Signature Healthcare at North Hardin Rehab & Welln

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure its dish machine and range hood grates were free of dust accumulation, which had the potential to affect 111 of 111 residents receiving meals from the kitchen.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure the personal privacy and confidentiality of residents' personal health information (PHI) for 1 of 57 sampled residents (Resident (R)112).

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure staff provided care within professional standards for 1 of 3 residents sampled during medication (med) pass out of the total sample of 57 Residents, (Resident (R)54).

Inspectors wroteBased on observation, interview, record review, and facility document and policy review, the facility failed to ensure residents received necessary assistance to carry out their activities of daily living (ADLs) for 2 of 6 residents sampled for ADLs out of the total sample of 57 Residents, (Residents (Rs)73 and 224).

Inspectors wroteBased on observation, interview, record review, and facility document and policy review, the facility failed to ensure residents received proper treatment and assistive devices to maintain hearing abilities for 1 of 1 residents sampled for communication and sensory problems out of a total sample of 57, (Resident (R) 3).

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure staff disposed of medication appropriately for 1 of 3 residents observed during medication administration, (Resident (R)86).

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure staff secured all medications in a locked storage area/cart for 1 of 5 residents reviewed for accident hazards, (Resident (R)28).

Inspectors wroteBased on observation, interview, record review, and facility document and policy review, the facility failed to ensure a resident received meals in accordance with their food preferences and meal ticket for 1 of 11 sampled residents reviewed for food preferences, (Resident (R)68).

Inspectors wroteBased on interview, record review, and review of the facility policy, the facility failed to ensure an allegation of abuse was reported to the Administrator and to the State Survey Agency within 2 hours for one of seven sampled residents, Resident (R)1. On 01/08/2025, a Certified Nurse Aide (CNA) reported to facility leadership an allegation of abuse involving R1 which allegedly occurred on 01/07/2025, approximately twenty-four hours prior the CNA reporting the allegation.

Inspectors wroteBased on observation, interview, and review of the Diet Guide Sheet, it was determined the facility failed to ensure menu items were served in the recommended portion sizes which were approved to meet the nutritional needs of the residents. Staff failed to follow the portion sizes on the menu guide which was approved by a Registered Dietician. Observation on 05/02/2024 during the noon meal revealed, pureed meal tray portions were small and the server was using a blue-handled scoop. The server stated the scoop was 2 ounces. Continued observation revealed 2 ounces of the meatless entrée and 2 ounces of pureed bread being placed on the plate.

Inspectors wroteBased on observation, interview and review of facility policy, it was determined the facility failed to store food in accordance with professional standards for food service safety related to food items opened, not dated, and/or labeled. This had the potential to affect 115 of 120 residents. Observation during the initial kitchen tour on 04/30/2024 at 9:40 AM, revealed assorted food items/containers not labeled, dated, or expired in both walk-in cooler #1 and walk-in cooler #2.

Inspectors wroteBased on observation, interview, record review, and policy review it was determined the facility failed to maintain infection control practices to prevent the development and transmission of communicable diseases and infections for three (3) of thirty-three (33) sampled residents (Residents #46, #97, and #171). On 06/04/19 at 10:06 AM a wound care observation of Resident #171 revealed staff failed to follow appropriate infection control practices and hand hygiene. On 06/03/19, Resident #46's urinary catheter drainage bag was observed to be leaking urine, which was draining into another open plastic bag. In addition, observations on 06/04/19, revealed staff failed to use personal protective equipment (PPE) when providing care to Resident #97, who had Methicillin Resistant Staph Aureus present in a decubitus wound.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure one (1) of thirty-three (33) sampled residents (Resident #97) was treated with dignity and respect. During observation of wound care on 06/04/19 at 2:15 PM, Licensed Practical Nurse (LPN) #8 opened the door to the hallway and exposed Resident #97's nude buttocks.

Inspectors wroteBased on observation and interview, it was determined that the facility failed to maintain the interior in good repair for one (1) of thirty-three (33) sampled residents (Resident #114). Observation revealed multiple holes in the wall below the window in Resident #114's room.

Inspectors wroteBased on observation, interview, record review, and review of the Resident Assessment Instrument (RAI) User's Manual, it was determined the facility failed to complete Minimum Data Set (MDS) assessments for one (1) of thirty-three (33) sampled residents (Resident #9). Resident #9 was admitted to hospice on 05/16/19; however, the facility failed to conduct a Significant Change in Status MDS assessment.

Inspectors wroteBased on interview and record review, it was determined that the facility failed to ensure each resident is assessed using the standardized Quarterly Review assessment tool no less than once every 3 months between comprehensive assessments for one (1) of 33 (thirty-three) sampled residents (Resident #2). Review of Resident #2's Minimum Data Set (MDS) assessments revealed the facility completed a quarterly assessment on 01/22/19, but failed to complete another quarterly MDS assessment until 05/24/19, forty-one (41) days late.

