Park Ridge Nursing Home

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure a medication error rate of less than five (5) percent for one (1) of three (3) residents reviewed (Resident #23). Specifically, Resident #23's scheduled 9:00 AM doses of chlorhexidine (an antimicrobial oral rinse used to reduce oral bacteria and prevent infection), fluoride sodium 1.1 percent paste (a prescription-strength fluoride dental medication used to prevent tooth decay), and zinc oxide-white petrolatum paste (a topical skin protectant medication used to treat and prevent skin irritation) were not administered and documented within the facility's established medication administration timeframe. There were three (3) medication errors out of 32 opportunities, resulting in a medication error rate of 9.375 percent.

Inspectors wroteBased on observations, interviews, and record review conducted during a Recertification Survey, it was determined that for four of four resident cottages the facility did not store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Specifically, potentially hazardous foods (raw shell eggs) were not being fully cooked.

Inspectors wroteBased on interviews and record review conducted during the Recertification Survey the facility did not ensure that all residents had the right to request, refuse, and/or discontinue treatment, and to formulate an advance directive (medical interventions in the event of a life-threatening episode) that would be honored for one (Residents #47) of one resident reviewed. Specifically, the facility did not ensure that Resident #47's advance directives (their preferred code status in the event of cardiac or pulmonary arrest) were accurately identified per their wishes. This is evidenced by the following: The facility policy, Advanced Directives for Long Term Care, dated [DATE] documented that the facility is committed to honoring the wishes of our patients' that include the right to accept or refuse medical or surgical treatment. [...]

Inspectors wroteBased on observations, interviews, and record review conducted during a Recertification Survey, the facility did not ensure that the resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for one (Resident #22) of one resident reviewed for edema (swelling caused by excess fluid in body tissues). Specifically, the facility did not ensure that the recommendations provided by the physician consult for vascular services for a lymphedema compression pump were consistently administered per the recommendation and no documented evidence as to why not. This was evidenced by the following. 1. Resident #22 had diagnoses including diabetes, high blood pressure, and lymphedema (an excess tissue fluid in the extremities results in swelling) of the left leg. [...]

Inspectors wroteBased on observations, interviews and record review conducted during the Recertification Survey, for one (Resident #40) of two residents reviewed for pressure ulcers, the facility did not ensure a resident received the necessary treatment and services consistent with professional standards of practice to promote healing and prevent new ulcers from developing. Specifically, Resident #40 was found to have an open area to their right ankle on 12/20/23. The facility was unable to provide documented evidence that the wound was consistently monitored and treated to promote healing and/or prevent worsening. This is evidenced by the following: Review of the facility policy and procedure Skin Inspection and Care, dated November 2019, revealed that the nurse would inspect skin integrity weekly and document the inspection on the Integumentary (an organ system that includes the skin) Flow Sheet. [...]

Inspectors wroteBased on observation, interviews and record review conducted during the Recertification Survey the facility did not ensure they established and maintained an Infection 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: Issue #1: The facility was unable to provide documented evidence of the current status for three (Residents #62, #88 and #352) of five residents reviewed for vaccinations (influenza and/or pneumococcal) or that education was consistently provided on the risks/benefits of vaccinations. Issue #2: The facility did not ensure appropriate signage or mask use on one (transitional care unit) of five residential care units due to a current positive covid-19 infection. Issue #3: [...]

Inspectors wroteBased on interviews and record review conducted during the Recertification Survey, the facility did not maintain medical records on each resident that were readily accessible. Specifically, the facility did not provide the survey team with timely access to all resident electronic health records that included all medical record information and instructions on how to access and use the electronic records by the end of the first day of survey. This is evidenced by the following: During the Entrance Conference meeting on [DATE] at 9:31 AM with the Operations Manager and the Director of Nursing, the following items were requested by the end of the first day of survey: 1. To provide each surveyor with access to all resident electronic health records 2. To not exclude any information that should be a part of the resident's medical record, and 3. [...]

Inspectors wroteBased on observations, interviews, and record reviews conducted during the Recertification Survey and complaint investigation (#NY00299342), completed on 8/19/22, it was determined that the facility did not ensure the resident's environment was free from accident hazards for two of two residents reviewed. Specifically, Resident #2, who was assessed by the facility to be at high risk for elopement was able to exit the facility unattended and unsupervised and Resident #107 who was not assessed to safely self-administer medications was observed to have unsecured medications at their bedside. This was evidenced by the following: 1. Resident #2 had diagnoses that included non-Alzheimer's dementia, hypertension, and anemia. [...]

Inspectors wroteBased on observations, interviews, and record review, conducted during the Recertification Survey completed on 8/19/22, the facility failed to ensure six of eight Registered Nurses RNs) were able to demonstrate competency in skills and techniques for two of two residents reviewed for care of parenteral access sites. Specifically, Resident #472 did not receive dressing and cap changes and site assessments to their peripherally inserted central catheter (PICC) and Resident #107 did not receive site assessments and care for a peripheral intravenous (IV) catheter placing both residents at risk for potential infection.

