Republic Nursing & Rehab

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards of practice and in a manner to prevent possible contamination when the facility failed to keep dented cans separated from other cans; failed to ensure all food items were properly labeled and sealed; failed to ensure transported foods were covered; failed to ensure fans, vents, and ceilings in food areas were free from dirt and debris; and when staff stacked dishes while still wet. This had the potential to affect all residents who consumed food from the facility kitchen. The facility census was 115 residents.1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to notify the physician of a change in resident condition and abnormal laboratory results in a timely manner for one resident (Resident #1). The facility census was 94. Review of the facility policy titled, Condition Change, Resident (Observing, Recording, and Reporting), dated March 2015, showed staff are to observe, record, and report any condition change to the attending physician so that proper treatment can be implemented. Review of the facility policy titled, Lab Reporting Guidelines, dated March 2015, showed the following information: -Nurse will document resident name and lab ordered in the 24-hour report book and the date it is to be drawn; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to use appropriate infection control measures to prevent or reduce the risk of spreading bacteria or other infectious causing contaminants when staff failed to provide a clean barrier for supplies, failed to appropriately wash hands, and failed to appropriately utilize personal protective equipment for one resident (Resident #2) during wound care and one resident (Resident #3) during blood sugar checks and insulin administration. The facility census was 94. 1. Review of the facility's policy and procedure for Wound Care and Treatment, dated March 2015, showed the following: -Medications should be for one designated resident only except for large volume liquids. These may be poured into a cup to take to the bedside; -Set-up supplies on a clean surface at bedside. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to keep food safe from potential contamination when staff stacked clean dishware inside one another trapping moisture; the facility failed to keep dented cans separate from other canned goods; and failed to ensure dry food containers were properly sealed. This could potentially affect all the residents. The facility census was 82. 1. Review of the facility's policy titled, Dishwashing, by Nutrition and Dining Services Manual, dated May 2015, showed the following information: -Rack dishes and trays in appropriate rack; -Rack cups, bowls, and glasses upside down; -Allow items thoroughly dry before unloading racks or storing items. Review of the 1999 Food Code, issued by the Food and Drug Administration (FDA), showed the following information: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents' environment remained as free of accident hazards as possible when staff failed to care plan transfer method and failed to obtain therapy's assessment and recommendations of how to safely transfer one resident (Resident #1) who was non-weight bearing and when staff failed to ensure access to smoking materials were limited to residents assessed able to keep them when two residents (Resident #36 and #66) kept smoking materials in an unsecured manner. The facility census was 82. 1. Review of a facility policy entitled Transfer Activities (Nursing Guidelines Manual, March 2015) showed the following: -Purpose to transfer the resident from bed to chair, toilet or tub safely; -Obtain assistance of another individual if necessary for safe transfer; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a sanitary environment for all residents and staff when the facility staff did not keep walls, baseboards, and vents clean in the kitchen area. The facility census was 82. 1. Observation on 03/11/24, beginning at 8:42 A.M., showed the following areas were dirty with grease, lint, and debris: -The walls and baseboards behind the ovens; -The baseboards underneath the metal, three-bin kitchen sink; -The space behind the ice machine, between the unit and wall; -The ceiling vents; -The ceiling air conditioning unit. During an interview on 03/14/24, at approximately 1:45 P.M., Dietary Aide O said he/she does do a lot of cleaning, but had not noticed the baseboards or up high like any of the ceiling vents or on the air conditioner. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the Minimum Data Set (MDS - a federally mandated comprehensive assessment instrument completed by facility staff) included accurate nutritional and weight loss information for one resident (Resident #28). The facility census was 82. Review of the facility provided document titled, MDS and Care Planning Guidelines, dated 10/01/15, showed the following information: -It is the policy of the facility to use the most current Centers for Medicare and Medicaid Services (CMS) MDS Resident Assessment Instrument (RAI) Manual, and any published interim RAI manual errata documents, as the authoritative guide for completion of the MDS and establishing and maintaining resident care plans. 1. Review of Resident #28's face sheet showed the following information: -admission date of 02/28/22; [...]

