Rehabilitation Center of Independence, the

Inspectors wroteBased on interview and record review, the facility failed to prevent misappropriation for one sampled resident (Resident #4) when Social Services Director (SSD) used the resident's debit card to pay his/her personal cell phone bill in the amount of $350.00 out of seven sampled residents. The facility census was 121 residents. On 1/28/26 the Administrator and Director of Nursing were notified of past non-compliance which occurred on 1/21/26. On 1/21/26 the facility Administrator was notified of the incident and the investigation was started. No employees were allowed to work prior to reeducation completed 1/21/26. SSD was terminated on 1/22/26. The deficiency was corrected on 1/22/26. Review of the facility's Abuse Prevention and Prohibition Program dated 10/24/22 showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident's physician was notified of all injuries sustained after a fall for one sampled resident (Resident #1) out of eight sampled residents. The facility census was 118 residents. Review of the facility Fall Evaluation and Prevention Policy dated 8/2020 showed: -Following a fall, the following steps should be undertaken: --Evaluate the resident promptly in order to identify and treat injuries. --Monitor closely for indications of pain or discomfort in any areas, reddened or discolored areas or other signs of injury. Review of the facility Change of Condition Notification Policy dated 6/2020 showed: -To ensure residents, family, legal representatives, and physicians are informed of changes in the residents condition in a timely manner. [...]

Inspectors wroteBased on interviews and a review of medical records, the facility failed to identify and implement the necessary care and services to address the needs of diabetic residents. Specifically, facility staff failed to: 1. Recognize and appropriately respond to signs and symptoms of hyperglycemia, such as changes in mental status, feelings of anger, excessive hunger, excessive thirst, and frequent urination. 2. Implement blood glucose monitoring as ordered by the medical provider. Failed to transcribe and/or verify insulin orders and blood glucose monitoring with the physician upon admission. 3. Administer insulin as ordered by the medical provider resulting in the resident becoming physically and verbally combative, excessively hungry, resulting in hypoglycemia and a blood sugar of 541. [...]

Inspectors wroteBased on interviews, and record review, facility leadership failed to maintain adequate nursing staffing, as established by the facility's leadership, to provide appropriate nursing care and services to meet the needs of residents. This deficient practice had the potential to affect all residents living in the facility.

Inspectors wroteBased on resident interviews, a resident council meeting, observations, and an observation of a test tray meal evaluation, the facility failed to provide palatable foods per resident preferences for taste and temperature as evidenced by improper temperatures. This deficient practice had the potential to affect residents residing on four (4) out of five (5) units eating meals from the kitchen.

Inspectors wroteBased on interviews and record review, the facility was unable to provide documentation of regular Quality Assurance Performance Improvement Plan (QAPI) meetings and evidence of participation by the required parties. This affected all facility residents.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure a resident's right to a dignified existence, including being treated with respect during all care interactions for three (3) of three (3) residents observed for dignity (Resident #66, Resident #82 and Resident #39).

Inspectors wroteBased on observation, interviews and record review, the facility failed to appropriately address and resolve grievances raised during previous resident council meetings. Residents voiced specific concerns regarding food, missing laundry items, and not receiving showers over numerous monthly meetings. This deficient practice had the potential to affect all residents who resided in the facility. The census on the first day of survey entrance was 96 residents.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure residents received the necessary nursing care and services for activities of daily living by failing to 1) Provide residents with showers in accordance with bathing schedules for two residents (Resident #2 and Resident #58) and 2) Provide residents requiring assistance with toileting the necessary care and services to transfer on and off the toilet for one (1) of six (6) residents reviewed (Resident #70), and 3) Ensure that two (2) of 36 residents sampled (Resident #39 and Resident #82) were provided with personal hygiene care and/or adaptive eating equipment in accordance with their preference and Care Plans.

Inspectors wroteBased on interviews, credential review and review of facility policy, the facility failed to employ a qualified social worker as mandated for facilities with greater than 120 beds. This failure affected 96 of 96 residents at the facility.

