Northchase Nursing and Rehabilitation Center

Inspectors wroteBased on observations and staff interviews, the facility failed to discard expired medications on 2 of 4 medication (med) carts observed (200 hall and 100 hall med carts) and date medications when they were opened to allow for the determination of their shortened expiration date for medications stored on 3 of 4 med carts (100 hall, 200 hall, and 400 hall) med carts reviewed for medication storage.

Inspectors wroteBased on record review, observations and staff interviews, the facility failed to remove expired food items stored for use in 1 of 1 walk-in refrigerator and 1 of 2 nourishment rooms and failed to label and date leftover food in 1 of 2 nourishment rooms observed (Rehabilitation Hall nourishment room). This deficient practice had the potential to affect the food served to the residents.

Inspectors wroteBased on record review, and staff and family interviews, the facility failed to honor a resident's choice to receive a shower for 1 of 1 resident reviewed for choices (Resident #172).

Inspectors wroteBased on record review, and staff, Nurse Practitioner (NP), Medical Director interviews, and Consultant Pharmacist interviews, the facility failed to protect a resident's right to be free from neglect, when a nurse (Nurse #1) disregarded a severe drug-to drug interaction alert sent from the pharmacy to the resident's electronic medical record (EMR), regarding a newly prescribed antibiotic and a heart medication the resident (Resident #30) was currently prescribed. Nurse #1 neglected to read a severe drug-to-drug interaction alert received from the pharmacy regarding a newly prescribed antibiotic and did not notify the physician of the alert. The resident was administered the antibiotic by the nurse and there was no significant harm to the resident. This deficient practice occurred for 1 of 1 resident reviewed for neglect.

Inspectors wroteBased on record review and interviews with staff, Consultant Pharmacist, and Pharmacy Manager, the facility failed to prevent misappropriation of a resident's controlled medication (30 hydrocodone/acetaminophen 5-325 milligrams (mg) pills and 30 oxycodone hydrochloride 10 mg pills) prescribed by the physician for pain for 1 of 1 resident reviewed for misappropriation of property (Resident #267).

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) assessments in the area of Preadmission Screening and Resident Review (PASRR) for 2 of 26 residents reviewed for MDS assessments (Resident #14 and #16).

Inspectors wroteBased on record review and staff and Nurse Practitioner (NP), and Consultant Pharmacist interviews, the facility failed to prevent the administration of unnecessary medication when a resident (Resident #30) a) received a dose of ceftriaxone (an antibiotic used to treat bacterial infections) as a one-time dose by intramuscular injection. Resident #30 had a documented allergy to ceftriaxone documented on the allergy list in the electronic medical record (EMR) and b) administered azithromycin ( an antibiotic used to treat bacterial infections) that had a drug to drug interaction alert not to be administered with amiodarone without a baseline electrocardiogram (EKG is a test that measures the electrical impulses in the heart for abnormal rhythms because of risk of long QT syndrome (prolonged QT interval on the EKG (which increases the risk of a dangerous heart rhythm). [...]

Inspectors wroteBased on observations, record review, resident and staff interviews, the facility failed to honor a resident's food preferences. This deficient practice was for 1 of 3 residents reviewed for food preferences (Resident #14).

Inspectors wroteBased on record review and staff interviews, the facility failed to code the Minimum Data Set (MDS) assessments accurately in the area of nutrition for 4 of 11 residents whose MDS assessments were reviewed for nutrition (Residents #107, #12, #19, # 69).

Inspectors wroteBased on record review, and staff and resident interviews, the facility failed to update the comprehensive care plan to reflect changes in care interventions in the areas of mobility and nutrition. This was for 3 of 11 residents whose care plans were reviewed (Resident #107, Resident #12, and Resident #19).

