBL (Extended Spectrum Beta-Lactamase, a bacteria that could not be killed by many antibiotics which made it harder to treat) in the urine. The record for Resident 35 was reviewed on 05/17/2023 at 11:13 a.m. Diagnosis included, but were not limited to, schizophrenia, anxiety, essential hypertension, ischemic cardiomyopathy, bipolar disorder, heart failure, asthma, allergic rhinitis, personal history of covid-19, and sleep disorder. The facility matrix indicated the resident was in transmission-based precautions for ESBL. A physician's order, dated 05/07/23, indicated Amoxicillin-Pot Clavulanate (an antibiotic) tablet 875-125 mg (milligram) was started on 05/07/2023 and to give 1 tablet by mouth two times a day due to a UTI bacterial infection for 28 days. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident received twice weekly activities and a resident received the identified preference for the activity of their choice for 2 of 5 residents for activities. (Resident 3 and 253)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the physician was notified of a weight gain as ordered for a resident who was diagnosed with congestive heart failure for 1 of 1 resident reviewed for edema. (Resident 41)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was re-assessed for interventions to treat and prevent further contracture for 1 of 2 residents reviewed for limited range of motion. (Resident 3)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident who was at risk for falls had their bed in the lowest position for 1 of 4 residents reviewed for falls. (Resident 3)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an informed consent was completed for the use of side rails for 1 of 2 residents reviewed for accident hazards. (Resident 3)

Inspectors wrote2. The record for Resident 45 was reviewed on 05/16/23 at 4:44 p.m. Diagnoses included, but were not limited to, Parkinson's disease, anxiety, and insomnia. A physician's order, dated 2/18/23, indicated lorazepam (a medication for anxiety) 0.25 mg (milligrams) every 12 hour as needed. A physician's order, dated 3/21/23, indicated lorazepam 0.25 mg every 12 hours as needed. A physician's order, dated 5/10/23, indicated lorazepam 0.25 ml every 4 hours as needed. During an interview, on 05/19/23 at 4:03 p.m., Anonymous Staff 5 indicated the resident was frequently restless and they tried to keep her occupied. The staff member was not aware the PRN order for the lorazepam needed reviewed every 14 days. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure ceilings panels were free from stains, rooms were free from flying insects and garbage, loose baseboard trim and paint on a bathroom floor, and failed to ensure the second-floor dining room was free from scuff marks and gouges on the walls for 8 of 36 rooms observed. (room [ROOM NUMBER], 219, 220, 222, 238, 239, 240, 245 and the second-floor dining room)