Tiffany Square

Inspectors wroteLICENSE REFERENCE NUMBER TITLE 175 CHAPTER 12-006.09Based on record reviews, and interviews, the facility failed to follow practitioner orders for 1 resident (Resident 1) of 3 sampled residents. The facility census was 90.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)(iv)(5)Based on record review, interview, and observation the facility failed to re-evaluate and revise interventions to treat ongoing constipation for 4 of (Residents 57, 14, 30, and 75) residents sampled. The facility census was 77.

Inspectors wroteLicensure Reference Number 175 NAC 1-005.06(D)Licensure Reference Number 175 NAC 12-006.18(B)Based on observation, record review, and interview the facility failed to perform hand hygiene (hand washing using soap and water or an alcohol-based hand rub (ABHR) to remove germs for reducing the risk of transmitting infection among patients and health care personnel) prior to applying gloves for patient contact, and failed to maintain infection control for catheter use for Resident 42. The facility census was 77.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(H)Based on Record review and interviews, the facility failed to ensure approved diagnosis and monitoring for medications and side effects of antipsychotic medications for 2 of 5 residents reviewed (Resident 57 and Resident 10) as required. This had the potential for adverse side effects of antipsychotic medication to go unaddressed. The facility census was 77.

Inspectors wroteLicensure Reference Number 175 NAC 12-00.609 (H)(iii)(2) Based on observation, record review, and interview, the facility failed to provide wound care according to physcian orders for 2 residents, (Resident 2 and Resident 3) of 3 sampled residents, and the faccility failed to obtain physican orders for wound care for a pressure injury for 1 residnet (Resident 1) of 3 sampled residents. The facility census was 71.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.18B Based on observation, record review, and interview, the facility failed to use Enhanced Barrier Precautions during direct care and to clean lifts between resident use for 1 resident (Resident 3) of 3 sampled residents, failed to provide wound cleansing in a manner to prevent cross contamination for 1 resident (Resident 2) of 3 sampled residents. The facility census was 71.

Inspectors wroteLicensure Reference Number 175NAC 12-006.09(H) Based on observation, record review, and interview; the facility failed to ensure residents medication regimen was free from unnecessary psychotropic medications for 2 (Residents 10, and 32) of 6 sampled residents, and the facility failed to implement a stop date for a PRN (as needed) psychotropic medication for 1 (Resident 12) of 5 sampled residents. The facility census was 77.

Inspectors wroteLicensure Reference Number 175NAC 12-006.11(A)(i) Based on observation, interview and record review the facility failed to ensure that residents were served the required food portion size per the menu to meet nutritional needs for 50 of 58 residents (Residents 68, 19, 7, 57, 28, 5, 9, 47, 22, 36, 41, 32, 61, 49, 46, 71, 38, 45, 20, 63, 39, 14, 30, 279, 229, 59, 43, 64, 76, 48, 18, 52, 16, 53, 66, 3, 40, 74, 17, 51, 50, 75, 4, 62, 72, 24, 35, 29, 25, and 8). The facility census was 77.

Inspectors wroteLicensure Reference Number 175NAC 1-005.06(D) Licensure Reference Number 175NAC 1-005.06(F) Based on record review, interview, and observations; the facility failed to ensure staff complete hand hyigene between resident rooms while delivering laundry to prevent the potential for cross contamination for 4 (Residents 71, 16, 53, and 43) of 5 residents observed and the facility failed to ensure that oxygen equipment and supplies were maintained per infection control procedures as required for 1 of 2 residents (Resident 50). The facility census was 77.

Inspectors wroteLicensure Reference Number 175NAC 12-006.09(G)(i) Based on record review and interview; the facility failed to ensure that a recapitulation (a concise summary of the resident's stay and course of treatment in the facility) of the resident's stay was completed as required for 1 of 1 residents reviewed (Resident 78). The facility census was 77.

Inspectors wroteLicensure Reference Number 175NAC 12-006.10(D) Based on observation, record review, and interview, the facility failed to maintain a Medication Error rate less then 5% with an actual medication error rate of 12% (25 medication administrations were observed with 3 errors occurring) affecting 3 of 11 sampled residents (Residents 13, 30, and 33). The facilty census was 77.

Inspectors wroteLicensure Reference Number 175NAC 12-006.12(D)(vi) Based on observation, record review, and interview; the facility failed to ensure medications were labeled properly for 1 resident (Resident 229), of 11 sampled residents. The facility census was 77.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09D7b Based on observations, interviews, and record reviews, the facility failed to identify and implement interventions to prevent the potential for falls for 2 (Residents 3 and 1) of 3 sampled residents. The facility census was 77.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.011E Licensure Reference Number 175 NAC 12.006.017B Based on observation, interview, and record review, the facility failed to ensure the sanitizer (chemical cleaning) bucket was tested regularly and failed to ensure the top of the oven was clean to prevent food-borne illness. This had the potential to affect all 68 residents that consumed food from the kitchen; and the facility failed to serve meals to residents in a manner to prevent the potential for cross contamination (the spread of bacteria from one surface or resident to another). This affected 14 residents (Residents 29, 61, 36, 8, 37, 1, 35, 50, 56, 23, 20, 42, 59, and 118). The facility census was 68.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09B Based on record review and interview, the facility failed to reflect 1 resident's (Resident #22) of 1 sampled resident use of non-invasive Mechanical Ventilator (Trilogy) on the MDS (Minimum Data Set, mandated assessment used for care planning). The facility census was 68.

Inspectors wroteLicensure Reference Number 175NAC 12-006.09C1a Based on record review and interview the facility failed to ensure that the written summary of the baseline care plan (a written plan required to be developed within 48 hours of admission detailing the instructions needed to provide initial effective and person-centered quality care for a resident) was provided to the resident/resident representative in the required timeframe for 3 residents (Residents 5, 34, and 60). This prevented the resident/resident representative from participating in the care plan and identifying any additional care needed by the resident. The facility census was 68.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.17B Licensure Reference Number 175 NAC 12.006.17D Based on observation, interview, and record review, the facility failed to clean 3 (Resident 18, 41, and 26) of 6 sampled resident's nebulizer administration set (neb kit)(a system used to deliver liquid medications to the lungs) after each treatment and failed to perform hand hygiene (sanitizing) and change gloves when going from contaminated (dirty) process to clean process during wound care on 1 (Resident 18) of 4 sampled residents to prevent cross contamination (transfer of bacteria from one surface to another). The facility census was 68.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.09C Based on observation, interview, and record review, the facility failed to ensure the Comprehensive Care Plan (Care Plan)(the plan of how the facility will care for a resident) included oxygen use and nebulizer (a system used to deliver liquid medications to the lungs) treatments for Residents 18, 41, and 47, nebulizer treatments for Resident 26, non-invasive ventilator (a machine used to assist a resident in breathing by using a mask) for Residents 9 and 13, wound vacuum (vac) system for Resident 13, and oxygen use for Resident 6. This had the potential to affect 7 of 17 sampled residents. The facility census was 68.