Waters of Rockport Skilled Nursing Facility, the

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from misappropriation for 1 of 1 residents reviewed for misappropriation. Three checks were taken from a resident's checkbook by a QMA. The QMA then used two checks in an attempt to transfer money from the resident's bank account to the QMA's account. (Resident D)

Inspectors wroteBased on interview and record review, the facility failed to ensure a baseline care plan was developed for a newly admitted resident within 48 hours of admission for 1 of 2 newly admitted residents with pressure ulcers. A resident admitted on a Thursday and had no baseline care plan in place until the following Monday. (Resident C)

Inspectors wroteBased on interview and record review, the facility failed to ensure services were provided for treatment of an existing pressure ulcer for 1 of 2 residents reviewed for pressure ulcers. Following admission and then readmission from a hospital, a resident's pressure ulcer was not routinely assessed, and wound care orders were not immediately obtained for treatment. (Resident B)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident received adequate supervision to prevent falls for 1 of 2 residents reviewed for accidents. The plan of care was not updated, and interventions were not implemented and reviewed for effectiveness for a high risk to fall resident with severely impaired cognition. This deficient practice resulted in multiple falls, one with major injury, where the resident sustained an acute fracture to right hip/pelvis and subacute left hip fracture. (Resident 28)

Inspectors wroteBased on interview and record review, the facility failed to ensure employment of kitchen staff with appropriate competencies and skills. The kitchen manager was not certified. (Kitchen Manager)

Inspectors wroteBased on interview and record review, the facility failed to ensure accurate documentation for 4 of 11 residents reviewed for clinical record accuracy. Residents medications and treatments were left blank on the Medication Administration Record (MAR) and Treatment Administration Record (TAR). (Resident 136, Resident 19, Resident 30, Resident 9)

Inspectors wroteBased on interview and record review, the facility failed to provide at least 80 square feet (sq. ft) per resident in double occupancy rooms and 100 sq. ft. in single occupancy rooms. This was evidenced in 14 of 43 resident rooms in the facility. (room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER])

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident's medication regimen was free from chemical restraints for 1 of 5 residents reviewed for unnecessary medications. A resident's confusion increased after initiating Zoloft (antidepressant also used to control anxiety) and Ativan (antianxiety). Staff documented administering Ativan was ineffective for controlling the resident's restlessness and anxiety, the resident was given additional doses. (Resident 28)

Inspectors wroteBased on interview and record review, the facility failed to ensure an accurate assessment of resident status for 3 of 11 residents reviewed for MDS (Minimum Data Set) assessment accuracy. Preadmission screening, antibiotic use, and UTI (urinary tract infection) diagnoses were incorrectly coded. (Resident 6, Resident 4, Resident 9)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate treatment and services to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being of 1 of 2 residents reviewed for dementia care. A resident with dementia that was a high risk to fall was not kept active resulting in increased restlessness and multiple falls. (Resident 28)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staffing sheets were posted for the correct day for 5 of 5 days during the survey.

Inspectors wroteBased on interview and record review, the facility failed to ensure services were provided to prevent the development of pressure ulcers for 1 of 2 residents reviewed for pressure ulcers. A resident's plan of care was not developed with interventions to prevent new pressure from developing after the resident was assessed to be at risk for pressure, and no documentation in the resident's record indicated the resident was turned or repositioned in accordance with physician orders. (Resident D)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received food at safe and appetizing temperatures for 1 of 1 meal trays tested for taste and temperature of food.

Inspectors wroteBased on interview and record review, the facility failed to ensure adequate pharmaceutical services were available to provide physician prescribed routine medications to 4 of 4 residents reviewed for pharmacy services. After the facility's contracted pharmacy failed to deliver routine medications, residents missed multiple prescribed daily medications. (Resident B, Resident C, Resident D, Resident F)

Inspectors wroteBased on interview and record review, the facility failed to ensure the food service department was directed by a supervisor competent in food service management and knowledgeable in sanitation standards and food handling for 1 of 1 dietary managers reviewed. The dietary manager was not certified. (Dietary Manager)

Inspectors wroteBased on interview and record review, the facility failed to employ a qualified Infection Preventionist. The full time Director of Nursing was also completing the Infection Preventionist duties.

