Trinidad Rehabilitation and Healthcare Center

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents were kept free from physical abuse for six (#3, #1, #7, #2, #5 and #6 ) of 9 residents reviewed for abuse out of nine sample residents. Specifically, the facility failed to: -Protect Resident #3 from physical abuse by Resident #4;-Protect Resident #1 from physical abuse by Resident #2;-Protect Resident #7 and Resident #2 from physical abuse by each other; and,-Protect Resident #5 and Resident #6 from physical abuse by each other.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents received treatment and care in accordance with professional standards for one (#1) of five residents reviewed for failure to transcribe and initiate the physician's orders out of nine sample residents. Specifically, the facility failed to ensure Resident #'1 post hospitalization orders for hematoma care were entered into the electronic medical record (EMR) and followed.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure residents received treatment and care in accordance with professional standards for one (#1) of five residents reviewed for maintaining resident health records out of nine sample residents. Specifically, the facility failed to ensure physicians' progress notes for Resident #1 were available in the electronic medical record (EMR).

Inspectors wroteBased on observations and interviews, the facility failed to store, prepare, distribute, and serve food in a sanitary manner in the facility's kitchen and dining room. Specifically, the facility failed to: -Ensure nourishment beverages in the main dining room and unit refrigerators were dated and labeled; -Ensure cooking utensils were dried appropriately; -Ensure food preparation area vents were free from hanging dust and lint; -Ensure the main dining room refrigerator maintained a safe operating temperature; and, -Ensure dented food cans were not used.

Inspectors wroteBased on record review and interviews, the facility failed to complete a performance review of every nurse aide at least once every 12 months and provide regular in-service education based on the outcome of these reviews for four of four staff reviewed. Specifically, the facility had not completed annual performance reviews and/or provided regular in-service education based on the outcome of the reviews for certified nurse aide (CNA) #2, CNA #3, CNA #5 and CNA #6.

Inspectors wroteBased on record review and interviews, the facility failed to ensure residents had a right to participate in the development and implementation of their person-centered plan of care for one (#2) of one resident out of 37 sample residents. Specifically, the facility failed to invite Resident #2's representative to participate in the care conferences to review the resident's plan of care.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure the resident environment remained as free of accident hazards as possible for one (#87) of three residents reviewed for accidents/hazards out of 37 sample residents. Specifically, the facility failed to ensure Resident #87 had an order for a medication (Aleve) found at his bedside or a self medication assessment.

Inspectors wroteBased on interviews and record review, the facility failed to ensure two (#18 and #19) of four residents investigated for abuse out of 37 sample residents were kept free from physical abuse. Specifically, the facility failed to: -Prevent a physical altercation between Resident #93 and Resident #19, and, -Prevent a physical altercation between Resident #71 and Resident #18.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#80) of three residents with skin conditions of 37 sample residents received the highest practicable treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan. Specifically, the facility failed to identify, assess, monitor and care plan a large growth on Resident #80's face.

Inspectors wroteBased on observations, record review, and interviews the facility failed to use a person-centered approach when determining the use of bed rails for four (#27, #36, #40, and #70) of ten residents reviewed for bed rails out of 37 sample residents. Specifically, for Resident #27, #36, #40 and #70, the facility failed to: -Assess the resident for risk of entrapment prior to installing the bed rails; -Obtain consent, which included the risks versus benefits of bed rails, from the resident and/or the resident's representative prior to bed rail installation; and, -Conduct quarterly assessments of the bed rails to evaluate the safety and/or continued need for bed rails.

Inspectors wroteBased on record review and interviews, the facility failed to ensure three (#2, #21, #54) of five residents reviewed for unnecessary medications out of 37 sample residents were free from unnecessary medications. Specifically, the facility failed to: -Ensure Resident #2, Resident #21 and Resident #54 had appropriate non-pharmacological interventions for behaviors initiated; and, -Ensure informed consent, which included the risks associated with taking a psychotropic medication, were obtained from the resident or resident's representative before the resident's use of a psychotropic medication for Resident #2, Resident #21 and Resident #54.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that the hospice services provided met professional standards and principles that applied to individuals providing services in the facility for one (#89) of five residents receiving hospice services out of 37 sample residents. Specifically, the facility failed to orient hospice aides to the facility, including the policies and procedures.

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure freedom from abuse for six (#14, #19, #29, #36, #37 and #66) of six residents reviewed out of 52 sample residents. Specifically, the facility failed to protect Residents #29, #37 and #66 from physical abuse by Resident #36 who was physically aggressive toward others and protect Resident #14 from physical abuse by Resident #19. Cross reference F609 failure to report abuse allegations.

