Providence Kodiak Island Med LTC

Based on interview and record review the facility failed to designate a registered nurse to serve as the Director of Nursing (DON) on a full-time basis. Specifically, from 11/13-22/24 there was no full-time DON. This failed practice, of not having a full-time DON to provide oversight of nursing staff, daily management, direction and support, had the potential to place all residents (based on census of 21) at substantial risk for subquality of care. Findings: During an entrance conference on 11/18/24 at 4:20 PM, the Providence Kodiak Island Medical Center (PKIMC) Chief Executive Officer (CEO) stated Licensed Nurse (LN) #2, who was a nursing supervisor, was designated as DON since the DON was on leave. Review of the email from DON, dated 11/13/24, revealed the DON would be out and return on 12/2/24. Further review of the email revealed the points of contact for assistance were: . -First point of contact . [ name of Support Manager (SM)] -Second point of contact . [name of LN #2] - If you need additional support or escalation, please contact . [name of PKIMC Executive Director of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation, interview, and record review, the facility failed to ensure foods were prepared, stored and labeled in accordance with professional standards for food safety for all residents (based on a census of 21). Specifically, the facility failed to ensure: 1) foods were labeled and dated; 2) expired foods were discarded; 3) proper sanitization of food surfaces; and 4) proper sanitizing of dishes and cookware. These failed practices had the potential of causing or spreading foodborne illness to all residents, who received food from the affected kitchens. Findings: Main Kitchen 1) Dry Storage: An observation, during the initial main kitchen tour on 11/18/24 at 4:30 PM, revealed: -Two- 20-ounce packages of Rana Family Size 5 Cheese Tortellini with a use or freeze by dated 09/09/2024; -One- 1 gallon container of Four [NAME] Wine Vinegar with a best if used by dated [DATE]; -Six- 13-ounce packages of Monarch Classic [NAME] Gravy Mix, dated 101824; -Three- 1-gallon containers of Kraft Mayo Light…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on record review and interview, the facility failed to ensure emergency care equipment was maintained. Specifically, the facility failed to complete the Automated External Defibrillator (AED) regular maintenance per manufacturer's recommendation. This failed practice had the potential to place all residents (based on a census of 21) at risk of not receiving emergency care. Findings: Record review of the facility's 2024 [NAME] AED Plus Monthly Inspection Log, dated from 1/2024 to 12/2024, revealed five steps to inspect the AED as: Step 1 press and hold the On/Off button; Step 2 AED Status Indicator Test Red X or [NAME] as check mark; Step 3 Defibrillator unit is clean, no spills, clear of objects on top, & casing intact with response choices of Yes or No; Step 4 Cables and Connectors are secured, and not damaged (cracks, broken wires, etc.) with response choices of Yes or No; and Step 5 AED unit supplies have two pads. One for Adult and Pediatric. Further review of the inspection log revealed: Step 2 was…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation, interview, and record review, the facility failed to ensure: 1) Informed consent was obtained prior to the use of bed rails for 16 residents (#'s 1, 2, 4, 5, 6, 10, 11, 12, 13, 15, 16, 18, 19, 72, 122, and 172), out of 21 residents reviewed; and 2) Assessments for the risk and benefits of the use of bedrails, prior to the use of bedrails, for 5 residents (#'s 4, 13, 16, 18 and 19), out of 21 residents reviewed. This failed practice had the potential to place residents at risk of falls, entrapment, and other preventable accidents. Findings: Random observations on 11/18-22/24 revealed Resident #'s 1, 2, 4, 5, 6, 10, 11, 12, 13, 15, 16, 18, 19, 72, 122, and 172 all had raised upper side rails on his/her beds. During an interview on 11/21/24 at 12:15 PM, Licensed Nurse (LN) #4 stated nurses completed a weekly nursing summary about bedrails. When asked if any consents or assessments were required with the use of bedrails, LN #4 stated he/she was not aware. LN #4 further stated that LN #7 took…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, observation and interview, the facility failed to ensure residents' right to dignity and respect was honored for three residents (#'s4, 13, and 15), out of 21 residents (total census). Specifically, Certified Nurse Assistants (CNAs) used a cloth protector to wipe the residents' nose and mouth after dining. Additionally, a CNA transferred a resident in an ARJO lift (transfer lift device) from the resident's room to a chair in the living room. These failed practices placed the residents not being valued as a person with dignity and respect. Findings: Dining Experience: Resident #4 Record review on 11/18-22/24, revealed Resident #4 was admitted to the facility with diagnoses that included Parkinson's disease (a disorder of the central nervous system that affects movement) and dementia (a condition that affects memory and thinking). Review of Resident #4's Care Plan, dated 9/27/24, revealed: .assist me with food/fluid intake to promote adequate nutrition/hydration. During a dining observation on 11/18/24 at 4:57 PM at Salmonberry Unit, Resident #s 2, 4, 7, & 15…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review the facility failed