Valley Healthcare Center

Inspectors wroteBased on interview, and record review the facility failed to ensure and follow facility policy and procedure for providing a log for signing out for one of four residents (Resident 4), for overnight pass. This failure had the potential to place a clinically compromised resident (Resident 4 ' s overall health and safety at risk.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the environment was free from potential serious accident hazards for residents and staff in the facility when: 1. The facility failed to assess and identify one of 10 residents (Resident 104) for smoking upon admission and failed to complete quarterly smoking assessments (an evaluation used to determine a resident's ability to smoke safely) for four of 10 residents (Residents 4, 13, 31, and 71). 2. The facility failed to ensure safety when eight of 10 residents (Residents 4, 13, 26, 32, 71, 79, 82, and 104) were observed smoking unsupervised in a non-oxygen free facility. 3. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to adhere to established food safety and sanitation standards when: 1. A container of parsley flakes was past the best buy date. 2. Two unopened bags of bread were past the best buy date. 3. Food debris was found on the floor under the stove and under the large food mixer. 4. A scoop was on top of grains and cereals container. 5. Wet trays that were stacked together and not air dried. These had the potential to place susceptible residents who receives food from Dietary Services at risk for food-borne illnesses.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure garbage and refuse was not overflowing and dumpster's lids were completely closed. This failure had the potential to attract pests (like flies and rodents) and spread diseases and infection to the residents.

Inspectors wroteBased on interview and record review, the facility failed to provide written information concerning the right to formulate an Advance Directive (a written document specifying an individual's medical care wishes) for nine of 10 sampled residents (Residents 4, 13, 15, 16, 18, 34, 35, 49, and 55). This failure had the potential for the residents' decisions regarding their healthcare and treatment options not being honored.

Inspectors wroteBased on interview and record review, the facility failed to provide a written Bed-Hold (the process of holding or reserving a resident's bed while the resident is in the acute care hospital) Notification to one of three closed sampled residents (Resident 45) at the time of Resident 45's transfer to the hospital. This failure had the potential for Resident 45 and/or the resident's responsible party to be unaware of their rights to return to the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure timely completion of the comprehensive admission Minimum Data Set (MDS - a federally mandated resident assessment tool) assessments for two of 20 sampled residents (Residents 104 and 204). This deficient practice had the potential to delay the care planning process to meet Resident 104 and Resident 204's comprehensive and individualized care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure the individualized care plans (the plans showing specific interventions to provide effective and person-centered care to meet the resident's needs) were developed for two of 20 sampled residents when: 1. Resident 70 did not have the care plans developed for the use of divalproex (a medication that affects mood, behavior, or thought processes) and quetiapine (an antipsychotic medication used to treat conditions where someone experiences hallucinations, delusions, or disorganized thinking). 2. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the appropriate respiratory care was provided to two of two final sampled residents (Residents 51 and 67) when: 1. The facility failed to follow the physician's order for oxygen administration for Resident 51. 2. The facility failed to obtain a physician's order for oxygen administration for Resident 67. This failure had the potential for respiratory complications related to inadequate oxygen administration for Residents 51 and 67.

Inspectors wroteBased on interview, and record review, the facility failed to provide the necessary care for one of one sampled residents (Resident 204). The facility failed to ensure Resident 204's Sevelamer (a medication used to control high blood levels of phosphorus in people with chronic kidney disease who are on dialysis) was administered as ordered by the physician on the days the resident left the facility for dialysis (also known as hemodialysis; a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly). This had the potential for Resident 204 not getting the appropriate doses of medications as ordered, resulting in health complications.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure a resident's nutritional and dietary needs were met when the Registered Dietitian (RD) failed to review the quarterly assessment. This had the potential for nutritional and dietary needs to remain unmet for one of six sampled residents (Resident 18).