Inspectors wroteBased on observation, interview, record review and review of the facility policy, the facility failed to ensure that residents received wound care in a manner to prevent infections for two (2) of two (2) residents observed for wound care (Resident #26 and Resident #82), and 2) Failed to implement Enhanced Barrier Precautions as indicated by the resident's plan of care for one (1) of three (3) residents reviewed from a total of 36 residents sampled.

Inspectors wroteBased on interviews and facility policy, the facility staff failed to protect the rights of a resident whose room was changed without notice prior to the change for one (1) of one (1) resident reviewed for room changes. Resident #65 left the facility for an appointment and returned to learn his/her belongings had been moved to another room.

Inspectors wroteBased on observation, interviews and record review, the facility failed to ensure appropriate notification following a fall during a transfer for one (1) of 36 residents sampled (Resident #39). Resident # 39 reported falling while being transferred from a wheelchair to the bed by Restorative Nursing Aide (RNA) AA and Maintenance Supervisor. The staff involved did not notify the nurse or physician of the incident, as required. This deficient practice compromised the resident's right to prompt assessment and care and potentially placed the resident at risk for unrecognized or untreated injuries.

Inspectors wroteBased on interview and record review, the facility failed to provide documentation of appropriate notification of pending benefit changes to Medicare services for one (1) of three (3) residents sampled for beneficiary notices (Resident #90).

Inspectors wroteBased on interviews and record review, the facility failed to notify the resident and the resident's representative of a facility-initiated emergency transfer to an acute care hospital. This deficient practice affected one (1) of two (2) residents reviewed for hospitalizations from a total of 36 residents sampled (Resident #101).

Inspectors wroteBased on interviews and record review, the facility failed to provide the resident and the resident's representative with a written notice of the facility's bed-hold policy upon transferring a resident to an acute care hospital. This deficient practice affected one (1) of two (2) residents reviewed for hospitalizations from a total of 36 residents sampled (Resident #101).

Inspectors wroteBased on observation, interviews and record review, the facility failed to ensure the accuracy of a skin assessment when the corresponding assessment did not reflect the actual condition of the skin for one (1) of 36 residents sampled (Resident #39). Inaccurate documentation compromised the facility's ability to provide appropriate and timely care, potentially putting the resident at risk for further complications.

Inspectors wroteBased on interviews and record review, the facility failed to obtain a physician ordered urinalysis (UA) sample in a timely manner for Resident #5, one (1) of one (1) resident reviewed for laboratory results from a total of 36 residents sampled.

Inspectors wroteBased on observation, interview and policy review, the facility did not provide meaningful activities on the weekends for two (2) residents (Resident #58 and Resident #78), and did not get one (1) resident out of bed for activities that they wanted to attend (Resident #39) out of 36 residents sampled.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the environment was as free from accident hazards by failing to 1) Ensure residents smoked only in the areas designated by the facility's safety committee in accordance with the facility's policy; and 2) Supervise residents while they smoked in accordance with the facility's policy. This deficient practice affected two (2) of four (4) residents reviewed for accident hazards related to smoking from a total of 36 residents sampled (Resident #13 and Resident #20).

Inspectors wroteBased on observation, interview, record review, and review of the facility policy, the facility failed to ensure that perineal care was provided in a manner to prevent urinary tract infection for one (1) of 36 residents sampled (Resident #82).

Inspectors wroteBased on observations, interviews, and record review, facility staff failed to ensure residents fed by enteral means receive the appropriate treatment and services to maintain the resident's nutritional status by failing to monitor the resident's intake and administer supplemental tube feedings for meal intakes less than 50%. This deficient practice affected one (1) of two (2) residents reviewed for tube feeding from a total of 36 residents sampled. (Resident #73)