to ensure infection control procedures were properly implemented. Specifically, the facility failed to ensure staff contained linen during transportation. This failed practice had the potential to affect all residents (based on census of 21) for risk of the spread of infectious disease. Findings: During an observation on 11/19/24 at 9:50 AM, Certified Nursing Assistant (CNA) #2 with gloves on was transporting unbagged linen from Resident #172's room passing through the community area to the dirty linen cart. During an interview on 11/21/24 at 10:05 AM, CNA #4 stated all linens brought from a resident's room should be placed into a plastic bag before leaving the room and taken to the dirty linen cart in the hall of the community area. During an interview on 11/21/24 at 2:50 PM, Infection Control Preventionist (ICP) stated all linens should be bagged inside the resident's room before transporting. ICP stated no PPE (personal protective equipment) was required when placing bags into the dirty linen cart. Record…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and interview, the facility failed to post the daily total number and the actual hours worked for all residents (based on census of 21) care per shift worked by the Certified Nurse Assistants (CNAs), Licensed Practical Nurses (LPNs), and Registered Nurses (RNs). This failed practice provided inaccurate information to the all residents and their families. Findings: Random observation from 9/18-22/23 in the Fireweed and Salmonberry units' common area, revealed staff postings displaying the name of the facility, names of staff (RN and CNA) on duty per shift per day, and resident census were written on the whiteboard. Further review of the posting revealed the total number of staff and actual hours worked of nursing staff per shift was not documented. During an interview on 9/22/23 at 10:45 AM, the Director of Nursing (DON) stated the whiteboard had daily nurse staffing information for the residents and family. When asked if the total number and actual hours of nursing staff who provided direct resident care should have been included in the posting, she stated the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and document review, the facility failed to ensure: 1) food was stored under proper sanitary conditions; and 2) concentrations of sanitizing solutions were tested correctly to assure the solutions were maintained within acceptable parameters. These failed practices placed all residents (based on a census of 21) at risk for foodborne illness and/or communicable disease. Findings: Walk-in freezer During the initial tour of the kitchen on 9/18/23 at 9:00 AM, the walk-in freezer was observed. In the middle of the freezer were 4 boxes of frozen food placed on top of a milk crate. Behind these boxes were 2 Sterilite brand plastic containers stacked on top of one another, the bottom container was placed directly on the floor. Inside the container located on the floor were 10 bags of frozen fresh cut green beans. During an interview on 9/21/23 at 12:19 PM, the Food Service Manager (FSM) stated the plastic containers containing food should not have been stored on the floor. The FSM further stated the containers should have been placed 6 inches off the floor.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, observation, and interview, the facility failed to have an antibiotic stewardship program (ASP), a program that monitors antibiotic usage and effectiveness. This failed practice had the potential, for all residents (based on a census of 21), to receive an ineffective and inaccurate implementation of antibiotic protocols for antibiotic use. Findings: Record review on 9/18-22/23 of the electronic health record (EHR) revealed Resident #13 was admitted to the facility with diagnoses that included bronchiectasis (a condition in which the airways of the lungs remain permanently damaged and widened due to persistent infection) and chronic obstructive pulmonary disease. Review on 9/19/23 at 1:40 PM of Resident #13's electronic medication administration record (eMAR), revealed an order for Azithromycin (antibiotic) 250 MG Tablet (1 tablet/250 mg) to be administered in the morning three times a week on Monday, Wednesday, and Friday for bronchiectasis with an entry date on 10/20/20. An observation on 9/20/23 at 10:15 AM of the medication administration, revealed LN #1…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview, observation and record review, the facility failed to ensure a private space for the Resident Council meetings. This failed practice had the potential to affect all resident's choosing to attend the meetings, based on a census of 21, by preventing the group members from expressing their concerns or recommendations affecting their care. Findings: On 9/20/23 at 9:02 AM, the Resident Council meeting commenced in the main dining area on the Fireweed unit with 4 residents in attendance. The table where the residents were seated was in the center of the large room, which was near the open kitchen area, and surrounded by the resident's rooms and the open seating area where the TV was located. During the Resident Council meeting on 9/20/23 at 9:12 AM, when asked if the Council could have met without staff present, Resident #16 stated it bothered him/her that people walked back and forth and could have heard what was said. During the meeting at 9:30 AM, Licensed Nurse #1 approached the table where the meeting was being held and administered several oral