Gardner Rehabilitation And Nursing Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and policy review, the facility failed to adhere to safe food practices to prevent contamination of food and beverage items intended for resident consumption in the facility's main kitchen. Specifically, the facility failed to implement safe food practices in the main kitchen relative to: -labeling/dating, storage guidelines. -use of hair restraints in order to reduce the risk of cross contamination/spoilage of food items. -maintaining the facility kitchen in a clean, sanitary, and free of dust and debris manner. Findings include: Review of the facility policy titled Dietary Rules, dated July 2020, included the following: -Personal items: should be stored in the office. No bags, jackets, sweaters or purses should be kept in the kitchen . -Drinks and food: Drinks should never be brought into the kitchen from outside. Food from the outside is not allowed in the kitchen for personal consumption. Food may not be consumed in the kitchen except for taste testing (trying food).…

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 2. Review of facility policy titled Enhanced Barrier Precautions, revised August 2024, indicated the following: - Enhanced Barrier Precautions (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and gloves use during high contact resident care activities. -High-contact resident care activities include (in part): a. dressing b. bathing c. transferring d. providing hygiene g. Device care or in use: urinary catheters h. Wound care: any skin opening requiring a dressing -Enhanced Barrier Precautions should be used for the duration of the affected resident's stay in the facility or until resolution of the wound or discontinuation of the indwelling medical device that placed them at higher risk. Resident #18 was admitted to the facility in August 2024, with diagnoses including Ileostomy Status, Pressure ulcer of the sacral Region (bottom of the spine), Pressure ulcer of the left heel, and a local infection of the skin and…

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, record and policy review, the facility failed to provide a dignified experience for one Resident (#19) out of a total sample of 23 residents. Specifically, for Resident #19, the facility failed to provide incontinence care after the Resident was incontinent of bowel and prior to engaging in a group activity. Findings include: Review of the facility policy titled Dignity, revised May 2024, indicated the following: -That each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. -Residents are treated with dignity and respect at all times. -Demeaning practices and standards of care that compromise dignity are prohibited. -Staff are expected to promote dignity and assist residents; for example: .promptly responding to a resident's request for toileting assistance . Resident #19 was admitted to the facility in August 2024, with diagnoses including repeated falls, Depression (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 interview, record review and policy review, the facility failed to notify a Resident Representative of a change in condition, for one Resident (#5) out of a total sample of 23 residents. Specifically, the facility failed to notify Resident #5's Representative when the Resident developed a skin rash which required an outpatient appointment to a Dermatologist and medication to treat the condition. Findings include: Review of the facility policy titled Notification of Changes, reviewed/revised May 2024, indicated the facility promptly informs the resident, consults with the resident's physician, and notifies, consistent with his or her authority, the resident's representative when there is a change requiring notification. The policy included the following: -Circumstances requiring notification include: >significant change in the resident's physical condition .which may include clinical complications . >circumstances that require a need to alter treatment . and may include a new treatment >a transfer .from the facility -Competent individuals: >the facility will notify 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 interview, and record review, the facility failed to ensure that a Preadmission and Resident Review Level I (initial PASRR - initial pre-screening completed prior to admission to a Nursing Facility that assess for Serious Mental Illness[SMI] or Developmental Disabilities[DD]) screen was completed prior to admission to the facility for one Resident #72) out of a total sample of 23 residents. Specifically, the facility failed to ensure that a Level I screen was completed prior to admission to the facility when Resident #72 had active diagnoses of mental disorders. Findings include: Review of the facility policy titled Resident Assessment-Coordination with PASARR Program {sic}, reviewed/revised September 2024, indicated the following: -All applicants to this facility will be screened for serious mental disorders or intellectual disabilities and related conditions in accordance with the State's Medicaid rules for screening. -PASARR Level 1-initial pre-screening that is completed prior to admission {sic} Resident #72 was admitted to the facility in August 2023, with diagnoses 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.

