Unique Rehabilitation and Health Center LLC

Inspectors wroteBased on observations, record reviews, and resident and staff interviews, the facility staff failed to develop a care plan for one (1) of four (4) residents who used a powered(electric) wheelchair. (Resident #2).

Inspectors wroteBased on record review and staff interviews, facility staff failed to have documented evidence that they followed their policy by providing education for one of four residents who used medical equipment (powered wheelchair).

Inspectors wroteBased on observation, record reviews and staff interviews, for one (1) of three sampled residents, the facility staff failed to report an injury of unknown origin to the Administrator, and for two (2) of three sampled residents, the facility staff failed to report a resident-to-resident altercation to the Administrator of the facility and to other officials (including to the State Survey Agency, Adult Protective Services, and Metropolitan Police Department) within the required timelines per the facility's Abuse policy and federal regulations. Residents #1 and #2.

Inspectors wroteBased on observation, record review, and staff and resident interview, facility staff failed to develop care plans for two (2) of nine sampled residents to address: (1) Resident #6's refusal to allow nursing staff to clean his room, including the nightstand and closet; and (2) Resident #4's use of a mechanical lift for transfer out of bed. (Residents #4 and #6).

Inspectors wroteBased on observations, record reviews, resident and staff interviews, for four (4) out of 40 sampled residents identified as smokers, facility staff failed to ensure effective and adequate supervision was provided as evidenced by the surveyor's observing residents in non-designated smoking areas with smoking paraphernalia that included cigarettes and/or lighters. Residents' #103, #117, #43, #21. Due to these failures, an Immediate Jeopardy (IJ) was identified on 11/05/24 at 12:15 PM and an IJ was called on 11/12/24 at 1:15 PM related to supervision of resident's who smoke. The facility's Administrator submitted a corrective action plan to the Survey Team that was accepted on 11/12/24 at 9:25 PM. The Survey Team verified implementation of the corrective plan while onsite and the Immediate Jeopardy was lifted on 11/15/24 at 3:00 PM. [...]

Inspectors wroteBased on observations and staff interview, facility staff failed to distribute and serve foods under sanitary conditions.

Inspectors wroteBased on observations and staff interview, facility staff failed to serve foods under sanitary condition, causing possible risk of infection.

Inspectors wroteBased on observations and staff interview, facility staff failed to maintain essential mechanical and electrical equipment in safe condition.

Inspectors wroteBased on observations made during an environmental walkthrough of the facility on November 20, 2024, between 11:30 AM, and 1:00 PM, facility staff failed to maintain resident call bells in good condition as evidenced by call bells in two (2) of 23 resident rooms, and in two (2) of three (3) shower rooms that did not initiate an alarm when tested; and failed to provide a call system to Resident #39 that was adequately equipped to allow the resident to call for staff assistance from the resident's bedside.

Inspectors wroteBased on observation, record review and staff interviews for one (1) of 75 sampled residents, facility staff failed to respect a resident's right to personal privacy, including the right to promptly receive unopened mail, evidenced by a resident's personal mail being opened without his signed consent. (Resident #111)

Inspectors wroteBased on observation and staff interview for four (4) of 75 sampled residents, facility staff failed to provide a comfortable, sanitary, homelike environment to four (4) residents, as evidenced by two (2) resident's rooms with dirty floors covered with debris and a sticky-like substance, including multiple wheelchair tire tracks, two (2) resident's rooms with flies, two (2) resident's rooms with a clutter of boxes, bins and other unboxed items piled against the wall and around the resident's bed, two (2) resident's rooms without bed linens on their bed, one (1) resident with a foul odor of urine beginning at the doorway, and one(1) resident with a dirty sticky floor and a foul odor in the room. Residents #76, #7,#103 and #115.

Inspectors wroteBased on record review and staff interview, for one (1) of 75 sampled residents, facility staff failed to follow the physician's order for narcotic pain administration. Resident #229.

