Riverview Nursing Center

Inspectors wroteBased on interview and record review, facility staff failed to prevent the commingling of 13 residents' (Resident #10, #33, #34, #38, #42, #43, #44, #45, #46, #47, #48, #49, #50) personal funds with the facility operating funds out of 37 sampled residents. The facility census was 37. Review of the facility's policy titled Conveyance of Resident Funds, revised 05/21, showed the residents personal funds and a final accounting of funds are returned to the resident, the resident representative, or the resident's estate as applicable within 30 days from the date of the resident's discharge from the facility or death. Should a resident pay for services which then retroactively become Medicare/Medicaid eligible, the facility promptly refunds the amount charged to the resident for those services as soon as the facility receives the intermediary's payment. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to store medications in a safe manner when staff failed to ensure expired insulin vials were not stored with current resident medications, and failed to ensure medications were not loose in one medication cart out of two sampled. The facility census was 37. 1. Review of the facility's policy titled Medication Labeling and Storage, dated February 2023, showed multi-dose vials that have been opened or accessed (e.g., needle punctured) are dated and discarded within 28 days unless the manufacturer specifies a shorter or longer date for the open vial. Medications and biologicals are stored in the packaging, containers or other dispensing systems in which they are received. Only the issuing pharmacy is authorized to transfer medications between containers. [...]

Inspectors wroteBased on record review and interview, facility staff failed to prevent the misappropriation of money from one resident's, out of four sampled residents, (Resident #1) checking account when Certified Nursing Aide (CNA) A stole checks from the resident, and had a third party cash the checks, without authorization of the resident. The facility census was 34. The administrator was notified on 3/13/24 of past Non-Compliance which occurred on 2/05/24. On 2/05/24, the administrator suspected CNA A used a resident's debit card to make multiple purchases from businesses, without the authorization of the resident. Upon discovery, staff suspended CNA A on 2/05/24. The facility conducted an investigation, in-serviced all staff on the facility's abuse, neglect, and misappropriation policies on 2/5/24, and terminated CNA A on 2/7/24 for violation of facility policy. 1. [...]

Inspectors wroteBased on observation, interview and record review, the facility staff failed to store food in a manner to protect from potential contamination and out-dated use. Facility staff failed to perform hand hygiene as often as necessary using approved techniques to prevent cross-contamination. Facility staff failed to allow sanitized dishes to air dry prior to stacking in storage and use to prevent the growth of food-borne pathogens and cross-contamination. The facility staff also failed to wear hair restraints to protect food and food contact surfaces from potential contamination. The facility census was 35. 1. Review of the facility's Food Storage (Dry, Refrigerated, and Frozen) policy dated 2016, showed: -All food items will be labeled. The label must include the name of the food and date by which it should be sold, consumed, or discarded. [...]

Inspectors wroteBased on record review and interview, facility staff failed to keep eight residents (Resident #6, #11, #14, #15, #17, #38, #189 and #190) from going into a negative balance, which allowed the residents to spend another resident's money without written authorization and failed to maintain written authorization to manage funds for two residents (Resident #1 and #18). The facility census was 35. 1. Review of the facility's Management of Resident's Personal Funds policy, revised in March 2021 showed: -Should the resident elect to have the facility manage his or her personal funds, it is authorized in writing by the resident or the resident's representative, and a copy of such authorization is documented in the resident's medical record; -The resident is informed in advance of any charges imposed to his or her personal funds. 2. [...]

