Paradise Valley Health Care

Inspectors wroteBased on observation, interview and record review the facility failed to develop and implement an appropriate care plan and admission orders to ensure safety interventions were in place, including maintaining non-weightbearing (NWB) status and keeping the immobilizer/splint on at all times, for one of three sampled residents (Resident 1). This deficient practiced placed Resident 1 at risk for worsening of the right lower extremity (RLE) fracture, delayed healing, increased pain, falls and additional injury due to not having proper instructions and interventions in place. Cross Reference F684Findings:A review of Resident 1's admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses which included history of Periprosthetic Fracture around Internal Prosthetic Right Knee Joint (a break in the bone surrounding the replaced joint). [...]

Inspectors wroteBased on observation, interview and record review the facility failed to follow physician (MD) orders and failed to put safety measures in place to prevent injury, for one of three sampled residents (Resident 1). This deficient practice placed one resident (Resident 1) at risk for worsening of a fracture, unsafe movement of the injured limb, potential accidents (falls)and additional injury due to failure to carry out non-weight bearing (NWB) and continuous immobilizer orders. Cross Reference F656Findings:A review of Resident 1's admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses which included history of Periprosthetic Fracture around Internal Prosthetic Right Knee Joint (a break in the bone surrounding the replaced joint). [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the Preadmission Screening and Resident Review (PASARR, a federal requirement to help ensure individuals are not inappropriately placed in nursing homes) was completed correctly for one of two residents (42). This failure had the potential to result in Resident 42's mental health needs to be unmet.

Inspectors wroteBased on interview and record review, the facility failed to provide needed care and services that are resident-centered in accordance with professional standards of practice for one of 18 residents (Resident 82) reviewed with congestive heart failure (CHF-a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling). This failure had the potential to contribute to Resident 82's declining health status with worsening CHF complications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure low air loss mattresses (LAL - an air flow mattress used to prevent skin breakdown by distributing weight over the mattress to reduce pressure to the skin) were set according to the physician's order, for one of four residents (Resident 47) reviewed for pressure ulcers. This failure had the potential to increase the risk for skin breakdown and pressure ulcers for residents who used LAL mattresses.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure dialysis (the process of cleaning the blood through a machine) access site was properly cared for two of two residents reviewed for dialysis (2 and 78). This deficient practice had a potential for Resident 2 and Resident 78's dialysis access to clot.

Inspectors wroteBased on observation, interview, and record review, the facility failed to include the appropriate indication (reason) and monitor the target behaviors for two of five residents (16 and 134) when: 1. Resident 16 did not have appropriate indications for the use of an antipsychotic medication (a medication used to treat symptoms of psychosis such as hallucinations and delusions). 2. Resident 134 did not have appropriate indication for anti-anxiety (medication used for worry and fear) medications and appropriate target behavior for the use of anti- anxiety medications. These failures had the potential for unnecessary psychotropic (mind-altering medications) medication use and a decline for resident's psychological and mental well-being.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure infection control procedures were followed when a Licensed Nurse (LN) 14 did not perform hand hygiene (the practice of cleaning hands to remove germs, dirt, or other harmful substances) consistently after removing her gloves while providing wound care to one of four residents (Resident 43), reviewed for pressure ulcer (sore). This failure had the potential for cross contamination, spread of infection, and Resident 43's decline in health.

Inspectors wroteBased on interview and record reviews the facility failed to ensure a care plan for Resident 1 ' s refusal of medications was developed and implemented. This failure had the potential for the care and interventions to not be communicated to all health care providers. Findings. A review of Resident 1 ' s dated admission Record indicated that Resident 1 was admitted to the facility on [DATE] with diagnoses that included Orthopedic Aftercare Following Surgical Amputation, Diabetes (abnormal blood sugar) with chronic kidney disease (failure of the kidneys to filter waste from the blood). An interview was conducted on 3/13/24 at 10:47 A.M., with certified nursing assistant (CNA) CNA 1 stated Resident 1 never complained of not having water at his bedside. An interview on 3/13/24 at 10:55 A.M., with licensed nurse (LN) LN 1 was conducted. [...]

