River Valley Nursing and Rehabilitation

Inspectors wroteBased on a record review, staff and family interviews, and a policy review, the facility failed to refund an overpayment within 30 days after 1 of 1 residents passed away at the facility (Resident #5). The facility reported a census of 37 residents.

Inspectors wroteBased on clinical record review, facility policy review, resident and staff interview, the facility failed to develop and implement a discharge planning process, including identifying discharge goal, preferences and necessary referrals to assist 1 of 2 residents (Resident #2) who expressed a desire to leave the facility. The facility reported a census of 37 residents.

Inspectors wroteBased on a clinical record review, staff and resident interviews, and a policy review, the facility failed to implement Restorative care to assist a resident in maintaining his highest practical level of walking for 1 of 1 resident (Resident #2) reviewed for restorative care. The facility reported a census of 37 residents.

Inspectors wroteBased on clinical record review, policy review, and resident, staff and physician interviews, the facility failed to notify the physician of changes in a resident's condition, failed to intervene in a timely manner that included the collection of a urinalysis specimen for immediate processing, and failed to communicate laboratory results that indicated treatment was required to a resident's physician after their discharge for 1 of 3 residents reviewed with urinary catheters (Resident #4). The facility reported a census of 29 residents.

Inspectors wroteBased on observation, clinical record review and staff interview, the facility failed to implement infection control practices when completing wound dressing changes for 1 of 1 resident (Resident #1) reviewed for wound care. The facility reported a census of 28 residents.

Inspectors wroteBased on observation, clinical record review, and staff and resident interviews, the facility failed to maintain an effective pest control program that kept the facility free of ants and vermin. The facility reported a census of 34 residents.

Inspectors wroteBased on observation, clinical record review, wound care provider and facility staff interviews, the facility failed to notify the physician of pressure ulcer deterioration and implement nutritional orders in an effort to promote healing for 1 of 3 residents (Resident #3) reviewed for pressure ulcers. The facility reported a census of 36 residents. Stage 3 Pressure Ulcer: Full-thickness skin loss: Full-thickness loss of skin, in which subcutaneous fat may be visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible but does not obscure the depth of tissue loss. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. [...]

Inspectors wroteBased on observations, clinical record review, Registered Dietician, staff and resident interviews, the facility failed to provide food that met the individual preferences of 1 of 7 residents reviewed (Resident #4). The facility reported a census of 37 residents.

Inspectors wroteBased on clinical record review, facility assessment review, and staff interviews the facility failed to employ sufficient numbers of staff to meet resident needs. The facility reported a census of 36 residents.

Inspectors wroteBased on previous CMS-2567 review, staff interview and facility policy review the facility failed to ensure a comprehensive, effective Quality Assessment and Performance Improvement (QAPI) program. The facility reported a census of 36 residents.

Inspectors wroteBased on record review, staff interview, and policy review the facility failed to ensure the Dietary Manager met the minimum qualification of having a national certification for food service management and safety in the required timeframe. The facility reported a census of 36 residents.

Inspectors wroteBased on record review, observations, resident and staff interviews, and policy review the facility failed to serve at the safe temperature, and palatable. The facility reported a census of 36 residents.

Inspectors wroteBased on record review, observation, staff interview, and policy review the facility failed to assure food was properly prepared and appropriate to meet resident needs. The facility reported a census of 36 residents.

Inspectors wroteBased on observations, policy review, and staff interview the facility failed to prevent the potential for cross contamination due to lack of hand hygiene during preparation and plating of meals, proper storage of opened food items, uncovered garbage cans, and a lack of adequate chemical concentration in cleaning buckets. The facility reported a census of 36 residents.

Inspectors wroteBased on observations, clinical record review, and staff interviews the facility failed to follow accepted infection control technique and use Enhanced Barrier Precautions during wound care for 2 of 2 residents (Residents #15, and #87), and use Enhanced Barrier Precautions when emptying a urinary catheter collection bag for 1 of 1 residents (Resident #86). The facility reported a census of 36 residents.

