The Nicol Home

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide a written notice for a transfer for Resident (R)5, R7, and R26 (or their representatives) when they were transferred to the hospital or the bed hold policy. The facility also failed to complete a discharge summary with a recapitulation (a concise medical document required during discharge from a long-term care facility or nursing home. It summarizes the resident's course of treatment, diagnoses, and medical progress) of R33's stay when R33 was discharged from the facility.

Inspectors wroteBased on observation, record review, and interview, the facility failed to initiate interventions to prevent the development of a Stage 2 pressure ulcer (localized injury to the skin and/or underlying tissue usually over a bony prominence, because of pressure, or pressure in combination with shear and/or friction) for Resident (R) 26.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents. Based on the interview and record review, the facility failed to submit complete and accurate information to the federal regulatory agency through Payroll Based Journaling (PBJ) when the facility failed to submit accurate staffing hour date for all direct care personnel as required. This placed the residents at risk for unidentified issues with inadequate staffing.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents. Based on observation, record review, and interview, the facility failed to develop a comprehensive care plan that addressed the individual resident needs for Resident (R)17, R12, R5, R13, and R26. This placed the residents at risk for impaired care due to uncommunicated needs.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents, with seven reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure an appropriate indication, or a documented physician rationale, which included the unsuccessful attempts for nonpharmacological symptom management and risk versus benefit for continued use for Resident (R)4, R13, R2, and R12s' antipsychotic (a medication used to treat any major mental disorder characterized by a gross impairment testing) medication and failed to ensure a 14-day stop date or specified duration for R13 and R12's ongoing as needed (PRN) antianxiety (a class of medications that calm and relax people with excessive anxiety, nervousness, or tension). This placed the residents at risk for unintended effects related to psychotropic (alters mood or thought) drug medications.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents. Based on observation, record review, and interview, the facility failed to revise the resident's care plan to reflect the resident's current health needs for Resident (R)3. This placed the resident at risk for impaired care due to uncommunicated care needs.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents, with three reviewed for quality of care. Based on observation, record review, and interview, the facility failed to implement interventions to prevent skin tears for Resident (R) 3 and failed to provide general skincare and services for R29, who had multiple sores on his arms. This placed the residents at risk for further skin injury and related complications.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents of which eight residents were reviewed for falls. Based on observation, record review, and interview, the facility failed to identify and implement interventions to prevent Resident (R) 25 and R13 from falling which placed the residents at risk for further falls and injuries.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents. Based on observation, record review, and interview, the facility failed to provide Resident (R) 2 with the appropriate treatment and services to attain the highest practicable mental and psychosocial well-being. This placed the resident at risk for unmet mental health care needs.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents. Based on observation, record review, and observation, the facility failed to ensure the Consultant Pharmacist (CP) identified and reported Resident (R) 12 and 13's as needed (PRN) antianxiety medication without a stop date and the lack of an approved indication, or the required documentation, for the use of an antipsychotic (a class of medications used to treat major mental conditions that cause a break from reality) medications for R12 and R2. This placed the residents at risk for inappropriate and/or unnecessary medication.

Inspectors wroteThe facility had a census of 30 residents. The sample included 13 residents. Based on observation, interview, and record review, the facility failed to implement antibiotic use protocols to avoid unnecessary and/or inappropriate antibiotic use to reduce the risk of adverse events, including antibiotic resistance, when the facility failed to monitor effectiveness and evaluate appropriateness for the extended administration of prophylactic antibiotics for Resident (R) 5 and R12. This placed the resident at risk for complications related to antibiotic use including the development of antibiotic-resistant organisms.

Inspectors wroteThe facility had a census of 31 residents. The sample included 12 residents. Based on observation, interview, and record review, the facility failed to label Resident (R)12, and R29's insulin (hormone which allows cells throughout the body to uptake glucose) vial with the date opened and expiration date, failed to discard R2's expired insulin pen and failed to discard expired stock medications in one medication cart. This placed the affected residents at risk for ineffective medications.

Inspectors wroteThe facility had a census of 31 residents. The sample included 12 residents with five reviewed for immunizations. Based on interview and record review the facility failed to assess four sampled residents for the eligibility to receive the pneumococcal (pneumonia infection that inflames air sacs in one or both lungs which may fill with fluid) )vaccine, Resident (R) 3, R5, R14, R28. This placed the residents at risk for illness and pneumonia infection.

Inspectors wroteThe facility had a census of 31. The sample included 12 residents. Based on record review, interview and observation the facility failed to treat residents with respect, dignity, and privacy during medication administration. This placed the resident at risk for impaired psychosocial wellbeing.

Inspectors wroteThe facility had a census of 31 residents. The sample included 12 residents with five reviewed for unnecessary medication. Based on observation, interview and record review the facility failed to care plan the use of antipsychotic medications (class of medications used to manage delusions, hallucinations, and paranoia). This deficient practice placed Resident (R)3 at risk for unmet care needs related to the use of the antipsychotic medications.

Inspectors wroteThe facility had a census of 31 residents. The sample included 12 residents. Based on observation, record review and interview the facility failed to complete a safe-smoking evaluation for one sampled resident, Resident (R) 6. This placed the resident at risk for unsafe smoking practices and accidents while smoking.

Inspectors wroteThe facility had a census of 31 residents. The sample included 12 residents with one reviewed for bladder incontinence. Based on observation, interview and record review the facility failed to develop and initiate a toileting program for Resident (R) 4 who was assessed as being a good candidate for bladder retraining to improve urinary continence. This deficient practice placed R4 at risk for increased incontinence.

Inspectors wroteThe facility had a census of 31 residents. The sample included 12 residents with five reviewed for unnecessary medication. Based on observation, interview and record review the facility failed to ensure the Consultant Pharmacist (CP) identified and reported to the physician and the director of nursing (DON) that antipsychotic medications (class of medications used to manage delusions, hallucinations, and paranoia) had an inappropriate diagnosis per CMS (Center for Medicare/Medicaid Services) guidelines. The facilty further failed to ensure the phsyician responded to the CP's recommendation. This deficient practice placed Residents (R)3, R14, and R26 at risk for adverse effects from the use of the antipsychotic medications.

Inspectors wroteThe facility had a census of 31 residents. The sample included 12 residents with five reviewed for unnecessary medication. Based on observation, interview and record review the facility failed to ensure antipsychotic medications (class of medications used to manage delusions, hallucinations, and paranoia) were used for an appropriate diagnosis per CMS (Center for Medicare/Medicaid Services) guidelines. This deficient practice placed Residents (R)3, R14, and R26 at risk for adverse effects from the use of the antipsychotic medications.