Millennium Institute For Advance Nursing Care Inc
Inspection history, citations, penalties and survey trends for this long-term care facility in Rio Piedras, PR.
- Location
- Calle Cosme Reparto San Lucas, Rio Piedras, PR 00926
- CMS Provider Number
- 405030
- Inspections on file
- 14
- Latest survey
- May 1, 2025
- Citations (last 12 mo.)
- 0
Citation history
Health deficiencies cited at Millennium Institute For Advance Nursing Care Inc during CMS and state inspections, most recent first.
The facility did not have a full-time DON for two months after the previous DON resigned and left immediately. The administrator temporarily took on both acting DON and MDS coordinator roles, and a new MDS coordinator was hired but not appointed as DON. Staff interviews and documentation confirmed that no one was designated as acting DON during this period.
Several residents reported that their meals were often served cold or at inadequate temperatures, with some expressing dissatisfaction with the taste and quality of the food. Test tray evaluations confirmed that multiple food items were not maintained within the required temperature range, contrary to facility policy.
Surveyors identified that the kitchen's three-compartment sink did not reach the required washing temperature, loose food items were present under storage racks, and an insect was found in the dry storage area. These deficiencies could impact all residents receiving care at the facility.
Surveyors identified that RNs did not perform hand hygiene before accessing gloves during medication pass, and one RN placed gloves on a resident's bedside table without disinfecting them. The soiled linen room was also found to lack proper labeling, ventilation, temperature/humidity monitoring, and accessible hand sanitizer, with no policy or procedure provided for its management.
Surveyors identified multiple environmental deficiencies, including mold, dust, water damage, loose grab bars, unstable furniture, and broken tiles, which compromised the safety, cleanliness, and comfort of all residents. These issues were observed throughout various rooms and common areas, affecting the overall homelike environment.
Surveyors identified that the facility failed to maintain a safe, functional, sanitary, and comfortable environment for all residents, staff, and the public. Observations included rippled vinyl flooring, pigeon nesting and droppings on exterior walls and windows, and green mold on exterior lights at the entrance and parking area.
A resident admitted for rehabilitation after a femur fracture, with a known diagnosis of Cerebral Palsy, did not have this diagnosis included in her baseline care plan within 48 hours of admission. The omission was identified during a record review, despite the diagnosis being recognized in psychiatric consultation.
Two residents were repeatedly served food items they do not consume, such as milk, without being offered alternatives, even though their dietary preferences and restrictions were documented and included on their meal cards. The facility also lacked an alternate menu to address individual food dislikes.
The facility failed to provide sufficient support personnel for the food and nutrition service, as revealed by the Administrative Dietitian. The lack of a designated dishwasher position required the use of a TSA for dishwashing duties, impacting kitchen functionality and potentially affecting 22 residents.
The facility failed to provide food in an attractive manner and maintain an appetizing temperature, as breakfast was served in Styrofoam trays and containers instead of insulated thermal food domes and trays. Two residents confirmed this practice, and the Administrative Dietitian cited a job vacancy for the dishwasher position as a contributing factor.
The facility failed to comply with the required sink compartment sanitations. During an inspection, it was observed that the three-compartment sink was not prepared according to the facility's policies and procedures. The staff did not know the required temperatures for the sink compartments, and the sanitizer concentration in the third compartment was below the required minimum.
The facility failed to maintain equipment in a safe operating condition. Observations revealed rust on the parallel bars in the Physical Therapy room and rough areas on the handrails of the steps apparatus. These deficiencies could potentially affect all 22 residents and staff members.
The facility failed to maintain an effective pest control program, with flying insects and centipedes found on light fixtures in the recreational room and three cockroaches observed in the women's bathroom in the Physical Therapy room.
The facility failed to maintain a safe, clean, and homelike environment. Observations revealed mold stains on ceiling tiles in the Occupational Therapy and Medical Record rooms, water-damaged shelves in the Occupational Therapy room, and a loose plinth with exposed glue in the physical therapy area. These issues had the potential to affect all 22 residents.
The facility failed to perform comprehensive assessments for two residents who chose to self-administer their medications. One resident required respiratory therapy for asthma, and another used eye drops for cataracts. In both cases, no assessments or care plans were documented to ensure the safety and appropriateness of their self-administration requests.
The facility failed to develop a complete baseline care plan within 48 hours for a resident admitted for rehabilitation after a knee replacement. The care plan did not include goals for managing the resident's Neobladder, which was not identified during admission. The resident managed her own catheterization, and no assessment was done to evaluate her ability to do so while recovering from surgery.
