Midlands Health & Rehabilitation Center

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure kitchen staff thoroughly cleaned and air-dried plates and bowls prior to storage. This failure had the potential to increase the risk of foodborne illness and had the potential to affect 72 of 86 residents who received dietary servicesFindings include:Review of the facility policy titled, Storage and Cleaning of Dishes and Utensils dated 07/21/23 revealed, Proper ware-washing and storage is also important in food safety . Inspect clean dishes for debris and send back through the dish machine as needed . Clean dishes, silverware, pots, pans, and utensils are stored in a clean dry area at least 6 [sic] [inches] off the floor. These items should be air dried before storing or they should be stored in a way that will allow them to air dry. [...]

Inspectors wroteBased on record review, interview, review of the Centers for Disease and Prevention (CDC) recommendations, and facility policy review, the facility failed to ensure that 4 residents (Resident (R)6, R16, R25, and R46) out of 5 reviewed, were offered the COVID-19 vaccine booster out of a total sample of 26 residents. This failure had the potential for the residents and/or their responsible party of not being informed to make a decision if they wanted the vaccine and a potential risk of contracting COVID-19.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure that the Ombudsman was notified of 2 residents (Resident (R)56 and R93) discharge to an acute care hospital out of a sample of 26 residents. This failure increased the risk for inappropriate transfer or discharge and increased the risk for the resident having access to an advocate who could inform them of their options and rights.

Inspectors wroteBased on record review and interview, the facility failed to ensure that assessments accurately reflected the medication status for 1 resident (Resident (R)7) in a sample of 26 residents. This had the potential to lead to inaccurate reimbursements and unmet care needs for the resident.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to clean respiratory equipment for 3 of 4 residents (Resident (R)6, R87, and R68) reviewed for respiratory care in the sample of 26 residents. The failure to maintain a clean oxygen concentrator filter had the potential to increase the risk of infections for the residents.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure that 1 of 4 medication carts were properly secured. This had the potential for the medications to be accessed by staff, residents, or visitors with the potential for adverse effects.

Inspectors wroteBased on observation, interview, and review of facility policy, the facility failed to ensure glucometers (machines to check blood glucose levels) were disinfected after use for 2 (Residents (R)96 and R46) out of 2 observed during glucose monitoring out of a total sample of 26 residents. This had the potential to cause the spread of infection.

Inspectors wroteBased on the facility policy, observations and interviews, the facility failed to ensure expired medications were removed and not stored with other medications in use for residents in 3 of 4 med carts and 2 of 2 medication rooms. The facility further failed to ensure medications that were discontinued, or the medications for discharged residents were not stored in a med room on the North Hall. The facility additionally failed to ensure personal snacks were not stored on the North Hall front med cart. Review of the facility policy titled, Section 5 - Medication Disposal and Returns, states under procedures: 1. When medication is discontinued or a resident is discharged , facility staff should refer to the LTC Provider Pharmacy policies regarding medication return eligibility and the process to be followed for returns. 2. [...]

Inspectors wroteBased on the facility policy, records reviews and interviews, the facility failed to ensure Resident (R)41 and her responsible party received notice of transfer, for a hospital stay, in writing and in a language they could understand of the reason for transfer for 1 of 2 residents reviewed for hospitalization. Review on 08/26/24 at 03:10 PM of the facility policy titled, Admission, Discharge and Transfer, states: 4. Facility staff provides, upon admission, at the time of transfer to a hospital, and before therapeutic leave begins, written information to the patient/resident and a family member or representative concerning the duration of the bed-hold policy under the state plan and under alternative payor plans. Facility staff documents in the medical record that written notice was provided. 21. [...]

Inspectors wroteBased on the facility policy, record reviews and interviews, the facility failed to ensure Resident (R)41) or her responsible party received a copy of the Bed Hold Policy, in a timely manner, for a discharge to the hospital from [DATE] through 07/31/24. Review of the facility policy titled, Facility's Policy and State Requirements for Temporary Leave Bed-Hold, states, If a resident leaves the facility for temporary hospitalization or therapeutic leave, the resident or his/her representative may ask the facility to hold the resident's bed until the resident is ready to return. The resident and/or his/her representative will be given an copy of the facility's bed-hold policy before the resident actually leaves for his/her temporary leave or hospitalization. [...]

