River Crossing Rehab and Healthcare Center

Inspectors wroteBased on interview and record review, the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week. The RN working on the hall was serving as the acting Director of Nursing (DON). This deficiency had the potential to affect all residents. The census was 87. Review of the nursing schedules provided by the facility, dated 12/30/24 through 1/23/25, showed: -On 1/3, 1/4, 1/5, 1/6, 1/8, 1/12, 1/13, 1/20 and 1/22, there was no RN; -On 12/31/24, 1/1, 1 /2, 1/7, 1/9, 1/10, 1/11, 1/14, 1/16, 1/17, 1/18, 1/21 and 1/23/25 the only RN scheduled was the DON. During interviews on 1/22/25 at 3:30 P.M. and at 4:13 P.M., the Administrator said the facility missed having RN coverage for four out of 30 days. The facility had posted an ad for an RN. The facility said the RN who was on the schedule was the DON. [...]

Inspectors wroteBased on observation and interview, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety by failing to label, date and cover food. The facility also failed to ensure kitchen equipment and the floor was kept clean during three of four days of observation, in addition to ensuring that staff followed sanitary conditions when staff used their bare hands to clean out a mixing bowl and failed to ensure the mixing bowl was properly clean before preparing the next pureed dish. These deficient practices had the potential to affect all residents who consumed food from the facility kitchen. The census was 87. 1. Observation on 1/21/25 at 9:35 A.M., 1/22/25 at 4:06 P.M., and 1/23/25 at 11:38 A.M. of the kitchen, showed the following: -Dry storage room: -A bag of chocolate chips wrapped in plastic and without a date; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure residents who received dialysis (procedure to remove waste products and excess fluid from the blood when the kidneys are not working properly) services had written communication with the dialysis center. The facility identified seven residents who received dialysis services. Three residents were sampled (Resident #32, #58 and #60), and issues were found with all three residents. The sample was 19. The census was 87. Review of the facility's Dialysis Care policy, dated 10/24/22, showed: -Policy: The facility will be responsible for the overall care delivered to the resident, monitoring of the resident prior to and after the completion of each dialysis treatment, and providing all non-dialysis needs of the resident including during the time period when the resident was receiving dialysis; [...]

Inspectors wroteBased on observation and interview, the facility failed to follow recipes for three of four pureed meals observed to ensure that the desired consistency was achieved for nine residents on pureed diets. In addition, the facility failed to ensure food at time of service measured at least 120 degrees Fahrenheit (F) for hot food, and the cold food measured under 41 degrees F and to ensure that food was palatable. This had the potential to affect all residents who consumed food from the facility kitchen. The census was 87. 1. Observation on 1/23/25 at 11:14 A.M., showed Dietary [NAME] (DC) I prepared pureed chicken. He/She placed an unmeasured amount of the chicken from a white plastic container into the blender and started the blender. He/She thought it may have been about 8 ounces in the container but to be on the safe side he/she said it may have been 12 ounces. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all residents were treated in a manner to maintain dignity and respect for one sampled resident (Resident #22) after Housekeeper E dismissed the resident when he/she was trying to talk to him/her. Housekeeper E told the resident he/she did not speak the resident's language. In addition, the facility failed to follow their policy and ensure residents could participate in their treatment in a language they understood. The sample size was 19. The census was 87. Review of the facility's Resident's Rights policy, revised 5/1/23 showed: -Purpose: To promote and protect the rights of all residents at the facility; -Policy: [...]

Inspectors wroteBased on interview and record review, the facility failed to follow their policy and accepted professional standards and practices for complete and thorough documentation, when staff failed to follow-up and document appropriately when one resident experienced a change of condition (Resident #82). The sample was 19. The census was 87. Review of the facility's Change of Condition Notification policy, revised on [DATE], showed: -Purpose: To ensure residents, family, legal representatives, and physicians are informed of changes in the resident's condition in a timely manner; -Documentation: A Licensed Nurse will document the following; -Date, time, and pertinent details of the incident and the subsequent assessment in the Nursing Notes; - The time the Attending Physician was contacted, the method by which he was contacted, the response time, and whether or not orders were received; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection prevention and control program when staff failed to change gloves and perform hand hygiene during wound care for one resident (Resident #75). In addition, the staff disconnected the catheter tubing from the drainage bag to untwist the tubing and reconnected the tubing without disinfecting the catheter tubing for one resident (Resident #236). Furthermore, the staff failed to wear appropriate personal protective equipment (PPE), in accordance with the facility's policy, during high-contact activities with residents on enhanced barrier precautions (EBP, precautions for use during high-contact resident care activities for residents infected with a multidrug-resistant organism (MDRO, microorganisms that are resistant to one or more classes of antimicrobial agents) for one resident (Residents #46). [...]

