Walnut Hills Nursing Home

Inspectors wroteBased on observation, interview and review of the laundry check-list, the facility failed to ensure the dryer lint vents were free from build up. This had the potential to affect all residents residing in the facility. The facility census was 38.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure the Advanced Directive code status was consistent throughout the medical record. This affected two (#7 and #19) of two residents reviewed for code status, with the potential to affect all residents except for six (#6, #15, #16, #28 and #43) who were identified as having a full code status. The facility census was 38.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medications were not left at a resident's bedside and further failed to ensure medications were not expired. This affected one (#21) of five residents reviewed for medication administration. Additionally, the facility failed to ensure medications were not left unattended and unsecured on a medication cart. This had the potential to affect 10 (#5, #12, #14, #19, #21, #22, #18, #31, #33, and #36) residents identified by the facility as being independently mobile. The facility census was 38.

Inspectors wroteBased on medical record review, review of a facility Self-Reported Incident (SRI), resident and staff interviews and review of facility policy, the facility failed to ensure allegations of abuse were thoroughly investigated. This affected one (#24) of three residents reviewed for abuse. The facility census was 38.

Inspectors wroteBased on medical record review, observation and interview, the facility failed to ensure physician ordered treatments were completed by licensed nursing staff. This affected one (#28) of three residents reviewed for quality of care. The facility census was 38.

Inspectors wroteBased on medical record review, staff interviews and review of facility policy, the facility failed to implement non-pharmacological interventions prior to the administration of pain medications. This affected one (#11) of five residents reviewed for unnecessary medication. The facility census was 38.

Inspectors wroteBased on record review, observation, interview and review of facility policy, the facility failed to ensure enhanced barrier precautions (EBP) were followed during wound care. This affected one (#23) of three residents reviewed for transmission-based precautions (TBP). The facility census was 38.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record reviews, reviews of a facility investigation, review of self-reported incidents (SRIs), and review of a facility policy, the facility failed to ensure residents were free from misappropriation. This affected two (#4 and #47) of two residents reviewed for misappropriation. The facility census was 47.

Inspectors wroteBased on record review and interview, the facility failed to completely and accurately report staff hours worked for the Payroll Based Journal (PBJ) report. This had the potential to affect all 41 residents residing in the facility.

Inspectors wroteBased on observation, staff interviews, and facility policy review, the facility failed to complete hand hygiene during the dining room and room tray meal service. This affected two residents (Resident #25 and Resident #39) with the potential to affect all 13 residents on the skilled unit. The facility census was 41. Findings Include: 1. Observation on 11/04/24 at 12:04 P.M. revealed Certified Nursing Assistant (CNA) #356 was performing the lunch meal service in the skilled unit dining room for nine residents. CNA #356 had served the residents their drinks of choice prior to the tray cart being delivered from the kitchen. Upon receiving the tray cart in the dining room, CNA #356 began serving the trays to each resident, and assisting in preparing the food (such as removing lids to items and cutting up meat as needed) for ease of eating by the residents. [...]

Inspectors wroteBased on observation, record review, staff interview and facility policy review the facility failed to perform hand hygiene during medication administration. This deficient practice affected two residents (#10 and #16) out of six residents observed for infection control medication administration. The facility census was 41. Findings Include: Observation on 11/05/24 from 12:57 P.M. to 1:15 P.M. revealed Licensed Practical Nurse (LPN) #344 completing noon medications administration for residents residing on the skilled unit. LPN #344 sanitized hands prior to preparing Resident #16's narcotic medication for administration and locked the medication cart. LPN #344 then knocked on Resident #16's room door and entered the room. LPN #344 handed the medication cup to Resident #16 and Resident #16 took the medication with a drink of water. [...]

Inspectors wroteBased on record review, observation, interview, and facility policy review, the facility failed to follow physician ordered oxygen settings for administration of oxygen to residents. This affected one resident (Resident #15) out of four residents reviewed for respiratory care. The facility census was 41. Findings Include: Review of Resident #15's medical record revealed Resident #15 was admitted on [DATE] with diagnoses including respiratory disorder, dementia, and breast cancer. Resident #15 required assistance from staff for activities of daily living (ADL) tasks. Review of Resident #15's physician orders revealed an order dated 10/11/24 to administer continuous oxygen 1 to 2 liters per minute (LPM) via nasal cannula to maintain oxygen saturation (SAT) above 90 percent (%) for dependence on supplemental oxygen. [...]

Inspectors wroteBased on record review, staff interview, review of infection control logs, and policy review, the facility failed to update and implement their antibiotic stewardship program policy to ensure antibiotics were ordered appropriately. This affected one (Resident #30) out of one reviewed for antibiotic use.

Inspectors wroteBased on observation, medical record review, policy review and interview, the facility failed to provide adequate care and services to prevent the development and decline of pressure ulcers. This affected three residents (#37, #87 and #91) of four residents reviewed for pressure ulcers. The facility identified three residents with pressure ulcers and the facility census was 45.

