Royal of Westerly Nursing Center

Inspectors wroteBased on clinical record review and staff interview, the facility failed to inform the resident or resident's representative, in advance, of the care to be furnished by the physician or other provider, of the risks and benefits of proposed care or treatment alternatives relative to the ordering of, and administration of, psychotropic medications (a medication that affects brain activities associated with mental processes and behavior) for 5 of 5 residents reviewed for psychotropic consent, Resident ID #s 3, 9, 26, 46 and 64.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for 3 of 3 residents reviewed for Hospice services, Resident ID #s 3, 5, and 48 and and for 1 of 1 resident reviewed for a medication with administration parameters, Resident ID #67.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to provide appropriate treatment and services for 1 of 3 residents reviewed with a foley catheter (a flexible plastic tube inserted into your bladder to drain urine), Resident ID #70, and for 1 of 1 resident reviewed with a suprapubic catheter (SP tube, a flexible plastic tube inserted into your bladder to drain urine through an opening in the abdomen), Resident ID #5.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure the medical care of each resident is supervised by a physician for 3 of 3 resident's reviewed who receive Hospice services, Resident ID #s 3, 9 and 48.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that the resident's drug regimen is free from unnecessary drugs for 2 of 2 residents reviewed for antibiotic use who were receiving hospice services, Resident ID #s 3 and 48.

Inspectors wroteBased on clinical record review, surveyor observation, and staff interview, the facility failed to store and label drugs and biologicals in accordance with currently accepted professional standards for 3 of 3 medication carts observed and 1 of 1 medication rooms observed.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to establish an Infection Prevention and Control Program (IPCP) that must include, at a minimum, an antibiotic stewardship program which includes antibiotic use protocols and a system to monitor antibiotic use to ensure that residents who require an antibiotic, are prescribed the appropriate antibiotic for 3 of 3 residents reviewed for antibiotic use, Resident ID #s 1, 3, and 48.

Inspectors wroteBased on surveyor observation, clinical record review, and staff interview, the facility failed to provide appropriate treatment and services for 1 of 1 resident reviewed who had skin impairments without any treatment orders in place. Additionally, the facility failed to ensure the resident was placed on Enhanced Barrier Precautions (EBP, in addition to standard precautions, EBP includes wearing personal protective equipment (PPE) that includes a gown and gloves when performing high contact care activities) as required relative to his/her wounds, Resident ID #14.

Inspectors wroteBased on surveyor observation, clinical record review, and staff interview, the facility failed to maintain medical records that are accurately documented, in accordance with professional standards and practices, for 1 of 3 residents reviewed with skin impairments, Resident ID #14.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for 1 of 1 resident reviewed who was transferred to the hospital and found to have an ileus (a temporary lack of movement in the intestines that can lead to pain, nausea, bloating, and other symptoms) and a fecal impaction (when a large, hard mass of stool is stuck in your colon or rectum and you are unable to push it out), Resident ID #1.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to provide appropriate treatment and services for 1 of 1 resident reviewed with an indwelling catheter (a flexible tube that collects urine from the bladder and leads to a drainage bag), Resident ID # 1. According to Brunner & Suddarth's Textbook of Medical-Surgical Nursing Volume 2, 10th Edition, page 1282 states, For patients with indwelling catheters, the nurse assesses the drainage system to ensure that it provides adequate urinary drainage. The color, odor, and volume of urine are also monitored. An accurate record of fluid intake and urine output provides essential information about the adequacy of renal function and urinary drainage. [...]

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that a resident receives treatment and care in accordance with professional standards of practice for 1 of 1 resident reviewed with edema (swelling due to excess fluid trapped in the body's tissues), Resident ID #260.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that residents are free of any significant medication errors for 1 of 5 residents reviewed for medication administration, Resident ID #1.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to maintain an infection prevention and control program to help prevent the transmission of communicable diseases and infections, for 2 of 4 residents reviewed relative to the use of transmission-based precautions, Resident ID #s 13 and 260.

Inspectors wroteBased on record review, staff, and resident interview, it has been determined that the facility failed to provide routine medications to its residents for 5 of 15 residents reviewed, Resident ID #s 165, 1, 57, 21, and 46.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to store and label drugs and biologicals in accordance with currently accepted professional principles for 1 of 1 medication storage rooms and 2 of 3 medication carts observed.

Inspectors wroteBased on record review, staff, and resident interviews, it has been determined that the facility failed to ensure that residents are free from significant medication errors for 3 of 15 sample residents reviewed, Resident ID #s 165, 1, and 57.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that each resident was given a written accounting of his/her deposits, withdrawals, and balances at least quarterly for 5 of 5 residents reviewed, Resident ID #s 6, 9, 28, 35, and 363.