medications to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review, the facility failed to provide quarterly statements for personal fund accounts to 2 residents (#'s 8 and 13) and/or their Power of Attorneys (POAs), out of 2 sampled residents whose money was held by the facility. This failed practice placed the residents and/or their POAs at risk for not receiving a complete and accurate accounting of their personal funds entrusted to the facility. Findings: During an interview on 9/18/23 at 1:57 PM, Resident #13 stated the facility held his/her money and he/she had not received quarterly statements from the facility. During an interview on 9/19/23 at 1:41 PM, Resident #8's POA stated the facility held the resident's funds. When asked if he/she had received quarterly statements of Resident #8's funds from the facility, the Resident's POA stated he/she was unsure if the statements were sent quarterly. During an interview on 9/22/23 at 9:41 AM, when asked to show quarterly statements that were sent to residents and/or their POAs, the Manager of Support Services (MSS) stated the Patient Navigator (PN) was…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, observation and interview, the facility failed to ensure 1) a physician's order for restraint was obtained in a timely manner; and 2) direct care staff (Certified Nursing Assistants (CNAs) and Licensed Nurses (LNs) on-going re-evaluation of the restraint use was documented in 1 resident's medical record (#2) out of 1 resident investigated for restraints. This failed practice had the potential to deny the resident's highest practicable wellbeing. Findings: Record review from 9/18-22/23 revealed Resident #2 was admitted to the facility with diagnosis of dementia. An observation of 9/18/23 at 4:07 PM revealed Resident #2 sitting in the common room in his/her wheelchair with a seat belt clipped around his/her waist. During an interview on 9/19/23 at 1:08 PM, Resident #2's family member stated the Resident was wearing the seatbelt to prevent him/her from sliding, and the Resident was unable to remove the seatbelt on his/her own. The family member further stated the facility had planned to order something more comfortable for the Resident. An observation on 9/20/23…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to ensure accuracy of assessment was reported in the quarterly Minimum Data Set (MDS- a federally mandated assessment for all residents of long-term care facility) for 1 resident (#18) out of 13 sampled residents. This failed practice had the potential to report inaccurate resident's status. Findings: Record review on 9/18-22/23 of the facility's electronic health record (EHR) revealed Resident #18 was admitted to the facility with diagnoses that included right hip osteoarthritis (degenerative joint disease), and hypertension. Record review on 9/18-22/23 of Resident #18's quarterly MDS assessment, dated 7/17/23, revealed MDS Section N. N0410 Medications received during the last 7 days were antipsychotic (the resident received the medication once) and antibiotic (the Resident received the medication for 6 days). Review of Resident #18's current and discontinued physician's orders from 10/20/22 to 9/22/23, revealed no orders for antipsychotics and/ or antibiotic medications. Review of the electronic medication administration…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview, the facility failed to ensure 1 resident (#16) out of 13 sampled residents, were free from significant medication errors. Specifically, the resident was not provided with the ordered ear drop medication prior to the physician's procedure of ear wax removal. This failed practice had the potential to place the resident at risk for decreased quality of life due to incomplete removal of wax build-up, which potentially affected the resident's hearing. Findings: Record review from 9/18-22/23 revealed Resident #16 was admitted to the facility with diagnoses that included cancer and chronic kidney disease. The resident had a BIMS (brief interview for mental status) score of 15, which indicated the resident was cognitively intact. During an interview on 9/18/23 at 12:01 PM, when asked about his/her hearing, Resident #16 stated he/she had wax in his/her ears, which was irrigated by Physician #1. The Resident stated the physician removed the earwax about a month or so ago. The Resident further stated he/she was still having trouble hearing and stated that…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, interview and observation, the facility failed to ensure resident food preferences were honored for 1 resident (#16), out of 13 sampled residents. This failed practice had the potential to place the resident at risk of inadequate nutritional intake and weight loss. Findings: Record review from 9/18-22/23 revealed Resident #16 was admitted to the facility with diagnoses that included failure to thrive syndrome (syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol) and hand weakness. The resident had a BIMS (brief interview for mental status) score of 15, which indicated the resident was cognitively intact. During an interview on 9/18/23 at 12:01 PM, when asked about the facility's food service, Resident #16 stated he/she had alerted staff on multiple occasions of his/her dislike for peppers. The resident further stated he/she still received peppers and alerted staff again, who assured him/her the kitchen was aware of his/her dislikes.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.