Tremont Rehabilitation & Skilled Care Center

Inspectors wroteBased on observation, document review, and interview, the facility failed to ensure professional standards of practice were maintained when providing care for three Residents (#14, #75, and #10), out of a total sample of 19 residents. Specifically, the facility failed to ensure:1. For Residents #14 and #75, narcotic pain medications were administered in accordance with the prescribed parameters in the physician's order; and 2. For Resident #10, a splint/palm guard was not applied to the Resident's left hand after it was discontinued.

Inspectors wroteBased on observation, interview, and document review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and potential transmission of communicable diseases and infections. Specifically, the facility failed to:1. Maintain an infection prevention and control program which included a complete and accurate system of surveillance to identify any trends or potential infections; and2. Ensure nasal cannula oxygen tubing was stored in a sanitary manner to protect it from potential contamination by germs and environmental debris for one Resident (#14), out of a total sample of 19 residents.

Inspectors wroteBased on observation, document review, and interview, the facility failed to develop and implement a smoking policy, that included a process for their independent smokers ensuring designated smoking areas, proper receptacles for safe cigarette disposal, and the storage of the lighting and smoking materials for 8 out of 16 current smokers in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that medications were labeled and stored in accordance with accepted professional principles in one out of two medication carts observed. Specifically, the facility failed to ensure medications were stored in the container with the pharmacy label; and ensure topical use medications were stored separate from oral medications.

Inspectors wroteBased on document review and interview, the facility failed to provide written documentation related to transfer discharge notices and bed hold upon hospitalizations and ensure this information was part of the medical record for two Residents (#1 and #8), out of a total sample of 19 residents.

Inspectors wroteBased on observation and interview, the facility failed to provide an ongoing program of individual and group activities designed to meet the interests of and support the physical, mental, and psychosocial well-being of Residents on one (B Unit) of two nursing units and specifically for two out of 21 sampled Residents (#6 and #48). Specifically, the facility failed: 1. For Resident #6, to ensure that staff offered and encouraged engagement in activities according to their comprehensive assessment and identified preferences; 2. For Resident #48, to ensure that staff offered and encouraged engagement in activities according to their comprehensive assessment and identified preferences; and 3. To ensure staff provided a meaningful and engaging activity program, including materials for self-directed activity, for residents residing on the B Unit (secured).

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment, and to help prevent the development and potential transmission of communicable diseases and infections for four Residents (#294, #295, #40 and #144), out of a total sample of 21 residents. Specifically the facility failed: 1. For Resident #294, to maintain sanitary conditions of a nebulizer tubing set up and mask (parts of the nebulizer to administer aerosolized medications); 2. For Residents #295 and #40, to ensure appropriate personal protective equipment (PPE) was worn by staff while providing close contact care for a Resident on Enhanced Barrier Precautions (EBP); and 3. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow professional standards of practice for one Resident (#40), out of a total sample of 21 residents. Specifically, the facility failed to administer medications per physician's orders.

Inspectors wroteBased on observation, document review, and interview, the facility failed to ensure it provided an environment free of potential safety hazards for one Resident (#59 ), out of a total sample of 21 residents. Specifically, the facility failed to ensure medications were administered safely and not left at the Resident's bedside unsecured by the licensed staff.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents receiving psychotropic medications receive gradual dose reductions (GDR) unless clinically contraindicated, in an effort to discontinue these drugs for one Resident (#6), out of a total sample of 21 residents. Specifically, the facility failed to ensure a GDR of the antipsychotic medication Seroquel was attempted, unless documented by the prescriber as clinically contraindicated in the medical record.

