Seneca Nursing

Inspectors wroteBased on observation, interview, and record review, the facility failed to promote and facilitate the right of self-determination for every resident when staff failed to honor reasonable shower preferences for three residents (Resident #6, #7, and #8). The facility census was 53. Review showed the facility did not provide a policy related to showers. 1. Review of Resident #6 's face sheet showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to protect residents from sexual and physical abuse when one resident (Resident #1) exhibited repeated behaviors against others, including touching breasts and chest, biting chest and attempted to lay on another resident unclothed. The attempts at unwanted contact impacted three residents (Resident #2, #3, and #4). The facility census was 53. [...]

Inspectors wroteBased on interview and record review, the facility failed to report all allegations of abuse immediately to facility management and to the Department of Health and Senior Services (DHSS) within the required two-hour timeframe when staff did not report multiple allegations of abuse involving four residents (Resident #1, #2, #3, and #4). The facility census was 53. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete timely and thorough investigations of all allegations of abuse when staff failed to document investigation into allegations of abuse involving four residents (Resident #1, #2, #3, and #4). The facility also failed to document steps taken to protect all residents during the investigation. The facility census was 53. Review of the facility policy Abuse, Prevention and Prohibition Policy. [...]

Inspectors wroteBased on record review and interview, the facility failed to have services in place to ensure the accurate document of administration of controlled pain medications for three resident's (Resident #2, Resident #3, and Resident #4). The facility census was 45. [...]

Inspectors wroteBased on interview and record review, the facility failed to promptly notify the ordering physician of labs out of normal ranges when staff failed to notify one resident's (Resident #1) physician of critical lab results. The facility census was 45. Review of the facility's policy titled Significant Condition Change and Notification, undated, showed the following:-To ensure that the resident's family and/or representative and medical practitioner are notified of resident changes such as those listed below:-A significant change in the resident's physical, mental, or psychosocial status including abnormal lab values;-When the above situation exists, the licensed nurse will contact the resident's representative and their medical practitioner;-Calls will be made to the resident's representative until they are reached. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure all residents' records were complete and accurate when staff failed to document one resident (Resident #1) sliding out of a chair. The facility census was 45. Review of the facility's policy titled, Significant Condition Change and Notification, undated, showed the following:-All significant changes will be recorded on the communication board in the computer and in the resident record. Charting will include an assessment of the resident's current status as it relates to the change in condition. Charting will be done each shift for 72 hours for resident with change of condition. Change of condition is reviewed by Director of Nursing (DON) or designee for the continued need for additional documentation. [...]

Inspectors wroteBased on record review and interview, the facility failed to provide respiratory care per standards of practice when staff failed to clarify hospital discharge orders for pulse oximetry (a test used to measure the oxygen level of the blood), failed to have the resident's oxygen order on the Treatment Administration Record (TAR), and failed to document oxygen usage and pulse oximetry readings for one resident (Residents #1). The facility census was 50. Review of facility policy titled Oxygen Administration, dated February 2021, showed the following: -Verify there is a physician's order for oxygen administration; -After completing the oxygen setup or adjustment, the following information should be recorded in the resident's medical record: the date and time that the procedure was performed; the rate of oxygen flow, route; the frequency and duration of the treatment; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain complete medical records for all residents when staff failed to document full details and notifications related to one resident (Resident #1) who died at the facility. The facility census was 50. Review of the facility's policy titled Charting and Documentation, dated February 2021, showed the following: -Chart all pertinent changes in the resident's condition, reaction to treatments, medications as well as routine observations; -Be concise, accurate and complete and use objective terms. Document only the facts. Use only approved abbreviations and symbols; -For death of a resident document code status of resident and whether CPR (cardiopulmonary resuscitation - an emergency lifesaving procedure performed when the heart stops beating) was performed; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure six nurse aides (NA) ( NA B, NA G, NA J, NA K, NA L,and NA C) completed a certified nurse aide (CNA) training program and obtained certification within four months of employment at the facility as a nurse aide. The facility census was 53. Review showed the facility did not provide a nurse aide certification or training policy. 1. Review of a facility list of current nurse aides showed NA B had an initial hire date of 03/28/23 and a rehire date of 12/07/24. Review of the facility's October 2024, November 2024, and December 2024, showed NA B scheduled to work. During interviews on 01/09/25, at 2:26 P.M., and on 01/13/24, at 11:00 A.M., NA B said the following: -He/she had worked at the facility for a month; -He/she had previously worked at the facility for a few years, but left and came back; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all controlled medications were stored per standards of practice when controlled substances were not stored in a locked compartment. The facility's census was 53. Review of the facility policy Controlled Substance Policy, revised October 2022, showed the following: -Controlled substances were subject to special handling, storage, disposal and record-keeping requirements; -Controlled substances in Schedules II, III, and IV were subject to special handling, storage, disposal, and record-keeping requirements. Such drugs were to be accessible only to authorized nursing and pharmacy personnel. The Director of Nursing (DON) was responsible for the control of such drugs; -Drugs listed in Schedules II, III, and IV were to be stored under double-lock conditions; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective infection control program when staff failed to perform proper hand hygiene when performing personal cares for two residents (Resident #46 and #38), when staff failed to have an Enhanced Barrier Precautions (EBP-infection control measures used to reduce transmission of resistant organisms) policy, and when staff failed to follow EBP when providing care to one resident (Resident #5) with a wound. The facility census was 53. Review of the facility policy Hand Hygiene, dated 2019, showed the following: -Purpose to cleanse hands to prevent the spread of potentially deadly infections; -Purpose to provide a clean and healthy environment for residents, staff and visitors; [...]