Based on interview, and record review, the facility failed to ensure that professional standards of care were maintained for diabetic management for one Resident (#8) out of a total sample of 23 residents. Specifically, for Resident #8, the facility failed to ensure that Physician's orders were implemented and Physician notification occurred when the Resident experienced periods of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). Findings include: Review of the facility policy titled Blood Glucose Monitoring, undated, indicated the following: -The facility will perform blood glucose monitoring as per Physician's orders. -License Nurse to follow Physician orders set for high and low parameters. Review of the facility policy titled Hypoglycemia Management, reviewed/revised February 2024, indicated the following: -Diabetic residents will have their blood sugar tested as per Practitioner's (Physician/ Nurse Practitioner) orders. -If the blood glucose (blood sugar) reading is 60 milligram (ml)/deciliter (dL) [ml/dL: a unit of measure used for blood glucose testing] or…

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 provide necessary respiratory care and services in accordance with professional standards of practice for two Residents (#35 and #23) out of a total sample of 23 residents. Specifically, the facility failed to: 1. For Resident #35, ensure that Physician's orders were in place to address the liter flow (LPM-flow rate of Oxygen that is received from an oxygen delivery device) of Oxygen and appropriate maintenance and storage were in place for the Resident's nebulizer (machine that administers medication via a mist that is inhaled) device. 2. For Resident #23, notify the Provider timely for updated orders/interventions when there was a change in the Resident's condition and Oxygen was no longer being administered continuously per Physician's orders. Findings include: Review of the AARC (American Association for Respiratory Care) Clinical Practice Guideline, updated 2014: https://www.aarc.org/wp-content/uploads/2014/08/08.07.1063.pdf indicates: -All oxygen must be prescribed and dispensed in accordance with…

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 ensure that a recommendation made by the Behavioral Health Care Team was implemented for one Resident (#104) out of a total sample of 23 residents. Specifically, for Resident #104, the facility failed to ensure that a recommendation made by the Psychiatric Nurse Practitioner to increase the Resident's antianxiety medication after he/she experienced an increase in Anxiety (feeling of unease, such as worry or fear, that can be mild or severe/ intense, excessive, and persistent worry and fear about everyday situations) was reviewed by the Physician and implemented or alternate treatments were put into place. Findings include: Resident #104 was admitted to the facility in February 2024, with diagnoses including Generalized Anxiety Disorder and Major Depressive Disorder (symptoms lasting greater than two weeks of a persistently low or depressed mood and a loss of interest in activities that a person used to enjoy). Review of the Psychiatric Nurse Practitioner's Note dated 10/9/24, indicated the following: -The Resident 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 interview, and record review, the facility failed to ensure that recommendations made by the Consultant Pharmacist during a monthly Medication Regimen Review (MRR) were acted upon as required for one Resident (#59), of five applicable residents reviewed for unnecessary medications, out of a total sample of 23 residents. Specifically, the facility failed to act upon the Consultant Pharmacist recommendations dated 8/21/24 and 9/18/24, to include an evaluation and/or stop date for a PRN (as needed) psychotropic (medication that affects how the brain works and causes changes in mood, awareness, thoughts, feelings or behavior) medication. Findings include: Resident #59 was admitted to the facility July 2024, with diagnoses including unspecified Dementia (the loss of cognitive function, thinking, remembering and reasoning, to such an extent that it interferes with a person's daily life and activities). Review of the October 2024 Physician's orders, indicated the following: -Lorazepam (anti-anxiety medication) oral tablet 0.5 milligrams (mg), give 0.5 mg by mouth every 12 hours as…

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, policy review and interview, the facility failed to ensure that as needed (PRN) orders for psychotropic (medication that affects how the brain works and causes changes in mood, awareness, thoughts, feelings or behavior) medications were only used when necessary and PRN use is limited for one Resident (#59), of five applicable residents reviewed for unnecessary medications, out of a total sample of 23 residents. Specifically, for Resident #59, the facility failed to ensure that PRN Lorazepam (Ativan: antianxiety medication) was limited to 14 days, unless otherwise documented by the Attending Physician or Prescribing Practitioner that it was appropriate to extend beyond 14 days. Findings include: Review of the facility policy titled Use of Psychotropic Medications, dated March 2024, indicated the following: -PRN orders for all psychotropic drugs shall be used only when medication is necessary to treat a diagnosed specific condition that is documented in the clinical record and for a limited duration (i.e.14 days). -If the Attending Physician or Prescribing…

