cms_ME
Data source: Big Local News · About: big-local-datasette
4,239 rows sorted by zip
This data as json, copyable, CSV (advanced)
| Link | rowid | facility_name | facility_id | address | city | state | zip ▼ | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 978 | 978 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2018-03-21 | 645 | E | 1 | 0 | H38711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interview, the facility failed to coordinate assessments for the Pre-Admission Screening and Resident Review (PASRR) Level I and Level II program for 3 of 3 sampled residents with a possible serious mental disorder (Resident #1, #2, #3). Findings: Instructions on the PASRR Level I Screen: ANY YES response for questions (6.1) (Has the individual even been diagnosed with [REDACTED].) or (6.6) (Does the individual have an intervention due to a mental illness in the past 2 years .) meets PASRR criteria for the presence of mental illness or that the presence of mental illness is suspected. Fax this entire form to Goold Health Systems. GHS will determine whether a Level II is necessary. 1. During review of Resident #1's clinical record, a surveyor noted that Resident #1 has a [DIAGNOSES REDACTED]. The surveyor could not locate evidence that the PASRR Level I instructions were followed to ensure completion of a PASRR Level II for determination of potential recommended specialized services. 2. During review of Resident #2's clinical record, a surveyor noted that Resident #2 has a [DIAGNOSES REDACTED]. The surveyor could not locate evidence that the PASRR Level I instructions were followed to ensure completion of a PASRR Level II for determination of potential recommended specialized services. 3. During review of Resident #3's clinical record, a surveyor noted that Resident #3 has a [DIAGNOSES REDACTED]. The surveyor could not locate evidence that the PASRR Level I instructions were followed to ensure completion of a PASRR Level II for determination of potential recommended specialized services In an interview with the Licensed Social worker on 3/22/18 at 4:05 p.m., the surveyor confirmed that currently there is no evidence that a determination was made on the PASRR Level I or if it was faxed to Goold Health Systems for a determination. | 2020-09-01 |
| 979 | 979 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2019-06-12 | 623 | B | 0 | 1 | 2VWO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interview, the facility failed to issue a written transfer/discharge notice to a resident or their representative for a facility-initiated transfer/discharge for 2 of 3 residents sampled for discharge or transfer (Residents #13 and #75). Findings: 1. Documentation in Resident #75's clinical record indicated that he/she was discharged /transferred to an acute care facility on 4/26/19 for treatment of [REDACTED]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or legal representative. In an interview with the Licensed Social Worker (LSW) on 6/11/19 at 12:14 p.m. the surveyor confirmed that the clinical record did not support evidence that the transfer/discharge notice was sent. 2. Documentation in Resident #13's clinical record indicated that he/she was discharged /transferred to an acute care facility on 5/16/19 for treatment of [REDACTED]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or legal representative. In an interview with the Licensed Social Worker (LSW) on 6/11/19 at 1:07 p.m., the surveyor confirmed that the clincal record did not support evidence that the transfer/discharge notice was sent. | 2020-09-01 |
| 980 | 980 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2019-06-12 | 625 | B | 0 | 1 | 2VWO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to issue a written bed hold notice to a resident or their representative for a facility-initiated transfer/discharge for 2 of 2 residents sampled for discharge or transfer to a hospital (Residents #13 and #75). Findings: 1. Documentation in Resident #75's clinical record indicated that he/she was discharged /transferred to an acute care facility on 4/26/19 for treatment of [REDACTED]. The clinical record lacked evidence that the facility issued a written bed hold notice to the resident and/or legal representative. In an interview with the Licensed Social Worker (LSW) on 6/11/19 at 12:14 p.m. the surveyor confirmed that the clinical record does not support evidence that the bed hold notice was issued. 2. Documentation in Resident #13's clinical record indicated that he/she was discharged /transferred to an acute care facility on 5/16/19 for treatment of [REDACTED]. The clinical record lacked evidence that the facility issued a bed hold notice to the resident and/or legal representative. In an interview with the Licensed Social Worker (LSW) on 6/11/19 at 1:07 p.m., the surveyor confirmed that the clincal record does not support evidence that the bed hold notice was sent. | 2020-09-01 |
| 981 | 981 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2019-06-12 | 761 | D | 0 | 1 | 2VWO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview, the facility failed to ensure expired medications were removed from the supply available for use in 1 of 6 inspected medication storage areas (Nursing Care Wing medication treatment cart). Finding: On 6/11/19 at 8:25 a.m., a surveyor and a Registered Nurse (RN), Unit Manager, observed in the Nursing Care Wing medication treatment cart the following expired medications: [REDACTED] > One tube of Equate Anti-Itch Plus with an expiration date of 6/2014; > One box of [MEDICATION NAME] for Inhalation 0.083% with an expiration date of 11/2018; > One box of [MEDICATION NAME] for Inhalation 0.083% with an expiration date of 3/2019; and > One box of [MEDICATION NAME] for Inhalation 0.083% with an expiration date of 4/2019. The surveyor confirmed the findings at the time of the observation and the Unit Manager removed the medications from the treatment cart. | 2020-09-01 |
| 982 | 982 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2019-06-12 | 880 | D | 0 | 1 | 2VWO11 | Based on observation and interview, the facility failed to handle linen in a manner to prevent the potential spread of infection on 1 of 3 survey days. On 6/10/19 at 10:15 a.m. a surveyor observed a CNA (Certified Nursing Assistant) transfer waste in a plastic bag and deposit the bag in the trash container while wearing only one glove, remove the glove and touch the outside of the waste area with a bare hand and preceded to the clean linen cart. The CNA then removed two bed sheets and placed them against her body to enter a room. A surveyor confirmed the finding with the CNA, who deposited the linen in the soiled linen cart and washed his/her hands. On 6/10/19 at 11:30a.m., in an interview with the nurse Manager, a surveyor confirmed the finding. On 6/10/19 at 1:30p.m., in an interview with the Director of Nursing, a surveyor confirmed the finding. | 2020-09-01 |
| 983 | 983 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2018-06-20 | 656 | E | 0 | 1 | J41K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to ensure that care plans were developed in the area [MEDICAL CONDITION] drug use and anticoagulant drug use for 2 of 5 residents reviewed for unnecessary medications (Resident #31 and #36). Findings: 1. On review of Resident #31's electronic Medication Administration Record [REDACTED]. On further review of the clinical record, the surveyor also noted that the order for [MEDICATION NAME] was originally dated 4/14/18: [MEDICATION NAME] 7.5 mg by mouth every bedtime for 6 days, then increase to 15 mg every bedtime for depression/[MEDICAL CONDITION]. As of 6/20/18, there is no evidence in Resident #31's clinical record to indicate that the use of an antidepressant was developed into a care plan. In an interview with the Director of Nursing (DON) on 6/20/18 at 12:58 p.m., the surveyor confirmed that a care plan was not developed to include use of an antidepressant. 2. On review of Resident #35's electronic Medication Administration Record [REDACTED]. On further review of the clinical record, the surveyor also noted that the order for Xarelto started on 8/9/2017. As of 6/20/18, there is no evidence in Resident #36's clinical record to indicate the use of an anticoagulant was developed into a care plan. In an interview with the Director of Nursing (DON) on 6/20/18 at 1:03 p.m., the surveyor confirmed that a care plan was not developed to include use of an anticoagulant. | 2020-09-01 |
| 984 | 984 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2018-06-20 | 657 | D | 0 | 1 | J41K11 | Based on record review and interview, the facility failed to ensure a care plan was updated in the area of skin integrity for 1 of 3 Residents (#41) reviewed with a pressure ulcer. Finding: Resident #41's clinical record revealed that the resident developed a facility acquired Stage 2 pressure ulcer on 3/22/18. Resident #41's Annual Minimum Data Set (MDS) 3.0 comprehensive assessment, dated 5/7/18, reflected the presence of a Stage 2 pressure ulcer. Additionally, a review of the clinical record also revealed that the wound continues to require treatment. On review of Resident #41's current care plan, the surveyor noted the care plan indicated The resident is at risk for skin breakdown due to some incontinence and impaired mobility, but could not locate a care plan to address actual skin breakdown. On 6/19/18 at 1:32 p.m., during an interview with the Director of Nursing and Assistant Director of Nursing, the surveyor confirmed that the care plan had not been updated to reflect actual skin breakdown. | 2020-09-01 |
| 985 | 985 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2018-06-20 | 755 | D | 0 | 1 | J41K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure expired medications were removed from the an emergency supply available for use in 1 of 2 medication rooms (Gillis Way). Finding: On 6/19/18 at 8:13 a.m., a surveyor, the Director of Nursing (DON) and a Registered Nurse (RN) observed in the Gillis Way medication storage room, 5 doses of emergency stock [MEDICATION NAME] 5mg, with an expiration date of 4/2018. The DON and RN confirmed with the surveyor the expiration date and immediately destroyed the medication at the time of the finding. | 2020-09-01 |
| 1961 | 1961 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2015-04-16 | 282 | D | 0 | 1 | 2U6H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure that care plan approaches for completing a base-line Abnormal Involuntary Movement Scale (AIMS) Test, and see orders for adaptive equipment following Speech Language Pathologist recommendations were implemented for 1 of 5 residents whose medication regime's were reviewed (#141) and 1 of 1 resident's reviewed for hydration. (#87). Findings: 1. Resident #141's current care plan, under the identified problem area of daily [MEDICAL CONDITION] administered, related to dementia with behaviors, depression and agitation manifested by verbal distress, and aggressive behaviors directs staff to do a base-line AIMS and report any noted extrapyramidal changes to physician as soon as observed. The clinical record lacked evidence that a base-line AIMS was completed as directed by the care plan. On 4/16/15 at 12:10 p.m. finding was confirmed in an interview with the Director of Nursing. 2. Resident #87's current care plan under the identified problem area alteration in nutrition related to meal intake less than or equal to 75% manifested by potential for weight loss directs staff to see orders for adaptive equipment. Documentation in Resident #87's clinical record indicated the resident had a speech therapy evaluation for dysphasia. Recommendations were made by the speech therapist, on 4/9/15, which indicated a dietary change: a nosey cup, and no straws. The current physician diet order directs staff texture: puree, thin liquids, no straws, nosey cup, assist. On 4/16/15 at 9:28 a.m., a surveyor observed a CNA (certified nursing assistant) assisting Resident #87 with the breakfast meal, including fluids in a regular cup with straws. On 4/16/15 at 10:08 a.m., a surveyor observed, from an open doorway to hall, a Medication Technician (MT)) administering fluid from a small cup by a straw to Resident # 87. On 4/16/15 at 12:35 p.m., a surveyor observed, a CNA assisting Resident #87 wi… | 2018-08-01 |
| 1962 | 1962 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2015-04-16 | 329 | D | 0 | 1 | 2U6H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to complete a base-line Abnormal Involuntary Movement Scale (AIMS) test in accordance with the approaches outlined in a care plan, and current guidelines for the use of antipsychotic medications for 1 of 5 residents whose medication regime were reviewed (#141). Finding: Resident #141's Physician Block Order's direct staff to administer the anti-psychotic medication [MEDICATION NAME] 50 mg (milligrams) PO (by mouth) BID (twice daily) for treatment of [REDACTED]. The clinical record lacked evidence of a base-line AIMS completed. On 4/16/15 at 12:10 p.m. finding was confirmed in an interview with the Director of Nursing. | 2018-08-01 |
| 1963 | 1963 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2015-04-16 | 428 | D | 0 | 1 | 2U6H11 | Based on record review and interview, the facility failed to ensure that the Consultant Pharmacist identified and reported to the Attending Physician and the Director of Nursing, that an anti-psychotic medication (Seroquel) was being administered without a base-line Abnormal Involuntary Movement Scale (AIMS) test having been completed for 1 of 5 resident's whose medication regime were reviewed (#141). Finding: Resident #141's Physician Block Orders direct staff to administer the anti-psychotic medication Seroquel 50 milligrams (mg) PO (by mouth) BID (twice daily). The Consultant Pharmacist completed monthly medication reviews on 12/2/14, 2/17/15, 3/4/15, and 4/7/15, and failed to report to the Attending Physician or the Director of Nursing that a base-line AIMS test had not been completed. On 4/16/15 at 12:10 p.m. finding was confirmed in an interview with the Director of Nursing. | 2018-08-01 |
| 2077 | 2077 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2015-04-23 | 279 | D | 1 | 0 | X1NK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a care plan was developed in accordance with the interdisciplinary team's decision to proceed with care planning in the areas of: Activities of Daily Living (ADLs); urinary incontinence; falls; pressure ulcer; [MEDICAL CONDITION] drug use; pain and community discharge planning for 1 of 3 sample residents (#1). Finding: Resident #1's Care Area Assessment Summary, dated March 4, 2015, indicated that the interdisciplinary team had determined to proceed with care planning for the identified care areas of: Activities of Daily Living (ADLs); urinary incontinence, falls; pressure ulcer, [MEDICAL CONDITION] drug use, pain and community discharge planning. On April 24, 2015, the residents medical record lacked evidence of care plans to address theses areas. On April 24, 2015 at approximately 11:45 a.m., in an interview with a surveyor, the Charge Nurse stated the care plan seems to be incomplete. | 2018-04-01 |
| 2914 | 2914 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2012-12-20 | 253 | E | 0 | 1 | 2KVX11 | Based on observations and interviews, the facility failed to ensure wheelchairs were maintained in a clean and sanitary manner for 8 of 35 residents observed in wheelchairs (#20, #83, #5, #22, #43, #54, #88 and #117). In addition, the facility failed to ensure that the doors/doorways to bathrooms used by residents were maintained 2 of 34 resident rooms. Findings: 1. On 12/18/12 at 9:03 a.m. and on 12/20/12 at approximately 11:30 a.m., a surveyor observed that Resident #20's wheelchair had a stained seat and the wheels had dried food particles and fluid marks. The resident's wheelchair also had tears on both armrests that were partially covered with duct tape. On 12/20/12, a surveyor discussed this finding with the Administrator in Training at the time of the second observation. 2. On 12/20/12 at 9:08 a.m., a surveyor observed Resident #83 seated in his/her wheelchair. The resident's wheelchair was soiled with stains and dried on fluid marks. The right and left armrests were torn creating an uncleanable surface. 3. On 12/20/12 during a tour of the facility at approximately 9:08 a.m., a surveyor observed wheelchairs that were stained, and soiled with dried on food and fluids for Residents #5, #20, #22, #43, #54, #88 and #117. On 12/20/12 at 9:46 a.m., a surveyor discussed the unclean wheelchairs and the wheelchairs with the tears with the Administrator in Training and the Registered Nurse, Director of Clinical Operations. 4. On 12/18/12 at 8:42 a.m. a surveyor observed the doorway to Resident #50's bathroom had chipped paint. The door to the bathroom had laminate at the base of the door that was coming off the base of the door. 5. On 12/18/12 at 10:58 a.m., a surveyor observed the doorway to Resident #49's bathroom had scuffed wood and chipped paint. On 12/20/12 at 9:18 am, in an interview with a surveyor, the Environmental Supervisor stated that the chipping paint along the doorframes to Resident rooms and bathrooms was due to the residents' wheelchairs bumping into them. The Environmental Supervisor stated that t… | 2016-06-01 |
| 2915 | 2915 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2012-12-20 | 329 | D | 0 | 1 | 2KVX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure that a Schedule II narcotic, [MEDICATION NAME], was not administered beyond the automatic stop date for 1 of 10 sampled residents, whose medication regimes were reviewed (#53). Finding: The current standard of practice for Schedule II narcotics is that the orders are time limited to 7 days, unless indicated that the medication could be used for up to 30 days. Resident #53 had a physician's orders [REDACTED]. The resident's Medication Administration Record [REDACTED]. On 12/19/12 at 11:30 a.m., in an interview with a surveyor, the Registered Nurse (RN), Unit Manager stated that the medication was given almost nightly and sometimes twice a night to the resident, related to his/her gastroparesis. On 12/19/12 at 11:40 a.m., in an interview with a surveyor, the attending physician stated that he was aware the resident was receiving the Scheduled II medication and that he wanted the resident to continue receiving the Scheduled II medication. A surveyor discussed this finding with the Unit Manager and the Medical Director, on 12/20/12 at 1:00 p.m. | 2016-06-01 |