Inspectors wroteBased on observation, staff interview, and record review, facility staff failed to provide a safe, clean, homelike and comfortable environment when staff failed to maintain resident rooms, common areas and the building structure clean and in good repair. The facility census was 35. 1. Review of the maintenance director's inspection checklist for residents' rooms for the month of January, 2023 showed rooms #12, ##13, #21, #15, #18, #34, #25, and #23 were checked off as not needing repairs or maintenance. Observation on 1/24/23 at 10:42 A.M., showed the floor of room [ROOM NUMBER] with food and debris on it. Further observation showed ants crawling on the sink and the sink vanity. The transition strip from the hall flooring into the room was tall and in disrepair. The wall trim was off and lay on the floor. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to ensure hazardous chemicals were stored in safe manner not accessible to residents, failed to provide safe mechanical lift transfers for two residents (Residents #11 and #12) and failed to propel two residents (Residents #27 and #8) in a wheelchair in a manner to prevent accidents. The facility census was 35. 1. Review of the facility's policies provided showed the staff did not provide a policy for the storage of chemicals. Observation on 01/24/23 at 9:35 A.M., showed the door to room [ROOM NUMBER] unlocked and unattended by staff. Observation showed the room under construction and used for the storage of toxic chemicals which included paint, floor adhesive, and disinfectant spray. Observation showed residents traversed in the hallway by the room. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to provide oxygen as ordered by the physician for one resident (Resident #4). The facility census was 35. 1. Review of the facility's Oxygen Administration policy, revised October 2010, showed: -Verify that there is a physician's order for this procedure. Review the physician's orders for oxygen administration; -Review the resident's care plan to assess for any special needs of the resident; -Did not include usage of oxygen concentrators or BiPAP. Review of Resident #4's admission Minimum Data Set (MDS), a federally mandated resident assessment tool, dated 01/04/23, showed facility staff assessed the resident as follows: -Cognitively intact; -Diagnoses included pneumonia, chronic lung disease, obesity, atrial fibrillation (rapid beating of upper heart chambers), coronary (heart) artery disease, heart failure; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to ensure five Nurse Aides (NA) ( NA H, NA J, NA M, NA N and NA O) completed the nurse aide training program within four months of their employment in the facility. The census was 35. 1. Review of the facility's Nurse Aide Qualifications and Training Requirements Policy, revised May 2019, showed the following: -The facility will not employ any individual as a nurse aide for more than four (4) months full-time, temporary, per diem, or otherwise; -That individual is competent to provide designated nursing care and nursing related services; -That individual has completed a training program and competency evaluation program, or a competency evaluation program approved by the state; -That individual has been deemed competent as provided in 483.150(a) and (b) of the Requirements of Participation. 2. [...]

Inspectors wroteBased on observation, resident and staff interview, and record review facility staff failed to provide alternative meals for residents which accommodated the residents' preferences. This had the potential to affect all residents. The facility census was 35. 1. Review of the resident council minutes from 12/27/22 through 1/23/23 showed the council addressed food preferences with the facility staff. 2. Observation on 1/24/23 at 12:05 P.M., showed the menu board in the dining area to have peanut butter and jelly sandwiches posted as the only alternative to the main menu item. 3. During an interview on 1/24/23 at 10:45 A.M., Resident #12 said the facility only offers a peanut butter and jelly sandwich for an alternative meal so if he/she does not like the main menu item he/she does not eat. [...]

Inspectors wroteBased on observation, interview, and record review, facility staff failed to follow appropriate infection control procedures to prevent the spread of bacteria or other infectious causing contaminants when staff failed to remove soiled gloves and/or perform hand hygiene during the provision of care for two residents (Residents #12 and #16). The facility census was 35. 1. Review of the facility's Handwashing/Hand Hygiene Policy, revised August 2019, showed staff are directed to use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: -before and after direct contact with residents; -before performing any non-surgical invasive procedures; -before and after handling an invasive device (e.g., urinary catheters, IV access sites); [...]

Inspectors wroteBased on interview and record review, facility staff failed to implement policies and procedures to ensure 100% of staff were fully vaccinated for COVID-19 (a highly contagious virus that causes serious illness or death) or have been granted a qualifying exemption, or have a temporary delay as recommended by the Centers for Disease Control (CDC) for two employees (Certified Nurse Assistant (CNA) D and CNA D). The facility census was 35. 1. Review of facility's Covid-19 Vaccine Policies and Procedures, updated 4/22, showed: -Per the CMS Memorandum - Center for Clinical Standards and Quality/Quality, Safety & Overight Group Ref: QSO-22-09-All Date: January 14,2022: [...]