Northern Cardinal Rehabilitation and Nursing

Inspectors wroteBased on staff interview, clinical record review and facility document review, it was determined the facility staff failed to provide complete and accurate documentation for one of eight residents, R3.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure that the facility accurately reflected the advance directive status for three of 12 sampled residents (Resident (R) 1, R73, and R109) reviewed for advance directives. Advance directive forms were not present for residents who were identified as DNR (do not resuscitate) status. Although physicians signed forms indicating code status, the forms were not signed by the resident or a health care surrogate named in an advance directive form. The failure to ensure that the facility has current, complete advance directive documentation places residents at risk of not receiving the end of life care they desire and/or having their wishes for code status honored.

Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to notify the resident and/or the resident's representative, as well as the Ombudsman of transfers and the reason for the move in writing for two (Resident (R) 19 and R69) of three residents reviewed for hospitalization. The facility failed to provide a written notice, containing all required information, including the reason, date, and location to which the resident was transferred, as well as information about appeal rights, when R19 and R69 were transferred to the hospital for emergency care.

Inspectors wroteBased on resident and staff interviews, clinical record review and facility documentation review, the facility staff failed to invite 3 residents to attended their person-centered care plan and failed to update and revise one resident care plan who had a change in their code status for 4 of 57 residents (Resident #73, #63, #161 and #109) in the survey sample. PARTICIPATION IN CARE PLANNING 1. a. Review of R73's admission Record, located in the electronic medical record (EMR) under the Profile tab, indicated the resident was admitted to the facility on [DATE] with diagnoses that included Alzheimer's Disease with late onset. [...]

Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to ensure one (Resident (R) 63) of five residents reviewed for unnecessary medications received their medication in accordance with accepted professional standards. The facility failed to administer medications in a timely manner as ordered on four of four weekends that were reviewed.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure that three of 57 sampled residents (Resident (R) 32, R73, and R94) were free of potential accidents while residing in the facility. Specifically, the facility failed to verify placement and function of wander guards (device worn to prevent elopements) for the three residents, who had wandering and/or exit-seeking behaviors. This failure placed the resident at risk for elopement and potential injury. In addition, the facility failed to thoroughly assess one resident (R211) after a fall, as well as conduct a thorough investigation with a root cause analysis to determine the reason for the resident's fall so as to initiate steps to prevent further accidents.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to ensure staff washed their hands/performed hand hygiene as required during wound care for one (Resident (R) 28) of 57 sampled residents. In addition, soap dispensers needed for handwashing in three resident bathrooms were not functioning properly. This failure involved six (Resident (R) R3, R5, R17, R19, R69, and R162).

Inspectors wroteBased on interview, record review, and review of the Facility Assessment, the facility failed to provide training/education on the required topic of dementia for five of five Certified Nurse Assistants (CNAs) reviewed under the Sufficient and Competent Nursing Staff facility task. This failure had the potential to leave staff unprepared to meet the needs of residents in the facility with a diagnosis of dementia.

Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to provide the resident and/or resident representative with a written bed hold notice upon transfer to the hospital for two (Resident (R) 19 and R69) of three residents reviewed for hospitalization.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Minimum Data Set assessment accurately reflected the resident's status for three (Resident (R) 28, R73 and R211) of 55 sampled residents. The facility failed to ensure that alarm use, oxygen therapy, and falls were accurately coded to reflect the residents' devices, needs, and/or history. This failure placed the resident at risk for unmet care needs.

Inspectors wroteBased on observation, staff interview and clinical record review the facility staff failed to ensure 2 residents out of 57 (Resident #57 and 74) in the survey sample who was unable to carry out activities of daily living receives the necessary services to maintain fingernail care and showers.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to provide oxygen therapy as needed for one (Resident (R) 28) of two residents reviewed who required respiratory care received out of a total sample of 57 residents. Oxygen was not continuously delivered at the rate ordered by the physician and was removed by staff who were not qualified to perform this task.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure that medication irregularities identified by the consultant pharmacist were acted upon for two (Resident (R)35 and R80) of five residents reviewed for unnecessary medication use. The failure to ensure that the physician reviewed and responded to the pharmacist's recommendations placed the residents at risk for unnecessary medications and associated side effects.

Inspectors wroteBased on resident and staff interview, clinical record review and facility document review, the facility staff failed to ensure 1 of 57 residents (Resident #312) in the survey sample were free of significant medication errors.

