The Emeralds at Fairbault LLC

Inspectors wroteBased on interview and document review, the facility failed to ensure ongoing surveillance for infections, ongoing review of surveillance data, and documentation of follow-up activity and response. This practice had the potential to affect all 82 residents residing in the facility.

Inspectors wroteBased on interview and document review, the facility failed to implement a process for antibiotic review to determine appropriate indications, dosage, duration, trends of antibiotic use and resistance. This had the potential to affect all 82 residents residing in the facility.

Inspectors wroteBased on interview and document review, the facility failed to ensure each resident or the resident's representative received education on pneumococcal immunization and failed to offer resident's the opportunity to receive or decline pneumococcal immunizations for 3 of 5 residents (R2, R35, R69) reviewed for immunizations.

Inspectors wroteBased on interview and document review, the facility failed to ensure each resident or the resident's representative received education on Covid-19 immunizations and boosters and failed to offer Covid-19 immunizations for 3 of 5 residents (R2, R35, R69) reviewed for immunizations.

Inspectors wroteBased on interview and document review, the facility failed to ensure bathing safety for 1 of 1 resident (R38) reviewed for activities of daily living (ADLs), when a safety seatbelt had not been applied during the bathing process. In addition, based on interview and document review, the facility failed to ensure safe electric wheelchair use for 1 of 1 resident (R73) reviewed for accidents, when a resident fell from her wheelchair on a community outing.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain a safe environment for 2 of 2 residents (R4, R5) who were observed with wet floors and no indication that floor was wet while either residing in room or when returning to room.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide oral hygiene to 1 of 3 residents (R2) observed for oral hygiene cares.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow physician's orders for negative pressure wound therapy (wound vac) (device that applies gentle suction to help complex, large, or slow-healing wounds close) care for 1 of 2 residents (R1) who did not receive wound vac changes as scheduled. In addition, the facility failed to update the physician when attempt to reapply the wound vac failed for 1 of 2 residents (R1) reviewed for wound care and failed to update the physician for 1 of 1 residents (R2) who had a choking incident and required the Heimlich maneuver.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow infection prevention protocols including enhanced barrier precautions (EBP) when providing care to 2 of 3 residents (R2 and R4) observed during cares.

Inspectors wroteBased on interview and document review the facility failed to ensure care plan interventions related to anticoagulant therapy were effectively communicated to direct care staff responsible for observing and reporting changes in condition and failed to develop a comprehensive individualized care plan that addressed cardiac management for 1 of 3 residents (R2) reviewed for quality of care who had a significant cardiac history and administered blood thinning medications.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure a timely comprehensive cardiac assessment and response when 1 of 3 residents (R2) exhibited acute cardiac symptoms and requested emergency medical evaluation, which resulted in delayed provider notification and emergent hospital transfer, reviewed for quality of care.

Inspectors wroteBased on interview and document review, the facility failed to ensure complete and accurate documentation in the medical record when a nurse failed to document a cardiac assessment and the residents request for hospital evaluation for 1 of 3 residents (R2), reviewed for quality of careFindings includeR2's face sheet identified the following diagnoses; [...]

Inspectors wroteBased on interview and document review, the facility failed to implement its policy to prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of property when pre-employment background screening procedures were not completed for one of 11 staff members reviewed for background screening. This had the potential to affect all 71 residents residing in the facility as the staff member worked on all units.

Inspectors wroteBased on interview and document review, the facility failed to ensure four of five residents (R1, R4, R2, and R5) reviewed for financial exploitation were free from misappropriation of personal property and financial exploitation when facility staff stole resident credit/debit cards or card information and made unauthorized transactions totaling over $5,000. This had the potential to affect all residents residing at the facility.

Inspectors wroteBased on interview and document review, the facility failed to ensure allegations of financial exploitation were reported to the State Agency (SA) within 24 hours for four of five residents (R1, R2, R3, and R4) reviewed for allegations of financial exploitation.

Inspectors wroteBased on interview and document review, the facility failed to identify and protect all residents at risk of financial exploitation during investigations into 4 of 4 residents (R1, R2, R3, R4) reviewed who made allegations of financial exploitation. This had the potential to affect all 67 other residents who were residing in the facility, including R5, whose representative subsequently identified and reported additional allegations of financial exploitation.

Inspectors wroteBased on observation and interview, the facility failed to post accurate data reflecting the total number and actual hours worked per shift by nursing staff directly responsible for resident care on a daily basis. This had the potential to affect all 71 residents residing in the facility and their visitors who may wish to review the information.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure the three-compartment dish sink was of proper sanitization parts per million (ppm) which had the potential to affect all 76 residents who received meals from the main kitchen. Furthermore, the facility failed ensure employees wore beard restraints to prevent hair from contacting food. Findings Include: A report titled Diet/consistency Rollup printed on 4/30/25, categorized each diet and had total meals served out of the main kitchen as 76. During the initial kitchen walk through conducted on 4/28/25 at 1:22 p.m., an area over the three-compartment sink had logs for documentation of water sanitization for April 2025, completed for April 1-24th. Above the sink were two large bottles held by a wire rack with two tubes that ran down into the three compartment sink, both were empty. [...]

