Ranch House Senior Living LLC

Inspectors wroteThe facility reported a census of 36 residents. The 12 sampled residents included three dependent residents reviewed for activities of daily living (ADLs). Based on observation, interviews, and record review the facility failed to provide bathing opportunities and grooming of facial hair in accordance with the residents' preferred bathing schedule to ensure necessary services to maintain good personal hygiene for Resident (R)5 and R9. This placed the residents at risk for impaired dignity and poor hygiene.

Inspectors wroteThe facility identified a census of 36 residents, with 12 residents sampled, including two residents reviewed for pressure ulcers (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction). Based on observation, interview, and record review, the facility failed to identify and implement measures consistent with in accordance with professional standards of practice to prevent the development of and promote the healing of pressure ulcers for Resident (R) 34 when staff failed to ensure R34's heels were offloaded and failed to develop a consistent repositioning plan. The facility further failed to ensure R24 received the required interventions including a low air loss mattress to prevent pressure ulcers. [...]

Inspectors wroteThe facility reported a census of 36 residents with 12 residents in the sample and seven residents reviewed for accidents. Based on observation, interview, and record review, the facility failed to provide an environment free from accident hazards for two residents. The facility failed to complete an investigation to determine causative factors and implement interventions to prevent further falls for Resident (R) 24. This failure placed the affected resident at risk for further falls, accidents, and related injuries.

Inspectors wroteThe facility reported a census of 36 residents, with 12 residents selected for review which included six residents reviewed for unnecessary medications. Based on observation, interview, and record review, the facility failed to ensure the residents remained free from unnecessary medications when the facility failed to follow physician orders related to blood pressure monitoring and related parameters for three residents, Resident (R)10, R25, and R9. This placed the resident at risk for adverse medication effects.

Inspectors wroteThe facility reported a census of 36 residents with 12 residents selected for review which included six residents reviewed for unnecessary medications. Based on observation, interview, and record review, the facility failed to complete an industry-accepted assessment for abnormal movements related to antipsychotic (class of medications used to treat major mental conditions that cause a break from reality) use for Resident (R) 24 who received Zyprexa (antipsychotic). This deficient practice placed the affected resident at risk for adverse effects associated with the use of psychotropic (alters mood or thoughts) medications.

Inspectors wroteThe facility reported a census of 45 residents. The sample included 15 residents reviewed for misappropriation and exploitation. Based on interview and record review, the facility failed to ensure Resident (R)1 remained free from misappropriation of funds, when housekeeping staff I exploited the resident of approximately $100.00. This deficient practice placed R1 at risk for a negative psychosocial impact in safety and security.

Inspectors wroteThe facility reported a census of 50 residents, with 13 residents included in the sample, including two residents reviewed for accidents. Based on observation, interview, and record review the facility failed to prevent a fall with fracture for cognitively impaired Resident (R)35 when staff did not assess for the safe use of an electric lift chair. On 07/15/23, staff found R35 on the floor in front of her fully raised electric lift chair and required transfer to the emergency room where R35 was diagnosed with a fractured (broken) clavicle (collar bone). The facility further failed to implement the immediate fall prevention intervention related to the fall with fracture, for at least 10 days, when staff did not remove the electronic lift chair, leaving the resident at risk for continued falls from the chair.

Inspectors wroteThe facility census totaled 50 residents with one central kitchen. Based on observation, interview, and record review the facility failed to store, prepare and serve foods safely and in a sanitary manner which included failure to date and reseal open food items in the refrigerator and freezer; failure to clean and disinfect the food thermometer while taking the temperature of food items; and failure to use gloves appropriately when handling/serving of food. This had the potential to affect all 50 residents receiving meals from the kitchen. Findings Included: - On 07/25/23 at 12:30 PM, initial tour of the kitchen revealed the following items: The walk-in refrigerator contained a raw meat patty in a baggie with no identification of what it was or a date; cooked hamburger patties in separate bags undated; an open package of cheese slices undated; [...]

Inspectors wroteThe facility reported a census of 50 residents. Based on interview and record review, the facility failed to maintain a quality assessment and assurance committee that consisted at the minimum of the director of nursing services, the medical director or his/her designee, at least three other members of the facility's staff, at least one of who must be the administrator, owner, board member or other individual in a leadership role, and the infection preventionist, as required.

Inspectors wroteThe facility reported a census of 50 residents with 13 residents sampled. Based on observation, interview and record review, the facility failed to maintain an effective infection control program when they failed to provide safe and sanitary care for one Resident (R) 20, regarding his urinary catheter (insertion of a catheter into the bladder to drain the urine into a collection bag), for R3, in regards to incontinent care, R2 in regards to failure to change gloves from dirty to clean during wound care, and failure to change gloves in the kitchen who served food to all of the residents of the facility.