Inspectors wroteBased on observation, staff interviews and facility documentation review the facility staff failed to ensure a bottle of medication (Aspirin 81 mg) was stored in a secured location, accessible to designated staff only.

Inspectors wroteBased on interview, record review, and facility policy reviews, the facility failed to ensure that three (Resident (R) 38, R62, and R414) of five residents reviewed for vaccine administration, were offered and/or received the pneumococcal series and/or influenza vaccination. Specifically, R38 was not educated or offered the pneumococcal series or influenza vaccination, R62 was not educated or offered the pneumococcal series, and R414 was not offered the influenza vaccination.

Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to timely notify the families of two (Resident (R) 63 and R73) of 57 sampled residents by 5:00 PM the following day when the residents tested positive for COVID-19.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to provide required education and offer immunization to one (Resident (R) 414) of five residents reviewed for immunizations. Specifically, the facility failed to provide education and offer the COVID-19 vaccine to the resident.

Inspectors wroteBased on resident interviews, staff interviews, and clinical record review the facility staff failed to administer medications as ordered by the physician for 2 of 42 residents in the survey sample, Resident #3 and #25.

Inspectors wroteBased on observation, resident interview, staff interviews, clinical record review and facility document review, the facility staff failed to determine that it was safe for one of 42 residents in the survey sample to self-administer medications, Resident #7.

Inspectors wroteBased on observation, resident interview, staff interviews, clinical record review and facility document review the facility staff failed to revise the comprehensive person-centered care plan to include medication self-administration for one of 42 residents in the survey sample, Resident #7.

Inspectors wroteBased on resident interview, staff interviews, clinical record review and facility documentation review the facility staff failed to meet professional standards for the administration of medications for 1 of 42 residents (Resident #25) in the survey sample. Resident #25 was administered her roommate's medications in error.

Inspectors wroteBased on observations, resident interview, staff interviews and clinical record review the facility staff failed to ensure 3 residents (Resident #15, #57, #288) out of 42 residents in the survey sample, received the necessary services to maintain good personal hygiene.

Inspectors wroteBased on observation, staff interview and clinical record review the facility staff failed to ensure 1 of 42 residents in the survey sample received the appropriate treatment and services to prevent further decrease in range of motion, Resident #57. The facility staff failed to consistently apply the left comfy knee orthosis as ordered.

Inspectors wroteBased on resident interview, staff interviews, clinical record review and facility documentation review, the facility staff failed to ensure 1 out of 42 residents, Resident #25 was free from the use of unnecessary medications. Resident #25 was administered another resident's medications in error.

Inspectors wroteBased on general observations of the nursing facility, the facility failed to ensure medications were labeled in accordance with currently accepted professional principles in 1 out of 5 medication carts.

Inspectors wroteBased on staff interview and documentation review the facility staff failed to ensure 2 out of 6 Certified Nursing Assistants (CNA) received their required annual dementia training.

Inspectors wroteBased on observation, resident interview, staff interview, facility documentation review, and clinical record review, the facility staff failed to maintain a safe environment for 2 of 41 residents in the survey sample (Resident #25 and Resident #4). This citation was originally found at a level four isolated and upon acceptance of the plan of correction, it was lowered to a level two isolated. During initial tour, an oxygen E tank was observed in Resident #40's room. The tank was unsecured. There was approximately 2000 PSI (pounds-force per square inch) reading on the gauge of the tank. It was sitting, without a stand or holder, left of the door going out to the hall. The observation constituted the notification of immediate jeopardy. An additional unsecured oxygen tank was observed sitting in the corner of Resident #4's room. [...]

Inspectors wroteBased on clinical record review, resident interview, and staff interview, the facility failed to provide baseline care plan summaries to the resident or the resident's respresentative; and failed to document in the medical record that summaries were provided for 7 of 41 residents in the survey sample (Residents #25, #64, #213, #96, #103, #51, and #57).

Inspectors wroteBased on an extended survey task, a review of the facility's competencies for the Certified Nursing Assistants (CNA) was completed. The facility staff failed to demonstrate the required 12 hours continual competencies were completed for 6 CNAs.

