Seneca Health & Rehabilitation Center

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure that oxygen tubing, nasal cannula (NC) and mask were stored in a sanitary manner for 3 residents (Resident (R)4, R119, and R105) out of 24 sampled residents. In addition, 1 of 3 residents (R4) did not have an order for the use of the oxygen.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to provide a safe, clean microwave for 1 of 3 Nourishment rooms (200-Hall). The failure to ensure the microwave was clean and in good repair had the potential to add metal paint flecks to the 43 residents on the 200 hall who may have their food heated/reheated in the microwave.

Inspectors wroteBased on observation, record review, interview, and facility policy review, facility staff failed use the required Personal Protective Equipment (PPE) of eye protection, gowns, and gloves, prior to entering the room, for 1 of 1 residents (Resident (R)102) reviewed for enteric precautions (enhanced infection control measures used to prevent the spread of spore-forming pathogens) out of a total sample of 24 residents. Specifically, R102 was in enteric precautions isolation for a potential C-Difficile (stool infection). This failure had the potential to increase the risk of transmission of C-Difficile to all residents in the facility.

Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to ensure that Resident (R)2 had the right to be free from misappropriation of property. Specifically, R2 had his bank account/credit card compromised by Certified Nursing Assistant (CNA)1. This incident had the potential to affect all residents in the care of CNA1. For 1 of 4 residents reviewed for abuse/neglect/misappropriation of property.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure the preplanned menus were followed. The facility's failure to follow the menus altered the nutritional content of the meals, reduced the calories and increased the risk of weight loss for all residents receiving meals prepared by the dietary department.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that foods were stored, prepared, and distributed under sanitary conditions. Specifically, meat was observed thawing in a pan with another meat; two can opener blades were sticky to the touch and not cleaned and free of food debris when not in use; the outside of the reach-in refrigerator, the two food processors, the warmer and the steamer had dried food debris on the outside of the equipment, boxes of health shakes were thawing in the refrigeration without documentation as to when the thawing process began; two of three sanitizer buckets did not have sufficient sanitizer solution; and the cook served scrambled eggs that had not been reheated to the appropriate temperature before serving on a resident's tray. [...]

Inspectors wroteBased on observation, interview, review of facility policy, and review of Centers for Disease Control (CDC) guidance, the facility failed to establish and maintain an infection prevention and control program (IPCP) for recording incidents of infections identified under the facility's IPCP, surveillance, tracking and trending, and the corrective actions taken by the facility. This deficient practice has the potential to affect all residents in the facility. In addition, the facility staff failed to perform hand hygiene prior to and after removing gloves or touching a contaminated item and prior to touching a resident (R)35).

Inspectors wroteBased on interview, record review, Center for Disease Control (CDC) guidance and policy review, the facility failed to monitor, evaluate antibiotic use, and track measures of antibiotic usage for three of five residents (Resident (R) 26, R29, and R5) reviewed for antibiotic usage out of 27 sample residents. In addition, the Antibiotic Stewardship Program lacked documentation of the tracking or trending of antibiotic usage or where infections occurred in the facility. This failure had the potential to affect all residents in the facility safety related to antibiotic usage.

Inspectors wroteBased on interview, document review and policy review, the facility failed to ensure the Infection Preventionist (IP), had sufficient time to assess, develop, implement, monitor, and manage the facility's Infection Prevention and Control Program (IPCP). The failure placed all residents in the facility at risk.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to notify the resident and the resident's responsible party of a transfer or discharge in writing for one of one resident (Resident (R) 64) reviewed for hospitalization. This created potential for the resident or their representative to have incomplete information and misunderstand the reason and process for transfer or discharge and the discharge appeal process.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to ensure one of one resident (Resident (R) 64) reviewed for hospital transfers was given a written copy of a bed hold notice prior to or within 24-hours of emergency transfer to the hospital. This failure created the potential for residents or resident representative not to have the information needed to safeguard their return to the facility.

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure that the oxygen tubing was changed and dated, and that the oxygen concentrator was cleaned for three residents (Resident (R) 27, R89, and R64) out of 27 sampled residents. This failure had the potential to impact the residents' treatment and interventions.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents who refused the meals served were offered an alternate meal for two residents (Resident (R)26 and R21) of 27 sampled residents. Failure to ensure the two residents were offered an alternate meal placed them at risk for weight loss.

Inspectors wroteBased on review of facility policy, interviews, observation, and record review, the facility failed to prevent verbal abuse of Resident (R)6 by Certified Nursing Assistant (CNA)1.

Inspectors wroteBased on record review, observation, policy review, and interview, the facility failed to provide care and services in a manner that maintained and promoted dignity for one Resident(R)70 of a sampled of 45 residents reviewed for resident rights. Specifically, the staff failed to ensure R70's privacy curtain was pulled, while she was partially clothed, exposing her to other residents, visitors, and staff. This failure placed residents at risk for diminished self-worth, self-esteem, and feelings of embarrassment.

Inspectors wroteBased on observations, interview, record review, and policy review, the facility failed to ensure residents who were dependent on staff for Activities of Daily Living (ADL) received services for one Resident(R)3 of 2 sampled residents for shaving. This failure placed residents at risk for diminished self-worth, self-esteem, and/or feelings of embarrassment.

Inspectors wroteBased on record review, observation, interview, and policy review, the facility failed to provide respiratory care in accordance with professional standards for two Resident (R)24 and R57) of two sampled residents. Specifically, the facility failed to ensure, 1. R24 received continuous oxygen as ordered by the physician, and 2. R57's oxygen tubing was stored in a bag when not in use. This failure had the potential for residents to develop respiratory issues, infections, or other medical issues.

Inspectors wroteBased on record review, interviews, and policy review, the facility failed to ensure professional standards of practice were maintained for one (Resident (R)38) reviewed for pain management. R38 had physician orders for two different narcotic pain medications to be used for moderate pain as needed (prn), being administered for both mild/moderate pain due to unspecified instructions and parameters addressing at what level of pain to administer each narcotic. Additionally, R38 had orders to administer acetaminophen prn for temperature only. There were no parameters indicating at what temperature to administer the acetaminophen, furthermore R38 was being administered acetaminophen for pain without an order. This failure placed residents at risk for adverse side effects and/or a medical decline.

Inspectors wroteBased on observations, resident interviews, record review and facility policy review the facility failed to follow the prescribed diet and honor food preferences for two (Residents (R)26 and R44) of two residents sampled for food preferences. Specifically, (R)26 requested an alternate meal, and was not served it. (R)44 was not aware of alternate meal options.