| 2916 | 2916 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2012-12-20 | 428 | D | 0 | 1 | 2KVX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure that the Pharmacist identified and reported to the attending Physician and the Director of Nursing that a Schedule II narcotic, Dilaudid, was being administered beyond the automatic stop date (7 days) for 1 of 10 sampled residents, whose medication regimes were reviewed (#53). Finding: The current standard of practice for Schedule II narcotics is that the orders are time limited to 7 days, unless indicated that the medication could be used for up to 30 days. Resident #53 had a physician's orders [REDACTED]. The pharmacy consultation review form indicated that the pharmacist visited on 12/11/12 but did not identify that the Scheduled II medication, Dilaudid had not been renewed after the automatic stop order date and had been administered by staff, without a physician's orders [REDACTED]. | 2016-06-01 |
| 3196 | 3196 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2012-10-09 | 241 | D | 1 | 0 | PNQP11 | Based on review of the facility's investigation report and interviews, the facility failed to promote an environment that maintained the resident's dignity, when staff posted a nude photo of 1 of 2 sampled residents (Resident #2). This posting resulted in the resident stating he/she felt belittled. Finding: On 9/26/12, the Division of Licensing and Regulatory Services received an incident report that indicated a staff member had hung a nude picture (with genital covered) of Resident #2 on the wall in the resident's room. The facility's investigative report indicated that the resident had stated he/she felt belittled by the picture. The facility's investigative report indicated that five staff members had seen the picture and had not removed the picture. On 10/9/12 at 1:00 p.m., in an interview with a surveyor, Resident #2 stated he/she was nude in the picture when it was hung up on the wall near his/her bed. The resident stated he/she had not granted staff permission to hang this picture. The resident stated that although he/she no longer felt offended by the incident, he/she felt belittled at the time. The resident stated that some of the staff had seen the photo and laughed. On 10/9/12 at 10:30 a.m., in an interview with the a surveyor, the Administrator confirmed that a Licensed Practical Nurse (LPN) had posted a nude (no genitals showing) photograph of Resident #2 without his/her permission on 9/24/12. Multiple staff had knowledge of or had seen the photo and had not taken actions to remove the picture to promote the resident's dignity. On 10/11/12 at 1:45 p.m., in a phone interview with a surveyor, the Administrator acknowledged that the facility had addressed the resident's right to privacy, but had not addressed dignity with all staff involved in the incident. | 2015-10-01 |
| 3310 | 3310 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2012-08-21 | 226 | D | 1 | 0 | H9QC11 | Based on policy review and interviews, the facility failed to implement written policies and procedures for investigating and reporting allegations of exploitation of a resident's personal property. Finding: The facility's policies for "Reporting Abuse, Neglect & Exploitation" indicates on page 1, #6, that when there is suspected exploitation of resident's property, the nurse is to begin the investigation including an interview of family, other staff members, other residents etc. and document the findings. The policy indicates that the staff member must report all incidents of suspected exploitation to the State agency and that all staff employed by the facility are responsible for reporting any issues of exploitation. The policy indicates the Administrator, Director of Nursing and the Social Worker are responsible for the internal investigations. The policy indicates that the resident, family, staff members and witnesses will be interviewed and the investigation is to be concluded within 3 to 4 working days. On 8/21/2012 at 8:20 AM, in an interview with a surveyor, Resident #1 stated that when he/she went to therapy on 8/8/12, he/she had left his/her electronic reader on the bed. The resident stated when he/she returned an hour later, the electronic reader was missing. The resident stated that he/she reported the missing electronic reader to the staff immediately. The resident stated that the staff searched his/her room and the laundry but that the electronic reader was not found. Resident #1 stated he/she contacted his/her spouse and informed the spouse of the missing electronic reader. On 8/21/12 at 12:00 PM, in an interview with a surveyor, the Administrator in Training (AIT) stated he first became aware of the missing electronic reader on 8/10/12 (two days after it was reported missing). The AIT stated that he then spoke with the resident's spouse and stated that he did not have any additional information. The AIT supplied the surveyor with a document, dated 8/10/12, that indicated the AIT's conversation wit… | 2015-08-01 |
| 3515 | 3515 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2012-01-13 | 333 | D | 0 | 1 | TWTP11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that 1 of 40 stage I sampled residents remained free of any significant medication errors (#67). Finding: The facility's copy of Mosby's 2012 Nursing Drug Reference (25th Edition) book states: [MEDICATION NAME] - Do not break, crush or chew extended release tablets. Page 839 Resident #67 had a physician's orders [REDACTED]." On 1/10/12 at 8:55 a.m., during the medication pass observation, the surveyor observed a Licensed Practical Nurse (LPN) prepare medications for Resident #67. The surveyor observed the LPN place medications into a plastic medication crush pouch which included [MEDICATION NAME] Extended Release (ER). The surveyor intervened just as the LPN was about to crush the medication tablets. In an interview with the LPN, on 1/10/12 at 9:00 a.m., she acknowledged that she was going to crush the extended release medication and removed the [MEDICATION NAME] ER tablet from the plastic medication crush pouch. | 2015-05-01 |
| 4145 | 4145 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 241 | E | LZFK11 | Based on observations and interviews, the facility failed to have all residents sharing a table in the dining room eat at the same time during 1 meal for 5 residents (#53, #62, #63, #67 and #104.) Finding: On 12/28/10 at the noon meal, on the Feeney Unit, a surveyor observed Resident #53, #62, #63, #67 and #104 at the same dining table. Resident #62 and #104 received their lunch and were being fed. Resident #67 had his/her lunch tray placed in front of him/her with his/her food covered. Resident #67 watched Resident #62 and #104 eat for 12 minutes before a staff member assisted the resident with his/her meal. While Resident #67 watched his/her tablemates eat, he/she had attempted to pull his/her tray closer to him/herself. A Certified Nursing Assistant (CNA), who was at the table, pulled it away until a second CNA arrived. The surveyor discussed this finding in an interview with the Registered Nurse, on 12/29/10 at 11:53 a.m. | 2014-03-01 | ||
| 4146 | 4146 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 280 | E | LZFK11 | Based on record review, observation and interviews, the facility failed to revise the care plan for 2 of 30 Stage II sampled residents in the area of a Functional Maintenance Plan (FMP) for mobility (#35) and the current needs for provision of care (#24). Findings: 1. Resident #35's current care plan for Activities of Daily Living (ADL) did not include the Rehabilitation Functional Maintenance Program (FMP) for arm exercises that was created by the Facility's rehabilitation team on 8/25/10, to maintain the resident's functional ability. The resident's care plan, which was reviewed on 9/8/10, following an MDS assessment, was not updated to reflect the FMP. The surveyor discussed this finding in an interview with Licensed Practical Nurse Manager and the Occupational Therapist, on 1/3/11 at 11:55 a.m. 2. On 1/3/10, the surveyor conducted 2 staff interviews; one at 10:15 a.m. and another at 1:30 p.m. In both interviews, nursing staff informed the surveyor that more than one staff member was to be present when providing care for Resident # 24. In review of Resident # 24's care plan and Certified Nursing Assistant (CNA) Kardex, there was no documentation to indicate the need for more than one staff member when providing care. On 1/3/10 at 3:00 p.m., in an interview with the Nurse Manager, she acknowledged the care plan and CNA Kardex had not been revised to indicate the number of staff required to provide daily care needs to this resident. | 2014-03-01 | ||
| 4147 | 4147 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 282 | D | LZFK11 | Based on record reviews and interviews, the facility failed to ensure care plan interventions were implemented for 2 of 30 Stage II sampled residents (#121 and #35) Findings: 1. Resident #121's care plan, updated on 11/17/10, under the identified problem area of high risk for falls, indicated that the resident was to be removed from the areas by entrance doors due to the resident's attempts to elope from the facility. In addition, the care plan identified under the area of increased behaviors, that the resident liked to be pushed in the wheelchair, to always face the resident when speaking and to explain to the resident what staff was going to do to assist him/her. On 12/28/10 at approximately 10:55 AM, two surveyors observed Resident #121 seated in a broda style chair. A Certified Nursing Assistant (CNA) was observed pulling the chair backward down the hallway. The resident's heels were observed bouncing on the carpeted floor as the CNA pulled the resident backward down the hallway and positioned resident in front of fire entrance/exit doors overlooking the day care parking lot. The resident's care plan interventions were not implemented by staff. On 1/3/11 at 12:00 PM, a surveyor discussed this finding with the Administrator. 2. Resident #35's current clinical record indicated that the resident was to have an exercise program implemented as part of a Functional Maintenance Program (FMP). In an interview with the resident on 1/3/11 at 11:00 a.m., the resident stated that the facility stopped doing the exercise program with him/her "a while ago" and he/she was unsure as to why. The surveyor discussed this finding in an interview with LPN Manager, on 1/3/11 at 11:55 a.m. who provided no additional information. | 2014-03-01 | ||
| 4148 | 4148 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 311 | E | LZFK11 | Based on record reviews, and interviews, the facility failed to provide interventions to maintain physical functioning as outlined in the resident's care plan for 1 of 30 Stage II sampled residents (#35). Finding: Resident #35's current clinical record indicated that the resident was to have an upper extremity exercise program implemented as part of a Functional Maintenance Program (FMP). In an interview with the resident on 1/3/11 at 11:00 a.m., the resident stated that the facility stopped doing the exercise program with him/her "a while ago" and he/she was unsure as to why. The surveyor discussed this finding in an interview with Occupation Therapist, on 1/3/11 at 11:55 a.m. who stated that he thought the resident was still getting the exercises. In an interview with the resident's Certified Nursing Assistant (CNA) on 1/3/11 at 12:20 p.m., she stated that she was not familiar with an FMP for upper extremity exercise and she believed that it had been discontinued a while ago. This finding was discussed with the Licensed Practical Nurse (LPN) Manager, on 1/3/11 at 12:30 p.m. | 2014-03-01 | ||
| 4149 | 4149 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 323 | D | LZFK11 | Based on record review, observation and interview, the facility failed to ensure the environment maintained was free of potential accident hazards for 1 of 30 Stage II sampled residents (#121) Finding: On 12/28/10 at approximately 10:55 AM, two surveyors observed Resident #121 seated in a broda style chair. A Certified Nursing Assistant (CNA) was observed pulling the chair backward down the hallway. The resident's heels were observed bouncing on the carpeted floor as the CNA pulled the resident backward down the hallway and positioned the resident in front of the fire entrance/exit doors overlooking the day care parking lot. In addition, the resident's tab alarm was observed loosely attached to the residents waist with a long string to the alarm mechanism at the back of the chair. The resident would have been able to stand and move approximately a foot before the alarm mechanism would disconnect and ring. The resident's care plan, updated on 11/17/10, indicated the resident wandered throughout the unit in his/her wheelchair and was to be redirected if the resident was in other residents' space/rooms and to redirect the resident away from entrance doors. The resident was not protected from potential injury when the staff member failed to ensure the resident's heels/feet were protected from potential injury during transport, was not protected from potential elopement by placing the resident by an entrance/exit door and did not have the tab alarm properly applied. On 1/3/11 at 12:00 PM, a surveyor discussed these findings with the Administrator. | 2014-03-01 | ||
| 4150 | 4150 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 329 | E | LZFK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to monitor MEDICATION ORDERS FOR [REDACTED] Findings: 1. Resident #169 was admitted on [DATE], with a medications order for [MEDICATION NAME] by mouth every hour of sleep (hs). No dose was indicated. Mosby's "Nursing Drug Reference 2011" included [MEDICATION NAME] comes in many doses--25, 50, 100, 250, 500, and 1000mg. In a discussion with a Registered Nurse and the surveyor on 1/3/11 at 2:00 p.m., the bottle of [MEDICATION NAME] being used was 500mg, but the physician's order did not indicate the dose. 2. The clinical record for Resident #35 contained a physician's order for the medication, [MEDICATION NAME], along with a physician's order to obtain a TSH level every 3 months. In an interview with the physician on 1/3/10 at 10:50 a.m., he stated that the [MEDICATION NAME] dosage is based on the results of the TSH blood test in order to ensure appropriate therapy. The clinical record contained a TSH result dated, 7/15/10, which was normal. As of 01/04/11, there was no further evidence of testing or monitoring. This finding was confirmed in an interview with the Licensed Practical Nurse (LPN) on 1/3/11 at 10:55 a.m., who advised the surveyor that she would contact the lab. On 1/3/11 at 1:20 p.m., the surveyor was informed by the Registered Nurse (RN) on the Feeney unit that there was no TSH level drawn after the 7/15/10 result. | 2014-03-01 | ||
| 4151 | 4151 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 428 | D | LZFK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the Consultant Pharmacist failed to identify irregularity in the medication regimen for 2 of 30 Stage II sampled residents (#35 &169). Finding: 1. The clinical record for Resident #35 contained a physician's orders [REDACTED]. In an interview with the physician on 1/3/10 at 10:50 a.m. he stated that the Levothyroxine dosage is based on the results of the TSH blood test in order to ensure appropriate therapy. The clinical record contained a TSH result dated 7/15/10 which was normal. As of 01/04/11, there was no further evidence of testing or monitoring. This finding was confirmed in an interview with the Licensed Practical Nurse (LPN) on 1/3/11 at 10:55 a.m. who advised the surveyor that she would contact the lab. On 1/3/11 at 1:20 p.m. the surveyor was informed by the Registered Nurse (RN) on the Feeney unit that there was no TSH level drawn after the 7/15/10 result. There was no evidence in the clinical record to indicate that the Consultant Pharmacist had identified the lack of the TSH level for October 2010 and brought it to the facility of Physician's attention. 2. The clinical record of Resident #169 contained an order for [REDACTED]. | 2014-03-01 | ||
| 4152 | 4152 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 431 | D | LZFK11 | Based on observation and interview, the facility failed to ensure expired medications were not available for use. Findings: 1. On 12/29/10 at 10:00 a.m., the surveyor observed a box containing Ipratropium Bromide 0.5 mg and Albuterol Sulfate 3.0 mg nebulizer treatment ampoules, on the Hogan unit medication cart, available for administration to Resident # 62. The box contained 6 packs, each containing 5 ampoules and two additional loose ampoules which had expired on 10/2010. On 12/29/10 at 10:05 a.m., in an interview with a Certified Nurse Assistant (CNA) and the Nurse Manager, they acknowledged the expired medication. 2. On 12/29/10 at 10:10 a.m., during inspection of the medication room, the surveyor observed 2 bottles of CMP Vancomycin solution 250 mg/5 ml, which had expired on 12/18/10 and 12/21/10, available for use by Resident # 25 and Resident # 121. On 12/29/10 at 10:15 a.m., in an interview with a Certified Nurse Assistant and the Nurse Manager, they acknowledged the expired medications. | 2014-03-01 | ||
| 4153 | 4153 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 441 | D | LZFK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, infections control measures were not adhered to during an eye medication administration for one resident (# 43), and failed to ensure denture cups, bed pans and lift devices were stored and maintained in a sanitary manner on 1 of 5 days of survey. . Findings: 1. During an medication administration observation on 1/3/11 at 9:20 a.m., a Licensed Practical Nurse (LPN) administered one eye drop of [MEDICATION NAME] 0.3% to the right eye of Resident #43. The LPN failed to wear gloves and failed to wash his/her hands after administering the drops. The LPN agreed that she had not worn gloves or washed her hands as the "Instillation of Eye Drops" procedure supplied by the facility. 2. On 12/28/10 at approximately 10:00 AM, surveyors observed the following: ? An unlabeled uncovered denture cup with resident's dentures in the cup, located in the semiprivate bathroom of room [ROOM NUMBER] ? An unlabeled fracture pan covered with plastic and stored between the grab bar and the wall in the semiprivate bathroom of resident room [ROOM NUMBER] ? An unlabeled urinary collection style hat in the semiprivate bathroom of room [ROOM NUMBER] ? An unlabeled fracture pan stored between the wall and the grabrail behind the toilet, an unlabeled urinal located in the spa on the Hand Unit ? A Sara style lift was observed with a soiled base stored on the Finley Unit ? An unlabeled fracture pain was observed stored with plastic wrap in the semi private bathroom of resident room [ROOM NUMBER] ? A Hoyer lift with a soiled base, was observed stored in the shower of the spa room on the Hand Unit. | 2014-03-01 | ||
