Portsmouth Health and Rehab

Inspectors wroteBased on interview, record review, and review of the facility's policy, the facility failed to ensure the nursing staff followed the resident's do not resuscitate (DNR) order for one of three residents (Resident (R) 109) reviewed for advance directives out of 47 sampled residents. On [DATE], R109 was found unresponsive in her room, the nursing staff did not verify her code status prior to providing chest compressions in the absence of a pulse; when the code status was verified the nurse stopped chest compressions and R109 was sent to the hospital. Additionally, the nursing staff were not aware where to locate the code status of the residents during a power outage. An Immediate Jeopardy was identified on [DATE] and was determined to exist [DATE] in S483.24, F678 Cardio-Pulmonary Resuscitation (CPR). [...]

Inspectors wroteBased on interview and record review, the facility failed to provide one of four residents (Resident (R) 106) reviewed for activities out of a total sample of 47 with the opportunity to be offered diversional activities or to be moved to another room when his roommate (R119) passed away. This had the potential for a resident to be traumatized due to being a vulnerable resident.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to protect the residents' right to be free from a verbal threat of potential physical abuse by staff for one of five residents, (Resident (R) 53), reviewed for abuse out of a total sample of 47. This failure had the potential to cause physical or psychosocial harm to the resident.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure potential allegations of abuse was reported timely to the Administrator and to the State Survey Agency (SSA) two of six residents (Resident (R) 53 and R79) reviewed for abuse out of 47 sampled residents. This failure increased the risk of other vulnerable residents being abused.

Inspectors wroteBased on interview, record review, and review of the facility's policy, the facility failed to ensure the nursing staff provided care that met professional standards of practice when an order was not obtained from the physician for a controlled substance, lorazepam (narcotic medication), prior to administration to a resident during a seizure for one of four residents (Resident (R) 13) reviewed for nursing standards out of a sample of 47 residents. This failure placed the resident at risk for complications related to administration of the medication without an order.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure narcotic pain medications were administered to one of three residents (Resident (R) 106) reviewed for pain management out of a total sample of 47. This resulted in the resident missing multiple doses of pain medication and potentially reducing his quality of life.

Inspectors wroteBased on interview, record review, and review of the facility's policy, the facility failed to remove and destroy a controlled medication, lorazepam (narcotic medication), that was discontinued and subsequently administered to a resident during a seizure without an order for one of four residents (Resident (R) 13) reviewed for pharmacy services. out of a sample of 47 residents. This failure placed the resident at risk for complications related to administration of the medication without an order. (Cross Reference F658)

Inspectors wroteBased on observation, resident interview, staff interview, clinical record review, and review of facility documents, the facility staff failed to ensure a resident was free of a significant medication error which resulted in an opioid overdose, which caused harm for 1 of 5 residents (Resident #4), in the survey sample.

Inspectors wroteBased on observation, resident interview and staff interview, the facility's staff failed to ensure 1 of 21 residents (Resident #111) who was unable to carry out activities of daily living (ADL) received the necessary services to include nail care.

Inspectors wroteBased on observation, staff interviews and clinical record review the facility staff failed to ensure 1 resident (Resident #104), in the survey sample of 21 Residents who was unable to carry out activities of daily living receives the necessary services to maintain toenail care.

Inspectors wroteBased on observation, staff interview, clinical record review, and review of facility documents, the facility's staff failed to ensure a wander guard was placed on an at risk, wandering, exit seeking resident for monitoring for 1 of 21 residents (Resident #112), in the survey sample.

Inspectors wroteBased on observations, resident interviews, staff interviews, clinical record review, and review of facility documents, the facility's staff failed to answer call bells promptly for 3 of 21 residents in the survey sample, Resident #106, Resident #108, and Resident #110 .

Inspectors wroteBased on clinical record review, family interview, staff interviews, and review of facility documentation, the facility's staff failed to identify, address, and obtain necessary psychiatric services for the behavioral health care needs of 1 of 15 residents (Resident #1), in the survey sample who had self-harming behaviors that ultimately caused the resident's death and identification of Immediate Jeopardy.

Inspectors wroteBased on observation, resident interview, staff interview, clinical record review, and review of facility documents, the facility failed to provide care that met the needs of residents with mental health disorders and/or behaviors requiring frequent monitoring. The facility staff failed to ensure sufficient staff was provided frequent safety checks with one-to-one supervision by staff to address the resident's behavioral health care needs and safety for 4 of 15 residents (Resident #1, Resident #3, Resident #5, and Resident #11) in the survey sample which resulted in immediate jeopardy.

