Rayville Nursing and Rehabilitation

Inspectors wroteBased on observations and interviews, the facility failed to maintain a safe, clean, comfortable and homelike environment for 2 (#12 and #45) of 2 residents reviewed for environment, and by having an area in the kitchen that was in need of repair. The failed practice was evidenced by having an air conditioner and a wheelchair that was in need of repair, and by having a part of the wall missing in the kitchen behind the three-compartment sink.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure an accurate assessment was completed for 3 (#2, #4, and #8) of 3 (#2, #4, and #8) residents reviewed for physical restraints. The failed practice was evidenced by Residents #4 and #8 having an inaccurate assessment related to the use of bed rails. Resident #2 had an an inaccurate assessment related to the use of bed rails and a pommel cushion.

Inspectors wroteBased on record reviews and interviews, the facility failed to implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet the resident's needs by not having documentation of meal percentage intakes for 1 (#55) of 3 (#2, #47 and #55) residents reviewed for nutrition.

Inspectors wroteBased on observations and interviews the facility failed to ensure each resident environment remains as free of accident hazards as is possible for 1 (#36) of 4 (#8, #10, #33, #36) residents reviewed for accident hazards. The facility failed to ensure the water temperature in Resident #36's bathroom was not greater than 120 degrees Fahrenheit.

Inspectors wroteBased on observation and record review the facility failed to provide care and services that is in accordance with physician's orders and facility policy for 1 (#35) of 1 resident reviewed for respiratory care by not ensuring the nebulizer and tubing were changed weekly.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure a resident who is unable to carry out activities of daily living received the necessary services to maintain good personal hygiene for 4 (#17, #23, #29 and #44) of 6 (#17, #22, #23, #28, #29, #44) residents reviewed for Activities of Daily Living (ADL) care. The facility failed to ensure 1.) residents' fingernails were kept clean and trimmed for #17, #23, #29 and #44 , and 2. resident #23 received oral hygiene and grooming.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide, based on the comprehensive assessment, care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities for 4 (#1, #23, #29 and #43) of 5 (#1, #23, #29, #30, and #43) residents reviewed for activities.

Inspectors wroteBased on record reviews, observations, and interviews, the facility failed to ensure residents were assessed for the risk of entrapment from bed rails and received a written order from the physician for bed rails prior to installation for 6 (#1, #16, #17, #23, #29, and #30) of 6 (#1, #16, #17, #23, #29, and #30) residents reviewed for accident hazards.

Inspectors wroteBased on observations and interviews, the facility failed to store, distribute, and serve food in accordance with professional standards with food service safety by: 1) having opened food items stored in the freezers, exposed to air and not being labeled with an opened date, 2) having dirt and grime buildup in the kitchen and 3) storing employee personal items in the food preparation area.

Inspectors wroteBased on observations and interviews, the facility failed to maintain all mechanical equipment in safe operating condition by having: 1.) a microwave in the secured unit that contained rust and 2.) a deep fryer located in the kitchen that contained dust and grime.

Inspectors wroteBased on record review, observation, and interviews, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice by failing to administer eye drops as ordered for 1 (#32) of 1 (#32) residents reviewed for vision.

Inspectors wroteBased on record review, observations, and interviews, the facility failed to ensure that a resident who needs respiratory care is provided such care, consistent with professional standards of practice and the comprehensive person-centered care plan for 1 (#42) of 2 (#10 and #42) residents reviewed for respiratory care. The facility failed to ensure resident #42 was administered oxygen via nasal cannula per the physician's orders.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure that the resident's environment remains as free of accident hazards as is possible and each resident receives adequate supervision to prevent accidents for 2 (#35, #36) of 6 (#10, #19, #27, #31, #35, #36) sampled residents that were ambulatory with or without assistive devices, according to a list provided by S2Director of Nursing (DON).

Inspectors wroteBased on record review and interview the facility failed to ensure the pharmacist must report any irregularities to the attending physician, the facility's medical director, and director of nursing, and these reports must be acted upon for 1 (#32) of 5 (#5, 10, 31, 32, and 149) residents reviewed for unnecessary medications. The pharmacist failed to address that resident #32 did not receive sliding scale insulin as ordered.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure that each resident's drug regimen was free from unnecessary drugs for 2 (#32, #149) of 5 (#5, #10, #31, #32, #149) sampled residents reviewed for unnecessary medications. The facility failed to ensure the nurses followed the residents' insulin sliding scale parameters as ordered.

Inspectors wroteBased on observations and interviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. This deficient practice had the potential to affect the 44 residents that received meals prepared in the facility's kitchen.

Inspectors wroteBased on observations and interviews, the facility failed to maintain an infection prevention and control program to provide a sanitary environment to help prevent the development and transmission of communicable diseases and infections. This deficient practice had the potential to affect all 47 residents who currently received laundry services provided by the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the resident has the right to make choices about aspects of his or her life in the facility that are significant to the resident for 1 (#24) of 1 (#24) residents investigated for choices, by failing to ensure resident #24 received a whirlpool bath every Monday, Wednesday, and Friday, in accordance with resident #24's personal choices.

Inspectors wroteBased on observation of medication administration, record review, and interview, the facility failed to ensure the medication error rate are not 5% or greater. The facility had an 11.54% medication error rate with 3 medication errors for 1 (#26) of 2 (#13 and #26) residents observed for medication administration. The facility had 3 medication administration errors out of 27 opportunities. The facility's current census was 47 residents.