cms_NH
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| Link | rowid ▼ | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 550 | D | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review and staff interview the facility failed to protect and promote the rights of 2 of 43 sampled residents (Resident identifiers are #18 and #49). Findings include: Resident #18 was admitted to the facility on [DATE] without having a [DIAGNOSES REDACTED]. However on 7/18/16 Resident #18 was diagnosed with [REDACTED]. The facility from 7/18/16 when the [MEDICAL CONDITION] disorder [MEDICAL CONDITION] type [DIAGNOSES REDACTED].#18. Staff L (Social Services Director) aknowledged during a 3/2/18 interview that the facility has not made a PASARR II referral for Resident #18. Resident #18's new [DIAGNOSES REDACTED]. Resident #49, according to Staff L was an emergency admission who was admitted into the facility on [DATE]. The Consent to Admission and Treatment form was signed by a Family Friend without any documentation being provided to the facility which showed that this individual had been given the legal authroization to sign for Resident #49 on their behalf. Also, this family friend of Resident #49 signed consent forms without having any documentation showing that they had the authority to do so for administering antipsychotic, antidepressant, antianxiety and hypnotic medications to Resident #49. Resident #49's comprehensive care plan states that Resident #49 is able to make her own health care decisions at this time. A Social Service note of 9/26/17 stated that Resident #49 is able to make (his/her) own decisions. Interviews on 3/2/18 and 3/5/18 with respectively Staff L (Social Service Director) and Staff D (Unit Manager) revealed that Resident #49 was not competent to make his/her own health care decisions. This was confirmed by Resident #49's admission MDS assessment of 9/25/17 and 12/18/17 quarterly MDS that indicated Resident #49 is severely cognitively impaired. Also, Resident #49's care plan indicated that their Advance directives are not on file. A Social Service note of 9/26/17 stated that Social Services is atte… | 2020-09-01 |
| 2 | 2 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 609 | D | 0 | 1 | 6C1411 | Based on interview and record review, it was determined that the facility failed to ensure that the all alleged violations involving abuse, neglect, exploitation and/or mistreatment are reported to the State Survey Agency within the prescribed time frames (see regulation above for timeframes) for one resident out of a subgoup of one resident, with an allegation of resident to resident abuse, in a survey sample of 43 residents. (Resident identifier is #130). Findings include: Resident #130: 2/27/18 1:37 PM: Interview with Resident #130 revealed a verbal report as follows: (Resident #121) came at me and knocked me down. I thought (he/she) would kill me but two staff saved me. This was a couple of months ago. I will never forget the experience! Social services comes to talk to me and make sure I'm okay. I still watch (him/her) like a hawk whenever (he/she) is nearby. (He/She) hasn't tried anything lately. 2/28/18 1:00 pm: Interview with Staff D, Unit Manager revealed that Staff D felt that the incident was overplayed by Resident #130, and it was most likely that both residents were frightened by each other and that caused Resident #130 to fall. Staff D stated, when asked, that the facility did not report this incident as the residents both have dementia, and would not remember what happened. Staff D went on to say that she was unaware that resident to resident altercations needed to be reported to the State Survey Agency if the residents both had dementia. 03/02/18 07:52 AM: Review of nurses notes from the alleged incident on 2/14/18 confirm that there was a resident to resident altercation in Resident #130's room with Resident #121, who held Resident #130 by the upper arms and knocked him/her down. This was witnessed by a nurse, Staff F, and an LNA (un-named) assisted with separating Resident #121 and redirecting him/her from the room so that Resident #130 could be assessed for injury. On nursing assessment by Staff F, an abrasion to the left elbow was noted to be sustained by Resident #130, and neurological checks… | 2020-09-01 |
| 3 | 3 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 655 | B | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care within 48 hours of admission for one resident in standard survey sample of 43 (Resident identifier is #194). Findings include: During recertification survey on 3/4/18 and 3/5/18 Resident #194's medical record was reviewed. In this review it was identified that the resident was admitted to the facility on [DATE]. Review of the care plan section of the medical record given to this surveyor for review by Staff M (Assistant Administrator) identified that the first care plan that had been developed for Resident #194 had been developed and initiated on 2/13/18 In addition to being late this initial baseline care plan did not include any reference to dietary orders or social services involvment. Interview with Staff M on 3/5/18 confirmed that the document given to this surveyor was a copy of the initial care plan. | 2020-09-01 |
| 4 | 4 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 656 | D | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility Comprehensive Person-Centered Care Plan policy and procedure the facility failed to develop and implement a person-centered comprehensive care plan for 5 residents in a survey sample of 43 residents. (Resident identifiers are #15, #49, #80, #93 and #152.) Findings include: Resident #152. Record review on 3/5/18 of the Physical Therapy Plan of Care for Resident #152 dated 1/28/2018 revealed in the section titled Medical History Related to Diagnosis/Condition: . R (right) BKA (below knee amputation) due to osteo[DIAGNOSES REDACTED] 6/2105 . Record review on 3/5/18 of the PT (physical therapy) - Therapist Progress note for Resident #152 dated 2/26/18 revealed The pt (Resident #152) continues to have deficits in ROM (range of motion) in B LE (bilateral lower extremities), which limit pt's ability to stand upright on LLE (left lower extremity) and prepare for ambulation via prosthesis due to limited ROM in R knee .barrier is that the pt. (Resident #152) does not currently have a functional prosthesis, as .socket does not fit despite use of shrinker nearly 24/7. PT has been working with prosthesis to obtain a new socket . Interview and review, on 3/5/18 at approximately 12:30 pm. with Staff [NAME] (Registered Nurse), of the comprehensive care plan for Resident #152 revealed no documented evidence of care plan indicating a below knee amputation with interventions for Resident #152. Staff [NAME] reported that if you read this care plan and had not seen .(Resident #152) you wouldn't know that .had a [MEDICAL CONDITION]. Resident #49 who was admitted to the facility on [DATE] has a comprehensive plan of care initiated on 9/26/17 which states that this resident is able to make (his/her) own health care decisions at this time. Interviews on 3/2/18 and 3/5/18 with respectively Staff L ( Social Services Director) and Staff D (Unit Manager, RN) revealed that Resident #49 was not competent upon the… | 2020-09-01 |
| 5 | 5 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 658 | D | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to note/validate a medication order for 1 Resident in a sample size of 43 (Resident identifier is #180.) and failed to ensure proper assessments were performed before moving residents after they sustained falls. (Resident identifiers are: #152 and #186.) Findings include: Potter, [NAME] [NAME], and Anne Griffin Perry. Fundamentals of Nursing. 7th Edition, St Louis, Missouri: Mosby Elsevier, 2009. Chapter 16 Nursing Assessment, page 243. Data Documentation Data documentation is the last part of a complete assessment. The timely, thorough and accurate documentation of facts is necessary when recording client data . If you do not record an assessment finding or problem interpretation, it is lost and unavailable to anyone else caring for the client. If there is not specific information, the reader is left with only general impressions. Observation and recording of client status is a legal and professional responsibility. The nurse practice acts in all states and the American Nurses Association Nursing's Social Policy Statement (2003) mandate, or require, accurate data collection and recording as independent functions essential to the role of the professional nurse. Resident #186 This Surveyor requested an Accident /Incident Report and an Investigation Report. Review of an Event Report, written by Staff O, LPN (Licensed Practical Nurse), and provided by Facility Staff for an Event that occurred on 2/25/18 at 0100 hours revealed the following: While standing in the hallway heard a bump heard a resident yelling for help, found resident laying between the beds, on her R (right) side (Resident) stated unsure all (he/she) know (sic) that (he/she) was asleep. ask (sic) resident if (he/she) hit (his/her) head, (stated no) resident assist to bed X3 (times three person assist), while in bed began a head to toe assessment no apparent bruising or open areas noticed at this time, Neuro checks performed … | 2020-09-01 |
| 6 | 6 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 677 | D | 0 | 1 | 6C1411 | Based on medical record and interview it was determined that the facility failed to provide assistance with activities for daily living for 1 resident in a standard survey sample of 43 residents. (Resident identifier is #93.) Findings include: Resident #93 Review on 03/02/18 of Resident #93's medical record revealed that Resident #93 has dementia. Review of Resident #93's the care plan on 03/05/18 reveals Resident #93 is an extensive assist with a shower. Review of Resident #93's activities of daily living task for showers revealed that during the time frame of 2/3/18-3/5/18 he/she only received one shower since 2/3/18. He/She refused a shower on 2/17/18. Interview on 3/2/18 with Staff N, (Licensed Practical Nurse) revealed that he/she is to be re-approached on another day to receive a shower for the week that he missed. There is no documentation that showes that Resident #93 was reapproached and Resident #93 only received a bedbath. Resident Council notes. On 2/28/18 at approximately 11:00 a.m. during a Resident Council meeting with seven (7) residents in attendance it was stated that 2 nurses were known to residents to give showers; most (nurses) do not seem to have the time to do that. Additionally, one of the residents stated that some days they are told that no one is available to give showers on some shifts. As residents are only scheduled for 1 or 2 showers per week, if residents miss a scheduled shower, it could be several days before they receive another shower. It was further stated by Resident Council members that some call lights are being shut off by staff reaching behind curtains and canceling the call lights without acknowledging the residents affected. Interview on 3/1/18 at approximately 7:15 a.m. with Staff U, Licensed Nursing Assistant revealed, Staffing here really impacts the residents a lot here. 2nd shift showers are missed a lot because there is not enough staff. Interview on 3/1/18 at approximately 7:20 a.m. with Staff V, Licensed Nursing Assistant revealed, We are always short staffed, b… | 2020-09-01 |
| 7 | 7 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 684 | D | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview with staff, and interview with resident, it was found that the facility failed to provide care and services to meet 1 of 1 resident's bowel regime by failing to notified the physician to establish a bowel regime in a survey sample of 43 residents. (Resident identifier is #192) Findings include: During the initial tour of the facility on 2/27/18 it was stated by Resident #192 to surveyor during interview that they had not had a bowel movement for over 5 days and had told staff several times but no medications where given to help. Resident #192 did state that they did finally move their bowels but it was very uncomfortable during that period of time. On review of the bowel record for the month of (MONTH) it was found that from 2/20/18 until 2/25/18 Resident #192 did not have a bowel moment as documented on the bowel record, not until 2/26/18 did it show that a bowel movement occurred. On 3/2/18 at 11:35 a.m. Resident #192 record was further reviewed and on 3/1/18 a Bowel and Bladder Evaluation was in progress and under section 13 Bowel Evaluation Summary part (B) it states Does the resident have bowel movements with regularity (every 3 days or more often)? If no please establish bowel regime with Physician. This information was shown to Staff C (DON) at 8:45 a.m. on 3/2/18 who confirmed the finding and notified the physician, getting orders that state Senna Tablet 8.6 mg Give 1 tablet by mouth at bedtime for constipation and [MEDICATION NAME] Suppository 10 mg insert 1 suppository rectally as needed for Constipation if no BM x 2 days. | 2020-09-01 |
| 8 | 8 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 688 | D | 0 | 1 | 6C1411 | Based on observation and interview, the facility failed to ensure that residents with limited range of motion receive appropriate equipment for 1 of 2 residents with limited range of motion in a sample size of 43 residents. (Resident identifier is #80.) Findings include: Resident #80 Observation of Resident #80 on 3/2/18 at 10:15 a.m. revealed the resident's right foot was not resting on the foot plate of their wheelchair and the resident's slipper was dangling from their foot. There was towel wrapped on the foot plate. Interview with Resident #80 on 3/2/18 at 10:15 am. revealed that when Resident #80 was admitted the resident had brought an electric wheelchair from home that was no longer taking a charge so was now using a facility manual wheelchair. Resident #80 also revealed that the resident had limited range on motion of the right hip and knee. Interview on 3/2/18 at 10:30 a.m. with Staff G (5-2 Unit Manager) revealed the Staff G had not seen Resident #80 using the electric wheelchair in a while because the battery would no longer charge. Interview also revealed that the unit manager believed that Occupational Therapy (OT) was working with Resident #80 on the manual wheelchair currently being used by the resident. Interview with Staff P (Rehabilitation Program Director) revealed the director did not know that Resident #80 was not using the electric wheelchair anymore. Interview further revealed that the rehabilitation department was not aware was that Resident #80 was not positioned properly in the manual wheelchair and did have not referral to work with Resident #80 on the manual wheelchair. | 2020-09-01 |