Inspectors wroteBased on observation, resident interview and staff interview, the facility's staff failed to ensure 1 of 21 residents (Resident #111) who was unable to carry out activities of daily living (ADL) received the necessary services to include nail care.

Inspectors wroteBased on observation, staff interviews and clinical record review the facility staff failed to ensure 1 resident (Resident #104), in the survey sample of 21 Residents who was unable to carry out activities of daily living receives the necessary services to maintain toenail care.

Inspectors wroteBased on observation, staff interview, clinical record review, and review of facility documents, the facility's staff failed to ensure a wander guard was placed on an at risk, wandering, exit seeking resident for monitoring for 1 of 21 residents (Resident #112), in the survey sample.

Inspectors wroteBased on observation, resident interview, staff interview, clinical record review, and review of facility documents, the facility's staff failed to answer call bells in a timely manner for 3 of 21 residents in the survey sample. Resident #106, Resident #108, and Resident #110.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide care and services to prevent the development of a pressure ulcer in one of four residents (Resident (R) 69) reviewed for pressure ulcers in a total sample of 20 residents. The failure to provide care and services resulted in the development of a deep tissue injury (DTI) and a Stage III pressure ulcer to R69's left foot which constitutes harm.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to ensure food was prepared and served in a sanitary manner. This involved failure to change gloves and/or wash hand between touching soiled dishes and touching clean dishes; failure to ensure sanitizing solution was at the proper level to sanitize food contact surfaces, pans, and serving utensils; failure to ensure food carts were cleaned and sanitized after transporting soiled dishes and before placing resident meal trays in them. This had the potential to affect all 67 residents in the facility who receive food from the dietary department.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to have a functioning call system that relayed a call to a staff member or to a centralized staff work area.

Inspectors wroteBased on observation, menu review, and staff interview, the facility failed to follow the menus during lunch service on 05/26/21. The facility failed to serve residents a full portion of the garlic and rosemary roasted red skin potatoes, the sauteed zucchini, and the baked macaroni and cheese and failed to follow the renal menu for one resident (Resident (R)1). This failure involved 20 of the 67 residents who receive food from the facility dietary department.

Inspectors wroteBased on observation, interview, record review, review of policies and procedures, and review of medical device and product user information, the facility failed to ensure the nursing staff used a barrier between surfaces and cleaned and disinfected multi-use glucometers per the manufacturer's instructions when performing fingerstick blood glucose monitoring in three of three nurses observed.

Inspectors wroteBased on record review, interview, policy review, and review of Centers for Disease Control and Prevention (CDC) guidelines, the facility failed to offer pneumococcal vaccines to four out of five residents (Resident (R) 36, R27, R73, and R35) reviewed for pneumococcal immunizations out of a sample of 20 residents. Failure to provide pneumococcal vaccines increased the risk for pneumococcal pneumonia, a type of bacterial pneumonia, that is a common cause of hospitalization and death in the elderly.

Inspectors wroteBased on observation and staff interview, the facility failed to provide privacy related to hospice care for one resident (Resident (R)50) out of total sample of 20 residents. Signage was posted above the bed stating R50 was receiving hospice care, including bathing, on Monday, Wednesday, and Friday.

Inspectors wroteBased on record review and staff interview, the facility failed to complete a level II Preadmission Screen and Resident Review (PASARR) screening for three residents (Resident (R) 8, R51, and R33) reviewed out of 20 sampled residents. Level II PASARR screenings are required for individuals with serious mental disorders to determine the need for specialized services.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure one resident's plan of care was revised for code status. This involved one resident (Resident (R) 54) of 20 sampled residents.

Inspectors wroteBased on observations, interviews, record review, and review of facility policy, the facility failed to provide treatment to maintain and/or prevent decrease in range of motion (ROM), including the provision of equipment for limited range of mobility, for three out of three residents (Resident (R) 32, R45, and R69) reviewed for ROM/splints out of a sample of 20. Specifically, the facility failed to: 1. Provide an evaluation and treatment to R32's contracture of the right hand; 2. Provide care and services for R45's upper and lower extremities; and 3. Continue services for R69, including application of splints, after readmission to the facility. This failure has the potential to adversely affect the range of motion to each residents' contracted extremities.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure the attending physician reviewed recommendations, documented in the medical record that recommendations were reviewed, and documented rationale for not acting on the recommendations made by the pharmacist during monthly medication regimen reviews (MRR) for two of five residents (Resident (R) 49 and R54) reviewed for unnecessary medications.