| 4154 | 4154 | DURGIN PINES | 205132 | 9 LEWIS RD | KITTERY | ME | 3904 | 2011-01-04 | 502 | D | LZFK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure that laboratory tests were obtained as ordered for 1 of 30 Stage II sampled residents (#35). FINDINGS: The clinical record for Resident #35 contained a physician's orders [REDACTED]. In an interview with the physician on 1/3/10 at 10:50 a.m., he stated that the [MEDICATION NAME] dosage is based on the results of the TSH blood test in order to ensure appropriate therapy. The clinical record contained a TSH result, dated 7/15/10, which was normal. As of 01/04/11, there was no further evidence of testing or monitoring. This finding was confirmed in an interview with the Licensed Practical Nurse (LPN) on 1/3/11 at 10:55 a.m. who advised the surveyor that she would contact the lab, as there should have been a TSH level drawn in October 2010. On 1/3/11 at 1:20 p.m., the surveyor was informed by the Registered Nurse (RN) on the Feeney unit that there was no TSH level drawn after the 7/15/10 result. | 2014-03-01 | ||
| 593 | 593 | PINNACLE HEALTH & REHAB AT N BERWICK | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2020-02-18 | 609 | B | 1 | 0 | EG5Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interviews the facility failed to report an incidents of potential neglect (elopement) to the Division of Licensing and Certification (State Survey Agency) and Adult Protective Services within 24 hours for 1 of 3 sampled residents with elopement risk potential. (Resident #1) Finding: Review of Resident #1's record reveals two incidents in which Resident #1 was found outside of the facility without the knowledge/supervision of facility staff, on 12/25/19 and again on 2/1/20. A review of Resident #1's Minimum Data Set, Version 3.0 assessment dated [DATE] under cognitive patterns indicates a moderate impairment. Further review reveals reportable incident forms were completed by the facility, however; the surveyor could not locate evidence that the two incidents of potential neglect (elopement) were reported to the State Survey Agency and Adult Protective Services within 24 hours as required. On 2/18/20 at 1:40 p.m., in an interview with the Administrator the surveyor confirmed the incidents of potential neglect (elopement) were not reported to the State Survey Agency and Adult Protective Services. | 2020-09-01 |
| 594 | 594 | PINNACLE HEALTH & REHAB AT N BERWICK | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2018-03-21 | 689 | D | 0 | 1 | VHV811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure the resident environment was free from accident hazards in 1 of 1 Whirlpool Room used by residents on 3 of 3 units on 1 of 3 survey days. Finding: On 3/19/18 at 6:16 p.m., the surveyor observed the Whirlpool Room door that was unlocked and opened, with an unlocked closet inside with a sign on the door stating: This Closet Has Chemicals - It Must Stay Locked. The unlocked closet contained a bottle of NeutraFect disinfectant cleaner and 2 boxes of shaving razors. The Material Safety Data Sheet (MSDS) for - NeutraFect indicates the following - Potential Health Effects: -Skin: Direct skin contact may produce sever irritation, which upon prolonged contact, may produce skin burns. Harmful if absorbed through the skin. -Inhalation: Mists and vapors can irritate the throat and respiratory tract. High vapor concentrations may cause central nervous system effects. Symptoms may include headaches, dizziness, and drowsiness. Harmful if inhaled. -Ingestion: Ingestion can cause gastrointestinal irritation, swelling of the larynx, difficulty in breathing, circulatory shock, convulsions and possible death. Of a total of 57 residents, 25 have been diagnosed with [REDACTED]. The Whirlpool Room and closet doors were observed opened from 6:16 p.m. to 6:46 p.m., at which time the surveyor intervened and informed the A/B Unit Charge Nurse. On 3/19/18 at 6:46 p.m., the surveyor and the Unit Charge Nurse together observed the unsecured chemical and razors, at this time in an interview with the Unit Charge Nurse the surveyor confirmed the finding, and the Unit Charge Nurse locked the closet door. On 3/21/18 at 9:15 a.m., in an interview with the Administrator, the surveyor confirmed the finding. | 2020-09-01 |
| 595 | 595 | PINNACLE HEALTH & REHAB AT N BERWICK | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2019-04-05 | 761 | D | 0 | 1 | EZXR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to adequately date and properly dispose of all biologicals after opened and according to manufacturer specifications for 1 of 5 insulin vials (Resident #40) on 1 of 2 treatment carts. Finding: On 4/4/19 at 7:42 a.m., the surveyor and a Licensed Practical Nurse (LPN) observed 1 opened [MEDICATION NAME] 100 unit/ml vial for Resident #40 that did not contain an open date on the vial or the box. Per manufacturer specifications for [MEDICATION NAME], dispose of when: In-use (opened) 28 days refrigerated or room temperature. At the time of the observation and in an interview with the LPN he/she confirmed the finding and disposed of the vial. On 4/4/19 at 8:22 a.m., a surveyor confirmed the finding in an interview with the Director of Nursing. | 2020-09-01 |
| 596 | 596 | PINNACLE HEALTH & REHAB AT N BERWICK | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2019-08-19 | 606 | B | 1 | 0 | IZH111 | > Based on interviews and record reviews, the facility failed to ensure employment of 1 of 6 sampled nursing staff did not have disciplinary action against their professional license by a state licensure body as a result of a finding of exploitation and misappropriation of resident funds. Finding: On 8/19/19, surveyor reviewed Registered Nurse #1's personnel record, who was hired at facility 6/4/19 with a New Hampshire multi-state license, she oriented 6/19-7/17/19 and worked 7/19/19 prior to termination. On 7/31/19, the facility notified the State of Maine that this nurse had an outstanding settlement for exploitation of a Resident in Vermont, having accepted money from a Resident and being brought before the New Hampshire State Board of Nursing. Although the facility had conducted background check and verified the nurse had an active license, the facility overlooked outstanding settlement against this nurse upon hire. On 8/19/19 at 10:45 am, in an interview with the Administrator, the surveyor confirmed the finding. | 2020-09-01 |
| 1614 | 1614 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2016-02-04 | 253 | B | 0 | 1 | GE7G11 | Based on observations and interview, the facility failed to ensure that resident rooms, bathrooms and common areas were maintained in good repair in during 1 of 4 days of survey. Findings: On 2/1/16, between 9:00 a.m. through 3:00 p.m., during a facility tour and Stage 1 observations, a surveyor observed resident rooms, bathrooms, and common areas on Long Term Care units A, B and C units with environmental concerns identified as: 1. Room C-3 call bell outlet dislodged and turned on the wall leaving open areas in the wall. 2. Room C-17 ceiling tile with 2 open holes in it and commode seat in adjoining bathroom with missing paint exposing wood. 3. C unit linen closet, in the hallway outside room C-17, had wood trim/molding that was pulled forward and away from the wall. 4. Whirlpool room on A/B unit had base board trim pulling away from wall at the front left side of the tub. 5. C unit shower stall had large yellowish brown colored water stains on 4 ceiling tiles, and a small open hole in the wallboard of the shower. 6. At the entrance to the main dining room, there were 2 large square areas cut out of the wood floor which contained debris. 7. Room C-7 sink had a rusty drain opening. 8. Room B-18 cove base trim beside closet is pulled loose away from wall. The findings were confirmed by the Environmental Services Director and the Administrator during a tour of the facility conducted on 2/3/16 at 8:30 a.m. | 2019-05-01 |
| 1615 | 1615 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2016-02-04 | 279 | D | 0 | 1 | GE7G11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a care plan to address activities and the application of a splint device for 2 of 11 stage 2 residents whose care plans were reviewed. (#55 and #68) Findings: 1. Resident #55 had a Preadmission Screening and Resident Review (PASRR) Level 2 Assessment completed on 9/24/14 and most recently reviewed on 12/17/15. Recommendations made, based on the assessment included: a. Encourage the resident to attend activities; b. Provide him/her coloring materials; c. Encourage the resident to use the piano; d. Encourage the resident to attend church and e. Provide the resident a quiet place for the resident to meet with visitors and family as needed. The surveyor reviewed Resident #55's overall care plan, dated 4/28/15, and was unable to locate any care plan by the activities department to support the PASRR recommendations. In an interview with the surveyor on 2/2/16 at 1:26 p.m., the Activities Director confirmed the care plan did not address the activity approaches recommended on PASRR but did confirm the activities are done as recommended and documented in the clinical record. 2. Resident #68's clinical record contained an admission Minimum Data Set (MDS) 3.0, dated 4/15/15, and a quarterly MDS, dated [DATE], that indicated the resident has a functional impairment on 1 side to both his/her upper and lower extremity. On review of the current care plan, dated 1/15/16 and previous care plan, dated 4/14/15, the surveyor could not locate a care plan to address the resident's functional impairment. In an interview with the surveyor on 2/2/16 at 2:00 p.m., a Certified Nursing Assistant confirmed Resident #68 has left-sided weakness and requires assistance with putting on his/her splint device (an ankle/foot orthotic /AFO). In an interview with the surveyor on 2/2/16 at 2:08 p.m., a Registered Nurse (R.N.) confirmed the resident has left-sided weakness that requires assistance to put on the AF… | 2019-05-01 |
| 1616 | 1616 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2016-02-04 | 371 | E | 0 | 1 | GE7G11 | Based on observation and interview, the kitchen failed to store food in a safe sanitary manner during 2 of 3 days of survey; and maintain equipment in a safe sanitary manner during 1 of 3 days of kitchen observations. Findings: 1. During kitchen tour, conducted on 2/1/16 at 8:45a.m., two surveyors observed 1 open and unsealed package of pasta (spaghetti) on the shelf in the dry storage room. The Food Service Director (FSD) confirmed the open pasta package and instructed a dietary aide to address the open packaging. 2. On 2/3/16 a surveyor observed the kitchen from 9:15 a.m. to 10:25 a.m. with the following findings: The surveyor observed in the Dry Storage Room 1 open box of dry lasagna fully open at the end; 1 package of pancake mix open to air inside the fully open unsealed box; and 1 box of baking soda open and unsealed. The white plastic ice guard on the inside of the ice machine was observed to have a large area of pink discoloration with black specks in multiple areas. The FSD was immediately alerted, confirmed the finding, and then removed the ice machine from service. The walk in refrigerator was observed to have a large area of rusty flooring in the middle and along the inside wall at the right side of the door. An interview was conducted, on 2/3/16 at 12:00 p.m., with the Food Service Director who confirmed the findings. The findings were discussed in an interview with the Administrator on 2/4/16 at 11:15 a.m. | 2019-05-01 |
| 1739 | 1739 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2016-02-04 | 499 | B | 1 | 0 | GE7G11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview the facility failed to maintain verification that a Certified Nursing Assistant's certification was in active status between the time frame of [DATE] to [DATE]. Finding: During an review of a Certified Nursing Assistant (CNA) employee file, indicated the employee was hired on [DATE] and CNA's certification expired on [DATE]. On [DATE] at 12:33 p.m., during an interview with the surveyor, the Administrative Assistant confirmed that the employee record lacked a current CNA certification for 64 days. | 2019-02-01 |
| 2015 | 2015 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2014-12-11 | 278 | B | 0 | 1 | 1SR211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and interviews, the Minimum Data Set 3.0 (MDS) assessment failed to accurately reflect the resident's status in the areas of vision and terminal prognosis for 2 of 4 Stage 2 residents sampled for these care areas (#38 and 58). Findings: 1. During a review of Resident #58's annual Minimum Data Set, Version 3.0 (MDS) assessment, dated 6/19/14 and a quarterly MDS assessment, dated 9/16/14, was coded to identify the resident has a visual impairment and did not use corrective lenses (Sections B1000 and B1200) coded for Resident #58. On 12/08/14 at 12:18 p.m., 12/09/14 at 1:16 p.m. and on 12/10/14 at 11:22 a.m., a surveyor observed Resident #58 wearing corrective lenses. Resident #58's Medication Administration Record [REDACTED]. In an interview with a surveyor, the Charge Nurse on 12/09/14 at 1:21 p.m., stated to the surveyor that Resident #58's glasses are stored in the medication cart when not in use and put on the resident when he/she is up for the day. On 12/09/14 at 1:50 p.m. in an interview with the surveyor, the MDS Coordinator stated she wasn't sure whether she saw the resident wear glasses or not. The MDS Coordinator confirmed in a follow up interview with the surveyor on 12/10/14 at 10:03 a.m. that she did not ask other staff about the resident's use of glasses and confirmed she did not note the use of glasses recorded in the MAR indicated [REDACTED] 2. During a review of Resident #38's significant change MDS, dated [DATE], and quarterly MDS, dated [DATE], a surveyor noted the MDS indicated Resident #38 did not have a condition or chronic disease that may result in a life expectancy of less than 6 months (Section J1400). The Hospice Plan of Care for Resident #38 indicated that, on 8/12/14, the resident had a terminal [DIAGNOSES REDACTED]. On 12/10/14 at 9:57 a.m., the MDS Coordinator stated to the surveyor that she was not aware that the clinical record contained the terminal prognosis to accurately c… | 2018-05-01 |
| 2016 | 2016 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2014-12-11 | 282 | E | 0 | 1 | 1SR211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to follow the care plan, in the area of Abnormal Involuntary Movement Scale (AIMS) assessment, for 1 of 5 stage 2 residents (#1), reviewed for Unnecessary Medications. Finding: Resident #1 has a physician's orders [REDACTED]. The comprehensive care plan, under the problem area of At risk for side effects of [MEDICAL CONDITION] medications, directs staff to conduct an AIMS assessment per facility policy. The facility's policy states that residents receiving antipsychotic medications will be monitored using a mental status test such as AIMS or other objective measures. The evaluation process will occur at admission, every six months thereafter, or more often if deemed necessary. The last AIMS test found in the medical record of Resident #1 was dated 4/25/13. The surveyor discussed this finding with the Director of Nursing, on 12/10/14 9:15 a.m. | 2018-05-01 |
| 2017 | 2017 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2014-12-11 | 371 | E | 0 | 1 | 1SR211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner, discard expired and outdated foods and failed to store foods in a sanitary manner on 1 of 2 kitchen tours. Findings: 1. During the initial kitchen tour on 12/8/14 between 9:16 a.m. and 9:40 a.m., the following were observed by a surveyor and then confirmed with the Food Services Director (FSD), on 12/8/14 at 9:40 a.m. a. The vegetable preparation sink had no airgap or backflow prevention; b. The surveyor and FSD noted an operating fan located in the food preparation/cooking area with visible dust on the grill; c. In the dry storage area, the surveyor and FSD noted 1 dented #10 can of Al Dente Pasta Sauce and 1 dented #10 can of diced beets available for use; d. The surveyor and FSD noted black encrusted residue on the stove's cooktop; e. The surveyor and FSD noted 4 unlabelled and undated sandwiches and 1 bowl of soup; f. The surveyor and FSD noted 5 uncoverered, unlabelled and undated dessert bowls filled with cake and 1 plastic container with strawberries in the walk-in refrigerator; g. The surveyor and FSD noted an unlabelled and undated plastic bag of bread rolls in the walk-n refrigerator and h. The surveyor and FSD noted 2 of 12 containers of fresh strawberries with mold on most of the berries in the walk-in refrigerator. 2. On 12/9/14 at 8:00 a.m. during an inspection of the kitchenette refrigerator on the C unit, a surveyor noted 1 quart of [MEDICATION NAME] available for use with an expiration date of 11/25/14. The refrigerator also had 1 other quart of unexpired [MEDICATION NAME] available for use. The surveyor immediately confirmed this finding with the FSD. The surveyor also discussed these findings with the Administrator on 12/10/14 at approximately 11:00 a.m. | 2018-05-01 |
| 2459 | 2459 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 241 | E | 0 | 1 | UPNM11 | Based on observation and interviews, the facility failed to ensure dignity was maintained for 4 of 30 sampled residents (#33, #35, #49 and #70). Findings: 1. On 11/18/13 during the noon meal observation, Resident #35 was observed by the surveyor in the large dining room filled with other residents and staff, asking to go to the bathroom. A staff member was heard telling the resident in a loud voice, that the resident needed to eat his/her meal; that the resident had just been to the bathroom and that the staff person would take the resident to the bathroom after lunch. On 11/28/13 at 1:30 p.m., in an interview with a surveyor, Resident #35 stated that the staff would only take him/her to the bathroom every two hours. The resident stated if I have to go more often they tell me to wait. Sometimes I can't wait. The resident stated they talked to me about the plan but I don't agree. On 11/21/13 at 9:30 a.m., in an interview with a surveyor, a Licensed Practical Nurse (LPN) stated that staff have been told to speak softly and explain why the resident would not be taken to the bathroom. 2. On 11/18/13 at 1:05 p.m., a surveyor observed an incontinence brief lying on top of bed belonging to Resident # 49. The incontinence product was visible from the doorway. Resident # 49 was unable to verbally respond to questions, or voice consent about the visible display of the incontinence product in the room 3. On 11/19/13 at 8:10 a.m., a surveyor observed an incontinence brief lying on a tray table belonging to Resident #70, which was visible from the doorway. Resident # 70 is cognitively impaired, and was unable voice consent about the visible display of the incontinence product in room. 4. On 11/21/13 at 1:20 p.m., a surveyor observed an incontinence brief lying on top of a bedside table belonging to Resident # 33. The incontinence product was visible from the doorway. Resident #33 is cognitively impaired, and was unable voice consent about visible display of the incontinence product in room. On 11/22/13 at 11:50 a.m. the findi… | 2017-04-01 |
