Totally Kids Rehabilitation Hospital - D/P SNF

Inspectors wroteBased on interview and record review, the facility failed to ensure the arbitration agreements (a private way to settle a legal disagreement outside of a traditional courtroom) provided with the selection of a venue convenient to facility and resident (both parties) for three of three sampled residents (Residents 27, 47, and 51). This failure had the potential to limit Residents' choices and access to a fair arbitration process and impede oversight of dispute resolution outcomes.

Inspectors wroteBased on interview and record review, the facility failed to ensure a comprehensive Minimum Data Set (MDS-a facility assessment and care planning process used by nursing home staff as required by the Centers of Medicare and Medicaid Services [CMS]) assessment was completed and submitted to CMS in accordance with the required federal submission timeframe for one of two sampled residents (Resident 23). This failure resulted in inadequate monitoring of progress or decline for Resident 23 and the lack of resident specific information to CMS for payment and quality measure monitoring.

Inspectors wroteBased on interview and record review, the facility failed to ensure the quarterly Resident Assessment Instrument/Minimum Data Set (RAI/MDS- a facility assessment and care planning process used by nursing home staff as required by the Centers of Medicare and Medicaid Services [CMS] every 3 months or quarterly) was completed in accordance with federal submission timeframes, for one of two residents (Residents 23) when Resident 23's quarterly RAI/MDS assessment was not completed within 92 days following the previous assessment. This failure had the potential to result in a delay in determining the resources necessary to competently care for the residents during day-to-day operations and emergencies for Resident 23.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Minimum Data Set (MDS-a facility assessment and care planning process used by nursing home staff as required by the Centers of Medicare and Medicaid Services [CMS]) assessments were accurately coded to reflect the residents' status, care, and services in active diagnoses under Section I for four (4) of 20 residents (Residents 1,19, 20, and 23). This failure had the potential to cause inaccuracy in identifying Resident 1, 19, 20, and 23's care and support needs.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan (an individualized plan that includes residents' health problems, preferences and goals) to meet the needs for one of three sampled residents (Resident 46) when Resident 46 was diagnosed and prescribed medication for new on-set seizures (uncontrolled changes in behaviors and movement) and Resident 46's care plan did not reflect this diagnosis. This failure had the potential for safety measures not to be in place, inadequate monitoring, and poor coordination of care which could lead to physical injury and rehospitalization.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory and tracheostomy (a surgically created hole in the front of the neck leading directly into the windpipe to help a patient breathe) care consistent with the facilities policy and procedure (P&P) for two of three sampled patients (Patients 14 and 46) when suction canisters (a disposable container that attaches to a suction machine to safely collect bodily fluids) and suction tubing (a hollow plastic tube connected to suction used to remove fluids, mucus, or blood from a patient's body) were not changed weekly and were available for continued patient use. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff followed safe infection control practices when one Licensed Vocational Nurse (LVN 3) did not perform appropriate hand hygiene (cleaning hands with soap and water or sanitizer to remove germs and prevent sickness) practices during wound care for one of one sampled resident (Resident 6). This failure had the potential to result in cross contamination (the transfer of harmful bacteria) and cause a preventable infection for (Resident 6).

Inspectors wroteBased on interview and record review the facility failed to ensure one of three sampled residents (Resident 1) was free from abuse as stated in the facility's policy and procedure (P&P) when a nursing student witnessed Certified Nurse Assistant (CNA 1) used verbally abusive words to Resident 1. This failure had the potential to result in Resident 1 having emotional harm such as feeling unsafe, loss of trust, and can lead to behavioral issues.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Minimum Data Set (MDS- a facility assessment tool that consists of the resident assessment instrument (RAI) and the care area assessment (CAA) was conducted and submitted to the Centers of Medicare and Medicaid Services (CMS) in accordance with federal submission timeframes, for nine of nine residents (Residents 1, 2, 6, 21, 23, 24, 31, 38, and 42) reviewed for resident assessment. These failures resulted in inadequate monitoring of progress or decline for Residents 1, 2, 6, 21, 23, 24, 31, 38, and 42), and a lack of resident specific information to be sent to CMS for payment and quality measure monitoring.

