Nu Roc Health and Rehabilitation Ctr

Inspectors wroteBased on observation, staff interview, record review, and policy review, the facility did not ensure direct care staff were aware of enhanced barrier precautions (EBP) for 3 residents (R) (R10, R11, and R12) of 10 sampled residents. R10 was on EBP but did not have an order or the appropriate signage to indicate the necessary precautions. R11 and R12 were on EBP but did not have the appropriate signage to indicate the necessary precautions.

Inspectors wroteBased on observation, staff interview, and record review, the facility did not ensure food was stored and prepared in a safe and sanitary manner. This practice had the potential to affect all 34 residents residing in the facility. Staff did not monitor and document food cooling temperatures. Staff did not test the Quaternary sanitizing solution (used to sanitize food preparation surfaces) per manufacturer's instructions and did not have a procedure to monitor and document the temperature and parts per million (PPM) of the sanitizing solution. Staff did not monitor warewashing temperatures to ensure the minimum wash and rinse temperatures were achieved to prevent the spread of foodborne illness. In addition, the PPM of the facility's low temperature warewashing machine were not monitored and documented per manufacturer's recommendations. Staff did not date items upon receipt or opening.

Inspectors wroteBased on staff interview and record review, the facility did not ensure a Pre-admission Screening and Resident Review (PASRR) Level II Screen was completed for 1 resident (R) (R3) of 14 sampled residents. R3's PASRR Level I Screen was inaccurate and indicated R3 did not have a diagnosis of a mental health disorder and was not prescribed medication to treat a mental health disorder. As a result, a PASRR Level II Screen was not submitted to determine if R3 was in need of specialized services.

Inspectors wrote2. On 6/16/25, Surveyor reviewed R2's medical record. R2 was admitted to the facility on [DATE] and had diagnoses including chronic obstructive pulmonary disease (COPD) and heart failure. R2's MDS assessment, dated 5/27/25, had a BIMS score of 15 out of 15 which indicated R2 had intact cognition. R2 had a physician order, dated 5/27/25, for oxygen 4 liters per nasal cannula continuous every shift for hypoxia. On 6/16/25 at 11:09 AM, Surveyor noted R2's oxygen concentrator was running at 4 liters per minute and R2's nasal cannula was on R2's bed, however, R2 was not in the room. On 6/16/25 at 11:14 AM, Surveyor observed R2 return from having R2's hair washed and noted R2 was not using portable oxygen. Surveyor interviewed R2 who indicated R2 did not wear oxygen when R2's hair was washed or when R2 ate. [...]

Inspectors wroteBased on observation, staff interview, and record review, the facility did not ensure 2 residents (R) (R6 and R37) of 6 sampled residents were provided safe administration of drugs and biologicals. R6 had an order for 81 milligrams (mg) of enteric coated (EC) aspirin daily. On 6/17/25, R6 was administered 81 (mg) of chewable aspirin. R37 had an order for a 4% lidocaine patch on the back at bedtime and removed in the morning. On 6/17/25, staff put a 4% lidocaine patch on R37's left knee.

Inspectors wroteBased on observation, staff interview, and record review, the facility did not maintain an infection prevention and control program designed to prevent the transmission of communicable disease and infection for 1 resident (R) (R37) of 3 sampled residents. R37 was on enhanced barrier precautions (EBP) due to a percutaneous endoscopic gastrostomy (PEG) tube. On 6/17/25, Licensed Practical Nurse (LPN)-I did not wear a gown while providing medication via R37's PEG tube.

Inspectors wroteBased on staff interview and record review, the facility did not ensure accurate mandatory staffing information based on payroll data was submitted to the Centers for Medicare & Medicaid Services (CMS). This practice had the potential to affect all 34 residents residing in the facility. Staffing information for fiscal quarter 2 (1/25/25-3/31/25) of the Payroll Based Journal (PBJ) was not submitted accurately to CMS.