Inspectors wroteBased on record review, pharmacy and nurse practitioner interview, and policy review, the facility failed to attempt a gradual dose reduction (GDR) for one of five residents (Resident (R)24) reviewed for unnecessary medications in a total sample of 20 residents.

Inspectors wroteBased on observations, interviews and policy review, the facility failed to ensure that all medicines and equipment in one of two medication storage rooms were not expired or opened.

Inspectors wroteBased on an Adult Protective Services Report, medical record review, staff interviews and facility document review the facility staff failed to ensure that assessed level of activities of daily living assistance was provide for 1 of 41 Residents in the survey sample to prevent an accident which resulted in harm for Resident #262. For Resident #262, the facility staff failed to use the assessed two person extensive assist for bed mobility during incontinent care on 3/11/18 that resulted in a fall with injury which constituted harm.

Inspectors wroteBased on observation and staff interviews, the facility staff failed to maintain a clean, sanitary and homelike environment. The facility staff failed to ensure the privacy curtains were in good repair, heating/air vents in all the rooms were without excessive dust and debris, and toilets were clean, sanitary and homelike.

Inspectors wroteBased on resident interviews, staff interviews and clinical record review the facility staff failed to provide personal care to include showers for two resident in the survey sample (Resident #30 and #363) who were unable to independently carry out activities of daily living (ADL's). 1. The facility staff failed to ensure Resident #30 was offered and received a scheduled twice-weekly shower to maintain good personal hygiene. 2. The facility failed to ensure that Resident #363 was provided ADL (Activities of Daily Living) Care to include shaving of his beard.

Inspectors wroteBased on observations, staff interview, and facility document review the facility staff failed to store and label food in accordance with food service safety guidelines.

Inspectors wroteBased on observations, staff interviews and clinical record review the facility staff failed for 1 of 41 residents in the survey sample (Resident #67) to deliver personal laundry in a timely manner, therefore violating his dignity and rights as an individual. A resident council meeting was held in the resident dining hall on 02/05/19 at 10:30 AM. Twelve residents attended the meeting. The residents chief complaint was that they were not receiving their personal laundry on time. Resident #67 stated that it took him a week before he received his laundry on several occasions. Some residents stated that although the laundry is done daily, they may not receive their personal laundry until a week later.

Inspectors wroteBased on clinical record review, staff interviews and facility documentation, the facility staff failed to ensure Medicare Beneficiary Notices, were issued to 2 of 41 residents (Residents #411 and #412) in the survey sample. 1. Resident #411 was not issued a Notice of Medicare Provider Non-Coverage form (NOMNC). The NOMNC informs the beneficiary of his or her right to an expedited review of a services termination. 2. Resident #412 was not issued a Notice of Medicare Provider Non-Coverage form.

Inspectors wroteBased on review of facility records of employees hired within the last two years, staff interviews, and review of the facility's policy the facility staff failed to implement their policy for screening new employees for abuse, neglect and mistreatment of others for 1 of 25 employees. The facility's staff failed to obtain a criminal history report within 30 days of hire for 1 employee, Employee #6.

Inspectors wroteBased on staff interviews, clinical record review and facility documentation review the facility staff failed, for two of 41 residents (Resident #30 and 105) in the survey sample, to send a copy of the Resident's Care Plan after being transferred and admitted to the hospital. 1. The facility staff failed to send Resident #30's care plan when discharged and admitted to the hospital on [DATE] and 12/20/18. 2. The facility failed to ensure that Resident #105's Plan of Care Summary was sent upon transfer to the hospital on [DATE] and 1/16/19.

Inspectors wroteBased on resident record review, staff interviews and facility document review, the facility failed to notify the Office of the State Long-Term Care Ombudsman in writing of hospital discharges for 1 of 41 residents (Resident #30) in the survey sample. The facility staff failed to notify the Office of the State Long-Term Care Ombudsman of Resident #30's transfer to the local hospital on [DATE] and 12/20/18.

Inspectors wroteBased on staff interviews, clinical record review and facility documentation review the facility staff failed send a copy of the Bed-Hold Policy for 2 residents (Resident #30 and #105) after being transferred to and admitted to the hospital. 1. The facility staff failed to ensure that Resident #30 was made aware of the facility's bed-hold and reserve bed payment policy upon transfer/discharge to the hospital on [DATE] and 12/20/18. 2. The facility failed to ensure that Resident #105 received a written notice of the Bed-Hold Policy upon transfer to the hospital on [DATE] and 1/16/19.

