Riverview Nursing & Rehabilitation Center

Inspectors wroteBased on observation, resident and staff interview, record review and facility policy review, the facility failed to develop and/or implement a person-centered care plan for monitoring side effects of medications, range of motion (ROM) and providing nail care for 11 of 24 resident care plans reviewed. Resident #4, #9, #10, #17, #18, #19, #39, #44, #51, #55 and #58. Findings Include: Record review of the facility policy titled Comprehensive Assessments and the Care Delivery Process with a revision date of 12/16 revealed under, Policy Statement: Comprehensive assessments will be conducted to assist in developing person-centered care plans. Resident # 4 Record review of Resident #4's care plan revealed under focus, Closed fracture of right tibia and fibula, date initiated 05/01/2024. [...]

Inspectors wroteBased on staff interview, record review, and facility policy review the facility failed to monitor for side effects and obtain a stop date for a psychotropic medication for five (5) of 40 residents receiving psychotropic medications reviewed.

Inspectors wroteBased on observations, staff interviews and record reviews the facility failed to promote dignity as evidenced by a resident not being assisted with his meal immediately after nursing staff delivered the meal tray to his room for one (1) of eight (8) residents reviewed for dining. Resident #16 Findings Included: Record review of the facility policy titled, Residents' Rights with no revision date revealed Residents Rights Under Federal Law. The facility shall protect and promote the rights of each resident, including each of the following rights: 1. The resident has a right to a dignified existence, self-determination, communication with access to people and services inside and outside the facility . [...]

Inspectors wroteBased on resident and staff interview, record review, and facility policy review, the facility failed to honor a resident's right to make health care decisions for one (1) of 25 residents reviewed for advanced directives. Resident #58 Findings Include: Record review of the facility policy titled Advanced Directives with a revision date of 8/11 revealed under, Policy Interpretation and Implementation: 1. Prior to or upon admission of a resident to our facility, the Social Services Director or designee will provide written information to the resident concerning his/her right to make decisions concerning medical care including the right to accept or refuse medical or surgical treatment, and the right to formulate advance directives. Record review of the Advanced Directive Form for Resident #58 revealed a family member signed the form dated 4/23/24, with no signature from the resident. [...]

Inspectors wroteBased on observation, resident and staff interviews, and facility policy review, the facility failed to provide a safe, clean, and comfortable environment, as evidenced by an over-bed table with exposed jagged edging (Resident #4) and a sagging mattress (Resident #58) for two (2) of 61 residents.

Inspectors wroteBased on observation, staff interview, record review and facility policy review, the facility failed to ensure residents were free from physical restraints as evidenced by a resident with full side rails to both sides of the resident's bed for one (1) of two (2) residents reviewed for restraints. Resident #44. Findings Include: A review of the facility policy titled Residents' Rights with no revision date revealed The facility shall protect and promote the rights of each resident, including each of the following rights: . The resident has a right to be free from any physical restraints imposed or psychoactive drugs administered for the purpose of discipline or convenience and not required to treat the resident's medical symptoms. During an observation on 11/03/24 at 3:35 PM, Resident #44 was observed in bed with side rails extending the length of the bed on both sides. [...]

Inspectors wroteBased on staff interview, record review, and facility policy review the facility failed to ensure that the Minimum Data Set Assessment (MDS) was coded accurately for one (1) of 22 sampled residents. Resident #19. Findings Included: Record review of the facility policy, titled Resident assessment Instrument revealed Policy Statement: A comprehensive assessment of a resident's needs shall be made within fourteen (14) days of the resident's admission. Policy Interpretation and Implementation .4. Information derived from comprehensive assessment helps the staff to plan care that allows the resident to reach his/her highest practicable level of functioning. 7. All persons who have completed any portion of the MDS Resident Assessment Form must sign such a document attesting to the accuracy of such information. [...]

Inspectors wroteBased on resident and staff interviews, record review, and facility policy review the facility failed to complete a baseline care plan timely and provide a summary of the baseline care plan to the resident and their representative for two (2) of three (3) baseline care plans reviewed.

Inspectors wroteBased on observation, resident and staff interviews and record review, the facility failed to provide assistance with Activities of Daily Living (ADL) care to maintain hygiene as evidenced by: Resident # 9, # 17, #58 were observed with long jagged fingernails and Resident #12 was observed with unkept and greasy hair and an unkept beard for four (4) of 61 residents reviewed for ADL care. Residents #9, #12, #17 and #58. Findings Included: Record review of a statement on facility letterhead, undated, and signed by the Administrator revealed We do not have a direct policy ADLs. Resident #9 An observation on 11/03/24 at 2:30 PM revealed, Resident #9 lying in bed with long jagged nails on both hands, measuring approximately three-eighths (3/8) inch in length past the tips of the fingers with a brown substance underneath. [...]

Inspectors wroteBased on observation, staff interview, record review and facility policy review, the facility failed to provide the services needed for a resident to maintain and/or improve their level of range of motion (ROM) and mobility for four (4) of 32 residents reviewed for positioning and mobility. (Resident #17, # 19, #22, and #39).

