Ruleme Center

Inspectors wroteBased on record review and interview, the facility failed to ensure residents' treatment choice for 1 of 4 residents reviewed, Resident #28.

Inspectors wroteBased on observation and interview, the facility failed to provide a clean and homelike environment in 1 of 2 halls, Hallway 200.

Inspectors wroteBased on record review and interview, the facility failed to coordinate assessments for the residents with newly evident or possible serious mental disorder and failed to ensure an accurate Level I Preadmission Screening and Resident Review (PASRR) screen was completed for 1 of 4 residents reviewed for PASRR, Residents #9.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received intravenous (IV) therapy consistent with professional standards of practice for 1 of 5 residents reviewed for medication administration, Resident #39.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff performed hand hygiene during medication administration and used appropriate personal protective equipment (PPE) while providing high contact care to the residents on enhanced barrier precautions (EBP) for 2 of 6 residents reviewed for medication administration, Residents #39 and #51, and failed to ensure respiratory care equipment were stored in a hygienic manner for 2 of 4 residents reviewed for respiratory services, Residents #73 and #98, to prevent the possible spread of infection and communicable diseases.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff used proper personal protective equipment (PPE) while providing high contact care to the residents on enhanced barrier precautions (EBP).to prevent the possible spread of infection and communicable diseases.

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to ensure residents were administered oxygen as per physician order for 1 of 3 residents reviewed for respiratory care (Resident #13).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were securely stored in 1 of 2 residential halls, Hall 100.

Inspectors wroteBased on observation, interview, and record review, the facility administration failed to assume full responsibility for the day-to-day operations of the facility by allowing unlicensed staff to work outside the accepted professional standards and current federal, state, and local regulations to ensure the highest degree of quality care was maintained. The facility administration failed to verify the licensure status of a nurse prior to employment who was found to not have a valid Florida license as a registered nurse.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medical records were accurate and complete for 1 of 3 residents reviewed for wound care, Resident #13.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff performed hand hygiene during medication administration for 6 of 9 medication administration observations to prevent the possible spread of infection and communicable disease.

Inspectors wroteBased on record review, interview, and policy and procedure review the facility failed to ensure the residents rights were honored by failing to provide an opportunity to formulate advance directives. Resident #1's advance directive for Do Not Resuscitate (DNR) was not honored by the facility when they failed to obtain clarification of code status during the admission process, per facility policy. This failure resulted in the resident experiencing serious psychosocial harm by not honoring the resident's wishes for a natural, dignified death. Successful Cardiopulmonary Resuscitation (CPR) may result in major physical trauma including broken ribs, lung bruising, damage to the airway and internal organs, and internal bleeding. Along with the physical trauma, residents who receive CPR may have to deal with serious long-term consequences like possible brain damage from oxygen deprivation.

Inspectors wroteBased on interview and record review the facility failed to promptly notify the physician or advanced registered nurse practitioner of critical laboratory results in accordance with professional standards of practice for 1 out of 3 residents reviewed for physician notification of laboratory results. (Resident #1)

Inspectors wroteBased on interview and record review the facility failed to maintain accurate and complete medical records for 1 out of 3 residents reviewed for advanced directives. (Resident #1)

Inspectors wroteBased on observation, interview, and policy and procedure review, the facility failed to ensure food is safely stored, covered, labeled, or discarded in the kitchen and 1 of 2 nourishment rooms.

Inspectors wroteBased on record review and interview the facility failed to ensure 1 residents, Resident #68, of 3 residents sampled for advance directives review received information related to the right to formulate an advance directive upon admission.

Inspectors wrote2. During an observation on 4/17/23 at 10:10 AM, Resident #78 was lying in bed, nasal cannula was in place, with the oxygen concentrator administering oxygen at 2.5 L/min [liters per minute]. During an observation on 4/18/23 at 12:20 PM, Resident #78 was sitting in her wheelchair, nasal cannula in place, with the oxygen concentrator administering oxygen at 2.5 L/min. During an observation on 4/19/23 at 8:08 AM, Resident #78 was lying in bed, nasal cannula in place, with the oxygen concentrator administering oxygen at 2.5 L/min. Review of the admission documented Resident #78 was admitted to the facility with a diagnosis of, but not limited to: hypertensive heart disease, with heart failure and shortness of breath. Review of the physician's order, dated 10/4/21, read O2 [oxygen] at 2L/min. via nasal cannula for shortness of Breath. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles in 2 of 4 medication carts and failed to ensure all medications were stored in locked compartments to permit only authorized personnel to have access for 2 of 4 residents, Residents #13 and #68.