rowid,facility_name,facility_id,address,city,state,zip,inspection_date,deficiency_tag,scope_severity,complaint,standard,eventid,inspection_text,filedate
1,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,164,D,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, observations during medication pass with the Registered Nurse (RN) (Employee #1) performed from 5/2/17 thru 5/4/17, it was determine that the facility failed to ensure that residents are treated with respect and dignity during delivery of nursing care, for 1 out of 28 residents (Suplemental Sample Resident #11). Findings include: 1. During de medication pass on 5/3/17 at 9:37 am with the RN (Employee #1) on room [ROOM NUMBER]A it was observed that the RN was administering medication and explaining the medications to the resident and the physician (MD) (Employee #2) entered to the residents room without knocking the door and requesting permission to enter, and immediately started talking to the RN (Employee#1) ignoring the presence of the resident. 2. The MD (Employee #2) gave to the RN (Employee #1) information about the medication that had just ordered to the resident of room [ROOM NUMBER][NAME] During Interview with Administrator (Employee #3) on 5/3/17 at 3:12 pm, she stated: I already talked to the physician about the incident on room [ROOM NUMBER]A and he told me that he did not mention the name of the resident just the room number and the medication. But we are going to keep working on that.",2020-09-01
2,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,166,D,0,1,ZOYB11,"Based on a recertification extended survey, review of the admission package it was determined that the facility failed to provide the correct telephone numbers for grievance process. This deficient practice could affect 28 out of 28 admitted residents. Findings include: On 05/02/17 at 10:30 am during the review of the admission package it was identified that the facility admission packet booklet did not have the correct numbers to file a grievance to the Puerto Rico Health Department (Instituciones de Salud Ley 101) and Medicare Hot Line. The facility fail to maintain an updated telephone numbers for the patient's grievance process.",2020-09-01
3,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,241,H,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, observations during medication pass with the Registered Nurse (RN) (Employee #1) performed from 5/2/17 thru 5/4/17, it was determine that the facility failed to ensure that residents are treated with respect and dignity during delivery of nursing care, for 2 out of 28 residents (Resident #9 and Suplemental Sample Resident #11). Findings include: 1. During de medication pass on 5/3/17 at 9:37 am with the RN (Employee #1) on room [ROOM NUMBER]A it was observed that the RN was administering medication and explaining the medications to the resident and the physician (MD) (Employee #2) entered to the residents room without knocking the door and requesting permission to enter, and immediately started talking to the RN (Employee #1) ignoring the presence of the resident. During Interview with Administrator (Employee #3) on 5/3/17 at 3:12 pm, she stated: I already talk to the physician about the incident on room [ROOM NUMBER]A and he told me that he did not mention the name of the resident just the room number and the medication. But we are going to keep working on that. 2. Resident # 9 is a [AGE] years old male patient with a diagnostic of left femur fracture. On 5/04/2017 at 2:48 pm during interview resident # 9 was observed with pants' down to his knee, he stated I have my pants' down to my knees because I called the nurse 25 minutes ago because my diaper is wet. At 3:00 pm resident # 9 continued with the pant down to his knees and the diaper wet. At 3:05 pm the surveyor notified the administrator (employee #3) about the situation and the nursing personnel proceed to change resident # 9 diaper. The facility failed to ensure that residents are treated with respect and dignity during delivery of nursing care",2020-09-01
4,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,252,F,0,1,ZOYB11,"Based on a recertification extended survey, observations during the initial observational tour with Nurse Supervisor (employee #4) and during the physical environment tour performed on 5/4/17 with the Physical Plant Director (employee #12) , it was determined that the facility failed to ensure that safe, clean, comfortable and homelike environment, related to staining, holing cubicles curtains, broken formica dinner tables and broken formica on night tables affecting 11 out of 20 residents rooms (R) visit ( R #102, #103, #104, #105, #107, #108, #109, #110, #111, #112, and #115). Findings include: 1. During the initial tour of the facility on 5/4/17 from 8:40 am until 9:30 am, eleven resident's rooms were visited and the facility had twenty-two admitted residents. In resident room # 109-B it was observed night table with broken front door and chairs located on room 109-A and 109-B were observed with dark spots. 2. Rooms #102, #103, #104, #105, #107, #108, #109, #110, #111, #112, and #115 cubicles curtain with stains, burst seam and dirty. 3. Rooms #105 and #107 the window curtain with black spots.",2020-09-01
5,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,253,F,0,1,ZOYB11,"Based on a recertification extended survey, observations, review of documentation and policies/procedures and interviews with personnel and residents made during the physical environment survey, it was determined that the facility failed to ensure housekeeping and maintenance service necessary to maintain a sanitary, orderly, and comfortable interior affecting 28 out of 28 admitted residents. Findings include: As observed tour through the facility on 5/2/17 at 9:00 am the following was found: 1. Spider webs hanging on the medication room with spider in the middle. 2. Accumulated dirt by the edges of the ceramic tile base and all the edges of the floors of the rooms of residents. 3. Resident's room with trash on the floor; (plastics cups and dirty gauze). During interview with Supervisor of the house keeping subcontractor (employee #13) on 5/3/17 at 1:47 pm she stated I do not know what is going on here, not more than 4 months ago an intense cleaning was carried out in this area; that even I cleaned; so that everything was well. In this area we only have employees from 6:00 am until 5:00 pm.",2020-09-01
6,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,254,E,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, observations made during the survey and group interview, it was determined that the facility failed to ensure that cubicles drapers and linens are in good condition. This could affect 10 of 28 admitted . (Rooms #103-A, #107-A,#108, #109, #110-A, #114-A,#115, #116-C,#117 and #120) Findings include: 1. During the initial tour performed on 5/2/17 at 9:20 am and physical environment with Physical Plant Director (employee #12) performed on 5/4/17 at 8:34 am it was found that rooms #110-A the linen was observed with holes, #107-A with stain on the linens, #114-A linen with holes, #116 -C it was observed a flat sheet in front of patient feet with a lot of blood all over it. # 107, #108, #109-B ,#115, #117 and # 120 cubicles curtain with holes, stains, burst seam and dirty. Interview performed on 5/4/17 at 9:45 am to (employee #14) reveals that the facility is in charge to clean and distribute the curtains and the sheets . They have to check the sheets before perform the delivery of it. The laundry area was visited on 5/4/17 at 10:40 am until 11:05 am interview to Laundry staff (employee #14) reveals that the laundry does not have an exclusive inventory for the linen for the Skilled Nursing.The only inventory is the cubicle curtain that it is color blue. Lundry staff (employee #15) on 5/4/17 at 10:55 am stated: At the moment we pick up the first round of linen at 6:30 am and delivered it at 9:00 am when we made the second pick up round. And then we delivered it at 1:00 pm to 1:30 pm. 2. During the initial tour performed on 5/2/17 and during the physical environment tour perform on it was observed in residents' room [ROOM NUMBER]-A, #107-A and 110 A that clean sheets were located on top of one of the visitors' chairs.",2020-09-01
7,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,256,D,0,1,ZOYB11,"Based on a recertification extended survey, the observational tour of the physical environment and tests to ceiling and overhead bed lamps with the facility's Engineer, it was determined that the facility failed to ensure that one out of twenty resident's rooms have overhead lamps that work appropriately (resident's rooms #115A-B overhead lamps) which could affect 1 out of 28 admitted residents (R) (random sample selection R #11). Findings include: 1. All resident's sleeping rooms were visited on 5/2/17 from 9:00 am until 10:45 am and on 5/3/17 from 9:00 am until 11:45 am and the following was observed in one out of twenty resident's rooms related to ceiling lights and overhead lamps (located behind resident's beds): a. The overhead lamp in resident's room's #115A and B (random sample selection residents #11 no resident was in bed #115B) partially did not work when tested . These lamp are three way lamp with three different fluorescent lights, every time the pull cord is pulled different lights turn on and off. The overhead lamp identified did not works.",2020-09-01
8,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,257,E,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, the observational tour of resident's rooms, temperature measurements and group interview during the survey for the physical environment, it was determined that the facility failed to ensure that 5 out of 28 resident's rooms during the initial tour (resident's room [ROOM NUMBER]-A, #111-A, B, C and D) has an appropriate temperature for their comfort. Findings include: 1.During the observational tour of resident's sleeping rooms performed on 5/2/17 from 9:00 am until 10:45 am, it was found that R#4 sleeping room [ROOM NUMBER]-A was not in the temperature parameters. Surveyor took the temperature with the laser thermometer and it was on 68.5 degrees Fahrenheit . During interview with his son on 5/2/17 at 10:50 am he state: My father was in the bed C; he starts to cough a lot and complain of cold. Yesterday I told to the nurse the problem and they change my father to this side (Bed A). On 5/3/17 at 1:25 pm until 2:00 pm the group interviwe was performed. A caregiver from resident room [ROOM NUMBER]-A indicates during group interview that the room where her sister is staying it is too cold. During the physical environment performed on 5/4/17 from 9:15 am until 11:45 am surveyor visited the residents' room [ROOM NUMBER] with capacity for four residents. The temperature was taken with the laser thermometer at 10:25 am and it was on 64.5 degrees Fahrenheit . During the interview on 5/4/17 at 9:20 am with R#4 sons' and random sample (RS) #2 from room [ROOM NUMBER]-D he stated that the temperatures in the night are cold. Interview with Physical Plant Director (employee #12) performed on 5/4/17 at 10:25 am; he stated: I'm controlling and monitoring the temperatures from my office. We do not have problem with the temperature at this moment. The facility provided evidence that they verified resident's room temperatures to ensure that the temperature range is between 71 F and 81 F; however they are taking this reading off of the thermostat located in the rooms. Periodic resident room temperatures using the thermometer must be performed and documented by the facility, and residents shall be asked if the temperature is comfortable to ensure that residents can recuperate to their fullest potential and are reasonably accommodated.",2020-09-01
9,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,271,D,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, review of eight records and interview with the resident sister, resident #2, nursing supervisor (employee #4) and medical director (employee #17), it was determined that the facility failed to ensure that all admission orders [REDACTED]. Findings include: 1. Resident #2 is an [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was admitted to the SNF for antibiotic therapy and rehabilitation. He is bedridden since (MONTH) (YEAR) due to the Pneumonia. 2. During record review performed on 5/2/17 at 1:00 am the following was found: [NAME]On the drug reconciliation sheet (Hoja de reconciliacion de medicamento) written by the RN in the initial assessment dated [DATE] the patient use these medication in his home: [MEDICATION NAME] 2 mg 1 tab PO HS, Norvacs 10 mg 1 tab PO daily [MEDICATION NAME] 40 mg 1 tab PO HS, [MEDICATION NAME] 50 mg 1 tab PO daily, [MEDICATION NAME] 50 mg 1 tab PO twice a day, [MEDICATION NAME] 20mg 1 tab PO daily and [MEDICATION NAME] 5 mg 1 tab PO daily. b.The admission order perform on 4/29/17 by the physician wrote the following medications; [MEDICATION NAME] 1 tab PO daily, ).45 NSS at 20 ml per hour intravenous, Zozyn 3.375 mg intravenous every twelve hours per seven days, [MEDICATION NAME] 10mg 1 tab PO HS, Intestinex 1 tab PO every 8hrs, [MEDICATION NAME] 40 mg SQ daily, [MEDICATION NAME] 20 mg intravenous every 12 hour, [MEDICATION NAME] DM 15 ml PO every eight hour, [MEDICATION NAME] 2% apply in sacral [MEDICAL CONDITION] twice a day, [MEDICATION NAME] cream apply in sacral area and pubic area in each diaper change, [MEDICATION NAME] 1.25 mg by FFN every four hours, Preprotein 30 ml PO three times a day, Multivitamin 1 tab PO daily, Zinc 10 mg 1 tab PO twice a day and Incontinence Kit. During interview with resident #2 on 5/3/17 at 9:01 am indicates that in the night of yesterday he could not sleep well. The inspector asks if he takes medicine to sleep and resident says yes. During interview with the sister of resident #2 on 5/3/17 at 9:10 am she indicates that her brother always took the pills without fail. He had problem to sleep and he starts having problems of depression. The first day he was admitted here the RN told me that I need to bring all his medications and I brought it because the facility is going to give to him all the medication that he took in my house. c. The medications that the RN wrote in the Drug reconciliation are not the same of the initial admission order that the physician wrote. During the investigation it was found that the physician did not prescribe the [MEDICATION NAME] 5 mg, [MEDICATION NAME] 20 mg, [MEDICATION NAME] 2 mg and the [MEDICATION NAME] 50 mg. When the surveyor asked the employee #4 and to the employee #5 they indicates that they do not know why the physician did not order the medications that the resident uses in his house. However on 5/4/17 at 10:50 am it was found a clarifying note written by the medical director indicating the following: Dr. Solivan informed that the nephrologist during the resident hospitalization discontinue the medication. That the use of [MEDICATION NAME] is not indicated for optimal awareness during rehabilitation process; the [MEDICATION NAME] is especially contraindicated for risk of gastritis/GI bleeding while on anticoagulant and the determination of recommending [MEDICATION NAME] will be evaluated according to his clinical performances while at SNF. 3. The facility fails to ensure that all continuity medications used by the resident in the home are administered to the SNF during the resident's stay.",2020-09-01
10,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,309,D,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, ten records reviewed (RR), interviews with the Registered Nurse in charge of resident care (employee #8), the Infection Control Preventionist (employee #7), the Head Physician (employee #6) and the resident (RR #4), policies and procedures (P&P's) related to skin care, pain management and observations performed during monitoring round, performed from 05/02/17 thru 05/04/17, from 8:30 am to 5:00 pm, it was determined that the facility failed to ensure that the nursing staff perform an accurate assessment of a skin burn, to develop a plan of care with interventions for burn care and the implementation of the pain management protocol by all professional staff, as observed in 1 out of 10 RR, (RR # 4). Findings include: 1. Resident #4 is an [AGE] years old male resident who was admitted on [DATE] with a diagnose of Right Foot Ulcer with secondary diagnoses, such as: [MEDICAL CONDITIONS], Hypertension and Alzheimer. During observational tour performed on 05/02/17 at 9:45 am accompanied by The Infection Control Preventionist (employee #7) it was found that resident was bedridden and was accompanied by his son. It was observed that resident has a medicated patch on his right foot sole. During interview with the Infection Control Preventionist (employee #7) performed on 5/3/17 at 9:30 am, she stated the following: The resident has a burn in his right foot sole. According to interview performed to resident's son, this resident was disoriented and he began to walk around the neighborhood. He was using flip flops and apparently, the flip flop was out of his right foot. Probably he was walking over the hot street. We think that is the way that he develop the burn in his right foot sole. It is not an ulcer because the [MEDICAL CONDITION] is not over a bony prominence. It is located at the foot sole. During RR #4 performed on 5/3/17 at 1:00 pm it was found the following: a. On 4/27/17 at 11:30 pm, the physician ordered to implement the skin care protocol. No evidence was found of a diagnose of skin burn. The physician's history and physical examination [REDACTED]. Six days have passed and it was not determined the burn degree. On the Minimum Data Set (MDS), section I -Active Diagnoses, the nurse wrote that resident's active diagnose is Right Foot Plantar Lesion. According to the ICD 10 codification that was written on this section, it is related to a Burn of Unspecified Degree of Ankle and Foot not to a plantar (sole) lesion. No evidence was found of the MDS Coordinator or the Physician to perform the diagnose correction on this section of the MDS. The resident has a skin burn on his right foot sole but no evidenced was found of the burn degree that resident has and could established accurately the diagnose. If the resident's burn would be as a second degree, the ICD 10 codification changes. However, could not be determined the classification of the burn due to lack of documentation on the clinical record. The nursing staff documented the assessment and intervention form that is part of the Protocol for Prevention and Management of Patients with Altered Skin Integrity. However, the nurse that performed the initial documentation in this assessment on 4/27/17, failed to write the risk factors on section A of this form. On section B related to the Nursing Interventions, the nurse failed to place a check mark besides the interventions that applies to the resident's burn care and management. The first item of these interventions are related to ulcer assessment. However, there are items applicable to burn care that were not identified. b. It was found that the nursing staff failed to identify on the daily nursing skin reassessment form that the resident has a burn. This was observed on the nursing notes from 4/27 thru 5/3/17. The nursing staff only wrote right foot sole on the section known as location(Localizacion) which is part of this reassessment form. The anatomical diagram that is attached to the skin reassessment form was not documented by the nurse. She failed to identify on this diagram the location of the burn and how extended is it over the foot sole. To determine if the nursing staff has knowledge of the burn classification and treatment to be provided to this resident, an interview with the Registered Nurse (RN employee #8) was performed on 5/3/17 at 2:00 pm. It was requested to classify the [MEDICAL CONDITION] of resident #4 and how she knows that the patient is improving. Employee #8 stated the following: The treatment provided is as if it were an ulcer and the Infection Control Preventionist takes pictures of it. I think that watching the pictures we can figure out patient's improvement. On the other hand, on the MDS section M for Skin Conditions, on item M1040 related to other ulcers, wounds and skin problems, the nurse placed a check mark besides item c that belongs to other open lesion on the foot. In her handwriting she added (right foot sole area). On item f which belongs [MEDICAL CONDITION](second or third degree) the nurse failed to identify this item. According to professional literature review and to observations performed to the resident's burn performed on 5/4/17 at 11:00 am this [MEDICAL CONDITION] could be a second degree burn. However, no evidence was found on the clinical record documentation of the classification of the resident's burn. c. The surveyor asked the physician (employee #6) if there is a mechanism that help him to determine if the burn lesion is decreasing in size and the healing process is adequate according to the treatment provided. During interview with the head physician (employee #6) performed on 5/4/17 at 8:30 am, he stated the following: The skin burn can be measure, if we want to have an objective criteria to determine if the lesion is decreasing in size. I can write an order requesting the skin burn measurement every 3 days. Through direct observation, one indicator that can help to determine if the healing process is adequate is if granulation tissue is present. However, it was not found written evidence that determine resident's improvement according to the provided care and treatment. During interview with the Infection Control Preventionist (employee #7) performed on 5/3/17 at 9:30 am, she stated the following: We do not perform measurements in burn [MEDICAL CONDITION]. I took a picture during the admission process and on the next (medicated) patch replacement I will take a picture to watch its improvement. However, it was not found on the clinical record documentation performed by the Infection Control Preventionist (employee #7) related to her observations and conclusions after analyzing the burn condition throughout the pictures. d. The skin burn documentation performed by the nursing staff, lacked of the following characteristics on almost of the daily documentation of the skin reassessment form from 4/27 thru 5/2/17: -status of the surrounding skin ([MEDICAL CONDITION], blister, ecchymosis, degree of the burn) -skin characteristics (tunneled, necrosis, depth) -description of the secretions (it has to be mentioned that the nursing staff identified mild secretions but failed to write color, odor and other characteristics of it). e. On the admission's order from 4/27/17 at 11:00 pm, the physician ordered to apply [MEDICATION NAME] over the right foot sole burn on a daily basis. However, on the nursing skin reassessment form from 4/27 and 4/28/17, the nursing staff failed to write the applied treatment. They left blank spaces. On 5/1/17 at 1:20 pm, the head physician changed the skin care treatment to Allevyn AG 7x7 to be put on the right foot sole and to change it every 3 days. However, the nursing staff failed to write this new treatment on the skin reassessment form on 5/2 and 5/3/17. f. During review of the resident plan of care performed on 5/3/17 at 1:00 pm it was found that the problem related to potential for [MEDICAL CONDITION] risk was activated on 4/27/17. Some of the interventions established to work this problem are the following: - daily documentation of the skin condition on the reassessment form - daily assessment of the skin - to apply [MEDICATION NAME] creams over skin or to put [MEDICATION NAME]es - to follow the Protocol for Prevention and Management of Patients with Altered Skin Integrity However, the nursing staff failed to write on the clinical record the observations and interventions performed to the resident according to the plan of care. The nursing staff failed to write on the plan of care the expected results and dates of when it was reviewed. No evidence was found of an ongoing monitoring and review of the plan of care. The problem known as [MEDICAL CONDITION] was also activated on 4/27/17. The nurse identified that resident has an opened lesion on his right foot sole but failed to identify that the lesion is a burn. The nursing staff dated a review of the plan of care on 5/2/17. However, it was not found evidence of previous reviews of the plan of care between the admitted s until 5/2/17. According to these findings, the nursing staff is not aware of how a burn is classified, what to document on the clinical record and when to perform plan of care reviews. 3. The nursing staff failed to perform a daily and an accurate pain assessment. During RR #4 performed on 5/3/17 at 1:00 pm it was found that the head physician (employee # 6) ordered on [DATE] at 11:30 pm to begin the pain protocol. During review of the pain management order form it was not documented by the head physician. He failed to place an order for [REDACTED]. During review of the physician's history and physical examination [REDACTED]. During review of the nurse's skin reassessment form, since 4/27/17 until 5/3/17, it was found that the nursing staff failed to perform a daily pain assessment. This was evidenced by not writing on the Wong Baker's pain scale. The nursing staff failed to identify on this pain scale is resident was having or not pain. During interview with the Infection Control Preventionist (employee #7) performed on 5/3/17 at 9:30 am, she stated the following: Every morning, the Nursing Supervisor performs an observational round with some of the nurses. Among the questions she asks to the residents is, if they have pain. According what I heard from the nursing staff, this resident is not having pain. Sometimes he is disoriented and maybe he can't tell us specifically if he is feeling pain on his right foot. However, on 5/4/17 at 11:00 am, the surveyor requested the Infection Control Preventionist (employee #7) to take out the medicated patch on patient's right foot sole to observe its condition and to determine if resident was in pain. When employee #7 began to pull out the patch, it was observed that the resident moved his right foot backwards and with non-verbal facial gestures, showed that he was in pain. The surveyor asked the resident if he was feeling pain on his foot and he answered Yes. The surveyor asked the resident, in the presence of employee #7: What moment of the day do you feel pain or discomfort? His answer which was very clear, was: When the nurses come to bring care to my foot (he pointed with his finger his right foot). The surveyor asked employee #7, what is the meaning of resident's facial gestures? She answered: Of pain. That he is having pain. According to interview with the head physician (employee # 6) performed on 5/4/17 to determine if he assessed pain on each visit, he stated the following: For that type of burn, he can feel pain. The nursing staff has not referred me that he is having pain. During review of the medication's administration record performed on 5/3/17 at 1:00 pm it was not found physician's orders [REDACTED]. During review of the Physical Therapist (PT) documentation performed on 5/3/17 at 1:00 pm it was found the following: In the PT initial assessment performed on 4/28/17 by the PT and the progress notes from 4/29, 5/1 and 5/2/17 performed by the Physical Therapist Assistant (PTA), it was determined that the PT staff failed to perform an accurate pain assessment. This staff wrote on the pain assessment section the nomenclature of N/A which means: Not applied. They failed to write on the Wong-Baker's scale a zero if patient was not having pain at the moment they offered the physical therapy. During review of the MDS documentation performed on 5/3/17 at 1:00 pm, on section V, related to Care Area Assessment (CAA) summary, item # 19 the care area for pain was not identified by the person who completed the care plan decision form. The facility failed to ensure that the professional staff perform daily accurate pain assessment and interventions according to the plan of care and as established on the Protocol for Pain Management.",2020-09-01
11,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,314,G,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, observations from 5/2/17 thru 5/4/17, interviews with nursing staff and record review (RR), it was determined that the facility failed to establish preventive measures to avoid the development of pressure ulcer for 1 out of 8 residents in the sample selection (R# 2) . Findings include: 1. Resident #2 is an [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was admitted to the SNF for antibiotic therapy and rehabilitation. He is bedridden since (MONTH) (YEAR) due to the Pneumonia. 2. During RR performed on 5/2/17 from 1:30 p.m. thru 3:45 p.m. the following was found: a. The Protocol of prevention and Management of patients with alteration in skin integrity. Protocolo de Prevencion y Manejo de Pacientes con alteracion en integridad de piel that the Registered Nurse (RN) in charge of performing the admission of the resident on 4/29/17 identified on the section called as Estimado de Factores de Riesgo Estimating risk factors that the resident has Musculoskeletal limitations. On the Braden scale (risk for developing ulcers) the points obtained was 15, meaning that the patient is not at high risk of developing ulcers. b. The ulcer protocol was found in the record. The criteria that were indicated are: Make assessment of the skin and observe changes, evaluate: State (turgor, appearance), Location of pressure area, Pressure Area Size, Appearance (red, wet, dry), and Type of exudate (color and quantity). However, the only thing that was marked was to estimate the skin and observe changes, not specifying which skin issues the nurse is going to evaluate. The other interventions identified by the RN were to evaluate: Keep resident bed dry, clean and wrinkle free, Make use of pillows to position and provide comfort, Lifting heels out of bed with pillows or splints, Use of protectors in elbows and heels, Care for the back and osseous prominences by applying lubricating lotions, Minimize trauma to remove tape or tape in skin, Care according to medical order. c. The initial evaluation performed by nursing staff the section of the integumentary system subsection 1. Condition of the skin only marks dry skin. d. The initial medical evaluation indicates that the patient only has rash in the sacral area. e. The sheets of the Protocol of Prevention and handling of residents with alteration in the integrity of the skin of days 4/30/17, 5/1/17 and 5/2/17 indicate that multiple lacerations are observed and [MEDICATION NAME] is being applied and [MEDICATION NAME]. It is observed that [MEDICATION NAME] was only being applied once a day and not twice a day according to the medical order of 4/29/17. It was also found that in the medical order of 4/29/17 the doctor writes that the [MEDICATION NAME] Cream should be applied in the area of the sacrum and pubic areas at each diaper change. f. No documentation of the RN was found on the clinical record indicating what interventions she performed to decrease the red skin on the buttocks area. It was not determined the frequency in which the skin medications were administered. g. The progress notes of the registered nurses do not reflect the observations and care provided by the RN who is the professional that is performing the Braden Scale assessment, daily skin assessments, and the care provided to the [MEDICAL CONDITION]. h. No evidence was found on the registered nurses progress notes information related to the importance of doing changes position every 2 hours to avoid skin breakdown. This is part of skin prevention aspects that is recommended on the guidelines for Prevention and treatment of [REDACTED]. 3. On 5/3/17 at 11:00 am when the resident was visited, the sister told the surveyor that she is worried because her brother has a rash in his buttock and in the sacrum; when the nurse came to change the diaper she saw blood on the brief. Surveyor asked about what the nurse is applying on the rash and she said and ointment cream. The surveyor asks her how she found this. She stated that her brother told her that it hurts quite in the back. When she checked the resident's sacrum area it was redder than yesterday and with some blood. 4. The resident can perform by himself the changes of position. However, during the survey process, it was observed that the resident remained in the same position when observations were performed on different days and hours. 5. On 5/3/17 at 9:05 am the license practical nurse (LPN) in charge of the resident was asked by the surveyor about what is happening with resident #2. She indicates that she is applying an ointment that the resident has in the drawer and when she bath the resident she applied it on the laceration areas. She stated: The RN is in charge to apply the medication on the resident lacerations. The surveyor asked if she wants to access the resident skin and she said that the LPN do the assessment during the patient bed bath. The RN observed the area and indicates that the area is red and with some blood spots because of the friction of the brief due to the resident movements. She says that the skin it is not open. 6. On 5/3/17 at 11:20 am the surveyor accompanied by the infection control preventionist (employee #7) requested for a RN to look at the affected area of the resident. The RN indicated that she was going to care the lacerations in that moment. Employee #7 asked to the RN what she is applying to the resident; the RN answered that she has to check because she did not remember. 7. However, no documentation related to this new problem was found on the clinical record. The nursing staff failed to identify the new concern, to write their observations on the daily skin assessment form and to develop a plan of care according to the new findings observed. 8. The facility failed to ensure an accurate initial assessment to implement a protocol for risk of pressure ulcer development.",2020-09-01
12,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,323,F,0,1,ZOYB11,"Based on a recertification extended survey, observations and review of accident reports, it was identified that the facility failed to promote that the environment remains as free of accident hazards as is possible and each resident receives adequate supervision and assistance devices to prevent accidents related to the resident in room #111 related to an air conditioner water leak, puddle in front of residents bathrooms #113, #114 and #116, broken chair in the recreational area and loose bed side rails affecting 4 out of 28 random sample. Findings include: 1. During survey procedures throughout the five days of survey on 5/2/17 to 5/5/17 from 9:00 am to 5:00 pm the following was identified related with failure by the facility to promote an environment that is free from accident hazards to prevent avoidable accidents: a. On 5/4/17 at 9:15 am until 11:45 am there was a puddle of water in front of the bathroom door of rooms # 113, # 114 and #116. This can cause a resident to slip and produce a fall. b. Facility failed to promote best practices that can help to prevent slips and falls using wet floor signs to indicate wet floor areas and immediately clean up all spills and wet spots. c. Resident's sleeping room #111 was visited during the initial tour on 5/2/17 at 9:45 am and 5/4/17 at 10:25 am large puddle of water was observed under the air conditioner unit. The room has a capacity for four residents. d. During observation in the area where residents watch television on 5/3/18 at 3:58 pm a resident is observed that he is going to seat in one of the rocking chair. The rocking chair was without a screw and the resident almost falls from it. The infection control preventionist employee #7 and another nurse help him sit in another chair.",2020-09-01
