Neurorestorative Colorado

Inspectors wroteBased on observations, record review and interviews, the facility failed to store, prepare and distribute food in a sanitary manner in the main kitchen and nourishment refrigerator/freezer. Specifically, the facility failed to ensure time and temperature control food was labeled, dated and disposed of timely.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure accurate assessments, informed risks, and ongoing monitoring was in place for three (#1, #13 and #6) of six residents with bed rails out of 20 sample residents. Specifically, the facility failed to: -Ensure risks of bed rails were explained to Resident #1 or the resident' s representatives prior to the initiation of the bed rails; -Ensure bed rail assessments were accurately completed for Resident #1, Resident #6 and Resident #13; -Ensure consent was obtained for the use of a bed rail from Resident #1; and, -Ensure ongoing monitoring of bed rails in use was completed for Resident #1, Resident #6 and Resident #13.

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide each resident with a nourishing, palatable and well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences for each resident. Specifically, the facility failed to: -Provide a balanced menu for residents; -Ensure Resident #5 received a variety of pureed dessert options; -Ensure international dysphagia diet standardization initiative (IDDSI) standards were utilized for production of IDDSI modified texture diet orders; and, -Ensure Resident #18 received a minced and moist level five texture diet instead of a pureed diet.

Inspectors wroteBased on observations, record review and interviews, the facility failed to implement their policy regarding the use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling and consumption. Specifically, the facility failed to: -Implement the facility policy for food brought by visitors and ensure food that was kept in resident's refrigerators had safe and sanitary storage; and, -Ensure the residents personal refrigerator temperatures were monitored correctly for appropriate temperatures.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents on a pureed diet out of 20 sample residents received food and fluids prepared in a form designed to meet his or her needs. Specifically, the facility failed to ensure residents who were prescribed pureed texture diets were served food that was prepared according to their diet order as indicated on their meal tray cards.

Inspectors wroteBased on observations, record review and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease on one of two units. Specifically, the facility failed to ensure enhanced barrier precautions (EBP) were followed during wound care for Resident #1.

Inspectors wroteBased on record review and interviews, the facility failed to implement policies and procedures related to pneumococcal vaccinations for one (#5) of five residents out of 20 sample residents. Specifically, the facility failed to provide the pneumococcal vaccination to Resident #5.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure the resident environment remained free from accidents hazards as was possible and that each resident had adequate supervision to prevent accidents for one (#15) of one resident reviewed for accidents and hazards out of 17 sample residents. Specifically, the facility failed to: -Ensure Resident #15 did not receive first/second degree burns to both thighs during the use of electrical stimulation in a physical therapy session; -Ensure Resident #15 had a physician order in place for use of neuromuscular electrical stimulation (NMES); and -Ensure the therapy care plan documented therapy use of NMES for Resident #15.

Inspectors wroteBased on record review and interviews, the facility failed to employ a director of food and nutrition services with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service for 19 census residents. Specifically, the facility failed to ensure the business office manager (BOM) who was in charge of the kitchen services, had sufficient qualifications for this position.

Inspectors wroteBased on record review and interviews, the facility failed to meet all the requirements for the provision of hospice care for one (#9) of one resident reviewed for hospice services out of 17 sample residents. Specifically the facility failed to: -Ensure a contract was signed between the facility and the hospice agency; -Ensure a hospice care plan was initiated for Resident #9 determining who was responsible for resident care; and -Ensure there was a medical diagnosis for hospice services.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to ensure food was stored, prepared, and served under sanitary conditions in one of one kitchen. Specifically, the facility failed to ensure: -Appropriate hand hygiene was done by food service staff; and, -The cutting boards were free from deep scratches and stains making them an uncleanable surface.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure as needed (PRN) orders for psychotropic drugs are limited to 14 days for two (#22 and #26) of five residents reviewed for unnecessary medications out of 17 sample residents. Specifically, the facility failed to discontinue a PRN psychoactive medication after 14 days without a physician's rationale for Resident #22, and Resident #26.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure that the hospice services provided meet professional standards and principles that applied to individuals providing services in the facility for one (#10) of one resident reviewed for hospice services out of 17 sample residents. Specifically, the facility failed to: -Have a written agreement to ensure Resident #10, had a written plan of care which included both the most recent hospice plan of care and a description of the services furnished by the long term care (LTC) facility; and, -Ensure that the LTC facility staff provide orientation regarding the policies and procedures of the facility, including patient rights, appropriate forms, and record keeping requirements, to hospice staff furnishing care to LTC residents.