Richmond Healthcare & Rehab Center

Inspectors wroteThe facility documented a census of 49 residents. The sample included three residents. Based on observation, interviews, and record review, the facility failed to respond to speech therapy recommendations for dietary changes and a swallow study result recommendation for Resident (R) 1.

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents and five Certified Nurse Aides (CNA) reviewed for yearly performance evaluations and the associated in-service training. Based on record review and interview, the facility failed to ensure one of the five CNA staff reviewed had yearly performance evaluations completed. This deficient practice placed the residents at risk for inadequate care.

Inspectors wroteThe facility identified a census of 47 residents and one kitchen. Based on record review and interviews, the facility failed to provide the services of a full-time certified dietary manager for the 47 residents who resided in the facility and received their meals from the kitchen. This placed the residents at risk for inadequate nutrition.

Inspectors wroteThe facility identified a census of 47 residents with one kitchen. Based on observation, record review, and interviews, the facility failed to follow sanitary dietary standards related to storage, preparation, and meal service. This deficient practice placed the residents at risk for food-borne illnesses and food safety concerns. Findings Included: - On 02/24/25 at 07:00 AM, a walkthrough of the facility was completed. An inspection of the dining hall revealed the dining room was closed off to the residents. The dining room ceiling fixtures hung from the ceiling. Dust covered the tables and floor of the dining room. No barriers were in place between the construction area and the food preparation areas. [...]

Inspectors wroteThe facility had a census of 47 residents. Five Certified Nurse Aides (CNA) were sampled for required in-service training. Based on record review and interview, the facility failed to ensure five of the five CNA staff reviewed had the required 12 hours of in-service education. This placed the residents at risk for decreased quality of life and/or inadequate care.

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents. Based on observation, record review, and interviews, the facility failed to develop and implement individualized activities programming based on resident preferences for the residents on weekends. This deficient practice placed the affected residents at risk for decreased psychosocial well-being, boredom, and isolation. Findings Included: - A review of the facility's Activity Calendars for December 2024, January 2025, and February 2025 was completed. The calendars revealed church services, coloring, puzzles, and movies were provided on Sundays. The calendars revealed reminiscing, coloring, puzzles, and independent activities were provided on Saturday. On 02/25/25 at 10:30 AM the facility's Resident Council reported activities on the weekends were inconsistent compared to weekdays. [...]

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with one medication room and four medication carts. Based on observation, record review, and interviews, the facility failed to ensure controlled substances were accounted for and reconciled between shifts. This deficient practice placed the residents at risk for misappropriation and/or diversion of controlled substances.

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with one medication room and four medication carts. Based on observation, record review, and interviews, the facility failed to appropriately store medications and biologicals when staff failed to ensure the tuberculin (a sterile liquid used to diagnose tuberculosis) test serum was dated after the vial was opened. This placed the residents at risk for adverse outcomes or ineffective medication regimens.

Inspectors wroteThe facility identified a census of 47 residents. The facility identified eight residents on Enhanced Barrier Precautions (EBP - infection control interventions designed to reduce transmission of resistant organisms that employ targeted gown and glove use during high contact care). Based on record review, observations, and interviews, the facility failed to ensure the linen cart was covered, and wash clothes were not stuffed in the guard rails outside of resident's rooms, and further failed to ensure all oxygen cannulas and nebulizer (a device that changes liquid medication into a mist easily inhaled into the lungs) masks were stored in a sanitary manner. These deficient practices placed the residents at risk for infectious diseases.

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with one resident reviewed for dignity. Based on observation, interview, and record review, the facility failed to provide a dignified care environment for Resident (R) 35 and R43. This deficient practice placed the residents at risk for impaired dignity and quality of life. Findings Included: - On 02/24/25 at 07:23 AM, Certified Nurse Aide (CNA) PP stood over R35 during the breakfast meal service. CNA PP fed R35 her breakfast standing over her for the entirety of her meal. On 02/24/25 at 12:20 PM, R43 sat in her electric wheelchair with her lunch. An unidentified staff member stood over R43 several times during meal service to assist by feeding her meal due to R43's difficulty using the silverware. [...]