Inspectors wroteBased on interview and record review, the facility failed to ensure a bed hold policy was given to residents or resident representatives for 8 of 9 residents reviewed for hospitalizations. The bed hold form was not completed. There was no documentation of a resident or representative receiving a bed hold at the time of hospitalization. (Resident 17, Resident 30, Resident 29, Resident 8, Resident 19, Resident 21, Resident 10, Resident 7)

Inspectors wroteBased on interview and record review, the facility failed to ensure staff were completed with the CNA (Certified Nursing Aide) training program and evaluation within 4 months of their hire date for 5 of 5 staff that completed the CNA training program at the facility. The facility lacked information and supplies related to the CNA training program.

Inspectors wroteBased on interview and record review, the facility failed to ensure adequate monitoring and supervision was done to keep a resident's drug regimen free from unnecessary drugs for 1 of 5 residents reviewed for unnecessary medications. A resident was getting narcotic pain medications from an outside physician. (Resident 29)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure proper storage and disposal of medications for 2 of 3 medications carts and 1 of 1 medication storage rooms observed. A bottle of medication in the medication cart was not labeled, expired medications and medications of discharged residents were observed in the medication storage room, and medication carts were observed unlocked. (Resident 86, Resident 87, Resident 21, Resident 88, Resident 33, Resident 11, Resident 5, Resident 2, Resident 22, Resident 8)

Inspectors wroteBased on observation and interview, the facility failed to store, prepare, and serve food in accordance with professional standards for food service safety for 2 of 2 observations of the kitchen. Foods were not labeled and open to air. Facial masks were adjusted with hands and food was prepped without sanitizing hands. Plate warmer lids and food containers were held against clothing. Bottom of shoe rested on shelf under table where food serving trays were stored. (Kitchen)

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were informed of the benefits of influenza and pneumococcal vaccines, consents or refusals were obtained for vaccines, and vaccines were offered based on resident preference for 5 of 5 residents reviewed for vaccines. (Resident 1, Resident 15, Resident 3, Resident 23, Resident 26)

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were informed of the benefits of Covid vaccines, or consents and/or refusals were obtained for 4 of 5 residents reviewed for vaccines. (Resident 1, Resident 15, Resident 3, Resident 23)

Inspectors wroteBased on interview and record review, the facility failed to provide at least 80 square feet (sq. ft) per resident in double occupancy rooms and 100 sq. ft. in single occupancy rooms. This was evidenced in 14 of 43 resident rooms in the facility. (room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER])

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents that were self administering medications were assessed for capability to self administer medications for 1 of 1 residents reviewed for self administering medications. A resident did not have a physician's order, care plan, or assessment to self administer medications. (Resident 29)

Inspectors wroteBased on interview and record review, the facility failed to ensure an accurate Minimum Data Set (MDS) Assessment was completed for 1 of 1 residents reviewed for activities of daily living, 1 of 1 residents reviewed for hospice services, and 1 of 5 residents reviewed for unnecessary medications. The MDS inaccurately indicated one resident received a hypoglycemic medication, one resident had a current diagnosis of pneumonia and septicemia, and one resident did not receive hospice services. (Resident 17, Resident 21, Resident 27)

Inspectors wroteBased on observation, interview and record review the facility failed to develop care plans for 3 of 5 residents reviewed for unnecessary medications and 1 of 1 reviewed for hospice. The facility failed to develop care plans for residents on an anticoagulant, diuretic, antidepressant, risk of opioid overdose, and a resident that received hospice services. (Resident 11, Resident 29, Resident 21)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff had knowledge of and appropriate training for Narcan administration for 1 of 5 residents reviewed for unnecessary medications. Staff were not educated and inserviced on the use of Narcan ordered for resident with a history of substance abuse and overdose, the drug was not available for use in the facility. (Resident 29)

