The Terrace Transitional

Inspectors wroteBased on interview and record review, it was determined there was a delay in care for a resident complaining of leg numbness and weakness for 1 of 4 sampled residents. Resident identifier: 1. Findings Include: Resident 1 was admitted to the facility on [DATE] and discharged on 6/30/2024 with diagnoses of wedge compression fracture of the thoracic (t) vertebra of t7-t8 , multiple rib fractures, muscle weakness, cognitive communication deficit, and schizophrenia. On 6/26/2024 at 12:38 PM, a provider documented a cranial nerve exam and neurological exam was conducted on resident 1 due to complaints of being unable to move or feel their legs for the last day. The provider documented no abnormalities were noted. Resident 1 had been able to feel and move their lower extremities at the time of the exam. [...]

Inspectors wroteBased on interview and record review, the facility did not develop and implement written policies and procedures that; prohibit and prevent abuse, neglect, and exploitation of residents. Specifically, for 2 out of 5 sampled staff members, the facility did not follow their abuse policy by screening prospective employees licenses prior to employee working with residents.

Inspectors wroteBased on interview, observation and record review it was determined, for 12 of 36 sampled residents, that the facility did not have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment. Specifically, there were observations of resident's call lights alarming up to 30 minutes before assistance was provided, residents complained of long call light wait time and resident council minutes revealed resident concerns with staffing. Resident identifiers: 10, 12, 14, 20, 29, 34, 38, 56, 58, 70, 133 and 383.

Inspectors wrote2. Resident 22 was admitted to the facility on [DATE] with diagnoses which included spastic hemiplegia affecting right dominate side, intracranial injury without loss of consciousness, muscle weakness, hypothyroidism, hypertension, pressure hydrocephalus, epilepsy, schizophrenia, and major depressive disorder. Resident 22's medical record was reviewed on 8/25/24 through 8/28/24. On 10/23/23, resident 22's TSH level was 0.079 which was low. It was written on the laboratory results Reduce Levothyroxine to 125 mcg [micrograms] recheck in 6 weeks. Signed with a date of 10/26/23. A physician's order dated 10/26/23, revealed TSH one time a day for lab. On 12/7/23, there was a laboratory results that revealed Test not performed. Insufficient specimen to perform or complete. A physician's order dated 2/4/24, revealed CBC and CMP urgently for lethargy. [...]

Inspectors wroteBased on observation, interview, and record review it was determined, for 10 of 36 sampled residents, that the facility did not provide food prepared by methods that conserve flavor and appearance or provide food and drink that was palatable, attractive, and at an appetizing temperature. Specifically, there were multiple complaints from residents about the quality of the food, there were multiple resident council complaints about the flavor of the food, and a test tray was bland to the taste with overcooked foods. Resident identifiers: 10, 12, 14, 20, 28, 34, 38, 56, 59, and 68. Findings Include: On 8/25/24 at 12:51 PM, an interview was conducted with resident 10. Resident 10 stated that the food served at the facility was not good. Resident 10 stated that the food served gave her diarrhea. [...]

Inspectors wroteBased on observation and interview, the facility did not 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. Specifically, for 1 out of 36 sampled residents, a medication was touched by bare hands and administered to a resident and hallway meal trays were not delivered in a sanitary manner. Resident identifier: 28. Findings Included: 1. On 8/27/24 at 7:44 AM, an observation was made of Registered Nurse (RN) 4 during medication pass. RN 4 removed a pill that was taped back into a bubble pack. RN 4 was unable to remove the pill from the tape and pulled the pill off the tape and dropped the pill into the medication cup. RN 4 administered the pill to resident 28. [...]

Inspectors wroteBased on observation and interview, it was determined for 1 out of 36 sampled residents, the facility did not treat each resident with respect and dignity and care for each resident in a manner in an environment that promoted maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. Specifically, a resident was covered in towels in a shower chair with the sides of her buttocks exposed and being pulled backwards through the hallway. Resident Identifier: 56.

