Snow Hill Rehabilitation & Healthcare Center

Inspectors wroteBased on observations and facility staff interview, it was determined that the facility failed to safely store food items and maintain food service equipment in a manner that ensures sanitary food service operations. This was identified during multiple observations of kitchen food service operations.

Inspectors wroteBased on observations and facility staff interviews, it was determined that the facility failed to ensure that the environment of resident care was kept clean, comfortable, safe, and sanitary for resident use. This was evident for all environmental tours conducted on the recertification survey.

Inspectors wroteBased on observations and facility staff interview, facility personnel records review, and review of facility policies it was determined that the facility failed to ensure proper sanitization of multi-resident use equipment. This was evident for 3 of 3 medication administration observations for residents (#27, #14, and #21) conducted during the recertification survey.

Inspectors wroteBased on record review and interviews, it was determined that the facility failed to provide a resident with a written notice and reason for the room change before the resident was moved. This was found to be evident in 1 (Resident #6) of 33 residents reviewed during the recertification survey.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to ensure information regarding advance directives was offered and documented for residents. This was evident for 2 (Residents #5 and #9) of 8 residents reviewed for advance directives.

Inspectors wroteBased on interviews and record reviews of financial statements, it was determined that the facility failed to explain or justify the proration calculation for a 3-day resident stay and applied a retroactive Medicaid billing change across multiple months without an active agency determination letter. This was found to be evident for 1 resident (Resident #72) during the investigation of complaint #2803485 during the recertification survey.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to ensure an allegation involving a resident elopement was reported to the State Agency within the required time frame. This is evident for 1 (Incident #2989264) of 2 facility reported incidents investigated during the annual survey.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to ensure residents were provided notice of the facility's bed-hold policy at the time of transfer to the hospital and/or that the bed-hold policy was maintained for review. This was evident for 3 (Residents #5, 58, and 59) of 3 residents reviewed for discharge process.

Inspectors wroteBased on medical record review and staff interviews, it was determined that the facility failed to complete a significant change Minimum Data Set (MDS) assessment within 14 days of the resident's enrollment in hospice. This was found to be evident for 1 (Resident #63) of 1 resident reviewed for hospice services during the recertification survey.

Inspectors wroteBased on interviews and resident and facility record review, it was determined that the facility failed to provide the resident with advance notice of care planning conferences. This was evident for 1 (Resident #43) of 1 residents reviewed for care planning during the recertification survey.

Inspectors wroteBased on medical record review and interviews, it was determined that the facility failed to 1) provide adequate supervision to prevent accidents as evidenced by a resident eating solid food while on nothing by mouth (NPO) diet restrictions and 2) ensure adequate supervision for a vulnerable, cognitively impaired resident which resulted in elopement. This was found to be evident in 2 (Resident #6 and #9) of 5 residents reviewed for accidents during the recertification survey. The facility implemented effective and thorough corrective measures following these incidents prior to the start of this survey. The facility's plan and action were verified during this survey; therefore, this deficiency was found to be past noncompliance with a compliance date of 4/25/2026.

Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to ensure a nurse aide completed required dementia training and competency evaluation within 120 days of employment. This is evident for 1 (Staff #22) of 5 employee records reviewed during the annual survey.

Inspectors wroteBased on observations and facility staff interview, it was determined that the facility failed to properly contain garbage and refuse. This was evident for 2 of 2 observations conducted during the recertification survey.

Inspectors wroteBased on medical record review and interviews, it was determined that the facility failed to maintain documentation of Covid-19 vaccine administration. This was found to be evident in 1 (Resident #15) of 5 residents reviewed for immunizations during the recertification survey.

Inspectors wroteBased on observation and staff interview, it was determined that the facility failed to make the results of the most recent survey readily available and accessible to residents and visitors. This was evident for the facility's survey results binder.

Inspectors wroteBased on surveyor observation and staff interviews, it was determined the facility failed to ensure a functioning house wide call bell system. This was evident for all residents residing in the facility's 2 nursing units.

Inspectors wroteBased on complaint, reviews of a closed and active clinical record and administrative records, and staff interviews, it was determined that the facility nursing staff failed to follow the physician's specific pulse and blood pressure parameters before administering cardiac medications. This was evident for 2 (Resident #1, Resident #3) of 6 residents reviewed during a complaint survey

Inspectors wroteBased on reviews of facility reported incident and staff interview, it was determined the facility staff failed to immediately report an allegation of suspected resident abuse to the local police. This was evident for 1 (Resident #3) of 6 residents reviewed during a complaint survey.

Inspectors wroteBased on reviews of a facility reported incident, a closed medical record and staff interview, it was determined that the facility staff failed to obtain psychiatric consultation for Resident #3 after the facility concluded an abuse investigation and determined Resident #3 should be referred to the facility psychiatric services. This is evident for 1 (Resident #3) of 6 residents reviewed during a complaint survey.