Inspectors wroteBased on interview and record review, the facility failed to maintain an complete, accurate clinical record for 1 of 5 residents reviewed for unnecessary medications. A narcotic pain medication was documented under the name of the Nurse Practitioner when it was ordered by an outside physician and the clinical record lacked documentation of destroying medications. (Resident 29)

Inspectors wrote2. On 4/3/24 at 11:26 A.M., Resident 27's clinical record was reviewed. Diagnosis included, but was not limited to, Covid-19 (dated 3/30/24). Current physician orders included, but were not limited to: For COVID-19 + residents record temperature, pulse, respiration, blood pressure, and oxygen saturation every shift (report immediately any temperature 99.1 degrees or higher), dated 4/1/24. Resident 27's Medication Administration Record (MAR) for April 2024 indicated a temperature reading of 100 degrees on 4/2/24 day shift, and a temperature reading of 99.1 degrees on 4/2/24 evening shift. Resident 27's clinical record lacked notification to the physician related to the temperature readings on 4/2/24. On 4/5/24 at 2:30 P.M., the Director of Nursing (DON) and Administrator indicated notification to the physician related to the temperature readings could not be located. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure nurse staffing forms were posted in an area accessible to residents and visitors, or updated daily during 3 of 5 days of the survey.

Inspectors wroteBased on interview and record review, the facility failed to designate one or more individual(s) as the Infection Preventionist with qualifying training or certification. The facility did not have a current certified Infection Preventionist for 3 of 5 days of survey.

Inspectors wroteBased on interview and record review, the facility failed to ensure the plan of care was revised for 1 of 4 residents reviewed for care planning and care plan conferences were held timely for 6 of 7 residents reviewed for care plan conferences. A resident's care plan indicated they had a current urinary tract infection but they did not and interventions were not updated. Six residents had not had timely care plan conferences. (Resident 6, Resident 9, Resident 12, Resident 17, Resident 25, Resident 26)

Inspectors wroteBased on interview, observation, and record review, the facility failed to provide food that was palatable, attractive, and at a safe and appetizing temperature for 1 of 2 trays tested.

Inspectors wroteBased on interview and record review, the facility failed to provide at least 80 square feet (sq. ft) per resident in double occupancy rooms and 100 sq. ft. in single occupancy rooms. This was evidenced in 14 of 43 resident rooms in the facility. (room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER])

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a safe, functional, sanitary, and comfortable environment was maintained for 2 of 2 resident halls. Bathroom flooring was loose from the subfloor, a sink was slow to drain, paint was peeling in a resident's room as well as in the hallways, and wallpaper was peeling off the wall. (room [ROOM NUMBER], Resident 25, Resident 12, Resident 28, East Hall, [NAME] Hall)

Inspectors wroteBased on interview and record review, the facility failed to ensure baseline care plans were initiated within forty eight hours of admission for 1 of 2 residents reviewed for baseline care plans. (Resident 26)

Inspectors wroteBased on observation, interview and record review, the facility failed to develop a care plan for 3 of 4 residents reviewed for development of care plans. (Resident 15, Resident 6, Resident 26)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who needed respiratory care were provided such care consistent with professional standards of practice. A resident lacked an order and care plan for a CPAP (continuous positive airway pressure) machine in use, and oxygen was not administered as ordered for 3 of 3 residents reviewed for respiratory care(Resident 23, Resident 26, Resident 6)

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from unnecessary medications for 1 of 5 residents reviewed for unnecessary medications. A resident's as needed anti-anxiety medication was ordered for greater than 14 days. (Resident 26)

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure accurate staffing sheets were posted daily for 5 of 5 days during the survey.