Iva Post-Acute

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interviews, the facility failed to ensure one of one resident (Resident (R)1) reviewed for oxygen administration received oxygen per nasal cannula and the oxygen tubing was changed according to the physician's order. This failure had the potential for the resident to receive increased oxygen causing hyperoxia (cells, tissues and organs are exposed to an excess supply of oxygen.)Findings include:Review of R1's admission Record in the electronic medical record (EMR) under the Profile tab revealed R2 was admitted to the facility on [DATE] with diagnoses that included acute respiratory failure with hypoxia.Review of R1's annual Minimum Data Set (MDS) under the MDS tab of the EMR with an Assessment Reference Date (ARD) of 09/17/25 and a Brief Interview for Mental Status (BIMS) score of 12 out of 15 which indicated no cognitive impairment. The resident was coded as receiving oxygen therapy.Review of R1's Care Plan located under the Care Plan tab of the EMR dated 04/03/23…

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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview, and facility policy review, the facility failed to ensure a resident received their scheduled morning medications before or after a resident returned from dialysis for one of one resident (R)64) reviewed for dialysis out of sample of 22 residents. This had the potential to affect all residents who went out for dialysis treatment.Findings include:Review of the undated facility's policy titled, Care of a Resident with End-Stage Renal Disease revealed, Residents with end-stage renal disease will be cared for according to currently recognized standards of care. Staff caring for residents with ESRD, including residents receiving dialysis care outside the facility, shall be trained in the care and special needs of these residents. Education and training of staff include, specifically timing and administration of medications, particularly those before and after dialysis.Review of R64's Face Sheet located in the Profile tab of the electronic medical record (EMR) revealed R64 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, record review, and facility policy review, the facility failed to follow infection control and prevention guidelines regarding Enhanced Barrier Precautions (EBP) while performing indwelling urinary catheter care for two of two residents (Resident (R)1 and R12) reviewed for indwelling urinary catheters of 22 sampled residents. This failure had the potential to spread multidrug resistant organisms (MDROs) to the residents.Findings include:Review of the facility's undated policy titled EBP revealed, Which patients need EBP? Patients with indwelling devices, such as: Urinary Catheters. EBP for all of the following activities: device care or use: urinary catheter. Precautions are to remain in place for duration of resident's stay or until resolution of wound or discontinuation of indwelling medical device.1. Review of R1's admission Record, in the electronic medical record (EMR) under the Profile tab revealed R1 was admitted to the facility on [DATE] with diagnosis of retention 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 record review and interviews, the facility failed to ensure the correct form was issued for Resident (R)28 and R35, when Medicare Part A services were ending. Specifically R28 and R35 received the form CMS-R-131 for Part B services and not the correct CMS-10055 for Part A services for 2 of 3 residents reviewed for advanced beneficiary notices. Findings include: Review of a facility document titled, Form Instructions Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNFABN) states, Medicare require's SNFs to issue the SNFABN to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is: Not medically reasonable and necessary; or Considered custodial. The SNFABN provides information to the beneficiary so that she/he can decide whether or not to get the care that may not be paid for by Medicare and assume financial responsibility. SNFs must use the SNFABN when applicable for SNF Prospective Payment System services (Medicare Part A). Review…

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 facility policy, the facility failed to ensure that Resident (R)31 received medications safely through enteral feeding, for 1 of 1 resident reviewed. Findings include: Review of the facility policy titled Administering Medications through an Enteral Tube dated 2001, states, The purpose of this procedure is to provide guidelines for the safe administration of medications through an enteral tube. Preparation: 3. Assemble the equipment and supplies as needed. General Guidelines: 7. Towel or Chux pad 12. Stethoscope Steps in the Procedure: 4. d. Fold bed linens to the resident ' s waist and cover the chest with a towel or Chux pad. 6. Verify placement of feeding tube Review of (R)31 ' s Face Sheet revealed R31 was admitted to the facility on [DATE], with a diagnoses including but not limited to: Parkinson ' s Disease with Dyskinesia, without mention of fluctuations. Review of (R)31 ' s Quarterly Minimum Data Set (MDS) with an Assessment Reference Data (ARD) of 07/03/24,…

