Nassawadox Rehabilitation and Nursing

Inspectors wroteBased on information from the family interview, staff interview, and review of facility documents, the facility's staff failed to deposit monthly personal needs allowance funds in the account for 1 of 8 residents (Resident #1), in the survey sample.

Inspectors wroteBased on information from a family interview, staff interview, and review of facility documents, the facility's staff failed to ensure resident and other funds were not commingled with facility funds for six (6) of 6 reviewed resident accounts (Resident #1, Resident #2, Resident #3, Resident #4, Resident #5, and Resident #6), in the survey sample.

Inspectors wrote3. The facility staff failed to ensure the necessary treatment to prevent the development of a sacral pressure ulcer that was initially identified at an advanced stage (unstageable with 100% necrotic/dead tissue) resulting in harm for Resident #339. Resident #339 was admitted on [DATE] with diagnoses that included osteoarthritis, unspecified vascular dementia. Resident #339 clinical record review revealed a Braden Scale for Predicting Pressure Sores Risk Assessment as being completed on 11/19/21 as being at RISK. On 11/25/21 a clinical record review revealed a second Braden Scale for Predicting Pressure Sores Risk assessment was completed as being at Moderate risk. The admission, Minimum Data Set (MDS) assessment with an assessment reference date (ARD) of 11/23/2021 coded the resident as completing the Brief Interview for Mental Status (BIMS) and scoring 14 out of a possible 15. [...]

Inspectors wrote4. The facility staff failed to assure Resident #79's bilateral pressure reducing boots were in place at all times. Resident #79 was originally admitted to the facility on [DATE]. The Resident diagnoses included; pressure injuries related to a fall at home and remaining down for an unknown period of time, dementia, high blood pressure and atrial fibrillation. The admission MDS assessment with an assessment reference date (ARD) of 4/25/22 coded the resident as completing the Brief Interview for Mental Status (BIMS) and scoring 13 out of a possible 15. This indicated Resident #79's cognitive abilities for daily decision making was intact. Resident #79 Physician's Order Summary included an order dated 4/21/22, for bilateral heel float boots at all times. May remove for activities of daily living (ADL) care, every shift. A nurse's note dated 4/24/22 at 6:06 p.m., read; [...]

Inspectors wroteThe facility staff failed to notify the physician or the wound Nurse Practitioner of a deteriorating stage II pressure ulcer prior to advancing to an unstageable pressure ulcer for 1 out of 55 residents (Resident #291) in the survey sample.

Inspectors wroteBased on information gleamed during a complaint investigation, staff interviews, and clinical record review, the facility staff failed to provide the necessary care and services for 3 of 55 residents (Resident #189) in the survey sample. For resident #189, the facility staff failed to recognize, assess and provide the necessary care and services after the resident experienced a significant change in condition presenting as shortness of breath because of low oxygen saturation 87 percent on room air. At the hospital the resident was diagnosed with acute respiratory failure, severe sepsis, a urinary tract infection and severe dehydration evidenced by a blood pressure reading of 80/50, only 30 milliliter of dark urine when catheterized and dry tongue and mucous membranes and peeling lips. Resident #189's lab values were critical upon arrival to the hospital; [...]

Inspectors wroteBased on observation, staff interviews, clinical record review, and review of facility documents, the facility staff failed to ensure a resident received emergency dental services promptly after referrals were made adequately while experiencing the acute dental problem for 1 of 1 resident (Resident #190), with dental concerns in the survey sample. The STAT (now) dental appointment ordered 3/1/22, was scheduled on behalf of Resident #190 on 3/10/22, with a local general practice dentistry office for 3/23/22, which was 22 days after the STAT order. Prior to 3/10/22, the facility's staff was unable to provide evidence of attempting to obtain a dental appointment for Resident #190 and there was no evidence in the resident's clinical record or elsewhere of what extenuating circumstances led to the delay in obtaining the STAT ordered dental appointment. constituting harm for Resident #190.

Inspectors wroteBased on observation, resident interview, staff interviews, and clinical record review, the facility staff failed to make sleeping accommodations for 1 of 55 residents (Resident #84), in the survey sample.

Inspectors wroteBased on a complaint investigation, observations and record reviews the facility staff failed to provide reasonable access to the facility by an outside entity which provided services to 4 residents (Residents #31, #39, #69 and #77) and failed to have written policies and procedures regarding visitation rights of residents receiving outside services in survey sample of 55 residents.