13,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,334,F,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on ten sample records reviewed (RR), Influenza and Pneumococcal vaccines registry review and interviews with the DON (employee #4) and Administrator (employee #3) performed during recertification extended survey from 05/02 thru 05/04/17 it was determined that the facility failed to organize the Influenza and Pneumococcal Vaccine Program and continued the influenza vaccination as required by the state due to the influenza outbreak as evidence on 2 out of 10 records reviewed (RR#5 and #10) Findings include: 1. During RR # 5, performed on 05/02/17 at 2:30 pm, a [AGE] years old male admitted on [DATE] due to Left Total Knee Replacement, High Blood Pressure and Diabetes it was found that resident record have Influenza and Pneumococcal vaccines refused by the patient however the protocol did not have the signature of the patient or legal representative refusing the vaccine. 2. During the Influenza and Pneumococcal vaccine program evaluation performed on 05/03/17 at 11:30p.m., it was found the following issues: a. On 5/03/2017 at 11:30 am during interview with DON employee #4 state that all influenza vaccine were expire on 4/30/2017. b. On 5/03/2017 at 3:05 pm on interview the administrator employee #3 state Puerto Rico did not have the influenza vaccine available. 3. During RR # 10, performed on 05/04/15 at 8:04 am, a [AGE] years old male admitted on [DATE] due to Right Foot Ulcer Non Pressure Chronic Ulcer, it was found that resident record have Influenza and Pneumococcal vaccines refused by the patient however the protocol did not have the signature of the patient or legal representative refusing the vaccine. The facility failed to organize the Influenza and Pneumococcal Vaccine Program and continued the influenza vaccination as required by the state due to the influenza outbreak.",2020-09-01
14,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,371,F,0,1,ZOYB11,"Based on a recertification extended survey, the kitchen observational tour, review of policies/procedures and interview with the administrative Dietitian (employee #16) and Physical plant director (employee #12) , it was determined that the facility failed to ensure a safety place for the store, prepare and serve food under sanitary conditions which can affect 28 of 28 admitted residents. (R#1 to R#28) Findings include: During the observational tour performed on 5/2/17 at 11:31 am until 12:15 pm the following was observed: 1. The Freezer #1 was observed that it was used like a fridge and not a freezer because the cooler system of the freezer is not functioning. Interview with the kitchen director (employee #16) on 5/2/17 at 11:40 am indicates that since the past Friday the freezer is not working. She is working with a contingency plan. She is ordering and receiving that she needs the same day. She is using the big freezers from the General Storage. Interview with the Physical plan director (employee #12) performed on 5/4/17 at 10:03 am him state: I'm waiting for the refrigerant 408 because it is very difficult to find out this kind of refrigerant. 2. The freezer floor was observed with expose concrete. Interview with the Physical plant director (employee #12) performed on 5/4/17 at 10:03 am states: I'm waiting for the guy that repair and makes the jobs here in the hospital; because he is doing other jobs and do not have time until he finish the other jobs. 3. It was observed on the A/C system a big leak. The employees from the kitchen are picking the water from the leak in three trash can. 4. Wall tiles in the stoves area are broken and with old stain. 5. Wall tiles broken in the fridge area and griddle area. 6. Already cleaned trays were observed stacked upside down one on top of the other and they were found wet with an accumulation of water. 7. Floor tiles on the tray machine area were broken. Interview with (employee #12) performed on 5/4/17 at 10:10 am he stated: Every year we have to change them since that is quarry tile; the steam and heat break it.",2020-09-01
15,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,385,D,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, Record Review (R.R.) with the Registered Nurse (RN) (Employee #1) during a recertification survey performed from 5/2/17 thru 5/4/17, it was determine that the facility failed to ensure that physicians participate actively supervising the services that residents (R) receive at the facility, for 1 out of 28 (R#1). Findings include: 1. During R.R. R #1 on 5/2/17 at 1:00 pm it was found between the nurses notes a Urinalysis Report from 4/21/17 12:02 pm, that was not signed by the physician as evidence of evaluation of the results. 2. The laboratory result of 4/21/17 12:02 pm that was altered included: a. Clarity: Turbid (normal range: Clear) b. Leukocytes: Large (normal range: Negative) c. [MEDICATION NAME]: Positive (normal range: Negative) d. Glucose: 150 mg/dL (normal range: Negative) e. Blood: Small (normal range: Negative) f. RBC (Red Blood Cell): 8-30 (normal range: g. WBC ([NAME] Blood Cell): Over 50 (normal range: h. [NAME] Blood Cell Clump: Many (normal range: i. Bacteria: Many (3+) (normal range: j. Budding Yeast: Few (normal range: During interview with RN (Employee #1) on 5/3/17 at 11:00 am, she stated: If the laboratory results does not have the signature of the physician it probably because it has not been informed. Let me call the physician and confirm this information. 3. During R.R. on 5/3/17 at 12:00 pm was found evidence of telephone medical order: Catheterize and perform a urinalysis, urine culture and notify physician the laboratory results. 4. During R.R. R#1 on 5/3/17 at 11:15 am was found that there was no evidence of the altered urinalysis report being notified to the physician for 4/21/17. There was found that there is no evidence on the physician progress notes [REDACTED]. During interview with Nursing Supervisor (Employee #4) on 5/3/17 at 11:30 am, she stated: If the urinalysis was miss place and archive between the nursing notes that is probably the reason of why the physician did not see the results. Nursing staff should have identified that urinalysis report and notified the physician immediately. During interview with the Physician (Employee #5) on 5/3/17 at 1:15 pm, she stated: It is possible that I have not seen that urinalysis report because I always write my signature when I evaluate them. I ordered a new urinalysis and urine culture.",2020-09-01
16,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,425,D,0,1,ZOYB11,"Based on a recertification extended survey, drug pass, medication reconciliation, records reviewed (R.R.) and interviews with the Nursing Supervisor (Employee #4) and Registered Nurse (RN) (Employee #1 ) at the facility performed on 5/3/17 from 9:15 am thru 11:00 am, it was determined that the facility failed to provide a mechanisms to ensure that all received medications are accurate acquired, received, dispensed and administered to meet the resident (R) needs for 1 out 28 admitted residents. (Supplemental Sample Resident #11) Findings include: A lack of mechanism to ensure that the resident Medication Administration Record [REDACTED]. 1. According to MAR indicated [REDACTED] a. The physician order from 4/26/17 at 8:30 pm establishes Haldol 5 mg PO Bedtime (hours of sleep) (HS). However the nursing staff was administrating Haldol 5 mg 1 tablet PO Daily at 9:00 am since 4/29/17 thru 5/3/17 (5 days). No physician's order was found in the clinical record establishing that this medication will be given in the morning medication pass. During interview with RN (Employee #1) on 5/3/17 at 10:55 am, she stated: The original order is Haldol 5 mg 1 Tab PO at Bedtime. But this medication has been administered in the morning medication pass according to the MAR indicated [REDACTED]. During interview with the Nursing Supervisor (Employee #4) on 5/3/17 at 10:57am, she stated: The medication must be administered at bedtime, as the medical order indicates. It seems that there was a mistake in transcribing the order in the electronic MAR. 2. After interviewing the RN (Employee #1) who performed the drug pass and the Nursing Supervisor (Employee #4) performed on 5/3/17 at 10:55 am it was found that the facility failed to have an ongoing surveillance to avoid near future adverse effects from medication administration related to time error. This resident has been taking the medication for 5 consecutive days in a wrong timing and no one of the professional staff observed that issue. It was requested an investigation on 5/3/17 at 11:00 am and the Nursing Supervisor (Employee #4) delivered on 5/4/17 at 4:40 pm the medications error report with information related to the event. During review of the medications error report performed on 5/4/17 at 4:50 pm it was not found pertinent information in some sections of this report that shows if residents had side effects, if it was requested an ongoing monitoring of the resident to determine if she needed changes on treatment and a review of the plan of care by the nursing staff. a. On section I, it was not included the resident's diagnose, how many doses of Haldol were administered during the morning hours for 5 days and it was not signed and dated by the Nursing Supervisor. b. On section II, no evidence that the physician was notified due to space assigned to physician notification was left in blank, was not signed by the Nursing Supervisor, and no information was included when the event was notified to the Pharmacy Services. c. On section III, reasons for error was not identified . In section known as staff related to the event, it was not documented. In section known as side effects on the resident, it was not documented.",2020-09-01
17,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,428,E,0,1,ZOYB11,"Based on a recertification extended survey, ten records reviewed (RR), interviews with the nursing staff and with the Physician (employee #6) and drug regimen review policies and procedures (P&P's) performed during a recertification survey from 5/2 to 5/4/17 from 8:30 am until 5:00 pm, it was determined that the facility failed to ensure that a drug regimen review will be perform during the resident's admission process, as observed in 1 out of 10 RR, (RR #4 ) Findings include: 1. During RR #4 review performed on 5/3/17 at 1:00 pm it was found that the Registered Nurse (RN) who performed the admission's process wrote the following: Resident is alone, he can not bring requested information. This form was dated by the RN on 4/27/17. However, 6 days have passed since the admitted and no evidence was found of the nursing staff requesting the resident's family members information related to the medications that the resident was taking at home. According to interview with the physician (employee #6) performed on 5/4/17 at 8:30 am, he obtained the medications information from resident's son and the resident was taking at home the following mediations: - Aricept 5 mg 1 tab by mouth at bed time (HS) - Klonopin 1 mg 1 tab by mouth at bed time (HS) - Plavix 75 mg 1 tab by mouth daily However, the nursing staff failed to make arrangements with family members to obtain the information needed to fill out the drug regimen review in a manner that resident's treatment will not be delayed.",2020-09-01
18,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,441,F,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, observational tour, interviews with the Infection Control Preventionist (employee # 7), Housekeeping Supervisor (employee #9), Infection Control Coordinator (Hospital/employee #10), Infection Control Committee President (employee # 11), policies & procedures (P&P's) review performed on 5/3/17 at 10:00 am it was determined that the facility failed to established an accurate mechanism for preventing, investigating and reporting infection control issues. Findings include: 1. During observational tour performed on 5/3/17 at 10:00 am it was found in the janitor's room the following items: - 2 gallons of Sodium Hypoclorite (known as Clorox) - 2 gallons of Lemon Quat Germicidal detergent - 1 gallon of Green Apple cleaner for floor and surfaces These 5 products were not labeled when they were opened for their use. According to interview with the Housekeeping Supervisor (employee # 9) performed on 5/3/17 at 2:00 pm, he stated the following: All opened cleansing containers must be labeled with date and signed with the initials of the person who opened it. That is part of the policies and procedures of our company. I will check it out because all janitors of our company are instructed about the labeling of the containers. 2. Besides one shelve, it was observed wood and metal sticks unidentified. A red mop was put in a holding rack but it was unidentified. According to interview with the Housekeeping Supervisor, (employee #9) performed on 5/3/17 at 10:00 am, he stated the following: The red mop is used for hazard materials, such as blood, vomits. The green mop is used inside the resident's rooms and the blue mop is used in halls. These mops were not identified, specifically the one that is used for hazards. On 5/4/17 at 10:00 am an observational tour was performed to the janitor room. However, no improvement was observed in this room. The germicidal and cleaning containers were not labeled and the wood and metal sticks remained in that room, unidentified. The housekeeping services failed to establish a secure mechanism of labeling and identifying the opened containers and the uses of the cleansing equipment (sticks). 3. During review of the policy and procedure (P&P) for cleansing and disinfection of medical durable equipment performed on 5/3/17 at 3:00 pm, it was found that durable medical equipment will be clean and disinfected with germicidal solution that has been approved by the facility. The P&P's step 2 procedure mentions the following quote: the sphygmomanometer cuff will be disinfected as many times as needed during the round of blood pressure measurements. However, this step does not specify if the blood pressure cuff will be disinfected after its use between residents. Saying to be disinfected as many times as needed could be interpreted differently by the nursing staff. For example: during morning observational tour by resident's rooms performed on different days and hours, it was observed that the Licensed Practical Nurse (LPN) was performing the blood pressure measurement procedure. She put the paper towel around resident's arm, put the sphygmomanometer and when finished the procedure, she took out the equipment, put the cuff in the equipment basket and finished her intervention with the resident. She went out of the room and continued her duties. The LPN failed to clean and disinfect the sphygmomanometer cuff. During interview with the Infection Control Preventionist (employee #7) performed on 5/3/17 at 2:00 pm she stated the following: The nursing staff puts a piece of paper towel around resident's arm. They performed the procedure of measuring the blood pressure and then they clean with alcohol swabs the equipment, including the thermometer. However, the P&P for cleansing and disinfection of medical and durable equipment does not mention which equipment will be disinfected with alcohol swaps and what other durable equipment will be disinfected with other approved germicidal by the Infection Control Program of the facility. The facility failed to review with actualized professional guidelines the P&P's for cleaning and disinfection of the medical durable equipment in a manner that the nursing staff can follow the cleansing and disinfection procedures. 4. During interview with the Infection Control Preventionist (employee #7) related to the hand washing competencies evaluation for the rehabilitation program staff, she stated the following: The Physical Therapy (PT) Supervisor is in charge of performing the competencies on their staff. If during her observations she watches deficient practices, she works directly with her staff members. I don't receive information of when she performs the evaluation and I do not know if there is a plan of corrective actions for the staff members. The PT Supervisor discusses the infection control issues of her program on the Infection Control staff meetings that are performed quarterly. The PT Supervisor does not share with me information related to deficient practices performed by her staff. She writes her quality indicators and reports and send them to the Medical Director of the Rehabilitation Services and to the Infection Control Coordinator (hospital and SNF coordinator). The facility failed to develop a collaborative plan where the PT Supervisor shares with the Infection Control Preventionist (employee #7) information related to deficient practices on infection control procedures that were performed by the physical, occupational and speech therapists staff, in a manner that both professionals can develop an ongoing surveillance plan with specific indicators and with monitoring and tracking activities as part of the quality of care to be observed. 5. During review of P&P's related to the [DIAGNOSES REDACTED] (TB) screening procedures, performed on 5/3/17 at 10:00 AM, it was found that the facility failed to develop a mechanism where a TB screening will be performed to all residents during the admission process. According to the review of the nursing initial assessment, physician's history and physical exam form and other documentation forms, it was found that the professional staff is not performing a TB screening to each resident. 6. Quality reports of the facility's Infection Control program were reviewed on 5/4/17 at 9:25 am accompanied by the Infection Control Preventionist (employee #7) and the hospital Infection Control Coordinator (employee # 10). It was not found on these reports analysis discussion of the antibiograms. According to interview with the hospital and SNF Infection Control Coordinator (employee # 10), she stated the following: The Infection Control Committee discussed on quarterly meetings the antibiotics analysis. Right now, we don't have the person who was responsible of obtaining the data of the antibiotics and put that data on a graphic chart presentation. There is a new person that was performing that function but the physician that leads this committee was not satisfied with the graphic chart presentation. He decided to postpone the antiobiogram presentation until the graphic chart was performed better. Since (MONTH) (YEAR) until (MONTH) (YEAR), we have not discussed the antibiogram. During interview with the Infection Control Committee President (employee # 11) performed on 5/4/17 at 11:40 am, he stated the following: The person who prepares the graphic chart with the antibiotic data does not work with us. The person that is working with that data does not know how to prepare a graphic chart. I explained to her how to do it before each meeting. I meet with[NAME](Employee #10) and we discuss all skilled nursing residents that are in antibiotic treatment. However, no evidence of an alternate plan for antibiogram discussion was presented. 7. During QAPI reports review performed on 5/4/17 at 10:00 am accompanied by the Infection Control Preventionist (employee # 7) it was found that the infection control indicators are included on the QAPI program report. According to interview to employee #7, performed on 5/4/17 at 10:00 am, she stated the following: I collect data for each quality indicator. Quarterly, I send the report to the Infection Control Coordinator (employee #10). Every week, on an administrative staff meeting, we discuss the results of the surveillance. We discuss all the indicators that we have identified including those related to the Infection Control Program. I include on the quarterly QAPI reports the infection control indicators. I don't prepare a separate QAPI report of the Infection Control Program. The facility failed to recognize the Infection Control Program as a hospital based institutional program that has to be organized independently with its own surveillance activities and respond to the Administration and Governing Body of the hospital. The facility failed to organize an ongoing infection control surveillance program where all services that provide care to the skilled nursing facility residents participate and collaborate on the development of indicators that are related to infection control deficient practices. There is no integration of the services, such as: Therapy Services, Housekeeping, Dietitian, Social Services and Physician services on the Infection Control Program surveillance activities.",2020-09-01
19,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,455,F,0,1,ZOYB11,"Based on a recertification extended survey, tests to equipment, maintenance documentation and observations made during the survey for Life Safety from Fire with the Physical Plant Director (employee #12), it was determined that the facility failed to meet some applicable provision of the 2012 edition of Life Safety Code of the NFPA 101 which could affect 28 out of 28 admitted residents (R). (R#1 to R #28) Findings include: The Life Safety from Fire survey was performed from 5/4/17 from 8:45 am until 3:00 pm with the Physical Plant Director (employee #12); for deficiencies related to Life Safety from fire (form 2786R) please see tags with letter K on the 2687R (10/2016) form (K0271 and K0712).",2020-09-01
20,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,456,F,0,1,ZOYB11,"Based on a recertification extended survey, observations, review of documentation ,policies/procedures (P&Ps) and interviews with personnel and residents (R) made during the physical environment survey, it was determined that the facility failed to ensure a safe and functional environment affecting 28 out of 28 admitted residents. (R#1 to R#28) Findings include: During the physical environment tour performed on 5/4/17 from 8:45 am thru 10:00 am it was found the following: a. Room #104B bed side rails deteriorated and the cover of them broken. b. Room #107A bed the side rails covers are broken. The mattress for the B it was observed with stains and deteriorated. c. Room #109C the dinner table Formica broken. d. Room #110B the dinner table Formica broken. B the mattress was observed deteriorated. e. Room #112A bed side rails are loose. B- Night table Formica broken, mattress was observed with a bump in the middle and the back wall does not have the sign to identify the resident bed. C- Night table Formica broken. The bed does not have the handle to raise and lower it in the front, does not have the mattress. f. Room #107A the mattress was observed with a hole. The dining table is broken in one of the side. The night table Formica broken. g. Room #107B the rest board of the bed was broken and with old tape around the side rails. h. Room #107C the night table Formica broken. i. Room #108A the night table Formica broken. The dining table deteriorated. The chair was observed with black spots. j. Room #112C the bed rest board was broken and it was covered with tape. k. Room #116A without the rest board of the backside and the rest board of the front was broken and covered with tape. Night table Formica broken. l. Room #118A night table Formica broken.",2020-09-01
21,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,465,F,0,1,ZOYB11,"Based on a recertification extended survey, tests, observations, review of documentation policies/procedures and interviews with personnel and residents (R) made during the physical environment survey, it was determined that the facility failed to ensure a safe and functional environment affecting 28 out of 28 admitted residents. (R#1 to R#28) Findings include: 1. During observations of the physical therapy room on 5/4/17 from 9:45 am through 11:15 am it was found: a) All the physical therapy beds are peel and deteriorated. b) The air conditioning ducts covers rusty. 2. The rocking chair located on the activity area was without a screw and the resident almost falls from it. 3. All pull cords of the call system located in the restrooms of the residents are observed with mold. 4. Ceiling tiles in rooms # 107 with water leak spots. 5. Ceiling tiles in the Physical Therapy area were observed with black spots. 6. The sprinkler system pipe located in front the Physical Therapy area was observed with rust. 7. Wall in front the main entrance of the physical therapy area was observed with mold (black spots). 8. Physical Therapy Area: a. Ceiling tiles out of place b. Floor tile in front of the main entrance broken and loose. c. The weight scale was observed with rust. d. The handle of 10 wheel chairs in front the weight scale was observed broken and with rust.",2020-09-01
22,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,469,F,0,1,ZOYB11,"Based on a recertification extended survey, observational round, interview with the Infection Control Preventionist (employee # 7), administrative documentation related to pest control performed on 5/3/17 at 10:00 am it was determined that the facility failed to establish a pest control plan. Findings include: 1. During review of the pest control registry form from year (YEAR), it was observed that a kind of trap was placed by the fumigator on (MONTH) 2, (YEAR). The same action was written on (MONTH) 4, (YEAR). a. No explanation was found of what places the traps were put in the facility. No information was written related to the kind of trap they were installing according to the kind of pest that the fumigator has identified. 2. During interview with the Infection Control Preventionist (employee # 7) performed on 5/3/17 at 10:00 am related to the installed traps, she stated the following: That registry is kept by the Administrator. If the fumigator installs traps I do not receive the information until I see them when I perform the observational tour to residents' areas. I do not receive an official communication telling me that there are pest control planning that includes the installment of traps. The facility failed to share the pest control mitigation program with the Infection Control Preventionist in a manner that she can develop and monitor the pest control surveillance as part of the Infection Control quality plan.",2020-09-01
23,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,490,F,0,1,ZOYB11,"Based on an observational tour performed during recertification extended survey from 5/2 thru 5/4/17 from 8:00 am to 5:00 pm, accompanied by residents and staff interviews and review of policies, procedures and other administrative documents as well as clinical records reviewed, it was determined that the facility failed to ensure that all staff members have to perform their duties effectively and efficiently to maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Findings include: 1. The facility failed to ensure that the QAPI and Infection Control programs work independently from each other with their own rules and planning methods that guarantee the quality of care that has to be provided to each resident and to ensure an environment free of infectious agents that cause cross contamination issues. a. According to administrative documents review such as: QAPI quarterly reports, the Infection Control planning methods and interviews performed to the Infection Control Preventionist (employee #7) on 5/4/17 at 10:00 am, the Infection Control indicators are included in the quarterly reports of QAPI program and no specific interventions are seen to work with the infection control issues that help to discontinue the deficient practices that were identified. The Administration failed to monitor that the activities that are performed for monitoring and tracking the infection control issues are different from the QAPI program activities. The facility has to ensure that each program has to define their mechanism of action establishing a solve problem method, to develop a specific plan of corrective actions, to provide evidence of a written plan of action and perform monitoring surveillance to guarantee compliance with state and federal rules and regulations. 2. The facility failed to ensure that the Nursing Supervisor and other nurses in leadership positions ensure that the nursing staff performs accurate skin assessment in a manner that the written documentation in the clinical records shows the residents real problems and that their interventions are performed according to the interventions that were written in the plan of care. During clinical records review performed from 5/2 to 5/4/17 it was identified that there is no correlation between the nurses' notes documentation with the plan of care. 3. The facility failed to ensure that the interdisciplinary staff performs an accurate pain assessment to each resident according to the Pain Management Protocol. They have to ensure that an ongoing mechanism is established in compliance with the Pain Management Protocol and other professional guidelines that are in compliance with the state and federal regulations. 4. The facility failed to perform monitoring activities where the staffing from housekeeping, physical environment and Safety Officer perform their routine tours for identifying issues that can affect the sanitary and comfortable environment that the residents needs to ensure quality of life and quality of care. 5. The facility failed to establish an ongoing mechanism to ensure that each professional complies with the state law requirements related to providing actualized credentials documents.",2020-09-01
24,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,492,F,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, the review of six medical staff credential files and nine physical therapy credential files, it was determined that the facility failed to comply with federal and state local law related to Influenza Vaccine in accordance to State Administrative Order #244 of [DATE] and #362 of [DATE] of the Department of Health of Puerto Rico, Health Certificate, updated Cardiorespiratory certification (CPR), Malpractice insurance, Controlled Substances Federal License, Membership of the College of Medical Surgeons of Puerto Rico, [MEDICAL CONDITION] Vaccine, Certificate of negative criminal record, and State local Law #300 sex offender certification for 6 out of 6 Physician (MD) Credential Files (C.F.) reviewed (C.F. MD#1, MD#2, MD#3, MD#4, MD#5, and MD#6) and 1 out of 9 Physical Therapy credential file (C.F#4) . Findings include: 1. During the review of six medical staff credential files on [DATE] at 2:40 pm the following was found: a. Three out of six medical staff's credential files did not have evidence of their Influenza profiles or responsibility exoneration. (C.F #2, #3, and #4) b. Four out of six medical staff's credential files did not have evidence of their Health Certificate. (CF #2, #3, #5, and #6) c. Four out of six medical staff's credential files did not have evidence of their updated cardiorespiratory certification (CPR). (CF #1, #2, #3, and #6) d. One out of six medical staff's credential files did not have evidence of their updated Malpractice insurance. (CF #2) e. Four out of six medical staff's credential files did not have evidence of their updated Controlled Substances Federal License. (CF #6) f. One out of six medical staff's credential files did not have evidence of their updated Membership of the College of Medical Surgeons of Puerto Rico. (CF #3) g. One out of six medical staff's credential files did not have evidence of their Certificate of negative criminal record. (CF #2) h. Three out of six medical staff's credential files did not have evidence of the State local Law #300 sex offender certification. (CF #1, #5, and #6) i. One out of nine Physical Therapy staff's credential files did not have evidence of their [MEDICAL CONDITION] Vaccine. (Physical Therapy C.F #4).",2020-09-01
25,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,505,G,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, Records Reviewed (R.R.) with the Registered Nurse (RN) (Employee #1) performed from 5/2/17 thru 5/4/17, it was determine that the facility failed to ensure that the physician is notified of all laboratory results so that prompt, appropriate action may be taken if indicated for the resident's care, for 1 out of 28 (Resident (R) #1). Findings include: 1. During R.R.#1 on 5/2/17 at 1:00 pm it was found between the nurses notes a Urinalysis Report from 4/21/17 12:02 pm, that was not signed by the physician as evidence of evaluation of the results. 2. The laboratory result of 4/21/17 12:02 pm that was altered included: a. Clarity: Turbid (normal range: Clear) b. Leukocytes: Large (normal range: Negative) c. [MEDICATION NAME]: Positive (normal range: Negative) d. Glucose: 150 mg/dL (normal range: Negative) e. Blood: Small (normal range: Negative) f. RBC (Red Blood Cell): 8-30 (normal range: g. WBC ([NAME] Blood Cell): Over 50 (normal range: h. [NAME] Blood Cell Clump: Many (normal range: i. Bacteria: Many (3+) (normal range: j. Budding Yeast: Few (normal range: During interview with RN (Employee #1) on 5/3/17 at 11:00 am, she stated: If the laboratory results does not have the signature of the physician it probably because it has not been informed. Let me call the physician and confirm this information. 3. During R.R. R#1 on 5/3/17 at 11:15 am was found that there was no evidence of the altered urinalysis report being notified to the physician from 4/21/17 until 5/3/17. During interview with Nursing Supervisor (Employee #4) on 5/3/17 at 11:30 am, she stated: If the urinalysis was miss place and archive between the nursing notes that is probably the reason of why the physician did not see the results. Nursing staff should have identified that urinalysis report and notified the physician immediately. During interview with the Physician (Employee #5) on 5/3/17 at 1:15 pm, she stated: It is possible that I have not seen that urinalysis report because I always write my signature when I evaluate them. I ordered a new urinalysis and urine culture. The facility failed to assure that the physician is notified of all laboratory results so that prompt, appropriate action may be taken if indicated for the resident's care.",2020-09-01
