The Heights on Valley Ranch

Inspectors wroteBased on interview and record review the facility failed to establish and 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 diseases and infections to meet the needs of 2 of 5 residents (Resident #1 and Resident #2) reviewed for infection control. The facility failed to enter Resident #1's contact isolation orders in her electronical medical record and failed to initiate contact precautions for Resident #1 who was positive for c.difficile (a bacterium that causes an infection of the colon) for 2 days. The facility failed to separate Resident #2 from Resident #1, who had a confirmed c. difficle infection, in a timely manner. This failure could place residents at risk of spread of infection.

Inspectors wroteBased on interview and record review, the facility failed to promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of laboratory results that fall outside of clinical reference ranges in accordance with facility policies and procedures for notification of a practitioner or per the ordering physician's orders for 1 of 5 residents (Resident #1) reviewed for physician notification of laboratory services. The facility failed to review Resident #1's stool test results for c. difficile (a bacterium that causes an infection of the colon) and notify the MD/NP in a timely manner. The results were reviewed and NP was notified approximately 17 hours after the results were sent to the facility. This failure could place residents at risk of delayed treatment and spread of infection.

Inspectors wroteBased on interview and record review, the facility failed to transmit encoded, accurate, and complete MDS data to the Center for Medicaid/Medicare System (CMS) System for 3 of 6 closed records (CR #1, #2 and #3) reviewed for Minimum Data Set (MDS) transmission. CR #1, CR #2 and CR #3's discharge MDS assessment was not completed and transmitted within 14 days of CR's discharges. This failure could place residents at risk of not having assessments completed and submitted in a timely manner as required.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for dietary services, in that: The facility failed to ensure the ice machine was free from items (wet towel) within the stored ice. These failures could place residents at risk for food borne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a clean, comfortable, and homelike environment including a clean bed in good condition for 1 of 9 Resident's (Resident #4) whose bed was observed for sanitation. The facility failed to change Resident #4's bed linen which had several spills. This deficient practice could affect any resident and result in dissatisfaction and poor self-esteem.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure in accordance with State and Federal laws, all drugs and biologicals were stored securely in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for one (Medication Aide Cart South Station 500 (Medication Cart #1)) of five medication carts observed for storage of medications. The facility failed to ensure the Medication Cart #1 was secured when unattended. This deficient practice could place residents at risk for loss of prescribed medications, resident's safety, and drug diversion.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an infection prevention and control program designed to provide a safe, and sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 6 residents (Resident #195) reviewed for infection control. The facility failed to ensure intravenous tubing was stored safely with medication attached, dated, timed, initialed, and free of contamination while hanging on pole. This failure could place residents at risk of infection, worsening infection, and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to dispose of garbage and refuse properly for 2 of 2 dumpster reviewed for food and nutrition services. 1. The facility failed to ensure doors were closed on 2 of 2 dumpsters and 1 of the 2 dumpsters had exposed bagged trash at the door's opening. This failure could place residents at risk of contact with pests and associated diseases

Inspectors wroteBased on interviews and record review, the facility failed to promote and facilitate resident self- determination through support of resident choice for 1 of 4 residents (Resident #1) reviewed for resident rights. The facility failed to promote Resident #1's self-determination by not allowing her to eat in the dining room during meal time. This failure could place residents at risk of a decreased self-worth due to their preferences not being met.

Inspectors wroteBased on interviews and record reviews, the facility failed to recognize the residents right to formulate an advance directive for 1 of 20 residents (Resident #264) reviewed for advanced directives. The facility failed to enter a code status (the type of emergent treatment a person would or would not receive if their heart or breathing were to stop) for Resident #264 from admission on [DATE] to 3/21/24. This failure could place residents at risk of not having their end of life wishes met.

Inspectors wroteBased on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights for 3 of 6 residents (Resident #24, Resident # 40, and Resident #213) reviewed for care plans. -Resident #24's care plan reflected she had a DNR status despite having orders to be full-code (desiring resuscitation if the heart stops) . -Resident #40's and Resident #213's care plans reflected they were a full-code status despite having orders and an active DNR on file. These failures could lead to confusion related to life saving measures, life saving measures being provided to a resident who had a DNR status, not providing life saving measures to a resident who had a full-code status.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents who were unable to carry out activities of daily living were provided with the necessary services to maintain good personal hygiene for 1 of 20 (Resident #48) residents sampled for ADL care. -The facility failed to provide Resident #42 with a specialized call bell between 3/19/24 and 3/21/24. -The facility failed to shower and dress Resident #42 in his own clothes between 3/19/24 and 3/21/4. -The facility failed to get Resident #42 up out of bed between 3/19/24 and 3/21/24. These failures could place residents who are dependent on staff for ADLs, at risk of not receiving personal hygiene, experiencing a delay in receiving necessary careb.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 (Resident #42) of 20 residents reviewed for quality of care. - The facility failed to treat Resident #42's wounds to his shins with available ointment that was prescribed. - The facility failed to treat Resident #42's tracheostomy stoma as directed by the Physician Orders. This failure could place residents at risk for diminished quality of care, pain, infection, and worsening conditions.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident with limited range of motion received appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion for 1 of 20 residents (Resident #42) reviewed for quality of care The facility failed to ensure Resident #42's interventions for his bilateral hand rolls (rolls for contractures), posey palm pad (pad in palm for contractures), and getting him up into a Geri chair (chair that helps prevent falls), were implemented. This failure could place residents at risk of a decrease in range of motion, problems with skin integrity, and decreased quality of care.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents were offered sufficient fluid intake to maintain proper hydration and health for 1 of 20 residents (Residents #8) reviewed for hydration. The facility failed to ensure Resident #8 received adequate fluids from 3/19/24-3/21/24. This failure could place residents at risk for dehydration, electrolyte imbalance, and infections.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents who were fed by enteral means received the appropriate treatment and services to prevent complications of enteral feeding for 1 (Resident #42) of 1 resident reviewed for gastrostomy tube management. The facility failed to follow the physician orders for Resident #42's enteral water flush (a set amount of water that is delivered into the digestive system via the feeding tube) that was ordered on 3/15/24. This failure could place residents at risk for fluid overload and nutritional deficits.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the medication error rate was not five percent (%) or greater. The facility had a medication error rate of 5% based on 2 errors out of 38 opportunities, which involved 1 of 6 residents (Resident #43) reviewed for medication errors. -LVN T did not administer Ferrous sulfate (Iron) to Resident #43 and administered one Buspirone tablet (antianxiety medication) instead of two as prescribed by the physician. These failures could place residents at risk of inadequate therapeutic outcomes, increased negative side effects, and a decline in health.

Inspectors wroteBased on observations, interview and record review, the facility failed to maintain a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infection for 1 resident of 8 (Resident #359) observed for physical environment. The facility failed to maintain sanitary, functioning and a clean restroom for Resident #359. This failure placed the resident at risk for discomfort, infection and diminished quality of life and diminished clean, homelike environment.