Salem North Healthcare Center

Inspectors wroteBased on record review, interviews, review of a facility self-reported incident (SRI) and facility policy review, the facility failed to prevent misappropriation of opioid medication. This affected one resident (#32) out of three residents reviewed for misappropriation. The facility census was 63.

Inspectors wroteBased on record review, observation, interview, review of manufacture's guidelines and facility policy review, the facility did not ensure medications were not left at the bedside for Resident #42. This affected one (Resident #42) of three residents observed for medication administration. The facility also failed to store medications in a manner to preserve efficacy and proper discard time frames affecting eight (Residents #59, #6, #9, #48, #18, #33, #55, and #57) medications observed during medication storage observation. The facility census was 70.

Inspectors wroteBased on observation and interview, the facility failed to ensure the smoking area of the courtyard was maintained in a clean and sanitary manner free from cigarette butts. This had the potential to affect all six (Residents #16, #21, #34, #41, #56, and #66) identified by the facility as utilizing the smoking area. The facility census was 70.

Inspectors wroteBased on record review, observation, interview and facility policy review, the facility failed to ensure accurate and complete clinical documentation and failed to notify the physician of resident refusals of a prescribed cervical collar (C collar). This affected one (Resident #6) of two residents reviewed for orthotic devices. The facility census was 70.

Inspectors wroteBased on record review, observation, interview and facility policy review review, the facility failed to ensure falls were thoroughly investigated for Resident #18 and failed to ensure safe smoking practices were followed for Resident #16. This affected one (Resident #18) of three residents reviewed for falls and one (Resident #16) of three residents reviewed for smoking. The facility identified six residents (Residents #16, #22, #34, #41, #56 and #66) in the facility who smoked. The facility census was 70.

Inspectors wroteBased on record review, interview, observation and facility policy review, the facility failed to ensure oxygen tubing was changed every seven days. This affected one (Resident #42) of two residents reviewed for respiratory care and had the potential to affect eight additional (Residents #1, #5, #7, #16, #35, #48, #54, and #65) identified by the facility as utilizing oxygen. The facility census was 70.

Inspectors wroteBased on resident interview, observation, staff interview, record review, and review of the facility policy, the facility failed to ensure foods were served at a palatable temperature. This had the potential to affect 64 of the 66 residents (excluding Residents #16 and #65) who received meals prepared and served by the facility kitchen.

Inspectors wroteBased on medical record review, staff interview, review of online medication resources, and review of facility policy, the facility failed to ensure residents did not receive unnecessary or duplicate medications. This affected one (Resident #67) of three residents reviewed for medication administration. The facility census was 66.

Inspectors wroteBased on closed medical record review, review of telehealth progress notes, Life flight progress notes, policy review, and interviews, the facility failed to provide adequate and necessary care to meet the total care needs of Resident #70. The facility failed to consistently monitor blood (sugar) glucose levels as ordered, failed to administer insulin as ordered and failed to monitor Resident #70, who was assessed as being severely cognitively impaired and dependent on staff for activities of daily living, after an acute/significant change in condition. This resulted in Immediate Jeopardy and actual harm with the potential for serious impairment and/or death beginning on [DATE] at 4:18 P.M. when Resident #70's blood glucose level was elevated at 517 milligram/deciliter [mg/dl] (normal-74-106 mg/dl). [...]

Inspectors wroteBased on closed medical record review, policy review and interview, the facility failed to timely notify Resident #70's representative of an acute change in condition. This affected one resident (#70) of 12 residents reviewed for notification of change.

Inspectors wroteBased on observation, staff interview, and review of the facility policy, the facility did not ensure frozen foods in the reach-in freezer were labeled and dated appropriately to prevent food spoilage. This had the potential to affect 70 residents who received food from the kitchen. The facility identified three residents (#19, #22, and #30) as receiving nothing by mouth (NPO). The facility census was 73.

Inspectors wroteBased on observation and interview the facility failed to maintain sanitary conditions during observations of meal preparations . This affected all residents except for Resident #18 and Resident #21 who do not receive food prepared in the kitchen. The facility census was 57.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure Resident #60's fall interventions were in place to help prevent falls. This affected one Resident (#60) out of one Resident reviewed for accidents. The facility census was 57.

Inspectors wroteBased on medical record review, observation and staff interview, the facility failed to follow physician's orders for tube feed formula infusion time and proper labeling of tube feed formula. This affected one Res(Resident #18) of one Resident reviewed for tube feedings. The facility census was 57.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure laboratory testing was obtained prior to initiating antibiotic therapy for a resident with a possible infection. This affected one (Resident #32) of five residents reviewed for infections. The facility census was 57.

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to ensure palatable meals for Residents #53, #67, #43, #30 and #42. This had the potential to affect the 72 residents who received meals from the facility.

Inspectors wroteBased on observation, personnel record, medical records, policy review and staff interview, the facility failed to ensure sanitary procedures during a pressure ulcer dressing change, post incontinence care and the handling of laundry/ personals and employee tuberculin testing per protocol. This affected one resident (Resident #11) of the 11 residents the facility identified as having pressure ulcers and had the potential to affected all 74 residents in the facility.

Inspectors wroteBased on medical record review and interview, the facility failed to ensure a resident received restorative nursing programs in accordance with therapy recommendations. This affected one (Resident #45) of three residents reviewed for activities of daily living.

Inspectors wroteBased on observations, medical record review and interview, the facility failed to ensure physician's orders and recommendations for pressure ulcer interventions were implemented. This affected one (Resident #45) of five residents reviewed for pressure ulcers. The facility identified 11 residents with pressure ulcers, excluding stage I ulcers (nonblanchable redness of a localized area, usually over a bony prominence).

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure Resident #37 had interventions in place for significant weight loss. This affected one of one residents reviewed for weight loss.

Inspectors wroteBased on record review and staff interview, the facility failed to monitor therapeutic levels for thyroid medication. This affected one (Resident #31) of five residents reviewed for unnecessary medications.