Susquehanna Nursing & Rehabilitation Center, L L C

Inspectors wroteBased on record review, observation, and interview the facility failed to ensure a safe, clean, comfortable, and homelike environment for one (1) resident unit. Specifically, the temperature of the facility's hot water was not maintained.

Inspectors wroteBased on record review and interviews during the abbreviated survey (NY00371419), the facility did not ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive care person-centered care plan, and the resident's choices for 2 of 3 residents (Resident #1 and 7) reviewed. Specifically: -Resident #1 had a feeding tube (a device that delivered liquid nutrition into the stomach or intestine through a surgically created opening in the abdomen) and had physician orders to verify placement and check residuals. There was no documented evidence that placement and residuals were checked for 4 months. The resident developed new onset diarrhea and nausea, and there was no documented evidence the resident was assessed to determine if the resident's tube feeding should have been held. [...]

Inspectors wroteBased on record review and interview during the abbreviated survey (NY00371419), the facility was not administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental and psychosocial well-being for 1 of 3 residents (Resident #2). Specifically, facility Administration, including the Director of Nursing, did not ensure a complete and accurate investigation was completed following an allegtion of abuse. Additionally, the staff statements provided to the Department of Health (as part of the abuse investigation) were falsified. The staff that provided statements stated they did not author the statements or provide a verbal statement to anyone at the facility, they did not sign the statements, and the signatures on the documents were not theirs.

Inspectors wroteBased on record review and interviews during the recertification and abbreviated (NY00350839) surveys conducted 9/9/2024-9/16/2024, the facility failed to ensure a resident with pressure ulcers received the necessary treatment and services, consistent with professional standards of practice, to promote wound healing, prevent infection and prevent new ulcers from developing for 2 of 6 residents (Residents #88 and #195) reviewed. Specifically, Resident #88's wound treatments were not consistently documented as completed; and Resident #195 developed impaired skin integrity on the sacrum (the triangular bone at the base of the spine) that was not assessed by a qualified professional to determine interventions and routine monitoring, and treatments were not consistently applied as ordered. [...]

Inspectors wroteBased on observation, record review, and interview during the recertification and abbreviated surveys (NY00314894 and NY99331169) conducted 09/9/2024-9/16/2024, the facility did not provide a safe, clean, comfortable, and homelike environment for 4 of 4 resident areas (Main Lobby, Second floor resident room [ROOM NUMBER]A, Third floor nursing station, and Third floor day room area) reviewed; and for 2 of 2 oxygen storage rooms (Third and Fourth floor oxygen storage rooms) reviewed. Specifically, there were multiple walls with peeling wallpaper and unclean floors with dust and food debris. Additionally, Resident #36's right wheelchair brake was broken and not repaired timely.

Inspectors wroteBased on record review and interview during the recertification and abbreviated (NY00350839 and NY00331169) surveys conducted 9/9/2024-9/16/2024, the facility did not ensure maintenance of acceptable parameters of nutritional status for 3 of 4 residents (Residents #2, #88, and #195) reviewed. Specifically, Residents #2, #88, and #195 developed pressure ulcers and their nutritional needs were not reassessed timely to accommodate increased requirements for wound healing.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure drugs and biologicals were labeled and stored in accordance with currently accepted professional principles and include the expiration date when applicable for 3 of 3 medication carts (Second floor short hall, Second floor long hall, and Third floor long hall) reviewed. Specifically, - the Second floor short hall medication cart contained 49 loose, unidentified pills; eye drops for Resident #446 without an opened or expired/discard date; inhalers for Residents #127, #118 and #47 without an opened or expired/discard date; and an inhaler without any resident identifiers. - the third-floor long hall medication cart had one loose pill; 2 opened medicated pain patches and a vial of nitroglycerin (treats chest pain) tablets without resident identifiers; [...]

Inspectors wroteBased on observation and interview during the recertification and abbreviated (NY00336546) surveys conducted 9/9/2024-9/16/2024, the facility did not ensure each resident received food and drink that was palatable, flavorful, and at an appetizing temperature for 1 of 2 meals (the 9/10/2024 dinner meal) reviewed and for 4 of 4 residents (Residents #15, #93, and #112). Specifically, food was not served at palatable and appetizing temperatures during the dinner meal on 9/10/2024. Additionally, Residents #15, #93, and #112 stated the food was served cold, and Resident #36 stated the food was not palatable and was served cold.