Inspectors wroteBased on observation, clinical record review, policy review, and staff and resident interviews, the facility failed to ensure 1 of 7 residents reviewed for abuse remained free from physical abuse (Resident #16) when a staff member threw a box of gloves toward a resident. The facility reported a census of 36 residents.

Inspectors wroteBased on observation, clinical record review, policy review, and staff and resident interviews, the facility failed to separate a staff member from residents immediately after an an allegation of abuse involving the staff member and Resident #16. The facility reported a census of 36 residents.

Inspectors wroteBased on observation, staff interview, and policy review the facility failed to appropriately prime an insulin pen prior to administration for 1 of 1 insulin injections observed (Resident #13) and follow physician orders after a hospitalization for 1 of 2 residents reviewed (Resident #17). The facility reported a census of 36 residents.

Inspectors wroteBased on observation, record review and staff interview the facility failed to provide baths for 2 out of 3 residents reviewed (Resident #6 and #32 ). The facility reported a census of 36 residents.

Inspectors wroteBased on observation, record review, resident, family and staff interview, the facility failed to carry out interventions for 2 of 2 residents reviewed (Resident #17 and Resident #33). Resident #17 had a lab result return with a high white blood cell count and did not intervene for two days, and Resident #33 identified with 2+ pitting edema. The facility reported a census of 36 residents.

Inspectors wroteBased on observation, record review, resident and staff interview, the facility failed to complete dressing changes as ordered for a re-opening pressure ulcer for 1 of 1 residents (Resident #15) reviewed. The facility reported a census of 36 residents.

Inspectors wroteBased on observation, record review and staff interview the facility failed to provide range of motion for 1 of 1 residents reviewed to maintain current level of range of motion to all extremities (Resident #32). The facility reported a census of 36 residents.

Inspectors wroteBased on clinical record review, policy review, and staff interview, the facility failed to follow the Care Plan and utilize a mechanical lift for 1 of 3 residents reviewed for mechanical lift transfers(Resident #16). The facility reported a census of 36 residents.

Inspectors wroteBased on clinical record review, policy review, and staff and resident interviews, the facility failed to ensure the physician provided orders for a resident's immediate care and needs for 1 of 3 residents reviewed for a change in condition (Resident #33). The facility reported a census of 36 residents.

Inspectors wroteBased on clinical record review, staff and resident interviews, and policy review the facility failed to provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and Care Plan for 1 of 1 resident reviewed (Resident #6). The facility reported a census of 36 residents.

Inspectors wroteBased on clinical record review, staff interview, and policy review that facility failed to provide pneumococcal and influenza immunizations as required for 2 out of 5 residents reviewed (Resident #10, Resident #19 ). The facility reported a census of 36 residents.

Inspectors wroteBased on record review, staff interviews, and facility policy review, the facility failed to document monthly Infection Surveillance for the months of September, October and November 2023, after the previous Infection Preventionist left the position in August 2023. The facility reported a census of 25 residents. Findings Include: 1. A review of the Infection Surveillance Data revealed no data collected for the months of September, October and November 2023. In an interview on 11/20/23 at 9:06 AM, the former Infection Preventionist (IP) reported she resigned in August 2023 and had not collected any data for monthly Infection Surveillance. She had returned to the facility to assist with completion of Minimum Data Sets (MDS), however, she did not assist with Infection Prevention. [...]

