Northwood Skilled Nursing And Rehabilitation

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that residents were free from significant medication errors, as nursing staff did not administer medications according to physician orders. Medical record reviews, staff and resident interviews, and policy review revealed that six out of seven residents reviewed for late medications received their prescribed medications significantly past the scheduled administration times. The facility's policy required medications to be administered within one hour of the prescribed time, but medications were often given several hours late. Residents affected had various medical diagnoses, including acidosis, coronary artery disease, heart failure, renal insufficiency, chronic obstructive pulmonary disease, diabetes, dementia, and psychotic disorders. For example, one resident with heart failure and renal insufficiency received multiple medications, including anticonvulsants, cholesterol medication, and insulin, more than an hour late. Another resident with chronic obstructive pulmonary disease and diabetes received medications such as atorvastatin, divalproex, insulin, and antipsychotics up to three hours late. Several residents reported in interviews that their medications were consistently late and expressed a preference for receiving them on time. Staff interviews indicated that late medication administration was due in part to workload issues, such as responding to resident falls, and a lack of available assistance, as there was no unit manager present and other nursing staff were occupied with their own medication passes. The nurse practitioner confirmed that she was not informed of the late medication administration. The facility's policy on medication administration was not followed, resulting in non-compliance with prescribed medication schedules for multiple residents.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to implement and maintain an effective infection prevention and control program, specifically regarding enhanced barrier precautions (EBP), cleaning and disinfection of durable medical equipment (DME), and proper hand hygiene and glove use. Surveyors found that residents requiring EBP did not have clear signage or instructions indicating the required personal protective equipment (PPE) or which care activities necessitated specific PPE. Instead, rooms were marked only with a magnetic square labeled 'EP,' without further information. Staff interviews revealed inconsistent understanding of EBP requirements, with some staff unsure of what PPE to use or the meaning of the signage. Additionally, EBP was inconsistently documented, sometimes only in care plans and not in physician orders, and there was no clear indication at the door for which resident in a shared room was under EBP. Observations showed that staff did not consistently follow protocols for cleaning and disinfecting DME between residents. For example, an LPN used the same finger pulse oximeter, blood pressure cuff, and forehead thermometer on two different residents without cleaning the equipment in between, despite being aware of the policy requiring disinfection. The DON confirmed that all DME should be cleaned between uses, and the facility's policy also required this practice. Hand hygiene and glove use were also found to be deficient. During incontinence care, a CNA failed to change gloves and wash hands between caring for two different residents in the same room. The CNA admitted to not following proper procedure, stating it was not her normal practice. The facility's hand hygiene policy required handwashing or use of hand sanitizer before and after resident contact, after removing gloves, and after contact with bodily fluids, but this was not followed during the observed care.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency was identified when a resident with severe cognitive impairment, multiple medical diagnoses including disorganized schizophrenia, heart failure, Alzheimer's disease, and cerebrovascular accident, was observed to have a saturated incontinence brief that had leaked onto the incontinence pad beneath her. The resident was dependent on staff for toileting and transfers, and was frequently incontinent of bladder and always incontinent of bowel. During an early morning observation, a CNA confirmed that the resident's brief was saturated and emitted a pungent odor, with leakage onto the pad. The CNA reported that the resident had last been changed approximately four hours prior, despite the expectation that incontinence care should be provided every two hours. This lapse in timely incontinence care was verified through medical record review, observation, and staff interview.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain water temperatures within normal limits, resulting in a deficiency affecting a resident with severe cognitive impairment and multiple medical diagnoses, including disorganized schizophrenia, heart failure, Alzheimer's disease, and cerebrovascular accident. During incontinence care, staff were unable to obtain warm water from the resident's bathroom and had to leave the room to find water that was only lukewarm. The resident displayed discomfort during care, pulling away from the washcloth as aides attempted to wash her, and staff acknowledged that the water was cold. Review of facility records showed that a mixing valve for hot water had been replaced, but the issue persisted, requiring another replacement shortly after. Water temperature logs indicated that temperatures were within normal limits at one point, but direct measurement during the observed care showed the water was 93.7°F, which was confirmed by the DON to be too cold. Staff interviews revealed ongoing problems with water temperature, and there was no policy available for review regarding water temperature management.

Penalty

Inspection fine: $19,383

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide adequate supervision and intervention to prevent a resident with impaired cognition and a history of elopement from leaving the facility unsupervised. The resident, who was housed in a secured memory care unit, managed to elope through his bedroom window without staff knowledge. This incident placed the resident at potential risk for serious life-threatening harm and/or injury, as he was found 2.3 miles away from the facility in a busy area of town. The resident had a history of elopement, having previously exited the facility through the same window in May 2023. Despite this history, the resident's care plan did not include specific interventions to address the risk of elopement through the window. On the day of the incident, the resident was observed pacing near the nurse's station and closely watching an LPN, which was not recognized as a potential sign of elopement risk. The staff on duty were insufficiently equipped to monitor the resident effectively, as one STNA was pulled to work on another unit, leaving only one nurse and one aide to care for twenty-three memory care residents. The facility's failure to implement effective interventions and provide adequate supervision allowed the resident to elope undetected. The resident was eventually located by the Director of Rehabilitation, who found him leaving a store and walking in a busy area. The resident was returned to the facility by EMS, and a head-to-toe assessment revealed abrasions on both knees but no pain or distress. Interviews with staff indicated that the memory care unit was challenging to manage with limited personnel, and the facility's management was unaware of the previous elopement incident.