Inspectors wroteBased on observations, record review, staff, and the Nurse Practitioner interviews the facility failed to 1.) obtain blood pressure readings or heart rate prior to administering the antihypertensive medication Metoprolol which had parameters to hold the medication if the systolic blood pressure was less than 110 mmHg (millimeters of mercury) or heart rate less than 60 beats per minute. (Resident #17) and 2.) obtain physician ordered weekly weights for a resident with congestive heart failure. (Resident #44). This occurred for 2 of 2 residents (Resident #17, Resident #44) reviewed for quality of care.

Inspectors wroteBased on record review, observations and staff, resident and Nurse Practitioner interviews, the facility failed to provide physician ordered nutritional supplements on meal trays and failed to obtain physician ordered weights for 2 of 10 residents reviewed for nutrition (Resident #107 and Resident #19). 1. Resident #107 was admitted on [DATE]. Resident's medical diagnosis included stroke, failure to thrive, protein calorie malnutrition and diabetes. Review of Resident #107's electronic health record revealed the following weights were recorded: 10/2/2023- 207.3 pounds (Lbs.) 11/10/2023- 205.1 Lbs. 12/5/2023- 194.2 Lbs. 1/19/2024- 181.8 Lbs. 1/30/2024- 177.1 Lbs. 2/9/2024- 172.5 Lbs. 3/26/2024- 147.6 Lbs. 4/2/2024- 152.3 Lbs. 4/10/2024- 158.1 Lbs. 4/16/2024- 158.0 Lbs. 4/23/2024 No weight recorded. 4/30/2024 No weight recorded. 5/7/2024- 161.3 Lbs. 5/14/2024- 157.8 Lbs. [...]

Inspectors wroteBased on record review, and resident, staff and Nurse Practitioner interviews, the facility failed to ensure a resident had an appointment scheduled for a physician ordered mammogram (Resident #22) for 1 of 1 resident sampled for medically related social services.

Inspectors wroteBased on record review, and staff, Pharmacy Consultant, and Nurse Practitioner interviews the facility failed to 1a.) administer the antihypertensive medication Metoprolol prescribed to lower blood pressure, the oral diabetic medication Tradjenta prescribed to lower blood sugar , a phosphate binder Sevelamer (a medication prescribed to lower the amount of phosphorus in the blood when receiving dialysis), and Cymbalta prescribed for neuropathy to a hemodialysis resident after returning from dialysis treatments. This resulted in the resident (Resident #17) not receiving a total of 15 doses of Metoprolol, 15 doses of Tradjenta, 15 doses of Sevelamer, and 8 doses of Cymbalta. 1b.) administer the full course of the oral antifungal Diflucan prescribed for treatment of vaginitis according to the physicians order (Resident #17). This resulted in 2 of the 3 doses of Diflucan not administered. [...]

Inspectors wroteBased on observation, record review, resident and staff interview, the facility failed to ensure food was palatable and served at an appetizing temperature for 4 of 8 residents reviewed for food palatability and temperature (Residents #22, #116, and #107) and 5 of 5 Resident Council members in attendance at a Resident Council meeting (Residents #23, #119, #14, #75 and #41).

Inspectors wrotec. Resident #22 was admitted to the facility on [DATE]. Resident #22's quarterly Minimum Data Set (MDS) dated [DATE] indicated the resident was cognitively intact. An interview was conducted with Resident #22 on 5/13/24 at 12:00 PM. Resident #22 stated she wished she could make a choice about what she received to eat. An interview was conducted on 5/14/24 at 9:12 AM with Resident #22. The resident indicated the only thing she was offered as an alternate was a grilled cheese sandwich. A meal observation conducted on 5/16/24 at 12:26 PM revealed Resident #22 was in bed with the head of the bed elevated feeding herself a pasta take out meal. Resident stated she ordered take out as she did not like the lunch and did not want a grilled cheese sandwich again. [...]

