Tupper Lake Center for Nursing and Rehabilitation

Inspectors wroteBased on interviews and record review during a recertification survey from 1/22/2024 to 1/30/2024, the facility did not ensure a Registered Nurse was scheduled for at least 8 consecutive hours a day, 7 days a week. Specifically, no registered nurse worked on 1/28/2024. This is evidenced by: Record review of the written working schedule for 1/28/2024 revealed no registered nurse was scheduled to be in the building that day. During an interview on 1/29/2024 at 1:58 PM, Scheduler #1 stated they made sure all the shifts were covered and was aware that a registered nurse needed to be scheduled for eight consecutive hours, seven days a week, per the regulation. The Scheduler could not explain why no registered nurse was scheduled on 1/28/2024, and stated they must have missed that. [...]

Inspectors wroteBased on observation, record review, and interviews during the recertification survey from 01/22/2024 to 01/30/2024, the facility did not ensure food was stored, prepared, distributed or served in accordance with professional standards for food service safety in the main kitchen and two (2) of 2 kitchenettes. Specifically, toxic vapor-emitting fly strips were used in food preparation areas, cleaning equipment was not stored properly, and equipment and floors were not clean. This is evidenced by: During observations of the main kitchen on 01/22/2024 at 11:37 AM, two toxic vapor-emitting fly strips were found near the 3-compartment sink; a broom and dust bin were stored next to the stove; and the can opener and holder, cooking line drawers, wall fan in the dishwashing machine area, and floor under and behind cooking equipment were soiled with food particles. [...]

Inspectors wroteBased on record review and interviews during the recertification survey from 01/22/2024 to 01/30/2024, the facility did not ensure that residents and/or their designated representative were fully informed of their right to an expedited review of a service termination for one (1) of 3 residents reviewed. Specifically, the facility did not ensure Resident #111 received timely notification (2-day notification) of the termination of Medicare Part A services. This is evidenced by: The document titled, Notice of Medicare Non-Coverage, Form CMS 10123-NOMNC and dated 09/08/2023, documented that Resident #111 last received rehabilitative services on 09/08/2023 and was provided the Notice of Medicare Non-Coverage, Form CMS 10123-NOMNC to inform the resident of their right to an expedited review of service termination on 09/18/2023 (date signed), ten days after the termination of services. [...]

Inspectors wroteBased on interviews and record review conducted during the recertification survey from 1/22/2024 to 1/30/2024, the facility did not ensure that written notification was sent to a representative of the Office of the State Long-Term Care Ombudsman of a resident's transfer or discharge for two (2) (Resident #17 and #57) of three (3) residents reviewed for hospitalization. Specifically, the written notice of transfers to the Ombudsman was not provided when Resident #17 and #57 transferred to the hospital. This is evidenced by: The Policy and Procedure titled, Facility Initiated Transfer or Discharge, dated 11/2017, stated if the transfer or discharge was facility initiated, the transfer-discharge notice would be faxed to the county Ombudsman program before or as close to the time of transfer/discharge as possible. [...]

Inspectors wroteBased on record review and interviews during the recertification survey conducted from1/22/2024 to 1/30/2024, the facility did not ensure that the residents were free of unnecessary medications for 3 (Resident #'s 5, 16, 42) of 5 residents reviewed. Specifically for Residents #5 and #16, multiple medication orders did not include an indication for use; and for Resident #42, one medication did not have an indication for use, and a second medication with an order to administer as needed did not have parameters indicating what symptoms the as needed medication was for. This is evidenced by: [...]

Inspectors wroteBased on observation, interview and record review during abbreviated survey (NY00324981, NY00325409, NY00327186, NY00327811, and NY00327951), the facility did not ensure sufficient nursing staff to provide nursing services to attain or maintain the highest practicable physical, mental and psychosocial well-being for all residents in the facility. Specifically, the facility did not ensure there were sufficient staff to meet resident needs, including activities of daily living, meals, medications, and treatments. In addition, five of the complaints investigated onsite had an allegation of insufficient staff and during Residents' interviews on 11/13/2023 - 11/15/2023, multiple residents stated there were long waits for call lights, showers were not given, medications were late, and there were not enough staff to provide care. This is evidenced by: [...]

