Regency Health and Rehabilitation Center

Inspectors wroteBased on observation, staff interview, facility documentation review and clinical record review, the facility failed to prevent pressure sore formation, for one resident (Resident #3) in a sample of 3 residents. For Resident #3 the facility failed to provide consistent and accurate skin care assessments, provide available prevention techniques, wound care monitoring, and treatment for Resident #3 who suffered an avoidable sacral pressure ulcer.

Inspectors wroteBased on staff interview and clinical record review, the facility staff failed to maintain a complete and accurate clinical record for one Resident (Resident #3) in the survey sample of 3 Residents.

Inspectors wroteBased on observation, staff interview, and facility documentation review, the facility staff failed to ensure the posting of nurse staffing information on the nursing unit.

Inspectors wroteBased on staff interview, clinical record review, and review of facility documents, the facility staff failed to ensure the care plan was revised for 1 of 8 residents reviewed for code status. The care plan did not accurately indicate the correct code status of the resident (Resident #1), in the survey sample.

Inspectors wroteBased on staff interview, clinical record review, and review of facility documents, the facility staff failed to follow the professional standards of quality regarding documentation for 1 of 8 residents (Resident # 1 ), in survey sample.

Inspectors wroteBased on resident interview, staff interview, clinical record review, and review of facility documents, the facility's staff failed to provide supervision for a dependent resident who rolled off of the bed causing pain and discomfort for 1 of 8 residents (Resident #3), in the survey sample.

Inspectors wroteBased on information obtained during the as worked nursing schedule nursing staff, the facility staff failed to staff a Registered Nurse (RN) for at least 8 consecutive hours a day, 7 days a week which could potentially affect all residents. The facility staff failed to staff a Registered Nurse (RN) for at least 8 consecutive hours a day, 7 days a week.

Inspectors wroteBased on observation, staff interview, and facility document review, the facility staff failed to provide Registered Nurse coverage 8 consecutive hours per day for 9 days out of 32 days sampled.

Inspectors wroteBased on staff interview, facility documentation review, and clinical record review, the facility staff failed notify the responsible party of a change in condition for one resident (Resident # 154 ) in a survey sample of 23 residents.

Inspectors wroteBased on staff interview, clinical record review, and facility documentation review, the facility staff failed to provide care and services in accordance with professional standards of medication administration for 2 residents, Residents #204 and #33, in a survey sample of 23 residents.

Inspectors wroteBased on observation, staff interview, and facility documentation, the facility staff failed to appropriately label medication with accepted professional principles in 1 of 2 medication carts.

Inspectors wroteBased on observation, staff interview, and facility documentation, the facility staff failed to maintain infection control practices and perform the required reporting of a communicable disease in accordance with the Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health guidelines.

Inspectors wroteBased on interview, clinical record review and facility documentation, the facility staff failed to ensure residents are free from misappropriation of property for 1 Resident (Resident #1) in a survey sample of 2 Residents.

Inspectors wroteBased on observation, interview, and clinical record review the facility staff failed to provide medication administration that meets professional standards of care for 1 of 2 medication carts.

Inspectors wroteBased on interview, clinical record review, and facility documentation the facility staff failed to provide pharmaceutical services to include procedures that assure the accurate reconciliation and accounting for all controlled medications for 1 Resident (Resident #1) in a survey sample of 2 Residents.

Inspectors wroteBased on observation, interview, facility documentation and clinical record review, the facility staff failed to provide routine medications to 4 Residents (#'s 8, 36, 51, and 26) in a Survey sample of 21 Residents.

Inspectors wroteBased on observation, staff interviews, and facility documentation review, the facility staff failed to label and date a biological in accordance with currently accepted professional principles which was located in one out of one medication rooms. Specifically, an opened multi-dose vial of tuberculin purified protein derivative was observed undated in the medication room refrigerator on 07/15/2021. On 07/15/2021 at 9:30 A.M., this surveyor and Licensed Practical Nurse A (LPN A) observed an opened box of tuberculin purified protein derivative. There were two dates handwritten on the box: 06/21/21 and 07/13/21. Inside the box, an opened vial of tuberculin purified protein derivative was observed. There was a clear solution in the vial and LPN A verified there was no handwritten date or initials observed on the vial. [...]

Inspectors wroteBased on observation, staff interview, and facility documentation review, the facility staff failed to store food in accordance with professional standards for food safety in 3 of 4 food storage areas. The facility staff failed to label and date prepared food items, opened food items and discard foods that had exceeded the use by date in 3 of 4 food storage areas.

Inspectors wroteBased on observation, Resident interview, staff interview and clinical record review, the facility staff failed to provide services in accordance with professional standards of practice for 2 Residents (Resident #2 and Resident #8), in a survey sample of 21 Residents. 1. For Resident #2 the facility staff failed to document the administration of Byetta insulin as ordered by the physician. The facility staff documented the administration of Bydureon insulin, despite this order being discontinued. 2. For Resident #8 the facility failed to give Oxycodone 20 mg every four hours as ordered by the physician, and failed to document why medications were held.