Inspectors wroteBased on observation and interview, it was determined the facility failed to ensure the pureed diets were followed according to the menu. This failed practice affected two (2) residents with pureed diets out of 93 residents who received meals from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one sampled resident (Resident #18) was free from resident to resident abuse. On 5/31/23 around 2:00 A.M., Resident #78 struck Resident #18 with a wooden back scratcher resulting in multiple bruises to his/her face, arms, legs, and lower rib cage; a broken left pinky finger; and laceration to his/her head that required 5 staples. The facility census was 91 residents. Review of the undated Facility Abuse and Prohibition Program policy showed: -The purpose of the policy included ensuring a standardized methodology for the prevention of abuse. -Each resident had the right to be free from abuse. -The facility was committed to protecting the residents from abuse by anyone. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide a Registered Nurse (RN) for eight consecutive hours per day seven days a week in the first quarter of the fiscal year for October 2022 and November 2022. The facility maintained a census of greater than 60 residents and this deficiency had the potential to affect all residents. The census was 91 residents. Review of the facility's Nursing Department - Staffing, Scheduling & Postings dated 12/2020 showed: -The facility must use the services of a RN for at least eight consecutive hours a day, seven days per week, unless a waiver applies. -The facility will designate a RN to serve as the Director of Nursing (DON) on a full-time basis. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to keep the walk-in refrigerator and walk-in freezer floors clean; to maintain sanitary utensils and food preparation equipment; to properly document hot food temperatures to ensure they were suitably cooked to lessen the chance of bacterial contamination; to maintain plastic cutting boards and utensils in good condition to avoid food safety hazards (cross-contamination); and to separate damaged foodstuffs, in accordance with professional standards for food service safety. These deficient practices had the potential to affect all residents, visitors, volunteers, and staff who ate food from the kitchen. The facility's census was 91 residents with a licensed capacity for 130 residents at the time of the survey. 1. Observations during the initial kitchen inspection on 6/5/23 between 9:04 A.M. and 11:53 A.M. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and maintain a comprehensive, facility-specific infection prevention and control program designed to help prevent the development and transmission of water-borne pathogens (a bacterium, virus, or other microorganism that can cause disease), and failed to provide documented assessments for such an outbreak with accepted response protocols, in accordance with Centers for Medicare and Medicaid Services (CMS) guidelines. This deficient practice had the potential to affect all residents, visitors, volunteers, and staff who reside, visit, use, or work in the facility; [...]

Inspectors wroteBased on interview and record review, the facility failed to provide 12 hours of training/in-services in the last 12 months, from June 2022 to May 2023, to include abuse/neglect prevention, behaviors, resident rights, and training areas of weakness as determined in the nurse assistants performance reviews for three out of three sampled Certified Nursing Assistants (CNA) and abuse/neglect prevention, behaviors, resident rights for two out of two sampled Licensed Practical Nurses (LPN). This had the potential to affect all residents. The facility census was 91 residents. Review of the facility's Care Standards policy dated 6/2020 showed: -Ensure all residents receive necessary care and services that are evidence-based and in accordance with accepted professional clinical standards of practice. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a Notice of Medicare Provider Non-Coverage (NOMNC) ((Centers for Medicare and Medicaid Services (CMS) form CMS-10123) was provided to the resident or their representative for one sampled resident (Resident #355) and to ensure a Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) (form (CMS)-10055) was provided to the resident or their representative for three sampled residents (Resident #355, #74 and #20) out of three sampled residents who were discharged from Medicare part A (insurance that covers inpatient hospital care, skilled nursing facility, lab tests, surgery, home health care for individuals who are [AGE] years of age and above or disabled). The facility census was 91 residents. [...]

Inspectors wroteBased on interview, and record review, the facility failed to notify in writing the reason for a transfer for three sampled residents, (Resident #42, #71, and #87) who were sent to the hospital out of 19 sampled residents. The facility census was 91 residents. Review of the facility's policy, Transfer and Discharge dated October 24, 2022 showed the facility may transfer a resident for the following reason: -The transfer was necessary for the resident's welfare. -The resident's needs could not be met in the facility. -Documentation relating to the resident's transfer would be maintained in the resident's medical record. -Prior to transfer the Social Services Staff or designee would have provided the resident or responsible party with reasonable notice that the resident was going to be transferred. -The Notice of Transfer would include the following information: [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure residents who were sent to the hospital received a written bedhold policy for three sampled residents, (Resident #42, #71, and #87) out of 19 sampled residents. The facility census was 91 residents. Record review of the facility's policy Transfer and discharge date d October 24, 2022 showed: -Before the Facility transfers a resident to a hospital the Facility would provide written information to the resident or his/her personal representative which specifies: -The duration of the bed-hold during which the resident was permitted to return and resume residence in the nursing facility. -The Facilities policies regarding bed-hold periods permitting a resident to return. [...]

