Park Manor Health And Rehabilitation, LLC

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews, review of the 2017 Food Code regulations and the facility policies related to Leftover Food Storage and Foods from Families and Friends the facility failed to ensure: 1) Food was consistently labeled with open and use-by date (UBD) and used within seven days after opening; 2) Food below recommended temperatures on the 6/19/19 lunch tray line were reheated to at least 165 degrees Fahrenheit (F); and 3) Residents' refrigerators in three of three nursing station pantries were clean and residents' food was labeled with name and date, and discarded within three days as directed by facility policy. These failures had the potential to affect all 130 residents for whom meals were prepared and served at the time of this survey. Findings Included: 1) FOOD LABELING The facility policy: Leftover Food Storage and Use, with an effective date of 8/15/09, specifies the purpose, To assure that food borne illnesses are avoided. The processes by which this is achieved included: .b. Leftover foods…

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, review of pest control treatment logs, review of a facility policy titled Quality Assurance/Quality Assurance Performance Improvement, review of facility documents titled Quality Assurance Committee Action and Emergency Q.A.P.I. (Quality Assurance Performance Improvement) Meeting Minutes and review of the Administrator's job description, Employee Identifier (EI) #1, the facility's administrator, failed to provide necessary oversight to ensure a Quality Assurance Performance Improvement plan was implemented after the identification of bed bugs on 5/09/19 in Resident Identifier (RI) #41 and RI #105's room, Room Locator (RL) #1, which resulted in the spread of bed bugs. This affected RI #s 41, 42, 46, and 105, four of 11 residents sampled for bed bugs. Bed bugs were identified in 6 of 81 total resident rooms in the facility, as well as in common areas, including the day room and dining room. Findings Include: Cross reference F867 and F925. Review of the job description, last reviewed 6/30/03, for EI #1, the Administrator, revealed: . General Purpose To direct 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 interviews, review of pest control treatment logs, review of a facility policy titled Quality Assurance/Quality Assurance Performance Improvement, and review of facility documents titled Quality Assurance Committee Action and Emergency Q.A.P.I. (Quality Assurance Performance Improvement) Meeting Minutes, the facility failed to ensure their QAPI plan was implemented to prevent the spread of bed bugs after they were identified on 5/09/19 in Resident Identifier (RI) #41 and RI #105's room, Room Locator (RL) #1. This affected RI #s 41, 42, 46, and 105, four of 11 residents sampled for bed bugs. Bed bugs were identified in 6 of 81 total resident rooms in the facility, as well as in common areas, including the day room and dining room. Findings Include: Cross reference F925. On 5/14/19 the State Agency received a complaint alleging the resident residing in RL #1 was ate up with bed bugs. The complainant alleged the facility was not treating for the bed bugs as they should have. On 6/07/19 the State Agency received a second complaint alleging the facility was infested with bed…

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, review of a facility document titled Emergency Q.A.P.I. (Quality Assurance Process Improvement) Meeting Minutes, review of the facility's Quality Assurance Committee Action, review of the facility's pest control contract, and review of the facility's policies titled Bed Bugs and Insect and Rodent Control, the facility failed to ensure measures were implemented to provide effective pest control and prevent the spread to other rooms after the identification of bed bugs in Room Locator (RL) #1 on 5/9/19. Resident Identifier (RI) #s 41 and 105, who resided in RL #1, were taken to another room on Station 2 prior to receiving a shower on 5/9/19. Further, RI #s 46 and 42's clothing and other items were not removed from RL #5 after bed bugs were also discovered in that room. Further, RL #5 was not cleaned and vacuumed as outlined in the facility's Quality Assurance Committee Action and Bed Bugs policy. This affected RI #s 41, 42, 46, and 105, four of 11 residents sampled for bed bugs. Bed bugs were identified in 6 of 81 total resident rooms in 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 and interview the facility failed to ensure the controlled box containing narcotics, in the Station 1 medication storage room, was permanently affixed to the inside of the refrigerator. This was observed on 6/20/19 at 10:30 AM during the medication storage observation and affected one of two medication storage rooms observed. Findings include: On 6/20/19 at 10:30 AM the surveyor and Employee Identifier (EI) #12, a Registered Nurse (RN)/Unit Manager, observed the medication storage room on Station 1. EI # 12 was asked if there was a secured box for controlled refrigerated medications. EI #12 replied, yes it is the locked box. EI # 12 was then asked if the locked box was permanently affixed to the refrigerator. EI #12 said the locked box was affixed to the shelf in the refrigerator. EI #12 was asked if the shelf was permanently affixed to the refrigerator, and EI #12 proceeded to pull on the shelf, removing the shelf along with the locked controlled medication box. On 6/20/19 at 10:40 AM, EI #12 was asked if the controlled medication lock box, in the Station 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 observation, interview, and review of a facility policy titled, Medication Administration Procedures, Eye Drops , the facility failed to ensure that a Licensed Nurse did not take multi-use items into a resident's room and place them on an unclean surface during medication administration of eye drops, then return and place items in the medication cart without first cleaning the items. This deficient practice affected Resident Identifier (RI) # 93, one of one resident observed receiving eye drops, and one of six total residents observed during medication administration observations. Findings include: Review of the facility policy titled, Medication Administration Procedures, Eye Drops, dated 03/11, revealed the following: . Procedures 1. Leave the . outside box on the medication cart. Only take the actual eye drops container into the resident's room. 2. Obtain a clean barrier and place on over-bed table . On 6/19/19 at 4:31 PM, Employee Identifier (EI) #11, a Licensed Practical Nurse (LPN), was observed administering medications to RI #93. EI #11 obtained sani cloths, a…