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 ensure that documentation was maintained in the medical record that weekly skin checks had been completed for one Resident (#72) out of a total sample of 23 residents. Specifically, for Resident #72, the facility failed to ensure that weekly skin check documentation was completed for the Resident who was at risk of skin break down, and maintained in the medical record putting the Resident at risk for having skin break down go untreated. Findings include: Review of the facility policy titled Skin Assessment, reviewed/revised June 2024, indicated the following: -A full body, or head to toe, skin assessment will be conducted by a Licensed or Registered Nurse upon admission/re-admission, daily for three days, and weekly thereafter. -Documentation of skin assessment: include date and time of the assessment, your name, and position title. Resident #72 was admitted to the facility in August 2023, and had diagnoses including a pressure ulcer (injury to skin and underlying tissue resulting from prolonged pressure on the skin) 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 ensure the Arbitration Agreement was explained to one Resident's (#59) Resident Representative, out of a total sample of four arbitration agreements reviewed. Specifically, the Resident Representative for Resident #59 was not given the opportunity to have the Arbitration Agreement explained to him/her by the facility when it was determined that Resident #59 was cognitively impaired. Findings include: Review of the facility policy titled Binding Arbitration Agreements, reviewed/revised November 2023, indicated the following: -When explaining the arbitration agreement, the facility shall: >Ensure the resident or his or her representative acknowledges that he or she understands the agreement. Resident #59 was admitted to the facility in August 2024, with a diagnoses of Cognitive Communication Deficit (difficulty paying attention to conversation, remembering information, and responding accurately), Dementia with Agitation (progressive disease with impairment in memory and functioning that includes symptoms such as agitation),…

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, and record review, the facility failed to offer an updated COVID-19 vaccine, in accordance with the Centers for Disease Control and Prevention (CDC) recommendations for one Resident (#11) out of five applicable sampled residents, out of a total sample of 23 residents. Specifically, the facility failed to offer an updated COVID-19 vaccine to Resident #11 when the Resident was not considered up-to-date with the COVID-19 vaccine, the updated COVID-19 vaccine was available to the facility, and the COVID-19 vaccine was not clinically contraindicated for the Resident, which increased the Resident's risk for acquiring COVID-19 infection and COVID-19 associated complications. Findings include: Review of the CDC Guidelines titled Use of an Additional Updated 2023-2024 COVID-19 Vaccine Dose for Adults Aged Greater than/Equal to 65 Years: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024, dated 4/25/24, indicated the Advisory Committee on Immunization Practices…

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, document review and interview, the facility failed to maintain appropriate standards for safe and sanitary food services. Specifically, the facility failed to ensure that staff: 1. Maintained appropriate standards for safe and sanitary practices related to hand washing and hair restraints. 2. Monitored and documented beverage temperatures during meal service. Findings include: Review of the facility's Proper Food Handling policy, undated, indicated the following: -Washing hands frequently according to hand washing procedures. -Follow Hazard Analysis Critical Control Point (HACCP-includes a temperature control step ensuring that foods are held at appropriate temperatures and kept out of the danger zone between 4 degrees Celsius (C) to 60 degrees C) Guidelines for temperature control. Review of the facility's Hand Washing policy, undated, indicated the following: -Protect clean hands by turning off faucets with a paper towel. -Review of a facility policy, untitled and undated, indicated the following: -If a beard is not kept short, it must be under a beard/hair…

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 implement the plan of care for one Resident (#45), out of a total sample of 20 residents. Specifically, the facility staff failed to implement medication monitoring relative to anticoagulant medication (medication taken to prevent blood from clotting) and diuretic medication (medication taken to increase the elimination of water from the body) as ordered. Findings include: Resident #45 was admitted to the facility in February 2023 with diagnoses including Congestive Heart Failure (CHF-a condition where the heart is unable to pump properly, causing blood to pool and fluid to build up in the lungs) and Atrial Fibrillation (rapid and irregular beating of the heart which can increase the risk of forming blood clots). Review of the Minimum Data Assessment (MDS) dated [DATE], indicated Resident #45 was cognitively intact as evidenced by a Brief Interview for Mental Status (BIMS) score of 13 out of a total possible score of 15. Review of the active…

