The Blossoms at Fort Smith Rehab & Nursing Center

Inspectors wroteNumber of residents sampled:1Number of residents cited:1Based on observations, interviews, record review, facility document review, facility policy review, it was determined that the facility failed to ensure a resident was not allowed to self- administer their medications for 1 (Resident #7) of 6 sampled residents (R#1, R#7, R#13, R#16 R#30 and R#72) who reside in a secure neighborhood.

Inspectors wroteNumber of residents sampled:1Number of residents cited:1Based on observations, interviews, record reviews, facility records and policy review the facility failed to ensure physician orders were consistently implemented for 1 (resident #111) of 1 final sample resident reviewed for position and mobility.

Inspectors wroteNumber of residents sampled:3Number of residents cited:2Based on observations of the 8:00 AM medication administration, interviews, record reviews and facility policy review, it was determined that the facility failed to ensure medications were administered according to the physician's orders for 2 (residents #30 and #85) of 3 residents who were observed during medication administration.

Inspectors wroteNumber of residents sampled:1Number of residents cited:1Based on observation of the 8:00 AM medication administration, interviews, record reviews and facility policy review the facility failed to ensure that an insulin pen was prepared and administered according to manufacturer's instructions for 1 (resident #30) of 1 resident observed for insulin administration.

Inspectors wroteNumber of residents sampled:5Number of residents cited:1Based on observations, interviews, facility in-services, and facility policy review, it was determined that the facility failed to follow proper infection control precautions during wound care for 1 (Resident #79) of 5 residents reviewed for infection control.

Inspectors wroteBased on record review and interview, the facility failed to coordinate with the State Designated Authority. Specifically, the facility failed to notify the State Designated Authority when one (Resident #3) of one sampled resident was admitted on [DATE] and failed to request the level II PASARR (Pre-admission Screening and Resident Review) to ensure Resident #3 was receiving all recommended care and services.

Inspectors wroteBased on interviews, the facility failed to hire a certified Social Worker with a bachelor ' s degree in social work or a Human Services-related field and at least one year of supervised social work experience in a healthcare setting when the number of beds in the facility exceeded 120.

Inspectors wroteBased on interviews, record review, facility document review, and facility policy review, it was determined that the facility failed to ensure staff reported allegations of verbal abuse to the Administrator within two hours of the allegation being made for 2 (Residents #2 and #3) of 3 sampled residents reviewed for abuse and/or neglect.

Inspectors wroteBased on interviews, record review, facility document review, and facility policy review, it was determined that the facility failed to ensure staff used safe laundry transport techniques to prevent accidents for 1 (Resident #1) of 11 residents reviewed for accidents and hazards.

Inspectors wroteBased on observations, interviews, record review, facility document review, and facility policy review, it was determined that the facility failed to maintain dignity by supplying toilet paper and paper towels for 1 (Resident #10) of 1 resident reviewed for resident rights with the potential to affect all 24 residents residing on the women's secured unit.

Inspectors wroteBased on observations, interviews, record review, facility document review, and facility policy review, it was determined that the facility failed to ensure safe wheelchair transport techniques were used for 1 resident (Resident #6) and cigarettes were stored out of residents access for 1 resident (Resident #11) of 11 residents reviewed; the facility failed to ensure the women's secure unit shower was clean, sanitary, and decluttered; failed to repair broken tile in the doorway of room [ROOM NUMBER]; and the facility failed to ensure an employee's cigarettes were not securely stored away from residents of the 200 Hall and 300 Hall for 4 halls reviewed; and failed to provide adequate number of fitted sheets for resident beds in the men's secured unit when reviewed for a safe, clean, comfortable, homelike environment.

Inspectors wroteBased on interviews, record review, facility document review, facility policy review, it was determined that the facility failed to obtain written authorization to manage personal funds, ensure a resident was aware of process to access personal funds, and had knowledge of facility charges for 1 (Resident #8) of 5 residents reviewed for personal funds.

Inspectors wroteBased on observations, interviews, record review, facility document review, and facility policy review, it was determined that the facility failed to provide perineal care during a soiled brief change for 1 (Resident #10), and failed to ensure physician orders were followed for medication administration, specifically not crushing and administering iron tablets labeled DO NOT CRUSH for 1 (Resident #7) of 11 residents reviewed for Quality of Care.

Inspectors wroteBased on observations, interviews, record reviews, and review of facility policy, the facility failed to provide appropriate treatment and services to prevent complications from enteral feedings for 2 of 3 residents (Resident #7 and Resident #9) reviewed for tube feeding. Specifically, the facility failed to appropriately check tube placement prior to administering flushes and/or medications for Resident #7 and Resident #9.

Inspectors wroteBased on observation, interview, and policy review, it was determined the facility failed to ensure an accident/hazard free environment, as evidenced by not keeping doors locked on rooms containing chemicals and hazards.

Inspectors wroteBased on observations, interview, and policy review, it was determined the facility failed to ensure residents had reasonable accommodation of needs by not ensuring the residents call lights were within reach for 1 (Resident #6) sampled resident.

Inspectors wroteBased on observations, interviews, and record reviews, it was determined the facility failed to ensure 1 (Resident #13) of 4 sampled residents reviewed for activities of daily living (ADL) care was kept clean and dry.

