Social Circle Nsg & Rehab Ctr

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled Resident Mobility and Range of Motion Policy and Procedure,.The facility failed to ensure R7 received needed range of motion (ROM) and contracture prevention services. This failure placed R7 at increased risk for worsening contractures.

Inspectors wroteBased on observations, record review, staff interviews and review of the facility's policy titled Oxygen Administration, the facility failed to ensure one resident (R) R37, out of six residents was administered oxygen therapy as per the physician's orders. The deficient practice had the potential to increase the probability of respiratory complications for the residents receiving respiratory care and treatment.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policy titled, Enteral Tube Feeding via Continuous Pump, the facility failed to administer nutritional enteral feedings and hydration according to the current physician orders for one of two residents (R) (R33) receiving tube feeding in the facility. The deficient practice had the potential for the resident to not receive the correct amount of nutrition ordered by the physician which could result in negative outcome for resident.

Inspectors wroteBased on observation, staff interviews, record review and review of the facility's policies titled, Administering Medication, and Storage of Medication, the facility failed to properly secure a medication cart when not in use or clearly visible to the personnel administering medication and failed to ensure an eye drop medication was dated appropriately when opened to determine the discard date, for one of two medication carts (North Hall medication cart). The facility census was 56 residents.

Inspectors wroteBased on observations, resident representative and staff interviews, and record review, the facility failed to document care for one 28 sampled residents (R) (R160). Specifically, personal, bowel, and bladder care were not documented in the medical record.

Inspectors wroteBased on observations, staff interviews, and record review, the facility failed to properly disinfect a glucometer before use for one of eight residents (R) (R22) that have glucometer checks ordered. The deficient practice has the potential to place residents at high risk for infection.

Inspectors wroteBased on observations, staff interviews, and review of the facility's policy titled, Maintenance Service, the facility failed to keep one call light in working condition in one out of 18 rooms on North Hall (Room North 3-B). This deficient practice had the potential to place the resident at risk for unmet care needs, delayed response during emergencies, and increased likelihood of injury due to the inability to request assistance.

Inspectors wroteBased on observations, staff interviews, and review of the facility policy titled, Dating & Labeling Policy, the facility failed to ensure that opened food items were labeled, dated, and appropriately stored. This failure had the potential to affect 59 of 61 residents who receive an oral diet from the kitchen.

Inspectors wroteBased on observations, record review, staff interviews, and review of the facility's policies titled, Infection Prevention and Control Program, Laundry Operations Manual, Handwashing/Hand Hygiene, and Dressing Change for Vascular Access Devices, the facility failed to practice acceptable infection control practices to prevent possible cross-contamination during laundry services, performing hand hygiene during medication administration for one of two nurses, and failed to ensure one peripherally inserted central catheter (PICC) dressing was changed for resident (R) R53, every seven days. The sample size was 27.

Inspectors wroteBased on observation, record review, staff interview, and review of the facility's policy titled, Quality of Life - Dignity, the facility failed to maintain dignity by ensuring a dignity bag was provided for one of one resident (R) (R26) reviewed with an indwelling catheter.

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled, Advance Directives the facility failed to obtain and/or transcribe a physician's order for code status for one resident (R) (R260) of 27 sampled residents.

Inspectors wroteBased on staff interviews, record review, review of the facility's policy titled, Care Plan, Comprehensive Person-Centered, and review of the facility's procedure document titled, Dressing Change for Vascular Access Devices, the facility failed to ensure that care plan interventions were followed for one resident (R) (R53) of one resident reviewed for peripherally inserted central catheter (PICC) (an intravenous catheter that is inserted into a vein in the arm and advanced in the body in the veins until the internal tip of the catheter is in the superior vena cava) line. In addition, the facility failed to develop a comprehensive person-centered care plan to treat and prevent further contractures for one resident (R28) of 27 sampled residents reviewed for care plans.

Inspectors wroteBased on observation, staff interviews record review, and review of the procedure document titled Dressing Change for Vascular Access, the facility failed to ensure a physicians' order was in place for the care of a peripherally inserted central catheter (PICC) line (an intravenous catheter that is inserted into a vein in the arm and advanced in the body in the veins until the internal tip of the catheter is in the superior vena cava) and failed to document care of the PICC line for one resident (R) (R53) of one reviewed for intravenous access lines.

Inspectors wroteBased on observations, record review, staff and resident interviews and review of facility's policy titled Transitioning to Functional Maintenance Care from Restorative Nursing Program, the facility failed to ensure one resident (R) (28) of 27 sample residents reviewed for limited range of motion received restorative services as needed to address limited range of motion in his right arm. This failure created a potential for worsening contracture (fixed resistance to passive stretch), pain, or skin breakdown.

Inspectors wroteBased on observations, staff and resident interviews, record review, and review of the facility's policy titled, Oxygen Administration, the facility failed to ensure that the respiratory nasal cannula tubing was dated when changed and the oxygen concentrator filters were maintained in a sanitary condition for three of five residents (R) (R21, R260, R213) receiving oxygen therapy and failed to ensure sanitary storage of a respiratory nasal cannula when not in use for one of five residents (R213) receiving oxygen therapy.

Inspectors wroteBased on record review, staff interview, and review of the facility's policy titled Antipsychotic Medication Use, the facility failed to ensure a stop date was implemented, not to exceed 14 days for psychotropic medications for two residents (R) (R35 and R41) of six residents reviewed for unnecessary medications. Specifically, the facility failed to implement a stop date for antianxiety medication ordered as needed (PRN) for R35 and R41.

Inspectors wroteBased on observations, interviews, and review of facility policies titled, Storage of Medications, Administering Medications, and Discarding and Destroying Medications, the facility failed to ensure one medication cart and one treatment cart were locked when not in use; failed to ensure insulin was dated appropriately when opened to determine the discard date and failed to discard expired medications in one of two medication carts. In addition, the facility failed to implement the process for discarding and destroying discontinued medications. The facility census was 61.

Inspectors wroteBased on observation, staff interviews, and review of the facility's policy titled, Maintenance Service, the facility failed to ensure that essential equipment in the laundry was in proper working order, as evidenced by a water leak behind one of one industrial washer.