Paramount Convalescent Hosp.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement proper infection control practices for all residents in the facility by failing to:1. To ensure Resident 27 was on Enhanced Barrier Precautions (EBP-infection control measure to prevent the spread of germs), for a chronic pressure injury (PI- injury to skin and underlying tissue resulting from prolonged pressure on the skin).2. To ensure hand hygiene was performed prior to checking the residents' lunch meal trays. These failures had the potential to spread germs through cross-contamination (the transfer of bacteria, viruses, microorganisms, or other harmful substances from one surface to another through improper or unsanitary equipment, procedures, or products) to residents, staff and visitors.

Inspectors wroteBased on interview and record review the facility failed to ensure a safe discharge and transfer for four of four residents (Resident 3, Resident 27, Resident 29 and Resident 51) by failing to:1. Ensure the Long Term Care (LTC) Ombudsman (an advocate for residents of nursing homes, board and care centers, and assisted living facilities) was notified when Resident 3, Resident's 27 and Resident 29 were transferred to the General Acute Care Hospital (GACH).2. Ensure Resident 3, Resident 27 and Resident 51 were offered a bed hold before being transferred to the GACH.These failures violated Resident 3, Resident 27, Resident 29 and Resident 51's rights and had the potential to affect Resident 3, Resident 27 and Resident 51's emotional wellbeing if they could not return to the facility.

Inspectors wroteBased on interviews and record review, the facility failed to:1. Complete a change of condition ([COC] a sudden, clinically important deviation from a patient's baseline in physical, cognitive (ability to think, understand, learn, and remember) behavioral, or functional status which without immediate intervention, may result in complications or death) for three of four sampled residents (Resident 2, Resident 7, and Resident 13). 2. Review Resident 2's general acute care hospital (GACH) notes during the admission Interdisciplinary Team ([IDT] team members from different departments working together with a common purpose to set goals and make decisions that ensure residents receive the best care) meeting. These failures resulted in the lack of necessary care and treatment related to antibiotic use for Resident 2, Resident 7, and Resident 13.

Inspectors wroteBased on interview and record review, the facility failed to ensure two of two sampled residents (Resident 2 and 27) drug regimen was free from unnecessary medications by failing to: 1. Include a stop date for prescribed antibiotics, and by failing to reassess the continued need for the medications for Resident 2. 2. Ensure Resident 27 was not overprescribed antibiotics. This deficient practice resulted in Resident 2 receiving prolonged antibiotic therapy without appropriate monitoring or clinical justification, increasing the risk of adverse drug effects (unwanted, harmful, or unexpected problem as a result of a medicine) and had the potential for Resident 27 to develop multi-drug-resistant organisms (MDROs- bacteria resistant to multiple antibiotics.)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure infection control practices in the kitchen were followed by failing to ensure the [NAME] and Dietary Aid washed hands and changed gloves when switching tasks during tray line (process where staff assemble meal trays for residents). These deficient practices had the potential to place residents at risk for acquiring food-borne illnesses (any illness resulting from ingestion of food contaminated with bacteria or viruses).

Inspectors wroteBased on observation, interview and record review, the facility failed to follow the antibiotic stewardship program (coordinated program that promotes the appropriate use of antibiotics by clinicians) including the use of McGeer's Criteria (standardized surveillance definitions to identify and track infections for prevention and control) for three of six residents (Resident 2, Resident 25, and Resident 27). This failure placed the Resident 2, Resident 25 and Resident 27 at risk for unnecessary antimicrobial therapy, adverse drug reactions, and the development of antimicrobial resistance.

Inspectors wroteBased on interview and record review, the facility failed to notify the physician of a significant weight loss (a weight loss greater than 5% in one month, or 10% change in weight in six months) following readmission from General Acute Care Hospital (GACH) stay for one of four sampled residents (Resident 53). This deficient practice had the potential to delay the Physician's assessment and intervention, placing Resident 53 at risk for continued weight loss and malnutrition.

Inspectors wroteBased on observation, interview and record review, the facility failed to monitor target behaviors for one of 14 residents (Resident 25) while on a psychotropic medication (substance that affects how the brain works, used to treat mental illnesses). This failure resulted in Resident 25 not receiving individualized behavior monitoring necessary to identify the presence, absence, or change in behaviors targeted by the psychotropic medication.

Inspectors wroteBased on interview and record review the facility failed to implement goals and interventions on the care plan for two of two residents (Resident 2 and Resident 27) by failing to: 1. Ensure the Interdisciplinary Team ([IDT] team members from different departments working together with a common purpose to set goals and make decisions that ensure residents receive the best care), developed a care plan for Resident 27 who had multiple Urinary tract infections (UTI- an infection in the bladder/urinary tract) and was prescribed multiple antibiotics (medication that kills bacteria). 2. [...]

