Walker Rehabilitation Center, INC

Based on observations, interviews and facility policies titled Cleaning Dishes/Dish Machine and Resource: Taking Accurate Temperatures, the facility failed to ensure: 1) Plate domes/covers and trays were not wet nesting and; 2) The temperatures on the tray line were taken and recorded. This had the potential to affect 40 residents who received meals from the kitchen. Findings include: 1.) A facility policy titled Cleaning Dishes/Dish Machine dated 2017 documented the following: . Procedure . 9. Dishes should be air dried on the dish racks. Do not dry with towels. 11. Dishes should not be nested unless they are completely dry. On 11/06/2024 at 09:28 AM during an observation of dishwashing, clean trays and domes were staked on top of each other as they came out of the dishwasher. Kitchen staff were observed transporting the trays and domes out of the dish room onto a cart and they were stacked on top of each other. On 11/06/2024 at 11:18 AM the surveyor observed seven trays with water in them, four domes with a small amount of water in the top of the dome, and one dome with a large…

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 interviews, record review, and review of the job responsibilities of the Certified Medication Aide (CMA), the facility failed to ensure subcutaneous insulin injections were not administered to residents by CMA/MAC (Medication Assistant, Certified) #10, #11, #12 and #13 from May 2023 through October 2023. This affected RI #6, #10, #18, #28, #31, #32 and #98 seven of 16 sampled residents receiving medications in the facility. This deficient practice affected four of five Med Techs who administered insulin to residents. This deficient practice was cited as a result of investigation of complaint/report number AL00046139. Findings include: Review of the facility's CMA, Job Title, with an effective date of 04/15/2021, revealed the following: PURPOSE OF THE JOB: . The CMA will adhere to the scope of practice with regard to the Medication Aide Act and facility rules, regulations, policies and procedures applicable in the performance of duties to enhance and safeguard resident(s). ACCOUNTABILITY . A MAC may perform limited medication administration tasks delegated to the MAC by 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and facility policy titled, Homelike Environment the facility failed to ensure: 1) Screens were on the windows for Resident Identifier (RI) #8, RI #10, RI #11, RI #12, RI #19, and RI #44. 2) Holes were not in the glass windowpanes of RI #10, RI #11, and RI #44's room. 3) Paint was not peeling off of the ceiling in RI #10, RI #11, and RI #44's room. 4) The bathroom floor was not stained yellow under the sink and around the toilet in the shared bathroom for RI #8, RI #10, RI #11, RI #12, RI #19, and RI #44. 5) Wires for the call light were not intertwined with plumbing for the sink in the shared bathroom of RI #8, RI #10, RI #11, RI #12, RI #19, and RI #44. 6) Open gaps were not between the glass windowpanes and the wall in RI #10, RI #11, and RI #44's room. 7) Baseboards were not missing in RI #10, RI #11, RI #44's room. Findings include: A review of the facility policy titled, Homelike Environment with a revised date of February 2021, revealed: Policy Statement Residents are…

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 observations, record review, interviews, and a facility policy titled, POSITIONING THE RESIDENT, the facility failed to ensure Resident Identifier (RI) #25 was turned and repositioned every two hours. This affected one of two residents observed for a pressure ulcer. Findings include: A facility policy titled, POSITIONING THE RESIDENT, revised 10/1/19, revealed, . II. Policy Residents who are bed bound will be turned and repositioned every 2 hours. RI #25 was admitted to the facility on [DATE] and readmitted on [DATE]. RI #25 had a diagnosis of Type 2 diabetes mellitus with unspecified complications. The resident's care plan revealed, . Problem Start Date 12/26/2019 . pressure ulcer stage IV to coccyx . Approach . Turn and reposition every 2 hrs and prn (as needed). On 02/06/20 at 8:20 a.m., the resident was observed on his/her back. The wedges were on the floor. On 02/06/20 at 10:31 a.m., the resident was observed on his/her back. The wedges were observed on the floor beside bed. On 02/06/20 at 11:16…

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, interviews and review of POTTER AND [NAME], FUNDAMENTALS OF NURSING, NINTH EDITION, the facility failed to ensure a licensed nurse cleaned Resident Identifier (RI) #7's nasal spray container after contact with the resident's nares before recapping the container and returning it to the medication cart. Findings Include: A review of POTTER AND [NAME], FUNDAMENTALS OF NURSING, NINTH EDITION, CHAPTER 32, Medication Administration, BOX 32-16 PROCEDURAL GUIDELINES, Administering Nasal Medications, documented: 16. Administer nasal spray: .18. Wipe tip of bottle with clean, dry tissue and replace the cap, . RI #7 was readmitted to the facility on [DATE]. A diagnosis included allergic rhinitis. On 02/06/20 at 8:07 a.m., Employee Identifier (EI) #3, Licensed Practical Nurse (LPN), was observed administering RI #7's nasal spray to each nare. EI #3 was then observed recapping RI #7's nasal spray without wiping off the tip of the container and returning the container to the medication cart. On 02/06/20…

