Norridge Gardens

Inspectors wroteBased on observation, interviews and record review, facility failed to implement fall precautions to prevent falls with injuries. This applies to 2 out of 3 residents (R2, R3) reviewed for fall precautions.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow their Water Management Program, failed to follow their policy for PPE (Personal Protective Equipment) during care of a resident in contact isolation, and failed to follow their policy for hand hygiene and glove use during provisions of care. This applies to all 206 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide incontinence care, oral care, and grooming to residents who depend on the facility for care. The facility also failed to shave female and male resident's long facial hair and trim and clean resident's long fingernails. This applies to 13 of 13 residents (R16, R21, R42, R61, R77, R80, R106, R115, R134, R160, R167, R190, R199) reviewed for ADL (Activities of Daily Living) in the sample of 35.

Inspectors wroteBased on observation, interview, and record review, the facility failed to label and date medication to determine the expiration date once it was opened and failed to ensure narcotic medications were accounted for. This applies to 9 of 11 residents (R4, R11, R18, R36, R38, R89, R90, R134, R136) reviewed for medication storage and labeling in the sample of 35.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess and treat a resident with a contracture of the left hand and failed to apply a splint in accordance with physician orders. This applies to 2 of 6 residents (R117 and R160) reviewed for range of motion in the sample of 35.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide safe transfer and feeding supervision to residents who required assistance for activities of daily living care. This applies to 3 of 4 residents (R24, R42, R58) reviewed for safety during ADL assistance in the sample of 35.

Inspectors wroteBased on observations, interview and record review, the facility failed to provide double protein portion as ordered by the physician. This applies to 2 of 2 residents (R95 and R168) observed for dining in the sample of 35.

Inspectors wroteBased on interview and record review, the facility failed to follow their policy to offer residents the pneumococcal vaccine. This applies to 3 of 5 residents (R63, R79, and R118) reviewed for immunization in the sample of 35.

Inspectors wroteBased on observation and interview, the facility failed to ensure that the results of survey were readily available for residents to view. This failure has the potential to affect all 206 residents who reside in the facility.

Inspectors wroteBased on interview and record review, the facility failed to provide showers twice a week per facility policy. This applies 2 of 5 residents (R3, R6) reviewed for showers in the sample of 7.

Inspectors wroteBased on interview and record review, the facility failed to ensure nursing staff remained with a resident until all of the resident's medications were administered per facility policy. This applies to 1 of 6 residents (R2) reviewed for medications left at bedside in a sample of 7.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide personal care to dependent residents. This applies to 2 of 4 residents (R2, R3) reviewed for activities of daily living care in a sample of 4. Findings Include: 1. R2 is a [AGE] year-old female with moderate cognitive impairment as per the Minimum Data Set (MDS) dated [DATE] and dependent on staff for personal hygiene. On 5/30/24 at 10:10 AM, R2 was observed with V10 (LPN-Licensed Pratical Nurse) in her room. R2 was noted with a strong urine odor. V10 (Licensed Practical Nurse/LPN) checked on R2, and R2 was observed to be dirty and soaked incontinent brief with urine and discoloration (blackish). On 5/30/24 at 10:10 AM, V10 stated, The CNAs are supposed to change residents every two hours. I don't think R2 was changed today, and I will check with my CNA (Certified Nursing Assistant) to change R2. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure urinary catheter insertion was completed to prevent potential cross contamination. This applies to 1 of 3 residents reviewed for urinary tract infection in a sample of 4.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure Activities of Daily Living assistance was provided for three of three residents (R1, R2, R3) reviewed for requiring extensive assistance with Activities of Daily Living on the sample list of eight.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure comfortable temperatures for 3 of 8 residents (R1, R2, and R3), a comfortable bed mattress for 1 of 8 residents (R1), and odorless air for all 93 residents third-floor residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide incontinent care and provide Activities of Daily Living care to residents. This applies to 8 of 8 residents (R3-R10) reviewed for incontinent care and Activity of Daily Living Care on the sample list of 10.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to supervise a resident that ingested another resident's medication. This failure resulted in R1 being hospitalized for drug overdose, fast heartbeat, and altered mental status. This applies to one out of seven residents (R1) reviewed for supervision with medication.

