Providence Valdez Medical Center

Inspectors wroteBased on record review, observation, and interview, the facility failed to implement its abuse prevention screening process to ensure an employee with regular resident contact maintained a valid State of Alaska background check clearance before continuing to work in the facility. Specifically, the facility failed to ensure an individual who had direct contact with residents had a valid criminal history check conducted under 7 Alaska Administrative Code (AAC) 10.900-10.990. This resulted in 1 employee working (Assistant #3) at the facility without valid clearance from the Alaska Background Check program. This failed practice placed all residents (based on a census of 9) at risk for abuse, neglect or exploitation.

Inspectors wroteBased on record review and interview, the facility failed to: 1) Report an allegation of verbal intimidation/harassment, involving inappropriate sexual comments made by Certified Nursing Assistant (CNA) #4 to 1 Resident (#9), to the State Survey Agency immediately, or not later than 2 hours after the allegation was made/reported; and 2) Develop and implement an accurate reporting policy for allegations of abuse that aligned with regulatory requirements. Not reporting an allegation of abuse in an appropriate and timely manner placed all residents (based on a census of 9) at risk for future exposure to potential abuse.

Inspectors wroteBased on record review, interview, and observation, the facility failed to clearly designate one registered nurse to serve as the full-time Director of Nursing (DON) for the long-term care (LTC) unit. Specifically, the facility's leadership documents, Human Resources (HR) records, payroll records, staff identification, and administrative interviews identified conflicting roles for the Director of Clinical Services (DCS), the LTC Manager, and the newly hired DON. As a result, the facility could not demonstrate that one RN was consistently designated to serve as the full-time DON responsible for LTC nursing leadership and oversight. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure residents, or resident representatives, had the right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives or treatment options, and to choose the alternative or option he or she preferred. Specifically, the facility failed to document that the resident or resident representative was able to accept or decline the initiation or continued use of the psychotropic medication (any chemical substances that affect brain function, altering a person's mood, thought, perceptions, or behavior) after receiving information about the risks, benefits, and alternatives for 3 residents (#'s 2, 6, and 9), out of 5 residents reviewed for unnecessary medications. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure the MDS (Minimum Data Set, a federally required nursing assessment) quarterly review requirements for 2 residents (#'s 6 and 7), out of 5 residents were followed. Specifically, the facility failed to complete quarterly review assessments at least every 92 days from the last assessment of any type. This failed practice placed the residents at an increased risk for improper monitoring of decline and/or progress over time and inadequate care and services to maintain their highest practicable well-being.

Inspectors wroteBased on record review and interview, the facility failed to ensure physicians consistently assessed residents in person at least once every 60 days for all residents (based on a census of 7). This failed practice placed all residents at risk for delayed identification of changes in medical condition and unmet medical care needs.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Medical Director(MD) fulfilled responsibilities for oversight and coordination of medical care in the facility. Specifically, the MD did not provide adequate oversight to ensure physician compliance with required visits. This failed practice placed residents at risk for unmet medical needs, delayed medical treatment, and diminished quality of care.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure correct medication labeling for two residents (#s 5 and 7) out of seven sampled residents. Specifically, the facility failed to ensure: 1) medications were labeled according to physician's order and 2) contained an expiration date. These failed practices placed all residents at risk of adverse effects and complications from receiving incorrect dosage and an expired medication.

Inspectors wroteBased on record review and interview, the facility failed to ensure the medical record included documentation of the education provided to the resident or resident representative (RR) regarding the Influenza and Pneumococcal immunizations benefits and potential side effects before signing or declining the vaccine administration for five residents (#s 3; 4; 5; 7; and 8) out of five residents reviewed. This failed practice had the potential to affect all residents (based on census of seven) who were residing in the facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure the medical record included documentation of education provided to the resident or resident representative (RR) regarding the COVID-19 immunization benefits and potential side effects before signing or declining the vaccine administration for four residents (#s 3; 4; 5; and 7) out of five residents reviewed. This failed practice had the potential to affect all residents (based on census of seven) who were residing in the facility.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure one resident (#5) out of seven sampled residents was provided care in a manner that promoted dignity and respect. This failed practice placed the resident at risk of poor self-esteem and/or self-worth and a potential for poor quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one resident (#3) out of seven sampled residents, with a known food allergy, received a diet free of identified allergens. Specifically, the facility failed to verify ingredients in a newly introduced menu item, resulting in Resident #3 being served and consuming pineapple, an identified allergen. This failed practice placed Resident #3 at risk for allergic reactions and adverse health outcomes.

Inspectors wroteBased on observation and interview, the facility failed to ensure daily nurse staffing information posted in the facility was maintained for 18 months. This failed practice had the potential to provide limited transparency regarding staffing levels, affecting all residents (based on a census of 7 residents) and visitors' ability to evaluate the adequacy of nursing care provided.

Inspectors wroteBased on observation and interview, the facility failed to post, in a clear and readable format, the facility name, daily total number of staff and the actual hours worked by Certified Nurse Aides (CNAs), and Registered Nurses (RNs). This failed practice denied the residents and/or resident representatives accurate information about staffing and the facility's ability to provide care to all residents (based on a census of 10).

Inspectors wroteBased on observation, and interview, the facility failed to ensure expired medical products were removed from the medication storage cabinet. This failed practice placed the residents, who required these products for services (based on a census of 10), at risk of adverse effects or complications from use of expired products.

Inspectors wroteBased on record review and interview, the facility failed to comprehensively assess 1 resident (#9) out of 8 sampled residents using the Resident Assessment Instrument 3.0 Minimum Data Set (MDS, a federally required nursing assessment for long term care residents). Specifically, a medically necessary trunk restraint was not coded in the most recent quarterly assessment. This failed practice placed the resident at risk for inconsistent care.

Inspectors wroteBased on record review, interview, and observation, the facility failed to develop an individualized care plan that addressed resident's care needs. Specifically, the facility failed to develop a care plan to address the resident's edema (swelling caused by excess fluid trapped in tissues) for 1 resident (#10) out of 8 sampled residents. This failed practice placed the resident at risk for not receiving necessary care and services to address the individual's needs.

Inspectors wroteBased on record review and interview, the facility failed to ensure 1 resident (#3) out of 2 residents investigated for wander guards (as system used to detect residents who wander close to certain doors), received monitoring of its functionality. Specifically, the facility failed to check the wander guard battery according to the manufacturer's instruction manual. This failed practice placed the resident at risk for potential elopement.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure 1 resident (#2) out of 5 residents observed for medication administration was free from unnecessary medications. Specifically, the facility failed to write administration parameters on a laxative (Miralax - a medication to treat constipation). This failed practice had the potential to place the resident at risk of being improperly medicated.