Norterre

Inspectors wroteBased on interview and record review, the failed to protect the residents right to be free from physical abuse when Licensed Practical Nurse (LPN) A pushed Resident #1 down into a chair when he/she kept trying to stand up and later the same day, during a dressing change, LPN A pushed down hard while applying a dressing to the resident's head and caused the resident to cry out in pain. This affected one of twelve residents sampled. The facility census was 55. Review of the facility's Abuse, Prevention and Prohibition Policy, dated 01/2024, showed:-Each resident has the right to be free from abuse, corporal punishment, and involuntary seclusion. Residents must not be subjected to abuse by anyone, but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving the resident, family members or legal guardians, friends, or other individuals. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that a resident's environment remained free of accident hazards when the facility used a portable electric heater in a resident's room (Resident #1). The facility census was 55. The facility did not provide the requested policy for safe environment and/or accident hazards.1. Review of Resident #1's Quarterly Minimum Data Set (MDS, a federally mandated assessment completed by facility staff) dated 10/23/23 showed:-Severe cognitive impairment;-Impairment on both sides upper and lower extremities;-Dependent on staff for all Activities of Daily Living (ADL)s;-Diagnosis included respiratory failure and anxiety. Review of the resident's care plan dated 10/29/25 showed:-The resident had a self-care deficit related to disease process;-The resident was dependent on staff for all aspects of care. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide personal conveyance of personal funds within thirty days of discharge. This affected three of fifteen of sampled residents (Resident #205, #206, and #207). The facility census was 58. Review of facility policy, Resident trust policy, dated [DATE], showed: -If resident has personal funds deposited expires, the facility shall refund the resident's account balance within thirty days and provide a full accounting of these funds to the individual, probate jurisdiction administering the resident's estate, or other entity as required by state law or regulation. 1. Review of the facility's interim aging report, dated [DATE], showed: -Resident #205 discharged on [DATE], with a balance of $3,250.00; -Resident #206 discharged on [DATE], with a balance of $6,490.00; -Resident #207 discharged on [DATE], with a balance of $325.00. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for three of fifteen sampled residents (Resident #10, #203, and #33) by not addressing use of side rails. The facility census was 58. Facility did not provide requested policy regarding comprehensive care plans. Review of facility policy, restraint use, dated 12/2024, showed: -Physical restraints are defined as any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the individual cannot remove easily, which restricts freedom of movement or restricts normal access to one's body. -The definition of a restraint is based on the functional status of the resident and not the device. [...]

Inspectors wroteBased on observation, interviews and record review, the facility failed to meet professional standards of quality care when Licensed Practical Nurse (LPN) B, prepared medications in advance and placed them in the second drawer of the medication cart for five residents (Resident #6, #32, #31, #105, and #106) out of 24 sampled resident's. The facility census was 58. Review of the Drug Administration General Guidelines policy, dated 5/2019 showed medications that are prepared by the nurse are given to the resident at the time they are prepared. 1. During an observation on 1/14/25 at 8:47 A.M. showed LPN C administered the resident his/her medications in a cup that was labeled with his/her room number. Review of Resident #6's admission Minimum Data Set (MDS, a federally mandated assessment completed by the facility staff), dated 12/19/24 showed: - Diagnoses included: [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure dependent residents who were unable to carry out activities of daily living (ADL's) received the necessary services to maintain good personal hygiene when the facilty failed to provide perineal care every two hours for three residents (Resident #22 #24, and #2) and when facilty failed to provide regular showers for one resident (Resident #28) of 15 sampled residents. The facility census was 58. Review of the facilty's policy titled, Activities of Daily Living, undated, showed: -This facilty provides the resident with care according to the resident's care plan; -Staff will assist residents in bathing, grooming and toileting. 1. Review of Resident #22's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 10/31/24, showed: -Severe cognitive impairment; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide an ongoing program to support residents in their choice of activities designed to meet the interest of and support the physical, mental, and psychosocial well-being of each resident when residents were not offered convenient access to activities, informed when activities would occur, or encouraged to attend activities. This affected 6 residents (Residents #1, #28, #33, #37, #42 and #250) out of 15 sampled. The facility census was 58. Review of the facility's Life Enrichment Philosophy, undated, showed: - The Life Enrichment programming is rooted in person-centered care philosophy and honoring the choices of our residents; - To provide a multidisciplinary, team oriented approach to life enrichment in which all team members are responsible for the enrichment of the lives of the residents; [...]

