Rio Grande Rehabilitation and Healthcare Center

Inspectors wroteBased on observations and interviews, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in the main kitchen. Specifically, the facility failed to:-Ensure staff did not touch ready-to-eat food with their bare hands; -Ensure staff performed proper hand hygiene during meal service;-Ensure expired food was discarded;-Ensure equipment was in good repair; and,-Ensure artificial nails and jewelry were not worn.

Inspectors wroteBased on interviews and record review, the facility failed to ensure three (#15, #28 and #30) of five residents out of 31 sample residents had the right to choose their own attending physician. Specifically, the facility failed to allow Resident #15, Resident #28 and Resident #30 to choose their primary care physician while the resident resided in the facility.

Inspectors wroteBased on record review and interviews, the facility failed to ensure four (#1, #41, #34 and #22) of nine residents were free from chemical restraints out of 31 sample residents. Specifically, the facility failed to:-Document a physician's rationale for Resident #1, #41, and #34's psychotropic medications in order to justify the continued use of the medications;-Document resident specific care approaches, to include medication specific target behaviors and person-centered interventions for Resident #1, #41, and #34's psychotropic medications; and, -Ensure Resident #22's as needed (PRN) antipsychotic medication had corresponding documentation of identified behaviors and use of non-pharmological interventions.

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents diagnosed with a mental disorder or psychosocial adjustment difficulty received appropriate treatment and services to attain the highest practicable mental and psychosocial wellbeing for three (#34, #1 and #5) of five residents out of 31 sample residents. Specifically, the facility failed to:-Ensure expressions of suicidal ideations were addressed in order to secure Resident #34's safety;-Ensure Resident #1, who had a history of trauma and suicidal ideations, was monitored for signs and symptoms of suicidal ideation; and, -Ensure individualized care approaches were provided and monitored with ongoing assessment for Resident #5 in order to meet the emotional and psychosocial needs of the resident.

Inspectors wroteBased on observations, record review and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the possible development and transmission of infectious diseases on two of four hallways. Specifically, the facility failed to:-Ensure hand hygiene was performed appropriately when incontinence care was provided to Resident #2; -Ensure the vital signs equipment was disinfected between residents; and, -Ensure blood sugar glucometers were disinfected appropriately between residents.

Inspectors wroteBased on interviews on record review, the facility failed to ensure two (#35 and #41) of three residents reviewed for Medicare or Medicaid covered services out of 31 sample residents were notified of changes in their services covered, including their financial responsibility and their appeal rights. Specifically, the facility failed to: -Ensure Resident #35 was provided notification that his Medicare Part A covered skilled services were ending within the required time parameter; -Ensure Resident #41's representative was provided written notification of the Medicare Notice of Non-Coverage (NOMNC) letter when Resident #41's Medicare Part A covered skilled services were ending; and,-Ensure Resident #41's representative was notified of the right to appeal when the resident's Medicare Part A covered skilled services were ending.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents were free from physical restraints for two (#3 and #7) of two residents out of 31 sample residents. Specifically, for Resident #3 and Resident #7, the facility failed to:-Ensure that the resident's representatives were informed of the potential risks and benefits of a wanderguard (a wearable device that helps prevent residents from eloping from the facility);-Ensure the wanderguard was the least restrictive approach for the residents;,-Ensure the residents' wanderguards were monitored for continued use; and,-Develop and implement interventions for reducing the restraint.

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents were provided services that met professional standards of quality for one (#5) of nine residents out of 31 sample residents. Specifically, the facility failed to ensure Resident #5, who was receiving an anticoagulant medication (blood thinner), received international normalized ratio (INR) blood draws (a blood test that measures how long it takes the blood to clot) per the physician's orders.

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide supervision, assistance, services, and implement effective person-centered interventions to prevent falls for one (#34) of five residents reviewed for accidents/hazards out of 31 sample residents. Specifically, the facility failed to thoroughly assess Resident #34's falls to reduce individual risks and ineffective interventions.

