Richmond Post Acute Care

Inspectors wroteBased on observation, interview, and record review, the facility failed to allow four residents (Residents 15, 5, 9, and 13) to exercise their rights to self-determination when: 1. One out of 27 residents (Resident 15) was not provided nutrition in accordance with their preferences. 2. Three of six residents (Resident 5, 9, and 13) who followed the facility's smoking policy were not allowed to continue from smoking. These failures had the potential to result in Residents 15, 5, 9 and 13 feeling upset and disrespected.

Inspectors wroteBased on interview and record review, the facility failed to ensure two out of three sampled residents (Resident 22 and Resident 77), participated in their care planning process. This failure had the potential for Residents 22 and 77 to receive inappropriate interventions and care that was not aligned with their choices.

Inspectors wroteBased on interview and record review, the facility failed to ensure two of two sampled residents (Resident 4 and Resident 22), were free from unnecessary medications when: 1. Resident 4's antibiotic (treats bacterial infection) order of Levaquin oral tablet 250 milligrams (mg) did not have an adequate indication for use. 2. Resident 22's antibiotic order of Ciprofloxacin oral tablet 500mg did not have an adequate indication for use and a stop date. These failures had the potential to result in unnecessary and prolonged use of antibiotic medications, placing Resident 4 and Resident 22 at risk for adverse side effects and health safety issues.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure safe medication storage and labeling practices for a census of 28 when: 1. The medication refrigerator contained five bags of Resident 9's expired and discontinued intravenous (IV, administered directly into the vein) medications. 2. An unlabeled, undated, and unsecured prefilled pen (an injection device that delivers preloaded medication) of Ozempic (Diabetes medicine) was stored in the refrigerator. 3. An expired insulin pen (Diabetes medicine) was stored in an active storage area of the medication cart. 4) An unopened insulin pen with pharmacy label of refrigerate until opened was stored at room temperature in the medication cart. 5) The medication cart contained a discharged resident's bottle of Nitroglycerin medication (medicine to treat and prevent chest pain). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was stored under safe and sanitary conditions when: 1. Refrigerated and frozen food items were stored beyond their use by date. 2. Refrigerated and frozen resident food items were unlabeled and undated. 3. Staff food items were stored in the Resident refrigerator with resident food items. These failures had the potential to put 27 residents residing at the facility at risk for food borne illness and cross-contamination (transfer of bacteria or other microorganisms from one substance to another) that could have resulted in infection or spread of infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement infection control practices for four of four sampled residents (Resident 9, 3, 129, and 22) when the blood pressure (BP) cuff and medication tray were not cleaned and sanitized after each use. These deficient practices had the potential spread of infection among residents at the facility.

Inspectors wroteBased on observation and record review, the facility had seven resident rooms (Rooms 3, 4, 5, 6, 7, 8, and 9) with multiple beds that provided less than 80 square feet (sq. ft.) per resident. This deficient practice had the potential to result in inadequate space for the delivery of care to each of the residents in each room and for storage of the residents' belongings.

Inspectors wroteBased on interview and record review, the facility failed to ensure there was a full time dietician or certified dietary manager. This failure had the potential to put 32 out of 32 residents at risk for food-borne illnesses (illnesses caused by food contaminated with bacteria, viruses, parasites, and toxins) and/or malnutrition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was stored in accordance with professional standard for food service when five packages of frozen pancakes, four packages of frozen waffles, one large sheet tray of frozen meat, and one tray of pre-poured beverages were unlabeled and undated. This failure had the potential to put 32 out of 32 residents at risk for food-borne illnesses leading to hospitalization.

Inspectors wroteBased on interview and record review, the facility failed to educate and offer a pneumococcal vaccine (an injection to reduce the risk of getting pneumonia; an infection of the lungs) to one resident (Resident 2) out of five sampled residents. This failure had the potential for increased risk to residents eligible for pneumococcal vaccines to contract pneumonia which is preventable through vaccination.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one resident room's water temperature was in the proper range. This failure resulted in the hot water in room [ROOM NUMBER] being too hot at 138 degrees Fahrenheit.

