Paramount Community Living and Rehab Inc

Inspectors wroteThe facility reported a census of 91 residents, with one main kitchen and eight kitchenettes. Based on observation, interviews and record review, the facility failed to prepare and serve food in accordance with food safety requirements regarding adequate temperatures and sanitary food storage.

Inspectors wroteThe facility identified a census of 91 residents. The sample included 19 residents with five residents sampled for unnecessary medications. Based on observation, interview, and record review, the facility failed to inform R59 or the resident's representative about the risk and benefits of taking a psychotropic (alters mood or thoughts) medication.

Inspectors wroteThe facility identified a census of 91 residents. The sample included 19 residents with five reviewed for unnecessary medications. Based on interview and record review, the facility failed to ensure Resident (R) 8 was free from unnecessary psychotropic medications and/or chemical restraints when they failed to ensure both of R8's as needed (PRN) lorazepam (antianxiety medication) had a 14 day stop date or a specified duration with a supporting physician rationale.

Inspectors wroteThe facility had a census of 91 residents. The sample included 19 residents with three in the sample reviewed for hospitalization. Based on observation, interview and record review the facility failed to provide a written bed hold policy at the time of transfer for Resident (R) 10.

Inspectors wroteThe facility reported a census of 91 residents; 19 residents were selected for review. Based on observation, interview, and record review, the facility failed to accurately complete the Minimum Data Set to reflect the condition for Resident (R) 59's falls.

Inspectors wroteThe facility had a census of 91 residents; the sample included 19 residents. Based on observation, interview and record review, the facility failed to provide consistent activities for Resident (R) 7.

Inspectors wroteThe facility reported a census of 91 residents with 19 residents selected for review. Based on observation, interview, and record review, the facility failed to follow fall prevention interventions to prevent falls for Resident (R) 59.

Inspectors wroteThe facility identified a census of 91 residents. The sample included 19 residents with three residents reviewed for respiratory care. Based on observation, interview, and record review, the facility failed to ensure emergency equipment was readily available in the event of an accidental extubation (removal of a medical tube) of Resident (R)7's tracheostomy (opening through the neck into the trachea through which an indwelling tube may be inserted) cannula.

Inspectors wroteThe facility identified a census of 91 residents. The sample included 19 residents with two residents reviewed for dialysis (blood purifying treatment given when kidney function is not optimum). Based on observation, record review, and interviews, the facility failed to ensure ongoing communication and collaboration with the dialysis facility regarding dialysis care and services for Resident (R) 6 and R13.

Inspectors wroteThe facility reported a census of 91 residents; the sample included two residents reviewed for bed rail safety. Based on interview, observation, and record review, the facility failed to obtain informed consent from the residents or the resident's legal representative for installation of bedrails for Resident (R) 53 and for R86.

Inspectors wroteThe facility reported a census of 92 residents. Based on observation, record review, and interview, the facility failed to prepare and serve food under sanitary conditions, to the residents of the facility appropriately to prevent the potential for food borne bacteria.

Inspectors wroteThe facility reported a census of 92 residents with 22 included in the sample. Based on observation, interview, and record review, the facility failed to ensure infection control techniques for Resident (R)9, regarding oxygen (O2) tubing/cannula storage, for R60, related to urinary catheters and perineal care, R242, related to storage of soiled catheter collection device stored next to personal care items of toothbrush and toothpaste, and R78, related to incontinence cares, to prevent the spread of infections in the facility.

Inspectors wrote- Review of Resident (R) 37's medical record revealed diagnoses that included Alzheimer's disease (progressive mental deterioration characterized by confusion and memory failure), anxiety disorder (mental or emotional reaction characterized by apprehension, uncertainty, and irrational fear, chronic kidney disease, congestive heart failure (a condition with low heart output and the body becomes congested with fluid), and osteoarthritis (degenerative changes to one or many joints characterized by swelling and pain). The admission Minimum Data Set (MDS), dated [DATE], assessed the resident with a Brief Interview for Mental Status (BIMS) score of five, which indicated severe cognitive impairment. The resident required extensive assistance of staff for dressing and personal hygiene. [...]

Inspectors wroteThe facility reported a census of 92 residents, which included 10 residents residing in one of the six Green Houses. Based on observation, record review, and interview, the facility failed to provide unstained towels and washcloths to the residents in one [NAME] House.

Inspectors wroteThe facility reported a census of 92 residents with 22 selected for review. Based on observation, interview, and record review, the facility failed to develop comprehensive care plans for four of the 22 residents reviewed. Resident (R)37 for use of support hose, R35 for fluid restriction, R78 for type of music, TV shows and religious preferences and R242 for shaving preferences.

Inspectors wroteThe facility reported a census of 92 residents with 22 residents selected for review which included six residents reviewed for activities. Based on observation, interview, and record review, the facility failed to ensure appropriate activities for five Residents (R)7, R20, R33, R37, and R78, of the six residents reviewed for activities.

Inspectors wroteThe facility reported a census of 92 residents. Based on observation, interview, and record review, the facility failed to complete an accurate Minimum Data Set (MDS) for two residents, that included Resident (R)31, regarding the failure to complete the Care Area Assessments (CAA) for nutrition and pressure ulcers (PU) and R 33, regarding the failure to complete CAAs for psychotropic drugs, pain and mood state.

Inspectors wroteThe facility census totaled 92 residents with 22 residents included in the sample. Based on observation, interview, and record review, the facility failed to revise care plans for two residents. Resident (R)9, related to the failure to care plan a fall with a fractured foot that required a special walking boot, and R9, related to skin care for a pressure ulcer (localized injury to the skin and/or underlying tissue usually over a bony prominence, because of pressure, or pressure in combination with shear and/or friction).