The facility failed to develop and implement a comprehensive person-centered care plan for a resident admitted for rehabilitation services following a left knee replacement. Despite the resident's need for respiratory therapy due to asthma, no comprehensive care plan with measurable objectives and timeframes was prepared by the interdisciplinary group.
The facility failed to ensure proper infection prevention practices, affecting all 22 residents. Observations included non-functional lights, black dust on faucet borders, peeling paint, lack of trash cans, moldy benches, dirty corridors, and improperly stored medical supplies. The recreational therapy room and medication room also had significant cleanliness and maintenance issues.
Failure to Designate Full-Time Director of Nursing
Penalty
Summary
The facility failed to designate a registered nurse to serve as the director of nursing (DON) on a full-time basis for a period of two months. The previous DON submitted a resignation letter on March 1, 2025, with an effective date of March 14, 2025, but left the facility immediately upon submitting the letter. During this period, the facility administrator assumed the roles of both acting DON and Minimum Data Set (MDS) coordinator. A new MDS coordinator was hired on April 28, 2025, but was not appointed as the DON and was expected to complete training in the MDS role before any further appointment. Interviews with staff confirmed that no one was designated as acting DON, and documentation reviewed showed that the new hire was only assigned the MDS coordinator position. As a result, the facility did not have a full-time DON in place and had no expected date to fill the position.
Failure to Provide Palatable and Properly Tempered Food and Drink
Penalty
Summary
The facility failed to ensure that food and drink provided to residents was palatable, attractive, and maintained at a safe and appetizing temperature. Multiple residents reported dissatisfaction with the taste and temperature of their meals. One resident stated that the food was not pleasant to the taste and that items she did not consume were brought to her, with food temperatures being inadequate. Another resident reported that her food was often cold and required reheating in the microwave, while a third resident also noted that the temperature of her food was not adequate most of the time. Additionally, a fourth resident described receiving cold boiled eggs for breakfast and chose to eat only one to avoid going hungry, expressing reluctance to have the eggs reheated due to concerns about changes in texture and flavor. A test tray evaluation revealed that several food items were not within the recommended temperature ranges, with meatballs measured at 118.3°F, spaghetti at 132.6°F, salad at 57.9°F, fruit cocktail at 45.5°F, fruit juice at 51.2°F, and milk at 49.5°F. The facility's policy requires that food temperatures on the serving line be maintained outside the danger zone of 41°F to 135°F. These findings, based on resident interviews, direct observation, and policy review, demonstrate that the facility did not consistently provide food and drink at safe and appetizing temperatures for residents.
Deficient Food Sanitation and Storage Practices Identified
Penalty
Summary
Surveyors observed that the facility failed to maintain proper sanitation and food safety practices in the kitchen. Specifically, the water in the washing compartment of the three-compartment sink did not reach the required temperature of 110 degrees Fahrenheit as indicated by the manufacturer's signage. Additionally, loose rice and beans were found underneath the storage racks in the dry storage area, and a grasshopper was observed in the same area. These findings were based on direct observation and staff interviews conducted during the survey. All 15 residents admitted to the facility and receiving care could be affected by these deficiencies, as they pertain to the preparation and storage of food served to residents.
Infection Control Deficiencies During Medication Pass and Soiled Linen Room Management
Penalty
Summary
Surveyors observed multiple instances during medication pass where registered nurses failed to perform hand hygiene before accessing gloves, specifically noting that two different RNs accessed the glove box without hand hygiene and one RN placed gloves on a resident's bedside table without disinfecting them, then proceeded to wash her hands and put on the gloves. Additionally, the soiled linen room was found to be non-compliant with infection control standards, as it lacked proper labeling, a functioning extractor fan, a thermometer to measure temperature and humidity, and an accessible hand sanitizer dispenser. The facility was also unable to provide a policy or procedure for the soiled linen room when requested.
Environmental Deficiencies Compromise Resident Safety and Comfort
Penalty
Summary
Surveyors observed multiple deficiencies in the facility's physical environment that compromised the residents' right to a safe, clean, comfortable, and homelike setting. During the facility tour, mold stains were found on ceiling tiles in the Occupational Therapy room, and dust clogs were present in one resident room. Medical tape was improperly placed on a curtain rail, and several rooms exhibited water damage on window walls, ceilings, and behind sprinkler piping. Additional issues included loose grab bars in bathrooms, a perforated air conditioning pipe, unstable furniture due to uneven wheels, loose cement plastering on the ceiling, peeling paint behind beds, and broken tiles around a shower drain. One room was closed due to a non-functioning toilet. These findings were based on direct observation, policy and procedure review, and staff interviews, and had the potential to affect all 15 residents in the facility. No specific resident medical histories or conditions at the time of the deficiency were mentioned in the report.