Inspectors wroteBased on record review and interviews the facility failed to report to the state survey and certification agency, in accordance with state law, five of five incidents of physical abuse stemming from resident-to-resident altercations in the memory care unit. The facility failure to report alleged abuse involved six (#14, #19, #29, #36, #37 and #66) of six residents reviewed for abuse reporting out of 52 sample residents.

Inspectors wroteBased on record review and interviews, the facility failed to provide written notice of the bed hold policy before transfer to the hospital to the residents or their representatives in a sample of four ( #248, #63, #80 and #60) of four out of 52 total sample residents reviewed. Specifically the facility failed to ensure: Resident #248, #63, #80 and # 60 were informed,in writing of the bed hold policy, when they were transferred to the hospital from the facility.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure the dietary department followed safe practices to prevent the potential contamination of food and spread of food-borne illness through proper kitchen sanitation procedures. Specifically, the facility failed to ensure: -Holding temperatures were at appropriate level; -Adequate hand washing occured; -Moisture was not between stacked pans; and, -Health shakes were appropriately dated.

Inspectors wroteBased on record review, and staff interviews, the facility failed to conduct and document a facility-wide assessment to determine and identify what resources are necessary to care for its residents appropriately during both day-to-day operations and emergencies. Specifically, the facility failed to develop a facility assessment which was specific to the residents of the facility.

Inspectors wroteBased on staff, medical director interviews and record review, the facility failed to ensure all responsibilities of the medical director were effectively performed, which had the potential to affect all residents of the facility. Specifically the facility failed to ensure: -The medical director fulfilled his responsibility for the implementation of resident care policies or the coordination of medical care in the facility; and, -Participated in the Quality Assessment and Assurance (QAA) committee or assigned a designee to represent him/her.

Inspectors wroteBased on record review and staff interview the facility failed to have in effect a written transfer agreement with one or more hospitals approved for participation under Medicare and Medicaid programs in order to reasonably ensure residents would be transferred from the facility to a hospital, and assured of timely admission to the hospital when transfer was medically appropriate.

Inspectors wroteBased on interviews and record review, the facility failed to ensure an effective quality assurance program to identify and address facility compliance concerns was implemented, in order to facilitate improvement in the lives of nursing home residents, through continuous attention to quality of care, quality of life, and resident safety. Specifically, the quality assurance performance improvement (QAPI) program committee failed to identify and address concerns related to, abuse prevention and reporting, kitchen sanitation, staff competencies, meaningful activities, medication administration, facility assessment, unnecessary medications.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure for three (#25, #82, and #94) of six residents who receive Medicaid benefits were notified out of 52 total sample residents. Specifically, the facility failed to ensure: -Residents/legal representatives were notified when personal funds account reached $200.00 less than resource limit allowed for one person.

Inspectors wroteBased on record review, staff interview, the facility failed to inform two of three sample residents (#18 and #96) of changes in services covered by Medicare, in a timely and appropriate manner. Specifically, the facility failed to demonstrate that residents who previously received skilled nursing facility services (SNF), funded through Medicare benefits, had received timely and appropriate written notice of discontinuation of benefits and notice of liability.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure five (#1, #78, #26, #77 and #37) of 10 residents reviewed for activities of 20 sample residents had an ongoing activity program based on comprehensive assessments, care plans and resident preferences. Specifically, the facility failed to provide person centered, meaningful activities that met the interests and needs of Residents #1, #78, #26, #77 and #37.

Inspectors wroteBased on record review and interview, the facility failed to ensure five out of five nurses were able to demonstrate competencies in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care. Specifically, the facility failed to conduct comprehensive competencies in skills for nurses.

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure six (#14, #19, #29, #36, #37 and #66) of six residents reviewed out of 52 sample residents received the appropriate treatment and services to maintain their highest practicable physical, mental, and psychosocial well-being. The facility was aware that Resident #36 with a diagnosis of dementia with behavioral disturbance and had physical resident-to-resident altercations with four residents (#29, #36, #66 and #37) when she resided on the secured unit. The facility failed to comprehensively assess and effectively identify person-centered approaches for dementia care for Resident #36 by addressing repeated behavioral issues created an environment where the 16 other residents residing on the secured unit were at risk for harm. [...]

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure it was free of a medication error rate of five percent or greater for two (#8 and #96) out of nine residents observed during medication administration. Specifically, the facility failed to: - Ensure the correct strength of Refresh eye drop was administered to Resident #96, - Ensure prescribed medications were administered at the scheduled time for Residents #8 and #96, - Ensure Resident #8's mouth was rinsed after the administration of his inhaler, - Prevent an error rate of 36.67%, resulting from eleven medication errors out of 30 opportunities.