Inspectors wroteThe facility reported a census of 92 residents with 22 residents sampled, including five residents reviewed for Activity of Daily Living (ADL). Based on observation, interview and record review, the facility failed to provide appropriate care to one dependent Resident (R)241, regarding facial shaving.

Inspectors wroteThe facility reported a census of 92 residents with 22 residents selected for review and included three residents reviewed for pressure ulcers. Based on observation, interview, and record review, the facility failed to ensure alternative methods of pressure relief provided for one Resident (R)20, of the three residents reviewed for pressure ulcers.

Inspectors wroteThe facility reported a census of 92 residents with 22 selected for review, which included three residents reviewed for restorative services. Based on observation, interview and record review, the facility failed to ensure staff provided range of motion (ROM) services for one Resident (R)78, of the three residents reviewed for restorative.

Inspectors wroteThe facility reported a census of 92 residents with 22 residents included in the sample, including four residents reviewed for indwelling urinary catheters (insertion of a catheter into the bladder to drain the urine into a collection bag). Based on observation, interview, and record review, the facility failed to utilize an anchoring device for one Resident (R)78 and failed to ensure catheter tubing was kept up off the floor for R 242.

Inspectors wroteThe facility census totaled 92 residents with 22 residents included in the sample. Based on observation, interview, and record review, the facility failed to monitor one Resident (R)35, for a physician ordered fluid restriction.

Inspectors wroteThe facility reported a census of 92 residents with 22 residents selected for review, which included five residents reviewed for unnecessary medication use. Based on observation, interview, and record review, the facility failed to monitor one of the five Residents (R)7 for hypotension and bowel movements and one resident, R 41, regarding a failure to follow physician ordered blood pressure parameters. (instructions to hold medication for blood pressures below a threshold).

Inspectors wroteThe facility reported a census of 87 residents. Based on record review and interview, the facility failed to ensure nursing staff followed the principles of antibiotic stewardship in a proactive manner to ensure residents received antibiotics in a safe and effective manner to prevent unnecessary side effects of antibiotics and antibiotic resistance. The facility failed to track and trend infections and causative microorganisms throughout the facility and failed to compile antibiotic use data for prescribing practitioners.

Inspectors wroteThe facility reported a census of 87 residents with 23 selected for review, including five reviewed for respiratory care. Based on observation, record review, and interview, the facility failed to change the oxygen tubing for Resident (R)73, failed to change the oxygen tubing for R18 and to clean the concentrator and filter, failed to change the oxygen tubing for R68, failed to date the oxygen tubing, humidifier bottle and tubing, nebulizer tubing and store those items in a sanitary manner when not in use as well as the nebulizer kit after cleansing and allowing to air dry for R335, and failed to date the oxygen tubing and nebulizer tubing and kit when changed and to store items in a sanitary manner when not in use for R72. These practices increased the risk of these five residents for developing a respiratory infection.

Inspectors wroteThe facility reported a census of 87 residents. The sample included 23 residents with one resident reviewed for choices. Based on observation, interview, and record review, the facility failed to provide choices for Resident, (R)30 related to food.

Inspectors wrote- Review of Resident (R)68's Physician Order Sheet, dated 03/16/22, revealed diagnoses that included Parkinson's disease (slowly progressive neurologic disorder characterized by resting tremor, rolling of the fingers, masklike faces, shuffling gait, muscle rigidity and weakness,) osteoarthritis (degenerative changes to one or many joints characterized by swelling and pain,) and atrial fibrillation (rapid, irregular heartbeat.) The Significant Change Minimum Data Set (MDS), dated [DATE], assessed the resident with normal cognitive function and received oxygen therapy. The ADL (Activity of Daily Living) Functional/Rehabilitation Potential Care Area Assessment (CAA), dated 04/13/22, assessed the resident required assistance with ADLs due to generalized weakness and decreased functional ability. [...]

Inspectors wroteThe facility reported a census of 87 residents with 23 residents sampled, including one resident reviewed for restorative services. Based on observation, interview, and record review, the facility failed to provide restorative services for one sampled Resident (R)27 to maintain or prevent decline in range of motion (ROM) ability.

Inspectors wroteThe facility reported a census of 87 residents with 23 selected for review including two residents reviewed for pain management. Based on interview and record review, the facility failed to order one resident's narcotic (class of medication used to treat moderate to severe pain) medication in a timely manner, resulting in four missed scheduled doses and an increased pain level, for Resident (R)63.

Inspectors wroteThe facility reported a census of 87 residents with five selected for review of unnecessary medications. Based on observation, interview and record review, the facility and consulting pharmacist failed to identify the need for baseline and subsequent assessment for extrapyramidal side effect of antipsychotic medications at the initiation of Seroquel (antipsychotic medication used to treat certain mental/ mood conditions)and periodically thereafter during therapy to ensure the resident did not experience adverse effects of this antipsychotic medication.

Inspectors wroteThe facility reported a census of 87 residents with five residents selected for review for unnecessary medications. Based on observation, interview and record review, the facility failed to assess for extrapyramidal (a group of symptoms that may occur due to antipsychotic medication) side effects for one of the five sampled residents (R)70 and failed to ensure as needed psychotropic medications did not exceed 14 day use without physician re-evaluation and specified duration for three of the five sampled residents (R) 70, 68 and 45.

Inspectors wroteThe facility reported a census of 87 residents, with 40 residents residing in [NAME] Hall. Based on observation, interview and record review, the facility failed to display accurate and identifiable staffing information, on a daily basis, on a Daily Nurse Staffing as required for the 40 residents that reside in the [NAME] Hall for a period of five days.