Inspectors wroteBased on observations record reviews and staff interviews for one (1) of 75 sampled residents, the facility staff failed to ensure that a resident who is fed by enteral means received appropriate treatment and services to prevent complications as evidenced by an observation in which Resident #39's enteral tubing was observed tied in a knot. Resident #39.

Inspectors wroteBased on observation, record review and staff interviews, for one (1) of 75 sampled residents, facility staff failed to ensure that Resident #362 received care and services, consistent with professional standards of practice for her right upper chest central venous intravenous (IV) catheter\line.

Inspectors wroteBased on observation and staff interview, facility staff failed to ensure that empty oxygen tanks were not stored in the same area as full oxygen tanks in one (1) of five (5) clean utility rooms observed.

Inspectors wroteBased on record review and staff interviews for one (1) of 75, sampled residents, facility staff failed to schedule a gynecology follow-up appointment for a resident. Resident #215.

Inspectors wroteBased on observation, record review and staff interview, for one (1) of 75 sampled residents, facility staff failed to ensure that the system for accurate reconciliation and accounting for all controlled medications was followed. Resident #229.

Inspectors wroteBased on observations and staff interview, facility staff failed to ensure that medical supplies and medications (vaccines) stored for use were not expired.

Inspectors wroteBased on observation and interview, facility staff failed to maintain handrails in safe condition, as evidenced by a loose handrail on one (1) of eight (8) resident care units.

Inspectors wroteBased on record reviews and staff interviews, for one (1) out of 75 sampled residents, facility staff failed to ensure that they took the steps to investigate Resident #56's grievance that an aide handled him roughly during ADL care.

Inspectors wroteBased on record review and staff interview for one (1) of 75 sampled residents, facility staff failed to provide adequate supervision and intervention to prevent one resident's aggressive behavior towards others from escalating as evidenced by a resident-to-resident altercation in the courtyard and subsequently, one resident sustaining an injury. (Residents #220 and #222)

Inspectors wroteBased on record reviews and staff interviews, for three (3) of 75 sampled residents, the facility staff failed to implement its own written policies and procedures for reporting allegations of abuse or neglect in the required timeframes for three residents. (Residents' #24, #216, and #412)

Inspectors wroteBased on record reviews and staff interviews for four (4) of 75 sampled residents the facility staff failed to notify the State agency of allegations of abuse or neglect as evidenced by the following: a resident to resident altercation with injuries not being reported in the required 2-hour timeframe,a report of an unusual incident involving a resident who was found unresponsive and administered Naloxone by staff and an incident where a resident alleged he was handled roughly by a certified nurse aide. (Residents #24, #216, #412 and #56)

Inspectors wroteBased on observations, record reviews and staff interviews for one (1) of 75 sampled residents, the facility staff failed to implement a comprehensive person-centered care plan for Resident #175 as evidenced by the staff failing to implement the residents falls care plan intervention to place the residents bed in the lowest position. (Resident #175)

Inspectors wroteBased on record review and staff interviews, for one (1) of 75 sampled residents, facility staff failed to provide ongoing in-service training related to abuse, neglect, and exploitation, per the facilities policy when there are allegations of abuse. (Resident #12)

Inspectors wroteBased on record review and staff interview, for two (2) of 63 sampled residents, facility staff neglected to provide the needed care and services evidenced by 1. Resident #204 developing pressure ulcers that were first observed at an advanced stage, and 2. Resident #3 flipping out of a wheelchair in a transportation vehicle due to staff neglecting to secure him with a seatbelt. These failures resulted in actual harm to Resident #204 and Resident #3.

Inspectors wroteBased on record reviews, resident and staff interviews, for one (1) of 63 sampled residents, facility staff failed to ensure residents received care consistent with the professional standards of practice to prevent the development of pressure ulcers. Resident #204. These failures resulted in actual harm to Resident #204 when the resident obtained facility acquired ulcers first observed at advanced stages.

