Wilson Care and Rehab

Inspectors wroteThe facility identified a census of 34 residents, with 12 included in the sample. Based on observation, record review, and interview, the facility failed to ensure nursing staff donned (put on) the appropriate required Enhance Barrier Precautions (EBP- infection control interventions designed to reduce transmission of resistant organisms which employ targeted gown and glove use during high contact care) before providing direct cares to Resident (R) 5 and ensure staff did not set R5's catheter bag (medical device that collects urine) directly on the resident's floor. The facility failed to ensure nursing staff donned the required EBP and performed hand hygiene prior to and during the wound dressing change for R15.

Inspectors wroteThe facility had a census of 34 residents. The sample included 12 residents. Based on observation, record review, and interview, the facility failed to resolve recurring issues reported by the Resident Council.

Inspectors wroteThe facility had a census of 34 residents. The sample included 12 residents, with three reviewed for Medicare Liability Notices. Based on record review and interview, the facility failed to provide the resident (or representative) a fully completed Advanced Beneficiary Notice (ABN) Centers for Medicare and Medicaid Services (CMS) Form 10055 for skilled services for Resident (R) 2, R20, and R28, which included the estimated cost of services.

Inspectors wroteThe facility identified a census of 34 residents. The sample included 12 residents, with five sampled residents reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure the Consultant Pharmacist (CP) identified and reported the omission of blood pressure or pulse monitoring for Resident (R) 4 prior to the administration of the antihypertensive (a class of medication used to treat high blood pressure) beta blocker (a medications that reduce the workload of the heart by slowing its rate and relaxing blood vessels) Carvedilol. The facility failed to implement recommendations made by the CP for a dosage amount for R4's Voltaren gel (a topical medication used to relieve arthritis pain).

Inspectors wroteThe facility identified a census of 34 residents. The sample included 12 residents, with five sampled residents reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure that blood pressure or pulse monitoring was obtained for Resident (R) 4 prior to the administration of the antihypertensive (a class of medication used to treat high blood pressure) beta blocker (a medications that reduce the workload of the heart by slowing its rate and relaxing blood vessels) Carvedilol. The facility failed to ensure a physician-ordered dosage amount was indicated for R4's Voltaren gel (a topical medication used to relieve arthritis pain).

Inspectors wroteThe facility had a census of 34 residents. The sample included 12 residents. Based on observation, record review, and interview, the facility failed to ensure Resident (R) 2's injectable medications were not expired.

Inspectors wroteThe facility identified a census of 34 residents. The sample included 12 residents, with one resident, Resident (R) 7, reviewed for Hospice care. Based on observation, record review, and interview, the facility failed to ensure the collaboration of care between R7's hospice provider and the facility which included the hospice provider contact information, the services the hospice provider would provide to the resident, the supplies, equipment and medications the hospice provider would provide, as well as how often hospice staff members would visit the facility.

Inspectors wroteThe facility had a census of 34 residents. The facility had one kitchen. Based on observation, interview, and record review the facility failed to ensure appropriate sanitation of dishware used for preparing, and serving residents' meals, and failed to prepare, store, distribute, and serve food under sanitary conditions for the 34 residents in the facility, who receive their meals from the kitchen. This deficient practice placed the residents of the facility at risk for food-borne illness.

Inspectors wroteThe facility had a census of 34 residents. Based on record review and interview, the facility failed to submit complete and accurate staffing information through the Payroll-Based Journal (PBJ) as required. This deficient practice placed the residents at risk for unidentified and ongoing inadequate nurse staffing.

Inspectors wroteThe facility had a census of 34 residents. Based on observation, record review, and interview the facility failed to resolve grievances recorded during resident council meetings. This placed the residents at the facility at risk for unresolved grievances and decreased quality of life.

Inspectors wroteThe facility had a census of 34 residents. Based on observation, interview, and record review, the facility failed to label insulin (a hormone that lowers the level of glucose in the blood) pens or vials with an opened date or discard date. This placed residents who received the insulins at risk for expired or ineffective insulin.

Inspectors wroteThe facility identified a census of 34 residents. The sample included 12 residents with five residents reviewed for immunizations, Resident (R)3, R4, R10, R16, R19, and R87, to include pneumococcal vaccinations (helps protect against serious illnesses like pneumonia). Based on record review and interviews, the facility failed to follow the latest guidance from the Centers for Disease Control and Prevention (CDC) when they failed to offer, obtain an informed declination or a physician-documented contraindication for the pneumococcal PCV 20 vaccination. This deficient practice placed the residents at risk of acquiring, spreading, and experiencing complications from the pneumococcal disease.

Inspectors wroteThe facility had a census of 34 residents. The sample included 12 residents with one reviewed for hospitalization. Based on observation, interview, and record review the facility failed to notify the state's Long Term Care Ombudsman (LTC) Ombudsman (a person who advocates for residents of nursing homes), as required, of Resident (R) 19's discharge from the facility. This placed the resident at risk for impaired rights and/or advocate involvement.

Inspectors wroteThe facility had a census of 34 residents. The sample included 12 residents with one reviewed for hospitalization. Based on observation, interview, and record review, the facility failed to provide Resident (R)19 with a Bed Hold Notice (the right of an individual to resume nursing facility residency after he or she has been away from the facility due to hospitalization or therapeutic leave). This placed the resident at risk of not being allowed to return to the same room upon discharge from the hospital.