Inspectors wroteThe facility reported a census of 50 residents. Based on interview and record review, the facility failed to maintain an in-service training program for nurses' aides that was appropriate and effective to ensure the continuing competence of nurse aides. Four of five current certified nurse aide records reviewed for the required annual in-service trainings revealed the lack of dementia management training, resident abuse prevention training, and/or social media training, out of the 12 required in-service trainings, to ensure the continuing competence of nurse aides and appropriate care and services to all the residents of the facility.

Inspectors wroteThe facility reported a census of 50 with 13 residents in the sample that included six residents reviewed for unnecessary medications. Based on observation, interview, and record review, the consultant pharmacist failed to identify an unnecessary medication for Resident (R)12, related to an antibiotic that the resident was resistant to. In addition, the facility failed to ensure a system to acknowledge and respond to the consultant pharmacist recommendations for R 21, R 38, R 42, and R 2.

Inspectors wroteThe facility reported a census of 50 residents with 13 residents sampled, including one resident sampled for hospitalization. Based on interview and record review, the facility failed to provide a copy of the facility bed hold policy to Resident (R)38 and/or their representative, with a written notice specifying the duration and cost of the bed hold policy, at the time of the resident's two transfers to the hospital.

Inspectors wroteThe facility census totaled 50 residents with 13 included in the sample. Based on observation, interview, and record review, the facility failed to develop comprehensive care plans for two of 13 residents reviewed for care plans. Resident (R)3 and R20 regarding urinary catheter use and one resident, R12, related to pressure ulcers/wound care.

Inspectors wroteThe facility reported a census of 50 residents with 13 selected for review including three residents reviewed for wounds. Based on observation, record review, and interview, the facility failed to perform an ongoing assessment and treatment of pressure ulcers (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction) and implement interventions to prevent further development of pressure areas for one of the three Residents (R)12.

Inspectors wroteThe facility reported a census of 50 residents, with 13 residents in the sample that included six residents reviewed for unnecessary medications. Based on interview and record review, the facility failed to ensure Resident (R)12 was free from unnecessary medications, when on two occasions, the facility administered an antibiotic medication that she was resistant (the ability not to be affected by something) to.

Inspectors wroteThe facility identified a census of 50 residents. The sample included 13 residents with five reviewed for medications. Based on observation, interview, and record review, the facility failed to implement antibiotic use protocols to avoid unnecessary and/or inappropriate antibiotic use to reduce the risk of adverse events, including antibiotic resistance, when the facility failed to monitor effectiveness and identify inappropriate extended administration of antibiotic administration for Resident (R) 12. This placed the resident at risk for complications related to extended antibiotic use.

Inspectors wroteThe facility reported a census of 42 residents. The facility had one main kitchen where food was stored and prepared serving two dining rooms. Based on observation, interview, and record review the facility failed to properly store food in the main kitchen refrigerator and two nourishment room refrigerators due to the lack of temperature monitoring; failed to discard expired food items; failed to ensure the dishes and cookware were washed under sanitary conditions due to the lack of chemical or temperature monitoring; failed to store clean pots and pans separate from used, soiled pots and pans; failed to use appropriate hand hygiene when handling food; [...]

Inspectors wroteThe facility reported a census of 42 residents with 12 sampled including one for hospitalization. Based on observation, interview, and record review the facility failed to provide a copy of the facility bed hold policy to Residents (R) 12 or her representative for her facility-initiated hospitalizations. Findings Include: - Review of R12's Minimum Data Set (MDS) tracking form dated May 2020 documented the resident discharged to the hospital on [DATE] and returned to the facility on [DATE]. Review of R12's Minimum Data Set (MDS) tracking form dated February 2021 documented the resident discharged to the hospital on [DATE] and returned to the facility on [DATE]. Review of R9's Electronic Health Record lacked evidence of written notification of the facility-initiated hospitalization transfers and bed holds to R12 or her representative. [...]

Inspectors wroteThe facility census totaled 42 residents with 12 residents included in the sample. Based on observation, interview, and record review the facility failed to revise the care plan related to the use of psychotropic medications (Haldol/Haloperidol/Remeron) for Resident (R)40.

Inspectors wroteThe facility reported a census of 42 residents with 12 residents in the sample and two residents reviewed for accidents. Resident 13, and Resident 30. Based on observations, interview, and record review the facility failed to implement care planned fall prevention measures to include the use of a floor mat at night to prevent falls for Resident (R) 13 and failed to ensure staff monitoring the wander guard bracelet for R30 every shift to prevent a potential elopement.

Inspectors wroteThe facility census totaled 42 residents with five residents reviewed for unnecessary medications. Based on observation, interview, and record review the facility failed to ensure the physician was notified when parameters for blood sugars were exceeded for Resident (R)3 and R40.

Inspectors wroteThe facility census totaled 42 residents with five residents reviewed for unnecessary medications. Based on observation, interview, and record review the facility failed to ensure an appropriate diagnosis for the use of antipsychotic medications (Haldol/Haloperidol) for R40 and failed to ensure the staff did not administer as needed (PRN) longer than 14 days without a renewed physicians order or reason provided by the physician for the continued administration of Haldol on a PRN basis.