Richmond Pines Healthcare and Rehabilitation Cente

Inspectors wroteBased on record review, and staff, Pharmacist, and Physician interviews, the pharmacy failed to provide the correct dose of Depakote (an anticonvulsant medication used to treat epilepsy) for a resident. This was for 1 of 6 residents reviewed for medications (Resident #53).

Inspectors wroteBased on observations, record review, and staff, Pharmacist, and Physician interviews, the facility failed to administer the correct dose of Depakote (an anticonvulsant medication used to treat epilepsy). This was for 1 of 6 residents reviewed for medications.

Inspectors wroteBased on record review, observations, resident, and staff interviews, the facility failed to provide a privacy curtain for 1 of 3 residents reviewed for privacy (Resident #86).

Inspectors wroteBased on record review, resident representative, and staff interviews, the facility failed to administer influenza and pneumonia vaccines on admission for 1 of 5 residents reviewed for immunizations (Resident #13).

Inspectors wroteBased on record review, Resident Representative, and staff interviews, the facility failed to administer COVID-19 vaccine on admission for 1 of 5 residents reviewed for immunizations (Resident #13).

Inspectors wroteBased on record review and staff interviews, the facility failed to post accurate staffing information as compared to the daily staff schedule for licensed nursing staff for 13 out of 57 days reviewed for sufficient staffing. The facility also failed to ensure the resident census was present on the daily nurse staffing sheets for 54 out of 57 days.

Inspectors wrote5. Resident #78 was admitted on [DATE] with a diagnosis of a Cerebral Vascular Accident. Review of Resident #78's previous quarterly Minimum Data Sets (MDS) dated [DATE] and 1/26/22 indicated he was incontinent of bowel. His most recent quarterly MDS dated [DATE] indicated he was continent of bowel. Resident #78 was care planned 10/24/18 last revised 2/15/22 for toileting assistance due to incontinence related to his left sided weakness. An interview was conducted with Nursing Assistant (NA) #9 on 5/11/22 at 5:00 PM. She stated that she had worked with Resident #78 and that he has been incontinent of bowel for as long as she could recall. An interview was conducted with NA #10 on 5/11/22 at 5:05 PM. She stated Resident #78 was incontinent of bowel for as long as she could recall. An interview was conducted with the MDS Nurse on 5/12/22 at 12:26 PM. [...]

Inspectors wroteBased on observations, staff, resident and family interviews and record review, the facility failed to provide shaving assistance for Resident #17 and Resident #34 dependent on assistance with activities of daily living (ADLs). The facility also failed to provide nail care for ADL dependent residents (Resident #17, Resident #38, Resident #78, Resident #34 and Resident #26). This was for 5 of 20 residents reviewed for ADLs.

Inspectors wroteBased on observations, staff and Medical Director (MD) interviews and record review, the facility failed to ensure MD ordered specialty air mattress was set according to the weight of the resident (Resident #30 and Resident #38). The facility also failed to ensure the MD ordered air mattress was implemented for Resident #26. This was for 3 of 3 residents reviewed for pressure ulcers.

Inspectors wroteBased on observations, staff, resident and Medical Director (MD) interviews and record review, the facility failed to ensure Physician orders were obtained and implemented for the care and assessment of residents with indwelling urinary catheters (Resident #30, Resident #38 and Resident #74). The facility also failed to place a securement device for an indwelling urinary catheter (Resident #30). This was for 3 of 6 residents reviewed for urinary catheters.

Inspectors wrote4. Resident #40 was originally admitted to the facility on [DATE] with a readmission date of 1/18/22. His diagnoses included necrotizing fasciitis (a severe soft tissue infection that is caused by bacteria), abscess of the perineum, and type 2 diabetes. A quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #40 was cognitively intact and had surgical wounds present. A review of the active physician orders for Resident #40, revealed the following orders dated 4/1/22: - Clean the perineal wound with normal saline using gauze, pat dry with clean gauze, apply Calcium Alginate with Silver (a highly absorbent gel-like covering to help maintain a moist environment that promotes wound healing) and secure every day. - Clean the right buttock wound with normal saline using gauzes, pat dry with clean gauze, apply Calcium Alginate with Silver and secure every day. [...]

Inspectors wroteBased on record review, observations, resident and staff interviews, the facility failed to promote dignity by not providing a privacy cover over a urinary drainage bag for 1 of 1 residents reviewed for dignity (Resident #34).

Inspectors wroteBased on observations, staff and resident interviews and record review, the facility failed to ensure an adaptive call light was positioned within resident's access. This was for 1 of 1 resident (Resident #38) reviewed for accommodation of needs.

Inspectors wroteBased on record reviews, observations, resident, staff and physician interviews, the facility failed to provide surgical wound care as ordered for 1 of 3 residents reviewed for non-pressure related wound care (Resident #40).

Inspectors wroteBased on observations, staff and resident interviews and record review, the facility failed to apply splints as ordered for contracture management (Resident #38). This was for 1 of 1 residents reviewed for range of motion (ROM).

Inspectors wroteBased on observations, resident, staff, Vascular Nurse and Medical Director (MD) interviews, the facility failed to provide a dressing change to a Peripherally Inserted Central Catheter (PICC) line as ordered. This was for 1 (Resident #73) of 1 residents reviewed for infections.

Inspectors wroteBased on observations, staff and Medical Director (MD) interviews and record review, the facility failed to administer continuous oxygen at the prescribed rate (Resident #73 and Resident #80). This was for 2 of 3 residents reviewed for respiratory care.

Inspectors wroteBased on observations, record review and resident, staff, Medical Director (MD) and Physician #1 interviews, the facility failed to obtain and implement Physician orders for the care and monitoring of a resident on hemodialysis (Resident #17). This was for 1 of 1 resident reviewed for dialysis.

Inspectors wroteBased on record reviews and interviews with staff and the Medical Director, the facility failed to ensure as needed psychotropic medications were time limited in duration for 2 of 5 residents reviewed for unnecessary medications (Residents #50 and #59).

Inspectors wroteBased on record review, staff and Medical Director interviews, the facility failed to administer an antipsychotic medication as ordered by a physician, for a resident with aggressive behaviors (Resident #59). This was for 1 of 1 residents reviewed for behavioral and emotional status.

Inspectors wroteBased on observations and staff interviews, the facility failed to discard three expired insulin vials and failed to date one insulin vial when opened for 1 of 2 medication carts reviewed for medication storage (400 hall- SPARKS).