Torrington Center for Nursing & Rehabilitation LLC

Inspectors wroteBased on review of the clinical record, facility documentation, facility policy, and interviews for one (1) of four (4) residents (Resident #3) reviewed for change in condition, the facility failed to notify the physician when a resident was exhibiting behaviors that included agitation, anxiety, and aggression.

Inspectors wroteBased on review of the clinical record, facility documentation, facility policy, and interviews for one (1) of four (4) residents (Resident #4) reviewed for abuse, the facility failed to ensure a resident who was exhibiting verbal and physical behaviors did not physically abuse another resident.

Inspectors wroteBased on review of the clinical record, facility documentation, facility policy, and interviews for one (1) of three (3) residents (Resident #3) reviewed for behaviors, the facility failed to ensure a comprehensive care plan with appropriate interventions was implemented for a resident who exhibited physical and verbal behaviors.

Inspectors wroteBased on clinical record review, review of facility policy and interviews for nine sampled residents (#26, #27, #32, #43, #50, #61, #64, #69, and #376) reviewed for care planning, the facility failed to ensure the interdisciplinary team (IDT) resident care plan meetings were held following comprehensive and quarterly assessments and failed to ensure comprehensive care plans were developed by the IDT team with resident/family/responsible party involvement.

Inspectors wroteBased on review of the resident council meeting minutes, review of facility documentation, review of facility policy and interviews, the facility failed to respond to concerns identified by the resident council regarding the need to speak with a Social Worker in the facility.

Inspectors wrote1. Based on observations, and interviews, the facility failed to provide a homelike, safe, and sanitary environment for two shower rooms on the central and middle unit and for the identified carpeted areas on the central unit.

Inspectors wroteBased on clinical record reviews and interviews for five sample residents (Resident #26, #35, #69, and #376) who required psychosocial support, the facility failed to ensure a Social Worker was available to meet resident needs.

Inspectors wroteBased on review of facility documentation, facility policy and interviews, during a review of the facility antibiotic stewardship program, the facility failed to ensure that the facility's antibiotic surveillance tracking form was completed as directed and failed to ensure that the reports presented at the monthly and quarterly medical staff meetings contained the Antibiotic Stewardship review.

Inspectors wroteBased on observations, interviews, facility documentation, and policy for the facility Infection Prevention position, the facility failed to ensure the Infection Preventionist had appropriate time to complete IP duties at the facility.

Inspectors wroteBased on review of the clinical record, review of facility policy, and interviews for one of three sampled residents (Resident #27) reviewed for advance directives, the facility failed to accurately document the resident's life support choices. The acute care Hospital Discharge summary dated [DATE] identified Resident #27's code status (directs the medical team to administer or withhold life support systems in the event of a cardiac or respiratory arrest) was: full resuscitation (all resuscitative and aggressive curative treatments are provided). Resident #27 was admitted to the facility on [DATE] with diagnoses that included metabolic encephalopathy, dementia, and pneumonia. [...]

Inspectors wroteBased on observation, clinical record review, review of facility policy, and interviews for one of five sampled residents (Resident #59) observed for medication administration, the facility failed to ensure that an extended-release medication was not crushed and that a physician's order was in place to administer crushed medications to a resident.

Inspectors wroteBasedonclinicalrecordreview reviewoffacilitypolicy andinterviewsforoneofthreesampledresidents(Resident#26) reviewedfordischargeplanning thefacilityfailedtodevelopadischargeplaninatimelymanner Thefindingsinclude Resident#26 wasadmitted inthefacilityon7/3/24 withdiagnosesthatincludedpericardialeffusion hypertensiveheartdiseasewithheartfailure orthostatichypotension atrialfibrillation andimplantablecardiacdefibrillator Theinitialcareplandated7/4/24 identifiedthefocusedareaofdischargeplanningwithandinterventiontoevaluateshorttermorlongtermstayplacementandsocialserviceevaluation TheadmissionMDSassessmentdated7/10/24 identifiedResident#26 waswithoutcognitivedeficits andrequiredextensiveassistancefortoileting hygiene bedmobility dressing andtransfers Theassessmentfurtheridentifiedtheresidentreceivedoccupationalandphysicaltherapyandhadadischargeplaninplace [...]