| 2460 | 2460 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 253 | E | 0 | 1 | UPNM11 | Based on observations and interview, the facility failed to ensure that 34 of 34 resident room doors were maintained and that 11 of 34 resident rooms, (walls, heating covers, vanities and ceilings) were maintained in good repair. Findings: 1. On 11/22/13 at 9:15 a.m., during an environmental tour with the Administrator and the Maintenance Director the following findings were observed and discussed: -All thirty-four room doors were noted to be scuffed and marred; -In Resident Room #8 a two inch piece of laminate veneer on the left bedside table was missing; -In Resident Room#7 paint on the lower wall by the door, was chipped and marred. The paint on the baseboard heater cover was also marred; -In Resident Room# 9 there was a water stain on the upper left ceiling tile; -In Resident Room#11 the paint on the baseboard heater cover was chipped; -In Resident Room #12 the wooden sink vanity doors and drawers were scratched and marred; -In Resident Room #13 the wooden sink vanity doors and drawers were marred; -In Resident Room #14 the left lower corner of the tray table had a one inch piece of trim missing, creating a rough edge; -In Resident Room #15 the bathroom wall was scuffed on the lower right side; -In Resident Room #17 the baseboard cover was chipped; -In Resident Room #19 a five inch piece of baseboard trim on the left corner of the vanity sink, was peeled away from the wall; and -In Resident Room #24 a five inch piece of sheetrock on the lower left corner of the vanity sink was torn and damaged. 2. On 11/22/13 at 12:10 p.m., a surveyor found a broken acrylic fire extinguisher cover on the C Unit. On 11/22/13 at 12:15 p.m., the Administrator acknowledged the safety concern and stated it would be replaced. During the environmental tour with a surveyor the Maintenance Director stated that cosmetic repairs and upkeep of all rooms was ongoing. The Administrator provided a list of projected facility upgrades and maintenance projects, and line item costs for this. The Administrator also stated that the facility owner… | 2017-04-01 |
| 2461 | 2461 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 282 | D | 0 | 1 | UPNM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure laboratory testing was completed and results were provided to a physician in accordance with a care plan approaches for 1 of 5 residents whose medication regimes were reviewed. Finding: Resident #1's current care plan, updated on 9/18/13 under changes in mood and behaviors, contained an approach to monitor the resident's laboratory values, including [MEDICATION NAME] Levels every four months and to report results to the physician for adjustments as needed. An Outpatient Ordering Requisition form, dated 9/24/13, indicated that the resident was to have a complete metabolic panel, a complete blood count with differential, a Glycohemoglobin (A1C), [MEDICATION NAME] Level and a TSH. There was no evidence in the resident's clinical record that the laboratory results were obtained. On 11/22/13 at 12:21 p.m., in an interview with a surveyor, the Registered Nurse (RN), Unit Manager stated that they were still looking for the laboratory test and that she was unable to find that these laboratory tests were drawn. | 2017-04-01 |
| 2462 | 2462 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 314 | E | 0 | 1 | UPNM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews, the facility failed to ensure assessments of pressure ulcers were completed and documented in accordance with professional guidelines to promote healing for 3 of 4 sampled residents with pressure ulcers (#77, #53 and #75). Findings: 1. Resident # 75 admission nursing assessment, dated 10/3/13, indicated the resident was admitted with a pin point green area on his/her right ankle that was sore to touch. A 10/10/13, nursing note indicated that a dressing change was completed and the area was identified as a Stage III ulcer, measuring 0.5 by 0.2 centimeters. A 10/21/13, progress note indicated that a dressing change was completed and a q-tip was used to clean the wound tunnel and the wound was then packed with [MEDICATION NAME]-Cover with [MEDICATION NAME] and metapore. There was no documentation of the size, shape, depth, stage, condition of surrounding tissue, whether the was presence of infection, ordor or drainage and no identification of the appearance of the wound bed. On 10/31/13, progress notes indicated measurements were available. On 11/15/13, progress notes indicated the area was small with 0.3 cm tunneling, a 0.3 cm opening, no odor, no surrounding [DIAGNOSES REDACTED], with scant drainage. On 11/20/13 at 11:00 a.m., in an interview with a surveyor, a Registered Nurse (RN) confirmed that the measurements have been done by the physician, but the physician did not come every week. The RN stated that the nurses thought that the physician was doing them so they were not doing them. On 11/20/13 at 1:00 p.m., in an interview with a surveyor, a physician stated that the staff should have been documenting the status of the area at least weekly and had suggested they do this with each dressing change. 2. Resident #53's Admission Nursing Assessment, dated 10/3/13, indcated the resident had sacral and gluteal ulcers. The resident's Wound Tracking forms, dated 10/3/13 through 10/20/13, indicat… | 2017-04-01 |
| 2463 | 2463 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 323 | E | 0 | 1 | UPNM11 | Based on observations and interviews, the facility failed to ensure that a medication room was secured on 1 of 4 days of survey and denture tablets were secured from a wandering resident on 2 of 4 days of survey. In addition, the facility failed to ensure that a handrail was secured to prevent an accident and that a fire estinguisher was maintained to prevent an accident on 1 of 4 days of survey. Findings: 1. On 11/20/13 at 10:50 a.m., a surveyor observed Resident #70 enter the shared A and B Unit nurse station, while 2 surveyors but no facility staff were behind the nurse station. At this time, one of the surveyors observed the medication room door was slightly adjar, tested the door handle, which was unlocked, and stood in front of the medication room door, so the resident could not enter the medication room. At this time the Administrator entered the nurse station to redirect the resident out of the area. During the observation the surveyor informed the Administrator of the potential accident hazard, and upon surveyor intervention the Administrator devised a plan to keep residents from entering the nurse stations where the medication rooms are located. 2. 11/18/2013 at 0915 a.m., during the initial tour on the C Unit, 5 linen closets contained 3 to 16 denture cleaning tablets. The side of the denture tablet box indicated Keep out of the reach of children. Do not put tablets or solution into mouth and do not gargle or rinse. On 11/18/13 at 9:40 a.m., a surveyor observed Resident #70 wandering in and out of other resident rooms, and checking doors. On 11/18/13 at 10:20 a.m., during a interview with a surveyor, a family member stated that Resident #70 comes in and out of other resident rooms and if there were things missing the staff would have to go look to see what this resident had taken. On 11/18/2013 at 2:30 p.m., a surveyor discussed the denture tablets and review the MSDS sheets with the Director of Nursing. All denture tablets were removed. On 11/19/13 and 11/20/13, a surveyor rechecked all closets and no… | 2017-04-01 |
| 2464 | 2464 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 329 | E | 0 | 1 | UPNM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interviews, the facility failed to ensure [MEDICATION NAME] levels were drawn to determine if adjustments in the medication [MEDICATION NAME] were needed for 1 of 5 residents whose medication regimes were reviewed (#1). Finding: Resident #1's current care plan, updated on 9/18/13, indicated the resident would be free from injury relating to his/her [MEDICAL CONDITION] disorder. The care plan contained an approach indicating that the resident's level of the anti-[MEDICAL CONDITION] medication [MEDICATION NAME], would be checked every four months and a report would be made to the physician for adjustments as needed. A Outpatient Ordering Requisition form, dated 9/24/13, indicated the resident was to have a [MEDICATION NAME] level drawn. The resident's laboratory (lab) report indicated the resident's last [MEDICATION NAME] level was drawn in June 2013. The facility laboratory communication book indicated that as of 11/22/13 at 12:21 p.m., the lab had not been signed off by a Laboratory Technician as being drawn. On 11/22/13 at 10:00 a.m., in an interview with a surveyor, the Registered Nurse (RN), Unit Manager stated that they use the communication book to communicate with laboratory staff and physicians and the lab person initials when she comes and draws the labs. On 11/22/13 at 12:21 p.m., in a follow up interview with a surveyor, the RN, Unit Manager stated that she was still looking for the lab slip and that the book was not signed for this date indicating that the blood had been drawn. As of 11/22/13, there was no [MEDICATION NAME] levels available to monitor the resident's need for a medication adjustment. | 2017-04-01 |
| 2465 | 2465 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 371 | E | 0 | 1 | UPNM11 | Based on observation, record review and interview, the facility failed to follow the manutacturer's recommendation for sanitizing food preparation surfaces on 1 of 4 days of survey. Finding: On 11/18/13 at 10:00 a.m., a surveyor observed the red buckets used for wiping down food preparation surfaces had sanitizing solution in them. The Food Service Supervisor (FSS) reported that the solutiion was tested for effectiveness monthly by EcoLab The manufacturer's recommendation was New test strips are available for testing the quat solution each time it is dispensed. The facility only had a record of testing being done monthly, instead of three times a day when the solution was dispensed. There has been no outbreak of food borne illness. On 11/20/13 at 8:45 a.m., the FSS confirmed that the solution should be tested each time the solution is dispensed. | 2017-04-01 |
| 2466 | 2466 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 468 | D | 0 | 1 | UPNM11 | Based on observations and interviews, the facility failed to ensure that all handrails were securely affixed to walls on 1 of 4 days of survey. Finding: On 11/22/13 at 8:14 a.m., a surveyor inspected all facility handrails. The handrails are made of a molded synthetic composite material. One handrail on the C unit had a 1 inch gap on the right corner piece and was loose. All other handrails were securely affixed to the walls. The facility Administrator and Maintenance Director inspected the loose handrail with the surveyor, and said the handrail would be repaired immediately. At 8:45 a.m., a maintenance worker repaired the loose handrail, and the surveyor verified that the handrail was now securely affixed to the wall. | 2017-04-01 |
| 2467 | 2467 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-11-22 | 503 | E | 0 | 1 | UPNM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, and interviews, the facility failed to provide lab monitoring of three of three residents for two months. Findings 1. Resident #1' had an Outpatient Ordering Requisition form, dated 9/24/13, indicated that the resident was to have a complete metabolic panel, a complete blood count with differential, a Glycohemoglobin (A1C), [MEDICATION NAME] Level and a TSH. There was no evidence in the resident's clinical record that the laboratory results were obtained. On 11/22/13 at 12:21 p.m., in an interview with a surveyor, the Registered Nurse (RN), Unit Manager stated that they were still looking for the laboratory test and that she was unable to find that these laboratory tests were drawn. 2. Resident # 36 had an Outpatient Ordering Requisition form, dated 9/24/13, indicating the resident was to have a Basic Metabolic Panel (BMP), a Complete Blood Count with Auto Differential and an A1C drawn. There was no evidence in the resident's clinical record that the laboratory results were obtained. The laboratory communication book was not ititialed by the laboratory technician indicating the lab work was drawn. On 11/22/13 at 12:21 p.m., in an interview with a surveyor, the Registered Nurse (RN), Unit Manager stated that they were still looking for the laboratory test and that she was unable to find that these laboratory tests were drawn. 3. Resident # 37 had an Outpatient Ordering Requisition form, dated 9/24/13, indicating the resident was to have a Basic Metabolic Panel (BMP) drawn. There was no evidence in the resident's clinical record that the laboratory test had been completed. The laboratory communication book was not ititialed by the laboratory technician indicating the lab work was drawn. On 11/22/13 at 12:21 p.m., in an interview with a surveyor, the Registered Nurse (RN), Unit Manager stated that they were still looking for the laboratory test and that she was unable to find that these laboratory tests were drawn. | 2017-04-01 |
| 2859 | 2859 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2013-08-12 | 323 | E | 1 | 0 | ZZT511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide adequate resident supervision to prevent multiple occurrences of aggressive resident to resident altercations for 1 of 3 residents reviewed with behaviors. (Resident #1) Finding: On 7/3/13 Resident #1 assaulted Resident #2 resulting in bruising to the left side of his/her face and injuries to the left elbow and right knee. The facility provided documented evidence of 15 minute safety checks, dated from 7/4/13 to 7/6/13. Resident #1 had been sent to the emergency roiagnom on [DATE] due to combative behavior. According to Resident #1's care plan, initially dated 2/4/13, the facility noted an increase in restlessness and agitation on 6/4/13, as well as aggressive behaviors noted on 6/27/13. The care plan also noted 15 min. checks instituted, however, there was no date as to when this intervention was added to the care plan. According to the Nurse's Notes dated as follows, the resident had acted out toward other residents multiple times prior to the incident on 7/3/13: On 4/16/13, staff observed Resident #1 pushing on Rm 9 door resulting in Resident 9W sustaining a laceration to head. On 5/7/13, Resident #1 Stood in front of Resident #14W which other residents perceived as 'threatening posture & verbally abused. On 6/26/13, Resident #1 picked up knife & spoon off trays that were discarded and raised the knife in a threatening fashion toward another resident who was shouting at the time. On 6/27/13, Resident #1 walked quickly toward another resident who was ambulating in the C unit hallway and hit his/her in the chest causing the resident to fall to the floor. On 6/30/13, Resident #1 Pushed table up against resident and spilled coffee on another. On 8/12/13 at 10:00 a.m., in an interview with the Administrator and Director of Nursing, they confirmed that 15 minute safety checks were instituted on 7/4/13 after the incident on 7/3/13. Both confirmed that 15 minutes safety checks ha… | 2016-07-01 |
| 3029 | 3029 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2012-11-16 | 272 | D | 0 | 1 | UI1O11 | Based on record review and interview, the facility failed to ensure that the summary information for the triggered area of pressure ulcers was accurate for 1 of 3 Stage 2 sampled residents (#52) reviewed for pressure ulcers. Finding: Resident #52's significant change Minimum Data Set, Version 3.0 assessment, dated 9/27/12, was coded (in section M), to indicate the resident had a Stage II pressure ulcer. The 9/28/12, Care Area Assessment form under the area of pressure ulcers, indicated that the care area for pressure ulcers had triggered and that the interdisciplinary team had determined to proceed with care planning, as the resident was at risk for skin breakdown. The summary information to support the rationale to proceed to care plan failed to identify the presence of a pressure ulcer on the resident's left heel. A surveyor discussed this finding with the Director of Nursing, on 11/16/12 at 10:45 a.m. | 2016-03-01 |
| 3030 | 3030 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2012-11-16 | 279 | E | 0 | 1 | UI1O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and observation, the facility failed to ensure a comprehensive care plan was developed to address the presence of a pressure ulcer in accordance with the interdisciplinary team's decision for 1 of 3 residents sampled with pressure ulcers (#52). Finding: Resident #52's significant change Minimum Data Set, Version 3.0 (MDS) assessment, dated 9/27/12, was coded (in section M), to indicate the resident had a Stage II pressure ulcer. The 9/28/12, Care Area Assessment form under the area of pressure ulcers, indicated that the care area for pressure ulcers had triggered and that the interdisciplinary team had determined to proceed with care planning, as the resident was at risk for skin breakdown. A physician progress notes [REDACTED].#52 had a Stage II left heel ulcer with an unstageable one centimeter eschar area. The most recent physician progress notes [REDACTED]. On 11/15/12 at 2:20 p.m., a surveyor observed a large area of eschar on the back and bottom of Resident #52's left heel. Resident #52's current comprehensive care plan, revised after the significant change MDS assessment of 9/27/12, identified that the resident was at risk for skin breakdown; but, failed to identify the presence of an unstageable pressure ulcer of the left heel. A surveyor discussed this finding with the Director of Nursing, on 11/16/12 at 10:45 a.m. | 2016-03-01 |
