Premier Health & Rehabilitation Center of Lv, LP

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure nursing staff completed required steps when a resident was discharged against medical advice (AMA). Specifically, there was no documentation of: (1) a discussion of the risks associated with leaving; (2) a signed AMA form; and (3) notification of the physician and the administrator or director of nursing for 1 of 8 sampled residents (R1). The deficient practice placed the resident at risk for an unsafe or uncoordinated discharge, which could have resulted in unmet care needs or rehospitalization.

Inspectors wroteBased on observation, record review, and interview, the facility failed to obtain a physician order, instructions for use, and monitoring for a soft neck collar for 1 of 17 sampled residents (Resident 95). The deficient practice had the potential to place residents at risk of potential injury from improper use of a soft neck collar.

Inspectors wroteBased on observation, record review, document review, and interview, the facility failed to ensure a resident who experienced and reported pain received pharmacological interventions for pain management for 1 of 17 sampled residents (Resident 23). The deficient practice had the potential for residents not to receive pain relief.

Inspectors wroteBased on interview and record review, the facility did not follow the Legionella Water Management Plan.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure the free water flushes (FWF) via Percutaneous Endoscopic Gastrostomy (PEG) tube (a feeding tube inserted through the abdominal wall into the stomach and used to provide nutritional support and feed patients who are unable to eat or drink) were provided as prescribed for 3 of 4 sampled residents (Residents 53, 48, and 45). The deficient practice could have led to an increased risk of inadequate hydration, delayed wound healing, electrolyte imbalance and adverse health outcomes.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure the head of the bed was elevated to 30-45 degrees while the tube feeding (TF) was infusing and TF formula was delivered as prescribed for 4 of 4 sampled residents (Residents 53, 45, 48, and, 1) The deficient practice could have led to an increased risk of inadequate nutrition, weight loss, aspiration, and potential respiratory complications for the affected residents.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure the kitchen vent hood, filters and dish machine were cleaned and maintained per policy. On 09/10/24 at 7:43AM, the initial kitchen observation revealed the following: -The kitchen vent exhaust hood filter with a copious amount of buildup. The Kitchen Manager indicated maintenance took care of the cleaning. -The dish machine had a copious amount of white and lime green build up on the exterior. The Dish Machine cleaning schedule was reviewed with the Kitchen Manager. The schedule documented the dish machine had been cleaned on 09/09/2024. The Kitchen Manager indicated the cleaning did not include the exterior. The Kitchen Manager verbalized; the dish machine appeared to be neglected. On 9/12/2024 at 11:14 AM, the Kitchen Manager showed that the oven, hood and dishwasher were cleaned. [...]

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure the IV (intravenous) heplock was monitored, or discontinued when not in use for 1 of 16 sampled residents (Resident 171). This deficient practice could have resulted in potential risks, including infection, infiltration and phlebitis.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure the transmission-based precautions (TBP) and enhanced barrier precautions (EBP) were followed upon entering the rooms, and a garbage bin was available for 2 of 16 sampled residents (Residents 33 and 69). The deficient practice could potentially lead to the spread of infectious diseases, an increased risk of cross-contamination, and compromised health and safety for both residents and staff.

Inspectors wroteBased on record review, interview and policy review, the facility failed to ensure quality of care delivery for 1 of 11 residents (Resident #1) by failing to document and notify a provider of significant changes in real time, failing to document facility required charting, and failing to demonstrate monitoring and documentation of the resident's status.

Inspectors wroteInterviews with three Certified Nurse Assistants, one Registered Nurse, one Licensed Practical Nurse, the Director of Staff Development, the Director of Nursing, the Medical Director, and the Administrator evidenced an understanding of the policies and procedures related to oxygen therapy and change in resident condition. A review of the employee files of three Certified Nurse Assistants and one Licensed Practical Nurse indicated orientation training had included information on how to manage resident changes in condition including who and when to notify. A review of the medical records of Residents #8 and #11 with hypoxia in the setting of an emergency transfer to the hospital within the last six months, indicated the residents were assessed and managed in a manner synonymous with the facility policies and procedures. The deficient practice occurred in 2020. [...]

Inspectors wroteInterviews with three Certified Nurse Assistants, one Registered Nurse, one Licensed Practical Nurse, the Director of Staff Development, the Director of Nursing, the Medical Director, and the Administrator evidenced an understanding of the policies and procedures related to oxygen therapy and change in resident condition. A review of the employee files of three Certified Nurse Assistants and one Licensed Practical Nurse indicated orientation training had included information on how to manage resident changes in condition including who and when to notify. A review of the medical records for Residents #8 and #11 with hypoxia in the setting of an emergency transfer to the hospital within the last six months indicated the residents were assessed and managed in a manner synonymous with the facility policies and procedures. The deficient practice occurred in 2020. [...]

Inspectors wroteInterviews with one Registered Nurse, one Licensed Practical Nurse, the Director of Staff Development, the Director of Nursing, the Medical Director, and the Administrator evidenced an understanding of the policy and procedure related to laboratory tests. A review of the employee files of one Licensed Practical Nurse indicated orientation training had included information how, when, and to whom to inform of laboratory test results. A review of the records of Residents #7, #8 and #11 with laboratory test results in the setting of an emergency transfer to the hospital within the last six months indicated the laboratory tests were reported in a manner synonymous with the facility policy and procedure. The deficient practice occurred in 2020. [...]

