Vantage at Andover LLC

Inspectors wroteBased on observations and interviews, the facility failed to ensure resident rooms were maintained in good repair, clean and homelike on 2 of 3 resident care units.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to accurately document in the medical record for four Residents (#12, #67, #95, and #96) out of 24 total sampled residents. Specifically,1.) For Resident #12, the facility failed to ensure nursing documented weekly blood sugar checks and administration of hydrocodone-acetaminophen (a narcotic pain medication).2.) For Resident #67, the facility failed to ensure nursing accurately documented that seizure pads were not applied to bilateral side rails when in bed.3.) For Resident #95, the facility failed to ensure dressing changes were accurately documented. 4.) For Resident #96, the facility failed to ensure dressing changes were accurately documented.

Inspectors wroteBased on observations and interviews, the facility failed to ensure resident protected health information (PHI) was secure and not visible to others on one of two nursing units.

Inspectors wroteBased on record review and interview the facility failed to ensure for 1 Resident (#39), out of a total sample of 24 residents that an antianxiety medication administered PRN (as needed) was limited to 14 days, and that the prescriber documented in the clinical record the rationale for continued use and the duration of the use of the PRN antianxiety medication. Specifically, Resident #39 was administered PRN Ativan, (a medication used to treat anxiety signs and symptoms) without a duration for the use of the PRN Ativan.

Inspectors wroteBased on observation, record review and interview the facility failed to implement the plan of care for two Residents (#95 and #96) out of a total sample of 24 residents. Specifically: For Resident #95 the facility failed to change a dressing to the forearm as ordered. For Resident #96 the facility failed to change a dressing to the right temple as ordered.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure one Resident (#71), out of 24 total sampled residents, received adequate supervision and assistance devices to prevent accidents. Specifically, for Resident #71, who had multiple recent falls, the facility failed to ensure staff implemented fall interventions, including the use of a baby monitor when in bed and ensuring his/her call bell was within reach.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide care and maintenance of a peripherally inserted Intravenous catheter (IV), consistent with professional standards of practice for one Resident (#94), out of a total sample of 24 residents. Specifically, for Resident #94, the facility failed to monitor a peripherally inserted Intravenous IV catheter site and failed to develop a plan of care for the IV.

Inspectors wroteBased on observations, and interviews, the facility failed to ensure staff stored drugs and biologicals in accordance with State and Federal requirements. Specifically, the facility failed to ensure nursing staff secured medications in the medication cart prior to leaving the cart unattended on the first-floor unit.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure proper food handling practices to prevent cross contamination during the meal distribution service in the kitchen.

Inspectors wroteBased on observation and interview, the facility failed to provide a homelike environment in two resident rooms on the second floor. Specifically, the facility failed to 1. repair a broken overhead light and 2. failed to maintain hot water temperatures in a resident bathroom.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure the Minimum Data Set (MDS) assessment was accurately coded to reflect the status of one Resident (#70) out of a total sample of 19 residents. Specifically, two comprehensive MDS assessments failed to code Resident #70 with obvious or likely carious or broken natural teeth.

Inspectors wroteBased on record review and interview the facility failed to ensure for one Resident (#15), out of a total sample of 19 residents, was referred for a Preadmission Screening and Resident Review (PASARR) evaluation (an evaluation to determine if a resident needs specialized services to address his/her Serious Mental Illness (SMI) once it was identified the Resident had a new diagnosis of schizoaffective disorder.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure for one Resident (#39), out of a total sample of 19 residents, that newly identified skin injuries, including an open skin area, was reported to the physician or the nurse practitioner, that the open area was measured, and that a treatment order was obtained to treat the open area.

Inspectors wroteBased on observation, record review and interview the facility failed to implement the use of a hand splint in accordance with the rehabilitation plan of care for one Resident (#70), out of a total sample of 19 residents.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the catheter bag for one Resident (#14) was off the floor to prevent potential contamination, out of a total sample of 19 residents.

Inspectors wroteBased on observation and interview, the facility failed to serve food that is palatable and at a safe and appetizing temperature.

Inspectors wroteBased on record review and interview the facility failed to obtain consent for the use of a psychotropic medication for 1 Resident (#66) out of a total sample of 18 residents. Findings Include: Resident #66 was admitted to the facility in April 2023 with diagnoses including dementia, acute embolism and adult failure to thrive. Review of Resident #66's most recent Minimum Data Set (MDS), dated [DATE], indicated he/she was assessed by staff to have severe cognitive impairment. Review of Resident #66's June 2023 Physician Orders, indicated the following: - Lorazepam (a medication used to treat anxiety) 2 mg/ml, Give 0.25 milliliters (ml) by mouth at bedtime for anxiety. Review of Resident #66's June 2023 Medication Administration Record (MAR) indicated he/she received Lorazepam 0.25 ml daily at bedtime from 6/8/23 to 6/20/23. [...]

Inspectors wroteBased on record review, interview and observation, the facility failed to implement 1 Resident's (#60) oxygen plan of care out of a total of 18 sampled residents. Findings Include: Resident #60 was admitted to the facility in May 2023 with diagnoses including dysphagia, polymyalgia rheumatica and spinal stenosis. Review of the facility policy titled Oxygen Administration, dated 12/22, indicated All tubing will be changed at least weekly, more often if soiling with secretions occurs. Review of Resident #60's most recent Minimum Data Set (MDS), dated [DATE], indicated he/she scored a 15 out of a possible score of 15 on the Brief Interview for Mental Status (BIMS) which indicated he/she was cognitively intact. During an observation on 6/20/23 at 8:50 A.M., the surveyor observed Resident #60 in bed with oxygen running via nasal cannula, the oxygen tubing was not dated. [...]

Inspectors wroteBased on policy review, observation and interview the facility failed to provide assistance with Activities of Daily Living (ADLs) for 2 Residents (#7, and #66) out of a total sample of 18 residents. Findings Include: Review of the facility policy titled, Activities of Daily Living (ADL), dated 12/2022, indicated A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. The facility will provide care and services for the following activities of daily living: d. Dining- eating, including meals and snacks 1. Resident #7 was admitted to the facility in May 2023 with diagnoses including end stage renal disease, severe protein-calorie malnutrition, and renal dialysis. [...]

Inspectors wroteBased on observation, record review and interview the facility failed to ensure 1.) an air mattress was on the correct setting for 1 Resident (#60) who had actual skin breakdown 2.) heels were offloaded as ordered for 1 Resident (#273) who had actual skin breakdown to the right heel out of a total sample of 18 Residents. Findings Include: 1. Resident #60 was admitted to the facility in May 2023 with diagnoses including dysphagia, polymyalgia rheumatica and spinal stenosis. Review of the facility policy titled, Specialty Mattress Procedure, not dated, indicated The residents' weight will be obtained as necessary for settings. Review of Resident #60's most recent Minimum Data Set (MDS), dated [DATE], indicated he/she scored a 15 out of a possible score of 15 on the Brief Interview for Mental Status (BIMS) which indicated he/she was cognitively intact. During an observation on 6/20/23 at 8: [...]

Inspectors wroteBased on observation, record review and interview the facility failed to ensure staff provided appropriate care and services for one Resident (#60) with a Gastrostomy tube (G-tube: a tube that is placed directly into the stomach through an abdominal incision for administration of nutrition, fluids, and medication), out of 18 sampled Residents. Specifically, the facility failed to date and label the G-tube solution bottle and water flush bag.