Unsafe and Unsanitary Physical Environment Identified
Penalty
Summary
Surveyors observed several deficiencies in the facility's physical environment during an inspection. The vinyl flooring was found to have ripples, which may have been caused by moisture damage or an uneven subfloor, presenting a potential fall hazard. Additionally, an undetermined number of pigeons were seen nesting in and around the facility, with droppings present on the exterior walls and windows of resident rooms. Exterior lights at the entrance and parking area were also noted to be covered in green mold. These conditions were identified through direct observation and staff interviews, and had the potential to affect all 15 residents in the facility. No specific information about the medical history or condition of the residents at the time of the deficiency was provided in the report.
Incomplete Baseline Care Plan on Admission
Penalty
Summary
The facility failed to develop and implement a complete baseline care plan within 48 hours of admission for one resident. Specifically, a female resident admitted for rehabilitation services following a left femur neck fracture, who also had a diagnosis of Cerebral Palsy, did not have this diagnosis included in her baseline care plan. Although the Cerebral Palsy diagnosis was identified in consultation with a psychiatrist, it was omitted from the initial care plan, as discovered during a record review. This omission occurred despite the requirement to address all relevant diagnoses in the baseline care plan to ensure continuity of care and communication among staff.
Failure to Accommodate Resident Food Preferences and Allergies
Penalty
Summary
The facility failed to provide food that accommodates resident allergies, intolerances, and preferences for two out of eight sampled residents. One resident reported repeatedly receiving food she does not eat and was not offered alternative options, despite her dietary preferences being documented in her initial nutrition assessment. Another resident stated she does not drink milk but was served milk on several occasions without being offered a substitute, even though her preferences were also documented. Review of both residents' meal cards confirmed that their taste and preference specifications were included. Additionally, the facility's menu cycle review revealed that there was no alternate menu available for residents who do not like the food served. These findings were based on dining observations, record reviews, and resident interviews conducted over a three-day period.
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 Administrative Dietitian, it was revealed that the facility did not have a designated dishwasher position covered. As a result, the Administrative Dietitian had to use a TSA (Temporary Staff Assistant) for dishwashing duties, which hindered the kitchen's functionality. This deficiency had the potential to affect 22 admitted residents.
Deficiency in Food Presentation and Temperature Maintenance
Penalty
Summary
The facility failed to provide food to residents in a manner that is attractive and maintains an appetizing temperature. During survey procedures, it was observed that breakfast was delivered to residents in Styrofoam trays and containers instead of insulated thermal food domes and trays. This practice was confirmed by interviews with two residents who stated that their breakfast was served in Styrofoam containers since their admission, and they noted that the use of insulated thermal food plates and trays would ensure consistent food heat distribution and a more attractive presentation. Additionally, one resident specifically mentioned that the food arrived cold in the Styrofoam trays. The Administrative Dietitian revealed that the facility had a job vacancy for the dishwasher position since March 12, 2024. This vacancy necessitated assigning dishwashing duties to other kitchen employees, which could delay the task until 9:00 AM or later. This delay in dishwashing likely contributed to the use of Styrofoam trays and containers for breakfast, as the insulated thermal food plates and trays were not available for use. The deficiency affected all 22 admitted residents at the time of the survey.
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 'Limpieza y Desinfeccion en Fregadero de Tres Compartimientos'. During a visual inspection and staff interview, it was observed that the three-compartment sink was not prepared according to the facility's policies and procedures. The staff working at the sink did not have knowledge of the required temperatures for the different sink compartments. Additionally, the concentration of sanitizer in the third compartment was measured at 100 ppm, which is below the required minimum of 200 ppm.
Failure to Maintain Safe Equipment
Penalty
Summary
The facility failed to maintain equipment in a safe operating condition, as observed during a tour with the Physical Plant Supervisor. The observations, conducted from 04/15/2024 to 04/16/2024, revealed that the parallel bars in the Physical Therapy room were rusted in many parts. Additionally, the steps apparatus had rough areas on some parts of the handrails. These deficiencies could potentially affect all 22 residents and staff members in the facility.
Pest Control Deficiency
Penalty
Summary
The facility failed to maintain an effective pest control program, as evidenced by observations made during a tour with the Physical Plant Supervisor. Flying insects and centipedes were found on light fixtures in the recreational room area. Additionally, three cockroaches were observed in the women's bathroom in the Physical Therapy room.
