Mercer Manor Rehabilitation

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure adequate staffing to meet the needs of dependent residents and failed to ensure nursing aides are certified for 3 of 3 residents (R1, R2, R3) reviewed for staffing in the sample of 6. This has the potential to affect all residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure nursing aides completed a training and competency evaluation program prior to working. This affects all 58 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to keep medical records private for six (R1, R5, R12, R37, R51, R58) of six residents reviewed for medication administration in a sample of 46.

Inspectors wroteBased on interview and record review, the facility failed to ensure each resident was reviewed no less than every three months using the standardized assessment tool for 7 of 56 residents (R2, R6, R9, R16, R27, R45, R53) in a sample of 46.

Inspectors wroteBased on observation, interview, and record review the facility failed to administer medications in a safe manner for one resident (R9) of thirty-two residents observed during mealtime in a total sample of 46. This failure has the potential to affect all thirty-two residents (R1, R4, R5, R9, R11, R13, R15, R18, R19, R26, R27, R29, R30, R31, R32, R33, R34, R36, R37, R39, R40, R41, R42, R43, R44, R45, R47, R48, R51, R58, R63, R65) who dined in the main dining room.

Inspectors wroteBased on observation, interview, and record review the facility failed to correctly don personal protective equipment/PPE for one resident (R6) of 2 residents reviewed for infection prevention practices in a sample of 46.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide an ongoing program of activities for 15 residents (R13, R14, R19, R20, R25, R26, R28, R36, R41, R44, R47, R48, R49, R50, R51) that reside on the Memory Care Unit of 33 residents reviewed for activities in the sample of 33.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure an appropriate indication for use to administer antipsychotic medications and failed to identify and document target behaviors for six residents (R25, R26, R36, R48, R50, R51) of seven residents reviewed for unnecessary psychotropic medications in the sample of 33.

Inspectors wroteBased on observation, interview, and record review the facility failed to develop a comprehensive assessment for the use of oxygen for one of 17 residents (R33) reviewed for care plans in a sample of 17.

Inspectors wroteBased on interview and record review the facility failed to weigh a resident daily and report weights to the doctor as ordered for one resident (R23) of 17 residents reviewed for weight loss or gain in a total sample of 33. Findings Include: R23's hospital discharge instructions dated 08/20/24 documents weigh daily with same scale and at the same time of the day if possible. Report weight gain of 3 pounds in one day or 5 pounds in one week to the cardiologist/CHF (Congestive Heart Failure Clinic) (phone number listed) every day shift for cardiac health. R23's MAR (Medication Administration Record) dated 08/20/24-8/31/24 does not document any weight for R23 on 8/22/24,8/23/24,8/24/24.8/25/24,8/27/24, 8/28/24 and 8/30/24. R23's MAR for August 2024 documents her weight on 8/20/24 as 158.2 and her weight on 8/21/24 as 163.5 which would indicate a weight gain of 5.3 pounds in one day. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to thoroughly assess and measure a pressure ulcer for one resident (R23) of two residents reviewed for wounds in a total sample of 33. Findings Include: The Facility's Skin Prevention, Assessment and Treatment policy dated 11/1/2015 documents that the purpose of the policy is to identify factors that place the residents at risk for the development of pressure ulcers, to implement appropriate interventions to prevent the development of clinically avoidable wounds, to promote a systematic approach and monitoring process for the care of the residents with existing wounds and for those who are at risk for skin breakdown and to promote healing of existing pressure ulcers. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure oxygen equipment was changed as ordered for one (R33) of two residents reviewed for respiratory care in a total sample of 33.

Inspectors wroteBased on observation, interview, and record review the facility failed to prepare medications without cross contaminating the pills for one resident (R23) of four residents observed during a routine medication pass. Findings Include: The Facility's Standard Precautions policy dated 11/1/2015 documents It is this Facility's policy that Standard Precautions will apply to the care of all residents in all situations regardless of their suspected or confirmed infection disease process. Standard Precautions assume all blood, body fluids and secretions/excretions, non-intact skin and mucous membranes may contain transmissible infectious agents. On 01/08/24 at 10:30 AM V5 (Registered Nurse) had all R23's 9:00 AM medication in a medicine cup that she sat on R23's bed on a clean field while she unclamped and flushed R23's gastric tube. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the memory care unit exit doors and bracelet alarms were loud and widespread enough to alert staff when activated. The facility failed to identify and investigate incidents of elopement, revise a care plan, and implement interventions for a resident who eloped from the facility. The facility failed to follow facility elopement policies and failed to provide adequate supervision for one of three residents (R1) reviewed for elopement in the sample of three. These failures resulted in a cognitively impaired resident (R1) who resides in the facility's locked memory care unit, exiting the facility without staff knowledge and being found soaking wet, laying on the parking lot pavement with facial and head trauma accompanied with excessive bleeding, approximately 50 to 70 feet from the exit doors. [...]

Inspectors wroteBased on observation, interview, and record review, facility dietary staff failed to have their hair restrained while handling and preparing food. This failure has the potential to affect all 60 residents currently residing in the facility. Findings Include: The facility policy, Personnel Adherence to Sanitary Procedures, dated November 5, 2019 directs staff, Food services personnel shall follow appropriate sanitary procedures. In addition to employee personnel policies, food services and dietary personnel will be required to adhere to the following sanitary standards: Hair nets or approved hats, covering all of the hair, will be worn while handling or preparing food. On 4/6/24 from 8:30 A.M. until 8:55 A.M., V11 (Dietary Assistant) was in the facility Main Dining Room serving the morning meal from the facility steam table. V11 had no hair net or approved hat on. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide twice weekly showers for one of four residents (R3), reviewed for showers, in a sample of 7. Findings Include: The facility policy, Shower Care, dated November 24, 2020 directs staff, It is the practice of this facility to assist residents with bathing to maintain proper hygiene and help prevent skin conditions. R3's Physician Order Sheet, dated April 2024 documents that R3 was admitted to the facility on [DATE] with the following diagnoses: Dementia and Parkinson's Disease. The (undated) facility Shower List documents that R3 is to receive morning showers on Wednesday and Saturday. R3's Care Plan, dated 12/12/2023 documents that R3 requires staff assistance for all Activities of Daily Living (ADLs). [...]

Inspectors wroteBased on interview and record review the facility failed to follow its policy for the Antibiotic Stewardship Program. This failure has the potential to affect all 57 residents who currently reside in the facility. Findings Include: Facility Room Resident Room Roster dated 3/5/24 documents 57 residents in the facility. The Facility's Infection Control with Antibiotic Stewardship Policy dated 11/01/2015 documents this policy establishes directives for antibiotic stewardship at this facility in order to develop antibiotic use protocols and a system to monitor antibiotic use. The Facility's Infection Control with Antibiotic Stewardship Policy dated 11/01/2015 documents The Antibiotic Stewardship Committee will: support and promote antibiotic use protocols which include Assessment of residents for infection using standardized tools and criteria. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to revise the care plans for three residents (R13, R16, R53) of 14 residents reviewed for care plans in the sample of 25.

Inspectors wroteBased on observation, interview and record review the facility failed to provide an appropriate indication for use of an antipsychotic medication for two residents (R13, R53) with a diagnosis of Dementia of five residents reviewed for unnecessary medications in the sample of 25.