Az - Rio Vista Post Acute And Rehabilitation

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, clinical record review, staff interviews, and review of facility policy, the facility failed to ensure one (#4) of three sampled residents was provided respiratory care consistent with professional standards and highest practicability of care. The deficient practice could result in respiratory complications. Findings include: Resident #4 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus, hypertension, and heart failure with preserved ejection fraction. Review of the Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 12, indicating moderate cognitive impairment. Review of the care plan revealed no evidence of oxygen use or needs and no evidence of the resident having a focus related to respiratory issues. Review of the progress notes revealed Physician and nurse practitioner (NP)/physician asssistant (PA) progress notes from November 2, 2024 to November 27, 2022 which recommended supplemental oxygen use to keep…

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, clinical record review, resident and staff interviews, and review of facility policy, the facility failed to ensure one (#5) of three sampled residents' choices regarding personal hygiene care were considered and honored in regard to shower preferences. The deficient practice could result in residents not having their choice in personal preferences that are significant to them. Findings include: Resident #5 was admitted to the facility on [DATE] with diagnoses that included metabolic encephalopathy, urinary tract infection, and end stage renal disease. Review of the Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 13, indicating intact cognition. Review of the care plan revealed a problem focus initiated on September 10, 2024, which revealed that the resident could be resistive to care, such as refusing showers. Interventions in place included allowing the resident to make decision about treatment regime to provide a sense of control,…

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, clinical record review, staff interviews, and review of facility policy, the facility failed to ensure one (#2) of four residents reviewed for pressure ulcers was provided care and services to prevent and safely treat pressure ulcers. The deficient practice could result in the development and worsening of pressure ulcers. Findings include: Resident #2 was admitted to the facility on [DATE] with diagnoses that included (cystitis) inflammation of the bladder, Type two diabetes mellitus, and generalized muscle weakness. Review of the nursing progress note dated April 8, 2025 revealed that on admission, the resident was noted to have a wound to the right heel, which had a clean dressing in place. There was no evidence of other wounds noted at this time. Review of the Initial admission Record revealed that on April 9, 2025, the resident was observed to have a right heel wound. There was no evidence of any other wounds or skin impairments at that time. Review of Resident #2's care plan revealed 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff and resident interviews, and facility policy, the facility failed to ensure medication were not left unsecured at bedside for two sample residents (#105 & #67). The deficientpractice of unattended medications does not align with accepted professional standards of practice and may result in undesirable medication-induced harm. Findings include: -Resident #105 was admitted on [DATE] with diagnoses of alcoholic cirrhosis of liver, depression, opioid abuse, and anxiety disorder. Review of resident #105 medical records revealed a significant change Minimum Data Set (MDS) completed December 08, 2024 when admitted on to hospice. He had a Brief Interview for Mental Status (BIM) score of 15/15 which means he has no cognitive impairment. Review of medical records did not reveal an assessment to allow self-administration nor to allow storage of medications or treatment at bedside. On April 01, 2025 at 10:19 AM, during initial observation, a beige color asthma mist inhaler unit was observed 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, resident and staff interviews, and policy review, the facility failed to ensure a Peripherally Inserted Central Catheter (PICC) line was discontinued when not required prior to, or at time of, discharge for one of three Residents (#1). The deficient practice could result in residents utilizing the PICC line inappropriately or getting infection if not prope. Findings include: Resident #1 was admitted to the facility on [DATE] with diagnoses that included sepsis, psychoactive substance abuse, depression, and anxiety. An order was initiated on January 23, 2025 to flush the PICC line right upper extremity (RUE) before and after use of intravenous IV medications. An order was initiated on January 23, 2025 to do PICC line care and dressing changes. An order initiated on January 24, 2025 revealed that Resident #1 ' s opioid risk was high risk. An order initiated on January 24, 2025 revealed that upon discharge, the facility should have removed the negative pressure wound therapy (NPWT)…

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 -Resident #66 was admitted on [DATE] with diagnoses of cerebral infarction, hemiplegia and hemiparesis affecting right dominant side, aphasia, epilepsy unspecified, type 2 diabetes mellitus, atrial fibrillation, unspecified dementia and anxiety disorder. The care plan initiated on October 21, 2021 included that resident was on anticoagulant therapy related to atrial fibrillation. Interventions included to take/give medication at the same time each day. The current comprehensive care plan included an intervention to administer medications as ordered and to monitor/document for side effects and effectiveness. Review of the physician orders revealed the following morning medications: -Aspirin (nonsteroidal anti-inflammatory) 81 mg (milligrams) give 1 tablet by mouth one time a day for DVT (deep vein thrombosis) prophylaxis; -Tramadol (narcotic analgesic) 50 mg give 1 tablet by mouth every 6 hours as needed for pain 1-10; -Acetaminophen (analgesic) 325 mg give 2 tablets by mouth every 6 hours as needed for…

