The Blossoms at Van Buren Rehab and Nursing Center

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure medications were not stored unlocked at the residents ' bedside, and failed to ensure medication treatment carts were locked to three (Resident #37, Resident #71, Resident #72) of 11 sampled residents, to prevent accidents and injuries.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure hand hygiene was performed while assisting with wound care, to prevent the risk for infection for one (Resident #71) of three sampled residents observed for wound care. The facility also failed to ensure Enhanced Barrier Precautions (EBP) were followed during flushing of a feeding tube, for one of one observation for one (Resident #4) of one sampled resident observed for feeding tube care, to prevent infections and cross contamination.

Inspectors wroteBased on record review, interview, and Resident Assessment Instrument (RAI) manual review, the facility failed to ensure a discharge was coded to the Minimum Data Set (MDS) in a timely manner for one (Resident #65) of one sampled resident reviewed for accuracy of assessments to accurately capture a residents health status at the time of discharge.

Inspectors wroteBased on interview and record review, the facility failed to ensure that the State Designated Agency was notified that one (Resident #6) of two residents, reviewed for Preadmission Screening and Resident Review (PASARR), had been admitted to the facility.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure medications were not left in resident rooms unattended for 2 (Resident #3 and Resident #6) of 2 residents and failed to ensure medication was not left on the floor of a resident's room for 1 (Resident #2) of 1 resident family interviewed for unattended medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an indwelling urinary catheter drainage bag was concealed in a privacy bag when visible to promote dignity and privacy for 1 (Resident #31) of 3 (Residents #1, #31, and #428) sampled residents who had an indwelling urinary catheter.

Inspectors wroteBased on observation, and interview, the facility failed to ensure the call light was within reach for 2 (Residents #11, and #128) of 15 (Residents #1, #10, #11, #16, #20, #23, #26, #29, Resident #31, #42, #53, #65, #278, #428, and #429) sampled residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 1 (Resident #278) of 1 sampled resident was taken to a scheduled appointment.

Inspectors wroteBased on observation and interview, the facility failed to ensure that the 2023 survey results were located in the State Inspection Book made accessible to residents and family members.

Inspectors wroteBased on observations and interviews the facility failed to provide a safe, clean, comfortable, and homelike environment for Rooms #103B and #108, and the floor in front of the 300 hall shower. This failed practice had the potential to affect 2 out of 31 residents that reside on 100 hall and 15 residents that reside on 300 hall and walk past the shower room.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure bathing services were regularly provided to maintain good hygiene for 4 (Residents #28, #69, #128, and #331) sampled residents who were dependent on staff for bathing/showers, and nail care was provided for 1 (Resident #20), and oral care was provided for 1 (Resident #28) to promote good personal hygiene and grooming.

Inspectors wroteBased on interview and record review the facility failed to complete the required quarterly assessments for 2 (Residents # 6, and #278) of 2 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the water temperature was maintained at a safe level to prevent burns on the 200 Hall, and failed to ensure medications were not left at bedside for 1 (Resident #278) of 1 sampled resident.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the head of the bed was elevated appropriately to decrease the potential of aspiration for 1 (Resident #53) of 1 sampled resident who required a Percutaneous Endoscopic Gastrostomy (PEG) tube (a tube passed into the stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate).

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure oxygen was administered as ordered by the physician for 1 (Resident #428) of 10 sampled residents who had a physician's orders for oxygen; the facility failed to ensure a (portable ventilator) filter and tubing was changed weekly and dated for 1 (Resident #23) of 1 sampled resident who required the use of a (portable ventilator); the facility failed to ensure a tracheostomy collar was changed for 1 (Resident #26) of 1 sampled resident who required the use of a ventilator.

Inspectors wroteBased on interview and record review, the facility failed to ensure there was Registered Nurse (RN) coverage for at least 8 consecutive hours per day, 7 days a week.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure monthly medication regimen reviews (MRR) were performed for 2 (Residents #10 and #28) of 5 (Residents #10, #26, #28, #65, and #128) sampled residents who were selected for unnecessary medication review.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Quality Assurance and Performance Improvement program (QAPI) Committee developed and implemented appropriate plans of action to prevent repeated deficiencies for (561) Self Determination (677) failed to ensure bathing services, nail care and oral care were provided for residents dependent on staff, (684) Quality of Care (695) Physician Order (PO) was followed for Use of Oxygen (O2), (727) failed to ensure a Registered Nurse (RN), worked 8 consecutive hours a day seven days a week, (847) Arbitration Agreement was explained to resident/representative. These failed practices had the potential to affect 79 residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that staff washed their hands in between residents when administering medication for 1 (Resident #53) sampled resident, failed to ensure an uncapped feeding tip was not connected to the percutaneous enteral gastrostomy (PEG) for 1 (Resident #53) sampled resident, and failed to ensure that dirty linen did not touch employee clothing.

