Riverview at the Park Care and Rehabilitation Cent

Inspectors wroteBased on observation, interview, and record review, the facility nursing staff failed to contact the physician in a timely manner for one resident (Resident #1) of five residents sampled when experiencing a change in condition resulting in a hospitalization. The facility census was 100. Based on observation, interview, and record review, the facility nursing staff failed to contact the physician in a timely manner for one resident (Resident #1) of five residents sampled when experiencing a change in condition resulting in a hospitalization. The facility census was 100. Review of the facility's revised policy titled, Change in Resident's Condition or Status, dated 02/2021, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of a transfer or discharge to a hospital, including the statement of appeal rights or the name, address, or telephone number of the Office of the State Long Term Care Ombudsman (advocates for the residents in nursing facilities) within the transfer and discharge notices for seven residents (Resident #2, #4, #10, #13, #14, #39, and #107) out of 22 sampled residents and three residents (Resident #12, #111, and #120) outside the sample. The facility census was 106. Review of the facility's policy, Transfer or Discharge, Facility Initiated, revised October 2022 showed: - Once admitted to the facility, residents have the right to remain in the facility. [...]

Inspectors wroteBased on interview and record review, the facility failed to document an accurate Minimum Data Set (MDS - a federally mandated assessment completed by facility staff) for one resident (Resident #14) out of 22 sampled residents and one resident (Resident #8) outside the sample. The facility census was 106. Review of the facility's policy, Comprehensive Assessments, revised October 2023, showed: - Comprehensive MDS assessments are conducted to assist in developing person-centered care plans; - The facility conducts comprehensive, accurate, standardized, reproducible assessments of each resident's functional capacity using the Resident Assessment Instrument (RAI) specified by CMS; - The comprehensive assessment process includes direct observation and communication with residents, as well as communication with licensed and non-licensed direct care staff members on each shift; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to ensure residents with limited range of motion (ROM) received appropriate treatment and services to increase their ROM and/or prevent a further decrease in their ROM. The facility staff failed to perform restorative services as ordered for three residents (Resident #13, #50, and #82) out of 22 sampled residents and one resident (Resident #35) outside the sample. The facility census was 106. The facility did not provide a policy for restorative services. 1. Review of Resident #13's medical record showed: - admitted on [DATE]; - Diagnoses of muscle weakness, pain in right hip, pain in left hip, reduced mobility, need for assistance with personal care, and repeated falls; - An order for Restorative Nursing Program one to seven days a week as tolerated by resident to aid in maintaining current level of function. Provide: [...]