Inspectors wroteBased on interview and record review, the facility failed to keep all residents free from misappropriation of resident property when the staff could not account for 30 doses of medication for one resident (Resident #14) that had been signed by staff as being received from the pharmacy. The facility census was 53. Review of the facility policy Abuse, Prevention, and Prohibition, revised 10/2022, showed the following: -Misappropriation of resident property is defined as the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's belongings without the resident's consent; -The facility prohibits misappropriation of resident property; -The owner, licensee, administrator, employee or agent of the facility must prohibit the misappropriation of resident property; [...]

Inspectors wroteBased on interview and record review, the facility failed to implement an abuse/neglect policy that ensured all reported allegations of possible abuse were reported to the State Survey Agency (Department of Health and Senior Services-DHSS) within two hours when staff failed to report a documented allegation of verbal abuse involving two residents (Resident #7 & #35). The facility census was 53. Review of the facility policy titled, Abuse, Prevention, and Prohibition Policy, undated showed the following: -Each resident has the right to be free from abuse, corporal punishment, and involuntary seclusion. Residents must not be subjected to abuse by anyone, including but not limited to, facility staff, other residents, consultants or volunteers, staff or other agencies serving the resident, family members or legal guardians, friends or other individuals. [...]

Inspectors wroteBased on interview and record review, the facility failed to implement an abuse/neglect policy that ensured staff completed and documented a timely investigation of all reported allegations of possible abuse when staff failed to complete a documented investigation of a documented allegation of verbal abuse involving two residents resident (Resident #7 and #35). The facility census was 53. Review of the facility policy titled, Abuse, Prevention, and Prohibition Policy, undated, showed the following: -Each resident has the right to be free from abuse, corporal punishment and involuntary seclusion. Residents must not be subjected to abuse by anyone, including but not limited to, facility staff, other residents, consultants or volunteers, staff or other agencies serving the resident, family members or legal guardians, friends or other individuals; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to routinely monitor for edema (swelling caused by too much fluid trapped in the body tissues), failed to notify the physician of changes in weight and edema, and failed to apply interventions as ordered for one resident (Resident #2). The facility census was 53. Review of a facility policy titled Significant Condition Change and Notification, undated, showed the following: -Facility to ensure the resident's family and/or representative and medical practitioner are notified of the following resident changes: new wounds, bruises, or skin tears; abrupt onset of edema; onset of swelling; or a need to significantly alter treatment. When any of the listed situations exists, the nurse will contact the resident representative and their medical practitioner; -Medical practitioner contacted immediately for emergencies. [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to ensure an environment as safe and as free from accident hazards as possible when staff failed to complete a safe transfer, as care planned, for one resident (Resident #46) and when staff failed to care plan and transfer one resident (Resident #38) who was non-weight bearing in a safe fashion. The facility census was 53. Review of the facility policy Safe Lifting and Movement of Residents, reviewed 02/2021, showed the following: -Resident safety, dignity, comfort and medical condition will be incorporated into goals and decisions regarding safe lifting and moving of residents; -Manual lifting of residents shall be eliminated when feasible; -Staff responsible for direct resident care will be trained in the use of manual (gait/transfer belts, slide boards) and mechanical lifting devices. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was served in accordance with standards of practice when staff had bare hand contact with food and food contact surfaces while assisting residents with meals. The facility census was 53. Review of the facility policy Hand Hygiene, dated 2019, showed the following: -The purpose was to cleanse hands to prevent the spread of potentially deadly infections; -The purpose was to provide a clean and healthy environment for residents, staff and visitors; -Hand hygiene was the primary means of preventing the transmission of infection. Review of the 2022 Food Code, by the Food and Drug Administration (FDA), showed the following: -Bare hand contact with ready-to-eat foods can contribute to the transmission of food borne illness; -There should be no bare hand with ready-to-eat food. 2. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure all residents were treated with dignity and respect when one staff member (Certified Nursing Assistant (CNA) B) placed his/her hand close to one resident's (Resident #1) mouth while providing cares to the resident to muffle the sound of the resident yelling. Four residents were sampled out of a facility census of 50. Review of the facility's policy titled Resident Rights, undated, showed the following: -Residents have the right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside facility; -A facility must treat each resident with respect and dignity and care for each resident in a manner and environment that promotes maintenance or enhancement of her quality of life, recognizing each resident's individuality. [...]

