Premier Nursing and Rehabilitation Center

Inspectors wroteBased on observation, record review, and staff interviews, the facility failed to treat a resident with dignity when a nurse aide did not sit while feeding a resident who needed assistance with meals for 1 of 2 dining observations (Resident #51). The reasonable person concept was applied as individuals have the expectation of being treated with dignity and would not want staff to stand over them while assisting with meals.

Inspectors wroteBased on observations, record review, and resident and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) assessment in the areas of swallowing/nutritional status (Resident #39) and hospitalization (Resident #138). This was for 2 of 24 residents reviewed for accuracy of assessments.

Inspectors wroteBased on observation, record review, and resident, Responsible Party (RP) and staff interviews, the facility failed to implement the comprehensive care plan in the area of activities of daily living (Resident #27), and failed to develop an individualized, person-centered comprehensive care plan to include the use of a percutaneous endoscopic gastrostomy feeding tube (a PEG tube is a feeding tube placed into the stomach through the abdominal wall) (Resident #39), and the use of a noninvasive mechanical ventilator (a device to help with nighttime breathing for people with respiratory issues) (Resident #290 and Resident #71). This was for 1 of 5 residents reviewed for activities of daily living, 1 of 2 residents reviewed for tube feeding, and 2 of 4 residents reviewed for respiratory services.

Inspectors wroteBased on observations, record review, and resident, staff and Medical Director interviews the facility failed to obtain a physician's order for the use of a BiPAP machine (a device that delivers two levels of air pressure during inhalation and exhalation to help people with breathing difficulties) (Resident #290) and a physician's order for use of a CPAP machine (a machine that used mild air pressure to keep breathing airways open while sleeping) (Resident #71). The facility also failed to administer oxygen by tracheostomy (a surgical opening in the neck for breathing) in accordance with the Physicians order (Resident #39). This was for 3 of 4 residents reviewed for respiratory care (Resident #290, Resident #71 and Resident #39).

Inspectors wroteBased on observations, record review, and resident and staff interviews the facility failed to attempt alternatives, assess entrapment risk, review risks and benefits and obtain informed consent prior to installing and utilizing bilateral quarter length side rails for 1 of 1 resident reviewed for side rails (Resident #290).

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to maintain an accurate medical record with regards to documentation of actual oxygen (O2) administration rate and route. This was for 1 of 4 residents (Resident #39) reviewed for the accuracy of medical records related to respiratory care.

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to implement their policy for enhanced barrier precautions (EPB) when Nurse #4 failed to wear a gown when providing tracheostomy (a surgical opening in the neck for breathing) care for Resident #27 and when Nurse #5 and Nurse #6 failed to wear a gown during a high contact care activity that included transfer and the provision skin care and hygiene for Resident #39 who had a tracheostomy. This was for 3 of 8 staff members observed for infection control practices. This had the potential to result in the risk of multidrug-resistant organism (MDRO) transmission.

Inspectors wroteBased on record review, staff, and Psychiatric Nurse Practitioner interviews, the facility failed to protect 2 of 5 residents' rights to be free from physical abuse (Residents #114 and #29). All residents involved resided in the memory care unit. Resident #99 struck the back of Resident #114's head on 9/8/23 and hit Resident #114's left jaw twice on 10/11/23. Both incidents occurred after Resident #114 wandered into Resident #99's room. Resident #114 had redness and a small amount of swelling to the left side of face after the second incident. Resident #99 slapped Resident #29 on the cheek after Resident #29 touched Resident #99's pants in the activity room. Resident #29 sustained no injuries. A reasonable person would not expect to be physically abused in their home and would experience feelings such as intimidation, fear, humiliation, embarrassment, and anxiety. [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to complete and submit an initial report for an abuse allegation within 2 hours of discovery to the state regulatory agency. The facility also failed to notify the police department, or Adult Protective Services (APS) for staff to resident abuse (resident #350) for 1 of 3 residents investigated for facility reported incidents.