Inspectors wroteBased on observations, clinical record review, staff interviews and facility documentation, the facility staff failed to ensure a Level I PASRR (Preadmission Screening Resident Review) was conducted prior to admission or within 30 days of admission to the nursing facility for 2 of 41 residents (Residents #45 and #88) in the survey sample with diagnoses of either a mental disorder and or intellectual disability . 1. The facility staff failed to ensure Resident #45, who was identified with a mental illness, had a PASRR completed prior to admission. 2. The facility staff failed to ensure a Level 1 PASRR was completed prior to admission for Resident #88.

Inspectors wroteBased on facility information obtained during the Sufficient and Competent Nurse Staffing task, and staff interview, the facility staff failed to staff a Registered Nurse for at least 8 consecutive hours a day, 7 days a week. The facility staff failed to staff a Registered Nurse (RN), for at least 8 consecutive hours on 1/16/19.

Inspectors wroteBased on staff interview, facility record review, and review of the facility's policy, the facility staff failed to consistently have required members at each quarterly Quality Assessment and Assurance Committee (QAA) meeting and failed to meet on a quarterly basis for one year.

Inspectors wroteBased on information gleamed during the Infection Prevention and Control Program review and staff interview the facility's staff failed to have an current and active Infection Prevention and Control Program policy. The facility staff failed to sign the Infection Prevention and Control Program policy into effect, effective 1/1/2019.

Inspectors wroteBased on clinical record review and staff interview the facility staff failed to provide the contact information to the independent reviewer authorized by Medicare upon issuance of a Notice of Medicare Non-Coverage for 3 residents in the survey sample of 30, Residents #25, 26 and 27. The facility staff failed to provide in writing the name of the Quality Improvement Organization (QIO) and toll-free contact number to appeal and or ask questions when issued a Notice of Medicare Non-Coverage for Residents #25, 26 and 27.

Inspectors wroteBased on observation, resident group interview, staff interview, and facility document review, the facility staff failed to ensure residents had access to their personal funds 7 days a week.

Inspectors wroteBased on clinical record review and staff interview, the facility staff failed to assure prompt encoding and transmittal to Centers for Medicaid and Medicare (CMS) for 4 of 30 residents (Resident #21, #22, #23 and #30). 1. The facility staff failed to electronically transmit any Minimum Data Set (MDS) assessments after 2/17/17 to the National Data Base, the Centers for Medicare and Medicaid (CMS) for Resident #21 who was a current resident. 2. The facility staff failed to electronically transmit any Minimum Data Set (MDS) assessments after 1/2/17 to the National Data Base, the Centers for Medicare and Medicaid (CMS) for Resident #22 who was a current resident. 3. The facility staff failed to electronically transmit any Minimum Data Set (MDS) assessments after 1/18/17 to the National Data Base, the Centers for Medicare and Medicaid (CMS) for Resident #23 who was a current resident. 4. [...]

Inspectors wroteBased on observations, resident interview, medical record review, facility documentation review, and staff interview the facility staff failed to ensure MD (Medical Doctor's) orders were followed for vascular wound care for 1 Resident (Resident #12) of 30 Residents in the survey sample.

Inspectors wroteBased on observations, resident interview, medical record review, facility documentation review, and staff interview the facility staff failed to ensure wound care was done to promote healing and to prevent infection of pressure ulcers for 2 Residents (Resident #1 and #6) of 30 Residents in the survey sample.

Inspectors wroteBased on observation, staff interview, clinical record review and facility document review, the facility staff failed to ensure ongoing healthcare-associated infection (HAI) surveillance and failed to maintain appropriate infection prevention and control practices to prevent infections for 2 of 30 sampled residents, (Residents #1, #12 ), failed to implement appropriate hand hygiene practices, failed to ensure medical equipment and supplies were maintained in a clean and sanitary manner and failed to place soiled items in the appropriate storage space. 1. The facility staff failed to ensure surveillance for healthcare-associated infections were completed for October 2016, November 2016 and December 2016. 2. The facility staff failed to ensure infection control measures were followed to prevent the potential transmission of infection for Resident #1. 3. [...]

Inspectors wroteBased on observation and staff interviews, the facility staff failed to maintain a safe, clean, comfortable and sanitary environment.