Inspectors wroteBased on observation and interview, the facility failed to ensure all medications used in the facility were safely and securely stored in accordance with currently accepted professional principles. Specifically, the facility failed to ensure unauthorized personnel do not have unsupervised access to medications in one of two medication rooms as required.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff provided food that accommodated the allergies, intolerances, and preferences of one Resident (#85), out of a total sample of 21 residents. Specifically, the facility failed to ensure the Resident was not served gluten (a protein found in some grains including wheat) and onions despite being listed as allergens in the Resident's medical record; and sausage despite preferences listed to not receive.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were provided care in accordance with professional standards of practice for six Residents (#15, #36, #39, #47, #42 and #30), out of a total sample of 18 residents. Specifically, the facility failed: 1. For Residents #15, #36, #39, and #47, to ensure a physician's order was in place to transfer them to the hospital; and 2. For Resident #42, to ensure a physician's order was followed to obtain a blood pressure prior to administering antihypertensive medication (used to lower blood pressure); and 3. For Resident #30, to ensure Physician's orders were in place to include PICC line catheter flushing before and after administration of intravenous antibiotic medication according to professional standards of practice and facility policy.

Inspectors wroteBased on observations, interview, and policy review, the facility failed to ensure staff stored all drugs and biologicals used in the facility in accordance with currently accepted professional principles. Specifically, the facility failed to: 1. Ensure the medication and treatment carts were locked when not in direct supervision of the licensed nurse; and 2. Ensure safe storage of medications and biologicals according to current standards of practice.

Inspectors wroteBased on observation, policy review, and interview, the facility failed to follow their policy and professional standards of practice for food safety and sanitation to prevent the potential spread of foodborne illness to residents who are at high risk. Specifically, the facility failed to: 1. Ensure the main kitchen was maintained in a clean and sanitary condition; 2. Ensure two of two unit kitchenettes were maintained in a clean and sanitary condition; 3. Ensure food items were properly labeled, dated, and stored in the main kitchen; and 4. Ensure food items were properly labeled and dated in two of two unit kitchenettes.

Inspectors wroteBased on record review, document review, observations, and interviews, the facility failed to maintain an infection prevention and control program to help prevent the development and potential transmission of communicable diseases and infections. Specifically, the facility failed to: 1. Ensure COVID-19 testing was conducted in accordance with manufacturers guidelines during a COVID-19 outbreak; 2. Ensure Personal Protective Equipment was donned/doffed (put on/ taken off) according to current professional standards; and 3. Ensure Resident #48 performed hand hygiene prior to flushing his/her gastrostomy tube (G-tube inserted through the belly that brings nutrition and medication directly to the stomach).

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to notify the physician of a need to alter treatment significantly for two Residents (#9 and #30), out of a total sample of 18 residents. Specifically, the facility failed: 1. For Resident #9, to ensure the Resident's physician and Resident Representative (RR) were notified of the recommendations made by the Psychiatric Mental Health Nurse Practitioner (PMHNP) to adjust psychotropic medication because of the Resident's continued fluctuations of mood with paranoid behavior; and 2. For Resident #30, to ensure the physician was notified that STAT (urgent) labs were not obtained timely.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure that necessary information was communicated to the receiving health care institution to ensure a safe and effective transition of care for one Resident (#36), out of a total sample of 18 residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents were free from accident hazards for one Resident (#34), out of a total sample of 18 residents. Specifically, the facility failed to complete his/her quarterly smoking evaluation and safety screen.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure that necessary behavioral health care and services were provided to create an environment to maintain the highest psychosocial well-being for two Residents (#34 and #9), out of a total sample of 18 residents. Specifically, the facility failed to review and revise the behavioral health care plan when the Residents had a change in condition.

Inspectors wroteBased on document review and interview, the facility failed to conduct and implement a comprehensive facility wide assessment that was inclusive of resources necessary to provide both emergency and day to day care of the population the facility currently serves. Specifically, the facility failed to: 1. Ensure the identification for residents with special treatments and conditions the facility consistently provides services for was accurately completed; 2. Failed to identify facility Resources needed to provide competent support and care for resident population every day and during emergencies; and 3. Failed to accurately identify Managing Health Care System.