The Laurels of Middletown

Inspectors wroteBased on medical record review and staff interview, the facility failed provide appropriate assistance for a resident during care to prevent a fall. This effected one (#8) of three residents reviewed for falls. The census was 93.

Inspectors wroteBased on medical record review, review of an incident report, staff interview, and policy review, the facility failed to ensure residents had active orders for a medication prior to administration, resulting in a significant medication error. This effected one (#10) of three residents reviewed for medication administration. The census was 93.

Inspectors wroteBased on observations, staff interviews and policy review, the facility failed to store, prepare, and distribute food in a sanitary manner. This had the potential to affect all 97 residents residing at the facility who receive their meals from the facility kitchen. The facility census was 97.

Inspectors wroteBased on observations and resident and staff interviews, the facility failed to provide a clean, comfortable, and sanitary environment for the residents. This affected four (#25, #36, #46 and #51) out of four residents reviewed for the physical environment. The facility census was 97.

Inspectors wroteBased on record review, observations, resident and staff interviews, and review of the Resident Assessment Instrument (RAI) Manual 3.0, the facility failed to accurately code Minimum Data Set (MDS) assessments. This affected six (#01, #24, #41, #74, #82, and #92) residents out of the 25 residents reviewed for MDS accuracy. The facility census was 97.

Inspectors wroteBased on medical record review, staff interview, and policy review, the facility failed to ensure a Pre-admission Screening and Resident Review (PASRR) was completed upon admission. This affected one (#25) out of the two residents reviewed for PASRR completion. The facility census was 97.

Inspectors wroteBased on record review, observations, resident and staff interviews, the facility failed to develop a comprehensive care plan to address resident's dental status. This affected two (#82 and #92) of 25 resident care plans reviewed. The facility census was 97.

Inspectors wroteBased on medical record reviews, resident and staff interviews, and policy review, the facility failed to conduct resident care conferences. This affected three (#24, #54 and #79) residents out of the five residents reviewed for care conferences. The facility census was 97.

Inspectors wroteBased on medical record review, observations, resident and staff interviews and policy review, the facility failed to ensure a resident was provided with hand hygiene. This affected one (#49) out of four residents reviewed for personal hygiene. The facility census was 97.

Inspectors wroteBased on medical record review, observations, resident and staff interviews and policy review, the facility failed to ensure a resident's hand splint was applied as physician ordered. This affected one (#49) out of four residents reviewed for range of motion. The facility census was 97.

Inspectors wroteBased on medical record review, staff interview and review of the facility policy, the facility failed to provide timely care and services to treat a urinary tract infection. This affected one (#298) out of three residents reviewed for change of condition. The facility census was 97.

Inspectors wroteBased on record review, observations, resident and staff interviews and policy review, the facility failed to ensure a resident was observed to take their medications at the time of administration. This affected one (#74) of five residents reviewed medication administration. The facility census was 97.

Inspectors wrote2. Review of the medical record for Resident #298 revealed an admission date of [DATE] with medical diagnoses of pneumonia, chronic obstructive pulmonary disease, atrial fibrillation, hypertension, and neuromuscular dysfunction of the bladder. Further review of the medical record revealed Resident #298 was discharged to the hospital on [DATE] and expired at the hospital. Review of the medical record for Resident #298 revealed an admission Minimum Data Set (MDS) assessment, dated [DATE], which indicated Resident #298 had moderate cognitive impairment and required maximum staff assistance for bed mobility and transfers and was dependent for toilet hygiene and bathing. [...]

Inspectors wroteBased on record review, observations, staff interview and policy review, the facility failed to ensure staff followed proper infection control procedure when administering intravenous medication. This affected one (#50) out of five residents observed for medication administration. Facility census was 97.

Inspectors wroteBased on medical record review, staff interview, and policy review, the facility failed to complete weekly wound evaluations of a surgical wound. This affected one (#105) out of three residents reviewed for wound care. The facility census was 101.

