Providence Rehab and Hlthcare Ctratmercyfitzgerald

Inspectors wroteBased on observations of care and services, clinical record reviews, reviews of policies and procedures and interviews with staff and residents, it was determined that for each resident reviewed with functional limitations with activities of daily living, the facility failed to ensure that a person-centered care plan related to therapeutic exercises and restorative nursing care was developed and implemented for two of seven residents reviewed. (Residents R118 and R88)

Inspectors wroteBased on record review and review facility policy was determined the facility failed to ensure that medications were administered to residents according to physician's instructions for one of 24 residents reviewed. (Resident R130)Review of facility policy on Administering medications revealed that under section policy Statement: Medications are administered in a safe and timely manner, and as prescribed. Under section Policy Interpretation and Implementation #2. the director of nursing services supervises and directs all personal administer medications and or have related functions. #4. medications are administered in accordance with prescriber orders including any required timeframe. #7. Medications are administered within one hour of their prescribed time unless otherwise specified. [...]

Inspectors wroteBased on observations, review of clinical records, interview with staff and review of facility policies, it was determined that the facility failed to ensure that residents receive oxygen according to physician's order for one of 24 residents reviewed (Resident R3). Review of facility policy on Oxygen Administration revealed that under section Purpose The purpose of this provide guidelines for safe oxygen administration Preparation #1. Verify that there is a physician's order for this procedure. #2. Review the physician's orders or facility protocol for oxygen administration. Under section Steps in the Procedure #8. Turn on the oxygen. Unless otherwise ordered, start the flow of oxygen at the rate of 2 to 3 liters/minute. #10. Adjust the oxygen delivery device so that it is comfortable for the resident and the proper flow of oxygen is being administered. [...]

Inspectors wroteBased on review of facility policy, clinical record review and interview with staff and residents, it was determined that the facility did not ensure that residents were free from misappropriation of resident property for three of 10 residents reviewed (R1, R2, R3). This deficiency is cited as past non-compliance. Clinical record review revealed that resident R1 was admitted to the facility on [DATE], with diagnoses including, but not limited to hemiplegia and hemiparesis (weakness and paralysis affecting one side of the body), and dementia. Continued review revealed that resident R2 was admitted to the facility on [DATE], with diagnoses including, but not limited to muscle wasting and systemic lupus erythematosus (a chronic auto immune disorder that cause widespread organ and tissue, and causes inflammation that can affect multiple body systems). [...]

Inspectors wroteBased on review of clinical records, interviews with staff, facility documentation and policy, it was determined that the facility failed to implement fall interventions for one of two residents reviewed for falls. (Resident CL1)

Inspectors wroteBased on review of facility policies, review of facility documents, clinical record reviews, and interviews with residents and staff, it was determined that the facility failed to conduct a thorough investigation related to allegations of neglect for one of six residents reviewed (Resident R1).

Inspectors wroteBased on observations, review of facility policies, clinical record reviews and interviews with residents and staff, it was determined that the facility failed to ensure that intravenous (IV) devices were maintained in accordance with professional standards of practice for one of six residents reviewed (Resident R2).

Inspectors wroteBased on observations, review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to maintain an effective infection control program related to transmission-based precautions and air mattresses, for two of six residents reviewed (Residents R3 and R5).

Inspectors wroteBased on facility policy, review of facility documentation, observations, interviews with resident, it was determined that the facility failed to provide a safe, clean, comfortable, homelike environment for two of 12 resident reviewed. (Resident R1 and Resident R2)

Inspectors wroteBased on observations, clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that resident rooms were free from offensive odors for one of 34 residents reviewed (Resident R79).

Inspectors wroteBased on review of facility policy, review of clinical records and staff interview, it was determined that the facility did not ensure that residents were free of misappropriation of resident property related to diversion of a narcotic medication for two of seven residents prescribed narcotic medications reviewed. This deficiency was cited as past non compliance. (Resident R20, Resident R21)

Inspectors wroteBased on review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to develop a comprehensive care plan related to diabetes management for one of 34 residents reviewed (Resident R80).

Inspectors wroteBased on observations, interviews with residents and staff and a review of facility documentation and review of clinical records, it was determined that the facility failed to ensure that a safe environment was maintained related to medication being left on a residents over bed table on two occasions for one of 34 residents reviewed (Resident R213).

Inspectors wroteBased on observations, review of facility policies, review of clinical records and interview with staff, it was determined that the facility failed to ensure that medications were properly and accurately labeled in accordance with currently accepted professional principles for one of twenty-six medications. (Resident R42)

Inspectors wroteBased on observations, review of facility policies, review of clinical records and interview with staff, it was determined that the facility failed to ensure that medications were properly and accurately labeled in accordance with currently accepted professional principles for one of twenty-six medications.

Inspectors wroteBased on observations and interviews with staff, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety.

Inspectors wroteBased on observations, review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that tube feedings were properly labeled for one of three residents reviewed for tube feedings (Resident R79).

Inspectors wroteBased on review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that residents had the capacity to understand the terms of a binding arbitration agreement for three of five residents reviewed (Residents R44, R41 and R72).

Inspectors wroteBased on observations, review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to maintain effective infection control practices related to enhanced barrier precautions for one of two residents reviewed for pressure ulcers (Resident R79).

Inspectors wroteBased on clinical record reviews and interviews with staff, it was determined that the facility failed to notify the Office of the State Long-Term Care Ombudsman of facility-initiated emergency transfers and discharges for four of six residents reviewed (Residents R2, R3, R4 and R6).

Inspectors wroteBased on observation, review of facility policy, interview with resident and staff, it was determined that the facility failed to ensure that resident's call bells were within reach for four of 25 residents observed (Resident R1, R2, R3, and R4).

Inspectors wroteBased on review of facility policy, review of clinical records, interview with staff and residents, it was determined the facility failed to ensure that Resident records were complete and accurately documented regarding wound care treatments for one resident reviewed (Resident R1).

Inspectors wroteBased on clinical record reviews, interviews with staff and policy and procedure reviews, it was determined that the facility failed to ensure that cardiac medication was administered as ordered by the physician for one of three residents reviewed. (Resident CL1)

Inspectors wroteBased on review of facility policy, observations, and staff interviews, it was determined that the facility failed to follow acceptable infection control practices related to hand washing during medication administration and cleaning and disinfection of resident care equipment for one 2 of 2 staff observations. (Employee E4 and Employee E5)

Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to developed a care pan related to anticoagulant medication for one of five resident reviewed (Resident R37).

Inspectors wroteBased on the review of facility policy, observations and interviews with staff, it was determined that the facility failed to ensure that the medications were dispensed and administered according to professional standards of practice. One of four residents reviewed. (Resident R54) Findings Include: Review of facility policy Administering Medications, dated April 2019, revealed that Medication Administration times are determined by resident need and benefit, not staff convenience. Factors that are considered include: a. Enhancing optimal therapeutic effect of the medication. b. Preventing potential medication or food interactions and c. Honoring resident choices and preferences, consistent with his or her care plan. Observation of Resident R54's room on February 4, 2024, at 10:34 a.m. revealed that there was a medication cup sitting on the bedside table with a tablet inside. [...]

Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to ensure that anticoagulant medication was administered with adequate monitoring for adverse consequences for one of five resident reviewed (Resident R37).