Inspectors wroteBased on interview, record review and document review, the facility failed to ensure a timely notification of a Notice of Medicare Non-Coverage (NOMNC) for 1 of 3 sampled (Resident 10). The failure of a timely notification of a discharge could prevent a resident from filling an appeal to ensure the notice was within the criteria for discharge under Medicare skilled services. Findings Include: The Center for Medicare/Medicaid Services - CMS Form 10123 - NOMNC, documented you must make your request to the Quality Improvement Organization (QIO). A QIO is the independent reviewer authorized by Medicare to review the decision to end skilled services. Your request for an immediate appeal should be made as soon as possible , but no later than noon of the day before the effective date indicated on the form. [...]

Inspectors wroteBased on interview, record review and document review, the facility failed to ensure resident belongings were inventoried prior to discharge from the facility for 1 of 21 sampled resident (Resident 273). The deficient practice had the potential of preventing misappropriation of property for a resident.

Inspectors wroteBased on interview, and document review the facility failed to ensure a resident was free from physical and verbal abuse for 1 of 21 sampled residents (Resident 2). The deficient practice had the potential to cause physical or psychosocial harm to the resident.

Inspectors wroteBased on interview, record review and document review, the facility failed to provide documented evidence the investigation of an allegation of a resident-to-resident altercation was completed for 1 of 21 sampled residents (Resident 4); and an allegation of abuse was reported in a timely manner for 2 of 21 sampled residents (Resident 36 and 58). The deficient practice had the potential for the delay in the identification and prevention of similar incidents involving the same residents. Resident 4 (R4) R4 was admitted on [DATE], with diagnoses including unspecified psychosis not due to a substance or known physiological condition and obesity. The Situation Background Assessment/Appearance Recommendation (SBAR) form dated 03/19/2023 at 6:53 AM, documented the following: - Situation: R4 was found in another resident's room, verbally aggressive, looking for a cream colored clothing (blouse). [...]

Inspectors wroteBased on interview, record review and document review, the facility failed to ensure a comprehensive assessment was completed in a timely manner for 1 of 21 sampled residents (Resident 4). The deficient practice had the potential for the delay in the identification and provision of the specific interventions for the resident's care and needs.

Inspectors wroteResident 3 (R3) R3 was admitted on [DATE] with diagnoses including dementia without behavioral disturbances in psychotic feature, bipolar disorder, and major depressive disorder. Review of R3's clinical record documented the resident's PASARR level 1 was completed on 09/07/2021. The PASARR determination indicated R3 did not have mental illness, developmental delay, dementia, or related condition. Review of R3's clinical record documented an active diagnosis of bipolar disorder. A physician order for Depakote tablet delayed release 500 milligrams (mg), give one tablet by mouth every 8 hours for stabilizing related to bipolar disorder. The facility lacked documented evidence the resident was referred for a PASARR level 2. Resident 22 (R22) R22 was admitted on [DATE] with diagnoses including bipolar disorder current episode manic, anxiety, and hypertension. [...]

Inspectors wroteBased on record review and document review, the facility failed to ensure a baseline care plan was developed in a manner that included interventions to prevent injuries related to falls for 1 of 21 sampled residents (Resident #62). The deficient practice had the potential to place the resident in a risk for fall-induced injuries.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure splints were applied to a resident following physical therapy recommendations for 1 of 21 sample residents (Resident #48). The deficient practice had the potential risk for the resident's further decline in mobility.

Inspectors wroteBased on interview, record review and document review, the facility failed to provide documented evidence the physician was notified about a resident's refusal to have weights taken for 1 of 21 sampled residents (Resident 4). The deficient practice had the potential for the facility failing to provide the resident's nutritional needs and prevent the resident from significant weight change.

Inspectors wroteBased on interview, record review and document review, the facility failed to ensure peripherally inserted central catheter (PICC) line dressing was completed during the specified intervals for 1 of 21 sampled residents (Resident 274). The deficient practice had the potential of a resident developing a catheter related infection. Resident 274 (R274) R274 was admitted on [DATE] with diagnoses including psoas muscle abscess and infection of the intervertebral discs. On 09/12/2023 at 7:59 AM, R279 was observed with a double lumen PICC (a type of catheter used to access the large veins in the chest) at the left upper arm. The dressing on the PICC was dated 09/02/2023. R279 indicated receiving intravenous (IV) antibiotic, but no noted IV pump at the bedside. On 09/12/2023 at 9:03 AM, the licensed practical nurse (LPN) confirmed the date on the PICC line was more than a week old. [...]

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure a mineral oil enema stored in one of the two medication rooms, was discarded after the printed safety seal of the carton was broken. The deficient practice had the potential to cause cross contamination and infection to a recipient resident.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure glucometers were cleaned and disinfected following the facility infection control policy for 2 of 6 glucometers. The deficient practices had the potential to cause cross contamination and exposure to blood borne pathogens.