Servicios Integrados De Rehabilitacion (siro) Inc
Inspection history, citations, penalties and survey trends for this long-term care facility in Hormigueros, PR.
- Location
- Calle 4-l-10 Urb Colinas Del Oeste, Hormigueros, PR 00660
- CMS Provider Number
- 405029
- Inspections on file
- 16
- Latest survey
- April 29, 2025
- Citations (last 12 mo.)
- 0
Citation history
Health deficiencies cited at Servicios Integrados De Rehabilitacion (siro) Inc during CMS and state inspections, most recent first.
The facility failed to accurately transmit the assessment status for two residents, resulting in incorrect documentation of a community discharge as a hospital transfer in one case, and a hospitalization as a home discharge in another. These errors were identified during record review and confirmed by the MDS coordinator.
Surveyors observed that chicken was stored in the freezer in a broken package with exposed parts, staff did not properly air dry utensils after sanitizing, and the kitchen supervisor was present near the food serving area without a hairnet.
Staff were observed failing to perform hand hygiene and use gloves when required, including during the placement of ice packs on a resident and during medication administration. Facility policies for these procedures did not include hand washing or glove use requirements, and these deficiencies were confirmed through staff interviews and policy review.
The facility did not provide ongoing education to physicians and nursing staff on appropriate antibiotic use, despite having written stewardship policies in place. Reports to the Department of Health showed prolonged antibiotic use in residents without documented justification, and the facility's monitoring lacked necessary detail.
Surveyors identified water damage and humidity in a bathroom ceiling and bed area, as well as condensation from air conditioning vents causing water to accumulate on the floor near an exit door. These issues created a slip and fall risk and affected all residents in the impacted areas.
Surveyors observed several spiders in a resident's room, indicating the facility did not maintain an effective pest control program. This deficiency was identified during an inspection of the physical environment and staff interviews.
Several residents who had undergone right total knee replacement were prescribed antibiotics upon admission, but the facility did not provide documentation in physician progress notes to justify the continued use of these medications. The DON confirmed that residents arrived with prescriptions from their surgeons, yet the necessary clinical justification was missing from the records.
Two dirty linen carts were found unattended in the exterior patio area, resulting in a failure to maintain a safe, clean, and homelike environment for all residents receiving services.
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. During a kitchen tour, products such as cheese and meat were found unlabeled in the refrigerator.
The facility failed to provide a safe, functional, sanitary, and comfortable environment, with issues such as a room detached from the wall, a loose towel rack, and chipped Formica in various rooms. These deficiencies had the potential to affect all 18 residents receiving services in the affected areas.
The facility failed to transmit the MDS assessment data within the required 7-day period for a resident admitted with a Right Hip Replacement. The delay was due to missing assessment data from physical therapy personnel, resulting in an MDS record over 120 days old.
A facility failed to accurately transmit the resident assessment status for a resident who was discharged home after lumbar stenosis surgery. The resident was incorrectly documented as being discharged to a hospital, which was later corrected by the MDS coordinator.
The facility failed to provide a designated person to serve as the director of food and nutrition services. During observations and an interview with a TSA, it was revealed that the facility did not have a Diet Department Manager. The TSA was later designated as the Diet Department Manager, potentially affecting 18 residents.
The facility failed to ensure a safe, clean, and homelike environment for its residents. Observations revealed rust on the weight in the shower area, excessive dust on the wheelchair weight in Recreational Therapy, and a loose grab bar in the shower area, potentially affecting all 18 residents.
Inaccurate Electronic Transmission of Resident Assessment Status
Penalty
Summary
The facility failed to accurately transmit the resident assessment instrument status for two residents, resulting in incorrect documentation in the electronic system. In the first case, a female resident admitted for a left total knee replacement was discharged to home with home care and medical equipment. However, her discharge was incorrectly entered into the system as a transfer to a short-term general hospital, rather than a community discharge, as indicated in the MDS Section A A0310 F. This error was identified during a record review and confirmed by the MDS coordinator. In the second case, a male resident admitted for a right total knee replacement was transferred to the hospital due to suspected kidney failure. Despite the transfer being a hospitalization, the electronic system incorrectly documented the discharge as a return home. The MDS coordinator acknowledged the error during an interview. Both cases demonstrate failures in accurately transmitting resident assessment data, as required.
Deficiencies in Food Storage, Preparation, and Service Standards
Penalty
Summary
During an observational tour of the kitchen, surveyors identified several deficiencies related to food storage, preparation, and service. Chicken pieces were found in the freezer in a broken, sealed package with some parts exposed outside the wrapping and only covered in plastic wrap; kitchen staff stated the chicken was received from the supplier in that condition. Additionally, staff were seen using a scoop to serve rice and did not follow the proper process for sanitizing utensils, specifically failing to allow the utensil to air dry after sanitizing. The kitchen supervisor was also observed near the food serving area without wearing a hairnet.
Failure to Maintain Infection Prevention and Control Program
Penalty
Summary
The facility failed to establish and maintain an effective infection prevention and control program, as evidenced by multiple observed lapses in hand hygiene and glove use by staff. During rounds in resident rooms, a physical therapy assistant was seen entering a resident's room and placing ice packs on the resident without washing hands or wearing gloves. Review of the facility's policy for cold compress placement revealed that it did not include requirements for hand washing or glove use. Additionally, during a medication pass, a registered nurse did not wash her hands on four out of ten opportunities before entering five different resident rooms. These observations were confirmed through staff interviews and policy review.
