Totally Kids Specialty Healthcare - Sun Valley

Inspectors wroteBased on observation, interview and record review, the facility failed to provide care in a manner that promoted and maintained residents' rights for two of four sampled residents (Resident 2 and Resident 3) by failing to ensure Physical Therapy Assistant 1 (PTA 1) knocked on Resident 2 and Resident 3's door prior to entering Resident 2 and Resident 3's room. This deficient practice had the potential to compromise Resident 2 and Resident 3's dignity, privacy, autonomy (resident's right to make their own choices), self-esteem and sense of self-worth. a. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of three sampled staff (Certified Nursing Assistant 1 [CNA 1]) donned (put on) personal protective equipment (PPE - clothing and equipment that is worn or used to provide protection against hazardous substances and/or environments) in the appropriate order prior to entering the room of a resident who was placed on droplet precautions (infection control measure used to prevent transmission of infectious agents spread through respiratory droplets [tiny, moisture-filled particles of mucus and saliva expelled from the nose and mouth] which are generated by coughing, sneezing, or talking) and contact precautions (infection-control measure used to prevent the spread of germs transmitted through direct or indirect contact). [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow the facility menu by failing to serve the resident's hamburger bun, lettuce leaf, tomato slices, sweet potato fries, pea and cheese salad, and 1 percent (% - one part of every 100) milk as indicated on the facility menu to be served for lunch on 3/23/2026 for one of three sampled residents (Resident 2). This deficiency had the potential for Resident 2 to not receive the nutrition needed.

Inspectors wroteBased on interview and record review, the facility failed to Inform the resident and/or the responsible party in advance regarding the risks and benefits of administration of a vaccine (a substance that helps the body learn how to fight a specific disease without causing the illness itself) for one of five sampled residents (Resident 3) reviewed during the Infection Control task. This deficient practice resulted in Resident 3 receiving the COVID-19 (a vaccine designed to induce immunity against SARS-CoV-2 [the virus responsible for coronavirus disease 2019]) vaccine without Resident 3's responsible party knowing the risks and benefits of the vaccine prior to administration.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement comprehensive person-centered care plans (a plan for an individual's specific health needs and desired health outcomes) for six of 15 Resident 1, 10, 35, 2, 5, and 3) residents reviewed under care planning by failing to: 1. Develop a care plan addressing Resident 1's critically high (a test result that is so far outside the normal range that it indicates a potentially life-threatening situation) Depakote (brand name to valproic acid - medication used to treat epileptic seizures [sudden surge of abnormal electrical activity in the brain, causing jerking and stiffness]) laboratory value obtained on 10/10/2025. 2. Develop a care plan addressing a Resident 10`s oral care needs. 3. Develop a care plan addressing Resident 35's bowel and bladder program. 4. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide an environment that was free from accidents and hazards to three of three residents (Resident 1, 18, and 5) reviewed under the accidents care area by failing to: a. and b. Provide bilateral bed rail padding for Resident 1 and Resident 18, who have a history of seizures (a sudden surge of abnormal electrical activity in the brain, leading to a range of symptoms like muscle spasms, loss of consciousness). c. Implement the facility's policy on resident safety and care plans addressing use of a helmet when Resident 5 was observed wearing a soft helmet without a chin strap.

Inspectors wroteBased on interview and record review the facility failed to ensure physician's orders were obtain prior to the administration of the COVID-19 vaccine (a vaccine designed to induce immunity against SARS-CoV-2 [the virus responsible for coronavirus disease 2019]) for three of five sampled residents (Resident 5, Resident 35, and Resident 3). This deficient practice placed Resident 5, Resident 35, and Resident 3 at risk for experiencing adverse effects and for having contraindications or allergies that were assessed by a physician.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free of any significant medication errors by failing to ensure a resident was given clonidine (medication used to treat hypertension [high blood pressure - when the force of the blood pushing on the blood vessel walls is too high]) for its indication of use as ordered for one of five sampled residents (Resident 1). This deficient practice had the potential to cause adverse side effects and cause confusion in the delivery of care and services for the resident.

