Rib Lake Health Services

Inspectors wroteBased on observation and interview, the facility did not ensure each resident has a safe, clean, comfortable, and homelike environment, including, but not limited to, receiving treatment and support for daily living for 5 (R5, R6, R7, R8, and R9) of 7 residents who independently use the East Hall to receive therapy services. For 6 of 13 (R5, R13, R14, R15, R17, and R3) residents residing in the southeast hall who independently ambulate. For 20 of 32 (R5, R6, R10, R20, R11, R7, R4, R12, R13, R1, R8, R14, R9, R2, R15, R16, R17, R18, R19, and R3) residents who have the potential to independently ambulate to the dining room to use the vending machines. [...]

Inspectors wroteBased on interview and record review, the facility did not immediately inform the resident's representative when there was a significant change in the resident's physical, mental, or psychosocial status for 2 of 3 residents (R) reviewed. (R1 and R3). R1 became lethargic and confused and was sent to the emergency department. There is no evidence that representative/emergency contact was updated. R3 had severe abdominal pain, acute leukocytosis with concern of sepsis (life threatening condition) would progress, and was transferred to the emergency department. There is no evidence that representative/emergency contact was updated. The facility policy titled, Change in condition of the Resident, states, Documentation . 4. Notification of responsible party - include date, time, what was conveyed, any comments (each time notified). [...]

Inspectors wroteBased on observation and interview, the facility did not maintain a safe and sanitary environment in which food is prepared and distributed. This had the potential to affect all 38 residents in the facility. Facility staff did not label, date, or cover food. Facility is not protecting clean dishware from contaminants. Facility staff did not keep personal clothing from touching food when serving residents.

Inspectors wroteBased on interview and record review, the facility did not ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment are reported immediately, but not later than 2 hours after the allegation is made to the administrator of the facility and to other officials in accordance with State law through established procedures for 1 resident (R8) reviewed. Facility failed to report R8's allegation of abuse/neglect to State Agency (SA) and law enforcement.

Inspectors wroteBased on interview and record review, the facility did not ensure alleged violations of abuse or neglect was thoroughly investigated, preventions for further abuse/neglect implemented, and corrective actions were taken as a result of investigation for 1 resident (R8) of 1 resident. Failure by the facility to thoroughly investigate R8's allegation of abuse/neglect denied protection of R8's health, welfare and rights as a resident to feel safe while residing at facility.

Inspectors wroteBased on interviews and record review, staff did not follow the facility's post fall assessment for 1 out of 1 resident (R26) investigated for falls. The facility did not ensure post fall neurological (neuro) checks were performed as required following R26's unwitnessed fall.

Inspectors wroteBased on interview and record review, the facility failed to ensure each resident receives adequate supervision and assistance devices to prevent accidents for 1 of 6 residents (R9) who smoke in the facility. R9 did not have a smoking care plan, or a nicotine assessment completed.

Inspectors wroteBased on observation, interview and record review, the facility did not prepare, distribute, and serve food in a manner that prevents foodborne illness. This has the potential for foodborne illness to all 35 residents (R) in the facility. The facility staff did not ensure proper hand hygiene when preparing and plating of food. The facility did not take internal food temperatures of all cooked foods before serving.

Inspectors wroteBased on observation, interview, and record review, the facility did not maintain an infection prevention and control program to help prevent the development and transmission of communicable diseases and infections. This has the potential to affect all 14 residents (R) living on the unit. R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, R16, R17, R18 Staff did not wear proper personal protective equipment (PPE) when interacting with residents on contact precautions (R5, R6, R7, R8, and R9). Staff entered rooms of residents on contact precautions (R5, R6, R7, R8, R9) without proper PPE and then passed food trays to residents not on contact precautions which had the potential to develop and transmit communicable disease and infections.

Inspectors wroteBased on record review and interview, the facility did not revise resident care plans to reflect residents' current needs and to provide the needed direction to staff in providing necessary care and services. The facility practice affected 2 of 4 residents care plans reviewed (R3 and R4). R3's care plan directs staff with intervention on toileting schedule when R3 is fully incontinent and requires checking for incontinence, providing incontinent care and/or changing or brief if warranted. R4's care plan directs staff to remove her Hoyer sling when in wheelchair when current interventions include leaving R3's sling in place when up in her wheelchair for her safety. This is evidenced by: Surveyor requested and reviewed the facility policy titled Comprehensive Care Plan dated as most recently revised 9/23/2022. The policy in part read: Policy: [...]

Inspectors wroteBased on observation, record review and interview, the facility did not provide the necessary activities of daily living (ADLs) services for residents dependent on staff for care. The facility practice affected 1 of 4 residents reviewed for ADLs (R3). This is evidenced by: Surveyor requested and reviewed the facility policy tilted Perineal Care dated as most recently revised 4/04/2023. The policy in part read: Policy: It is the practice of this facility to provide perineal care to all incontinent residents .as needed to promote cleanliness and comfort . Policy Explanation and Compliance Guidelines: ~Gather supplies needed. ~Place water proof pad underneath resident. ~Reposition resident in supine position and continue with perineal care. Surveyor reviewed R3's record and noted the following: [...]