Inspectors wroteBased on observations and interviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility failed to provide assistance with hand hygiene to the residents before meals.

Inspectors wroteBased on staff interviews and resident record review, the facility failed to designate a resident representative to advocate for the resident and ensure advance directives matched the resident's current needs and wishes for one (#83) of three residents reviewed out of 52 sample residents. Specifically, the resident was not provided an opportunity to have interested parties attend care plan conferences, and be involved in advanced directives as the resident's health and ability to participate had declined.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#94) of one out of a total of 52 sampled residents who entered the facility with limited mobility and range of motion received appropriate services and assistance to maintain or improve mobility with the maximum practicable independence unless a reduction in mobility was demonstrated as unavoidable, out of 52 sample residents. Resident #94, who required supervision with ambulation in his room and on the corridor had a decline in his mobility which showed he no longer ambulated in the corridor and required limited assistance in his room. He had an avoidable decline in his walking ability after staff failed to assess for interventions. The staff failed to update the care plan with interventions and to initiate recommendations for walking with the resident. [...]

Inspectors wroteBased on observations, staff interviews, and record review the facility failed to ensure residents were free from accidents for two of one residents (#61) out three out of 52 total sampled residents. Specifically the facility failed to ensure: -Resident #61 received appropriate assessments, interventions, and post-fall reviews to ensure further falls were prevented. (Cross-reference to F695).

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure appropriate respiratory services were provided for one (#61) of five residents reviewed out of 52 sample residents. Specifically, the facility failed to ensure physician orders were followed and respiratory care was provided per professional standards for Resident #61. Cross-reference to F689, accident hazards

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure for two (#16 and #248) of six residents reviewed for the use of unnecessary medications out of 52 total residents were free from unnecessary drugs. Specifically, the facility failed to: -Ensure gradual dose reduction was attempted for Resident #16; and -Provide non pharmacological interventions for Resident #248 before administering antipsychotic medications.

Inspectors wroteBased on record review and interview, the facility failed to have sufficient staff with the appropriate competencies in skills and techniques necessary to care for residents ' needs, as identified through resident assessments, and described in the plan of care. Cross reference F838-failed to have a completed comprehensive facility assessment Specifically, the facility failed to: -Provide a completed facility assessment and with the lack of skill competencies the facility could not make sure the cares provided were up to professional standards; and, -Document and ensure the above CNAs and CNA-MED had completed competencies in skills and techniques.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to ensure food was stored, prepared, and served under sanitary conditions in one of one kitchens. Specifically, the facility failed to ensure: -Appropriate hand hygiene by food service staff.

Inspectors wroteBased on record review and interview, the facility failed to conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies. Specifically, the facility failed to have a comprehensive facility assessment. I.

Inspectors wroteBased on observations and staff interviews, the facility failed to provide sufficient support personnel competent to carry out the functions of the dietary service for one of two dining rooms. Specifically, the facility failed to ensure an adequate system was in place to provide meal services in a timely fashion to residents seated in the secured dining room.

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure for one (#42) of 34 residents had a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility out of 34 sample residents. Specifically, the facility failed to allow Resident #42 a visit with a lawyer for a change of power of attorney (POA). I. Professional reference Shari D Caton, Esq. Colorado Bar association, Power of Attorney, http://www.cobar.org/portals/cobar/repository/SLH/chap23.pdf (2/12/19), .Does a power of attorney take away a principal's rights? A power of attorney does not take away a principal ' s right to make decisions. An agent simply has the power to act along with the principal in accordance with the authorization set forth in the document. [...]

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure a resident who is unable to carry out activities of daily living receives the necessary services and assistance during meals for one (#77) of four residents reviewed for meal assistance of 34 sample residents. Specifically, the facility failed to provide timely assistance during a meal for Resident #77.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to provide an ongoing program to support residents in their choice of activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for three (#84, #3 and 58) of eight residents reviewed for activities out of 34 sample residents. Specifically, the facility failed to: -Ensure Resident #84, #3 and #58 were invited and encouraged to attend activities of their preference.

Inspectors wroteBased on resident and family interviews and record review, the facility failed to ensure the resident received treatment and care in accordance with professional standards of practice, their comprehensive, person centered care plan and the residents choice for one (#55) of five residents reviewed for supplemental oxygen use out of 34 sample residents. Specifically, the facility failed to notify Resident #55s physician of low oxygen saturation levels (SATs); and did not educate or remind the resident when he was found without his oxygen on.