Inspectors wroteBased on staff interviews, record review, and facility policy review, the facility failed to ensure sufficient weekend nursing staffing for the 3rd quarter payroll-based journal (PBJ) for one (1) of three (3) quarters reviewed.

Inspectors wroteBased on staff interview, record reviews and facility policy review, the facility failed to monitor a resident receiving anticoagulant medication for side effects for one (1) of (10) residents on anticoagulant medications.

Inspectors wroteBased on observation, resident and staff interview, and facility policy review, the facility failed to accommodate a resident's food preference during one (1) of three (3) meal services observed. (Resident # 55) Findings Include: A review of the facility policy titled, Resident Nutrition Services, with a revision date of 11/2015 revealed, Policy Statement: Each resident shall receive meals, with preferences accommodated . A dining observation on 11/3/24 at 5:45 PM, revealed the admission Nurse set the meal tray up for Resident #55. The meal tray was observed to have a ham and cheese sandwich with no observation of the admission Nurse offering the resident condiments for the sandwich, and there were no condiments observed on the meal tray. [...]

Inspectors wroteBased on observation, resident/staff interviews, and facility policy review, the facility failed to ensure snacks/nourishments were offered to residents for two (2) of four (4) survey days. Resident #10.

Inspectors wroteBased on observation, record review, staff interview and facility policy review the facility failed to prevent the possibility of the spread of infection during wound care for one (1) of two (2) treatments observed. Resident # 11. Findings Included: Record review of facility policy titled, Enhanced Barrier Precautions Checklist revised January 2012 revealed .Policy Interpretation and Implementation 1. Staff shall apply Enhanced Barrier Precautions to the care of all residents in high contact care activities regardless of suspected or confirmed presence of infectious disease . Record review of facility policy titled Pressure Ulcer Treatment revised September 2013, revealed . Steps in the Procedure 1. Clean bedside stand. Establish a clean field. 2. Place the clean equipment on the clean field .7. Put on clean gloves. Loosen tape and remove soiled dressing. 8. [...]

Inspectors wroteBased on staff interviews, facility policy/procedure review, and record review, the facility failed to implement the interventions of a care plan for a resident related to medication administration for one (1) of six (6) residents care plans reviewed.

Inspectors wroteBased on staff and resident interviews, facility policy/procedure review, and record review, the facility failed to ensure that one (1) of six (6) residents sampled received care and services that would meet the professional standards of quality as evidenced by Resident #1 not receiving medications as ordered.

Inspectors wroteBased on staff and resident interviews, facility policy/procedure review, and record review the facility failed to ensure that one (1) of six (6) residents sampled were free from any significant medication errors. Resident #1.

Inspectors wroteBased on observation, staff interviews, facility policy review and record review, the facility failed to label an enteral feeding with nurse's initials, and date and time the formula was hung/administered for one (1) of five (5) residents with enteral feeding.

Inspectors wroteBased on observation, staff interview, record review and facility policy review, the facility failed to ensure a medication error rate of less than five percent (5%), out of 27 medication administrations observed. The medication error rate was 14.81%.

Inspectors wroteBased on observations, staff interview, record review, and facility policy review, the facility failed to ensure measures to prevent the possible spread of infection and/or cross contamination for five (5) of nine (9) residents observed during the medication administration observations, Residents #2, #13, #15, #29, and #52.

Inspectors wroteBased on observation, staff interview and facility policy review, the facility failed to provide privacy for Resident #2 during the administration of medications through a Percutaneous Endoscopic Gastrostomy (PEG) Tube, for one (1) of nine (9) residents observed for medication administration.

Inspectors wroteBased on observation, staff and resident interviews, record review and facility policy review, the facility failed to develop a care plan to address Resident #27's hospital return with a new medication and diagnosis; to implement Resident #45's care plan for Passive Range of Motion (PROM) exercises, to implement Resident #40's use of an alarm only while in bed, and to store and change Residents #24 and #50's oxygen (O2) tubing. This concern was identified for five (5) of 19 residents reviewed.

Inspectors wroteBased on staff interview, resident interview, facility policy review and record review, the facility failed to provide Resident #45's Passive Range of Motion (PROM) exercises correctly to prevent the potential decline in range of motion for one of three (1 of 3) residents reviewed receiving restorative services.

Inspectors wroteBased on observation, staff interview, and record review, the facility failed to address Resident #40's care plan after a fall with an intervention to prevent the potential for another fall. Resident #40 was assessed a high risk for falls by the facility, on 11/15/2019, and experienced another fall on 12/9/2019. This concern was identified for one (1) of two (2) residents reviewed for falls.

Inspectors wrote` Based on observation, staff interview, resident interview, record review and facility policy review, the facility failed to store and change oxygen (O2) tubing to prevent the possibility of infection/cross contamination, for two (2) of 17 residents reviewed on oxygen therapy.

Inspectors wroteBased on observation, staff interview and facility policy review, the facility failed to properly label medications for two of four (2 of 4) medication carts and one (1) of two (2) medication storage rooms.