Sunny Vista Living Center

Inspectors wroteBased on observations, interviews and record review, the facility failed to store, distribute and serve food in a sanitary manner in the main kitchen. Specifically, the facility failed to:-Ensure kitchen equipment was stored in a clean and sanitary manner; and, -Ensure perishable foods were discarded after the date of expiration.

Inspectors wroteBased on record review and interviews, the facility failed to ensure five (#63, #46, #73, #112 and #50) of nine residents were free from chemical restraints and were receiving the least restrictive approach for their needs out of 52 sample residents. Specifically, the facility failed to:-Ensure prescribed as needed (PRN) antipsychotic medication for Resident #63 had corresponding documentation of identified behaviors and use of non-pharmological interventions; -Ensure resident specific care approaches, to include medication specific target behaviors and person-centered interventions were documented and monitored for Resident #63, #46, #73, and #112's psychotropic medications; and,-Identify specific resident behaviors, conduct behavior monitoring and ensure the least restrictive intervention was used prior to administration of psychotropic medications for Resident #50's.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure proper storage of medications in two of four medication storage rooms and three of five medication carts. Specifically, the facility failed to:-Ensure medications were labeled with the date they were opened;-Ensure expired medications were removed and discarded from medication carts and storage refrigerators; and,-Ensure the temperature in a medication storage refrigerator was maintained within an acceptable temperature range.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#4) of two residents who required respiratory support received care consistent with professional standards of practice out of 52 sample residents. Specifically the facility failed to obtain a physician ordered bilevel positive airway pressure (BiPAP) machine (a type of non-invasive ventilation that helps people breathe by providing pressurized air through a mask or nasal plugs) for Resident #4 to use during sleep hours.

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents diagnosed with a mental disorder or psychosocial adjustment difficulty received appropriate treatment and services to attain the highest practicable mental and psychosocial wellbeing for one (#12) of six residents out of 52 sample residents. Specifically, the facility failed to:-Ensure individualized care approaches were provided and monitored with ongoing assessment for Resident #12 in order to meet the emotional and psychosocial needs of the resident;-Ensure Resident #12, who had expressed suicidal ideations with intent and a history of trauma, was monitored for signs and symptoms of suicidal ideation; and, -Ensure expressions of suicidal ideations were addressed in a timely manner in order to secure Resident #12's safety.

Inspectors wroteBased on observations, record review and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infection. Specifically, the facility failed to:-Ensure housekeeping staff completed proper hand hygiene, cleaned high-touch surfaces and followed the appropriate guidelines for disinfectant solution when cleaning residents' rooms; and,-Ensure appropriate infection control procedures were followed urinary catheter care for Resident #68.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that residents who were trauma survivors received culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents' experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident for two (#3 and #4) of three residents reviewed out of four sample residents. Specifically, the facility failed to identify Resident #3 and Resident #4's post traumatic stress disorder (PTSD) and identify triggers which may retraumatize them.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#2) of three residents reviewed for psychosocial concerns out of four sample residents received the appropriate treatment and services to attain the highest practicable mental and psychosocial well-being. Specifically, the facility failed to: -Provide Resident #2 with psychosocial support who had increasing depression since February 2024; -Update Resident #2's comprehensive care plan to identify the resident's increasing depression and recent wish to die; and, -Develop a comprehensive care plan that depicted Resident #2's accurate antidepressant medication.

Inspectors wroteBased on observations, interviews and record review, the facility failed to store, prepare, distribute and serve food in a sanitary manner in the main kitchen, one of four serving areas, two of six dish machines in four serving areas and two of two resident snack refrigerators. Specifically, the facility failed to: -Ensure staff washed hands and changed single use gloves appropriately while plating and serving resident meals in one of four serving areas; -Ensure the high temperature dish washing machines maintained sanitizing rinse temperatures for two of six dish machines in four serving areas; and, -Maintain the kitchen in a sanitary condition.

Inspectors wroteBased on observations and interviews, the facility failed to maintain emergency response carts and equipment in safe operating condition, and failed to display required precautionary signs where oxygen was stored for four of four carts reviewed out of a sample of four emergency (crash) carts. Specifically, the facility failed to: -Ensure staff were trained on how to use the emergency oxygen cylinders, how handle and when to replace empty cylinders; -Ensure staff completed daily the equipment checks; -Ensure expired items were removed from the crash cart; -Ensure missing items were replaced on the crash cart; -Ensure staff were trained on where the crash carts were located; and, -Ensure signs were displayed on store rooms where oxygen was stored.

Inspectors wroteBased on observations, record review and interviews, the facility failed to implement their policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling and consumption. Specifically, the facility failed to: -Ensure resident refrigerator temperatures were monitored correctly for refrigerated food storage; and, -Implement the facility policy for food brought by visitors and ensure food that was kept in resident's refrigerators had safe and sanitary storage.

Inspectors wroteBased on observation, record review, interviews, facility policy review, and review of current Centers for Disease Control and Prevention (CDC) guidance, it was determined that the facility failed to ensure an effective infection control program was implemented to prevent the spread of COVID-19 throughout the facility. Specifically, the facility failed to: 1. Ensure staff working during a COVID-19 outbreak wore N95 masks in accordance with CDC guidelines and failed to ensure staff wore appropriate personal protective equipment (PPE) while providing direct care to a resident (Resident #76) who was COVID-19 positive; 2. Ensure staff were fit tested for N95 masks before use; 3. Ensure proper signage was posted on the residents' doors to indicate what PPE precautions should be in place for five residents on precautions (Resident #64, Resident #35, Resident #105, Resident #73, Resident #46); [...]

Inspectors wroteBased on observation, interview, record review, and facility document review, the facility failed to ensure residents who were unable to carry out activities of daily living (ADLs), specifically nail care, received the necessary services to maintain clean, trimmed nails for two (Resident #39 and Resident #20) of two residents reviewed for ADLs.

Inspectors wroteBased on observation, record review, interviews, and facility policy review, the facility failed to provide a meaningful program of activities for one (Resident #50) of one resident reviewed for activities. Specifically, the facility failed to ensure the activity program was designed to meet the individual activity needs, interests, and abilities for Residents #50, who was bedbound.

Inspectors wroteBased on observations, interviews, record review, and review of facility document, it was determined that the facility failed to provide enteral nutrition per the physician's order for one (Resident #66) of two residents reviewed who required tube feeding for nutrition. Specifically, the facility failed to provide Resident #66's tube feeding per the physician's order on two occasions.

Inspectors wroteBased on observation, interviews, and facility policy review, it was determined the facility failed to ensure medication carts were locked when unattended for one medication cart (700 Hall) of three medication carts that were observed during medication administration observations.