Minneola District Hospital Ltcu

Inspectors wroteThe facility reported a census of 19 residents, with eleven residents sampled, including five residents reviewed for accidents. Based on observation, interview, record review, the facility failed to ensure that dependent resident (R)2 remained free from accident hazards/harm related to staff feeding R2 pureed foods, without ensuring the pureed foods were at a safe temperature to eat. The staff attempted to give R2 bites of pureed food which included: hot pureed soup, which had been heated 196 degrees Fahrenheit (F) and placed in an insulated container on the steam table; and a pureed grilled sandwich, which had been heated to 150 degrees F, without obtaining the temperature prior to serving the dependent resident. This failure placed R2 in immediate jeopardy.

Inspectors wroteThe facility identified a census of 19 residents, with 11 sampled, including one reviewed for hydration. Based on observation, interview, and record review, the facility failed to offer sufficient fluid intake to maintain proper hydration and health for Resident (R)6. This deficient practice resulted the hospitalization admission of R6 for dehydration.

Inspectors wroteThe facility census totaled 19 residents and one medication carts. Based on observation, interview, and record review, the facility failed to ensure the staff had secured storage of resident medications when observation onsite revealed an unlocked and unattended medication cart, not in the line of vision of the attending staff, and contained oral, topical and inhaled medications. This deficient practice placed nine cognitively impaired, independently mobile residents at risk.

Inspectors wroteThe facility reported 19 residents with 11 residents sampled. Based on observation, interview and record review the facility failed to store, prepare and serve food in a sanitary manner. This placed all residents at risk for food bourne illness.

Inspectors wroteThe facility reported a census of 19 residents with 11 residents reviewed. Based on observation, interview and record review, the facility failed to maintain a comprehensive infection control program related to laundry delivery. This failure had the potential to lead to contamination of clean linens during delivery which had the potential to negatively affect all the residents in the facility.

Inspectors wroteThe facility reported a census of 19 residents. Based on observation, interview, and record review the facility failed to provide a safe, functional, and sanitary environment in the laundry service area.

Inspectors wroteThe facility reported a census of 19 residents with 11 residents sampled. Based on observation, interview, and record review, the facility failed to protect the dignity of Resident (R) 10, when staff transferred the resident from her room to the shower room with her buttocks exposed. The facility failed to honor the dignity of residents in the dining room, when observation revealed a container in the dining room for soiled clothing protectors was labeled bibs only, no trash, and was visible to all residents and guests in the area. These deficient practices had the potential to negatively impact each residents dignity and psychosocial well-being.

Inspectors wroteThe facility reported a census of 19 residents with 11 residents sampled, including four residents reviewed for advanced directives (a written document which indicated the medical decisions for health care professionals when the person could not speak). Based on observation, interview, and record review, the facility failed to have a process in place to ensure each resident's code status was accurate and easily identified for Resident (R)17, R3, R14, and R171.

Inspectors wroteThe facility reported a census of 19 residents. Based on observations, interviews and record review, the facility failed to ensure the facility had an effective system in place for the accurate accounting and reconcilliation of controlled medicaiton.

Inspectors wroteThe facility reported a census of 19 residents with 15 residents sampled which included five residents reviewed for unnecessary medications. Based on observation, interview, and record review the facility failed to ensure a timely response to the pharmacist's identify and reported irregularities to the facility for four of the five residents sampled, Resident (R)8, R15, R17, and R6.

Inspectors wroteThe facility reported a census of 19 residents with 15 residents sampled which included five residents reviewed for unnecessary medications. Based on observation, interview, and record review the facility failed to ensure Residents who use psychotropic drugs (any drug that affects brain activities associated with mental processes and behavior. receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs) related to a timely response to the pharmacist's identify and reported irregularities to the facility for four of the five residents sampled, Resident (R)8, R15, R17, and R6.

Inspectors wroteThe facility reported a census of 19 residents. Based on observation, interview, and record review, the facility failed to ensure the posted daily nurse staffing sheets included accurate and identifiable information to include the facility name and daily licensed and unlicensed staff hours, as required.