Inspectors wroteBased on interview and record review, the facility failed to protect all resident's from misappropriation of property when a staff member had one resident's (Resident #1's) personal cellular phone, in his/her possession. The facility census was 52. Review of the facility policy titled, Abuse, Prevention, and Prohibition Policy, revised November 2018, showed the following: -Misappropriation of resident property is defined as the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent; -The facility prohibits misappropriation of resident property; -The facility will not knowingly employ individuals who have been found guilty of abusing , neglecting, or mistreating residents or misappropriating their properties. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to employ a Director of Food and Nutrition Services (Dietary Manager) with required education/training in food service management. The facility census was 53. Record review showed the facility did not provide a policy related to the qualifications of the Dietary Manager. 1. During interviews on 3/1/23, at 8:12 A.M., and 3/3/23, at 10:50 A.M., [NAME] A said the following: -The facility did not have a Dietary Manager (DM) and had not had one for at least six months; -He/she completed the ordering and general upkeep in the kitchen including cleanliness, temperatures of refrigerators and freezers and food, and ensured food items were marked and dated; -The Administrator completed the hiring; -The facility placed advertisements for a DM, but he/she did not know if they received any responses; [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to assist the residents to meet on a regular basis and failed to designated a staff person responsible for providing assistance with the meeting and responding to resident concerns brought forth in the meetings. The facility census was 53. Record review showed the facility did not provide a policy regarding resident council meetings 1. During a group interview on 03/02/23, at 10:07 AM, the residents said the following: -They do not have regular resident council meetings, but they would like for there to be; -The residents said the council is supposed to meet once a month; -There was a consensus that the council did meet in January of this year; -One resident said there has only been one resident council meeting, and it was last calendar year sometime; [...]

Inspectors wroteBased on interview and record review, the facility failed to maintain a surety bond in an amount sufficient to ensure protection of all resident funds for two of the last twelve months. The facility's census was 53. Record review of the facility's policy titled Facility Resident Trust Fund Policy, revised May 2012, showed the following: -It will be the policy of the management company that the resident trust fund is managed and accounted for in accordance with state and federal regulations. Each facility should follow the state guidelines of the payment programs using the greatest level of specificity if requirements vary in state and federal programs; -The facility shall purchase and maintain a surety bond that will protect resident personal funds against loss, theft, and insolvency. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all residents received the necessary services to maintain good personal hygiene when the home did not provide routine showers/baths to three dependent residents (Residents #40, #42, and #207). The facility census was 53. Record review showed the facility did not provide a policy related to bathing/showers. 1. Record review of the facility's Shower Schedule showed the following: -Shower sheets must be filled out and given to the charge nurse. If a resident refuses, try again then notify the charge nurse; -Showers scheduled for Monday/Thursday, Tuesday/Friday and Wednesday/Thursday with residents' names and two numbered lines next to the residents' names. 2. Record review of Resident #207's face sheet (a document that gives a patient's information at a quick glance), showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed have an effective activity program when the home failed to provided to routinely scheduled activities for residents including two residents (Resident #17 and #42); failed to care plan residents' activity preferences and need for three residents (Resident #9, #207, and #208); and when the facility documented residents participated in activities when the residents were not present for the activity three residents (Resident #9, #22, and #208). The facility census was 53. Record review showed the facility did not provide a policy related to the Activity Program. 1. Observation on 3/3/23, at 9:28 A.M., of the large activity calendar by the dining room showed the scheduled activities of 7:00 A.M. news with breakfast, 10:00 A.M. chair yoga, 11:30 A.M. coffee talk, and 2:30 P.M. fun with bingo/fun word games. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to properly store a large amount of discontinued medications in a secure proper storage area in the facility. The facility census was 53. Record review of the facility policy titled Storage of Medications, dated 6/1/18, showed the following: -Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications; -Only licensed nurses, pharmacy personnel, and those lawfully authorized to administer medications (such as medication aide) permitted to access medications. Medication rooms, carts. and medication supplies are locked when not attended by persons with authorized access; [...]