Inspectors wroteBased on observation, Resident interview, staff interview and clinical record review, the facility staff failed to ensure Residents were free from significant medication errors for 2 Residents (Resident #2 and Resident #8), in a survey sample of 21 Residents. 1. For Resident #2 the facility staff documented the administration of Bydureon insulin three times after it was discontinued. 2. For Resident # 8 the facility failed to give routinely scheduled Narcotic Pain Medicine as ordered by physician to a Resident with a diagnosis of Cancer and is on comfort care.

Inspectors wroteBased on observation, resident interview, staff interview, clinical record review, and facility documentation review, the facility staff failed to accommodate a resident's food preference for 1 resident (Resident #42) in a survey sample of 21 residents. For Resident #42, the facility staff served a pork chop for lunch service with a documented food preference indicating, No Pork.

Inspectors wroteBased on observation, interview, and facility documentation the facility staff failed to maintain an effective pest control program. On 7/13/21 approximately 1:00 PM during initial tour of the facility it was noted that there were small flies or gnats in room [ROOM NUMBER], in the kitchen area, and surveyors also killed 2 or 3 of them in the conference room on 7/13/20. The gnats were seen several times over the 3 days on survey. The Administrator was made aware of the issue on 7/13/21 during the end of day conference and a request to see the pest control log was made. On 7/14/21 at 10:00 AM the pest control logs were reviewed and excerpts are as follows: 7-6-21-The pest Control Company notes the facility is on the Cockroach/ rodent program, large fly program and the ant program. Sanitation issues: location: Kitchen area interior Open since:

Inspectors wroteBased on observations, staff interviews, and facility documentation review, the facility staff failed to store and distribute food in accordance with professional standards for food service safety for the following: 1) There was expired milk in the refrigerator 2) The food in the 'walk-in' fridge and 'walk-in' freezer was not shelved to allow air circulation 3) The internal temperatures for the 'reach-in' fridge, the 'walk-in' fridge, and the 'walk-in' freezer were not being monitored 4) Coffee and milk temperatures were not being monitored 5) There was half-melted ice cream and popsicles in the pantry freezer 6) Handwashing by kitchen staff was not performed according to guidelines

Inspectors wroteBased on observation, staff interview and clinical record review the facility failed to ensure resident rights were implemented for one of 26 residents. (Resident #14) For Resident #14 the facility failed to assist in obtaining a Responsible Party or Power of Attorney for a resident with Dementia and severe cognitive impairment.

Inspectors wroteBased on observation, resident interview, staff interview, and clinical record review, the facility staff failed to determine if it was safe for Resident to self-administer Afrin Nasal Spray for one Resident (Resident #1 ) in a sample of 26 residents.

Inspectors wroteBased on staff interview, clinical record review and facility documentation the facility failed to ensure that a PASARR Screening was done for 1 Resident (#14) in a survey sample of 17 Residents. For Resident #14 the facility failed to ensure PASARR Screening obtained prior to admission.

Inspectors wroteBased on observation, staff interview, family interview, clinical record review and facility documentation the facility failed to develop and implement a comprehensive care plan that is Resident Centered for 1 Resident (#102) in a survey sample of 26 Residents. For Resident #102 the facility failed to address total knee replacement surgical care, hip pin removal, and discharge planning in the comprehensive care plan. The Findings Include: Resident #102 an [AGE] year old woman admitted to the facility on [DATE] with diagnoses of but not limited to Osteoporosis, Hypertension, Diabetes, chronic kidney disease and acute kidney failure. Resident #102 was a new admission and therefore did not have an MDS (Minimum Data Set). On 10/29/2018 the resident observed in bed with Knee Immobilizer in place to Left knee. [...]

Inspectors wroteBased on staff interview, facility documentation review, clinical record review, and during a complaint investigation, the facility staff failed to follow the professional standards of nursing for 1 Resident (Resident #11) in the survey sample of 26 residents. For Resident #11, the facility staff failed to obtain finger stick blood sugar parameters.

Inspectors wroteBased on observation, clinical record review, and staff interview, the facility staff failed to apply hand splints for one Resident, (Resident #30) in a sample of 26 residents. For Resident #30, the facility staff failed to provide hand splints as ordered by the physician.

Inspectors wroteBased on staff interview, clinical record review and facility documentation the facility failed to ensure that 1 Resident (#36) was free from accident/hazard in a survey sample of 26 Residents. For Resident #36 the facility failed to ensure that Resident received adequate supervision to prevent accidental rolling off of bed.

Inspectors wroteBased on observation, staff Interview, and clinical Record Review, the facility staff failed to ensure expired medications were not available for use, for one resident (Resident #32) out of 26 residents in the survey sample. The medication cart had two opened vials of Lantus that were past the expiration date. In addition, a vial of Pneumovax was not dated upon opening.