Rising Star Nursing Center

Inspectors wroteBased on observation, interview and record review the facility failed to develop and implement a comprehensive person -centered care plan for each resident, consistent with the resident rights, that included measurable objectives and timeframes to meet a residents medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 3 of 8 residents (Residents #6, #25, #26, ) reviewed for care plans. 1. The facility failed to ensure a care plan was developed for Resident #6's scalp wound.2. The facility failed to ensure a care plan was developed for Resident #25's psychosocial issues 3. The facility failed to ensure a care plan was developed for Resident #26's psychosocial issues.

Inspectors wroteBased on interview and record review the facility failed to provide the necessary behavioral health care to maintain their highest level of practicable physical, mental and psychosocial well-being for 2 of 6 residents (Resident #25 and #26) reviewed for psychosocial adjustment.1. The facility failed to ensure Resident #25's had the services to cope with psychosocial issues related to statements of age-related wanting to die and feeling useless.2. The facility failed to ensure Resident #26's psychosocial triggers were addressed, the COTA failed to communicate a history of psychosocial distress that needed to be addressed. These failures could affect residents by placing them at risk of not receiving individualized care and services to meet their psychosocial needs.

Inspectors wroteBased on observations, interview and record review the facility failed to ensure that certified nurse aide were able to demonstrate competency in skills and techniques to provide nursing and related services for 1 of 4 residents (Residents #36) by 1 of 2 certified staff (CNA A) reviewed for competent staff, in that: While providing incontinent care for Resident #36, CNA A did not perform peri-care to Resident #36's vaginal area. These failure could place residents at risk for not receiving nursing services by adequately trained and certified aides and could result in infections.

Inspectors wroteBased on observation, interviews and record reviews the facility failed to ensure that residents receive care, consistent with professional standards of practice, to prevent pressure ulcers and do not develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable; and residents with pressure ulcers receive necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 of 12 (Resident #27) residents reviewed for pressure ulcers. The facility failed to assess Resident #27's pressure ulcer weekly. The facility failed to assess Resident #27's skin weekly. These failures could place residents at risk of infections and worsening of wounds.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents who needed respiratory care were provided respiratory care consistent with professional standards of practice for 1 of 13 residents (Resident #133) reviewed for oxygen administration. The facility failed to ensure an Oxygen in Use sign was posted on the outside of Resident #133's door. These deficient practices could place residents who received oxygen and treatments at risk of respiratory infection.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 5 (LVN A and CNA B) staff observed for infection control. 1. The facility failed to ensure LVN A sanitized insulin flex pen rubber stopper prior to applying pen needle. 2. The facility failed to ensure CNA B sanitized catheter bag drain after emptying bag. 3. The facility failed to ensure Resident #183's catheter bag was stored off the floor. These failures could place residents of the facility at risk of infections due to not sanitizing equipment and not storing catheter bag off the floor.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop a baseline care plan within 48 hours of a resident's admission that included the instructions needed to provide effective and person-centered care of 1 of 13 (Resident #133) residents reviewed for care plan completion. The facility failed to include Resident #133's oxygen use, smoking status, and discharge goals in the baseline care plan within the required 48-hour timeframe. This failure could place residents who were newly admitted at risk for not receiving necessary care and services or having important care needs identified.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the comprehensive care plan was developed within 7 days after completion of the comprehensive assessment for 1 of 13 (Resident #28) residents reviewed for comprehensive person-centered care plans. The facility failed to develop Resident #28 comprehensive care plan within 7 days of the completion of the comprehensive assessment. This failure could affect the residents by placing them at risk for not receiving care and services to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being.

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records on each resident, in accordance with accepted professional standards and practice, that were complete and accurate for 1 of 12 (Resident #11) residents reviewed for resident records. The facility failed to ensure physician order parameters were accurate on Resident #11's cardiac medications (carvedilol. hydralazine and losartan potassium) This failure could place residents at risk of having errors with their care and treatment.

Inspectors wroteBased on observation, interview and record review the facility failed to attempt to use alternatives prior to installing a side or bed rail, assess the resident for risk of entrapment from bed rails prior to installation for 6 of 6 residents (Resident #7, Resident #14, Resident #18, Resident #20, Resident #22, and Resident #232) reviewed for bed rails. The facility failed to assess residents for entrapment risks and attempt less restrictive measures prior to installing bed rails. These failures could place residents at risk for injury.

Inspectors wroteBased on interview and record review the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, seven days a week for one of one facility reviewed for RN services. The facility failed to provide evidence a Registered Nurse (RN) worked 8 consecutive hours a day, seven days a week for 6 days (1/1/23, 1/14/23, 1/15/23, 1/28/23, 1/29/23, and 2/12/23) of the FY Quarter 2 (January1- March31) out of 4 Quarters. This failure could place residents at risk for altered physical, mental, and psychological well-being due to decisions that would have required an RN to make in the management of the residents' healthcare needs and in managing and monitoring the direct care staff.

Inspectors wroteBased on observation, interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen surveyed for kitchen sanitation. 1. The facility failed to ensure food items were disposed after the use by or expiration date. 2. The facility failed to ensure dinnerware was stored in a way to prevent contamination. These failures could place residents at risk of foodborne illness and a decline in health status.

Inspectors wroteBased on observation, interview and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 1 (CNA-C) staff observed for infection control. The facility failed to ensure CNA-C performed proper hand hygiene while providing incontinent care. These failures could place residents at risk for unnecessary infections.