Rocky Mountain Care - Riverton

Inspectors wroteBased on interview, the facility did not employ a clinically qualified full-time dietitian or another clinically qualified nutrition professional to serve as the director of nutrition services. Specifically, the facility did not employ a full time Registered Dietitian (RD) and the Dietary Manager (DM) did not meet the requirements to serve as the director of nutrition services.

Inspectors wroteBased on observation and interview, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. Specifically, the dish machine was not running properly to sanitize the dishes after meals.

Inspectors wroteBased on observation, interview, and record review, the facility did not establish an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, for 3 out of 22 sampled residents, staff were not using the appropriate personal protective equipment (PPE) for residents on Enhanced Barrier Precautions (EBP). In addition, a resident with a physician's order for EBP did not have signage posted on their door and PPE was not readily available. Resident identifiers: 21, 84, and 85.

Inspectors wroteBased on observation, interview, and record review, the facility did not ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible. Specifically, for 1 out of 22 sampled residents, a resident had a urinary catheter without a physician's order. Resident identifier: 180.

Inspectors wroteBased on interview and record review, the facility did not ensure that each resident's drug regimen was free from unnecessary drugs. An unnecessary drug was any drug when used in excessive dose; or for excessive duration; or without adequate monitoring; or without adequate indication for its use; or in the presence of adverse consequences which indicated that the dose should be reduced or discontinued. Specifically, for 1 out of 22 sampled residents, a resident's blood pressure (BP) support medication was administered outside of the physician's ordered parameters. Resident identifier: 21.

Inspectors wroteBased on interview and record review, it was determined, the facility did not consult with a resident's physician when there was a change in the resident's status. Specifically, for 1 out of 21 sampled residents, a resident had a blood glucose reading below 60 and the physician was not notified per the physician's order. Resident identifier: 137.

Inspectors wroteBased on observation, interview, and record review, it was determined, the facility did not develop and implement a comprehensive person-centered care plan for each resident to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment. Specifically, for 2 out of 21 sampled residents, residents that were receiving oxygen therapy did not have the oxygen therapy included in their comprehensive care plan. Resident identifiers: 4 and 17.

Inspectors wroteBased on interview and record review, it was determined , the facility did not provide the necessary services to maintain good nutrition, grooming, and personal and oral hygiene to residents who were unable to carry out activities of daily living. Specifically, for 1 out of 21 sampled residents, a resident did not receive showers or bathing assistance in a timely manner and according to the facility schedule for showers. Resident identifier: 7.

Inspectors wroteBased on observation, interview, and record review, it was determined, the facility did not ensure that each resident receives necessary respiratory care and services that are in accordance with professional standards of practice. Specifically, for 2 out of 21 sampled residents, oxygen therapy was provided to residents without a physician's order and there was no documentation regarding the oxygen concentrator tubing maintenance. Resident identifiers: 4 and 17.

Inspectors wroteBased on interview and record review it was determined, for 2 of 22 sample residents, that the facility did not ensure each resident was free of significant medication errors. Specifically, a resident with a known allergy was administered a medication she was allergic to and required Narcan. This finding resulted in a harm level deficiency. In addition, another resident that required medication with food was not administered medication with food. Resident identifiers: 28 and 195.

Inspectors wroteBased on observation and interview it was determined, for 5 of 22 sample residents, that the facility did not provide each resident with food and drink that was palatable, attractive, and at a safe and appetizing temperatures. Specifically, residents complained that the food was not palatable and the test tray was not attractive and palatable. Resident identifiers: 5, 17, 25, 28 and 191.

Inspectors wroteBased on observation and interview, it was determined that the facility did not store, prepare, distribute and serve food in accordance with professional standards of food service safety. Specifically, the kitchen floor was dirty, cracked and taped in several areas, the floor under the 3 sink wash station was buckling, the wall behind the stove had white splatter on it.

Inspectors wroteBased on observation, interview and record the review, for 3 of 22 sample residents, it was determined that the facility did not establish an effective infection control program to help prevent the development and transmission of communicable diseases and infections. Specifically, staff members were not wearing personal protective equipment (PPE) in resident rooms that required isolation precautions and there was no aerosolizing generating policy and procedures for a resident that used a Continuous Positive Airway Pressure (CPAP) machine. In addition, food was transported through the hall uncovered. Resident identifiers: 5, 199 and 204.

Inspectors wroteBased on observation and interview it was determined, for 1 of 22 sample residents, that the facility did not treat each resident with respect, dignity and care in a manner and in an environment that promoted maintenance or enhancement of his quality of life. Specifically, a resident was sleeping on a mattress with no sheets. Resident identifier: 21.

Inspectors wroteBased on interview and record review it was determined, for 1 of 22 sample residents, that the facility did not coordinate assessment with the pre-admission screening and resident review (PASARR) program under Medicaid in subpart C of that part. Coordination included referring all level II residents and all residents with newly evident or possible serious mental disorder for level II resident review upon significant change in status assessment. Specifically, a resident did not have all diagnoses check on the PASARR for a level II referral. Resident identifiers: 21.

Inspectors wroteBased on observation, interview and record review it was determined, for 1 of 22 sample residents, that the facility did not provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administration of all drugs and biological's) to meet the needs of each resident. Specifically, a resident did not have diabetic medication for 2 days. Resident identifier: 3.

Inspectors wroteBased on interview and record review it was determined, for 2 of 22 sample resident, that medical records were not complete, accurately documented, readily accessible and systematically organized. Specifically, a resident that passed away did not have nursing progress note related to the event and another resident did not have dialysis communication forms in the medical record. Resident identifiers: 28 and 40.