Orchards of East Liverpool, the

Inspectors wroteBased on observation, review of insulin inserts, interview and review of the facility policy, the facility failed to label and store medication in a manner that enabled staff to know when the medication should be discarded. This affected four (Residents #12, #36, #41, and #60) of five residents who had insulin stored on the [NAME] wing medication cart. The facility census was 45.

Inspectors wroteBased on observation and interview, the facility did not ensure chemical sanitation was completed on kitchen dishes in the rehabilitation unit. This had the potential to affect all ten (Residents #9, #19, #20, #23, #32, #40, #42, #44, #45, and #57) residing on the rehabilitation unit. The facility census was 45.

Inspectors wroteBased on observation, medical record review and interview, the facility failed to ensure comprehensive assessments of skin impairment were documented for one (Resident #32) of two residents reviewed for non-pressure-related skin impairment. 16 residents were screened for non-pressure skin impairment. The facility census was 45.

Inspectors wroteBased on medical record review, interview and facility policy review, the facility failed to ensure recommendations from pharmacy reviews were addressed in a timely manner. This affected one (Resident #40) of five residents reviewed for medication use and one (Resident #42) of two residents reviewed for antibiotic use. The facility census was 45.

Inspectors wroteBased on record review, observation, interview and facility policy review, staff failed to wear appropriate personal protective equipment (PPE) while administering medication intravenously (IV) and failed to maintain infection control practices while changing an IV access dressing. This affected one (Resident #42) of four residents observed for medication administration and one (Resident #42) of one resident observed for dressing change. The facility census was 45.

Inspectors wroteBased on medical record review, facility investigation review, facility policy review, and interviews, the facility failed to timely report an allegation of misappropriation. This affected one resident (#1) of three residents reviewed for abuse. The facility census was 42.

Inspectors wroteBased on record review, facility policy review and interview the facility failed to ensure routine skin assessments were completed for Resident #28 to timely identify the deterioration of a pressure ulcer. Actual Harm occurred on 09/23/22 after the facility failed to complete routine assessments (from 09/02/22 to 09/23/22) and evaluation of treatments for skin impairment resulting in Resident #28's sustaining a deterioration in skin integrity and subsequent Stage III (full thickness skin loss involving damage or premature death of subcutaneous tissue that may extend down to, but not through, underlying connective tissue. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue) pressure ulcer to the right buttocks. This affected one resident (#28) of two residents reviewed for pressure ulcers. [...]

Inspectors wroteBased on observation, record review, facility policy and procedure review and interview the facility failed to ensure Resident #33, who required staff assistance for activities of daily living care was provided adequate grooming and personal hygiene. This affected one resident (#33) of one resident reviewed for activities of daily living (ADL) care.

Inspectors wroteBased on observation, record review, facility policy and procedure review and interview the facility failed to ensure a fall investigation was completed after a resident reported a fall and failed to update the comprehensive care plan for Resident #37. The facility also failed to ensure adequate assistance using a mechanical (Hoyer) lift was provided to Resident #33 during a transfer to prevent a possible fall/injury. This affected two residents (#37 and #33) of three residents reviewed for accidents and hazards.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure Resident #41 had a medical necessity for a urinary catheter. This affected one resident (#41) of two residents reviewed for urinary catheters. The facility identified two residents with indwelling urinary catheters.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure Resident #4's oxygen tubing and humidification bottle were maintained in a clean and sanitary manner and changed weekly as ordered by the physician. This affected one resident (#4) of two residents reviewed for oxygen use.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure Resident #11 received medication/treatment only while necessary by failing to discontinue an antibiotic medication cream after an area to the resident's back was healed. This affected one resident (#11) of five residents reviewed for unnecessary medication use.

Inspectors wroteBased on record review, facility policy review and interview the facility failed to ensure as needed (PRN) anti-anxiety medication (Xanax) ordered for Resident #33 was not ordered longer than 14 days, had a specific duration for use and stop date. The facility also failed to ensure an appropriate indication for use of the anti-psychotic medication (Seroquel) for Resident #26. This affected two residents (#26 and #33) of five residents reviewed for unnecessary medication use.

Inspectors wroteBased on observation, record review, facility policy review and interview the facility failed to ensure Resident #32's Levemir long-acting insulin was discarded once expired. This affected one resident (#32) of one resident identified during the medication storage review who had insulin stored in the medication storage cart on the East Wing.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure medication was stored, labeled and disposed to meet professional standards. This had to the potential to affect all the residents at the facility. The facility's census was 45. Findings Include: Observation on [DATE] from 2:28 P.M. to 2:52 P.M. of the facility medication storage rooms, medication cart and refrigerator revealed, an open stock bottle of Calcium with vitamin D with an expiration date of 09/2019 in the medication room, an open bottle of eye drops being stored with an open bottle of ear drops, open nasal sprays being stored in the same bin as open eye drops in the top drawer of the medication cart, and an open undated vial of tuberculin that was dispensed on [DATE] in the medication refrigerator. Interview on [DATE] at 2:52 P.M. [...]

