Richmond Health Care Center

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to maintain 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 disease and infection for 1 of 2 residents (Resident #1) reviewed for infection control, in that: - CNA Z and CNA R failed to wear PPE for EBP, when they provided incontinence care to Resident #1.- The facility failed to have Enhanced Barrier Precaution signage on the door or anywhere visible in Resident #1's room.- The facility failed to have PPE readily available for staff to don before entering Resident #1's room. This deficient practice could place residents at risk for infection, sepsis (infection throughout body), and hospitalization due to cross contamination.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a copy of the 30-day discharge notice was sent to a representative of the State Long-Term Care Ombudsman for one (Resident #35) of four residents reviewed for discharge planning. -The Long-Term Care Ombudsman did not receive a copy for Resident #35's discharge notice. -The Ombudsman contact information on the letter was incorrect. The failure could place residents at risk for not being able to have representation to contest the discharge.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 of 18 residents (Resident #53) reviewed for ADLs. The facility failed to ensure CNA B provided incontinent care every two hours as required for Resident #53 on 08/28/24, which resulted in a saturated brief, linens, and mattress. This failure could result in pressure injuries, infections, psychosocial harm, and a decreased quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that pain management was provided to residents who require such services, consistent with professional standards of practice for 1 of 5 residents (Resident #4) reviewed for pain management. The facility failed to ensure Resident #4's pain control was maintained at a level acceptable to the resident. This failure could place the resident at risk of a decrease in quality of life due to pain.

Inspectors wroteBased on interview and record review the facility failed to ensure there was a communication process, which included how the communication would be documented between the LTC facility and the hospice provider, to ensure that the needs of the resident were addressed and met 24 hours per day for 1 of 2 residents (Resident #36) reviewed for hospice services. -The facility failed to maintain required hospice forms and documentation to ensure Resident #36 received adequate end-of-life care. This failure could place the residents who receive hospice services at-risk of receiving inadequate end-of-life care.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to establish and maintain 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 infection for 1 of 6 residents (Resident #53) reviewed for infection control. The facility failed to ensure CNA A followed proper infection control and hand washing procedure during incontinent care for Resident #53. This failure could lead to cross-contamination and the development of infection.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the daily staffing was posted and readily accessible for review for 1 of 1 facility reviewed for required postings. -The facility failed to post the daily nursing staffing information on 08/27/2024. This failure could affect residents, facility visitors, vendors and emergency personnel by placing them at risk of not having access to information regarding daily nursing staffing in a timely manner. Findings Included: Observation on 08/27/24 at 11:05a.m., during rounds revealed nursing staffing information was posted by the receptionist desk dated 08/20/2024. Observation on 08/28/24 at 9:05a.m., during rounds revealed nursing staffing information was posted by the receptionist desk dated 08/20/2024. [...]

Inspectors wroteBased on interview and record review, the facility failed to safeguard, manage, and account for the personal funds of the residents, deposited with the facility, for one (Resident#2) of three residents reviewed for trust funds - The facility failed to provide Resident#2 with the $75 that she was supposed to get. This failure could place residents whose personal funds were managed by the facility at risk of loss of those funds.

Inspectors wroteBased on interview and record review the facility failed to establish and follow a written policy on permitting residents to return to the facility after they are hospitalized or placed on therapeutic leave for 1 of 2 residents (CR #1) reviewed for discharge requirement, in that: -The facility failed and refused to readmit CR #1 from the hospital where he was transferred for evaluation and treatment. This failure placed residents at risk of not receiving care and services to meet their needs upon discharge.

Inspectors wroteBased on interviews and records reviews, the facility failed to develop and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality of care for 1 (CR#1) out of 3 residents reviewed for base-line care plans. -The facility failed to ensure CR#1 had a baseline care plan developed within 48-hours after admission with goals and interventions. The failure could place newly admitted residents at risks of not receiving the care and continuity of services.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that residents who needed respiratory care were provided with such care, consistent with professional standards of practice for 1 (Resident #2) of 2 residents reviewed for respiratory care. -Resident #2's Nebulizer mask was not labeled/bagged while not in use on 02/09/2024. This failure could place residents that receive oxygen therapy at risk for inadequate care and respiratory infection. Findings Included: Record review of Resident#2's Face Sheet (undated) revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure all alleged violations involving abuse were reported immediately within 2 hours to state agency for 1(Resident #1) of 6 reviewed for reporting in that: Administration failed to report to the state agency when Resident #1, who had dementia was not able to tell them how she got skin tears to both sides of her neck on 1/10/2024. This failure placed current residents at risk for abuse. Findings Included: Observation on 1/12/2024 at 10:00 a.m. of Resident #1's neck revealed a skin tear and bruise on the right side of her neck and a bandage slightly left of her throat. Record review of Resident #1 undated face sheet revealed a [AGE] year-old female that was admitted to the facility on [DATE] with diagnoses: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services to include procedures that assured the accurate administration of all drugs to meet the needs of each resident for 16 of 18 residents (Resident #1, Resident #2, Resident #3, Resident #4, Resident #5, Resident #6, Resident #7, Resident #8, Resident #9, Resident #10, Resident #11, Resident #12, Resident #13, Resident #14, Resident #15, and Resident #16) reviewed for pharmacy services. The facility failed to ensure medications that were scheduled three and four times daily were administered at their scheduled times, resulting in medications being administered with only 2-4 hours between doses for Residents #1, #2, #5, #6, #8, and #13. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to have sufficient nursing staff with the appropriate competencies and skill sets to provide nursing care to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 12 of 30 days reviewed for sufficient staffing. The facility failed to ensure there were enough staff to administer medications timely from 11/3/23 through 11/10/23. The facility failed to ensure the night and weekend staff had an appropriate amount of nurses and CNAs to meet the needs of the residents. This failure could place residents at risk of their needs not being met, injury, skin breakdown, low self-esteem, depression, embarrassment, and psychological harm.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store all drugs and biologicals in locked compartments and permitted only authorized personnel to have access in accordance with State and Federal laws for 3 of 3 storage rooms, (Medication room [ROOM NUMBER], Medication room [ROOM NUMBER], and Oxygen Storage room [ROOM NUMBER]) reviewed for storage of drugs and biologicals. The facility failed to ensure all drugs, including antipsychotics, anticonvulsants, antidepressants, anti-hypertensives, blood thinners, antibiotics, and antihistamines, were properly secured when staff conspicuously wrote the code to the keypad lock on the door/door frame for two of two medication rooms and an oxygen tank storage room. This failure placed residents at risk of drug overdose, drug interactions, and other health complications from possible misuse of medications and supplies.

