Park Village Health Care Center Inc

Inspectors wroteBased on observation, interview with staff, and review of the recommendations of the US Department of Agriculture, the facility failed to store and serve food in a manner to prevent foodborne illness. This had the potential to affect 75 of 76 residents who received meals from the facility kitchen. The facility census was 76.

Inspectors wroteBased on medical record review, policy review, and staff interview, the facility failed to ensure the Pre-admission Screening and Resident Review (PASARR) document reflected accurate medical diagnoses. This affected two (Resident #9 and #69) of two residents reviewed for PASARR documents. The facility census was 76.

Inspectors wroteBased on closed record review, hospice record review, interview, review of a contract between the facility and an outside hospice agency, and facility policy review, the facility failed to effectively communicate with Resident #83's hospice agency as per the written agreement to ensure the resident's need for medication administration was met. This affected one resident (#83) of four residents reviewed for hospice care. The facility census was 76.

Inspectors wroteBased on observation, interview, review of Centers for Disease Control (CDC) guidelines, and facility policy review, the facility failed to provide routine cleaning and disinfection of resident care equipment including equipment shared among residents (blood pressure cuff and pulse oximeters). This affected two residents (#7 and #67) of seven residents observed for infection control during medication administration. Further, the facility failed to ensure staff demonstrated the proper use of gloves with hand hygiene during incontinence care. This affected one resident (#71) of three residents reviewed for incontinence care. The facility identified 63 incontinent residents. The facility census was 76.

Inspectors wroteBased on observation, interview and policy review, the facility failed to properly store food in the refrigerators. This had the potential to affect 73 of 74 residents in the facility who receive meals from the kitchen. The facility identified Resident #1 to receive alternate nutrition. The facility census was 74.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident #57 had a Pre-admission Assessment Screening (PASRR) in place after the expiration of a Hospital Exemption. This affected one (Resident #57) of one resident reviewed for PASRR. The facility census was 74.

Inspectors wroteBased on medical record review, policy review and staff interview the facility to ensure residents had an appropriate indication for antibiotic use. This affected one (Resident #54) of five residents reviewed for medication use. The facility census was 74.

Inspectors wroteBased on interview, record review and policy review revealed the facility failed to provide Resident #72 written bed hold notice upon admission to the hospital. This affected one (Resident #72) of two residents reviewed for hospitalizations. The facility identified 41 residents who do not have Medicaid as their payer source. The facility census was 74.

Inspectors wroteBased on record review, interview, and facility policy review the facility failed to ensure proper infection control practices and procedures were in place to prevent the spread of Respiratory Syncytial Virus (RSV). This had the potential to affect all 70 residents who resided in the facility. Findings Include: Resident #76 was admitted to the facility on [DATE] and expired [DATE]. Diagnoses included diabetes mellitus, persistent mood affect disorder, major depressive disorder, and anxiety disorder. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment, dated [DATE], revealed Resident #76 had severely impaired cognition and required substantial assistance for walking and had behaviors of wandering one to three days during the seven-day look back period. Review of the order note dated [DATE] at 4:57 P.M. [...]

Inspectors wroteBased on medical record review, review of hospital records, interviews, and facility policy review, the facility failed to provide timely and necessary care and treatment to prevent complications following a fall with injury and changes in resident condition. This resulted in Immediate Jeopardy and serious life-threatening harm on [DATE] when Resident #2 sustained a fall with his left arm assessed to have an area that was raised, red, and warm to touch between his ulna and humerus bone without evidence of additional medical treatment. Between [DATE] and [DATE] Resident #2 continued to exhibit changes in condition including his arm being red, edematous, warm, and tender to touch, Resident #2 was lethargic and experienced episodes of decreased appetite, elevated body temperatures, and decreased oxygen saturation levels. [...]

Inspectors wroteBased on record review and interview the facility failed to implement an effective plan/policy to prevent recurrence of a system failure that resulted in harm for Resident #5. This affected one resident (#5) and had the potential to affect all 83 residents residing in the facility.

Inspectors wroteBased on record review, review of physician's communication book, review of staff education, interviews, and policy review the facility to ensure the resident physician was notified timely of fall with suspected injury. This affected one resident (#5) of three residents reviewed for change of condition.

Inspectors wroteBased on record review and interview, the facility failed to ensure Resident #2 had a physician order for oxygen therapy. This affected one (Resident #2) of three residents reviewed for respiratory care. The facility census was 77.

Inspectors wroteBased on record review, review of risk management report, review of hospital records, interview, and policy review the facility failed to implement an effective pain management program for one resident (Resident #5) after sustaining a fall with fracture. This affected one (#5) of three residents reviewed for change of condition.

Inspectors wroteBased on record review, review of risk management report, review of hospital records, review of tracking logs, interviews, and policy review the facility failed to ensure a complete and accurate medical record. This affected one resident (#5) of three residents reviewed for falls.