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 clinical record review, resident and staff interviews, facility documentation and policy review, the facility failed to ensure that assessments consistently identified and accurately described the skin condition for one resident (#2). The deficient practice could result in resident not receiving the appropriate care and services according to their needs. Findings Include: Resident #2 was readmitted on [DATE] with diagnoses of abscess of bursa to right shoulder, cellulitis of right upper limb, end stage renal disease (ESRD), type 2 diabetes and anemia. The care plan dated February 17, 2023 included the resident had potential for pressure ulcer development related to right shoulder abscess, s/p (status post-surgical debridement, morbid obesity, and had a wound to the right shoulder. Interventions included to follow facility policies/protocol for the prevention/treatment of skin breakdown; to monitor/document/report to physician as needed changes in skin status such as appearance, color, wound healing,…

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 personnel file review, staff interviews and facility documentation and policy review, the facility failed to ensure that evidence of training to safely and effectively carry out the functions of the food and nutrition services were not expired for two staff members (#92 and #132). The deficient practice could result in dietary not having the appropriate skills to carry out their functions and responsibilities. Findings include: -Regarding the dietary aide (staff #92) The personnel file of dietary aide (staff #92) revealed a hire dated of November 14, 2019. The file also included a completion of a Food Handler Card Training dated November 12, 2019 and was valid through November 12, 2022. However, there was no evidence found that the food handler card training was renewed and completed after November 12, 2022. Review of the punch details for staff #92 revealed that staff #92 worked more than 50% of the time after November 12, 2022. -Regarding dietary aide/cook (staff #132) The personnel file of dietary aide/cook (staff # 132) revealed a hire date of April 13, 2022. The file…

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, staff interviews and review of facility documentation, policies and procedures, the facility failed to ensure that staff were consistently screened for COVID-19 upon entry to the facility and prior to working their shift. The deficient practice could result in the spread of infection to residents and staff. Findings include: During an observation conducted on February 28, 2022 at 8:00 a.m., the receptionist instructed the staff and visitors waiting in the lobby to wear a mask and perform hand hygiene using the alcohol-based hand rub (ABHR) also located in the lobby. At the corner of the lobby, there was an I-Pad which the receptionist directed the staff and visitors to go for COVID-19 screening questions. The electronic screening questions included signs and symptoms of COVID-19, recent travel, COVID-19 exposure, and temperature. A laminated poster with information on handwashing and precautionary measures for symptomatic staff and visitors was also posted on the door as you entered the lobby. Review of the Labor Hours Reports dated February 19, 20 and 21, 2022…

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, clinical record review, resident and staff interviews, and facility policy, the facility failed to ensure an ongoing activity was provided based on the comprehensive assessment and preferences for one resident (#462). The deficient practice could result in the not having meaningful activities based on the resident's interest and preferences. Findings Include: Resident #462 was admitted to the facility on [DATE] with diagnoses of orthopedic aftercare, unilateral primary osteoarthritis, left hip and presence of left artificial hip joint. A nursing progress note dated February 16, 2022 revealed the resident was alert and oriented x 4 and was able to make needs known. An activity admission evaluation dated February 17, 2022 revealed the resident was alert and oriented to person, place and time with adequate communication and cognition skills. Activity interests included card games, computer games, puzzles, exercise groups, music, reading, walking and wheeling outdoors, sewing and watching…

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, clinical record review, resident and staff interviews and facility policy and procedure review, the facility failed to ensure care and assistance with the use of hearing aids was provided to one resident (#65). The deficient practice could lead to the resident not able to hear and maintain hearing abilities resulting in difficulty in communication. Findings include: Resident #65 was readmitted on [DATE] with diagnoses of unspecified fracture of the shaft of the humerus, anxiety disorder and osteoarthritis. The care plan dated August 11, 2020 revealed the resident was at risk for communication problem related to hearing deficit and had bilateral hearing aids. The goal was that the resident will be able to make needs known on a daily basis. Interventions included to anticipate and meet needs, and use of adaptive communication equipment, hearing aid. A nursing progress note dated January 28, 2022 revealed the resident's hearing aids were delivered. The hearing aid service note dated January…

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.