San Juan Nursing Home, Inc.

Inspectors wroteBased on interview and record review, the facility failed to ensure that care and services were provided by qualified persons in accordance with the written plan of care for 1 or 3 residents (Resident #1) reviewed for qualified persons. The facility failed to provide direct supervision to a student nurse while the student nurse administered a gastrostomy tube bolus feeding. This failure could place residents with a G-tube at risk of abdominal discomfort, aspiration, and decreased quality of life.

Inspectors wroteBased on interview and record review the facility failed to complete a significant change MDS assessment within 14 days after a significant change in the resident's mental and physical condition for 3 of 5 residents (Resident #12, #4, and #2) reviewed for assessments.1. The facility failed to complete a Significant Change in Status MDS Assessment after Resident #12 admitted to hospice services on [DATE].2. The facility failed to complete a Significant Change in Status MDS Assessment after Resident #2 had four new diagnoses changes: Klebsiella Pneumoniae ([DATE]), Urinary Tract Infection (UTI [DATE]), Do Not Resuscitate (DNR [DATE]), and Pleural Effusion ([DATE]).3. [...]

Inspectors wroteBased on interviews and record review, the facility failed to coordinate assessments with the Pre-admission Screening and Resident Review (PASRR) program to the maximum extent practicable to avoid duplicative testing and effort for 5 of 16 residents reviewed for PASRR. (Residents #2, 7, 8, 9, and 11) 1. The facility failed to refer Resident #2 for PASRR Level II assessment when the facility incorrectly coded his PASRR Level I assessment. 2. The facility failed to refer Resident #7 for PASRR Level II assessment when the facility incorrectly coded her PASRR Level I assessment. 3. The facility failed to refer Resident #8 for PASRR review following new mental illness diagnosis. After admission, he was diagnosed with mood disorder due to known physiological condition, delusional disorders, and insomnia. 4. [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed and 1 of 1 nutrition rooms for storage, preparation, and sanitation. The facility failed to discard damaged pans and utensils. The facility failed to keep food products in the refrigerators and freezers sealed properly. The facility failed to follow a cleaning schedule. These failures could place residents at risk for food contamination and foodborne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments for 1 of 6 medication carts (Nurse Med-Cart, [NAME] Wing, Long Hall) reviewed for labeling and storage. The facility failed to ensure the Nurse Medication Cart for the long hall in Wing 1 was locked and secured. This failure could place the residents at risk of gaining access to unlocked medications which were not prescribed to them.

Inspectors wroteBased on interview and record review the facility failed to develop a QAPI plan that described the process for conducting quality assessment and assurance activities, including the process on how the committee would identify and correct quality deficiencies for 3 of 16 residents. The facility did not have a QAPI plan process for conducting change in condition assessments. This failure could place residents at risk of not receiving quality care and services.

Inspectors wroteBased on observation, record review, and interview, the facility failed to establish and maintain 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, for one of six Residents (Resident #5) that were reviewed for infection control and transmission-based precautions policies and practices. 1) The facility failed to ensure LVN performed hand hygiene after removing gloves prior to and after setting up Resident #5's wound care supplies. 2) The facility failed to ensure LVN used a sterile, individually wrapped applicator to apply medication to Resident #5's wound. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure all drugs and biologicals were labeled in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable in 7 of 12 boxes of medical supplies (200 hallway) reviewed for medication storage and labeling. The facility failed to ensure7 boxes of medical supplies in the medication storage room, on the 200 hallway, had current usage dates and expired supplies were stored along with current medications/supplies. This failure could place residents at risk of receiving expired medical supplies, wound dressings that past expiration date would not have the intended therapeutic level or effect on a resident's wound.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 7 residents (Resident #71) reviewed for care plans: The facility failed to ensure Resident #71's care plan reflected her diagnosis of Dementia. This deficient practice could place residents in the facility at risk of not being provided with the necessary care or services and not having personalized plans developed to address their specific needs.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a resident who needed respiratory care was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents' goals and preferences for 1 of 3 residents (Resident #12) reviewed for respiratory care. The facility failed to ensure Resident #12 received oxygen at the prescribed rate. This failure could place residents at risk for respiratory distress.

Inspectors wroteBased on record review and interviews, the facility failed to develop a base line care plan that included instructions needed to provide effective and person-centered care of the resident for 1 resident (Resident #117) of 17 residents reviewed for base line care plans. The facility did not develop a base line care plan for Resident #117 that addressed Resident #117's use of antipsychotic medication. This failure could place resident receiving antipsychotic medications of not receiving the necessary care required to maintain psychosocial well-being.