Inspectors wroteBased on observation,clinical record review, facility document review, and staff interviews, the facility staff failed to ensure an effective infection control program to help prevent the development and transmission of communicable diseases and infections. 1. The facility staff failed to report and track infection control data for months. 2. The facility staff failed to ensure infection control measures were implemented during a glucometer check to prevent the potential of cross contamination. 3. The facility staff failed to ensure handwashing between feeding of residents in the dining room was implemented to prevent the potential of cross contamination. 4. Facility failed to ensure resident # 96 nebulizer was stored in a sanitary manner. 5. Facility failed to store respiratory equipment in a sanitary manner for resident #103.

Inspectors wroteBased on resident interview, staff interview, clinical record review and facility documentation review, the facility staff failed to invite 2 of 41 residents in the survey sample, to attend their person centered care plan meeting (Resident #10 and #75).

Inspectors wroteBased on staff interview, resident interview, and facility documentation review, the facility staff failed notify the physician and resident representative of an abuse allegation with injury for one (1) of 41 residents (Resident #75) in the survey sample.

Inspectors wroteBased on clinical record review, staff interviews, and facility documentation, the facility staff failed to ensure Medicare Beneficiary Notices were issued to 2 of 41 residents (Residents #75 and #94) in the survey sample.

Inspectors wroteBased on record review, staff and resident interview, and the investigation of a Facility Reported Incident (FRI), The facility staff failed to ensure privacy and confidentiality was maintained for two residents (Resident #34 and #163) in the survey sample of 41 residents.

Inspectors wroteBased on staff interview, resident interview, and review facility documentation, the facility staff failed to notify the State Survey Agency of an allegation of abuse in a timely manner for 2 of 41 residents (Resident #75 and 34) in survey sample. 1. The facility staff failed to report to the State Survey Agency an allegation of abuse involving Resident #75 within 24 hours of their knowledge of the incident. 2. 1. The facility staff failed to ensure the results of an investigation of alleged abuse involving Resident #34 was reported to the State Survey Agency within 5 days.

Inspectors wroteBased on record reviews, and staff interviews the facility staff failed complete a thorough investigation of a Facility Reported Incident (FRI) for 1 resident (Resident #34) in the survey sample of 41 residents.

Inspectors wroteBased on staff interviews, clinical record review, and facility documentation review, the facility staff failed send a copy of the Bed-Hold Policy for 1 of 41 residents in the survey sample (Resident #109). The facility staff failed to provide Resident #109 or the resident's representative, with a written or a copy of the bed hold policy after being transferred to the hospital on 1/20/18.

Inspectors wroteBased on observation, resident interviews, staff interviews, facility documentation review, and clinical record review, the facility staff failed to review and revise the comprehensive care plan for 1 of 41 residents in the survey sample (Residents #263 and #34). The facility failed to include painful thickened toenails on the care plan for Resident # 263.

Inspectors wroteBased on observation, resident interview, staff interview, facility documentation review, clinical record review, and in the course of a complaint investigation, the facility staff failed to follow physician orders and to ensure insulin and glucometer checks were done per plan of care for 1 resident of 41 Residents in the survey sample (Resident #267).

Inspectors wroteBased on observation, resident interviews, staff interviews, facility documentation review, and clinical record review, the facility staff failed to ensure Podiatry services were provided in a timely manner for 1 Resident of 41 Residents in the survey sample (Resident # 263).

Inspectors wroteBased on observation, resident interviews, staff interviews, facility documentation review, and clinical record review, the facility staff failed to ensure pain management with prescribed Fentanyl Patch after Hospice services were discontinued for 1 Resident of 41 residents in the Survey Sample (Resident # 263).

Inspectors wroteBased on observation, staff interview and clinical record review, the facility staff failed to communicate ongoing assessments of condition and monitoring for complications before and after dialysis treatments for 1 of 41 residents in the survey sample (Resident #51). The Facility staff failed to communicate ongoing assessments for Resident #51 who attended outpatient dialysis three days per week on Tuesday, Thursday and Saturday.

Inspectors wroteBased on observation, staff interview, facility documentation review, and clinical record review, the facility staff failed to ensure medications accepted from family or outside sources were reconciled by the facility for 1 of 41 residents in the survey sample (Resident #5).

Inspectors wroteBased on observations, record review, and staff interview, the facility staff failed to ensure medical records were accurately documented for 1 of 41 residents in the survey sample (Resident #413). Facility staff failed to maintain accurate Treatment Administration Record (TAR).