Inspectors wroteBased on observation, interview, and records review, the facility failed to obtain initial screening for rehabilitative services for one of 20 sampled residents, (Resident 455) upon admission. This failure had the potential to result in a decrease in resident's range of motion (the extent and degree of movement a joint or series of joints can achieve) mobility and muscle strength.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement infection control and prevention measures when: 1. Licensed Vocational Nurse (LVN) 2 did not perform proper hand hygiene (the process of cleaning one's hands to remove dirt, germs, and microorganisms with soap and water or an alcohol based foam or gel) during medication administration for Residents 48, 58, and 59. 2. Certified Nurse Assistant (CNA) 1 failed to perform hand hygiene and don (put on) gloves and an isolation gown before entering Resident 355 room, who was on Contact Isolation Precautions (a set of precautions used to stop the spread of germs from a patient to others). 3. [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to follow its policy and procedure to provide care and services for residents and ensure call lights are answered in a timely manner for all four sampled residents (Residents 1, 2, 3, and 4). This failure has the potential to jeopardize the health and safety of clinically compromised Residents (Residents 1, 2, 3, and 4) when their requests for assistance with activities of daily living were not responded to promptly.

Inspectors wroteBased on observation, interview, and record review, the facility failed to adhere to its food-related garbage disposal policy when two outdoor dumpsters were left open. This failure had the potential to attract vermin (pest or animals that spread diseases) which could pose a significant health risk to the 100 clinically compromised residents currently residing in the facility.

Inspectors wroteBased on interview and record review the facility failed to follow their policy when a staff did not notify the responsible party of blisters observed on the right hand of one of three sampled residents (Resident 1) and document in the medical record. This had the potential to exclude the family and responsible party of (Resident 1) to actively participate in the plan of care related to the resident's change of condition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure: 1. The call lights are answered in a timely manner for two of three residents (Resident 2 and Resident 3). This failure placed two clinically compromised Residents (Resident 2 and Resident 3) health and psychosocial (emotional) status at risk when their need for nursing care was not met timely. 2. Nursing staff monitor one of three residents (Resident 1) every shift for hydration after a change of condition. This failed practice had the potential for a delay in treatment and placed Resident 1 at risk for dehydration.

Inspectors wroteBased on interview and record review the facility failed to assess and develop a plan of care with interventions to preventing and developing pressure ulcer for one of three residents (Resident 1). This failure placed a clinically compromised Residents (Resident 1) health and safety at risk. When Resident 1 developed a facility acquired pressure ulcer.

Inspectors wroteBased on observations, interviews, and record review, the facility did not maintain professional standards for food service safety when: 1. There was five shelves that had a rust colored substance on the reach-in refrigerator, and four shelves with rust colored substance in the walk-in refrigerator, this had the potential for the rust colored substance to be transferred to the foods stored on the shelves. 2. There was a personal item stored in the food prep area, this had the potential to contaminate food during food prep. 3. The large ice machine had black smudges on the top ceiling of the ice bin. This had the potential to contaminate the ice. These failures to ensure a safe and sanitary kitchen resulted in the increased risk of resident harm from food borne illness to a population of 90 immuno-compromised residents who received food from the kitchen.