Inspectors wroteBased on observations and interviews conducted during the Recertification Survey completed on 8/19/22, it was determined that for one (cottage 400) of four resident care cottages reviewed, the facility did not ensure that all drugs and biologicals were properly labeled and stored in accordance with State and Federal laws. Specifically, multiple medications in blister packs and stocked medication bottles were found unsecured and unsupervised on a workstation (computer) on wheels (WOW) near the cottage entrance that were easily accessible to residents, visitors, and all disciplines of facility staff. This is evidenced by the following: The facility policy Medication Administration, dated February 2020, documented that all medications must remain in secure storage until administered to the patient by the nurse or respiratory therapist. [...]

Inspectors wroteBased on observations, interviews, and record review conducted during the Recertification Survey completed 8/19/22, for four (cottages 100, 200, 300 and 400) of five resident care areas reviewed the facility did not post, in a manner accessible and understandable to residents and resident representatives, the pertinent contact information for the State Long-Term Care Ombudsman Program and the State Agency Complaint Hotline number, including a statement that the resident may file a complaint.

Inspectors wroteBased on observations and interviews conducted during the Recertification Survey completed on 8/19/22, the facility did not ensure that the nurse staffing data was posted at the beginning of each shift in a prominent place readily accessible to residents and visitors and included the required information. Specifically, the posted forms did not consistently provide the hours worked by the licensed and unlicensed nursing staff and was not posted in a prominent place. This was evidenced by the following: Nurse staffing sheets reviewed 7/27/22 through 8/19/22 revealed the 'actual hours worked under Registered Nurses (RNs) Licensed Practical Nurses (LPNs) and Certified Nurse Aides (CNAs) were blank for 51 of 72 shifts (over 24 days) reviewed. [...]

Inspectors wroteBased on interviews and record reviews conducted during the Recertification Survey, it was determined that for one of two residents reviewed for choices, the facility did not allow each resident the right to make choices about aspects of life that were significant to them. Specifically, Resident 63 was not showered twice a week per plan of care or when requested. This is evidenced by the following: Resident #63 was admitted to the facility on [DATE] and had diagnoses including Parkinson's, influenza, and macular degeneration. The Minimum Data Set Assessment, dated 12/18/19, revealed the resident was cognitively intact and required physical help with bathing. The resident was transferred to another room on 1/22/20. [...]

Inspectors wroteBased on interviews and record reviews conducted during the Recertification Survey, it was determined that for one (Resident #106) of one resident reviewed for hospitalization, the facility did not ensure that each resident received treatment and care in accordance with professional standards of practice, their comprehensive, person-centered care plan, and the resident's choice. Specifically, the resident complained of severe pain with all movement and a decreased functional status for several days that was not addressed in a timely manner. This is evidenced by the following: Resident #106 was admitted to the facility on [DATE] with diagnoses that included osteoarthritis, morbid obesity and recent total hip arthroplasty (replacement) on 11/14/19. [...]

Inspectors wroteBased on interviews and record reviews conducted during the Recertification Survey, it was determined that for one (Resident #23) of four residents reviewed for positioning and mobility, the facility did not ensure that nurse aides demonstrated competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care. Specifically, the resident was observed with a palm protector incorrectly applied on two occasions. This is evidenced by the following: Resident #23 had diagnoses including arthritis, Parkinsonism hand tremors and a Dupuytren-like contracture (a condition where the development of connective tissue between fingers causes the fingers to be bent inward and may cause pain and tenderness of the palm) of the left hand. [...]

Inspectors wroteBased on interviews and record reviews conducted during the Recertification Survey, it was determined that for one (Resident #106) of one resident reviewed for hospitalization, the facility did not ensure that the resident or the resident's representative and the Office of the State-Long Term Care Ombudsman was notified in writing of the resident's transfer/discharge to the hospital. This is evidenced by the following: Resident #106 was admitted to the facility on [DATE] with diagnoses including osteoarthritis and a recent right hip arthroplasty (replacement) on 11/14/19. The Minimum Data Set (MDS) Assessment, dated 11/29/19, revealed the resident was cognitively intact. The discharge MDS Assessment, dated 12/3/19, revealed the resident was discharged to the hospital on [DATE]. [...]

Inspectors wroteBased on interviews and record reviews conducted during the Recertification Survey, it was determined that for one (Resident #106) of one resident reviewed for hospitalization, the facility did not notify the resident or the resident's representative of the facility policy for bedhold, including the reserve bed payment at the time of transfer to the hospital. This is evidenced by the following: The current facility policy, Bedhold Policy, included that at the time of transfer for hospitalization the facility will provide the resident and representative a written notice of the bedhold policy. Resident #106 was admitted to the facility on [DATE] with diagnoses including osteoarthritis and status post hip arthroplasty (replacement) on 11/14/19. The Minimum Data Set (MDS) Assessment, dated 11/29/19, revealed the resident was cognitively intact. [...]