Inspectors wroteBased on observation and interview, the facility failed to maintain an effective pest control program. This practice affected five residents (Resident #13, #26, #51, #71, and #201) out of 20 sampled residents and seven residents (Resident #17, #28, #41, #54, #61, #85 and #86) outside the sample, and had the potential to affect all residents in the facility. The facility's census was 99. Review of the facility's policy, Pest Control, revised May 2018, showed: - Our facility shall maintain an effective pest control program; - This facility maintains an ongoing pest control program to ensure that the building is kept free of insects and rodents; - Pest control services are provided by Van Pest; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean, comfortable, and homelike environment. This deficient practice affected four residents (Residents #3, #13, #66, and #201) out of 20 sampled residents and four residents (Residents #23, #27, #87, and #251) outside the sample, and had the potential to affect all residents in the facility. The facility's census was 99. Review of the facility's policy titled, Work Orders, Maintenance, revised April 2010, showed: - Maintenance work orders shall be completed in order to establish a priority of maintenance service; - In order to establish a priority of maintenance service, work orders must be filled out and forwarded to the maintenance director; - It shall be the responsibility of the department directors to fill out and forward such work orders to the maintenance director; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that Nurse Aide (NA) Registry checks were completed prior to the employment start date of four employees out of a sample of ten employees and failed to ensure their policy addressed checking the NA Registry for all employees prior to employment. The facility also failed to follow their policy to ensure the Criminal Background Check (CBC), Employee Disqualification List (EDL) or Family Care Safety Registry (FCSR) were completed prior to the employment date of one employee out of a sample of ten employees. The facility's census was 99. Review of the facility's policy, Background Screening Investigations, revised March 2019, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to notify the resident and/or the resident's representative in writing of a transfer to hospital, including the reason for transfer, and failed to notify the Office of the State Long-Term Care Ombudsman for four residents (Resident #7, #66, #71, and #201) out of 20 sampled residents and two residents (Resident #41 and #43) outside the sample. The facility's census was 99. Review of the facility's policy, Discharging the Resident, revised December 2016, showed: - The resident should be consulted about the discharge; - If the resident is being discharged to a hospital or another facility, ensure that a transfer summary is completed and telephone report is called to the receiving facility; - The policy does not address notifying the resident and/or representative in writing or notifying the ombudsman. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to inform the resident and/or resident's representative, in writing, of the facility's bed hold policy at the time of transfer to the hospital for three residents (Resident #7, #66, and #201) out of 20 sampled residents. The facility's census was 99. Review of the facility's policy, Bed Holds and Returns, revised October 2022, showed: - Residents and/or representatives are informed (in writing) of the facility and state (if applicable) bed hold policies; - All residents/representatives are provided written information regarding the facility and state bed-hold policies, which address holding or reserving a resident's bed during periods of absence (hospitalization or therapeutic leave). Residents, regardless of payer source, are provided written notice about these policies at least twice: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure three nurse aides (NAs) completed a nurse aide training program within four months of his/her employment at the facility. The facility's census was 99. Review of the facility's policy, Nurse Aide Qualification and Training Requirements, revised August 2022, showed: -The facility will not employ any individual as a nurse aide for more than four months full-time, temporary, per diem, or otherwise unless: that individual is competent to provide designated nursing care and nursing related services; and that individual has completed a training program and competency evaluation program, or a competency evaluation program approved by the state; or that individual has been deemed competent as provided in ss483.150 9 (a) and (b) of the requirements of participation; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement an infection control program and a risk management process specific to Legionella disease (a serious type of pneumonia caused by Legionella bacteria) which had the potential to affect all residents, staff, and the public. The facility's census was 94. 1. Review of the facility's policy titled, Legionella Water Management Program, revised September 2022, showed: - Our facility has a water management program, which is overseen by the water management team; - Water management team consists of infection preventionist, administrator, medical director or designee, director of maintenance and director of environmental services; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to obtain physician's orders for bed rails and failed to care plan specific monitoring and supervision provided during the use of the bed rails, including how needs will be met during use of the bed rails, such as for re-positioning, hydration, meals, use of the bathroom and hygiene for ten residents with side rails (Residents #6, #11, #13, #22, #24, #30, #35, #52, #73, and #248) out of 19 sampled residents. The facility's census was 94. Review of the FDA (Federal Drug Administration) documents entitled, Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment dated [DATE] showed 413 people died as a result of entrapment events in the United States. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to conduct regular inspections of all bed frames, mattresses and side rails as part of a regular maintenance program for ten residents with side rails (Residents #6, #11, #13, #22, #24, #30, #35, #52, #73, and #248) out of 19 sampled residents. The facility's census was 94. Review of the facility's policy titled, Bed Safety and Bed Rails, revised [DATE], showed: - Bed frames, mattresses and bed rails are checked for compatibility and size prior to use; - Maintenance staff routinely inspects all beds and related equipment to identify risks and problems including potential entrapment risks; - Maintenance provides a copy of inspections to the administrator and reports results to the quality assurance committee; [...]

Inspectors wroteBased on interview and record review, the facility failed to issue a Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN: Medicare requires SNFs to issue a SNF ABN to beneficiaries prior to providing care that Medicare usually covers, but may not pay for because the care is not medically reasonable and necessary or considered custodial) Form 10055 for one resident (Resident #84) out of two sampled residents who remained in the facility when benefits were not exhausted and failed to get the SNF ABN Form 10055 signed no later than two days before covered services ended for two residents (Resident #4 and #84) out of two sampled residents. The facility's census was 94. 1. Review of Resident #4's SNF ABN form showed: - The resident discharged from skilled Medicare services on 06/15/23, and remained in the facility; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean, and comfortable homelike environment. This had the potential to affect all residents. The facility's census was 94. Observation on 07/24/23 between 10:42 A.M. and 03:00 P.M. showed: - A three foot section of cove base pulled away from the wall and lying in the floor between the bathroom and first bed in room [ROOM NUMBER]; - An approximately five-inch piece of cove base pulled away from the wall and lying in floor on the right side of the bathroom door in room [ROOM NUMBER]; - An approximately two and one half foot (ft) long and approximately one inch (in) wide divot in the drywall by the nutrition room window on 300 hall; - An approximately one foot square area of repaired but unfinished and unpainted drywall on the wall between the bathroom and the first bed in room [ROOM NUMBER]; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to document an accurate Minimum Data Set (MDS- a federally mandated assessment) for two residents (Resident #8 and #83) out of 19 sampled residents. The facility's census was 94. 1. Record review of Resident #8's MDS showed: - A quarterly MDS assessment, dated 04/16/23, oxygen not marked on Section O: Special Treatments and Programs; - An annual MDS assessment, dated 07/17/23, with pneumonia (an infection that inflames the air sacs in one or both lungs) coded on section I2000; oxygen not marked on Section O: Special Treatments and Programs. Review of the resident's Physician Order Sheet (POS), dated 07/26/23, showed: [...]