Inspectors wroteBased on personnel file review, facility policy review, and staff interview the facility failed to ensure Cardiopulmonary Resuscitation (CPR) certified staff scheduled 24/7 for 4 of 15 days in [DATE]. The facility reported a census of 25 residents. Findings Include: A review of staff CPR certifications revealed Staff G, Registered Nurse (RN) CPR certification expired on [DATE]. During an interview on [DATE] at 3:00 PM, the Regional Administrator stated Staff G updated her CPR certification on [DATE]. A review of the [DATE] through [DATE] schedules revealed Staff G worked the following days with an expired CPR certification: a. [DATE] b. [DATE] c. [DATE] d. [DATE] During an interview on [DATE] at 4:26 PM, the Director of Nursing (DON) stated the facility has residents who have a full code status. She stated she would expect at least one CPR certified staff to be scheduled at all times. [...]

Inspectors wroteBased on facility assessment review, observations, and staff interviews the facility failed to employee a sufficient amount of staff to meet residents needs. The facility reported a census of 25 residents. Findings Include: A review of the Facility Assessment, updated on 5/18/23, revealed the facility needed an average of 4 to 6 Certified Nursing Assistants (CNA) per day to care for the residents' needs. An observation on 11/14/23 at 11:45 AM, revealed the facility had one CNA on duty. During an interview on 11/14/23 at 12:00 PM, Staff B, Licensed Practical Nurse (LPN) stated there is one CNA today, and the Director of Nursing (DON) is assisting the CNA as needed. Staff B stated she is unaware of how often there is only one CNA at the facility. Staff B stated there have been two instances when she has been the only staff in the building from 6:30 AM until 7:50 AM. [...]

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to follow proper food preparation techniques during a meal service. The facility reported a census of 25 residents. Findings Include: During an observation of the noon meal on 11/14/23 starting at 12:00 PM, the Dietary Manager (DM) donned gloves and began to plate meals with the following noted: a. At 12:09 PM, the DM removed a bun from a bag and touched handles of ladles and counter attached to steam table. b. At 12:11 PM, the DM did not change gloves, plated 2 meals, removed 2 buns from plastic bag and touched surface of counter attached to steam table. c. At 12:12 PM, the DM did not change gloves, plated 2 meals, removed 2 buns from plastic bag and touched counter attached to steam table. d. [...]

Inspectors wrote4. The (MDS) Assessment Tool, dated 10/1/23, listed diagnoses for Resident #14 included multiple sclerosis, depression, and polyneuropathy (malfunction of nerves throughout the body). The MDS assessed the resident dependent on staff for all care related to toileting. The MDS listed the resident's BIMS score as 15 out of 15, indicating intact cognition. The Care Plan, dated 7/27/23, revealed a Focus Area related to a Stage 4 coccyx pressure ulcer. A review of Physician Orders revealed a 11/3/23 order to change the wound vacuum, wash wound, and apply duoderm two times weekly. During an observation on 11/20/23 at 11:32 AM, Staff B, LPN completed wound care. During cares Staff B observed to not complete hand hygiene in between glove changes during the following tasks transitions: a. At 11:37 AM, Staff B donned gloves, applied wound cleanser to 4 X 4 in a basin and opened the wound vac. b. [...]

Inspectors wroteBased on clinical record review, observations, resident and staff interviews, and facility policy review, the facility failed to treat residents with dignity during services related to incontinence care for 2 of 4 residents (Residents #9, and #14). The facility reported a census of 25 residents. Findings Include: 1. The Minimum Data Set (MDS) Assessment Tool, dated 10/17/23, listed diagnosis for Resident #9 included Parkinson's Disease, schizophrenia, and type 2 diabetes. The MDS assessed the resident dependent on staff for all care related to toileting. The MDS listed the resident's Brief Interview for Mental Status (BIMS) score as 4 out of 15, indicating severely impacted cognition. The Care Plan, dated 4/25/22, addressed a Focus Area of bladder incontinence, and bowel incontinence. [...]