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 assure professional standards of communication occurred between the facility and the dialysis center for 1 of 1 resident reviewed, Resident (R)10. Findings include: Review of the facility policy titled End-Stage Renal Disease, Care of a Resident With with a revision date of September 2010, the policy statement revealed, Residents with end-stage renal disease (ERSD) will be cared for according to currently recognized standards of care. Policy Interpretation and Implementation, 4. Agreements between facility and contracted ERSD facility include all aspects of how the resident's care will be managed including: b: how information will be exchanged between the facilities. Review of the facility's SNF (Skilled Nursing Facility) Dialysis Services Agreement dated 12/27/11 revealed, Obligations of Nursing Facility, 2. Interchange of information: The Nursing Facility shall provide for the interchange of information useful or necessary for the care of the ERSD…

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, record review, and interviews, the facility failed to include a Registered Nurse (RN) on the daily staff posting for the month of March, June, and July of 2024. Findings include: A policy for the daily staffing sheet was not provided when requested on 07/11/24 at 2:00 PM. Review of the daily staffing sheets, as worked, posted for each shift from March 2024, June 2024, and July 1-11, 2024, did not include a designated registered nurse for at least eight (8) hours. Review of the Daily Staffing sheets revealed a line which indicated RN, each sheet revealed a blank indicating RN hours were not listed. During an interview on 07/11/24 at 1:20 PM, the Operation Manager stated the RN hours should be included on the daily staff posting. The Operation Manager revealed they were completing the daily staff posting in January and February and they are not sure why the Human Resource (HR) officer for the facility did not include the RN hours when they took over the task. The Operation Manager concluded the HR officer was new.

Based on observation, interview, and review of facility policy, the facility failed to ensure that medications and biologicals that were outdated or without proper labeling were removed from the medication treatment cart for 1 of 1 medication treatment cart. Findings include: Review of the facility policy titled Storage of Medications revised on November 2020, states, The facility stores all drugs and biologicals in a safe, secure, and orderly manner. Procedures: 4. Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. During an observation on 07/10/24 at 6:26 AM, of Unit 100/200 Treatment Cart, with Licensed Practical Nurse (LPN)1 revealed the following: 1. Maxorb II AG Alginate Wound Dressing with antibacterial Silver, Lot#83623126340, Ref MSC 9945EP - opened sterile dressing, no longer sterile. 2. Opticell Chitosan-Based Gelling Fiber 4.25 x 4.25 square, Lot#W056844, Ref MSC…

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 review of facility policy, record review, and interview, the facility failed to ensure Resident (R)15's coordination of care between hospice and the facility, for 1 of 1 resident reviewed for Hospice Care and Services. Findings include: Review of the undated facility policy titled, Hospice Program revealed , Policy Interpretation and Implementation: #9. In general, it is the responsibility of the hospice to manage the resident's care as it relates to the terminal illness and related conditions, including the following: a. Determining the appropriate hospice plan of care; b. Changing the level of services provided when it is deemed appropriate; c. Providing medical direction, nursing and clinical management of the terminal illness; #10. In general, it is the responsibility of the facility to meet the resident's personal care and nursing needs in coordination with the hospice representative, and ensure the level of care provided is appropriately based on the individual resident's needs. d. Communicating with the hospice provider (and documenting such communication) to ensure…

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, interview, record review, and facility policy review, the facility failed to ensure infection control procedures were followed for two residents (R)29 and R41 of six residents observed during medication administration and for one resident (R48) of seven residents observed for the provision of wound care. Findings include: The facility's policy related to infection control specific to medication administration were requested but no specific policy was able to be located by the facility prior to survey exit on 04/13/22. 1. Review of the undated admission Record, found in the electronic medical record (EMR) under the Profile tab, revealed R29 was admitted to the facility on [DATE] with diagnoses including type 2 diabetes. Review of R29's Order Summary Report most recently dated 02/16/22 and found in the EMR under the Orders tab revealed orders for blood glucose monitoring, Humalog insulin per sliding scale, subcutaneously, four times daily, via insulin pen for her diagnosis of type 2…

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, interviews and review of facility policy, the facility failed to ensure appropriate monitoring for one Resident (R) R6 of three residents reviewed for unnecessary use of psychotropic medication. Specifically, behaviors were not monitored related to medications administered for psychosis and sleep for R6. Findings include: The facility's Behavioral Assessment, Intervention and Monitoring Policy most recently revised in 03/2019 read, in pertinent part, Behavioral symptoms will be identified using facility approved behavioral screening tools and the comprehensive assessment; and When medications are prescribed for behavioral symptoms, documentation will include: e. Specific target behaviors and expected outcomes; and h. monitoring for efficacy and adverse consequences. Review of the admission Record located in the Electronic Medical Record (EMR) revealed R6 was admitted to the facility on [DATE] with diagnoses including unspecified dementia with behavioral disturbance, unspecified psychosis…

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.