Inspectors wroteBased on observation and interview the facility did not provide, 4 of 36 sampled residents, the right to have secured and confidential personal and medical records. Specifically, the computer screen was left open on the medication carts with resident personal information and a nurse report paper was left face up on the medication cart with resident personal information. Resident identifiers: 4, 8, 70, and 76.

Inspectors wroteBased on interview and record review, the facility did not ensure that the transfer or discharge was documented in the resident's medical record and appropriate information was communicated to the receiving health care institution or provider. Specifically, for 1 out of 36 sampled residents, a resident did not have any transfer documentation in their medical record when they were transferred to the hospital. Resident identifier: 8.

Inspectors wroteBased on interview and record review, the facility did not provide written information to the resident or resident representative that specifies the duration of the state bed-hold policy, if any, during which the resident was permitted to return and resume residence in the nursing facility. Specifically, for 2 out of 36 sampled residents, resident's were transported to the hospital and were not informed of the facility bed-hold policy. Resident identifiers: 8 and 56.

Inspectors wroteBased on interview and record review, the facility failed to ensure that each resident received adequate supervision to prevent accidents. Specifically, for 2 out of 36 sampled residents, a resident that was considered an elopement risk with a wandergaurd left the facility unattended and the resident was a smoker without a smoking assessment. In addition, another resident that had an unwitnessed fall and did not have neurological checks completed. Resident identifiers: 59 and 185.

Inspectors wroteBased on interview and record review, the facility did not provide pharmaceutical services which included procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident. Specifically, for 1 out of 36 sampled residents, the resident did not have gabapentin available. Resident identifier: 14.

Inspectors wroteBased on interview and record review it was determined, for 2 of 36 sampled resident, that the facility did not ensure that each resident's drug regimen was free from unnecessary drugs. An unnecessary drug was any drug when used in excessive dose; or for excessive duration; or without adequate monitoring; or without adequate indications for its use; or in the presence of adverse consequences which indicate the dose should be reduced or discontinued; or any combinations of the reasons above. Specifically, blood pressure medication was administered when a residents blood pressure was outside of the physician ordered parameters. In addition, another resident missed his antipsychotic and diuretic medication because he was scheduled for dialysis during the scheduled administration time. The same resident was not administered insulin according to physician's orders. Resident identifiers: [...]

Inspectors wroteBased on observation and interview, the facility did not ensure safe and secure storage of drugs and biologicals in accordance with accepted professional principles; or include the appropriate accessory and cautionary instructions, and the expiration date on the medication. Specifically, an opened multi-dose vial in the medication cart had exceeded the 28 day expiration date, an insulin pen was not dated with the date it was opened, and bubble packs had medication taped back in. Resident identifiers: 28.

Inspectors wroteBased on interview and record review, the facility did not establish an antibiotic stewardship program that included antibiotic use protocols and a system to monitor antibiotic use. Specifically, for 1 out of 36 sampled resident, staff were not aware of who and why a resident was ordered prophylaxis antibiotics. Resident identifier: 56.

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility did not provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Specifically, surveyors made multiple observations of the lunch and meal services being served and delivered later than the posted meal times, there were multiple resident complaints about food being served late and cold, and there were multiple recent resident council notes documenting resident complaints about food being served cold and late. Resident Identifiers: 12 and 28. Findings Include: The following meal times were provided upon entrance: [...]

Inspectors wroteBased on observation and interview it was determined, for 5 of 27 sampled residents, that the facility did not provide a safe, clean comfortable and homelike environment. Specifically, resident wheelchairs were dirty and a lift was dirty. Resident identifiers: 13, 17, 33, 34, and 52.

