Park Place

Inspectors wroteBased on interviews and review of a document titled, [Facility Name] QAPI [Quality Assurance Performance Improvement] Plan, the facility failed to ensure the QAPI committee was composed of the required committee members. Specifically, the facility failed to provide evidence that a Medical Director (MD) or designee participated as a required QAPI committee member at least quarterly.

Inspectors wroteBased on record review, interviews, and review of the Centers for Medicare & Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual, the facility failed to ensure a comprehensive Significant Change in Status Minimum Data Set (MDS) was completed within fourteen days of Resident Identifier (RI) #55's discharge from hospice services. This affected RI #55, one of one resident reviewed for hospice services.

Inspectors wroteBased on interviews, record review, and review of a policy titled, Psychotropic Medication Use, the facility failed to attempt a gradual dose reduction (GDR) for Resident Identifier (RI) #90, one of five residents reviewed for unnecessary medications.

Inspectors wroteBased on observations, record review, interviews, and a review of the facility policy titled, Medication Administration, the facility failed to ensure a medication administration error rate of less than 5%. The facility had 3 errors out of thirty-one opportunities, resulting in a medication error rate of 9.68%. Medication errors were observed for Resident Identifier (RI) #294, one of four residents reviewed who received medication administration from Employee Identifier (EI) #30, a Licensed Practical Nurse, one of four nurses observed passing medications.

Inspectors wroteBased on interviews, record reviews, document review, and review of the facility's policy, Physician's Orders, the facility failed to ensure Resident Identifier (RI) #244's diet orders were changed from regular to pureed upon readmission to the facility on [DATE]. This affected RI #244, one of three sampled residents reviewed for therapeutic diets.

Inspectors wroteBased on interviews, medical record review, review of a facility policy titled, Abuse, Neglect, Misappropriation, Exploitation Policy and facility reported incidents, the facility failed to timely report three reported incidents to the State Agency. These incidents involved Resident Identifier (RI) #26, #60, #243 and #244. This deficient practice affected three of six allegations of abuse that were reviewed. Findings Include: A review of the facility policy titled, Abuse, Neglect, Misappropriation, Exploitation Policy with an effective date of 01/19, revealed: .Purpose: To prohibit and prevent abuse, neglect .and to ensure reporting .of alleged violations (to include injuries of unknown source .) in accordance with Federal and State Laws . Injuries of Unknown Source: When both of the following criteria are met: [...]

Inspectors wroteBased on interviews and review of residents' medical records, the facility failed to accurately code the Minimum Data Set (MDS) assessment of Resident Identifier (RI) #3, #16 and #20. This deficient practice affected RI #3, #16, and #20, three of 30 sampled residents. Findings Include: 1) RI #3 was admitted to the facility on [DATE], with a diagnosis of Cerebral Infarction Due to Embolism of Right Middle Cerebral Artery. RI #3's Order Summary Report dated 05/16/19, revealed the resident was ordered to be on a NPO (nothing by mouth) diet on 12/13/17, and ordered to receive enteral feedings of Jevity 1.5 five times a day on 03/22/18. RI #3's Quarterly MDS, dated [DATE], coded RI #3 as receiving parenteral/IV (intravenous) feedings, rather than enteral tube feedings. [...]

Inspectors wroteBased on observation, interview, medical record review, and a review of [NAME] and Perry's, FUNDAMENTALS OF NURSING, the facility failed to ensure nursing staff wiped the perineal area and buttocks up toward the back during incontinence care for Resident Identifier (RI) #21. This affected one of one resident observed during incontinence care. Findings Include: A review of [NAME] and Perry's, FUNDAMENTALS OF NURSING, Ninth Edition, pages 858 and 859 revealed: . SKILL 40-1 BATHING AND PERINEAL CARE . STEP . (5) Clean buttocks and anus, washing front to back .Cleaning motion prevents contamination perineal area with fecal matter or microorganisms . RI #21 was admitted to the facility on [DATE], with a diagnosis of Alzheimer's Disease. [...]

Inspectors wroteBased on observation, interview, medical record review, and a review of [NAME] and Perry's FUNDAMENTALS OF NURSING, the facility failed to ensure nursing staff disposed of the perineal wash bottle after it was handled with the same gloved hand used to remove stool from Resident Identifier (RI) #21's buttocks. This affected one of one resident observed for during incontinence care. Findings Include: A review of [NAME] and Perry's FUNDAMENTALS OF NURSING Ninth Edition, page 443 revealed: CHAPTER 29 . Reservoir. A reservoir is a place where microorganisms survive, multiply, and await transfer to a susceptible host. Humans can transmit microorganisms . inanimate objects can also be reservoirs for infectious organisms. RI #21 was admitted to the facility on [DATE], with a diagnosis of Alzheimer's Disease. [...]

Inspectors wroteBased on observations, interview, and review of a facility policy titled, Refrigerated Storage, the facility to ensure: 1) food items in the walk in cooler were labeled with an open and use by date; and 2) a bag of sliced roast beef was discarded after the use by date. These deficient practices had the potential to affect all 93 residents receiving meals from dietary: Findings Include: A review of a facility policy titled, Refrigerated Storage, with an effective date of 01/01/017 revealed: . POLICY It is the policy of this center to store, prepare, and serve food in accordance with federal, state, and local sanitary codes. PROCEDURE . 3. All foods should be . labeled and dated. All foods will be checked to assure that foods (including leftovers) will be consumed by their safe use by dates . or discarded . [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a care plan was developed for the use of Resident Identifier (RI) #46's oxygen. This deficient practice affected RI #46, one of 35 sampled residents whose plans of care were reviewed. Findings Include: RI #46 was admitted to the facility on [DATE], with diagnoses of Chronic Systolic Congestive Heart Failure and Wheezing. An admission Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 03/22/18, revealed RI #46 was using oxygen during this assessment period. RI #46's May 2018 Physician Orders documented: . 02 via (by way of) Nasal cannula at 2 L (liters)/min (minute) . On 05/17/18 at 9:04 a.m., the surveyor observed RI #46's using his/her oxygen. [...]