Inspectors wroteBased on interview and record review, the facility failed to keep all residents safe from physical abuse by failing to educate nursing staff on the risk of resident-to-resident physical assault, failed to educate staff on immediate interventions to deescalate verbal altercations, and failed to provide adequate supervision for one resident (Resident #1). Resident #1 was cognitively intact when he/she willfully physically assaulted Resident #2 on 4/13/24. The nursing staff was not aware Resident #1 was a risk to physically assault other residents and did not immediately intervene when Resident #1 had a verbal altercation with Resident #2, which then escalated to the physical assault. Resident #1 was then given an immediate discharge due to the assault. The sample was five. The census was 90. Review of the facility's abuse prevention and prohibition program, updated, showed: -Purpose: [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain complete and accurate medical files for residents. The facility failed to document verbal and physical aggressive incidents, encounters with the Social Services Director (SSD) discussing behaviors after they occurred and failed to document when psychiatric services or counseling was offered to one resident (Resident #1). The facility also failed to upload neurological checks into a resident's medical record in a timely manner for one resident (Resident #2). The sample was five. The census was 90. 1. Review of Resident #1's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 4/5/24, showed: -admitted on [DATE]; -Cognitively intact; -Verbal behavioral symptoms directed towards others occurs every four to six days, but less than daily; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure 10 out of 10 Certified Nurse Aides (CNAs) received the required annual 12 hour resident care training. The census was 92. Review of the CNA Individual Service Records, showed the following: -CNA V hired 6/1/21, with no identified number of hours of in-service education; -CNA W hired 7/22/22, with no identified number of hours of in-service education; -CNA X hired 6/10/22, with no identified number of hours of in-service education; -CNA Y hired 12/1/21, with no identified number of hours of in-service education; -CNA Z hired 7/22/22, with no identified number of hours of in-service education; -CNA AA hired 4/20/22, with no identified number of hours of in-service education; -CNA BB hired 6/27/22, with no identified number of hours of in-service education; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow recipes to ensure adequate nutritive value, taste and texture for pureed foods (a very smooth blended food like applesauce or mashed potatoes). In addition, the facility failed to ensure residents were served hot foods at the appropriate temperature of 120 degrees Fahrenheit (F). Also, the facility failed to serve foods that were palliative and appetizing for five residents (Residents #37, #19, #76, #51 and #24) of 19 sampled residents and members of the Resident Council. This deficient practice affected all residents who ate meals at the facility. The census was 92. 1. Review of the facility's morning menu sheet, dated 8/25/23, showed breakfast consisted of pancakes, sausage and oatmeal. Observation on 8/25/23 at 6:59 A.M., showed [NAME] II prepared pureed sausage for four residents. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain a homelike environment. Flies flew in the assisted dining room and in the main dining room during meal time, trash was on the floor in the main dining area, the shower rooms were untidy and used for storage (the resident shower room located in room [ROOM NUMBER], 100 hall shower room and 200 hall shower room, and in the resident shower room located in room [ROOM NUMBER] and and room [ROOM NUMBER]), one resident's room had paint peeling from the ceiling (room [ROOM NUMBER]), one resident's room had a hole behind their door and their foot board was in need of repair and there were several holes behind the resident's bed with chipped paint (Resident #76), one resident's bathroom toilet was filled with a brown substance and the sink was leaking (Resident #24), and one resident's room had a brownish [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of an immediate discharge notice, including the reasons for the discharge for 5 of 9 sampled residents who transferred to the hospital (Residents #100,, #46, #353, #88 and #78). The census was 92. Review of the undated facility admission agreement, showed: -The Facility may involuntarily transfer or discharge a resident for only one or more of the following reasons: -For medical reasons; -For the resident's physical safety; -For the physical safety or other residents, the facility staff or facility visitors; -For either late payment or non-payment for the resident's stay, except as prohibited by Titles XVIII and XIX of the Federal Social Security Act; [...]