Inspectors wroteBased on interview and record review, the facility failed to implement the facility's immunization policy by failing to ensure residents' responsible parties were provided education regarding the influenza vaccine (prevents infection from influenza [a common, sometimes deadly viral infection of the nose, throat, and lungs]) for three of five sampled residents (Resident 5, Resident 35, Resident 3). This deficient practice had the potential for Resident 5, Resident 35, and Resident 3's responsible party to not be aware of the risks and benefits of the influenza vaccine.

Inspectors wroteBased on interview and record review, the facility failed to implement the facility's immunization policy by failing to ensure residents' responsible parties were provided education regarding the Coronavirus Disease vaccine (prevents infection from Coronavirus Disease [COVID-19, a severe respiratory illness caused by virus and transmitted from person to person]) for three of five sampled residents (Resident 5, Resident 35, Resident 3). This deficient practice had the potential for Resident 5, Resident 35, and Resident 3's responsible party to not be aware of the risks and benefits of the COVID-19 vaccine.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide care in a manner that maintained a resident's dignity and promoted respect by failing to ensure Licensed Vocational Nurse (LVN 1) knocked or request permission before entering the room of one of two sampled residents (Resident 37) reviewed under the dignity care area. This deficient practice violated the resident`s rights to be treated with respect and dignity and had the potential to negatively affect the resident's sense of self-worth and self-esteem.

Inspectors wroteBased on interview and record review, the facility failed to notify a resident's responsible party (RP-the person designated for all care decisions of a resident) regarding a change of condition for one of five residents (Resident 1) reviewed for unnecessary medications when the facility failed to notify Resident 1's responsible party (RP 1) of a critically high (a test result that is so far outside the normal range that it indicates a potentially life-threatening situation) Depakote (brand name to valproic acid - medication used to treat epileptic seizures [sudden surge of abnormal electrical activity in the brain, causing jerking and stiffness]) laboratory value (reference range was 50-100 micrograms per millimeter [mcg/ml-unit of measurement]) greater than 150 mcg/ml on 10/10/2025. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure confidential personal information of residents were protected by failing to ensure meal tickets containing protected information ([PHI]- any health information that can be used to identify specific individual which must remain confidential to prevent harmful consequences) were shredded prior to disposing in the trash receptable for two of six residents (Resident 5 and Resident 35) who receive food from the kitchen. This failure had the potential to violate the residents' rights to privacy and confidentiality of personal and medical records.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide the necessary services to maintain good grooming and personal hygiene for three of three sampled residents (Resident 10 and Resident 5) by failing to: 1. Ensure Resident 10 was provided oral care in accordance with the facility policy and procedure (P&P) titled Oral Hygiene, reviewed 12/3/2025, which indicated Each resident will be provided proper oral hygiene daily, beginning in the morning, after every meal, before bedtime, and as needed to maintain a healthy oral cavity and prevent complications of poor oral hygiene. This deficient practice placed the resident at risk for oral infections and tooth decay.2. Ensure Resident 5 and Resident 35's nails were trimmed. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure Registered Nurse (RN 1) maintained current CPR (cardio-pulmonary resuscitation - an emergency, life-saving technique performed when someone's breathing or heartbeat has stopped) certification for healthcare providers through a CPR provider whose training includes a hands-on session in accordance with accepted national standards for one of five staff members investigated during review of the staffing facility task. This deficient practice had the potential for delayed provisions of emergency care, including CPR to residents who wish to have full treatment in life threatening illnesses or injuries.

Inspectors wroteBased on interview and record review, the facility failed to implement a bowel (tube-shaped organ in the abdomen that completes the process of digestion) and bladder (a hollow organ that stores urine) training program (B&B retraining program - aim to establish or regain control over bowel and bladder function) for one of two sampled residents (Resident 5) by failing to ensure Resident 5 was placed on the toilet every two hours per physician's order. This deficient practice had the potential for Resident 5 to not their highest functional level and not establish or regain control over bowel and bladder function.

Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Obtain and document the weight of two of five residents (Resident 4 and Resident 32) reviewed under the nutrition care area in accordance with the physician's order. This deficient practice had the potential to prevent staff from identifying significant weight changes and addressing potential nutritional concerns. 2. Ensure the total volume of water to be infused via gastrostomy tube (G-tube, a feeding tube inserted through the abdomen to provide nutrition, fluids, and medications) was documented on the water bag label for one of three residents (Resident 22) reviewed under the hydration care area, in accordance with the physician's order. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure the facility's policy and procedure (P&P) titled, Medication Administration, reviewed 12/3/2025, was followed for one of eight residents (Resident 1) observed during medication administration, when Licensed Vocational Nurse 4 (LVN 4) failed to check placement of Resident 1's gastrostomy tube (G-tube, a tube inserted through the abdomen, to deliver nutrition and medications directly to the stomach) prior to administration of medications. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure seven medium-sized and six large-sized boxes of drinks and food items were not stacked higher than 18 inches from the ceiling in the dry storage area of the facility's kitchen. This failure had the potential to prevent water sprinkler clearance to reach the top of these boxes in the event of a fire and the potential for the boxes to fall and dent resulting in harmful bacteria growth for six of 37 medically compromised and vulnerable residents who received food from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to dispose garbage and refuse properly by failing to: 1. Ensure two of two black dumpsters (a movable waste container designed to be brought and taken away by a special collection vehicle, or to a bin that a specially designed garbage truck lifts) and one of one blue dumpster were completely closed while not actively being used. 2. Ensure there were no soiled gloves on the floor area and surroundings of the facility's dumpster. This deficient failure had potential to attract birds, flies, insects, pests, and possibly spread infection to 37 of 37 facility residents.

Inspectors wroteBased on interview and record review, the facility failed to electronically submit direct care staffing information daily, based on payroll data in the first quarter of 2024. This deficient practice had the potential to not provide the required staffing to ensure residents' care and safety.

Inspectors wrote3.a. During a review of Resident 22's admission Record, the admission Record indicated the facility originally admitted the resident on 1/6/2020 with diagnoses including cerebral palsy (central nervous system [CNS] motor disorders which are characterized by impairment of voluntary muscle movement), anoxic brain damage (condition when the brain is completely deprived of oxygen, causing damage to brain cells due to a lack of necessary oxygen supply), and convulsion (sudden , uncontrolled shaking of the body muscles, often associated with seizures). During a review of History and Physical, dated 1/7/2024, the History and Physical indicated that Resident 22 had seizures. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure drugs and biologicals were stored in accordance with accepted professional principals by failing to: 1. Ensure staff did not leave two of two medication carts (Medication Cart A and B) unlocked and unattended and leave medications unattended. This deficient practice had the potential for unsafe facility practices, unauthorized entry to the medication cart, and contamination of the prepared medications. 2. Ensure two opened (in-use) olopatadine hydrochloride (HCL) solution (type of eye drops used to treat eye itching) 0.1% (measurement of concentration) vials were discarded after 30 days after opening for one of one sampled resident (Resident 24). 3. [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure one of one sampled resident (Resident 16) with limited range of motion (ROM- full movement potential of a joint) received appropriate treatment and services to prevent further decrease in range of motion by failing to: 1. Provide Passive Range of Motion (PROM-when an outside force such as a therapist exclusively causes movement of a joint) exercises as ordered by the physician. 2. Develop and implement a person-centered care plan (a plan of care that summarizes a resident's health conditions, specific care and services facility staff need to provide a resident to promote healing and prevent a worsening of a condition, and current treatments) for Resident 16`s contracture. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident with a physician's order to wear a soft helmet when out of the crib was wearing the soft helmet when the resident was out of the crib for one of three sampled residents (Resident 13) This deficient practice placed Resident 13 at risk for injury if a fall incident occurred.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of two sampled residents (Resident 26) received the appropriate treatment and services for bladder incontinence (the loss of bladder control) by failing to apply warm compress and bladder massage prior to the in and out catheterization and failing to perform in and out catheterization (when the catheter is inserted and left in only long enough to empty the bladder and then is removed) as ordered by the physician. This deficient practice had the potential to result in the inadequate care and monitoring of Resident 26 and placed him at an increased risk of infection.