Inspectors wroteBased on interview and record review, the facility failed to transmit Minimum Data Sets (MDS-a federally mandated assessment tool completed by facility staff for care planning) to the Centers for Medicare & Medicaid Services (CMS) system for three sampled residents (Resident #31, #86 and #43) out of 19 sampled residents. The facility census was 91 residents. 1. Review of the CMS System showed that an MDS had not been transmitted for Resident #31 for over 120 days. Review of the CMS System showed no entry tracking form for 6/6/19 for Resident #31. During an interview on 6/12/23 at 11:31 A.M., MDS Coordinator B said: -Resident #31's assessment was completed on 5/9/23 also due on 5/9/23. -It was transmitted on 6/5/23 by the corporate office staff. -Corporate staff were responsible for submission and transmitting. 2. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure oxygen tubing and equipment was stored in a sanitary means, kept clean, and changed out per physician's order for three sampled residents, (Resident #7, #62, and #87) out of 19 sampled residents. The facility census was 91 residents. Review of the facility's policy titled Oxygen Administration, dated 6/20 showed: -All oxygen tubing, humidifiers masks, and cannulas used to deliver oxygen: -Would be changed out weekly and when visibly soiled, or as indicated by state regulation. -Oxygen items would be stored in a plastic bag at the resident's bedside to protect the equipment from dust and dirt when not in use. 1. Review of Resident #7's face sheet showed he/she was admitted to the facility on [DATE] with the following diagnoses: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staffing information was posted daily in a prominent place, readily accessible to residents and visitors of the daily resident census, or the number of nursing staff for each shift. This practice had the potential to affect all residents and visitors who were inquiring about the facility staffing hours. The facility census was 91 residents. Review of the facility's Nursing Department-Staffing, Scheduling & Postings policy dated October 24, 2022 showed: -To ensure an adequate number of nursing personnel are available to meet resident needs. -The facility will post the following information on a daily basis: --Facility name. --The current date. --The total number and actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to sign out a narcotic medication before administering it to one sampled resident (Resident #100), to have two signatures for each shift, resulting in four signatures each day, when counting narcotic medications at the beginning and end of each shift; to ensure the narcotic count sheet was not presigned by one nurse prior to counting narcotic medications; to ensure the narcotic count was accurate and to report a discrepancy of a narcotic count for one sampled resident (Resident #77) out of 19 sampled residents; and to ensure the signature page for the narcotic count sheet had the accurate number of narcotic medication cards for the 500 hall medication cart. The facility census was 91 residents. Review of the facility's policy Storage of Controlled Substances, dated 8/2020 showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the Medication Regimen Review (MRR)s were reviewed monthly by a pharmacist, were included in the medical charts, were acted upon and maintained the physician's response to the MRRs for four sampled residents (Residents #47, #40, #28 and #47) out of five residents sampled for unnecessary medications. This practice had the potential to effect each resident's physical and mental well-being. The facility census was 91 residents. Review of the facility's Medication Regimen Review policy, dated August 2020, showed: -The consultant pharmacist was responsible for performing a comprehensive review of each resident's medication regimen and clinical record at least monthly. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the medication refrigerator was checked daily to ensure the temperature was within range. The facility census was 91 residents. Review of the facility's policy, Refrigerator/Freezer Temperature Records dated 12/20 showed: -A daily temperature record was to have been kept for the refrigerated and frozen storage areas. -The services manager or designee was to have recorded daily all refrigerator temperatures on the Refrigerator Temperature Log during A.M. and P.M. shifts. -The refrigerator temperature must be 41 degree Fahrenheit (F) or below. -Temperatures above this should be reported to the service manager. -Corrective action should have been taken to correct the temperature, or the items should have been moved to another storage area to maintain acceptable temperature. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide Pneumococcal (lung inflammation caused by bacterial or viral infection) vaccines, assessments and education for three sampled residents (Resident #355, #28 and #71) out of five residents sampled for immunizations. This practice had the potential to effect all residents. The census was 91 residents. Review of the facility's Pneumococcal Disease Prevention policy, dated 12/1/2017, showed: -The purpose of the policy was to ensure the facility prevented and controlled the spread of pneumococcal disease in the facility. -The facility offered training to facility staff upon hire and inform residents on precautions and best practices to prevent and control the pneumococcal disease in the facility. -The pneumococcal vaccine was recommended for: --All adults [AGE] years of age or older. [...]

