Redmont Health and Rehabilitation Center

Inspectors wroteBased on record review, interview and a facility policy titled Medicare Advanced Beneficiary Notice, the facility failed to ensure Resident Identifier (RI) # 13, RI #22, and RI #125 were issued a Notice of Medicare Non-Coverage (NOMNC) (CMS 10123). This affected three of three Skilled Nursing Facility (SNF) Beneficiary Protection Notices reviewed. Findings Include: A review of a facility policy titled Medicare Advanced Beneficiary Notice, dated April 2021 documented: .2. If the resident's Medicare Part A benefits are terminating for coverage reasons, the director of admissions or benefits coordinator issues the Notice of Medicare Non-Coverage (CMS form 10123) to the resident at least two calendar days before Medicare covered services end . RI # 13 was admitted to the facility on [DATE]. RI # 22 was admitted to the facility on [DATE] and readmitted on [DATE]. [...]

Inspectors wroteBased on interview, record reviews, and review of Centers for Medicare & Medicaid Services (CMS)Long-Term Care Facility Resident Assessment Instrument 3.0 User ' s Manual, the facility failed to ensure Resident Identifier (RI) #23's Quarterly Minimum Data Set (MDS) dated [DATE] and RI #32's Annual MDS dated [DATE] were accurately coded to reflect RI #23's, and RI #32's active/current diagnoses. This affected two of 19 sampled residents for whom MDS assessments were reviewed. Findings Include: A review of the Centers for Medicare & Medicaid Services Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual Version 1.17.1, dated October 2019, revealed: . SECTION I: ACTIVE DIAGNOSES Intent: [...]

Inspectors wroteBased on interview, record review and review of a facility policy admission CRITERIA, the facility failed to ensure a Level II evaluation for Resident Identifier (RI) #58 was completed as indicated when the Level I screening determined a Level II was necessary. This affected Resident Identifier (RI) #58 one of two residents sampled for Pre-admission Screening and Resident Review (PASARR). Findings Include: A review of a facility policy with a revised date of December 2016 titled admission CRITERIA revealed . Policy Interpretation and Implementation . 8. Nursing and medical needs of individuals with mental disorders or intellectual disabilities will be determined by coordination with the Medicaid Pre-admission Screening and Resident Review program (PASARR) to the extent practicable. [...]

Inspectors wroteBased on Record review, interview and a facility policy titled Care Plans, Comprehensive Person-Centered, the facility failed to ensure a care plan was developed for Resident Identifier (RI) #1 when he/she was prescribed an anticoagulation medication. This affected one of two residents sampled for the use of anticoagulation (AC) medication. Findings Include: A review of a policy titled Care Plans, Comprehensive Person-Centered with a revised date of December 2016 documented: . A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. RI #1 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include acute respiratory failure with hypoxia, COVID-19 and Cerebral Palsy. [...]

Inspectors wroteBased on observations, interviews, and review of a facility policy titled Cleaning and Disinfection of Environmental Surfaces, the facility failed to ensure: 1. Resident Identifier (RI) #54's mattress did not have a large smear of a brown substance covered by a sheet and 2. RI #34's side rail was free of a dried brown substance for two days. These observations were made on days one and two of the survey and affected two of 24 residents whose enviroment was observed.

Inspectors wroteBased on record reviews, interview, and review of a facility policy titled In-Service Training Program, Nurse Aide , the facility failed to ensure Certified Nursing Assistants received annual dementia management training. This affected two of three Certified Nursing Assistants (CNA)s, Employee Identifier (EI) #11 and #12, whose training records were reviewed. Findings Include: A review of a facility policy title In-Service Training Program, Nurse Aide revealed . Policy Statement All nurse aide personnel shall participate in regularly scheduled in-service training classes . 3. Annual in-service must : . f. Include training in dementia management and abuse prevention. On 12/12/19 the surveyor reviewed Continuing Education records for the facility CNAs. Upon review no in-service was noted for dementia management training for EI #11 and #12. [...]

Inspectors wroteBased on interviews, record review, and facility policies titled Antipsychotic Medication Use and Behavioral Assessment, Intervention, and Monitoring, the facility failed to ensure: Resident Identifier (RI) #38 did not receive Seroquel, an anti-psychotic medication, without adequate monitoring including observation for side effects, effectiveness, and a baseline Abnormal Involuntary Movement Scale (AIMS). This affected one of five residents sampled for anti-psychotic medication usage. Findings Include: A facility policy titled Antipsychotic Medication Use, with a revised date of December 2016 revealed . Policy Interpretation and Implementation . 16. The staff will observe, document, and report to the Attending Physician information regarding the effectiveness of any interventions, including antipsychotic medications. 17. [...]

Inspectors wroteBased on record review, interviews, and a facility policy titled Antipsychotic Medication Use, the facility failed to provide continued medical justification and indicated duration for as needed lorazepam for Resident Identifier (RI) #48 and RI #70. This affected two of six residents whose medical record was reviewed for as needed psychotropic medications. Findings Include: A facility policy titled Antipsychotic Medication Use, with a revised date of December 2016 revealed . Policy Interpretation and Implementation . 14. The need to continue PRN (as needed) orders for psychotropic medications beyond 14 days requires that the practitioner document the rationale for the extended order. The duration of the PRN order will be indicated in the order . 1) RI #48 was admitted to the facility on [DATE] and re-admitted on [DATE]. [...]