Inspectors wroteBased on observation, record review, and interviews conducted during an abbreviated survey (Case #s NY00324981 and NY00325409), the facility did not ensure that residents were free from any significant medication errors for 3 (Residents #s 3, 4, and 11) for 4 residents reviewed for not receiving their medications in a timely manner per physician orders. This is evidenced by: The facility Policy and Procedure for Medication Administration dated 12/2018, documented all medications should be administered one hour before or after the prescribed time. Medications should be given per facility's policy for times as well as recommended administration times. Medication Administration Records should be signed after administration. Resident #3: Resident #3 was admitted to the facility with diagnoses of atrial fibrillation, hypertension, and heart disease of native coronary artery. [...]

Inspectors wroteBased on record review and interviews during an abbreviated survey (Case# NY00298857), the facility did not ensure that all alleged violations involving neglect were reported immediately-but not later than 24 hours if the events that cause the allegation did not involve abuse and did not result in serious bodily harm-to the Administrator of the facility and to the State Survey Agency for 1 (Resident #1) of 3 residents reviewed. Specifically, on 7/6/2022 at 2:45 PM, Registered Nurse #1 was made aware that Resident #1 rolled out of bed when staff attempted to dry the resident's back. Upon arrival to the facility, Registered Nurse #1 found the resident lying flat on their back with legs partially extended toward the foot of the bed, an icepack on their forehead, a laceration approximately 2 centimeters long on the right forehead with minimal bleeding and significant swelling. [...]

Inspectors wroteBased on record review and interviews during an abbreviated survey (Case #s NY00298857 and NY00324981), the facility did not ensure it developed and implemented a comprehensive, person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs for 2 (Resident #s 1 and 3) of 3 residents reviewed. Specifically, (A) Resident #1's comprehensive care plan for Self-Performance Deficit documented the resident had limited mobility and required 2 staff to assist with bed mobility. The facility did not ensure the care plan intervention for 2 staff to assist with bed mobility was implemented when, on 7/06/2022, Certified Nurse Aide #1 did not wait for Certified Nurse Aide #2 to assist with bed mobility and turned the resident on their side towards the edge of the bed to dry them. [...]

Inspectors wroteBased on record review and interviews during an abbreviated survey (Case # NY00324981), the facility did not ensure acceptable parameters of nutrition were maintained for 1 (Resident #3) of 3 residents reviewed. Specifically, for Resident #3, who was admitted to the hospital by a family member on 9/24/2023 with colitis and acute kidney injury, the facility did not recognize, evaluate, and address the nutritional needs of the resident who was at risk for dehydration. The Hospital Discharge Summary Report, dated 9/27/2023, documented a final diagnosis of prerenal acute kidney injury in the setting of colitis and poor oral intake. This is evidenced by: The undated facility Policy and Procedure titled, Hydration and Prevention of Dehydration, documented the facility would strive to provide adequate hydration and to prevent and treat dehydration. [...]

Inspectors wroteBased on interview and record review during an abbreviated survey ( NY00324981, NY00325409, NY00327186, NY00327811, and NY00327951), the facility did not ensure that the Facility Assessment was completed and available to determine what resources were necessary to care for its residents. This is evidenced by: Upon entrance on 11/13/2023 at approximately 2:00 PM, the Administrator was asked for the Facility Assessment (a facility-completed document required to establish staffing levels and competencies based on residents' assessed needs). The Administrator provided a binder with words, 'Facility Assessment' written on the front. Record review of the binder revealed it did not include the Facility Assessment. On 11/13/2023 at 4:00 PM, the Administrator stated they had not looked at the Facility Assessment. [...]