Inspectors wroteBased on observation and interview, the facility failed to ensure a safe environment on the 100 Hall. This potential failed practice had the potential to affect 7 (Residents # 6, #8, 17, #51, #55, 72, and #284) sampled residents who could independently locomote.

Inspectors wroteBased on record review, and interview, the facility failed to notify a resident's representative about change of services. This failed practice had the potential to affect 1 (Resident #53) of 1 sampled resident who are receiving therapy and have a power of attorney (POA).

Inspectors wroteBased on interview and record review, the facility failed to provide a written discharge notice for 1 (resident #53) of 6 sampled residents who were sent to the hospital in the last month.

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate Minimum Data Sets were performed for 1 (Resident #55) of 25 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to form a baseline care plan within 48 hours of admission for 1 (Resident #67) of 25 sampled residents.

Inspectors wroteBased on observation and interview the facility failed to ensure 1 (Resident #128) of 17 sampled residents who depended on staff for bed mobility was repositioned in bed.

Inspectors wroteBased on observation and interview, the facility failed to ensure staff assisted 1 (Resident #128) of 5 sampled residents that depended on staff for assistance with meals.

Inspectors wroteBased on interview and record review, the facility failed to ensure medications were administered as ordered for 1 (Resident #69) of 25 sampled residents who received medications from staff in the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure the binding arbitration agreement was explained in a manner that the residents or resident's representatives fully understood for 2 (Residents #42, and #278) of 3 sampled residents who signed a binding arbitration agreement upon admission. This failed practice had the potential to affect 191 residents who signed binding arbitration agreements since September 16, 2019.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to ensure that the proper smoking equipment was available in the designated smoking area. This had the ability to affect 8 (Residents #21, #27, #32, #36, #37, #43, #50, #52) sampled residents who use the smoking area.

Inspectors wroteBased on interview and record review, facility failed to ensure Home Health was provided at the time 1 (Resident #283) resident was discharged back to the community from the facility.

Inspectors wroteBased on observation, record review and resident and staff interviews, the facility failed to treat a resident with dignity and respect for 1 (R4) of 5 (R1, R2, R3, R4 and R5) Case mix residents reviewed.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident with a feeding tube (g-tube) received care and services for the feeding tube to meet the resident's needs for 1 (R4) of 5 (R1, R2, R3, R4 and R5) Case mix residents. The facility also failed to ensure liquid feeding formula was not expired and safe to administer. This had the potential to affect 1 resident in the facility with a feeding tube.

Inspectors wroteBased on interview, and record review, the facility failed to ensure there was Registered Nurse (RN) coverage for at least 8 consecutive hours per day, 7 days a week.

Inspectors wroteBased on observation and interview, the facility failed to ensure staffing schedules for Nursing staff and Certified Nursing Assistants (CNAs) were posted in a prominent area that was readily accessible to residents and visitors in 1 of 1 facility.

Inspectors wroteBased on observation, and interview, the facility failed to ensure foods stored in the kitchen area and in the freezer were covered, sealed and dated to minimize the potential for food borne illness for residents who received meals from 1 of 1 kitchen; failed to ensure 1 of 1 ice machine was maintained in a clean and sanitary condition to prevent potential contamination of residents' beverages and failed to ensure dietary staff washed their hands before handling clean equipment or food items to prevent potential food borne illness for residents who received meals from 1 of 1 kitchen. These failed practices had the potential to affect 55 residents who received meals from the kitchen (total census: 57), as documented on a list provided by the Dietary Supervisor on 01/25/23 at 8:22 AM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure Certified Nursing Assistants (CNAs) were provided with the required in-service training to ensure they were prepared and competent with the skills required to meet the needs of the residents of 1 of 1 facility.