Inspectors wroteBased on interview and record review, the facility failed to implement their policy on intake and output by failing to ensure licensed nurses documented the residents output every shift for two of two sampled residents (Resident 18 and 8). This deficient practice had the potential to place Resident 18 and Resident 8 at risk for dehydration (deficit of total body water, with an accompanying disruption of body processes).

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement their enteral tube feeding (gastrostomy tube - GT, a surgical opening fitted with a device to allow feedings to be administered directly to the stomach common for people with swallowing problems) policy and procedure (P&P) for one of four sampled residents (Resident 4) investigated for gastrostomy tube care by failing to label Resident 4`s y-connector (a silicone tube used for patient with gastrostomy to deliver nutrition and medications directly to the stomach) with the date it was last changed. This deficient practice had the potential to place Resident 4 at an increased risk of infection and may cause adverse reactions (an undesired effect of a treatment) such as upset stomach and/or diarrhea (loose, watery stool more frequently than normal).

Inspectors wroteBased on interview and record review the facility failed to ensure residents who needed respiratory care (the health care discipline that specializes in the promotion of optimum cardiopulmonary function and health and wellness) was provided such care, consistent with professional standards of practice by failing to change the aerosol/ventilator (a machine that helps a person breathe by moving air in and out of their lungs) humidifier water bottle (equipment to produce and dispense water vapor, adding moisture to oxygen and restoring healthy level of humidity [the amount of water vapor in the air]) every three (3) days for one of three sampled resident (Resident 22) investigated for respiratory care. This deficient practice had the potential for Resident 14 to develop a respiratory infection.

Inspectors wroteBased on interview and record review, the facility failed to maintain complete and accurate medical records in accordance with accepted professional standards for one of three sampled residents (Resident 2) by failing to ensure a specific indication was written for an order of Augmentin (antibiotic- medication that fights bacterial infections). This deficient practice placed the resident at risk of not receiving appropriate care due to inaccurate resident medical care information and the potential to result in confusion in the care and services for Resident 2.

Inspectors wroteBased on interview and record review, the facility failed to provide an Arbitration Agreement (a legal contract that requires parties to resolve disputes through arbitration [a formal method of dispute resolution involving a third party who makes the binding decision] instead of going to court) that included the selection of venue (a location in which to carry out arbitration proceeding) which should be convenient to both parties (resident and facility) to ensure a fair arbitration process to the facility's residents. This deficient practice had a potential to not provide a neutral and fair arbitration process to the facility's residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement its policy titled, Sterile Tracheal Suction (a means of clearing the airway of secretions or mucus through the application of negative pressure via suction catheter) by failing to ensure that Respiratory Care Practitioner 2 (RCP 2) doffed (removing gloves in a way that avoids self-contamination [the act of contaminating oneself with potentially pathogenic organism]) nonsterile gloves before the donning (putting on personal protective equipment [PPE] to achieve the intended protection and minimize the risk of exposure) of sterile ( free of gems or living organisms, especially microorganisms) gloves when performing a sterile tracheal suction to one (Resident 4) out of five residents investigated during review of the infection control task. [...]

Inspectors wroteBased on interview and record review, the facility failed to electronically submit staffing information based on payroll data on a quarterly schedule to the Centers for Medicare & Medicaid Services (CMS) in 2022 for one of one fiscal (relating to a period of 12 months) quarter (Fiscal Quarter 4). The deficient practice prevented the provision of complete and accurate direct care staffing information to the public.