Inspectors wroteBased on observation, record review and interviews during a recertification survey and abbreviated survey (Case #NY00285055) on 06/14/2022 through 06/17/2022, the facility did not ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 (Resident #144) of 5 residents reviewed for accidents. Specifically, for Resident #144, who fell 5 (five) times between 9/29/21 and 10/16/2021, the facility did not ensure the reasons for each of the resident's 5 falls were identified and interventions developed and implemented to prevent further falls. Additionally, the facility did not follow their policy for Accident and Incident reporting that documented that the root cause of the incident must be determined, and immediate interventions put in place to decrease or eliminate risk for recurrence. This was evidenced by: [...]

Inspectors wroteBased on observation and staff interview during the recertification survey, the facility did not provide effective housekeeping services. Specifically, floors were not clean on 2 of 2 resident units. This is evidenced as follows. Observations of the resident units on 11/21/2019 at 9:15 AM, revealed that the floors were not clean in the [NAME] resident unit hallways and in resident rooms #'s 107, 117, 122, 123, 124, 206, 210, and #216. The Environmental Services Manager stated in an interview on 11/21/2019 at 9:45 AM, that the floors should have been kept clean, and will ensure that the floors are cleaned. 483.10(i)(2)

Inspectors wroteBased on observation, record review, and interview during a recertification survey, the facility did not provide the resident and their representative with a written summary of the baseline care plan for 10 (Resident #'s 6, 13, 19, 27, 36, 44, 46, 50, 51 and #249) of 10 residents reviewed. Specifically, for Resident #'s 6, 13, 19, 27, 36, 44, 46, 50, 51 and #249, the facility did not ensure a written summary of the baseline care was provided to the residents and resident representatives. This is evidenced by; The policy and procedure titled Care Plans: Creation and Maintenance of Baseline and Comprehensive Care Plans dated 11/28/18, documented the facility must provide the resident and their representative with a summary of the baseline care plan. Resident #6: The resident was admitted to the facility with a diagnosis of diabetes, Multiple Sclerosis and hypertension. [...]

Inspectors wroteBased on record review and interview during the recertification survey, the facility did not ensure a policy was developed for the Monthly Medication Regimen Review (MRR) that included timeframes for the different steps in the process. Specifically, the facility did not ensure there were timeframes established documented in the policy for steps in the MRR process concerning actions the pharmacist and facility needed to take when an irregularity was identified. This is evidenced by: The Policy and Procedure titled Medication Regimen Review dated 6/3/19, documented resident-specific irregularities and/or clinically significant risks resulting from or associated with medications were documented in the resident's active record and reported to the Director of Nursing (DON), Medical Director, and/or prescriber as appropriate. [...]

Inspectors wroteBased on record review and interview, the facility did not ensure menus met the nutritional needs of the residents in accordance with national guidelines and were reviewed by the facility's dietitian for nutritional adequacy. Specifically, the facility did not ensure menus met basic nutritional needs by providing enough fruits and vegetables based established national guidelines, and that menus were reviewed and revised as needed to ensure nutritional adequacy after changes were made to the menu. This is evidenced by: The 2015-2020 Dietary Guidelines for Americans documented the recommended amounts of food on a 2,000 calorie diet: - 2 1/2 cups of vegetables per day - 2 cups of fruit per day - 6 ounces of grains per day - 3 cups of dairy per day - 5 1/2 ounces of protein per day A review of the facility menu documented the following: [...]

Inspectors wroteBased on observation, record review and interview during the recertification survey, the facility did not ensure comprehensive care plans (CCP) were developed and implemented for each resident that included measurable objectives and time frames to meet a resident's medical, nursing and mental and psychosocial needs for 6 (Resident #'s 27, 44, 46, 49, 50 and #249) of 13 residents reviewed for comprehensive care plans. Specifically, for Resident #27, the facility did not ensure a CCP was developed to address the diagnoses of depression, hypertension, heart failure, diabetes and the use of psychotropic medications; for Resident #44, the facility did not ensure a CCP was developed to address dental care; for Resident #46, the facility did not ensure a CCP was developed to address the use of psychotropic medication; [...]