Inspectors wroteBased on record review, staff interviews, and Nurse Practitioner (NP) interview the facility failed to notify the provider of significant weight gain greater than 3-pounds (lbs.) in 24-hours (hrs.), or 5-lbs. in a week, for a resident that required weight gain monitoring for possible cardiac fluid overload due to resident's history of Congestive Heart Failure (CHF). This deficient practice occurred for 1 of 11 sampled residents reviewed for notification of change. (Resident #20)

Inspectors wroteBased on record review and staff interviews the facility failed to provide a Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advanced Beneficiary Notice (SNF-ABN) prior to discharge from Medicare Part A skilled services for 2 of 3 residents reviewed for beneficiary protection notification who required the provision of the SNF-ABN form (Resident #126 and #129).

Inspectors wroteBased on observations, record review, resident and staff interviews the facility failed to provide tray set-up and assistance with eating to maintain resident's ability to feed themselves for 3 of 3 residents (Resident #112, #126, and #131) reviewed for activities of daily living (ADL).

Inspectors wroteBased on record review, observation, and resident, staff and Nurse Practitioner interviews, the facility failed to obtain an appointment with an ophthalmologist for evaluation of vision for 1 of 1 resident (Resident # 22) reviewed for vision.

Inspectors wroteBased on observations, and staff interviews the facility failed to secure a medication cart that was left unattended and unlocked with the keys in the lock while the cart was in the hallway near resident rooms. This was observed for 1 of 4 medication carts reviewed for medication storage. (400 Hall medication cart)

Inspectors wroteBased on observations, record review, and staff, resident, and the Nurse Practitioner interviews the facility failed to implement the Enhanced Barrier Precautions (EBP) policy regarding donning Personal Protective Equipment (PPE) to include donning gloves and gown during high contact resident care activities. Two Nurse Aides were observed providing care to a resident with an indwelling central venous catheter used for dialysis and who received wound care to the right lower extremity and were not wearing a gown during care. This occurred for 1 of 5 resident (Resident #82) observed for Infection Control.

Inspectors wroteBased on observations, record review, and staff and resident interviews, the facility failed to provide a safe transfer when a resident (Resident #1) fell from a mechanical lift while being transferred by Nurse Aide #1 and Nurse Aide #2 and sustained a 10-centimeter laceration to the right ankle requiring 9 sutures, a contusion to the left wrist and left shoulder, and pain as a result of the fall for 1 of 3 residents observed for falls.

Inspectors wroteBased on observations, record review, and staff interviews the facility failed to maintain the final rinse cycle temperature of the high temperature sanitizing dish machine at or above 180 degrees Fahrenheit per manufacturers recommendations and failed to routinely monitor and record the dish machine wash and rinse cycle temperatures for 1 of 1 dish machines observed. 2) failed to obtain food temperatures prior to serving and failed to maintain consistent food temperature logs during 1 of 2 observations. 3). failed to label and date leftover food and ensure the nourishment room refrigerator was free from debris for 1 of 2 nourishment rooms (200 Hall nourishment room). This practice had the potential to affect the food served to the residents.

Inspectors wroteBased on observations and staff interviews the facility failed to: 1a) repair drywall wall damage in 6 of 7 resident rooms (302, 309, 506, 508, 514, and 612), 1b) failed to remove the black greenish substance from the commode base caulking in 4 of 13 resident rooms (506, 508, 510, and 615), 1c) failed to ensure the ceiling light cover was free from damage in 1 of 4 shower rooms (300 hall), 1d) failed to ensure the florescent ceiling light cover was free from damage in 1 of 3 nursing stations (over exit door by [NAME] nursing station).

Inspectors wroteBased on observation, record review, resident and staff interview and test tray evaluation, the facility failed to ensure food was palatable and served at an appetizing temperature for 3 of 24 residents reviewed on the 100, 400 and 700 halls for food palatability and temperature (Resident #332, Resident #18, and Resident #81).

Inspectors wroteBased on record review, observations and staff interviews the facility's Quality Assessment and Assurance (QAA) program failed to maintain implemented procedures and monitor interventions the committee put in place following the complaint survey conducted on 8/13/21. This was for two recited deficiencies on the current recertification and complaint survey in the areas of Resident Rights (F584) and Food and Nutrition Services (F804). The continued failure during two federal surveys of record shows a pattern of the facility's inability to sustain an effective QAA program.