Titusville Rehabilitation & Nursing Center

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure sufficient nursing staff was available on 1 of 3 units to meet residents' needs related to the timely administration of scheduled medications, (Unit 2).

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services in accordance with professional standards of practice by: failing to appropriately dispose of medications during medication administration for 1 of 2 residents reviewed during medication pass observations (#4); failing to accurately account for and document controlled substance administration and maintain security of medications for 1 of 4 residents reviewed for narcotic administration, (#11); and failing to administer medications according to physician orders and the facility's established medication administration schedule for 10 residents on 1 of 3 units reviewed, out of 19 sampled residents, (#1, #3, #5, #13, #14, #15, #16, #17, #18, and #19).

Inspectors wroteBased on interview, and record review, the facility failed to maintain a complete and accurate medical record for one of one residents sampled for wound treatments, of a total sample of 19 residents, (#3).

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Quality Assurance and Performance Improvement (QAPI) committee implemented, monitored, evaluated, and revised a Performance Improvement Plan (PIP) to address identified concerns related to narcotic accountability and diversion prevention. The facility failed to ensure corrective actions were sustained after identifying repeated narcotic management concerns, resulting in continued deficiencies related to narcotic accountability, documentation, and medication management practices.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Quality Assessment & Assurance (QAA) / Quality Assurance and Performance Improvement (QAPI) committee conducted performance improvement activities to ensure prior improvement measures were sustained.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services to maintain the highest practicable physical well-being by failing to prevent a facility acquired pressure ulcer, implement revisions to the pressure ulcer care plan after a change in wound status, and failing to implement physician orders for existing pressure ulcers for 2 out of 2 residents reviewed for pressure ulcers, of a total sample of 44, (#7, & #107).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure frying pans, refrigerated foods, and spices were stored under clean and sanitary conditions, dry food was stored at the appropriate temperature; prepare, distribute and serve food in a manner to prevent food borne illness, by failing to maintain potentially hazardous pureed and regular foods at the correct hot holding temperature for four residents on a puree diet, and 57 residents on regular house diet, of a total population of 93 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to honor resident rights in regard to self-determination for 1 of 7 residents reviewed for reviewed for choices, of total sample of 44 residents, (#63).

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for 1 out of 2 residents reviewed for care plans, of a total sample of 44 residents, (#99).

Inspectors wroteBased on observation, interview, and record review, the facility failed to revise the comprehensive care plan to include wound management for 1 of 2 residents reviewed for non-pressure related skin conditions, of a total sample of 44 residents, (#36).

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide appropriate care consistent with professional standards of practice, and treatment to promote healing of other skin conditions for 1 of 4 residents reviewed for skin conditions, of a total sample of 44 residents, (#107).

Inspectors wroteBased on observation, interview, and record review, the facility failed to monitor supplemental oxygen therapy for 1 of 2 residents reviewed for respiratory care, of a total sample of 44 residents, (#1).

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain complete and accurate medical records for 1 of 2 residents reviewed for non-pressure related skin conditions, of a total sample of 44 residents, (#36).

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide maintenance services necessary to maintain a homelike environment for residents on 2 of 3 units, (100 unit and 200 unit).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the provision of care for blood pressure monitoring for 1 resident, (#2), reviewed for Quality of Care, and failed to ensure staff implemented physician orders to ensure residents received treatment and care in accordance with professional standards of practice, (#5), of a total sample of 7 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain accurate documentation for medication administration for 1 out of 7 sampled residents, (#7).

Inspectors wroteBased on interviews from the Resident Group Meeting and record reviews, the facility did not promote an environment for residents to voice grievances about care and treatment without fear of discrimination, and/or reprisal.

Inspectors wroteBased on Resident Group interview, and record review, the facility failed to properly and promptly respond to Resident Council concerns and grievances.

Inspectors wroteBased on Resident Group meeting, review of Resident Council Minutes, and interview, the facility staff failed to review and inform residents of their rights in the facility.