Inspectors wroteBased on observation, interview, and record review the facility failed to promote care for residents in a manner and in an environment that maintained or enhanced each resident's respect and dignity for 2 (Resident #1 and Resident #12) of 3 residents reviewed for dignity in that: The facility failed to provide dignity and respect for Resident #1 and Resident #12 by leaving the resident's privacy bag off their foley bag exposing the full urinary bag to open doorway. This failure placed resident with an indwelling catheter at risk for embarrassment and low self- esteem.

Inspectors wroteBased on observations , interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident medical, nursing, mental, and psychosocial needs for 1 (Resident #1) of 3 residents reviewed for care plans in that: The facility failed to implement a fall mat for Resident #1 who was care planned for a fall mat due to being a high risk for falls. The facility failed to implement the intervention that the bed should be in low position at night for Resident #1 who was care planned for high risk for falls. These failures place residents at risk of not receiving appropriate needs based on interventions listed in resident's care plans.

Inspectors wroteBased on observation, interview, and record review the facility failed to establish and maintain 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 for 1 (Resident #1) of 3 residents reviewed for infection control in that: The facility failed to ensure Resident #1's Foley bag was secured to the bed and not touching the ground. This failure placed residents with an indwelling catheter at risk of unnecessary infections.

Inspectors wroteBased on interview and record review the facility failed to implement policies addressing resident admission to the facility for 1 of 6 residents (Resident #1) reviewed for admissions. -The facility failed to provide a signed admission packet for Resident #1 upon his admission. Resident #1 continued to reside in the facility without a signed admission agreement since 03/21/22. This deficient practice could place residents at risk of not being made aware of their rights, the facility characteristics, and services provided by the facility or policies of the facility. Findings Included: Record review of Resident #1's face sheet, dated 06/08/2023, revealed a [AGE] year-old male with an admit date of 03/21/2022. [...]

Inspectors wroteBased on interview and record review the facility failed to develop and implement a baseline care plan that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 1 (Resident #48) of 6 residents reviewed for baseline care plans. -The facility failed to complete a baseline care plan within the required 48-hour timeframe for Resident #48. This failure could place residents at risk for not receiving necessary care and services or not having important care needs identified. Findings Included: Record review of Resident #48's face sheet, dated 06/08/2023, revealed an [AGE] year-old female with an initial admit date of 02/09/2023. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of 1 (Resident #6) of 7 residents reviewed for medication administration. -1) MA L dispensed medications for Resident #6 but was following the MAR of Resident #44. -2) Surveyor intervention was necessary to prevent the possibility of Resident #6 receiving incorrect medications. These failures could place residents at risk for receiving the wrong medications and the possible complications from those medications. Findings Include: Record review of the admission Record for Resident #6 (printed on 06/08/2023) revealed Resident #6 was a [AGE] year-old male admitted to the facility on [DATE]. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 facility kitchen, reviewed for sanitation in that: 1) The facility failed to ensure the stove's vent hood was free from dust build-up. 2) The facility failed to ensure the ice machine's vent cover was free from grease and dust build-up. These failures could affect all residents who receive meals from the kitchen and place them at risk for foodborne illness. Findings Include: Observation on 06/06/2023 at 8:40 a.m. accompanied by the DM during a walk-through inspection of the kitchen revealed the following: -Dust build-up on the stove vent hood. -Dust and grease build-up on the ice machine's vent cover located above the ice bin. Observation on 06/06/2023 at 8:45 a.m. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program so that the facility is free of pests and rodents for 1 of 1 facility reviewed for pest control. -The facility failed to ensure it was free from ants. This failure placed residents at risk of a decreased quality of life.