Silver Heights Skilled Nursing and Rehabilitation

Inspectors wroteBased on observations and interviews, the facility failed to provide a comfortable and homelike environment for eight of 36 rooms. Specifically, the facility failed to provide residents with hand towels on a daily basis.

Inspectors wroteBased on record review and interviews, the facility failed to ensure three (#259, #15 and #10) of five residents reviewed out of 30 sample residents were free from unnecessary medications as possible. Specifically, the facility failed to: -Ensure the facility had proper justification for the implementation of an antipsychotic medication (Seroquel) for Resident #259; - Ensure Resident #15 or their responsible party was informed of the resident's use of Risperdal (antipsychotic) had black box warnings; -Ensure the ongoing use of Risperdal for Resident #15 was justified by consistent documented behaviors; and, -Ensure a consent was obtained for Resident #10's use of Sertraline (antidepressant).

Inspectors wroteBased on observations and interviews, the facility failed to ensure all drugs and biologicals were properly stored and labeled in accordance with professional standards in one of one medication storage rooms. Specifically, the facility failed to ensure Tubersol (tuberculin purified protein derivative), Hepatitis B vaccine, Prevnar (pneumococcal vaccine), Fluzone (influenza vaccine), Spikevax (COVID-19 vaccine) and Basaglar insulin pens were stored within the appropriate medication storage refrigerator temperature guidelines.

Inspectors wroteBased on observations, record review and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease on three of three units. Specifically, the facility failed to: -Ensure hand hygiene was performed during wound care; -Ensure clean technique was followed during wound care; -Ensure residents' rooms were cleaned in a sanitary manner; -Ensure laundry was sorted in a sanitary manner; -Ensure laundry was washed in a different cycle for residents in isolation; and, -Ensure residents' personal items were labeled and stored in a sanitary manner.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents who were unable to carry out activities of daily living (ADL) received appropriate treatment and services to maintain or improve his or her abilities for one (#24) of three residents out of 30 sample residents. Specifically, the facility failed to provide timely toileting assistance or incontinence care for Resident #24.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#12) of one resident with limited range of motion received appropriate treatment and services out of 30 sample residents. Specifically, the facility failed to: -Develop a comprehensive care plan for Resident #12's left hand contracture (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints); and, -Ensure Resident #12 was provided the recommended preventive measures for contracture management of her left hand.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#259) of three residents reviewed for accidents out of 30 sample residents received adequate supervision to prevent accidents. Specifically, the facility failed to identify the root cause of Resident #259's falls and implement effective person-centered interventions.

Inspectors wroteBased on record review and interviews, the facility failed to assist residents to obtain routine or emergency dental services, as needed, for one (#12) of one resident reviewed for ancillary services out of 30 sample residents. Specifically, the facility failed to ensure a dental referral was followed upon timely for Resident #12.

Inspectors wroteBased on record review and interviews, the facility failed to implement policies and procedures related to influenza and pneumococcal vaccines for two (#26 and #43) of five residents reviewed for immunizations out of 30 sample residents. Specifically, the facility failed to: -Document the influenza vaccine was offered annually for Resident #26 and #43; -Document the pneumonia vaccine was reoffered for Resident #26; and, -Administer the pneumococcal vaccination after consent was provided for Resident #43.

Inspectors wroteBased on record review and interviews, the facility failed to ensure two (#15 and #42) of five residents out of 30 sample residents were kept free from abuse. Specifically, the facility failed to: -Ensure Resident #15 was kept free from physical abuse by Resident #13; and, -Ensure Resident #42 was kept free from physical abuse by Resident #58.

Inspectors wroteBased on record review and interviews, the facility failed to notify the physician timely for one (#15) of three residents reviewed out of 18 sample residents. Specifically, the facility failed to ensure Resident #15's physician was notified when the resident consistently refused her anticoagulant medication (medication used to decrease the risk of stroke and blood clots).

Inspectors wroteBased on observations, record review and interviews, the facility failed to take steps to protect one (#1) of five residents reviewed for abuse out of 18 sample residents. Specifically, the facility failed to ensure Resident #1 was kept free from physical abuse by Resident #2.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents who were unable to carry out activities of daily living (ADL) received the necessary services to maintain good grooming and personal hygiene for three (#10 and #16) of four residents reviewed out of 18 sample residents. Specifically, the facility failed to: -Provide Resident #10 and Resident #16 with timely incontinence care; and, -Provide the necessary assistance for Resident #10, who required physical assistance and encouragement with meals.

Inspectors wroteBased on record review and interview, the facility failed to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of one (#18) of three residents out of 18 sample residents. Specifically, the facility failed to follow procedures to prevent the drug diversion of Resident #18's Ativan (a Schedule IV controlled substance medication for treatment of anxiety).

Inspectors wroteBased on record review and interviews, the facility failed to maintain accurately documented medical records for two (#4 and #12) of four residents reviewed out of 18 sample residents. Specifically, the facility failed to ensure nursing staff documented skin assessments accurately for Resident #4 and Resident #12.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to 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. Specifically, the facility failed to ensure control measures for monitoring and preventing Legionella and waterborne pathogens growth were included in the facility's water management plan.