| 3031 | 3031 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2012-11-16 | 280 | D | 0 | 1 | UI1O11 | Based on record review, interview and observation, the facility failed to ensure a care plan was updated to reflect the 1 of 3 residents sampled for vision, refusal to wear corrective lenses (#11). Finding: Resident #11's current care plan, under the problem area of injury potential related to severe Alzheimer's Dementia, indicated that the resident would wear his/her glasses during the day to prevent falls. On 11/13/12, in an interview with a surveyor, the resident's family member stated that the resident refused to wear the glasses and would take them off as soon as someone put them on. On 11/15/12 at 2:00 p.m., in an interview with a surveyor, the Nursing Supervisor stated the resident had three pair of glasses, but refused to wear the glasses. On 11/16/12 at 10:15 a.m., in an interview with a surveyor, a Certified Nursing Assistant stated that the resident refused to wear his/her glasses and would get angry if you asked him/her to put them on. On 11/15/12 at 11:00 a.m. and on 11/16/12 at 8:30 a.m., a surveyor observed the resident out of bed and not wearing his/her glasses. The resident's care plan had not been updated to address the resident's refusal to wear his/her glasses. On 11/16/12 at 12:00 p.m., a surveyor discussed this finding with the Unit Manager. | 2016-03-01 |
| 3032 | 3032 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2012-11-16 | 329 | D | 0 | 1 | UI1O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure that staff did not exceed parameters for the dosage of Tylenol in a 24-hour period as set by the physician, for 1 of 10 residents, whose medication regimes were reviewed (#60). Finding: Resident #60's physician's orders [REDACTED]. The physician's orders [REDACTED]. The resident's physician block order's indicated that the resident also had an as needed order (prn) for Tylenol 325 mgs, to be given every four hours as needed. This order also directed staff not to administer more than 3,000 mgs in a 24-hour period. The resident's Routine Med form for November 2012, indicated that the resident had received the prescribed dosage of 1000 mgs of Tylenol at 8:00 a.m., at 2:00 p.m. and at 8:00 p.m. from 11/5/12 through 11/14/12. The resident's PRN Med form for November 2012, indicated the resident also received an as needed dosage of Tylenol on 11/13/12 at 3:37 p.m., which exceeded the dosage parameters set by the physician, (the resident received 3650 mgs in less than a 24-hour period). In an interview on 11/15/12 at 10:55 a.m., with the nursing supervisor, she stated, to the surveyor, that the as needed Tylenol order should have been discontinued when the scheduled order was written. | 2016-03-01 |
| 3033 | 3033 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2012-11-16 | 431 | E | 0 | 1 | UI1O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and staff interviews, the facility failed to ensure that outdated medications and medical supplies were removed from 3 of 3 storage units which contained items/supplies designated for general use. Findings: 1. On 11/16/12, at 10:30 a.m., a surveyor reviewed the medication cart and medication storage room for Units A & B with a Registered Nurse. The following expired medications were observed in the general use storage: One 16 oz bottle of Docusate Sodium, 50 milligrams (mg) per 5 Milliliters (ml), with an expiration date of [DATE]. Nine oral culture swabs, with an expiration date of October 2012, and one oral culture swab with an expiration date of September 2008. One unopened 473 ml bottle of Diphenhydramine HCL Oral Liquid (12.5 mg/5 cubic centimeters (CC), with an expiration date of September 8, 2012. The Medication Registered Nurse (RN) for units A and B verified that the expiration dates for the items listed, had expired, and were available for resident use. 2. On 11/16/12, at 10:50 a.m., a surveyor reviewed the medication cart and medication storage room for the C Unit with a Registered Nurse. The following expired medications were observed in the general use storage. Fourteen Providone (Iodine) Swabs with an expiration date of March 2010. Two packets of Extra Large Cavi Wipe Towelettes with an expiration date of May 2012. One bottle (100 count) Vitamin E Softgels, 400 mg, with an expiration date of September 2012. One 50 Gram tube of Zeel Cream (Arthritic Pain and Stiffness), with expiration date of September 2012. The Medication RN for unit C verified that the expiration dates for the items listed, had expired, and were available for resident use. | 2016-03-01 |
| 3170 | 3170 | VARNEY CROSSING NURSING CARE CENTER | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2015-06-11 | 356 | B | 1 | 0 | L11511 | Based on observations and interview, the facility failed to post the nurse staffing data visible to the public for 2 out of 3 survey days. Finding: On 6/9/15 and 6/10/15, the facility's form, the (Report of Nursing Staff Directly Responsible of Resident Care), was not posted to reflect the 24 hour staffing coverage on those days of survey. This finding was confirmed with the Director of Nurses at 3:15 PM on 6/10/15. | 2015-10-01 |
| 734 | 734 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2019-01-10 | 584 | B | 0 | 1 | SX4O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure the resident environment was clean and homelike on 3 of 3 resident floors. On 1/9/19 at 9:15 a.m., during tour of the facility, the surveyor and Director of Environmental Services observed the following findings: -Resident room [ROOM NUMBER] had long tears and worn areas in wall paper approximately 2 feet in length from bed along wall. -Resident room [ROOM NUMBER] had worn wall paper and gouged sheet rock approximately 1 foot in length from bed along wall. -Resident room [ROOM NUMBER] had 2 wood closet doors that were marred and a soiled/stained privacy curtain. -Resident room [ROOM NUMBER] had sheet rock in disrepair behind the toilet in the bathroom and floor edges were duct taped between the doorway threshold from the bathroom into the Resident's room. -Resident room [ROOM NUMBER] had marred walls and chipped paint on the left wall as you enter the room. -Resident room [ROOM NUMBER] had marred walls and chipped paint on the wall as you enter the room. -Resident dining area on the 3rd floor had a table missing laminate extending approximately 3 feet along the side of the table. -Ground floor bathroom used by residents has a mold like substance behind the toilet and a wall in disrepair under the soap dispenser. On 1/9/19, during tour of the facility, the surveyor confirmed the above findings in an interview with the Director of Environmental Services. | 2020-09-01 |
| 735 | 735 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2019-01-10 | 689 | E | 0 | 1 | SX4O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure the resident environment remained free of accident hazards as is possible related to hot water temperatures over 120 degrees Fahrenheit in resident rooms on 2 of 3 floors on 1 of 3 survey days. Finding: On 1/7/19 at 9:11 a.m., a surveyor observed a water temperature of 120.9 degrees Fahrenheit in room [ROOM NUMBER], posing a burn risk to the resident. A surveyor also observed elevated hot water temperatures on 1/7/19 at 11:45 a.m. on the first floor, including the following Resident rooms: room [ROOM NUMBER] at 122.3 degrees Fahrenheit, room [ROOM NUMBER] at 122.2 degrees Fahrenheit and room [ROOM NUMBER] at 122.4 degrees Fahrenheit. On 1/7/19 at 12:24 p.m., in an interview with the Acting Director of Nursing, he/she confirmed there had been no burn incidences by hot water in the past 3 months. On 1/7/19 at 12:37 p.m., the surveyor and Food Services Director, who was filling in for the Director of Environmental Services, together observed Resident room [ROOM NUMBER] with a water temperature of 121.9 degrees Fahrenheit. On 1/7/19 at 2:15 p.m., in an interview with maintenance personnel, he/she stated the mixing valve was stuck and a plumber is on the way to the facility. On 1/7/19 at 3:00 p.m., the survey team leader confirmed the finding in an interview with Administrator. | 2020-09-01 |
| 736 | 736 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2019-01-10 | 758 | D | 0 | 1 | SX4O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to monitor and document targeted behaviors to support the use of an antipsychotic and antianxiety medication for 1 of 5 residents reviewed for unnecessary medications (Resident #72). Finding: Resident #72's clinical record contained a physician's orders [REDACTED]. Additionally, on review of Resident #72's clinical record, the surveyor noted an order, dated 12/13/18, for [MEDICATION NAME] (an anti-anxiety medication) for anxiety. A review of Resident #72's clinical record revealed the facility was monitoring daily for the targeted behavior of [MEDICAL CONDITION], but there was no evidence of monitoring for behaviors associated with [MEDICAL CONDITION] or anxiety. In an interview with the Interim Director of Nursing, on 1/08/19 at 2:34 p.m., the surveyor confirmed that Resident #72 was not monitored for side effects or the presence of behaviors related to use of an anti-anxiety and antipsychotic medication. | 2020-09-01 |
| 737 | 737 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2018-01-25 | 760 | D | 1 | 1 | 2E8P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interviews, the facility failed to ensure 1 of 18 sampled residents was free of a significant medication error (#51). Finding: On 1/23/18, during record review, Resident #51 who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The Nurse Manager stated the medication did not properly carry forward in the electronic system, therefore information did not translate properly to the Medication Administration Record [REDACTED]. | 2020-09-01 |
| 738 | 738 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2018-01-25 | 812 | E | 0 | 1 | 2E8P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure containers of liquids were dated when opened and not used beyond discard dates as indicated on containers per manufacture specifications; and failed to ensure that containers were removed from the refrigerators and unavailable for resident use. In 5 of 5 refrigerators on 1 of 3 days of survey. Finding: On 1/24/18 at 10:30 a.m.during a check of refrigerators located on the three floors of the facility, two surveyors observed the following. The first-floor dining room, the refrigerator contained: One (1) opened[NAME]Thickened water container with discard if not used within seven (7) days of opening on the container. There was no open date noted on the container. Two (2) opened Hormel thick and easy Orange juice containers with discard if not used within ten (10) days. There was no open date noted on the containers. Two (2) opened Hormel thick and easy Apple juice containers with discard if not used within ten (10) days. There was no open date noted on the containers. The second-floor dining room, the refrigerator contained: One (1) opened[NAME]Thickened lemon flavored water container with must be used within seven (7) days of opening. There was no open date noted on the container. The second-floor kitchenette, the refrigerator contained: One (1) opened[NAME]thickened lemon flavored water container with must be used within seven (7) days of opening. There was no open date noted on the container. The third-floor dining room, the refrigerator contained: One (1) opened Hormel thick and easy clear water container with discard if not used within ten (10) days of opening. There was no open date noted on the container. Two (2) opened Hormel thick and easy clear thickened cranberry juice containers with discard if not used within ten (10) days of opening. There were no open dates noted on the containers. One (1) opened [MEDICATION NAME] milk container with consume within seven (7) days.… | 2020-09-01 |
| 739 | 739 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2018-01-25 | 880 | D | 0 | 1 | 2E8P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to maintain a sanitary environment related to the use of urine collection devices during 2 of 3 survey days. Finding: -On 1/23/18 at 6:28 a.m., a surveyor observed in a shared bathroom between rooms [ROOM NUMBERS], 2 soiled urinals labeled with Resident #17 and #58 names and a urine collection device (catheter bag) hanging on the hand rail with no identification on catheter bag with a cap on the tubing and visible sediment in tubing. At this time the Licensed Practical Nurse (LPN) confirmed both Residents #17 and #58 have an indwelling catheter and use catheter bags. -On 1/24/18 at 8:52 a.m., a surveyor observed in a shared bathroom between rooms [ROOM NUMBERS], a catheter bag capped and hanging on the hand rail beside the toilet next to 2 urinals. On 1/24/17 at 9:35 a.m., in an interview with a Certified Nurses Aide (CNA), he/she confirmed that only Resident #17's catheter bag is changed over to a leg bag during the day. The catheter is drained, recapped and hung on the hand rail in the bathroom. He/she also confirmed there was no identification on the catheter bag, however Resident #17 is the only resident whose catheter bag is changed over to leg bag during the day. He/she then labeled the catheter bag with Resident #17's name. On 1/25/18 at 8:00 a.m., in an interview with a surveyor, the Director of Nurses (DON) stated that the proper procedure of changing a catheter bag to a leg bag consists of rinsing out the catheter bag, capping it and placing it in a clean plastic bag then store it in the residents room. At this time the DON confirmed the above observations did not support good infection control practice. | 2020-09-01 |
| 740 | 740 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2017-05-10 | 323 | D | 1 | 0 | EN5Y11 | > Based on observations and interview, the facility failed to ensure that chemicals were properly secured in the shower room chemical storage closet on 1 of 3 units on 1 of 2 days of survey. Finding: 5/9/2017 at 1:35 p.m., a surveyor observed the chemical storage closet in the main shower room on the 3rd floor to be closed, but unlocked. There was a sign on the door that indicated the closet contained chemicals and should be kept closed and locked at all times. After securing the door, the surveyor notified the charge nurse who observed and confirmed the chemicals in the chemical closet to contain: -One (1) bottle of Comet Bathroom Cleaning Solution, approximately 1/4 of the solution remained in the bottle, and with a caution statement on the back. -One (1) bottle of Air Lift chemical, approximately 2/3 of the solution remained in the bottle, with a caution statement on the back label stating eye and skin irritation. Review of the Material Safety Data Sheets (MSDS) for the Comet Disinfecting Sanitizing Bathroom Cleaner-Ready solution indicated the solution causes eye irritation and is harmful if swallowed. Review of the Material Safety Data Sheets (MSDS) for the Air Lift Fresh Scent, an air freshener, indicated the solution may be harmful if swallowed, may cause eye/skin irritation, and to keep it out of the reach of children. On 5/9/17, at 2:00 p.m., the finding was confirmed in an interview with the Administrator. | 2020-09-01 |
| 741 | 741 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2018-06-13 | 761 | D | 1 | 0 | 7NKW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview, record review, and policy review, the facility failed to adequately store and reconcile a controlled substance ([MEDICATION NAME]) for 1 of 1 facility reported incidents reviewed. Finding: On 5/17/18 at 1:32 p.m. the Division of Licensing & Certification received a faxed reportable incident form from St. Andre's Healthcare indicating missing medication with the date of the incident noted as 5/4/18. On 6/13/18 from 9:45 a.m. through 2:15 p.m. an on-site investigation was conducted by 2 surveyors with the following reviewed: A review of the facility investigation record reveals the Registered Nurse who received the two [MEDICATION NAME] pills from the pharmacy placed them into the locked narcotic box inside one of the medication carts, however; this was to be temporary until the pills could be loaded into the automated medication dispensing system (pyxis), which requires two nurses to load controlled substances. Additionally, the nurse did not log the two [MEDICATION NAME] pills in the bound book for reconciliation count. As a result of the medication not being loaded into the automated medication dispensing system or logged into the bound book for reconciliation it was not noted by nursing staff that the medication was missing until the pharmacy alerted the facility. The facility conducted a full investigation, to include obtaining written statements from any potential staff involved, and reporting the incident to local law enforcement. The whereabouts of the missing [MEDICATION NAME] could not be determined. A review of the written statement of the receiving Registered Nurse dated 5/15/18 indicated that on (MONTH) 3, (YEAR) he/she received from pharmacy personnel narcotic medications of 2 pills of [MEDICATION NAME] sealed in a plastic bag, which he/she placed in the locked narcotic box since he/she cannot enter the Scheduled II medication into pyxis system by him/herself, and further indicates that on (MONTH) 7th a calle… | 2020-09-01 |
| 742 | 742 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2019-11-21 | 657 | D | 0 | 1 | HCB311 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure a care plan was updated to reflect the resident's current needs in the area of infection control for 1 of 18 sampled residents (#42). Finding: On 11/18/19 at 9:30 a.m., a surveyor observed the entrance to Resident #42's room was posted with signage instructing to stop and check with nurse before entering. The surveyor also observed personal protective equipment (PPE) hanging from the entrance door. On 11/18/19 at approximately 10:00 a.m., in an interview with the charge nurse, the surveyor asked if any residents were currently on infection control precautions. The charge nurse stated Resident #42 required contact precautions for VRE ([MEDICATION NAME] Resistant [MEDICATION NAME]) in his/her urine. On 11/19/19 at 11:50 a.m., in an interview with a Certified Nurses Aide-Medications (CNA-M), the surveyor asked what type of precautions the resident requires. The staff stated he/she's on precautions to prevent him/her from getting an infection. On 11/19/19 at 11:55 a.m., in an interview with the charge nurse, the surveyor asked what type of precautions the resident requires. The charge nurse stated he/she is on reverse precautions because his/her blood levels are low and he/she [MEDICAL CONDITION]. It's to protect him/her. The surveyor asked if the resident has a history of VRE. The charge nurse stated he/she had VRE and we are treating him/her as if he/she is colonized. he/she has his/her own bathroom and we use universal precautions when we provide care for him/her. A review of Resident #42's clinical record revealed [DIAGNOSES REDACTED]. Nursing documentation dated 3/25/19, revealed a note which stated, call to New [MEDICAL CONDITION] Specialist - (Resident #42) will continue on Neutropenic Precautions indefinitely status [REDACTED]. Neutropenic precautions include gloves and mask upon entry into room unless providing personal care, at which time, gloves, gown a… | 2020-09-01 |