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents who required dialysis services received services consistent with professional standards of practice for one (#2) of one resident reviewed for dialysis out of 31 sample residents. Specifically, the facility failed to ensure staff was assessing and documenting on Resident #2's dialysis fistula (the connection between an artery and a vein for hemodialysis) site on a routine basis.

Inspectors wroteBased on record review and interviews, the facility failed to provide a rationale to act upon the pharmacist's recommendations in a timely manner for one (#15) of nine residents out of 31 sample residents. Specifically, the facility failed to provide a rationale for not acting upon the pharmacist's recommendations for Resident #15.

Inspectors wroteBased on record review and interviews, the facility failed to establish an effective antibiotic stewardship program that included antibiotic use protocols and a system to monitor antibiotic use for one (#34) of four residents reviewed for antibiotic stewardship out of 31 sample residents. Specifically, the facility failed to ensure Resident #34's antibiotic therapy for a potential urinary tract infection (UTI) was discontinued in a timely manner after the facility received a negative urine culture and sensitivity (C&S - a test that identifies the organism in the urine and determines the most effective antibiotic therapy) report.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for one (#2) of seven residents reviewed for foley catheter care and catheter assessments out of eleven sample residents. Specifically, the facility failed to ensure staff were appropriately trained in the care needs of a resident with quadriplegia and effectively monitoring Resident #2, who had an indwelling foley catheter for signs and symptoms of urinary retention. This resulted in the resident being transferred to the hospital where she was admitted to the hospital's intensive care unit for a higher level of care. Resident #2, was admitted [DATE] with diagnoses of quadriplegia, acute renal failure, dementia, dysfunctional bladder and severe cognitive impairment. [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents were kept free from abuse for one (#10) of three residents reviewed for abuse out of 11 sample residents. Resident #10 was admitted on [DATE] with diagnoses of autistic disorder, dementia and depression. Resident #11 was admitted on [DATE] with diagnoses of dementia and schizophrenia (mental illness). On 9/7/25, Resident #10 entered the facility from outside. Resident #11 approached Resident #10 and pushed him to the floor. Resident #10 complained of left leg pain and was transferred to the hospital where he was diagnosed with a femur fracture that required surgical repair. Specifically, the facility failed to protect Resident #10 from physical abuse by Resident #11.

Inspectors wroteBased on , observations, record review and interviews, the facility failed to ensure residents received treatment and care in accordance with professional standards for two (#1 and #2) of five residents reviewed for wound care and weekly skin assessments out of 11 sample residents. Resident #1 was admitted on [DATE] and discharged to the hospital on [DATE]. Resident #1 had a diagnosis of heart failure, multiple sclerosis, dementia and diabetes. Resident #1 had a history of hemorrhoids and was receiving as needed topical medication. Upon admission to the hospital on [DATE], it was discovered that Resident #1 had a perianal abscess which required surgery and intravenous (IV) antibiotics. Review of the facility documentation revealed the facility failed to complete skin assessments to monitor the status of the resident's hemorrhoids. Specifically, the facility failed to: [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure the resident had the right to be free from involuntary seclusion not required to treat the resident's medical symptoms for one (#2) of one out of seven sample residents. Specifically, the facility failed to ensure Resident #2 was not told to go to her room or taken to her room as punishment for her behaviors.

Inspectors wroteBased on interviews and record review, the facility failed to provide person-centered dementia care and services for two (#2 and #1) of seven residents reviewed for dementia care out of seven sample residents. Specifically, the facility failed to:-Implement appropriate person-centered dementia interventions for Resident #2; and,-Implement person-centered dementia interventions for Resident #1.

Inspectors wroteBased on record review and interviews, the facility failed to complete a performance review of every nurse aide at least once every 12 months and provide regular in-service education based on the outcome of these reviews for four of four staff reviewed. Specifically, the facility had not completed annual performance reviews and/or provided regular in-service education based on the outcome of the reviews for certified nurse aide (CNA) #2, CNA #3, CNA #4 and CNA #5.

