Princeton Nursing & Rehabilitation

Inspectors wroteBased on observation, interview, and review of facility policy, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Observation on 09/08/2024 of the reach-in cooler revealed multiple food items which had been opened; however, were not labeled and undated. The facility's failure had the potential to affect 96 of the facility's 98 residents who consumed food from the kitchen.

Inspectors wroteBased on observation, interview, record review and review of facility policy, it was determined the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, with measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs as identified in the comprehensive assessment for two (2) of three (3) sampled residents. (Resident (R)38), and R26. The facility care planned R38 for alteration in nutritional status related to receiving enteral (tube) feedings, with interventions that included elevating the head of bed (HOB) during feedings, and maintaining the resident in an upright posture to decrease aspiration risk. [...]

Inspectors wroteBased on observation, interview, record review, and review of the facility policies, the facility failed to ensure the comprehensive care plan was reviewed and revised by its Interdisciplinary Team (IDT following a fall with major injury for 1 of 22 sampled residents, Resident (R)26. On 06/23/2024 a perimeter defining mattress (PDM) was recommended as an intervention by the IDT for R26, and a PDM was placed on the resident's bed. The PDM was removed at R26's request; however, was not added to the resident's falls care plan to accurately reflect the resident's plan of care. In addition, R26's falls care plan noted a high rise mattress r/t fall from bed remained as an active intervention, but was not observed to be in use.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to ensure medical provider orders were entered upon receipt for 1 of 22 sampled residents, Resident (R)26. On 06/25/2024 at 11:11 AM, Registered Nurse (RN) 3 contacted the Advanced Practice Registered Nurse (APRN) 1 to report R26 had right leg pain, scattered bruising of the right leg and swelling of the right knee. RN 3 said APRN 1 ordered an x-ray of R26's right leg the previous night. Review of the medical record revealed no documented evidence of an x-ray order or documentation of the nurse's communication with APRN 1 on 06/24/2024.

Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to ensure the use of assistive devices to prevent injury for 1 of 3 sampled residents, Resident (R)26. Review of the Physician's Order History revealed an order with a start date of 03/29/2023 and a discontinue date of 9/11/2024 for High rise mattress as intervention r/t falls from bed. However, observation of R26's bed mattress revealed a standard mattress was in place, not the ordered high rise mattress. Therefore, on 6/23/2024 R26 sustained a fall from the bed that resulted in a comminuted impacted extra-articular (bone broken into multiple pieces with the ends driven into each other) right distal femur fracture with lateral displacement that required surgical repair.

Inspectors wroteBased on observation, interview, record review, and review of the facility policy, the facility failed to ensure a resident who was fed by enteral (tube) feedings, received the appropriate treatment and services to prevent complications of enteral feeding including but not limited to aspiration pneumonia for 1 of ?? sampled residents, Resident (R)38. 1. Review of the manufacturer's instruction manual for R38's feeding system revealed the feeding set should be replaced after 24 hours from initiation of the feeding to prevent bacterial growth that could be a hazard to the patient. However, observation on 09/09/2024 at 12:49 PM, revealed R38's enteral (tube) feeding bottle had been hanging for greater than 24 hours, and included a 4 hour holding of the feeding solution. 2. Review of R38's care plan revealed the head of the resident's bed was to be elevated during enteral feedings. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 2 sampled residents, Resident (R)2. Observation revealed staff failed to follow infection control guidelines related to catheter care, clean linen placement, and hand hygiene for R2. Additionally, staff failed to perform proper hand hygiene while passing residents' meal trays.

Inspectors wroteBased on interview and review of the facility policy, it was determined the facility failed to ensure residents received mail delivery on the weekends.

Inspectors wroteBased on observation, interview, record review and facility policy review, it was determined the facility failed to develop and/or implement a comprehensive person-centered care plan for three (3) of eighteen (18) sampled residents (Resident #61, #38, and #31). Resident #61 was care planned for staff to check the resident's Arteriovenous (AV) Fistula, however, further review of the record revealed there was no documented evidence staff conducted assessments of the AV fistula. Resident #38 was assessed for behaviors, favorite activities, etc; however, the facility failed to develop a Person Centered Comprehensive Care Plan to include the resident's choices and goals. Resident #31 was care planned for shower twice a week; however, the resident was provided bed baths instead of a shower/full bath for eight (8) days.

Inspectors wroteBased on interview, record review and review of facility policy, it was determined the facility failed to ensure five (5) of eighteen (18) sampled residents who were unable to carry out activities of daily living received the necessary services related to weekly showers (Residents #31, 36, 62, #6, and #24). Residents #31, 36, 62, #6, and #24 were assessed and care planned for staff to assist with showers two (2) times a week; however, the facility failed to ensure the residents received the showers.

Inspectors wroteBased on interview, record review, and facility policy review, it was determined the facility failed to ensure two (2) of eighteen (18) sampled residents were free from abuse (Residents #42 and #4). Certified Nurse Aide (CNA) #1 and #2 stated they witnessed Certified Medication Technician (CMT) #1 state, You're acting like a f****** child. to Resident #42, and lunge at Resident #4 stating, Shut up.

Inspectors wroteBased on interview, record review, and review of the Resident Assessment Instrument (RAI) Minimum Data Set (MDS) User's Manual, it was determined the facility failed to accurately assess one (1) of eighteen (18) sampled residents to reflect his/her status (Resident #43).

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure one (1) of one (1) sampled resident who required dialysis in a sampled of eighteen residents received services consistent with professional standards of practice (Resident #61). Resident #61 was a dialysis patient and had a Arteriovenous (artery connected to a vein in the arm, to create a fistula) Fistula (a blood vessel made wider and stronger by a surgeon to handle the needles that allow blood to flow out to and return from a dialysis machine). Review of the original Physician's Orders revealed to check the shunt to the left upper extremity for a thrill (a rumbling sound that you can feel) and bruit (a rumbling sound you can hear) every shift; however, the order was not carried over to the July, August, and September 2019 Physician's Orders. [...]

Inspectors wroteBased on observation, interview, and review of the facility's policy and procedure, it was determined the facility failed to ensure drugs used in the facility are labeled in accordance with currently accepted professional principles. Observation on 09/19/19 revealed staff failed to ensure medications on two (2) of four (4) medication carts on Wing 1 and Wing 2, were dated when opened.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to serve food in accordance with professional standards for food service safety. Observation on 09/10/19 revealed a Certified Nurse Aide (CNA) handled a residents' bread with her bare hands.