Inspectors wroteBased on medical record review, staff and guardian interviews, and policy review, the facility failed to provide the correct location for discharge on a discharge notice. This affected one (Resident #204) of three residents reviewed for proper discharges. The facility census was 101.

Inspectors wroteBased on medical record reviews, observations, staff interview, review of facility policies, and review of the facility legionella water prevention program, the facility failed to implement transmission based precautions for residents with Coronavirus (COVID-19) like symptoms. This affected four Residents (#8, #24, #46, and #72) and had the potential to affect all residents of the facility. The facility also failed to have a sufficient legionella prevention plan. This had the potential to affect all the residents of the facility. The facility also failed to ensure staff washed their hands when distributing meals to residents. This affected two (#1 and #37) residents observed during meals. The census was 81.

Inspectors wroteBased on observations, medical record reviews, resident and staff interviews, and review of facility's resident care guidelines, the facility failed to ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, and personal and oral hygiene. This affected two (#16 and #22) of four residents reviewed for Activities of Daily Living (ADLs). The facility census was 81.

Inspectors wroteBased on observations, record review, and staff and resident interviews, the facility failed to provide each resident with an ongoing program of individual activities, consistent with the comprehensive assessment, designed to meet their specific interests in order to promote psychosocial well-being. This affected one (#83) of four residents reviewed for activities. The facility census was 81.

Inspectors wroteBased on medical record reviews, observations, staff interviews, review of facility policy, the facility failed to accurately document pressure ulcer treatments and accurately document resident's pressure ulcers. This affected two (#16 and #21) of five residents reviewed for pressure ulcers. The census was 81.

Inspectors wroteBased on medical record reviews, observations and staff interviews, the facility failed to ensure the medication error rate was below five percent. A total of 26 medications were observed administered with two medication errors, resulting in error rate of 7.69 percent. This affected two (#136 and #1) of two residents observed for medication administration. The facility census was 81.

Inspectors wroteBased on observations, medical record review, staff and resident interviews, the facility failed to assist a resident in obtaining routine dental care. This affected one (#26) of four residents reviewed for dental services. The facility census was 81.

Inspectors wroteBased on record review, observation, interview, review of Self Reported Incident (SRI) and review of facility policy the facility failed to ensure residents received adequate supervision. This resulted in actual harm to Resident #25 when the resident entered another residents room, the other resident shoved Resident #25 and caused her to fall. Resident #25 sustained a fractured hip and was admitted to the hospital. The facility also failed to ensure fall devices were in place and residents received adequate supervision with smoking. This affected three Residents (#13, #25, and #84) of four reviewed for supervison to prevent accidents and hazards. The facility census was 101.

Inspectors wroteBased on medical record review, staff and resident interviews and policy review the facility failed to ensure residents pain was properly managed and failed to ensure a speciality appointment for pain was scheduled in a timely manner. This resulted in actual harm to Resident #5 who had uncontrolled pain and difficulty sleeping. This affected one (#5)of one resident reviewed for pain management. The facility identified 53 residents on a pain management program. The facility census was 101.

Inspectors wroteBased on observations, staff interview and review of the facility policy, the facility failed to ensure the dishwasher and food items were being properly maintained to prevent contamination and spoilage. This affected 99 of 99 residents who receive meals from the facility kitchen. The facility identified for two (#55 and #58) residents who receive nothing by mouth (NPO). The facility census was 101.

Inspectors wroteBased on record review, interview, and policy review the facility failed to provide a copy of the transfer and discharge notification to the Ombudsman. The facility also failed to provide residents with notifications that included the reasons for their discharges. This affected four (#6, #19, #21 and #38) of eight residents reviewed for discharge notification. The facility census was 101.

Inspectors wroteBased on record review, interview, and policy review the facility failed to ensure residents received bed hold notification. This affected four (#6, #19, #21 and #38) of eight residents reviewed for discharge notification. The facility census was 101.

Inspectors wroteBased on record review, and interview the facility failed to ensure resident's Minimum Data Sets (MDS) assessments assessed the resident's cognition, mood and pain. This affected four Resident's (#5, #84, #105 and #303) of 27 reviewed for MDS. The facility census was 101.