26,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,514,F,0,1,ZOYB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on ten records reviewed (RR), performed on a recertification extended survey from 5/2/ to 5/4/17 from 8:00 am thru 5:00 pm, it was determined that the facility failed to ensure that the professional staff documents in the clinical record accurately information showing the residents' needs and the interventions performed to satisfy these needs, as observed in 2 out of 10 records reviewed (RR #4 and #8). Findings include: 1. Resident #4 is an [AGE] years old male patient who was admitted on [DATE] with a [DIAGNOSES REDACTED]. During RR #4 performed on 5/3/17 at 1:00 pm it was found the following: a. According to observations performed on 5/2/17 at 9:00 am during the morning tour accompanied by the Nursing Supervisor (employee # 4) it was observed that all toe nails show a dark color and lack of brightness, characteristics of feet fungus. During interview with the head physician (employee # 6) performed on 5/4/17 at 8:30 am, he stated: The resident has fungus in his toe nails. I did not placed a consult to the Podiatrist because sending him to an outside office with a consult will cause that resident loose one day of therapy here. I prefer during discharge planning, give to resident's family the order for a Podiatrist evaluation after discharge home. During review of the clinical record, no documentation was found of these descriptions on the nursing progress nor the physician's note. b. It was found on the nurses' notes from 5/2/17 at 5:00 pm that the resident showed respiratory distress characteristics, such as documented by the nurse: resident with abdominal breathing, Respiratory rate: 27. A phone call to the physician was performed and he ordered to transfer the resident to the emergency room . A phone call to resident's son was performed and notified that resident showed changes, he answered that he will go to the emergency room . Transfer performed with a stretcher and oxygen with nasal cannula at 2 liters. On the nurse's note from the night shift, the nurse failed to write in the clinical record the results of the evaluation that was performed at the emergency room and no evidence was found of any recommendations that the physician of the emergency room has ordered for continuity of care. It was not determine the health condition of the resident as soon as he arrived to the skilled nursing facility due to lack of documentation. An interview to the head physician (employee #6) was performed on 5/4/17 at 8:30 am, where he stated: The resident showed fast breathing and dry cough. I ordered to transfer him to the emergency room . After been evaluated at the emergency room , his condition was good. No big issues were found in him. Those changes in his respiratory pattern can be a consequence of the [MEDICAL CONDITIONS] that he suffered few months ago. He can shows a diffuse weakness and it may be manifested with dry cough and changes in the respiratory rate. I ordered him liquid oral medication to control dry cough and respiratory therapy every 6 hours as needed (PRN). The nursing staff failed to write accurate information on the clinical record related to resident changes on his health condition. 2. RR #8 belongs to a male resident of [AGE] years old who was admitted to the facility on [DATE] with a Left shoulder fracture and an infected wound on his left shoulder. During RR#8 performed on 5/4/17 at 1:30 pm it was found on the admission nurse's note from 4/24/17 at 8:00 pm that the resident was placed on an isolation room with contact precautions. However, it was not found on the physician's progress notes nor the nurses 'notes an explanation of why this resident has been put in an isolation room with contact precautions. a. According to interview with the Infection Control Preventionist (employee # 7) performed on 5/4/17 at 3:30 pm, she stated the following: The resident had [MEDICAL CONDITION]-resistant Staphylococcus Aureus (MRSA) on the wound located on his left shoulder, during hospitalization . When he arrived to our facility, the wound was closed with no secretions. A wound culture was performed and the results were negative [MEDICAL CONDITION]. We notified the physician and he cancelled the order for isolation room with contact precautions. However, this explanation was not written in the clinical record by the nursing staff, the physician nor by employee #7. At least, 3 days has passed while the culture results arrived to the nursing station but no evidence was found of orientation given to the resident and his family members of the procedures to be performed while the resident was in the isolated room with contact precautions. The infection control problem in the nursing plan of care (P[NAME]) was activated on 4/24/17. However, the nurse failed to include in the P[NAME] the isolation room and contact precautions interventions to ensure compliance with Infection Control guidelines while the physician's orders [REDACTED]. According to the Minimum Data Set (MDS) review on 5/4/17 at 3:30 pm it was found on section I, Active [DIAGNOSES REDACTED]. [MEDICAL CONDITION] infection as a second diagnose was not congruent with the information provided by the Infection Control Preventionist (employee #7), where she stated that the resident arrived this facility without an active infection. This information was corroborated with employee #7 and she said: that is an error. The resident's diagnose is Left shoulder Fracture. The facility failed to ensure that correct information is shared between the interdisciplinary staff and failed to monitor that accurate information of the resident's problems and interventions performed are written in the clinical record. b. During RR #8 performed on 5/4/17 at 3:30 pm it was found that the Vaccine assessment documentation form has incomplete documentation. The physician failed to place a check mark besides one or more contraindications that are mentioned in this form. This lack of documentation allows that the clinical record keeps incomplete documentation. This issues have been identified on the quality monitoring activities",2020-09-01
27,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2017-05-04,520,F,0,1,ZOYB11,"Based on a recertification extended survey performed from 5/2 to 5/4/17, from 8:00 am thru 5:00 pm, accompanied by the Infection Control Preventionist (employee # 7) it was determined that the facility failed to ensure that the QAPI Committee members have develop a plan of corrective actions as part of the QAPI surveillance program. Findings include: 1. During review of the QAPI quarterly reports from October- November- (MONTH) (YEAR) and (MONTH) (YEAR) (data from (MONTH) thru (MONTH) (YEAR)), performed on 5/4/17 at 10:30 am accompanied by the Infection Control Preventionist (employee #7), it was found that the indicators that have been identified do not mention a plan of corrective actions (P[NAME]) that will ensure compliance according to facility's P&P's and other professional regulations. a. On the quarterly reports from (MONTH) (YEAR) and (MONTH) (YEAR) the indicators develop for adequacy on the application of Influenza vaccine, the obtained percentage for compliance was 89% (October), 75% (November) and 31% (December) . The threshold for compliance is between 95 to 100 %. The P[NAME] for (MONTH) results was Notified to the physician. The P[NAME] for (MONTH) results was left in blank space and for (MONTH) results was reorientation (to staff) related to patient's vaccine documentation form. These P[NAME]'s do not mention a time frame where these ongoing activities will be performed and does not mention which other required activities are needed to reach the established goals. The same indicator was develop on the (MONTH) (YEAR) quarterly report and the reached percentage of compliance was 90%. The P[NAME] established activity was: Is still being evaluated. However, no evidence of a P[NAME] previous activities review has been performed due to lack of information. There is no mechanism that allows the coordinator to compare quality previous activities with the new activities that are needed to ensure compliance. 2. Other indicators that have been develop on the (MONTH) (YEAR) quarterly report and have been identified again in the (MONTH) (YEAR) quarterly report, are: adequacy on the protocol documentation of falls prevention whose percentage of compliance dropped from 100% (December2016) to 80% (March (YEAR)). However, the activity established on the P[NAME] is to continue reorientation (to staff). No other activities were develop to ensure compliance. 3. On the (MONTH) (YEAR) quarterly report, it was identified the indicator for adequacy on the clinical record documentation. The reached percentage was 84%. The P[NAME] established activities were: to continue with all staff reorientation related to clinical record documentation. It does not mention which areas of the documentation on the clinical record has to be improved, which members of the staff has to improve their documentation and no timeframe period has been established to perform the surveillance activity. 4. During review of the QAPI reports performed on 5/4/17 at 10:30 am, the indicators established are related to the Nursing Services. No evidence was found of the participation on tracking and monitoring activities for the QAPI program from other programs that offer services or direct care, such as: Therapy Rehabilitation Program, Social Services, Physician Services, Dietitian services, etc.",2020-09-01
28,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,655,D,0,1,L8MV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification survey, review of ten medical records, resident interview and interview with the Nursing Supervisor (employee #1) performed from 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm, it was determined that the facility failed to provide written care plan to residents/relatives as required by 483.21 (a) Comprehensive Person - Centered Care plan in tag F 655 of the State Operations Manual appendix PP -Guidance to Surveyors for Long Term Care Facilities. This deficient practice was identified in 8 out of 16 active cases reviewed. (RS #80, #81,#181, #182, #230, #231, #232 and #233) Findings include: 1. A mechanism to ensure that facility provide residents with a copy of the baseline care plan developed within the first 48 hours of admission was not performed, accordingly with the following findings identified during survey procedures performed from 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm: a. Eight out eight residents were interview during survey procedures on 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm and they stated that Facility did not provide a written copy of the baseline care plan developed the first 48 hours right after admission. RS #80, #81, #181, #182, #230, #231, #232, #233 b. Relative of resident sample # 80 was interview on 05/21/19 at 10:45 am and she stated that facility did not provide a written copy of the baseline care plan developed the first 48 hours right after admission. During interview on 05/21/19 at 10:05 am the Nursing Supervisor (employee #1) she stated that facility personnel discuss with residents and relatives the baseline care plan developed the first 48 hours right after admission. He also stated that facility did not implement a mechanism to comply with this requirement yet. She said that facility is in the process of design a format to document the information of the baseline care plan. c. During review of facility plan of care policy reviewed on 08/17/16 it was identified that procedure did not include mechanism to be follow to provide baseline care plan written copy to residents and relatives. 2. Resident # 181 is an [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. Evidence was found that resident #182 was oriented related to the interdisciplinary care plan and the registered nurse activate the plan of care however no evidence was found that the facility provide to the resident a copy of a written sumarry of the baseline care plan. 3. Resident # 182 is a [AGE] years old female admitted on [DATE] with an [DIAGNOSES REDACTED]. Evidence was found that resident #182 was oriented related to the interdisciplinary care plan and the the registered nurse activate the plan of care however no evidence was found that the facility provide to the resident a copy of a written sumarry of the baseline care plan. 4. Resident #230 is an [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. Evidence was found that resident #230 was oriented related to the interdisciplinary care plan and the registered nurse activate the plan of care however, no evidence was found that the facility provide to the resident a copy of a written sumarry of the baseline care plan. 5. Resident #232 is a [AGE] years old male admitted on [DATE] with an [DIAGNOSES REDACTED]. Evidence was found that resident #232 during the interview performed on 5/22/19 at 1:30 pm the resident stated that the nurse personnel was oriented related to the interdisciplinary care plan and the registered nurse activate the plan of care however, no evidence was found that the facility provide to the resident a copy of a written sumarry of the baseline care plan. 6. Resident # 231 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. Evidence was found that resident #231was oriented related to the interdisciplinary care plan and the registered nurse activate the plan of care however no evidence was found that the facility provide to the resident a copy of a written summary of the baseline care plan. 7. Resident # 233 is a [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. Evidence was found that resident #233 was oriented related to the interdisciplinary care plan and the registered nurse activate the plan of care however no evidence was found that the facility provide to the resident a copy of a written summary of the baseline care plan.",2020-09-01
29,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,661,D,0,1,L8MV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification survey, review of ten medical records, resident interview and interview with the Nursing Personnel (employee #3 ) performed from 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm, it was determined that the facility failed to ensure that discharge summary include relevant information related with medication regimen to be followed after discharge home. This deficient practice was identified in 1 out 1 closed record cases reviewed. (CR # 31). Findings include: 1. A mechanism to ensure that facility perform reconciliation of all pre-discharge medications with the resident's post-discharge medications (both prescribed and over-the-counter) during discharge process was not performed, accordingly with the following findings identified during survey procedures performed from 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm: a. Closed record review # 31 is a [AGE] years old female resident admitted on [DATE] with a [DIAGNOSES REDACTED]. No evidence was found documented on the medical record related with reconciliation of all pre-discharge medications with the resident's post-discharge medications. During interview with Registered Nurse (employee #3) on 05/23/19 at 9:15 am, she stated that facility did not perform reconciliation of all pre-discharge medications with the resident's post-discharge medications during the discharge process. b. During review of facility medication reconciliation policy reviewed on 07/20/16 it was identified that procedure did not include the reconciliation of all pre-discharge medications with the resident's post-discharge medications during the discharge process as part of the policy.",2020-09-01
30,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,756,F,0,1,L8MV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification survey, review of ten medical records and resident interview with Pharmacist (employee #7 and #8) performed on 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm, it was determined that the facility failed to ensure that reviewed every resident drug regimen. This deficient practice was identified in 4 out of 16 active cases reviewed. (RS #80, #182, #231 and #233) Findings include: A mechanism to ensure that facility conduct a medication regimen review of each resident in order to identify irregularities and act upon those irregularities was not performed, accordingly with the following findings identified during survey procedures performed from 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm: 1. Resident Sample # 80 is a female resident admitted on [DATE] with a diagnostic of left [MEDICAL CONDITION]. Resident had ordered and was receiving medications for Hypertension, insulin [MEDICATION NAME] and Humalog, anticoagulant among other eleven medications ([MEDICATION NAME], [MEDICATION NAME], [MEDICATION NAME] , [MEDICATION NAME] DS [MEDICATION NAME] and [MEDICATION NAME] ) medications since admitted to receive services. No evidence was found of a medication regimen review performed by a pharmacist as required by 483.45 (c) Drug Regimen Review Requirement, in order to assess the potential or actual unnecessary medication therapy. 2. Resident #182 is a [AGE] years old female with a [DIAGNOSES REDACTED]. During the record review performed on 05/22/19 10:27 AM provide evidence that the physician ordered on [DATE] at 4:20 pm [MEDICATION NAME] 300 mg 1 tab PO at Bed Time (HS), [MEDICATION NAME] 10 mg 1 tab PO HS, [MEDICATION NAME] 40mg 1 tab PO HS, [MEDICATION NAME] 1 mg 1 tab PO daily, Integra Plus 1 tab PO daily, Folic Acid 1 mg 1 tab PO daily, [MEDICATION NAME] ([MEDICATION NAME]) 20 mg 1 tab PO daily, [MEDICATION NAME] 100 mg 1 tab PO daily, Eliquis 2.5 mg 1 tab PO daily, Pre protein 30 ml PO 3 time daily (TID), [MEDICATION NAME] 2 tab PO every 6 hour for pain per 48 hour. On 5/18/19 at 6:40 am the physician ordered Pneumococcus vaccine and Influenza vaccine IM at discharge home. On 5/18/19 the physician ordered Tylenol 500 mg 2 tab PO stat. On 5/19/19 at 2:45 pm the physician ordered [MEDICATION NAME] 15 mg 1 tab PO HS per 5 days. On 5/19/19 at 9:00 pm the physician ordered [MEDICATION NAME] 50 mg 2 tab PO every 6 hour as needed for pain per 48 hour. On 5/21/19 at 7:20 am the physician ordered [MEDICATION NAME] cream plus Zinc Oxide apply in the gluteus area and in the posterior side of the thigh. No evidence was found that the License Pharmacist performed a Medication Regimen review in order to assess the potential or actual unnecessary medication therapy. 3. Resident # 231 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 05/21/19 09:48 AM provide evidence that the Resident have high risk medication orders [REDACTED]. No evidence was found that the License Pharmacist performed a Medication Regimen review in order to assess the potential or actual unnecessary medication therapy. 4. Resident # 233 is a [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 05/21/19 10:29 AM provide evidence that the Resident have high risk medication orders [REDACTED]. No evidence was found that the License Pharmacist performed a Medication Regimen review in order to assess the potential or actual unnecessary medication therapy.",2020-09-01
31,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,757,E,0,1,L8MV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification survey, review of ten medical records and resident interview with Pharmacist (employee #7) performed from 05/21/19 thru 05 23/19, from 8:00 am thru 4:30 pm, it was determined that the facility failed to promote mechanisms to identify unnecessary drug regimen on residents receiving services and treatment. This deficient practice was identified in 4 out of 16 active cases reviewed. (RS #80, #182, #231 and #233) Findings include: A mechanism to ensure that facility conduct a medication regimen review of each resident in order to ensure each resident's drug regimen is free from unnecessary drugs was not performed, accordingly with the following findings identified during survey procedures performed from 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm: 1. Resident Sample #80 is a female resident admitted on [DATE] with a diagnostic of left [MEDICAL CONDITION]. Resident had ordered and was receiving medications for hypertension, insulin [MEDICATION NAME] and Humalog, anticoagulant among other eleven medications ([MEDICATION NAME], [MEDICATION NAME], [MEDICATION NAME] DS, [MEDICATION NAME] and [MEDICATION NAME]) medications since admitted to receive services. No evidence was found of a medication regimen review performed by a pharmacist as required by 483.45 ( c) Drug Regimen Review Requirement in order to assess and identify situations where the medications ordered and administered to this resident had the potential to be use in excessive dose (including duplicate drug therapy); or for excessive duration; or without adequate monitoring; or without adequate indications for its use; or in the presence of adverse consequences which indicate the dose should be reduced or discontinued. 2. Resident #182 is a [AGE] years old female with a [DIAGNOSES REDACTED]. During the record review performed on 05/22/19 10:27 AM provide evidence that the physician ordered on [DATE] at 4:20 pm [MEDICATION NAME] 300 mg 1 tab PO at Bed Time (HS), [MEDICATION NAME] 10 mg 1 tab PO HS, [MEDICATION NAME] 40mg 1 tab PO HS, [MEDICATION NAME] 1 mg 1 tab PO daily, Integra Plus 1 tab PO daily, Folic Acid 1 mg 1 tab PO daily, [MEDICATION NAME] ([MEDICATION NAME]) 20 mg 1 tab PO daily, [MEDICATION NAME] 100 mg 1 tab PO daily, Eliquis 2.5 mg 1 tab PO daily, Pre protein 30 ml PO 3 time daily (TID), [MEDICATION NAME] 2 tab PO every 6 hour for pain per 48 hour. On 5/18/19 at 6:40 am the physician ordered Pneumococcus vaccine and Influenza vaccine IM at discharge home. On 5/18/19 the physician ordered Tylenol 500 mg 2 tab PO stat. On 5/19/19 at 2:45 pm the physician ordered [MEDICATION NAME] 15 mg 1 tab PO HS per 5 days. On 5/19/19 at 9:00 pm the physician ordered [MEDICATION NAME] 50 mg 2 tab PO every 6 hour as needed for pain per 48 hour. On 5/21/19 at 7:20 am the physician ordered [MEDICATION NAME] cream plus Zinc Oxide apply in the gluteus area and in the posterior side of the thigh. No evidence was found that the License Pharmacist performed a Medication Regimen requirement in order to assess and identify situations were the medicatios ordered and administered to this resident had the potential to be use in excessive dose (including duplicate drug therapy); or for excessive duration; or without adequate monitoring; or without adequate indications for its use; or in the presence of adverse consequences which indicate the dose should be reduced or discontinued. 3. Resident # 231 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 05/21/19 09:48 AM provide evidence that the Resident have high risk medication orders [REDACTED]. No evidence was found that the License Pharmacist performed a Medication Regimen requirement in order to assess and identify situations where the medications ordered and administered to this resident had the potential to be use in excessive dose (including duplicate drug therapy); or for excessive duration; or without adequate monitoring; or without adequate indications for its use; or in the presence of adverse consequences which indicate the dose should be reduced or discontinued. 4. Resident # 233 is a [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 05/21/19 10:29 AM provide evidence that the Resident have high risk medication orders [REDACTED]. No evidence was found that the License Pharmacist performed a Medication Regimen requirement in order to assess and identify situations where the medications ordered and administered to this resident had the potential to be use in excessive dose (including duplicate drug therapy); or for excessive duration; or without adequate monitoring; or without adequate indications for its use; or in the presence of adverse consequences which indicate the dose should be reduced or discontinued.",2020-09-01
32,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,758,D,0,1,L8MV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification survey, review of ten medical records and resident interview with Pharmacist (employee #7) performed from 05/21/19 thru 05 23/19, from 8:00 am thru 4:30 pm, it was determined that the facility failed to promote mechanisms to identify the [MEDICAL CONDITION] drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record. This deficient practice was identified in 2 out of 16 active cases reviewed. (RS #231 and #233). Findings include: 1. Resident # 231 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 05/21/19 09:48 AM provide evidence that the Resident have high risk medication orders [REDACTED]. No evidence was found that the License Pharmacist performed a Medication Regimen requirement in order to identify the [MEDICAL CONDITION] drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record. 2. Resident # 233 is a [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 05/21/19 10:29 AM provide evidence that the Resident have high risk medication orders [REDACTED]. No evidence was found that the License Pharmacist performed a Medication Regimen requirement in order to identify the [MEDICAL CONDITION] drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record.",2020-09-01
33,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,761,F,0,1,L8MV11,"Based on a recertification survey, observation and interview during the drug pass, it was determined that the facility failed to provide an mechanism to ensure security of the medication cart during the medication administration due to the medication cart did not have a security lock. Findings include: 1. During the drug pass performed on 05/23/2019 at 8:00 am thru 9:30 am, it was observed that the medication cart security lock did not lock, not function and during the medication administration the RN employee #12 did not put the lock and the cart was left unattended. During interview with the DON (employee #1) on 05/23/2019 at 10:30 am she state that the security lock of the medication cart was damage and in many time was changed and repair. But this time the preventive maintenance employee said to her that the cart has to change. During Interview with the administrator (employee #2) on 05/23/2019 at 10:45 am she state that she verified the medication cart to buy 3 cart for the facility but the chief executive inform her that a few month the facility going to change the system and bring new medication computer system that did not buy the cart. During interview with the pharmacist employee #7 on 05/23/2019 at 11:00 am state that the facility is going to start with medication computerized system that this is going to start between (MONTH) or (MONTH) 2019. 2. The facility failed to provide a mechanism to ensure that the medication cart is secured when the registered nurse enter to the resident's room to provide medication and left the medication cart unattended during the medication administration.",2020-09-01
34,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,865,C,0,1,L8MV11,"Based on a recertification survey, review of QAPI program activities and interview with hospital pharmacist (employee #8) and facility director (employee #2) performed from 05/21/19 thru 05/23 /19, from 8:00 am thru 4:30 pm, it was determined that the facility failed to ensure that Quality Assurance and Performance Improvement QAPI program plan include relevant information of QAPI/QAA activities, related with medication use and the appropriateness of pharmacy services. Findings include: 1. A mechanism to ensure that facility maintain written plan containing the process that will guide the facility's efforts in assuring the appropriateness of medication use and pharmacy services was not performed, accordingly with the following findings identified during survey procedures performed from 05/21/19 thru 05/23/19, from 8:00 am thru 4:30 pm: a. The facility QAPI documentation, reviewed on 5/23/19 at 10:17 am with facility director did not include information related with the appropriateness of medication use and pharmacy services. During interview on 5/23/19 at 10:29 am the facility director (employee #2) stated that they used to have a pharmacist assigned exclusively for the Skilled Nursing Facility (SNF) but this professional no longer works with them since year (YEAR). The facility director (employee #2) also stated that she had assigned a nurse in the facility to perform medication reconciliation and supervise medication use and related therapies of the resident. Other aspects related with medication use irregularities (ej- medication error and adverse drug reactions) will be reported analyzed and discussed in the hospital pharmacy and therapeutic committee meeting. However no indicators, results, or discussions related with the appropriateness of medication use in the SNF was included in their QAPI program documentation. This information is documented and remain as part of the hospital pharmacy and therapeutic committee meeting documentation. b. QAPI documentation, related with medication use and pharmacy services were reviewed on 5/23/19 at 10:30 am with hospital pharmacist (employee #8). Information presented by hospital pharmacist (employee #8) are only included on the hospital pharmacy and therapeutic committee meeting discussions as stated during interview by the hospital pharmacist (employee #7) on 5/23/19 at 10:35 am. c. The facility QAPI plan did not contain indicators related with the appropriateness of pharmacy services. Hospital pharmacist (employee #8) provide evidence and explain activities performed by hospital pharmacy and therapeutic committee who meet every three months were the members of committee discuss appropriateness of pharmacy services in the SNF. However this information is not included as part of the documentation of SNF QAPI program.",2020-09-01
35,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,880,D,0,1,L8MV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification survey, observations and staff interview performed during the survey process from [DATE] thru [DATE] from 8:00 am thru 4:00 pm it was determined that the facility failed to comply with accepted infection control precautions and standards of practice. Findings include: On [DATE] at 1:00 p.m. till 4:00 p.m. true [DATE] at 8:00 am. till 4:00 pm. during the performed visual inspection on different resident's rooms and others areas of the skill nursing facility the following was found: 1. Upper part of the column that divides room [ROOM NUMBER] and 117 outside facing corridor was observed open space per the area where the emergency call system cables exit. 2. In the closets of resident's rooms 113, 114 and 115 were observed disposable abduption pillows. Rooms were empty at the time of visual inspection. 3. In resident rooms 101, 102, 104, 105, 106, 107, 108, 110, 111, 113 all dispensers of hand held paper were observed closed and empty. Rolls of hand held paper were observed outside the dispenser placed on the top of the soap dispenser. When the facility personnel, residents and visits perform hand washing they take the paper roll with wet hands cut a piece of paper they need and then place it on the top of the soap dispenser or on the surface of the area of the sink. The roll of hand paper becomes wet as soon as it is used which incurs cross-contamination. 4. All of the residents rooms, corridors and others areas, offices and recreative areas of the skill facility was visit and it was observed deteriorate floor, walls and ceilings. Broken and detached sockets, peeling paint on the walls were observed in residents' rooms and others areas of the skill nursing facility. 5. On [DATE] at 1:45 pm the regular and biohazard trash cans in room [ROOM NUMBER] was observed without identification label. 6. Equipment room used to offer physical therapy service does not have an identification sign. Was observed dirty, with mush dusty, humid smell, the ceiling was observed with black color apparently mold, broken and detached sockets, dirty walls and floor, frame and door deteriorated. On the left side of the entrance was observed a dispenser used to discard syringes inside it was observed garbage, one disposable abduction pillow and the plan of the facility. 7. On [DATE] at 2:00 pm the janitor room was visit and the floor was observed with dusty and dirty, mildew stains. Service sink with clogged cement material and dirty. All of the room included the roof was observed with dark spots, dusty and dirty. Absence of acoustic right side of the ceiling. 8. Yellow spots was observed in the ceiling in resident room [ROOM NUMBER]. 9. No paper dispenser in resident room [ROOM NUMBER] a roll of paper was observed in the top of the hand washing soap. 10. On [DATE] at 8:50 am the medication area was observed that the dispenser hand paper does not work, two rolls of paper are maintained on counter near the sink, one on the right side of the counter near the sink was observed wet. 11. On [DATE] at 8:45 am in the area of surgical medical equipment an Irrigation Tray with [MEDICATION NAME] Syringe Lot 37ZC01 with expired date on (MONTH) (YEAR) was found. 12. The daily record of the glucometer machine was not done on day [DATE]. 13. The daily record of the medication refrigerator was done on 2/ ,[DATE] the temperature was 28 F, [DATE] was on 25 F and in (MONTH) 17 and ,[DATE] the temperature was on 27 F, on [DATE] was on 28 F and [DATE] was on 29 F. According of the policies and procedures established the parameters for the refrigerator was to be maintain in 30 F to 40 F to maintain the medications, however no evidence of notification or intervention by the nursing staff to the technical to check changes in temperature that may affect the drugs. 14. On [DATE] at 9:55 am the license practical nurse (LPN) employee #9 during the procedure of treatment of [REDACTED].#10 in the ulcer care procedure. The LPN maintain a pair of gloves in her left hand and she maintain various gloves in her right pocked. A tube of Solocite fell on the floor, the LPN picked it up and placed it on the table of non-sterile materials however, she did not clean or disinfect the tube. Then she put a plastic apron washing her hands and dries, then she took two gloves from the pocket of her shirt and put them on. 15. On [DATE] at 1:31 pm the register nurse employee #13 enter at the resident case #230 room [ROOM NUMBER]A with tray to remove intravenous line. The nurse was observed placing gloves removed IV line then discarded line removed gloves but did not wash her hands before and after performing procedure. 16. The facility failed to comply with accepted infection control precautions and standards of practice. 17. During the Drug pass with the employee #9 on [DATE] from 8:00 am thru 9:30 am, it was observed that the RN #9 takes the Blood Presure to the resident that have medication to control the high blood pressure. During the procedure the RN failed to clean and desinfected the non critical equipment (Sphignomanometer) before and after used, due to she puts the equipment on the resident bed or resident table.",2020-09-01
36,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2019-05-23,908,F,0,1,L8MV11,Based on a recertification survey and visual inspection of the kitchen perform on 05/23/2019 at 11:17 AM it was determined that the facility fail to maintain all mechanical and electrical equipment in safe operating condition. That deficiency practice can affect all admitted resident. Findings include: 1. During the kitchen survey on 05/23/2019 at 11:17 am it was identified that the walking refrigerators and freezers roof paint are peeling. The hot cart with 8 compartment have multiples holes on different areas. 2. The facility fail to maintain all mechanical and electrical equipment in safe operating condition,2020-09-01
37,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2018-08-16,607,C,0,1,88RA11,"Based on interview, review of the facility's policy and staff training records, the facility failed to include in its abuse and neglect prohibition policy the mandatory timeframes for reporting all allegations of, and the results of all investigations pertaining to, abuse, neglect, exploitation or mistreatment, including injuries of unknown origin and misappropriation of resident property to the State Agency and all other required agencies. The facility also failed to ensure the staff had been trained regarding the mandatory timeframes for reporting allegations of abuse and neglect. Findings include: Review of the facility's Abuso, Negligencia, Maltrato (Abuse and Neglect) policy, dated 07/13/16, revealed the policy did not include the requirement to report all allegations of abuse, neglect, exploitation or mistreatment, including injuries of unknown origin and misappropriation of resident property to the State Agency and other required agencies immediately, but not later than two hours if the alleged violation involved abuse or resulted in serious bodily injury, or not later than 24 hours if the alleged violation did not involve abuse and did not result in serious bodily injury. Further review of the policy indicated the facility would report investigation results according to State and Federal law; however, the policy subsequently indicated the proper authorities would be notified within five days of completing an investigation only when it was determined abuse or neglect had occurred. Review of the facility's (YEAR) and (YEAR) Abuse and Neglect staff's in-service documentation revealed the training did not include the timeframes for mandatory reporting. Interview on 08/16/18 at 12:12 PM with the facility's Director revealed the facility reports to the State Agency only when they have an allegation that the investigation determined that the allegation was substantiated. She stated they initiate their investigations immediately, but the reporting to the State Agency was only completed after an investigation has been completed. The facility Director further stated that the allegation was reported to the State Agency within five days of completing an investigation. The facility's Director stated she was unaware of the reporting timeframe (within 2 hours and within 24 hours) requirements.",2020-09-01