Inspectors wroteBased on interview and record review the facility failed to recognize, treat and notify the primary physician of severe/significant weight loss for two of the 15 sampled residents (Resident #37 and #251). The facility census was 47. Review of facility policy Nutrition Impaired/Unplanned Weight Loss, undated, showed: - The nursing staff will monitor and document the weight and dietary intake of residents in a format which permits readily available comparisons over time; - 1 month 5% weight loss is significant, greater than 5% is severe; - 3 months 7.5% weight loss is significant, greater than 7.5% is severe; - The Physician will review possible causes of anorexia or weight loss with the nursing staff and/or Dietitian before ordering interventions; [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to assess residents for risk of entrapment from bed rails prior to installation, failed to obtain informed consent of risks and benefits of side rails prior to installation, failed to obtain physician's orders for side rails prior to installation, and failed to ensure the bed's dimensions were appropriate to the resident's size and weight, and failed to have a system in place to check bed rails regularly to make sure they were installed correctly for three of fifteen sampled residents (Resident #10, #203, and #33). The facility census was 58. Review of facility policy, restraint use, dated 12/2024, showed: [...]

Inspectors wroteBased on observation, record review and interview The facility failed to maintain a medication error rate less than five percent when Licensed Practical Nurse (LPN) B prepared the 8:00 A.M. medications for Resident #6 and LPN C administered the medications LPN B prepared to the resident. The facility staff had seven medication errors out of 25 opportunities resulting in a 28% medication error rate. This deficient practice affected one of 24 residents sampled. The facility census was 58. Review of the Drug Administration General Guidelines policy, dated 5/2019 showed: - Only the licensed personnel who prepare the resident's medication may administer it; - The medication is to be recorded in the residents medication administration record (MAR) at the time the medication is administered. 1. [...]

Inspectors wroteBased on observation, record review, and interviews, the facility failed to store, prepare and serve food in accordance with professional standards of food service safety when staff failed to date the receipt of incoming products, label, seal, and date used products, store food items off of the floor of the dry storeroom, and properly dispose of expired products, leftovers, and dented cans. This affected all residents by putting them at risk for a food borne illness. The facility census was 58. Review of facility policy Food Storage (Dry, Refrigerated, and Frozen), undated, showed: - Guideline: Food shall be stored on shelves in a clean, dry area, free from contaminants; - All food items will be labeled. The label must include the name of the food and the date by which it should be sold, consumed, or discarded; - Rotate products so the oldest are used first (Observation: [...]

Inspectors wroteBased on observation and interview, the facility failed to provide sufficient dining space to accommodate all residents for dining resulting in crowded dining room tables, lack of privacy for residents, and residents turned away from dining room service. This affected four of 15 residents (#34, #42, #201, #250) sampled. The facility census was 58. 1. Review of Resident #250's admission record, dated 1/16/25, showed: - admission date 1/3/25; - Diagnosis: cerebral ischemia (brain deprived of oxygen), cerebral infarction (stroke), spondylosis (arthritis), osteoarthritis left hip (cartilage and bone breakdown); Review of resident's care plan, dated 1/6/25, showed: - Resident has potential nutritional problems, provide and serve diet as ordered; - Resident is able to eat independently after set-up; During an interview on 1/13/25 at 2:38 P.M, resident #250 said: [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to employ a qualified activity professional to oversee the activity program of the facility. The facility employees a full time activity director but he/she has not completed an approved activity professional training program. The facility census was 58. The facility did not provide a policy regarding activity professional training and requirements. Review of facility policy, life enrichment, undated, showed: -It was responsibility of all team members under the guidance of the Activity Director to ensure implementation of minimum standards for life enrichment programming; -Life enrichment program was built on five dimensions of wellness: Physical, social, emotional, spiritual, and Intellectual and should be informed by resident references, expressed interests, and goals. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff developed comprehensive, person-centered care plans that include interventions and objectives with time-frames to meet the residents' medical, nursing, mental and psycho-social needs for five out of 12 sampled residents (Residents #4, #5, #8, #16 and #26). The facility census was 32. Review of the facility's policy related to comprehensive, person-centered care plan development, dated December 2016, showed, in part: - A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. - Interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. - The care plan will include: [...]

