Whitehall of Deerfield

Inspectors wroteBased on observation, interview and record review the facility failed to ensure fall interventions were in place for a resident at high risk for falls for 1 of 3 residents (R3) reviewed for safety and supervision in the sample of 3.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff performed hand hygiene and wore and/or changed personal protective equipment (PPE) in a manner to prevent potential exposure to and transmission of contagious diseases. These failures have the potential to affect all 151 residents living in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure facility recipes were followed. This has the potential to effect all residents receiving food from the kitchen.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure safe food handling procedures were being practiced. This has the potential to effect all residents receiving food from the kitchen.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure insulin pens and tuberculin purified protein derivative (PPD) were labeled with open and with expiration dates, and failed to ensure medications were stored securely for 5 of 10 residents ( R78, R16, R384, R385 and R386) reviewed for medication labeling/storage in the sample of 27.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure enhanced barrier precautions (EBP) were in place and failed to change gloves and perform hand hygiene in a manner to prevent cross contamination for five of 27 residents (R30, R51, R383, R382, R376) reviewed for infection control in the sample of 27.

Inspectors wroteBased on observation, interview, and record review, the facility failed to treat a resident in a dignified manner for one of 27 residents (R51) reviewed for dignity in the sample of 27.

Inspectors wroteBased on observation, interview, and record review the facility failed to monitor weights for a resident with weight loss and failed to apply compression stockings for a resident with a history of blood clots which applies to 2 of 2 residents (R96, R5) reviewed for quality of care in a sample of 27.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure pressure relieving interventions were in place for residents at risk for developing pressure injuries for three of six residents (R276, R26, R51) reviewed for pressure injuries in a sample of 27.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure interventions were in place to prevent a contracture from getting worse for one of 27 residents (R69) reviewed for range of motion in the sample of 27.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure medications were administered according to professional standards. This applies to 1 of 27 residents (R380) reviewed for pharmacy services in the sample of 27.

Inspectors wroteBased on interview and record review the facility failed to administer a pneumococcal vaccine to 1 of 5 residents (R26) reviewed for immunizations in the sample of 27.

Inspectors wroteBased on the interview and record review, the facility failed to ensure that a resident's caregiver immediately reported a new injury of unknown origin for 1 of 1 residents (R1), who were reviewed for injuries of unknown origin in the sample of 4.

Inspectors wroteBased on interview and record review the facility failed to provide cares to a resident in manner that prevented a resident injury. The facility failed to ensure a resident was transferred via mechanical lift in a safe manner. These failures apply to 1 of 4 residents reviewed for safety and supervision in the sample of 4.

Inspectors wroteBased on interview and record review the facility did not inform/invite a resident's representative to a care plan meeting for 1 of 3 residents (R1) reviewed for care plans in the sample of 3.

Inspectors wroteBased on observation, interview, and record review the facility failed to change gloves while using the dishwasher and failed to sanitize food thermometers in a manner to prevent cross contamination. This applies to all residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents followed smoking contracts for 2 of 2 residents (R24 & R27) reviewed for safety, supervision, and smoking in the sample of 28.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure indwelling urinary catheter tubing was not laying or dragging on the floor for 1 of 3 residents (R434) reviewed for indwelling urinary catheters in the sample of 28.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident took their medications. This applies to 1 of 1 resident (R79) reviewed for medication administration in the sample of 28.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident's soup was nectar thick for 1 of 4 residents (R68) reviewed for thickened liquids in the sample of 28.

Inspectors wroteBased on interview and record review the facility failed to ensure interventions/hip precautions were used to keep a resident's left hip prosthetic in place. This applies to 1 of 3 residents (R1) reviewed for quality of care in the sample of 3.

Inspectors wroteBased on interview and record review, the facility failed to ensure an injury of unknown origin was investigated for 1 of 4 residents (R2) reviewed for injuries in the sample of 11.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow the facility's menu and recipe for residents on puree diet for eight of eight residents (R21, R22, R27, R43, R50, R72, R82, and R357) reviewed for pureed diets in the sample of 25.

Inspectors wroteBased on interview and record review the facility failed to record daily weights per physician orders for a resident with congestive heart failure for 1 of 25 residents (R2) reviewed for quality of care in the sample of 25.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure pressure relieving interventions were in place for 1 of 5 residents (R7) reviewed for pressure wounds in a sample of 25.

Inspectors wroteBased on observation, interview, and record review the facility failed to offer additional pain medication for a resident with pain for 1 (R405) of 25 residents reviewed for pain in the sample of 25.

Inspectors wroteBased on observation, interview, and record review, the facility failed to administer medications at the ordered time and ordered dosage. There were 31 opportunities with 2 errors resulting in a 6.45 % error rate. This applies to 1 of 5 residents (R405) observed in the medication pass.

Inspectors wroteBased on observation, interview, and record review facility staff failed to wear appropriate PPE (personal protective equipment) in a contact isolation room for a resident and failed to place a resident on contact isolation with a suspected shingles outbreak. This applies to 2 of 25 residents (R356, R405) in the sample of 25.