Ridge Valley Center for Nursing and Rehabilitation

Inspectors wroteBased on observations and staff interviews, the facility failed to remove 2 expired Bisacodyl suppositories, 10 expired omeprazole tablets in accordance with the manufacturer's expiration date, and 27 unidentifiable loose pills from the medication carts. The facility also failed to date 2 opened insulin pens per manufacturer's specification for 4 of 4 medication carts (A, B, C and D) reviewed for medication storage.

Inspectors wroteBased on observations, record reviews and staff interviews, the facility failed to identify the need for Enhanced Barrier Precautions (EBP) for Resident #2 with an unhealed surgical wound and failed to implement their infection control policy when Nurse #2 did not apply a gown when performing wound care for Resident #2. In addition, Nurse #2 failed to change gloves and perform hand hygiene after cleansing wounds and applying the ordered dressing on Resident #2 and Resident #3. This occurred for 1 of 1 staff member observed for infection control practices.

Inspectors wroteBased on record reviews and staff interviews, the facility failed to maintain an accurate Treatment Administration Record (TAR) for 1 of 3 residents (Resident #1) reviewed for wound care.

Inspectors wroteBased on observation, record review, and staff interviews, the facility failed to secure an opened tube and an opened container of topical ointment for 1 of 1 Resident reviewed for medication storage. (Resident #3).

Inspectors wroteBased on record review and staff and resident interviews, the facility failed to treat a resident with respect and dignity when Nurse #3 told a resident (Resident #48) that he would not be sent out to the hospital after he yelled that he was uncomfortable and felt that no one was helping him. The facility also failed to treat a resident with respect and dignity when the facility failed to address unwanted facial hair on a resident (Resident #20) This was for 2 of 6 residents reviewed for treating residents with respect and dignity.

Inspectors wroteBased on record review, staff interview, and Nurse Practitioner (NP) interviews the facility failed to ensure a resident's code status election was accurate throughout the medical record (Resident #25) and failed to ensure an advanced directive form was signed by the Resident or Responsible Party (RP) (Resident #60) for 2 of 3 residents reviewed for advanced directives (Resident #25 and Resident #60).

Inspectors wroteBased on record review and staff interview the facility failed to protect Resident #125 from being physically restrained by Nurse Aide #2 when Resident #125 had terminal agitation and was attempting to sit up in bed for 1 of 3 residents reviewed for employee to resident abuse. Nurse Aide #2 used her hand to push Resident #125's head back into the pillow in an attempt to keep him in the bed.

Inspectors wroteBased on observations, record reviews, and staff and Nurse Practitioner (NP) interviews, the facility failed to develop and implement a person-centered care plan for a resident on one-on-one supervision for 1 of 4 residents reviewed for development and implementation of a comprehensive care plan (Resident # 51).

Inspectors wroteBased on observations, record reviews and resident and staff interviews, the facility failed to trim a dependent female resident's facial hair for 1 of 6 residents (Resident #20) reviewed for activities of daily living (ADL).

Inspectors wroteBased on record review, staff, and Nurse Practitioner interviews the facility failed to assess Resident #125 before transferring him back to bed after he was found on the floor for 1 of 2 residents reviewed for falls.

Inspectors wroteBased on observations, record review, and staff, Registered Dietitian (RD), Nurse Practitioner (NP), and Medical Director (MD) interviews the facility failed to meet the recommended fluid needs for 1 of 2 residents (Resident #42) reviewed for nutrition.

Inspectors wroteBased on record review, Resident, and staff interviews, the facility failed to assess a resident for pain on admission and when there was a change in condition for 1 of 3 residents reviewed for pain management (Resident # 88).

Inspectors wroteBased on record reviews, and staff, Nurse Practitioner and Pharmacist interviews, the facility failed to identify the lack of documentation of monitoring for side effects (Resident #35) for psychotropic medications for 1 of 5 residents reviewed for unnecessary medications.

Inspectors wroteBased on observations, record reviews, and resident and staff interviews, the facility staff failed to don appropriate Personal Protective Equipment (PPE) before entering residents' room under transmission-based precautions. The facility also failed to utilize hand hygiene after removing gloves for 2 of 4 residents reviewed for infection control (Resident #40 and Resident #74).