Inspectors wroteBased on interview and record review, the facility failed to perform consistent monitor Resident 53's nutritional status by failing to:a. Initiate a weight variance (monitoring process triggered when a resident experiences significant weight fluctuations) andb. Discuss nutritional recommendations during the Interdisciplinary Care Conference {(ICC), a collaborative meeting involving various healthcare professionals to review and update the resident's care plan} after Resident 53 had a significant weight loss (a weight loss greater than 5% in one month, or 10% change in weight in 6 months) of 40 pounds (unit for measuring weight) following admission from the General Acute Care Hospital (GACH) for one of four sampled residents (Resident 53). This deficient practice had the potential to place resident at risk for continued weight loss.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Infection Prevention Nurse (IPN) demonstrated competency in implementing infection control practices related to antibiotic usage for one of one sampled residents (Resident 2). The facility failed to:1. Monitor Resident 2 who was administered two antibiotics (medications used to treat an infection) since admission on [DATE] with no end date to stop treatment. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that expired enteral nutrition products (specialized liquid formulas used in tube feeding to provide essential nutrients to residents unable to eat by mouth) were removed from the medication storage room after their expiration date. This failure had the potential to result in adverse side effects, including gastrointestinal distress, infection, and loss of potency (strength of a drug or its effectiveness in achieving a desired result), compromising the health and safety of residents receiving enteral nutrition.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure consent to treatment documentation was completed with all required elements for one of 14 sampled residents (Resident 44). This deficient practice has the potential to result in residents receiving treatments or interventions without understanding the risks, benefits, or alternatives.

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess one of five residents (Resident 1) during a change of condition and notify the physician in a timely manner during multiple episodes of elevated blood pressure. This failure resulted in Resident 1 having a headache and had the potential to result in dizziness, cerebral infarction (part of the brain dies because it's not getting enough blood and oxygen) and re-hospitalization for Resident 1.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure one of two sampled residents (Resident 1) was treated with respect and dignity by failing to ensure Resident 1 ' s indwelling urinary catheter (medical device which helps drain urine from the bladder) drainage bag was covered with a privacy bag (a bag used to the cover and hold the catheter drainage/collection bag so it is not visible). This deficient practice had the potential for Resident 1 to feel embarrassed and have low self-esteem by not having his catheter drainage bag not covered.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide services to three of seven sampled residents (Resident 43, 5, and 18) with limited range of motion [(ROM) full movement potential of a joint (where two bones meet)] and mobility (ability to move) by failing to: 1. Obtain baseline (initial measurement taken at an early point and used for comparison over time to monitor changes) ROM measurements of Resident 43's both arms and legs upon admission on [DATE] using the Joint Mobility Assessment ([JMA] brief assessment of a resident's range of motion in both arms and both legs) in accordance with the facility's policy titled, Joint Mobility and Screening and Assessment revised on 1/25/2024. 2. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to observe infection control measures. The facility failed to : a. Ensure Resident 1 and 48's tube feeding ( medical device used to provide nutrition to resident who cannot obtain nutrition by mouth ) and water bags were changed every 24 hours. These failures had the potential to result in cross contamination and place the residents at risk for the spread of infection. b. To practice handwashing during wound care treatment on Resident 18 who had a Stage 4 pressure injury (full-thickness skin and tissue loss with exposed muscle, tendon, ligament, cartilage, or bone) in the sacro coccyx (tail bone) area. c. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure two of three residents had clean and trimmed nails (Resident 17 and 45). This failure had the potential to negatively impact the resident's quality of care and self-esteem.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure two of four sampled residents (Resident 39 and Resident 18) received the necessary treatment and services that will prevent development and promote healing of pressure injury (localized, pressure-related damage to the skin and/or underlying tissue usually over a bony prominence) by: a. Failing to monitor and assess Resident 39's skin areas where the nasal cannula (a small plastic tube, which fits into the person's nostrils for providing supplemental oxygen) was applied. b. Failing to ensure Resident 18 who had Stage 4 pressure injury on the Sacro coccyx area (full-thickness skin and tissue loss with exposed muscle, tendon, ligament, cartilage, or bone on the tail bone) was repositioned to offload (method of reducing or removing pressure on the area to help prevent and heal pressure injury) was implemented. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure two of 14 sampled residents received effective pain management by: 1. Failing to assess and treat one of three resident's experiencing pain (Resident 11). 2. Failing to ensure Resident 18's pain level assessment is based on the cognitive level (mental process involved in knowing, learning, and understanding things) of the resident. These failures had the potential to put Resident 11 and Resident 18 at risk for pain to go unrecognized and untreated leading to delay of care and treatment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to: a. Ensure five of five Restorative Nursing Assistants ([RNA] certified nursing aide program that helps residents to maintain their function and joint mobility) had an annual competency evaluation (systematic process that evaluated an individual's skill and knowledge) for providing range of motion ([ROM] full movement potential of a joint [where two bones meet]) exercises, application of orthotics (also known as splints, material used to restrict, protect, or immobilize a part of the body to support function, assist and/or increase range of motion), and ambulation (the act of walking) to 13 residents receiving RNA services, including one of seven sampled residents (Resident 43) with limited ROM and mobility (ability to move). [...]