Inspectors wroteBased on staff interviews, clinical record reviews and facility documentation review, the facility staff failed to ensure 3 out of 55 residents (Resident #74, 85, 30) were given the opportunity to formulate an advance directive and 1 out of 55 residents (Resident #79) in the survey sample have collaborating documentation of code status throughout the clinical record.

Inspectors wroteBased on a clinical record review, staff interviews and facility document review the facility staff failed to ensure accurate Minimum Data Set (MDS) Assessments for 3 of 55 residents in the survey sample, Resident #78, Resident #79 and Resident #190. For Resident #78, the facility staff failed to ensure the Quarterly MDS dated [DATE] was accurately coded at section N0300 and section N0350. For Resident #79, the facility staff failed to ensure the admission MDS was accurately coded at section E0800. For Resident #190, the facility staff failed to ensure the Significant Change MDS dated [DATE] was accurately coded at section L0200.

Inspectors wroteBased on staff interviews, clinical record reviews, and review of facility documents, the facility staff failed to adequately identify, keep systems functioning properly and implement necessary action plans to assure the provisions of quality care for the residents using the Quality Assessment and Assurance (QA&A) committee to identify quality deficiencies in the areas of Pressure Sores F-686 and Dental Services F-791 and the facility staff failed to conduct quarterly QA&A meetings.

Inspectors wroteBased on observation, resident interview, staff interview, clinical record review, and review of facility documents, the facility's staff failed to provide two residents quarterly statements for 2 of 55 residents (Resident #24 and Resident #60), in the survey sample.

Inspectors wroteBased on staff interview, and review of facility documents, the facility staff failed to purchase a current surety bond.

Inspectors wroteBased on clinical record review, staff interviews and facility document review the facility staff failed to ensure Comprehensive Care Plan Goals were sent upon transfer to the hospital for 2 out of 55 residents in the survey sample, Resident #47 and Resident #58.

Inspectors wroteBased on clinical record review, staff interviews and facility document review the facility staff failed to notify the Office of the State Long-Term Care Ombudsman of 3 hospital discharges and 1 hospital transfer for 3 of 55 residents in the survey sample, Resident #58, Resident #70 and Resident #36.

Inspectors wroteBased on a family interview, staff interview, and review of the clinical record review, the facility staff failed to develop and implement a person-centered comprehensive care plan to address rejection of care for 1 of 55 residents (Resident #48) in the survey sample.

Inspectors wroteBased on resident interviews, staff interviews, clinical record review and facility documentation review, the facility staff failed to invite 2 of 55 residents, (Resident #75 and #60) in the survey sample to attend their person centered care plan meeting.

Inspectors wroteBased on observation, resident interview, staff interviews, and clinical record review, the facility staff failed to provide 1 of 55 residents (Resident #84) in the survey sample with as much information as possible to encourage a smooth transition from the facility to his private home after voicing a desire to be discharged .

Inspectors wroteBased on observations, clinical record review, staff interviews and facility document review the facility staff failed to ensure that 4 of 55 residents (Resident #85, #66, #13, and #69) in the survey sample who were unable to carry out grooming activities of daily living (ADL) were provided showers and nail care.

Inspectors wroteBased on clinical record review, staff interviews and facility documentation, the facility staff failed to provide necessary toenail care for 1 of 55 residents (Resident #13, a totally dependent resident for activities of daily living), in the survey sample.

Inspectors wroteBased on observation, staff interviews, and clinical record review, the facility staff failed to ensure a resident didn't experience a reduction in range of motion of bilateral knees and failed to provide necessary services to prevent further decrease in range of motion for 1 of 55 residents (Resident #190), in the survey sample.

Inspectors wroteThe facility staff failed to assure dietary recommendations made by the Registered Dietitian (RD) were implemented for 1 out of 55 resident (Resident #291) in the survey sample.

Inspectors wroteBased on observation, staff interviews, clinical record review and facility documentation review, the facility staff failed to provide 1 of 55 residents (Resident #288) in the survey sample with respiratory care in accordance with professional standards of practice.

Inspectors wroteBased on observations, staff interview, and clinical record reviews, the facility staff failed to have a pharmaceutical system which assured timely receiving and accurate dispensing and destruction of medications for 2 of 55 residents (Resident #13 and 14), in the survey sample.