Inspectors wroteBased on interview and record review, the facility failed to ensure the pharmacists Monthly Medication Review (MRR- a review of patient medications by a pharmacist aimed at optimizing the health outcomes of residents) was reviewed in a timely manner for two of 50 residents dated October 1, 2024, through October 31, 2024, when the facility failed to implement a policy and procedure (P&P) that included timelines and steps to be followed once the MRR was received. This failure resulted in a delay of two months in physician review of the MRR recommendations provided by the pharmacist and had the potential for an urgent recommendation to go unnoticed, that could have resulted in residents' harm.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure infection control practices were developed and maintained for two of 20 sampled residents (Residents 7 and 10) when: 1. Enhanced Barrier Precautions (EBP - extra steps taken to prevent the spread of germs to vulnerable residents during close contact care by wearing gowns and gloves) were not implemented when providing wound care for one resident (Resident 10). 2. Sterile technique (the use of practices that restrict microorganisms in the environment and prevent contamination of the field) was not followed during urinary catheterization (procedure where a thin, flexible tube called a catheter is inserted into the urethra to drain urine from the bladder) for one resident (Resident 7). 3. Hand hygiene (hand washing) was not performed after resident care for one resident (Resident 7). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of 22 sampled residents (Resident 42) had a comprehensive care plan (an individualized plan for the medical care of a resident) in place for his tracheostomy (an opening into the trachea [windpipe] from outside the neck to help air and oxygen reach the lungs) and ventilator dependent status (someone who requires a machine [ventilator] to breathe because they are unable to breathe independently.) This failure had the potential for Resident 42 to have unidentified care concerns related to the monitoring and care of his tracheostomy or ventilator dependent status.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure controlled medications (medications that are controlled by the government because it may be abused or cause addiction) verification process was not accurately completed for two of seven medication carts (room [ROOM NUMBER] and room [ROOM NUMBER] medication cart) when the medication verification was not completed and signed with two (2) licensed nurses. This failure had the potential to cause the diversion (illegal distribution of controlled drugs for any illicit use) of controlled medications by staff in a highly vulnerable population of 50 patients.

Inspectors wroteBased on interview and record review the facility failed to ensure the PRN (as needed) lorazepam (anti-anxiety drug) medication order did not exceed 14 days time limitation without the prescriber's documented rationale in the resident's medical record for one (Resident 99) of five residents reviewed for medications. This failure had the potential to result in adverse health outcomes, including but not limited to exposure to unnecessary medications, side effects, and/or habit-forming mental or physical dependence.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a medication was stored in accordance with the facility's policy and procedure (P&P) when one bottle of Humulin R ( a short-acting medication used to lower blood sugar) 100 units per milliliter (ml-units of measurement) medication was found with an expiration date of [DATE] (33 days expired) in one of four medication emergency kits (E-Kit- a collection of medications and supplies that can be used to treat medical emergencies when pharmacy services are unavailable). This failure had the potential to cause unsafe medication administration and care during an emergency situation to residents from beyond the use date (expired) medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow safe and sanitary food storage practices when: - Seven onions located in the facility's dry storage area, were available for use and labeled with an expired use by date. - Ice cream in the facility's walk-in freezer was found unlabeled. These failures had the potential to compromise the integrity of the food and cause foodborne illness to three of fifty vulnerable residents who received food from the kitchen.

Inspectors wroteBased on interview and record review, the facility failed to ensure the quarterly Minimum Data Set (MDS- a facility assessment tool that consists of the resident assessment instrument (RAI) and the care area assessment (CAA)) assessment was completed and submitted to the Centers of Medicare and Medicaid Services (CMS) in accordance to federal submission timeframes, for four of four residents (Residents 41, 14, 8, and 21) reviewed for resident assessment. These failures resulted in inadequate monitoring of Residents 41, 14, 8, and 21's progress and decline, and the lack of resident specific information to CMS for payment and quality measure monitoring.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Minimum Data Set (MDS- a facility assessment tool) assessment was submitted and completed to the Centers of Medicare and Medicaid Services (CMS) in accordance with federal submission timeframes, for four of four residents reviewed for resident assessment (Residents 8, 14, 21, and 41). These failures resulted in inadequate monitoring of Residents 8, 14, 21, and 41's progress and decline, and the lack of resident specific information to CMS for payment and quality measure monitoring.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure correct medication administration technique was followed by one of the three sampled licensed staff (Registered Nurse [RN2]) when an extra dose of a Heparin flush (solution used for maintenance of patency of intravenous [IV-within vein] line was not properly wasted prior to administration Resident 24. This failure had a potential for medication error (observed or identified preparation or administration of medications which is not in accordance with the prescriber's order; manufacturer's specifications or accepted professional standards) which may lead to harm for Resident 24.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure accurate records of controlled medications (narcotic medications that are controlled by the government because it may be abused or cause addiction) were being maintained in accordance with their own policy and procedure for one of eight medication carts (room [ROOM NUMBER] medication cart). This failure had the potential for drug diversion (illegal distribution of controlled drugs for any illicit use) of controlled medications by the staff in a highly vulnerable population of 49 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure safe and sanitary practices were maintained in the kitchen when: 1. One portion scoop with a light brown residue was found in the kitchen drawer, stored with other clean utensils. 2. One can opener with rust (a reddish or a brown substance that forms on iron or steel) was found on top of a metal food prep counter. These failures had the potential for bacteria to grow and cause foodborne illness (nausea, vomiting, and/or diarrhea) in a highly susceptible population of two residents who received prepared food from the kitchen.

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate and complete documentation for one of three residents (Resident 17) reviewed for hydration when there were missing intake and output documentation's (used for the purpose of documenting and tracking information regarding the fluid given and removed from the resident) from December 9, 2023 to December 21, 2023 on Resident 17's medical record This failure had the potential for Resident 17 to have unmet care needs due to incomplete and inaccurate medical information.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a sanitary and safe medication storage when staff's personal items were found inside the medication cart. This failure had the potential for cross contamination and infection (the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect) which can jeopardize the health and safety of highly vulnerable population of 49 residents.