Inspectors wroteBased on record review, observation, interview and policy review the facility failed to ensure residents had care plans developed and implemented for smoking, falls, activities, psychotropic medications, and range of motion. This affected five Resident's (#13, #43, #55, #58 and #84) of 27 residents reviewed for care planning. The facility census was 101.

Inspectors wroteBased on record review, and interview the facility failed to ensure a resident's care plan was revised. The facility also failed to provide residents with the ability to participate in the implementation and development of their care plans. This affected five (#5, #6, #19, #67 and #76) of 27 residents reviewed for care planning. The facility census was 101.

Inspectors wroteBased on medical record review, observation, and resident and staff interview, the facility failed to ensure activities were provided for a resident who was deaf , failed to ensure residents were assessed and that the activities met the residents interests. This affected four (#5, #19, #55 and #58) of seven reviewed for activities. The census was 101.

Inspectors wroteBased on record review, staff interview and review of the Resident Assessment Instrument (RAI) the facility failed to identify and complete a significant change assessment. This affected two Residents (#21 and #25) of 27 reviewed for resident assessments. The facility census was 101.

Inspectors wroteBased on record review and interview the facility failed to accurately code an injectable medication on the Minimum Data Set (MDS). This affected one Resident (#72) of five reviewed for unnecessary medications. The facility census was 101.

Inspectors wroteBased on record review and interview the facility failed to accurately complete a baseline plan of care within 48 hours of admission. This affected two Residents (#21 and #72) of 27 reviewed for baseline plan of care. The facility census was 101.

Inspectors wroteBased on medical record review, family and staff interview and policy review the facility failed to ensure restorative therapy was provided to residents. This affected one (#55) of one resident reviewed for rehabilitation and restorative care. The facility identified 23 residents who received rehabilitative services. The census was 101.

Inspectors wroteBased on record review observation, and interview and the facility failed to ensure a pressure reducing device was monitored and had the correct settings. his affected one Resident (#25) of six reviewed for pressure. The facility identified two residents who utilized alternating pressure mattress. The facility census was 101.

Inspectors wroteBased on record review, observation and interview the facility failed to ensure a resident with a history of weight loss and who was pocketing food received a speech evaluation. This affected one Resident (#27) of one reviewed for nutritional status. The facility census was 101.

Inspectors wroteBased on record reviews and staff interviews, the facility failed to ensure residents who were receiving psychotropic medications were assessed for non pharmaceutical interventions prior to receiving the medications and also failed to ensure gradual dose reductions were attempted for the use of psychotropic medications. This affected three (#30, #33, and #88) of three residents reviewed for unnecessary medications. The facility census was 101. Finds include: 1. Review of Resident #88's medical record revealed an admission date of 10/14/15. Diagnosis included hypertension, diabetes, schizophrenia, coronary artery disease anxiety disorder, chronic gout, major depressive disorder, insomnia, renal impairment, diverticulitis, acquired coagulation factor deficiency, and heart failure. [...]

Inspectors wroteBased on observations and staff interview, the facility failed to ensure expired medications and laboratory supplies were discarded appropriately and medications were secure and inaccessible to unauthorized staff. This affected two of two medication carts and an undetermined number of residents who utilize the medications and supplies from the storage rooms. The facility census was 101.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure laboratory tests were completed as ordered by the physician. This affected one (#33) of five residents reviewed for laboratory services. The facility census was 101.

Inspectors wroteBased on observations, record review, staff interview and review of facility policy, the facility failed to ensure medical records were complete, accurate and protected. This affected three (#5, #35 and #20) 27 of residents reviewed during the investigation portion of the survey. The facility census was 101.

Inspectors wroteBased on observations, staff interview, record review and review of the facility policy, the facility failed to implement their smoking policy in regards to supervising residents with smoking and smoking materials. This affected one (#84) of one resident reviewed for smoking. The facility census was 101.