Inspectors wroteBased on observation, interview, and record review it was determined, for 12 of 27 sampled residents, that the facility did not serve food that was prepared by methods that conserved nutritive value, flavor, and appearance or serve food and drink that was palatable, attractive, and at a safe and appetizing temperature. Specifically, residents complained of cold and unappetizing food. In addition, green beans and peas were overcooked and resident council minutes revealed residents' complaints of food quality. Resident identifiers: 1, 7, 13, 20, 34, 37, 41, 45, 49, 55, 59, and 61. Findings Included: 1. On 12/13/22 at 2:56 PM, resident 1 was interviewed. Resident 1 stated that the eggs were usually cold and not good. 2. On 12/13/22 at 3:01 PM, resident 7 was interviewed. Resident 7 stated that the food was always cold by the time they received it. 3. [...]

Inspectors wroteBased on observations and interviews, it was determined that the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. Specifically, uncooked meats were stored above ready to eat foods, there were soiled areas in the kitchen, cracked paint, missing grout and broken tiles. Findings Include: 1. On 12/13/2022 at 9:46 AM, an initial tour of the kitchen was conducted. The following was observed: a. In the walk-in refrigerator, a box of raw hamburger patties was found stored above breadsticks. b. Inside the walk-in freezer there were large chunks of ice on the floor and ice circles hanging from the ceiling. c. The door handle from the kitchen to the dining room was observed to have crumbs and debris in it. d. There was cracked paint and drywall under the vents above the stove. e. [...]

Inspectors wroteBased on observation, interview and record review it was determined, for 1 of 27 sampled residents, that based on the comprehensive assessment residents were not provided the necessary care and services to ensure that a resident's abilities in activities of daily living did not diminish. Specifically, a resident was not provided oral care and was observed with build up on her teeth. Resident identifier: 33.

Inspectors wroteBased on interview and record review it was determined, for 1 of 27 sample residents, that the facility did not ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible. Specifically, a resident did not receive brief changes, skin checks, and toileting services in coordination with good nursing care and outlined in the resident's care plan. Resident identifier: 24.

Inspectors wroteBased on interview and record review, it was determined for 1 of 27 residents that the facility failed to reevaluate the risks versus benefits of the installed side rails for a resident. Specifically, one resident had a skin tear occur from the use of the current side rail. Resident identifier: 3. Findings Include: Resident 3 was admitted to the facility on [DATE] with diagnoses which included heart failure, type 2 diabetes mellitus, morbid obesity, and reduced mobility. On 12/13/22 at 12:01 PM, an interview was conducted with resident 3. Resident 3 stated she injured her left forearm on the inside of the side rail. Resident 3 stated that the inside of her side rail had something that stuck out for her to put her remote in. Resident 3 stated that her arm slid off the side of the rail and scraped the part for the remote-control holder. [...]

Inspectors wroteBased on observation, interview and record review it was determined that the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. Specifically, recently-washed dishes were observed to be placed with clean dishes when the dishmachine did not reach the manufacture required temperatures for sanitation. In addition, there was no process to track when health shakes were removed from the freezer and placed in the refrigerator.

Inspectors wroteBased on observation, interview and record review, it was determined for 5 of 22 sample residents, that the facility did not ensure the resident's environment remained as free from accident hazards as possible and that each resident received adequate supervision and assistance to prevent accidents. Specifically, residents were observed to not be using smoking equipment and a resident sustained feet injuries while operating an electric wheelchair without a follow-up assessment or intervention. In addition, a resident did not have items available to prevent falls. Resident identifiers: 22, 34, 35, 50 and 58.

Inspectors wroteBased on observation, interview, and record review it was determined, for 2 of 22 sample residents, that the facility did not assist residents in obtaining routine and 24-hour emergency dental services and did not promptly, within 3 days, refer residents with lost or damaged dentures for dental services. Specifically, the facility did not follow-up when a resident's dentures did not fit properly and were painful to wear and another resident had painful teeth with bleeding gums. Resident identifiers: 1 and 49.

Inspectors wroteBased on interview and record review it was determined that the facility did not employ a clinically qualified full-time dietitian or another clinically qualified nutrition professional to serve as the director of food and nutrition services. Specifically, the facility did not a employee a full time Registered Dietitian (RD) and the Dietary Manager (DM) did not meet the requirements to serve as the director of food and nutrition services.