Inspectors wroteBased on observation, record review, and interviews during the recertification survey conducted 9/9/2024- 9/16/2024, the facility did not ensure food was prepared, distributed, and served in accordance with professional standards for food service in the facility's main kitchen and Third floor kitchenette. Specifically, in the main kitchen, there was debris on the floors and counters, unclean areas, a drain back up, gloves were not used properly, and food was not cooled properly. The Third floor kitchenette was unclean.

Inspectors wroteBased on observation, interview, and record review during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure each resident had the right to a dignified existence for 2 of 6 residents (Residents #37 and #137) reviewed. Specifically, Resident #37 was not provided with a requested shower prior to attending a significant family event, and Resident #137's urinary collection bag was visible in plain sight.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted [DATE]-[DATE] the facility did not ensure that residents were assessed to determine their ability to safely self-administer medication, when clinically appropriate for 3 of 3 residents (Residents #38, #41, and Resident #95) reviewed. Specifically, Residents #38, #41, and #95 had prescription medications at their bedsides without physician orders for self-medication administration or resident assessments to determine their ability to safely self-administer medications. Additionally, Resident #95 had a discontinued prescription medication at their bedside.

Inspectors wroteBased on observation, record review, and interviews during the recertification and abbreviated (NY00336546) surveys conducted 9/9/2024- 9/16/2024, the facility did not ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 4 of 9 residents (Residents #2, #35, #37, and #64) reviewed. Specifically, Resident #2 was not provided with assistance during meals as planned; and Residents #35, #37, and #64 had unclean and untrimmed fingernails.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure ongoing provision of programs to support each resident and their choices of activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident for 1 of 2 residents (Resident #5) reviewed. Specifically, Resident #5 was not offered meaningful activities that included their interests and preferences.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 of 4 residents (Resident #120) reviewed. Specifically, Resident #120's physician ordered urinalysis (a laboratory test that examines urine for a variety of conditions) was not obtained timely.

Inspectors wroteBased on observation, record review, and interviews during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 2 residents (Resident #137) reviewed. Specifically, appropriate hand hygiene was not performed by Licensed Practical Nurse #31 during a wound care treatment for Resident #137.

Inspectors wroteBased on observation, record review, and interview during the recertification survey conducted 9/9/2024-9/16/2024, the facility did not ensure they were adequately equipped to allow residents to call for staff assistance through a communication system which relayed the call directly to a staff member or to a centralized work area for 1 of 1 resident (Resident #90) reviewed. Specifically, Resident #90's call bell did not function as designed and they did not have the means of directly contacting caregivers.

Inspectors wroteBased on observation, interview, and record review during the extended and abbreviated surveys (NY00298775) conducted 7/25/22-8/2/22, the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment for 144 out of 144 residents including Residents #3, 12, 42, 53, 62, 78, 104 and 502 and for 1 additional resident area (beauty salon). Specifically, adequate hot water was not provided to resident rooms and shower rooms on all resident units (Units 2, 3, 4) and the beauty salon on floor 1. Review of the May 2022 Resident Council minutes included that the facility was getting a new boiler due to lack of hot water. The facility had several complaints regarding lack of hot water dating back to 2021. According to plant operation records, 1 of 3 hot water heaters supplying hot water to the facility became inoperable on June 7, 2022. [...]

Inspectors wroteBased on observation, interview, and record review during the recertification and abbreviated surveys (NY00282793, NY00275980, NY00296065, NY00274624, NY00283438, NY00298775, NY00296718, NY00277703, and NY00277484) conducted 7/25/22-8/2/22, the facility failed to ensure residents who were unable to carry out activities of daily living (ADLs) received the necessary services to maintain good grooming and personal and oral hygiene for 11 of 17 residents (Residents #1, 24, 53, 55, 62, 63, 78, 82, 104, 112, and 149) reviewed. Specifically; - Resident #1 was not assisted with their preferred frequency of bathing and hair washing. - Resident #24 was not assisted with daily dressing. - Resident #53 received bed baths in place of preferred showers because the facility did not have warm water or a shower gurney available for resident use. [...]

Inspectors wroteBased on observation, interview, and record review during the recertification and abbreviated surveys (NY00277703, NY00296718, NY00283438, NY00282793, NY00277484, NY00275980 and NY00274624) conducted 7/25/22-8/2/22, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 2 of 3 resident units (Units 3 and 4) and 2 resident rooms observed. Specifically, there were unclean floors on Units 3 and 4, unclean walls on Unit 4, unclean privacy curtains on Unit 3, room [ROOM NUMBER] had a strong urine odor, and room [ROOM NUMBER] had an unclean commode.