Inspectors wroteBased on review of survey findings and staff interview, the facility failed to ensure corrective plans were initiated and/or comprehensively evaluated in regard to identified concerns. This had the potential to affect all 45 residents.

Inspectors wroteBased on observation, record review, review of infection control monthly tracking sheets and interview, the facility failed to ensure accuracy and completeness of the logs and failed to monitor infections on an ongoing basis in order to identify patterns or trends in a timely manner. The facility also failed to implement appropriate infection control practices during cleaning of glucometers and during provision of incontinence care. This had the potential to affect all 45 residents and affected Residents #14, #19, and #242.

Inspectors wroteBased on observation, interview and record review the facility failed to implement the bowel protocol for Resident's #3, #8, #18 and #27 and failed to comprehensively assess a non-pressure skin area for Resident's #32 and #8. This affected four of five residents reviewed for unnecessary medications and two of two residents reviewed for non-pressure skin areas.

Inspectors wroteBased on observation and interview, the facility failed to ensure the facility building was maintained. This had the potential to affect all the residents in the facility. The facility census was 45.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure an Advanced Directive was clearly and accurately represented on a resident's medical record. This affected one resident (Resident #28) of one resident reviewed for Advanced Directives.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the physician was notified with a change in condition for Resident #8's bruising and Resident #39's development of a pressure ulcer. This affected two of 12 residents (Residents #8 and #39) reviewed for notification of change.

Inspectors wroteBased on interview and record review the facility failed to implement the abuse policy when Resident #8, who was cognitively impaired, was found to have injuries of unknown origin (IUO). This affected one of one residents reviewed for abuse (Resident #8).

Inspectors wroteBased on interview and record review the facility failed to report injuries of unknown origin (IUO) obtained by Resident #8, who was cognitively impaired, to the state agency as required. This affected one of one residents reviewed for abuse.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure Resident #8's injuries of unknown origin (IUO) were thoroughly investigated. This affected one of one residents reviewed for abuse.

Inspectors wroteBased on observation, staff interview and record review, the facility failed to ensure nail and oral care were provided to a dependent resident. This affected one (Resident #191) of one resident reviewed for activities of daily living.

Inspectors wroteBased on observation, interview and record review revealed the facility failed to ensure Resident #39's multiple pressure areas were comprehensively assessed with ongoing tracking to ensure interventions were in place to prevent re-occurrence of the pressure area specifically the left heel. This affected two of two residents reviewed for pressure ulcers (Residents #39 and #191).

Inspectors wroteBased on observation, interview and record review the facility failed to ensure Resident #91 was properly assessed and had proper interventions in place when the resident was determined to be at risk for falls. After the resident sustained falls the facility failed to implement further interventions in an attempt to prevent the resident from further falls and injuries. This affected one of two residents reviewed for falls.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a comprehensive nutritional plan was in place including accurate weights, monitoring/offering supplements and ensuring the resident's meal consumption was optimal for Resident #39, who sustained severe weight loss and developed multiple pressure ulcers. This affected one of three residents revealed for nutrition.

Inspectors wroteBased on medical record review and interview, the facility failed to maintain a record of fluid intakes for a resident receiving dialysis who had orders for fluid restriction. This affected one (Resident #36) of one resident reviewed for dialysis. The facility identified three residents as receiving dialysis.

Inspectors wrote2. Record review revealed Resident #8 was admitted to the facility on [DATE] with diagnoses which included Alzheimer's dementia, dementia with behaviors and brief psychotic disorder which was diagnoses on 02/04/18. Review of the quarterly minimum data set (MDS) 3.0 dated 01/13/19 revealed the resident was severely cognitively impaired. The resident had no concerns with mood or behaviors and the resident needed extensive assistance of one to two staff for activities of daily living (ADL). Review of the nursing note dated 05/03/19 revealed the resident was exit seeking. There was no evidence of non-pharmalogical interventions. Review of the nursing note dated 05/04/19 revealed the resident was rocking back and forth in her chair and was spitting out half chewed food. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure an accurate resident medical record. This affected two of 17 records reviewed (Residents #32 and #191).

Inspectors wroteBased on observation and interview the facility failed to ensure wheelchairs were maintained in good condition. This affected two (Resident's #21 and #36) out of 16 residents in the initial pool. The facility's census was 45.

Inspectors wroteBased on review of Quality Assessment and Assurance (QA) meeting attendance records, policy review and interview, the facility failed to ensure the minimum required QA committee members met quarterly. This had the potential to affect all 45 residents.