Inspectors wroteBased on observations, record reviews, and staff interviews, for three (3) of 63 sampled residents, facility staff failed to provide adequate supervision and assistance to residents to prevent accidents and injury as evidenced by: 1. failure to secure Resident #3's wheelchair with the seatbelt in the transportation van; 2. failure to assign a 1:1 monitor to Resident #505; and 3. failure to provide Resident #176 with 1:1 supervision while in the courtyard. (Residents' #3, #505 and #176) These failures resulted in actual harm to Resident #3, example #1.

Inspectors wroteBased on observations and interview, facility staff failed to provide housekeeping services necessary to maintain a safe, clean, comfortable environment as evidenced by ceiling vent covers that were soiled throughout on six (6) of eight (8) resident care units, and ceiling tiles that were stained on five (5) of eight resident care units.

Inspectors wroteBased on record review and staff interview, for four (4) of 63 sampled residents, facility staff failed to accurately code the Minimum Data Set (MDS) for one resident's functional impairment, one resident's bowel status, one resident's fall and one resident's fall and oxygen use. Residents' #20, #102, #133, and #158.

Inspectors wroteBased on record review and staff interviews, for four (4) of eight (8) nursing units, the facility staff failed to account for the receipt, usage, disposition, and reconciliation of controlled medications.

Inspectors wroteBased on record review and staff interview, for two (2) of 63 sampled residents, facility staff failed to provide laboratory services in a timely manner to meet resident needs. Residents' #158 and #204.

Inspectors wroteBased on observations and staff interview, facility staff failed to prepare, serve, and distribute foods under sanitary conditions as evidenced by 16 of 16 six-inch half-pans that were stored wet and ready for use, soiled equipment such as two (2) of two (2) convection ovens, two (2) of two (2) grease fryers, one (1) of one (1) meat slicer, and six (6) of seven (7) cutting boards, dishwasher temperature logs that were improperly documented, six (6) of six (6) stained fire suppression nozzle covers , and food temperatures that tested below 135 degrees Fahrenheit on two (2) of two (2) food trays assessment.

Inspectors wroteBased on observations and staff interview, facility staff failed to maintain essential equipment in safe condition as evidenced by one (1) of one (1) dishwashing machine that did not reach 180 degrees Fahrenheit and failed to complete the fill cycle during start-up, one (1) of six (6) steam well covers with no handle, four (4) of six (6) steam well covers with a loose handle, one (1) of eight (8) unsecured baffle from the kitchen hood system, and four (4) of four (4) curtains from the dishwasher that were marred.

Inspectors wroteBased on observation, record review, resident, and staff interviews, for three (3) of 63 sampled residents, the facility's staff failed to ensure that they were provided dignity and privacy. Residents' #193, #132, and #158.

Inspectors wroteBased on record review and staff interview, for two (2) of 63 sampled residents, facility staff failed to ensure that residents or their representatives were provided the Notice of Medicare Non-Coverage (NOMNC) form no later than noon of the day before the effective date listed for discontinuance of skilled services. Residents' #202 and #203.

Inspectors wroteBased on record reviews and staff and resident interviews, for three (3) of 63 sampled residents, facility staff failed to implement its abuse policies and procedures. Residents' #505, #148, and #191.

Inspectors wroteBased on record reviews and resident and staff interviews, for two (2) of 63 sampled residents, facility staff failed to report a reasonable suspicious crime (physical assault of one resident to another) to the appropriate law enforcement entity. Residents' #505 and #148.

Inspectors wroteBased on observation, record review, resident and staff interviews, for three (3) of 63 sampled residents the facility staff failed to: report an incident of alleged staff of resident abuse/mistreatment the State Agency; report an unusual incident in which a resident was found unresponsive after going into the facility's courtyard; and report the results of its investigation of one resident's allegation of staff verbal abuse and violation of dignity. Residents' #193, #53, and #403.

Inspectors wroteBased on record review, resident, and staff interview for three (3) of 63 sampled residents, facility staff failed to: investigate an unusual incident in which a resident was found unresponsive; and to take necessary corrective actions after a resident-to-resident incident. Residents' #53, #148, and #505.