Inspectors wroteBased on interview, and record review, the facility failed to ensure residents had the right to receive visitors of their choice in their home for 1 (Resident #36) of 1 sampled resident who desired to have their visitors come indoors for visits.

Inspectors wroteBased on observation, record review, and interview, the facility failed to reassess the effectiveness of interventions, and review and revise the Care Plan for 3 (Residents #18, #43 and #55) of 15 (#3, #9, #10, #13, #16, #18, #19, #31, #34, #36, #43, #45, #55, #67 and #219) residents whose Care Plans were reviewed. This failed practice had the potential to affect all 57 residents in the facility as documented on the Resident Census and Conditions of Residents provided by the Minimum Data Set (MDS) Coordinator on 01/23/23 at 8:39 AM.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure fingernails were cleaned and trimmed for 1 (Resident #219) of 1 (Resident #219) sampled resident who was dependent or required assistance with nail care.

Inspectors wroteBased on interview, and record review, the facility failed to ensure residents received all of their physician ordered medications in a timely manner after admission for 1 (Resident #67) of 1 sampled resident.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide specialized care needs for the provision of respiratory care in accordance with professional standards of practice by administering oxygen at the prescribed rate for 3 (Residents #16, #45 and #219) and failed to date the oxygen tubing and humidifier bottle for 1 (Resident #55) of 14 (Residents #3, #9, #12, #16, #22, #31, #34, #36, #39, #45, #53, #55, #58, and #219) sampled residents who had a Physician's Order for oxygen as documented on a list provided by the MDS (Minimum Data Set) Coordinator on 01/25/23 at 10:00 a.m.

Inspectors wroteBased on observation, and interview, the facility failed to ensure pureed food items were blended to a smooth, lump free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 2 of 2 meals observed. This failed practice had the potential to affect 2 residents who received pureed diets, as documented on a list provided by the Dietary Supervisor on 01/25/23 at 8:22 AM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Binding Arbitration Agreement stated the resident and/or the resident's representative were not required to sign the agreement, allowed the resident and/or the representative to communicate with the Office Long Term Care (OLTC) Ombudsman, and was not required as part of the admission process for 3 (Residents #8, #23 and #45) of 3 sampled residents who were contacted regarding their Binding Arbitration Agreement signed upon admission since September 16, 2019. This failed practice had the potential to affect 39 residents who signed Binding Arbitration Agreements upon admission since September 16, 2019.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Binding Arbitration Agreement provided for the selection of a neutral arbitrator and a venue convenient to both parties for 3 (Residents #8, #23, and #45) of 3 sampled residents who signed Binding Arbitration Agreements upon admission since September 16, 2019. This failed practice had the potential to affect 39 residents who signed Binding Arbitration Agreements upon admission since September 16, 2019.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the care plan addressed the use of oxygen therapy to assure necessary information was available to provide care for 1 (Resident #55) of 14 (Resident #3, #9, #12, #16, #22, #31, #34, #36, #39, #45, #53, #55, #58 and #219) sampled residents who had Physician Orders for oxygen therapy as documented on a list provided by the Minimum Data Set (MDS) Coordinator on 01/25/23 at 10:00 a.m.

Inspectors wroteBased on observation, record review, and interview, the facility failed to complete a Significant Change in Status Minimum Data Set (MDS) after a decline in two or more activities of daily living (ADL) for 1 (Resident #16) of 15 (Resident #3, #9, #10, #13, #16, #18, #19, #31, #34, #36, #43, #45, #55, #67 and #219) residents whose MDS was reviewed. This failed practice had the potential to affect all 57 residents in the facility as documented on the Resident Census and Conditions of Residents provided by the Minimum Data Set Coordinator (MDSC) on 01/23/23 at 8:39 PM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure Options Counseling referrals were submitted and the Notice of admission process was completed for residents and resident representatives who wished to receive information about returning to the community for 1 (Resident #67) of 1 sampled resident closed record review. This failed practice had the potential to affect 13 residents who were discharged home from the facility since 06/30/22 as documented on the Beneficiary Notice - Residents discharged Within the Last Six Months worksheets provided by the Administrator on 01/24/23 at 7:47 AM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure required notices were provided to the resident/resident representatives when Medicare Part A services were no longer covered for 2 (Residents #68 and #69) of 2 sampled residents whose Beneficiary Notices were reviewed.