Inspectors wroteBased on interview and record review, the facility failed to assure staff provided the necessary care and services to attain or maintain the highest practicable physical, mental, or psychosocial well-being when they failed to answer call lights in a timely manner. This affected one of 12 sampled resident (Resident #26). The facility census was 32. Review of the facility policy titled Answering the Call Light, dated October 2010, showed the following: - Answer the resident's call as soon as possible; - If you have promised the resident you will return with an item or information, do so promptly. 1. Review of Resident #26's admission Minimum Data Set (MDS), a federally mandated assessment tool completed by facility staff, dated 7/25/19, showed: - Diagnoses included fusion of spine, lumbar region; - Always continent of bowel and bladder; - Required two person assist to the bathroom; [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure staff invoked (activated by verifying incapacity of the resident to make decisions) Durable [NAME] of Attorney (DPOA) prior to allowing the designated agent to sign Outside of Hospital Do Not Resuscitate (OHDNR) documents which affected one of 12 sampled resident (Resident #14). The facility census was 32. Review of the facility policy titled Advance Directives, dated December 2016, included the following: - Advance directive will be respected in accordance with state law and facility policy; - Prior to or upon admission of a resident, the Social Services Director or designee will inquire of the resident, his/her family members and/or his or her legal representative, about the existence of any written advance directives; [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to provide a safe, clean, comfortable, and homelike environment. This affected two of 12 sampled residents (Resident #33 and #89). The facility census was 32. Review of the facility policy titled Cleaning and Disinfecting Residents' Rooms, dated August 2013, showed: - Housekeeping surfaces (for example, floors, tabletops) will be cleaned on a regular basis, when spills occur, and when these surfaces are visibly soiled; - Environmental services will be disinfected or cleaned on a regular basis (for example, daily, three times per week, and when surfaces are visibly soiled. 1. Observation on 8/21/19, at 3:40 P.M., in Resident #33's room showed: - Dust light gray on top of soap dispenser and over the sink light; - Penny and dime-sized brown colored spots on the shower floor; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to assure staff provided proper respiratory care when staff failed to properly clean oxygen concentrator filters and failed to date tubing when opened. This affected two of 12 sampled residents (Resident #8 and #94). The facility census was 32. The facility did not provide a policy on maintaining oxygen concentrators and tubing. 1. Review of Resident #8's admission Minimum Data Set (MDS), a federally mandated assessment tool completed by facility staff, dated 6/19/19, showed: - Severe cognitive impairment; - Diagnoses included Alzheimer's disease. Review of the resident's care plan, dated 8/20/19, showed the resident required oxygen therapy. The approaches included change oxygen tubing as ordered; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff administered medications with an error rate of less than 5%. Facility staff made two errors out of 25 opportunities for error, resulting in an error rate of 8%. This affected two residents (Residents #5 and #139). The facility census was 32. Review of the facility's policy related to medication administration, dated December 2012, showed: - Medications must be administered in accordance with the orders, including any required time frame. - The individual administering the medication must check the label three times to verify the right resident, right medication, right dosage, right time and right route of administration before giving the medication. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff followed hand hygiene techniques to prevent the spread of infection for two out of 12 sampled residents (Residents #19 and #86) when staff did not perform hand hygiene between dirty and clean tasks during resident care. The facility census was 32. Review of the facility's policy related to hand hygiene, dated August 2015, showed, in part: - This facility considers hand hygiene the primary means to prevent the spread of infections. - All personnel shall follow the hand-washing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. [...]