Inspectors wroteBased on observations, interviews, and record reviews, the facility did not maintain equipment in safe operating conditions when: 1. The reach-in refrigerator was leaking, and this had the potential to contaminate food and effect the proper functioning of the refrigerator. 2. The walk-in refrigerator was leaking and had ice buildup on a pipe, this had the potential to affect the proper functioning of the refrigerator 3. The freezer had ice chunks on the pipe, which had the potential to affect the proper functioning of the freezer. These failures to maintain equipment had the potential to place the health of the # residents who received food from the kitchen at risk since refrigeration units in disrepair may no longer be capable of properly cooling or holding time/temperature control for safety foods at safe temperatures.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure safe and effective pharmaceutical services for a universe of 95 residents when: 1. For Resident 54, the facility could not demonstrate controlled substance accountability for liquid Ativan (anti-anxiety medication) controlled substances (highly regulated drugs due to potential for abuse or misuse). This occurred when the quantity dispensed by the Pharmacy did not match the starting amount indicated on the resident's controlled substance record (narcotic count sheet). This failure had the potential to result in drug diversion (illegal use of narcotics) and/or inadequate controlled substances accountability. 2. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility did not follow their daily menu for lunch when, on August 1, 2022, at 12:04 PM, three residents on renal diets (a diet low in sodium, phosphorus, and protein for people with kidney disease) received two ounces of protein instead of three ounces. This failure had the potential to affect the nutritional status of the three residents on a renal diet.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a safe infection prevention and control program when: 1. Treatment Nurse 1 (TN 1) did not wash her hands with soap and water after performing wound care for Resident 141 who was on contact isolation precautions (to prevent transmission of infectious agents that are spread by direct or indirect contact with the resident or the resident's environment. Contact Precautions require the use of a gown and gloves on every entry into a resident's room) for an infection with Clostridium difficile (C. diff-a bacterium that causes diarrhea and colitis-an inflammation of the colon). 2. A laundry staff (LS 1) did not follow the manufacturer's guidelines for the disinfectant used to disinfect the dirty linen carts and barrels. 3. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one of one sampled resident (Resident 12) was treated with respect and dignity when the resident, who was unable to feed himself, was stood over by a Certified Nursing Assistant (CNA 1) while assisting Resident 12 to eat. This failure had the potential to cause the resident to feel humiliated having to look up at CNA 1 while having food spooned into his mouth and placed him at risk for aspiration.

Inspectors wroteBased on interview and record review, the facility failed to discuss and provide information on advanced directives for two of two sampled residents (Residents 85 and 88). This failure had the potential to cause Residents 85 and 88's values and desires related to end-of-life care not to be carried out.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop a care plan for one of one resident (Resident 83) when Resident 83 refused nail grooming. This failure had the potential to miss opportunities to identify alternatives and consequences of refusing care that can negatively impact Resident 83.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure necessary treatment and service to promote healing of pressure ulcers was provided for one of three residents observed (Resident 293) when Resident 293's left and right heels were not floated (legs elevated on pillow to keep heels from touching the bed), to relieve pressure as indicated in the care plan. This failure had the potential to lead to worsening of the wounds and delay wound healing which would further compromise the health and welfare of Resident 293.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as possible and failed to ensure all residents received adequate supervision to prevent accidents when, one of two residents (Resident 23) was reviewed for falls. The facility failed to implement the interventions of placing the Resident 23's bed in its lowest position and did not provide a fall mat. These failures had the potential for further falls, serious injuries, and even death.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure pain was assessed and managed before, during and after wound care, for one of one sampled resident (Resident 141). This failure caused Resident 141 to suffer pain at a level that was unacceptable to the resident.

Inspectors wroteBased on the observation, interview, and record review, the facility failed to ensure medications were appropriately labeled in accordance with standards of practice and/or policy when: For Resident 43,70, and 295, four insulin (drug used to lower blood sugar) pens were observed stored opened and undated in the Medication Carts 2 & 3 as follows : a. For Resident 70, on Medication Cart 3, there was a lispro insulin pen was opened and undated. b. For Resident 295, on Medication Cart 2, there was an aspart insulin pen was opened and undated. c. For Resident 43, on Medication Cart 2, there were two glargine insulin pens opened and undated. These failures placed Residents 43, 70, and 295 at risk for receiving ineffective or outdated medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide assistance for dental services needed for one of one sampled resident (Resident 58) when they did not follow up on the status of eligibility for dentures for Resident 58 who was missing upper and lower teeth. This failure prevented Resident 58 from obtaining an identified need for dental services in a timely manner.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure collaboration and coordination with contracted hospice services for one of one sampled resident (Resident 14) when there was no current hospice plan of care available in the facility and there was no schedule on when skilled nursing, hospice aide, social worker or spiritual counselor visits would be conducted. This failure had the potential to cause Resident 14 not to receive hospice services based on a comprehensive person-centered care plan.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure safe and sanitary food preparation and storage practices for dietary services when: 1) Plastic pitchers used for food service were not air dried and stored for use. 2) Bowls used for food service were found dirty and stacked for use. 3) The food preparation sink had no air gap and were plumed directly to the waste water system. This had the potential for waste water to enter and contaminate the food preparation sink. These failures had the potential to contaminate resident food sources that can cause foodborne illness (a disease caused by consuming contaminated food or drink), in a vulnerable population of 90 out of 94 residents receiving dietary services, resulting in severe resident harm, and even death.

