Waterville Residential Care Center

Inspectors wroteBased on record review and interviews during the abbreviated survey (IQIES #2576672) the facility did not ensure residents received treatment and care in accordance with professional standards of practice for one (1) of three (3) residents (Resident #1) reviewed. Specifically, Resident #1 exhibited a change in condition on the morning of [DATE] and was sent to a scheduled pulmonology appointment where they expired during transport. There was no documented evidence of the resident's change of condition and staff provided conflicting versions of what the resident's condition was on the morning of [DATE].

Inspectors wroteBased on observations, record review, and interviews during the abbreviated survey (IQIES 2576672), the facility did not ensure residents received adequate supervision and assistive devices to prevent accidents for two (2) of three (3) residents (Residents #1 and #2) reviewed. Specifically, Resident #1 had multiple falls, and the facility investigation did not identify the root cause of the fall and establish person-centered interventions to prevent further falls; and Resident #2's interventions to prevent falls were not implemented as planned.

Inspectors wroteBased on observation, record review, and interviews during the recertification survey conducted [DATE]-[DATE], the facility did not ensure drugs and biologicals were labeled and stored in accordance with currently accepted professional principles and include the expiration date when applicable for 2 of 6 medication carts (East and Center medications carts), and for 2 of 2 treatment carts (East and [NAME] treatment carts) reviewed. Specifically, - The East and Center medication carts contained multiple packaged 3 milliliter syringes that expired on [DATE]. - The Center medication cart contained one insulin pen that was opened and did not have an expiration date. - The East and [NAME] treatment carts were left unlocked and unattended.

Inspectors wroteBased on observation and interviews during the recertification survey conducted 10/7/2024-10/10/2024, the facility did not ensure each resident received food and drink that was palatable, flavorful, and at an appetizing temperature for 2 of 2 meal test tray reviewed (the 10/8/2024 lunch meal and the 10/9/2024 breakfast meal). Specifically, food was not served at palatable and appetizing temperatures during the lunch meal on 10/8/2024 and the breakfast meal on 10/9/2024. Additionally, Residents #11, #16, #22, #27, #29, #44, #48, #51, and #84 stated the food did not taste good and was cold.

Inspectors wroteBased on observation, record review, and interviews during the recertification survey conducted 10/7/2024 - 10/10/2024, the facility did not ensure food was stored, prepared, distributed, and served in accordance with professional standards for food service safety in the main kitchen and in 1 of 3 nursing unit kitchenettes (West Unit) reviewed. Specifically, in the main kitchen the hot water boost pump was turned off on the dishwasher and was not heating properly; there were outdated, expired, moldy food items, and dented cans; and the sanitizer at the three bay sink registered as empty. The [NAME] Unit dining room refrigerator contained undated, outdated, and moldy food items.

Inspectors wroteBased on record review, observations, and interviews during the recertification survey conducted 10/7/2024-10/10/2024, the facility did not ensure residents had a safe, clean, comfortable, and homelike environment for 3 of 5 nursing units on the Second floor (all resident units were located on the Second floor), the middle dining room, the first floor hair salon area, and the staff hallway near the timeclock Specifically, room [ROOM NUMBER] had a strong smell of urine; the floors in the 2nd floor middle dining room were dirty and sticky; the staff hallway near the timeclock had a section of plywood that was unclean and not flush with the wall; the East 100's unit shower room toilet was not attached to the floor and the radiator was rusty and had sharp edges; the East 200's unit shower room had chipped wall tiles near the floor; [...]

Inspectors wroteBased on observation, record review, and interviews during the recertification survey conducted 10/7/2024-10/10/2024, the facility did not ensure residents were provided an ongoing program to support their choice of activities, designed to meet their interests and support their physical, mental, and psychosocial well-being for 1 of 1 resident (Resident #28) reviewed. Specifically, Resident #28 was not included in or provided activities to meet their interests and preferences.

Inspectors wroteBased on observation, record review, and interviews during the recertification survey conducted 10/7/2024-10/10/2024, the facility did not ensure residents with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote wound healing, prevent infection, and prevent new ulcers from developing for 1 of 2 residents (Resident #30) reviewed. Specifically, Resident #30's pressure relieving heel boots were not in place while in bed as planned.

Inspectors wroteBased on observation, interview and record review during the recertification survey conducted 3/1/23-3/7/23, the facility failed to ensure food was stored, prepared, and served in accordance with professional standards for food service safety for two isolated areas (the dry food storage room and the main kitchen). Specifically, shelving units with boxes of disposable dinnerware and kitchen equipment were stored directly under a sewage drain line in the dry food storage room; a 10 pound box of raw hamburger patties was stored directly above a box of ice cream cups in the reach in freezer; the floors under and behind the cookline equipment and the #10 can opener (commercial grade heavy duty can opener) were soiled and unclean with food debris; the high temperature commercial dishwasher was not operating at proper rinse temperatures for sanitizing; and garbage was not disposed of properly.

Inspectors wroteBased on observation, record review and interview during the recertification survey the facility did not ensure drugs and biologicals were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 2 of 2 medication rooms (East and West) and 2 of 3 medication carts (East and West) observed. Specifically, multiple expired medications were found in 2 medication rooms and 2 medication carts.

Inspectors wroteBased on observation, record review, and interview during the recertification survey, the facility did not ensure food and drinks were palatable, attractive, and at a safe and appetizing temperature for 3 of 3 meals (breakfast, lunch, and dinner) reviewed. Specifically, food and drinks were not served at palatable temperatures for 3 meals (chipped beef, ham and cheese sandwich, pancakes, milk).

Inspectors wroteBased on observation and interview during the recertification survey, the facility did not ensure a safe, clean, comfortable, and homelike environment for 1 of 2 units (West Unit). Specifically, multiple resident areas on the [NAME] Unit were in disrepair (ice machine, walls, base molding, a toilet seat, a toilet paper roll holder and a countertop).

Inspectors wroteBased on observation, record review and interview during the recertification survey, the facility did not ensure the development and implementation of comprehensive person-centered care plans for 1 of 2 residents (Resident #48) reviewed. Specifically, Resident #48 did not have skin breakdown prevention boots in place as planned.

Inspectors wroteBased on observation, record review and interview during the recertification survey the facility did not ensure that residents with limited range of motion (ROM) received appropriate treatment and services to prevent further decrease in ROM for 2 of 2 residents (Residents #31 and 48) reviewed. Specifically, Residents #31 and 48 did not have hand contracture devices in place as care planned.

Inspectors wroteBased on observation, interview, and record review during the recertification survey, the facility did not store food in accordance with professional standards for food service safety in 1 of 3 coolers (three-door nourishment cooler). Specifically, the air temperature within the three-door nourishment cooler was not maintained at 41 degrees Fahrenheit (F) or less. The cooler contained glasses of milk that had temperatures higher than 41 degrees F.