Sunny Acres Nursing Home

Inspectors wroteBased on interview and record review the facility failed to notify a resident's family of a hospitalization for one (R1) of three residents reviewed for quality of care in the sample of four.

Inspectors wroteBased on interview and record review the facility failed to properly store medication for one (R2) of three residents reviewed for quality of care in the sample of four.

Inspectors wroteBased on interview and record review, the facility failed to ensure that an established fall intervention was functional and active, failed to keep an assistive device (wheelchair) within a high-risk resident's reach, and failed to investigate a fall incident to implement necessary preventive interventions for one of three residents (R1) reviewed for accidents in a sample of five.

Inspectors wroteA.Based on observation, interview, and record review, the facility failed to ensure wound treatments were completed as ordered, appropriate infection control practices were followed during wound care, a readmission assessment was completed, physician ordered pressure relieving interventions were implemented, and worsening wound conditions were monitored and reported to the physician for one (R66) of six residents reviewed for wound care in the sample list of 32. This failure resulted in worsening wound conditions with development of osteomyelitis to R66's right foot requiring hospitalization, surgical debridement, and intravenous antibiotic therapy B. [...]

Inspectors wroteBased on interview and record review, the facility failed to properly dispose of controlled substances for five residents (R1, R5, R6, R7, and R9) who were reviewed for improper disposal of controlled substances in a sample of nine. Findings Include:The facility's Controlled Drug Handling, Reconciling, Count Discrepancy, & Disposal Policy and Procedure dated 5/30/2017 documents, it is the policy of the facility that controlled medications be counted by nurses between shifts and/or whenever there is a change in nurses. This count is to ensure the correctness of the count of the controlled medication and appropriate documentation. Each controlled medication received from pharmacy will be counted, and a count sheet initiated by a nurse. The individual controlled drug record and the between shift count sheets will be kept on each medication cart. Disposal Procedure, 3. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the narcotic count was correct by maintaining the accurate reconciliation and accounting of a controlled substance for one (R3) of nine residents reviewed for improper disposal of controlled substances in a sample of nine.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide adequate supervision to prevent verbal and physical resident-to-resident abuse for two of four residents (R1 and R2) reviewed for abuse in the sample of seven. These findings resulted in R1 physically assaulting R2 causing R2 pain, a laceration to the left cheek, and two large hematomas to the bilateral shins which required emergency room services.

Inspectors wroteBased on record review, interview the facility failed to follow all fall management safety protocols by manually lifting a resident from the floor after a fall and transferring them to a wheelchair without utilizing a mechanical lift for one (R1) of three residents reviewed for falls in the total sample of 11.

Inspectors wroteBased on observation, interview and record review the facility failed to follow infection control standards for Enhanced Barrier Precautions during wound cares for two of three residents (R4, R5) reviewed for wound care in the total sample of 14 residents.

Inspectors wroteBased on interview and record review, the facility failed to follow its hot liquids policy; failed to identify potential hazards relating to hot liquids; and failed to provide staff supervision to prevent hot liquid incident/accident for one (R1) resident of three residents reviewed for accidents/incidents in a sample of three. This failure resulted in R1 sustaining blisters from the spilled hot liquid.

Inspectors wroteBased on Observation, Interview and Record Review, the facility failed to ensure resident rooms were kept free from leaking water condensation, water damaged ceilings and dark fuzzy discoloration on the walls and ceilings for 15 of 16 residents (R1, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, R16) reviewed for environment in the sample of 16.

Inspectors wroteBased on Observation, Interview and Record Review, the facility failed to ensure a resident was provided with an appropriately sized wheelchair, preferred toileting equipment and showers for one of three residents (R2) reviewed for accommodations in the sample of 16.

Inspectors wroteBased on observation, interview, and record review the facility failed to protect a resident from staff-to-resident mental and verbal abuse for two of three residents (R4 and R9) reviewed for abuse in the sample of 17. These findings resulted in V5 (CNA/Certified Nursing Assistant) yelling at R4 and causing R4 to feel belittled, to feel like a child, and feel verbally abused.