Inspectors wroteBased on observation, medical record review, resident right posting review, and interview, the facility failed to ensure resident mail was delivered unopened. This affected two residents (#79 and #91) of five sampled residents. The census was 45.

Inspectors wroteBased on observation, medical record review and interview, the facility failed to ensure ostomy supplies were available as ordered. This affected one of one resident (#9) residing in the facility with an ostomy. The facility census was 45.

Inspectors wroteBased on medical record review, policy review and interview, the facility failed to obtain weights as ordered. This affected one resident (#37) of six sampled residents. The census was 45.

Inspectors wroteBased on medical record review and staff and resident interviews, the facility failed to ensure their pharmacy services provided resident intravenous medication in a timely manner. This affected one resident (#45) of two residents reviewed for intravenous medication administration. The census was 45.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to maintain an accurate medical record. This affected three residents (#45, #87 and #99) of six sampled residents. The census was 45.

Inspectors wroteBased on medical record review, observation, policy review, and interview, the facility failed to maintain adequate infection control practices. This affected one resident (#87) of three residents observed for pressure ulcer treatments and one resident (#25) resident observed for incontinence care. The census was 45.

Inspectors wroteBased on observation, medicare health inspection report review, survey inspection review and interview, the facility failed to ensure state survey results were readily accessible for review including the most recent survey of the facility. This had the potential to affect all 45 residents residing in the facility.

Inspectors wroteBased on observation, and interview, the facility failed to post nursing staff data in a place that was readily visible. This had the potential to affect all 45 residents residing in the facility.

Inspectors wroteBased on medical record review, job description review, and interview the facility failed to ensure a medication assistant did not perform duties outside her scope of practice. This affected four residents (#25, #32, #35 and #38 ) of nine residents reviewed for care and service. The facility census was 50.

Inspectors wroteBased on record review, observation, and interview, the facility failed to maintain a medication error rate of less than five percent. Three errors occurred within 27 opportunities for error resulting in a medication error rate of 11.0 %. This affected two residents (Resident #45 and #49) of four reviewed for medication administration. The facility census was 50.

Inspectors wroteBased on review of the medial record and interview with staff, the facility failed to ensure the physician was notified Resident #31 had not received her antidepressant medication as ordered by the physician. This affected one resident (Resident #31) of three residents reviewed for medication administration. The facility census was 53.

Inspectors wroteBased on observation, review of the medical record and interview with the staff, the facility failed to ensure fall interventions were in place for Resident #13. This affected one resident ( Resident #13) of six residents reviewed for plan of care. The facility census was 53.

Inspectors wroteBased on medical record review and staff interview the facility failed to ensure Resident #31, who had diagnoses of dementia and schizophrenia received adequate treatment, including the administration of the anti-depressant medication, Zoloft as ordered to assist the resident to maintain her highest practicable level of well-being. This affected one resident (#31) of three residents reviewed for medication administration. The facility census was 53.

Inspectors wroteBased on medical record review and interview the facility failed to ensure the anti-anxiety medication, Ativan was only administered to Resident #13 with a valid physician order. This affected one resident (#13) of three residents reviewed for medication administration. The facility census was 53. Findings Included: Review of the medical record revealed Resident #13 was admitted to the facility on [DATE] with diagnoses including heart failure, dementia, hypertension, osteoarthritis, insomnia, history of falling and hearing loss. Review of the quarterly Minimum Data Set assessment dated [DATE] revealed Resident # 13 had severely impaired cognition, was frequently incontinent of bladder and bowel and did not have any pressure areas. [...]

Inspectors wroteBased on record review, interview and policy review the facility failed to ensure all potential new hires were checked against the state Nurse Aide Registry (NAR), reference checks were completed and background checks were completed in timely manner to ensure no employee had findings concerning abuse, neglect, exploitation or misappropriation of residents' property prior to working with residents. This was identified for seven employees, State Tested Nursing Assistant (STNA) #107, STNA #108, STNA #109, STNA #110, [NAME] Specialist #112, [NAME] #114 and Maintenance Staff (MS) #115, out of ten employees reviewed and had the potential to affect all 44 residents residing in the facility.

Inspectors wroteBased on observation, interview, record review and policy review the facility failed to ensure a resident received recommended Restorative Range of Motion (ROM) services after being discharged from therapy. This affected one of one resident reviewed for restorative nursing services (Resident #27). The facility census was 44.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident received adequate monitoring while receiving blood thinning medication. This affected one of six residents reviewed for unnecessary medication use (Resident #11). The facility census was 44.

Inspectors wroteBased on medical record review, staff interview and policy review, the facility failed to ensure residents receiving antibiotic medication had appropriate indication for antibiotic use. This affected two (Resident #25 and #29) of five residents reviewed for medication use. The facility census was 44.