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure soiled personal laundry and linens were bagged (i.e., contained) at the point-of-use and transported in a manner to reduce the risk of cross-contamination and potential infectious spread in 1 of 1 main washrooms and 2 of 2 units (70's, 90's) reviewed. This had potential to affect all 75 residents within the care center.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure dignity was maintained for 2 of 2 residents (R54, R74) who utilized urinary catheters.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure a sanitary and homelike environment for 1 of 1 residents (R40) whose tube feeding pole and equipment had dried, white substance on it.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure grievances were sufficiently acted upon for 1 of 1 resident (R53) reviewed for grievances. Findings Include: R53's quarterly Minimum Data Set (MDS) dated [DATE], indicated R53 was cognitively intact. During an interview on 4/28/25 at 4:28 p.m., R53 stated approximately two months ago, during an evening shift a nursing assistant entered her room and attempted to change an incontinent brief. R53 was concerned because she didn't wear incontinent briefs, and the aid was unkind during the encounter. The following morning R53 reported the incident to staff. During a subsequent interview on 4/29/25 at 1:28 p.m., R53 stated she filed a grievance approximately two months ago and requested the nursing assistant not return to the unit. [...]

Inspectors wroteBased on interview, observation, and documentation review, the facility failed to ensure a comprehensive care plan was developed and maintained to ensure appropriate care was provided for 1 of 1 resident (R51) reviewed for smoking.

Inspectors wroteBased on observation, interview, and document review, the facility failed ensure the care plan was updated and revised to reflect current interventions for 1 of 1 resident (R62) reviewed for positioning and mobility.

Inspectors wroteBased on interview and document review the facility failed to reassess a resident with known constipation to determine what, if any, new interventions could be put in place to prevent constipation for one of one resident (R28) reviewed for constipation.

Inspectors wroteBased on observation, interview and document review, the facility failed to follow-up and implement treatment for improved hearing for 1 of 1 resident (R62) who had complaints of hearing loss which were not addressed.

Inspectors wroteBased on observation, interview and document review, the facility failed to comprehensively reassess and, if needed, determine or develop proactive interventions to help address pressure injury risk and development after a new pressure injury was identified (i.e., change of condition) for 1 of 2 residents (R13) reviewed whom had active pressure injuries.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide services to maintain and/or prevent loss of range of motion and contracture care for 1 of 1 residents (R51) reviewed for limited range of motion.

Inspectors wroteBased on observation, interview and document review the facility failed to ensure a resident with a catheter had medical justification for continued use and failed to attempt a trial removal, if recommended, for one of one resident (R35) reviewed for indwelling catheter.

Inspectors wroteBased on interview, observation and document review the facility failed to comprehensively reassess a resident for pain who was hospitalized for concerns with her pain medication and had pain medication changes, and who still reported frequent pain for one of one resident (R1) reviewed for pain.

Inspectors wroteDuring observation and interview, the facility failed to ensure resident records that contained private, medical, and personal information were not accessible to unauthorized personnel. This had the potential to affect 20 residents on the first floor of facility, and all 13 residents on the second floor whose personal information was listed on exposed care sheets.

Inspectors wroteBased on interview and record review, the facility failed to immediately assess a resident after a change in condition for one of one resident (R1). License practical nurse (LPN)-A noticed a change in condition at 8:00 a.m. on 3/4/25, started taking vital signs at 10:30 a.m., and emergency medical services (EMS) was not called until 11:33 a.m.

Inspectors wroteBased on interview and record review, the facility failed to obtain an order for oxygen for one of seven residents (R1) who was on continuous oxygen.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure allegation of a potential drug diversion was recognized and reported to the state agency (SA), reviewed for misappropriation of property. Finding s included: R1's admission Minimum Data Set (MDS) dated [DATE], identified R1 was cognitive and had a diagnosis of narcolepsy (a rare neurological condition that makes people very sleepy during the day and can cause them to fall asleep suddenly). R1's order summary dated 1/6/25, identified an order for methylphenidate long acting (LA) (a stimulant medication to help with narcolepsy) 20 mg capsule to be given every day in the morning for narcolepsy. R1's Medication Administration Record (MAR) dated 1/6/25, identified R1 did not receive methylphenidate extended release (ER) 20 mg capsule as indicated by the number, 5 documented that indicated to see progress note. [...]

Inspectors wroteBased on observation, interview and document review the facility failed to put a protection plan in place and thoroughly investigate an allegation of drug diversion for 1 of 1 resident (R1), reviewed for misappropriation of property. Finding s included: R1's admission Minimum Data Set (MDS) dated [DATE], identified R1 was cognitive and had a diagnosis of narcolepsy (a rare neurological condition that makes people very sleepy during the day and can cause them to fall asleep suddenly). R1's order summary dated 1/6/25, identified an order for methylphenidate long acting (LA) (a stimulant medication to help with narcolepsy) 20 mg capsule to be given every day in the morning for narcolepsy. [...]