Inspectors wroteBased on clinical record review, staff interviews, and review of facility documents, the facility staff failed to assure the Licensed Pharmacist recommendation were reviewed and responded to by the Physician and/or Practitioner for 1 of 55 residents (Resident #37), in the survey sample.

Inspectors wroteBased on the medication pass and pour observations, clinical record review, staff interviews and resident interview, the facility staff failed to ensure they were free of medication errors rates of five percent (%) or greater. During the medication passes totaling 25 observed opportunities for errors, two medication errors were made which resulted in a medication rate of 8%. The residents involved in the medications errors were Resident #55 and #28.

Inspectors wroteBased on staff interviews, and clinical record review, the facility staff failed to assure a resident was free of significant medication errors for 1 of 55 resident (Resident #13), in the survey sample.

Inspectors wroteBased on staff interview, clinical record review and a review of facility documents the facility's staff failed to ensure accurate documentation in one of 55 resident (Resident #66), clinical records.

Inspectors wroteBased on resident interview, staff interview, clinical record review, and review of facility documents, the facility staff failed to assure the Hospice Agency provided the facility staff with the coordinated plan of care to identify which services the Hospice Agency would provide, when the services would be provided, the communication process, and when or why the nursing facility staff should notify the Hospice Agency for 1 of 1 resident receiving Hospice services (Resident #36).

Inspectors wroteBased on observation, staff interview, clinical record review, review of facility documents and during the course of a complaint investigation, the facility's staff failed to provide and or coordinate services for 1 of 55 residents (Resident #338, a closed record resident) a requested COVID-19 vaccine.

Inspectors wroteBased on medical record review, staff interviews, and facility document review, the facility staff failed to send the comprehensive care plan goals upon transfer to the hospital for 3 of 56 residents in the survey sample (Residents #101, #61, and #128).

Inspectors wrote3. Resident #129 was originally admitted to the facility for skilled services on 7/5/19 following a fall at home resulting in a left hip fracture and then readmitted on [DATE] after a hospitalization with diagnosis of Foley related sepsis Urinary Tract Infection (UTI), other diagnoses included neurogenic bladder (a dysfunction of the bladder) and dementia. The current MDS (Minimum Data Set) a 14 day with an assessment reference date of 7/19/19 coded the resident as having long and short term memory deficits and severely impaired cognitive skills for daily decision making. The clinical record face sheet evidenced the resident was not his own responsible party. The resident representative was listed as a son. The resident was sent out to the emergency room and admitted to the hospital for a change in condition on 7/28/19. The resident was re-admitted to the facility on [DATE]. [...]

Inspectors wroteBased on staff interview, facility document review, and clinical record review, it was determined that facility staff failed to revise the care plan for three of 56 residents in the survey sample, Resident #80, #134, and #121.

Inspectors wroteBased on staff interview, clinical record review and facility document review the facility staff failed to ensure 1 of 56 residents in the survey sample was free from unnecessary psychotropic drugs, Resident #121. The facility staff failed to implement non-pharmacological approaches prior to administration of the anti-anxiety drug Ativan and failed to obtain a stop date for as needed (PRN) Ativan.

Inspectors wroteBased on observation, staff interview, and facility document review, it was determined that facility staff failed to store and prepare food in a sanitary manner in the facility kitchen.

Inspectors wroteBased on observation, staff interview and facility document review, it was determined that facility staff failed to maintain the facility dumpster in a manner to prevent pests for one of two facility dumpsters.

Inspectors wroteBased on observation, staff interviews, clinical record review and facility document review the facility staff failed to provide draping to prevent exposure of body parts and maintain dignity during the provision of care for 1 of 56 residents in the survey sample, Resident #124.

Inspectors wroteBased on observation, staff interview, and clinical record review the facility staff failed to ensure medical equipment was maintained in good repair for 1 of 56 residents in the survey sample, Resident #78. Resident #78's mobility chair was observed to have areas that were ripped, torn and a piece of the foam arm rest was missing.

Inspectors wroteBased on staff interview and facility record review, it was determined that the facility failed to develop and implement an abuse policy to include conducting a reference screening for one (1) prospective employee out of 25 records reviewed. Review of personnel records obtained from facility revealed that no verification of reference screenings was conducted for a current employee, Certified Nursing Assistant (CNA) #9.

Inspectors wroteBased on resident record review, staff interviews and facility document review the facility staff failed to ensure that a Quarterly Review Assessment was submitted no less than once every three months for 3 of 56 residents in the survey sample, (Residents #2, #3 and #4).

