Residences at Vantage Point

Inspectors wroteBased on record review and staff interview it was determined that the facility failed to develop and implement policies and procedures for medication regimen reviews, as evidenced by 1) failing to ensure that pharmacist identified irregularities reviewed by the attending physician, along with the action taken or not taken including rationale, was documented in the resident's medical record, and 2) failing to ensure medication irregularities were identified during monthly medication regimen reviews. This was evident for 4 (#6, #5,#16, #13) of 5 residents reviewed for unnecessary medication.

Inspectors wroteBased on medical record review and staff interview, it was determined the facility staff failed to reveal evidence that the resident or resident representative was informed of their right to formulate an advanced directive, and failed to ensure that a current copy of a resident's advance directive was in the resident's medical record. This was evident for 3 (#5, #12, #4) of 11 residents reviewed for advanced directives.

Inspectors wroteBased on record review and interview it was determine the facility staff failed to notify the physician when a resident was identified to have a significant weight loss. This was evident for 1(#13) of 5 residents reviewed for Nutrition.

Inspectors wroteBased on observation, medical record review and staff interview it was determined that the facility failed to develop and implement comprehensive resident person-centered care plans with measurable goals and interventions. This was evident for 1 (#18) of 3 resident's reviewed for respiratory care, and 2 (#6, #5) of 5 residents reviewed for unnecessary medications.

Inspectors wroteBased on observation, record review and interview it was determined the facility staff failed to ensure that each resident received necessary respiratory care and services consistent with professional standards of practice by failing to administer oxygen at the prescribed rate, failing to assess and document the resident's immediate and ongoing need for, provision of and response to supplemental oxygen. This was evident for 1 (#18) of 3 residents reviewed for Respiratory Care.

Inspectors wroteBased on a review of the medical record and interview with staff it was determined that the facility failed to ensure that the physician addressed a significant weight gain/weight loss. This was evident for 1 (#3) of 5 residents reviewed for weight gain/weight loss.

Inspectors wroteBased on medical record review and staff interview it was determined the facility failed to keep a resident's drug regimen free from unnecessary drugs by failing to follow physician orders to follow blood pressure and pulse parameters for administering a blood pressure medication. This was evident for 1 (#6) of 5 residents reviewed for unnecessary medications.

Inspectors wroteBased on medical record review and staff interview, it was determined that the facility staff failed to keep complete and accurate medical records. This was evident for 5 (#4, #12, #11,#18, #16) of 10 residents reviewed for Advanced Directives and 1 (#13) of 5 residents reviewed for nutrition.

Inspectors wroteBased on observation, record review, and interview it was determined the facility staff failed to ensure respiratory care equipment was 1) properly date labeled, and 2) cleaned and stored as per the manufacturer's instructions. This was evident for 2 (#18 and #13) of 3 residents reviewed for Respiratory Care.

Inspectors wroteBased on observations, interviews and facility record review it was determined the facility failed to ensure food handling practices were followed in accordance with professional standards for food service safety, ensure the dishwashing system met the required minimum temperatures and chemical concentration, ensure monitoring of dishwasher chemical concentration and food service equipment functioning, ensure thorough environmental cleaning of the kitchen, and ensure the monitoring of food temperatures and food storage. These deficient practices have the potential to affect all residents.

Inspectors wroteBased on observation and interview it was determined the facility failed to ensure privacy of protected health information was maintained for residents of the facility (#8, #16, #12, #122, #2, #3, #11, #14, #7, #1, #17). This was evident for 11 out of 21 residents during the facility's recertification/complaint survey.

Inspectors wroteBased on interview and record review it was determined the facility failed to timely report an injury of unknown origin to the Office of Health Care Quality. This was evident for 2 (#MD00200761, and #MD00162737) out of 2 facility reported incidents reviewed for injuries of unknown origin for Resident #220 during the facility's recertification/complaint survey.

Inspectors wroteBased on record review and interview it was determined the facility failed to ensure a thorough investigation was performed for an injury of unknown origin. This was evident during the surveyor's review of facility reported incident #MD00200761 reviewed by the surveyor during the facility's recertification/complaint survey.

