Marquis Centennial Post Acute Rehab

Inspectors wroteBased on interview and record review, it was determined the facility failed to timely report allegations of abuse to the State Agency for 1 of 3 sampled residents (#2) reviewed for abuse. This placed residents at risk for abuse.

Inspectors wroteBased on observation and interview it was determined the facility failed to provide maintenance to maintain a safe, comfortable and homelike environment for 1 of 1 facility reviewed for physical environment. This placed residents at risk for an unsafe and unkempt interior building.

Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure foods were labeled in a way to minimize food spoilage in 1 of 2 unit refrigerators and safe food storage handling techniques for 1 of 1 meal service reviewed for kitchen. This placed residents at risk for potential infections related to foodborne pathogens and cross contamination.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure infection control practices were implemented for 2 of 2 residents (#1 and 18) reviewed for catheter care and pressure ulcers pressure ulcer. This placed resident at risk for infection.

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to implement a physician order on the care plan for thickened liquids for 1 of 1 sampled resident (#36) investigated for hydration. This placed residents at risk for choking and aspiration.

Inspectors wroteBased on observation, interview, and record review it was determined the facility failed to ensure a bed was in good repair for 1 of 5 sampled residents (#8) reviewed for unnecessary medications. This placed residents at risk for potential injury.

Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure staff followed the care plan related to fall safety and provide sufficient supervision to prevent a fall for 2 of 2 sampled residents (#s 306 and 47) reviewed for accidents. This failure resulted in resident 306 having a fall with serious injury including a left shoulder fracture, a rib fracture and periprosthetic fracture involving the left greater trochanter (fracture of a previously-repaired hip) which required emergency medical services and treatment at the hospital.

Inspectors wroteBased on interview and record review it was determined the facility failed to provide a written Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (SNF ABN) in a timely fashion for 1 of 3 sampled residents (#47) reviewed for Beneficiary Protection Notification. This placed residents at risk for unknown financial liabilities.

Inspectors wroteBased on observation, interview and record review it was determined the facility failed to protect the resident's right to be free from physical abuse by another resident for 2 of 5 sampled residents (#s 34 and 29) reviewed for abuse. This placed residents at risk for abuse.

Inspectors wroteBased on observation, interview and record review the facility failed to conduct a new/accurate Level I PASARR when the facility became aware of indicators of a serious mental illness diagnoses and failed to complete a referral for a Level ll PASARR (Pre-admission Screening and Resident Review) for 1 of 5 residents (# 46) reviewed for medications. This placed residents with a mental health disorder at risk for delayed care, emotional distress related to mental illness and lack of services to attain their highest practicable well-being.

Inspectors wroteBased on observation, interview and record review it was determined the facility failed to develop a person centered comprehensive care plan for 1 of 1 resident (#53) reviewed for communication. This placed residents at risk for unmet care needs.

Inspectors wroteBased on interview and record review it was determined the facility failed to follow physician orders for 1 of 5 sampled residents (#47) reviewed for unnecessary medications. This placed residents at risk for unmet needs.

Inspectors wroteBased on observation, interview and record review it was determined the facility failed to perform post-dialysis assessments on 1 of 1 sampled residents (#33) reviewed for dialysis. This placed residents at risk for unidentified complications related to dialysis treatment.

Inspectors wroteBased on interview and record review it was determined the facility failed to ensure RN coverage for 8 consecutive hours per day 7 days per week for 54 out of 151 days reviewed for staffing. This placed residents at risk for lack of timely assessments and care.

Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure food was labeled and stored in a manner to minimize spoilage and cross contamination. The facility also failed to ensure the ice machine was plumbed correctly to prevent backflow of contaminated matter into the ice machine for 1 of 1 kitchen reviewed for sanitary conditions. This placed residents at risk for foodborne illness.

Inspectors wroteBased on interview and record review, it was determined the facility failed to develop and implement a water management program and conduct a risk analysis assessment for potential areas of growth and spread of water borne pathogens. This placed residents at risk for exposure to water borne pathogens.

Inspectors wroteBased on interview and record review it was determined the facility failed to screen residents for eligibility and failed to administer influenza and pneumococcal vaccines in accordance with CDC recommendations for 4 of 5 sampled residents (#s 18, 23, 31 and 32) reviewed for immunizations. This placed residents at risk for illness.

Inspectors wroteBased on interview and record review it was determined the facility failed to ensure resident care plans were revised to accurately reflect resident needs for 1 of 2 sampled residents (#6) reviewed for food. This placed residents at risk for unmet care needs.

Inspectors wroteBased on observation and interview it was determined the facility failed to ensure waste was properly contained in dumpsters and garbage storage areas were maintained in a sanitary condition for 1 of 1 garbage area reviewed for kitchen sanitation. This placed residents at risk for potential exposure to pathogens related to the harborage and feeding of pests.