Lack of Antibiotic Stewardship Education and Monitoring
Penalty
Summary
The facility failed to implement an effective antibiotic stewardship program that promotes appropriate antibiotic use and provides education to nursing and medical staff. During an interview with the Infection Control coordinator, it was revealed that while the facility maintains policies and procedures regarding antibiotic stewardship, including information on dosage, indication, renal adjustment, administration, precaution, monitoring, and dilution and stability, there is no ongoing educational program for physicians and nursing professionals on the appropriate use of antibiotics. Additionally, reports sent to the Puerto Rico Department of Health document the monthly volume of patients using antibiotics but lack specificity and do not justify prolonged antibiotic use in residents.
Environmental Safety and Sanitation Deficiencies Identified
Penalty
Summary
Surveyors observed that the facility failed to maintain a safe, functional, sanitary, and comfortable environment for residents, staff, and the public. During the inspection, water damage and humidity were noted on the bathroom ceiling and in the bed area of a specific room. Additionally, condensation on air conditioning vents resulted in water drops wetting the floor in front of the exit door to the back patio, creating a slip and fall risk. These environmental deficiencies were present in areas where all 18 residents receiving services could be affected.
Failure to Maintain Effective Pest Control Program
Penalty
Summary
The facility failed to maintain an effective pest control program, as evidenced by the presence of several spiders observed in a resident's room during an environmental inspection. This observation was made during a survey conducted on 04/28/2025, where three spiders were specifically noted in one of the resident rooms. The deficiency was identified through direct observation of the physical environment and interviews with facility staff. No additional information regarding the medical history or condition of the resident(s) in the affected room was provided in the report.
Lack of Documentation for Antibiotic Use in Post-Surgical Residents
Penalty
Summary
The facility failed to ensure that each resident's medication regimen was free from unnecessary drugs, specifically antibiotics, for several residents who had undergone right total knee replacement. Medical record reviews revealed that multiple residents were prescribed antibiotics such as Augmentin, Cipro, and Keflex upon admission, with orders originating from their orthopedic surgeons. However, there was no documentation in the physician's progress notes to justify the continued use of these antibiotics. The nursing staff's documentation in the care plans was limited to observations of the surgical site, such as the presence of a surgical patch and edema, without further clinical justification for antibiotic therapy. Interviews with the Director of Nursing confirmed that residents typically arrived with prescriptions and instructions from their surgeons, but the facility did not provide evidence in the medical records to support the necessity of these medications. This lack of documentation affected at least three residents, as identified in the survey, and was observed during a review of eight medical records. The deficiency was based on the absence of physician progress notes justifying the use of antibiotics for these residents.
Unattended Dirty Linen Carts Compromise Clean and Homelike Environment
Penalty
Summary
Surveyors observed that two dirty linen carts were left unattended in the exterior patio area during an observational tour. This occurred on April 28, 2024, at approximately 10:00 AM. The facility's failure to properly manage and store soiled linens resulted in a physical environment that was not maintained in a safe, clean, comfortable, and homelike manner for residents. This deficiency had the potential to affect all 15 residents receiving services at the time of the survey.
Failure to Adhere to Food Service Safety Standards
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. During an observational tour of the kitchen, products such as cheese and meat were found unlabeled in the refrigerator. This observation was made on April 22, 2024, at approximately 8:52 AM. The deficiency was identified based on observations, review of policies and procedures, and staff interviews conducted from April 22, 2024, through April 23, 2024, between 8:00 AM and 4:00 PM.
Environmental Deficiencies in Facility
Penalty
Summary
The facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public. Observations revealed multiple deficiencies, including a room detached from the wall behind the bed and in the bathroom, a loose towel rack, and chipped Formica in various rooms. Specific rooms with chipped Formica included rooms 111, 110, 109, 108, 107, 106, 105, 104, 103, 102, and 101, affecting night tables, closets, and bathroom doors. Additionally, glue was observed on the side of closet A in room 105, and hinges on closets in room 104 were in need of repair. These deficiencies had the potential to affect all 18 residents receiving services in the affected areas.
Failure to Transmit MDS Assessment Data Timely
Penalty
Summary
The facility failed to transmit the Minimum Data Set (MDS) assessment data within the required 7-day period. This deficiency was identified during a review of records and an interview with the MDS Coordinator. Specifically, the MDS discharge data for a female resident who was admitted with a diagnosis of Right Hip Replacement and later discharged home was not transmitted on time. The delay occurred because the physical therapy personnel did not provide the necessary assessment data, leaving the case open and resulting in an MDS record that was over 120 days old.
Incorrect Electronic Transmission of Resident Assessment
Penalty
Summary
The facility failed to accurately electronically transmit the resident assessment instrument status for one out of two closed records reviewed. Specifically, a resident who was a [AGE] year-old female admitted with a diagnosis of status post-surgery of lumbar stenosis was incorrectly documented as being discharged to a short-term general hospital instead of being discharged home to the community. This error was identified during a record review on 04/23/24. The resident had completed her goals and was discharged with follow-up appointments and home care services arranged. The MDS coordinator acknowledged the error during an interview and subsequently corrected it in the system.
Lack of Designated Director of Food and Nutrition Services
Penalty
Summary
The facility failed to provide a designated person to serve as the director of food and nutrition services. This deficiency was identified during observations and an interview with the TSA (employee #2) conducted from 04/22/2024 to 04/23/2024. The TSA stated that the facility did not have a Diet Department Manager. On 04/23/2024, surveyors were informed that TSA (employee #2) was designated as the Diet Department Manager. This practice had the potential to affect 18 admitted residents.
Failure 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, it was noted that the weight in the shower area had rust on the base and other parts. Additionally, the wheelchair weight in the Recreational Therapy area was found with excessive dust. Furthermore, the grab bar in the shower area was observed to be loose, presenting a risk to patients taking a shower. These deficiencies had the potential to affect all 18 residents receiving services at the facility.
Latest citations in PR
No citations found matching the criteria.
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