38,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2018-08-16,623,D,0,1,88RA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and medical record review, the facility failed to notify the designated State Ombudsman of a hospital transfer, and the reasons for the transfer, for one out of one sampled residents reviewed for hospital transfers, (Resident (R) 101), from a total sample of eight residents. Findings include: Review of R101's undated Admission Sheet, indicated the facility admitted the resident on 04/21/18. R101 had a [DIAGNOSES REDACTED]. Review of the Progress Notes for R101 revealed the facility transferred the resident to the hospital on [DATE] at 7:45 PM for, .left hip swelling. Patient will be hospitalized for [REDACTED]. The facility did not provide a policy regarding the notification of the State Ombudsman when a resident was transferred to the hospital. During an interview on 08/16/18 at 11:45 AM, the Director of Nursing (DON) stated the facility did not notify the Ombudsman when the R101 transferred to the hospital. The DON stated neither she, nor the social worker, were aware of the new requirement to notify the Ombudsman of hospital transfers. The DON further stated the facility did not have a policy and procedure for notifying the State Ombudsman.",2020-09-01
39,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2018-08-16,700,F,0,1,88RA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview the facility failed to assess the residents prior to the installation of bed rails; failed to review the risk and benefits of the bed rails with the residents or resident representatives and failed to obtain informed consent prior to installation of the bed rails. This deficient practice affected 11 (R8, R9, R10, R14, R7, R13, R16, R1, R4, R5, R2) of 11 residents sampled for the use of bed rails. Findings include: 1. On 08/13/18 at 10:21 AM Resident (R) 8 was observed in bed with metal half bed rails in the raised position on the upper portion of the bed. On 08/15/18 at 1:10 PM the bed rails were in the raised position and were inspected with the Director of Nursing (DON). Review of R8's Patient Information sheet indicated the resident had been recently admitted to the facility with a [DIAGNOSES REDACTED]. Review of the Admission Minimum Data Set (MDS) assessment (a resident assessment tool), with an assessment reference date of 08/06/18 revealed a Brief Interview Mental Score (BIMS) score of 7 at Section C, Cognitive Patterns, which indicated that R8 was moderately cognitively impaired. The Nursing Progress Notes from admission through 08/13/18 as well as the entire medical record revealed there was no documentation of an assessment for the use of the bed rails, that facility staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 2. On 08/13/18 at 2:05 PM, R9 was observed in bed asleep with the metal bed rails in the raised position on both sides of the head of the bed. On 08/14/18 at 9:39 AM, R9 was observed in bed with metal bed rails in the raised position on both sides of the head of the bed. Review of R9's Hospital Discharge Summary sheet dated 8/9/18 revealed she was admitted to the nursing facility with [DIAGNOSES REDACTED]. Review of R9's Admission MDS with an assessment reference date of 8/13/18 revealed she was assessed as requiring extensive assistance for bed mobility according to section G, Functional Status. Section C, cognitive patterns indicated R9's BIMS score of 13 which indicated that R9 was cognitively intact. Review of the Nursing Assessment sheets dated 08/09/18 through 08/14/18 as well as the entire medical record revealed there was no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 3. On 08/13/18 at 2:52 PM, on 08/14/18 at 11:22 AM, and on 08/15/18 at 1:10 PM and at 1:46 PM, R14 was observed lying in bed with half bed rails on the top portion of the bed in the raised position. During the observation on 08/15/18 at 1:10 PM the DON verified the top bed rails were used for the resident. Review of R14's Admission Record dated 08/01/18 revealed R14 was admitted to the facility for therapy after she experienced a right [MEDICAL CONDITION]. According to a physician's progress note dated 08/01/18, the resident had [DIAGNOSES REDACTED]. Review of the Admission MDS with an assessment reference date of 08/15/18 revealed the resident was identified as requiring limited assistance with transfers, walking, and locomotion according to Section G, Functional Status. Section C, Cognitive Patters, R14 was documented as being cognitively intact (BIMS score of 13). The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 4. On 08/14/18 at 11:33 AM, R10 was observed in bed with the top bed rails in the raised position. Review of the Physician's history and physical dated 08/06/18 revealed the resident had a [DIAGNOSES REDACTED]. The Admission MDS with an assessment reference date of 08/13/18 indicated that R10 required limited assistance for transfers; required supervision for walking; and as not steady and only stable with staff assistance for moving from seated to standing position, walking, turning around, and for surface to surface transfers according to Section G, Functional Status. The assessment identified the resident as being cognitively intact (BIMS score of 15) at Section C, Cognitive Patterns. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 5. Observation on 08/13/18 at 10:45 AM revealed R1 was in bed with half plastic bed rails at the head of the bed. Interview with R1 and his family at that time revealed he was alert and oriented and used the bed rails for positioning. Review of R1's Patient Information sheet revealed he had been admitted on [DATE] for rehabilitation services post knee replacement. Review of R1's Admission MDS dated [DATE] revealed Section G that R1 required staff assistance for walking, transfer from bed, and moving from seated to standing. According to Section C, R1's BIMS score had not been completed at the time of survey due to his recent admission. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 6. Observation on 08/14/18 at 01:53 PM, R7 was in bed with half metal bed rails in the raised position at the head of the bed. Interview at that time with his wife revealed R7 used the bed rails for positioning. During an observation on 08/15/18 at 1:10 PM, the DON confirmed R7's use of the metal bed rails. Review of R7's Admission MDS, dated [DATE] revealed Section G, R7 required limited assistance of one person for bed mobility. He required extensive assistance of one person to transfer from bed. He required extensive assistance of one person for ambulation. He had range of motion impairment in his upper and lower extremities on both sides of his body. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 7. Observation on 08/14/18 at 1:22 PM, R13 was in bed with metal half side rails in the raised position at the head of the bed. Interview at that time with R13 and her family revealed she was alert and oriented and used the bed rails for positioning. During an observation on 08/15/18 at 1:10 PM, the DON confirmed R7's use of the metal bed rails. Review of R13's Patient Information form revealed she had been admitted on [DATE]. She had been admitted for rehabilitation from a knee replacement. Review of R13's Admission MDS dated [DATE] Section G revealed she required limited assistance of one person for bed mobility. She required extensive assistance of one person for transfers and ambulation. She had limited range of motion in her upper and lower extremities on both sides of her body. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 8. Observation on 08/14/18 at 02:07 PM, R16 was in bed with metal bed rails in the raised position at the head of bed. During an observation on 08/15/18 at 1:10 PM, the DON confirmed R16's use of the bed rails. Review of R16's Patient Information sheet revealed she had been admitted on [DATE]. She had been admitted for short term rehabilitation. Review of R16's Admission MDS, dated [DATE] Section G revealed R16 required limited assistance of one person for bed mobility. She required extensive assistance of one person for transfers and limited assistance of one person for ambulation. She had Range of Motion (ROM) impairment of her lower extremities on one side. She had no ROM issues in her upper extremities. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 9. Review of Resident 2's Admission Sheet, dated 08/15/18, indicated the facility admitted the resident on 07/21/18. R2 had a [DIAGNOSES REDACTED]. Review of R2's MDS assessment, Section G for functional status, indicated he required minimal assistance from staff. R2's BIMS indicated a score of 14, which indicated he was cognitively intact. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 10. Review of Resident 4's Admission Sheet, dated 08/15/18, indicated the facility admitted the resident on 08/07/18. R4 had a [DIAGNOSES REDACTED]. Review of R4's MDS assessment Section G for functional status, indicated R4 required extensive assistance from staff with transfers, bed mobility and locomotion on the unit. R4's BIMS score indicated R4 was severely cognitively impaired. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 11. Review of Resident 5's Admission Sheet, dated 08/15/18, indicated the facility admitted the resident on 07/31/18. R5 had a [DIAGNOSES REDACTED]. Review of R5's MDS assessment Section G for functional status, indicated R5 required extensive assistance from staff with transfers, bed mobility and locomotion on the unit. R5's BIMS score was 11 which indicated he was moderately cognitively impaired. Interview on 08/15/18 at 1:10 PM with the Director stated that all residents in the facility had hospital beds with half bed rails at the head of the bed. The facility's standard practice was to use those bed rails for positioning. It was not the facility's practice to assess residents for use of those bed rails. During an interview on 08/15/18 at 1:20 PM, the DON stated all the beds in the facility are equipped with bed rails. She stated they do not assess the resident prior to placing the residents in the beds with the bed rails. She confirmed that the 11 sampled residents did not have assessments for the use of the bed rails. On 08/15/18 at 3:26 PM, the Administrator was informed that the facility had substandard quality of care related to the widespread use of the half-bed rails without first assessing the residents for appropriate alternatives prior to installing the bed rails; without a system in place to ensure the bed rails were maintained in a safe manner; without assessing the residents for risk of entrapment prior to the installation; without reviewing the risks of bed rails with the resident or resident representative and obtaining informed consent prior to the installation. On 08/16/18 at 9:51 AM Licensed Practical Nurse (LPN) 1 stated when a resident was admitted to the facility the bed was ready with the bed rails are in the raised position. She stated she explains to the resident and any family present that only the top bed rails are to be in the raised position and if the bed has bottom rails attached she tells them do not raise the bottom bed rails because the resident could fall if they attempted to get out of bed. She stated when she leaves the resident in bed alone she ensures the top rails are in the raised position to prevent them from falling out of bed. On 8/16/18 at 10:55 AM, LPN 2 stated when the resident arrives the bed should be ready and that the half bed rails would be in the raised position. She stated the bed rails are left in the raised position to prevent the residents from falling. Review of the facility's policy titled Use of bed rails with a last updated date of 07/14/16 revealed, Standard section of the policy it indicated, the beds in the Skilled Nursing unit will have only two bed rails elevated (in the superior part or the head of the bed) with the purpose of the resident helping themselves to position in bed. No resident will have four bed rails elevated on their bed except those who have a medical justification. Under the procedure portion of the policy it indicated that the nurse or medical professional would educate the resident or family about the standard use of bed rails. During daily rounds, the supervisor would ensure each resident's bed only had the two side rails at the head of the bed in the raised position. The policy did not address that the residents were to be assessed prior to using the side rails.",2020-09-01
40,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2018-08-16,812,F,0,1,88RA11,"Based on observation, review of manufacturer's instructions, and interview, the facility failed to ensure the sanitizer in the sanitizing solution containers was at the proper level to sanitize food preparation surfaces in the kitchen, and the facility failed to ensure one food item on the steam table was held at a safe temperature level. This had the potential to affect 16 of 16 residents in the facility. Findings include: 1. During the tour of the kitchen on 08/13/18 at 9:45 AM with the Food Service Supervisor (FSS), the FSS checked the quaternary sanitizer level of the two of two containers of sanitizing solution used to store wiping clothes. The FSS stated that the cloths were used to sanitize food preparation surfaces. Each of the containers measured zero parts per million (ppm). Each of the containers contained wiping clothes and one of the two containers was visibly soiled with food particles. The FSS verified the solution was not strong enough to sanitize the food preparation counters and equipment. Review of the Product Data for the Arrex-100 Disinfectant and Sanitizer revealed the manufacturer's instructions stated for sanitizing food processing equipment and food utensils the sanitizer was required to be 200 ppm of active quaternaries. 2. On 8/15/18 at 11:10 AM, Food Service Employee (FSE)1 used a laser thermometer to check the temperature of the foods on the steam table. The temperature of two steam table pans of spaghetti registered 129.2 and 125 degrees Fahrenheit (F). FSE1 verified the temperature. At 11:13 AM, the FSS rechecked the temperature of each pan of spaghetti using a stem food thermometer. Both pans of spaghetti registered 130 degrees F. When asked what the temperature of the foods on the steam table should be, the FSS stated at least 135 degrees F.",2020-09-01
41,RYDER MEMORIAL HOSPITAL INC,405018,355 AVE  FONT MARTELO,HUMACAO,PR,792,2018-08-16,909,E,0,1,88RA11,"Based on observation, record review and staff interview, the facility failed to conduct regular inspection of all the bed rails to the bed rails were maintained. This deficient practice affected five (R8, R9, R7, R13 and R16) of 11 residents sampled for the use of bed rails. Findings include: 1. On 08/13/18 at 10:21 AM Resident (R) 8 was observed in bed with metal half bed rails in the raised position on the upper portion of the bed. The bed rails were loose and moved side to side and rocked at a 45-degree angle parallel with the bed mattress. On 08/15/18 at 1:10 PM the bed rails on the same bed were in the raised position and were inspected with the Director of Nursing (DON). The bed rails were loose and moved/rocked back and forth parallel to the bed when little pressure was placed on the rails. The DON verified the metal bed rails on each side of the bed were loose. 2. On 08/13/18 at 2:05 PM, R9 was observed in bed with the bed rails in the raised position on each side of the bed. On 08/14/18 at 9:39 AM, R9 was observed in bed with metal bed rails in the raised position on both sides of the bed. The bed rail on the right side of the bed was noted to be loose and to move back and forth parallel with the bed when light pressure was applied to the rail. On 08/15/18 at 1:10 PM the bed rails were checked with the assistance of the DON. At the time of the inspection the bed rails were in the raised position. The bed rails on each side of the bed rocked back and forth when little pressure was applied to the rails. The rails were connected to the metal bed frame with a bracket located in the bottom middle of the rail. 3. Observation on 08/14/18 at 01:53 PM of R7 was in bed with the half metal bed rails in the raised position. Observation on 08/15/18 at 1:10 PM, the DON confirmed R7 had metal bed rails were loose and could shift parallel with the side of the bed. 4. Observation on 08/14/18 at 1:22 PM of R13 was in bed with the metal half side rails in the raised position at the head of the bed. Interview at that time with R13 and her family revealed she was alert and oriented and used the side rails for positioning. Observation on 08/15/18 at 1:10 PM, the DON confirmed R7 had metal side rails were loose and could shift parallel with the side of the bed. 5. Observation on 08/14/18 at 02:07 PM, R16 was in bed with the metal half bed rails in the raised position at the head of bed. Observation on 08/15/18 at 1:10 PM, the DON confirmed R16 had metal bed rails that were loose and could shift parallel with the side of the bed. On 08/15/18 at 3:26 PM, the Administrator and the Biomedical Employee were interviewed about the use and maintenance of the side rails. The Biomedical Employee stated he oversaw the maintenance of the entire facility. The Administrator stated all the residents' beds are equipped with half-bed rails on the upper portion of the bed. She stated the facility did not have a policy, schedule or system in place to ensure the bed rails were properly attached to the bed and tight. She stated if there was an issue with the functioning of the bed rails maintenance would be notified. The Biomedical Employee stated he had never had the loose bed rails reported to him. At the time of the interview the manufacturer's information was requested for each of the types of bed rails the facility had in use. On 08/15/18 at 4:00 PM the Biomedical Employee stated he was not able to locate manufacturer's information for any of the bed rails used in the facility. He also confirmed the facility did not have any preventative maintenance policies related specifically the preventative maintenance of the bed rails. On 8/16/18 at 9:28 AM the DON stated they did not have a protocol or policy for ensuring the bed rails were maintained in safe condition and stated if the employees caring for the residents notice the bed rails were loose they tighten them up. She stated they do not routinely check the bed rails to ensure they are not loose. She also stated bed rails were in use on all the resident's beds. Review of the facility's policy titled Use of bed rails with a last updated date of 07/14/16 was reviewed. Under the Standard section of the policy it stated, the beds in the Skilled Nursing unit will have only two bed rails elevated (in the superior part or the head of the bed) with the purpose of the resident helping themselves to position in bed. No resident will have four bed rails elevated on their bed except those who have a medical justification. Under the procedure portion of the policy it stated the nurse or medical professional would educate the resident or family about the standard use of bed rails. During daily rounds, the supervisor would ensure each resident's bed only had the two side rails at the head of the bed up. The policy was silent to the preventative maintenance of the bed rails to ensure the bed rails were maintained in a safe functioning manner.",2020-09-01
42,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2019-03-28,578,F,0,1,HR5211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on recertification survey observations, review of twelve clinical sample records, and interview with nursing supervisor ( employee # 1 ) , it was determined that the facility failed to comply with the requirements specified in 42 CFR part 489, subpart I related with Advance Directives. This deficient practice was identified in 12 out of 12 cases of resident sample (R#1, R#15, R#65, R#64, R#66, R#69, R#113, R#114, R#115, R#117 R#119 and R#118) Findings include: 1.A mechanism to ensure that facility provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment as an option and to formulate an advance directive, was not performed accordingly with these findings identified during survey procedures performed from 03/25/19 thru 03/28/19, from 8:00 am thru 3:00 pm: a.It was identified during interviews performed to 11 out to 12 residents during survey procedures from 03/25/19 thru 03/28/19, from 8:00 am thru 3:00 pm that admissions department did not provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment as an option and to formulate an advance directive. Nursing supervisor ( employee #1 ) stated on interview on 3/27/19 at 10:57 am that she went to admissions department to ask for about the availability of any written information prepared with the purpose to be provided to residents concerning the right to accept or refuse medical or surgical treatment as an option and to formulate an advance directive. She stated that admission department personnel inform her that during admission process information related with the rights to accept or refuse medical or surgical treatment as an option and to formulate an advance directive was well explained to residents and relatives, however they did not provide written information or brochure who explain this to them. 2.A mechanism to ensure that facility promote the right of each resident to formulate an advance directive was not performed accordingly with these findings identified during survey procedures performed from 03/25/19 thru 03/28/19, from 8:00 am thru 3:00 pm: a. Resident #115- is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 3/26/19 at 10:12 am and provided evidence that resident was disoriented since admission. No information was found documented on the medical record related with medical treatment and care relatives of resident representative make or advance directives formulation. Documentation related with the person who makes medical decisions for resident in the near future was not found. Nursing supervisor ( employee #1 ) stated on interview on 3/27/19 at 10:17 am that this resident lives in a remote location and only make visits to resident during weekends. She also stated that based on the situation that resident was disoriented a relative or representative appoint by relatives must be informed about the right to formulate advance directives. b. However there are no documentation found on the medical record who evidence resident relatives were informed of this matter. Facility failed to promote the right to inform advance directive information to the individual's resident relative/ representative as required when resident is unable to receive this information.",2020-09-01
43,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2019-03-28,658,E,0,1,HR5211,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on recertification survey observations, review of twelve clinical sample records, nutritional assessment and interviews, it was determined that the facility failed to ensure the appropriateness of resident weight procedures standard of practice for 4 out of 12 resident sample. (Resident R#66, R#69, R#70 and R#115). Residents interview and interview with the Hospital Escort Pool Coordinator Services (employee #3) during a survey process performed from 03/25 /19 thru 03/28/19, from 8:00 am thru 3:00 pm, it was determined that the facility failed to ensure an expedite process to transfer residents between departments for the purpose of the provision of rehabilitation services which affect 2 out of 12 residents (R#1 and R#117) Findings include: 1. A mechanism to ensure that facility had in place a system who guarantee the accuracy of weight taken to residents on wheelchair was not performed accordingly with these findings identified during survey procedures performed from 03/25/19 thru 03/28/19, from 8:00 am thru 3:00 pm: a.Resident #66 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 3/27/19 at 10:18 am and provided evidence that resident was weighted after admission on 03/12/19 while was on wheelchair and was documented to weigh 139 pounds. On the weight registry document it was found that personnel document that wheelchair used by resident weight 51 pounds. Personnel who weight resident perform an arithmetic subtraction of the total weight of the resident 180 (weight of the resident in wheelchair) -51 (weight of the wheelchair) and document as the final weight of the resident 139 pounds. In the arithmetic subtraction 180-51=129, the final weight of the resident must be 129 pounds instead of 139 pounds. The facility failed to maintain best practices when perform and record weight and identify circumstances that could impact weight accuracy. b. Resident #69 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 3/27/19 at 11:00 am and provided evidence that resident was weighted after admission on 03/18/19 while was on wheelchair and was documented to weigh 135 pounds. On the weight registry document it was found that personnel document that wheelchair used by resident weight 49 pounds. Personnel weight resident again on 03/26/19 standing and document as the final weight of the resident 125 pounds. There is a difference of 10 pounds on 8 days from the first weight on wheelchair and the second weight. No information was found documented on the weight chart related with the circumstances were the resident weight was taken while was on wheelchair ( with shoes, clothes, coat ) ( with linens, clothes and without shoes ) There is no explanation for the 10 pounds difference between resident weight on 03/18/19 and on 03/26/19. The resident stated on interview on 03/27/19 at 1:00 pm that she was eating well since his admission and that she does not believe that had been losing weight. The facility failed to maintain best practices when performing and record weight and identify circumstances that could impact weight accuracy. c. Resident #70 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 3/27/19 at 9:00 am and provided evidence that resident was weighted after admission on 03/15/19 while was on wheelchair and was documented to weigh 111 pounds. On the weight registry document it was found that personnel document that wheelchair used by resident weight 49 pounds. Personnel weight resident again on 03/19/19 while was on wheelchair and was documented to weigh 145 pounds. On the weight registry document it was found that personnel document that wheelchair used by resident weight 41 pounds. Personnel took resident weight standing 03/26/19 and document as the final weight of the resident 135 pounds. There is a difference of 10 pounds on 7 days from the first weight on wheelchair and the second weight. No information was found documented on the weight chart related with the circumstances were the resident weight was taken (with shoes, clothes, coat) (with linens, clothes and without shoes) There is no explanation for the 34 pounds difference between resident weight during admission on 03/15/19, the difference of 10 pounds of resident weight on 03/19/19 and 03/26/19 while weight was measure while resident was on wheelchair. Resident stated on interview on 03/27/19 at 9:55 am that she was eating well since her admission and that she does not believe that had been losing weight. d. The facility failed to maintain best practices when perform and record weight and identify circumstances that could impact weight accuracy. Interview was performed with biomedical services technician ( Ciracet Outside Contractor Company ) ( employee # 2) on 3/27/19 at 11:59 am and he stated that scale used to weight residents on wheelchair and standing scale had the preventive maintenance updated and that biomedical personnel performed a weekly revision of the equipment. He also stated that equipment works well and provide evidence of the preventive maintenance. e. The facility had a policy and procedure related with resident weight that was review on 3/27/19 at 2:35 pm. This policy did not include a process step by step who guide the personnel while taking weight on wheelchair accordingly with manufacturers' specifications or manual for use. f. Resident #115- is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 3/26/19 at 10:12 am and provided evidence that resident have a weight of 123 pounds on 3/12/2019 on wheel chair and on 3/19/2019 and 3/26/2019 have a weight of 114 stand up. 2. A mechanism to ensure that facility had in place a system who facilitate resident flow between departments for the purpose of the provision of clinical care, rehabilitation services and maintain best practices while transferring residents in the facility surrounding setting was not promoted, accordingly with the following findings identified during survey procedures performed from 03/25/19 thru 03/28/19, from 8:00 am thru 3:00 pm: R#1 [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. On 3/25/2019 at 2:46 pm during interview R#1 stated that he think the facility need more escort because they have to wait too long to be transport to therapy. R# 117 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. On 3/25/2019 at 2:16 pm on interview R# 117 stay that he think the facility need more escorts because sometimes they take long to get us to therapy During interview on 3/27/19 at 1:12 pm Hospital Escort Pool Coordinator Services (employee #3) stated that facility had 4 escort personnel to provide services to all hospital acute departments and the skilled nursing facility residents. She had 2 escorts assigned for day shift and two escorts assigned for night shift from Monday through Friday. As explained by her they had a pool process were the requisitions for escort assistance appear on an electronic (computer system) when the escort transfer the patient or resident to the assigned area, returns to the assigned pool area where is assigned to escort another patient or resident. She also stated that escorts will accompany or transfer acute care patients whenever they are transferred externally to another acute hospital for diagnostic procedure, treatment, ongoing care, specialist care.",2020-09-01
44,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2019-03-28,689,G,0,1,HR5211,"Based on recertification survey, observations, review of twelve clinical sample records, and interviews, it was determined that the facility failed to maintain adequate supervision and assistance devices to prevent accidents. The facility fail to maintain the environment free of accident hazards for 1 out of 12 resident sample. (Resident #115) Findings include: During record review of Resident #115 it was found that she have fall two times during the stay, one on 03/20/2019 at 1:40 am and the other on 03/22/2019 4:00 am. The fall report reflect on 03/20/2019 that the resident was found on the floor beside the bed with the wet floor in front of the bed. The floor was wet because the resident urinated on the floor. In the report is written that the resident refer that she was coming back from the bathroom and got dizzy and she hit on the head and right hip. The upper side rails were up. No injuries or bleeding were found. MD evaluation was perform on 03/20/2019 at 2:10 am. On 03/22/2019 at 4:00 am the report reflect that a resident start screaming Nurse a resident fell . Resident #115 was observe sitting on the floor and refer that she try to sit in between the bed rails and she slides to the floor and hit the lower back. In the incident report at the Environmental Factor is written that the four bed rails were up. The resident was evaluated by the MD on 02/22/2019 at 4:52 am and no injuries were found. 03/25/19 12:13 PM During Telephone interview with Daughter of the Resident #115 refer that my mother have two falls during the stay. The last fall was on Friday night On 03/27/2019 at 10:00 AM During interview with Resident # 115 it was identified that the resident did not recall any of the falls in the SNF. On 03/28/19 10:45 AM it was identified that Resident # 115 was evaluated by Neurocognitive Rehabilitation on 03/13/19 and identified that the patient was moderately disoriented in time and have her recent memory slightly impaired. The facility failed to maintain adequate supervision to prevent accidents. The facility fail to maintain the environment free of accident hazards.",2020-09-01
45,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2019-03-28,700,D,0,1,HR5211,"Based on recertification survey, observations, review of twelve clinical sample records, and interviews, it was determined that the facility failed to attempt to use appropriate alternatives prior to put the bed rail up. The facility fail to present evidence of the Policies and Procedure for the use of bed rails for 1 out of 12 resident sample. (Resident #115) Findings include: During record review of Resident #115 it was found that she have fall two times during her stay, one on 03/20/2019 at 1:40 am and the other on 03/22/2019 4:00 am. The fall report reflect on 03/20/2019 that the resident was found on the floor beside the bed with the wet floor in front of the bed. The floor was wet because the resident urinated on the floor. In the report is written that the resident refer that she was coming back from the bathroom and got dizzy and she hit on the head and right hip. The upper side rails were up. No injuries or bleeding were found. MD evaluation was perform on 03/20/2019 at 2:10 am. On 03/22/2019 at 4:00 am the report reflect that a resident start screaming Nurse a resident fell . Resident #115 was observe sitting on the floor and refer that she try to sit in between the bed rails and she slides to the floor and hit the lower back. In the incident report at the Environmental Factor is written that the four bed rails were up. The resident was evaluated by the MD on 02/22/2019 at 4:52 am and no injuries were found. 03/25/19 12:13 PM During Telephone interview with Daughter of the Resident #115 refer that my mother have two falls during the stay. The last fall was on Friday night On 03/27/2019 at 10:00 AM During interview with Resident # 115 it was identified that the resident did not recall any of the falls in the SNF. On 03/28/19 10:45 AM it was identified that Resident # 115 was evaluated by Neurocognitive Rehabilitation on 03/13/19 and identified that the patient was moderately disoriented in time and have her recent memory slightly impaired. The facility failed to attempt to use appropriate alternatives prior to put the bed rail up. The facility fail to present evidence of the Policies and Procedure for the use of bed rails.",2020-09-01
46,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2019-03-28,812,F,0,1,HR5211,"Based on a recertification survey, observational tour of the facility's kitchen during a survey process performed from 03/25/19 thru 03/28/19, from 8:00 am thru 3:00 pm, with administrative dietitian ( employee #4) it was identified that the facility failed to comply with accepted infection control precautions and standards of practice. Findings include: 1. A mechanism to ensure that facility personnel maintain infection prevention and control food hygiene guidelines was not promoted not performed, accordingly with the following findings identified during survey procedures performed from 03/25/19 thru 03/28/19, from 8:00 am thru 3:00 pm: On 03/25/19 from 9:40 am through 10:05 am the following was identified during observational tour in the kitchen with the administrative dietitian: a. One electric oscillating fan supported by and adjustable stand was observed in front of the food production area (area where stoves and tray line is located). This fan was observed in need of cleaning. b. One kitchen employee (employee #5) was observed moving from the three compartment sink area to the kitchen administrative office with gloves on. He came inside the office and then move to the area where the tray washing machine is located without taking off the gloves. The facility failed to ensure personnel change gloves when change task or move from different areas on the kitchen in order to prevent cross contamination. c. During review of the registry log for the sanitation and temperature of the three compartment sink it was identified that on 03/05/19 percent of sanitation chemical and temperature was not recorded in the morning.",2020-09-01
47,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2019-03-28,921,F,0,1,HR5211,"Based on recertification survey, observations and interviews with employee #6, it was determined that facility failed to maintain a functional and comfortable physical therapy (PT) area related to restrooms not available in the PT area which can affect all admitted resident. Findings include: On 03/27/19 at 02:26 PM it was found that the facility did not have a restroom on the PT area. On interview with the PT Supervisor (employee #6) refer that in the area they do not have restroom but outside they have one and they take there the residents that are prepared to go to the restroom. The resident who are not prepared we call the escort and take them to their rooms. The PT area is in the first floor and the resident rooms are on the third floor. When employee #6 was ask to show the restroom it provides evidence that the restroom key was not on PT area and the employee #6 went to the administration office and ask for the key. At front of the restroom there is a sign that have written Ask for the key on the front desk. The facility failed to maintain a functional and comfortable physical therapy (PT) area related to restroom not available in the PT area for residents' use.",2020-09-01