Inspectors wroteBased on observation and interview, the facility failed to ensure food items stored in the freezer were covered or sealed to prevent potential freezer burn; expired food items were promptly removed/discarded by the expiration or use by dates; one of 2 ice scoops and 1 of 2 ice machines were maintained in clean and sanitary condition to prevent food and beverages contamination; staff washed hands prior to clean tasks and before handling clean equipment or food items to minimize the potential for contaminating food items; and cold food items were maintained at or low 41 degrees Fahrenheit while awaiting service to prevent potential food borne illness for residents who received meals from 1 of 1 kitchen. This failed practice had the potential to affect 104 residents who received meals from the kitchen.

Inspectors wroteBased on observation, record review, and interview it was determined the facility failed to ensure a Resident who was lying in bed wearing only a brief, and a Resident who was receiving a brief change with perineal care, were not visually exposed from the hall in order to maintain dignity and privacy for 2 (Resident #7 and Resident #88) of 2 sampled residents reviewed who required total assistance.

Inspectors wroteBased on observations, interviews, and record review, it was determined that the facility failed to ensure proper hand hygiene was performed during perineal care for 1 (Resident#88) of 1 Resident reviewed for perineal care; and to ensure proper hand hygiene was performed during medication pass, and meal and beverage service.

Inspectors wroteBased on interviews and record review, the facility failed to protect the resident's right to be free from physical abuse by another resident for 1 (Resident #83) of 1 resident reviewed for abuse. Specifically, the facility failed to protect Resident #83 from a resident with known behaviors, Resident #19, which resulted in Resident #83 being hit by Resident #19 hard enough in the back of the head to move Resident #83 out of their wheelchair.

Inspectors wroteBased on observations, interviews, record review, and facility document review, it was determined the facility failed to ensure supervision of a cognitively impaired resident at risk for choking for 1 (Resident #91) of 2 residents observed during in room meal service.

Inspectors wroteBased on observations, interviews, record review, facility document review, and facility policy review, it was determined that the facility failed to ensure prescribed medications remain with the nurse for a Resident who is not assessed to self-administer medications for 1 (Resident #31) of 1 Resident reviewed for medications left at the bedside.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure residents who were trauma survivors received culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents' experiences and preference in order to eliminate or mitigate triggers that may cause recurring traumatization for 3 (Residents #24, #91 and #96) sampled residents of 27 (Residents #1, # 6, #15, #16, #20, #23, #24, #26, #27, #28, #33, #35, #38, #42, #50, #58, #63, #66, #71, #72, #85, #91, #95, #96, #103, #105 and #165) sampled residents with positive responses to trauma informed care assessments.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure hall trays were transported on food carts in a manner to prevent the potential for cross contamination for 50 residents who received meals on the 100 Hall, 16 residents who received meals on the 200 Hall and 35 residents who received meal trays on the 300 Hall; foods stored in the freezer, refrigerator and dry storage area were covered, sealed and dated to minimize the potential for food borne illness for residents who received meals from 1 of 1 kitchen; and dietary staff washed their hands before handling clean equipment or food items. These failed practices had the potential to affect 104 residents who received meals from the kitchen (total census: 109) as documented on a list provided by Dietary Supervisor on 04/27/23 at 12:49 PM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Minimum Data Set (MDS) assessments accurately reflected the resident's status at the time of assessment for 2 (Residents #15 and #28) of 31 (Residents #1, # 6, #15, #16, #18, #20, #23, #24, #26, #28, #33, #35, #38, #42, #48, #50, #51, #58, #63, #66, #71, #85, #91, #95, #96, #97, #103, #105, #113, #114 and #165) sampled residents whose MDS was reviewed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a comprehensive person centered Care Plan included measurable objectives and timeframes to meet the residents' psychosocial needs to include trauma informed care and the residents' goals, desired outcomes, and preferences for 3 (Residents #24, #91 and #96) of 27 (Residents #1, # 6, #15, #16, #20, #23, #24, #26, #27, #28, #33, #35, #38, #42, #50, #58, #63, #66, #71, #72, #85, #91, #95, #96, #103, #105 and #165) sampled residents with positive responses to trauma informed assessments as documented on a list provided by the Social Services Director on 04/27/23 at 8:10 AM.

Inspectors wroteBased on interview, and record review the facility failed to ensure the Care Plan was revised for 2 (Residents #35 and #95) of (30) (Resident #1, #6, #15, #16, #18, #20, #23, #24, #26, #28, #33, #35, #38, #42, #48, #50, #51, #58, #63, #66, #71, #85, #91, #95, #96, #97, #103, #105, #113 and #114) sampled residents who was required to have a Care Plan.

Inspectors wroteBased on record review, and interview, the facility failed to ensure a written Discharge Summary was completed to include a recapitulation of the resident's stay with a concise summary of the stay and course of treatment for 1 (Resident #114) of 1 sampled resident who was discharged in the past 120 days, as documented on a list provided by the Director of Nursing (DON) on 04/26/23 at 12:03 PM.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the Physician was notified when 1 (Resident #35) of 1 sampled resident who had a catheter with pus-like drainage coming from the catheter insertion site.