Silver State Pediatric Skilled Nursing Facility

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure 1) sanitizer test strips were available to measure the concentration of the sanitizing solution of the three-compartment sink, 2) the refrigerator and nourishment room did not contain expired food items and 3) dented cans were discarded. The deficient practice had the potential to compromise food safety and cause foodborne illness.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure physician orders were followed for the use of a helmet device for a resident with plagiocephaly (malformation of cranial bones) for 1 of 12 sampled residents (Resident 22). The deficient practice placed the resident at risk for skin breakdown and discomfort.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure the resident's tube feeding (TF) bag was labeled with complete and accurate information for 1 of 12 sampled residents (Resident 3). The deficient practice had the potential to result in TF-related complications.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure an inhalation bag for BIPAP (bilevel positive airway pressure machine) use was dated for 1 of 12 sampled residents (Resident 3). The deficient practice placed the residents at risk for compromised quality care.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure the ice machine did not have brown-colored build up and was not overdue for vendor maintenance. This deficient practice may result in contamination of ice intended for consumption.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure the area behind the cooking area was maintained clean and food items were labeled with an open date. The deficient practice had a potential for fire hazard, attract pests and track viability for consumption of food products.

Inspectors wroteBased on observation, interview, record review and document review, the facility failed to ensure polices were reviewed, updated, were suited to the resident population, and reflected current facility practices. The deficient practice had a potential for residents to receive care not meeting the expectation of the facility guidelines of care; and impede the uniform training of staff on the correct practices for delivering optimum care to the pediatric resident population.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure: 1) expired items were not stored in the refrigerator and discarded; and 2) feeding formula and items were appropriately labeled in the nourishment room refrigerator. The deficient practice posed a potential risk to safety and health standards, as it could lead to contamination or inadequate storage conditions.

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure care and management orders were obtained, clarified, and transcribed for residents receiving gastric tube feeding (TF) for 6 of 12 sampled residents (Residents 16, 18, 1, 2, 10, and 20). This deficiency could lead to potential significant risks, including increased susceptibility to infections, dehydration, malnutrition, fluid overload, and gastrostomy tube (GT) dysfunction.

Inspectors wroteBased on interviews, record review and document review, the facility failed to implement care plan interventions for monitoring side effects for psychotropic and diuretic medication for 2 of 12 sampled residents (Residents 8 and 9). The deficient practice had the potential for adverse effects of medication for the residents of the facility.

Inspectors wroteBased on observations, interviews, record reviews, and document review, the facility failed to ensure the following: 1) The clonidine patch was removed timely as ordered, or the physician was notified of the delay for 1 of 12 sampled residents (Resident 20). 2) The bowel protocol was administered as ordered for 1 of 12 sampled residents (Resident 18). 3) An external cream was timely applied as ordered for 1 of 12 sampled residents (Resident 12). These deficient practices could have led to potential risks, such as unintended overdose, adverse reactions, or inadequate management of the resident's medical condition.

Inspectors wroteBased on observation, interviews, and document review, the facility failed to ensure that medications were available during medication administration and administered timely as ordered. The deficient practice resulted in delays in treatment and compromised the overall effectiveness of the medication regimen.

Inspectors wroteBased on interviews, record review, and document review the facility failed to ensure consent was obtained for use of psychotropic medications for 2 of 12 sampled residents. The deficient practice had the potential for unnecessary medication administration.

Inspectors wroteBased on observations, interviews, record reviews, and document reviews, the facility failed to ensure their medication error rate was below five percent when three errors were identified with 28 opportunities observed, calculating an error rate of 10.71 percent. Failure to follow physician orders and timely administer medications posed a potential risk of injury or harm to the resident.

Inspectors wroteBased on observations, interviews, and document review, medications were not labeled with the date of opening in the medication cart and medication room. The deficient practice posed a potential risk of compromised patient safety and medication efficacy due to the lack of accurate information on the duration of use and potential expiration.