48,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,226,L,1,1,NJQB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on a standard and extended FOSS survey for recertification and a complaint investigation PR 598, review of the facility's grievance and complaint registry, policies and procedures (P&P's), and interviews performed on 5/22, 5/23, 5/24, and 5/25/17 it was determined that the facility failed to prevent patients from harm. This constitutes an Immediate Jeopardy to 13 out of 13 residents (R) admitted at the facility. (R#1 to R#13) Findings include: During the resident #6 complaint investigation performed on 5/24/17 at 10:30 am, the following was found: 1. Resident #6 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident #6 was admitted for physical therapy, occupational therapy and wound care. The resident #6 was discharge home on 5/18/17 at 12:50 pm, having a length of stay of 51 days in the facility. The close record review was performed on 5/25/17 at 2:00 pm. 2. The Resident #6 complaint allegations of 4/6/17 were the following: a. The nursing staff talked to him and treated him in a rude way. b. The nursing staff ignored when he called the nursing station. c. The nursing staff did not come to the room to change him on bed positioning. d. The nursing staff did not assess and manage the pain that the sacral ulcer caused. e. The pain provokes constantly vomit episodes to the resident #6. f. The nursing staff did not come to the room to clean resident #6. 3. During close record review (RR) of Resident #6 on 5/25/17 at 2:00 pm was found the following: a. The Minimum Data Set (MDS) report of 4/4/17 on section G0110. Activities of Daily Living (ADL) Assistance on 5/25/17 at 3:12 pm provides evidence that the resident #6 is total dependent on bed mobility and that includes how resident moves to and from lying position, turns side to side, and positions body while in bed or alternate sleep furniture. The resident #6 needs full staff performance every time in bed mobility, one personal physical assist. b. The Minimum Data Set (MDS) report of 4/4/17 on section J0100 Pain Management on 5/25/17 at 3:12 pm provides evidences that the resident #6 is received scheduled pain medication regiment, received PRN pain medication or was offered and declined, pain is suffered occasionally, the worst pain event during the last five days was 8/10 and severe. c. During review of the nursing notes of 4/6/17 was found incongruence between the pain documentation of the nursing staff and what the patient referred. The nursing note provides evidence that the patient did not had pain, however the patient referred that he had such pain that caused him vomiting episodes. d. During review of the nursing notes of 4/6/17 was found evidence that the nursing staff did not included in her note information related of the resident #6 clinical changes and needs. e. During the Change of position form of 4/6/17 provides evidence that the nurse change the patient position at 12:00 am, 2:00 am, 4:00 am, and 6:00 am. However the patient referred that the nursing staff did not perform any changes on position after 1:35 am thru 6:00 am. f. During review of the Facility Re-assessment of Pain form was found evidence that the nursing staff documented the pain scale on 4/6/17 at 12:00 am (0/10), 4/6/17 at 4:00 am (0/10), and 4/6/17 at 6:00 am (5/10). However the resident #6 referred that the nursing staff did not come to the room from 1:35 thru 6:00 am and that he was suffering of pain during that time. g. During review of the Medication record was observed that the patient received [MEDICATION NAME] 5/325 mg 1 tab Oral (PO) every 3 hours when needed (PRN) for pain on 4/3/17 at 9:00 am and 9:50 pm, 4/4/17 at 10:00 am and 5:30 pm, 4/5/17 at 10:00 am and 5:00 pm. However from 4/5/17 at 5:00 pm thru 4/6/17 at 6:00 am (11 hours) the patient did not received medication for pain during eleven hours. The patient referred during interview that he had such pain that caused him vomiting episodes. h. During the medical order reviews was found evidence of a telephone order from the physician of [MEDICATION NAME] 5/325 mg 1 tab PO PRN every 3 hours for pain. The medication was administered on 4/6/17 at 6:00 am. i. During the interdisciplinary group notes was found evidence that RN employee #10 oriented the resident #6 about the importance of position changes every 2 hours and to avoid the pressure on the affected area. j. During review of the nursing care plans was found evidence that the Pain, Fall, and Pressure Ulcer care plans were open. The Pain care plan establishes the following: i. The use of therapeutic modalities for the pain management and pain control like: Positioning. ii. Administer medication according to medical order for pain management. iii. Pain note in clinical file must include: sounds, complaints, facial expressions, and movements. However the resident #6 referred that from 1:35 am thru 6:00am he did not received change of position and pain medications. The Fall care plan establishes the following: i. Provide rounds every two hours to three hours and / or more frequent in patients identified at risk. However the resident #6 referred that the nursing staff did not come to the room from 1:35 am thru 6:00 am. The Pressure Ulcer care plan establishes the following: i. Perform interventions aimed at preventing the development of area and pressure ulcers ii. Promote and reposition every two hours iii. Keep the skin dry, clean and lubricated iv. Educate the resident and family about the treatment of [REDACTED]. However the patient referred that the nursing staff did not reposition him after 1:35 am thru 6:00 am. He also states that he vomited and the nursing staff did not come to the room to clean him. According to telephone interview with the Resident #6 on 5/31/17 at 9:52 am, he stated: I really do not have much to tell because I have nothing against those people. I was complaining of pain and discomfort and the nurses came and treated me roughly. They also told me two comments that were not pleasant and made me feel bad and like I was not welcome. One of the nurses said she would not come to the room until it was 4:00 am. The other nurse said that I had only come to the facility for physical therapy and nothing else. I felt bad and could not move to change my position that already bothered me. I needed to change my position, which would have alleviated the pain a little. The pain became so strong that it made me vomit several times. It was not until 6:00 am that I was given pain medication, almost 4 hours after I complained. Sometimes the pain caused by the ulcer was linked to the pain caused by a surgery that was recently performed. I also suffer from pain from not being able to evacuate. In the end I decided to call my wife who was sleeping at home so she could help me. So she came to the facility at about 4:30 am and helped me clean up, change my position and fix my bed. The nurses did not come. The patient in the bed and his wife witnessed how much I called to the nursing station and all my episodes of vomiting. We waited for the shift supervisor to arrive in the morning and we complained to her. After she intervened the nurses treated us better. According to telephone interview with the wife of Resident #6 on 5/31/17 at 9:30 am, she stated: That day when the situation occurred, it seems that the nurses did not have much staff or they had their situations. My husband called me crying about 4:00 am, and he said he was being mistreated. Immediately I got dressed and went to the facility. I got there at about 4:30 am, I found my husband lying in bed with disorganized bed sheets, without pillow, with vomit, and pain. He told me that the nurses had mistreated him. He told me that at 1:35 am he called the nurses to help him because he was in pain and he was vomiting. When the nurses arrived to the room they helped him but they were very rough in providing the care to my husband. The two nurses told him inappropriate comments. One of the nurses said: I have many patients, do not bother anymore and the other nurse said: You just came here for physical therapies, and nothing else. My husband is an elderly person and has recently had an open heart surgery and that still causes him pain. He also suffered from a stroke during the surgery. I decided to help my husband myself and not disturb the nurses, but as soon as the supervisor came to the unit I went and filled the complaint form. After that day they continued to attend my husband and there was no further problems. The wife of the resident next to my husband heard everything. She testified in the complaint investigation of the facility. The most annoying thing to my husband was the rough treatment and the inappropriate comments of the nurses in charge of him. 4. The facility's grievance and complaint registry was reviewed on 5/24/17 at 10:30 am, the following was found: a. There was found evidence that two residents (resident #6 and #7) filed a grievance report on 4/6/17. b. During review of the Facility's complaint investigation for resident #6 complaint was found the following: i. The resident's #6 wife referred: The resident called at 1:35 am the nurse, employee #11 comes to the resident's room and he asked her to change his position, as per physician's orders [REDACTED]. She did the change but in a rude attitude and nurse said to my husband I will not come back until 4:00 am. Resident called back before that time because was in pain. The nurse delay; he had so much pain that he vomited. At 4:30 am I entered to the room and found my husband on the bed without linen and without pillow. Also, my husband alleges that one of the nurses told him you came here for therapy, not for anything else. c. During review of the Facility's complaint investigation for resident #7 complaint was found the following allegations: i. The resident reported what had happened to her tearfully. ii. During the night resident #7 called the nursing staff on multiple occasions for assistance with the bedpan. iii. The resident #7 referred that in one occasion urine was spilled to the bed and the nursing staff, the RN (Employee #1) and LPN (Employee #2) cleaned and changed the bed sheets. However they performed the care in a rough manner that was uncomfortable to the resident #7. iv. The resident #7 referred that on the last time that the LPN (Employee #2) assisted her with the bedpan the LPN (Employee #7) told her: I am going to train you so you can use the bedpan by yourself because you are calling too much. v. The resident asked to the LPN (Employee #7) for another sheet, however she never received it. vi. The resident informed that nursing staff left the bedpan under the patient and the she had to remove it by herself and she put it on the eating table beside the tooth brush that had been for oral care. She states that the nursing staff did not cleaned the area. vii. The resident #7 referred that one of the nurses (Employee #1 and #2) talked to her in a loud tone and with courage. d. During review of the facility complaint investigation interviews was found that resident #9 was in the same room as resident #7, and he referred: all that my roommate said is true. My roommate was educated and cooperative, but the nursing staff talked to her like they were mad with her and in a loud voice. One of them told to my roommate that she was going to train her to use the bedpan on her own. e. During review of the nursing staff roster was found evidence that from 4/6/17 thru 5/25/17 the RN (Employee #1) and the LPN (Employee #2) were working in the same unit that the resident #6 and #7. The facility maintained the resident #6 and #7 at risk of service interruption, restrictions and other forms of retaliation. Also, all other residents were exposed to abuse and neglect (census: 11 residents). 5. During review of the two facilities complaint investigation that started on 4/6/17 and was completed on 4/18/17 was found evidence that the facility's conclusions were the following: a. They found that the nursing staff (Employee #1 and #2) did not perform the correct nursing interventions with residents #6 and #7. b. They found that the nursing staff (Employee #1 and #2) had bad attitude and behavior towards the resident #6 and #7. c. The facility proceeded to send letters to inform the resident #6 and #7, and the nursing staff (Employee #1 and #2) related to the event of the facility's resolution of the investigation. d. The facility provided re-education to the LPN (Employee #2) related to Abuse and Neglect policy on 5/16/17 because she had previous involvements on related events; however the RN (Employee #1) was not re-educated. According to interview with the Quality and Risk Management Director (employee #6) on 5/24/17 at 10:30 am, she stated: The manner in which complaints and complaints are investigated in the facility is that as soon as we receive the report is send to the unit where the situation related to the complaint occurs. The unit's director and staff are responsible for conducting the interviews and then the interviews are evaluated by the hospital's grievance evaluation committee. The skilled nursing facility does not have its own committee for investigating complaints and grievances. After the committee evaluates the interviews, it sends its recommendations and the skilled nursing facility performs them. The abuse and neglect course was offered this year to all staff. According to interview with the Director of Nursing (employee #14) on 5/25/17 at 9:33 am, she stated: I have knowledge of both of the complaints. The practical nurse was reoriented about out abuse and neglect policy. The registered nurse received a warning. We do not have the habit of removing our staff from the unit during the period of an investigation. According to interview with the Administrative Supervisor (employee #3) on 5/25/17 at 2:00 pm, she stated: The two complaints were investigated at the same time, because they happened the same night. Nurses were interviewed because they had not performed the correct nursing interventions in the management of both patients. One of the patients was presenting clinical changes that required skilled nursing management and coordination with the doctor. One of the nurses denied that the patient was vomiting during that night; however I went to the room and noticed that there was a bag for vomiting that was given to the patient by the nurses. As part of the process after I formally receive the patient's complaint I interview the staff of the unit and those affected. I then deliver the interviews and evidence to the hospital's grievance evaluation committee so they can evaluate it and give the suggestions to follow. According to interview with the physician (employee #15) on 5/25/17 at 2:30 pm, he stated: That patient I remember very well, came without being able to walk to the unit. I have no complaints from him, although I am aware that the resident complained to the nursing staff. My intervention in the care of the residents is clinical, the part of complaints and quarrels are handled administratively. But I understand that while investigating an employee of the facility for abuse and neglect should be removed as the administration understands the unit. This would be the right way to protect and prevent all residents including the complainer. So that person will have no contact with the staff of the facility. I know there is a complaint investigation committee in the hospital but I do not belong to it. 6. During the facility Abuse and Neglect policies and procedures (P&P's) on 5/24/17 at 11:10 am was found that the facility failed to have a mechanism that protects and prevents from abuse and neglect the resident a filled a grievance and all other residents during the investigation processes. A Statement of Deficiency was provided to the facility on [DATE] at 4:25 pm notifying the IJ and requesting a Plan of Correction (P[NAME]). The facility provided a P[NAME] on 5/25/17 at 6:00 pm as follow: General instruction and corrective Actions: 1. The policy and procedure will be amended to include safety measures to prevent exposure of abuse and neglect to other residents meanwhile the investigation process is completed 2. The personnel involve in the allegation will be remove immediately from the skilled nursing facility until the allegation is fully investigated 3. As immediate corrective action the two (2) nurses were remove from the facility 4. The policy will be amended to shorten the time of the investigation when abuse or neglect allegation are suspected The P[NAME] was accepted by the surveyors on 5/25/2017 at 6:05 pm. A mechanism establish by the facility to ensure and protect the residents and to be used with the staff being investigated. During the abuse and neglect investigation process, the Abuse and Neglect Detection and Prevention program was reviewed on 5/24/17 at 11:10 am and it was found that the program, standard and procedure during an employee's investigation that is being investigated for abuse or negligence does not indicate what action to take with the employee during the investigation. No action was provide to protect the resident and / or other residents admitted during the investigation. It was also found during the review of the policies that do not have an independent committee from the hospital to carry out investigations of the cases that occur in the Skilled nursing home. Interview with) 5/24/17 at 9:30 am state I did not participate in the investigations of the complaints; Director of Nursing (employee #14 that is done by the Department of Legal Affairs of the hospital. Interview with the Administrative supervisor (employee #3) performed on 5/24/17 at 1:00 pm she cite: I do part of the investigation, I present it to the committee of complaints from the hospital and I only hear the decision that they take. I do not take decisions in that committee. This committee attends to all complaints from both the hospital and the Skilled Nursing",2020-09-01
49,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,241,E,1,1,NJQB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on a recertification extended FOSS survey and complaint investigation PR 598, record review, facility's grievance report, and observations during ulcer care with the Register Nurse (RN) (employee #10) and investigation of 2 complaint performed by 2 residents with the Administrative Supervisor (Employee #3) performed on 5/22, 5/23, 5/24, and 5/25/17, it was determine that the facility failed to ensure that residents are treated with respect and dignity during delivery of nursing care, for 2 out of 13 residents (Resident #4 and #6). Findings include: 1. Resident #6 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident #6 was discharge home on 5/18/17 at 12:50 pm. The close record review was performed on 5/25/17 at 2:00 pm. 2. During review of the compliant investigation performed on 5/24/17 at 10:30 am provides evidence that on 4/6/17 the Resident #6 filled a grievance. 3. During review of the facility compliant report provided evidence that the resident #6 referred that when the RN (Employee #11) went to room [ROOM NUMBER]A on 4/6/17 at 1:35 am she stated: I will not come back until 4:00 am. 4. During review of the facility compliant report provided evidence that the resident #6 referred that when the practical nurse (LPN) (Employee #12) went to room [ROOM NUMBER]A on 4/6/17 at 1:35 she stated: you only came to this facility for physical therapy and nothing more. During telephone interview with the resident #6 on 5/31/17 at 9:52 am, he referred: Those two comments made me feel like if I am annoying them and unwelcome. 5. The resident #6 referred on the grievance report that during 1:35 am thru 4:00am he called the nursing staff on multiple occasions because his bed position had cause him to have pain in the sacral ulcer area, and that produced repeated vomit episodes. 6. During review of the facility compliant investigation report performed on 5/24/17 at 10:30 am, the interview of the resident #6's wife provided evidence that the resident #6 called her for assistance, and that she came to the facility on [DATE] at 4:30 am. She referred on the report that she found her husband lying in bed with disorganized sheets and without pillow, and that the resident #6 was dirty with vomits that she cleaned without nursing assistance. 7. During review of the facility compliant report performed on 5/24/17 at 10:30 am provides evidence that the resident #8 and he's wife were witness that the resident #6 was calling the nursing staff because of the pain and that they heard him vomiting constantly. They referred that they did not hear the nursing staff entered to the room to take care of the resident, they only heard the patient's calls for help and assistance. 8. During review of the Minimum Data Set (MDS) report of 4/4/17 on section G0110. Activities of Daily Living (ADL) Assistance on 5/25/17 at 3:12 pm provides evidence that the resident #6 is total dependent on bed mobility and that includes how resident moves to and from lying position, turns side to side, and positions body while in bed or alternate sleep furniture. The resident #6 needs full staff performance every time in bed mobility, one personal physical assist. The facility failed to ensure that residents are treated with respect and dignity during delivery of nursing care. 9. A mechanism to ensure that residents are treated with respect and dignity during delivery of nursing care related to knocking the door before entrance to the resident room. a. During the observation of ulcer care on 5/24/17 at 10:37 am with the RN (Employee #10) on room [ROOM NUMBER]A it was observed that the RN (employee #10) entered to the resident #4 room without knocking the door and requesting permission to enter. The facility failed to ensure that residents are treated with respect and dignity during delivery of nursing care.",2020-09-01
50,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,254,E,0,1,NJQB11,"Based on a recertification FOSS survey, observations made during the survey and group interview, it was determined that the facility failed to ensure that linens are in good condition. This could affect 2 of 13 admitted . (Rooms #309-A and #311-B) Findings include: 1. During the initial tour performed on 5/23/17 at 9:00 am it was found that rooms #309-A and #311-B the linen was observed with old stains. Interview performed on 5/23/17 at 1:45 pm to Administrative Supervisor (employee #3) reveals that the facility have a contract for the laundry. Our personnel have to check the sheets before dress the beds.",2020-09-01
51,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,309,L,1,1,NJQB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on a standard/extended FOSS and complaint investigation PR 598 survey conducted on 5/22, 5/23, 5/24, and 5/25/17, seven records review (RR), and review of policies and procedures (P&P's), it was determined that the facility failed to provide the necessary care to assess and manage pain of residents who had more than one medical comdition to ensure that residents (R) reach their highest practicable well-being for 1 out of 7 sample selection residents (R #6). Findings include: 1. Resident #6 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident #6 was admitted for physical therapy, occupational therapy and wound care. The resident #6 was discharge home on 5/18/17 at 12:50 pm, having a length of stay of 51 days in the facility. The close record review was performed on 5/25/17 at 2:00 pm and the following was found: a. The Minimum Data Set (MDS) report of 4/4/17 on section G0110. Activities of Daily Living (ADL) Assistance on 5/25/17 at 3:12 pm provides evidence that the resident #6 is total dependent on bed mobility and that includes how resident moves to and from lying position, turns side to side, and positions body while in bed or alternate sleep furniture. The resident #6 needs full staff performance every time in bed mobility, one personal physical assist. b. The Minimum Data Set (MDS) report of 4/4/17 on section J0100 Pain Management on 5/25/17 at 3:12 pm provides evidences that the resident #6 is received scheduled pain medication regiment, received PRN pain medication or was offered and declined, pain is suffered occasionally, the worst pain event during the last five days was 8/10 and severe. c. During review of the nursing notes of 4/6/17 was found incongruence between the pain documentation of the nursing staff and what the patient referred. The nursing note provides evidence that the patient did not had pain, however the patient referred that he had such pain that caused him vomiting episodes. d. During review of the nursing notes of 4/6/17 was found evidence that the nursing staff did not included in her note information related of the resident #6 clinical changes and needs. e. During the Change of position form of 4/6/17 provides evidence that the nurse change the patient position at 12:00 am, 2:00 am, 4:00 am, and 6:00 am. However the patient referred that the nursing staff did not perform any changes on position after 1:35 am thru 6:00 am. f. During review of the Facility Re-assessment of Pain form was found evidence that the nursing staff documented the pain scale on 4/6/17 at 12:00 am (0/10), 4/6/17 at 4:00 am (0/10), and 4/6/17 at 6:00 am (5/10). However the resident #6 referred that the nursing staff did not come to the room from 1:35 am thru 6:00 am and that he was suffering of pain during that time. g. During review of the Medication record was observed that the patient received [MEDICATION NAME] 5/325 mg 1 tab Oral (PO) every 3 hours when needed (PRN) for pain on 4/3/17 at 9:00 am and 9:50 pm, 4/4/17 at 10:00 am and 5:30 pm, 4/5/17 at 10:00 am and 5:00 pm. However from 4/5/17 at 5:00 pm thru 4/6/17 at 6:00 am (11 hours) the patient did not received medication for pain during eleven hours. The patient referred during interview that he had such pain that caused him vomiting episodes. h. During the medical order reviews was found evidence of a telephone order from the physician of [MEDICATION NAME] 5/325 mg 1 tab PO PRN every 3 hours for pain. The medication was administered on 4/6/17 at 6:00 am. i. During the interdisciplinary group notes was found evidence that RN employee #10 oriented the resident #6 about the importance of position changes every 2 hours and to avoid the pressure on the affected area. j. During review of the nursing care plans was found evidence that the Pain, Fall, and Pressure Ulcer care plans were open. 2. The Pain care plan establishes the following: a The use of therapeutic modalities for the pain management and pain control like: Positioning. b. Administer medication according to medical order for pain management. c. Pain note in clinical file must include: sounds, complaints, facial expressions, and movements. The resident #6 referred that from 1:35 am thru 6:00am he did not received change of position and pain medications. 3. The Fall care plan establishes the following: a. Provide rounds every two hours to three hours and / or more frequent in patients identified at risk. The resident #6 referred that the nursing staff did not come to the room from 1:35 am thru 6:00 am. 4. The Pressure Ulcer care plan establishes the following: a. Perform interventions aimed at preventing the development of area and pressure ulcers b. Promote and reposition every two hours c. Keep the skin dry, clean and lubricated d. Educate the resident and family about the treatment of [REDACTED]. 5. During the complaint investigation PR 598 of the resident #6 it was found the following: a. The resident #6 called the nursing station for help in bed mobility on 4/6/17 at 1:35 am. The Registered Nurse (RN) (Employee #11) went to the room and helped him; however she did it with a rude attitude towards him. b. The resident #6 referred that when the RN (Employee #11) went to room [ROOM NUMBER]A she stated: I will not come back until 4:00 am. c. The resident #6 referred that when the practical nurse (LPN) (Employee #12) went to room [ROOM NUMBER]A she stated: you only came to this facility for physical therapy and nothing more. d. The resident #6 called the nursing station on multiple occasions for help and assistance in bed mobility because he was in pain caused by the sacral ulcer and a previous surgery. The pain caused that the resident suffer from vomit episodes. The resident referred that the nursing staff did not return to the room anymore. e. The resident #6 referred that he made a telephone call to his wife at approximately 4:00 am and she arrived to the facility on [DATE] at 4:30 am. The report of the complaint provides evidence that the wife of the resident #6 found him without bed sheets, with pain, and dirty with vomit to which she had to clean without nursing assistance. 6. The facility failed to manage pain to residents who had more than one active medical condition (pressure sore, status [REDACTED].",2020-09-01
52,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,371,L,0,1,NJQB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a standard and extended FOSS survey for recertification, observation tour at the Kitchen and interview with administrative dietitian (employee #1) Safety Officer (employee #9) and Physical Plant engineer (employee #5) on 5/22, 5/23, 5/24, and 5/25/17 it was determined that the facility failed to prevent patients from harm. This constitutes an Immediate Jeopardy to 9 out of 9 residents (R) admitted at the facility. (R #1 to R#9) Findings include: Observational tour at the Kitchen perform on 5/22/17 at 10:15 am until 12:30 pm, it was found that the facility failed to establish effective infection control precautions to avoid widespread nosocomial infections. The cold storage room is located at the ground floor of this facility. During the observational tour it was found the following: 1. The cold room was found to be out of the temperature range, temperature taken revealed that the cold room was at 75 degree Fahrenheit ( F) 2. The air condition unit of the cold room not functioning and the console did not have cover on with rust and dust that was falling over the counter where the meat is prepared, 3. The vegetable refrigerator had mold around the gaskets and with white mold on the fans 4. A tray of coleslaw and three trays of cantaloupe uncover and without label in front of the refrigerators fans 5. Two refrigerators inside the cold room were filled with mold on the walls and ceilings 6. It was observed that five boxes of 10 pounds of pork chop, five boxes of 10 pounds of turkey, three boxes of 8 pounds of meat, and 8 boxes of 1 pound of chicken were left thawing on the preparing table at 75 'F. The boxes were not label. According to interview with the kitchen staff (Employee #2) on 5/22/17 at 10:30 am, he stated: Those boxes of meats are for production and are to be prepared. The meats were brought early today at 8:30am. They should have been labeled. According to interview with the engineer (employee #5) at 11:45 a.m. he state; Yes I know the situation and we are working on it. It is supposes that for this Friday the air conditioner of the cold room is ready. After that the other air conditioners consoles will be fix it. According to interview with the Dietitian (employee #1), at 10:35 am she state: I reported on this situation since February. Temperatures started to be out of parameters in the Formula room and in the Cold room since February. I have been reporting this situation to the physical plant department and my boss has also mentioned it in the Quality meetings. A Statement of Deficiency was provided to the facility on [DATE] at 2:15 pm notifying the IJ and requesting a Plan of Correction (P[NAME]). The facility provided a P[NAME] on 5/22/17 at 3:30 pm as follow: General instruction and corrective Actions: 1. A portable Air Conditioner will be installed on the Formula Room and the Cold room to reach the adequate temperature 70 degrees. 2. The DL Refrigeration Service Company will provide service to install the covers at the air conditioner console. The labor will be completed on Friday. 3. The vegetable fridge fans will be cleaned immediately by terminal cleaning. 4. Tray of [NAME] slaw and other trays will be cover with Zaron Wrap and labeled with preparation date. 5. The refrigerator and the freezer on the cold room will be cleaned by terminal cleaning including the wall and the ceiling. An onsite visit was performed on 5/23/2017 at 11:15 am to the Kitchen's cold room The P[NAME] was accepted by the surveyors on 5/22/2017 at 3:48 pm. Based on a standard and extended FOSS survey conducted on 5/22, 5/23, 5/24, and 5/25/17 for recertification, the kitchen observational tour, review of official documents and interview with the Nutrition Director (employee #1) and Physical plant director (employee #5), it was determined that the facility failed to ensure a safety place for the store, prepare and serve food under sanitary conditions which can affect 9 of 9 admitted residents (R). (R#1 to R#9) Findings include: 1. During observational tour performed on 5/22/17 at 10:05 am thru 12:05 pm it was found in the following: a. One can of plum of 104 ounces was dent and was located on the active food storage. Was immediately remove by the food storage supervisor (employee #4) b. On the lacteous refrigerator was observed a leak of water that fell on the bottles of milks that were in plastic baskets. The bottles of milks were observed wet. c. On the lacteous refrigerator was observed that boxes of eggs were wet with the splash of the water leak from the refrigerator's air conditioning unit. d. On the bread refrigerator was observed a water leak from the air conditioning unit and water on the floor. The shelves in this refrigerator had rust. e. The air conditioning units from the cold room where not functioning and had not the covers on. It was observed that the facility was using two portable air units that were maintaining a temperature of 75'F. The drainage of the portable air conditioning units was leaking water to the floor. f. It was observed five boxes of 10 pounds of pork chop, five boxes of 10 pounds of turkey, three boxes of 8 pounds of meat, and 8 boxes of 1 pound of chicken that were left on the preparing table inside the boxes at 75'F. The boxes were not label. During interview with the kitchen staff (Employee #2) on 5/22/17 at 10:30 am, he stated: Those boxes of meats are for production and are thawing to be prepared. The meats were brought early today at 8:30am. They should have been labeled. Facility fails to ensure that the regulations establish method to safely thaw frozen food are follow. g. On the second refrigerator of the cold room was observed one tray with 9 Egg beaters of 32 ounces, one of the egg beater box was broken causing a spill of 32 ounces of egg beater all over the tray. h. On the second refrigerator of the cold room was observed a bag of grated cheddar cheese that was opened and without label. i. On the cabinets of the cold room was observed a meat grinder that was uncover, on top of a piece of box, and with white stains. Also, was observed a food crusher that was uncover and on top of a tray that was with dust and white stains. During interview with the kitchen staff (employee #2) on 5/22/17 at 10:45 am, he stated: The meat grinder and the food crusher are not being used. They were cleaned and storage there. j. On cold room was observed that kitchen staff (employee #2) was peeling potatoes from a carton box and inside the box was a partially peal potato with all the pieces of the potato peel. It was observed that right next to the carton box was a tray with uncover vegetables. k. On cold room were observed two carton boxes on top of kitchen materials, the kitchen staff (Employee #2) removed them immediately. The performed a change of gloves and hand wash, however he shake the hands to remove the excess of water and then dried hands with paper. The facility failed to ensure that the kitchen staff performs hand hygiene in accordance with the Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene and Glove Use (CDC, 2002) in Healthcare Settings. l. On cold room were observed green and black stains on the floor next to the refrigerators and freezer. m. In the kitchen tour were observed nesting pans, the pans were observed stacked upside down one on top of the other and they were found wet with an accumulation of water. n. On the snack refrigerator was observed bag of American cheese and a bag of turkey jam that were opened and not label. o. On the cabinets use to store the snack food were observed 4 bags of crackers (galletas exporsodas) and 2 bags of vanilla crackers that were not label. p. The refrigerator use to storage the apples, juice box, milks, milk supplements, Jell-O, yogurt, and butter while stoking the line trays was observed on 5/23/17 at 12:15 pm and maintained a temperature of 67degree Fahrenheit ( F). The yogurt internal temperature was measure and showed that it was 65.3 F. However the facility provided evidence that the immediately removed the food from that refrigerator that was expose to high temperatures to prevent residents of potential hazard food. The facility failed to store, maintain, and prepare food in a safe and sanitary manner related to maintaining food at or below 41 F. q. A sample tray was evaluated on 5/23/17 at 11:20 am and showed the following temperatures out of recommended range: (i) Rice: 132.3 F (ii) Turkey: 126.4'F A sample tray was the evaluated on the kitchen on 5/23/17 at 12:00 pm and showed the following temperatures out of recommended range: (i) Rice: 137.4'F (ii) Turkey: 124.4'F The facility failed to store, maintain, and prepare food in a safe and sanitary manner related to maintaining food at hot holding temperature of 135'F to prevent the growth of infectious organisms.",2020-09-01