Inspectors wroteBased on the facility policy, observations, record reviews and interviews, the facility failed to ensure Resident (R)20) was afforded and/or provided an ongoing program of activities designed to meet her interest and preferences for 1 of 2 residents reviewed for activities. Review of the facility policy titled, Activity/Recreation Programming, states as the policy, Based on a comprehensive assessment, individualized care plan and the preferences of each resident, the Activity/Recreation Director and staff shall provide an ongoing Activity/Recreation program to support resident's personal choice of activities, facility-sponsored group and individual activities, and independent activities designed to meet the interests of and support the physical, mental and psychosocial well-being of each resident, encouraging both independence and community interaction. Purpose: [...]

Inspectors wroteBased on review of facility policy, interviews, and record review, the facility failed to ensure Resident (R)1 and R2 was free from electrical hazards. On 04/08/24 at 4:00 PM, the Administrator and Director of Nursing were notified that the failure to maintain all mechanical, electrical, and patient care equipment in safe operation constituted Immediate Jeopardy (IJ) at F908. On 04/08/24 at 4:00 PM, the survey team provided the Administrator with a copy of the CMS Immediate Jeopardy (IJ) Template and informed the facility IJ existed as of 12/15/23. The IJ was related to 42 CFR 483.90 - Physical Environment. On 04/08/24 at 6:18 PM, the facility presented an acceptable plan of removal of the IJ. On 04/08/24 at 6:18 PM, the survey team, validated the facility's corrective actions and removed the IJ. [...]

Inspectors wroteBased on review of facility policy, record review, observations, and interviews, the facility failed to assist residents with Activities of Daily Living (ADL) care for 6 of 8 residents (R)13, R18, R25, R68, R74, and R78, who were dependent for ADL care in a total sample of 21 residents.

Inspectors wroteBased on observations, interview, record review, and review of facility policy, the facility failed to ensure the environment remained as free from potential accident hazards as possible for 1 of 1 resident (R)23 reviewed for smoking. The facility failed to ensure R23 was effectively monitored to prevent smoking in non-smoking areas per facility policy.

Inspectors wroteBased on review of facility policy, record review, observation, and interviews, the facility failed to ensure that residents who required feeding assistance were able to dine with dignity. Two of 21 sampled residents (R)59 and R5, that were dependent on staff for feeding assistance, were observed to receive assistance from staff who were standing and not at eye level with the resident. Additionally, dining signage and Certified Nursing Assistant (CNA) staff did not use person-centered language and referred to residents who required assistance with dining as feeders.

Inspectors wroteBased on review of the facility policy, record review, observations and interviews, the facility failed to provide adequate accommodations to Resident (R)13 related to bedding sheets. Additionally, staff were unaware that the Hoyer lift is able to meet R1's3 bariatric needs, 1 of 5 residents reviewed for Activities of Daily living (ADL).

Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure a resident with a history of falls had Care Plan interventions implemented for one Resident (R)20 of two reviewed for falls. This had the potential for R20 to sustain a fall with injury.

Inspectors wroteBased on facility policy review, record reviews, observation, and interview, the facility failed to provide range of motion (ROM) services per the Care Plan for 1 of 1 Resident (R)25 reviewed for ROM in the total sample of 21. This had the potential for R25 to have a decline in functional status.

Inspectors wroteBased on review of facility policy, record review, observation, and interviews, the facility failed to provide ordered supplements used to potentially prevent weight loss for 1 of 2 residents (R)59 reviewed for nutrition in a total sample of 21 residents.

Inspectors wroteBased on interview, observations, record review, hospital record review, and review of facility policy, the facility failed to ensure residents were free from use of unnecessary psychotropic medications for 1 of 1 resident (R)62 reviewed for behavioral/emotional health.