Inspectors wroteBased on reviews of a closed medical record and all pertinent administrative records, and staff interview, it was determined that the facility failed to have a system in place to ensure clinical records were complete and accurately documented. This was found to be evident for 1 (Resident #3) of 3 residents reviewed during a complaint survey.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to meet proper internal cooking temperatures and failed to ensure beverages were served at an appropriate temperature. This was evident during the Kitchen Observation within the facility. This deficient practice has the potential to affect all residents who consume meals.

Inspectors wroteBased on interviews and record reviews, it was determined that the facility failed to ensure its Infection Preventionist met the mandatory qualifications for the position. This deficient practice has the potential to affect all residents in the facility.

Inspectors wroteBased on observation, clinical record review and interviews, it was determined that the facility failed to provide activities of daily living (ADL) care to dependent residents. This was evident for 4 (#12, #42, #47, #63) of 4 residents reviewed for ADL care during the annual survey.

Inspectors wroteBased on observations, interviews, and record reviews it was determined that the facility failed to ensure medications were properly labeled and stored. This was evident for 2 of 2 medication carts observed for medication storage during the annual survey.

Inspectors wroteBased on observation and interview, it was determined that the facility failed to store/prepare food under sanitary conditions. This was found to be evident during the Kitchen Observations.

Inspectors wroteBased on observations and staff interviews, it was determined that the facility failed to 1) ensure that oxygen administration equipment and nebulization masks were stored in a sanitary manner when not in use and 2) ensure that the environment was maintained in a manner that minimized the potential spread of infection. This was evident for 1 (#42) out of 28 sampled residents and 1 random observation of the laundry room during the annual survey.

Inspectors wroteBased on interview and record review, it was determined that the facility failed to provide the residents with the opportunity to choose their shower schedules. This was evident for 2 ( Resident #65 and #14) of 2 residents reviewed for choices during the recertification survey.

Inspectors wroteBased on interviews and facility record reviews it was determined that the facility failed to ensure that facility records for abuse and neglect were maintained for correction of alleged violations and completed investigations. This was found to be evident for 3 (Resident #18, #28 and #219) out of 5 Residents reviewed for investigation and correction of alleged violations of abuse and neglect.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to develop a baseline care plan. This was evident for 1 (Resident #65) of 28 residents reviewed for baseline care plans during the recertification survey.

Inspectors wroteBased on observation, record review and interview, it was determined that the facility failed to develop and implement a comprehensive care plan for the use of oxygen. This was evident for 1 (Resident #42) of 28 residents reviewed care plans during the recertification survey.

Inspectors wroteBased on medical record review and staff interview, it was determined the facility failed to develop/revise care plans to meet residents' needs. This was evident for 1 (Resident #63) of 28 residents reviewed for care planning

Inspectors wroteBased on record review, interviews, and observations, it was determined that the facility failed to ensure 1) that physician laboratory orders were performed as ordered, 2) medications were administered as ordered and 3) a resident received proper cardiac monitoring. This was found to be evident for 3 (Resident #65, #45, and #12) out of 3 residents reviewed for quality of care during the annual survey.

Inspectors wroteBased on interview, observation and record review, it was determined that the facility failed to 1) ensure that a resident with a pressure ulcer received the necessary treatment to promote healing and 2) implement the recommendations made by the wound clinic to the resident with pressure ulcer. This was evident for 2 (Resident #12 and #42) of 4 residents reviewed for pressure ulcers during the recertification survey.

Inspectors wroteBased on observation, interview, and medical record review, it was determined that the facility failed to ensure that drinking water was provided to the residents at the bedside for hydration. This was evident for 1(Resident #5) of 1 resident reviewed for hydration.

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to provide necessary respiratory care services for residents by failing to 1) label oxygen administration equipment 2) put a physician oxygen order in place and 3) place signage outside the entrance of residents' room to indicate oxygen in use. This was evident for 3 (Resident #5, #18 and #42) of 3 residents reviewed for respiratory care during the recertification survey.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to ensure that pain medications were given consistent with the professional standards of practice. This was evident for 1 (Resident #42) of 1 resident reviewed for pain management during the recertification survey.

Inspectors wroteBased on interviews and employee record reviews it was determined that the facility failed to ensure that the required Geriatric Nursing Assistant (GNA) perform review - 12 hour/year in-service were completed. This was found to be evident in 2 ( #24 and #25) out of 2 GNA employee files reviewed for required perform review - 12 hour/year in-service.

Inspectors wroteBased on observation, interviews and facility record review it was determined that the facility failed to ensure that the posted nurse staffing information contained all the required information. This was found to be evident on the posted staffing sheet on the nursing unit reviewed for sufficient and competent nurse staffing.

Inspectors wroteBased on interviews and record reviews, it was determined that the facility failed to provide behavioral health care services. This was found to be evident for 1 resident (Resident #45) out of 1 resident reviewed for behavioral health.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to implement the recommendations from the Medication Regimen Review (MRR) and conduct a monthly MRR. This was found evident for 1 (Resident #45) out of 1 resident, reviewed for Medication Regimen Review.

