Nottingham Health and Rehabilitation

Inspectors wroteBased on observation, record review, and interviews, the facility failed to appropriately store medications and biologicals when staff failed to ensure the medication carts were always locked when the cart was not within the nurses' view.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure Resident (R)80 had been assessed for the ability to safely self-administer medication before staff left medications at her bedside unsupervised.

Inspectors wroteBased on observation, record reviews, and interviews, the facility failed to ensure Resident (R)15's call lights were within her reach. Findings Included:- R15's Electronic Medical Record (EMR) from the Diagnoses tab documented diagnoses of hemiparesis/hemiplegia (weakness and paralysis on one side of the body) following cerebral infarction (stroke - sudden death of brain cells due to lack of oxygen caused by impaired blood flow to the brain by blockage or rupture of an artery to the brain), neuromuscular dysfunction of the bladder (the muscles that control the flow of urine out of the body do not relax and prevent the bladder from fully emptying), unsteadiness on feet, and major depressive disorder (major mood disorder that causes persistent feelings of sadness). [...]

Inspectors wrote- R43's Electronic Medical Record (EMR) from the Diagnoses tab documented diagnoses of hemiparesis/hemiplegia (weakness and paralysis on one side of the body), hypertension (HTN-elevated blood pressure) and atrial fibrillation (rapid, irregular heartbeat). The Annual Minimum Data Set (MDS) dated [DATE] documented moderately impaired cognition with poor decision-making ability under staff interview. The MDS documented R43 had functional limitation of his range of motion (ROM- the full movement potential of a joint, usually its range of flexion and extension) on one side of his upper extremities. The MDS documented R43 required partial to moderate assistance from staff for transfers from the bed to the wheelchair. The MDS documented R43 had two non-injury falls since the prior MDS assessment. R43's Falls Care Area Assessment (CAA) dated 04/16/24 documented he had multiple falls. [...]

Inspectors wroteThe facility identified a census of 74 residents. The facility had four kitchens. Based on observation, record review, and interviews, the facility failed to ensure that food items were properly stored in a safe and sanitary manner after the original sealed package had been opened. The facility failed to ensure all foods were labeled and dated after opening. This placed the affected residents who ate food from the facility at risk for food-borne illness.

Inspectors wroteThe facility identified a census of 74 residents. The facility identified 14 residents on enhanced barrier precautions (EBP-infection control interventions designed to reduce transmission of resistant organisms which employs targeted gown and glove use during high contact care). Based on record review, observations, and interviews, the facility failed to follow sanitary infection control standards related to enhanced barrier precautions, hand hygiene, and disinfection of shared mechanical lifts. These deficient practices placed the residents at risk for infectious diseases. Findings Included- - On 06/17/24 at 07:19 AM Certified Nurse Aide (CNA) T pushed the Hoyer lift (total body mechanical lift) out of Resident (R)12's room to the hallway and walked back into the room without sanitizing the lift. On 06/17/24 at 09:07 AM, soiled linens sat on the floor of R24's room. [...]

Inspectors wroteThe facility identified a census of 74 residents. The sample included 19 residents with one resident reviewed for dignity. Based on observation, record review, and interviews, the facility failed to ensure Resident (R) 40's right to be treated with respect and dignity when staff provided personal care with the window blinds open to the side street of the facility. This deficient practice placed the R40 at risk for negative psychosocial outcomes and decreased dignity.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 19 residents with one reviewed for care plan revisions. Based on observation, record review, and interviews, the facility failed to revise Resident (R) 44's care plan to reflect toileting needs after meals. This deficient practice placed R44 at risk for preventable accidents and falls related to uncommunicated care needs. Findings Included: [...]

Inspectors wroteThe facility identified a census of 74 residents. The sample included 19 residents with one resident reviewed for hemodialysis (a procedure using a machine to remove excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally). Based on observation, record review, and interviews, the facility failed to consistently communicate Resident (R) 7's medical condition with a pre-dialysis assessment prior to hemodialysis. This deficient practice placed R7 at risk of potential adverse outcomes and physical complications related to dialysis.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 19 residents with nine residents reviewed for accidents. Based on observation, record review, and interviews, the facility failed to ensure that Resident (R) 60 had a documented risk assessment for the use of side rails, consent for the use of the side rails, and failed to ensure the resident and/or responsible party were advised of the risks and/or benefits of the use of the side rails. This placed the R60 at risk for uninformed decisions and impaired safety related to the risks associated with the use of side rails.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 19 residents with five residents reviewed for immunization status. Based on record review and interviews, the facility failed to offer and/or obtain the Pneumococcal Conjugate Vaccine (PCV20- vaccination for bacterial infections) pneumococcal (type of bacterial infection) vaccination, and influenza (highly contagious viral infection that attacks the lungs, nose, and throat and can be deadly in high-risk groups) vaccination consents or informed declinations for Resident (R) 17. This placed R17 at increased risk for influenza, pneumonia, and related complications.

Inspectors wroteThe facility identified a census of 40 residents and had three medications carts. Based on observation, record review, and interview, the facility failed to date one insulin (a hormone which regulates blood sugar) pen and failed to discard one expired l insulin pen in one of the three medication carts. This deficient practice left the residents at risk for adverse consequences or ineffective medication treatment.

Inspectors wroteThe facility identified a census of 40 residents. The sample included 12 residents with two reviewed for incontinence. Based of observations, record review, and interviews, the facility failed to failed to assess and identify the services and assistance necessary to promote bladder continence for Resident (R)24 and R13. This deficient practice placed them at risk from decreased psycho-social wellbeing and increased incontinence. Findings Included: - The Medical Diagnosis section within R24's Electronic Medical Records (EMR) included diagnoses of macular degenerations (progressive deterioration of the retina), overactive bladder , muscle weakness, cognitive communication deficit, unsteadiness of feet, and left femur fracture (broken bone) with routine healing. [...]

Inspectors wroteThe facility identified a census of 40 residents. The sample included 12 residents with one resident reviewed for pain. Based on observation, record review, and interviews, the facility failed to address and treat Resident (R) 17's pain when providing care. This placed R17 at risk of ongoing pain, impaired psychosocial wellbeing, and diminished quality of life.