Inspectors wroteBased on observation and interviews, the facility failed to ensure the box that contained the controlled Lorazepam (Ativan) was permanently affixed in the medication refrigerator in the Station 2 medication room. This was observed on 12/12/19 and affected one of two medication room refrigerators observed for stored medications. Findings Include: On 12/12/19 at 10:10 AM, the surveyor observed the medication room at station 2 with Employee Identifier (EI) #7, Licensed Practical Nurse. The surveyor asked what was stored in the refrigerator. EI #7 replied, medications only. EI #7 opened the locked refrigerator; the surveyor asked if there was stock Ativan in the refrigerator. EI #7 replied, yes and removed the locked box from the bottom shelf. The surveyor asked what was in the box. [...]

Inspectors wroteBased on observations, interviews and review of the 2017 U.S. (United States) Public Health Service Food Code, the facility failed to ensure: (1) a container of sliced dill pickles, mayonnaise, dill relish pickles, mustard, jelly and barbeque sauce in the walk-in-cooler contained a use by date; this was observed on 10/29/18, during the initial tour of the kitchen; (2) dented cans in the dry storage were not stored with the other canned food items; this was observed on 10/29/18, during the initial tour of the kitchen; and (3) dust was not on the fan on the back of the oven and on the pipes and sprinkler heads over the serving area; this was observed on two of four days of the survey. These deficient practices had the potential to affect all 90 residents receiving meals from the kitchen. According to the facility's RESIDENT CENSUS AND CONDITION OF RESIDENTS form, the census was 108. [...]

Inspectors wroteBased on observations, interviews and a facility policy titled, Quality of Life-Dignity, the facility failed to ensure staff did not conduct a social conversation with another staff while feeding RI (Resident Identifier) #96 during the lunch meal on 10/31/18. This deficient practice affected RI#96, one of nine residents who required assistance with meals. Findings Include: A review of a facility policy titled, Quality of Life-Dignity with a revised date of August 2009 documented: . Each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect and individuality . RI #96 was admitted to the facility on [DATE] with a diagnosis of Unspecified Dementia with Behavioral Disturbance. On 10/31/18 at 1:12 p.m., the surveyor observed EI (Employee Identifier) #2, a LPN (Licensed Practical Nurse), feeding RI #96 during the lunch meal on 10/31/18. [...]

Inspectors wroteBased on interview and a document review of the SNF (Skilled Nursing Facility) Beneficiary Protection Notification Review, the facility failed to ensure RI ( Resident Identifier) #63 and RI #84 were issued a Medicare Coverage/Liability Notice. This deficient practice affected two out of three SNF Beneficiary Protection Notices reviewed. Findings Include: RI #63 was admitted to the facility on [DATE]. RI #84 was admitted to the facility on [DATE]. On 11/01/18 at 4:36 p.m., a SNF Beneficiary Protection Notification review was conducted. There was no evidence that RI #63 and RI #84 were issued a SNF, ABN(Advance Beneficiary Notice of Non-Coverage) letter which was required. On 11/01/18 at 4.59 p.m., an interview was conducted with EI (Employee Identifier) #1, Regional Business Office Consultant. EI #1 was asked if RI #63 and RI #84 were given a SNF-ABN letter. EI #1 said, No. [...]

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure: (1) the right arm rest on Resident Identifier (RI) #35's wheelchair (W/C) was not torn; (2) the arm of RI #66's recliner chair was not torn/ripped; and (3) the right arm rest on RI #78's Geri chair was not torn/ripped. These deficient practices affected RI #'s 35, 66 and 78, three of 34 sampled residents who used a recliner chair, W/C or Geri chair. Findings Include: 1) RI #35 was admitted to the facility on [DATE], and readmitted on [DATE]. RI #35's Quarterly Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 08/22/18, revealed RI #35 used a W/C for mobility. On 10/30/18 at 7:45 a.m., the surveyor observed RI #35 sitting in a W/C. The left arm rest of the W/C was torn. On 10/31/18 at 7:30 a.m., the surveyor again observed RI #35 sitting in the W/C. [...]

Inspectors wroteBased on observations, interviews, review of the 2018-2019 Fall and Winter Menus and a facility policy titled, MENUS, the facility failed to ensure RI (Resident Identifier) # 19, #34 and #66 received their dessert during the lunch meal on 10/31/18 and RI #13 and RI #22 received their dessert during the dinner meal on 10/31/18. This deficient practice affected five of nine residents observed for meals. Findings Include: A review of an undated facility policy titled, MENUS revealed: POLICY .Menus are implemented by the Dietary Manager .Well planned menus aid in meeting the nutritional and psychosocial needs of the residents . A review of a document titled, .2018-2019 Fall and Winter Menus dated 10/3/18, revealed the dessert for the lunch meal for 10/31/18 was Oatmeal Raisin Cookie and the dessert for evening meal was Fruit Crisp. [...]

Inspectors wroteBased on observations and interviews, the facility failed to ensure the door to the dumpster was not left opened. This was observed on 10/29/18, during the initial tour of the kitchen. This deficient practice had the potential to affect all 108 residents residing in the facility. Findings Include: On 10/29/18 at 5:38 p.m., the surveyor observed the dumpster. The side door on the dumpster was open and three trash bags and a cardboard box with yellow looking gowns on the inside of it was observed. On 11/01/18 at 9:30 a.m., the surveyor conducted an interview with Employee Identifier (EI) #5, Dietary Manager. The surveyor asked EI #5 how should the door on the dumpsters be kept. EI #5 said closed. When asked what was there a potential for when left opened, EI #5 replied pests and rodents could get in the dumpster.