Alternative Healthcare Solutions Llc
Inspection history, citations, penalties and survey trends for this long-term care facility in San Juan, PR.
- Location
- Septimo Piso Doctors Center Hospital, San Juan, PR 00910
- CMS Provider Number
- 405000
- Inspections on file
- 9
- Latest survey
- December 3, 2024
- Citations (last 12 mo.)
- 0
Citation history
Health deficiencies cited at Alternative Healthcare Solutions Llc during CMS and state inspections, most recent first.
The facility failed to ensure that care and management of PICC lines were provided by competent and trained nursing staff, affecting two residents. The DON confirmed that the competence of 12 nurses providing care to residents with PICC lines had not been assessed in 2024, and no evidence of competence certification was provided during the survey.
The facility failed to provide sufficient support personnel for the food and nutrition service, leading to the Dietitian using a TSA for dishwashing duties, which complicated kitchen operations.
The facility failed to comply with required sink compartment sanitations. Staff did not know the required temperatures for each compartment, and the sanitizing solution concentration in the third compartment was 600 ppm instead of the required 200 ppm.
The facility failed to comply with its policy on the use and storage of foods brought by family and visitors. Snacks in the residents' refrigerator were found without the required labels, including initials, room number, and date.
The facility failed to maintain equipment in a safe operating condition. Observations revealed broken plastic coverings on electrical cords of two residents' beds, a broken ABHR dispenser, and a broken window shade cover lying on the floor in different rooms.
The facility failed to maintain a safe, clean, and comfortable environment. Three residents complained about cold room temperatures, and a review of the temperature log showed that temperatures exceeded the established parameters. Additionally, peeling paint due to water damage was observed in one room.
The facility failed to develop a baseline care plan for a resident with a power central line, necessary for antibiotic therapy. Despite the resident having the central line upon admission, the care plan did not include instructions for its local care. The Nursing Supervisor acknowledged the omission, although nursing personnel were providing local care and changing bandages every 72 hours.
The facility failed to ensure care for a PICC line and a power central line was performed according to a physician order for two residents. Both residents were admitted with these vascular access devices, and nursing staff provided local care and changed bandages every 72 hours without formal orders in place.
Failure to Ensure Competent PICC Line Care
Penalty
Summary
The facility failed to ensure that care and management of peripherally inserted central catheter (PICC) lines were provided by competent and trained nursing staff, affecting two residents with PICC lines. During an interview with the Director of Nursing (DON), it was revealed that the competence certification and skills of nursing personnel interacting with residents who had PICC lines were not performed in 2024. Despite requests for competence certification information, no evidence was provided during the survey procedures. The DON confirmed that the competence of 12 nurses providing care to residents with PICC lines had not been assessed in 2024.
Insufficient Support Personnel in Food and Nutrition Service
Penalty
Summary
The facility failed to provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. During an interview with the Dietitian, it was revealed that the facility did not have a designated dishwasher position covered. As a result, the Dietitian had to use a TSA (Temporary Staff Assistant) for dishwashing duties, which made the kitchen operations difficult.
Non-Compliance with Sink Compartment Sanitations
Penalty
Summary
The facility failed to comply with the required sink compartment sanitations as per their policy and procedure. During a visual inspection and staff interview, it was observed that the staff working the three-compartment sink did not have knowledge of the required temperatures for each compartment. Specifically, the first compartment should be at 110°F, the second at 75°F, and the third at least 75°F with a sanitizing solution concentration of 200 ppm. However, the concentration measurement in the third compartment was found to be 600 ppm, which is significantly higher than the required 200 ppm, indicating overuse of the sanitizing agent.
Non-Compliance with Food Storage Policy
Penalty
Summary
The facility failed to comply with its policy regarding the use and storage of foods brought to residents by family and other visitors. The policy, ND-0003 Almacenaje de los alimentos en la nevera de los residentes, requires that all food in the refrigerator be identified with the resident's initials, room number, and date. During a review conducted on 04/17/2024, it was observed at approximately 1:30 PM that some snacks, including juice, desserts, and vegetables (carrots), in the residents' refrigerator were not labeled with the required information.
Failure to Maintain Safe Equipment
Penalty
Summary
The facility failed to maintain equipment in a safe operating condition. During an observational tour, it was noted that the electrical cords on the beds of two residents in a specific room had broken plastic coverings. Additionally, an alcohol-based hand rub (ABHR) dispenser was found to be broken in another room. Furthermore, a window shade cover was observed to be broken and lying on the floor in a different room.
Failure to Maintain Safe and Comfortable Environment
Penalty
Summary
The facility failed to promote a safe, clean, comfortable, and homelike environment for its residents. During an observational tour, three residents in rooms 706A, 708A, and 709A complained about cold temperatures in their rooms. A review of the room temperature log for 04/14/24 revealed that daily measurements exceeded the established parameters of 71 to 81 degrees. Additionally, it was observed that the wall behind the door in one room had peeling paint due to water damage. The facility's policy on room temperatures stated that rooms should be maintained between 71 to 81 degrees, and no patients with skin lesions were admitted at the time of the survey, which would have required different temperature settings.
Failure to Develop Baseline Care Plan for Central Line
Penalty
Summary
The facility failed to develop and implement a baseline care plan for a resident with a power central line in the right subclavian, which was necessary for administering antibiotic therapy. The deficiency was identified during a record review and interviews with the Nursing Supervisor and the resident. The resident, a male with a diagnosis of Lumbar Discitis and Osteomyelitis, was admitted to the facility for a 90-day antibiotic therapy regimen. Despite the resident having the power central line upon admission, the baseline care plan did not include instructions for its local care. The Nursing Supervisor acknowledged the omission, stating that the care plan was not developed because the central line was inserted at another facility. However, the nursing personnel were providing local care and changing bandages every 72 hours on an ongoing basis.
Failure to Ensure Physician Orders for PICC and Power Central Line Care
Penalty
Summary
The facility failed to ensure care provided to a peripherally inserted central catheter (PICC) and a power central line was performed in accordance with a physician order. This deficiency was identified in two residents. One resident, a male admitted with a diagnosis of intraspinal abscess and granuloma, had a PICC line in his left arm for antibiotic therapy. Upon review, it was found that there was no physician order for the care of the PICC line. The Nursing Supervisor confirmed that the resident had the PICC line upon admission and that nursing personnel provided local care and changed bandages every 72 hours without a formal order in place. The resident corroborated this information during an interview, stating that he was admitted with the PICC line and received regular care from the nursing staff. Another resident, a male admitted with a diagnosis of lumbar discitis and osteomyelitis, had a power central line in the right subclavian for antibiotic therapy. Similarly, there was no physician order for the care of this power line. The Nursing Supervisor acknowledged the absence of an order and mentioned that the resident had the power line upon admission, with nursing staff providing local care and changing bandages every 72 hours. The resident confirmed that he was admitted with the power line and received regular care from the nursing staff. Both cases highlight the facility's failure to ensure that care for these vascular access devices was performed according to a physician's order, as required.
Latest citations in PR
No citations found matching the criteria.
Trusted data from CMS and state health departments
Every citation, penalty and Plan of Correction is sourced from public CMS records (latest release May 27, 2026) and official state health department websites — never guesswork.
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