53,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,441,F,0,1,NJQB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a standard and extended FOSS survey conducted on ,[DATE], ,[DATE], ,[DATE], and [DATE] for recertification, observational tour, and interviews, and review of policies and procedures (P&P's), it was determined that the facility failed to established an accurate mechanism for preventing, investigating and reporting infection control issues for all residents (R ). (R#1 to R#13) Findings include: 1. During medication pass with registered nurse (RN) (Employee #13) on [DATE] at 9:05 am thru 10:10 am was observed that the RN (Employee #13) poured liquid soap over her dried hands, opened the faucet, and then wet her hands. When finish washing hands the RN (Employee #13) was observed to remove the excess of water by shaking the hands, and then used a paper towel to dry both hands. During review of the Hand Wash P&P's perform on [DATE] at 9:53 am related to the hand wash procedures, establishes the following on item #1 and #6: a. Item #1: Moisten your hands and apply enough soap. b. Item #6: Dry your hands using paper towel. However, the facility failed to ensure that all nursing personnel follow these steps and to follow the hand washing techniques according the Centers for Disease Control and Prevention (CDC). 2. During medication pass with registered nurse (RN) (Employee #13) on [DATE] at 9:05 am was observed that the RN (Employee #13) discarded [MEDICATION NAME] DM 10ml and Xarelto 10mg tab in the residents room (310B) trash can after the resident referred that he did not wanted the medication because he felt nausea. During interview with the Clinical Nurse Supervisor (Employee #7) on [DATE] at 10:30 am, she stated: The nursing staff should discharge those unused medication on the medication car trash can, to avoid that any disoriented residents can have access to them. 3. During medication pass with registered nurse (RN) (Employee #13) on [DATE] at 9:12 am was observed that the RN (Employee #13) cut a [MEDICATION NAME] 5 mg in half according to physician's orders [REDACTED]. During interview with the Clinical Nurse Supervisor (Employee #7) on [DATE] at 10:30 pm, she stated: When the pharmaceutical department send us a tablet presentation with a different dose we have to cut it. That is not common here; the usual practice is that they have the medications according to the physician's prescription. In case that we would have to cut a pill and the cuter is dirty the nursing staff should clean it. That practice would avoid adverse reactions. 4. During the narcotic medication box with RN (Employee #13) on [DATE] at 3:20 pm was observed two wooden boxes containing the medications. The facility failed to have boxes to maintain the medications in the narcotic box that are made of non-porous and easy to clean and disinfect. 5. During review of the crash cart with Clinical Nursing Supervisor (Employee #7) on [DATE] at 4:35 pm was found that on the top drawer was a Hilo oral/nasal Tracheal Tube Cuffed with an expiration date of ,[DATE] and lot number 0391x. On the first, second, and third drawer of the crash cart was observed dust particles and hairs. During interview with the Clinical Nurse Supervisor (Employee #7) on [DATE] at 4:50 pm, she stated: That expired tracheal tube was not supposed to be there, I will remove it immediately. I will also have this crash cart clean.",2020-09-01
54,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,455,F,0,1,NJQB11,"Based on a recetification FOSS extended survey, tests to equipment, maintenance documentation and observations made during the survey for Life Safety from fire with the Safety Officer (employee #9), it was determined that the facility does not meet some applicable provision of the 2012 edition of Life Safety Code of the NFPA 101 which could affect 13 out of 13 admitted residents (R) .(R#1 to R#13) Findings include: The Life Safety from Fire survey was performed from 5/24/17 from 9:45 am until 11:40 am with the Safety Officer (employee #9); for deficiencies related to Life Safety from fire (form 2786R) please see tags with letter K on the 2567 (10/2016) form (K0712).",2020-09-01
55,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,465,F,0,1,NJQB11,"Based on a recertification FOSS survey, tests, observations, review of documentation policies/procedures and interviews with personnel and residents made during the physical environment survey, it was determined that the facility failed to ensure a safe and functional environment affecting 13 out of 13 admitted residents (R). (R#1 to R#13) Findings include: 1. During observations of the physical therapy room on 5/24/17 from 9:45 am through 11:15 am it was found: a. Bathroom of Room # 307 is was observed in the bath tub area a hole in the shower. Painting the bare walls. Accessories deteriorated. b. Resident Room bathroom #308 accessories deteriorated and putty on the wall exposed. c. Resident room #308-B the closet door is uneven and not permit a complete close. d. Residents' room #318 the nursing call system lamp in front of the door do not have the cover. e. Bath floor tiles with old stains in resident rooms # 309, # 310, # 311, # 315, # 316 and # 317.",2020-09-01
56,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,490,C,1,1,NJQB11,"> Based on a standard and extended FOSS survey for recertification, complaint investigation PR 598, observation, interviews, policies and procedures, and record review performed on 5/22, 5/23, 5/24, and 5/25/17, it was determine that the facility failed to ensure that the facility is administered in a manner that enabled each resident to attain or maintain their highest practicable well-being for all residents.(R#1 to R#13) Findings include: 1. Deficiencies in Resident Behavior and Facility Practice, Quality of Life, and Quality of Care were identified on survey procedures on 5/22, 5/23, 5/24, and 5/25/17 and were defined as substandard quality of care. 2. During standard and extended FOSS survey for recertification, complaint investigation PR 598 perform on 5/22, 5/23, 5/24, and 5/25/17 to review compliance with all the tags within this section ( 483.70) deficiencies were found in the following tags: F 492- Compliance with federal, state and local laws and professional standards. F 514- Clinical records F 518- Emergency procedures 3. Evidence that facility governing body ensures that facility complies with all Administration requirements established in State Operations Manual Appendix PP for Long Term Care Facilities was not provided. 4. The facility failed to be aware of deficiencies in the areas of Resident Behavior and Facility Practices, Quality of Life, Quality of Care, Dietary Services, and Administration, the Administrator failed to take effective steps to prevent and correct these deficiencies and assure that each resident received the care they needed. 5. The findings of the survey conducted on 5/22, 5/23, 5/24, and 5/25/17 revealed Actual Harm and Substandard Quality of Care in Quality of life and Resident Behavior and Facility Practices. 6. Observation, interviews, and record review during the survey of 5/22, 5/23, 5/24, and 5/25/17 revealed that residents sustained actual harm when care was not provided as needed. Substandard quality of care had the potential to affect all residents relative to the development and implementation of abuse/neglect policies. (Cross reference: Tag F226, F309, and F371) 7. Deficiencies were identified in the areas of Resident Behavior and Facility Practices, Quality of Life, Quality of Care, Dietary Services, Pharmacy Services, Infection Control, Physical Environment, and Administration. (Cross reference: F226, F241, F254, F309, F371, F441, F455, F465, F492, F514, and F518).",2020-09-01
57,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,492,F,0,1,NJQB11,"Based on the review of personnel credential files (CF) at the extended FOSS survey performed on 5/23/17 from 2:00 a.m. thru 4:30 p.m., it was determined that the facility failed to ensure that 3 out of 5 Licensed Practical Nurses, 6 out of 13 Registered Nurses, 6 out of 22 Nutritional Department employees comply with facility, state and federal laws. (CF#1, #3, # #6, #8, #11,#12, #13, #16 and #18) Findings include: 1.It was found that 6 of 22 CF failed to show a Health Certificate,(CF # 3, #6, #11, #13, #16 )(Kitchen Personnel) and CF # 3 (Nutritionist). 2. It was found that 6 out of 18 CF have evidence on the Influenza vaccine or refusal incomplete, (CF # 1, # 8, #12, #13, #16, and #18).",2020-09-01
58,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,514,F,0,1,NJQB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a standard and extended FOSS survey conducted on 5/22, 5/23, 5/24, and 5/25/17 for recertification, five records review (RR), and review of policies and procedures (P&P's), it was determined that the facility failed to maintains accurate, complete and organized clinical information about each resident, as observed in 1 out of 7 records reviewed (RR #5). Findings include: 1. Resident #5 is a [AGE] years old Female admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 5/22/17 at 2:00 pm it was found the following: a. The physical therapy progress note of 2/11/17 was not counter signed by the physical therapist. b. During review of the occupational therapy progress notes from 2/24/17 and 3/11/17 were not signed. c. During review of the occupational therapy progress notes from 3/3/17 documented that the patient had pain however did not documented the pain scale. d. During review of the physician medical orders a telephone orders was place on 2/9/17 at 5:00 pm and was signed by the physician on 2/10/17; however the physician did not include the time in which the telephone order was signed. During P&P's review related to Medical Orders in the skilled nursing facility on 5/22/17 at 2:30 pm was found evidence that item #1 states: 1. Telephone and verbal orders are accepted, they are to be signed by the physician during the 24 hour period since the order was made. The facility failed to ensure that the physician staff include the time in which the telephone order was signed to certify that was on the 24 hour timeframe. e. During review of the graphic sheets of 2/3/17 thru 3/6/17 was found evidence that the nursing staff failed to document the resident's weight. On the Weight Sheet Registry form was documented on 2/28/17 that the resident's weight is 128.6 pounds. However there is no evidence that the resident's weight was re-assessed. During P&P's review related to Weight assessment in the skilled nursing facility on 5/22/17 at 2:30 pm was found evidence that item #10 and #11 states: 10. Once the resident is admitted to the unit, the initial weight of the resident will be taken and documented in the nursing profile, the weekly weight on the weight record sheet. 11. If the resident refuses or cannot be weighed, documentation will be done on the weight record sheet. The resident will be heavy every Tuesday, and the weight should be documented on the weight record sheet the same day the weight is taken. However the facility failed to ensure that nursing staff perform and documents the weekly weight assessment according to facility's P&P's. f. During review of the Nursing Initial Assessment of 2/3/17 at 7:30 pm was found evidence that the height of the resident was not documented. g. During review of the Nursing progress notes was found the following: (i) Nursing note of 2/6/17: Skin care: Yes Skin appearance: Normal Skin integrity: Altered Wounds: Extremities Appearance: Close, dry, and granulating (ii) Nursing note of 2/7/17: Skin care: No Skin appearance: Normal Skin integrity: Altered Wounds: Hip Appearance: Close, dry and granulating (iii) Nursing note of 2/10/17: Skin care: No Skin appearance: Normal Skin integrity: Altered Wounds: Extremities Appearance: Close, dry and granulating There is inconsistency in nursing documentation related to whether or not the resident receives skin care and the location of the wound. During interview with the Administrative Supervisor (Employee #3) on 5/22/17 at 2:00 pm, she stated: There is incongruence on the nursing progress notes of 2/6/17, 2/7/17, and 2/10/17. The nursing staff will be re oriented of documentation related to skin care. The facility provides constant in-services related to documentation, ulcer classification, and other topics.",2020-09-01
59,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2017-05-25,518,F,0,1,NJQB11,"Based on review of the facility's in-service training for Emergency Preparedness during the rectification FOSS extended survey, it was determined that the facility failed to ensure that staff and employee are trained in emergency procedures and equipment to work in the facility which could affect 13 out of 13 admitted residents. (R#1 to R#13) Findings include: During the review of the facility's training manual, documentation and observation made of the physical environment on 5/24/17 at 2:45 pm, no evidence was found that nursing staff and employee are trained and competent related to defibrillator use in the event of an emergency and Green Code.",2020-09-01
60,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2018-07-27,550,E,0,1,Z15R11,"Based on observations and interviews the facility failed to provide meals in a dignified manner. The facility served meals to seven of eight sampled residents ((R) (R56, R57, R59, R60, R63, R64, and R104). The facility also failed to coordinate lunch meal delivery times to the seven residents in accordance with their physical therapy schedules. Findings include: On 07/24/18 at 10:00 AM, during the initial tour of the kitchen accompanied by the Dietary Supervisor (DS) and the Manager of Institutional Programs, the DS stated the facility was using disposable three-compartment cardboard containers (coated with a thin layer of plastic on the inside) to serve hot food in to the residents. The cold food items were observed to be placed in brown paper bags along with a package of disposable plastic utensils and a napkin. On 07/24/18 at 11:10 AM, the lunch meals were delivered to the Skilled Nursing Unit. The hot food was in the disposable three-compartment containers which were heat-sealed with a plastic covering and were stacked in a bus tub. Each container had the resident's room and bed number written in black marker on the top. The brown paper bags which contained the cold food items were labeled with the resident name and were also in a bus tub. Two dietary aides delivered the meals to the resident's over-bed tables. The seven residents (R56, R57, R59, R60, R63, R64, and R104) were not in their rooms at the time the meals were delivered. The residents were in physical therapy on a different floor of the hospital. On 07/24/18 at 11:12 AM, the lunch meal for R57 was observed setting on the resident's over-bed table. The resident was not in the room at the time. The resident returned to her room at 11:45 AM. with her daughter and the daughter stated her mother had been in physical therapy. The daughter stated she re-heated her mother's food in the activity/dining room microwave when her mother was ready to eat. On 07/24/18 at 11:12 AM, the lunch meal for R65 was observed setting on the resident's over-bed table. The resident was not in the room at the time. At 1:15 PM the resident was observed in her room eating her lunch. She was asked if her food was hot, she stated the staff heat the food up for her. On 07/25/18 at 11:06 AM, the lunch meals arrived on the skilled nursing unit. Two dietary aides delivered the meals to the rooms of R56, R59, R60, R63, R64, and R104, (R57 had been discharged home) placing the three-compartment containers with hot food and the brown paper bag on the residents' over-bed tables. The six residents were not in their rooms at the time the delivery was completed at 11:12 AM. A visit to the physical therapy department at 11:15 AM revealed the six residents were receiving physical therapy at the time the meals were delivered. At 12:00 PM, the residents remained in physical therapy. Between 12:00 PM and 1:00 PM the residents were brought back to their rooms from physical therapy. On 07/26/18 at 7:47 AM, R 56 was observed in her room with her breakfast meal. She stated she had to be careful to remove the plastic covering from the hot food container because it would come off in pieces and fall in her food. She stated that if she tried to pull the plastic off too hard she was afraid the container would slide off the table. She also stated she disliked the plastic eating utensils. The resident stated she had asked facility staff about the use of the three-compartment containers and plastic eating utensils and they told her it was because of the hurricane (10 months ago). She also stated she did not think an older person could handle peeling the plastic off the food. In an interview with DS on 07/24/18, during the initial kitchen tour, the DS indicated the facility had only one elevator since the hurricane on (MONTH) 20, (YEAR), and although they had a machine for washing trays, the machine was not being used. On 07/27/18 at 10:00 AM, the Manager of Institutional Programs stated the facility had not identified meal delivery, during the time the residents were in physical therapy, as a concern.",2020-09-01
61,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2018-07-27,609,C,0,1,Z15R11,"Based on interview and record review, the facility failed to ensure its abuse and neglect prohibition policy included procedures for immediately reporting all alleged violations of abuse, neglect, exploitation, injuries of unknown source, and misappropriation of resident property to the State Survey Agency. This failure had the potential to affect all 14 residents, visitors, and facility staff. Findings include: Review of the facility's policy and procedure titled, Policy and Procedure for the Prevention of Abuse of Residents, revised 06/17, indicated the policy and procedure stated the Medical Director and the Skilled Nursing Administrator (SNA)will be notified of every complaint that may possibly be categorized as abuse and/or negligence, which will include serious harm, and will be reported 24 hours of the event. The policy did not include reporting to the State Survey Agency, nor did it include the reporting of misappropriation of resident's property. On 07/27/18 at 9:00 AM, an interview with the SNA and the Nursing Supervisor confirmed the policy for Prevention of Abuse to Resident's did not indicate that when allegations of abuse and/or negligence occurred with serious harm, the incident should be reported immediately, or within two hours of the incident. They also confirmed the policy did not address reporting of misappropriation of a resident's property.",2020-09-01
62,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2018-07-27,641,D,0,1,Z15R11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure one of eight sampled residents ((R) 60) Minimum Data Set (MDS), an assessment tool completed by the facility staff used to identify resident care problems and assist with care planning, was completed within 14 days of admission to the skilled nursing unit. Findings include: According to the MDS and Admission Records dated 06/29/18, resident (R)60 was admitted to the skilled nursing unit on 06/29/18, with [DIAGNOSES REDACTED]. Review of an MDS with a handwritten notation on the front page 07/13/18 14-day, revealed Section A 2300. Assessment Reference Date, (the end-point of the evaluation period) and Section Z0500: Signature of RN Assessment Coordinator Verifying Assessment Completion, were blank. An additional 28 sections of the MDS were also incomplete. On 07/26/18 at 9:22 AM, revealed the incomplete MDS was discussed with the Administrative Supervisor. She looked through the resident's clinical record and at the MDS and verified the 14-day comprehensive admission assessment MDS had not been completed by 07/13/18. Although the comprehensive assessment had not been completed, the clinical record revealed a comprehensive care plan had been completed for the resident.",2020-09-01
63,DAMAS HOSPITAL SNF,405023,2213 PONCE BY PASS,PONCE,PR,717,2018-07-27,655,D,0,1,Z15R11,"Based on interviews and record review, the facility failed to provide the resident with a written summary of their baseline care plan. This affected one of 12 residents (Resident (R)56) who did not receive a written summary of their baseline care plan. Findings include: On 07/24/18 at 1:14 PM, R56 was interviewed concerning her admission to the facility. The resident stated the staff had verbally reviewed her baseline care plan and the services she would be receiving while she was in the facility. R56 stated she did sign and acknowledge she was given a verbal summary of her care plan. She also stated she was not given a written copy of the baseline care plan. Review of R56's medical record revealed on 07/13/18 the resident had signed she was verbally given a summary of her baseline care plan. There was no evidence in the resident's record she was given a copy of the baseline care plan. In an interview with the Director of Nursing (DON) on 07/26/18 at 10:56 AM, the DON stated the staff review the admission care plans with the residents, have the resident sign the care plan, and will give them a copy if they ask for one. She also stated they do not have a policy/procedure for providing each resident with a copy of their baseline care plan.",2020-09-01
64,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,584,B,0,1,K21011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on recertification survey, observations and resident interview performed from 05/13/19 to 05/15/19, it was determined that the facility failed to promote comfortable environment which can affect 2 out of 20 admitted residents at the facility. (RS # 68 & RS #70 ) , Findings include: 1 . A mechanism to ensure each that facility promote comfortable environment in all areas where residents supports daily living activities was not performed accordingly with the following findings identified during survey procedures from 05/13/19 to 05/15/19: a. Resident of room [ROOM NUMBER]-B stated on interview on 5/14/19 at 1:30 pm that the patio porch ( terrace ) where facility offer recreative activities do not have a comfortable temperature. Porch had metal roof planks who accordingly with hot climate endure heat and sunlight. b. Resident #70 of room [ROOM NUMBER] B stated on interview on 5/14/19 at 1:00 pm that the patio porch (terrace) where facility offer recreative activities do not have a comfortable temperature. Porch had metal roof planks who accordingly with hot climate endure heat and sunlight.",2020-09-01
65,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,625,D,0,1,K21011,"Based on recertification survey, observations and resident interview performed from 05/13/19 to 05/15/19, it was determined that the facility failed to inform residents and relatives related with Notice of bed-hold policy and return which can affect 1 close record review case who was transferred to receive acute care ( Closed Record #13 ) Findings include: 1 . A mechanism to ensure each that facility provide residents and relatives with a notice ( written information ) that specifies the duration of the bed-hold policy before transfer to hospital was not performed accordingly with the following findings identified during survey procedures from 05/13/19 to 05/15/19: a. During review of closed case #13 on 05/15/19 at 2:45 pm it was identified that resident was transferred to receive acute care. No evidence was found during the review of the notice ( written information ) that specifies the duration of the bed-hold policy before transfer to hospital provided to resident or relative.",2020-09-01
66,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,655,F,0,1,K21011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification survey, review of twelve medical records and resident interview and the Director of Nursing ( employee #1 ) during a survey process performed from 05/13/19 thru 05/16/19, from 8:00 am thru 4:30 pm, it was determined that the facility failed to provide written care plan to residents/relatives as required by 483.21 (a) Comprehensive Person - Centered Care plan in tag F 655 of the State Operations Manual appendix PP -Guidance to Surveyors for Long Term Care Facilities. This deficient practice was identified in 8 out of 12 active cases reviewed. ( RS #64, #65 , #68, #69, #71, #72, #74, #75) Findings include: 1. A mechanism to ensure that facility provide residents with a copy of the baseline care plan developed within the first 48 hours of admission was not performed, accordingly with the following findings identified during survey procedures performed from 05/13/19 thru 05/16/19, from 8:00 am thru 4:30 pm: Four residents (R#64, #65, #68, #69) were interview during survey procedures and they stated that Facility did not provide a written copy of the baseline care plan developed the first 48 hours right after admission. During interview on 05/15/19 at 1:55 pm the Director of Nursing ( employee #1 ) stated that facility personnel discuss with residents and relatives the baseline care plan developed the first 48 hours right after admission. He also stated that facility did not implement a mechanism to comply with this requirement yet. He said that facility are in the process of design a format to document the information of the baseline care plan. b. Resident #71 of room [ROOM NUMBER]-B stated on interview on 5/14/19 at 11:07 am the resident stated that she participated in the initial care plan within the first twenty four hours of being admitted and sings it but did not receive a copy of it a. Resident #72 of room [ROOM NUMBER]-A, the resident was interviewed on 5/13/19 at 10:30 am and he said I participated in the care plan, the personnel discuss with me and explain all related to the plan and I sign the document however, the personnel did not provide a copy for me. c. Resident #74 of room [ROOM NUMBER]-B stated on interview on 5/13/19 at 11:15 am related to the participation in the initial care plan he said yes he signed the plan but the facility did not provide a copy of this plan to the resident. c. Resident #75 of room [ROOM NUMBER]-A stated on interview on 5/13/19 at 11:30 am that facility performed a plan of care in the first 24 hours and discuss with the resident the care plan however did not provide a copy to the resident in a first 48 hours right after admission.",2020-09-01
67,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,679,B,0,1,K21011,"Based on a recertification survey, observations, resident interview and interview with the Recreative Therapist ( employee #5 ) during a survey process performed from 05/13/19 thru 05/16/19, from 8:00 am thru 4:30 pm, it was determined that the facility failed to maintain the monthy recreative activities schedule information available in order to support residents in thier choice of activities. This deficient practice was identified in 6 out of 12 active cases reviewed. ( RS #70, #71, #72, #73, #74 and #75 ) Findings include: 1. A mechanism to ensure that facility maintain residents informed on an ongoing basis about recreative activities was not performed, accordingly with the following findings identified during survey procedures performed from 05/13/19 thru 05/16/19, from 8:00 am thru 4:30 pm: a.On 05/13/19 9:00 am it was identified that no monthly activity schedule were observed posted on resident's rooms. b. Six residents were interview during survey on 05/13/19 thru 05/15/19, from 8:00 am thru 4:30 pm and they stated that facility inform on daily basis recreative activities planned for each day. However did not maintain schedule available to be reviewed in order to determine potential to participate on individual and group activities. During interview on 5/15/19 at 11:45 am Recreative Therapist ( employee #5 ) stated that every day facility inform residents in relation with activities planned for each day. However no schedule is posted in residents rooms or on the skilled nursing facility surrounding areas. c. During observations in the initial tour and resident's interview in a survey process performed on 5/13/19 from 8:00 am thru 11:30 am, it was observed that the facility did not maintain the monthy recreative activities schedule information available in the residents rooms. Residents #70, #71, #72, #73, #74 and #75 did not have a monthy recreative activities schedule in their respective rooms. On 5/13/19 at 11:15 am the residents said during interview that they paticipated in the activities but no evidence of the activity monthly schedule in the resident rooms.",2020-09-01
68,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,689,D,0,1,K21011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on recertification survey, observations and resident and staff interview performed from 05/13/19 to 05/15/19, it was determined that the facility failed to promote environment free of accidents hazard as possible which can affect 1 out of 20 admitted residents at the facility. (RS # 64), Findings include: 1. A mechanism to ensure each resident receive adequate orientation to prevent accidents (fire) was not performed accordingly with the following findings identified during survey procedures from 05/13/19 to 05/15/19: a. Resident R#64 is a male patient admitted on [DATE] with a diagnostic of Discitis on the lumbar region. Resident was admitted to receive antibiotics. On 05/13/19 at 10:29 AM the resident smoked. However he is independent and moved outside only one time during shift to smoke on 05/15/19 at 08:43 AM The MDS coordinator ( employee # 1) stated during interview on 5/14/19 at 9:55 am that this resident has history as smoker, but when admitted to receive services he stated that he is not smoking. There are no evidence documented ( ej-progress notes ) were facility orient resident related with designated area to smoke and prevention of fire and accidents. 05/15/19 at 9:49 AM In the history and physical exam when resident was admitted stated to the MD that is a former smoker. In the Registered nurse RN admission history and physical examination [REDACTED].",2020-09-01
69,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,692,D,0,1,K21011,"Based on re-certification survey, observations and resident interview performed from 05/13/19 to 05/15/19, it was determined that the facility failed to ensure that input of residents related with offered sufficient fluids intake to maintain proper hydration and health, this deficient practice can affect 1 out of 20 admitted residents at the facility. (Resident Sample # 71). Findings include: a. On 5/13/19 at 9:45 am and on 5/14/19 at 10:27 am the resident #71 meal table was observed stuck to the wall in front of the resident bed. The resident says that she do not drink coffee because they bring her milk and the coffee separately, she has vision problems and only takes the milk because cannot mix them. She also said that they always leave the table away from her and she has problem to drink water. b. On 5/14/19 at 11:45 am it was observed that the resident had eaten the lunch alone and she said that the water was spill on her bed because it was difficult for her to hold the glass. It was observed a portion of food around her mouth. There was no presence of nursing staff assisting the resident. c. On 5/15/19 at 1:00 pm the resident was visit and she was interview related to the coffee and she said that the coffee is good. She said that the nurse's assisted her during the breakfast and meals and the table used for foods was observed clean. However, the table was maintain away from her reach of her hands, which makes it impossible for the resident to consume water when they want.",2020-09-01
70,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,803,D,0,1,K21011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on recertification survey, observations and resident interview performed from 05/13/19 to 05/15/19, it was determined that the facility failed to ensure that input of residents related with food preferences is considered in order to promote the rights of the resident to make personal dietary choices. This deficient practice can affect 1 out of 20 admitted residents at the facility. (Resident Sample #62) Findings include: 1. A mechanism to ensure that facility make reasonable efforts to meet resident food choices and preferences was not performed accordingly with the following findings identified during survey procedures from 05/13/19 to 05/15/19: a. RS #62 is a female resident [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. Dietitian perform initial assessment of resident on 5/11/19 and accordingly with information reviewed with register nurse (employee #11) on medical record on 5/15/19 resident stated that she does not like coffee. b. On 5/13/19 at 8:55 am refer that coffee is included in her tray as part of the breakfast and that she does not want to drink coffee because she does not like it. Resident state that she want to drink hot tea in the morning, no coffee. c. On 5/14/19 at 2:30 pm clinical dietitian was informed that resident is receiving decaffeinated coffee as part of the breakfast and she does not like it. d. On 5/14/19 at 8:08 pm clinical dietitian evaluate the resident to acquire information of choices and preferences and change the coffee in the breakfast for tea. e. On 5/15/19 at 8:30 am resident stated on interview that she receive again decaffeinated coffee as part of the breakfast and she does not like it. f. Resident want to drink hot tea in the morning, no coffee. 2. The facility failed to maintain reasonable efforts, to comply and take under consideration the input received from residents related with food preferences.",2020-09-01