Inspectors wroteBased on record review and interview, the facility failed to complete a comprehensive and individualized care plan, including interventions, to address the use of antianxiety medications for one resident (Resident #56) and receipt of hospice services for one resident (Resident #89). The facility had a census of 82. Review of the facility's policy titled, Care Plan Comprehensive, dated March 2015, showed the following: -The interdisciplinary care plan team, with input from the resident, family, and/or legal representative. will develop and maintain a comprehensive care plan for each resident that identifies the highest level of functioning the resident may be expected to attain; -The comprehensive care plan will be based on a thorough assessment that includes, but is not limited to, the Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff); [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed provide care per standards of practice when staff failed to obtain a physician's order for hospice and update the resident's care plan to reflect admission to hospice for one resident (Resident # 6). The facility census was 82. Review of the facility's policy titled, Physician's Orders, dated March 2015, showed the following: -Physician's orders must be signed by the physician and dated when such order was signed; -Current lists of orders must be maintained in the clinical record of each resident to avoid confusion and errors. Review of the facility's policy titled, Care Plan Comprehensive, dated March 2015, showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care consistent with standards of practice when the facility failed to have a physician's diagnosis for continuous positive airway pressure (CPAP - machine that uses mild air pressure to keep breathing airways open while one sleeps) and failed to address the CPAP on the care plan or on the Minimum Data Set (MDS - a federally mandated comprehensive assessment instrument completed by facility staff) for one resident (Resident#83). The facility had a census of 82. Review of the facility's policy titled, MDS and Care Planning Guidelines, dated 10/01/15, showed the following information: [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure that one resident's (Resident #17) with Post-Traumatic Stress Disorder (PTSD - disorder that develops when a person has experienced or witnessed a scary, shocking, terrifying, or dangerous event) had his/her PTSD diagnosis listed in the medical record, failed to ensure the resident's PTSD was noted on the resident's care plan to include triggers and interventions, and failed to ensure staff were knowledgeable of the resident's history of PTSD. The facility census was 82. Record review of the facility assessment, updated December 2023, showed the following information: -Individualized care plans are developed for each resident to ensure each resident within the facility has their physical, mental, psychosocial, spiritual needs met. Review showed the facility did not provide a policy related to PTSD. [...]

Inspectors wroteBased on interview and record review, the facility failed to document checking the Nurse Aide (NA) Registry prior to the start date of one staff (Housekeeper A) out of five sampled staff to ensure they did not have a Federal Indicator (a marker given to a potential employee who has committed abuse, neglect, or misappropriation of property against residents) prohibiting them to work in a certified facility. The facility census was 91. Record review of the facility's protocol titled, Abuse Prohibition, dated November 2016, showed the following: -It is the purpose of this facility to prohibit mistreatment, neglect, abuse, misappropriation of resident's property, and exploitation of any resident; -To assure that everything possible is being done to prevent abuse, the facility has implemented screening of potential employees. [...]

Inspectors wroteBased on record review, observation, and interview the facility failed to complete routine fall risk assessments, to care plan new fall interventions after each fall, failed to lock wheels the wheelchair, and failed to ensure proper fit of the wheelchair to reduce the risk of falls for one resident (Resident #33). The facility also failed to ensure doors that led to an outside enclosed courtyard, and were unlocked at all time, allowed for residents, or others in the courtyard, to reenter the facility without assistance The facility census was 91. 1. Observations on 2/22/22, at 10:50 A.M. and 2:30 P.M., showed the following: -A door off the main dining room that led to a small interior courtyard; -The courtyard was completely surrounded by walls of the facility, and the only way in or out of the courtyard was the single door; [...]

Inspectors wrote2. Record review of Resident #60's face sheet showed the following: -admitted to the facility on [DATE]; -Diagnoses included chronic respiratory failure (oxygen levels cannot be kept normal and causes increased respiratory rate), chronic kidney disease (gradual loss of kidney function), amputation of right lower leg and absence of right leg above the knee, muscle weakness, chronic obstructive pulmonary disease (COPD - lung disease that blocks air flow and makes it difficult to breathe), and hypertension (high blood pressure). Record review of the resident's quarterly MDS, dated [DATE], showed the following -Moderately impaired cognition; -Extensive assistance of two staff required for bed mobility, toilet use, and personal hygiene; -Extensive assistance of two staff for transfers. Record review of the resident's side rail assessment and consent, dated 8/27/21, showed the following: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to routinely assess the effectiveness of interventions implemented for residents with dementia/behaviors and failed to complete person centered care plans related to residents with dementia/behaviors for for three residents (Resident #63, Resident #77 and Resident #82) in the special care unit (SCU-a secured unit for residents with a diagnosis of dementia) to ensure their highest practicable well-being. The SCU census was 18 and the facility census was 91. Record review of the facility's Special Care Unit Manual, dated 04/06, showed the following: -The overall objective of this facility's Special Care Unit is to provide a therapeutic, homelike environment that will maximize the resident's independent functioning for as long as possible and help ease the emotion/physical burden for families. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the floor under the ice machine located inside of the kitchen were kept clean and free from debris. The facility census was 91. Record review of the facility policy named Cleaning Schedules, dated April 2011, showed the following: -It is the responsibility of the Dining Services Manager (DSM) to enforce the cleaning schedules and to monitor the completion of assigned cleaning tasks; -Daily, weekly, and monthly cleaning schedules prepared by the DSM with all cleaning tasks listed posted in the dietary department; -It will specify the days the cleaning schedule will be done and specify who is responsible to do the cleaning by shift and positions; -Post the schedule prior to the beginning of each week and the employee will initial in the column under the day the task is completed; [...]

Inspectors wroteBased on interview and record review, the facility failed to protect residents from misappropriation of property when staff discovered missing doses of controlled medications that were in the possession of the facility for two residents (Resident #60 and #79). The facility census was 91. Record review of the facility's Abuse Prohibition Protocol Manual, dated November 2016, showed misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money with the resident's consent. Record review of the facility's policy Storage of Medications from the Nursing Guidelines Manual, March 2015, showed the following: -All mobile medication carts must be under visual control of the staff at all times, when not stored safely and securely. Carts must be either in a locked room or otherwise made immobile; [...]