Inspectors wrote2. Resident #68 was admitted to the facility on [DATE] with diagnoses which included, in part, hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side. A review of Resident #68's significant change Minimum Data Set (MDS), dated [DATE], indicated that Resident #68 was severely cognitively impaired. Hospice Care was not indicated. A review of Resident #68's Care Plan, last revised 12/13/23, revealed a problem of has advanced directives with an intervention of resident/responsible party elected hospice. This intervention was initiated on 09/28/23. A review of Resident #68's Physician orders revealed an order, dated 12/22/23, which read, admit to hospice services effective 09/21/23. An interview was conducted with the MDS Coordinator nurse on 03/21/24 at 1:37 p.m. [...]

Inspectors wroteBased on record review and staff interviews the facility failed to develop a person-centered care plan for 1 of 1 resident reviewed for respiratory services (Resident #37).

Inspectors wroteBased on observations, record review, and staff interviews the facility failed to keep a dependent resident's fingernails trimmed for 1 of 6 residents reviewed for activities of daily living care (Resident #69).

Inspectors wroteBased on record review and staff interview, the facility failed to investigate and analyze falls to determine causative factors and implement targeted interventions to reduce risk of further falls for 1 of 3 residents (Resident #348) reviewed for accidents.

Inspectors wroteBased on observations, record review, and resident and staff interviews the facility failed to administer oxygen (O2) in accordance with the physician's order for 1 of 3 residents (Resident #44) reviewed for respiratory care.

Inspectors wroteBased on observations and staff interviews the facility failed to secure resident medications stored in an unattended medication cart (the 700-hall medication cart) for 1 of 7 medication carts.

Inspectors wroteBased on observations, record review and staff interview the facility's Quality Assessment and Assurance Committee (QAA) failed to maintain implemented procedures and monitor interventions that the committee had previously put in place following the recertification and complaint surveys of 1/7/22 and 3/3/23, and the complaint survey of 10/27/22. This was for 5 recited deficiencies in the areas of Accuracy of Assessments (F641), Develop/Implement Comprehensive Care Plans (F656), ADL Care Provided For Dependent Residents (F677), Free Of Accident/Hazards/Supervision/Devices (F689), Label/Store Drugs & Biologicals (F761) and Infection Control (F880). The continued failure during 2 or more federal surveys of record showed a pattern of the facility's inability to sustain an effective Quality Assurance Program. The tag is cross-referenced to: [...]

Inspectors wroteBased on observations, record review and staff interviews the facility failed to implement their hand washing and alcohol-based hand sanitizer procedures as part of their infection control policies when Nurse Aide (NA) #4 failed to perform hand hygiene during meal delivery service after moving an overbed table and handling a bed control during 1 of 6 meal delivery service observations. This had the potential to result in cross contamination of microorganisms between residents.

Inspectors wroteBased on record review and staff and resident interviews the facility failed to offer the flu vaccine during the flu season for 2 of 5 residents reviewed for immunizations (Resident #56, Resident #69).

Inspectors wroteBased on observations and staff interviews the facility failed to: 1a) ensure the residents rooms were free from damaged drywall in 10 of 10 resident rooms noted to have drywall wall damage (101, 104, 114, 116, 203, 214, 217,303, 815, and 817), 1b) replace 1 of 1 missing privacy curtains in 1 of 4 shower rooms (300-Hall), and 1c) failed to replace broken or missing floor tiles next to shower drain in 1 of 4 shower rooms (100-Hall); 2a) clean and disinfect dried feces off a resident's room floor, and 2b) tell housekeeping staff to clean and disinfect the hallway area where Nursing Aide (NA) dropped soiled linen, for 2 of 2 resident rooms (room [ROOM NUMBER] and room [ROOM NUMBER]) that were observed for environment.

Inspectors wroteBased on observation, record review and staff interviews the facility failed to develop and implement a comprehensive person-centered care plan that addressed measurable goals and interventions for 4 of 6 residents (#8, #77 #123, #127) reviewed for care planning.

Inspectors wroteBased on record review, observations, and resident, staff, and physician interviews the facility failed to follow up on a Podiatrist (foot doctor) order from June 2022 for diabetic shoes to help with protecting the resident's feet secondary to loss of sensation, weakness, and deformity which caused the resident frustration and the inability for the resident to get out of his room and ambulate with his walker for 1 of 1 resident (Resident #36) reviewed for diabetic foot care.

