Palm Springs Post Acute

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), whose physician's orders included wound care and dressing changes to a wound on his/her buttocks, the facility failed to ensure professional standards of practice were maintained when the nursing staff did not document specific wound characteristics, as well as effectiveness of treatment, in accordance with nursing best practice and facility policy.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who was admitted to the facility with an unstageable pressure injury (full tissue loss covered with slough or dead tissue), the facility failed to ensure they adequately managed his/her pain, when he/she displayed both verbal and non-verbal indicators of pain and analgesics were not offered or administered.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), the facility failed to ensure they maintained an accurate and complete medical record related to 1) the anatomical location of a pressure injury and 2) the frequency of repositioning.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had a tracheostomy (a surgical procedure that creates and opening in the neck to facilitate breathing when the usual airway is obstructed or compromised) and required continual respiratory care and the administration of humidified oxygen, the facility failed to ensure that care and treatment provided were consistent with professional standards of practice, when physician's orders related to his/her respiratory equipment use/monitoring were not obtained by nursing.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), the facility failed to ensure they maintained complete and accurate records related to 1) the care and services associated with his/her tracheostomy (a surgical procedure that creates and opening in the neck to facilitate breathing when the usual airway is obstructed or compromised) and 2) the recording of the events during his/her Cardiopulmonary Resuscitation (CPR) Code.

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide supervision during meals for one Resident (#102) with an aspiration risk out of a total sample of 27 residents.

Inspectors wroteBased on observation and interview, the facility failed to store and prepare food in accordance with professional standards for food service safety. Specifically, the facility failed to ensure food was dated, stored off the floor, shelves on which food was stored were clean/free of possible contaminants, and that unpasteurized eggs were cooked thoroughly.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one Resident (#36) was free from restraints, out of a total sample of 27 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to accurately code in the Minimum Data Set (MDS) for one Resident (#7) out of 27 total sampled residents. Specifically, for Resident #7, the facility failed to accurately document a fall resulting in a right humeral fracture.

Inspectors wroteBased on interview and record review, the facility failed to ensure one Resident (#5), out of a total sample of 27 residents, was referred for a Level II Preadmission Screening and Resident Review (PASRR) evaluation (an evaluation to determine if a resident needs specialized services to address his/her new diagnosis of schizoaffective disorder, which is a serious mental illness (SMI)) as required.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure one Resident (#87) who was fed by enteral means (artificially via a tube), out of a total sample of 27 residents, received appropriate treatment to prevent complications of enteral feeding. Specifically, the facility failed to ensure that Resident #87's enteral nutrition formula was administered at the physician-prescribed rate.

Inspectors wroteBased on observations and interviews the facility failed to ensure drugs and biologicals were stored in accordance with acceptable professional standards of practice. Specifically,1. The facility failed to ensure that expired medications were removed from medication carts and medication rooms on 2 out of 3 units.2. The facility failed to ensure medication carts were locked while unattended.

Inspectors wroteBased on interview, record and policy review, the facility failed to inform in advance of changes to the plan of care relative to the use of psychotropic (medication that affects how the brain works and causes changes in mood, awareness, thoughts, feelings or behavior) medications for two Residents (#9 and #29) out of a total sample of 20 residents. Specifically, the facility failed to obtain written consent for the use of psychotropic medications before administering Lorazepam (Ativan - anti-anxiety medication) medication to Residents #9 and #29.

Inspectors wroteBased on observation, interview, and record and policy review, the facility failed to ensure that devices utilized for two Residents (#50 and #103), were assessed and consent was obtained by the Resident Representative, when used as physical restraints (defined as any manual method, physical or mechanical device, equipment, or material that meets all of the following criteria: is attached or adjacent to the resident's body, cannot be removed easily by the resident; and restricts the resident's freedom of movement or normal access to his/her body), for two applicable Residents who had gastrostomy tubes (G-tube: tube inserted through the stomach that delivers nutrition/hydration), out of a total sample of 20 residents. Specifically, the facility failed to: 1. [...]

Inspectors wroteBased on observation, record and policy review, and interview, the facility failed ensure a Resident who was dependent for activities of daily living (ADL's- personal care activities including but not limited to, eating, grooming, and personal hygiene) received the necessary care and services to maintain grooming for one Resident (#94) out of a total sample of 20 residents. Specifically, for Resident #94, the facility failed to provide assistance for grooming of facial hair per the Resident's preference.

Inspectors wroteBased on observation, policy and record review, and interview, the facility failed to provide respiratory care and services consistent with professional standards of practice for one Resident (#29) out of a total sample of 20 residents. Specifically, the facility failed to obtain Physician's orders for oxygen administration and maintenance of oxygen and respiratory equipment.

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure that an Influenza (Flu) vaccine was administered to one Resident (#16) out of five applicable residents, out of a total sample of 20 residents. Specifically, the facility failed to administer the Influenza vaccine for Resident #16 who had signed a consent for the vaccine to be administered.

Inspectors wroteBased on record review and interview the facility failed to complete an accurate assessment to reflect resident status for one Resident (#106) out of a total sample of 3 closed resident records. Specifically, for Resident #106, the facility failed to accurately enter in Minimum Data Set (MDS) Assessment that the Resident was discharged to the hospital and not to home/community resulting in an inaccurate medical record.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Advance Care Planning and Advance Directive rights for one Resident (#79), out of 21 sampled residents, to have a designated Health Care Agent make healthcare related decisions were upheld when the Resident was unable to make his/her own health care decisions. Specifically, the facility failed to arrange for Resident #79 to obtain a legally designated Health Care Agent when the Resident was incapacitated and his/her designated Health Care Agent was permanently unavailable to make healthcare related decisions for the Resident, resulting in facility communication of sharing confidential information and discussing health care related decision making, with an individual who was not the Resident's designated Health Care Agent.

Inspectors wroteBased on record review and interview, the facility failed to conduct an accurate comprehensive assessment of one Resident's (#79) functional capacity, out of 21 sampled residents according to the Centers for Medicare and Medicaid Services' (CMS) Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual instructions. Specifically, the facility failed to comprehensively assess Resident #79's cognitive patterns when the Resident did not require an interpreter and was identified to have: clear speech, the ability to make him/her self understood, and the ability to understand others.

Inspectors wroteBased on interview and record review, the facility failed to complete a Resident review (Level I (initial pre-screening) screening form required if Significant Change in Condition: newly indicated Serious Mental Illness [SMI]) for one Resident (#29) out of a total sample of 21 residents. Specifically, the facility failed to compete a Resident review for Resident #29 or refer the Resident to the PASRR (pre-admission screening and resident review) Office for a Level II (comprehensive evaluation) Evaluation, as required, when the Resident was identified to have Bipolar Disorder (mental disorder characterized by periods of depression and periods of abnormally elevated mood) after his/her admission to the facility.

Inspectors wroteBased on record review and interview, the facility failed to develop a comprehensive care plan for one Resident (#39), out of a total sample of 21 residents. Specifically, the facility failed to develop a care plan for urinary incontinence when Resident #39 was newly assessed as being occasionally incontinent of bladder on the Minimum Data Set (MDS) assessment and the decision was made to develop a care plan for urinary incontinence.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide one Resident (#76) out of a total sample of 21 residents, who had oropharyngeal phase Dysphagia (weakened throat muscles, making it difficult to move food from your mouth into your throat and esophagus when you start to swallow, and could result in choking, gagging or coughing, and could lead to pneumonia) with adequate supervision and setup of adaptive devices to ensure the Resident's safety while eating. Specifically, the facility failed to provide Resident #76 with straws for all drinks and continual supervision while he/she drank, when he/she required the use of straws and continual supervision for safety, when the Resident rapidly consumed liquids and increased his/her risk for choking.

Inspectors wroteBased on interview and record review the facility failed to provide one Resident (#21) out of a total sample of 21 residents, with pain management that was consistent with professional standards of practice. Specifically, the facility failed to ensure that its staff: (1) offered non-pharmacological approaches for pain management. (2) consistently assessed the Resident's location and description of pain, and factors that worsen or improve pain, prior to administering narcotic pain medications.

Inspectors wroteBased on interview and record review, the facility failed to follow Physician's orders related to pain medication for one Resident (#21) out of a total sample of 21 residents. Specifically, the facility failed to ensure that its staff did not administer more pain medication than was Physician ordered, which resulted in Resident #21 receiving more opioid (substances that act on opioid receptors to produce morphine-like effects) medication than ordered.