Inspectors wroteBased on observation, record review and interview, the facility did not provide the necessary services for residents at risk for pressure injuries or residents with actual pressure injuries. The facility practice affected 1 of 4 residents reviewed (R3). R3 was not provided repositioning from her wheelchair to off-load pressure from 6:30 AM until Surveyor concluded observation at 12:10 PM. This is evidenced by: Surveyor requested and reviewed the facility policy titled Pressure Injury and Non-pressure Injuries dated as most recently revised 7/20/22. The policy in part read: Policy: This center will complete a comprehensive assessment to identify risk factors for the development of pressure injuries and put measures in place intended to achieve the goal of prevention of pressure injuries in our residents. Friction and Shearing: [...]

Inspectors wroteBased on record review and interview, the facility did not take appropriate corrective action, educating all staff for 4 of 4 residents (R1, R2, R3, R4) reviewed for misappropriation of property. This is evidenced by: Surveyor reviewed the facility policy titled, Abuse, Neglect and Exploitation, revised on 07/15/22, which states, .It is the policy of this facility to provide protection for the health welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse neglect exploitation and misappropriation of resident property . Staff: Includes employees, the medical director, contractors, caregivers who provide care and services to residents, including therapy, social and activity programs. [...]

Inspectors wroteBased on interview and record review, the facility did not establish an Infection Control Program under which it investigates, controls, and prevents infections in the facility, or a system for recording incidents identified under the facility's Infection Control Program, including corrective action in a timely manner, for both residents and staff. This has the potential to affect all 39 residents in the facility. -The facility did not have an adequate surveillance program in place for tracking and monitoring infectious disease for staff and residents. -Observations were made of facility staff not implementing proper infection control practices during and after resident cares for 1 of 1 resident on Enhanced Barrier Precautions (R2).

Inspectors wroteBased on observation, interview and record review, the facility did not distribute foods and beverages in a manner to prevent contamination. The facility practice has the potential to affect 28 of 39 residents who routinely eat in their rooms. Surveyors observed meal service for lunch on 9/09/24 and breakfast service on 9/10/24. Surveyor observed foods and beverages being distributed to residents from a food cart down the wings to their rooms without cover to prevent contamination. This is evidenced by: Surveyor requested and reviewed the facility policy titled Meal Distribution with most recent revision of 2/2023. The policy in part reads: Policy Statement: Meals are transported in dining locations in a manner that .protects against contamination. Procedure: All foods that are transported to dining areas that are not adjacent to the kitchen will be covered. [...]

Inspectors wroteBased on observation, interview and record review, the facility did not develop and implement a comprehensive person-centered care plan for 1 (R19) of 12 sampled residents to meet a resident's medical, nursing and psychosocial needs that are identified. R19 did not have a comprehensive person-centered care plan for the use of a high risk medication.

Inspectors wroteBased on interview and record review, the facility did not provide care and treatment in accordance with professional standards of practice for 1 of 12 sampled residents (R2). On 03/16/24, R2 developed a fluid filled blister on left foot. On 3/19/24, a fluid filled blister developed on R2's right foot. Both blisters opened and resulted in a non-pressure injury, that was infected with Methicillin Resistant staphylococcus. (MRSA). A care plan was not implemented for the blister, and the facility did not follow through with the antibiotic order for the MRSA.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure 1 of 1 resident (R26) reviewed for post-traumatic stress disorder (PTSD) received culturally competent trauma-informed care in accordance with professional standards of practice and accounting for each resident's experience and preferences in order to eliminate or mitigate re-traumatization.

Inspectors wroteBased on interview and record review, the facility did not ensure 1 of 14 residents (R) R11, reviewed for comprehensive care plans had a developed care plan to include epilepsy (seizure disorder). R11 had a history of epilepsy and did not have a comprehensive care plan to include information concerning R11's history of epilepsy. This was evidenced by: R11 was admitted to the facility on [DATE] and had a diagnosis that includes epilepsy. R11's admission Minimum Data Set (MDS) assessment, dated 02/26/23 and the most recent MDS dated [DATE], were marked for seizure disorder/epilepsy as a medical condition. R11's care plan did not include information on anything pertaining to seizure disorder, to ensure staff would recognize and take correct action if a seizure were to occur. [...]

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure 2 of 3 residents with indwelling Foley catheters (R14 and R3) received appropriate treatment and services to prevent urinary tract infections (UTIs) and restore continence to the extent possible. - R14 was admitted with an indwelling Foley catheter. The facility did not assess R14's continued need for the device, there was no medical justification located for the catheter, and there was no trial discontinuation followed by a comprehensive bladder assessment with an individualized toileting plan to determine if R14 could remain as continent as able without the device. Furthermore, R14 receives catheter changes every month without justification. [...]