Inspectors wroteBased on interview and record review, the facility failed to notify one sampled resident's (Resident #25) responsible party when the physician made medication changes, ordered tests, and when the resident had a change in condition out of 19 sampled residents. The facility census was 91 residents. Review of the facility's Change of Condition Notification policy dated 6/2020 showed: -Residents, family, legal representatives, and physicians are informed of changes in the resident's condition in a timely manner. -The facility will promptly inform the resident, consult with the resident's Attending physician, and notify the resident's legal representative when the resident endures a significant change in their condition caused by, but not limited to: --A significant change in the resident's physical, cognitive, behavioral or functional status. --A significant change in treatment. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to complete a quarterly review assessment for one sampled resident (Resident #40) out of 19 sampled residents. The facility census was 91 residents. 1. Review on 6/9/23 of Resident #40's most recent Minimum Data Set (MDS-a federally mandated assessment tool completed by facility staff for care planning) showed it was a quarterly MDS dated [DATE]. Review during the survey conducted 6/1/23-6/13/23 of the Centers for Medicare & Medicaid Services (CMS) System showed that an MDS had not been transmitted for the resident for over 120 days. Observation on 6/5/23 at 1:46 P.M. showed: -The resident self-propelling himself/herself out of his/her room in a wheelchair. -The resident asking how to get out said he/she wondered if he/she could go out the window. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to accurately reflect wandering on the Minimum Data Set (MDS-a federally mandated assessment tool completed by facility staff for care planning) for one sampled resident (Resident #43) out of 19 sampled residents. The facility census was 91 residents. 1. Review of Resident #43's annual MDS dated [DATE] showed the following staff assessment of the resident: -The resident did not wander (the act of moving from place to place with or without a specified course or known direction and it may or may not be aimless). -An occupation was not listed for the resident. Review of the resident's quarterly MDS dated [DATE] showed the following staff assessment of the resident: -The resident did not wander. -An occupation was not listed for the resident. Review of the resident's care plan dated 4/5/23 showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to complete laboratory (lab) services as ordered for two sampled residents (Residents #40 and #61) out of 19 sampled residents. The facility census was 91 residents. Review of the facility's undated policy titled Laboratory, Diagnostic and Radiology Services showed: -Lab services would be coordinated pursuant to an order by a physician. -The facility was responsible for the quality and timeliness of services provided by the lab. -Lab results would be maintained as part of the resident's medical record. 1. Review of Resident #40's current orders showed a physician's order dated 4/11/22 for the following labs every three months: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to complete a dietary preferences/screen/assessment for one sampled resident (Resident #2) who had ethnic preferences for food out of 19 sampled residents. The facility census was 91 residents. Review of the facility's undated policy titled Resident Preference Interview showed: -The Nutrition Services Manager or designee would meet with the resident within 72 hours of admission or readmission to review the resident's diet, the types of food served at each meal and review the weekly menu and the locations where it was posted. -A Nutrition Screen would be completed upon admission, readmission and no less than annually to capture the resident's preferences. -Resident preferences would be reflected on the tray card and updated in a timely manner. [...]