| 1001 | 1001 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2018-02-26 | 755 | D | 1 | 0 | 1V8611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to maintain adequate pharmaceutical services to ensure the receipt and administration of medication for 1 of 4 sampled residents (#1). Finding: During a medical record review, a surveyor identified in Resident #1's clinical record an order originally dated 7/27/17, for an [MEDICATION NAME] Extended Release 24 hour, with directions to give by mouth twice a day. Resident #1's electronic Medication Administration Record [REDACTED]. Resident #1's electronic nursing notes, dated 2/5/18, indicated (Resident #1) brought to my attention that (he/she) been out of [MEDICATION NAME] for 3-4 days, I called (pharmacy) they will send out medication on the next run if no interference with insurance. This writer did refax the order that was originally faxed over on 01/11/2018 and only 14 pills (insufficient amt.) were sent at that time. On 2/26/18 at 2:51 p.m., in a telephone interview, the Director of Nursing stated that the medication was unavailable according to the pharmacy. The surveyor confirmed at this time that the facility's pharmaceutical services failed to deliver medications, resulting in the medication not being available for administration. | 2020-09-01 |
| 1002 | 1002 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2019-03-21 | 689 | D | 1 | 0 | Z5HC11 | > Based on interview and record review, the facility failed to ensure the electric circuit breaker door panels were closed and secured on 1 of 3 observations. In addition, the facility failed to ensure the bed controls and call bell were secured safely in a manner that would prevent potential entrapment. (#3) Findings: 1. On 3/20/19, at 12:40 p.m., the surveyor observed on the Skilled A unit's, electric circuit breaker panel, located in a small hallway's upper wall and facing the visitor's bathroom door, to be slightly open, unsecured by slide latch. A sign on the door stated, WARNING ARC FLASH AND SH[NAME]K HAZARD, PROPER PPE REQUIRED. The surveyor discussed the finding with the charge nurse who observed the finding and pushed the door closed to secure the latch. 2. On 3/20/19, at 12:41 p.m., the surveyor observed on the Skilled A unit's visitor bathroom, to contain an upper wall electric circuit breaker panel with the door slightly opened, unsecured by slide latch. A sign on the door stated, WARNING ARC FLASH AND SH[NAME]K HAZARD, PROPER PPE REQUIRED. At 12:50 p.m., the surveyor observed the circuit breaker panel door with maintenance staff who confirmed the latch was not working to secure the circuit panel door closed and needed replacement. At 2:30 p.m., the surveyor observed the circuit breaker panel door is securely closed and a pad lock in place. 3. During a closed record review for Resident #3, Nurses notes dated 12/22/18 indicated at 2240 staff heard resident hollering. Found resident laying on floor near right side of bed on his left side. The notes also indicated reddened area noted on left back, indent and dark red area noted on left arm where resident had been laying on top of cords attached to bed remote and call bell. Residents call bell and bed remote were tied up onto the trapeze bar with ties that had been cut off on the ends after twisting tightly which caused tension on the cords when resident fell to floor Staff were able to cut them off after a few minutes Interviews indicated the attached z… | 2020-09-01 |
| 1003 | 1003 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2019-05-23 | 880 | D | 0 | 1 | OC7O11 | Based on interview and record review, the facility failed to disinfect the multi-use blood glucose meters in accordance with CDC (Center for Disease Control) and manufacturer recommendations on 1 of 4 days of survey. Findings: 05/23/19 11:41 a. m., a Licensed Practical Nurse (LPN#1) was observed leaving a resident room with the blood glucose monitoring device and supplies in her/his hand. During an interview with the surveyor, the LPN #1 confirmed she/he cleaned the glucometer with an alcohol wipe pad for the next resident use and the LPN #1 pulled out the alcohol wipe prep pad to demonstrate what she/he used indicating the glucometer is a multiple resident use equipment at this facility. The LPN (#1) indicated she was cleaning the equipment according to the manufacture manual direction under option #2. Review of the manufacturers' manual indicated two options for disinfecting. The Assure Platinum, Blood Glucose Monitoring System, page 18, Maintenance, Cleaning and Disinfecting Guidelines, cleaning and disinfection which states, Option 1: Cleaning and disinfecting can be completed by using a commercially available EPA-registered disinfectant or germicide wipe. and Option 2: To disinfect the meter, dilute 1 ml of household bleach (5%-6% sodium hypochlorite solution) in 9 ml water to achieve a 1-10 dilution (final concentration of 0.5% - 0.6% sodium hypochlorite). Then use the dampened paper towel to thoroughly wipe down the meter. Note there are commercially available 1:10 bleach wipes from a variety of manufactures. During an interview with the surveyor on 5/23/19, at approximately 11:45 a. m., a Licensed Practical Nurse (LPN #2), indicated that alcohol wipes are used for cleaning the multi-use glucose meter between resident use, that the glucometers are disinfected on the night shift, and this practice follows the manufacturer's direction. In an interview with the surveyor and the Director of Nursing (DON) and Infection Control Preventionist, on 05/23/19, at approximately 11:50 a. m., the surveyor confirmed the … | 2020-09-01 |
| 1004 | 1004 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2018-06-28 | 689 | D | 0 | 1 | BWUZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure that a resident was supervised from a potential safety hazard by leaving a [MEDICATION NAME] mouth swab in the resident's mouth while unattended for 1 of 38 residents. (#3) On 06/25/18 at 11:12 a.m., a surveyor observed a plastic swab stick in Resident #3's mouth, visible outside of his/her mouth, lips closed over the stick, the resident was unattended. The surveyor immediately reported to the Nurse Manager, who removed the swab. The nurse stated the swab stick had been left in the resident's mouth following oral care to keep the mouth moist and stated the swab had only been in a few minutes. On 06/25/18 at 12:11 p.m., during an interview with the Nurse Practitioner, (NP), the NP stated the swab stick left in was discussed with the Medical Director, who indicated there was no acute danger regarding the swab, as there is no tongue movement. The NP stated this should not have been left in. A speech evaluation and treatment order was written. On 06/26/18 08:23 a.m., during an interview with the Director of Nursing, the DON provided a copy of education regarding Lemon [MEDICATION NAME] swab use. It states, Please note the standard of practice for the use of lemon [MEDICATION NAME] swabs on a resident does not include leaving the swab in the resident's mouth while the resident is unattended. Any use of a lemon [MEDICATION NAME] swab on a resident is to be practiced while you are with the resident. Please do not leave the swab in the resident's mouth unattended. | 2020-09-01 |
| 1005 | 1005 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2018-06-28 | 761 | D | 0 | 1 | BWUZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and observation the facility failed to adequately date and properly dispose of biologicals according to manufacturer specifications, failed to ensure removal of expired influenza vaccines, and failed to provide proper storage and temperature control monitoring of vaccines and biologicals in 1 of 2 medication storage refrigeration units. (B2, Oakridge) Findings: 1. On [DATE], at 08:10 a.m., a surveyor observed with the Clinical Coordinator the Oakridge, B2 unit's locked medication storage refrigerator to be a small refrigeration unit with an inside freezer compartment without a door to the freezer area and which contained: -one (1) opened vial of Influenza Vaccine (FLUCELVAX) with an expiration date of ,[DATE]. -one (1) opened, undated, vial of [MEDICATION NAME] Purified Protein Derivative. The side of the [MEDICATION NAME] box indicated the vial must be used within 30 days of opening. The vaccine and the [MEDICATION NAME] vials were removed from the refrigerator by the Clinical Coordinator for discarding during the observation. 2. On [DATE], at approximately 1:00 p.m., a review of the B2, Oakridge medication storage refrigerator's temperature logs indicated that in (MONTH) (YEAR) the refrigerator temperature was checked one (1) time daily on all but 2 days ([DATE] and [DATE]), the refrigerator's temperature was undocumented on [DATE], and on 2 days there was a lower recorded temperature of 35 degrees Fahrenheit (,[DATE] and [DATE]) . The Clinical Care Coordinator indicated the vaccines and [MEDICATION NAME]'s vials are stored in the refrigerator door compartment. A review of the Omnicare policy entitled LTC Facility Pharmacy Services and Procedure Manual, last revision [DATE], section #11 which indicated the Facility should ensure that medications and biologicals are stored at the appropriate temperatures according to the United States Pharmacopeia guidelines for temperature ranges. Facility staff should mon… | 2020-09-01 |
| 1006 | 1006 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2018-06-28 | 812 | E | 0 | 1 | BWUZ11 | Based on observations and interviews, the facility failed to store food under sanitary conditions in the kitchen area for 3 of 4 survey days. Findings: 1. On 6/26/18 at 9:45 a.m., two surveyors observed areas of debris, including insects and fecal droppings on the floor in the dry food storage area after facility staff had cleaned the kitchen floors. The debris observed was on the inside kitchen doorway and along the wall leading to outside the building, on the floor in a narrow storage cove under a shelving unit, and aside the ice machine. At 10:05 a.m., the surveyor and Administrator together observed the debris on the floors, which he/she had staff re-clean. On 6/26/18 at 11:34 a.m., in an interview with the Administrator, he/she produced daily kitchen cleaning schedules and pest control invoices. However, despite cleaning and pest control efforts, debris was observed on the kitchen floors during survey. On 6/26/18, at the time of the interview with the Administrator, the surveyor confirmed the finding. 2. On 6/27/18 at 10:40 a.m., the surveyor and Administrator observed more debris on the floor and lower tiled walls in the dishwashing area, a fan blowing to the outside of the building with caked on grease and dust build-up, and several live ants crawling on the window sill in the dish area. At the time of the observation and in an interview with the Administrator, the surveyor confirmed the findings and the Administrator instructed staff to clean the area. 3. On 6/28/18 at 11:42 a.m., two surveyors and the Food Services Director observed another fan that was turned on and pointed over the dishwashing area that contained dust and grease build up. At the time of the observation and in an interview with the Food Services Director, he/she agreed to clean the fan and re-run 2 trays of clean plastics bowls that were located under the fan through the dishwasher; at this time surveyors confirmed the finding. On 6/28/18 at 12:49 p.m., the surveyor informed the Administrator of the concern and the surveyor again confir… | 2020-09-01 |
| 1007 | 1007 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2018-06-28 | 880 | D | 0 | 1 | BWUZ11 | Based on observations and interviews, the facility failed to prevent the possible transmissions of infections by not wearing gloves when giving an injection for 1 of 1 Resident. (#32) Finding: On 6/27/18 between 7:00 a.m. and 8:30 a.m., during a medication pass observation, a surveyor observed the Licensed Practical Nurse (LPN) administer an insulin injection without wearing gloves. In an interview at the time of the medication pass observation with the LPN, he/she stated that it is acceptable practice to give insulin injection without wearing gloves. The facility's policy and procedure states Gloves must be worn when it can be reasonably anticipated that the employee may have hand contact with any potentially infectious body substance, mucous membrane or non-intact skin of any residents .for performing venipuncture and other vascular access procedures. On 6/27/18, a surveyor confirmed with the Nurse Manager that the LPN was not following standard infection control practices and that the break in infection control included not wearing gloves when giving an injection. | 2020-09-01 |
| 1008 | 1008 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2018-06-28 | 925 | E | 0 | 1 | BWUZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to maintain an effective pest control program so that the facility is free of pests for 1 of 4 days of survey. Finding: On [DATE] at 9:45 a.m., two surveyors observed areas of debris, including deceased insects and fecal droppings on the floor in the dry food storage area after facility staff had cleaned the kitchen floors. The debris observed was on the inside kitchen doorway and along the wall leading to outside the building, on the floor in a narrow storage cove under a shelving unit, and aside the ice machine. At 10:05 a.m., the surveyor and Administrator together observed the debris on the floors, which he/she had staff re-clean. On [DATE] at 11:34 a.m., in an interview with the Administrator, the Administrator produced daily kitchen cleaning schedules and pest control invoices. However, despite cleaning and pest control efforts, pest debris was observed on the kitchen floors during survey. At the time of the finding, a surveyor confirmed the finding with the Administrator. | 2020-09-01 |
| 1009 | 1009 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2017-08-02 | 323 | E | 0 | 1 | VVFY11 | Based on observations and interviews, the facility failed to maintain a resident environment as free from accident hazards as is possible on 1 of 2 units (Mapleridge) and failed to secure the storage of chemicals on 2 of 2 units (Oakridge; Mapleridge) during 1 of 3 days of survey. Findings: 1. On 7/31/17 at 9:00 a.m., during initial tour of the facility the surveyor observed a hallway closet door unlocked with exposed wires and in an unlocked shower room a container of Super Sani disinfectant wipes stored in an unlocked cupboard on the Mapleridge Unit. Both areas were accessible to residents. On 7/31/17 at 9:25 a.m., the surveyor and Administrator observed the safety concerns together and at this time in an interview he/she confirmed the findings and followed up to resolve. Material Safety Data Sheets (MSDS) indicated Super Sani product can cause irreversible eye damage and is considered a hazardous chemical. 2. On 7/31/17 at 9:15 a.m. through 9:30 a.m., during the initial tour of the facility, two surveyors observed the Oakridge B2 locked unit to contain a lower sink cabinet in the whirl pool/shower room to be unsecured with chemicals stored on the lower shelf and the keys hanging from a hook at the cabinet mirror. A sign on the cabinet door indicated to keep the door locked. Chemicals inside the cabinet included one (1) 3M QUAT disinfectant cleaner, in a spray bottle, with less than 1/4 solution remaining and one (1) CID-A-L II disinfectant cleaner, 64 ounce, with approximately 1/4 solution remaining. The Charge Nurse was made aware of the unsecured chemicals in the whirl pool/shower room. Material Safety Data Sheets (MSDS) indicated the chemical Cid-A-L II is a corrosive which can cause chemical burns with ingestion and severe contact irritation for eyes and skin. The MSDS indicated 3M Quat is an irritant to eyes, skin, respiratory and gastrointestinal system. On 7/31/17, at approximately 12:00 p.m., a wheel chair bound resident was observed coming out of the shower/whirlpool room unaccompanied by staff. In an… | 2020-09-01 |
| 1010 | 1010 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2017-08-02 | 371 | E | 0 | 1 | VVFY11 | Based on observations and interviews, the facility failed to maintain essential kitchen equipment and food storage room floor in a sanitary manner for 3 of 3 days of survey. In addition, the facility failed to ensure that food items were stored in a sanitary manner in the kitchen walk in freezer and to discard expired/undated bread in the kitchen food storage room for 1 of 3 days of survey. Findings: 1. On 7/31/17 at 9:15 a.m., during the initial tour of the kitchen, a surveyor observed the following: * Black mold type substance on the tile floor in front of the kitchen walk in freezer. * The walk in freezer contained a thick red substance on floor under the meat shelf, a piece of food and some plastic wrap underneath a shelf, 2 open/unsecured boxes of frozen rolls and one open/unsecured package of pie crusts. * The Kitchen food storage room floor had built up dirt/debris in the corners and along the floor in front of the shelves. * The bread shelf contained 1 bag of bread ends with expiration of 7/14, 6 bags of bread ends with expiration date of 7/27, 1 bag of bread ends with expiration date of 7/28, and 4 bags with no expiration date, indicating it was available for resident use. On 7/31/17 at 9:29 a.m., a surveyor confirmed with the Food Service Director that the bread ends were being saved to make bread pudding and the bags should be dated with an expiration date and thrown away when expired and the open/unsecured frozen rolls and pie crust was not a sanitary storage of product. 2. On 8/1/17 at 11:10 a.m. and 8/2/17 at 11:45 a.m., a surveyor observed a black mold type substance on the tile floor in front of the kitchen walk in freezer. The walk in freezer contained a thick red substance on floor under the meat shelf, a piece of food and some plastic wrap underneath a shelf. The Kitchen food storage room floor had built up dirt/debris in the corners and along the floor in front of the shelves. This finding was confirmed with the Food Service Director on 8/2/17 at 11:45 a.m. On 8/2/17 at 12:30 p.m., a surveyor … | 2020-09-01 |
