Pruitthealth-Rockingham

Inspectors wroteBased on observations, record reviews and interviews with the Nurse Practitioner and staff, the facility transferred a resident (Resident #88) with left hip pain after a fall. Resident #88 was diagnosed with a fracture of the left hip. The facility also failed to assess and obtain treatment orders for a skin tear (Resident #9). This deficient practice affected 2 of 2 residents reviewed for professional standards (Resident #88 and Resident #9).

Inspectors wroteBased on record review and staff interviews, the facility failed to maintain documentation of resolved grievances and evidence of the results of all grievances for 9 of 13 months reviewed (December 2023 to August 2024).

Inspectors wroteBased on record reviews, and pharmacist and staff interviews, the facility failed to protect the resident's right to be free from misappropriation of narcotic medications (oxycodone and hydrocodone) prescribed to treat pain. This affected 6 of 6 residents reviewed for misappropriation (Residents #6, #54, #223, #55, #27, and #224.

Inspectors wroteBased on record reviews, Pharmacist, and staff interviews, the facility failed to follow professional standards to prepare and administer medications to residents one at a time and had pre-poured pills in medication cups left on top of a medication cart (D hall) prepared by Nurse #6 for dispensing during the 9:00 PM medication pass. This affected 13 of 27 residents residing on D hall (#40, #226, #228, #58, #54, #227, #223, #225, #7, #36, #224, #55, and #20).

Inspectors wroteBased on record review, observations and staff interviews, the facility failed to honor a resident's choice to receive coffee as requested for 1 of 3 residents reviewed for choices (Resident #10). The reasonable person concept was applied for Resident #10 due to his inability to express his feelings and a reasonable person would feel angry and frustrated if their choices were not met.

Inspectors wroteBased on record review, resident and staff interviews, the facility failed to protect a resident's right to be free from staff to resident abuse when Nurse Aide #1 tilted Resident #10's wheelchair back, let it back down then pushed the wheelchair forcefully down the hall. This was for 1 of 8 residents reviewed for accidents.

Inspectors wroteBased on record review and staff interviews, the facility failed to develop an individualized and comprehensive care plan in the area of anticoagulant medication (Resident #25). This was for 1 of 21 residents whose care plans were reviewed.

Inspectors wroteBased on record review, and Wound Care Practitioner and staff interviews, the facility failed to obtain treatment orders when pressure areas were identified on readmission from the hospital and nursing staff provided treatments without a physician's order. This deficient practice affected 1 of 7 residents reviewed for pressure ulcers (Resident #221).

Inspectors wroteBased on observations, record review, and Pharmacist and staff interviews, the facility failed to label an open and in use insulin pen with the resident's name or prescribing information that was stored in 1 of 2 medication carts (D hall cart) and the facility failed to keep unopened insulin pens refrigerated per manufacturer instructions and discard expired medications in 1 of 2 medication carts (A hall cart).

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure accurate daily Posted Nurse Staffing sheets for 3 of 30 days reviewed (01/24/25, 01/27/25, and 02/07/25).

Inspectors wroteBased on record reviews and staff interviews, the facility failed to complete comprehensive Minimum Data Set (MDS) assessments within the required time frame for 4 of 19 residents selected to be reviewed for Resident Assessments (Residents #20, #178, #180 and #182).

Inspectors wrote5. Resident #18 was admitted to the facility on [DATE]. A review of Resident #18's most recent quarterly MDS was dated 10/1/2023. The electronic medical record indicated the assessment was in process and had not been completed. On 11/15/23 at 9:56 AM, an interview occurred with MDS Nurse #1 who stated the quarterly MDS assessment for Resident #18 had not been completed in the time frame required. She stated there had been an ongoing issue with the former Social Worker not completing her areas of the MDS assessment in the required time frame. MDS Nurse #1 stated she made the Administrator aware. MDS Nurse #1 stated the facility was currenly working to transmitt all past due assessments. [...]

Inspectors wroteBased on record review and staff interviews, the facility failed to transmit a discharge Minimum Data Set (MDS) assessment within the required timeframe for 1 of 3 residents reviewed for discharge. (Resident #33).

Inspectors wroteBased on observation, record review, Nurse Practitioner and staff interviews, the facility failed to provide care and maintenance, such as flushing the PICC line and changing the dressing to Resident #179's Peripherally Inserted Central Catheter (PICC) line. This occurred for 1 of 1 resident (Resident #179) reviewed for surgical wounds.

Inspectors wroteBased on record review and staff interviews, the facility failed to code the Minimum Data Set (MDS) accurately in the area of weight loss. This was for 1 (Resident #14) of 19 residents assessments reviewed.

Inspectors wroteBased on record review, interviews with staff and previous Social Worker (SW), the facility failed to revise a care plan in the area of advanced directives for 1 of 19 residents (Resident #77) reviewed.

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately transcribe the physician order for a protective skin covering (Resident #71) for 1 of 1 resident reviewed for skin impairments.

Inspectors wroteBased on record review, interviews with staff and Social Worker (SW), the facility failed to have complete and accurate medical records in the area of social services for 2 of 3 residents (Resident #77, Resident # 51) reviewed for closed records.

Inspectors wroteBased on record review, interviews with staff and previous Social Worker (SW), the facility failed to complete a referral to hospice for 1 of 3 residents (Resident #77) reviewed for closed records.

Inspectors wroteBased on record reviews, observations, resident, and staff interviews, the facility's Quality Assurance and Performance Improvement (QAPI) committee failed to maintain implemented procedures and monitor interventions the committee put into place following the annual recertification surveys conducted on 3/26/2021 and 8/31/2022 and during a complaint investigation conducted 5/24/2023. This was for 2 deficiencies that were cited in the area of accurate assessments and care plan revision. The deficient practice areas were recited on the current recertification and complaint survey on 11/16/2023. The duplicate citation of F641 during four federal surveys and F657 during two consecutive federal surveys of record shows a pattern of the facility ' s inability to sustain an effective QAPI program.

Inspectors wroteBased on record review and staff interviews, the facility failed to ensure annual dementia training was completed for 2 Nursing Assistants (NA #1 and NA #2) of 5 reviewed for staffing.