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 provide care and services in accordance with Physician's orders and the plan of care for one Resident (#51) out of a total sample of 20 residents. Specifically, the facility staff failed to perform wound care to a right lower extremity shin (front of lower leg) wound as ordered. Findings include: Resident #51 was admitted to the facility in November 2017 with diagnoses including Diabetes Mellitus (DM-a disease of inadequate control of blood sugar levels) and an open wound of the right shin. Review of the Minimum Data Set (MDS) assessment dated [DATE], indicated Resident #51 was cognitively intact as evidenced by a Brief Interview for Mental Status (BIMS) score of 15 out of a total possible score of 15. Review of the active Physician's orders dated July 2023, indicated the following wound care order initiated on 7/20/23: -Cleanse right anterior shin with normal saline -pat dry -apply single layer of Medihoney HCS (Hydrogel Colloidal Sheet)…

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 follow appropriate professional standards related to infection control for catheter care for one Resident (#62) out of a total sample of 20 residents. Findings include: Review of the facility policy titled Catheter Care, Urinary, Revised September 2022, indicated the following: -Changing indwelling catheters or drainage bags at routine, fixed intervals is not recommended. -Rather, it is suggested to change catheters and drainage bags based on clinical indications such as infection, obstruction, or when the closed system (when any part of the catheter system is exposed to air allowing transfer of matter into the catheter system or into the urethra) is compromised. Resident #62 was admitted to the facility in June 2023 with a diagnosis of Obstructive Uropathy (disorder of the urinary tract that occurs due to obstructed urinary flow) and had an indwelling catheter (also referred to as Foley catheter- tubing inserted into the bladder, that is left in place, and allows urine to drain). Review of a Nursing Note dated 7/17/23 at…

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 follow professional standards related to the care and services of a Continuous Positive Airway Pressure (CPAP) machine (machine that involves the administration of air by an external device at a predetermined level of pressure when sleeping) for one Resident (#74) out of a total sample of 20 residents. Specifically, the facility staff failed to clean and provide maintenance of the Resident's CPAP equipment per facility policy. Findings include: Review of the facility policy titled CPAP/BiPAP, revised 7/1/2023, indicated the following: -Empty the chamber (area on the CPAP machine that holds water) completely after each use and wipe dry. -Weekly cleaning: Wash headgear/straps in warm, soap water and air dry, Wash tubing with warm, soapy water and air dry. -Replace equipment routinely in accordance with manufacturer recommendations. General guidelines: Face mask and tubing - once every three months, Headgear, non-disposable filters, and humidifier chamber - once every six months. Resident #74 was admitted to 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 record review, policy review and interview, the facility failed to provide care and services consistent with professional standards for one Resident (#57) out of a total sample of 20 residents, who required renal dialysis (a lifesaving treatment that filters waste products and excess fluid when the kidneys stop working). Specifically, the facility failed to ensure accurate and complete communication with the dialysis facility for the Resident's dialysis appointments as required. Findings include: Review of the facility policy for Care of a Resident with End-Stage Renal Disease, last revised September 2022, indicated that Residents with end-stage renal disease (ESRD) will be cared for according to the currently recognized standards of care. Resident #57 was admitted to the facility in May 2023 with diagnoses including Acute Respiratory Failure and Chronic Kidney Disease, Stage 5 (end stage). Review of Resident #57's care plan for dialysis, initiated 5/8/23, indicated interventions to: -observe peripheral area for edema, hypertension, hypotension, altered mental status,…

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 provide education, assess for eligibility, and offer Pneumococcal Vaccinations per the Centers for Disease Control and Prevention (CDC) recommendations for two Residents (#22 and #87) out of a total sample of five residents. Specifically, 1. For Resident #22, the facility failed to ensure that staff offered, assessed, and provided education on the recommended 20-Valent Pneumococcal Conjugate Vaccine (PCV20). 2. For Resident #87, the facility failed to ensure that staff administered the requested Pneumococcal Polysaccharide Vaccine 23 (PPSV23). Findings include: Review of the facility policy titled Pneumonia Vaccine, revised October 2019, indicated the following: -Prior to or upon admission, residents will be assessed for eligibility to receive the pneumococcal vaccine series, and when indicated, will be offered the vaccine series within thirty (30) days of admission to the facility unless medically contraindicated or the resident has already been vaccinated. -Administration of the pneumococcal vaccines or revaccination…

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.