Sunny Acres Skilled Nursing and Rehabilitation Ctr

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide appropriate treatment and services relative to an indwelling urinary catheter (a thin, flexible tube inserted into the bladder to drain urine outside the body) for one Resident (#32) out of a total sample of 18 residents. Specifically, for Resident #32, the facility staff failed to follow the Physician order's relative to the foley (type of indwelling urinary catheter) catheter size, increasing the Resident's risk for indwelling urinary catheter complications.

Inspectors wroteBased on observation, and interview, the facility failed to ensure that medications were stored in a safe and secure manner for one unit (Unit 1) out of a total of two units. Specifically, the facility failed to ensure that six over-the-counter medications were not stored in an unlocked drawer at the nurses station where the medications were readily accessible to unauthorized individuals and were at risk for improper temperature, humidity, and light controls.

Inspectors wroteBased on interviews, and record reviews, the facility failed to administer Pneumococcal Vaccinations for one Resident (#44) of five applicable residents, out of a total sample of 18 residents. Specifically, for Resident #44, the facility failed to administer Pneumococcal Vaccines when the Resident was eligible to receive, and consented to, the Pneumococcal immunization, putting the Resident at risk of acquiring pneumococcal illnesses.

Inspectors wroteBased on record review and interview, the facility failed to honor the rights of two Residents (#33 and #49) out of a total sample of 18 residents, to formulate Advanced Directives (an individual's wishes regarding medical treatment). Specifically, 1. For Resident #33, the facility staff executed a Medical Order for Life-Sustaining Treatment (MOLST - a medical order form that converts an individual's wishes regarding life-sustaining treatment into medical orders) form that was signed by the Residents' Health Care Proxy (HCP- the person chosen as the healthcare decision maker when the individual is unable to do so for themself) when the Resident continued to be capable of making his/her own health care decisions. 2. [...]

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide care in accordance with professional standards of practice for two Residents (#56 and #58) out of a total sample of 18 residents. Specifically, the facility staff failed to: 1. off-load (minimizing or removing weight placed on the foot to help prevent and heal ulcers) Resident #58's heels when the Resident was in bed, had been identified as being at risk for skin breakdown, and had an active Physician's order to off-load his/her heels when in bed, increasing the Resident's risk for developing a pressure injury (PI: meaning an area of damage to skin or underlying soft tissue, usually over a bony prominence, as a result of prolonged pressure). 2. follow the Physician's order for Resident #56 not to exceed three grams (3 g: [...]

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to provide treatments in accordance with professional standards of practice for one Resident (#64) out of a total sample of 18 residents. Specifically, the facility staff failed to manage hypoglycemic (low blood sugar) episodes as required and implement and perform care and treatment consistent with the Physician orders and professional standards of practice for a Resident with Diabetes Type 1 (DM I - a chronic autoimmune disease that prevents the pancreas from making insulin), when the Resident's blood glucose levels decreased to less than 70 mg/dL on multiple occasions.

Inspectors wroteBased on record review and interview, the facility failed to provide the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week as required, placing all residents at risk for not having their clinical needs met either directly by the RN or indirectly by the Licensed Practical Nurse (LPN) or Certified Nurses Aides (CNA) that the RN was responsible for overseeing with provision of resident care. Specifically, review of the facility's Licensed Nurses schedule and interviews indicated that the facility failed to have an RN working at least eight consecutive hours over a 24-hour period for four days between 5/26/24 - 6/22/24, when no nursing staff waivers were in place.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to implement Contact Precautions (use of gloves and a gown for all interactions with a resident and their environment) to prevent the potential transmission of communicable diseases (a disease or infection that is easily spread from one individual to another) and infections within the facility for two Residents (#49 and #58), out of a total sample of 18 residents. Specially, the facility failed to: 1) For Resident #49, ensure that staff: -wore the required Personal Protective Equipment (PPE - items used to prevent the spread of infection such as gowns, gloves, face masks) while caring for the Resident with Clostridium difficile (C. diff- a bacterium that causes an infection of the colon [the longest part of the large intestine]. [...]

Inspectors wroteBased on interview, the facility failed to ensure its staff designated an Infection Preventionist (IP) who had completed specialized training in infection prevention and control prior to assuming the role of IP at the facility. Specifically, the facility designated an IP in November 2022 who had not completed specialized training in infection prevention and control before assuming the IP role, still had not completed the specialized training by the time survey began in February 2023 and continued to work as the designated IP at the facility.

Inspectors wroteBased on observation, policy review, and interview, the facility failed to ensure its staff maintained a clean and sanitary environment in the kitchen where food items were stored for resident consumption. The facility also failed to ensure its staff adhered to food storage requirements in the kitchen. Specifically, the facility failed to ensure its staff: 1) labeled and dated all open food stored for resident consumption, in the kitchen's reach-in refrigerator and freezer, 2) kept scoops from directly touching the ice and rice, 3) maintained a sanitary surface where clean dishes and pans were stored, and 4) maintained the microwave to be free of dried food and debris.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure its staff implemented infection control practices relative to 1) the facility's water management program, to provide a safe, sanitary, and clean water supply, for all residents and staff, and 2) required hand hygiene practices during care of a pressure ulcer (injury to skin and underlying tissue resulting from prolonged pressure) for one Resident (#54), out of a total sample of 18 residents. Specifically, the facility failed to ensure its staff: a) cleaned the ice machine every three months, as indicated in the facility's water management program, as an intervention to prevent waterborne pathogens, and b) implemented proper hand hygiene practices before and after glove use during a dressing change for Resident #54's pressure ulcer.