Inspectors wroteBased on observation, record review and interview during the recertification survey conducted 7/25/22-8/2/22 the facility failed to determine the clinical appropriateness of self-administration of medications for 1 of 2 residents (Resident #55) reviewed. Specifically, Resident #55 had a bronchodilator inhaler (used to treat asthma) at their bedside, was not assessed to determine their ability to safely self-administer medications and did not have a physician order for self-medication.

Inspectors wroteBased on observation, record review and interview during the recertification and abbreviated (NY00277703) surveys conducted 7/25/22-8/2/22, the facility failed to ensure residents had the right to reside and receive services with reasonable accommodation of needs and preferences for 1 of 1 resident (Resident #53) who required a shower gurney (a mobile shower bed used to transport a person with limited body movement into a shower) for bathing. Specifically, Resident #53 was assessed as requiring a shower gurney for bathing safety, the plan of care did not reflect the need for a shower gurney, a shower gurney could not be located by staff, and the resident was not showered as requested and planned.

Inspectors wroteBased on record review and interview during the recertification survey conducted 7/25/22-8/2/22, the facility failed to ensure that all allegations of abuse, neglect, exploitation, or mistreatment were thoroughly investigated for 1 of 1 residents (Resident #82) reviewed. Specifically, Resident #82 sustained a dislocated left shoulder and the investigation was not thorough and complete as there was no documented evidence the facility investigated possible causes of the dislocated shoulder; no documented evidence the facility ruled out abuse/neglect, and no documented evidence the facility determined whether the resident's comprehensive care plan (CCP) was followed when care was provided.

Inspectors wroteBased on record review and interview during the recertification survey conducted 7/25/22-8/2/22, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's nursing needs for 1 of 1 resident (Resident #8) reviewed for bathing care plans. Specifically, Resident #8's care plan documented they required extensive assistance with bathing, and they showered themself without assistance.

Inspectors wroteBased on record review and interview during the recertification and abbreviated surveys (NY00296799) conducted 7/25/22- 8/2/22, the facility failed to provide or obtain radiology or other diagnostic services to meet the needs of its residents; and be responsible for the quality and timeliness of the services for 1 of 2 residents (Resident #302) reviewed. Specifically, a STAT (emergent) X-ray of the right hip was ordered for Resident #302 on 5/29/2022 and it was not completed until 5/30/22 and the resident was diagnosed with a fractured right hip.

Inspectors wroteBased on observation, record review, and interview during the recertification survey, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety in the main kitchen. Specifically, 3 cracked eggs were stored in an egg carton container that were leaking onto the carton of eggs below, a reach-in cooler had several pans of outdated food, the walk-in freezer had 2 inches of uneven ice buildup on the floor, and 3 boxes of food were encased within ice.

Inspectors wroteBased on record review and interview during the recertification survey, the facility did not ensure a policy was developed regarding use and storage of foods brought to the residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption. Specifically, the facility did not ensure the policy included a process for assisting residents in accessing and consuming the food if a resident was unable to do so on his or her own.

Inspectors wroteBased on observation and interview during the recertification survey, the facility did not ensure each resident was treated with respect and dignity for 1 of 2 residents (Resident #22) reviewed for dignity. Specifically, two staff members referred to Resident #22 in a disrespectful and undignified manner during a dining service.

Inspectors wroteBased on record review and Interview during the recertification survey, the facility did not ensure residents participated in the development of their comprehensive care plans for 1 of 2 residents (Resident #94) reviewed for care plans. Specifically, Resident #94 was not invited to participate in her annual (comprehensive) care plan review meeting.

Inspectors wroteBased on observation, interview, and record review during the recertification survey, the facility did not ensure each resident maintained acceptable parameters of nutritional status for 2 of 2 residents (Residents #4 and 105) reviewed for nutrition. Specifically, Resident #4 was not provided all her meal items per her meal plan and her consumption was not accurately documented. Resident #105 did not receive his nutritional supplement as ordered.

Inspectors wroteBased on record review and interview during the recertification survey, the facility did not ensure certified nurse aide (CNA) performance reviews were completed at least once every 12 months for 2 of 2 CNAs (CNA #12 and 13) reviewed during the New York State Department of Health Nurse Aide Training Program review. Specifically, CNAs #12 and 13 did not have performance reviews documented at least once every 12 months.

Inspectors wroteBased on observation and interview during the recertification survey, the facility did not provide a safe, functional environment for residents and staff for 1 isolated area (third floor short hall tub room). Specifically, the third-floor short hall tub room had a hole in the floor and the access panel door for the tub was opened and not secured.