Rennes Health and Rehab Center-Rhinelander

Inspectors wroteBased on observations, interviews and record reviews, the facility did not ensure staff maintained an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. The facility did not transport soiled laundry in a sanitary manner. This has the potential to affect the 17 residents that live between R90's room and the dirty linen storage area. The facility did not transport clean linen from laundry through the facility to patient's rooms on a hanging rack. This has the potential to affect all 35 residents whose linen at minimum is laundered and transported by the facility. Registered Nurse (RN) F did not practice hand hygiene or wear gloves when giving a subcutaneous injection to a resident (R) (R32). [...]

Inspectors wroteBased on observations, record reviews and interviews, the facility did not ensure that a resident who is fed by enteral means received the appropriate treatment and services to prevent complications of enteral feedings for 1 out of 1 resident (R) reviewed. (R90)Nurse did not measure enteral feeding appropriately and if not questioned, she would have had too much enteral feeding in the tube feeding set up. Nurse did not prime the tubing before connecting the feeding tubing to the J-G tubing, resulting in the air in tubing to be pushed into R90's stomach.

Inspectors wroteBased on observation, interview, and record review, the facility did not ensure the residents' environment remains as free of accident hazards as possible. The facility did not ensure staff followed supervision of residents when needed to prevent accidents, which affected resident (R) R1 and had potential to effect 5 other residents. Facility staff did not stay with R1 during the time R1 was in a spa bath. Staff intermittently checked on R1 during the spa bath, and after approximately 2 hours, staff found R1 in the spa tub unresponsive, which required facility to call 911 for Emergency Medical Service (EMS). EMS found R1 with body temperature of 106 degrees Fahrenheit (F), Blood Pressure (B/P) 116/96, Respirations (R) 10 breaths per minute requiring intubation for breathing, and Pulse (P) 59 and increasing to 124 beats per minute (bpm). [...]

Inspectors wroteBased on observation and interview the facility did not provide adequate equipment to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member, or to a centralized staff work area, for 1 resident (R1) out of 6 sampled residents. This had the potential to affect all 6 residents. * R1 did not have access to a call light while R1 was left in spa room unsupervised.

Inspectors wroteBased on interview and record review, the facility did not immediately report to the resident's representative when a resident was found unresponsive in spa tub and was transferred via Emergency Medical Services (EMS) to the Emergency Department (ED). This occurred for 1 of 1 resident (R) reviewed, (R1).

Inspectors wroteBased on the interview and record review, the facility did not report 1 of 1 (R1) potential misconduct incidents to the State's Office of Caregiver Quality (OCQ) via the State's Misconduct Incident Reporting (MIR) system immediately upon learning of the incident.

Inspectors wroteBased on record review and interview, the facility did not conduct a Preadmission Screening and Resident Review (PASRR) Level II screen for R7, who has a serious mental disorder and is taking psychotropic medication to treat symptoms of major mental disorder to ensure he received care and services in the most integrated setting appropriate to his needs. The facility practice affected 1 of 2 residents reviewed (R7). This is evidenced by: Surveyor requested and reviewed the policy titled Forward Health Update, Your First Source of Forward Health Policy and Program dated November 2023. The policy in part read: PASRR Level II Referrals: ~As part of the PASRR Level I screen process in the portal, if required, the completed Level I screen will be forwarded on to Wisconsin's PASRR onto Wisconsin's PASRR Level II screen. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not develop and implement a comprehensive individualized care plan to meet the needs of 2 of 18 residents (R) R29 and R8. This is evidenced by: According to the Resident Assessment Instrument, The comprehensive care plan is an interdisciplinary communication tool. It must include measurable objectives and time frames and must describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and psychosocial well-being. The care plan should be revised on an ongoing basis to reflect changes in the resident and the care that the resident is receiving. Example 1 R29 was admitted to the facility on [DATE] with diagnosis of neurocognitive disorder with Lewy bodies-with behavior disturbance and dementia and is on palliative care. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not ensure treatment and care were provided in accordance with professional standards of practice for 1 of 3 sampled residents (R)228. The facility did not give instruction on the care plan for staff on the proper use of R228's C-collar (cervical neck brace) or Cervical Thoracic Orthosis (CTO) body brace, nor did staff recognize when the brace was applied incorrectly, and not applied as ordered by the physician. This resulted in pain and an emergency room visit for evaluation for R228. This is evidenced by: R228 was admitted to the facility on [DATE] at 3:25 p.m., and has diagnoses that include, in part, head injury, neck fracture in 3 areas, fractures in 2 areas of the upper back, multiple rib fractures and collar bone fracture following a motor vehicle accident. [...]

Inspectors wroteBased on observation, record review and interview the facility did not ensure appropriate care and services were provided to prevent urinary tract infection (UTI) for 1 of 1 resident reviewed with an indwelling catheter (R38). R38 did not have a physician order or care plan with specific approaches for care of the indwelling catheter. This is evidenced by: Surveyor requested and reviewed the facility policy titled Catheter Care, Urinary, which was not dated. The policy in part read: Purpose: The purpose of this procedure is to prevent infection of the resident's urinary tract. General Guidelines: ~Determine if changes in daily urinary catheter procedures have been made (e.g. review of care plan .physician orders, ect.). ~Observe the resident for signs and symptoms of urinary tract infection and urinary retention . On 08/28/23 at 10:22 AM, Surveyor spoke with R38 regarding her catheter. [...]

Inspectors wroteBased on record review and interview, the facility did not comprehensively assess trauma or develop a trauma-informed care plan for 1 of 1 resident (R) 1, with diagnosis of post-traumatic stress disorder (PTSD) and history of trauma. R1 has a diagnosis of PTSD with her admission assessment identifying past trauma. The facility did not comprehensively assess R1's trauma or develop a trauma informed care plan. This is evidenced by: Surveyor requested and reviewed the facility policy titled Trauma Informed Care, which is not dated. The policy in part reads: Purpose: To guide staff in appropriate and compassionate care specific to individuals who have experienced trauma. General Guidelines: ~This facility supports a culture of emotional well-being and physical safety for staff, residents and visitors. ~Trauma-informed care is culturally sensitive and person-centered . [...]

Inspectors wroteBased on observation, interview and record review, the facility did not ensure that nursing staff had the specific competencies and skill set necessary to care for 1 of 1 resident (R)228 with specialized needs. Staff did not have the competency and training to appropriately don and doff a C-collar (cervical neck brace) and a Cervical Thoracic Orthosis (CTO) (upper body brace) for R228's care.

Inspectors wroteBased on observations, interviews and record reviews, the facility did not ensure a medication administration rate of less than 5%. During the Medication Administration Task, there were 3 errors out of 36 opportunities observed, yielding a medication administration rate of 8.33%. Resident (R) 20 self administers her inhalers upon directions by staff. Registered Nurse (RN) E handed R20 the Corticosteroid inhaler to administer, before the bronchodilator inhaler. Following the Corticosteroid inhaler administration, RN E did not encourage or offer R20 to rinse her mouth. R45 was given fast-acting insulin (Humalog) at 7:32 AM and did not eat a meal until 8:28 AM. This was 56 minutes after the administration of a fast-acting insulin. This is evidenced by: Drugs. [...]

Inspectors wroteBased on observations and interviews, the facility did not implement appropriate infection prevention and control practices to help prevent the development and transmission of communicable diseases and infections. Staff did not perform hand hygiene when warranted or sanitize the durable medical equipment for 1 of 4 residents (R) R32 observed for cares. Certified Nursing Assistant (CNA) I did not perform hand hygiene when warranted when providing cares to R32. CNA I and CNA J did not sanitize mechanical lift before or after use for R32. This is evidenced by: Example 1 Surveyor requested and reviewed the facility policy titled Handwashing/Hand Hygiene. The policy in part reads, This facility considers hand hygiene the primary means to prevent the spread of infections. The policy lists instances where employees must conduct hand hygiene. such as: Before and after direct resident contact. [...]