Inspectors wroteBased on clinical record review, review of facility documents, review of facility policy, and interviews for one sampled resident (Resident #69) reviewed for activities. The facility failed to provide weekend recreation activities.

Inspectors wroteBased on observations, review of the clinical record, review of facility policy and review of facility documentation for two of four sampled residents (Resident #1 and #27) reviewed for skin conditions, the facility failed to implement the neurologist's orders for over 3 months and failed to ensure a compression glove ordered for dependent edema and comfort was applied and removed, per the physician's orders.

Inspectors wroteBased on clinical record review, facility policy review, and interviews for one of three sampled residents (Resident #36) reviewed for accidents, the facility failed to ensure adequate supervision was provided during toileting resulting in a fall.

Inspectors wroteBased on observations, review of facility policy and procedures, and interviews, the facility failed to ensure expired medications were not in use and removed from the medication cart, and failed to ensure medications were stored according to the manufacture's recommendation.

Inspectors wroteBased on observations, review of facility documentation, review of facility policy/procedures and interviews, the facility failed to ensure proper hand hygiene was utilized by staff and failed to ensure the infection prevention and control policies were reviewed and signed annually.

Inspectors wroteBased on clinical record reviews, review of facility documentation, review of facility policy, and interviews for two of two sampled residents (Resident #35 and #73) reviewed for hospitalization and discharge, the facility failed to provide the required notification of the transfer to the state Ombudsman's office.

Inspectors wroteBased on clinical record review, facility policy review, and interviews for 4 of 27 sampled residents (Resident #30, #35, #47, and #376) reviewed for resident assessment, the facility failed to ensure a yearly comprehensive assessment was completed.

Inspectors wroteBased on clinical record reviews, facility policy review, and interviews for 21 of 27 sampled residents (Residents #1, #8, #9, #10, #13, #15, #21, #29, #32, #33, #40, #43, #49, #52, #57, #59, #61, #63, #64, #67, and #68) reviewed for resident assessment, the facility failed to ensure quarterly MDS assessments were completed timely.

Inspectors wroteBased on observations, clinical record review, facility documentation review, facility policy review, and interviews for one of three residents (Resident #1) reviewed for abuse, the facility failed ensure the resident was free from mistreatment.

Inspectors wroteBased on record review and staff interview for 1 of 1 sampled resident (Resident #79) reviewed for an indwelling urinary catheter (foley catheter), the facility failed to ensure the Resident Care Plan (RCP) was comprehensive to include the presence and interventions related to the presence of an indwelling urinary catheter.

Inspectors wroteBased on observation, review of the clinical record, facility documentation, and interviews for 1 of 2 residents (Resident #430) reviewed for pressure ulcers, the facility failed to ensure appropriate settings were identified and maintained for an air mattress and failed to ensure Resident #430 was provided off-loading of the heels.

Inspectors wroteBased on clinical record review, facility documentation and interview for 1 resident (Resident #28) reviewed for Preadmission Screening and Resident Review (PASRR) and for 1 of 1 sampled resident (Resident #79) reviewed for an indwelling urinary catheter, the facility failed to code the Minimum Data Set correctly.

Inspectors wroteBased on review of the facility Minimum Data Set (MDS) assessment completions and staff interview for 7 of 7 residents (Resident #1, Resident #2, Resident #3, Resident #4, Resident #5, Resident #6 and Resident #7), the facility failed to ensure discharge MDS' were transmitted.

Inspectors wroteBased on observation, review of the clinical record, facility documentation, facility policy, and interviews for 1 of 4 residents (Resident #19) reviewed for falls, the facility failed to provide appropriate assistance to prevent a fall with injury.

