Palm Garden of Aventura

Inspectors wroteBased on observations, records reviewed and interviews, the facility failed to ensure oxygen was delivered at the prescribed rate for two (Resident #1 and Resident #5) out of two residents receiving oxygen. Observation of the oxygen flowmeters indicated Resident #1 whose oxygen orders were discontinued was receiving oxygen at 3 Liters Per Minute (LPM) and Resident #5 oxygen was being administered above the prescribed level.

Inspectors wroteBased on observations, records reviewed and interviews, the facility failed to ensure medications and biologicals are stored and secured in accordance with professional standards for four out of four sampled residents as evidenced by medications were left unattended in residents' rooms, and various ointments, lotions, shampoos, and other items were observed at residents' bedside. This practice significantly increases the risk of misuse and potential harm, which could result in severe adverse outcomes.

Inspectors wroteBased on observations, interviews and records review, the facility failed to implement infection prevention and control practices in accordance with the facility's policy related to Enhanced Barrier Precautions (EBP) for one (Resident # 2) out of two sampled residents, as evidenced by staff failure to wear required Personal Protective Equipment (PPE) during central line care. There were two residents residing in the facility receiving IV therapy at the time of the survey.

Inspectors wroteBased on observation and interviews, the facility failed to provide a clean and sanitary environment in the laundry room. As evidenced improper storage of chemicals-detergent, bleach, iron sour, softener-were being stored on the floor, washer bases rusted, washers draining into a two-compartment sink, soiled garbage can pallets, a large hole in the wall, and dry drainage residue on one of the washers. (Photographic evidence obtained).

Inspectors wroteBased on Observation, interview and record review the facility failed to follow pharmaceutical procedures and facility policy during medication administration for Residents (#4, #50). There were 108 residents residing in the facility at the time of the survey.

Inspectors wroteBased on record review and interview, the facility failed to ensure a Residents Advance Directive was honored for one (Resident #1) out of three residents sampled with a Do Not Resuscitate (DNR) order as evidenced by staff initiated Cardiopulmonary Resuscitation (CPR) on Resident #1. The facility's actions caused Resident #1 to have likely suffered serious psychological harm by the facility's attempt to be resuscitated against her wishes. Resident #1 could not express her reaction to this event; therefore, the reasonable person concept was applied. Additionally, there was a likelihood that Resident #1 experienced severe physical pain; broken ribs; broken sternum and bleeding in the chest area from the resuscitation efforts. The facility staff did not follow their procedure to verify code status prior to initiating CPR. This situation resulted in Immediate Jeopardy. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide adequate supervision for one out of three residents sampled as evidenced by failure to ensure the safety of a vulnerable resident (Resident #1) exited the facility through the first-floor dining room door undetected by the facility's staff. Resident #1 was found in the parking lot of the facility. There were 106 residents residing in the facility at the time of the survey.

Inspectors wroteBased on observations, interview and record review, facility failed to follow physician orders as evidenced by the physician prescribed 3 Liters per Minutes (LPM) continuous oxygen for one out of 34 sampled residents (Resident # 314)) as evidenced by observation of the resident receiving 4 LPM/4.5 LPM of oxygen.

Inspectors wroteBased on records reviewed, observations and interviews, the facility failed to ensure an accurate nutritional assessment to increase nutrition and to address identified significant weight loss in a timely manner for 5 of 7 residents reviewed for nutrition (Resident #83, Resident #69, Resident #46, and Resident #58). The facility failed to provide nutritional interventions in a timely manner that resulted in significant weight loss and failed to provide protein supplements to aid with a newly developed stage 3 pressure ulcer wound for Resident #41.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure privacy of confidential resident information by leaving computer unlocked on top of medication carts with resident's information visible for 2 out of 4 medication carts observed.

Inspectors wroteBased on record review, observations and interviews, the facility failed to provide a safe, clean, homelike environment for 5 out of 24 sampled residents (Residents #20, #27, #49, #53, and #80)

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to maintain a restraint free environment by using a chair that prevents the resident from rising for 1 of 1 resident sampled for restraints (Resident # 39).

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure an accurate tube feeding assessment by the facility's Clinical Dietitian to prevent weight loss. It failed to adjust the tube feeding regimen in a timely manner for 1 of 3 residents reviewed for tube feeding. (Resident #96)

Inspectors wroteBased on interviews and record review the facility failed to provide staffing at the minimum weekly average of 3.6 hours of care by direct care staff per resident per day (a week is defined as Sunday through Saturday).

Inspectors wroteBased on record review and interviews, the facility failed to ensure recommendations were implemented and failed to have the attending physician document action taken or not taken with rational in a timely manner for consultant pharmacy Medication Regimen Review (MRR) for 4 of 5 residents sampled and reviewed for unnecessary medications (Resident # 60, Resident #27, Resident #47, and Resident #94).

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to secure 1 medication room (for 1 out of 2 medication rooms observed) and failed to secure 1 medication cart with medications on top of the cart (for 1 out of 4 medication carts observed).

Inspectors wroteBased on record review, observations and interviews, the facility failed to provide the resident's food preferences. as evidenced by failure to provide a physician's ordered diet consistency for 1 of 6 residents reviewed for nutrition, Resident #95.

Inspectors wroteBased on record review and interviews, the facility failed to ensure complete and accurate documentation of resident's admission/readmission weights and failed to accurately assess resident's nutritional status upon admission/readmission for 7 of 24 sampled residents reviewed, Resident #83, Resident #198, Resident #312, Resident #96, Resident #69, Resident #82, and Resident #58.

Inspectors wroteBased on record review, interviews, and record reviews the facility failed to ensure an adequate Quality Assurance and Performance Improvement (QAPI) program were implemented in relation to infection control practices and nutrition services. The facility did not properly address the issues found in their infection control practices as evidenced by repeat deficient practice for infection control. the facility QAPI program failed to implement effective nutrition services through Performance Improvement Projects (PIP) to ensure the safe and proper care for the residents at the facility.

Inspectors wroteBased on record review, observations and interviews the facility failed to maintain adequate infection control practices for the residents residing in the facility. It was found that residents were not placed in proper isolation per written facility policy in regards to Airborne Isolation and Enhanced Barrier Precautions. As evidenced by only three residents had orders for isolation and only two of the three were on Enhanced Barrier Precautions out of the six residents who were reviewed for isolation concerns. In total, there were over 20 residents in the facility at the time of the survey who qualified, based on the facility's policy, for the Enhanced Barrier Precautions.