Inspectors wroteBased on interviews and record review, the facility failed to submit accurate data to Centers for Medicare and Medicaid Services (CMS) mandatory Payroll Based Journal (PBJ) for the fourth quarter of 2023 (July 1-September 30) and the first quarter of 2024 (October 1 - December 31). This has the potential to affect all 37 residents. This is evidenced by: Surveyor noted the facility triggered for excessively low weekend staffing for quarter 4 of 2023 and for quarter 1 of 2024 on the Payroll Based Journal (PBJ) staffing data report. On 05/15/24 at 8:20 AM, Surveyor interviewed Nursing Home Administrator (NHA) A regarding PBJ staffing triggers. NHA A reported, Staffing needs are based on census. A census of 37 would require 4 CNAs on day shift, 3 on PM shift, 2 on night shift. We use agency staff daily, and we have not had any excessively low weekend staffing. [...]

Inspectors wroteBased on observation, record review and interview, the facility did not ensure a sanitary environment to help prevent the development and transmission of communicable diseases and infections. The facility failed to sanitize mechanical lifts for 2 of 6 residents (R) that use mechanical lifts. (R8 and R24).

Inspectors wroteBased on interview and record review, the facility did not ensure creation of a culturally competent, trauma-informed care plan for 1 of 1 resident (R19) with an identified trauma history.

Inspectors wroteBased on observation, staff and resident interview, and record review, the facility did not ensure the right to privacy for 1 Resident (R) (R7) of 9 sampled residents. The facility required R7's door to remain open when R7 performed personal cares.

Inspectors wroteBased on observation, interview and record review, the facility did not ensure safe food handling practices were implemented. This had the potential to affect 36 of 37 residents residing in the facility. Cooling temperatures were not monitored for cooked foods saved for resident consumption. Holding temperature logs for foods served to residents contained missed entries. In addition, cooking temperatures logs for foods served to residents were not implemented. Sanitizing solution used to clean/sanitize kitchen surfaces was not tested for parts per million (PPM) sanitizer levels. In addition, testing strips for the sanitizing solution used in the dish machine were expired.

Inspectors wroteBased on record review and staff interview, the facility did not ensure comprehensive resident-centered care plans were developed for 4 Residents (R) (R5, R19, R189, and R240) of 13 sampled residents. R5 had a physician's order for Eliquis (an anti-coagulant medication used reduce the risk of stroke and blood clots). The facility did not develop a comprehensive care plan to monitor for the effectiveness and side effects of the medication. R19 had a physician's order for doxycycline (an antibiotic medication) used to treat chronic osteomyelitis (an infection in the bone). R189's diagnoses included diastolic (congestive) heart failure (impairment of the blood pumping function of the heart), moderate risk for falls and limited physical mobility. R189's medical record did not contain a comprehensive care plan to address those conditions. [...]

Inspectors wroteBased on staff interview and record review, the facility did not ensure a petition for protective placement was made for one resident (R) (R28) of four residents whose nursing home stay exceeded 60 days without active discharge planning (allowing an additional 30 days). R28's medical record documented R28 had a legal guardian in place at the time of admission on [DATE]. Protective placement was not pursued for R28's stay at the skilled nursing facility.

Inspectors wroteBased on staff interview and record review, the facility did not ensure 3 Residents (R) (R23, R28, and R1) of 5 residents reviewed for unnecessary medications had documentation the residents or their legal representatives were informed in advance of the risks and benefits of the prescribed psychotropic medications. R23 was prescribed olanzapine (an anti-psychotic medication). The facility did not obtain written consent from R23 for the medication. R28 was prescribed Seroquel (an anti-psychotic medication). The facility did not obtain written consent from R28's legal representative for the medication. R1 was prescribed buspirone and sertraline (anti-psychotic medications) as well as lamotrigine (an anti-convulsant medication prescribed for depression per R1's physician's order). The facility did not obtain written consents from R1 for the medications.

Inspectors wroteBased on staff interview and record review, the facility did not ensure 1 Resident (R) (R1) of 5 sampled residents met the PASRR (Pre-admission Screen and Resident Review) requirements. R1's medical record indicated R1 had mental illness diagnoses and was prescribed psychotropic medication. The facility did not complete a Level I screen or refer R1's information to the PASRR Screening Agency.

Inspectors wroteBased on interview and record review, the facility did not ensure speech therapy services were obtained timely for 1 Resident (R) (R12) of 13 residents reviewed. On 11/10/22, a swallow study was recommended for R12. A speech therapy evaluation was not provided until 1/12/23 and a swallow study was not completed.