Mission at Richfield Nursing and Rehabilitation

Inspectors wroteBased on interview and record review it was determined, for 1 of 36 sampled residents, that the facility did not ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices. Specifically, a resident's colostomy care was not provided timely and the resident experienced pain, redness, and tearfulness. Resident identifiers: 48.

Inspectors wroteBased on record review and interview, it was determined that for 2 out of 36 sampled residents, the facility failed to ensure each resident's environment remained as free of accident hazards as was possible; and that each resident received adequate supervision and assistance devices to prevent accidents. Specifically, a resident required an extensive two-person assist with brief changes and a Certified Nursing Assistant changed the resident's brief alone. Additionally, during the brief change the resident rolled out of bed and sustained a laceration and femur fracture. In addition, one resident removed his wander guard for a fourth time and eloped. Resident identifiers: 13 and 46.

Inspectors wroteBased on interview and record review, the facility failed to ensure that the resident environment remained as free of accident hazards as was possible and each resident received adequate supervision and assistance devices to prevent accidents. Specifically, for 1 out of 18 sampled residents, a resident that required extensive assistance of two or more persons for bed mobility and toilet use had a brief change performed by one Certified Nursing Assistant (CNA), rolled out of the bed, and fractured their right hip. Resident identifier: 34.

Inspectors wroteBased on interview and record review, the facility did not ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property were reported immediately, but not later than 2 hours after the allegation was made to the State Survey Agency (SSA) and Adult Protective Services (APS). Specifically, for 2 out of 18 sampled residents, notification to the SSA and APS were not done when a resident that required extensive assistance of two or more persons for bed mobility and toilet use had a brief change performed by one Certified Nursing Assistant (CNA), rolled out of the bed, and fractured their right hip. In addition, a resident that had a fall in the bathroom and fractured the tip of their scapula was not reported to the SSA and APS. Resident identifiers: 24 and 34.

Inspectors wroteBased on interview and record review, the facility did not ensure that the antibiotic stewardship program included antibiotic use protocols and a system to monitor the antibiotic use. Specifically, for 2 out of 18 sampled residents, residents were treated with an antibiotic for a Urinary Tract Infection (UTI) without verifying that the antibiotic used was susceptible to the microorganism identified. Resident identifiers: 2 and 10.

Inspectors wroteBased on observation and interview it was determined, for 5 of 22 sample residents, that the facility did not ensure each resident had the right to a dignified existence. The facility did not treat each resident with dignity in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. Specifically, a resident's pants were observed to fall below his buttock, exposing his buttock to four female residents. Resident identifiers: 17, 27, 30, 34 and 37.

Inspectors wroteBased on observation, interview and record review it was determined, for 1 of 22 sample residents, that the facility did not provide each resident with reasonable accommodation of resident needs and preferences. Specifically, a resident's foot board was removed because he was taller than the bed and the resident's feet hung over then bed. Resident identifier: 41.

Inspectors wroteBased on observation, interview, and record review it was determined, for 2 of 22 sample residents, that the facility did not ensure that a resident received care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrated that they were unavoidable; and a resident with pressure ulcers received necessary treatment and services, to promote healing, prevent infection and prevent new ulcers from developing. Specifically, a resident that was determined to be at risk for developing a pressure ulcer did not have interventions in place to prevent pressure ulcers from developing. The resident developed pressure ulcers that enlarged and one became infected. In addition, another resident's wound was enlarging in size and was not offered to be turned and repositioned. [...]

Inspectors wroteBased on observation, interview, and record review it was determined, for 3 of 22 sample residents, that the facility did not develop and implement a comprehensive person-centered care plan for each resident, that included measurable objectives and timeframe's to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment. Specifically, resident's did not have care plans with individualized interventions for pressure ulcers and edema. Resident identifiers: 21, 43, and 45.

Inspectors wroteBased on observation and interview it was determined that the facility did not store, prepare, distribute and serve food in accordance with profession standards for food service safety. Specifically, there were soiled areas in the kitchen and plastic cups and Styrofoam plates were used for resident dining.

Inspectors wroteBased on interview and record review it was determined, for 1 of 22 sample residents, that the facility did not assess if a resident was clinically appropriate to administer medications. Specifically, a resident was not assessed to administer her own inhaler. Resident identifier: 43.

Inspectors wroteBased on observation, interview, and record review it was determined, for 4 of 22 sample residents, that the facility did not provide a safe, clean, comfortable, and homelike environment. Specifically, resident's wheelchairs were dirty, had cracked arm rests, tape on arm rests, and a piece of foil on the back of the motorized wheelchair. Resident identifiers: 4, 36, 43, and 44.

Inspectors wroteBased on observation, interview, and record review it was determined, for 1 of 22 sample residents, that the facility did not provide appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living. Specifically, a female resident was observed to have long chin hair. Resident identifier: 43.

Inspectors wroteBased on observation, interview, and record review it was determined, for 2 of 22 sample residents, that the facility did not ensure that residents received treatment and care in accordance with professional standards of practice. Specifically, a resident with edema was not provided compression stockings according to physician's orders and was observed to have weeping edema. In addition, another resident was observed to have eyes that were red, swollen with discharge, and were not treated for 4 days. Resident identifiers: 43 and 46.

Inspectors wroteBased on observation, interview, and record review it was determined, for 1 of 22 sample residents, that the facility did not ensure the resident's environment remained as free of accident hazards as was possible and each resident received adequate supervision and assistance devices to prevent accidents. Specifically, a resident was transferred via the Hoyer Lift by one staff member instead of two. Resident identifier: 8.

Inspectors wroteBased on observation, interview, and record review it was determined, for 1 of 22 sample residents, that the facility did not ensure that a resident who was fed by enteral means received the appropriate treatment and services to prevent complications of the enteral feeding. Specifically, a resident was given incorrect amounts of water during administration of enteral feeds. Resident identifier: 48.

Inspectors wroteBased on observation, interview, and record review it was determined, for 2 of 22 sample residents, that the facility did not ensure that residents who need respiratory care are provided such care consistent with professional standards of practice and the comprehensive person-centered care plan. Specifically, the humidifier bottles attached to two resident's oxygen concentrators were empty for the duration of the survey. Resident identifiers: 22 and 48.

Inspectors wroteBased on interview and record review it was determined, for 1 of 22 sample residents, that the irregularities noted by the pharmacist during the drug regimen review were not reported to the attending physician and the facility's Medical Director (MD), nor were the reports acted upon. Specifically, a separate Consultation Report was not completed for a resident. In addition, the attending physician and facility MD did not document in the resident's medical record that the identified irregularities had been reviewed and what action had been taken to address the irregularities. Resident identifier: 17.

Inspectors wroteBased on interview and record review it was determined, for 2 of 22 sample residents, that the facility did not ensure that a resident who used psychotropic drugs was not given these drugs unless the medication was necessary to treat a specific condition as diagnosed and documented in the clinical record. Additionally, as needed (PRN) orders for psychotropic drugs are limited to 14 days, unless the attending physician or prescribing practitioner believed that it was appropriate for the PRN order to be extended beyond 14 days, and should document their rationale in the resident's medical record and indicate the duration for the PRN order. Specifically, a resident was given PRN psychotropic medications beyond 14 days without documented rationale for continuing the PRN orders and a resident was prescribed an antipsychotic medication for insomnia. Resident identifiers: 17 and 22.