Inspectors wroteBased on clinical record review and interviews for 1 of 1 sampled reviewed for weight loss (Resident #30), the facility failed to ensure a resident with special dietary and safety needs had a nutritional assessment in a timely manner and for 1 resident reviewed for hydration (Resident #62), the facility failed to ensure a nutritional assessment was completed quarterly according to facility policy.

Inspectors wroteBased on clinical record review and interviews for 2 of 4 residents reviewed for psychoactive medications (Resident #43 and Resident #73), the facility failed to ensure there was an indication for the use of an antipsychotic medication and target behaviors were not identified or monitored.

Inspectors wroteBased on observations, review of facility documentation, review of facility policy, and interviews for 2 of 2 nourishment refrigerator freezers, the facility failed to intervene when temperatures were out of acceptable range and maintain, clean, or defrost the nourishment refrigerator freezers per the facility policy.

Inspectors wroteBased on observation, review of the clinical record, facility documentation, facility policy, and interviews for 1 of 1 sampled resident observed eating with plastic cutlery (Resident #44), the facility failed to ensure a dignified dining experience and for 1 of 1 sampled residents reviewed for dignity (Resident #56), the facility failed to ensure Resident #56 was treated in a dignified manner.

Inspectors wroteBased on review of the clinical record, facility documentation, facility policy, and interviews for 1 of 18 residents reviewed for advance directives (Resident #228), the facility failed to provide documentation of an advance directives and/or ensure physician progress notes accurately reflected Resident #228's code status.

Inspectors wroteBased on review of the clinical record, facility documentation, facility policy, and interviews for 1 of 4 residents reviewed for psychoactive medications (Resident #43) the facility failed to ensure the resident care plan was comprehensive for the use of an antipsychotic.

Inspectors wroteBased on review of the clinical record, facility documentation, facility policy, and interview for 1 resident (Resident #30) reviewed for accidents and who sustained a fracture, the facility failed to revise the care plan in a timely manner after the resident was injured in the shower.

Inspectors wroteBased on clinical record review and interviews for 1 of 1 sampled resident reviewed for activities (Resident #24), the facility failed to ensure Resident #24 was able to attend activities of choice.

Inspectors wroteBased on review of the clinical record, facility documentation, facility policy, and interview for 1 resident (Resident #30) reviewed for accidents and who sustained a fracture, the facility failed to provide care according to physician's orders and/or professional standards of practice.

Inspectors wroteBased on review of the clinical record, facility documentation, facility policy and interviews for 1 resident (Resident #2) reviewed for dialysis, the facility failed to administer medications and fluids according to the physician's orders, and failed to provide ongoing communication and collaboration with the dialysis provider and the physician, and/or consistently monitor fluid intake/output per physician's orders.

Inspectors wroteBased on observations, review of facility documentation, review of facility policy, and interviews for 2 of 2 medication storage rooms, the facility failed to ensure that medications were dated when opened and/or discarded of when expired.

Inspectors wroteBased on observation, review of the clinical record, facility documentation, facility policy and interview for 1 resident (Resident #56) who had a history of a Multi-Drug Resistant Organism, (MDRO; common bacteria that have developed resistance to multiple types of antibiotics), the facility failed to implement transmission based precautions in a timely manner and/or implement infection control practices according to professional standards.

Inspectors wroteBased on observation, review of the clinical record, facility documentation, facility policy, and interviews for 1 resident reviewed for personal property (Resident #44), the facility failed to address a resident's grievance in a timely manner.

Inspectors wroteBased on clinical record review and interview for 6 of 22 residents selected for resident assessments (Resident #2, Resident #6, Resident #17, Resident #19 and Resident #30 and Resident #32), the facility failed to ensure resident Minimum Data Set (MDS) assessments were completed and/or transmitted and/or submitted per regulatory timeframes.