Inspectors wroteBased on interview and record review, the facility failed to ensure the facility's Shift Change Narcotic (a drug that in moderate doses dulls the senses, relieves pain, and induces profound sleep) Check document was signed by the facility's licensed nurses for three of 30 shift opportunities. This deficient practice had the potential to place the facility at an increased risk for the potential loss or diversion (illegal distribution of abuse of prescription drugs or their use for unintended purposes) controlled substances.

Inspectors wroteBased on observation, interview, and record review, the facility failed to document temperatures for three of three refrigerators and one of one freezer located in the facility's medication room as per the facility's policy and procedure. This deficient practice had the potential to compromise the therapeutic effectiveness of stored medication.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement the infection control practices by: 1. Failing to ensure one of three sampled staff (Housekeeping Staff [HS]) removed their gloves prior to exiting a resident's room and entering another resident's room. 2. Failing to ensure the facility's Infection Preventionist (IP) was able to articulate the facility's water management process to reduce the risk of Legionnaires' disease (a severe form of pneumonia [lung inflammation usually caused by infection]). The deficient practices had the potential to spread infection and cross contamination (the physical movement or transfer of harmful bacteria [germs] from one person, object, or place to another) among staff and other residents. 3. [...]

Inspectors wroteBased on interview and record review the facility failed to implement the facility's antibiotic stewardship program (a coordinated program that promotes the appropriate use of drugs used to treat infections, including antibiotics [a medicine that inhibits the growth of or destroys bacteria or germs]) by failing to provide documented evidence of the facility's monthly surveillance monitoring report for 11 of 11 months reviewed (1/2023- 11/2023). This deficient practice had the potential for residents to develop antibiotic resistance from unnecessary or inappropriate antibiotic use for future infections.

Inspectors wroteBased on interview and record review, the facility failed to notify the State Long-Term Care (LTC) Ombudsman (advocates for residents of nursing homes, board and care homes, and assisted living facilities) of transfers to the General Acute Care Hospital (GACH) from the facility for two of four sampled residents (Resident 13 and 15) investigated under the care area of hospitalizations. These deficient practices had the potential to deny residents protection from being inappropriately transferred or discharged .

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a person-centered care plan (a document designed to facilitate communication among members of the care team that summarizes a resident's health conditions, specific care needs, and current treatments) for two of seven sampled residents (Resident 13 and 5) by failing to: 1. Develop a comprehensive care plan for Resident 13's antibiotic (medicines that fight bacterial infections) therapy after they were readmitted to the facility with ongoing treatment for pneumonia (infection that affects one or both lungs). 2. Develop a comprehensive care plan for Resident 5 who had a physician order for hand mittens. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the facility provided care and services to maintain good grooming and personal hygiene for one of three sampled residents (Resident 5). This deficient practice resulted in Resident 5 having long fingernails that had the potential to result in a negative impact on the residents' self-esteem and self-worth.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement their enteral tube feeding (method of feeding that uses the gastrointestinal tract [relating to the stomach and intestines] to deliver nutrition and calories) policy by failing to ensure the gastrostomy tube (GT-an opening to the stomach from the abdominal wall made surgically for the introduction of food and medication) feeding formula was labeled with the time, date, and initial of the licensed nurse that first administered the feeding formula for one of three sampled residents (Resident 18). This deficient practice had the potential to result in the feeding formula to remain for more than the allotted time which could potentially cause an upset stomach and/or diarrhea.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents' admission pain risk assessment was accurately completed for two of three sampled residents (Resident 189 and Resident 33) This deficient practice had the potential to result in Resident 189 and Resident 33 not maintaining the highest possible level of comfort.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Annual Minimum Data Set (MDS - a comprehensive standardized assessment and screening tool) was completed within the required time frame for one of six sampled residents (Resident 27) investigated under Resident Assessment. This deficient practice had the potential to negatively affect the provision of necessary care and services for the residents.