Paramount Health and Rehabilitation

Inspectors wroteBased on record review and interview, it was determined for 1 of 25 sampled residents, that the facility failed to ensure that each resident received treatment and care in accordance with professional standards of practice. Specifically, one resident was not referred to a urologist or oncologist when it was ordered by the physician. Resident identifier: 48.

Inspectors wroteBased on observation, interview, and record review, it was determined for 1 of 25 sampled residents, that the facility failed to ensure that the resident environment remained as free of accident hazards as was possible; and that each resident received adequate supervision and assistance devices to prevent accidents. Specifically, one resident who required oxygen was observed to be smoking without staff supervision and had not been evaluated for safety while smoking. Resident identifier: 58.

Inspectors wroteBased on interview and record review it was determined, for 1 out of 25 sampled residents, that the facility did not maintain medical records on each resident that were complete; accurately documented; readily accessible; and systematically organized. Specifically, a resident's radiology report for a possible broken PICC (peripherally inserted central catheter) was not in the medical record. Resident identifier: 54.

Inspectors wroteBased on interview and record review, it was determined for 2 of 7 sampled residents, that the facility failed to provide each resident with staff supervision to prevent accidents. Specifically, a resident who was on supervised smoking was left unattended in the smoking area, and had accidentally caught on fire, which resulted in burn injuries and the resident expiring at the hospital, along with burn injuries to another resident's hand who was attempting to put the fire out. Resident Identifiers: 1, 2. On [DATE], the surveyor reviewed the facility's investigation involving an incident with Resident 1, dated [DATE], which revealed the following:On [DATE], PRN Physical Therapist (PT) 1 took Resident 1 out to smoke. Two other residents (Resident 2 and Resident 3) were in the smoking area and there were no other staff present. [...]

Inspectors wroteBased on interview and record review, it was determined that the facility failed to develop and implement written policies and procedures that prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property. Specifically, a nursing assistant who provided an invalid Social Security Number and failed to provide fingerprints was working in the facility for approximately three months. Findings Include. 1. On 12/3/24, Nursing Assistant (NA) 1's employee record was reviewed. NA 1 was hired at the facility on 9/4/24. NA 1 was reviewed in the Direct Access Clearance System (DACS). NA 1's current fitness determination was In Process and it was revealed that NA 1 did not submit fingerprints. NA 1 was involuntarily terminated on 12/2/24 due to providing the facility with an invalid Social Security Number. [...]

Inspectors wroteBased on observation, interview and record review, for 1 of 38 sampled residents, the facility did not ensure that each resident with limited mobility received appropriate services, equipment and assistance to maintain or improve mobility with the maximal practical independence unless a reduction in mobility was demonstrated unavoidable. Specifically, a resident with limited range of motion to his hand was not being provided range of motion services or devices to prevent further contracture. Resident identifier: 30.

Inspectors wrote4. Resident 257 was admitted to the facility initially on 1/17/23, and re-admitted on [DATE] with diagnoses that included type 1 diabetes, end stage renal disease, dependence on renal dialysis, chronic diastolic and systolic heart failure, morbid obesity, muscle weakness, and bilateral below the knee amputation. Resident 257 was initially unavailable for interview, and after re-admission to the facility, refused to be interviewed. Resident 257's medical records were reviewed between 4/3/24 and 5/14/24. An admission MDS assessment dated [DATE] revealed resident 257 had a BIMS of 15 indicating that he was cognitively intact. The assessment also revealed that resident 257 required substantial/maximal assistance with transferring from bed to chair/chair to bed, and was dependent while in his wheelchair for ambulation. [...]

Inspectors wroteBased on observation, interview and record review, for 2 of 38 sampled residents, the facility did not ensure residents maintained acceptable parameters of nutritional status. Specifically, resident's tube feedings were not administered as ordered, and a resident was not being positioned appropriately while the tube feeding was administered. Resident identifiers: 26 and 39.

Inspectors wroteBased on observation and interview, the facility did not provide meals with no more than 14 hours between the substantial evening meal and the breakfast meal the following day. Specifically, breakfast meals were being served more than 30 minutes beyond the posted time, causing more than 14 hours to elapse between the evening meal and the breakfast meal. Resident identifiers: 7, 9, 30 ,31, 49, 51 and 106.

Inspectors wroteBased on interview and record review, for 3 of 38 sampled resident, that the facility did not ensure that all violations involving abuse, neglect, exploitation or mistreatment including injuries of unknown source and misappropriation of resident property are reported immediately, but not later than 2 hours after the allegation was made. Specifically, the facility did nor report to the State Survey Agency (SAA) timely when a resident sustained a severe finger injury while in her wheelchair, a resident was not secured while being transported in a facility van, and a resident was not provided the ordered wound care to her foot. Resident identifiers: 20, 21, and 256.

Inspectors wrote2. Resident 258 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included presence of right artificial knee joint, cellulitis right lower extremity, type 2 diabetes mellitus, mobid obesity, gout, edema, and hypertension. Resident 258 was discharged from the facility on 6/28/23. On 4/3/24, resident 258's medical record was reviewed. On 5/12/23 at 11:00 PM, resident 258's the nursing note documented, Resident notified LN [licensed nurse] tonight that her aide was acting strange when she went to put [resident 258] to bed. [Resident 258] states that her aide placed a looped gait belt around her (the aide's) neck and mimicked her hanging herself while standing at the foot of the bed while [resident 258] was on the commode. [...]