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 job description for the Director of Maintenance, the facility failed to ensure Room Locator (RL) #s 19-26 were free of chipped paint and splintered plywood on walls, broken chair rail moulding, scuffed and chipped paint on door facings, misaligned furniture drawers, soap dispenser off wall, broken toilet tissue holder, dangling TV cable and wheelchairs with tape on armrests. This was observed on three of four days of the survey and affected RL #s 19-26, eight of 81 rooms in the facility. Findings Include: A facility document titled, JOB DESCRIPTION . JOB TITLE: Director of Maintenance, with a review date of 6/30/03, documented: . B. DEPARTMENTAL FUNCTIONS . 9. Maintain appearance of building and provide necessary repairs and painting as needed. 23. Paint interiror/exterior surfaces. 26. Repair departmental equipment . On 6/18/19 at 8:51 a.m., the surveyor observed the dresser in RL #19 with the top 2 drawers misaligned, and the 4th drawer difficult to open. On 6/18/19 at 9:17 a.m., the surveyor observed RL #20 with the bathroom soap…

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 and interviews the facility failed to ensure that dietary staff washed their hands after picking up an item from the floor and returning to their assigned task during lunch tray-line on 7/18/18, prevent dietary staff from entering the kitchen with a cloth apron on during the lunch tray-line on 7/18/18 and prevent the use of bowls with water in them . This had the potential to affect 119 residents receiving meals from the kitchen. On 07/18/18 at 11:45 AM EI#6, a dietary employee, was observed to drop a lid on the floor. EI# 6 picked the lid up off the floor with her gloved hands and placed the lid in dishwashing area. EI# 6 was observed to not remove her gloves, wash her hands or put on new clean gloves and she continued to adjust plates and touch items on resident lunch trays. On 07/18/18 at 2:58 PM an interview was conducted with EI# 6. EI# 6 was asked what she is to do if she drops an item on the floor during her duties in the kitchen? EI# 6 stated she should dispose of the item, take her gloves off, wash her hands and put on new gloves. When asked why 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 observation and interviews the facility failed to ensure: the grease receptacle was free of an accumulation of a grease like substance. This was observed two of three days of the survey. This had the potential to affect all residents receiving meals from the kitchen. On 07/17/18 at 8:58 AM and on 7/18/18 at 5:49 PM the grease bin located outside in the back of the kitchen was observed with a brown thick grease-like substance on the top of the bin behind the lid. On 7/18/18 at 5:49 PM an interview with EI # 7, the Dietary Manager, was conducted. EI# 7 was asked why the grease receptacle whould be free of an accumulation of a grease like substance on the outside of the receptacle. EI # 7 stated because flies and bugs could get stuck on it. anytime your contaminate your gloves Why should the grease bin be free of an accumulation of a grease like substance on the outside of the bin? A. Flies and bugs could get stuck up on it What is the potential harm of a staff member entering into the kitchen with an apron on and performing their assigned duties such as placing ice cream on…

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 a review of a facility policy titled, Pre-admission Screening for Mental Retardation and Mental Illness, record reviews and interviews, the facility failed to ensure a level II PASARR was completed for RI (Resident Identifier) # 118 transitioning from rehabilitation short term care to long term care. This affected one of 32 residents whose PASARRs were reviewed. RI #118's PASARR (Preadmission Screening for Mental Retardation and Mental Illness) Level I dated 11/07/17, documented the resident has a diagnosis of Schizophrenia and required a Level II screening. The Level II dated 11/20/17, documented the resident was receiving restorative nursing such as Physical Therapy five times a week for four weeks for gait training and therapeutic exercise for short term care. Section VII of the level II documented that if the status changed to long term and or rehab stopped a significant change Level I screening was required within 14 days. Another Level II should have been completed when the resident transitioned from short term care to long term care. On 07/18/18 at 4:23 PM 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 observation, interview and review of a facility policy Hand Hygiene, the facility failed to ensure: 1) licensed staff did not check tube placement without gloves for Resident Identifier (RI) #12 then without washing her hands return to the medication cart to prepare RI #12's medication; 2) a licensed staff did not drop a tablet on the medication cart then pick up the tablet with her bare hands and place it on the pill splitter. She further failed to wash her hands when leaving RI #26s room and returned to the medication cart. Findings Include: A review of a facility policy Hand Hygiene with an effective date of 9/1/17 revealed: PURPOSE: To provide guidelines to employees for proper and appropriate hand washing techniques that will aide in the prevention of transmission of infections. STANDARD: Hand washing should be performed between procedures with resident .based upon the principle that all blood, body fluids .may contain transmissible infectious agents III. Hand Hygiene .Upon and after coming in…

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.