Tower Road Post Acute, LLC

Inspectors wroteBased on observations, staff interviews, and review of the facility's policies titled, Food Storage: Cold Foods and Food Storage: Dry Goods, the facility failed to ensure opened food items in the walk-in refrigerator and dry storage area were labeled, dated, and discarded by expiration date. The deficient practice had the potential to affect residents who receive an oral diet from the kitchen.

Inspectors wroteBased on observations, staff and resident interviews, record review, and review of the facility policies titled, Abuse, Neglect and Misappropriations, the facility failed to protect residents by not reporting verbal abuse to the State Agency (SA) for one of 38 sampled residents (R) (R11). The deficient practice had the potential for other residents to experience verbal abuse.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled, Care Plans, Comprehensive Person-Centered, the facility failed to implement the care plan for one of 38 sampled residents (R) R19. Specifically, bilateral fall mats were not used in accordance with the care plan. This deficient had the potential to increase the risk of medical complications for R19Findings include:Review of the policy titled Care Plans, Comprehensive Person-Centered revised March 2022, Policy Statement revealed: A comprehensive, person-centered care plan that includes measurable, objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. [...]

Inspectors wroteBased on resident and staff interviews, record review, and review of the facility policy titled, Activities of Daily Living, the facility failed to provide assistance with activities of daily living (ADL) care for one of 38 residents (R) (R125) related to bathing.

Inspectors wroteBased on observations, staff interviews, record review, and a review of the facility policy titled, Oxygen Administration, the facility failed to ensure that two of 29 residents (R) (R1 and R125) were administered oxygen therapy in accordance with the physician's ordersFindings include:Review of facility policy titled Oxygen Administration revised date October 2010, revealed in section Purpose: The purpose of this procedure is to provide guidelines for safe oxygen administration. Under Preparation: 1. Verify that there is a physician's order for this procedure. Review the physician's order or facility protocol for oxygen administration. [...]

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policy titled, Infection Prevention and Control Policy, the facility failed to ensure proper infection control practices were followed for two of three residents (R) (R35 and R38) observed during medication administration. Specifically, during medication observation the nurse was observed administering medications without using hand hygiene prior to or after administering medications, did not wash or sanitize her hands before or after entering an enhanced barrier precaution room and then went to another room and administered medications. These deficient practices had the potential to lead to the spread of infection and illness.

Inspectors wroteBased on staff interviews, record review, and facility policy review, the facility failed to ensure the resident or responsible party (RP) was notified of a change in condition related to intravenous fluid and antibiotic use for one of nine sample residents (Resident (R) 4) reviewed for change in condition. This failure had the potential of R4 receiving treatments not aligned with the residents' or the responsible party's wishes for the residents' care.

Inspectors wroteBased on staff interviews and record review, the facility failed to provide an accurate Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) as required for one of three residents (Resident (R) 8) reviewed for beneficiary notices of nine sample residents. This failure could result in the residents not being informed of the residents' responsibility related to facility costs.

Inspectors wroteBased on observations, resident and staff interviews, and review of relevant facility documentation, the facility failed to maintain a safe, comfortable, homelike environment in resident rooms on three of three halls. Specifically, surveyor observations included peeling paint, missing air vent covers, holes in walls, bent/broken blinds, a broken light fixture pull cord, a loose electrical wall socket, and cracked floors. The sample size was 59 residents.

Inspectors wroteBased on observations, resident and staff interviews, and record review, the facility failed to maintain safe water temperatures below 120 degrees Fahrenheit (F) in 17 of 22 bathrooms sampled for water temperatures on three of three halls. This failure had the potential to cause serious injury to affected residents. The facility census was 118 residents.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policy titled, Resident Rights, the facility failed to maintain the dignity and privacy for one of five residents (R) (R50) with a Foley catheter. Specifically, the urinary catheter bag was left uncovered and visible while R50 was out in the hallway. Additionally, R50 was wearing a shirt on with her full name visible across her chest in thick black marker.

Inspectors wroteBased on observations, record review, resident and staff interviews, and review of the facility's policy titled, Self-Administration of Medications by Patients/Residents, the facility failed to ensure one of 59 sampled residents (R) (R13) was assessed for self-administration of medication prior to leaving medications at the bedside. The deficient practice had the potential to allow unauthorized access to unsecured medications to residents and visitors at the facility.

Inspectors wroteBased on observations, staff interviews, and review of the facility policy titled, Residents Rights Accommodation of Needs and Preference and Homelike Environment, the facility failed to accommodate the needs of one of 14 residents (R) (R112) reviewed for environmental concerns. Specifically, the facility did not ensure call light was within reach. This failure had the potential to prevent R112 from receiving care or service when needed.

Inspectors wroteBased on observations, staff interviews, and review of the facility policy, Visitation, the facility failed to have a system in place which allows visitors into the facility after hours.

Inspectors wroteBased on record review, staff interviews, and review of the facility policy titled, Review of the Beneficiary Notice, the facility failed to provide the Notice of Medicare Non-Coverage (NOMNC) (Form CMS-10123) to two of two residents (R) (R29 and R36) who remained in the facility and were discharged from Medicare Part A services.