Inspectors wroteBased on observation, interview and record review it was determined, for 3 of 38 sampled residents, that the facility did not ensure that all drugs and biological's were stored and labeled in accordance with accepted professional principles, under proper temperature controls and cautionary instructions, and the expiration date when applicable. Specifically, the temperature in one medication fridge was not within the required temperature range for medication storage. Resident identifiers: 4, 47 and 157.

Inspectors wroteBased on observation and interview, it was determined that the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. Specifically, food items in the walk-in freezer, walk-in refrigerator, and dry food storage room were open to air, a container in the walk-in refrigerator was not dated, the wall in the dry food storage area had black residue from a water leak, the vent in the dry storage room was not functioning and was rusty with an unknown dried substance on it, there were tiles in the dish room that were cracked and chipped.

Inspectors wroteBased on observation, interview, and record review, the facility did not establish and implement written policies and procedures for feedback, data collections systems, and monitoring, including adverse event monitoring. Specifically, multiple areas of harm were identified on the recertification survey and were not identified and corrected through the Quality Assurance and Performance Improvement (QAPI). Resident identifiers: 8, 13, 20, 21, 31, 35, and 257.

Inspectors wroteBased on observation and interview it was determined the facility did not provide a safe, clean, comfortable and homelike environment for each resident. Specifically, a resident had a red and orange substance on a piece of drywall secured to the wall by a residents bed. The drywall was protruding from the wall and the screws protruding from the wall. In addition, there were odors in the facility and mats next to residents beds were torn. Resident identifier: 8.

Inspectors wroteBased on interview and record review it was determined, for 1 of 38 sampled residents, that the facility did not ensure that the resident was free from abuse. Specifically, a resident reported physical and mental abuse when a nurse aide placed a sheet and towel over the resident's head and neck trapping them and preventing them from moving freely. Resident identifier: 258 and 261.

Inspectors wroteBased on observation, interview and record review, it was determined for 3 of 38 sampled residents, that the facility did not develop and implement a comprehensive care plan that included measurable objectives and time frames to meet resident's medical, nursing, and mental and psychosocial needs. Specifically, a resident with at risk for developing pressure ulcers did not have interventions implemented and another resident had interventions to have the call light within reach and observations were made of call light out of reach. Resident identifiers: 8, 17 and 36.

Inspectors wroteBased on observation, interview and record review, it was determined for 1 of 38 sampled residents, that the facility did not provide the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living. Specifically, a resident was not provided feeding assistance or supervision. Resident identifiers: 36.

Inspectors wroteBased on observation, interview and record review, for 1 of 38 sampled residents, the facility did not ensure that a resident who was unable to carry out activities of daily living received the necessary services to maintain good grooming. Specifically, a resident with contractures to his hands had long fingernails. Resident identifier: 30.

Inspectors wroteBased on observation, interview and record review it was determined, for 1 of 38 sampled residents, the facility did not ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan and the residents' choice. Specifically, a resident had skin breakdown that did not have the dressing changed according to orders and was observed to bump another area on the wheelchair. Resident identifier: 8.

Inspectors wroteBased on observation, interview, and record review it was determined, for 1 of 38 sampled residents, that the facility did not ensure that a resident who was fed by enteral means received the appropriate treatment. Specifically, a resident's head and torso were not elevated while a tube feeding was infusing. Resident identifier: 39.

Inspectors wroteBased on observation, interview and record review, it was determined for 1 of 38 sampled residents, that the facility failed to evaluate the risks versus benefits of an installed side rails for a resident. Specifically, one resident had a half side rail with no evaluation. Resident identifier: 17.

Inspectors wroteBased on interview and record review, it was determined the facility did not ensure that any individual working in the facility as a nurse aide for more that 4 months, on a full-time basis, was competent to provide nursing and nursing related services; and completed a training and competency program, or a competency evaluation program approved by the State. Specifically, a Nurse Aide (NA) was employed at the facility on a full-time basis, for approximately 6 months with out completion of training and competency evaluation program.

Inspectors wroteBased on interview and record review, it was determined that for 1 or 38 sampled residents, that the facility did not file in the resident's clinical record the signed and dated reports of radiological and other diagnostic services. Specifically, a residents hip x-ray result was not in the medical record. Resident identifier: 20. Findings Included: Resident 20 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included functional quadriplegia, delusional disorder, bipolar disorder, traumatic brain injury (TBI) and cervical disc disorder. Resident 20's medical record was reviewed from 4/3/24 through 5/14/24. On 5/2/23 at 2:40 PM, a nursing progress note documented, resident 20 came back from his appointment with [a local urology clinic] and told us that he was sitting in his electric wheelchair inside the van but was not seat belted in the van. [...]

Inspectors wroteBased on observation and interview it was determined, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, for 1 of 38 sampled residents, a staff member was observed to touch an unknown red/orange substance with gloves. Resident identifiers: 8.

Inspectors wroteBased on observation, interview and record review it was determined, for 1 of 38 sampled resident, that the facility did not provide an means for contacting nursing staff that was reliable and easily to use. Specifically, a resident did not have their call light within reach. Resident identifier: 36.

Inspectors wroteBased on interview and record review, the facility did not ensure that 4 of 26 sample residents saw a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter. Specifically, the physician did not alternate their visits with a nurse practitioner, resulting in residents only being seen by the physician every 6 months. Resident identifiers: 11, 12, 18, and 23.

Inspectors wroteBased on observation and interview, the facility failed to provide each resident with food that was palatable, attractive and at a safe and appetizing temperatures. Specifically, there was no color variation of foods served at the meal and food items had a bland flavor. In addition, multiple residents complained about the food quality. Resident identifiers: 3, 11, 18, and 48.