Inspectors wroteBased on interview and record review, the facility failed to inform the resident and family or legal representative of their bed hold policy at the time of transfer to the hospital for 5 of 9 sampled residents who were transferred to a hospital (Residents #100, #46, #353, #88 and #78). The census was 92. Review of the facility's bed hold policy, dated 4/21/21, showed: -Standard: It will be standard of this facility to provide residents with bed-hold policies upon admission to the facility and at the time of transfer (when transferring to hospital or going on therapeutic leave) in accordance with federal and state regulations; -Guidelines: The initial bed-hold policy should be provided to the resident/responsible party as soon after admission as possible when completing the admission packet to the facility; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure drugs and biologicals were labeled and stored per acceptable standards of practice. The facility identified six medication carts, one treatment cart, and two medication rooms. Four of the six medication carts, the treatment cart, and both medication rooms were checked for medication storage, and issues was found with all four carts and both of the medication rooms. Staff also failed to discard two bottles of expired medication stored in the refrigerator in one of medication rooms for one resident (Resident #353). The staff also had non-medication items such as two coffee makers plugged in, plates and a bowl in a medication drawer, and personal handbags in that medication room. The staff also failed to complete routine temperature monitoring for the other medication storage room. The sample was 19. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure menus were followed and updated periodically. The facility also failed to honor food preferences for five of 19 sampled residents and the resident council members (Residents #76, #51 #24, #12 and #32). This deficient practice had the potential to affect all residents who ate meals at the facility. The census was 92. Review of the facility's Always Available Menu, showed: -Soup of the day; -Small side salad/chef salad plate; -Turkey and cheese; -Hot ham and cheese sandwich; -Grilled cheese sandwich; -Peanut butter and jelly sandwich; -Tuna salad sandwich/Tuna scoop with crackers; -Egg salad sandwich/Egg salad scoop with crackers. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection control program designed to provide a safe and sanitary environment to help prevent the transmission of infections. Staff failed to follow proper hand hygiene during wound care for one resident (Resident #63) and staff failed to don (put on) appropriate personal protective equipment (PPE) for one resident while providing wound care (Resident #353). Staff failed to perform hand hygiene during perineal care (peri-care, cleansing of the genitals and buttocks area) for two out of three residents observed. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff completed routine inspections of bed frames, mattresses and bed/side rails as part of a regular maintenance program to identify areas of possible entrapment for eight of 19 sampled residents (Residents #51, #80, #97, #76 #2, #24, #37 and #63). The census was 92. Review of the facility's Bed Rails policy, dated 4/1/2009, showed: -It is the standard of this facility to ensure the safe use of resident mobility aids and to prohibit the use of bed rails as restraints unless necessary to treat a resident's medical symptoms; -If a bed or side rail is used, the facility will ensure correct installation, use and maintenance of bed rails. 1. Review of Resident #51's care plan, revised 3/6/23, showed: -Focus: Resident has bed rails related to resident or family request; -Goal: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure physician's orders and/or signed consent for code statuses were obtained and documented in the medical record for two residents (Residents #353 and #97) of 19 sampled residents. The facility also failed to ensure the code status was consistent and accurate for one resident (Resident #43). The census was 92. Review of the facility's Code Blue and cardiopulmonary resuscitation (CPR, an emergency lifesaving procedure performed when the heart stops beating) policy, revised [DATE], showed: -Definitions: Advance directive is defined as a written instruction, such as a living will or durable power of attorney for health care, recognized under State law (whether statutory or as recognized by the courts of the State), relating to the provision of health care when the individual is incapacitated; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents had complete, accurate and individualized care plans, to address the specific needs of the residents for two out of 19 sampled residents (Residents #43 and #80). The census was 92. 1. Review of Resident #43's quarterly Minimum Data Set, (MDS) a federally mandated assessment instrument completed by facility staff, dated [DATE], showed: -Cognitive impairment; -Required extensive assistance with transfers, dressing, toilet use and personal hygiene; -Limited assistance with bed mobility; -Indwelling urinary catheter (a sterile tube inserted into the bladder to drain urine) and frequently incontinent of bowel; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents received adequate assistance to prevent accidents by not utilizing two staff for residents (Residents #48 and #2) who required transfers utilizing a mechanical lift (device used to assist with transfers and movements of individuals who require support for mobility beyond the manual support provided by staff alone). The sample size was 19. The census was 92. Review of the facility's Mechanical Lift Policy, revised 3/27/21, showed: -Standard: It is the standard of this facility to provide a safe environment for our residents and staff. The Nursing and Therapy departments will coordinate the screening of residents to determine the appropriateness of mechanical lift transfers and/or repositioning. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident received appropriate person-centered care and met their highest practical psycho-social well-being when the facility failed to provide appropriate and accurate assessments and mental health services for one sampled resident (Resident #76) with a history of trauma. The facility failed to obtain information regarding the resident's history of trauma, including the stressors, triggers and causes of the trauma and failed to implement any interventions to support the resident's mental health and emotional well-being. The sample size was 19. The census was 92. Review of the facility's Standard and Guidelines for Mental and Psychosocial Adjustment Services, revised [DATE], showed: -Standard: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to reconcile the petty cash (a small amount of cash that is kept in a facility's business office to dispense to residents who have a resident trust account) on a monthly basis. The census was 92. Review of the facility's Resident Trust Fund policy, revised May 2023, showed: -Purpose: To assist residents with management of their funds and to pay for expenses while in a nursing facility. To establish internal controls to protect against misappropriation of funds and maintain an accurate accounting of funds; -Policy: In accordance with State/Federal regulations, each facility is required to offer resident trust fund services to all residents. [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain a surety bond sufficient (one and one-half times the average monthly balance) to ensure protection of resident funds. The facility held funds for 18 residents. The census was 68. Review of the facility's Resident Trust General Ledger (cash sheet) for the period of February 2019 through January 2020, showed an average monthly balance of $62,391.56, which would require a bond of $93,000.00. Review of the Department of Health and Senior Services approved bond list, showed the facility had an approved bond for $80,000. During an interview on 2/21/20 at 1:51 P.M., the administrator and bookkeeper said the current bond amount was not sufficient. They recently increased the bond amount, but it was not increased enough.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure resident's care plans accurately described current resident needs. The facility failed to identify one resident's severe weight loss and current supplements, one resident's pressure ulcers, one resident's weight gain and stasis ulcers and one resident's chronic leg pain and use of a continuous positive airway pressure (CPAP) machine. In addition, one resident's care plan identified interventions that were no longer in use (Residents #60, #24, #46, #59 and #58). The census was 68. 1. Review of Resident #60's facility medical record, showed: -Diagnoses included Alzheimer's disease, dementia with behavioral disturbance, glaucoma and abnormal posture; -A physician's order, dated 4/18/19, for admission to hospice due to Alzheimer's disease. Review of the resident's monthly weights, showed: -August 2019: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff notified one resident's physician for blood sugar levels that exceeded the physician's parameters for reporting. The facility identified 26 residents with orders for blood sugar checks, all 26 were reviewed, and one had blood sugar levels that exceeded the physicians parameters and problems were found with that one. In addition, the facility failed to ensure one resident with an order for oxygen received the oxygen and one resident using a continuous positive airway pressure (CPAP) had orders for its use (Residents #21, #119 and #59). The census was 68. 1. Review of Resident #21's quarterly Minimum Data Set (MDS), a federally mandated assessment instrument completed by facility staff, dated 12/13/19, showed: -admission date of 10/13/15; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to adequately assess and document a change of condition for one closed sampled resident (Resident #68). The census was 68. Review of the resident's Ambulance Patient Care Report, dated 12/18/19, showed: -Narrative: Responded to transfer call from hospital for a [AGE] year old resident being discharged to a skilled nursing facility (SNF) for rehabilitation. The patient was admitted to the hospital two months prior with sepsis (a serious life threatening infection) which progressed to Respiratory failure with hypoxia (an absence of enough oxygen in the tissues to sustain bodily functions). The patient is no longer ventilated but continues to receive oxygen via tracheotomy (a surgical procedure which consists of making an incision through the neck into the trachea. Used to help a person breathe) mask. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to adequately assess, monitor and treat pressure ulcers for three sampled residents. The facility identified six residents with pressure ulcers. Three were sampled, and problems were found with one sampled and two additional sampled residents (Residents #24, #66 and #59). The census 68. 1. Review of Resident #24's admission Minimum Data Set (MD'S), a federally mandated assessment instrument completed by facility staff, dated 11/21/19, showed; -Diagnoses of quadriplegia, respiratory failure and malnutrition; -No short/long term memory loss; -Required total staff assistance for all activities of daily living; -Foley catheter; -No pressure ulcers. Review of the resident's care plan, updated 11/21/19, showed: -Problem: At risk for pressure ulcers; -Intervention: Check skin for breakdown. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure unopened insulin pens observed on one of the facility's two nurse's medication carts were stored in the refrigerator until they were ready to be used. The census was 68. Observation of the 100/200 nurse's medication cart on 2/19/20 at 9:20 A.M., showed 14 insulin pens. Eight were opened and currently in use and six were unopened. During an interview at that time, Nurse M said unused insulin pens should be stored in the refrigerator until they are ready to be used. Once they are in use, they should be dated and discarded after 28 days. During an interview on 2/19/20 at 9:28 A.M., Nurse A, said unopened insulin pens should be stored in the refrigerator. [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain an adequate resident call system by failing to ensure the functionality of room call lights for three of 17 sampled residents (Residents #62, #59 and #8). The census was 68. During a group meeting on 2/21/20 at 1:32 P.M., Resident #62 said his/her call light did not work. His/her roommate has had several falls, and in order to call staff for assistance, Resident #62 has had to step around his/her roommate while they lay on the floor. Observation on 2/25/20 at approximately 8:56 A.M., showed call lights for Residents #62, #59 and #8, failed to work when tested. During an interview on 2/25/20 at 9:04 A.M., Nurse B said all resident call lights should work to alert staff when assistance is needed. [...]