Inspectors wroteBased on observations, interview, and record review the facility failed to ensure it was free from a medication error rate of five percent or greater as evidenced by the identification of eleven medications errors out of thirty-three opportunities for error, to yield a total error rate of 33.33 percent for the two of four sampled residents (Residents 28 and 37). This failure had the potential for medications to not maintain a therapeutic dose level (maintain a certain level in your blood to work well) when not administer according to physician orders.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure sanitary conditions were maintained in the kitchen by failing to: a. Date and label open bag of peanut butter dough, bag of frozen fries and open bottles of salsa in the freezer and refrigerator. b. Practice hand washing during cooking, checking of temperatures of cooked food items and distribution of food during tray line. c. Use a beard net ( worn to contain facial hair)during food preparation and food distribution during lunch tray line. These failures had the potential to cause cross contamination ( unintentional transfer of harmful bacteria from one object to another)and food borne illnesses (any illness resulting from eating contaminated/ spoiled foods)among the residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide therapy services, including Physical Therapy ([PT] profession aimed in the restoration, maintenance, and promotion of optimal physical function), Speech Therapy ([SLP] profession aimed in the prevention, assessment, and treatment of speech, language, communicative, and swallowing disorders), and Occupational Therapy ([OT] profession aimed to increase or maintain a person's capability of participating in everyday life activities [occupations]) to one of seven sampled residents (Resident 5) with range of motion ([ROM] full movement potential of a joint [where two bones meet]) and mobility (ability to move) concerns in accordance with Resident 5's physician signed care plans for OT, PT, and SLP. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to: a. Ensure accurate documentation for two of six sampled residents (Resident 43 and 32) with limited range of motion ([ROM] full movement potential of a joint [where two bones meet]) and mobility (ability to move) concerns. This failure resulted in inaccuracies in the provision of care recorded in the clinical records of Resident 43 and 32. b. Ensure one out of three sampled residents (Resident 38) medication administration record (MAR) accurately reflect licensed nurse administered Resident 38's medication on 10/3/2024 at 9 a.m. This failure had the risk for medication errors or omission in medication administration.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of four sampled residents (Resident 18) was free from physical restraint by not placing bilateral (both) 1/2 siderails on the bed without a physician's order or assessment. This failure had the potential to place Resident 18 at risk for unnecessary use of restraints that can lead to skin injuries , decline in mobility, and bed entrapment (an event in which a patient is caught, trapped, or entangled in the spaces in or about the bed rail, mattress, or bed frame).

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person focused care plan for two of 14 sampled residents (Resident 11 and Resident 18) by failing to: 1. Follow and implement interventions for Resident 11's management of pain. 2. Develop a comprehensive care plan that will address Resident 18's pain. These failures place Resident 11 and Resident 18 at risk for delay of care and treatment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of seven sampled residents (Resident 18) with limited range of motion [(ROM) full movement potential of a joint (where two bones meet)] and mobility (ability to move) had two staff members present while using a mechanical lift (a device that helps people who have difficulty moving on their own to be transferred or moved from one place to another) during a transfer from the bed to the shower bed. This failure placed Resident 18 at increased risk for accidents, including a fall from the mechanical lift which could have resulted in physical injury.

Inspectors wroteBased on observation, interview, and record review, Licensed Vocational Nurse (LVN) 4 failed to keep one of one sampled resident (Resident 38) head of the bed elevated at a minimum 30 degrees at all times during the administration of feedings or medications to prevent aspiration (accidental inhalation of food, liquid, or other material into the lungs) and pneumonia (lung infection) per facility's policy and procedure (P&P). This failure had the potential to place Resident 38 at risk for aspiration and pneumonia.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of four sampled residents (Resident 18) was free from unnecessary medication by: 1. Ensuring non-pharmacological interventions (intervention that does not primarily use medicine) was ordered for Resident 18 who was prescribed with psychotropic medicine ( any drug or substance that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, and behavior). This failure had the potential to result in the use of unnecessary psychotropic medication to Resident 18.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide one of two sampled Residents (Resident 43) with meals that accommodated resident's food preferences. This failure had the potential to result in decreased meal intake and can lead to weight loss.