Inspectors wroteBased on interview and document review, the facility failed to ensure the necessary coordination of services between the facility and the hospice agency for 1 of 3 residents (R2) reviewed for hospice services.

Inspectors wroteBased on interview and document review, the facility failed to report an allegation of sexual abuse immediately (within two hours) to the State Agency (SA) for 1 of 3 residents (R1) reviewed for abuse.

Inspectors wroteBased on interview and document review, the facility failed to ensure an allegation of sexual abuse was thoroughly investigated and adequate resident protection provided to ensure safety for 1 of 3 residents (R1) reviewed for abuse.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure 1 of 1 resident (R5) who was observed to have medications in his room, had been appropriately assessed and deemed safe to self-administer medications.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow the standards of practice for the: (1) administration of nebulizer treatment solution and do the necessary assessment during and after the administration of the nebulizer treatment solution; and (2) failure to follow physician order to apply compression stockings daily for one of one resident (R8) observed for medication administration. Findings Include: R8's admission record indicated R8 had a history of acute respiratory failure with hypoxia, chronic obstructive pulmonary disease, and history of pulmonary embolism. R8's admission Minimum Data Set (MDS) dated [DATE], indicated R8 was cognitively intact, had clear speech and was able to understand and be understood. MDS also indicated R8 had not exhibited rejection of cares. [...]

Inspectors wroteBased on interview, record review and observation, the facility failed to provide pharmacy services for 1 of 1 resident (R6), who did not receive her scheduled medication for pain resulting in uncontrolled pain and the use of narcotic pain medication. Furthermore, the facility failed to follow safeguards to ensure residents received the correct medications for 1 of 1 resident (R6). R6's admission record indicated R6 had a history of perforation of the intestine, encounter for surgery on the digestive system, gastrostomy status and colostomy status. R6's admission Minimum Data Set (MDS) dated [DATE], indicated she was unable to complete the cognitive assessment and was sometimes understood and sometimes able to understand. MDS also indicated R6 to have pain and used as needed pain medication (PRN) in the last 5 days. [...]

Inspectors wroteBased on interview and document review, the facility failed to ensure a provider order for a urine analysis with urine culture (UA/UC) and sensitivity had been obtained in a timely manner for 1 of 1 resident (R7) reviewed for change of condition.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure routine bathing and personal hygiene needs were addressed and completed for 3 of 5 residents (R47, R69, R31) reviewed for activities of daily living (ADLs) and who were dependent on staff for their care.

Inspectors wroteBased on observation and interview the facility failed to ensure 1 of 5 medication carts were kept locked or under direct observation of authorized staff in areas where residents, staff and guests could access medications. The deficient practice had the potential to affect all 13 residents that resided on the second floor of the facility.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure dignity was maintained for 1 of 1 residents (R20) who utilized a urinary catheter.

Inspectors wroteBased on interview and document review, the facility failed to ensure resident and/or resident representatives participated in the resident care planning process and subsequent development of interventions for 2 of 2 residents (R53, R74) reviewed for participation in care planning.

Inspectors wroteBased on observation, interview, and document review the facility failed to assess a resident for the ability to self-administer medications with an albuterol inhaler bedside for one of one residents (R43) reviewed for self-administration of medications.

Inspectors wroteBased on interview and document review, the facility failed to develop and implement a system to help facilitate resident' choice and preference with regards to provided therapy services scheduling for 2 of 2 residents (R34, R58) reviewed who expressed concerns with how such services were provided.

Inspectors wroteBased on observation, interview and document review, the facility failed to provide ambulation services to maintain and prevent decline of function for 2 of 2 residents (R58 and R69) reviewed who required assistance with ambulation. Additonally, the facility failed to provided an exercise range of motion (ROM) program for 1 of 1 resident (R43) reviewed for ROM.

Inspectors wroteBased on observation, interview and document review the facility failed to comprehensively assess a resident for safe smoking practices for 1 of 1 resident (R44) reviewed for smoking.

Inspectors wroteBased on observation, interview, and document review, the facility failed to comprehensively assess to determine what, if any, interventions were needed or available to help reduce the risk of recurrent urinary tract infections (UTI) for 1 of 2 residents (R34) reviewed who had multiple, repeated infections.

Inspectors wroteBased on interview and document review, the facility failed to ensure scheduled medication administration times reflected the actual, current physician orders to reduce the risk of administration error or complication (i.e. GI upset) for 1 of 5 residents (R34) reviewed for unnecessary medication use.

Inspectors wroteBased on interview and document review, the facility failed to ensure acute, potentially distressing psychoactive symptoms were recorded and non-pharmacological interventions were attempted or recorded prior to the administration of as-needed (i.e., PRN) psychotropic medication for 1 of 5 residents (R34) reviewed for unnecessary medication use.

Inspectors wroteBased on interview and document review, the facility failed to ensure recommended pneumococcal vaccinations, as outlined by the Centers for Disease Control (CDC), were offered and/or provided to reduce the risk of severe disease for 3 of 5 residents (R43, R44, R47) reviewed for immunizations.