Inspectors wroteBased on record review, observations and staff and physician interviews the facility failed to: 1) comprehensively assess residents for fall risk, thoroughly investigate falls and implement interventions to reduce the risk of falls for residents with a history of falls for 2 of 2 residents (Resident #8 and Resident #77) reviewed for falls; 2) ensure Resident #22, who was assessed as an unsafe smoker, had interventions implemented for safe smoking to include nursing staff to assist the resident to the designated smoking area, not leaving the resident unattended while smoking, and the use of a smoking apron; 3) secure smoking materials (Residents #22, #104, and #127); and 4) assess the safety of a resident who was a known smoker (Resident #127) for 3 of 4 residents reviewed for smoking.

Inspectors wroteBased on observations, record review, Nurse Practitioner, Pharmacist Consultant, and staff interviews the facility failed to implement a pharmacy recommendation which resulted in a resident (Resident #55) not receiving her daily dose of Victoza (a non-insulin medication to treat diabetes) for 21 days for 1 of 5 residents reviewed for unnecessary medications.

Inspectors wroteBased on record review, staff, Nurse Practitioner and Consultant Pharmacist interviews, the facility failed to accurately transcribe and administer a medication used to treat depression resulting in 23 doses administered at a higher dose than ordered for 1 of 3 residents (Resident #8) reviewed for psychotropic medication (a medication used to treat behavior, mood, thoughts, or perception).

Inspectors wroteBased on record review, staff, Nurse Practitioner and Consultant Pharmacist interviews, the facility failed to accurately transcribe and administer a medication used to treat hypertension (high blood pressure) resulting in 8 doses administered in error for 1 of 1 residents (Resident #8) reviewed for medication error.

Inspectors wroteBased on observations, record review, staff interviews, and review of the manufacturers guidelines the facility failed to label multi dose oral inhalers with resident names and failed to record opened dates on multi dose oral inhalers and on an insulin pen on 2 of 3 medication carts (300 and 400 hall medication carts) reviewed for medication storage.

Inspectors wroteBased on observations, and staff interviews the facility failed to discard milk cartons and nutritional supplements that were stored for use past the use by dates in 1 of 1 walk in refrigerators observed for food storage. This practice had the potential to affect all residents who consumed these products. The facility also failed to repair broken floor tiles in the kitchen adjacent to the dishwasher, and repair cracked, peeling paint hanging from the ceiling tiles above 2 of 3 the food preparation tables reviewed for sanitation.

Inspectors wroteBased on observations, record review, and staff interviews, the facility's Quality Assurance & Performance Improvement Program (QAPI) failed to maintain implemented procedures and monitor interventions that the committee put into place following a recertification and complaint investigation of 01/07/22 and complaint investigations of 06/30/22 and 12/23/20. This was for 3 deficiencies that were originally cited in the areas of accurate coding of the Minimum Data Set assessments (F641), developing/implementing comprehensive care plans (F656), and drug regimen reviews/report irregularities (F756) and were subsequently recited on the current recertification survey of 03/03/23. The continued failure during 2 or more federal surveys of record shows a pattern of the facility's inability to sustain an effective Quality Assurance (QA) Program.

Inspectors wroteBased on record review, observations and staff interviews the facility failed to provide a resident with privacy when Resident #29 was observed lying in bed with his naked body exposed when door to the hallway was opened and the privacy curtain not pulled around the bed in a semi-private room. The deficient practice affected 1 of 1 resident reviewed for privacy. The reasonable person concept was applied to Resident #29 as residents have an expectation of privacy in their home environment.

Inspectors wroteBased on record review and staff interviews the facility failed to accurately code the Minimum Data Set (MDS) assessment for 1 of 31 residents reviewed for MDS accuracy (Resident #127).

Inspectors wroteBased on record review and staff, Consultant Pharmacist and Nurse Practitioner interviews, the facility failed to order and administer a diabetes medication as prescribed by the physician for 1 of 6 residents reviewed for unnecessary medications (Resident #62).