| 9 | 9 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 689 | E | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the resident environment remains as free of accident hazards as is possible for all residents with 2 residents identified as smoking in an initial survey pool of 59 residents in a non-smoking facility. (Resident identifiers are #80 and #138.) Findings include: Observation on 2/28/10 at 8:25 a.m. revealed Resident #80 was outside in front of the main entrance smoking. Observation on 2/28/18 at 9:00 a.m. revealed Resident #80 was outside in front of the main entrance bundled up for weather with a bath blanket over legs in a manual wheelchair. Resident #80 had a cigarette that was put out wrapped in tissue paper. Interview with Staff G (5-2 unit manager) on 2/28/18 9:45 a.m. revealed that staff are aware that Resident #80 goes outside to smoke. Interview further revealed that Staff G did not know where Resident #80 gets or stores their cigarettes and if staff see lighters or cigarettes, they are supposed to take and hold them. Observation on 3/1/18 at 8:05 a.m. revealed Resident #80 outside the main entrance smoking. Observation also revealed three old cigarettes butts on the ground near the main entrance. Review of the facility's smoking policy (not titled or dated) revealed that the facility prohibits the use of tobacco and tobacco products on the facility's premises and there are no designated smoking times or locations. Interview on 3/2/18 at 9:07 a.m. with Staff C (Director of Nursing) revealed that they are a non-smoking facility and have always been a non-smoking facility. Interview also revealed that Staff C did not know where Resident #80 gets cigarettes. Interview confirmed the above smoking policy. Interview with Staff C on 3/2/18 at 9:45 a.m. there was a smoking assessment done on 12/29/17 for Resident #80 that looked at the resident's cognitive ability/vision/and functioning. The assessment did not include any observations of smoking. Interview fu… | 2020-09-01 |
| 10 | 10 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 725 | F | 0 | 1 | 6C1411 | Based on observation, interview (Residents, Family, Staff) and review of staffing records, the facility failed to provide adequate staffing to provide care, safety, and a healthy milieu to all residents at the facility. Findings include: During the recertification survey from 2/27 to 3/5, four members of the facility staff were asked if they had enough staffing to properly care for residents. Based on answers received from direct interviews, two of the four interviewed, Staff D Registered Nurse (RN) and Staff F (RN) replied there was not enough staff to properly care for residents. Staff [NAME] (RN) replied that adequate staffing depended on the shift, the occasion, residents, and acuity. Staff G replied that staffing was tough on the evening, nights, and weekend shifts. Resident #160. Interview on 2/17/18 at approximately 10:20 a.m. with Resident #160 revealed the following information: . not enough staff , especially evening, nights and weekends. . if you ring and they don't answer I expect they are doing something urgent so you fend for yourself. . sometimes you know at the beginning of shift whether your bell will get answered or not depending on whose working or who is not working. . sometimes medications are late and you have to ask for them . as long as two hours. Resident #404. Interview on 2/17/18 at approximately 10:45 a.m. with Resident #404 revealed the following information: . not enough staff, the staff here work hard but just not enough with all the people who need a lot more help then me. . call bells not always answered, we help each other out when they don't come . you can tell when the bells will be answered depending on the staff working that shift. . can be any shift but mostly evening, nights and weekends . you have to wait for medication you are suppose to get at certain times, you end up asking for them. In a 3/5/18 confidential family interview it was revealed that there has been a shortage of nursing staff for building one during the last five months. This family member stated that becau… | 2020-09-01 |
| 11 | 11 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 745 | D | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review and staff interview the facility failed to protect and promote the rights of 2 of 43 sampled residents (Resident identifiers are #18 and #49). Findings include: Resident #18, according to record review was admitted to the facility on [DATE] without having a [DIAGNOSES REDACTED]. Further record review revealed that on 7/18/16 this facility resident was newly diagnosed with [REDACTED]. The facility from 7/18/16 when the [MEDICAL CONDITION] disorder [MEDICAL CONDITION] type [DIAGNOSES REDACTED].#18. Staff L(Social Services Director) aknowledged during a 3/2/18 interview that the facility has not made a PASARR II referral for Resident #18 even though the [DIAGNOSES REDACTED]. Resident #49, according to a 3/5/18 interview with Staff L was an emergency admission who was admitted into the facility on [DATE]. Record review revealed that the Consent to Admission and Treatment form was signed by a Family Friend without any documentation being provided to the facility, according to a 3/5/18 interview with Staff L which showed that this individual had been given the legal authroization to sign for Resident #49 on their behalf. Also record review further revealed this family friend of Resident #49 signed consent forms without having any documentation showing that they had the authority to do so for administering antipsychotic, antidepressant, antianxiety and hypnotic medications to Resident #49. Resident #49's comprehensive care plan states that Resident #49 is able to make her own health care decisions at this time. A Social Service note of 9/26/17 stated that Resident #49 is able to make her own decisions. Interviews on 3/2/18 and 3/5/18 with respectively Staff L(Social Service Director) and Staff D (Unit Manager) revealed that Resident #49 was not competent to make her own health care decisions. This was confirmed by Resident #49's admission MDS assessment of 9/25/17 and her 12/18/17 quarterly MDS that coded Resident #49 as sev… | 2020-09-01 |
| 12 | 12 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 761 | E | 0 | 1 | 6C1411 | Based on interview, observation and record review it was determined that the facility failed to follow currently accepted professional principles for labeling and/or storing drugs and biologicals, storing drugs in locked compartments, and/or locking controlled drugs separately, for 3 out of a sample selection of 6 medication carts reviewed. Findings include: Medication Storage and Labeling 02/28/18: 7:18 AM: Observation of Facility Medication carts, medication rooms, and control logs for blood glucose machine quality control was initiated. 6 out of a possible 11 medication carts were reviewed with identified issues found in 3 out of 6 Medication Carts reviewed. Issues are as follows: Bld #2: 3/1/18 Medication cart review with (Staff I, RN) revealed that the narcotic medications were not double locked as required. Observation revealed that the medication cart itself was locked, but the narcotic boxes inside the cart were left ajar. Bldg #5: 3/1/18: 8:15 am Med cart: 3rd floor: Observation of box of blood glucose machine control fluids revealed that the boxes (which don't need to be dated) were dated with an opening date, but the control fluid bottles (which need to be dated) were not dated as to when they were opened. 3/1/18, 8:35: 2nd floor Med cart: Staff J, LPN: Observation of the cart revealed that the cart was not locked. Medications with several resident names and prescriptions were left out on top of medication cart, and the cart was left unattended. In the bottom drawer of the cart, there were empty bags with resident names and prescriptions, and creams and ointments that were not in resident identifiable bag(s). Open insulin vials/pens were not dated as to when they were opened. The nurse, Staff J, was observed to begin pulling out many empty bags and putting creams/ointments back into the labeled bags. The narcotics box inside of the cart was not locked, and cart was also not locked. Observation on 2/28/18 at approximately 6:40 a.m. in Building #3 revealed an unlocked, unattended medication cart in the r… | 2020-09-01 |
| 13 | 13 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 812 | E | 0 | 1 | 6C1411 | Based on observation during tour and interview with the director of food services it was found that the facility failed to maintain a sanitary environment along with maintaining kitchen equipment in safe operating conditions. Findings include: During the initial tour of the facility's kitchen on 2/27/18 at 12:17 p.m. it was observed and shown to Staff A (Director of Food Services) during interview that the floors throughout the kitchen areas had broken, chipped and missing tiles creating uneven surfaces throughout the whole kitchen. Also none of the floor surfaces can be cleaned due to deep porous grout lines that are broken and missing grout along with uneven surfaces creating areas that hold water and grease. Also it was observed that the wall behind the cooking equipment (one bay sink, dirty dish rack, double convection oven, main cooking stoves, kettle, and double steamer) had grease and staining along with mold damage as observed from the opposite side of the wall in the dinning room hallway which is under construction due to water damage. There was large amount of dust build up over the cooking area which could inadvertently enter the food, due to the hood suppression system not being cleaned. On review of the inspection tag it was found that the last inspected date was 7/2017 making it one month over due. While touring the units it was found that the delivery food cart doors, while passing trays were mostly left open and staff had trouble latch or close tightly due to gaps. On 3/5/18 all 14 carts were inspected with Staff A and found that all the doors on the carts were either bent, or broken with large splits in the metal doors preventing them from fully closing as designed. | 2020-09-01 |
| 14 | 14 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 880 | E | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews the facility failed to maintain a safe, sanitary enviroment to prevent the development and transmission of infections. Findings include: Observation on 3/1/18 at approximately 8:45 a.m. of the facility rehabilitation area showed multiple individual cloth gait belts and multiple individual synthetic gait belts. Review of the manufacturer's instructions, at the time of survey, with Staff P (Rehabilitation Director) revealed the following: Gait belts made from woven fibers, either natural or man-made can be laundered recommends washing in lukewarm water (100 degrees F / 38 degrees C) without bleach and low dry in order to maintain color brightness and product longevity. If, however, the woven Gait Belts are contaminated, they may be cleaned per the Centers for Disease Control and Prevention, Guidelines for Environmental Infection Control in Health-care Facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) . by washing in hot water (.160 degrees F / 71 degrees C) for a period of 25 minutes or more with, if desirable, the appropriate bleach concentration . Interview on 3/1/18 at approximately 9:00 a.m. with Staff P (Rehabilitation Director) revealed that the facility gait belts, (both the cloth and the synthetic) are wiped down with disinfectant after patient use and are not sent to the laundry to be cleaned. The rehabilitation department failed to ensure that the facility gait belts are cleaned and maintained to prevent the development and transmission of communicable diseases and infections. On 2/27/18 at approximately 1:23 PM Staff K (License Nursing Assistant ) was observed to come out out of room [ROOM NUMBER] without any garb on except for gloves. Staff K then discarded the gloves into room [ROOM NUMBER] and then proceed down the hallway without washing his/her hands. room [ROOM NUMBER] is a precaution room where as Resident #193 is on contact precau… | 2020-09-01 |
| 15 | 15 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 881 | D | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure that residents who required an antibiotic were prescribed the appropriate antibiotic by obtaining a culture for organism identification. Findings include: Review on 3/5/18 of the infection control line listings, revealed many residents who had infections within the past 5 months and who were placed on antibiotics without obtaining a culture for organism identification. Review on 3/5/18 of the facility's policy and procedure titled, Antibiotic Stewardship - Order for Antibiotics, date established was 11/2017, last revised is documented as 11/2017 and is listed as version 1.0. Section A, third paragraph reveals the following verbiage: Appropriate indications for use of antibiotics include: b. Criteria met for clinical definition of active infection or [MEDICAL CONDITION]; and c. Pathogen susceptibility, based on culture and sensitivity, to antimicrobial (or therapy begun while culture is pending). During review of the facility's Infection Control Logs, the following infections were revealed with no culture obtained but antibiotics were prescribed: Date identified Organism Antibiotic ordered Meets McGeer's Criteria 11/4/17 [MEDICAL CONDITION] - Wound [MEDICATION NAME] No 11/6/17 (blank) - UTI [MEDICATION NAME] No 11/7/17 (blank) - Infection [MEDICATION NAME] No 11/7/17 (blank) - Cyst [MEDICATION NAME] No 11/7/17 (blank) - Cyst [MEDICATION NAME] No 11/14/17 (blank) - Infection [MEDICATION NAME] No 11/14/17 (blank) - PNA (Pneumonia) [MEDICATION NAME] No 11/14/17 (blank) - Infection [MEDICATION NAME] No 11/20/17 (blank) - Wound Infection Keflex No 11/27/17 (blank) - PNA [MEDICATION NAME] No 11/27/17 (blank) - PNA [MEDICATION NAME] No 11/30/17 (blank) - Vaginal Itch [MEDICATION NAME] No 12/4/17 (blank) - PNA (normal flora) [MEDICATION NAME] No 12/11/17 (blank) - [MEDICAL CONDITION] [MEDICATION NAME] No 12/20/17 (blank) - PNA [MEDICATION NAME] No 12/21/17 [MEDICATION NAME] Keflex (In… | 2020-09-01 |
