Parkway Operator LLC

Inspectors wroteBased on observation and interview, the facility failed to maintain a sanitary kitchen to prepare food for the residents who received meals from the kitchen.

Inspectors wroteBased on interview and record review, the facility failed to follow the latest guidelines from the Centers for Disease Control and Prevention (CDC) to administer the COVID-19 vaccine following written consent or obtain informed declination documentation for Resident (R) 2, R1, R8, and R23.

Inspectors wroteBased on observation, interview, and record review, the facility failed to complete a recapitulation (a concise summary of the resident's stay and course of treatment in the facility) for Resident (R) 48, upon the resident's discharge from the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to adequately store drugs and biologicals for Resident (R) 35, R15, and R38 when staff failed to date insulin upon opening.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure coordinated care and services provided by the facility with the care and services provided by hospice for one resident, Resident (R) 4.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement Enhanced Barrier Precautions (EBP- infection control interventions designed to reduce transmission of resistant organisms, which employ targeted gown and glove use during high-contact care) for Resident (R) 5 and R35's wound care and R4's gastrostomy tube (G-tube: tube surgically placed through an artificial opening into the stomach) and tracheostomy care (opening through the neck into the trachea through which an indwelling tube may be inserted).

Inspectors wroteBased on observation, interview, and record review, the facility failed to submit complete and accurate staffing information through the Payroll-Based Journal (PBJ- an electronic record mandated by the Centers for Medicare and Medicaid Services (CMS) that details direct care staffing hours worked in long-term care settings) as required, resulting in a trigger for excessively low weekend staffing.

Inspectors wroteBased on record review, interview, and observation, the facility failed to provide cardiopulmonary resuscitation (CPR-an emergency lifesaving procedure performed when the heart stops beating) for Resident (R) 1 who had a documented desire for full resuscitative measures. On [DATE] at approximately 01:25 PM, Certified Nurse Aide (CNA) M was called to R1's room where R1 was leaned back against the toilet and mumbling. CNA M and CNA N called for Licensed Nurse (LN) G and placed R1 into her wheelchair because she asked to be laid down. During this time, LN G came in, assessed R1, and gave her some lorazepam (an antianxiety medication - a class of medications that calm and relax people) to help calm her down. The three staff then moved R1 towards her bed, and during that time, R1 became unresponsive. [...]

Inspectors wroteThe facility had a census of 36 residents. Based on observation, interview, and record review, the facility failed to submit complete and accurate staffing information through Payroll Based Journaling (PBJ) as required. This deficient practice placed the residents at risk for unidentified and ongoing inadequate nurse staffing.

Inspectors wroteThe facility identified a census of 36 residents. The sample included 13 residents. Based on observation, record review, and interview, the facility failed to ensure the medication error rate did not exceed five percent (%) when staff crushed and mixed Resident (R) 37's medications without a physician's order to administer via a gastrostomy tube (G-tube: tube surgically placed through an artificial opening into the stomach). This resulted in a medication error rate of 23.08%.

Inspectors wroteThe facility identified a census of 36 residents. The facility identified nine residents on Enhanced Barrier Precautions (EBP-infection control interventions designed to reduce transmission of resistant organisms that employ targeted gown and glove use during high contact care). Based on record reviews, observations, and interviews, the facility failed to implement signage or indicators within the physical environment to alert staff and visitors of the required EBP. These deficient practices placed the residents at risk for infectious diseases. Findings Included: -An initial walkthrough of the facility was completed on 08/05/24 at 07:10 AM. An inspection of Resident (R)35's room revealed an over-the-door storage bin for personal protective equipment (PPE). The bin contained gloves, gowns, masks, and foot covers. [...]

Inspectors wroteThe facility identified a census of 36 residents. The sample included 13 residents with one resident reviewed for hospitalization. Based on observation, interview, and record review, the facility failed to provide written notification of transfer to Resident (R)43 and/or their representative, with a written notice specifying the location and reason for R43's facility-initiated transfer. This deficient practice placed R43 at risk for miscommunication between the facility and resident/representative and possible missed opportunities for healthcare services.