| 1011 | 1011 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2017-08-02 | 431 | D | 0 | 1 | VVFY11 | Based on observation and interview the facility failed to ensure the proper storage of medication. A medication cart was left unlocked and unattended, allowing access to medications by residents and unauthorized persons on 1 of 2 units of the facility. Finding: 1. On 8/2/17 at 10:56 a.m., two surveyors observed Mapleridge unit's medication cart in the hallway unlocked and unattended for approximately seven minutes. During this time, the surveyors observed Resident #82 walk by the cart independently using a rolling walker with his/her visitor, as well as a dietary staff and the Doctor. The surveyors confirmed the above finding in an interview with the Certified Nurses Aid - Medication technician at 11:03 a.m. when he/she returned to the unlocked cart. On 8/2/17 at 11:05 a.m. two surveyors confirmed the above finding with the Director of Nursing. | 2020-09-01 |
| 1354 | 1354 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2017-02-09 | 280 | D | 1 | 0 | 8FOS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interviews and record review, the facility failed to ensure a care plan was updated to reflect the presence of a pressure ulcer for 1 of 2 Stage 2 residents reviewed for pressure ulcers. (#30). Finding: On 2/6/17 at 2:18 p.m. during a staff interview, a Licensed Practical Nurse informed the surveyor that Resident #30 had a Stage 3 pressure ulcer on the right malleolus (a rounded bony prominence such as those on either side of the ankle). On review of the Wound Care Specialist's progress note, dated 1/27/17, the resident has a right lateral malleolus which is a chronic unstageable pressure injury. The wound has been present many months. Resident #30's care plan, written 10/4/15 and reviewed most recently on 1/20/17 addressed the problem of Potential for skin breakdown. The surveyor could not locate evidence of a care plan update to reflect the actual presence and treatment of [REDACTED]. On 2/9/17 at 9:32 a.m., the Director of Nursing confirmed in an interview with the surveyor that Resident #30's care plan did not reflect the presence and treatment of [REDACTED]. | 2020-02-01 |
| 1564 | 1564 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2016-07-28 | 371 | D | 1 | 1 | OBQJ11 | > Based on observation and interview, the facility failed to ensure the food preparation sink was plumbed in accordance with code requirements to prevent food contamination on 1 of 4 required air gaps. In addition, the facility failed to date 1 opened food item available for use on 1 of 4 days of survey. Findings: The Maine State Internal Plumbing Code Based on the 2000 Uniform Plumbing Code, 22 Edition, (MONTH) 2005, Chapter 8, Section 801.2.3 page 63, states that food preparation sinks shall be indirectly connected to the drainage system by means of an air gap and the Code of Federal Regulation, Title 21, Part 1250, Section 1250.30 (d) states all plumbing shall be so designed, installed, and maintained as to prevent contamination of the water supply, food, and food utensils. 1. During a tour of the kitchen on 7/25/16 at 9:15 a.m., a surveyor and a cook observed the food preparation sink drain was connected directly to the wastewater system, creating a potential for contamination of food products. 2. On 7/25/16 at approximately 9:45 a.m., in the Oakridge Kitchenette, 4 Surveyors observed 1 opened 64 ounce container of Simply Thick Instant Food Thickener with no opened date or discard by date. Instructions on the food item directed staff to use within 90 days of opening. On 7/25/16 at approximately 11:00 a.m., in an interview with a surveyor, the Food Services Director (FSD) confirmed the finding of undated food item. On 7/25/16 at 1:50 p.m., in an interview with a surveyor, the FSD and the Environmental Services Director confirmed the absence of an air gap on the food preparation sink. | 2019-07-01 |
| 1565 | 1565 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2016-07-28 | 431 | E | 1 | 1 | OBQJ11 | > Based on observations and interview, the facility failed to ensure that expired medications were removed from the medication storage cabinet on 1 of 2 units and from 2 of 5 medication administration carts (Oakridge Unit). Findings: 1. On 7/26/16 at 1:45 p.m., during inspection of the medication storage cabinet on the Long Term Care Unit, B2-Oakridge, with the Certified Nursing Assistant-Medications (CNA-M), the surveyor noted 18 expired medications. The CNA-M confirmed the findings at the time of the observation and removed the medications from the locked storage cabinet. > Two, 16 ounce bottles of Liquid Tylenol 60 milligrams/5ml, with an expired date of 2/15; > Two, 16 ounce bottles of Liquid Vitamin, VI Daily, with an expired date of 4/16; > One, 16 ounce bottle of Geri Tussin with an expired date of 1/16; > One, 1000 tablet bottle of Multivitamin with an expired date of 5/16; > One, 100 tablet bottle of Simethicone 80 milligrams with an expired date of 6/16; > One, 100 tablet bottle of Enteric Coated Aspirin 325 milligrams, with an expired date of 6/16; > Five, 96 cap bottle of Anti- Diarrheal 2 milligrams, with an expired date of 3/16; > One, 100 tablet bottle of Cetirizine Hydrochloride with an expired date of 3/16; > One, 100 tablet bottle of Bisacodyl 5 milligrams, with an expired date of 6/16; > One, 100 tablets of Vitamin D 400 IU, with an expired date of 1/16; > One, 100 tablet bottle of Silver Senior with an expired date of 5/16; and > One, 100 tablet bottle of Calcium, 500 milligrams, with an expired date of 4/16 2. On 7/26/16 at 2:35 p.m., during the medication administration carts inspection on the Long Term Care unit, B2-Oakridge, with the CNA-M, the surveyor noted 8 additional expired medications in two of the carts. The CNA-M confirmed the findings at the time of the observation and removed the medications from the locked medication administration carts. > One bottle of Liquid Tylenol 160 milligrams/5ml, with an expired date of 10/15; > One bottle of Geri Tussin with an expired date of 1/16; >… | 2019-07-01 |
| 1740 | 1740 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2016-02-25 | 241 | B | 1 | 1 | 8R3111 | > Based on observations and interviews, the facility failed to maintain an environment that promoted dignity as evidenced by uncovered drainage bags for 2 of 4 residents with indwelling urinary catheters (#15 and #96) on 3 of 4 survey days. Findings: 1. On 2/22/16 at 11:05 a.m., during an interview with Resident #96, a surveyor observed the resident's urinary catheter drainage bag uncovered, with fluid in bag, and hanging on the bottom of the side rail on the resident's bed which faced the open doorway. 2. On 2/23/16, at 10:00 a.m., while standing just inside the resident room, a surveyor observed Resident #15's uncovered urinary catheter drainage bag, with fluid filled tubing, hanging on the bottom of the bed which faced the open doorway. On 2/23/16 at 10:30 a.m., a surveyor observed Resident #96's uncovered urinary catheter drainage bag, with fluid in the bag, hanging from the bottom of the bed at the resident's right leg, with the urinary catheter drainage bag visible immediately on entry to the room. 3. On 2/24/16 at 10:00 a.m., a surveyor observed Resident #96's uncovered urinary catheter drainage bag, with fluid in bag and tubing, visible on entry to the room. On 2/24/16, at 10:07 a.m., the surveyor observed Resident #15's urinary catheter drainage bag and tubing, uncovered and visible from the open doorway and hall. In an interview with the surveyor on 2/24/16 at 11:15 a.m., the Unit Manager confirmed that the facility has not been placing covers on the indwelling catheter drainage bags on 2nd floor. In an interview with a surveyor, conducted on 2/25/16 at 10:45 a.m., the Director of Nursing acknowledged the finding and confirmed that the indwelling catheter drainage bags for resident #15 and #96 should be covered. | 2019-02-01 |
| 1741 | 1741 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2016-02-25 | 279 | E | 1 | 1 | 8R3111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interviews and record review, the facility failed to develop a care plan related to the use of an antipsychotic, and an anticoagulant, on 2 of 5 residents reviewed for unnecessary medications (#96 and #128) and for 1 of 2 residents reviewed for hospice services (#96). Findings: 1. Resident #128's clinical record contained current orders for an antipsychotic medication, [MEDICATION NAME], originally dated 9/14/15. The surveyor did not locate in the current care plans any plan that specifically addressed the need and use of an antipsychotic. On 2/25/16 at 10:00 a.m., the Director of Nursing (DON) confirmed in an interview with the surveyor, that Resident #128's care plan did not include the use of an antipsychotic medication. 2. On review of Resident #96's clinical record, the surveyor noted current physician orders [REDACTED]. A review of the current comprehensive care plan for Resident #96 indicated no evidence of the need to monitor the resident for the risks of bleeding, associated with the use of the medication. In an interview with the surveyor, conducted on 2/25/16 at 10:45 a.m., the Director of Nursing confirmed the care plan did not include the risks associated with use of the anticoagulant medication. 3. On review of Resident #96's clinical record, the surveyor noted the resident received hospice services. A review of Resident #96's current comprehensive care plan, initiated on 12/22/15, revealed no evidence of the coordination of the hospice services for Resident #96. In an interview with the surveyor, conducted on 2/25/16 at 10:45 a.m., the Director of Nursing confirmed the care plan did not include the coordination of care with hospice sevices for Resident #96. | 2019-02-01 |
| 1742 | 1742 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2016-02-25 | 282 | E | 1 | 1 | 8R3111 | > Based on observations, interviews and record review, the facility failed to ensure the care plan intervention to cover the indwelling catheter was implemented on 1 of 23 Stage II sampled residents. (# 96) Findings: The current comprehensive care plan initiated on 12/22/15 for Resident # 96 ' s, under the problem area of indwelling catheter, directed the Nurse Aide to cover the catheter at all times. On 2/22/16 at 11:05 a.m., during an interview with Resident #96, a surveyor observed the resident ' s (#96) catheter drainage bag, with fluid in bag, uncovered hanging on the bottom of the side rail on the resident's bed. The bed is against the wall and facing the open doorway. On 2/23/16 at 10:30 a.m., a surveyor observed Resident # 96's indwelling catheter drainage bag, with fluid in the bag, hanging uncovered from the bottom of the bed at the resident's right leg. The resident is sitting sideways on the bed that is against the wall and the catheter drainage bag is visible immediately on entry to the room. On 2/24/16 at 10:00 a.m., a surveyor observed Resident # 96's uncovered indwelling catheter drainage bag, with urine in bag and tubing visible on entry to the room. The resident keeps the door open to hallway. In an interview with the Registered Nurse Unit Manager, on 2/24/16 at 11:15 a.m., the manager confirmed that the facility has not been placing covers on the catheter drainage bags. In an interview, conducted on 2/25/16 at 10:45 a.m., the Director of Nursing confirmed the care plan intervention to cover the catheter bag was not done, and then indicated the catheter drainage bag should be covered. | 2019-02-01 |
| 1743 | 1743 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2016-02-25 | 329 | E | 1 | 1 | 8R3111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to ensure that physician's orders for antipsychotics had appropriate [DIAGNOSES REDACTED].#128 and #134). Findings: 1. Documentation in Resident #128's physician order sheet, signed 1/15/16 with an original date of 9/29/15, indicated an order for [REDACTED]. On review of the documentation in Resident #128's Electronic Charting System (ECS) for behavior monitoring since 9/26/15, the indicated targeted behaviors were sad face and repetitive verbalizations, but the surveyor could not locate any supporting documentation that these targeted symptoms or other behavioral and/or psychological symptoms necessitated the use of [MEDICATION NAME]. In an interview with the surveyor on 2/25/16 at 10:00 a.m., the Director of Nursing (DON) confirmed the use of the antipsychotic [MEDICATION NAME] for anxiety is not an appropriate use of the medication and the target of symptoms of sad face and repetitive verbalizations are indicators for the use of an antipsychotic medication without supporting documentation. 2. Documentation in Resident #134's physician order sheet, signed 2/22/16 with an original date of 11/13/15, indicated an order for [REDACTED]. Resident #134's care plan, dated 10/1/15 indicated the use of an antipsychotic medication for mood problem. On review of the documentation in Resident #134's ECS for behavior monitoring since 11/13/15, the indicated targeted behavior was unpleasant mood, but the surveyor could not locate any supporting documentation that unpleasant mood necessitated the use of [MEDICATION NAME]. In an interview with the surveyor on 2/24/16 at 1:00 p.m., the DON confirmed the use of the antipsychotic [MEDICATION NAME] for dementia with behaviors, without targeted symptoms is not an appropriate use of the medication and confirmed that the use of an antipsychotic to treat repetitive anxious complaints and unpleasant moods without supporting documentation is not appropriate. | 2019-02-01 |
| 1908 | 1908 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2015-09-17 | 253 | E | 1 | 1 | Q4FY11 | Based on observations and interviews during Stage 1 of the survey, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly and comfortable interior for 3 of 4 survey days on 2 of 2 units. Findings: During Stage 1 of the survey process, 4 residents stated during confidential interviews that the facility was not clean. One resident stated a spill remained on the floor for a week, another stated the trash can had not been emptied for over 24 hours, and 2 other residents stated housekeeping could do a better job. The following observations were made by surveyors during the initial tour of the building on 9/14/15 at 9:00 a.m., throughout Stage 1 of the survey on 9/14/15 and 9/15/15, and confirmed by the Plant Engineer and Administrator in a tour with the surveyor on 9/16/15 at 9:34 a.m.: On the First Floor, Skilled Nursing Unit: 1. The hand rails had multiple areas throughout the unit with chipped paint; 2. The doors and walls throughout the unit had scratches and gouges; 3. The carpet in the living room by the entrance to the unit had several stained areas; 4. The threshold to Resident Room #107 has a missing piece of tile; 5. In the hallway outside of Resident Room #103, a surveyor noted a missing piece of tile; 6. All edges and corners of the floors had dirt and grime build up; 7. At the door entrance between the Cafe and the Skilled Nursing Unit, the threshold had an approximate 1 gap between the carpet, which had frayed edges, and the tile. 8. In Resident Room #101 at 9/14/15 at 1:00 p.m., the surveyor noted peeling paint and bare wood on the window sill; and 9. In Resident Room #104 at 9/14/15 at 11:13 a.m., the surveyor noted in the bathroom, between the heater unit and the wall, dirt build-up and a spider in a web; On the Second Floor, Oakridge Unit: 10. On 9/15/15 at 9:40 a.m., a surveyor noted in the sitting room, located between Residents Rooms #238 and #242, the wall had areas of exposed sheetrock; 11. The fan hanging on the wall outside of the Dining … | 2018-09-01 |
| 1909 | 1909 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2015-09-17 | 279 | D | 1 | 1 | Q4FY11 | Based on record review and interviews, the facility failed to ensure that resident care plans had measurable goals and timetables for an identified problem dental issues for 1 of 3 sampled residents. (#89) Finding: Resident #89's Care Area Assessment (CAA) summary, dated 1/27/15, was coded to indicate that the identified problem of dental would be addressed on the resident's care plan. The surveyor was unable to locate a care plan addressing Resident #89's assessed dental problems. The surveyor discussed the lack of care plan development with the Unit Manager, in an interview on 9/17/15 at 2:30 p.m., and the Unit Manager confirmed a care plan was not developed. In an interview with the surveyor, the Director of Nursing confirmed these findings on 9/17/15 at 2:45 p.m. | 2018-09-01 |
| 1910 | 1910 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2015-09-17 | 315 | D | 1 | 1 | Q4FY11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to insure an indwelling catheter for which continued use is not medically justified is discontinued as soon as clinically warranted for 1 of 2 sampled residents with indwelling catheters (#11). Finding: In an interview with the surveyor on 9/14/15 at 10:47 a.m., the Skilled Unit Manager, Registered Nurse (RN), stated Resident #11 had an indwelling catheter to treat [MEDICAL CONDITION]. Resident #11's hospital Discharge Summary, dated 7/31/15, indicated a [DIAGNOSES REDACTED]. Hence urinary catheter was placed Currently we are not taking catheter out. A trial of catheter can be given at the rehab. Possibly the patient might need urinary catheter long term. (He/she) can be tried on alpha-1 blockers to help with [MEDICAL CONDITION]. The surveyor could not locate any further documentation in Resident #11's medical record supporting the need for continued catheter use, orders for alpha-1 blockers or a trial period of bladder retraining to return the bladder to it's previous level of function. In an interview with a surveyor on 09/16/15 at 12:39 p.m., the Director of Nursing (DON) confirmed that it is best practice to remove a catheter after 5 days. She confirmed that there is no evidence in the medical record to support a trial removal of catheter, bladder retraining or the use of medications to help with [MEDICAL CONDITION]. | 2018-09-01 |
| 1911 | 1911 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2015-09-17 | 323 | D | 1 | 1 | Q4FY11 | Based on observations and interview, the facility failed to ensure that the resident environment remains as free of accident hazards as is possible on 1 of 2 units during 1 of 4 survey days. Findings: 1. In Resident Room #104 on 9/15/15 at 8:16 a.m., the surveyor noted the register heater cover joiner piece had pulled away from the unit. The edges were not sharp, but the piece protruded into the walking space of the resident, creating a tripping hazard. 2. On 9/15/15 at 9:33 a.m., the surveyor noted a missing end cap to the register heater across from 1st floor nursing station, right outside of the therapy room, with exposed sharp edges. On 9/15/15 at 9:35 a.m., in an interview with the surveyor, the Administer confirmed both the potential hazards and took immediate corrective action. | 2018-09-01 |