Inspectors wroteBased on interview with residents, review of resident medical records, and interview with facility staff, it was determined that the facility failed to hold care plan meetings at least quarterly. This was evident for 1 (Resident #17) of 1 resident reviewed for care planning during the recertification/complaint survey.

Inspectors wroteBased on observation during medication administration it was determined that the facility failed to follow infection control practices consistent with accepted standards of practice. This was evident for 3 (Residents #5, #10 and #13) of 4 residents reviewed for medication administration during the recertification/complaint survey.

Inspectors wroteBased on medical record review and interviews with the resident family and facility staff it was determined the facility failed to ensure that the appropriate equipment used to transfer a resident who receives dialysis was in place prior to the resident going to the scheduled dialysis appointment. This was found to be evident for 1 resident (Resident # 9) reviewed during the facility's annual Medicare/Medicaid survey.

Inspectors wroteBased on medical record review and staff interview it was determined the facility failed to conduct a thorough investigation of a fracture of unknown origin sustained by a functionally and cognitively impaired resident (Resident #7). This was evident for 1 of 3 residents reviewed for resident's rights during this annual recertification survey.

Inspectors wroteBased on medical record review and interviews with the resident family and facility staff, it was determined the facility failed to notify the resident and/or family representative in writing that they were being transferred out of the facility to the hospital and the reason for the hospital stay. This was evident for 2 (Resident # 24 and Resident # 9) of 3 residents reviewed for hospitalization during the facility's annual Medicare/Medicaid survey.

Inspectors wroteBased on medical record review and staff interview it was determined the facility failed to notify the resident/resident representative in writing of a transfer/discharge of a resident along with the reason for the transfer. This was evident for 1 (# 24) of 3 residents reviewed for hospitalization.

Inspectors wroteBased on medical record review and staff interview, it was determined facility staff failed to conduct a comprehensive assessment when a significant decline occurred in the Resident #19's condition. This was evident for 1 of 3 residents reviewed for a change in condition during this annual recertification survey. The Minimum Data Set (MDS) is a comprehensive assessment of the resident completed by the facility staff. The MDS is a multi-disciplinarian tool that allows many facets of the resident's care [cognition, behavior, mobility, activities of daily living, accidents, activities, weight, pain and medications to name a few] to be addressed. The MDS assessment directs the facility staff on issues that may need to be addressed.

Inspectors wroteBased on medical record review and interviews with facility staff it was determinedthat the facility failed to complete the discharge Minimum Data Set (MDS). This was found to be evident for 1 resident (Resident # 2) when assessments were triggered to be reviewed during the facility's annual Medicare/Medicaid survey.

Inspectors wroteBased on medical record review and staff interview it was determined the facility failed to develop and implement an individualized care plan that addressed the use of Paxil and Lorazepam for Resident #11. Also, it was determined the facility failed to develop comprehensive person-centered care plan for Resident #4 receiving two antidepressant medications. This was evident for 2 of 3 (R#4 & R#11) residents reviewed for care plan implementation during this annual recertification survey.

Inspectors wroteBased on medical record review and interviews with the resident family and facility staff it was determined the facility failed to update a resident's care plan to include non-compliance with treatment regimen. This was evident for 1 resident (# 9) reviewed during the facility's annual Medicare/Medicaid survey.

Inspectors wroteBased on observation and staff interview it was determined the facility staff failed to prominently post nurse staffing information to ensure that staff and visitors could easily identify staff to resident assignments. This was evident for the long-term care unit throughout this annual recertification survey.

Inspectors wroteBased on review of employee files, training records and staff interview it was determined the facility failed to consistently ensure that all staff received abuse prevention training that included activities that constitute abuse, neglect, exploitation, and misappropriation of resident property, procedures for reporting incidents of abuse, neglect, exploitation, or the misappropriation of resident property and Dementia management. This was evident for 2 of 4 nurses reviewed for training compliance during this annual recertification survey.

Inspectors wroteBased on review of employee files, training records and staff interview it was determined that the facility failed to ensure that all nurses' aides received 12 hours of training, annually, that included abuse prevention and Dementia management, and addressed areas of weakness as determined in the nurse aides' performance reviews. This was evident for 3 of 7 (GNA # 1, 2 and 3) nurses' aides reviewed for training compliance during this annual recertification survey.