The Courtyard Rehabilitation and Healthcare Center

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to ensure assessments accurately reflected the resident's status for 1of 5 residents (Residents #1) reviewed for resident assessments. The Facility failed to ensure Resident #1's infected wound was reflected on the quarterly MDS assessment dated [DATE]. This deficient practice could place residents at risk of missed or inaccurate care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store food accordance with professional standards for service safety in the facility's only kitchen observed for sanitary conditions. The facility failed to date food and beverages found within the facility's freezers and refrigerator. The deficient practice could affect residents by failing to ensure residents received appropriate care for their health condition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 2 resident (Resident #10) reviewed for incontinent care, in that: CNA A did not pull back Resident #10's foreskin (skin covering the head of the penis) and did not clean under the shaft of the penis and the top of the scrotum (sac of skin protecting the testicles) during incontinent care. This facility failure could place residents at-risk for infection and skin break down due to improper care practices.

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to 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 disease and infection for 1 of 4 residents (Resident #3) reviewed for infection control, in that: During incontinent care, CNA C failed to change her gloves after cleaning Resident #3 and before touching the clean brief. This facility failure could place residents at- risk for infection due to improper care practices.

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident was not given a psychotropic drug unless the medication was necessary to treat a specific condition as diagnosed and documented in the clinical record for 2 (Residents #17 & #105) of 6 residents reviewed for unnecessary medications, in that: 1. The facility failed to reduce the dosage of Resident #17's order for Cymbalta (Duloxetine) in accordance with the pharmacist's recommendation and physician concurrence. 2. Resident #105 was prescribed a psychotropic drug for depression without a documented diagnosis of depression in the clinical record. These deficient practices could place residents at risk of receiving unnecessary psychotropic medications.

Inspectors wroteBased on interview and record review, the facility failed to employ staff with the appropriate competencies and skill sets to carry out the functions of the food and nutrition service, taking into consideration resident assessments, individual plans of care, and the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required for 1 of 1 facility reviewed for dietary requirements, in that: The DM did not have the appropriate certification, education, or qualifications to serve as the Director of Food and Nutrition Services. This deficient practice could place the residents who consume food prepared from the kitchen at risk of food borne illness and not receiving adequate nutrition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to 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 disease and infection for 3 of 28 residents (Residents #7, #10 and #39) reviewed for infection control, and those residents who eat from meal trays in their rooms, in that: 1. LVN-A did not wash or sanitize her hands in between medication administration for Residents #7, #10 and #39. 2. CNA-B failed to wear gloves or wash hands with soap/water after obtaining used food tray following noon meal, from Resident #206's room, who was on contact precautions isolation for C-diff. These deficient practices could place residents at-risk for infection due to improper care practices.

Inspectors wroteBased on interviews and record review, the facility failed to ensure the resident had the right to be informed of the risks, and participate in, his or her treatment which included the right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives, or treatment options and to choose the alternative or options he or she preferred, for 1 (Resident #105) of 8 residents reviewed for resident rights. The facility failed to obtain a signed consent for antipsychotic medication, Escitalopram Oxalate (Lexapro) which was administered to Resident #105. This failure could place residents at risk of receiving medications without their, or that of their responsible party's prior knowledge or consent and could place the residents at an increased risk for adverse reactions to the medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident's right to respect and dignity for 2 (Resident #3 and Resident #206) of 18 residents reviewed for respect and dignity, in that: CNA B stood while assisting Resident #3 and Resident #206 to dine. This deficient practice could lead to psychosocial harm due to feelings of low self-esteem and/or embarrassment.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the MDS accurately reflected the resident's status for 1 of 21 residents (Resident #6) whose MDS assessments were reviewed, in that: Resident #6's Quarterly MDS, dated [DATE], did not document the resident was receiving hospice services. This failure could place residents at-risk for inadequate care and services due to an inaccurate assessments.

Inspectors wroteBased on interview and record review the facility failed to complete an accurate assessment of each resident's functional capacity for 1 of 8 residents (Resident #39) whose assessments were reviewed. The facility failed to ensure that Resident #39's diagnosis of depression was a focus area in the resident's comprehensive care plan. This deficient practice could affect residents by contributing to inadequate care.

Inspectors wroteBased on interview and record review, the facility failed to maintain resident medical records that were complete and accurately documented for 1 (Resident #105) of 8 residents reviewed for clinical records. 1. The facility failed to include multiple diagnoses on Resident #105's face sheet and list of diagnoses. 2. Resident #105 was administered supplemental oxygen without a physician's order. These failures could place residents at risk of not having accurate medical records and could create confusion in services provided or needed to be provided.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure professional staff were licensed, certified, or registered in accordance with applicable State laws for 1 of 3 staff (Staff A) reviewed for staff qualifications. The facility failed to ensure Staff A completed the appropriate educational requirements of a bachelor's degree in social work and was appropriately licensed to practice social work in the State of Texas. This failure could place residents at risk of not receiving care and services from staff who were properly trained and supervised.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 1 of 9 residents (Resident #32) reviewed for baseline care plan, in that: The facility failed to ensure Resident #32's baseline care plan included information related to the resident's foley catheter. This deficient practice could affect newly admitted residents and place them at risk of not receiving continuity of care and communication among nursing home staff to ensure their immediate care needs are met.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan that includes measurable objectives and timeframes to meet a resident's medical and nursing needs for one (Resident #1) of six residents reviewed for person-centered care plans: Resident #12's comprehensive person-centered care plan did not include/address or contain measurable goals and objectives for his pacemaker. This deficient practice could affect residents in the facility by placing in them at risk for not being provided necessary care and services, and not having plans developed to address their needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide the necessary care and services to attain or maintain the highest practicable physical, mental, psychosocial well-being, in that 1 of 3 residents reviewed for pacemakers (Resident #12) did not have documentation identifying normal pacemaker pulse limits or parameters in that: The facility did not maintain medical information needed to monitor for proper functioning. The facility did not have record of Resident #12's make or model number information for the pacemaker, did not monitor parameters for pacemaker failure, and Facility Nursing Staff were unaware that Resident #12 had a pacemaker. This deficient practice could affect residents at put them at risk for complications due to cardiac pacemaker malfunction.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure for a resident who enters the facility with an indwelling catheter or subsequently receives one had a clinical condition that demonstrates catheterization is necessary for 1 of 3 residents (Resident #32) reviewed for indwelling urinary catheterization necessity, in that: Resident #32 did not have a physician's order for an indwelling catheter. This deficient practice could affect residents in the facility who have an indwelling or external catheter and place them at risk for infection and improper care.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a medication error rate was not 5% or greater. The facility had a medication error rate of 24%, based on 6 errors out of 25 opportunities, which involved 1 of 5 residents (Resident #34) and 1 of 4 staff (RN A) reviewed for medication administration. The facility failed to ensure RN A administered medications according to the physician's orders and per professional standards which resulted in a 24% medication administration error rate. This deficient practice could place residents at risk of not receiving the therapeutic effects of their medications and possible adverse reactions.