Inspectors wroteBased on interview and record review, the facility failed to safeguard and properly store a medication that led to a confused resident ingesting that medication. This failure resulted in R1 being hospitalized for drug overdose, fast heartbeat, and altered mental status. This applies to one out of seven residents (R1) reviewed for medication storage.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure food was prepared in a form to meet a residents needs which applies to 5 of 5 residents (R76, R84, R153, R213, R222) reviewed for puree diets in a sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the food service areas were sanitized prior to serving food. This failure affects 5 of 5 residents (R84, R124, R153, R213, R380) reviewed for food service in a sample of 35.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure staff donned and doffed Personal Protective Equipment PPE when entering and leaving rooms with residents who were on isolation due to testing positive for the COVID-19 virus. The facility also failed to ensure doors were kept closed for rooms with COVID-19 positive residents, failed to ensure a COVID-19 positive residents remained isolated in their rooms. The facility also failed to implement enhance barrier precautions. These failures affect 16 of 35 residents (R129, R48, R73, R89, R18, R5, R139, R62, R79, R173, R159, R58, R6, R43, R134 and R100) reviewed for infection control in the sample of 35.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents who require extensive assist received assistance with incontinence care and toileting. This applies to 3 of 25 (R124, R41, R76) residents reviewed for activities of daily living in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure dressings and pressure relieving interventions were in place for residents with pressure injuries and at risk for pressure injuries. This applies to 3 of 8 (R3, R213, R84) reviewed for pressure in the sample of 35.

Inspectors wroteBased on observation, interview and record review the facility failed to safely transfer residents. The facility also failed to supervise a resident who is at a high risk for falls and has history of falls for 3 of 35 residents (R76, R68, R41) reviewed for safety and supervision in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a residents urinary catheter tubing and drainage bag was below the level of the bladder for 1 of 8 residents (R380) reviewed for urinary catheter care in the sample of 35.

Inspectors wroteBased on observation, interview and record review the facility to ensure a resident with a diagnosis of dementia that is exhibiting behaviors,, was provided necessary care and services. This applies to 1 of 10 residents (R68) reviewed for dementia care in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident's narcotic controlled substance record for was in place for 1 of 1 residents (R213) reviewed for controlled substance medications in the sample of 35.

Inspectors wroteBased on interview, and record review the facility failed to ensure medication regimen reviews (MRRs) were being completed and documented on a monthly basis. The facility also failed to ensure those recommendations were being followed up on by a physician. This applies to 2 of 5 (R3, R50) reviewed for MRRs in the sample of 35.

Inspectors wroteBased on interview and record review the failed to implement a pharmacy recommendation of a gradual dose reduction (GDR) for a resident who is receiving a antipsychotic medication. This applies to 1 of 5 residents (R185) reviewed for unnecessary medications in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure insulin administration pens were labeled with an opened date and failed to dispose of expired insulin for 2 of 8 residents (R160, R181) reviewed for medication storage in the sample of 35.

Inspectors wroteBased on observation, interview, and record review, the facility failed to have adequate staff to provide assistant with activities of daily living in a timely manner. This failure has the potential to affect all 248 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow the menu items as planned. This failure has the potential to affect all 235 residents consuming food from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to serve hot food to residents at a palatable temperature. This failure has the potential to affect all 235 residents consuming food from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide personal care to residents requiring assistance with ADL (Activities of Daily Living) needs. This applies to 6 of 9 residents (R4-R9) reviewed for activities of daily living (ADL) from a sample of 9.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide adequate staffing in order to: answer call lights timely, provide incontinent care, and provide showers/bed baths. This failure has the potential to affect all 245 residents who reside in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assist residents identified as needing assistance with incontinence care and toileting, and showers/bed baths. These failures affect 4 of 6 residents (R1, R2, R5, R8) reviewed for Activities of Daily Living in the sample of 8.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident with a current UTI (Urinary Tract Infection) had orders for an indwelling catheter and failed to change the indwelling catheter. This resulted in R26 experiencing chronic UTIs with the need for IV (intravenous) antibiotic treatment. The facility failed to provide incontinence care in a manner to meet professional standards. These failures apply to 2 of 7 residents (R26, R95) reviewed for catheter and bladder care in the sample of 35.

