Parmly on the Lake LLC

Inspectors wroteBased on observations, interviews, and document review the facility failed to ensure medications were stored securely to ensure residents, staff and guests could not access medications in 2 of 2 medication carts observed, potentially affecting two units of the facility, with 43 residents.

Inspectors wroteBased on observation, interviews, and document review, the facility failed to ensure skin assessments were performed as ordered for 1 of 3 residents (R3) reviewed for wound care. Additionally, the facility failed to ensure medication orders were followed for 2 of 2 residents (R4, R5) when saccharomycin (a probiotic yeast used to support digestive health and treat gastrointestinal - stomach and intestine- issues) was not administered as prescribed.

Inspectors wroteBased on observations, interviews, and document review, the facility failed to maintain an effective infection prevention and control program by ensuring staff utilized proper hand hygiene during wound care treatments for 1 of 1 resident (R3) observed for wound care.

Inspectors wroteBased on interview and document review, the facility failed to ensure orders for oxygen use were clarified and documented in the medical record to ensure continuity of care; and failed to ensure physician orders for continuous oxygen use were implemented for 1 of 1 resident (R1) reviewed who used continuous oxygen for comfort. R1's oxygen concentrator machine was not transferred over during a room change and then his portable oxygen tank ran out during the night, causing R1 to go without oxygen for several hours.

Inspectors wroteBased on observation, interview, and document review, the facility failed to protect 1 of 3 resident's (R74) right to be free from mental and physical abuse by staff.

Inspectors wroteBased on interview and record review the facility failed to that ensure treatment orders were implemented at the time prescribed for 2 of 3 residents (R1 and R2) reviewed for quality of care. R1 and R2 were receiving wound care from an outside provider and the facility did not transcribe and implement order changes for three to five days after the order was written.

Inspectors wroteBased on observation, interview and document review the facility failed to ensure staff performed the recommended hand hygiene for 1 of 2 residents (R77) reviewed who was on enteric precautions; and failed to ensure personal protective equipment (PPE) was utilized for 2 of 3 residents (R68 and R281) reviewed who had enhanced barrier precautions (EBP) in place. Additionally, the facility failed to ensure staff performed hand hygiene after changing soiled gloves for 1 of 1 residents (R74) reviewed for standard precautions with personal cares; and failed to ensure linens were covered during storage in the resident hallway. The uncovered linen had the potential to affect the 11 residents (including R82 and R83) residing in the southside transitional care unit.

Inspectors wroteBased on observation, interview and document review the facility failed to ensure methods to restrain residents were not used for 1 of 1 residents (R74) reviewed for restraints.

Inspectors wroteBased on interview and document review, the facility failed to ensure a bowel regimen was initiated for 1 of 1 residents (R18) reviewed for constipation.

Inspectors wroteBased on observation, interview, and document review the facility failed to implement pressure ulcer interventions for 2 of 3 residents (R25, R68) reviewed for pressure ulcers.

Inspectors wroteR69's quarterly Minimum Data Set (MDS) dated [DATE] indicated intact cognition and diagnoses of traumatic subarachnoid hemorrhafe with loss of consciousness of 30 minutes or less, adjustment disorder, and nicotene dependence. It further indicated R69 was independent with all activities of daily living (ADL) and mobility and had no history of falls. R69's Smoking Evaluation dated 8/20/24, indicated resident currently Identifies as a smoker. Resident was aware of smoking policy to store all smoking materials in the cart, sign out before leaving facility, and to leave facility grounds when smoking. Assessment will continue and updates will be made to nurse practioner (NP)/medical doctor (MD). R69's smoking evaluation lacked documentation that staff had observed him while smoking. R69's care plan dated 8/20/24, indicated R69 identified as smoker. [...]

Inspectors wroteBased on interview and document review the facility failed to ensure the provider's response to the monthly medication review was followed for 1 of 4 (R18) residents with identified medication irregularities.

Inspectors wroteBased on interviews and records review, the facility did not ensure timely provider notification pertaining to persistent right shoulder pain for 1 of 1 resident (R1) reviewed for change in condition.

Inspectors wroteBased on interview and document review, the facility failed to comprehensively assess and monitor for signs of injury after a fall, resulting in delayed diagnosis and treatment for injuries for 1 of 3 residents (R1) reviewed for delay in treatment. This resulted in an immediate jeopardy (IJ) for R1 who required emergent care and hospitalization as a result of their injuries. The immediate jeopardy began on [DATE], when R1was not assessed for any injuries after a witnessed fall, that resulted in displaced rib fractures, chest wall hematoma (blood collection outside of large vessels) and hemothorax (blood accumulation between the chest wall and lungs). The administrator and director of nursing (DON) were notified of the IJ on [DATE], at 2:45 p.m. [...]

Inspectors wroteBased on interview and record review, the facility failted to notify the medical provider regarding a fall and injuries sustained for 1 of 3 residents (R1) reviewed for falls.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure hand hygiene was completed and infectious waste was disposed of properly during wound care for one resident (R28) with methicillin resistant staphylococcus aureus (MRSA-a type of infection resistant to many antibiotics making it difficult to treat). Further the facility failed to ensure proper disinfection of a communal blood glucose monitor following use. This had the potential to affect four residents who required blood glucose monitoring on the Park Unit. In addition, the facility failed to initiate appropriate IC precautions for one resident (R132) diagnosed with Clostridium difficile (C-diff-a bacterium that causes diarrhea and inflammation of the colon).

Inspectors wroteBased on interview and document review, the facility failed to honor a resident choice for an additional shower for 1 of 2 residents (R16) reviewed for choices.

Inspectors wroteDuring observation, interview, and document review the facility failed to assess, monitor, and document 1 of 3 residents (R11) for skin alterations who had multiple bruises on both lower arms and a skin tear on his right upper arm.

Inspectors wroteBased on interview, observation, and document review, the facility failed to ensure 1 of 3 residents (R46) with repeated falls had implemented interventions to promote safety and reduce the risk of falls.

Inspectors wroteBased on interview and document review, the facility failed to ensure an International Normalized Ratio (INR a standard lab test used when taking blood-thinning medications) was obtained per physician order and the facility failed to administer Coumadin (a blood-thinning medication) per the INR level for four days for 1 of 7 (R54) residents reviewed for Coumadin use. This caused a delay in care and treatment and resulted in an immediate jeopardy (IJ) for R54. In addition, the facility failed to administer an antibiotic medication for 12 days, prior to being identified by the physician, for 1 of 15 (R35) residents, on antibiotic therapy. The IJ began on 2/10/22, when nursing staff failed to obtain an INR and did not administer Coumadin for four days to R54. R54 had history of pulmonary embolism(PE -blood clots in the lung) and was at increased risk of serious harm and/or death. [...]

Inspectors wroteBased on interview, and document review, the facility failed to ensure the medical record showed documentation of a current advanced directive, applicable to the State of Minnesota, and the resident's chosen healthcare decision-maker for 1 of 3 (R3) residents reviewed for advanced directives.

Inspectors wroteBased on interview and document review, the facility failed to ensure a resident's care plan was revised for 1 of 3 residents (R25) reviewed for weight loss, creating the potential for the resident to continue to experience unplanned weight loss.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure a resident with an indwelling urinary catheter had updated interventions and received care and services to prevent excessive tension on the catheter which led to urethral trauma for 1 of 2 (R38) residents reviewed for catheters.