Inspectors wroteBased on observation, interviews and record review, the facility failed to provide ongoing program of activities designed to meet the interests, and physical, mental, and psychosocial well-being of the residents for 3 out of 3 residents sampled for activities, of a total sample of 68 residents, (#10, #39, and #80).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure sufficient nursing staff was available to ensure residents received the nursing care and related services required to timely administer medication and failed to provide sufficient nursing staff to meet the residents' individualized care needs on all shifts on 2 of 3 Wings, (100, 200).

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure scheduled medications were administered within parameters on the 7 AM to 3 PM shift for 31 residents on the 100 Wing, of a total sample of 68 residents, (#3a #20, #77, #354, #3b #16, #33, #26 #68 #84, #5, #59, #56,#88, #34, #50, #95, #47, #19, #58, #651 #52 #55 #37, #38, #91,#89, #35,#23,#64, and, #14).

Inspectors wroteBased on interview and record review, the facility failed to ensure the Quality Assessment & Assurance (QAA) / Quality Assurance and Performance Improvement (QAPI) committee conducted performance improvement activities to ensure prior improvement measures were sustained.

Inspectors wroteBased on interview and record review, the facility failed to refer residents with a newly evident mental disorder for Level II Preadmission Screening and Resident Review (PASARR) evaluation and determination and failed to request a Level 1 PASARR evaluation for resident with new mental disorder diagnosis for 2 of 6 residents reviewed for PASARR, (#1, & #72), of a total sample of 68 residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure a Level 1 Preadmission Screening and Resident Review (PASARR) evaluation was accurate upon admission for 1 of 1 residents reviewed for PASARR accuracy, of a total of 68 residents, (#93).

Inspectors wrote2. Resident #25 was admitted to the facility on [DATE] with diagnoses including major depressive disorder, chronic atrial fibrillation, cardiac arrhythmia, unspecified glaucoma, hypertension and generalized anxiety disorder. Review of the Minimum Data Set (MDS) quarterly assessment with assessment reference date of [DATE] revealed resident #25 had a Brief Interview for Mental Status score of 13 which indicated she was cognitively intact. She did not exhibit any behavioral symptoms and did not reject care that was necessary to achieve her goals for health and well-being. The document revealed resident #25 had a diagnosis of unspecified glaucoma. A care plan for potential for impaired visual function related to history of glaucoma was initiated on [DATE] and revised [DATE]. Interventions included, Administer medication as ordered. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide documentation of education, proof of consent, or medical contraindication for both influenza and pneumococcal vaccines for 4 of 5 residents reviewed for influenza and pneumococcal immunizations, of a total sample of 68 residents, (#5, #10, #44, and #55).

Inspectors wroteBased on interview, and record review, the facility failed to follow policy and procedure related to Full Code status leading to a delay in initiating Cardiopulmonary Resuscitation (CPR) for 1 of 5 residents reviewed for Advance Directives of a total sample of 68 residents, (#100). Resident #100 a-[AGE] year-old male was admitted to the facility on [DATE]. His diagnoses included anemia, type II diabetes, occlusion and stenosis of the carotid artery. The resident was admitted to Hospice services on [DATE] with diagnosis of moderate protein-calorie malnutrition. The resident's physician's order dated [DATE] noted full resuscitation. Progress note dated [DATE] at 6:30 AM, documented by Licensed Practical Nurse (LPN) A read, Patient has expired Hospice notified MD (Medical Doctor) notified. Resident #100 died at the hospital on [DATE]. [...]

Inspectors wroteBased on interview and record review the facility failed to report potential abuse and/or neglect violations with respect to a delay in cardio-pulmonary resuscitation (CPR) due to inaccurate and incomplete investigation, for 1 of 1 resident reviewed for reporting of alleged abuse and/or neglect, of a total sample of 68 residents, (#100).

Inspectors wroteBased on observation, record review and interview, the facility failed to maintain kitchen equipment, cookware and refrigerators, in a clean, sanitary, and functional condition. The kitchen staff also failed to ensure milk was returned to the vendor or discarded after the expiration date.

Inspectors wroteBased on interview and record review, the facility failed to report an alleged violation of abuse for 1 of 1 resident reviewed for abuse of a total sample of 45 residents (#50).