Inspectors wrote3. The MDS Assessment Tool, dated 10/7/23, listed diagnoses for Resident #17 included history of a stroke affecting the left side, neurogenic bladder, and type 2 diabetes mellitus. The MDS assessed the resident dependent on staff for all care related to toileting and as always incontinent. The MDS listed the resident's BIMS score as 8 out of 15, indicating moderately impaired cognition. The Care Plan, dated 10/13/23, addressed a Focus Area of bladder incontinence due to history of a stroke. Interventions included checking the resident every two hours and as required for incontinence. During an observation on 11/13/23 at 11:40 AM, Staff A, CNA and Staff D, CNA assisted the resident in getting up and ready for the day. A strong odor of urine noted to be present in the room. At 11:45 AM, Staff A removed the blankets off of the resident. [...]

Inspectors wroteBased on clinical record review, staff interviews, and facility policy review, the facility failed to document a thorough assessment of a resident being transferred to the hospital for one of three residents reviewed (Resident #6). The facility reported a census of 25 residents. Findings Include: The Minimum Data Set (MDS) dated [DATE] identified Resident #6 as cognitively impaired with a BIMS (Brief Interview for Mental Status) of 6 out of 15 and had the following diagnoses: Metabolic Encephalopathy (an alteration in consciousness caused due to brain dysfunction), Renal Insufficiency (kidney failure) and Obstructive Uropathy (a disorder of the urinary tract that occurs due to obstructed urinary flow and can be either structural or functional). The MDS also identified Resident #6 had impairments to both arms and legs and required staff assistance with most activities of daily living. [...]

Inspectors wroteBased on observations, clinical record review, staff interviews, and facility policy review, the facility failed to ensure catheter tubing and catheter bag are positioned in a manner to prevent possible infection for 1 of 4 residents (Resident #21). The facility reported a census of 25 residents. Findings Include: The Minimum Data Set (MDS) Assessment Tool, dated, 10/29/23, listed diagnosis for Resident #21 included Alzheimer ' s disease, depression, and generalized weakness. The MDS listed the resident's Brief Interview for Mental Status (BIMS) score as 1 out of 15, indicating severely impaired cognition. A review of the clinical record revealed a 10/17/23 Physician Order for a Foley catheter. The Care Plan, dated 10/23/23, included a focus area for an indwelling catheter. The plan included an intervention to check the tubing for kinks each shift. [...]

Inspectors wroteBased on clinical record review, observations, resident and staff interviews, the facility failed to serve food that was warm and palatable for three of twenty four residents reviewed (Residents #3, #5 and #10). The facility reported a census of 25 residents.

Inspectors wroteBased on clinical record review, observations, resident and staff interviews, the facility failed to give one of one residents reviewed foods of his personal choice (Resident #3). The facility reported a census of 25 residents. Findings Include: 1. The Minimum Data Set (MDS) dated [DATE] identified Resident #3 as cognitively intact with a Brief Interview for Mental Status (BIMS) score of 15 and had the following diagnoses: Type 2 Diabetes Mellitus, Coronary Artery Disease and Anxiety Disorder. The MDS also identified Resident #3 had impairments to both sides of arms and legs and required staff assistance with most activities of daily living. In an interview on 11/13/23 at 9:51 AM, Resident #3 reported the food here is nasty. He will ask for it to be cooked a certain way, i.e.: eggs. He likes his eggs over-easy and they serve it to him overcooked. They do this most of the time. [...]

Inspectors wroteBased on clinical record review, resident and staff interviews, the facility failed to provide one of one residents reviewed who required assistance with his meal (Resident #5). The facility reported a census of 25 residents. Findings Include: The Minimum Data Set (MDS) dated [DATE] identified Resident #5 as cognitively intact with a Brief Interview for Mental Status (BIMS) score of 15 out of 15 and had the following diagnoses: Acute Kidney Failure requiring dialysis, Paraplegia (paralysis of one half of the body) and Multiple Sclerosis. The MDS also identified the resident had impairments to both sides of both arms and legs and required staff assistance with most activities of daily living. In an interview on 11/14/23 at 8:20 AM, Resident #5 reported he was served cold scrambled eggs, cold bacon and it was overcooked, could crack a tooth on it. [...]