Miami Shores Nursing and Rehab Center

Inspectors wroteBased on observation record review and interviews, the facility failed to meet infection control standards of practice for Resident #5 during hygiene care. This is evidenced by Staff A not performing hand hygiene, changing gloves or changing washcloths during hygiene care for Resident #5. There were 91 residents residing at the facility at the time of the survey.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to properly store controlled substances on three out of four sampled medication carts as evidenced by unreconciled medication monitoring/control record sheets. The facility had four medication carts.

Inspectors wroteBased on observations, record review and interviews the facility's Quality Assessment and Assurance (QAA)/QAPI) committee failed at demonstrating an effective plan of action to correct identified quality deficiency in problem areas as evidence by repeated deficient practice for F 880-Infection Prevention and Control and F 761- Label/Store Drugs and Biologicals. There were 91 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observation, record review and interviews, the facility failed to follow their infection control protocol in the East side soiled utility room and with Resident's #2 and #57. This is evidenced by trash and food observations on the floor inside the resident's pantry room on the East side nursing station, Resident #2 indwelling catheter tube touching floor, staff not wearing proper personal protective equipment (PPE) when entering droplet precaution rooms during meal tray distribution and Improper hand hygiene during wound care. There were 96 residents residing at the facility at the time of the survey.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to provide privacy for residents' information on two out of four computer screens on the East side nursing station as evidenced by an observation of an unlocked, unattended computer screen with resident information easily accessible/visible on the east side medication cart #1 and at the East side nursing station. There were 96 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure the Preadmission Screening and Resident Review (PASARR) Level I was completed accurately prior to admission for three Residents (#50, #83, #60) out of three residents reviewed for PASARR. There were 96 residents residing in the facility at the time of the survey. The findings Included: Record review of the Pre-admission Screening and Resident Review (PASARR) Policy and Procedure dated 2016 documented: Policy Intent-It is the policy of the facility to assure that all residents admitted to the facility receive a Pre-admission Screening and Resident Review; Procedure-1) A facility will coordinate assessments with the pre-admission screening and resident review (PASARR) program as stated under Federal Regulations. [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to develop and implement comprehensive care plans for Residents #43, #74 and #291 as evidenced by no comprehensive care plan with interventions for floor mats for one resident (#291), no implementation of a fall care plan for one resident (#74) out of 6 residents who use floor mats and no care plan for a neck brace for one (#43) out of two residents who require neck braces. There were 96 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide supervision to prevent safety hazards for one resident (#2) out of 32 sampled residents as evidenced by an observation of an electrical cord plugged into an outlet suspended in the air in such a way that caused a tripping hazard in the room of Resident#2. There were 96 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide appropriate treatment and services for catheter care for one (Resident #2) out of one resident who has a suprapubic catheter as evidenced by observations of the urinary catheter tubing being kinked, and touching the floor. There were 96 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to properly store medications as evidenced by an observation of a box of expired Rapid Antigen (Covid-19) test kits in one medication storage room and an unlocked cart (cart #1) on the west wing unit, and an unattended medication at the bedside for resident #2.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to assure cardboard boxes were properly disposed and contained on the facility grounds. Cardboard boxes were scattered on the ground outside the kitchen back door.

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure residents' medical records are accurate in accordance with accepted professional standards and practices for one (Resident #33) out of one resident sampled, as evidenced by a Nurses' Progress Note for Resident#33 documented the resident was COVID 19 positive and the resident was COVID 19 negative. These practices has the potential to affect any of the residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to demonstrate effective plans of actions were implemented to correctly identify quality deficiencies in the problem area related to repeated deficient practices for F880 Infection Prevention & Control, as evidenced by the infection control protocol was not followed on the east side soiled utility room and failed to follow infection control protocol for one Resident # 57, as evidenced by a failure to implement hand hygiene. There were 96 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for resident rooms.

Inspectors wroteBased on observation, interview and records review, the facility failed to ensure one resident (Resident # 59) was free from the use of physical restraints, as evidenced by the facility's staff inhibiting the resident's ability to get out of his bed by placing four wheelchairs on each side of his bed, out of one resident investigated for restraints. This facility practice had the potential to have a negative impact on the health and safety of all 90 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observation, interview, and record review, the facility failed to have the daily nurse staffing schedule posted prior to the beginning of shifts on two out of two nurses' stations. This practice had the potential to affect all 90 residents residing in those units and the public who visited the facility at the time of the survey.

Inspectors wroteBased on observation, record review and interview, the facility failed to implement infection control procedures for three (Residents #89, #347, #348) out of 28 sampled residents. As evidenced by Transmission Based Precaution (TBP) signage was not posted on Resident #347's door and oxygen therapy equipment not stored sanitarily for Resident's #89 and #348. This had the potential to affect 90 residents residing in the facility at the time of the survey. The Findings Included: 1. On 10/16/23 at 08:22 AM, observed Resident #89 in bed asleep, bed was in the lowest position, bilateral floor mats present, high back wheelchair in room, Continuous Positive Airway Pressure (CPAP) machine tubing and mask on the floor besides the resident's bed (Photo available). [...]

Inspectors wroteBased on observations, interviews, and record review the facility failed to provide a safe, clean, homelike environment for 4 out of 26 sampled residents (Residents #75, #54, #74, #288 and #11).

Inspectors wroteBased on observation, interview, and record review, the facility failed to assist during dining for 1 of 1 resident reviewed for Activities of Daily Living (ADLs), Resident #22.

Inspectors wroteBased on record reviews, observations and interviews the facility failed to follow tube feeding orders for 2 out of 5 sampled residents reviewed for tube feeding (Resident #72 and Resident #288).

Inspectors wroteBased on record reviews, observations and interviews, the facility failed to change the oxygen tubing weekly and document changing the oxygen tubing weekly as per facility's policy for 2 out of 3 sampled residents (Resident #288 and Resident #67).

Inspectors wroteBased on observations, interviews, and record review, the facility failed to monitor post-dialysis treatments. As evidenced by failure to administer medication for dialysis per the physician ' s orders for 1 of 1 resident reviewed for dialysis (Resident #84).

Inspectors wroteBased on record review, observations and interviews, the facility failed to secure medications for 1 out of 4 medication carts, and the facility failed to secure medications located in 1 of 2 nursing stations.