Inspectors wroteThe facility had a census of 34 residents. The sample included 12 residents, with five reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure the Consultant Pharmacist identified and reported an inappropriate indication or a documented physician rationale which included the multiple unsuccessful attempts for nonpharmacological symptom management and risk versus benefit for the continued use of Resident (R)31's antipsychotic medication (class of medications used to treat any major mental disorder characterized by a gross impairment in reality testing and other mental emotional conditions). This placed the resident at risk for unnecessary medications and related side effects.

Inspectors wroteThe facility had a census of 34 residents. The sample included 12 residents, with five reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure an appropriate indication or a documented physician rationale which included the multiple unsuccessful attempts for nonpharmacological symptom management and risk versus benefit for the continued use of antipsychotic (class of medications used to treat major mental conditions which cause a break from reality testing) for Resident (R)31. This deficient practice placed the resident at risk for unnecessary psychotropic medication and related complications.

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents. Based on observation, interview, and record review the facility failed to monitor laundry temperatures to ensure proper disinfection and cleaning of soiled linens and clothing. This deficient practice placed residents at risk for infection and illness.

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents. Based on observation, interview, and record review the facility failed to provide an environment reasonably free of insects. This deficient practice placed the residents of the facility at risk for irritation and potential insect borne illnesses.

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents. Based on observation, interview, and record review the facility failed to store hazardous cleaning chemicals in a safe manner. This deficient practice placed the five cognitively impaired, independently mobile residents at risk for injury and/or accidents.

Inspectors wrote- R17's Physician Order Sheet (POS), dated 08/01622 documented diagnoses of dementia without behavioral disturbance (progressive mental disorder characterized by failing memory, confusion,) cerebral ischemia (acute brain injury that results from impaired blood flow to the brain,) and anxiety (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear). R17's Quarterly Minimum Data Set (MDS), dated [DATE], recorded the resident had a Brief Interview for Mental Status (BIMS) score of five (moderately impaired cognition). The MDS recorded the resident required extensive assistance of one to two staff for bed mobility, locomotion on the unit, dressing and personal hygiene. The MDS documented R17 received an antipsychotic medication seven days during the lookback period. [...]

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents. Based on interview, and record review the facility failed to provide the Skilled Nursing Facility (SNF) Advanced Beneficiary Notice (ABN), CMS form 10055, which contained an estimated cost to continue services for skilled services, at the end of the skilled stay. This deficient practice placed three of three sampled residents, Resident (R) 24, R29, and R31, at risk for uninformed decisions regarding skilled services.

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents. Based on observation, interview, and record review, the facility failed to develop a comprehensive care plan for Resident (R) 187 who smoked which placed the resident at risk of unidentified and/or uncommunicated care needs related to smoking.

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents. Based on observation, record review, and interview, the facility failed to ensure Resident (R)25 received the necessary treatments and cares related to treatment of skin tears when staff failed to use appropriate hand hygiene during wound care and failed to accurately apply dressings and monitor as ordered by the physician. These deficient practices placed the resident for incomplete death record and delayed wound healing. Findings Included: - R25's diagnoses included anxiety disorder, major depressive disorder (mood disorder characterized by severe sadness), and dementia with behavioral disturbance (progressive mental disorder characterized by failing memory, confusion,) . [...]

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents with one reviewed for dialysis (the process of removing waste products and excess fluid from the body when the kidneys are not able to adequately filter the blood) . Based on observation, record review, and interview, the facility failed to provide ongoing communication and assessment of Resident (R) 16's dialysis treatment. This placed the resident at risk for complications and health decline.

Inspectors wrote- R17's Physician Order Sheet (POS), dated 08/01622 documented diagnoses of dementia without behavioral disturbance (progressive mental disorder characterized by failing memory, confusion,) cerebral ischemia (acute brain injury that results from impaired blood flow to the brain,) and anxiety (mental or emotional reaction characterized by apprehension, uncertainty and irrational fear). R17's Quarterly Minimum Data Set (MDS), dated [DATE], recorded the resident had a Brief Interview for Mental Status (BIMS) score of five (moderately impaired cognition). The MDS recorded the resident required extensive assistance of one to two staff for bed mobility, locomotion on the unit, dressing and personal hygiene. The MDS documented R17 received an antipsychotic medication seven days during the lookback period. [...]

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents. Based on observation, interview, and record review, the facility failed to label Resident (R)10, R16, R20, and R84's insulin (hormone which allows cells throughout the body to uptake glucose) pens with the date opened and expiration date. This placed these residents at risk for ineffective medications.

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents with one reviewed for hospice (a type of health care that focused on the terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life) services. Based on observation, record review, and interview, the facility failed to ensure a coordinated plan of care, which coordinated care and services provided by the facility with the care and services provided by hospice, was developed and implemented for Resident (R)30. This placed R30 at risk for inappropriate end of life cares.

Inspectors wroteThe facility had a census of 38 residents. The sample included 12 residents. Based on observation, interview, and record review the facility failed to post daily staffing in a public place.