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with two residents reviewed for accommodation of needs. Based on observation, record review, and interviews, the facility failed to provide wheelchair foot pedals for Resident (R) 16's wheelchair while pushing her in the hall. This placed R16 at an increased risk for preventable falls and injuries.

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with one resident reviewed for hospitalization. Based on observation, record review, and interviews, the facility failed to provide written notification of the reason and location for the facility-initiated transfer for Resident (R ) 7. This deficient practice placed R7 at risk of delayed care or uncommunicated care needs. Findings Included: - The Medical Diagnosis section within R7's Electronic Medical Records (EMR) included diagnoses of muscle weakness, type two diabetes mellitus (DM - when the body cannot use glucose, not enough insulin is made, or the body cannot respond to the insulin), repeated falls, insomnia (difficulty sleeping), and dysphagia (difficulty swallowing). [...]

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with one resident reviewed for hospitalization. Based on observations, interviews, and record review, the facility failed to provide a copy of the facility bed hold policy to Resident (R) 7 and/or their representative, with a written notice specifying the duration and cost of the bed hold, at the time of R7's transfer to the hospital. This placed the resident at risk for impaired rights. Findings Included: - The Medical Diagnosis section within R7's Electronic Medical Records (EMR) included diagnoses of muscle weakness, type two diabetes mellitus (DM - when the body cannot use glucose, not enough insulin is made, or the body cannot respond to the insulin), repeated falls, insomnia (difficulty sleeping), and dysphagia (difficulty swallowing). [...]

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with 12 residents whose Minimum Data Set (MDS) were reviewed. Based on observation, record review, and interviews, the facility failed to complete an accurate MDS assessment for Resident (R) 35's status regarding admission to hospice services. This deficient practice placed R35 at risk for inappropriate care planning and care needs.

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with one resident reviewed for activities of daily living (ADL) care. Based on observation, record review, and interviews, the facility failed to ensure staff assisted Resident (R) 16 with grooming and face shaving. This deficient practice placed R16 at risk for impaired dignity, comfort, and a further decline in ADLs. Findings Included: [...]

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with one resident reviewed for quality of care. Based on observation, record review, and interviews, the facility failed to follow a physician's order for weekly weights to monitor Resident (R) 17 for fluid overload. This deficient practice placed R17 at risk for delay in treatment related to fluid overload and untreated illness.

Inspectors wroteThe facility reported a census of 47 residents. The sample included 12 residents, with 5 reviewed for accidents. Based on observations, record reviews, and interviews, the facility failed to ensure a safe care environment related to the following Residents (R) 29, R33, and R32. This deficient practice placed the residents at risk for preventable accidents and injuries. Findings Included: [...]

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with one resident reviewed for respiratory care. Based on observation, record review, and interviews, the facility failed to ensure Resident (R) 15's nebulizer (a device that changes liquid medication into a mist easily inhaled into the lungs) mask and nasal cannula were stored in a sanitary manner. This placed R15 at an increased risk for respiratory infection and complications.

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with four reviewed for dementia (a progressive mental disorder characterized by failing memory, and confusion) care. Based on interviews, record reviews, and observations, the facility failed to provide dementia-related care services for Resident (R) 91 to promote the resident's highest practicable level of well-being. This deficient practice placed R91 at risk for decreased quality of life, isolation, and impaired dignity. Findings Included: [...]

Inspectors wroteThe facility identified a census of 47 residents. The sample included 12 residents, with three residents reviewed for hospice (a type of health care that focuses on the terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life) services. Based on observation, record review, and interview, the facility failed to ensure a coordinated plan of care, which coordinated care and services provided by the facility with the care and services provided by hospice, was developed and available for Resident (R) 15. This placed the resident at risk for inappropriate end-of-life care. Finding Included: [...]

Inspectors wroteThe facility reported a census of 45 residents with 22 residents selected for review, including 19 sampled for unnecessary medications. Based on record review and interview, the facility failed to ensure 19 residents, Resident (R) 3, R4, R5, R6, R8, R9, R11, R14, R15, R16, R17, R18, R19, R20, R21, R22, R23, R24, and R25 received their physician ordered medication scheduled on 04/08/24 during the 06:00 PM to 09:00 PM medication pass.