Inspectors wroteBased on interview and record review the facility failed to implement their Abuse Policy to thoroughly investigate an allegation of abuse and protect residents from the alleged perpetrator (V5/CNA/Certified Nursing Assistant) after an allegation of staff-to-resident abuse was made. These failures have the potential to affect all 78 residents residing within the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents' room walls, restroom floors, toilets, and sinks were clean, maintained, and in good repair, failed to ensure the facility was free of odor, failed to ensure waste receptacles were lined, and failed to properly dispose of soiled washcloths for ten of ten residents (R2, R4, R5, R10, R11, R12, R13, R15, R16, and R17) reviewed for clean/comfortable/homelike environment in the sample of 17.

Inspectors wroteBased on interview and record review the facility failed to implement their Abuse Policy to immediately report an allegation of abuse to the Administrator and the State Agency for one of three residents (R4) reviewed for Abuse in the sample of 17.

Inspectors wroteBased on observation, interview, and record review the facility failed to prevent resident injury during transfer in a wheelchair, failed to investigate the cause of the injury, and failed to develop interventions after the injury to prevent future injuries for one of three residents (R4) reviewed for accidents in the sample of 17.

Inspectors wroteBased on interview and record review, the facility failed to report allegations of staff to resident physical abuse to the Administrator/Abuse Coordinator for one (R1) of four residents reviewed for abuse in a sample of four.

Inspectors wroteBased on interview and record review the facility failed to administer a prescribed opioid medication to keep resident's pain controlled, failed to perform a pain assessment while the resident was not receiving her prescribed opioid medications, and failed to notify the physician of the need for a refill order and complaints of increased pain for one of one resident (R32) reviewed for pain in the sample of 35. These findings resulted in R32 experiencing stress and excruciating pain for over a week, that radiated to the neck and jaw.

Inspectors wroteBased on observation, interview and record review, the facility failed to properly cleanse a food thermometer before use and between foods when checking steam table food temperatures, ensure a hairnet was worn correctly in the kitchen, label and date open food items in refrigerators and dry food storage areas, ensure freezers contained internal thermometers and thermometers in working condition, use dishwasher temperature testing strips that reflect the required dish surface temperature, check the surface temperature daily to ensure dishes reach the required temperature during the rinse cycle of a high temperature sanitation dish machine, and ensure juice and coffee dispensers in the main dining room were clean and free from buildup and slime. These failures have the potential to affect all 85 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow a physician's order to reduce an anti-psychotic medication for one resident (R17) and failed to document behaviors and diagnoses to justify the use of anti-psychotic medications for four of six residents (R5, R10, R17, R64) reviewed for anti-psychotic drug use with the diagnosis of Dementia in the sample of 35.

Inspectors wroteBased on Observation, Interview, and Record Review the facility failed to complete hand hygiene between residents receiving medications, follow Enhanced Barrier Precautions during direct resident cares, and dispose of soiled washcloths in a sanitary manner for five of 25 residents (R6, R27,R30, R39, R47) reviewed for infection control in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to evaluate the use of physical restraints and prevent the use of physical restraints to prevent a resident (R5) from self-transferring out of bed for one of one resident (R5) reviewed for physical restraints in the sample of 35.

Inspectors wroteBased on interview and record review the facility failed to request a PASRR (Pre-admission Screening and Resident Review) for one of one resident (R10) reviewed for PASRR in a sample of 35. Findings Include: R10's admission Record documents that R10 was admitted to the facility on [DATE] with the following, but not limited to, diagnoses: Vascular Dementia, Unspecified Severity, With Other Behavioral Disturbance, Major Depressive Disorder, and Anxiety Disorder. R10's MDS (Minimum Data Set) Assessment, dated 1/30/25, documents R10 is cognitively intact, has no hallucinations or delusions, has no physical/verbal/or other behaviors directed at others, and does not reject care. R10's Medical Record does not include evidence of the facility obtaining R10's PASRR Level I prior to admission to the facility. [...]

