Wellington Rehabilitation and Healthcare

Inspectors wroteBased on observation, and resident and staff interviews, the facility failed to place a resident's call light device within reach to allow for the resident to request assistance as needed for 1 of 1 dependent resident reviewed for accommodation of needs (Resident #13).

Inspectors wroteBased on record review and staff interviews, the facility failed to accurately code the Minimum Data Set (MDS) assessment in the area of Pre-admission Screening and Resident Review (PASARR) status, medication, and falls for 3 of 22 resident MDS assessments reviewed (Resident #43, Resident #4, Resident #53).

Inspectors wroteBased on record review and resident and staff interviews, the facility failed to obtain further approval and screening through a Level II evaluation process in accordance with the Pre-admission Screening and Resident Review (PASRR) Level II Determination Notification. This was for 1 of 2 residents (Resident #53) reviewed for PASRR.

Inspectors wroteBased on record review and staff interviews, the facility failed to develop a comprehensive care plan that included Pre-admission Screening Resident Review (PASRR) Level II (Resident #53 and Resident #43) and hospice (Resident #8) for 3 of 20 comprehensive care plans reviewed.

Inspectors wroteBased on observations, record review and staff interviews, the facility failed to revise the comprehensive care plan to accurately reflect the code status (Resident #12), a pressure ulcer (Resident #13) and the discontinuation of bed rails (Resident #7). This was for 3 of 20 comprehensive care plans reviewed. 1. Resident #12 was admitted to the facility on [DATE] with diagnoses that included end stage renal disease dependent on hemodialysis. Review of Resident #12's medical record revealed an advance directive physician's order dated [DATE] indicating he was a full code, meaning he wished to have cardiopulmonary resuscitation (CPR) performed should his heart stop. Review of a hard copy of Resident #12's advance directive kept in a book at the nurses' station indicated Resident #12 was made a full code on [DATE]. [...]

Inspectors wroteBased on observations, record review, and resident, staff, and Nurse Practitioner (NP) interviews the facility failed to remove a topical pain patch in accordance with the physician's order. This was for 1 of 2 residents (Resident #82) reviewed for professional standards.

Inspectors wroteBased on observations, record review, and resident and staff interviews, the facility applied a resting hand splint (a brace used to keep the hand, wrist, and fingers in a neutral position preventing stiffness and contractures) without a physician's order, therapy instructions or in accordance with a splint wearing schedule. This deficient practice was for 1 of 3 residents reviewed for position and mobility (Resident #38).

Inspectors wroteBased on observation, record review and staff interviews the facility failed to follow professional standards of practice and infection prevention measures when Unit Manager #2 (UM #2) failed to remove soiled gloves, perform hand hygiene and don clean gloves during tracheostomy (a surgical procedure that creates an opening in the trachea (windpipe) through the front of the neck to create an artificial airway and assist with breathing) care for 1 of 1 residents reviewed for tracheostomy care (Resident #17).

Inspectors wroteBased on observations, record review, staff and resident interviews, the facility failed to attempt alternatives prior to installing side rails, complete a siderail assessment, assess entrapment risk, review the risks and benefits of side rails with the resident and obtain informed consent, complete a care plan for side rail usage and obtain a physician's order prior to siderail use for 1 of 3 residents (Resident #57) reviewed for side rails.

Inspectors wroteBased on observation, record review and staff interviews, the facility failed to implement their policies and procedures for hand hygiene when the business office manager failed to perform hand hygiene while passing a meal tray. This was for 1 of 8 staff members observed for hand hygiene practices (Business Office Manager).

Inspectors wroteBased on record review, and staff, Responsible Party (RP) and Physician interviews the facility failed to administer seizure medication to Resident #19 on 10/2/23 after he returned to the facility from the hospital, resulting in 4 missed doses of seizure medication. Resident #19 did not receive Keppra (an anti-seizure medication) beginning on 10/2/23 when he returned to the facility from the hospital through 10/4/23. On 10/4/23 Resident #19 suffered seizures in the facility, requiring readmission to the hospital. On 10/4/23 Resident #19 suffered a tonic/clonic seizure (loss of consciousness and violent muscle contractions which can be dangerous and potentially life threatening) lasting about 1 minute in the hospital which required the administration of intravenous (IV) Keppra. This was for 1 of 5 residents (Resident #19) whose medication administration was reviewed.