Inspectors wroteBased on record review and interviews, the facility failed to ensure three (#36, #40 and #49) of five residents were free from unnecessary psychotropic medications out of 23 sample residents. Specifically, the facility failed to: -Implement effective individualized behavior monitoring in the medical record to determine the efficacy of psychoactive medications for Residents #36, #40 and #49; and, -Ensure consents to review the risks versus benefits were in place prior to administration of psychotropic medications for Residents #40 and #49.

Inspectors wroteBased on interviews and record review, the facility failed to incorporate recommendations from the preadmission screening and resident review (PASRR) level II determination and evaluation from the State Mental Health Agency in the case of residents with serious mental illness or a related condition for one (#31) of three residents reviewed for PASRR out of 23 sample residents. Specifically, the facility failed to arrange and incorporate recommendations from the PASRR level II notice of determination for Resident #31.

Inspectors wroteBased on record review and interviews, the facility failed to ensure proper treatment and assistive devices to maintain vision and hearing abilities for two (#54 and #40) of three residents reviewed for vision and hearing out of 23 sample residents. Specifically, the facility failed to ensure: -Resident #54 had an eye exam; and, -Resident #40 obtained necessary hearing devices.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure the resident environment remained as free of accident hazards as possible for one (#26) of three residents reviewed for accidents/hazards out of 23 sample residents. Specifically, the facility failed to ensure Resident #26 had an order for a medication (icy hot) found at his bedside.

Inspectors wroteBased on interviews and record review, the facility failed to assist a resident in obtaining routine or emergency dental services, as needed for one (#54) of three residents reviewed for dental care out of 23 sample residents. Specifically, the facility failed to ensure dental services were offered to Resident #54.

Inspectors wroteBased on record review and staff interviews, the facility failed to develop and implement policies and procedures related to pneumococcal immunizations for one (#17) of three residents reviewed for vaccinations of 23 sample residents. Specifically, the facility failed to ensure Resident #17 was offered the secondary pneumococcal immunization.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to ensure food was stored, prepared, and served under sanitary conditions in one of one kitchen and for one (#41) of 21 sample residents. Specifically, the facility failed to ensure: -Appropriate hand hygiene by food service staff; -The freezer temperature was below zero degrees Fahrenheit; and -Outdated ready-to-eat foods were removed from Resident #41's room in a timely manner.

Inspectors wroteBased on record review and interview, the facility failed to conduct and document a facility-wide assessment to determine what resources were necessary to care for its residents competently during both day-to-day operations and emergencies. Specifically, the facility failed to have a comprehensive facility assessment.

Inspectors wroteBased on record review and interview, the facility failed to maintain readily accessible medical records for each resident. Specifically, the facility failed to have access to all electronic records during the recertification survey.

Inspectors wroteBased on record review and interviews, the facility failed to provide training to all staff, at a minimum, on dementia management and abuse prevention. Specifically, the facility failed to: -Ensure one of two registered nurses (RNs) reviewed received dementia management training and abuse prevention training; -Ensure two of three certified medication aide (CMAs) reviewed received dementia training and one of three received abuse training; and -Ensure four of six certified nurse aides (CNAs) reviewed received dementia management training, and one of six received abuse prevention training.

Inspectors wroteBased on record review and staff interview, the facility failed to inform four (#21, #100, #37, and #99) of four residents reviewed for liability notices and beneficiary appeal rights, out of 23 sample residents, both orally and in writing in a language that the residents understood, of their rights and all rules and regulations governing resident conduct and responsibilities during their stay in the facility. Specifically, the facility failed to: -Obtain a signature from the residents' authorized representatives on liability notices provided for Residents #21 and #100, who were unable to understand the information due to severe cognitive impairment; and -Provide notification of Medicare Non-Coverage letters to the beneficiary/representative after verbal notification of Medicare covered services ended for Residents #37 and #99.

