The Laurels of Chatham

Inspectors wroteBased on record review, observation and interviews with staff and the Medical Director the facility failed to provide care safely to a dependent resident (Resident #117). On 02/14/25 Resident #117 was sitting on a bath bench in the shower room while Nursing Assistant (NA) #1 was washing her hair when Resident #117's body suddenly went limp, and she went unresponsive. NA #1 laid Resident #117 onto the shower bench, ran approximately 10 feet away from her to yell for help, leaving Resident #117 with no staff support resulting in the resident falling off the shower bench. Resident #117 sustained a laceration to her right eyebrow with significant bleeding and bruising and a skin tear to her right elbow. Resident #117 was prescribed an anticoagulant (blood thinner) daily for blood clot prevention. This deficient practice affected 1 of 5 residents reviewed for supervision to prevent falls.

Inspectors wroteBased on record reviews and Paramedic and staff interviews, the facility failed to maintain a resident's (Resident #117) dignity when her nude body was left uncovered until after Emergency Medical Services (EMS) arrived following a fall on the shower room floor. EMS covered the residents' body upon their arrival. A reasonable person would not want to be left with their nude body fully exposed and would have experienced feelings such as embarrassment or humiliation. This deficient practice affected 1 of 4 residents reviewed for dignity.

Inspectors wroteBased on record review and staff interviews the facility failed to ensure a Preadmission Screening and Resident Review (PASRR) level II referral was made after a resident was given new mental health diagnoses for 1 of 2 residents (Resident #68) reviewed for PASRR.

Inspectors wroteBased on record review, and interviews with staff and Medical Director, the facility failed to thoroughly assess Resident #117, who had a do not resuscitate order and was prescribed an anticoagulant (blood thinner) daily for blood clot prevention, after she went unresponsive during a shower and after a fall that resulted in injury. On [DATE] Resident #117 was sitting on a bath bench in the shower room while Nursing Aide (NA) #1 was washing her hair. Resident #117 took a deep breath, her body suddenly went limp, and she went unresponsive. NA #1 laid Resident #117 onto the shower bench, ran approximately 13 feet away from her to yell for help, leaving Resident #117 with no staff support resulting in the resident falling off the shower bench. [...]

Inspectors wroteBased on record review, observations and staff interviews, the facility failed to administer water flushes via a feeding tube at the physician ordered flow rate for 1 of 1 resident reviewed with tube feedings (Resident #101).

Inspectors wroteBased on observation, record review, and staff interviews, the facility failed to follow sterile technique when Nurse #5 failed to apply sterile gloves for suctioning while providing tracheostomy care for 1 of 2 residents observed for tracheostomy care (Resident #38).

Inspectors wroteBased on record review, Nurse Practitioner and staff interviews, the facility failed to hold a blood pressure medication as ordered by the physician for 1 of 6 residents whose medications were reviewed (Resident #32).

Inspectors wroteBased on record reviews, observations and interviews with the Orthopedic Physician Assistant, Orthopedic Nurse, Wound Physician Assistant, Medical Director, Hospice Aide, and staff, the facility failed to assess Resident #102's skin under an immobilizer used following a fractured distal femur (the area of the leg just above the knee joint). This resulted in the development of an unstageable (full thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because the wound bed is obscured by eschar (dry, dark scab of dead skin), slough (yellow tissue that is stringy and thick) and granulation tissue (part of the healing process in which lumpy, pink tissue containing new connective tissue and capillaries form around the edges of the wound) pressure ulcer to the right inner ankle. [...]

Inspectors wroteBased on record review and staff and resident interviews, the facility failed to resolve resident council concerns regarding call bell responses on night shift. (Resident #s 23, 41, 77), and failed to provide the residents a private resident council meeting without staff interference for 2 of 4 months reviewed (March 2024 and April 2024).

Inspectors wroteBased on record review, observation, and staff and resident interviews, the facility failed to provide stool incontinence care on night shift for a dependent resident which caused him to feel angry (Resident #59) and failed to communicate with a resident. A reasonable person expects to be provided communication during care and understand what to expect (Resident #15). This deficient practice affected 2 of 3 residents reviewed for dignity.

Inspectors wroteBased on record review, observation, and staff interview, the facility failed to honor a resident's right to refuse care when Nursing Assistant (NA) #5 attempted to dress the resident in a gown despite the resident's (Resident #15) physical and verbal behaviors resisting this care. This deficient practice affected 1 of 2 residents reviewed for choices.

Inspectors wroteBased on record reviews, observations, and interviews with the Orthopedic nurse, Orthopedic Physician Assistant, Responsible Party (RP) , and staff, the facility failed to notify the orthopedic provider of a newly acquired pressure ulcer caused by a knee immobilizer and that the knee immobilizer was not being worn as ordered for Resident #102's fractured distal femur (the area of the leg just above the knee joint). The facility also failed to notify the RP of the addition and increase of medication prescribed for Resident #173. This was for 2 of 2 residents reviewed for notification.

Inspectors wroteBased on record review, observation, and staff and resident interviews, the facility failed to provide dependent residents nail care (Resident #s 59 and 92) and failed to provide hair care and facial hair shaving (Resident #59) for 2 of 7 residents reviewed for activities of daily living.