Inspectors wroteBased on record review and interviews during a recertification survey the facility did not ensure that each resident received adequate supervision and assistance devices to prevent accidents for 1 (Resident #36) of 1 resident reviewed for accidents. Specifically, for Resident #36, the facility did not ensure a smoking assessment was performed upon the resident's admission or afterwards to determine whether the resident required supervision to smoke, and store matches and lighters. Additionally, the facility did not ensure an individualized care plan for smoking was developed. This is evidenced by: Resident #36: The resident was admitted to the facility with a diagnosis of chronic obstructive pulmonary disorder (COPD), diabetes and heart failure. [...]

Inspectors wroteBased on observation, record review, and interviews during the recertification survey, the facility did not ensure acceptable parameters of nutritional status were maintained for 1 (Resident #23) of 2 residents reviewed for nutrition. Specifically, for Resident #23, the facility did not ensure the resident's weight was verified when a severe weight loss occurred and did not ensure the resident was consistently provided with finger foods and extensive assistance with eating as needed in accordance with the care plan. This is evidenced by: Resident #23: The resident was admitted to the facility with diagnoses of dementia with behavioral disturbance, adult failure to thrive, and metabolic encephalopathy. [...]

Inspectors wroteBased on record review and interviews during the recertification survey, the facility did not ensure residents who require dialysis receive such services, consistent with professional standards of practice. Specifically, for Resident #19, the facility did not ensure the following for a resident who received dialysis: ongoing communication and collaboration with the dialysis facility regarding dialysis care and services and physician orders for the provision of dialysis. This is evidenced by: Resident #19: The resident was admitted to the facility with diagnoses of end stage renal disease (ESRD) with dependence on dialysis, type 2 diabetes, and urinary tract infection. The Minimum Data Set (MDS - an assessment tool) dated 9/24/19 documented the resident had severely impaired cognition, could understand others and could make self understood. [...]

Inspectors wroteBased on record review and observations during a recertification survey the facility did ensure residents who used psychotropic drugs received gradual dose reductions, unless clinically contraindicated, in an effort to discontinue these drugs. Specifically, the physician approved pharmacy recommendations were acted upon to ensure prescribed antipsychotic medications were administered at the lowest possible dosage. This is evidenced by: The Policy and Procedure (P&P) titled Gradual Dose Reductions (GDR's) in Nursing Homes dated 5/2018 documented the facility would attempt GDR's for psychotropic medications (including antipsychotic and antidepressant drugs) unless clinically contraindicated. [...]

Inspectors wroteBased on record review and interview during a recertification survey, the facility did not ensure the Facility Assessment was reviewed and updated, as necessary, and at least annually. Specifically, the facility did not ensure the facility assessment included an updated evaluation of the overall number of facility staff needed to ensure sufficient number of qualified staff was available to meet each resident's needs. This is evidenced by: The Facility Assessment Tool, last reviewed 9/3/19, documented under Staffing Plan Section 3.2 to refer to the Facility (named) Nursing Staff Plan Policy and Procedure (P&P) for the nursing and direct care staffing plan. [...]

Inspectors wroteBased on record review and interviews during a recertification survey, the facility did not ensure medical records were maintained in accordance with acceptable standards of practice for 3 (Resident #'s 13, 15 and #50) of 13 residents reviewed. Specifically; for Resident #13, the facility did not ensure the resident's medical record included ongoing documentation regardng the status of the resident's stage 2 pressure ulcer, for Resident #15, the facility did not ensure elopement risk assessments were completed quarterly and for Resident #50, the facility did not ensure the medical record included documentation of physician notification when the resident's blood pressure and/or heart rate were below physician ordered parameters. This is evidenced by; Resident #13: The resident was admitted to the facility with a diagnosis of chronic kidney disease, dementia, and anemia. [...]