Inspectors wroteBased on interview, and record review, the facility failed to notify the resident and document in the clinical record for one of six sampled residents (Resident 39) when the pain medication order was changed. This failure resulted in Resident 39 not being aware of change of pain medication order which could result in inappropriate pain management.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure for one of 39 sampled residents (Resident 253) resident 253 medical records were secured to ensure confidentiality. This failure had the potential to allow unauthorized staff or visitors to access resident's confidential medical and personal information.

Inspectors wroteBased on interview, and record review, the facility failed to ensure an admission Minimum Data Set (MDS- facility assessment tool) assessment was completed according to the Centers of Medicare and Medicaid Services (CMS) timeframes, for one of three sampled residents (Resident 1). This failure had the potential for inadequate monitoring of Resident 1's progress and lack of resident specific information to CMS for payment and quality measure monitoring.

Inspectors wroteBased on interview, and record review, the facility failed to ensure a quarterly comprehensive assessment was completed and submitted to the Centers of Medicare and Medicaid Services (CMS) timeframes, for one of three residents (Resident 1). This failure had the potential for inadequate monitoring of Resident 1's progress and lack of resident specific information to CMS for payment and quality measure monitoring.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Minimum Data Set [MDS- a facility assessment tool that consists of the resident assessment instrument (RAI) and the care area assessment (CAA)] assessment was conducted and submitted to the Centers of Medicare and Medicaid Services (CMS) within set timeframes, for one of three residents (Resident 1). This failure had the potential for inadequate monitoring of Resident 1's progress and lack of resident specific information to CMS for payment and quality measure monitoring.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accurately code the Minimum Data Set (MDS- facility assessment tool) assessments for one of three residents (Resident 52) when Resident 52's MDS assessment indicated resident had anticoagulants (blood thinners) for seven days. This failed practice had the potential to result in unmet care needs for Resident 52, which can potentially jeopardize health and safety of Resident 52.

Inspectors wroteBased on interview, and record review, the facility failed to ensure one of six sampled residents (Resident 8) physician's order were followed when: 1. Resident 8's physician order for Range of Motion (ROM-a type of exercise to keep the muscles active) was not carried out by nursing services and communicated to Restorative Nursing Assistant (RNA 1- a member of the nursing department trained to provide ROM services to residents) 2. Resident 8's physician's order to monitor oxygen saturation (the amount of oxygen in the blood) every shift was not being done. This failure had the potential to result in the delay of therapy treatment, and to adversely affect the health and safety of Resident 8.

Inspectors wroteBased on observation, interview, record review, the facility failed to ensure a licensed staff perform a calibration (to check accuracy) test of the glucometer (device used to check blood sugar) when it malfunctioned during use for one of three sampled residents (Resident 100). This failure had the potential for licensed staff to obtain inaccurate blood sugar readings for Resident 100.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the medication Remeron (a medication used to treat depression) was available for one out of six sampled residents (Resident 69) when the medication was not available for use. This failure had the potential for Resident 69 not to receive the medication as ordered by the physician.

Inspectors wroteBased on interview, and record review, the facility failed to follow their policy and procedure for medication administration when: 1. For Resident 8, nursing staff did not document on the Medication Administration Record (MAR-a record used to document the administration of medications) pain medication was given. 2. For Resident 4 and 33, nursing staff did not document on the MAR the amount of units of insulin (a medication used to treat high blood sugar) was given per thesliding scale (the amount of insulin given based on the blood sugar results) order from the physician. This failure resulted in inaccurate documentation of medication administration which put Residents 8, 4, and 33's health and safety at risk.