Inspectors wroteThe facility census totaled 29 residents with 12 residents included in the sample. Of the 29 residents five were reported to be Covid positive and were in isolation in their rooms on the 200 hallway. The facility failed to provide a safe sanitary living environment for the residents by the failure to doff personal protective equipment (PPE) prior to leaving the positive residents rooms and using large trash receptacles in the hallway for contaminated PPE, to prevent the spread of covid and infections.

Inspectors wroteThe facility had a census of 29 residents. The sample included 12 residents with one reviewed for hospitalization. Based on observation, interview, and record review, the facility failed to provide a bed hold notice to Resident (R)25 or their representative when the resident was sent and admitted to the hospital. This deficient practice placed R25 at risk to not be allowed to return to her former room at the facility.

Inspectors wroteThe facility census totaled 29 residents with 12 included in the sample. Based on observation, interview, and record review the facility failed to develop comprehensive assessments by the failure to develop an admission Minimum data Set (MDS) within 14 calendar days after admission for Resident (R) 79 who admitted to the facility on [DATE] and failed to complete an annual comprehensive MDS for R 17 within 366 days of the previous comprehensive MDS.

Inspectors wroteThe facility census totaled 29 residents with 12 included in the sample. Based on interview and record review the facility failed to complete Quarterly Minimum Data Set (MDS) assessments within 92 days of the prior assessment for three of the sampled residents, including Resident (R) 20, R 5, R 14.

Inspectors wroteThe facility reported a census of 29 residents with 12 selected for review. Based on observation, interview, and record review, the facility failed to accurately complete the MDS for one sampled resident, Resident (R)13, with administration of an anticoagulant (a classification of medications used to decrease or prevent the clotting of blood). This placed the resident at risk for lack of needed cares.

Inspectors wrote- The 02/27/23 Electronic Health Records (EHR) documented that R22 had the following diagnoses: Parkinson's disease (a progressive disorder of the nervous system characterized by unintended/uncontrollable movements) and type 2 diabetes mellitus (a chronic metabolic disorder characterized by persistent high blood glucose when the body cannot use glucose, not enough insulin made, or the body cannot respond to the insulin). The 07/15/22 Quarterly Minimum Data Set (MDS) documented brief interview for mental status (BIMS) of 15, indicating intact cognition. The resident required extensive one person assist with all activities of daily living (ADLs) except eating, which required setup. Resident was at risk for development of pressure ulcers/injuries without pressure relieving devices on the bed or chair. The 10/14/22 Annual MDS documented a BIMS of 14, indicating intact cognition. [...]

Inspectors wroteThe facility reported a census of 29 residents with 12 sampled. Based on interview and record review, the facility failed to review and revise the care plan for one sampled Resident (R)25, regarding new interventions to prevent falls. This placed the R25 at risk for new injuries from repeated falls.

Inspectors wroteThe facility census totaled 29 residents with 6 residents reviewed for unnecessary medications. Based on observation, interview, and record review the facility failed to ensure the Consulting Pharmacist identified and reported blood sugar irregularities that were out of the parameters ordered by the physician for one of the six sampled residents, Resident (R) 19.

Inspectors wroteThe facility census totaled 29 residents with 6 residents reviewed for unnecessary medications. Based on observation, interview, and record review the facility failed to ensure one of the six sampled residents, Resident (R) 19, remained free of unnecessary medications by the failure to report blood sugars out of the parameters ordered by the physician.

Inspectors wroteThe facility reported a census of 29 residents. The facility had one central kitchen where food was stored and prepared for one dining room. Based on observation, interview, and record review, the facility failed to ensure staff distributed beverages to residents in a sanitary manner.

Inspectors wroteThe facility reported a census of 29 residents, with 12 residents included in the sample and five residents reviewed for immunizations. Based on interview and record review, the facility failed to ensure Resident (R)28 received her influenza vaccination and R10 received her pneumococcal vaccination.