Inspectors wroteBased on record review, observations, staff and responsible party (RP) interviews the facility failed to identify bolsters as a restraint, failed to assess the bolsters as a restraint, and utilized them without medical justification and without a physician order. This was for 1 of 1 resident (Resident #48)reviewed for restraints.

Inspectors wroteBased on record review and staff interviews the facility failed to complete a significant change in status Minimum Data Set (MDS) assessment following hospice election for 1 of 1 resident (Resident #78) reviewed for death and failed to complete a significant change in status Minimum Data Set (MDS) assessment for a resident who discharged from hospice services for 1 of 1 resident (Resident #48) reviewed for accidents.

Inspectors wroteBased on record review and staff interviews the facility failed to accurately code the Minimum Data Set (MDS) assessment in the area of medications for 1 of 5 residents (Resident #64) reviewed for unnecessary medications.

Inspectors wroteBased on observations, record review, and staff interviews the facility failed to keep dependent resident's fingernails trimmed for 1 of 6 residents reviewed for activities of daily living care (Resident #4).

Inspectors wroteBased on observations and staff interviews the facility failed to secure resident medications stored in an unattended medication cart (Rooms 143-150 hall) for 1 of 5 medication carts.

Inspectors wroteBased on observation, record review and staff interviews, the facility failed to implement their hand hygiene policy when the Respiratory Therapist (RT) failed to perform hand hygiene after touching a contaminated surface and before touching the tracheostomy and failed to implement their policy for enhanced barrier precautions when the RT failed to wear a gown while performing tracheostomy care for 1 of 1 resident (Resident #53) reviewed for tracheostomy care, and failed to perform hand hygiene between the removal of soiled gloves and the application of clean gloves for 1 of 2 residents (Resident #71) reviewed for pressure ulcers.

Inspectors wroteBased on observation, record review, resident interviews, and staff interviews, the facility failed to ensure repairs for cracks, holes, a water damaged wall, broken blinds, and discolored flooring were completed for two (Residents # 6 and # 7) of two residents reviewed for environmental concerns and for two random rooms.

Inspectors wroteBased on record review, resident interview, and staff interviews the facility failed to obtain medications from the pharmacy for administration. This was for two (Residents # 1 and # 5) of two residents whose medications were reviewed.

Inspectors wroteBased on record review and interviews with family, staff, physician assistant, independent apartment manager, staff from the Program of All-Inclusive Care for the Elderly (PACE), and contracted van driver for the PACE program, the facility failed to implement an effective discharge planning process that ensured care was coordinated with the resident's primary physician through PACE. On the day of discharge Resident #1 had a change in condition and the PACE physician was not made aware of the change prior to discharge. The PACE program is a community program that helps provide and coordinate medical care and basic care services for older adults. This was for one (Resident # 1) of three residents reviewed for discharge planning.

Inspectors wroteBased on observation, record review and staff, and contracted respiratory therapist interviews the facility failed to ensure 1) individualized care for Resident # 10's tracheostomy was clarified regarding routine frequency of care and type of inner cannula he needed 2) supplies were available to exchange his disposable inner cannula and 3) clarification regarding when the resident's external cannula exchange should be completed. This was for one of two sampled residents with a tracheostomy (Resident # 10).

Inspectors wroteBased on record review, staff interview, and facility laboratory employee interview the facility failed to ensure a urine specimen was received by the facility's lab in a timeframe which the lab considered acceptable to run the specimen for results. This was for one (Resident # 10) of one sampled resident whose lab results were reviewed.

Inspectors wroteBased on record review, and staff interview the facility failed to ensure a nurse's license was verified for 1 of 5 nurses reviewed for licenses. (Nurese # 1)

Inspectors wroteBased on record reviews, Physician interview and staff interviews the facility failed to arrange transportation for an outside appointment to avoid missing medical appointment for 1 of 2 residents reviewed for medically related social services (Resident #38).