Inspectors wroteBased on record review, observation and interviews, the facility failed to inform residents on how and to whom a grievance or complaint could be filed. Specifically, the facility failed to: -Provide information to the residents on how to file a grievance; -Ensure the residents had access to the information on how to file a grievance; and -Inform the residents of the name and role of the grievance official.

Inspectors wroteBased on record review and interviews, the facility failed to protect from and prevent abuse for seven (#38, #18, #8, #22, #21, #40 and #5) of seven residents reviewed of 23 sample residents. Specifically, the facility: -Failed to protect Resident #38 from abuse by Resident #46; and -Failed to protect Residents #18, #8, #22, #21 and #40 from verbal and physical abuse from Resident #5, and Resident #5 from bullying and potential retaliatory abuse by other residents. Cross-reference F610, the facility failed to report to state authorities and investigate incidents and allegations of verbal and physical abuse. Cross-reference to F943, the facility failed to provide training to all staff at a minimum on abuse prevention and dementia management.

Inspectors wroteBased on record review and interviews, the facility failed to have evidence that all alleged abuse/neglect violations were thoroughly investigated for nine (#46, #38, #98, #5, #18, #8, #22, #21 and #40) of nine residents reviewed of 23 sample residents. Specifically, the facility: -Failed to thoroughly investigate two altercations caused by Resident #46 towards Residents #38 and #98; and -Failed to investigate verbal and physical abuse by Resident #5 towards Residents #18, #8, #22, #21 and #40. Cross-reference to F600, the facility failed to protect residents from verbal and physical abuse. Cross-reference to F943, the facility failed to provide training to all staff at a minimum on dementia management and abuse prevention.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to ensure all drugs and biologicals were properly stored in one (AB hall cart) of two medication carts. Specifically, the facility failed to: -Ensure there were no expired medications in the AB hall medication cart; and -Ensure the AB hall medication cart was free from loose tablets at the bottom of the cart.

Inspectors wroteBased on observations and interviews, the facility failed to ensure a sanitary environment to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility failed to: -Ensure proper hand hygiene while cleaning residents' rooms; and -Ensure proper hand hygiene during medication administration.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents were free from physical restraints imposed for purposes of convenience and the least restrictive alternatives were used for one (#5) of three residents reviewed for assistive devices out of 23 sample residents. Specifically, the facility: -Failed to re-evaluate the ongoing use of a personal restraint; and -Failed to have a comprehensive care plan addressing the use of the restraint.

Inspectors wroteII. Resident #21 A. Resident status Resident #21, age [AGE], was admitted on [DATE] and readmitted on [DATE]. According to the November 2019 computerized physician orders (CPO), diagnoses included adult failure to thrive, depressive episodes, and chronic kidney disease. The 9/16/19 minimum data set (MDS) assessment revealed the resident had severe cognitive impairment with a brief interview for mental status (BIMS) score of six out of 15. Depressed mood with behavior symptoms were noted. He required extensive assistance for bed mobility and toileting. He required limited assistance with transfers and personal hygiene. B. Record review The care plan, initiated 10/1/18 and revised 7/15/19, identified depression and negative statements and requires antidepressant and antipsychotic medication. Interventions included: [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure qualified staff persons in accordance with each resident's written plan of care provided care for one (#5) of three residents reviewed for accidents out of 23 sample residents. Specifically, the facility failed to have a registered nurse (RN) assess Resident #5 following an unwitnessed fall.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure the resident environment remained as free of accident hazards as possible, and adequate supervision and assistance devices to prevent accidents were provided, for one (#46) of three residents reviewed for falls out of 23 sample residents. Specifically, the facility failed to keep the room door open, when care was not being provided, for Resident #46 who had a high risk for falls.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure no unnecessary psychotropic medication usage for one (#3) of five residents reviewed out of 23 sample residents. Specifically, the facility failed to assess for the continued use of Lorazepam as needed (PRN) drug for Resident #3.