Inspectors wroteBased on interviews and record review, the facility failed to ensure one (#62) of one resident reviewed for verbal abuse out of 32 sample residents were kept free from abuse. Specifically, the facility failed to ensure Resident #62 was kept free from verbal abuse and threats by a staff member.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure two (#1 and #11) of four residents reviewed out of 32 sample residents for assistance with activities of daily living (ADL) received appropriate treatment and services to maintain or improve his or her abilities. Specifically, the facility failed to: -Ensure Resident #1 and #11 received showers; and, -Ensure Resident #1 and Resident #11's care plan addressed shower refusals and preferences.

Inspectors wroteBased on interviews and record review, the facility failed to provide treatment and care in accordance with professional standards of practice for one (#51) of two reviewed for change of condition out of 32 sample residents. Specifically, the facility failed to ensure: -A cardiology appointment was scheduled for Resident #51 with a diagnosis of heart failure; and, -The physician was notified when Resident #51 had chest pain.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#14) of eight out of 32 sample residents received adequate supervision to prevent accidents. Specifically, the facility failed to ensure Resident #14 received the supervision he required to prevent falls.

Inspectors wroteBased on observations, staff interviews, and record review, the facility failed to consistently provide urostomy care, treatment and services to minimize the risk of urinary tract infections for one (#7) of two residents reviewed for urinary devices out of 32 sample residents. Specifically, the facility failed to ensure Resident #7 had orders for urostomy care.

Inspectors wroteBased on record review and interviews, the facility failed to complete a performance review of every nurse aide at least once every 12 months, and provide regular in-service education based on the outcome of these reviews for five of eight staff reviewed. Specifically, the facility had not completed annual performance reviews for certified nurse aide (CNA) #4, CNA #2, CNA #5, CNA #6 and activities aide (AA) #1.

Inspectors wroteBased on observations and interviews, the facility failed to ensure two out of three medication carts stored medications in accordance with accepted professional standards. Specifically, the facility failed to ensure the medication carts were locked when the nurse was not at the cart or in direct line of sight.

Inspectors wroteBased on record review and interviews, the facility failed to ensure registered nurses (RNs), licensed practical nurses (LPN), and certified nurse aides (CNA) were able to demonstrate competencies in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care. Specifically, the facility failed to ensure nursing staff both facility and agency had completed competencies prior to providing skilled services as ordered by the physician for four out of four CNAs, two of two LPNs, and two of two RNs reviewed for competencies.

Inspectors wroteBased on observations and staff interviews, the facility failed to maintain a sanitary, orderly, and comfortable environment for residents in 20 of 31 resident rooms, three of three hallways and the kitchen. Specifically, the facility failed to ensure walls, baseboard coves, halls, floors, handrails, and ceiling tiles were repaired, painted and properly maintained.

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure that its medication error rate was not five percent or greater for observed medication administration out of 25 opportunities. Specifically, the facility had a medication error rate of 12% regarding Resident #21.

Inspectors wroteBased on observations, record review and interviews the facility failed to comprehensively assess and care plan the continued use of personal alarms and wander guard as potential restraints for one (#35) of one resident reviewed for restraints out of 25 sample residents. Specifically, the facility failed to attempt an alternate intervention prior to the implementation of a wander guard for Resident #35. I. Facility policy The Elopement Risk policy, revised December 2007, provided by the nursing home administrator (NHA) on 7/20/2022 at 4:00 p.m., included: Staff shall investigate and report all cases of missing residents: Staff shall promptly report any resident who tries to leave the premises or is suspected of being missing to the Charge Nurse or Director of Nursing. If an employee observes a resident leaving the premises, he/she should: [...]

Inspectors wroteBased on resident observations, record review and staff interviews, the facility failed to ensure residents received proper respiratory treatment and care for two (#12 and #54) of four residents reviewed for supplemental oxygen use out of 25 sample residents. Specifically, the facility: -Failed to ensure physicians order was in place for Resident #12 continuous oxygen use; and, -Failed to administer oxygen in accordance with the physician's order for Resident #54.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure two (#22 and #19) of five out of 25 sample residents, received the appropriate treatment and services to maintain their highest practicable physical, mental, and psychosocial well-being. Specifically, the facility failed to: -Provide Resident #22, who was a supervised smoker, with sufficient supervision and interventions in the designated outdoor smoking area; and, -Effectively identify person-centered approaches for dementia care for Resident #22 and #19. I. Facility policy The Dementia Care policy, revised January 2021, was provided by the medical records (MR) on 7/21/22 at 11:00 a.m. It read in pertinent part: -Staff will involve the resident or family/representative in discussions about the potential use of any specific approaches to his/her care; [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure that the hospice services provided met professional standards and principles that applied to individuals providing services in the facility for one (#158) of three residents reviewed for hospice services out of 25 sample residents. Specifically, the facility failed to for Resident #158: -To have a Hospice care plan in order to maintain the resident's highest practicable physical, mental and psychosocial well-being; -To identify the responsibilities of the Hospice provider and the facility to include frequency of visits;and, -To have a facility care plan that identified the resident received Hospice cares. I. Facility policy The Hospice Program policy, no date, provided by medical records (MR) on 7/20/22 at 11:24 a.m. included; [...]