Removal Plan

• LPN #110 identified Resident #01 was not in his room and the facility began searching for the resident.
• DOR #85 located Resident #01 at a Dollar General Store and the facility was notified.
• Resident #01 was returned to the facility by [NAME] EMS, accompanied by the [NAME] Police Department. ADON #405 initiated one to one safety supervision for Resident #01.
• Registered Nurse (RN) #109 completed a head-to-toe assessment on Resident #01 and the resident was free from any pain or psychosocial distress related to the incident. Resident #01 did have an abrasion noted to his bilateral knees.
• RQAN #403 reviewed progress notes for the last 30 days for all current facility residents for any like behaviors and no other concerns were identified.
• The Administrator installed metal L Brackets and additional upgraded hardware to prevent Resident #01's window from opening more than six inches or wide enough to prevent the resident from exiting the window.
• The Administrator audited all resident accessible windows and upgraded securement hardware throughout the facility. All windows were noted to be secured without any identified concerns.
• Unit Manager (UM) #134 completed elopement risk assessments for all current facility residents. There were no identified concerns from prior elopement assessments.
• Clinical Operations Specialist (COS) #121 completed wander risk assessments for all current facility residents. There were no identified concerns noted from the prior assessments.
• The Administrator audited all egress doors, alarm panels and the facility wander guard system to ensure proper alarm and functioning. There were no identified concerns noted.
• COS #121 audited all current facility residents with physician orders for wander guards. All wander guards were placed properly, functioning and within required expiration. No identified concerns were noted.
• UM #134 audited all current facility residents at risk of elopement, to ensure all those at risk have a care plan with appropriate interventions in place. There were no identified concerns in the audit.
• COS #121 audited to ensure all current facility residents with a wander guard were appropriately assessed for placement as ordered, had a physicians order and had a care plan in place. There were no identified concerns noted.
• UM #122, Dietary Manager #400, DOR #85, Environmental Services Director #450 and Nursing Administrative Assistant #79 began educating all current facility staff in person, on the missing resident procedure and the facility Abuse/Neglect policy and all remaining staff via phone. The education was completed.
• The Administrator held an elopement drill in person with staff on dayshift and night shift. Staff response was immediate and appropriate. There were no identified concerns noted.
• The facility held a Quality Assessment and Performance Improvement (QAPI) meeting with the Administrator, RQAN #403, ADON #405, UM #134, UM #122, COS #121, RDO #402 and Medical Director #501. Resident #01's elopement and the facilities corrective action plan was discussed. The facilities corrective action plan was approved by the QAPI committee.
• Maintenance Director #130 or designee will conduct elopement drills on each shift, twice weekly for a period of four weeks to ensure staff respond accordingly.
• All variances will be corrected upon discovery and additional education/follow-up will be provided as deemed necessary. All findings will be reported to the facility's QAPI committee.
• Maintenance Director #130 or designee will conduct checks of exit doors/wander guard system once weekly, for a period of four weeks to ensure proper functioning. All variances will be corrected upon discovery and education/follow-up will be provided as deemed necessary. Ongoing compliance will be further maintained through audits as dictated by the facility's QAPI committee.
• The DON or designee will complete elopement risk and wandering risk assessments on current residents weekly for a period of four weeks, to ensure no changes in behavior patterns are present, placing residents at risk for elopement and ensuring that appropriate and effective interventions are in place. All variances will be corrected upon discovery and additional education/follow-up will be provided as deemed necessary.
• The DON or designee will review current resident progress notes in the clinical operations meeting five times weekly for a period of four weeks to monitor acute changes in behavior patterns that require further intervention. All variances will be corrected upon discovery and additional education and follow-up will be provided as deemed necessary.
• The DON or designee will audit all current facility residents with physician's order for wander guard five times a week, for a period of four weeks to ensure proper functioning, placement and devices within stated expiration. All variances will be corrected upon discovery and additional education/follow-up will be provided as deemed necessary. All findings will be reported to the facility's QAPI committee.
• The Administrator or designee will conduct checks of window securement hardware, three times a week for a period of four weeks to ensure windows are secure and safety latches remain intact. All variances will be corrected upon discovery and education/follow-up will be provided as deemed necessary. Further continued ongoing compliance will be further maintained through audits as dictated by the facility quality assurance committee.
• RDO #402 will review all audits weekly for a period of four weeks to ensure completion and compliance. All variances will be corrected immediately upon discovery and additional follow-up and education will be provided as deemed necessary.
• The DON or designee will educate new hires and/or agency staff working in the facility prior to working their shift on the Wandering elopement procedure and Abuse/Neglect policy for four weeks. All variances will be corrected upon discovery and additional education and follow-up will be provided as deemed necessary.

Penalty

Inspection fine: $19,383

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain a clean and sanitary kitchen, which had the potential to affect all 71 residents residing there. During an initial tour of the kitchen, it was observed that the three-compartment sink lacked sanitizing solution, and the Kitchen Supervisor confirmed that the facility had been out of sanitizer for several days. Additionally, there was dirt, food debris, and a black substance under the three-compartment sink and along the walls throughout the kitchen. The cove base covering was torn off the wall under the sink, and a tile was missing. Trash cans in the kitchen had food debris and splattered substances running down them, and there was unknown splatter and debris on the front of the dishwasher, with food debris along its top. Water was also dripping from the dishwasher into a large bucket placed underneath. Interviews with the Regional Dietary Director and the Customer Service Representative confirmed the lack of sanitizing solution in the three-compartment sink and the leaking dishwasher. The facility's policy on sanitization, dated October 2008, requires that the facility be maintained in a clean and sanitary manner, with all equipment washed to remove soils using hot water and sanitizing solutions. Kitchen waste should be kept in clean, leakproof, tightly closed containers, and sinks used for washing utensils, cooking equipment, or dishes should be cleaned between uses with an approved sanitizing agent. This deficiency was investigated under Complaint Number OH00153481.