Inspectors wroteBased on record review and staff interview, for one (1) of 63 sampled residents, the facility's staff failed to ensure the information required for resident-initiated discharge to occur was a part of the medical record. Resident #254.

Inspectors wroteBased on record review and staff interview for two (2) of 30 sampled residents, facility staff failed to document/record the specific reason(s) for the notice, the date of discharged , transferred, or relocated, and the destination on the notice before transfer (6-108) form for one (1) resident and failed to record the destination and the correct number of bed-hold days on the 6-108 form for one (1) resident. Residents' #6 and #8.

Inspectors wroteBased on record review and staff interview, for one (1) of 63 sampled residents, facility staff failed to provide Resident #253's responsible party (RP) written notice of the bed-hold policy when he was transferred to the hospital.

Inspectors wroteBased on record review and staff interview, for one (1) of 63 sampled residents, facility staff failed to complete Resident #1's Minimum Data Set (MDS) assessment within 14 days of the assessment reference date (ARD).

Inspectors wroteBased on record review and staff interview, for one (1) of 63 sampled residents, facility staff knowingly falsified Resident #1's Discharge - Return Anticipated Minimum Data Set (MDS) assessment.

Inspectors wroteBased on observation, record review, resident and staff interview, for two (2) of 63 sampled residents, facility staff failed to: develop a comprehensive person-centered care plan to address one resident's use of supplemental oxygen; and implement one resident's care plan intervention of having a one to one (1:1) supervision while in the courtyard. Residents' #64, and #176.

Inspectors wroteBased on record review, resident and staff interview, for one (1) of 63 sampled residents, facility staff failed to update Resident #20's fall and skin care plan focus areas with new goals and interventions after he sustained a fall and when he was observed with a bruise on his right cheek.

Inspectors wroteBased on observation, record review and staff interview, in one (1) of four (4) medication administration observations, facility staff failed to administer medications within the professional standards of practice.

Inspectors wroteBased on record review and staff interview, for one (1) of 63 sampled residents, facility staff failed to develop a discharge care plan for Resident #402 that addressed her needs for discharge back to the community.

Inspectors wroteBased on record review and staff interview, for two (2) of 63 sampled residents, facility staff failed to ensure: Resident #194 was provided a psychiatric evaluation in a timely manner; and that Resident #253 was administered his blood pressure medications as ordered by the physician. Residents' #194 and #253.

Inspectors wroteBased on observation, record review, resident and staff interview, for one (1) of 63 sampled residents, facility staff failed to ensure that one resident received the proper assistive device to maintain vision. Resident #53.

Inspectors wroteBased on observation, record review, and staff interview, for three (3) of 63 sampled residents, facility staff failed to ensure that residents received oxygen/respiratory care in accordance with the physician order. Residents' #123, #132 and #185.

Inspectors wroteBased on record review and staff interview, for one (1) of 63 sampled residents, facility staff failed to ensure that licensed nurses had the competency and skill sets necessary to implement, assess and document. Resident #204.

Inspectors wroteBased on observations, record reviews, and staff and resident interviews for two (2) of 63 sampled residents, facility staff failed to provide food that reflected the resident's food preferences and failed to ensure that the residents' menu was current and posted in plain sight for a resident to review and failed to make a reasonable effort to provide Resident #152 with double portions of food. Residents' #199 and #152.

Inspectors wroteBased on record review and staff interview, for one (1) of 63 sampled residents, facility staff failed to accurately document the location where Resident #102's blood pressure was being taken.

Inspectors wroteBased on observation and staff interview, the facility staff failed to follow accepted standards of infection control practices to prevent potential contamination and spread of infection related to failure to wear the appropriate shoe and failed to sanitize the blood glucose machine between residents. The resident census on the first day of survey was 208.