Facility Fails to Maintain Safe and Clean Environment
Penalty
Summary
The facility failed to promote the resident's right to receive services in a safe, clean, comfortable, and homelike environment. During an observational tour, mold stains due to humidity were noticed on ceiling tiles in both the Occupational Therapy room and the Medical Record room. Additionally, shelves in the Occupational Therapy room were observed with water damage due to a leak in the wall they were mounted on. Furthermore, the plinth in the physical therapy area was found to be loose from the wall and had exposed glue. These deficiencies had the potential to affect all 22 residents in the facility.
Failure to Assess Residents' Ability to Self-Administer Medications
Penalty
Summary
The facility failed to ensure that a comprehensive assessment was performed for residents who chose to self-administer their medications. This deficiency was identified in two out of sixteen records reviewed. One resident, a male admitted for rehabilitation after a left knee replacement, required respiratory therapy for his asthma. He expressed his desire to self-administer his respiratory therapy, as he did at home, but no assessment was documented in his medical record to determine his ability to do so safely. Additionally, no care plan was prepared by the interdisciplinary group and pharmacist to assess the clinical appropriateness and safety of his self-administration request. Another resident, a female admitted for rehabilitation after a right knee replacement, had a history of cataracts and used eye drops four times a day. She also expressed her desire to self-administer her eye drops, which she had been doing at home. However, no assessment was documented in her medical record to evaluate her ability to self-administer the medication safely. Similar to the first case, no comprehensive care plan was prepared by the interdisciplinary group and pharmacist to assess the clinical appropriateness and safety of her request. The Nursing Supervisor provided a copy of the procedure for determining a resident's ability to self-administer medications, but it was not followed in these cases.
Failure to Develop Baseline Care Plan for Resident with Neobladder
Penalty
Summary
The facility failed to develop and implement a complete baseline care plan within 48 hours of a resident's admission. This deficiency was identified during a recertification survey, where it was found that the baseline care plan for a female resident admitted for rehabilitation services after a left knee replacement did not include initial goals for the management and care of her Neobladder. The resident had undergone Neobladder reconstruction years ago and required intermittent catheterization to empty urine from the bladder. However, this critical aspect of her care was not identified or included in the baseline care plan upon admission. The Director Nursing Supervisor explained that the omission occurred because the Neobladder was not identified during the admission process, partly due to the resident managing her own catheterization. Additionally, there was no assessment performed to evaluate the resident's ability to manage intermittent catheterization while recovering from knee surgery, which could impact her mobility. This lack of assessment and inclusion in the care plan led to a failure in ensuring the resident's immediate needs were met within the required 48-hour timeframe.
Failure to Develop Comprehensive Care Plan for Resident
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident who was admitted for rehabilitation services following a left knee replacement. The resident, who also has a history of asthma and requires respiratory therapy, reported that he has been receiving respiratory therapy since his admission. The nursing personnel assist him in preparing the medications, and he administers the treatment himself. Despite this, the facility did not prepare a comprehensive care plan that includes measurable objectives and timeframes to meet the resident's medical and nursing needs while receiving respiratory therapy treatment. During the record review, it was identified that no comprehensive care plan was prepared by the interdisciplinary group for the resident's respiratory therapy treatment. The nurse in charge of medication pass confirmed that respiratory assessments were performed before and after the administration of the respiratory therapy to identify any respiratory system improvement or decline. However, the lack of a comprehensive care plan indicates a failure to individualize and review each plan of care, which is a deficiency in meeting the resident's medical, nursing, and psychosocial needs.
Infection Prevention Deficiencies
Penalty
Summary
The facility failed to ensure proper infection prevention practices, affecting all 22 residents. During an initial tour, multiple deficiencies were observed, including non-functional lights at the main entrance, black dust on faucet borders, and peeling paint on the ceiling in one resident's room. Bathrooms in some rooms lacked trash cans, and the yard had metallic benches with peeling paint and mold. The corridor near the physical therapy room had black spots, dust, and water around vending machines, while the grating bars were covered in dust. Additionally, the floor in another resident's room had black spots, and the ceiling paint was peeling. The biohazard trash can in the same room was deteriorated and dirty. The recreational room had black spots on the floor, dirty borders, and a trash can without a lid. The equipment storage area for wheelchairs and canes was dusty and dirty, with equipment placed directly on the floor. The pantry refrigerator, meant only for residents' dinners, contained hot/cold packs and ice cream. The clean sheets storage had empty spaces due to missing slashes. The recreational therapy room had water damage, mold, and dirty tables, while the warehouse had oxygen tanks with moisture-damaged paint and a broken thermometer. The medication room had a metal shelf with mold and dust, a dirty floor, and a drug cart with moldy rubbers. The shelf for storing medical supplies was dusty inside and out, with various medical materials improperly stored.
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