Restoracy of Carmel

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure new residents were correctly screened for tuberculosis and staff wore protective gowns for enhanced barrier precautions for 5 of 7 residents reviewed for infection control. (Resident 18, 40, 43, 66 and 54)

Inspectors wroteBased on interview and record review, the facility failed to ensure the physician was notified of a three (3) pound weight gain according to the physician's order for 1 of 3 residents reviewed for notification of change. (Resident 4)

Inspectors wroteBased on interview and record review, the facility failed to ensure proper discharge information was documented in the electronic health record for 3 of 6 residents reviewed for discharge. (Resident 5, 6 and 77)

Inspectors wroteBased on interview and record review, the facility failed to ensure a Preadmission Screening and Resident Review (PASSAR) level I screen contained current mental health diagnoses and mental health medications for 1 of 2 residents reviewed for PASSAR. (Resident 75) The deficient practice was corrected on 2/12/26, prior to the start of the survey, and was therefore past noncompliance.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication cart was free of expired medications for 1 of 3 medication carts reviewed for medication storage and labeling. (Cottage 3)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure refrigerated food was not expired and refrigerators were maintained at proper temperatures for food safety for 2 of 6 refrigerators reviewed (Cottage 6) which supplied food to 2 of 6 cottages. (Cottage 1 and Cottage 6)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure urinary catheter bags had dignity covers in place for 2 of 3 residents reviewed for dignity. (Resident 40 and 52)

Inspectors wroteBased on interview and record review, the facility failed to ensure staff followed the physician's orders regarding medication administration for 2 of 2 residents reviewed for quality of care. (Resident 19 and 7)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure catheter bags were not touching a dirty surface and catheters were disposed of properly for 3 of 5 residents reviewed for infection control. (Resident 52, 7 and 44)

Inspectors wroteBased on interview and record review, the facility failed to ensure residents' credit cards were kept safe and secure during their admission for 2 of 3 residents being reviewed for misappropriation of property. (Residents B and C) The deficient practice was corrected on 8/5/24, prior to the start of the survey, and was therefore past noncompliance.

Inspectors wroteA current policy, titled Pressure Injury Risk Assessment, not dated, indicated .the purpose of this procedure is to provide guidelines for the assessment and identification of resident at risk of developing pressure injuries .skin will be assessed for the presence of developing pressure injuries on a weekly basis or more frequently if indicated .nurses will conduct skin assessments at least weekly to identify changes .the following information should be recorded in the resident's medical record utilizing facility forms: type of assessment conducted (for example, admission assessment, weekly skin integrity tool) .the date and time and type of skin care provided, if appropriate .the name title (or initials) of the individual who conducted the assessment .any change in the resident's condition, if identified .the condition of the resident's skin (i.e. [...]

Inspectors wrote3. During an observation, on 2/19/24 at 3:17 p.m., Resident 38 appeared calm and smiled frequently. During an observation, on 2/20/24 at 10:30 a.m., Resident 38 was calm and appeared comfortable while lying in bed after breakfast with his wife at his bedside. During an observation, on 2/22/24 at 9:42 a.m., Resident 38 was trying to eat breakfast with his eyes closed. Despite frequent cuing from staff, the resident kept closing his eyes again and was having difficulty eating his breakfast. The clinical record for Resident 38 was reviewed on 2/22/24 at 11:07 a.m. The diagnoses included, but were not limited to, Parkinson's disease with dyskinesia, dementia in other diseases with psychotic disturbance, hallucinations, and insomnia. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure the refrigerators and freezers were clean, food was sealed, labeled, and dated, and expired foods were discarded for 4 of 6 kitchens reviewed. (Kitchen 3, 4, 5 and 6)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was asked or instructed prior to repositioning for 1 of 1 resident reviewed for respect and dignity. (Resident 28)

Inspectors wroteBased on interview and record review, the facility failed to ensure the Preadmission Screening and Resident Review (PASARR) were completed when new mental health diagnoses were added for 2 of 4 residents reviewed for PASARR. (Resident 5 and 36)

Inspectors wroteBased on interview and record review, the facility failed to complete a Level 1 Preadmission Screening and Resident Review (PASARR) prior to admission for 1 of 4 residents reviewed for PASARR. (Resident 3)

Inspectors wroteBased on observation, interview and record review, the facility failed to provide quarterly care plan conferences and failed to include the use of a positioning cushion in the comprehensive care plan of 2 of 5 residents reviewed for care planning. (Resident 53 and 6)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living (ADL) care received the oral care recommendations from the Registered Dental Hygienist for 1 of 2 residents reviewed for ADL care. (Resident 5)

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure cognitively stimulating activities were offered daily for 3 of 5 residents reviewed for activities. (Resident 23, 51 and 61)

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident who had a colostomy had specific direction for colostomy care for 1 of 1 resident reviewed for bowel and bladder. (Resident 25)

Inspectors wroteBased on interview and record review, the facility failed to recognize, provide interventions, and to notify the physician of a weight loss for 2 of 5 residents reviewed for nutrition. (Resident 51 and 5)

Inspectors wroteBased on interview and record review, the facility failed to ensure a designated Infection Preventionist was onsite to work within the facility and completed the qualifying training or certification for 1 of 1 Infection Preventionist reviewed. (DON 2)