Inspectors wroteBased on interview and record review, the facility failed to ensure Resident 3 was aware of what she was signing when she signed the arbitration agreement (AA- a contract in which you give up your right to being certain claims to court). This failure had the potential to result in Resident 3 not having her right to limit opportunity to initiate judicial proceedings that challenge unfavorable decisions.

Inspectors wroteBased on observation, interview, and record review, the Quality Assessment Assurance (QAA) Committee failed to implement corrective action from the previous re-certification survey regarding the provision of Restorative Nursing Aide ([RNA] certified nursing aide program that helps residents to maintain their function and joint mobility) services for range of motion ([ROM] full movement potential of a joint [where two bones meet]) and mobility (ability to move). This failure resulted in repeated deficient practices for Quality of Care related to the RNA program during the current re-certification survey.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the wall in one of 19 rooms (Room A) was properly maintained without any holes. This failure had the potential to expose one of 52 residents (Resident 27) to hazards located in the walls, including water, fire, and pests.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the resident, who underwent an open reduction internal fixation ([ORIF] a surgical procedure that puts pieces of a broken bone into place using screws, plates, sutures, or rods) surgery of the right ankle fracture (break in the bone), did not have the surgical wound infected with exposed surgical hardware (pins, plates, or screws used to help fix a broken bone, torn tendon, or to correct an abnormality in a bone) for one of three sampled residents (Resident 1). The facility failed to: 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and/or implement a care plan for one of three sampled residents (Resident 1) who was assessed at risk for elopement (leaving an institution without notice or permission). This deficient practice resulted in Resident 1 attempting to elope from the facility by climbing out of the facility s bathroom window and breaking her right leg when she fell to the ground outside that bathroom.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was stored and distributed under food safety requirements by failing to: 1. Ensure ice machine was maintained in a clean and sanitary way. 2. Ensure canned food stored in dry storage pantry had a received date label. These failures had the potential to cause food borne illness (food poisoning) for 49 out of the 49 residents in the facility.

Inspectors wroteBased on observation, interview and record review the facility failed to implement infection control practices to prevent the development and transmission of communicable diseases and infections. The facility failed to: 1. Ensure visitors wore Personal Protective Equipment (PPE: equipment to protect self and others from spreading infectious bacteria and virus) when entering Resident 26's room who were on contact isolation (when a patient has an infectious disease that may be spread by touching either the patient or objects the patient has handled), took a chair and brought it inside Resident 105's room and failed to do hand hygiene (cleaning one's hands that substantially reduces potential pathogens (harmful microorganisms) on the hands). 2. Ensure certified nurse assistant (CNA) 9 donned (put on )PPE inside the room of a resident who was on contact isolation while rendering care. 3. [...]

Inspectors wroteBased on interview and record review the facility failed to provide prompt efforts to resolve the grievances the residents voiced to the facility through the grievance reporting form and resident council (organized group of residents who meet regularly to discuss and address concerns about their rights, and care in the facility) meetings for three of seven residents (Resident 14, Resident 39, Resident 105) who attended the resident council meeting during the recertification survey. This failure has violated the residents' right to have grievances filed by residents in the facility during the resident council meeting was addressed and resolved.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure correct dosage of medications were administered per physician order to two of two sampled residents (Resident 50 and 32). This failure had the potential for harm to Resident 50 and Resident 32 receiving a medication dosage not ordered by the physician.

Inspectors wroteBased on interview and record review the facility failed to ensure one of four Residents (Resident 17) with limited mobility received assistance to improve, maintain and prevent avoidable decline in range of motion and mobility by failing to implement Physical Therapy ([PT] the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery) recommendations to start Restorative Nursing Assistive Services ([RNAS] nursing interventions that promote the residents ability to adapt and adjust to living) ordered on 9/18/2023 for Passive Range of Motion (PROM) for the bilateral (both) lower legs for joint integrity (inspection, palpation, active and passive range of motion, and the assessment of supporting structures and special testing). [...]

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure necessary care and services needed were provided to one of two sample residents (Resident 5). Facility failed to: 1. Ensure Resident 5 oxygen tubing was connected to oxygen machine and the nasal cannula (a device used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help) was on Resident 5 nostril. This failure had the potential for complications associated with lack of proper oxygen therapy for Resident 5.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of 17 sampled resident (Resident 205) medication was not left unattended at bedside without a physician order for self-administration. This failure had the potential for Resident 205 at risk for medication errors and had the potential for unsafe medication administration to an incorrect resident.

Inspectors wroteBased on interview and record review, the facility failed to permit one of one resident (Resident 1) to return to the facility after hospitalization when Resident 1 was ready to be readmitted too the facility on 9/5/2023 and on 9/12/2023. This deficient practice resulted in Resident 1 having to remain in acute care hospital and unable to go back home (facility)and had the potential to negatively affect Resident 1's wellbeing.