Inspectors wroteBased on record reviews, observations and interviews with the Medical Director, Orthopedic nurse, Orthopedic Physician Assistant and staff, the facility failed to apply a right knee immobilizer for a resident with a fractured distal femur (the area of the leg just above the knee joint) as ordered (Resident #102). In addition, the facility transferred a resident with an obvious deformity and pain to the right hip/leg after a fall. (Resident #30). This was for 2 of 3 residents reviewed for well-being.

Inspectors wroteBased on record review and staff interviews, the facility failed to have complete and accurate medical records in the areas of wound care (Residents #273 and #274). This was for 2 of 7 closed records reviewed.

Inspectors wroteBased on observations, record review and staff interviews, the facility's quality assurance (QA) process failed to implement, monitor, and revise as needed the action plan developed for the recertification survey dated 2/9/23 in order to achieve and sustain compliance. This was for recited deficiencies on a recertification survey on 4/14/24. The deficiencies were in the areas of dignity (550), activities of daily living, pressure ulcer, and accurate medical records. The continued failure during two federal surveys of record shows a pattern of the facility's inability to sustain an effective quality assurance program.

Inspectors wroteBased on staff, Physician and Consultant Pharmacist interviews and record review, the Consultant Pharmacist failed to identify the lack of documentation for the monitoring of side effects for a resident prescribed antipsychotic medications. This was for 1 (Resident #173) of 7 residents reviewed for unnecessary medications.

Inspectors wroteBased on staff and Physician interviews and record review, the facility failed to identify the lack of documentation for the monitoring of side effects for a resident prescribed antipsychotic medications. This was for 1 (Resident #173) of 7 residents reviewed for unnecessary medications.

Inspectors wroteBased on record reviews, observations, family member, resident and staff interviews, the facility failed to trim and clean dependent residents' nails (Residents #66, #28, #114, #40, #116 and #58) and failed to assist with shaving (Resident #84). In addition, the facility failed to assist a resident with bathing (Resident #33). This was for 8 of 12 residents reviewed for Activities of Daily Living (ADLs).

Inspectors wroteBased on record review, observations, and staff interviews, the facility failed to ensure the alternating pressure reducing air mattress was set according to the resident's weight for 3 of 12 residents reviewed for pressure ulcers (Resident #58, #87, and #14).

Inspectors wroteBased on observations, record reviews, and staff interviews, the facility failed to provide a dignified dining experience by providing residents with disposable food containers and plastic utensils during three observed meals (Resident #89 and Resident #31) and referring to a resident who needed assistance with meals as a feeder (Resident #75). This was for 3 of 9 residents reviewed for dignity. Based on the reasonable person concept residents would expect to utilize regular plates and utensils regardless of how fast they eat and would not expect to be identified as a feeder. Requiring a resident to utilize disposable food containers and plastic utensils while other residents were not or being labeled a feeder has the potential for a reasonable person to experience a negative psychosocial outcome.

Inspectors wroteBased on record reviews, interviews with staff, Responsible party, the facility failed to transfer a resident to the hospital when the Responsible Party's (RP) made the request for 1 of 1 (Resident #119) reviewed for choices.

Inspectors wroteBased on record review, observations, resident and staff interviews, the facility failed to honor a resident's choice related to showers (Resident #66) for 1 of 2 residents reviewed for choices.

Inspectors wroteBased on record review and staff interview, the facility failed to code the Minimum Data Set (MDS) assessments accurately in the areas of cognition (Residents #89, #87 & #19), pressure ulcer (Resident #114) and diagnoses (Resident #28) for 5 of 31 residents whose MDS were reviewed.

Inspectors wroteBased on record review, observation and staff interview, the facility failed to transcribe the correct medication administration route for 1 (Resident #87) of 4 residents reviewed for gastric feeding tube and with orders for nothing by mouth (NPO).

Inspectors wroteBased on record review, observations, and staff interviews, the facility failed to apply the right-hand palm guard (Resident #87) and bilateral elbow extension splints (Residents #58) as ordered for 2 of 3 residents reviewed for range of motion.

Inspectors wroteBased on record review, Medical Director and staff interviews, the facility failed to transcribe vital sign parameters for a blood pressure medication as ordered for 1 of 6 residents whose medications were reviewed (Resident #223).

Inspectors wroteBased on observation, interview with resident and staff, the facility failed to secure medication patches for 1 of 4 (Resident #16) residents observed for medication administration.

Inspectors wroteBased on record review and staff interviews, the facility failed to maintain accurate medical records for wound care (Resident #123), and respiratory care (Resident #123). This was for 1 of 7 closed records reviewed.

Inspectors wroteBased on record reviews, observations, resident, and staff interviews, the facility's Quality Assurance and Performance Improvement (QAPI) committee failed to maintain implemented procedures and monitor interventions the committee put into place following the annual recertification and complaint survey completed on 1/24/20. This was for 3 deficiencies that were cited in the areas of Accuracy of Assessments, Services Provided Meet Professional Standards, and Increase/Prevent Decrease in Range of Motion/Mobility. In addition, one further deficiency was cited during the annual recertification and complaint survey on 3/17/22 in the areas of Resident Records. The duplicate citations during three federal surveys of record shows a pattern of the facility's inability to sustain an effective QAPI program.

Inspectors wroteBased on record review and staff interviews, the facility failed to display accurate Posted Nurse Staffing Information as compared to the Staff Schedule/Assignment Sheets for 31 out of 31 days reviewed.