Inspectors wrote2. R56's admission sheet documents she was admitted to the facility on [DATE] with a primary diagnosis of multiple sclerosis (MS). The facility assessment of 11/8/22 shows R156 to have severe cognitive impairment. The order summary sheet for active orders of January 2023 shows R56 to have a monthly weight. The weights and vitals summary shows a documented weight of 158.9 pounds in January 2022, March and April 2022 she was 148. 6 pounds. No further weights were documented until August 2022, and R56 was 144.8, and the next weight was November 2002 and R56 was down to 136 pounds. No further weight was documented. On 1/26/23, V22 and V23 (Restorative Nurses) said the restorative department was responsible for monthly weights and monitoring. V22 said the restorative aides do the monthly weights and if there is a daily weight, nursing will complete those weights. [...]

Inspectors wrote2. R137's admission Record printed by the facility on 1/26/23 showed she had diagnoses including hemiplegia and hemiparesis following a cerebral infarction (paralysis and weakness affecting one side following a stroke), dysphagia (difficulty swallowing foods or liquids), following cerebral infarction aphasia (a disorder that affect how you communicate. It can impact your speech, as well as the way you write and understand both spoken and written language), and gastrostomy status (g-tube). R137's facility assessment dated [DATE] section C does not show a BIMS (Brief Interview for Mental Status) score. The assessment showed R137 had modified independence with her cognitive skills for daily decision making. The assessment also showed R137 was dependent on staff for eating (includes intake of nourishment by tube feeding). [...]

Inspectors wroteBased on observation, interview and record review the facility failed to have sufficient nursing staff to provide care and services for all residents in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to have an Infection Preventionist who completed the specialized training in Infection Prevention and Control. This has the potential to affect all of the residents in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to obtain vaccination status for residents. This has the potential to affect all of the residents in the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the residents, who are dependent on staff, received assistance with basic ADLs (Activities of Daily Living), such as feeding, toileting, oral hygiene and changing of adult garments in a timely manner. This applies to 5 of 8 resident (R345, R343, R45, R85 and R220) in the sample of 35.

Inspectors wroteBased on observation, interview, and record review, failed to ensure residents' air mattresses were inflated according to their weight; failed to ensure residents' pressure relieving interventions were implemented; and failed to identify a resident at risk for pressure injury for 6 of 15 residents (R124, R220, R224, R45, R26, R68) in the sample of 35.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents received their range of motion programs for 1 of 1 resident (R43) reviewed for range of motion in the sample of 35, and for 3 residents (R59, R55 and R90) outside of the sample.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure bedtime snacks were distributed to 4 of 4 residents (R220, R343, R350, and R228) reviewed for bedtime snacks in a sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide incontinence care in a dignified manner for 2 of 2 residents (R139, R65) reviewed for dignity in the sample of 35.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure there were no discrepancies with resident advanced directives for 3 of 3 residents (R193, R439, R177) reviewed for Advanced Directives in the sample of 35.

Inspectors wroteBased on observation, interview and record review the facility failed to supervise residents with swallow precautions while eating for 2 of 6 residents (R3, R95) reviewed for safety in the sample of 35.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a midline intravenous dressing was changed for 1 of 3 residents (R177) reviewed for intravenous fluids and dressings in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure medications were administered in a manner to meet professional standards for 1 of 5 residents (R112) reviewed during medication administration.

Inspectors wroteBased on interview and record review, the facility failed to have a system in place to offer, track, monitor, record and re-offer immunizations for influenza and pneumonia for 3 (R220, R22, R99) of 5 residents reviewed for immunizations in the sample of 35.