White Memorial Medical Ctr Dp

Inspectors wroteBased on interview and record review, the facility failed to ensure three (3) of four (4) sampled Residents (Residents 4, 60, and 111) and/or the Residents' representatives were informed and provided written information regarding the right to formulate an advance directive (a written statement of a resident's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the resident be unable to communicate them to the doctor). This deficient practice had the potential for Residents 4, 60, and 111 and/or residents' representative to not know their rights and cause conflict in carrying out the Residents wishes for medical treatment and health care decisions.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure safe and sanitary conditions were maintained in the kitchen as indicated on the facility policy when: 1. Dietary Aid 1 (DA 1) and Dietary Aid 2 (DA 2), observed with a beard, did not have a beard cover, while in the kitchen food preparation area. 2. An opened bottle of browning and seasoning sauce and a 60 ounce (oz, unit of mass, weight or volume) container of crushed pepper was observed unlabeled and undated. These deficient practices had the potential to result in pathogen (germ) exposure to residents, which could place the residents at risk for developing foodborne illness (food poisoning with symptoms including upset stomach, stomach cramps, nausea, vomiting, diarrhea, and fever) which could lead to other serious medical complications and hospitalization.

Inspectors wroteBased on interview and record review, the facility failed to offer five (5) of 5 sampled residents (Residents 4, 60, 61, 62, and 110) the Covid-19 (a respiratory viral infection that affects primarily the lungs and result in cough and difficulty breathing) vaccine (substance used to stimulate immunity to particular infectious disease) and failed to provide a documented evidence that the resident or their the resident's responsible party (RP) were provided education regarding the benefits and potential risks associated with COVID-19 vaccine. This deficient practice had the potential to expose the residents of the facility to Covid-19 infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent the development of a pressure ulcer (refers to localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device) for one of one sampled resident (Resident 60) by leaving the resident in chair without a pressure relieving device for five hours and 30 minutes in accordance with the facility policy. This deficient practice had the potential for Resident 60 to develop pressure ulcer.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of one sampled resident (Resident 111) was free from accident hazards in accordance with the facility policy when Resident 111's Family Member 1 (FM1), who was not provided training on how to assist resident with meals was observed giving the resident a drink through a straw while the resident's head of bed was flat. This deficient practice had the potential for Resident 111 to choke (have severe difficulty in breathing because of a constricted or obstructed throat or a lack of air) or aspirate (occurs when contents such as food, drink, saliva or vomit enters the lungs).

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess 8 of 8 sampled residents (Residents 8, 9, 10, 11, 12, 13, 14, and 15) for the risk of entrapment (an event in which a resident is caught, trapped, or entangled in the space in or about the bed and bed rail) from bed rails (adjustable metal or rigid plastic bars that attach to the bed) prior to installation, and failed to ensure safety standards were met prior to installation by ensuring bed dimensions were measured based on the residents' size and weight. This deficient practice placed Residents 8, 9, 10, 11, 12, 13, 14, and 15 at risk for entrapment that could cause serious harm, injury, or death.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure sanitary and clean environment was maintained in the kitchen. During the inspection of the kitchen the following were observed: 1. One open/ripped plastic bag containing garlic bread in the freezer was not labeled and dated when it was opened. 2. One dairy crate had flour tortillas and was labeled as dice chicken. 3. The dishwasher during rinse cycle (clean water as a final stage in washing) did not function since 6/7/2023 and the temperatures were not within normal ranges (were below 180 degrees Fahrenheit). 4. The facility had dairy crates as food storage containers: There were 52 open dairy crates in the walking freezer, on the second freezer there were 120 dairy crates, and inside the dry food storage there were 40 dairy crates. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to treat one (1) of eight (8) sampled residents (Resident 13) with dignity and respect in accordance with the facility's Privacy and Dignity of Residents policy and procedure. This deficient practice had the potential to result in decreased self-esteem and self-worth of Resident 13.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow its policy on Advanced Directives (written instructionrecognized under State law relating to the provision of health care when the individual is incapacitated [inability to perform regular daily activities because of a serious health condition]) by failing to inform and provide documented notification for 1 of 8 sampled residents (Resident 11) of the right to formulate an advanced directive. This deficient practice had the potential to deny Resident 11 the right to request or refuse medical care and treatment.

Inspectors wroteBased on interview, observation, and record review the facility failed to develop and implement an individualized and comprehensive care plan to meet the individual needs for two (2) of 8 sampled residents (Resident 11 and Resident 13) by failing to: 1. Implement interventions outlined in Resident 11's care plan indicating the need to ensure the residents blood glucose (blood sugar found in the blood, which is the body's primary source of energy) levels were maintained within the normal range of 80-100 milligrams (mg)/deciliter (dL, metric unit of capacity). 2. Implement interventions to address Resident 13's scrotal edema (a type of swelling in the pouch of skin that holds the testicles). These deficient practices placed Residents 11 and 13 at risk for lack or delay in delivery of care and services necessary for the residents' overall well being. Cross reference: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop an activity plan for 1 of 8 sampled residents (Resident 13) that reflected his needs and interests as indicated in the Activity Program Overview policy and procedure. This deficient practice had the potential for Resident 13 to experience boredom.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure 1 of 1 sampled resident (Resident 13) who was at risk for skin breakdown and pressure injuries (PI, areas of damaged skin caused by staying in one position for too long), had interventions to prevent PIs. This deficient practice had the potential for Resident 13 to develop PIs which could lead to discomfort, hospitalization and death.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the intravenous (IV, is a therapy that delivers liquid substances directly into a vein) tubing was labeled for 1 of 1 sampled resident (Resident 15) as indicated in the facility's Intravenous Therapy, Peripheral Site Maintenance Policy and Procedure. This deficient practice placed Resident 15 at risk for IV complications.

Inspectors wroteBased on interview and record review, the facility failed to develop a plan of care for two of ten sampled residents (Resident 3 and 55) as indicated in the facility's policy and procedure. a. For Resident 3, the facility failed to develop a specific plan of care for the use of chlordiazepoxide (a prescription medicine used to treat certain anxiety disorders and symptoms of alcohol withdrawal). b. For Resident 55, the facility failed to develop an individualized care plan for the use of Meropenem (an antibiotic that used to treat severe infections of the skin or stomach). These deficient practices had the potential for the residents not to adequate receive nursing interventions and not to meet their goals.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of ten sampled residents (Resident 56) received treatment to apply dressing to surgical wound site after shower as per physician's order. This deficient practice had a potential for lack of care and treatment on the surgical wound.

Inspectors wroteBased on observation, interview, and record review, the facility failed to monitor the behaviors and side effects for one of ten sampled residents (Resident 3) for the use of psychotropic (any drug that affects brain activities associated with mental processes and behavior) medication as indicated in the physician orders. This deficient practice had the potential for inadequate monitoring for effectiveness and adverse consequences of the medication.

Inspectors wroteBased on interview and record review the facility failed to ensure one of ten sampled resident's (Resident 58) Skilled Nursing Dialysis Record form was accurate and complete. This deficient practice had a potential for misinformation and misleading information of the care and treatment of the resident.

Inspectors wroteBased on interview and record review, the facility failed to provide to two of ten sampled residents (Resident 4 and 6) and their Family Member (FM), a written notice of proposed discharge prior to the residents discharge. Resident 4's written notice of proposed discharge had not been completed. This deficient practice had the potential for Resident 4 and 6 and their FM not have an opportunity to exercise their rights to appeal if they believe that the discharge was inappropriate.