Inspectors wroteBased on interview and record review, the facility failed to provide a Level I Preadmission Screening and Resident Review (PASARR, a federally mandated preliminary assessment to determine whether a resident may have a mental illness or an intellectual disorder to determine the level of care needed) for three residents (Residents #11, #24, and #35) out of 19 sampled residents. The facility's census was 94. The facility did not provide a policy regarding PASARR. 1. Review of Resident #11's medical record showed: - An admission date of 12/13/22; - Diagnoses of major depressive disorder (long-term loss of pleasure or interest in life), bipolar disorder (mental disorder that causes unusual shifts in mood) and anxiety disorder (persistent worry and fear about everyday situations); - No level I PASARR. 2. Review of Resident #24's medical record showed: - An admission date of 03/21/23; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement care plans for three residents (Residents #8, #13, and #36) out of 19 sampled residents. The facility's census was 94. Record review of the facility's policy titled Care Planning - Interdisciplinary Team, revised March 2022, showed: - The interdisciplinary team is responsible for the development of resident care plans; - Comprehensive, person-centered care plans are based on resident assessments and developed by an interdisciplinary team; - The IDT includes but is not limited to: the resident's attending physician; a registered nurse with responsibility for the resident; a nursing assistant with responsibility for the resident; a member of the food and nutrition services staff; to the extent practicable, the resident and/or the resident's representative; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow physician's orders for supplemental oxygen therapy for two residents (Residents #8 and #83) out of 19 sampled residents, and failed to follow physician's orders for one resident (Resident #83) with a tracheostomy (incision in the windpipe to relieve an obstruction to breathing) out of 19 sampled residents. The facility's census was 94. Record review of the facility's policy titled, Oxygen Administration, revised October 2010, showed: - Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration; - Review the resident's care plan to assess for any special needs of the resident. 1. Review of Resident #8's medical record face sheet, dated 07/26/23, showed: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to show adequate indication for the use of psychotropic medication for two residents (Residents #36 and #78) out of 19 sampled residents. The facility's census was 94. The facility did not provide a policy on psychotropic medications. 1. Record review of Resident #36's Physician's Order Sheet (POS), dated 7/27/23, showed: - Diagnosis of unspecified dementia (loss of cognitive ability) with other behavioral disturbance; - An order for Lexapro (antidepressant) five milligrams (mg) once daily, related to unspecified dementia with other behavioral disturbance, dated 12/6/22 and discontinued 01/12/23; - An order for Lexapro 10 mg once daily, related to unspecified dementia with other behavioral disturbance, dated 01/13/23 and discontinued 03/29/23; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications in the facility were not expired in one of three medication storage rooms and one of three medication carts reviewed. Failure to remove expired medications from circulation increased the likelihood of unintended use and side effects, which had the potential to affect all residents. The facility's census was 94. Review of professional reference from the United States Food and Drug Administration (FDA), Expiration Dates - Questions and Answers last updated 10/24/22, retrieved from https://www.fda.gov/drugs/pharmaceutical-quality-resources/expiration-dates-questions-and-answers, revealed: - 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program to control the fly population in the facility. This affected 11 residents (Resident #6, #8, #11, #14, #15, #22, #30, #35, #44, #73 and #248 ) out of 19 sampled residents, four residents (Resident #43, #59, #61 & #70) outside the sample and had the potential to affect all residents. The facility's census was 94. 1. Observations of Resident #6 showed: - On 07/25/23 at 11:59 A.M., Resident #6 in bed, three flies observed on resident's bed, then landed on resident's abdomen, then on resident's nose; - On 07/26/23 at 9:56 A.M., Resident #6 in bed, one fly observed on resident's face, another on leg, another fly on resident's face again; - On 07/27/23 at 08:24 A.M., Resident #6 in bed, a fly landed on abdomen. 2. Observations of Resident #8 showed: [...]