Inspectors wroteBased on record review, resident, staff, and Medical Director interview the facility failed to prevent a significant medication error for 1 of 3 residents reviewed for medication errors (Resident #31). Nurse #1 administered 38 units of insulin glargine (a long-acting insulin that lasts for 24 hours and does not have a peak onset of action) in error to Resident #31, a resident who did not have a diagnosis of diabetes. Resident #31's blood sugar dropped throughout the night and the resident was sent to the hospital due to a blood sugar level of 50 (normal range 90-100) requiring an overnight hospitalization. A serious set of symptoms of hypoglycemia can occur in people without diabetes including tremors, palpitations, anxiety, sweating, dizziness, weakness, increased risk for falls and fractures, drowsiness, confusion, altered mental status, loss of consciousness, or seizures. [...]

Inspectors wroteBased on observation, record review and staff interviews, the facility failed to follow the manufacturer's guidelines for cleaning and disinfection of a blood glucose meter which was stored in the medication cart after use for 2 of 2 residents observed (Resident #3 and Resident #105) during a medication pass on 06/06/23 at 9:05 AM. The blood glucose meter was stored in the medication cart and was not designated as an individual resident meter. The facility had three residents in the building with a diagnosis of a bloodborne pathogen (microorganisms that cause disease and are present in human blood) (Resident #104, Resident #64 and Resident #76). This deficient practice had a high likelihood for transmitting bloodborne pathogens within the facility. [...]

Inspectors wroteBased on record review, resident and staff interviews, and observations the facility failed to develop a comprehensive care plan after the admission assessment and failed to ensure individualized care plans were updated and accurate for 5 of 10 residents (Resident #20, Resident #37, Resident # 60, Resident #64, and Resident #355).

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to ensure leftover food items stored ready for use were labeled and dated and failed to remove expired food items in 1 of 1 walk-in freezer, 1 of 1 reach-in refrigerators and 1 of 2 nourishment rooms (the Intermediate Care Facility nourishment room). These practices had the potential to affect food served to residents.

Inspectors wroteBased on observations, record reviews, and staff interviews, the facility's Quality Assessment and Assurance (QAA) committee failed to maintain implemented procedures and monitor interventions the committee put into place following the complaint investigations that occurred on [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], and [DATE], a focused infection control survey of [DATE] and the recertification and compliant investigation survey that occurred on [DATE]. This failure was for six deficiencies that were originally cited in the areas of Notification of Change (F580), Resident Assessment (F641), Tube Feeding Management (F693), and Infection Prevention and Control (F880) and were subsequently recited on the current recertification, revisit, and complaint investigation survey of [DATE]. [...]

Inspectors wroteBased on record review, staff and Medical Director interview the facility failed to notify the physician after a non-diabetic resident was administered 38 units of insulin glargine (a long-acting insulin) in error by Nurse #1. This was for 1 of 1 resident reviewed for notification (Resident #31).

Inspectors wroteBased on record review, observation, and resident and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) for discharge status (Resident #102), range of motion limitations (Resident #211), and accumulative diagnoses (Resident #210) for 3 of 28 residents whose MDS were reviewed.

Inspectors wroteBased on observations, record review, resident and staff interviews, the facility failed to obtain orders for suprapubic catheter care for 1 of 1 resident reviewed for catheter use (Resident #64).

Inspectors wroteBased on observation, record review, staff and resident interviews the facility failed to ensure an opened bag of tube feed that was running through a feeding pump, had a date, time, and resident name on them for 1 of 3 residents reviewed for tube feeding. (Resident #89) Resident #89 was admitted to the facility on [DATE] with diagnoses of stroke, severe protein calorie malnutrition, and dysphagia. Review of Resident #89's quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated resident had severe cognitive impairment and required extensive assistance from staff with activities of daily living (ADLs). The assessment was also marked for tube feeding while a resident. Resident #89 was receiving 25% or less total calories through tube feed and 500 cubic centimeter (cc)/ day or less average fluid intake. [...]

Inspectors wroteBased on record review and staff interviews the facility failed to complete Minimum Data Set (MDS) assessments within 14 days of the Assessment Reference Date (ARD, which was the last day of the assessment period) for 2 out of 2 sampled residents (Resident #107 and #211).

Inspectors wroteBased on record review and staff interviews the facility failed to complete quarterly Minimum Data Set (MDS) assessments within 14 days of the Assessment Reference Date (ARD, which was the last day of the assessment period) for 5 out of 32 sampled residents (Resident #10, #33, #36, #48, and #71).