| 1912 | 1912 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2015-09-17 | 371 | E | 1 | 1 | Q4FY11 | Based upon observations and interviews the facility failed to ensure that food was stored under sanitary conditions during 1 of 3 kitchen tours. Findings On 9/14/15 at 9:15 am, during the initial tour of the kitchen, two surveyors observed the following: 1. Heavy ice buildup on the inside of the freezer door of the walk-in freezer and on boxes of food stored in the cooling unit; 2. One bage each of rice, barley, coconut, chocolate powder and potato chips unsealed and open to the air in the dry storage area; 3. A dirty shelf that contained cooling racks and cutting boards. The Food Services Director confirmed these findings at the time of the observation. | 2018-09-01 |
| 1913 | 1913 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2015-09-17 | 465 | D | 0 | 1 | Q4FY11 | Based upon observations and interviews the facility failed to ensure that the kitchen's physical environment was working in a functional condition during 1 of 3 days. On 9/14/15 at 9:15 a.m., during the initial tour of the kitchen, two surveyors observed the following: 1. Heavily dripping faucets in the kitchen hand washing sink and the cook sink; 2. A piece of missing threshold and a loose metal step in the walk-in refrigerator ; 3. A missing piece of floor tile in the kitchen, on the floor between the walk-in refrigerator and prep area; and 4. Two medium sized holes and one large open area with insulation hanging out from the wall facing the ice machine in the dry food storage area. The Food Services Director confirmed these findings at the time of the observations. | 2018-09-01 |
| 1914 | 1914 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2015-09-17 | 469 | D | 1 | 1 | Q4FY11 | Based on observations and interviews, the facility failed to maintain an effective pest control program so that the facility is free of pests on 1 of 2 units and in the kitchen (all on 1 floor). Findings: 1. On 9/14/15 at 9:15 a.m., during the initial tour of the kitchen, a surveyor noted a dead insect an open package of coconut and a dead insect on a re-sealed package of thickener. The Food Service Supervisor immediately discarded the items. 2. On 9/14/15 at 11:13 a.m., the surveyor noted in the bathroom of Resident Room #104, between the register heater unit and the wall, a spider in a spider web; 3. On 9/15/15 at 8:58 a.m., the surveyor noted a spider crawling across the floor in Resident Room #108. The surveyor informed a Certified Nursing Assistant immediately of the spider, who promptly stepped on it. 4. On 9/15/15 at 3:50 p.m., during an interview with a family member in the living room on the Skilled Nursing Unit, the surveyor noted a fly in the room. The family member confirmed there has been an increase in the number of flies lately. 5. On 9/16/15 at 11:30 a.m., 2 surveyors noted a fly in the Administrator's office, which is located on the first floor. 6. On 9/16/15 at 1:02 p.m., a surveyor noted a fly at the Skilled Nursing Station, confirmed by the Unit Manager at this time by stating, I need a fly swatter here. The surveyor discussed these findings with the Administrator on 9/17/15 at 12:24 p.m. | 2018-09-01 |
| 2070 | 2070 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2015-04-21 | 282 | D | 1 | 0 | 0UVW11 | Based on record review and interview, the facility failed to follow the care plan for 1 of 3 residents (#2), reviewed for falls. Finding: On review of Resident #2's clinical record, a surveyor noted the Care Plan, dated 3/3/15, addressed a decline in cognitive status manifested by a history of falls with an approach to Do not leave unattended when toileting. The surveyor noted on the Incident Report, dated 4/9/15, that a Certified Nurse Assistant (CNA) was toileting this resident and gave (the resident) privacy and said to ring the bell when finished. CNA stated this was the normal routine with this resident. The CNA confirmed this statement in an interview with the surveyor on 4/21/15 at 10:45 a.m. The CNA stated the Kardex, a guide used to direct CNA care, did not indicate to do not leave unattended when toileting. The CNA stated she remained in Resident #2's room while the resident was in the bathroom but did not have the resident in direct sight. In an interview with the surveyor on 4/21/15 at 10:30 a.m., the Director of Nursing confirmed that the Kardex did not reflect the need for attendance while the resident was in the bathroom. The DON and the CNA confirmed in their interviews that the CNA Kardex provided ongoing directions to the CNAs specific to the care and special needs of the residents. | 2018-04-01 |
| 2071 | 2071 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2015-04-21 | 323 | D | 1 | 0 | 0UVW11 | Based on record review and interview, the facility failed to provide adequate resident supervision as directed by the care plan to prevent a fall for 1 of 3 residents reviewed with falls. (Resident #2) Finding: On review of Resident #2's clinical record, a surveyor noted the Care Plan, dated 3/3/15, addressed a decline in cognitive status manifested by a history of falls with an approach to Do not leave unattended when toileting. The surveyor noted on an Incident Report, dated 4/9/15, that a Certified Nurse Assistant (CNA) was toileting this resident and gave (the resident) privacy and said to ring the bell when finished. The CNA stated this was the normal routine with this resident. The CNA confirmed this statement in an interview with the surveyor on 4/21/15 at 10:45 a.m. The CNA stated the Kardex, a guide used to direct CNA care, did not indicate for staff to stay with the resident in the bathroom. The CNA stated she remained in Resident #2's room while the resident was in the bathroom but did not have the resident in direct sight. She confirmed that since the incident, the resident is not left unattended in the bathroom. In an interview with the surveyor on 4/21/15 at 10:30 a.m., the Director of Nursing confirmed that the Kardex did not reflect the need for attendance while the resident was in the bathroom. The DON and the CNA confirmed in their interviews that the CNA Kardex provided specific ongoing directions to the CNAs specific to the care and special needs of the residents. | 2018-04-01 |
| 2129 | 2129 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2015-05-07 | 279 | D | 0 | 1 | BZ8K11 | Based on record review and interview, the facility failed to ensure a care plan was developed to include the nutritional needs for 1 of 30 Stage 2 sampled residents (#37). Finding: Documentation in Resident #37's electronic clinical record indicated the resident lost 16 pounds, or 15%, of his/her weight between 11/2/14 and 5/2/15. The resident's clinical record did not reflect the development of a care plan to address the measures utilized by the facility to manage weight loss. Documentation by the Registered Dietician on 10/10/14, 12/26/14 and 3/6/15 reflected recommendations made to address weight loss and the medical record reflected implementation of those recommendations. On 05/06/15 at 10:30 a.m., in an interview with the surveryor, the Interim Administrator confirmed that the facility implemented measures to address weight loss but did not care plan the problem. | 2018-02-01 |
| 2130 | 2130 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2015-05-07 | 371 | E | 0 | 1 | BZ8K11 | Based on observations and interviews, the facility failed to remove expired and unlabeled food items from 1 of 4 unit refrigerators that were available for resident use. On 5/4/15 at 6:30a.m., a surveyor observed the 1st floor kitchenette refrigerator to contain expired and unlabeled food items: 1. Activa Light, one container with an expiration date of 4/6/15. 2. Activa Light, three containers with an expiration date of 4/20/15. 3. One container labeled EGG SALAD with a use by date of 5/3/15 4. Damon Light and Fit, Raspberry, one container with an expiration date of 4/16/15. 5. Kozyshack Vanilla Pudding, Gluten Free with a use by date of 4/15/15. 6. Market Basket Sour Cream, 16 ounce container with an expiration date of 4/2/14. 7. A bowl of slaw was not dated or labeled. The unit charge nurse was made aware of the findings on 5/4/15 at approximately 6:35 a.m. The Food Service Director (FSD) was made aware of the findings in the 1st floor kitchenette refrigerator in an interview on 5/7/15 at 9:00 a.m. | 2018-02-01 |
| 2131 | 2131 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2015-05-07 | 441 | D | 0 | 1 | BZ8K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview, the facility failed to ensure that resident care equipment was stored in an sanitary manner on 2 of 4 days of survey. Findings: 1. On 5/4/15 at 9:32 a.m., a surveyor observed in the bathroom of Resident room [ROOM NUMBER] a bedpan stored uncovered and propped up in the hand rail. 2. On 5/06/15 at 2:08 p.m., a surveyor observed in the bathroom of Resident room [ROOM NUMBER] a bedpan stored uncovered and propped up in the hand rail. In an interview with the surveyor on 4/7/15 at 3:30 p.m., the Interim Administrator confirmed the findings do not reflect sanitary storage of resident equipment. | 2018-02-01 |
| 2297 | 2297 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2014-09-18 | 280 | E | 1 | 0 | 4R6W11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to ensure that care plans were updated to reflect the presence and treatment of [REDACTED].#35). Finding: Resident #35's care plan, written on 6/16/14 and last revised on 9/11/14, directed staff to a treat a diabetic wound on the resident's right foot. On 7/1/14, a physician's orders [REDACTED]. July, August and September 2014 treatment records indicated that Resident #35 had a left heel pressure ulcer with daily monitoring and provision of treatment by staff and the medical record indicated oversight by a physician specializing in wound treatment. The surveyor observed the presence of a nonstageable wound of the left heel during wound care performed by a Licensed Practical Nurse (LPN) on 9/18/14 at 10:15 a.m. The LPN confirmed at this time in an interview with the surveyor, the presence of the wound at the time of Resident #35's transfer to the current unit about 3 weeks ago. According to the resident's medical record, the transfer occurred on 9/3/14. This finding was discussed with the director of nursing (DON) on 9/18/14 at 10:00 a.m. The DON confirmed that care plan did not address the presence and treatment of [REDACTED]. | 2017-09-01 |
| 2298 | 2298 | SOUTHRIDGE REHAB & LIVING CTR | 205136 | 10 MAY ST | BIDDEFORD | ME | 4005 | 2014-09-18 | 514 | E | 1 | 0 | 4R6W11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure that medical records contained complete and accurate information in the areas of repositioning and restorative nursing programs for 1 of 25 stage 2 sampled residents (Resident #2). Findings: 1. Resident #2's care plan, dated 4/15/14 and reviewed on 9/10/14, related to alteration in skin integrity, included interventions that directed the staff to reposition the resident every 2 hours as tolerated and implement the Skin Care Protocol. The Skin Care Protocol directed staff to turn and reposition every 2 hours at a minimum or more frequently depending upon the resident's need. Review of the documentation on the Positioning Record Every 2 Hours sheets for June, July and August 2014 revealed a lack of evidence that the resident was repositioned every 2 hours, or that the resident refused repositioning, for 82 of 92 days. Resident #2's primary Certified Nurse Assistant (CNA) confirmed, in an interview on 9/17/14 at 9:20 a.m., that the resident is repositioned every 1 1/2 to 2 hours. Multiple observations of Resident #2 at various times of the day on 9/15/14, 9/16/14 and 9/17/14, confirmed the resident did not get out of bed but was in various positions throughout each day. The surveyor discussed this finding with the Director of Nurses (DON) in an interview on 9/17/14 at 4:00 p.m. In a follow up interview on 9/18/14 at 11:00 a.m., the DON confirmed that the staff did not consistently document that the resident is repositioned as indicated in the plan of care. 2. Resident #2's care plan, dated 4/15/14 and reviewed on 9/10/14, related to activities of daily living, included interventions that indicated the resident receives a restorative nursing for wheelchair positioning. The restorative nursing program described the positioning of the resident when he/she is the wheelchair. The Restorative Program sheet did not direct the frequency the resident is in the wheelchair but the Documen… | 2017-09-01 |
| 2518 | 2518 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2014-07-17 | 156 | D | 0 | 1 | 8GI211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a Notice of Medicare Provider Non-Coverage, with appeal rights was issued in advance of the termination of Medicare Services to 1 of 3 sampled residents (#148). Finding: Resident #148's admission notes indicated the resident was readmitted to the facility on [DATE] with rehabilitation and skilled services in place. The resident's discharge notes indicated the resident was discharged on [DATE]. The resident's closed medical record lacked evidence of a Notice of Medicare Provider Non-Coverage. On 7/17/14 at 12:00 p.m., in an interview with a surveyor, the Licensed Social Worker (LSW) stated that the social worker provides a notice of non-coverage to new admissions who do not qualify for skilled care. The LSW was unable to locate a Notice of Medicare Provider Non-Coverage for Resident #148. | 2017-03-01 |
| 2519 | 2519 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2014-07-17 | 253 | E | 0 | 1 | 8GI211 | Based on observations and interview, the facility failed to ensure that doors, walls and a floor mat were maintained in a manner to ensure sanitization in 12 of 58 resident rooms. In addition, three of four wall corners in the first floor bathing suite were not maintained in an orderly manner. Findings: On 7/16/14 at 2:20 p.m., a surveyor and Director of Plant Operations toured the facility and observed the following: 1. The first floor Bathing Suite had three wall corners with damaged sheet rock; chipped away exposing metal. 2. Resident Room #107's door had gouges, creating a rough uncleanable surface. 3. Resident Room #112's door had gouges, creating rough edges and an uncleanable surface. 4. Resident Room #206's doorway had laminate coming unpeeled and splitting apart. 5. Resident Room #213's bathroom wall had gouged sheet rock in 2 places. 6. Resident Room #214's door had gouges, creating a rough uncleanable surface. 7. Resident Room #215 had laminate around the door way that was coming unpeeled. 8. Resident Room #216's doorway had laminate coming unpeeled and splitting apart. 9. Resident Room #219's bathroom door had several areas of chipped painted, and 1 of 2 armoires had a door that had come undone from it's holding track. 10. Resident Room #221's bathroom doors had several areas of scuffed and peeling paint. 11. Resident Room #307's door was chipped and gouged, creating an uncleanable surface. 12. Resident Room #308 had 1 vinyl floor mat that was worn and edges that were separating, exposing foam and created an uncleanable surface; and the bathroom door was chipped. 13. Resident Room #314's bathroom door was scuffed and paint was chipped in several areas. On 7/16/14, during the tour of the environment, the Director of Plant Operations acknowledged the environmental issues listed above. | 2017-03-01 |
| 2520 | 2520 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2014-07-17 | 279 | D | 0 | 1 | 8GI211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure that a restorative toileting program was developed for 1 of 3 sampled residents, identified with urinary incontinence (#127). Finding: The Resident Assessment Instrument, (RAI), Chapter 4-CAA Process and Care Planning, Under section 4.8, directs care plan goals should be measurable. The interdisciplinary team (IDT) may agree on intermediate goals that will lead to outcome objectives. Intermediate goals must be pertinent to the resident ' s condition and situation (i.e., not just automatically applied without regard for their individual relevance), measurable and have a time frame for completion or evaluation. A separate care plan is not necessarily required for each area that triggers a CAA. Since a single trigger can have multiple causes and contributing factors and multiple items can have a common cause or related risk factors, it is acceptable and may sometimes be more appropriate to address multiple issues with a single care plan segment or to cross reference related interventions from several care plan segments. Under the examples 6.-Urinary Incontinence and Indwelling catheter= Urinary incontinence is the involuntary loss or leakage of urine or the inability to urinate in a socially acceptable manner. Although aging affects the urinary tract and increases the potential for urinary incontinence, urinary incontinence itself is not a normal part of aging. Urinary incontinence can be a risk factor for various complication. Incontinence may affect a resident ' s psychosocial well-being and social interactions. This CAA is triggered if the resident is incontinent of urine or uses a urinary catheter. When this CAA is triggered the nursing home staff should follow their facility policy for the chosen protocol or policy for performing the CAA. Successful management will depend on accurately identifying the underlying cause of the incontinence. The next step is to develop an ind… | 2017-03-01 |
| 2521 | 2521 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2014-07-17 | 309 | E | 0 | 1 | 8GI211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to ensure a physician order [REDACTED].#79). Finding: Resident #79's physician telephone orders, dated 6/3/14, directed staff to hold the resident's morning dosage of Klonopin for one month. The physician's MatureCare UNE note, dated 7/1/14, indicated that the physician had discontinued the resident's morning dosage of Klonopin but this was not done. On 7/15/14 at 8:42 a.m., a surveyor observed a Registered Nurse (RN) administer the morning dosage of Klonopin to Resident #79. The resident's electronic Medication Administration Record [REDACTED]. On 7/15/14 at 9:00 a.m., in an interview with a surveyor, the Registered Nurse (RN), Charge Nurse confirmed that the physician's orders [REDACTED]. Resident #79 behavioral and mood monitoring flow sheets for June 2014, did not indicate a change in the residents mood and behavior during this timeframe. | 2017-03-01 |
Advanced export
JSON shape: default, array, newline-delimited
CREATE TABLE [cms_ME] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );