The Estates at Bloomington LLC

Inspectors wroteBased on observation and interview, the facility failed to ensure dignity was maintained for 2 of 2 residents (R9, R13) reviewed for dignity when staff failed to knock, introduced themselves, and wait for permission to enter resident rooms prior to entry.

Inspectors wroteDuring observation, interview, and record review, the facility failed to accommodate resident needs by ensuring the call light was accessible for 1 of 1 residents (R9) reviewed for call lights.

Inspectors wroteBased on interview and document review, the facility failed to provide a written transfer notice and notice of bed hold for 1 of 1 residents (R4) reviewed for hospitalization.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement, or revise as needed, a comprehensive, person-centered care plan with individualized interventions for 1 of 1 resident (R67) reviewed for fluid management, related to the resident's diagnosis of polydipsia (excessive, persistent thirst or compulsive, excessive water consumption) and ongoing fluid-seeking behaviors

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate and complete respiratory care documentation and resident-specifc ordered settings for the use and management of a BIPAP device (bilevel positive airway pressure device - a non-invasive ventilation machine to helps in breathing) for 1 of 1 resident (R17) reviewed for respiratory care.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure non-pharmacological interventions were attempted and recorded prior to the administration of as-needed (PRN) narcotic/opioid and non-narcotic medication to help facilitate person-centered care planning and reduce the risk of complication (i.e., constipation, sedation) for 2 of 6 residents (R5, R28) reviewed for unnecessary medication use.

Inspectors wroteDuring observation and interview, the facility failed to maintain a safe, comfortable, and homelike environment for 2 of 2 residents (R9, R13) reviewed whose main bedroom ceiling light did not function properly.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure community use glucometers (machines to check blood sugar) were properly cleaned and disinfected between patient use, and failed to ensure staff who performed blood glucose checks were knowledgeable of process for cleaning and disinfecting blood glucose devices prior to and after use per manufacturer instructions. This had the potential to affect 9 of 9 (R10, R13, R15, R26, R29, R41, R49, R54, and R118) residents who were diabetic, had orders for blood glucose monitoring, and used a community glucometer.

Inspectors wroteBased on observation and interview, the facility failed to ensure a comfortable and homelike environment for 2 of 2 residents (R19, R23) who shared a room with a large area of the wall patched but left unfinished, unsanded, and unpainted.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure dental appliances (i.e., dentures) were offered or provided to promote safety and independence with eating for 1 of 4 residents (R60) reviewed for activities of daily living (ADL).

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure routine nail care was provided for 1 of 1 resident (R58) reviewed for activities of daily living (ADLs) who needed assistance from staff for nail care.

Inspectors wroteBased on observation, interview, and document review, the facility failed to assess and, if needed, develop interventions or refer to contracted therapy services to address poor wheelchair posture for 1 of 2 residents (R60), and failed to provide assessed interventions from occupational therapy to reduce the risk of skin injury or further mobility loss (i.e., contracture worsening) for 1 of 1 resident (R15) reviewed for limited range of motion (ROM).

Inspectors wroteBased on interview and document review, the facility failed to ensure an order for an audiology (medical specialty assisting with hearing) referral was acted upon promptly to promote better hearing and quality of life for 1 of 1 residents (R13) reviewed who expressed difficulty with hearing.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure an unsecured bed mattress was assessed for correct fit for a resident's bed for 1 of 1 residents (R59) reviewed for safety hazards.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure ongoing monitoring of resident oxygen use was completed to reduce the risk of respiratory complications for 1 of 1 residents (R13) reviewed for oxygen use.

Inspectors wroteBased on observation, interview, and document review, the facility failed to accurately or comprehensively assess the use of side rails and ensure installed side rails were secured to prevent injury or potential entrapment for 1 of 1 resident (R33) reviewed who used bilateral quarter-sized side rails on their bed.

Inspectors wroteBased on interview and document review, the facility failed to ensure consulting pharmacist recommendations were fully addressed or acted upon for 1 of 5 residents (R13) reviewed for unnecessary medications.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure acute, potentially distressing psychoactive symptoms were recorded and non-pharmacological interventions were attempted or recorded to ensure efficacy of as-needed (i.e., PRN) psychotropic medication for 1 of 5 residents (R2) reviewed for unnecessary medication use.

Inspectors wroteBased on interview and record review, the facility failed to verify orders written by a provider for one of one resident (R1) reviewed. R1 had orders for wound care treatments and the facility thought the orders were written in error but did not verify the orders with the provider.

Inspectors wroteBased on interview and document review, the facility failed to implement transfer interventions for 1 of 3 residents (R1) reviewed for accidents. This resulted in actual harm for R1 who hit her head and sustained a skin tear on the left forearm.

Inspectors wroteBased on interview and document review, the facility failed to report a fall with injury caused by not following the care plan to the State Agency (SA) for 1 of 1 resident (R1) reviewed for falls.

Inspectors wroteBased on interview and document review, the facility failed to provide a notice of rights and services to 2 of 3 residents (R1 and R4) reviewed for rights prior to or upon admission.

Inspectors wroteBased on interview and record review, the facility failed to report an allegation of abuse immediately but not later than 2 hours after the allegation was made to the State Agency (SA) and administrator for one of one resident (R3) reviewed abuse. Staff received an abuse allegation from R3 and did not report the allegation to the administrator or SA.

Inspectors wroteBased on interview and document review, the facility failed to ensure resident and/or resident representative participation in the care planning process and subsequent interventions for 1 of 1 residents (R35) reviewed for participation in care planning.

Inspectors wroteBased on interview and document review, the facility failed to refer a resident for a level II pre-admission screening and resident review (PASARR) evaluation and determination for one of one resident (R33) reviewed for PASSAR who had a new diagnosis of paranoid schizophrenia (a serious mental disorder in which people interpret reality abnormally) diagnosis.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure bathing or showers were provided for 1 of 1 residents (R5) reviewed for dependent activities of daily living (ADL's).

Inspectors wroteBased on observation, interview and document review, the facility failed to deliver pressure ulcer care consistent with professional standards of care to prevent a facility acquired pressure ulcer for one of one resident (R41) reviewed for pressure ulcers.

Inspectors wroteBased on observation and interview and policy review, the facility failed to ensure medications were securely and safely stored in 2 of 4 medication carts observed.

Inspectors wroteBased on observation, interview and document review, the facility failed to provide physician-ordered thickened liquids for 1 of 1 residents (R268) reviewed for therapeutic diets.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure nurse staffing information was posted on the weekend and in a timely manner at the start of the shift. This had potential to affect all 59 residents, staff, and visitors who could wish to review this information.

Inspectors wroteBased on interview and document review, the facility failed to ensure required Level I and/or Level II pre-admission screening(s) (PAS) were completed and/or clarified for 1 of 1 residents (R16) reviewed for pre-admission screening and resident review (PASARR).