Inspectors wroteThe facility reported a census of 45 residents with 22 residents selected for review, including 19 sampled for unnecessary medications. Based on record review and interview, the facility failed to ensure 10 residents, Resident (R) 3, R4, R5, R6, R17, R20, R21, R22, R24, and R25 received their physician ordered psychotropic (alters mood or thought) medication scheduled on 04/08/24 during the 06:00 PM to 09:00 PM medication pass.

Inspectors wroteThe facility reported a census of 43 residents. Based on observation, interview, and record review, the facility failed to maintain a clean, sanitary kitchen for food storage, preparation, and serving to the residents of the facility.

Inspectors wroteThe facility reported a census of 43 residents with 14 residents sampled, including two residents reviewed for hospitalization. Based on interview and record review, the facility failed to provide one of the two reviewed, Resident (R)24 and/or their representative, with a written notice specifying the duration and cost of the bed hold policy, at the time of the resident's transfer to the hospital.

Inspectors wrote- Resident (R)18's Physician Orders, dated 04/25/23, documentation included diagnoses of hemiplegia (paralysis of one side of the body)and hemiparesis (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscles) following a cerebral vascular event (CVA- damage to the brain from the interruption of its blood supply which affecting left non dominate side), muscle weakness, and hypertension (high blood pressure). The Annual Minimum Data Set (MDS), dated [DATE], documented a Brief Interview for Mental Status (BIMS) score of 13 indicating cognitively intact. He required extensive assistance of staff for bed mobility, transfer, locomotion, and walking did not occur. His balance during transition was not steady, and he could only stabilize with staff assistance. [...]

Inspectors wroteThe facility reported a census of 43 residents with 14 residents sampled, including three residents reviewed for Activity of Daily Living (ADL). Based on observation, interview and record review, the facility failed to provide appropriate care to one dependent Resident (R)29, regarding hair care.

Inspectors wroteThe facility reported a census of 43 residents with 14 residents sampled. Based on observation, interview, and record review, revealed the facility failed to complete adequate neurological checks (checks for disorders of the central nervous system) for one Resident (R)24, following a fall which resulted in a head injury.

Inspectors wroteThe facility reported a census of 43 residents with 14 residents sampled, including six residents reviewed for accidents. Based on observation, interview, and record review, the facility failed to implement appropriate interventions following falls for three dependent Residents (R)14, R 18 and R 28.

Inspectors wroteThe facility reported a census of 43 residents with 14 residents sampled including one resident reviewed for bowel and bladder. Based on observation, interview and record review, revealed the facility failed to toilet one Resident (R)24 timely in order to achieve or maintain as much normal bladder function as possible.

Inspectors wroteThe facility reported a census of 43 residents. The 14 sampled residents included six reviewed for unnecessary medications. Based on observation, interview and record review the facility failed to ensure the staff administered the resident's antidepressant medications as ordered by the physician for one of the six residents reviewed, (R)32.

Inspectors wroteThe facility reported a census of 48 residents. Based on observation, interview, and record review, the facility failed to store, prepare, and serve food under sanitary conditions to prevent the spread of food borne illnesses to the residents of the facility.

Inspectors wroteThe facility reported a census of 48 residents with 16 selected for review. Based on observation, interview and record review, the facility failed to review and revise the care plan for one sampled resident (R)37, with interventions for dementia (progressive mental disorder characterized by failing memory, confusion) care strategies when the resident frequently yelled/screamed out.

Inspectors wroteThe facility reported a census of 48 residents with 16 selected for review which included one resident selected for review for activities. Based on observation, interview and record review, the facility failed to provide activities for the one sampled dependent resident (R)37 with dementia.

Inspectors wroteThe facility reported a census of 48 residents with 16 residents sampled, including three residents reviewed for accidents. Based on observation, interview, and record review, the facility failed to place foot pedals on the wheelchair of one of the three sampled residents, Resident (R)7, when being propelled by staff, to prevent accidents.

Inspectors wroteThe facility reported a census of 48 residents with 16 selected for review which included one resident selected for review for dementia. Based on observation, interview and record review, the facility failed to provide appropriate treatment and care services for the one sampled resident (R)37 with dementia who frequently yelled out.