Inspectors wroteBased on record review and interview, the facility failed to ensure its staff notified the Physician/Non-Physician Practitioner (NPP) of unavailability and missed doses of an ordered medication for one Resident (#124), out of a total sample of 18 residents. Specifically, the facility failed to ensure its staff notified the Physician/NPP when ordered doses of Xarelto (anticoagulant-medication used to treat and prevent blood clots) was: a) unavailable for administration, and b) not administered to Resident #124 as ordered for three consecutive days.

Inspectors wroteBased on record review and interview, the facility failed to ensure its staff completed a Comprehensive Minimum Data Set (MDS) Assessment in a timely manner for one Resident (#39), out of a sample of five applicable residents. Specifically, the facility failed to ensure its staff completed a Comprehensive admission MDS Assessment for Resident #39 within 14 days after the Resident's admission to the facility.

Inspectors wroteBased on record review and interview, the facility failed to complete Quarterly Minimum Data Set (MDS) Assessment timely for two Residents (#5 and #48), out of a sample of five applicable residents. Specifically, the facility failed to ensure its staff completed the Quarterly MDS Assessments no later than 14 days following the assessment reference dates (ARDs) for each assessment.

Inspectors wroteBased on record review and interview, the facility failed to ensure that its staff electronically submitted timely Minimum Data Set (MDS) data to the Centers for Medicare and Medicaid Services (CMS) system for two Residents (#25 and #39), out of a sample of five applicable residents. Specifically, the facility failed to ensure its staff electronically submitted MDS data as required for: 1) Resident #25 relative to discharge tracking, and 2) Resident #39 relative to entry tracking within 14 days of completing the MDS assessments.

Inspectors wroteBased on record review and interview, the facility failed to ensure that its staff accurately completed a Minimum Data Set (MDS) Assessment for one Resident (#24) out of a total sample of 18 residents. Specifically, the facility staff failed to accurately code for an unplanned weight loss of 5% or more in one month for Resident #24.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that its staff implemented the plan of care for two Residents (#26 and #36), out of a total sample of 18 residents. Specifically, the facility staff failed to implement: 1) the use of fall mats for Resident #26, and 2) the plan of care relative to meals for Resident #36. Findings Include: 1) Resident #26 admitted to the facility in December 2016 with diagnosis of Dementia (group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily life). Review of the facility policy for Updating and Revising Care Plans, last revised 12/2022, indicated that the facility will develop and implement a comprehensive person-centered care plan to meet each resident's preferences and goals, and address the resident's medical, mental and psychosocial needs. [...]

Inspectors wroteBased on observations, interview, and record review, the facility failed to ensure its staff re-evaluated positioning concerns timely for one Resident (#36), out of a total sample of 18 residents. Specifically, decline in Resident #36's positioning that did not receive timely treatment to address the decline.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure its staff provided wound treatment and care in accordance with professional standards of practice for one Resident (#274), out of five sampled Residents. Specifically, the facility staff failed to ensure: 1) obtained wound treatment orders on admission to identify all wound areas and initiate treatment. 2) failed to implement wound treatment as ordered for several days to promote healing. 3) failed to implement an updated care plan for wound treatments.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that its staff provided appropriate care and services related to the use of an indwelling urinary catheter (a flexible tube passed through the urethra and into the bladder to drain urine) for one Resident (#63), out of a total sample of two applicable residents. Specifically, the facility staff failed to follow Physician's orders and ensure that the ordered urinary catheter was in place for Resident #63.

Inspectors wroteBased on record review and interview, the facility failed to ensure that its staff monitored and implemented interventions to address an unplanned significant weight loss for one Resident (#24), out of a total sample of 18 residents. Specifically, the facility staff failed to report and address an unplanned weight loss of greater than 5% for Resident #24.

Inspectors wroteBased on record review and interview, the facility failed and its staff failed to ensure that one Resident (#124), was free of significant medication errors. Specifically, facility staff failed to implement necessary action when: a) daily administration of Xarelto was ordered by the Physician/NPP, and b) Xarelto was omitted from the Resident's medication administration for three consecutive days, increasing his/her risk for development of blood clots.

Inspectors wroteBased on record review and interview, the facility failed to ensure its staff implemented the process for employee COVID-19 surveillance testing, according to current guidance for one Employee (#1), out of three sampled employees. Specifically, the facility failed to ensure its staff implemented the once per week COVID-19 surveillance testing procedure when the Employee (who had not been positive for COVID-19 in the previous 30 days) returned to work following a time-off leave, worked at the facility five days over a seven-day period of time, and was not tested for COVID-19, as required.