Inspectors wroteBased on observations and record review, the facility failed to accurately document the dental status in the annual Minimal Data Set (MDS) assessment for one of 59 sampled residents (R) (R72). This failure had the potential to prevent R72 from receiving necessary dental care.

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled, PASRR, the facility failed to ensure that the Preadmission Screening and Resident Review (PASARR) Level II was completed for one of 59 sampled residents (R) (R92). The deficient practice had the potential for R92 to not receive specialized care to treat mental illness.

Inspectors wroteBased on resident, resident family, and staff interviews, record review, and review of the facility policy titled, Minimum Data Set (MDS) / Care Plans, the facility failed to develop and implement a baseline care plan within 48 hours of admission for five of 59 sampled residents (R) (R49, R22, R113, R15 and R70). The deficient practice had the potential to affect the appropriate level of care and services provided for R49, R22, R113, R15 and R70.

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled, Minimum Data Set (MDS) / Care Plans, the facility failed to develop and implement a comprehensive person-centered care plan that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs for three of 59 sampled residents (R) (R49, R111 and R92). The deficient practice had the potential to affect the care and services provided to R49, R111, and R92.

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled, Minimum Data Set (MDS/Care Plans, the facility failed to include the resident (R), family, or family representative attended baseline care plan meetings and care plan meetings for one of 59 sampled residents (R) (R15).

Inspectors wroteBased on responsible party and staff interviews, record review, and review of the facility policy titled, Discharge Planning, the facility failed to provide discharge instructions to the responsible party (RP) of one of 59 sampled residents (R) (R366) at discharge. The deficient practice had the potential for the RP of the discharging resident to not have the knowledge of the medications and therapy needs to properly care for the resident at home.

Inspectors wroteBased on observations, interviews, record review, and review of the facility's policy titled, AM Care, the facility failed to provide fingernail care for one dependent Resident (R) (R80). The sample size was 59.

Inspectors wroteBased on responsible party (RP) and staff interviews, and record review, the facility failed to make follow up appointments with physicians and transportation to physicians' appointments after discharge from the hospital for one of 59 sampled residents (R) (R366). The deficient practice had the potential to cause the resident to become unstable and possibly have to return to the hospital.

Inspectors wroteBased on observations, record review, resident and staff interviews, and review of the facility's policy titled, Oxygen Administration, the facility failed to follow physician orders for oxygen therapy for one of 15 residents (R) (R111) on oxygen therapy. The deficient practice posed significant risks, including potential medical complications, unmet needs, and a diminished quality of life.

Inspectors wroteBased on observations, staff interviews, and a review of the facility's policy titled Medication Storage, the facility failed to ensure medications and biologicals were discarded on or after the expiration date in two of three medication rooms. This deficient practice placed residents at risk of receiving medications or biologicals with altered effectiveness. The facility census was 118 residents.

Inspectors wroteBased on staff interviews, record review, and policy titled Hospice Program, the facility failed to ensure one of two residents (R) (R45) reviewed for hospice had a physician's order for hospice services.

Inspectors wroteBased on observations, staff interviews, record review, and review of facility policy titled Infection Prevention and Control, the facility failed to ensure proper infection control practices were followed during medication administration via a gastrostomy tube (G-tube) for one of one resident (R) (R39) reviewed with a G-tube, during perineal care for one of 59 sampled R (R50), and during tracheostomy care for one of one R (R39) reviewed with a tracheostomy. In addition, the facility failed to properly clean or disinfect shared medical equipment between residents and failed to ensure hand sanitizer dispensers were filled for staff use. These failures had the potential of exposing residents to infections due to cross-contamination.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure the resident call light system was maintained in working order for one of two hallways (West Hall). This deficient practice had the potential to cause delays in response to resident needs.

Inspectors wroteBased on record review and interviews, the facility failed to provide a written notice of transfer for one of two residents (R) (R#20) reviewed for hospitalization out of a total sample of 31 residents. The failure to provide a written notice of transfer increased the risk that the residents and/or representatives would not know the specifics of the transfer or the right to appeal.

Inspectors wroteBased on record review, interviews, and policy review, the facility failed to provide a written bed hold notice for one of two residents (R) (R#20) reviewed for hospitalization out of a total sample of 31 residents. The failure to provide a written bed hold notice increased the risk that the residents and/or representatives would not know to request a bed hold and/or the cost of the bed hold.

Inspectors wroteBased on record review, interviews, and policy review, the facility failed to respond to pharmacy recommendations for a written rationale for continuing a PRN (as needed) order for Ativan (antianxiety medication) beyond 14 days and to include a duration date in one of four residents (R) (R#88) reviewed for psychotropic medications in a total sample of 31 residents. This failure increased the risk of R#88 receiving an excessive amount of antianxiety medication.

Inspectors wroteBased on record review, observations, interviews, and policy review, the facility failed to: 1. Identify and implement resident specific nonpharmacological interventions for yelling out prior to prescribing Seroquel (an antipsychotic medication) and administered Seroquel without documented behaviors for one resident (R) (R#99); and 2. Prescribe PRN (as needed) Ativan (an antianxiety medication) for a limited time of 14 days and failed to provide a written rationale for extending the medication beyond 14 days for one of four residents (R#88) reviewed for unnecessary psychotropic medications out of a total sample of 31 residents. This failure increased the risk of adverse side effects from the use of psychotropic medications.