Inspectors wroteBased on interview and record review, the facility failed to monitor and assess for signs and symptoms of infection which lead to one resident (Resident #97) acquiring osteomyelitis and necrosis and eventually partial amputation of his/her finger; failed to follow discharge orders including daily weights, failed to follow subsequent physician's orders for weekly weights, failed to get clarification on conflicting orders for obtaining weights, and failed to notify the physician of excessive weight gain which resulted in one closed record sampled resident (Resident #501) who gained a total of 112.5 pounds (lbs.) from 1/7/21 to 2/1/21 and failed to follow physician orders including daily weights and notifying the physician of weight changes for one sampled resident (Resident #84) out of 22 sampled residents and 16 closed record sampled residents. The facility census was 95 residents. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an unwitnessed injury, to the second finger of a resident who was severely cognitively impaired was thoroughly investigated and to immediately put interventions in place to prevent further injury. Within less than 30 days the resident sustained a similar injury to his/her third finger. The facility failed to thoroughly investigate the second injury and failed to immediately put interventions in place to prevent further injury. This affected one sampled resident (Resident #97) out of 22 sampled residents. The facility census was 95 residents. The Administrator was notified on 5/27/21 at 12:56 P.M. of an Immediate Jeopardy (IJ) which began on 4/5/21. The IJ was removed on 4/14/21 as confirmed by surveyor onsite verification. Record review of the facility's Care Planning policy, dated 6/2020 showed: [...]

Inspectors wrote2. Record review of Resident #502's admission Record dated 4/7/21 showed the resident was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included Atrial Fibrillation (A-fib the upper two chambers of the heart beat quickly and irregularly) and Hypertension (HTN High Blood Pressure). Record review of the resident's admission MDS, dated [DATE] showed: -The resident was admitted on [DATE]. -Had moderately impaired cognition. -Had a diagnosis of A-fib and HTN. Record review of the resident's Order Summary Report dated January 2021 showed: -Losartan Potassium Tablet 50 mg, give one tablet in the morning for HTN, start 12/1/20. --Parameters: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain sanitary food serving utensils and preparation equipment; failed to ensure plastic cutting boards were in good condition to avoid food safety hazards; failed to separate damaged food stuffs and keep others free from contamination; failed to refrigerate food stuffs when needed; and failed to keep all kitchen floor areas clean. These deficient practices potentially affected all residents who ate food from the kitchen. The skilled nursing facility census was 95 residents with a licensed capacity for 130 residents. 1. Observations during the kitchen inspection on 4/5/21 between 9:22 A.M. and 12:18 P.M., showed the following: -In the Dry Storage room the floor felt sticky when walked upon. -There was a 6 pound (lb.) 12 ounce (oz.) can of cut sweet potatoes heavily dented on one side and a 5 lb. 13 oz. [...]

Inspectors wroteBased on interview and record review, the facility failed to establish and maintain a comprehensive, facility-specific infection prevention and control program designed to help prevent the development and transmission of waterborne pathogens (a bacterium, virus, or other microorganism that can cause disease), and failed to provide documented assessments for such an outbreak, in accordance with Centers for Medicare and Medicaid Services (CMS) guidelines. This deficient practice had the potential to affect all residents, visitors, and staff who reside in, visit, use, or work in the facility. The facility census was 95 with a licensed capacity for 130 residents. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to obtain physician's orders for an electronic cardiac device for two sampled residents (Resident #61 and #69), and failed to accurately and consistently document the resident's vital signs (temperature, pulse rate, respiration rate, and blood pressure), right and left lung sounds, and respiratory status (e.g. shortness of breath or even respirations) for the resident's COVID (a new disease caused by a novel (new) coronavirus) respiratory assessments and to consistently document symptoms of COVID on the resident's Treatment Administration Record (TAR). The facility also failed to document administration of medications on the Medication Administration Record (MAR) for one sampled resident (Resident #77), out of 22 sampled residents. The facility census was 95 residents. [...]