Inspectors wroteThe facility identified a census of 36 residents. The sample included 13 residents with one resident reviewed for hospitalization. Based on observation, interview, and record review, the facility failed to provide a copy of the facility bed hold policy to Resident (R)43 and/or their representative, with a written notice specifying the duration and cost of the bed hold policy, at the time of the resident's transfer to the hospital. This deficient practice had the risk of impaired ability to return to the facility and to the previous room for R43.

Inspectors wroteThe facility identified a census of 36 residents. The sample included 13 residents. Based on observation, record review, and interview, the facility failed to ensure Resident (R) 37's comprehensive care plan addressed his functional abilities and how much assistance was needed from staff. The facility failed to ensure R37's comprehensive care plan included a care area and interventions for Foley catheter (a tube inserted into the bladder to drain urine into a collection bag) care. This placed R37 at risk of impaired care due to uncommunicated care needs.

Inspectors wroteThe facility identified a census of 36 residents. The sample included 13 residents with 13 reviewed for care plan revisions. Based on observation, record review, and interviews, the facility failed to revise Resident (R)6's Care Plan to reflect his bowel incontinence needs. The facility additionally failed to revise R22's plan to include preventative offloading of his heels and ankles. This deficient practice placed both residents at risk for complications related to uncommunicated care needs. Findings Included: [...]

Inspectors wroteThe facility reported a census of 36 residents. The sample included 13 residents with two reviewed for pressure ulcers (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction). Based on observations, interviews, and record review, the facility failed to ensure Resident (R)17's low air-loss mattress pump was appropriately set to his recommended weight range. This deficient practice placed R17 at risk for complications related to skin breakdown and pressure ulcers. Findings Included: [...]

Inspectors wroteThe facility identified a census of 39 residents. The sample included three residents reviewed for accidents. Based on record review, interview, and observations, the facility failed to ensure an adequate number of staff to provide assistance during a mechanical lift transfer to prevent accidents for Resident (R)1. As a result, R1 sustained a mid to lower coccyx (area at the base of the spine) fracture. This deficient practice also placed R1 at risk for increased pain and further impaired mobility.

Inspectors wroteThe facility had a census of 40 residents. The sample included 12 residents with one reviewed for dignity. Based on observation, interviews, and record review, the facility failed to treat Resident (R) 31 with respect and dignity and care for him in a manner that promoted quality of life. This placed the resident at risk for impaired dignity.

Inspectors wroteThe facility had a census of 40 residents. The sample included 12 residents with two reviewed for pressure ulcers (localized injury to skin and/or underlying tissue as a result of pressure, or pressure in combination with shear and/or friction). Based on record review and interview, the facility failed to complete a significant change assessment after the development of an unstageable pressure ulcer for one of two sampled residents, Resident (R) 40. This placed the resident at risk to have an inaccurate assessment of his health status.

Inspectors wroteThe facility had a census of 40 residents. The sample included 12 residents with two reviewed for diabetic ulcers (open wound caused by neuropathy (weakness, numbness, and pain from nerve damage) and/or poor blood circulation). Based on record review and interview, the facility failed to provide heel protectors (medical device used to offload pressure from the heel and foot to wounds and pressure ulcers) as ordered by the wound clinic for one of two sampled residents, Resident (R) 40. This placed the resident at risk to worsen his current diabetic ulcer or develop more skin issues.

Inspectors wroteThe facility had a census of 40 residents. The sample included 12 residents with three reviewed for accident hazards. Based on observation, record review and interview, the facility used side rails without a safety assessment or accident hazard care plan for one of three sampled residents, Residents (R) 36. This placed the resident at risk for entrapment and falls.

Inspectors wroteThe facility had a census of 40 residents. The sample included 12 residents with three reviewed for accident hazards. Based on observation, record review and interview, the facility failed to complete an assessment for the safe use of side rails the three sampled residents, Residents (R) 16, 25, 36. This placed the residents at risk for entrapment and injuries.

Inspectors wroteThe facility had a census of 40 residents. The sample included 12 residents. Based on observation, record review, and interview the facility failed to develop a comprehensive plan of care which included collaberation with the hospice provider for Resident (R) 39 who received hospice services. This placed the resident at risk for inappropriate end of life care.