Inspectors wroteBased on observation and interview, the facility had five resident rooms (Rooms 4, 5, 8, 9 and 10) with multiple beds that provided less than 80 square feet (sq ft) per resident. This deficient practice had the potential to result in inadequate space for the delivery of care to each of the residents in each room and for storage of the residents' belongings.

Inspectors wroteBased on observation, interview and facility document review, the facility failed to store, prepare, and distribute food safely when: 1. [NAME] 1 was placing lids on cups touching the drinking surface of the cups with no gloves. 2. The can opener had residue and paper from the can label sticking on the blade and the holder. 3. The 3-compartent dishwashing sink had no airgap (a gap of air between the floor a drainpipe.) 4. The refrigerator that stored food for the residents that are brought in by the family did not have a thermometer and was not clean. These deficient practices placed the residents at risk for contamination of food and equipment resulting in food borne illnesses for 28 residents who received food from the kitchen out of a facility census of 30.

Inspectors wroteBased on observation, interview, and facility document review, the facility failed to ensure staff followed the policy and procedure for food brought into residents by family and other visitors. This failure had the potential for decreased consumption of food preferred by 28 residents who ate food by mouth out of a facility census of 30.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the proper disposal of refuse and garbage when: 1. One of the two trash bins outside the facility was overfilled and did not have the lid closed completely. This deficient practice had the potential to attract rodents and insects resulting in pest related illness for all 30 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure accurate accountability and effective storage of controlled medications (those with high potential for abuse or addiction) when random controlled medication use audits two out of 4 residents (Residents 13 and 128) did not reconcile. The medications were signed out of the Controlled Drug Record (CDR, an inventory sheet that keeps record of the usage of controlled medications) but not documented on the Medication Administration Record (MAR) to indicate they were given to the residents. This failure resulted in the facility not having accurate accountability of controlled medications and potential for abuse or misuse of these medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure: - Seven bottles of methadone (a controlled substance; medication with a high potential for abuse or addiction) were labeled properly with a pharmacy label identifying the contents inside the bottles so they could be verified prior to administration; - Nine bottles of methadone were securely stored; - Eight opened inhalers and biologicals were dated with an open and discard date, to make sure they were not used beyond the discard date; - Nine expired medications were not available for resident use; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dietary staff competency when: 1. There was not enough Salisbury Steak to be served for lunch on 6/27/22 for three residents. 2. [NAME] 1 did not prepare a pureed vegetable salad to be served. These deficient practices had the potential for four residents out of 30 to not get the type and amount of food as indicated on the planned menu which could compromise their nutritional status.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the physician ordered diets were followed when: 1. Incorrect portion sizes for the diced fried potatoes were served for 11 residents with CCHO (Consistent Carbohydrate Diet for Diabetes) diet orders. 2. Incorrect portion size of corn with green peppers was served for four residents with small portion diet orders. 3. Butter/Margarine was not served for 2 out of 5 fortified diet orders These deficient practices had the potential for residents not receive the nutrients calculated for the menu and potentially lead to nutrition related health issues for 17 residents out of a facility census of 30.

Inspectors wroteBased on observation, interview, and facility document review, the facility failed to ensure the competency of the Certified Dietary Manager (CDM) when pureed food was prepared to a consistency too thin to hold it's shape. This failure had the potential for one resident who received a pureed diet, out of 28 residents who ate food by mouth, to aspirate (to breath fluid or food into the lungs) when eating the pureed food and/or to eat less due to an undesirable consistency of food.

Inspectors wroteBased on observation, interview, and facility document review, the facility failed to prepare food to meet the needs of residents when the texture of corn served to residents receiving a mechanical soft diet was not the texture indicated on the menu, recipe, and the diet manual. This failure had the potential for two residents who received a mechanical soft diet to choke out of 30 residents who received food from the kitchen.

Inspectors wroteBased on observation and interview, the facility had five resident rooms (Rooms 4, 5, 8, 9 and 10) with multiple beds that provided less than 80 square (sq. ft) per resident. This deficient practice had the potential to result in inadequate space for the delivery of care to each of the residents in each room, or for storage of the residents' belongings.