Inspectors wroteBased on record review and interview the facility failed to refer a resident to the PASRR (Preadmission Screening and Resident Review) State Agency to obtain a Level II PASRR after being diagnosed with a Mental Illness for one of one resident (R10) reviewed for Mental Illness in the sample of 35. Findings Include: R10's admission Record documents that R10 was admitted to the facility on [DATE] with the following, but not limited to, diagnoses: Major Depressive Disorder and Anxiety Disorder. R10's Diagnoses Listing documents R10 was diagnosed with Delusional Disorder (a serious mental illness) on 11/24/23. R10's current Physician Orders documents R10 has an order for Quetiapine (Antipsychotic medication) 12.5 mg (milligrams) by mouth at bedtime related to Delusional Disorders. [...]

Inspectors wroteBased on interview and record review the facility failed to develop a Care Plan for oxygen use for one of 18 residents (R185) reviewed for care plans in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident's fingernails (R36's) were kept trimmed and cleaned and ensure a resident (R32) received a shower or bath at least once a week for two of two residents (R32 and R36) reviewed for ADLs (Activities of Daily Living) in the sample of 35.

Inspectors wroteBased on interview and record review the facility failed to follow a physician ordered treatment for one of one resident (R32) reviewed for skin alterations in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to develop and implement services to maintain and/or improve range of motion limitations and failed to develop a care plan to address limitations in range of motion for two of two residents (R3 and R36) reviewed for limitations in range of motion in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide adequate supervision to prevent falls for one of one resident (R5) reviewed for falls in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to properly keep the catheter bag off the floor for one resident (R79) and failed to change gloves, perform hand hygiene, and perform indwelling urinary catheter care per facility policy for one resident (R39) for two of three residents (R39 and R79) reviewed for urinary catheters in the sample of in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to date oxygen tubing and a humidifier bottle for one of one resident (R185) reviewed for oxygen in the sample of 35.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident's indwelling urinary catheter maintained patency, monitor a resident's urinary output, notify the physician of no/decreased urinary output, obtain physician ordered urinalysis results, and follow up with the physician in regards to abnormal urinalysis results, for two of three residents (R1 and R5) reviewed for indwelling urinary catheters and has the potential to affect all five residents (R1, R3, R4,R5, R6) with indwelling urinary catheter out of a total sample of six. [...]

Inspectors wroteBased on record review and interview the facility failed to notify the physician of decreased/absent urinary output, resident having a urinary tract infection with no antibiotic medication orders, and urinalysis labwork being collected four days after ordered for one (R1) of five residents reviewed for physician notification in the total sample of six. These failures resulted in R1 being transferred to the emergency room for evaluation and subsequent hospitalization and treatment for an UTI (Urinary Tract Infection) receiving intravenous fluid and antibiotic medication. These failures also resulted in a repeated hospitalization for R1 where again she was diagnosed with a UTI as well as encephalopathy (brain disease that alters brain function or structure, common cause includes infections and can be life threatening if left untreated).

Inspectors wroteBased on interview, and record review the facility failed to ensure a Physician was available for emergency calls related to changes in condition for one (R1) out of six residents reviewed for physician services in the total sample of six.

Inspectors wroteBased on interview and record review, the facility failed to obtain a physician ordered urinalysis result timely for one (R1) of four residents reviewed for laboratory services in a total sample of six.

Inspectors wroteBased on record review and interview the facility failed to provide night time snacks. This failure has the potential to affect all residents in the facility who receive nutrition in the form of food. Findings Include: The Facility's undated Menus and Meal Service documents Snacks are available between meals. Evening (HS) snacks will be available to all residents. On 12/7/23 at 10:00 AM during resident council meeting R4,R35,R49,R55 and R62 all stated there were no snacks passed at bedtime. On 12/7/23 at 10:05 AM R4 stated I would like to have a snack at bed time. It depends on who is working whether or not I can get one. On 12/7/23 at 10:15 AM R35 stated I think snacks are available if we want them. But we have to go find them. I would like them to be offered to me, sometimes I am already in bed and would like a snack. [...]