71,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,806,D,0,1,K21011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on recertification survey, observations and resident interview performed from 05/13/19 to 05/15/19, it was determined that the facility failed to provide food that accommodates resident preferences. This deficient practice can affect 1 out of 20 admitted residents at the facility. (Resident Sample #62). Findings include: 1. A mechanism to ensure that facility is aware of resident preferences and provide an appropriate alternative when resident appears to refuse to drink items was not performed accordingly with the following findings identified during survey procedures from 05/13/19 to 05/15/19: a. RS # 62 is a female resident [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. Dietitian perform initial assessment of resident on 5/11/19 and accordingly with information reviewed with register nurse (employee #11 ) on medical record on 5/15/19 resident stated that she does not like coffee. b. On 5/13/19 at 8:55 am refer that coffee is included in her tray as part of the breakfast and that she does not want to drink coffee because she does not like it. Resident state that she want to drink hot tea in the morning, no coffee. c. On 5/14/19 at 2:30 pm clinical dietitian was informed that resident is receiving decaffeinated coffee as part of the breakfast and she does not like it. d. On 5/14/19 at 8:08 pm clinical dietitian evaluate the resident to acquire information of choices and preferences and change the coffee in the breakfast for tea. e. On 5/15/19 at 8:30 am resident stated on interview that she receive again decaffeinated coffee as part of the breakfast and she does not like it. f. The facility failed to observe breakfast services and identify a resident who appears to refuse drink items, and determine if she is offered the opportunity to receive substitutes.",2020-09-01
72,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,812,F,0,1,K21011,"Based on a recertification survey observational tour of the facility's kitchen during a survey process performed from 05/13/19 thru 05/16/19, from 8:00 am thru 4:30 pm, and interview with clinical dietitian ( employee # 7) it was identified that the facility failed to ensure frozen food are storage maintain in sanitary conditions. Findings include: 1. On 05/13/19 from 8:00 am through 8:55 am the following was identified during observational tour in the kitchen with the clinical dietitian: a.On the frozen meat freezer it was observed three or four boxes of frozen meat located directly on the floor rather than 6 inches off the floor.",2020-09-01
73,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,880,C,0,1,K21011,"Based on a recertification survey and observations and staff interview performed during the survey process from 05/13/19 thru 05/15/19, from 8:00 am thru 4:00 pm, it was determined that the facility failed to comply with accepted infection control precautions and standards of practice. Findings include: 1.A mechanism to ensure that facility maintain standard precautions during the management of ice to be used by residents , was not promoted not performed, accordingly with the following findings identified during survey procedures performed from 05/13/19 thru 05/15/19, from 8:00 am thru 4:00 pm, [NAME]On 5/13/19 at 8:00 a.m. till 4:30 p.m. true 5/15/19 at 8:00 am. till 4:30 pm. during the performed visual inspection on different resident's rooms and others areas of the skill nursing facility the following was found: 1. Residents rooms 101, 102, 103, 104, 106, 107, 108, 109, 110, 111, 112, 113, 122 and others areas corridors, offices and recreative areas of the skill facility was visit and it was observed dirty and deteriorate floor. 2. The designated area used for the personnel lunch located in front of the nurse station on 5/13/19 thru 5/15/19 during the recertification survey was observed the scale on the right side of the room and in the left side of the main entrance a resident food table was observed, on the top of this table a '' foam icebox with ice '' and near the foam icebox a stainless steel scoop place in the interior of a transparent small plastic bags '' was observed. On the lid of the ''foam icebox '' a sign indicating fridge for ice covers. The Infection Control Nurse (employee #8) was interview on 5/15/19 at 11:20 am and he said that '' foam icebox '' was used to maintain the ice use to supplement the bags used for cold compresses used for residents to manage the pain and swelling caused after surgery. 3. However, this type of foam icebox is not acceptable since the material with which it is made has pores and its use is definable. No evidence of policies and procedures for this foam icebox. No evidence of the cleaning and disinfection of this foam icebox and who is the personnel designated to supply the ice to the residents. The nurse supervisor (employee #2) said that the plastic icebox used for residents is in her office. The Infection Control Nurse removed the foam icebox immediately disinfected the plastic icebox and the scoop and placed a sign indicating the used of this plastic icebox. The facility failed to comply with accepted infection control precautions and standards of practice. 4. The main door was observed in poor condition dirty and deteriorate paint.",2020-09-01
74,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,908,F,0,1,K21011,"Based on a recertification survey, observational tour of the facility's kitchen during performed from 05/13/19 thru 05/15/19, from 8:00 am thru 4:30 pm, and interview with clinical dietitian (employee # 7) it was identified that the facility failed to maintain equipment safe operating in conditions good condition. Findings include: 1. On 05/13/19 from 8:20 am through 8:55 am the following was identified during observational tour in the kitchen with the clinical dietitian: a.The kitchen has three stoves, the one located on the right side has a big flame of fire near to the burner. The clinical dietitian (employee #7) stated on interview on 05/13/19 at 8:35 am that this stove had a broken burner and that's the reason why a big flame of fire appear every time you turn on the burner of the stove.",2020-09-01
75,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2019-05-15,921,D,0,1,K21011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on recertification survey, observations and resident and staff interview performed from 05/13/19 to 05/15/19, it was determined that the facility failed to promote a safe environment for residents, staff and the public which can affect 1 out of 20 admitted residents at the facility. (R # 64) Findings include: 1 . A mechanism to ensure that facility maintain an ongoing supervision of former smoker resident to prevent accidents (fire) was not performed accordingly with the following findings identified during survey procedures from 05/13/19 to 05/15/19: a. Resident R #64 is a male resident was admitted on [DATE] with a diagnostic of Discitis on the lumbar region. Resident was admitted to receive antibiotics. 05/13/19 10:29 AM Resident smoke. However he is independent and move outside only one time during shift to smoke. 05/15/19 08:43 AM The MDS coordinator ( employee # 1) stated during interview 0n 5/14/19 at 9:55 am that this resident had history as smoker, but when admitted to receive services he stated that he is not smoking. There is no evidence documented ( ej-progress notes ) were facility orient resident related with designated area to smoke and prevention of fire and accidents. During review of the medical record no evidence was found related with supervisory rounds in order to evaluate that resident is following the instructions to smoke in designated area in order to prevent fire.",2020-09-01
76,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2017-05-25,281,D,0,1,V2HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification FOSS survey, observations, medication pass, staff interviews and review of the facility policies and procedures (P & Ps), it was determined that the facility failed to ensure that the registered nurse (RN) performs hand hygiene accordance with infection control standard of practice after administering medications by mouth and failed to ensure to maintain appropriated infection control standard of practice during drug administration which can affect 1 out of 18 admitted residents at the facility. (R#7). Findings include: 1. On 5/23/17 at 8:25 am through 9:30 am during the drug pass the following was observed: a. The RN #13 was observed preparing and administrated medication by mouth to the resident on room [ROOM NUMBER] A during the process at 9:00 am it was observed open a individualized package of a pill, the RN cannot open the package, then uses the tap of the pen to punch the package cover and opened and put the pill in the small cup of medication. The RN proceed to administrated the medication to the resident and her hair cover her face and with the same glove that has to administered the medication turn her hair back and continue administration the medication. During the process a pill falls on the resident's bed, the RN picks up the pill, the resident asks to place it in the mouth, so the RN does it with the same gloves that touched her hair. When finish administrating the resident medication, removes her glove and proceed to wash her hand less than seven (7) second, not accordance to standard of practice of infection control and Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline in Health Care Setting, (MONTH) 25, 2002. Vol 51. Interview performed to the infection Control officer (employee #3) on 5/24/17 at 10:00 am stated that orientation related to hand washing was provided to the SNF personnel on (MONTH) 30, (YEAR) at 2:00 pm where the RN #13 attended and Competency was evaluated on 1/31/17.",2020-09-01
77,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2017-05-25,371,F,0,1,V2HC11,"Based on a recertification FOSS survey, the kitchen observational tour, review of policies/procedures and interviews, it was determined that the facility failed to maintain kitchen and entire environment area clean and in good condition to operationalize procedures to ensure that tiles in the area of Cookware storage near the dry food storage was in good condition, and the trays storage in the Cookware area was cleaned and good condition and the tray to place the resident trays in the dish washer was in good condition without mold and peeling that could affect 18 out of 18 admitted residents (R) ( R#101B , #102A, #104A, #105A, #106B, #107A, #107B, #108A, #109A, #109B, #110A, #110B, #111A, #113A, #113B, #122, #123A and #123B and sample residents #1 through #7). Findings include: 1. During the kitchen flash observational tour performed with the dietitian (employee #4) on 5/22/17 at from 10:45 am, the following was observed: a. In the cookware storage area near the dry food storage it was observed different cook ware storage in the area and the trays was observed with a black ollin spot in the back portion of the trays. b. In the cookware storage area near the dry food storage it was observed on the floor lack of tiles, the area with an approximated measure of 20 feet by 20 feet in porous cement that is not appropriated to clean and disinfected the area floor. c. In the dishwasher area was observed a trays used to put inside the dishwasher the resident trays, this trays was observed with mold and peeling paint.",2020-09-01
78,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2017-05-25,406,E,0,1,V2HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Base on a recertification FOSS survey, eight resident record reviewed and interviews it was determined that the facility failed to ensure that resident received the required Occupational Therapy (OT) services accordance to resident plan of care this affected 4 out of 8 resident (R) (R#2, #3, #4 and #5) Findings include: 1. Resident #3 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 5/22/17 at 3:13 pm it was found that the OT performed the OT Functional Assessment on 5/15/17 at 8:12 am, then provide services on 5/15/17 at 3:06 pm, on 5/16/17 at 2:51 pm, on 5/17/17 at 2:54 pm, on 5/18/17 at 3:46 pm, on 5/19/17 at 3:47 pm. No evidence was found that the OT provide OT services on 5/22/17 and on 5/23/17. The patient physiatrist recommendation was OT 5 intervention by weeks. OT failed to provide services accordance to physiatrist recommendation and resident plan of care. 2. Resident #4 is a [AGE] years old male admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 5/23/17 at 3:32 pm it was found that the OT performed the OT Functional Assessment on 5/12/17 at 9:13 am, then provide services on 5/12/17 at 2:36 pm, on 5/15/17 at 3:02 pm, on 5/17/17 at 3:28 pm, on 5/18/17 at 3:38 pm, on 5/19/17 at 3:40 pm. No evidence was found that the OT provide OT services on 5/16/17 and on 5/22/17. The patient physiatrist recommendation was OT 5 intervention by weeks. OT failed to provide services accordance to physiatrist recommendation and resident plan of care. 3. Resident #5 is an [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. On 5/7/17 the Material Data Sheet (MDS) was reevaluated and continue with OT services on 5/8/17, on 5/10/17, on 5/12/17, on 5/15/17, on 5/17/17, on 5/19/17, on 5/22/17. No evidence was found that the OT provide OT services on 5/9/17, 5/11/17, 5/16/17, 5/18/17, 5/23/17 and on 5/24/17. The OT documented on 5/10/17, 5/12/17, 5/17/17, 5/19/17, 5/24/17 that services was not provide yesterdays. The patient physiatrist recommendation was OT 5 intervention by weeks. OT failed to provide services accordance to physiatrist recommendation and resident plan of care. Interview performed on 5/23/17 at 1:50 pm with the medical director (employee # 6) stated I do not know that the resident did not receive the OT services accordance to resident plan of care. I do not know if Human resources authorized or not another OT personnel. The OT personnel did not request to me an assistant or another OT personnel to provide service to all resident. The human resource did not inform to me the need to have another OT personnel so the services not be affected. Interview performed on 5/23/17 at 1:50 pm with the Administrator (employee # 7) stated: the OT did not notified that need another OT personnel to cover all resident treatment. The OT do not concern me. There are communication failure. Interview performed on 5/23/17 at 3:00 pm with the Therapy department supervisor (employee #8) stated: I was contracted on 4/25/17. I performed a meeting with the therapist personal (occupational (OT) physical (PT) and recreational therapist (RT)). I separated the OT and PT discipline rooms. OT service is to be performed 5 days a week. This situation have many years that the OT services have only one personnel to cover all residents. I am verifying if the administration recruit an OT assistant but it has become difficult to recruit staff. I have made direct approaches with the medical director employee #6 and he has given me the support along with Human Resources and given me authorization to interview candidates for OT services. On 8/8/16 I informed the administration (medical director and Human Resources) of the need for OT for the high censuses, the extensive documentation that the OT must carry out. I have spoken directly with the medical director employee #6 since she is the one whom I respond to as therapist supervisor. I interview a person who has the credentials and the training to occupy the position of OT, but the last information that was offered to me by human resources was to continue looking for other candidates. Interview performed on 5/23/17 at 3:30 pm with the SNF supervisor (employee #9) state: I am the SNF supervisor since (MONTH) (YEAR). I did not know that the OT personal did not offer the services to all residents admitted 5 days a weeks and that the residents OT services was affected. With a Census of 13 or greater was impossible to give OT services to all resident with only one OT personnel. She has too much work on charge. She referred to me the need of a laptop to documented in residents room and not make double work writing in paper to then documented in the computer. 4. Resident #2 is an [AGE] years old female admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review performed on 5/23/17 at 11:00 a. m. it was found that the OT performed the OT Functional Assessment on 5/16/17. The Material Data Sheet (MDS) revealed that the resident initiated the OT services on 5/6/17, on 5/17/17, on 5/18/17 and 5/22/17. No evidence was found that the OT provide OT services on 5/19/17. The OT documented on 5/19/17 that services was not provide on this day. The patient physiatrist recommendation was OT 5 interventions per week. OT failed to provide services accordance to physiatrist recommendation and resident plan of care.",2020-09-01
79,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2017-05-25,441,D,0,1,V2HC11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification FOSS survey, observations, medication pass, staff interviews and review of the facility policies and procedures, it was determined that the facility failed to ensure that the registered nurse ( RN) performs hand hygiene accordance to infection control standard of practice after administering medications by mouth and failed to ensure to maintain appropriated infection control standard of practice during drug administration which can affect 1 out of 18 admitted residents (R ) at the facility. (R#7). Findings include: 1. On 5/23/17 at 8:25 am through 9:30 am during the drug pass the following was observed: a. The RN #13 was observed preparing and administrated medication by mouth to the resident on room [ROOM NUMBER]A during the process at 9:00 am it was observed open a individualized package of a pill, the RN did not open the package, then use the tap of the pen to punch the package cover and opened and put the pill in the small cup of medication. The RN proceed to administrated the medication to the resident and her hair cover her face and with the same glove that has to administer the medication turns her hair back and continue the administration of the medication. During the process a pill falls on the resident's bed, the RN picks up the pill, the resident asks to place it in the mouth, so the RN does it with the same gloves that touched her hair. When finish administrating the residents' medication removes her glove and proceed to wash her hand less than seven (7) second, not accordance to standard of practice of infection control and Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline in Health Care Setting, (MONTH) 25, 2002. Vol 51. Interview performed to the infection Control officer (employee #3) on 5/24/17 at 10:00 am stated that orientation related to hand washing was provided to the SNF personnel on (MONTH) 30, (YEAR) at 2:00 pm where the RN #13 attend and Competency was evaluated on 1/31/17.",2020-09-01
80,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2017-05-25,465,F,0,1,V2HC11,"Based on a recertification FOSS survey, observations tour to the kitchen area and interviews with administrative dietitian (employee #4) , it was determined that the facility failed to ensure a safe and functional environment related to missing tiles on the floor affecting 18 out of 18 admitted residents at rooms (R). (R#101B , #102A, #104A, #105A, #106B, #107A, #107B, #108A, #109A, #109B, #110A, #110B, #111A, #113A, #113B, #122, #123A and #123B). Findings include: During the initial tour to the kitchen with the administrative dietitian (employee #4) on 5/22/17 at 10:45 am it was observed in the cookware storage area near the dry food storage the floor lacks of tiles, the area with an approximated measure of 20 feet by 20 feet in porous cement that is not appropriated to clean and disinfect the area floor. This situation do not provide a safe, functional, sanitary environment for resident and employees.",2020-09-01
81,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2018-08-20,604,D,0,1,1LG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview the facility failed to ensure residents (Resident (R) 84 and R88 were free from physical restraints not required to treat the resident's medical symptoms and failed to assess the Residents to ensure the least restrictive alternative for the least amount of time was used. This involved 2 of 10 residents reviewed for bed rails. Findings include: 1. On 08/19/18 at 10:20 AM and 10:50 AM R88 was observed in bed with all side rails up. At 10:50 AM RN3 verified all four side rails were up and stated R88 was not able to put the side rails down. She stated only the staff could put the side rails down. On 08/20/18 at 3:22 PM he was in bed with all four side rails up. During the observation on 08/20/18 at 3:22 PM R88 stated he did not like the side rails up and he wanted them down because they made him feel like he was in Jail. The Active problem list in his electronic medical record (EMR) for R88 indicated his [DIAGNOSES REDACTED]. SNF (skilled nursing facility) admission note for R88 written by the physician and dated 08/15/18 indicated he was admitted to the facility for Physical, Occupational and Recreational therapy after being hospitalized with a DX (diagnosis) of acute UTI (urinary tract infection) and General Weakness. The note indicated the upper bed rails would be elevated for a therapeutic way. R88 had physician's orders [REDACTED]. The plan of care for use of the side rails with a start date of 08/15/18 indicated use of top rails as a therapeutic mode. Review of his Admission MDS with an ARD of 08/19/18 revealed he had a BIMS (Brief Interview for Mental Status) score of 14 at Section C, Cognitive Patterns and required limited assistance with bed mobility and transfers at Section G, Functional Status. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of all side rails. On 08/19/18 at 4:20 PM the Director of Quality and Utilization of Medicine verified R88 had not been assessed for the use of the bed rails. 2. On 08/17/18 Resident 84 was observed in bed with all four bed rails up at 11:57 AM and 12:19 PM. During the observation at 11:57 AM Registered Nurse (RN) 2 and Licensed Practical Nurse (LPN)1 were both in the room. Each of the nurses stated they routinely care for the resident. When asked if she moves around they each stated R84 does move around in the bed. On 08/18/18 at 8:45 AM, 9:15 AM, and 10:45 AM and on 08/19/18 at 3:27 PM R84 was observed in her room in bed with the upper and lower bed rails in the up position. There was no observation of the resident attempting to get out of bed or move around in the bed. The mattress fit securely against the bed rails. On 08/18/18 at 2:45 PM LPN2, Physical Therapy Assistant (PTA) 1, LPN3 and LPN4 were interviewed. During interview they each stated they have cared for R84. They all confirmed both the upper and lower side rails are raised when the resident is in bed. They all stated that R84 could get out of bed if the bed rails were down but not safely. PTA1 stated the resident could walk with assistance. The resident's [DIAGNOSES REDACTED]. According her Minimum Data Set Assessment (MDS), an assessment tool used by staff to identify resident care problems and care planning, with an Assessment Reference Date (ARD), end point of the assessment, of 06/06/18 and a completed date of 08/18/18, her cognitive skills for daily decision making were severely impaired at Section C, Cognitive Patterns, and she had balance problems during transfers and walking at Section G, Functional Status. This MDS was found in the electronic record only and was never transmitted. Review of the physician's orders [REDACTED]. On 08/17/18 at 11:57 AM an interview was conducted in the nursing station with RN3 and the Director of Nursing (DON). They both stated they routinely use all four side rails when R84 is bed for her safety. The bed rails have been used since admission over a year and no incidents have occurred. When asked if they had assessed the resident for appropriate alternatives and for a medical reason the Director of Nursing stated, they had not. The resident's electronic and paper medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails. The daily nursing notes were reviewed from 08/01/18 to 08/17/18. The nurses documented all up under the State of the Bed Rails column.",2020-09-01
82,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2018-08-20,636,D,0,1,1LG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to complete Minimum Data Assessments MDS, an assessment tool used by the facility to identify problems and assist in care planning, after 12/06/17 for resident (Resident (R) 84 of 8 sampled residents. Findings include: Review of R84's electronic medical record (EMR) revealed she was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of her MDS in the EMR revealed she had only a 5-day assessment dated [DATE], a 14-day assessment dated [DATE], a 30-day assessment dated [DATE], and a 90-day assessments dated 06/06/17, 09/06/17, and 12/06/17. She had no MDS assessment dated after 12/06/17. The assessments in the EMR were marked as complete in the facility's computer system however there was no indication they had been sent and were not present in the Centers for Medicare and Medicaid Services (CMS), system when reviewed in the surveyor's computer. On 08/20/18 at 12:40 PM the MDS Coordinator stated the MDS assessments in the computer system had never been transmitted to CMS and no MDS assessments were completed after 12/06/17 because the resident was not a Medicare resident. The resident was in a medicare bed.",2020-09-01
83,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2018-08-20,640,E,0,1,1LG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and policy review, the facility failed to ensure the required Minimum Data Set (MDS), Discharge assessment was encoded and transmitted for 12 of 12 residents reviewed, 11 unsampled and one sampled, (Resident (R)1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, and R84 when they left the care of the facility. Findings include: 1. Review of R1's EMR Summary revealed she had been admitted post left knee replacement on 12/08/17. According to her Discharge Notes she was discharged home with family present on 12/18/17. The MDS tab of R1's EMR listed an Entry Tracking assessment, dated 12/11/17, and an Admission MDS assessment, completed 12/12/17. The Admission MDS assessment indicated R1 expected to be discharged back to the community and discharge planning had been started (Section Q). There was no Discharge Assessment available in the EMR. 2. Review of R5's EMR Summary revealed she had been admitted post right knee replacement on 02/23/18. According to her Discharge Notes she was discharged home with family present on 03/02/18. The MDS tab of R5's EMR listed an Entry Tracking assessment, dated 02/23/18, and an Admission MDS assessment, completed 02/28/18. The Admission MDS assessment indicated R5 expected to be discharged back to the community and discharge planning had been started (Section Q). There was no Discharge Assessment available in the EMR. 3. Review of R11's EMR Summary revealed she had been admitted post left knee replacement on 04/06/18. According to her Discharge Notes she was discharged home with family present on 04/15/18. The MDS tab of R11's EMR listed no Entry Tracking assessment. An Admission MDS assessment was completed 04/10/18. The Admission MDS assessment indicated R11 expected to be discharged back to the community and discharge planning had been started (Section Q). She had a Non-PPS assessment dated [DATE] that was coded under A0310., section F) as Discharge assessment-return not anticipated. However Review of the ASPEN MDS Resident Viewer information revealed the resident was not listed for a Discharge MDS Assessment was submitted to the required national database. 4. Review of R3's EMR Summary revealed she had been admitted post right knee replacement on 03/22/18. According to her Discharge Notes she was discharged home with family present on 03/31/18. The MDS tab of R3's EMR listed an Entry Tracking assessment dated [DATE], and an Admission MDS assessment, completed 03/26/18. The Admission MDS assessment indicated R3 expected to be discharged back to the community and discharge planning had been started (Section Q). There was no Discharge Assessment available in the EMR. 5. Review of R8's EMR Summary revealed she had been admitted post right knee replacement on 03/15/18. According to her Discharge Notes she was discharged home with family present on 03/25/18. The MDS tab of R8's EMR listed an Entry Tracking assessment dated [DATE], and an Admission MDS assessment, completed 03/19/18. The Admission MDS assessment indicated R8 expected to be discharged back to the community and discharge planning had been started (Section Q). There was no Discharge Assessment available in the EMR. Review of the ASPEN MDS Resident Viewer information revealed none of the above residents had Discharge MDS Assessments submitted to the required national database. Interview on 08/20/18 at 12:20 PM with the MDS Coordinator revealed the facility was only able to show the MDS data submitted to the national database from (MONTH) (YEAR) to (MONTH) (YEAR). She could show where Discharge-return not anticipated MDS data had been done in the facility computer system, however she was unable to show where any MDS data had been submitted for the above residents. The MDS Coordinator was unable to explain why there were no Discharge Assessments submitted for those residents to the national database. 6. According to the facility electronic medical record (EMR) Profile, the facility admitted R2 on 02/19/18 and was discharged home on[DATE]. The MDS tab of the EMR listed a 5-Day MDS admission assessment, dated 02/25/18. The 5-Day admission assessment indicated R2 was expected to be discharged back to the community and discharge planning had been started (Section Q of the MDS). An 03/01/18 Progress Note indicated, Resident was discharged home with daughter. Review of R2's EMR revealed no evidence of a Discharge MDS assessment was completed or submitted. 7. According to the facility EMR Profile, the facility admitted R3 on 02/21/18 and was discharged home on[DATE]. The MDS tab of the EMR listed a 5-Day MDS admission assessment, dated 02/25/18. The 5-Day admission assessment indicated R3 was expected to be discharged back to the community and discharge planning had been started (Section Q). An 03/03/18 Progress Note indicated, Resident was discharged home with daughter. Review of R3's EMR revealed no evidence of a Discharge MDS assessment was completed or submitted. 8. According to the facility EMR Profile, the facility admitted R4 on 02/23/18 and was discharged home on[DATE]. The MDS tab of the EMR listed a 5-Day admission assessment, dated 02/27/18. The 5-Day admission assessment indicated R4 was expected to be discharged back to the community and discharge planning had been started (Section Q of the MDS). An 03/05/18 Progress Note indicated the, Resident was discharged home with spouse. Review of R4's EMR revealed no evidence of a Discharge MDS assessment was completed or submitted. 9. According to the facility EMR Profile, the facility admitted R6 on 03/06/18 and was transferred back to the hospital on [DATE]. The MDS tab of the EMR listed a 5-Day MDS admission assessment, dated 03/12/18, and a Non-PPS (Prospective Payment Systems) MDS assessment, completed 03/16/18. The 5-Day admission assessment indicated R6 was expected to be discharged back to the community and discharge planning had been started (Section Q of the MDS). An 03/16/18 Progress Note indicated, Resident was transferred back to hospital via ambulance. Review of R6's EMR revealed no evidence of a Discharge MDS assessment was completed or submitted. 10. According to the facility EMR Profile, the facility admitted R7 on 03/11/18 and was discharged home on[DATE]. The MDS tab of the electronic medical record listed a Non-PPS assessment, dated 03/19/18. that indicated R7 was discharged back to the community and discharge planning had been started (Section Q of the MDS). An 03/19/18 Progress Note indicated, Resident was discharged home with son. Review of R7's EMR revealed no evidence of a Discharge MDS assessment was completed or submitted. 11. According to the facility EMR Profile, the facility admitted R10 on 03/29/18 and was discharged home on[DATE]. The MDS tab of the EMR listed a 5-Day MDS admission assessment, dated 04/02/18, and a Non-PPS MDS assessment, completed 04/08/18. The 5-Day admission assessment indicated R10 was expected to be discharged back to the community and discharge planning had been started (Section Q of the MDS). An 04/08/18 Progress Note indicated, Resident was discharged home with son. Review of R10's electronic medical record revealed no evidence of a Discharge MDS assessment was completed or submitted. 12. Review of R84's EMR) revealed she was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of her MDS in the EMR revealed she had only had a 5-day assessment dated [DATE], a 14-day assessment dated [DATE], a 30-day assessment dated [DATE] and 90-day assessments dated 06/06/17, 09/06/17, and 12/06/17. She had no MDS assessment dated after 12/06/17. The assessments in the EHR were marked as complete in the facility's computer system however there was no indication they had been sent and were not present in the CMS system (in the surveyor's computer). On 08/20/18 at 12:40 PM the MDS Coordinator stated the MDS assessments in the computer system had never been transmitted to CMS and no MDS assessments were completed after 12/06/17 because the resident was not a Medicare resident.",2020-09-01
84,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2018-08-20,641,D,0,1,1LG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure the Minimum Data Set Assessment (MDS), an assessment tool completed by the facility used for care planning, accurately reflected for one of eight sampled residents (Resident(R) 86's related to his urinary continence and his diagnosis. Findings include: Review Active Problems in R86's electronic medical record (EMR) revealed his [DIAGNOSES REDACTED]. During interview with R86 on 08/17/18 at 1:58 PM he stated he was a paraplegic; he had a Foley catheter (indwelling urinary catheter); and he was in the facility for IV antibiotics due to an infection in the pressure ulcers on his hips. He also stated c Foley catheter he is incontinent of bladder. When ask why he had a Foley catheter he stated he was not sure. Observation of the resident revealed he had an indwelling urinary catheter bag hanging one the side of the bed. The pressure ulcer plan of care with an initiation date of 08/08/18 indicated the resident was admitted for IV (intravenous) therapy due to an infection of the ulcers. A Consult Note Infectiology dated 08/16/18 indicated R86 was on [MEDICATION NAME] due to hip osteo[DIAGNOSES REDACTED] due to the stage 3 decubitus ulcers of the bilateral hips. Review of R86's Admission MDS Assessment with an Assessment Reference Date (ARD), end point of evaluation, of 08/12/18 revealed the assessment was inaccurately coded. The assessment was inaccurately coded to indicate he was continent of urine at section H, urinary continence. At Section I, Active Diagnosis, the assessment was inaccurately coded with a no response at wound infections, diabetes mellitus, and [MEDICAL CONDITION], indicating he did not have any infections, did not have diabetes mellitus and was not paraplegic. Each area of the Assessment and the last section of the MDS was coded at completed and signed by the MDS Coordinator. On 08/20/18 at 11:26 AM the MDS Coordinator was interviewed. During interview she verified the MDS assessment was completed and signed. When the MDS was reviewed with her she verified the above sections were inaccurate.",2020-09-01