Inspectors wroteBased on interview and record reviews, the facility failed to ensure staff are competent in managing Resident 1 ' s Diabetes (a chronic [long lasting] health condition that affects how your body turns food into energy) when staff did not notify Resident 1 ' s medical doctor on his medication refusals. This failure had the potential to negatively affect Resident 1 ' s health condition and possible decline. Findings. A review of Resident 1 ' s dated admission Record indicated that Resident 1 was admitted to the facility on [DATE] with diagnoses that included Orthopedic Aftercare Following Surgical Amputation, Diabetes (abnormal blood sugar) with chronic kidney disease (failure of the kidneys to filter waste from the blood). An interview on 3/13/24 at 11:00 A.M., with licensed nurse (LN) LN 1 was conducted. [...]

Inspectors wroteBased on interview and facility document and policy review, the facility failed to ensure their water management plan was fully implemented to prevent the potential for waterborne illnesses, including Legionella (a bacteria most commonly transmitted through contaminated water sources that could cause Legionnaires' disease). This failure had the potential to affect all 81 residents residing in the facility.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure food was covered to prevent potential contamination during meal delivery to resident rooms. Specifically, the facility failed to ensure food was covered during meal delivery to resident rooms located on 1 (second floor) of 3 residential floors. This deficient practice had the potential to affect 29 residents who consumed their meals on the second floor of the facility.

Inspectors wroteBased on observation, interview, and facility document and policy review, the facility failed to ensure the environment was free from accident hazards by failing to secure a stairwell that started at the ground floor and extended to the first, second, and third floor residential areas. Specifically, the first, second, and third floors had doors that exited to an exterior stairwell. None of the doors had any type of safety precaution to prevent a resident from exiting into the stairwell unattended. This deficient practice had the potential to affect 8 of 8 residents identified by the facility as at risk for elopement and 5 of 5 residents identified by the facility as ambulatory.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow proper infection control practice when: 1. Two Certified Nurse Assistants (CNA 70, 71) entered, and exited the PUI isolation rooms (Person Under Investigation for COVID-19 [a contagious respiratory infection]) without performing hand hygiene, not wearing gloves and gowns while handling and passing meal trays in between residents. 2. The facility placed in the same room, residents that were considered PUI and residents that have been cleared and had completed quarantine days (a period of isolation). These failures had the potential to spread infection amongst the residents, staff, and visitors. In addition, placing PUI residents and cleared residents in the same room had the potential to infect the residents that had already been cleared from COVID-19.

Inspectors wroteBased on interview and record review, the facility failed to: 1. Obtain consent prior to administering psychotropic medications, and 2. Failed to utilize practitioner's (physician, nurse practitioner, or physician assistant) to obtain resident consent for vaccines for six residents sampled for consents (228, 9, 28, 48, 62, 233). As a result, the residents may not have been fully informed of the risks and benefits of the psychotropic medications and vaccines.

Inspectors wroteBased on observation, interview, and record review, the facility failed to keep the environment free of accident hazards for two of 30 sampled residents (9, 279) when: 1. Resident 9 kept her smoking materials at her bedside. 2. Resident 239 was left alone with a chemical disinfectant on her bedside table.

Inspectors wroteBased on observation, interview, and record review, the facility failed to correctly label a gastrostomy tube feeding (tube inserted in the abdomen to provide liquid nutrients) bottle and water flush bag for one of one sampled resident investigated for tube feeding (48). This failure had the potential for residents to receive expired feeding formula and contaminated water.

Inspectors wroteBased on observation, interview, and record review, the facility failed to remove expired medications from the facility. This failure had the potential for the facility to administer expired medications to residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to honor the meal preferences for 1 of 2 residents investigated for meal preferences (229). As a result, Resident 229's plate contained food she would not eat.

Inspectors wroteBased on observation, interview, and record review, the facility failed to remove expired items from the dry storage room and ensure staff covered all facial hair in the kitchen. As a result, there was the risk of: 1. The facility providing expired food to residents 2. Unsecured hair falling onto food.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure resident rooms measured at least 80 square feet (sq. ft.) per resident in four resident bedrooms. This failure had the potential to impact resident care and quality of life.