Inspectors wroteBased on staff interview, clinical record review and facility document review the facility staff failed to ensure an MDS (Minimum Data Set-an assessment tool) was accurate for 1 of 56 residents in the survey sample, Resident #121. Section E. Behaviors was not accurate for the quarterly MDS with an assessment reference date of 7/10/19.

Inspectors wroteBased on resident interview, staff interview, facility document review and clinical record review, it was determined that facility staff failed to implement the physician's recommendations for treatment to a non-intact blister; failed to document when the non-intact blister had healed in the clinical record; and continued to treat the non-intact blister when it was already healed for one of 56 resident in the survey sample, Resident #80.

Inspectors wroteBased on observation, staff interview, clinical record review and facility document review the facility staff failed to provide the necessary care and treatment to prevent and promote healing of a pressure injury for 1 of 56 residents in the survey sample, Resident #124.

Inspectors wroteBased on observation, staff interviews, clinical record review and facility document review the facility staff failed to provide a physician ordered safety device (a lidded cup) to promote safety for 1 of 56 residents in the survey sample, Resident #8.

Inspectors wroteBased on staff interview, facility document review and clinical record review, it was determined that facility staff failed to ensure one of 56 residents (Resident #128) in the survey sample was free from unnecessary medication; specifically excess units of insulin.

Inspectors wroteBased on staff interview, facility document review and clinical record review, it was determined that facility staff failed to ensure one of 56 residents was free from a significant medication error, Resident #128.

Inspectors wroteBased on observations and staff interviews the facility staff failed to maintain infection prevention for 2 of 56 residents in the survey sample. For Resident #12 the facility staff failed to perform wound care in a manner to prevent infection; and for Resident #129 the facility staff failed to maintain Foley catheter tubing and bag in a manner in accordance with infection control standards and practices.

Inspectors wroteBased on observations, clinical record review, staff and family interview and facility policy review, the facility staff failed to inform Resident Representatives of a change in condition for 1 out of 29 residents (Resident #3) in the survey sample. The facility staff failed to inform Resident #3's Resident Representative of a change in condition.

Inspectors wroteBased on resident interview, staff interviews, facility documentation review and clinical record review the facility staff failed to update a care plan give a resident the opportunity to participate in her care plan meeting for 2 of 29 residents (Resident #2 and #14) in the survey sample. 1. The facility staff failed to revise Resident #2's comprehensive care plan to include a fall that occurred on 09/04/17 and 09/14/17. 2. The facility staff failed to give Resident #14 the opportunity to participate in her care plan meeting.

Inspectors wroteBased on observation, resident interview staff interviews, facility documentation and clinical record review, the facility staff failed to follow physician orders for 1 out 29 Residents in the survey sample, (Resident #22). The facility staff failed to follow the physician orders for the administration of Zofran and MS Contin for (Resident #22). Resident #22 was originally admitted to the facility 09/08/16. Diagnosis included but not limited to Cancer, (1) and anemia (2). The current Minimum Data Set (MDS) an admission assessment with an Assessment Reference Date (ARD) of 09/15/16 coded the resident with a 15 out of a possible score of 15 on the Brief Interview for Mental Status (BIMS), indicating no cognitive impairment. [...]

Inspectors wroteBased on observation, resident interview, staff interview, facility documentation review, clinical record review the facility staff failed to follow wound care standard procedures to prevent the potential complications for two Residents (Resident #8 and Resident #11) in the survey sample size of 29. 1. The faciliy staff failed to ensure potential complications were avoided during wound care for Resident #8. 2. The facility staff failed to ensure potential complications were avoided during wound care for Resident #11.

Inspectors wroteBased on observation, resident interview, staff interview, facility documentation review, clinical record review the facility staff failed to ensure safety measures to prevent a potential accident of cutting a Resident's skin, were utilized when cutting off a soiled dressing using pointed tipped scissors and not bandage scissors for 1 Resident, (Resident #11) in the survey sample size of 29.

Inspectors wroteBased on observation, clinical record review, staff interviews and revised of the facility documentation the facility staff failed to maintain an infection control program to provide a safe, sanitary environment to prevent the development and transmissions of disease and infection for 2 of 29 residents (Resident #8 and 11) in the survey sample. 1. The facility staff failed to implement appropriate hand hygiene during a sacral wound care dressing change for Resident #8. 2. The facility staff failed to implement appropriate hand hygiene during a right ankle care dressing change for Resident #11.