Inspectors wroteBased on record review, interview and observation the facility failed to use Personal Protective Equipment appropriately during a COVID outbreak. This failure has the potential to affect all 79 residents who currently reside in the facility. Findings Include: The Facility's COVID-19 Testing and Response Plan dated 8/29/23 documents This facility recognizes that residents living in a congregate setting are at high risk of being affected by SARS-CoV-2 (COVID-19). Risk factors associated with living in a congregate setting and characteristics of the populations served (often older adults with chronic medical conditions) can result in more severe disease from COVID-19. Staff, family members, visitors & any person(s) who are exposed to communicable disease may represent a clinical safety risk as well. [...]

Inspectors wroteBased on interview and record review the facility failed to refer and obtain a level two PASARR (Preadmission screening and Resident Review) after a new diagnosis of Schizophrenia was identified for one resident (R18) of two residents reviewed for a level two PASARR in a sample of 45.

Inspectors wroteBased on interview and record the facility failed to develop a comprehensive care plan for one (R75) of 19 residents reviewed for care planning in the sample of 45.

Inspectors wroteBased on observation, interview, and record review the facility failed to report, assess and provide treatment for a new pressure ulcer for one (R56) of four residents reviewed for pressure ulcers in the sample of 45.

Inspectors wroteBased on observation, interview and record review the facility failed to have a Physician's Order for the use of Oxygen for one resident (R53) of 3 reviewed for oxygen in a total sample of 45. Findings Include: The Facility's Oxygen Administration dated 5/1/2017 documents the objective of the policy is to administer oxygen in conditions in which insufficient oxygen is carried by the blood to the tissues. The Facility's Oxygen Administration policy documents Oxygen may not be dispensed without a physician's order. On 12/5/23 at 10:15 AM and throughout the survey R53 had oxygen on at 4 liters per minute via nasal cannula. R53 stated I've had oxygen for years. R53's Physician Order Sheet for December 2023 does not include an order for any oxygen for R53. On 12/7/23 at 11:30 AM V1 (Administrator) confirmed that R53 did not have an order for oxygen. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide an appropriate indication for the use of an antipsychotic medication, document and care plan targeted behaviors to warrant the use of an antipsychotic medication, and perform GDR (Gradual Dose Reductions) for two of five residents (R18 and R32) reviewed for antipsychotics in the sample of 45.

Inspectors wroteBased on interview and record review, the facility failed to follow their protocol for monitoring residents after a head injury for one (R1) of three residents reviewed for monitoring in a sample of three.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement pressure ulcer prevention measures for two of two residents (R63, R20) reviewed for pressure ulcers in a sample of 35. These failures resulted in R63 and R20 developing stage 4 pressure ulcers.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident was offered and assisted with a shower at least one time per week for one of one resident (R41) in the sample of 35.

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident's Practitioner Order for Life-Sustaining Treatment (POLST) was signed by the Physician for one of twenty four residents (R384) reviewed for advance directives in the sample of 35.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement services to maintain and/or improve range of motion limitations for three of six residents (R39, R58, R63) reviewed for limited range of motion in the sample of 35.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents received nutritional supplement as ordered for two of two residents (R58, R35) reviewed for nutrition in a sample of 35.

Inspectors wroteBased on observation, interview and record review, the facility failed to document appropriate indications for use of an antipsychotic medication and perform gradual dose reductions at least yearly for one of five residents (R39) reviewed for unnecessary medication in a sample of 35.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure insulin was given as ordered for one of five residents (R25) reviewed for significant medication errors in a sample of 35.