Inspectors wrote2. Record review of Resident #7's Face Sheet showed: -He/she was originally admitted to the facility on [DATE] and was readmitted to the facility on [DATE]. -He/she had the following diagnoses: --Polyneuropathy (a condition involving damage to multiple nerves throughout the body outside of the brain and spinal cord; symptoms can include temporary or permanent numbness, tingling, pricking or burning sensations, increased sensitivity to touch, and pain). --Spinal stenosis (narrowing in the spine which puts pressure on the nerves and spinal cord which can cause pain and numbness). Record review of the resident's quarterly MDS, dated [DATE] showed: -Was cognitively intact. -Received as needed pain medication. -Had occasional moderate pain. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to properly contain waste in a garbage can in the kitchen, and in close-lidded dumpsters, to prevent the harboring and/or feeding of pests. This deficient practice potentially affected all residents who ate food from the kitchen. The facility census was 95 residents with a licensed capacity for 130 residents. 1. Observations during the kitchen inspection on 4/5/21 at 3:45 P.M. outside the Service Hall showed there were two dumpsters side-by-side, both facing northward, with the left lid of the east dumpster left completely open. 2. Observations during a follow-up kitchen inspection and the facility outer perimeter inspection on 4/6/21, showed the following: -At 8:18 A.M., both lids of the east dumpster were completely open. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to promote dignity when one cognitively impaired sampled resident (Resident #9) was exposed in an incontinence brief and hospital gown visible to the hallway and not dressed daily in appropriate clothing out of 22 sampled residents. The facility census was 95 residents. Record review of the facility's Privacy and Dignity policy revised 6/2020 showed: -The facility promoted resident care in a manner and an environment that maintained or enhanced dignity and respect, in full recognition of each residents' individuality. -The staff were to assist the resident in maintaining self-esteem and self-worth. -Residents were dressed appropriate to the time of day and season as well as individual preferences. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop an individualized plan and provide an activity program based on the resident's comprehensive assessments and activity preferences to meet the resident's interests and needs for one cognitively impaired sampled resident (Resident #9) and one cognitively intact sampled resident (Resident #72) out 22 sampled residents. The facility census was 95 residents. Record review of the facility's Activities Program policy revised 6/20/20 showed: -The purpose was to encourage residents to participate in activities to make life more meaningful, to stimulate and support mental and physical capabilities to the fullest extent and to enable the resident to maintain the highest social, physical and emotional functioning. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure tracheostomy care was performed in a manner to reduce the potential for complications for one sample resident (Resident #72), when staff failed to ensure appropriate supplies were available for tracheostomy care, and failed to follow physician's orders and administer oxygen via a tracheostomy shield. As a result, the resident was without his/her correct size inner cannula (the inner trach tube that acts as a liner that can be removed and replaced to prevent the build-up of mucus inside the trach tube) for 59 minutes. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure residents received required physician's visits with an alternating personal visit in a rotation of the resident's physician and nurse practitioner for one sampled resident (Resident #61) out of 22 sampled residents. The facility census was 95 residents. Record review of the facility's Physician Services and Visits policy revised 8/2020 showed: -The purpose was that the facility would provide residents with care under an attending physician. -The physician must evaluate the resident at least every 60 days unless there was an alternate schedule or state specific requirement. 1. Record review of Resident #61's admission Record showed the resident was admitted to the facility on [DATE] and had the following diagnoses: -Cerebrovascular Accident (CVA, stroke). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medication regime was free of psychoactive medications without adequate indications, and to ensure behaviors were identified for each psychotropic (a drug that affects brain activities associated with mental processes and behavior) medication used to address the resident's psychosocial needs, for use for one sampled resident (Resident #68), failed to ensure a Pro Re Nata (PRN - as needed) antianxiety (a drug that is used to prevent and treat anxiety (an emotion characterized by feelings of tension and worry) medication was limited to a 14 day duration or to indicate a specific duration if the medication was extended beyond that time period, and to ensure nurses documented specific behaviors and non-pharmacological interventions used prior to using a PRN antianxiety medication for one sampled resident [...]