Quyanna Care Center

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure foods were labeled and stored in accordance with professional standards for food service safety for 17 residents (#2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13, #14, #15, #16, #17, #18) out of 17 residents who received meals from the kitchen. Specifically: 1) frozen custom foods were labeled incorrectly; 2) spoiled fruits and vegetables were stored in the cooler; and 3) failure to conduct planned manufacturer's required 6 months maintenance on the kitchen's ice machine. These failed practices placed the residents who received meals from the kitchen at risk of consuming contaminated food and at risk of contracting foodborne illness .

Inspectors wroteBased on record review, observation, and interview, the facility failed to maintain the dignity and respect of 1 resident (#12) out of 18 residents. Specifically, a Certified Nursing Assistant (CNA) used the resident's clothing protector to wipe the resident's mouth while dining. This failed practice undermined the resident's right to a dignified existence and placing the resident at risk of diminished quality of life .

Inspectors wroteBased on record review, observation, and interview, the facility failed to prepare meals by methods that conserve nutritive value and ensure safe and appetizing food temperature for 1 resident (#11) out of 1 resident on a pureed diet. Specifically, 1) the cook did not measure the temperature after pureeing the food, 2) the cook added unmeasured amount of water into the food to be pureed, and 3) the cook did not follow the Simply Thick (a thickening agent) instruction for food and thickener ratio. These failed practices had the potential to compromise or diminish the nutritive value of food and palatability and affect resident's nutritional intake and/or weight loss .

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure complete nurse staffing information for each shift was posted to provide accurate information to all residents (based on a census of 18) and representatives. Specifically, the facility failed to post the total number and actual hours worked by Certified Nursing Assistants (CNAs), Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) per shift. This failed practice provided incomplete information to the residents, families, and other visitors the right to know who were responsible for resident care and the number of residents in their care.

Inspectors wroteBased on interview, observation, and record review, the facility failed to properly label and store drugs and medical supplies. Specifically, the facility failed to ensure: 1) expired medication was removed from 1 medication storage room, out of 1 total medication storage rooms; 2) opened and damaged sterile medical supplies were removed from 1 medication storage room, out of 1 total medication storage rooms; and 3) opened medications were labeled with an expiration date. These failed practices had the potential to place all residents (based on a census of 18) at risk of receiving expired and/or damaged medications and supplies and subsequent adverse effects.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure potentially hazardous foods were stored and labeled accordingly for 17 residents out of 18 residents (total census) who received food from the main kitchen. Specifically, the facility failed to ensure: 1) food was labeled and dated and 2) discard expired food. These failed practices had the potential to place residents at risk of or food borne illness.

Inspectors wroteBased on record review and interview, the facility failed to ensure a competent nursing staff provided nursing services to 1 resident (#119) out of 12 sampled residents in accordance with the physician's order. Specifically, the nurse failed to notify the provider of Resident's high blood glucose levels. This failed practice placed the diabetic resident at risk for delay in treatment and complications.

Inspectors wroteBased on record review, interview, and observation, the facility failed to ensure one Certified Nursing Assistant (CNA) (#7), out of 10 personnel records reviewed, had a valid Cardiopulmonary Resuscitation (CPR) certification. This failed practice placed all residents (based on a census of 18) at risk for not receiving timely CPR or emergency care when needed.

Inspectors wroteBased on record review and interview, the facility failed to ensure accurate medical records were maintained for 1 resident (#14), out of 12 sampled residents. Specifically, the facility failed to ensure the medical diagnoses for Resident #14 reflected his/her actual medical status. This failed practice had the potential to affect the achievement of the Resident's plan of care and goals.

Inspectors wroteBased on observation and interview, the facility failed to provide 2 residents (#s 3 and 10), out of 12 sampled residents a window to the outside within their sleeping room. This failed practice placed the residents at risk for less than optimal living conditions and increased risk for mood changes.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure expired medical products were removed from the medication storage room. This failed practice placed the residents, who required these products for services, out of a census of 17, at risk of complications from use of expired products.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food safety with preparation and distribution. Specifically, the facility failed to ensure temperatures for hot and cold foods were measured prior to service. This failed practice had the potential to affect any resident receiving food served from the kitchen of potentially contracting food-borne illness and affecting the palatability of the food.

Inspectors wroteBased on interview and record review, the facility failed to develop a policy regarding the use and storage of food brought to residents by family and other visitors. This failed practice had the potential to place residents, based on a census of 17, at risk for foodborne illness.

Inspectors wroteBased on record review, observation, and interview the facility failed to ensure a sanitary environment for all residents out of a census of 17. Specifically, the facility failed to ensure: 1) glove changes/hand hygiene with wound care; 2) appropriate hand hygiene with resident cares; 3) cleanliness of reusable medical equipment; and 4) cleanliness of the dining area. These failed practices had the potential to increase the development and transmission of communicable diseases and infections.

Inspectors wroteBased on record review and interview, the facility failed to provide behavioral health training consistent with the facility assessment in regards to psychosocial difficulties and history of trauma. This failed practice had the potential to exacerbate or trigger ongoing psychosocial difficulty and affect the residents' ability to attain the highest practicable mental and psychosocial well-being.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure a culture where residents were treated with dignity and respect for 2 residents (#'s 1 and 12) out of 17 residents. This failed practice placed the residents at risk for psychological harm from feelings of poor self-esteem and/or self-worth and a potential for a poor quality of life.

Inspectors wroteBased on record review and interview, the facility failed to obtain informed consent for psychotropic medications (medications in the class of either antipsychotics, antianxiety, or antidepressants that would have affected behavior, mood, thoughts, or perception) prior to use for 3 residents (#'s 7, 12 and 16) out of 5 residents reviewed for unnecessary medications. This failed practice denied the resident the right to consent to medications and be informed of the risk and benefits for medication use.

Inspectors wroteBased on record review and interview, the facility failed to ensure care plans were individualized to meet the psychosocial needs for 2 residents (#'s 7 and 16), out of 8 sampled residents. Specifically, trauma informed care interventions were not included in the care plans. This failed practice placed the residents at risk for not receiving necessary services to address their individual needs to attain or maintain their highest practicable well-being.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents that wore a wander guard received adequate supervision and monitoring. This failed practice placed 4 residents (#s 12, 4, 8, and 11) out of 4 residents reviewed for wander guard, at risk for potential elopement.

Inspectors wroteBased on record review and interview, the facility failed to ensure drug regimens/medication orders included an indication and/or diagnosis for 4 residents (#'s 3, 7, 11 and 12) out of 8 sampled residents. This failed practice had the potential to place residents at risk for medication errors and adverse effects.

Inspectors wroteBased on record review, and interview the facility failed to ensure baseline care plans were initiated within 48 hours of admission for 2 residents (#'s 16 and 17), out of a census of 17. This failed practice placed the residents at risk for not receiving necessary care and services.

Inspectors wroteBased on record review, observation and interview, the facility failed to ensure nursing staff were provided the appropriate competencies and skill sets to provide nursing care and related services to 3 residents (#'s 3, 11, and 16) out of census of 17 residents. Specifically, the facility failed to ensure: 1) staff had training and competency regarding medication administration assessments; and 2) staff were able to interpret medication order abbreviations. These failed practices placed all residents at risk of receiving inaccurate medication dosages.

Inspectors wroteBased on record review, observation and interview, the facility failed to ensure medication order dosing was clear and accurate for 1 resident (#11) out of 8 sampled residents. Specifically, the facility failed to accurately document the dosage of an antipsychotic medication in the physician's order. This failed practice had the potential to place the resident at risk for adverse medication outcomes related to receiving more or less than the intended/ordered dose.