85,CENTRO MEDICO WILMA N VAZQUEZ SNF,405025,ROAD 2 KM 39 5 BO ALGARROBO,VEGA BAJA,PR,693,2018-08-20,700,D,0,1,1LG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview the facility failed to assess the residents prior to the installation of bed rails; failed to review the risk and benefits of the bed rails with the residents or resident representatives and failed to obtain informed consent prior to installation of the bed rails. This deficient practice affected three residents (Residents(R)84, R86, and R88) of 10 residents sampled for the use of bed rails. Findings include: 1. On 08/17/18 at 11:57 AM and on 08/18/18 at 10:44 AM and at 12:37 PM R88 was observed in his bed with his upper/top side rails in the up position. On 08/19/18 at 10:20 AM and 10:50 AM the resident was observed in bed with all side rails up. The mattress fit tightly against the side rails. No gaps were observed between the side rails and the mattress. At 10:50 AM the RN3 verified all four side rails were up and stated R88 was not able to put the side rails down independently. She stated only the staff could put the side rails down. On 08/20/18 at 9:53 AM he was observed with the top side rails up. On 08/20/18 at 3:22 PM he was in bed with all four side rails up. On 08/20/18 at 3:22 PM R88 stated he did not like the side rails up and he wanted them down because they made him feel like he was in Jail. The Active problem list in his electronic health record stated his [DIAGNOSES REDACTED]. SNF admission note written by the physician and dated 8/15/18 stated he was admitted to the facility for Physical, Occupational and Recreational therapy after being hospitalized with a DX (diagnosis) of acute UTI (urinary tract infection) and General Weakness. The note indicated the upper bed rails would be elevated for a therapeutic way. The fall risk assessment in the dated 08/18/18 stated he was at high risk for falls. R88 had physician's orders [REDACTED]. Review of his Admission MDS with an assessment reference date of 08/19/18 revealed he had a Brief Interview for Mental Status (BIMS) (a cognitive evaluation) score of 14 at Section C, Cognitive Patterns indicating he was not cognitively impaired. The MDS indicated he required limited assistance with bed mobility and transfers at Section G, Functional Status. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. On 08/19/18 at 4:20 PM the Director of Quality and Utilization of Medicine verified R88 had not been assessed for the use of the bed rails and that the risk and benefits of the bed rails had not been explained to the resident nor the resident's representative and that informed consent had not been obtained. 2. On 08/17/18 R84 was observed in bed with all four bed rails up at 11:57 AM and 12:19 PM. On 08/18/18 Resident 84 was observed in her room in bed with the upper and lower bed rails in the up position at 8:45 AM, 9:15 AM, 10:45 AM during each observation the bed was at a regular height. On 08/19/18 R84 was observed in bed with the top side rails up and the bottom bed rails down at 10:55 AM, 11:02 AM, 12:40 PM, and 2:07 PM. On 08/19/18 at 3:27 PM she was observed in bed with all four-bed rail up. On 08/20/18 at 9:58 AM she was observed in bed with just the top rails up. There was no issue with the mattress fitting the bed tightly against the side rails. No gaps were noted between the side rails and the mattress. There was no observation of the resident moving around in the bed or attempts to get out of bed. The resident's [DIAGNOSES REDACTED]. Review of her plan of care with a start date of 03/06/17 for R84 revealed she had a care plan identifying her as high risk for falls. According her MDS with an Assessment Reference Date (ARD), end point of the evaluation period, of 06/06/18 and a completed date of 08/18/18, her cognitive skills for daily decision making were severely impaired at Section C, Cognitive Patterns, and she had balance problems during transfers and walking at Section G, Functional Status. Review of the physician's orders [REDACTED]. On 08/17/18 at 11:57 AM an interview was conducted in the nursing station with RN3 and the Director of Nursing (DON). They both stated they routinely use all four side rails when R84 is bed for her safety. When ask if they had assessed the resident for appropriate alternatives and for risk of entrapment prior to using the bed rails, the Director of Nursing stated they had not. She also confirmed she had no written documentation to prove the risk and benefits of the bed rails had not been reviewed with the resident's representative and she had no documentation of informed consent. The resident's medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives and that facility staff had not obtained an informed consent prior to installation of the bed rails. 3. On 08/17/18 at 10:57 AM R86 was in his room with the top bed rails up. The bed rails and the mattress fit tightly and there were no gaps noted. On 08/17/18 R86 was interviewed from 2:00 PM to 2:20 PM. During the interview he had the top side rails in the up position. He had lower rails on the bed however they were not up. When ask if they ever put the lower side rails up he stated they do put them up if they are going to be leaving him a lone for a long period of time. On 08/19/18 at 12:37 PM and 3:30 PM he was in bed with the top bed rails up. According to the active problem list in R86's EMR included [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED]. Review of his admission MDS with an assessment reference date of 08/12/18 revealed he had a BIMS Score of 15 at Section C, Cognitive Patterns. R86' medical record was reviewed in its entirety and revealed no documentation of an assessment for the use of the bed rails, that staff had reviewed the risk and benefits of the bed rails with the resident or resident representatives, and that facility staff had not obtained an informed consent prior to installation of the bed rails. On 08/19/18 at 4:20 PM the Director of Quality and Utilization of Medicine verified the resident had not been assessed for the use of the bed rails and that the risk and benefits of the bed rails had not been explained to the resident nor the resident's representative and that informed consent had not been obtained.",2020-09-01
86,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2019-03-27,655,C,0,1,PV3411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification standard survey, interview, observation and eight records reviewed it was determined that the facility failed to ensure that all patient has developed and implemented an activities plan of care within 48 hour of resident admission for 8 out of 8 residents in the sample (R#51, R#52, R#53, R#54 R#101, R#102, R#103 and R#104) Findings include: 1. Resident # 101 is a [AGE] years old female admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. On 03/25/19 at 10:00 am during interview with resident state that since arrive to the facility did not participate of any activity. That she entertain herself with letter soap book and watch television. On 03/26/2019 at 9:05 am during the record review no evidence was found related to the recreational therapist initial assessment. No evidence was found that the facility developed and implemented activities plan of care. 2. Resident # 102 is a [AGE] years old male admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. On 03/26/19 at 9:20 am, during interview with resident #102 she state that did not participate of any activity since he arrive. On 03/26/2019 at 9:50 am during the record review no evidence was found of the recreational therapist initial assessment was performed. No evidence was found that the facility developed and implemented an activities plan of care. 3. Resident # 103 is a [AGE] years old male admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. On 03/25/19 at 11:50 am, during interview with resident #103 he state that did not participate of any activity since he arrive. No one ask him about his preference for activities. On 03/26/2019 at 10:25 am, during the record review no evidence was found of the recreational therapist initial assessment was performed. No evidence was found that the facility developed and implemented an activities plan of care. 4. Resident # 104 is a [AGE] years old female admitted to the facility on [DATE] with a [DIAGNOSES REDACTED].#104 she state that since she arrive to the facility, no activity she has participate and no orientation was provided related to activities schedule. On 03/26/2019 at 10:00 am during the record review it was found no evidence of the recreational therapist initial assessment was performed. No evidence was found that the facility developed and implemented an activities plan of care. 5. No evidence was found in residents rooms of the activities program schedule. 6. No evidence was found in the recreational area of a schedule of the activity program since (MONTH) 2019. Interview with the administrator employee #3 on 3/25/2019 at 2:10 pm related to the activities program he state that the person in charge of the activity program was the recreational therapist and she was suspended from her job for 39 days. Interview with the Human Research Officer employee #1 on 3/26/2019 at 9:43 am she state that the Recreational Therapist was suspended for 45 days from (MONTH) 20, 2019 through (MONTH) 25, 2019 due to disciplinary measure after multiple disciplinary act for 45 days. The facility was in an intensive recruitment but after Maria Hurricane there was a shortage of professional. 7. The facility did not have a mechanism to cover the recreational therapist since (MONTH) 20, 2019 and did not ensure that the resident be affected due to not available of an activity program. 8. Resident #51 is a [AGE] years old female who was admitted on [DATE] with [DIAGNOSES REDACTED]. On 03/25/19 at 1:35 pm the resident was interview and she stated that the facility did not provide recreational activities. She stated that she received physical and occupational therapy but did not received recreational activities since admission. During the initial tour on 3/25/19 at 9:45 am it was not observed the weekly or monthly activity program in resident's room. On 3/26/19 at 9:00 am the resident record was reviewed and did not have the initial recreational assessment and no evidence of the activity program. No evidence was found that the facility developed and implemented an activities plan of care. 9. Resident #52 is a [AGE] years old female who was admitted on [DATE] to received Prosthesis Training of both lower extremities. The clinical record was reviewed on 3/23/16 at 9:00 am and provided evidence that the resident's had history of Amputation of both legs, Diabetes Mellitus, Hypertension and Heart by Pass. The admission plan of treatment was performed and revealed that the initial recreational assessment not performed by the recreational therapist. During the initial tour performed on 3/25/19 at 9:30 am no evidence of the recreational plan of activities in the resident room. On 03/25/19 03:12 pm during interview the resident stated that the facility did not provide recreational activities. She stated that today is the first physical therapy because was admitted on Saturday 23/2019 and today the physical therapist performed the initial assessment and she received the first physical therapy however, did not received recreational activities today. On 3/26/19 at 9:00 am the resident record was reviewed and did not have the initial recreational assessment and no evidence of the activity program. No evidence was found that the facility developed and implemented an activities plan of care. 10. Resident #53 is a [AGE] years old female who was admitted on [DATE] with [DIAGNOSES REDACTED]. On 03/25/19 at 2:35 pm the resident was interview and she stated that the facility did not provide recreational activities. She stated that received physical and occupational therapy but did not received recreational activities since admission. During the initial tour on 3/25/19 at 9:45 am did not observed the weekly or monthly activity program in resident's room. On 3/26/19 at 11:00 am the resident record was reviewed and did not have the initial recreational assessment and no evidence of the activity program. No evidence was found that the facility developed and implemented an activities plan of care. 11. Resident #54 is a [AGE] years old female who was admitted on [DATE] with [DIAGNOSES REDACTED]. During the initial tour on 3/25/19 at 10:00 am did not observed the weekly or monthly activity program in patient room. On 3/26/19 at 10:00 am the resident record was reviewed and did not have the initial recreational assessment and no evidence of the activity program. No evidence was found that the facility developed and implemented an activities plan of care. On 03/25/19 at 2:35 pm the resident was interview and she stated that the facility did not provide recreational activities. She stated that received physical and occupational therapy but did not received recreational activities since admission.",2020-09-01
87,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2019-03-27,679,C,0,1,PV3411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification standard survey, interview, observation and eight record review it was determined that the facility failed to ensure that the preferences of each resident and their choice of activities individual activities and independent activities was assess, with an ongoing program to support the physical, mental, and psychosocial well-being of each resident for 8 out of 8 resident (R#51, R#52, R#53, R#54 R#101, R#102, R#103 and R#104 Findings include: 1. Resident # 101 is a [AGE] years old female admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. On 03/25/19 at 10:00 am during interview with resident state that since arrive to the facility did not participate of any activity. That she entertain with letter soap book and watch television. On 03/26/2019 at 9:05 am during the record review it was found no evidence related to the recreational therapist initial assessment. No evidence was found that the facility developed and implemented an activities plan of care. 2. Resident # 102 is a [AGE] years old male admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. On 03/26/19 at 9:20 am during interview with resident #102 she state that did not participate of any activity since he arrive. On 03/26/2019 at 9:50 am during the record review it was found that no evidence of the recreational therapist initial assessment was performed. No evidence was found that the facility developed and implemented an activities plan of care. 3. Resident # 103 is a [AGE] years old male admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. On 03/25/19 at 11:50 am during interview with resident #103 he state that did not participate of any activity since he arrive. No one ask him about his preference for activities. On 03/26/2019 at 10:25 am during the record review it was found that no evidence of the recreational therapist initial assessment was performed. No evidence was found that the facility developed and implemented an activities plan of care. 4. Resident # 104 is a [AGE] years old female admitted to the facility on [DATE] with a [DIAGNOSES REDACTED].#104 she state that since she arrive to the facility none activity she participate and no orientation was provided related to activities schedule. On 03/26/2019 at 10:00 am during the record review it was found that no evidence of the recreational therapist initial assessment was performed. No evidence was found that the facility developed and implemented an activities plan of care. 5. No evidence was found in residents rooms of the activities program schedule. 6. No evidence was found in the recreational area of an schedule of the recreational activities program since (MONTH) 2019. Interview with the administrator employee #3 on 3/25/2019 at 2:10 pm related to the activities program he state that the person in charge of the activities program was the recreational therapist and she was suspended of her job for 39 days. Interview with the Human Research Officer employee #1 on 3/26/2019 at 9:43 am she state that the Recreational Therapist was suspended for 45 days from (MONTH) 20, 2019 through (MONTH) 25, 2019 due to disciplinary measure after multiple disciplinary act for 45 days. The facility was in an intensive recruitment but after Maria Hurricane there was a shortage of professional. 7. The facility did not have a mechanism to cover the recreational therapist since (MONTH) 20, 2019 and did not ensure that the resident be affected due to not available an activities program 8. Resident #51 is a [AGE] years old female who was admitted on [DATE] with [DIAGNOSES REDACTED]. On 03/25/19 at 1:35 pm the resident was interview and she stated that the facility did not provide recreational activities. She stated that received physical and occupational therapy but did not received recreational activities since admission. During initial tour on 3/25/19 at 9:45 am did not observed the weekly or monthly activity program in patient room. On 3/26/19 at 9:00 am the resident record was reviewed and did not have the initial recreational assessment and no evidence of the activity program. 9. Resident #52 is a [AGE] years old female who was admitted on [DATE] to received Prosthesis Training of both lower extremities. The clinical record was reviewed on 3/23/16 at 9:00 am and provided evidence that the resident's had history of Amputation of both legs, Diabetes Mellitus, Hypertension and Heart by Pass. The admission plan of treatment was performed and revealed that the initial recreational assessment was not performed by the recreational therapist. During the initial tour performed on 3/25/19 at 9:30 am no evidence of the recreational plan of activities in the resident room. On 03/25/19 03:12 PM During interview the resident stated that the facility did not provide recreational activities. She stated that today is the first physical therapy because she admitted on Saturday 23/2019 and today the physical therapist was performed the initial assessment and she received the first physical therapy however, did not received recreational activities today. 10. Resident #53 is a [AGE] years old female who was admitted on [DATE] with [DIAGNOSES REDACTED]. On 03/25/19 at 2:35 pm the resident was interview and she stated that the facility did not provide recreational activities. She stated that received physical and occupational therapy but did not received recreational activities since admission. During the initial tour on 3/25/19 at 9:45 am the weekly or monthly activity program was not observed in resident's room. On 3/26/19 at 11:00 am the resident record was reviewed and did not have the initial recreational assessment and no evidence of the activity program. 11. Resident #54 is a [AGE] years old female who was admitted on [DATE] with [DIAGNOSES REDACTED]. During the initial tour on 3/25/19 at 10:00 am the weekly or monthly activity program was not observed in resident's room. On 3/26/19 at 10:00 am the resident record was reviewed and did not have the initial recreational assessment and no evidence of the activity program. On 03/25/19 at 2:35 pm the resident was interview and she stated that the facility did not provide recreational activities. She stated that received physical and occupational therapy but did not received recreational activities since admission. 12. During the initial tour performed on 3/25/19 at 9:15 am from 11:00 am did not observed the weekly or monthly activity program in resident's room. The facility nurse supervisor employee #2 stated that the recreational employee was suspended from her duties for thirty nine days but does not know the reasons for this suspension. On 3/26/19 at 9:00 am the resident record was reviewed and did not have the initial recreational assessment and no evidence of the activity program. The facility Human Resource Officer employee #1 was interviewed on 3/26/19 at 9:43 am and she said that the recreational employee was suspended on (MONTH) 20/2019 per 45 days per disciplinary measures. She said that the facility was on intensive recruitment but after [NAME] Hurricane was a shortage personnel. However, since this moment the facility did not have a plan B to meet the patients' needs of recreational activities as part of its rehabilitation program. In the classroom recreational activities we observed on 3/25/19 during the survey a blackboard where the program of recreational activities is reflected and reflects the month of (MONTH) 2019, in the same activities are observed for only days 16, 17, 21, 22, 23,24,25, 28, 29, 30 and 31. There is no variety in the type of activities and lacks of the hours when the therapist provide this activities. The month of (MONTH) has 31 days however only offer eleven days of activities related to draw, singing, instrumental, meditate, games and aerobics on chair. No evidence was found in the recreational area of an schedule of the recreational activities program since (MONTH) 2019.",2020-09-01
88,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,254,E,0,1,I29Y11,"Based on observations made during the FOSS recertification survey and group interview, it was determined that the facility failed to ensure that linens are in good condition. This could affect 4 of 14 admitted residents. (Rooms #101-A, #102-A, #104-A and #105-B) Findings include: 1. During the initial tour performed on 5/11/17 at 9:20 am and physical environment with Physical Plant Supervisor (employee #4) performed on 5/11/17 at 10:23 am it was found that rooms #101-A, #102-A, #104-A and #105-B the linen was observed with holes. Interview performed on 5/11/17 at 1:45 pm to Director of Nursing (employee #2) reveals that the facility have a contract for the laundry. Our personnel have to check the sheets before dress the beds. Awe do not have at this moment inventory of new sheets.",2020-09-01
89,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,272,D,0,1,I29Y11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification FOSS survey, interview, and records reviewed (RR) it was determine that the facility failed to complete a Minimum Data Set (MDS). The facility fail to complete the Resident Assessment Instrument (RAI) in accordance with Utilization Guidelines for 1 out of 14 residents (RR#4). Findings include: 1.On 05/16/2017 at 1:45 pm during the review of the clinical record revealed that RR#4 was a private health insurance resident admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The review of the resident's record reveal that no Minimum Data Set (MDS) was started at the admission (MDS). Interview with the MDS coordinator (Employee 3) on 5/16/17 at 2:15pm revealed that the facility performed the MDS only to Medicare or Medicare advantage resident. The residents with a private health insurance the facility did not complete the MDS form 2. The facility failed to complete the resident MDS. The Facility fail to complete the Resident Assessment Instrument (RAI) in accordance with Utilization Guidelines affected.",2020-09-01
90,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,371,F,0,1,I29Y11,"Based on a recertification FOSS survey and the kitchen observational tour, it was determined that the facility failed to ensure a safety place for the store, prepare and serve food under sanitary conditions which can affect 14 of 14 admitted residents. (R#1 to R#14) Findings include: 1. During the observational tour performed on 5/16/17 at 10:10 am until 10:25 pm the following was observed: a. The white General Electric Freezer with vegetable it was observed about 2 inches of frost around. The stainless steel freezer was with a frozen red spill on the bottom shelf. b. One pear can have a dent, no received dates written on all cans and packages on the dry storage for the food movement control. The facility failed to ensure a safety place for the store, prepare and serve food under sanitary conditions.",2020-09-01
91,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,441,F,0,1,I29Y11,"Based on the recertification FOSS survey from 05/16 thru 05/18/17, and Medication Pass on 05/17/17 from 8:42 a.m. to 9:20 am, it was determined that the facility failed to ensure best practices of infection control in 2 out of 14 resident Supplemental Sample (SS) (SS#1 and SS#2). Findings include: 1. During the medication pass on 05/17/17 at 8:42 am it was observed that the Register Nurse (employee #1) proceed to administered the oral medications to Supplemental Sample # 1 (SS#1) then employee #1 put a new pair of gloves on without performing hand hygiene and proceed to administer sub cutaneous medication to SS#1. 2. During the medication pass on 05/17/17 at 8:50 am it was observed that the employee #1 proceed to administered the oral medications to Supplemental Sample # 2 (SS#2) then employee #1 put a new pair of gloves on gloves without performing hand hygiene and proceed to administer sub cutaneous medication to SS#2. The facility failed to ensure best practices of infection control.",2020-09-01
92,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,455,F,0,1,I29Y11,"Based ona FOSS recertification survey, tests to equipment, maintenance documentation and observations made during the survey for Life Safety from fire with the Physical Plant Supervisor (employee #4), it was determined that the facility does not meet some applicable provision of the 2012 edition of Life Safety Code of the NFPA 101 which could affect 14 out of 14 admitted residents. (R#1 to R#14) Findings include: The Life Safety from Fire survey was performed from 5/17/17 from 9:15 am until 1:00 pm with the Physical Plant Supervisor (employee #4); for deficiencies related to Life Safety from fire (form 2786R) please see tags with letter K on the 2567 form (K353).",2020-09-01
93,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,461,F,0,1,I29Y11,"Based on a FOSS recertification survey,observations, review of documentation ,policies/procedures and interviews with personnel and residents made during the physical environment survey, it was determined that the facility failed to ensure a safe and functional environment affecting 14 out of 14 admitted residents. (R#1 to R#14) Findings include: During the physical environment tour performed on 5/17/17 from 9:00 am thru 12:00 pm it was found the following: a. Rooms #101 A-B, #102B, #103-A (with tape on the cover of the side rail) #104 A, #105 A-B, #106 A-B , #107 A-B, #108 A-B, #109 Aside rails deteriorated, rusty and the cover of them broken. b. Rooms' #101A-B loose side rails.",2020-09-01
94,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,465,F,0,1,I29Y11,"Based on a recertification FOSS survey, tests, observations made during the physical environment survey, it was determined that the facility failed to ensure a safe and functional environment affecting 14 out of 14 admitted residents. (R#1 to R#14) Findings include: 1. During observations of the physical therapy room on 5/17/17 from 9:00 am through 12:00 pm it was found: a. Entry ramp to the skilled is observed with unevenness due to plumbing pipe repair. b. Floor ramp is broken and clean out is loose.",2020-09-01
95,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,492,F,0,1,I29Y11,"Based on a recertification FOSS survey, the review of fourteen staff credential files, it was determined that the facility failed to comply with federal and state local law related to Influenza Vaccine in accordance to State Administrative Order #244 of 10/10/08 and #362 of 12/8/16 of the Department of Health of Puerto Rico, Certificate of negative criminal record, and State local Law #300 sex offender certification for 5 out of 14 Credential Files (C.F.) reviewed (C.F.#2, C.F.#4 C.F.#10 C.F.#11 and C.F.#13). Findings include: 1. During the review of six medical staff credential files on 5/18/17 at 2:30 pm the following was found: a. Two out of fourteen staff's credential files did not have evidence of their Influenza profiles or responsibility exoneration. (C.F #2 and #13) b. One out of fourteen staff's credential files did not have evidence of their Certificate of negative criminal record. (CF #11) c. Three out of fourteen staff's credential files did not have evidence of the State local Law #300 sex offender certification. (CF #2, #4, and #10)",2020-09-01
96,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,493,C,0,1,I29Y11,"Based on the recertification FOSS survey, review of medical records and interviews performed on 5/17/17, it was determine that the Governing Body failed to maintain regularly meetings for the general operation of the facility could affect 14 out of 14 residents. (R#1 to #14) Findings include: 1. No evidence was provide of the Governing Body meeting 2. During interview with the Director of Nursing (DON) employee #2 on 5/17/17 at 1:00 pm, she stated the governing body minutes are locked and the president are not in Puerto Rico and she have the keys. The Governing Body failed to maintain regularly meetings for the general operation of the facility.",2020-09-01
97,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2017-05-18,514,F,0,1,I29Y11,"Based on a recertification FOSS survey, observation, record review, and interview, it was determined that the facility failed to ensure that clinical records are accurately documented, completed and maintained in good condition for 4 out of 8 medical records reviewed ( R#1, R#2, R#5 and R#6 ). Findings include: 1. During RR of R#1, R#2, R#5 and R#6 performed on 5/16/17 thru 5/18/17 from 9:00 am to 4:00 pm, it was found incomplete documentation on the following formularies: a. It was found that all admitted residents have a medical admission order. This order includes instructions for diet, vital signs, laboratories, consultations, prevention of ulcers, prevention of falls and recommendations for healing and wound care. Within the documentation and instructions of the recommendations for the care of the wounds; does not indicate how the dressing will be changed and what type of dressing is to be used.",2020-09-01
98,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2018-07-23,550,E,0,1,7WTE11,"Based on observation and interview, the facility failed to promote resident dignity in dining. The facility served 14 of 14 residents ((R)2, R3, R4, R5, R6, R7, R8, R9, R10, R11, F12, R13, R14, and R15) meal trays with plastic disposable eating utensils and disposable foam drinking cups. Findings include: On 07/20/18 at 9:30 AM, the dirty meals trays from breakfast were observed on a rack in the kitchen. The trays were observed to have soiled plastic disposable eating utensils and disposable foam cups. Cook 1 was asked if the facility had regular eating utensils and drinking glasses/cups. He stated they had regular utensils and cups for residents who required adaptive eating utensils and glasses/cups and showed them to the surveyor. He stated they did not have regular eating utensils or glasses/cups for residents who did not need adaptive equipment. Based on observations of resident lunch trays on 07/20/18 at 11:30 AM, dinner trays on 07/20/18 at 4:30 PM, lunch trays on 07/21/18 at 11:30 AM, and breakfast trays on 07/22/18, the 14 residents R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, and R15) all received disposable eating utensils and drinking glasses/cups. During interviews with the 14 residents none of them had complaints regarding the disposable items they received. On 07/20/18 at 1:30 PM, the Administrator verified they were currently using disposable eating utensils and disposable foam cups for residents. On 07/23/18 at 12:30 PM, the Registered Dietician stated dining needed to be more homelike.",2020-09-01
99,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2018-07-23,578,D,0,1,7WTE11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure three of 14 ((R)2, R6, and R8) resident records reviewed during the initial pool process indicated their decision whether they wished to formulate an advance directive on the facility's Advance Directive/Informed Decision for Health form. Findings include: 1. According to the Face Sheet R6 was admitted to the facility on [DATE]. An admission Minimum Data Set (MDS), an assessment tool completed by the facility staff used to identify resident care problems and assist with care planning, had been started for R6 (it was not required to be completed at the time of the survey) with an Assessment Reference Date (ARD), the end-point of the evaluation period, of 07/24/18. As specified under Section C: Cognitive Patterns, the resident had a Brief Interview for Mental Status (BIMS) (a cognitive evaluation) score of 15 out of 15, which indicated the resident was cognitively intact and could make independent decisions. Review of the resident's clinical record revealed an Advance Directive/Informed Decision for Health form signed by the resident on 07/20/18. The form did not indicate whether the resident did or did not want to formulate an advance directive. 2. According to the Face Sheet Resident R8 was admitted to the facility on [DATE]. An admission MDS had been started for R8 (it was not required to be completed at the time of the survey) with an ARD of 07/24/18. As specified under Section C: Cognitive Patterns, the resident had a s BIMS score of 15 out of 15, which indicated the resident was cognitively intact and could make independent decisions. Review of the resident's clinical record revealed an Advance Directive/Informed Decision for Health form signed by the resident on 07/20/18. The form did not indicate whether the resident did or did not want to formulate an advance directive. 3. According to the Face Sheet Resident R2 was admitted to the facility on [DATE]. An admission MDS had been started for R2 (it was not required to be completed at the time of the survey) with an ARD of 07/22/18. As specified under Section C: Cognitive Patterns, the resident had a BIMS score of 15 out of 15, which indicated the resident was cognitively intact and could make independent decisions. Review of the resident's clinical record revealed an Advance Directive/Informed Decision for Health form signed by the resident on 07/18/18. The form did not indicate whether the resident did or did not want to formulate an advance directive. 4. On 07/21/18 at 2:15 PM, the Director of Nursing (DON) was shown the three Advance Directive/Informed Decision for Health forms and was asked if the forms had been completed correctly. She stated they were not complete as the resident should indicate their decision as to whether they did or did not wish to formulate an advance directive.",2020-09-01
100,SERVICIOS INTEGRADOS DE REHABILITACION (SIRO) INC,405029,CALLE 4-L-10 URB COLINAS DEL OESTE,HORMIGUEROS,PR,660,2018-07-23,608,C,0,1,7WTE11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure its abuse and neglect prohibition policy included information on the mandated timeframes, and related staff education, for the reporting reasonably suspected crimes against a resident to the State Survey Agency and local law enforcement. The facility also failed to post, in a prominent location, information regarding the employee's right to be free of retaliation for reporting suspected crimes against a resident and how to file a complaint with the State Survey Agency in the event of suspected or actual retaliation. This failure had the potential to affect all 14 residents, visitors, and facility staff. Findings include: 1. Review of the facility's policy and procedure titled, Policy and Procedure for the Prevention of Abuse of Residents, revised (MONTH) (YEAR), indicated the policy and procedure failed to include: a. Procedures for reporting any reasonable suspicion of a crime against a resident to the State Survey Agency and local law enforcement, within two hours if the resident sustained [REDACTED]. b. Staff education regarding the types of acts considered to be a crime against a resident, and their obligation to report reasonable suspicions of a crime against a resident to the facility administration and/or directly to the State Agency and local law enforcement agencies. c. Provisions for posting information, in a prominent location, informing the employees of their right to be protected from retaliation for reporting a suspicion of crime against a resident to the facility administration and/or the State Survey Agency and local law enforcement. 2. Observations of the posted notices and information throughout the facility on 07/23/18 at 11:00 AM, revealed none of the information posted in the facility informed the staff of their right to remain free of retaliation from the facility for reporting reasonable suspicions of a crime against a resident, and how to file a complaint with the State Survey Agency in the event of suspected or actual retaliation. 3. During interviews on 07/22/18 at 11:25 AM and on 07/23/18 10:36 AM, the facility owner stated the facility does not report suspicions of a crime against a resident to the State Survey Agency and law enforcement S[NAME] The owner stated the facility's Administrator investigates the allegation, and if found to be true, reports the findings of the investigation to the State Survey Agency within five working days. The facility owner stated they had not posted information informing the employees of their right to be protected from retaliation for reporting suspicions of a crime against a resident.",2020-09-01