Inspectors wroteBased on staff interview, clinical record review and facility document review, the facility staff failed to maintain a complete and accurate medical record for 3 of 30 residents in the survey sample, Resident #3, Resident #1, Resident #6.

Inspectors wroteBased on observation, resident and staff interviews the facility staff failed to promote care to maintain or enhance the dignity for 1 out of 30 residents (Resident #14) in the survey sample. The facility staff failed to provide Resident #14 with a clothing protector during lunch.

Inspectors wroteBased on clinical record review and staff interviews, the facility staff failed to ensure quarterly Minimum Data Set (MDS) assessments were completed no less than once every 3 months for 1 of 30 residents (Resident #20) in the survey sample.

Inspectors wroteBased on resident interview, staff interview, clinical record review and facility document review, the facility staff failed to ensure resident assessments were accurate and/or complete for 3 of 30 sampled residents (Residents #16, Resident #10, and Resident #11). 1. The facility staff failed to accurately code Section O0100J (Dialysis (1)) under Special Treatments, Procedures, and Programs for Resident #16. 2. The facility staff failed to accurately code section C under Cognitive Pattern (Brief Interview for Mental Status - BIMS) and section J under Health Condition (Pain) for Resident #10. 3. The facility staff failed to accurately code section B under (Hearing, Speech and Vision) for Resident #11.

Inspectors wroteBased on staff interview, clinical record review and facility document review, the facility staff failed to develop a Comprehensive Resident-Centered Plan of Care based on the Care Area Assessments triggered by the MDS (Minimum Data Set) for 3 of 30 sampled residents (Residents #1, Resident #4 and Resident #6). 1. The facility staff failed to develop a Comprehensive Resident-Centered Care Plan for 6 out of 9 Care Area Assessments triggered by the MDS for Resident #4. 2. The facility staff failed to revise the Comprehensive Care Plan to show evidence for Care Plan Interventions for all CAAs (Care Area Assessments) triggered by the MDS (Minimum Data Set) for Resident #1. 3. The facility staff failed to revise the Comprehensive Care Plan to show evidence for Care Plan Interventions for all CAAs (Care Area Assessments) triggered by the MDS (Minimum Data Set) for Resident #6.

Inspectors wroteBased on observation, staff interview, clinical record review and facility document review the facility staff failed to provide the appropriate care and services to prevent complications for the use of a Foley catheter for 1 of 30 residents in the survey sample, Resident #7. The facility staff failed to ensure the Foley catheter tubing was anchored and secured properly and failed to implement appropriate infection control practices during the change of the Foley catheter leg bag for Resident #7.

Inspectors wroteBased on observation, facility documentation review, staff interviews and clinical record review the facility staff failed to implement interventions to reduce a potential accident hazard for 1 Resident (Resident #1) of 30 residents in the survey sample.

Inspectors wroteBased on observations, clinical record reviews and staff interview the facility failed to ensure that its medication error rates were not 5% or greater. A medication administration observation pass was conducted to include 27 opportunities, with 2 medication errors resulting in a 7.40% error rate, involving 2 residents, Residents #18 and #19. 1. The nurse failed to shake the drug Megace (an appetite stimulant) that was in a liquid suspension form for Resident #18 prior to administration. 2. The nurse failed to administer a 20 mEq (milieu) potassium tablet before dinner as ordered for Resident #19.

Inspectors wroteBased on staff interview, clinical record review and facility document review, the facility staff failed to ensure 1 of 30 sampled residents (Resident #24) was free of significant medication error. The facility staff failed to administer Resident #24's medications according to the times ordered by the physician.

Inspectors wroteBased on observation, staff interview and clinical record review the facility staff failed to ensure medications were acquired to meet the needs of 1 of 30 residents in the survey sample, Resident #19. The facility staff failed to ensure Potassium Chloride 20 mEq (milliequivalent) was available for administration as ordered for Resident #19.

Inspectors wroteBased on general observations of the nursing facility, the facility failed to ensure medications (Purified Protein Derivative) PPD-Aplisol was stored in a secured location and to ensure a medication label of a resident's drug was accurate for 1 out of 30 residents (Resident #18) in the survey sample. 1. The facility staff failed to ensure medication medications (Purified Protein Derivative) PPD-Aplisol was stored in a secured location, on 1 out of 2 units, Unit 2. 2. The facility staff failed to ensure that the medication label in response to an order change was accurate for Resident #18's Megace suspension.

Inspectors wroteBased on observations and staff interview, the facility staff failed to display a posting to identify the location of the past three (3) year's survey results.