Inspectors wroteBased on observations and interview, it was determined that facility staff failed to provide housekeeping services necessary to maintain a safe, clean and comfortable environment, as evidenced by torn chairs in one (1) of 33 resident's rooms and in one (1) of two (2) television (TV) rooms on the fourth floor, and bulk trash that was piled up in an area located next to the parking lot.

Inspectors wroteBased on record reviews and staff interviews for five (5) of 43 sampled residents, facility staff failed to update the care plan with goals and approaches to address one (1) resident who had an accident with injury, to address the removal of the protective dressing of graft/fistula site post dialysis for two (2) residents; to address the use of the wound vacuum-assisted closure (VAC) for one (1) resident, and for one (1) residents refusal to have his weight obtained. Residents' #11, #61, #114, #149 and #158.

Inspectors wroteBased on record review and staff interview, for two (2) of 43 sampled residents, facility staff failed to minimize potential adverse consequences related to medication therapy for one (1) resident on two occasions and failed to maintain the pharmacy drug regimen review on the active record for one (1) resident. Residents' # 50 and #172.

Inspectors wroteBased on record review and staff interview, for one (1) of 43 sampled residents, facility staff failed to adequately monitor Resident #178 for efficacy and adverse consequences who was prescribed Trazadone Hydrochloride (antidepressant and sedative).

Inspectors wroteBased on record review and staff interview of three (3) of 43 sampled residents, the facility staff failed to consistently document the removal of the protective dressing covering the residents access site post dialysis for two (2) resident's receiving dialysis, to consistently document one (1) resident's treatment on the Treatment Administration Record [TAR]. Residents' #61, #83, and #158.

Inspectors wroteBased on observations and staff interview, facility staff failed to maintain essential equipment in safe condition as evidenced by a loose door that failed to close as intended, a broken temperature gauge and a broken temperature adjustment knob from one (1) of two (2) food warmers, and two (2) of six (6) slats from one (1) of one (1) walk-in freezer that were torn.

Inspectors wroteBased on observations, record review and staff interview, for one (1) of 43 sampled residents, facility staff failed to treat residents with dignity and respect during dining observations for one (1) resident.

Inspectors wroteBased on record review and staff interview for one (1) of 43 sampled residents, facility staff failed to notify the responsible party of Resident #149's refusal to have his weight obtained by staff.

Inspectors wroteBased on record review and staff interview, facility staff failed to document pertinent discharge information on the Interdisciplinary Discharge Summary form for one (1) of 43 sampled residents, Resident #196.

Inspectors wroteBased on record review and staff interview for one (1) of 43 sampled residents, the facility staff failed to code the Minimum Data Set (MDS) to reflect one (1) resident's diagnosis of Malignant Neoplasm of the Prostate, Resident #191.

Inspectors wroteBased on record review and staff interview, facility staff failed to develop and implement a comprehensive person-centered care plan with goals and approaches to address the monitoring and side effects of Trazadone (antidepressant and sedative) for one (1) of 43 sampled residents, Resident #178.

Inspectors wroteBased on observation, record review and staff interview, facility staff failed to secure the indwelling catheter tubing and failed to maintain urinary catheter drainage systems below the level of the bladder for two (2) of 43 sampled residents. Residents' #35 and Resident #178.

Inspectors wroteBased on record review, resident and staff interviews for one (1) of 43 sampled residents, the facility staff failed to accurately assess Resident # 244's colostomy site in her progress note.

Inspectors wroteBased on record review and staff interview, the attending physician failed to act upon abnormal lab results in a timely manner for one (1) of 43 sampled residents, Resident #50.

Inspectors wroteBased on observations and interview, facility staff failed to distribute and serve foods under sanitary conditions as evidenced by breakfast food items such as scrambled eggs and ground turkey that were tested below 135 degrees Fahrenheit (F), and inconsistent food temperatures documentation during the months of July, August, and September 2020.

Inspectors wroteBased on observations and staff interview, in one (1) of one (1) observation, facility staff failed to wear required personal protective equipment (PPE) while in a resident care area to help minimize the transmission of COVID-19 to residents and other staff in the facility.