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, interviews, review of a facility policy titled Dietary Policy - Food Storage, the facility failed to ensure: 1. expired foods were not stored in kitchen refrigerators, 2. there was no rust present on kitchen food preparation tables and on clean dish storage shelving, and there was no chipping paint on the clean dish storage area above food serving hot bar, among other issues identified in the kitchen. This had the potential to affect 46 of 50 residents who received meals from the kitchen. Findings Include: The facility's policy titled Proper Food Storage - Refrigerated, no date, included: .13 .Leftover food is used within 3 days or discarded .14 . f . All foods should be covered, labeled, and dated. All foods will be .consumed by their safe use by dates, or frozen . or discarded . 1. On 11/18/18 at 08:47 a.m., during the initial tour of the kitchen, with Employee Identifier (EI) #1, Dietary Manager, observations were made of the refrigerators. Observed was a plastic ziploc bag of cornbread pieces dated 11/8/18, with a use by date of 11/11/18; two bags of baby…

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 observations, interviews and review of a facility policy titled, Facility Environment Policy & Procedure and a facility document titled, Director of Maintenance Job Description, the facility failed to ensure Room Locators (RL)'s #1-23 were free of scuffed and chipped paint, torn veneer on doors with sharp edges, exposed commode bolts, cracked commode lid and peeling commode seat, doorframes free of rust, missing baseboards and tiles. This was observed three of three days of the survey and affected 23 rooms on all three wings of the facility. Findings Include: A review of a facility policy titled, Facility Environment Policy & Procedure, no date, revealed: . Residents are provided with a safe, clean .homelike environment . A review of a facility document titled, Director of Maintenance Job Description, no date, revealed: . C. Safety . Functions Duties: . regularly inspect equipment, building . to ensure a safe and comfortable environment; . During the initial tour of the facility on 11/18/2018 the following observations were made: 1) RL #1: Doorframe with chipped paint,…

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 observations, interviews, and review of facility policies titled, Hand Hygiene/Glove Use Policy and Blood Glucose Testing, the facility failed to ensure: 1.) a Licensed Nurse cleaned Resident Identifier (RI) #38's personal glucometer before storing it in the medication cart and washed her hands after touching potentially contaminated objects before applying gloves to administer RI #38's insulin injection; 2.) a Licensed Nurse did not place a syringe filled with insulin for RI #39 on top of the medication cart without a barrier; 3.) a Certified Nursing Assistant (CNA) did not manipulate the paper towel dispenser with her bare hands after washing her hands and washed her hands after removing gloves during catheter care for RI #17, and 4.) a CNA removed her gloves after touching RI #15's colostomy bag during catheter care. These deficient practices affected two of nine residents observed during medication administration with two of four nurses and further affected two of two residents with two of two CNAs…

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, medical record review and review of Potter and [NAME], Fundamentals of Nursing, Ninth Edition, the facility failed to ensure physician's orders were followed for Resident Identifier (RI) #44, RI #7 and RI #251. This affected RI #44, RI #7 and RI #251, three of 15 residents whose physician's orders were reviewed. Findings Include: A review of Potter and [NAME], Fundamentals of Nursing, Ninth Edition, Chapter 23, Legal Implications in Nursing Practice, page 311, revealed: .Health Care Providers' Orders .Nurses follow health care providers' orders unless they believe that the orders are in error . 1.) RI #44 was readmitted to the facility on [DATE], with diagnoses including, Pseudobulbar Palsy, Contractures Hips, Knees, Elbows and Other Paralytic Syndromes. A review of RI #44's physician's orders revealed: .General 01/17/2017 .TRANSFER X (times) 2 ASSIST PER HOYER LIFT Every Shift . On 11/18/18 at 9:22 a.m., RI #44 stated he/she was being transferred by a staff member with a Hoyer…

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 interview, review of Resident Identifier (RI) #44's medical record and a facility document titled, INCIDENT/ACCIDENT REPORT - RESIDENT, the facility failed to ensure Employee Identifier (EI) #8, a Certified Nursing Assistant (CNA), obtained assistance of another staff member before transferring RI #44 using a Hoyer lift, as determined by RI #44's assessment and plan of care, during a transfer on 10/06/18. During the 6:00 a.m. to 2:00 p.m. shift on 10/06/18, EI #8 failed to follow RI #44's plan of care when she transferred the resident by herself using the Hoyer lift causing RI #44's gerichair to turn over and RI #44, a resident on antiplatelet medication and at increased risk for bleeding, to sustain a raised area to the back of his/her head and skin tear to the right forearm. Resident complained of head pain and dizziness and was transferred to a local hospital after the fall. This deficient practice affected RI #44, one of two residents investigated for falls. Findings Include: RI #44 was readmitted…

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.