Marian Regional Medical Center D/P SNF

Inspectors wroteBased on interview and record review, the facility failed to ensure portion of the MDS assessment (MDS - a tool used to assess residents in a nursing home) ccurately reflect the resident's medication status for two 2 of 16 sampled residents (Resident 11 & 39) at the time of the assessment. This facility failure has the potential to result in MDS misinformation which serves as the clinical basis for care planning and care delivery.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to maintain a medication error rate below 5%. When one of 18 sampled resident ( Resident 26), received multiple sets of eye drops without the required time delay between administrations as result staff committed two errors out of 29 opportunities, resulting in a 6.9% error rate. This facility failure has the potential to result in causing patient harm.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medication cart was kept locked if unattended and medications were stored and discarded after after expiration date when:A medication cart was observed to be unlocked and unattended. Povidone-iodine swabsticks (sterile, single-use, 10% solution applicators designed for antiseptic skin preparation, minor wound care) was expired. These failures had the potential to result to unlimited access to the medications and decreased medication mechanisms.1. During a concurrent observation and interview on [DATE] at 10:30 a.m., with the Administrative Support Nurse (ASN), a medication cart in wing 300 parked between room [ROOM NUMBER] and room [ROOM NUMBER] was observed to be unlocked and unattended. The ASN confirmed the medication cart was unlocked and it should be kept locked while unattended. [...]

Inspectors wroteBased on interview and record review, the facility failed to implement scheduled toileting interventions for one of three sampled residents (Resident 1), as indicated in the resident's care plan. This failure had the potential to result in negative outcomes such as incontinence, skin breakdown, and decreased quality of care.

Inspectors wroteBased on interview and record review, the facility failed to administer pain medications per physician orders for one resident (Resident 1). This failure had the potential to result in negative resident outcomes, jeopardizing the quality and safety of resident care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food and ice were stored in accordance with professional standards for food service safety when: 1. The ice machine located in the kitchen had a brown substance on the grate above the water trough where water was present; and 2. Food items were above 41 degrees Fahrenheit (F) in three of the four wings (Wing 100, 300, 400) unit refrigerators located on the nursing units. These failures have the potential to result in a growth of microorganisms which can increase the risk of foodborne illness for all the residents eating and drinking at the facility. The facility census was 89.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the grilled cheese sandwich, provided as an alternative meal option, was of similar or nutritive value to the scheduled entrée when residents (Residents 5, 9, 62) requested a different meal choice. This resulted in resident's not being provided equal nutritive value which may result in weight loss, further compromising the nutritional and medical status.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of four sampled residents (Resident 5), was transferred from wheelchair to bed using a two person assist. This failure had the potential to result in an avoidable fall for Resident 5.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the Food Service Manager (FSM) demonstrated skills sets to carry out the functions of the food and nutrition service when: 1. Dietary staff were not trained on monitoring, and documenting, wash water temperature for the high temperature dish machine in accordance with manufacturer's guidelines and facility policy and procedure. 2. There was not a system, to include a policy and procedure, to guide staff on the requirement to purchase pasteurized shell eggs to have readily available in order to honor a resident's request for an undercooked egg, such as sunny side up eggs, in a safe manner for Resident A (confidential resident). [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one of three sampled residents (Resident 61), had a comprehensive assessment (completion of the Minimum Data Set [MDS] a standardized assessment and care screening tool) including completion of the Care Area Assessment [CAA] a process for guiding review of the triggered areas of the MDS) and care planning (health professionals and the resident agreeing on specific care needs and treatments) after a significant change (a major decline in the resident's status that will not normally resolve itself without further intervention by staff) was identified by the Preadmission Screening and Resident Review (PASRR - a tool used to assess for a possible mental illness [MI]). This facility failure had the potential to delay the care or services recommended by the PASRR Level II Determination Report for Resident 61.

Inspectors wroteBased on interview and record review, the facility failed to ensure two of six sampled residents (Residents 6 and 61): 1. For Resident 6, a person-centered interdisciplinary team nutrition care plan (IDTNCP - detailed plans of care created by representatives from several medical disciplines or specialties) was developed to include resident's goals and preferences, clear measurable objectives, and resident specific nutrition interventions. This failure resulted in unclear measurable weight gain goal and lacked resident specific dietary instructions which impedes the IDT from effectively monitoring, evaluating and revising the care plan, as appropriate, to ensure nutrition care needs would not go unrecognized and unmet. (Cross Reference F806) 2. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an entrapment risk assessment (an assessment to evaluate and monitor a patient's risk for getting entangled on a bed rail) was completed and an informed consent (a process in which a healthcare provider educates a patient about the risks, benefits, and alternatives of a given procedure or treatment) was obtained prior to the use of bed rails for one of 18 sampled residents (Resident 21). These failures do not support optimal bed safety which could potentially place Resident 21 at risk for entrapment and serious injury.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that food was prepared in a form to meet resident needs for one of 18 sampled residents (Resident 67), when a minced and moist diet was served as a pureed diet. This failure had the potential for risk of weight loss for Resident 67.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of 18 sampled residents (Resident 6) food preferences were honored in a timely manner. This facility failure to honor Resident 6's food preferences in a timely manner could diminish appetite, caloric intake and promote continued weight loss.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure food was consistently dated in the kitchen in one of three chilling (refrigerator/freezer) units. This failure had the potential to affect food quality and/or food safety, and would not provide a mechanism to ensure the facility's shelf life guidelines could be followed.