Inspectors wroteBased on interview and record review, the facility staff failed to ensure the required two step Tuberculosis (TB - a potentially serious airborne bacterial infection affecting the lungs that spreads through the air when a person with TB coughs, sneezes, or talks) screening test was completed for all residents when the TB two-step test was not completed for two residents (Resident #23 and Resident #51) and staff failed to read the first step and administer the second step of the initial TB screening test for one resident (Resident #20). The facility had a census of 53. Record review of the facility policy titled Tuberculosis Surveillance, undated, showed the following: -It is facility policy to comply with state regulation for TB testing for residents; [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure all residents or residents' representative were provided education regarding and offered the pneumococcal vaccine when staff failed to document education and offering the pneumococcal vaccine to four residents (Residents #6, #19, #23, and #51). The facility census was 53. Record review of the facility policy titled Resident Pneumococcal Immunization Policy, undated, showed the following: -It is facility policy to offer pneumococcal immunizations to all residents; -All residents will be assessed on admission to see if they have previously been immunized; -Immunization status will be recorded in the resident immunization record; -If residents have not received a pneumococcal vaccine, it will be offered to them; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure all residents had a comprehensive care plan that addressed each resident's needs when staff failed to care plan one resident's (Resident #23) foley catheter (a flexible tube that a clinician passes through the urethra (the duct by which urine is conveyed out of the body from the bladder) and into the bladder to drain urine) and interventions related to the foley catheter and failed to care plan one resident's (Resident #207) anxiety and depression and anxiety and depression medications and failed to include interventions related to the resident's anxiety and depression. The facility census was 53. Record review of the facility's policy titled Care Planning - Interdisciplinary Team, reviewed 2/2021, showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure consistent pain management for all residents when the facility did not have a prescribed pain medication on-site for one resident (Resident #40) for multiple days. The facility had a census of 53. Record review of the facility's policy Medication Ordering and Receiving From Pharmacy, dated 06/01/18, showed the following: -Medications are received from the dispensing pharmacy on a timely basis. The facility maintains accurate records of medication order and receipt; -Refills are written on a medication order form/ordered by peeling the refill label and placing it in the appropriate area on the order for provided by the pharmacy for that purpose and/or ordered electronically ordered; [...]

Inspectors wroteBased on observation, interview, and record review, the facility staff failed to obtain stop dates of 14 days or less on as needed (PRN) anti-psychotropic medication (a chemical substance that changes brain function and results in alterations in perception, mood, consciousness or behavior) for two residents (Resident #9 and #23). The facility census was 53. Record review of the facility's policy titled Psychotropic Medication Use, reviewed 02/2021, showed the following: -Residents will only receive psychotropic medications when necessary to treat specific conditions for which they are indicated and effective; -Residents who are admitted from the community or transferred from a hospital and who are already receiving psychotropic medications will be evaluated for the appropriateness and indications for use. The interdisciplinary team will: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident's (Resident #14) medication regime was free from unnecessary medications when the facility failed to ensure the physician provided a rationale for administering a psychotropic medication (drugs that alter chemical levels in the brain which impact mood and behavior, used to treat mental illnesses). The facility also failed to provide a rationale to continue an as needed (PRN) psychotropic medication past 14 days for one resident (Resident #28). A sample of 13 residents was reviewed in a facility with a census of 47. Record review of the U.S. Food and Drug Administration (FDA) website showed the following: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff administered medications with an error rate of less than five percent when staff made two errors out of 25 opportunities, resulting in an error rate of 8.0 percent affecting one resident (Resident #13). The facility census was 47. According to Medscape website (medical reference website for healthcare professionals) showed the following: -Rapid-acting insulin can cause hypoglycemia (low blood glucose). This may occur when enough calories are not consumed after taking the insulin within the time frame; -Older adults may be more sensitive to the side effects of low blood glucose from rapid acting insulin's. Record review of the Novolog (rapid-acting insulin) undated manufacturer's insert showed the following: -Novolog starts acting fast; [...]