Inspectors wroteBased on interview and record review it was determined that the facility failed to transmit a completed discharge record for one (1) of thirty-three (33) sampled residents (Resident #1). The facility completed a 14-day discharge assessment for Resident #1 on 01/13/19; however, the facility failed to transmit the discharge information as required.

Inspectors wroteThe facility failed to ensure Minimum Data Set (MDS) assessments accurately reflected the status of two (2) of thirty-three (33) sampled residents (Resident #60 and #68). The facility failed to ensure Resident #68's admission MDS assessment stated that the resident required tracheostomy care, suctioning, and dialysis. In addition, the facility failed to ensure Resident #60's admission MDS stated that the resident utilized an indwelling urinary catheter.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to develop the baseline care plan to include the minimum health care information necessary to properly care for one (1) of thirty-three (33) sampled residents (Resident #370). Record review revealed Resident #370's State Registered Nurse Aide (SRNA) care plan was blank and failed to identify the resident's care needs. In addition, the resident's Baseline Care Plan did not address the resident's hydration/nutrition needs, interventions to prevent falls, or comfort measures the resident required.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined that the facility failed to develop a comprehensive plan of care for one (1) of thirty-three (33) sampled residents (Resident #60). The facility failed to develop a comprehensive plan of care with interventions to care for Resident #60's Peripherally Inserted Central Catheter (PICC) line (a catheter that is inserted into a large vein for long-term intravenous (IV) therapy).

Inspectors wroteBased on observation, interview, record review, and review of facility policy, it was determined that the facility failed to ensure the care plan was reviewed and revised for one (1) of thirty-three (33) sampled residents. Review of Resident #27's comprehensive care plan revealed the facility failed to revise the care plan when an increased need for assistance with activities of daily living was identified during a 03/19/19 comprehensive assessment.

Inspectors wroteBased on record review and interview, it was determined the facility failed to ensure that a resident who was unable to carry out activities of daily living (ADLs) received the necessary services to maintain good grooming and personal hygiene for one (1) of thirty-three (33) sampled residents (Resident #27). The facility failed to ensure Resident #27 received a shower/bath. There was no documented evidence that the resident received a shower from 11/08/18 to 11/15/18.

Inspectors wroteBased on observation, interview, record review, and policy review, it was determined the facility failed to ensure one (1) of thirty-three (33) sampled residents (Resident #97) received care and treatment consistent with professional standards of practice to promote healing and prevent infection. Observations of pressure ulcer care on 06/04/19 at 2:15 PM revealed Licensed Practical Nurse (LPN) #8 failed to follow the facility's policy and utilized a dirty urinary incontinence brief to dry the pressure ulcer.

Inspectors wroteBased on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure two (2) of thirty-three (33) sampled residents (Resident #60 and Resident #97) received appropriate treatment and services for indwelling urinary catheters. Observations of Resident #60 and Resident #97 revealed the facility failed to ensure the residents' catheters were secured to prevent injury to the residents.

Inspectors wroteBased on observation, interview, and facility policy review it was determined that the facility failed to offer sufficient fluid intake to maintain proper hydration and health for one (1) of thirty-three (33) sampled residents (Resident #370). The resident was observed on numerous occasions to be without a glass or facility pitcher in which to place drinks in.

Inspectors wroteBased on facility policy review, record review, observation, and interview, it was determined the facility failed to ensure care to an intravenous (IV) line insertion site was consistent with the facility's policy and physician orders for one (1) of thirty-three (33) sampled residents (Resident #60). The facility failed to ensure the dressing to Resident #60's Peripherally Inserted Central Catheter (PICC) site was completed as required by the facility's policy and as ordered by the resident's physician.

Inspectors wroteBased on observation, interview, record review, and review of the facility policy, it was determined the facility failed to ensure respiratory care was provided to one (1) of thirty-three (33) sampled residents (Resident #68). Review of documentation dated May and June 2019 revealed tracheostomy care was not provided, as ordered by the physician, to Resident #68 on multiple occasions during night shift.

Inspectors wroteBased on observation, interview, record review, and review of the facility's policy, it was determined the facility failed to ensure drugs and biologicals were stored in accordance with currently accepted professional standards in two (2) of two (2) medication carts on the 500 Hall. Observations on 06/06/19 revealed the packaging of Resident #43's Xanax and Resident #109's Ativan was compromised. In addition, liquid Ativan was stored at room temperature; however, the manufacturer's label indicated the liquid Ativan was to be stored in the refrigerator.