Inspectors wroteBased on record review and interview, it was determined that the facility failed to provide adequate behavior monitoring for residents on psychotropic medications. This was evident for 1 (Resident #65) of 4 residents reviewed for unnecessary medications during the recertification survey.

Inspectors wroteBased on record review and staff interviews, it was determined that the facility failed to screen and offer vaccinations to residents. This was evident for 3 (Residents #26, #51, #32) out of 5 residents screened for immunizations.

Inspectors wroteBased on interviews and employee record reviews it was determined that the facility failed to ensure that the required in-service training for Geriatric Nursing Assistants (GNA) was completed. This was found to be evident in 5 (#24, 25, 26, 27 and #30) out of 5 Geriatric Nursing Assistants (GNA) employee files reviewed for required in-service training.

Inspectors wroteBased on a review of facility investigations and interviews with facility staff, it was determined that the facility staff failed to maintain documentation that alleged violations of abuse were thoroughly investigated for residents (#9, #18, #30, #62, #63, #64, #65, #66, #67, #68, and #264) This was evident for 11 of 40 residents reviewed during the annual survey.

Inspectors wroteBased on observation and interviews it was determined the facility staff failed to have the most recent survey results in a place readily accessible to residents, family members, and legal representatives of residents. This has the potential to affect all the residents and visitors within the facility.

Inspectors wroteBased on medical record review and interview it was determined the facility staff failed to notify the physician when a resident refused to wear a medical device for at least a month. This was evident in 1 of 2 resident (Resident #12) records reviewed for treatment plans.

Inspectors wroteBased on medical record review and staff interview, the facility failed to timely report a violation of mistreatment, exploitation, neglect or abuse, including injuries of unknown source and misappropriation of resident property to the state authority. This was evident for 3 of 14 residents (Resident #15, #30, #7) investigated for reportable incidents.

Inspectors wroteBased on medical record review and interview it was determined the facility staff failed to complete a notice before transfer before a resident was transferred to the emergency room. This was evident in 2 of 4 residents (Resident #12 and #15) reviewed for transfer documentation.

Inspectors wroteBased on medical record review and interview, the facility staff failed to verify a weight reading resulting in an inaccurate weight loss calculation which led to an inaccurate Minimum Data Set (MDS) assessment. This was evident in 1 (Resident #42) of 7 residents reviewed for accuracy of assessments.

Inspectors wroteBased on medical record review and staff interview, it was determined facility staff failed to develop and then provide residents and/or their representative with a summary of the baseline care plan within 48 hours of admission to the facility. This was evident for 2 (Resident #43, #45) of 2 residents reviewed during a annual survey for baseline care plan.

Inspectors wroteBased on a medical record review and staff interview, it was determined that the facility staff failed to: 1.) initiate a care plan for a resident receiving a hypnotic and an antidepressant medication (Resident #43); 2.) failed to initiate care plans for activities (Resident #56 and #52); 3. initiate a care plan for a new treatment for Resident #12; 4.) to initiate a care plan for vision loss (Resident #52). This was evident for 4 out of 8 residents (Resident #12, #43, #52, and #56) selected for review during the annual survey.

Inspectors wroteBased on medical record review and interview, the facility failed to update the resident's care plan after a change in status. This was evident in 2 of 40 residents (Residents #5 and #63) reviewed during the facility's annual survey.

Inspectors wroteBased on medical record review and interview with facility staff, it was determined the facility failed to administer a bowel protocol as ordered by the physician (Resident #216) and failed to follow-up on nutritional supplements for Resident #24. This was evident for 2 of 8 residents reviewed for nutrition services during the annual survey.

Inspectors wroteBased on review of medical records and staff interviews, it was determined that the facility failed to monitor a resident's tube feeding program (Resident #5). This was evident for 1 of 1 residents being investigated for tube feeding during the annual survey.

Inspectors wroteBased on medical record review and interview it was determined the facility failed to follow up with the consultant pharmacist's recommendations for a resident. This was evident in 1 (Resident #52) of 3 residents reviewed for unnecessary medications.

Inspectors wroteBased on medical record review and staff interview it was determined the facility pharmacist failed to identify and report irregularities in resident's drug regimen to the physician, facility's medical director and/or the director of nursing. This was evident for 1 of 5 residents (Resident #43) reviewed for unnecessary medications.

Inspectors wroteBased on observation and interviews it was determined the facility's dietary staff failed to wear hair restraints while in the kitchen to prevent hair from contacting food. This was evident in 2 (Staff #5 and Staff #9) of 5 dietary staff observed in the kitchen during the annual survey.

Inspectors wroteBased on observations and interviews with facility staff it was determined the facility staff failed to adhere to infection control practices and guidelines by ensuring that the appropriate personal protective equipment (PPE) was worn before entering a resident room who was noted to be on transmission-based precautions (TBP). This was found to be evident during multiple observations made of 2 residents (Resident #164 and #165) during the facility's annual Medicare/ Medicaid survey.