| 16 | 16 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 883 | D | 0 | 1 | 6C1411 | Based on record review and interview, it was determined that the facility failed to provide influenza vaccination in a timely manner for one resident in a standard survey sample of 43 residents. (Resident identifier is #157.) Findings include: Interview with Staff D, unit manager, on 3/2/18 revealed Resident #157 was transferred to their unit from another unit in the facility in (MONTH) or (MONTH) of (YEAR), and that resident had not received a flu shot in the Fall of (YEAR). Another interview With Staff D on 3/5/18 revealed that there was a standing order for flu vaccine if not allergic to eggs, and Staff D related the resident is not allergic to eggs, and that there is no documentation in the record why the influenza vaccine was not given during the last four months of (YEAR) or documentation that the doctor was notified that the order for influenza vaccine was not administered. Review of the temperature log in the electronic medical record for Resident @157 revealed that for the period from 8/12/17 through 1/9/18 all recorded temperatures were less than 100.0, with the exception of 1/3/18 when the temperature was 103.6 degrees. Review of a nurses not for 1/3/18 reveals that the resident was sent out to the hospital, fever was 103.6, an update from the hospital confirmed flu. | 2020-09-01 |
| 17 | 17 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 908 | E | 0 | 1 | 6C1411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview it was found that the facility failed to maintain patient care equipment in safe operating condition to meet residents needs due to 5 of 6's batteries that failed to hold a charge and left 14 residents who are Hoyer lifts from getting care if needed. Also the facility failed to document temperatures of the hydrocllator on a daily bases to prevent burning during resident treatment. (Resident identifier is #90). Findings include: On 2/27/18 at 10:58 a.m. interview with Resident #90 stated they did not get a shower on 2/23/18 due to the Hoyer lift's not working and being able to get them out of bed. On review of the shower schedule for Resident #90 it was found that the information provided was correct and Resident #90 did not get a shower as documented on 2/23/18. Interview with Staff B (LNA) confirmed that none of the Hoyer lifts work due to the batteries not able to hold a charge. Staff B also confirmed that Resident #90 did not get a shower that day due to the lifts not working and also said other residents also did not always get up for the day due to the battery issues. Staff B when on to say that the Hoyer's would work for about 2 seconds and then they would have to find another battery to continue the task. Staff B also stated that lots of times the resident's would get stuck in the middle of transferring them and they would have to physically remove the resident from the Hoyer lift. On review of the facility's Battery Charging Tracking Tool sheet for 2/26/18 it documents that battery #'s (1, 3, 4, 6, and 7) under Comments no good. Observation on 3/1/18 at approximately 9:00 a.m. of the facility rehabilitation area with Staff P (Rehabilitation Director) revealed that the facility hydrocllator log did not have temperatures taken on the following dates: 1/1/18, 2/18/18, 12/25/17, 11/23/17, 10/6 & 10/7/17, 9/2/17, 9/4/17, 9/9/17, 9/16/17, 9/23/17, 9/30/17, 8/5/17, 8/12/17, 8/19/17, 8/26/17. Temperatures were not … | 2020-09-01 |
| 18 | 18 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-03-05 | 926 | E | 0 | 1 | 6C1411 | Based on observation, interview, and record review, the facility failed to have smoking policies and procedures that reflect practices at the facility. Findings include: Observation on 2/28/10 at 8:25 a.m. revealed Resident #80 was outside in front of the main entrance smoking. Observation on 2/28/18 at 9:00 a.m. revealed Resident #80 was outside in front of the main entrance bundled up for weather with a bath blanket over legs in a manual wheelchair. Resident #80 had a cigarette that was put out wrapped in tissue paper. Interview with Staff G (5-2 unit manager) on 2/28/18 9:45 a.m. revealed that staff are aware that Resident #80 goes outside to smoke. Interview further revealed that Staff G did not know where Resident #80 gets cigarettes and if staff see lighters or cigarettes, they are supposed to take and hold them. Observation on 3/01/18 at 8:05 a.m. revealed Resident #80 outside the main entrance smoking. Observation also revealed three old cigarettes butts on the ground near the main entrance. Review of the facility's smoking policy (not titled or dated) revealed that the facility prohibits the use of tobacco and tobacco products on the facility's premises and there are no designated smoking times or locations. Interview on 3/02/18 at 9:07 a.m. with Staff C (Director of Nursing) revealed that they are a non-smoking facility and have always been a non-smoking facility. Interview also revealed that the Staff C did not know where Resident # 80 gets cigarettes. Interview confirmed the the above smoking policy. Interview with Staff C on 3/02/18 at 9:45 a.m. there was a smoking assessment done for Resident #80 that looked at the resident's cognitive ability/vision/and physical functioning. The assessment did not include any observations of smoking. Interview further revealed that they do not do a complete assessment to include observation or Interdisciplinary team determination, because they are a non-smoking facility. Review on 3/2/18 at 9:35 a.m. of Resident #80's current care plan showed the following smoking … | 2020-09-01 |
| 19 | 19 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2017-09-07 | 157 | D | 1 | 0 | 9SPV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review and interview, the facility failed to notify the physician with a change of condition of a resident resulting in a hospitalization , for 1 resident in a survey sample of 1 resident. (Resident identifier is #1.) Findings include: Review on [DATE] of Resident #1's (MONTH) (YEAR) Care Plan revealed DPOA (Durable Power of Attorney) was activated [DATE]. The ADL Self Care Performance . section of this Care Plan revealed that Resident #1 was independent with transfers, toilet use, personal hygiene, oral hygiene and eating. This Care Plan also revealed that Resident #1 was an elopement risk/wanderer . Review on [DATE] of Resident #1's Care Plan revealed further that Resident #1 uses antidepressant medication with the Interventions/Tasks listed as Monitor/document/report to MD (medical doctor) prn (as needed) s/sx (signs/symptoms) of depression .slowed movement .disrupted sleep, fatigue, lethargy .changes in cognition . and in the section for . anti-anxiety medications r/t (related to) anxiety . with the Interventions/Tasks listed as . ANTIANXIETY SIDE EFFECTS: Drowsiness, lack of energy .confusion and disorientation .Implement interventions based on results of behavior assessment. Review on [DATE] of the nursing Progress Notes dated [DATE] at 23:36 revealed the following; Resident (Resident #1) had gone out with daughter today. (Resident #1) came back around ,[DATE]. Shortly after (Resident #1) came back, (Resident#1) started to obsess about .daughter . (Resident#1) couldn't sit still for more than 5 to 10 minutes before (Resident#1) got up and continued with .anxiety . After the LNA (Licensed Nursing Aide) got (Resident #1) in bed, (Resident #1) was quiet for a while, but then came back out into the hallway after 2100 still obsessed . Review on [DATE] of the nursing Progress Notes dated [DATE] for Resident #1 revealed the following three individual entries: when the writer was given off report to the on coming nurse… | 2020-09-01 |
| 20 | 20 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2017-09-07 | 281 | D | 1 | 0 | 9SPV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to follow the professional standard of practice for the assessment of a resident, for 1 resident in a survey sample of 1 resident. (Resident identifier is #1.) Findings include: Reference for the professional standard of practice for assessment documentation is: Fundamentals of Nursing, Potter-Perry, Mosby Elsevier, 7th Edition, St. Louis, Missouri, 2009, which revealed the following: Chapter 16 Nursing Assessment page 243. Data Documentation Data documentation is the last part of a complete assessment. The timely, thorough, and accurate documentation of facts is necessary when recording client data. If you do not record an assessment finding or problem interpretation, it is lost and unavailable to anyone caring for the client. If there is not specific information, the reader is left with only general impressions. Observation and recording of a client status is a legal and professional responsibility. The nurse practice acts in all states and the American Nurses Association Nursing's Social Policy Statement (2003) mandate, or require, accurate data collection and recording as independent functions essential to the role of the professional nurse. Review on [DATE] of Staff C's (Licensed Nursing Assistant) written statement dated [DATE] revealed the following: After breakfast I was told by my nurse (Staff D) that the resident was very tired and she put (Resident #1) in .chair because she could not convince the resident to lay down on (Resident #1's) bed. I (Staff C) checked on resident twice and reported to nurse (Staff D) that (Resident #1) was still sleeping A few hours after my nurse (Staff D) asked me (Staff C) to help her transfer the resident to . bed because (Resident #1) was hanging over .chairarm and she did not want (Resident #1) falling. The resident did not wake up during the transfer, after we got (Resident #1) on .bed, the visitor that was also in the room tried speaking t… | 2020-09-01 |
| 21 | 21 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-10-16 | 658 | D | 1 | 0 | QTPI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, interview and facility policy review, it was determined that the facility failed to follow physician orders [REDACTED]. (Resident identifier is #2.) Findings include: Review on 10/16/18 of Resident #2's Order Summary Report revealed that Resident #2 had a physician order [REDACTED]. Review on 10/16/18 of Resident #2's nurses notes, dated 9/20/18, revealed that Resident #2 was .admitted to (Proper Noun) hospital for [MEDICAL CONDITION], without any further notes indicating the signs or symptoms that Resident #2 was experiencing. The last documented nurses note prior to that note was a nurse's note, dated 9/18/18. Review on 10/16/18 of the Facility Policy, titled Charting and Documentation, last revised 4/2018, revealed that All services provided to the resident, progress toward the care plan goals, or any changes in the resident's medical, physical, functional or psychosocial condition, shall be documented in the resident's medical record . Interview on 10/16/18 at approximately 2:00 p.m. with Staff A (Director of Nursing) confirmed that there was no documentation of daily skilled notes. | 2020-09-01 |
| 22 | 22 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-10-16 | 660 | D | 1 | 0 | QTPI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, interview and facility policy and procedure it was determined that the facility failed to implement the discharge planning process to ensure that the needs of 1 resident were met at the time of discharge back to the home setting in a survey sample of 12 discharged residents. (Resident identifier is #1.) Findings include: Review on 10/16/18 of the facility policy and procedure titled Discharge Summary and Plan dated 11/2017 revealed the following: POLICY When a resident's discharge is anticipated, a discharge summary and post-discharge plan will be developed to assist the resident to adjust to his/her new living environment. Guidelines a) When the facility anticipates a resident's discharge to a private residence, another nursing care facility (i.e., skilled, intermediate care, ,,,, etc.), a discharge summary and post-discharge plan will be developed which will assist the resident to adjust to his or her new living environment. b) The discharge summary will include a recapitulation of the resident's stay at this facility and a final summary of the resident's status at the time of the discharge in accordance with established regulations governing release of resident information and as permitted by the resident. The discharge summary shall include a description of the resident's: a. Current diagnosis; b. Medical history .; c. Course of illness, treatment and/or therapy since entering the facility; d. Current laboratory, radiology, consultation, and [DIAGNOSES REDACTED].>e. Physical and mental functional status; f. Ability to perform activities of daily living .; g. Sensory and physical impairments (neurological, or muscular deficits, for example, a decrease in vision and hearing, paralysis, and bladder incontinence); h. Nutritional status and requirements; . i. Special treatments or procedures . j. Mental and psychosocial status (ability to deal with life, interpersonal relationships and goals, make health care decision… | 2020-09-01 |
| 23 | 23 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 580 | D | 0 | 1 | TYS711 | Based on interview and record review, it was determined that the facility failed to notify a physician for a resident who had a change in an AIMS (Abnormal Involuntary Movement Scale) assessment for 1 resident in a final survey sample of 35 residents. (Resident identifier is #17.) Findings include: Review on 10/28/19 of Resident #17's AIMS revealed the following: 11/9/18 - score 0 (no abnormal movements) 2/9/19 - score 0 (no abnormal movements) 5/9/19 - score 0 (no abnormal movements) 7/31/19 - score 6 (Resident scored a 1 in upper (arms, wrists, hands, fingers) include chronic movements, scored a 1 in lower (legs, knees, ankles, toes), scored a 2 in severity of abnormal movements, scored a 2 in incapacitation due to abnormal movements. Interview on 10/28/19 at approximately 1:00 p.m. with Staff K (Licensed Practical Nurse) revealed that there was no documentation that the physician was notified of the changes in Resident #17's AIMs. | 2020-09-01 |
| 24 | 24 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 584 | B | 0 | 1 | TYS711 | Based on observation and interview, it was determined that the facility failed to provided a safe, clean, comfortable and homelike environment for 2 of 5 units. Findings include: Observation on 10/23/19 at 1:12 p.m. during tour of the third floor revealed that the shower room located behind the nurses station had black like tar in 3 inch strips around the outside edges of the shower unit where the walls meet the floor. Also several tiles were broken failing to meet a home like environment. Interview on 10/23/19 at approximately 1:15 p.m. with Staff A (Unit Manager) reviewed the above findings and Staff A stated they are to be remodeling the shower units at some time but was not sure when. Observation on 10/26/19 at approximately 9:30 a.m. of unit one of building one had a strong and pervasive urine like odor which lasted until almost noontime. Observation on 10/23/19 at approximately 11:45 a.m. on the dementia unit revealed a strong urine like odor in the left hallway. | 2020-09-01 |
| 25 | 25 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 656 | B | 0 | 1 | TYS711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to develop and implement a comprehensive person-centered care plan that would include measurable objectives and time frames to meet the residents' needs for 3 residents who were smokers and 2 residents with other care needs out of a final survey sample of 35 Residents. (Resident identifiers are #49, #88, #340, #341 and #540). Findings include: Resident # 49 Interview on 10/23/19 at 01:03 p.m. with Resident #49 resulted in Resident #49 stating I get my cigarettes from the nurse. There's a sign out book at the nurse's station. I sign out the book and the nurse gets me my smoking materials. Then I go outside and smoke off the property. We have to smoke off the facility property, out on the sidewalk. When I'm done, I go back to the nurse's station to turn in my smoking materials to the nurse and then I sign back in. If no one is there to take my smoking materials, I keep them on me until I can find a staff member to give them to. This is what they tell me I have to do. Review of the Facility's Tobacco Free Environment Policy on 10/23/19 at 1:35 p.m. revealed that: (Summarized): *The facility will educate prospective admissions on the Tobacco Free Environment Policy. *The prospective resident will agree not to smoke at the facility or on the premises and will be offered smoking cessation information. *On admission, resident or resident representative will sign indicating that there is understanding that the resident will not smoke in the facility or on the premises. *Any residents who were smokers prior to the implementation of this policy will be allowed to smoke in a designated area and will receive a smoking safety assessment to determine the level of supervision to be provided and interventions to mitigate risk of injury. *Residents new to the facility will not receive a smoking assessment. *Policy will be placed in areas that are highly visible. Enfo… | 2020-09-01 |
| 26 | 26 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 658 | E | 0 | 1 | TYS711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and policy review, it was determined that the facility failed to meet professional standards for medication administrations via a Gastrostomy tube ([DEVICE]), and checking patency for a Peripherally Inserted Central Catheter (PICC) line prior to medication administrations for 2 out of 37 medication administrations observed; and 2 medication omissions noted on record review for 3 resident out of final sample size of 35 residents. (Resident identifiers are #22, #39, and #46.) Findings include: Resident #46 Wolters Kluwer Health (edited by [NAME] M. Nettina), Manual of Nursing Practice. 9th ed. Ambler, Pennsylvania: Lippincott[NAME] and Wilkins, 2010. Page 86 .Types of I.V. (Intravenous) Administration . .Precaution and Recommendations . .1. Before medication administration . .f. Assess patency of the I.V. line by the presence of blood return . Observation on 10/23/19 at 2:05 p.m. with Staff A (Unit Manager) during medication administration for Resident #46's Meropenem (antibiotic) revealed that Staff A cleaned Resident #46's needleless connector of the PICC line with an alcohol wipe then waited for needless connector to air dry. Staff A used a 10 ml (milliliter) Normal Saline Flush to flush the needless connector. Staff A was not observed to have aspirated the PICC line catheter and no red blood-like substance was observed when Staff A flushed Resident #46's PICC line catheter. Staff A then proceeded to administer Meropenem 1 Gm (gram) I.V. Review on 10/24/19 of facility's procedure titled, Central Vascular Access Device ([MEDICAL CONDITION]) Flushing and Locking, revision dated 5/1/2016, revealed that .[MEDICAL CONDITION] .considerations .1.1 Peripherally Inserted Central Catheter (PICC) .flushing/locking (sic) is performed to ensure and maintain catheter patency .5. Catheter patency must be verified prior to each access. To assess patency, aspirate catheter to obtain a positive blood return. The … | 2020-09-01 |
| 27 | 27 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 676 | D | 0 | 1 | TYS711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility failed to ensure that a resident received the appropriate monitoring to maintain or improve his or her ability to carry out the activities of daily living for 1 out of 2 residents reviewed for activities of daily living out of a final survey sample of 35 residents . (Resident identifier is #144.) Findings include: Review on 10/28/19 of Resident #144's medical record revealed that Resident #144 had an MBS (Modified [MEDICATION NAME] Swallow) done on 7/31/19 revealed the the following actions are recommended regarding the patient's feeding: .Treatment plan and further recommendations: . The following actions are recommended regarding the patient's feeding: Alternate Solids/Liquids, Positioned Upright, Small Bites/Sips, Upright at 90 degrees during PO (by mouth) and 30 minutes after meal. . Review on 10/28/19 of ST (Speech Therapist) notes revealed the following: Resident was seen by ST from 7/17/19-8/7/19. The following recommendations were noted on the ST progress and discharge summary: . Recommended strategies include alternating bites/sips, upright for all P.O., small bites/sips. . Discharge plans and instructions: . Monitor and report changes of vocal quality or swallow function. Review on 10/28/19 of Resident #144's care plans revealed that these interventions were not in Resident #144's care plan to be monitored. Interview on 10/28/19 at approximately 1:00 p.m. with Staff K (Licensed Practical Nurse) confirmed that the recommendations were not implemented in Resident #144's care plans. | 2020-09-01 |
| 28 | 28 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 690 | D | 0 | 1 | TYS711 | Based on record review, and interview, it was determined that the facility failed to provide care and services for 1 resident who is totally incontinent of urine in a final survey sample of 35 residents. (Resident identifier is #590.) Findings included: Interview on 10/24/19 at 8:11 a.m. Resident #590 stated the unit is short staffed. Resident #590 also states that prior to coming to this unit when they were on the skilled unit they were getting checked and changed every 3 hours. Resident #590 states now that they are on this unit they get changed 1-2 times per day. Review on 10/25/19 at 12:54 p.m. of Resident #590's medical record revealed LNA (Licensed Nursing Assistant) documentation showed that from 10/15/19-10/28/19 they are getting toileted only two times a day. Review on 10/25/19 of Resident #590's care plan states skin Actual Alteration in Skin Integrity Related to Rash/fungal infection in groin and abdominal fold . Care Plan states (Resident #590) has frequent bowel and bladder incontinence r/t Impaired Mobility/reconditioning. Review on 10/28/19 of the P[NAME] (Point of Care) Response History under Urinary continence for a 14 day look back period shows Resident #590 being incontinent daily. The times provided by the facility are as follows: 10/15/19 shows Resident #590 being changed only two times in a 24 hour period 10/16/19 shows Resident #590 being changed only two times in a 24 hour period 10/17/19 there is no documentation at all 10/18/19 shows Resident #590 being changed only three times in a 24 hour period 10/19/19 shows Resident #590 being changed only two times in a 24 hour period 10/20/19 shows Resident #590 being changed only two times in a 24 hour period 10/21/19 shows Resident #590 being changed only three times in a 24 hour period 10/22/19 shows Resident #590 being changed only one time in a 24 hour period 10/23/19 shows Resident #590 being changed only one time in a 24 hour period 10/24/19 shows Resident #590 being changed only two times in a 24 hour period 10/25/19 shows Resident #590 be… | 2020-09-01 |
| 29 | 29 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 692 | D | 0 | 1 | TYS711 | Based on interview, record review and facility policy review, it was determined that the facility failed to ensure that weight loss is monitored and weights are obtained for 2 residents in a final survey sample of 35 residents. (Resident identifiers are #135 and #172.) Findings include: Review of the facility policy, titled Weight Measurement, dated 5/23/18, revealed that .Weights will be obtained weekly X 4 (weekly for 4 weeks) after admission. Subsequent weights will be monthly, unless physician's orders or the resident's condition warrants more frequent as determined by Interdisciplinary Team .All residents with significant weight changes will be reweighed to assure accuracy of the weight. Verify re-weigh for accuracy and documentation purposes .Residents with significant unintended weight changes will be added to weekly weights X 4 weeks or until weight stabilizes . Resident #135 Review on 10/24/19 of Resident #135's weights and vitals summary revealed that Resident #135 had a weight of 116.8 pounds on 9/6/19, the date that they were admitted to the facility. The next weight documented was on 9/12/19 which was 113 pounds, which represented a 3.2% weight loss. There were no other weights documented after 9/12/19. Review on 10/25/19 of Resident #135's active physician orders revealed that there was no order to discontinue weights. Review on 10/25/19 of Resident #135's nutrition assessment, dated 9/22/19, revealed that there was no documented evidence that Resident #135 was not being weighed. Interview on 10/28/19 at approximately 11:20 a.m. with Staff J (Licensed Practical Nurse) confirmed that the last weight obtained for Resident #135 was the weight obtained on 9/12/19. Staff J also confirmed that they should have been obtained because there was no physician's order to discontinue them. Resident #172 Review on 10/25/19 of Resident #172's weights and vitals summary revealed that Resident #172 had a weight loss from 222 pounds on 8/9/19 to 178.5 pounds on 9/6/19, which represented a 19.5% weight loss. There was… | 2020-09-01 |
| 30 | 30 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 697 | D | 0 | 1 | TYS711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility has failed to ensure that proper pain management is provided to meet professional standards of care for 1 resident in a final survey sample of 35 residents. (Resident identifier is #47) Findings include: Interview on 10/24/19 at 9:47 a.m. with Resident #47 stated that they were not getting enough pain control. Review on 10/24/19 of the medial record shows Resident #47 is receiving scheduled pain medication along with PRN (as needed), these orders are written as follow: [MEDICATION NAME] Tablet 325 mg Give 2 tablet by mouth every 6 hours as needed for mild to moderate Pain NTE (Not to Exceed) 3 GM(grams)/24 hours . [MEDICATION NAME] HCI Tablet 5 MG (milligrams) Give 1 tablet by mouth as needed for for muscle pain Take one tablet once daily as needed. [MEDICATION NAME] HCI Tablet 50 MG Give 1 tablet by mouth every 6 hours as needed for moderate to severe pain. Pain Monitoring using Verbal/Non-Verbal 0-10 Scale every shift for Monitoring Level of Comfort Interview on 10/28/19 at 12:30 p.m. with Staff B (Director of Nurses) was asked if a resident is cognitively intact and what type of pain scale would be used. Staff B stated the numerical scale because Resident #47 is cognitively intact. Staff B was then shown the orders which are written above and asked if you are using the verbal pain scale and documenting using 1-10 but are administering PRN medication using mild-moderate or moderate to severe. Staff B was then asked what would the numerical pain scale in translation to mild-moderate or moderate to severe be. Staff B was not able to answer the question. Staff B then was asked if these levels are from the Wong backer assessment tool for pain, Staff B said yes. On review of this tool it is rated as 1-3 mild, 4-6 moderate, 7-10 severe. Review on 10/28/19 of the PRN orders for [MEDICATION NAME] 325 mg 2 tablets being given using numerical numbers from 7-10 which when using … | 2020-09-01 |
| 31 | 31 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 756 | D | 0 | 1 | TYS711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the pharmacist reports for irregularities in medications, it was determined that the facility has failed to act upon the reports in a timely manner for 2 residents in a final survey sample of 35 residents. (Resident identifiers are: #17 and #31.) Findings include: Resident #31 Review on 10/25/19 of Resident #31's medical record revealed a pharmacy review report showing a irregularity on 9/6/19. Review on 10/26/19 of Resident #31's pharmacy Consultation Report dated 9/6/19 with a Recommendation Please discontinue Montelukast. Rationale for Recommendation Due to a lack of adequate testing, guidelines do not recommend the use of leukotriene receptor antagonists for [MEDICAL CONDITIONS]. Use may be appropriate in the presence of allergic rhinitis or asthma-[MEDICAL CONDITION] overlap syndrome Physician's Response: I accept the recommendation(s) above, please implement as written: This was dated 10/2019 and signed by the physician. Interview with Staff B (Director of Nurses) on 10/26/19 was asked what day was it signed and Staff B stated just now the 26th. Review on 10/26/19 of the MAR (Medication Administration Record) revealed both (MONTH) and (MONTH) have orders that state Montelukast Sodium Tablet 10 MG Give 1 tablet by mouth at bedtime for [MEDICAL CONDITION] which have been given daily since the pharmacy report stating Please discontinue Montelukast. Resident #17 Review on 10/25/19 of Resident #17's medical record revealed that the pharmacist did an MRR (medication record review) on 9/3/19 with the following recommendation: Please attempt a gradual dose reduction (GDR) to quetiapine 50 mg (milligrams) HS (hour of sleep) while concurrently monitoring for reemergence of target behaviors and/or withdrawal symptoms. Physician's Response: I accept the recommendation(s) above, please implement as written. (signed 9/30/19) Review on 10/25/19 of Resident #17's Medication Administration Record [REDACTED… | 2020-09-01 |
| 32 | 32 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 757 | D | 0 | 1 | TYS711 | Based on interview and record review, it was determined that the facility failed to monitor behaviors for 1 resident taking antipsychotic medications, in a final survey sample of 35 residents. (Resident identifier is #25.) Findings include: Review on 10/25/19 of Resident #25's (MONTH) 2019 Medication Administration Record, [REDACTED]. Review on 10/25/19 of Resident #25's (MONTH) 2019 and (MONTH) 2019 nurses notes revealed that there was no documented behavior monitoring for Resident #25. There was also no behavior log found in Resident #25's medical record. Interview on 10/28/19 at approximately 11:00 a.m. with Staff N (Licensed Practical Nurse) confirmed that there was no behavior log for Resident #25 and that there should have been one. | 2020-09-01 |
| 33 | 33 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 758 | D | 0 | 1 | TYS711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that residents who use [MEDICAL CONDITION] medication received a gradual dose reduction for 1 resident, and ensure that PRN (as needed) orders for [MEDICAL CONDITION] medication was limited to 14 days, except, if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should indicate the duration for the PRN order for 1 resident out of a final sample size of 35 residents. (Resident identifiers are #17 and #42.) Findings include: Resident #42 Review on 10/28/19 of Resident #42's current physician order [REDACTED].#42 had an order for [REDACTED].#42's [MEDICATION NAME] order revealed no indicated duration of use. Review on 10/28/19 of Resident #42's (MONTH) to (MONTH) 2019 EMAR (Electronic Medication Administration Record) revealed that Resident #42's [MEDICATION NAME] 0.5 mg PRN with an order date of 6/5/19 was given on 6/10/19, 6/11/19, 6/16/19, 6/22/19, 6/30/19, 8/15/19, 8/19/19, 8/27/19, 8/28/19, 9/1/19, 9/11/19, 9/12/19, 9/20/19, 9/25/19, 9/29/19, 10/2/19, 10/4/19, 10/6/19, 10/14/19, 10/18/19, and 10/19/19. Review on 10/28/19 of Resident #42's Medication Regimen Review (MRR) dated 7/19/19 revealed .Comments: (Resident #42) has a PRN order for an anxiolytic, which has been in place for greater than 14 days without a stop date: [MEDICATION NAME] 0.5 mg BID PRN since 6/5/19 .Recommendation: Please discontinue PRN [MEDICATION NAME]. If the medication cannot be discontinued at this time, current regulations require that the prescriber document the indication of use, the intended duration therapy and the rationale for the extended time period . Further review of Resident #42's MRR dated 7/19/19 revealed that recommendations were declined by the physician on 7/23/19 and rationale to extend therapy was documented but no documented duration of use. Review on 10/28/19 of Res… | 2020-09-01 |
| 34 | 34 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 812 | E | 0 | 1 | TYS711 | Based on observation, record review, and interview, it was determined that the facility failed to properly maintain the dish machine in working order. Findings include: Observation on 10/23/19 while doing the initial inspection of the kitchen with Staff [NAME] (Director of Food Services) revealed that the high temperature dish machine failed to reach its max temperature of 180 degrees. Staff [NAME] ran the dish machine 5 times and the gauge never reached over 165 degrees. On review of the months temperature logs it revealed several days where the dish machine failed to reach its minimum temperature of 180 degrees. Interview on 10/23/19 at approximately 9:30 a.m. with Staff [NAME] confirmed the findings and provided the temperature logs to surveyor. Staff [NAME] contacted the vendor who came to the facility validating that the gauge was broken but the dish machine was running to temperature. The vendor provided a 160 degrees T test strip that tests the dish surface not the water temperature. The test result reflected that the dish machine is running at 180 degrees. | 2020-09-01 |
| 35 | 35 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 865 | B | 0 | 1 | TYS711 | Based on record review and interview, it was determined that the facility failed to develop a written Quality Assurance Performance Improvement (QAPI) plan for the facility. Findings: Review on 10/25/19 of the document provided by the facility for the Quality Assurance Performance Improvement (QAPI) plan requested at the time of survey entrance revealed a packet of information titled Quality Assurance and Performance Improvement Program Resource Guide with a revised date of 6/2019. Interview on 10/28/19 at approximately 2:45 P.M. with Staff D (Administrator) and Staff B (Director of Nursing) confirmed that the facility QAPI plan was the packet of information titled Quality Assurance and Performance Improvement Program Resource Guide listed above and that there was no written QAPI plan for the facility. | 2020-09-01 |
| 36 | 36 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2019-10-28 | 880 | D | 0 | 1 | TYS711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review, it was determined that the facility failed to maintain infection control in regards to hand hygiene during medication administration for 2 out of 37 medication administration observed. (Resident identifiers are #46 and #136.) Findings include: Review on 10/24/19 of facility's policy titled, Handwashing/Hand Hygiene, revision dated 4/2018, revealed that .Use an alcohol-based hand rub .alternatively soap . and water for the following situations: .before and after direct contact with residents .before preparing or handling medications .before and after handling an invasive device (intravenous access sites) .before donning gloves . .Washing hands 1. Vigorously lather hands with soap and rub them together, creating friction to all surfaces, for a minimum of 20 seconds or longer, under a moderate stream of running water, at a comfortable temperature . 2. Rinse hands thoroughly under running water. Hold hands lower than wrist. Do not touch fingertips to inside of sink . 3. Dry hands thoroughly with paper towels and then turn off faucets with a clean, dry paper towel . .Using Alcohol-Based Hand Rub (ABHR) 1. Apply generous amount of product to palm of hand and rub hands together . 2. Cover all surfaces of hands and fingers until hands are dry . Resident #136 Observation on 10/23/19 at 1:30 p.m. with Staff C (Unit Manager) during Resident #136's medication administration of Klonopin (benzodiazapine) revealed that Staff C went into Resident #136 room then left the room with medication cup in hand and headed to the supply closet and obtained a unopened 60 ml (milliliter) syringe and 500 ml basin. Staff C went to Resident #136's bathroom, opened the 60 ml syringe package and washed the 500 ml basin and the 60 ml syringe. Staff C went to Resident #136 without performing hand hygiene and used Resident #136's side table, placed the 500 ml basin and 60 ml syringe on the table and the crushed Klonopin in a me… | 2020-09-01 |
| 37 | 37 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 550 | C | 0 | 1 | P2R411 | Based on dining observations made on the West wing of building one during lunch on 12/13/18 and during lunch on 12/18/18 a confidential family interview and a staff interview, the facility failed to serve residents requiring assistance in a dignified manner. Findings include: On 12/13/18 in the West wing dining room of building one during lunch twenty-three residents had been brought into the room for this meal. Staff AA (RN) and Staff BB (LNA) each stood over residents instead of sitting while feeding them. Staff BB stood while helping to feed three residents (#81, #141 and an unidentified resident) at the same time going from resident to resident helping each with a few bites of food or a sip of a beverage before moving on to aid another of these three residents with their meal. Staff AA asssisted one resident with their meal standing the entire time while assisting them. Observation made on 12/18/18 during lunch two unidentified LNA's stood while they assisted one unidentified resident each with eating their meal. Interview with a family member on 12/14/18 confirmed that staff routinely stand in the West Wing dining room of building one while assisting residents with their meals. This family member stated that there's frequently not enough staff available to supervise, encourage or assist residents in theWest Wing dining room of building one which is why staff are standing while assisting residents to eat their meals. Observation on 12/13/18 in the West wing dining room of building one revealed that for the entire lunch Resident #40 remained asleep and at the waist slumped over the right arm of the chair they were sitting in without receiving the supervisory assistance and encouragement that Resident #40's care plan says they require during mealtimes. There was an over the bed table in front of Resident #40's chair with their uncovered lunch tray on the over the bed table. No staff member was observed during lunch attempting to assist Resident #40 with their meal. While Resident #40 slept in the chair their me… | 2020-09-01 |
| 38 | 38 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 561 | B | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed to put procedures in place for self administration of medications for 1 resident in a final survey sample of 40 residents. (Resident identifier is #196.) Findings include: Observation on 12/13/18 at approximately 1:00 p.m. of Resident #196's bedside table revealed an opened bottle of nasal spray and an opened bottle of [MEDICATION NAME] oral rinse on top of the bedside table that was right next to Resident #196's bed. Observation on 12/14/18 at approximately 8:50 a.m. of Resident #196's bedside table again revealed an opened bottle of nasal spray and an opened bottle of [MEDICATION NAME] oral rinse on top of the bedside table. Interview on 12/14/18 at approximately 8:50 a.m. with Resident #196 revealed that Resident #196 stated that they self administer the spray and the rinse whenever they need them. Resident #196 also revealed that they did not notify any staff members of when they had used them. Review on 12/17/18 of Resident #196's current Physician Orders revealed that there were no physician orders for the nasal spray or the [MEDICATION NAME] oral rinse. Review on 12/17/18 of Resident #196's current care plan revealed that there was no care plan for Resident #196's self administration of medications. Review on 12/17/18 of Resident #196's list of assessments revealed that there was no assessment done for Resident #196's ability to self administer medications. Interview on 12/18/18 at approximately 8:30 a.m. with Staff J (Unit Manager) revealed that they were unaware that Resident #196 was self administering any medications. Staff J also confirmed that there should have been physician orders and a self medication assessment done. | 2020-09-01 |
| 39 | 39 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 580 | D | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to notify the physician of significant change for 1 resident out of a final sample size of 40 residents. (Resident identifier is #207.) Findings include: Review on 12/18/18 of Resident #207's EMAR (Electronic Medication Administration Record) for the month of (MONTH) revealed that on 11/9, 16, 19, 21, 26, 28, and 30/2018 there were medications scheduled for 9:00 a.m. that were coded as 1 Out of the Facility which were [MEDICATION NAME] Acid 500 mg (milligram), Aspirin 325 mg, [MEDICATION NAME] 1000 units,[MEDICATION NAME] mg, [MEDICATION NAME] 6 units, [MEDICATION NAME] 1 mg, [MEDICATION NAME] 75 mg, [MEDICATION NAME] 300 mg, [MEDICATION NAME] 250 mg, Acidophilus 2 capsules, [MEDICATION NAME] 500 mg, [MEDICATION NAME] 800 mg, and Sodium [MEDICATION NAME] 650 mg. Review on 12/18/18 of Resident #207's EMAR for the month of (MONTH) (YEAR) revealed that on 12/3, 5, 7, 10, 12, 14, and 17/ (YEAR) there were medications scheduled for 9:00 a.m. that were coded as 1 Out of the Facility which were [MEDICATION NAME] Acid 500 mg, Aspirin 325 mg, [MEDICATION NAME] 1000 unit,[MEDICATION NAME] mg, [MEDICATION NAME] 6 units, [MEDICATION NAME] 1 mg, [MEDICATION NAME] 75 mg, [MEDICATION NAME] 300 mg, [MEDICATION NAME] 250 mg, Acidophilus 2 capsules, [MEDICATION NAME] 500 mg, [MEDICATION NAME] 800 mg, and Sodium [MEDICATION NAME] 650 mg. Interview on 12/18/18 at 2:08 p.m. with Staff J (Unit Manager) confirmed the above findings and that Resident #207 was out of the facility on the said dates listed above. Staff J also confirmed that on the EMAR for 12/14/18 it was their initials on the 9:00 a.m. medications, which were listed above, and that they did not administer as Resident #207 was at [MEDICAL TREATMENT]. Staff J revealed that Resident #207 goes to the [MEDICAL TREATMENT] center on Monday, Wednesday and Friday and that Resident #207 leaves that facility around 7:30 a.m. and com… | 2020-09-01 |
| 40 | 40 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 584 | B | 0 | 1 | P2R411 | Based on observation, and interview, it was determined that the facility failed to provide a homelike dining environment for 3 out of 5 buildings. (Resident identifiers #87,#187 and #191.) Findings include: Observation on 12/13/18 of Building 2 dining area at 12:56 p.m. revealed a white erasable board that stated that lunch would be at 12:00. Several residents were at various tables waiting for lunch to be delivered complaining to each other that lunch is always late and wondering how long today. Interview at 12:15 p.m. with Resident #87, #187 and #191, revealed that lunch is always late. Observation at 12:56 p.m. revealed that the lunch cart arrived and that lunch trays were being distributed to different tables by two staff members. At 1:03 p.m. Resident #87 did not like the meal serve and pushed the tray away. The staff members did not stop and ask Resident #87 if Resident #87 wanted an alternate. At 1:14 p.m. this resident got up to leave the room and the staff asked if Resident #87 was done and which time an affirmative answer was stated. Further observations revealed that all meals stay on the trays whether in the dining area or in the rooms in Building 2. Interview with Resident #87 at 1:45 p.m. revealed that the lunch trays are always late and if you do not like the main meal you can ask for an alternate but it will take up to an hour to get it so why bother. It would be nice to have some music while we eat; it is so quiet it and so institutional on the lunch trays. Interview on 12/19/18 at 1:45 p.m. with Staff C, (Administrator) revealed that they have tried everything with dining. With trays and without trays but can not seem to keep boundaries from other residents; so it is easier with the trays. Observation on 12/13/18 in the West Wing dining room of building one, a dementia unit, revealed the absence of a homelike environment as all twenty-three residents there for lunch received their meals on trays which remained left in front of them for the entire meal. | 2020-09-01 |
| 41 | 41 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 641 | C | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that assessments accurately reflect the resident's status for 25 residents out of the sample size of 40 residents. (Resident identifiers are #7, #13, #18, #19, #22, #25, #27, #74, #80, #84, #88, #89, #91, #94, #109, #112, #118, #135, #140, #177, #190, #204, #210, #212, and #226.) Findings include: Review on 12/19/18 of Resident #7, #18, #22 #25, #74, #80, #84, #88, #89, #91, #94, #109, #112, #118, #135, #140, #177, #190, #204, #210, #212, and #226 MDS (Minimum Data Set) for the month of (MONTH) to (MONTH) (YEAR) revealed that section C0100-C0500 (BIMS (Brief Interview of Mental Status)) was coded not assessed and with no BIMS score. Review on 12/19/18 of Resident #7, #18, #22, #25, #74, #80, #84, #88, #89, #91, #94, #109, #112, #118, #135, #140, #177, #190, #204, #210, #212, and #226 previous MDS dated between (MONTH) to (MONTH) (YEAR) revealed that Section C0100-0500 was coded with BIMS scores. Interview on 12/19/18 at 9:00 a.m. with Staff X (Social Worker) confirmed that above findings. Staff X revealed that they evaluate and document residents BIMS.Staff X states that they started working at the facility the last week of (MONTH) (YEAR) and that many of the BIMS for the month of (MONTH) to (MONTH) (YEAR) were not done and that they are trying to catch up with the BIMS assessments. Review on 12/19/18 of Resident #18, #22, and #88 BIMS assessment revealed that their last documented assessment were 727/18, 9/13/18, and 7/13/18, respectively. Interview on 12/19/18 at 10:47 a.m. with Staff U (MDS Head Coordinator) confirmed that Resident #18, #22, and #88's BIMS were not completed. Staff U states that the BIMS should have been completed. Staff U stated that the social worker evaluates residents BIMS and completed Section C of the MDS and the MDS coordinators electronically signs for the completion of the MDS. Resident #13 Review on 12/18/18 of Resident #13… | 2020-09-01 |
| 42 | 42 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 656 | D | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined the facility failed to develop and implement a person-centered comprehensive care plan for 2 resident out of a final survey sample of 40 residents. (Resident identifiers are #149, and #226.) Findings include: Resident #226 Review on 12/19/18 of Resident #226's medical record revealed that Resident #226 has Dow[DIAGNOSES REDACTED], Alzheimer and Dementia and was remitted on 10/5/18. Review of Resident #226's the care plan on 10/5/18 reveals Resident #226 is an extensive assist with Activities of daily living. Review on 12/19/18 of Resident 226's nurses notes revealed that Resident #226 had a fall on 10/9/18, 10/14/18, and 10/20/18 and a behavior where Resident #226 sat oneself onto the floor on 10/10/18. All falls had no injuries. Interview on 12/19/18 at 11:27 a.m. with Staff F, (Building 2 Unit Manager) confirmed that Resident #226 did not have a fall care plan since Resident #226 readmission. It had been created in the previous admission and resolved and Staff F did not know why the fall care plan would have been resolved. Resident #149 Review on 12/17/18 of Resident #149's medical record has a note dated 7/23/18 at 16:54 from social service stating When speaking with (Resident #149) this afternoon (Resident #149) said that (Resident #149) wanted to commit suicide earlier in the day. (Resident #149) stated that (Resident #149) had a plan of hanging himself with a cord. After speaking with (Resident #149) about this (Resident #149) stated (Resident #149) no longer wanted to hurt (self) . On 7/24/18 at 14:13 nurses note states (Resident #149) sent out via ambulance to (hospital) for Evaluation for SI (Suicidal Ideation). (Resident #149) states (Resident #149) wants to hurt (self) and verbalizes a plan. (Resident #149) was seen by our psych services and have stated that (Resident #149) should be evaluated at the hospital . On 7/27/18 at 16:00 an Evaluation Summary was complete and within t… | 2020-09-01 |
| 43 | 43 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 689 | E | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, it was determined that the facility failed to ensure that the non-smoking facility is free from accident hazards of smoking by allowing residents to have cigarettes and lighters on their person and not supervising residents when necessary who smoke on the facility's property for 5 of 5 residents in a final sample of 40 residents. (Resident identifiers are #227, #15, #105, #214 and #27.) Findings include: Review on 12/14/18 of the facility's policy titled Tobacco-Free Environment Policy, dated 11/2017, revealed the following: 3. Upon admission the patient/family sign the acknowledgment herein to demonstrate their understanding the patient will not smoke anywhere in the facility or on the premises . 11. The CEO/CCO (Chief Executive Officer/Chief Compliance Officer), ED/DNS (Director of Nursing Services), management and security personnel designate by the CEO/CCO and ED/DNS will enforce the Tobacco -Free policy by: .2) Confiscating tobacco products and light materials found in the facility (and returning such materials to the resident -owner upon the resident's discharge) . Resident #227 Interview on 12/14/18 at 9:31 a.m. with Resident #227 revealed the resident keeps cigarettes and lighter on their person or in their room. Resident #227 also revealed that they were told yesterday by staff (12/13/18) that they needed to smoke up by the street to smoke instead of on the facility property. Resident #227 stated It is dangerous up there and some of the smokers here should not be up there by the traffic. Review on 12/19/18 at 8:14 a.m. of Resident #227's admission packet revealed that on 11/20/2018 Resident #227 signed the following acknowledgment The Resident acknowledges that he/she received, reviewed, and understands the facility's Tobacco-Free Environment Policy and agrees not to use tobacco produces (sic) on the premises of the Center. Resident #15 Interview on 12/13/18 at approximately 10:45 a… | 2020-09-01 |
| 44 | 44 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 692 | E | 0 | 1 | P2R411 | Based on interview, record review, and facility policy review, it was determined that the facility failed to monitor significant weight loss for 4 residents in a final survey sample of 40 residents. (Resident identifiers are #15, #105, #118, and #196.) Findings include: Review on 12/18/18 of the Facility Policy titled, Weight Measurement, dated 5/23/18 revealed that .All residents with significant weight changes will be rewighed to assure accuracy of the weight. Verify re-weigh for accuracy and documentation purposes .Residents with significant unintended weight changes will be added to weekly weight X (times) 4 weeks or until weight stabilizes . Resident #15 Interview on 12/13/18 at approximately 12:00 p.m. with Resident #15 revealed that Resident #15 stated that they had a weight loss. Review on 12/14/18 of Resident #15's weight documentation log revealed that Resident #15 had a weight loss from 105 pounds on 6/4/18 to 92 pounds on 11/5/18. This was a 12.3% loss in approximately 5 months. Resident #15's weight on 10/8/18 had been 98 pounds, which indicated a 6 pound or 6.1% weight loss in 1 month The review also revealed that after the weight that was documented on 11/5/18 indicating the 6 pound weight loss, there was not another documented weight until 12/9/18. The review also revealed that the Resident #15's weight was documented approximately once a month and that the last documented weight was the one taken on 12/9/18. Resident #118 Review on 12/14/18 of Resident #118's weight documentation log revealed that Resident #118 had an unintended weight loss from 200 pounds on 7/20/18 to 186 pounds on 8/6/18. This represented a 7% weight loss in 17 days. There was no documentation of a reweight to confirm this weight loss in one month and the next documented weight for Resident #118 was on 9/4/18, which was 187 pounds. Resident #118's weight on 12/5/18 was 171.5 pounds which represents a 14.2% loss in less than 5 months. There were no documented weights since the one obtained on 12/5/18. The review of weights docu… | 2020-09-01 |
| 45 | 45 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 695 | D | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and interview it was determined that the facility failed to ensure that a resident who needs respiratory care, is provided such care, consistent with professional standards of practice, with a comprehensive person-centered care plan, to meet resident's goals for 1 resident out of a final survey sample of 40 residents. (Resident identifier is #149.) Findings include: Observation on 12/13/18 at 11:00 a.m. revealed Resident #149's call bell was ringing. When entering the room Resident #149 gestured to say she/he was choking, lightly spoke with a gurgled voice, and pointed to the suction machine at Resident #149's bed side. Review on 12/13/18 of the medical record there failed to be a physicians order for the use of [REDACTED]. Interview on 12/14/18 at approximately 2:30 p.m. with Staff [NAME] (Director of Nurses) revealed there were only two residents are needing suction and that Resident #149 was not one of those residents. Interview on 12/18/18 at 09:19 a.m. with Staff I (Nurse) on the phone revealed that Staff I provides suction to Resident #149 every morning and sometime in the afternoon pending on how much secretions form in Resident #149 throat. Staff I also stated when suctioning Resident #149's Staff I always removes clear/yellow discharge. Staff I stated Resident #149 needs the services but also feels it's a comfort measure that provides Resident #149 relief. Review on 12/18/18 at 11:52 a.m. of Resident #149 medical record revealed that new order were written for Resident #149, the orders written are: 1) Oral suctioning of increased secretion using [MEDICATION NAME]--every shift for maintain airway 2) (speech) Eval &(treat)/swallowing Also on 12/17/18 a care plan was written with a Focus stating potential for alteration in respiratory status (related to) Tube Feeding, increased secretions, need for oral suctioning PRN. | 2020-09-01 |
| 46 | 46 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 725 | E | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review, it was determined that the facility failed to ensure sufficient staffing to provide nursing care for 16 residents out of a facility census of 234 residents. (Resident identifiers are #15, #18, #27, #30, #78, #79, #89, #91, #140, #164, #165, #177, #190, #196, #203, and #535.) Findings include: Resident #165 Interview on 12/13/18 at 9:53 a.m. with Resident #165 revealed that there were not enough staff and that at times it took hours for nursing staff to answer call lights. Resident #91 Interview on 12/13/18 at 10:06 a.m. with Resident #91 revealed that on early mornings between 5:00 a.m. to 6:00 a.m. the call lights took up to 2 hours to be answered. Resident #140 Interview on 12/13/18 at 10:27 a.m. with Resident #140 revealed that weekend nursing staff are short, 3-11 shift would have 3 nursing staff on the floor (5-2 unit) and most times they do not get showers. Resident #30 Interview on 12/13/18 at 10:40 a.m. with Resident #30 revealed that most nights, it took 3 hours to get Resident #30 to be assisted back to bed because of short nursing staff. Resident #30 stated that they need the assistance to go back to bed. Resident #30 stated that there were 2 LNA's (Licensed Nursing Assistant) most nights. Resident #89 Interview on 12/13/18 at 11:53 a.m. with Resident #89 revealed that Resident #89 states that there were not enough nursing staff. Resident #18 Interview on 12/13/18 at 1:13 p.m. with Resident #18 revealed that the facility needs more nursing staff and that nursing staff were worst at night as they had one LN[NAME] Interview on 12/14/18 at 6:30 a.m. with Staff L (LNA) confirmed that there was one LNA scheduled most 11-7 (Night) shifts. Staff L states that the 5-3 unit residents need more assistance, staffing was unsafe and call lights were going to be answered when they were available to do so and residents had to wait. Resident #27 Interview on 12/14/18 at 8:11 a.m. with Resident #27… | 2020-09-01 |
| 47 | 47 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 726 | D | 0 | 1 | P2R411 | Based on observation record review and interview, it was determined that the facility failed to ensure that licensed nurses have the specific competencies and skill sets necessary to care for residents' needs for 1 resident in a final survey sample of 40 residents. (Resident identifier is #149.) Findings include: Observation on 12/13/18 at approximately 10:00 a.m. revealed Resident #149's call bell was ringing. When entering the room, Resident #149 gestured to say they were choking, lightly spoke with a gurgled voice, and pointed to the suction machine at Resident #149's bed side. Staff member was looked for to care for Resident #149 and no aide's could be found on the floor. Walking the length of the floor did not locate a staff member. Finally Staff G (Nurse) who was distrubuting medications, was told of the event , asking that they come to Resident #149 needs. Staff G walked down the hall and entered Resident #149's room. At this time Staff G told Resident #149 to clear their mouth themselves and use tissues, but Resident #149 was not able to clear their throat. The nurse then went to use the suction machine that was at Resident #149's bedside, but the canister was full and had to emptied. When doing this, the nurse removed the suction lines to the equipment, emptied the canister and cleaned it in the bathroom and returned to the suction machine at Resident #149 bedside. Then the nurse tried to hook up the suction machine but appered to not know where the suction lines hooked to. At this time surveyor showed Staff G where the suction lines go so the equipment could be used to help provide care to Resident #149. Once the tubing was properly connected to the suction machine Staff G said they did not have a piece of equipment for suction even though they had the yanko suction tube hooked to the machine. Staff G left the room again at 10:25 a.m. and returned with suction tubing trying to attach it to the end of the yanko then stopped. Staff G then said they will just use this (yanko tube) turning the suction machi… | 2020-09-01 |
| 48 | 48 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 755 | D | 1 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, interview and facility policy and procedure the facility failed to ensure accurate reconciliation of controlled narcotic medications for two residents resulting in the actual loss of the prescribed narcotic medications. (Resident identifiers are #30 and #48.) Findings include: Review on 12/14/18 of the facility policy and procedure titled Inventory Control of Controlled Substances with revision date of 1/1/13 revealed the following: Applicability: This Policy 5.4 sets forth the procedures for inventory control of controlled substances. Procedure: 1. With respect to Schedule II controlled substances . 1.2 Facility should ensure that the incoming and outgoing nurses count all Schedule II controlled substances and other medications with a risk of abuse or diversion at the change of each shift or at least once daily and document the results in the 'Controlled Substance Count Verification/Shift Count Sheet' set forth . 1.2.1 Reconcile the total number of controlled medications on hand , add newly received medications to the inventory and remove medications that are completed or discontinued from the inventory, pursuant to the Controlled Substance Verification Count Sheet and 1.2.2 Reconcile the number of doses remaining in the package to the number of remaining doses recorded on the Controlled Substance Verification Count Sheet. 1.2.3 The Facility should routinely reconcile the number of doses remaining in the package to the number of remaining doses recorded in the Controlled Substance Verification/Shift Count Sheet, to the medication administration record. Observation on 12/14/18 at approximately 7:30 a.m. showed Staff Y (Licensed Practical Nurse) and Staff Z (Registered Nurse) doing a shift change narcotic count. Observation showed Staff Y. oncoming nurse, holding individual resident narcotic packaged medications and verbally confirming the number of doses left in the medication package. Staff Z, outgoing … | 2020-09-01 |
| 49 | 49 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 756 | D | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined that the facility failed to receive and follow pharmacist report of irregularities to the attending physician for 1 resident in a final survey sample of 40 residents. (Resident identifier is #19.) Findings include: Resident #19 Review on 12/18/18 of Resident # 19's record had three pharmacist reviews checked off stating see recommendations. Review of the medication tab section of the record revealed that these recommendations were not within the chart with dates of service, 10/18/18, 11/14/18 and 12/10/18 Review on 12/18/18 of Resident #19 Consultation Report for 10/18/18, 11/14/18 and 12/10/18, reveled they were forwarded to the facility by the pharmacist. Review on 12/18/18 of an evaluation that was within the record dated 8/27/18 states Rationale for Recommendation: Evidence for the efficacy and safety of combined use of 2 or more antidepressant medications is limited. The risk for drug interactions, adverse events, noncompliance, and mediation errors are increased. The medication are: [MEDICATION NAME] and [MEDICATION NAME]. Review on 9/13/18 of the medical recorded revealed that the APRN wrote D/C [MEDICATION NAME] (sic-[MEDICATION NAME]), D/C [MEDICATION NAME], and [MEDICATION NAME] decreased to QHS. Both [MEDICATION NAME] and [MEDICATION NAME] are PRN medication and [MEDICATION NAME] was decreased from TID (three times a day) to QD (One time a day). Review on 12/18/18 of the The first Consulation Report dated 10/18/18 which was not in the cart was sent to the facility on [DATE] which states under comment REPEATED RECOMMENDATION from 8/27/18: Please respond promptly to assure facility compliance with Federal regulations Once the facility recived the report called the physican on 12/18/18 and wrote TORB (Telephone order read back) already addressed 9/13/18. Review on 12/18/18 of the second Consultation Report dated 11/14/18 that was sent to the facility on [DATE] with a Reco… | 2020-09-01 |
| 50 | 50 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 758 | D | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure PRN (As Needed) orders for [MEDICAL CONDITION] drugs are limited to 14 days except, if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order for 1 resident out of a final sample size of 40 residents. (Resident identifier is #212.) Findings include: Review on 12/18/18 of Resident #212 current physician orders [REDACTED].#212 had an order for [REDACTED]. Review on 12/18/18 of Resident #212 physician orders [REDACTED]. Review on 12/18/18 of Resident #212 EMAR (Electronic Medication Administration Record) for the month of (MONTH) (YEAR) revealed that [MEDICATION NAME] 1 mg by mouth every 6 hours PRN for anxiety with start date of 9/20/18 and with no end date was given on 9/21, 23, 24, 25, 26, 27, 28, and 30/2018. Review on 12/18/18 of Resident #212 EMAR for the month of (MONTH) (YEAR) revealed that [MEDICATION NAME] 1 mg by mouth every 6 hours PRN for anxiety with start date of 9/20/18 and with no end date was given on 10/1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,12, 14, 15, 17, 18,19, 20, 21, 22, 23, 24, 25, 26, 27, 29 and 30/2018. Review on 12/18/18 of Resident #212 EMAR for the month of (MONTH) (YEAR) revealed that [MEDICATION NAME] 1 mg by mouth every 6 hours PRN for anxiety with start date of 9/20/18 and with no end date was given on 11/1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 22, 23, 25, 26, 27 and 29/2018. Review on 12/18/18 of Resident #212 EMAR for the month of (MONTH) (YEAR) revealed that [MEDICATION NAME] 1 mg by mouth every 6 hours PRN for anxiety with start date of 9/20/18 and with no end date was given on 12/ 5-6, 9-12, and 14-17/2018. Review on 12/18/18 of Resident #212 physician and nurse practitioner notes dated 9/24/18, 10/1/18, 10/3/… | 2020-09-01 |
| 51 | 51 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 761 | D | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and facility policy review, it was determined that the facility failed to ensure that all medications are labeled, stored in locked compartments and discarded when expired for 3 residents in a final survey sample of 40 residents. (Resident identifiers are #109, #165 and #29) Resident #109 Observation on [DATE] at approximately 9:45 a.m. in Resident #109's room revealed the following treatment items: Wound packing strip container without a cover and open to air, and sterile water (single use container) opened and on Resident #109's dresser. Interview on [DATE] at approximately 9:46 a.m. with Staff A (Unit Manager) confirmed that the items did not have a date of opening, Staff A put the items in the garbage. Resident #165 Observation on [DATE] at approximately 10:00 a.m. in Resident #109's room revealed the following treatment item: lac-hydrin five lotion expiration date of ,[DATE]. Interview on [DATE] at approximately 10:30 a.m. with Staff B (Licensed Practical Nurse) confirmed that the items on the dresser were expired and the items were thrown in the garbage. Resident #29 Observation on [DATE] at approximately 12:30 p.m. in Resident #29's room revealed on the dresser was an opened, undated (single container) of sterile water. The sterile water container had several floating black substances in it. Interview on [DATE] at approximately 12:35 p.m. with Staff A (Unit Manager) was not able to identify the floating substances in the container of sterile water. Staff A confirmed that the container was opened and not dated. Review on [DATE] of the facility policy and procedure titled, Storage of Medications, Revision date ,[DATE] revealed: Policy: The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. Guidelines: . 2. The nursing staff shall be responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. . 4. The facility shall not use d… | 2020-09-01 |
| 52 | 52 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 802 | C | 0 | 1 | P2R411 | Based on observation, interview, and record review, it was determined that the facility failed to employ sufficient staff to effectively carry out food functions for 5 of 5 nursing units (Building 2, 5-2, 5-3). Findings include: Observation on 12/13/18 1:15 p.m. on unit 3 East revealed lunch meal trays being delivered to residents in their rooms. Review on 12/18/18 of meal delivery times revealed that 3 East is scheduled to have food delivered for lunch at 11:14 a.m. Observation on 12/13/18 approximately at 10:00 a.m. on Building 2 revealed Resident #191 eating breakfast in the bedroom. Resident #191 complained that the breakfast always has toast but today was different because it had peanut butter on the tray; usually the toast does not even have butter on it it is always burnt. Observation on 12/13/18 of Building 2 dining area at 12:56 p.m. revealed a white erasable board that stated that lunch would be at 12:00. Several residents were at various tables waiting for lunch to be delivered complaining to each other that lunch is always late and wondering how long today. Interview at 12:15 p.m. with Residents #87, #187 and #191 revealed that lunch is always late. Observation at 12:56 p.m. revealed that the lunch cart arrived and that lunch trays were being distributed to different tables by two staff members. At 1:03 p.m. Resident #87 did not like the meal served and pushed the tray away. The staff members did not stop and ask Resident #87 if Resident #87 wanted an alternate. At 1:14 p.m. this resident got up to leave the room and the staff asked if Resident #87 was done and which time an affirmative answer was stated. Further observations revealed that all meals stay on the trays whether in the dining area or in the rooms in Building 2. Interview with Resident #87 at 1:45 p.m. revealed that the lunch trays are always late and if you do not like the main meal you can ask for an alternate but it will take up to an hour to get it so why bother. It would be nice to have some music while we eat; it is so quiet it and s… | 2020-09-01 |
| 53 | 53 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 804 | E | 0 | 1 | P2R411 | Based on a resident complaint, resident record review, interview and observation it was determined the facilty failed to ensure that food is served at appetizing temperatures and not served cold. (Resident identifiers are #72 and #138) Findings include: Review on 12/19/18 Staff P's (Dietician) of documentation of the results of a test tray conducted on unit 5-3 recorded the food temperatures at unacceptably low levels according to the facility form the entree was recorded at 107 degrees and the vegetables recorded at 115 degrees. Staff T (Dietary manager) documented on 12/19/18 and on the other days of survey when the food carts were actually going out to the units next to the times they were supposed to be dispensed to each unit. This documentation showed that on all days of survey the food carts were being dispensed late to all units during all three meals daily because of a shortage of dietary staff. Interview on 12/19/18 with Staff T revealed that on 12/19/18 dietary had only four of the seven needed staff available to help prepare the food carts for dispensing lunch to the facility units. Staff T also revealed that the dietary department needed another cook, two full-time dietary aides and three part-time dietary aides. Review of a resident complaint regarding cold food noted in the minutes of the 11/27/18 meeting of the Resident's food committee revealed that this came from a resident on unit 5-3. The complaint stated that there's not enough staff to serve trays no one is there to pass out trays. Staff T confirmed that this information was verbally passed on to Staff P (Dietician). Interview with Staff P acknowledged receiving this complaint of cold food from Staff T but stated that there was no test tray or other follow up done in response to this resident's complaint of cold food on unit 5-3. Interview on 12/14/18 at 10:35 a.m.with Resident Council had 11 Residents present representing 3 different units in the building. All of the 11 residents in attendance felt like meals were always late getting to the … | 2020-09-01 |
| 54 | 54 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 806 | E | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to provide food that was appealing, and to ensure that the food offered took into consideration resident allergies and preferences for 4 out of 6 nursing units. Findings include: Resident #196 Interview on 12/14/18 at approximately 8:40 a.m. with Resident #196 revealed that Resident #196 stated that the food was not good. They stated that they have a [MEDICAL CONDITION] and are bothered by gassy foods. They stated that they met with the dietitian and that the dietitian listened and wrote down what their preferences were, but that it did not seem as though that information had been communicated with the kitchen, as they frequently got served the foods that they could not tolerate. Review on 12/19/18 of Resident #196's Diet History/Food Preferences form, that was not dated, revealed that Resident #196 indicated that they did not want to be served spicy foods, fish, broccoli, cabbage, cauliflower, spinach, yellow squash or zucchini. Review on 12/19/18 of Resident #196's Diet Order and Communication form, dated 9/17/18, revealed that Resident #196 was allergic to mushrooms. Review on 12/19/18 of Resident #196's diet slips from the kitchen revealed that it read that Resident #196 was allergic to mushrooms. There was nothing documented on the diet slip about Resident #196's preference not to be served spicy foods, cabbage, spinach, yellow squash or zucchini. Interview on 12/19/18 at approximately 11:10 a.m. with Resident #196 and Staff P (Registered Dietitian) confirmed that Resident #196 had an allergy to mushrooms and that they did not want to be served spicy foods. Resident #196 stated that they were served clam chowder for supper on 12/18/18, that they were served mushrooms very frequently and that they are served brussel sprouts, broccoli and cauliflower. Resident #536 Interview on 12/14/18 at 1:45 p.m. revealed that Resident #536 was not eating lunch… | 2020-09-01 |
| 55 | 55 | GREENBRIAR HEALTHCARE | 305005 | 55 HARRIS ROAD | NASHUA | NH | 3062 | 2018-12-19 | 880 | D | 0 | 1 | P2R411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review, it was determined that the facility failed to provide a safe and sanitary environment for infection control in regards to following transmission-based precautions and a unsanitary suction machine for 2 residents out of the facility census of 234 residents. (Resident identifiers are #84, and #118.) Findings include: Policy review Review on 12/14/18 of the facility's policy titled, Isolation- Categories of Transmission-Based Precaution, last revised date of 4/2018, revealed that .Droplet Precautions .when a private room is not available and cohorting is not achievable, use a curtain and maintain at least 3 feet of space between the infected resident and other residents and visitors .put on a mask when entering the room .the facility will implement a system to alert staff and visitors to the type of precaution the resident requires . Resident #84 Observation on 12/14/18 at approximately 8:10 a.m. in Resident #84's room revealed a mouth suction machine on the night stand next to Resident #84's bed. The suction machine canister was 1/2 filled with what appeared to be yellow/white remnants of mouth suctioning. The tubing connected to the canister had a film noted on the inside that was consistent with what was in the canister. Interview on 8/14/18 at approximately 8:15 a.m. with Staff B (Licensed Practical Nurse) confirmed that the canister was 1/2 filled with remnants of mouth suctioning and the tubing also. Staff B revealed that mouth suctioning had not been done on Staff B's shift, the night nurse may have done mouth suctioning on (pronoun omitted). Interview on 8/14/18 at approximately 8:20 a.m. with Staff D (Registered Nurse) who worked the night shift revealed that Staff D did not do any mouth suctioning with Resident #84. Review on 12/14/18 of Resident #84's physician orders [REDACTED]. Oral suctioning PRN (as needed) for increased secretions, start date 2/9/16. Review on 12/14/18 of Residen… | 2020-09-01 |
| 56 | 56 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2020-01-31 | 585 | B | 0 | 1 | 0IIF11 | Based on interview and record review the facility failed to maintain a complaint/grievance log. Findings include: Review on 1/31/20 of the facility policy and procedure titled Grievances revealed the following: Policy Interpretation and Implementation: 7. The patient/resident, or person filing the grievance on behalf of the patient/resident, will be informed of the findings of the investigation and the actions that will be taken to correct any identified problems. Such report will be made orally by the administrator, or her designee, within ten working days of the completion of initial investigation of the grievance. A written summary of the report will also be provided to the patient/resident upon request, and a copy will be filed in the Social Services Office. Review on 1/31/20 of the facility policy and procedure titled Investigating Grievances revealed the following: 3. The Grievance Investigation Report must be filed with the administrator within five (5) working days of the receipt of the grievance. 4. The patient/resident, or person acting on behalf of the patient/resident, will be informed of the findings of the investigation, as well as any corrective actions recommended, within ten (10) working days of the filing of the grievance. 5. A copy of the Grievance Investigation Report must be filed in the social services office. 6. Copies of all reports must be signed and a written summary of the report will be provided upon request to patient/resident or person acting on behalf of the patient/resident. Interview on 1/30/20 at approximately 11:30 a.m. with Staff [NAME] (Director of Social Services) revealed that grievances/complaints are addressed at the time of the grievance/complaint is reported to the facility. Staff [NAME] confirmed that there was no documented complaint/grievance log to track and/or trend complaints/grievances investigated by the facility within 3 years from the date of a complaint/grievance resolution. | 2020-09-01 |
| 57 | 57 | HANOVER HILL HEALTH CARE CENTER | 305009 | 700 HANOVER STREET | MANCHESTER | NH | 3104 | 2020-01-31 | 658 | D | 0 | 1 | 0IIF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined the facility failed to follow physician orders [REDACTED]. (Resident identifier is #47.) Findings include: Review of [NAME] [NAME] Potter and Anne Griffin Perry, Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders revealed the following: The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Review on 1/31/2020 of Resident #47's medical record revealed a physician's orders [REDACTED].#47 would have weekly skin assessment. Review on 1/31/2020 of Resident #47's weekly skin condition record revealed that Resident #47 did not receive timely weekly skin assessment. Resident #47 received one on 1/4/2020, which stated wounds to buttocks treated as ordered in MAR (Medication Administration Record) No s/s (signs/symptoms) of infections; the following week 1/11/2020 it revealed that it Continues with multiple open areas to coccyx/buttocks. Dressing and ointments applied as ordered. No changes noted. No s/s infection. This was the last note/input to the skin condition record. Review on 1/31/2020 of Resident #47's care plan revealed that Resident #47 has an alteration in skin integrity r/t (related /to) the pressure of Deep Tissue Injury (DTI). The care plan inventions include dressings as ordered. assesses placement and integrity of the dressing every shift and change if compromised. Interview on 1/31/2020 at approximately 2:00 p.m. with Staff D (Unit Manager) confirmed that Resident #47 developed a DTI on the heel. Staff D confirmed the heels started to be offloaded at this time. Review on 1/31/2020 of physician orders [REDACTED]. Heel foam cups BL (bilateral) heels- change weekly off-loading boot… | 2020-09-01 |
| 58 | 58 | HAVENWOOD-HERITAGE HEIGHTS | 305016 | 33 CHRISTIAN AVENUE | CONCORD | NH | 3301 | 2019-05-23 | 926 | D | 0 | 1 | XFUZ11 | Based on observation, interview, record review and policy review, it was determined that the facility failed to follow facility smoking policy for 1 out of 1 resident who smoked. (Resident identifier is #11.) Findings include: Review on 5/22/19 of facility's policy titled, Resident Smoking while in the Health Service Center, dated 10/07/16, revealed .complete a smoking evaluation .review status of resident's smoking privileges at least quarterly and more often as needed .update the resident's care plan to indicate the current status of smoking privileges/restrictions Review on 5/22/19 of facility's smoking evaluation, revision date 10/7/16, revealed .for resident who wishes to smoke, perform evaluation on admission, quarterly, at a significant change, or if there has been an incident of unsafe smoking observed or reported Interview on 5/21/19 at 11:42 a.m. with Resident #11 revealed that Resident #11 smoked once a day at the parking lot with staff supervision. Resident #11 stated that they kept their cigarettes in their bedside drawer and that the nurses kept their lighter. Observation on 5/21/19 at 11:42 am in Resident #11's room revealed that Resident #11 had a box of cigarette in their bedside table. Review on 5/23/19 of Resident #11's current smoking care plan revealed that Resident #11 wanted to continue to smoke and that Resident #11 will not smoke without someone present, Resident #11 will smoke 1 cigarette per outing, and Resident #11's friend will accompany resident outside of sliding glass doors, down the ramp, and outside the fence to smoke. Review on 5/23/19 of Resident #11's chart and EHR (Electronic Health Record) revealed that Resident #11's smoking evaluation was completed on 10/7/16. Further review of Resident #11's chart and EHR revealed no other smoking evaluation after 10/7/16. Interview on 5/23/19 at 8:45 a.m. with Staff B (Registered Nurse) confirmed that Resident #11 was the only resident who smoked. Staff B revealed that there was no smoking evaluation done. Staff B stated that they do not… | 2020-09-01 |
| 59 | 59 | HAVENWOOD-HERITAGE HEIGHTS | 305016 | 33 CHRISTIAN AVENUE | CONCORD | NH | 3301 | 2017-09-22 | 226 | D | 0 | 1 | NEVL11 | Based on interview and review of the facility policy, it was determined that the facility failed to include two of the seven required components that assure the facility is doing all that is within its control to prevent occurrences of abuse and neglect. Findings include: Review on 9/21/17 of the facility policy for abuse and neglect titled Resident Abuse, Neglect, & Exploitation dated 5/31/2017 revealed that of the seven required components that must be included in the facilities abuse policy two were not included. The components are: Screening, training, protection, prevention, identification, investigation, and reporting/response. The two components that were not included in the facility's policy are screening and identification. Interview on 9/21/17 at approximately 2:10 p.m. with Staff B (Director of Nursing) confirmed that the two components had been left out of the current policy when it was put into effect on 5/31/17. | 2020-09-01 |
| 60 | 60 | HAVENWOOD-HERITAGE HEIGHTS | 305016 | 33 CHRISTIAN AVENUE | CONCORD | NH | 3301 | 2017-09-22 | 279 | D | 0 | 1 | NEVL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility failed to develop comprehensive care plans for 2 residents out of a sample size of 18 residents. (Resident Identifiers are #3 and #9.) Findings include: Resident #9 Review on 9/21/17 of Resident #9's medical record in the nursing note dated 6/15/17 02:28 p.m. revealed that Resident #9 had a pacemaker. Review on 9/21/17 of Resident #9's care plans revealed that there was not a care plan for the pacemaker. Interview on 9/21/17 at approximately 2:00 p.m. with Staff A (Registered Nurse) confirmed that there was not a care plan for Resident #9's pacemaker. Resident #7 Review on 9/18/17 of Resident #7's comprehensive care plan indicates Resident #7 is receiving a regular diet. Interview on 9/22/17 with Staff H (Registered Dietician) revealed that Resident #7 since 8/28/17 Resident #7 has been receiving a mechanical soft diet with ground meat. The Facility failed to ensure that Resident #7's comprehensive care plan reflected the actual diet Resident #7 was receiving. Resident #3 Review on 9/21/17 of Resident #3's [DIAGNOSES REDACTED].#3 had a pacemaker in place. Review on 9/21/17 of Resident #3's current Care Plan, dated 7/13/17, revealed that there was no care plan for Resident #3's use of a pacemaker. Interview on 9/22/17 at approximately 11:00 a.m. with Staff [NAME] (Registered Nurse) confirmed that Resident #3 had a pacemaker and that there was no care plan in place for the pacemaker. | 2020-09-01 |
| 61 | 61 | HAVENWOOD-HERITAGE HEIGHTS | 305016 | 33 CHRISTIAN AVENUE | CONCORD | NH | 3301 | 2017-09-22 | 431 | D | 0 | 1 | NEVL11 | Based on observation and interview, it was determined that the facility failed to discard expired medications found in the medication room on Lighthouse Lane and medication cart on[NAME]Lane medication cart. Findings include: Observation on 9/22/17 at approximately 7:15 a.m. of the[NAME]Lane medication storage room refrigerator revealed the following expired medications: [REDACTED] Prochloroperazine 25 mg (milligram) suppositories expiration date 6/17. (House Stock) Glycerin suppositories expiration date 1/17. (House Stock) Interview on 9/22/17 at approximately 7:15 a.m. with Staff D (Licensed Practical Nurse) confirmed that the above medications were expired. Observation on 9/22/17 at approximately 8:10 a.m. of the medication cart on[NAME]Lane revealed the following expired medications: [REDACTED] Melatonin 3 mg (milligram) expiration date 3/16. (Resident # 10) Nitrostat 0.4 mg expiration date 5/25/17. (Resident #19) Nitrostat 0.4 mg expiration date 6/29/17. (Resident #20) Nitrostat 0.4 mg expiration date 6/28/17. (Resident #21) Risperdal 0.25 mg expiration date 7/19/17. (Resident #22) Tylenol 325 mg expiration date 9/6/17. (Resident #23) Sennokot S 8.6/50 mg expiration date 9/6/17. (Resident #23) Tylenol 325 mg expiration date 6/28/17. (Resident #24) Acidophilus with Pectin expiration 6/14/17. (Resident #24) Preservision Areds expiration date 5/30/17. (Resident #25) Sennokot S 8.6/50 mg expiration date 9/16/17. (Resident #26) Siltussin 100 mg/5 ml (milliliter) expiration date 9/3/17. (Resident #27) Siltussin 100 mg/5 ml expiration date 3/26/17. (Resident #27) Siltussin 100 mg/5 ml expiration date 5/14/17. (Resident #28) Clindamyocin 300 mg expiration date 6/23/17. (Resident #29) Interview on 9/22/17 at approximately 8:20 a.m. with Staff D and Staff C (Medication Nurse Assistant) confirmed that the above medications were expired. Interview on 9/22/17 at approximately 2:30 p.m. with Staff B (Director of Nurses) revealed that there was not a facility policy and procedure for discarding expired medications. Observa… | 2020-09-01 |
| 62 | 62 | HAVENWOOD-HERITAGE HEIGHTS | 305016 | 33 CHRISTIAN AVENUE | CONCORD | NH | 3301 | 2017-09-22 | 441 | D | 0 | 1 | NEVL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review, it was determined that the facility failed to prevent the potential for cross contamination during blood glucose monitoring on 1 of 2 units and that the professional standard of practice for hand hygiene was implemented to reduce the spread of infection and prevent cross contamination for 3 of 3 residents observed during medication pass observation. (Resident identifiers are #16, #17 and #18) Findings include Resident #16 Observation on 9/22/17 at approximately 7:30 a.m. of the medication pass on Lighthouse Lane B revealed Staff F, MNA (Medication Nursing Assistant) administering medications to Resident #16. The medications administered to Resident #16 were Tylenol tablets and Artificial Tears eye drops. Staff F administered the Tylenol and then donned gloves to administer the eye drops. Staff F removed the gloves after administering the eye drops and did not wash hands or apply hand sanitizer when done. Staff F walked over to the medication cart to start pouring medications for the next resident, Resident #17. Resident #17 Observation on 9/22/17 at approximately 7:40 a.m. of the medication pass on Lighthouse Lane B revealed Staff F, who had just finished administering medications to Resident #16, go over to the medication cart and started pouring medications for Resident #17. Staff F did not wash hands or apply hand sanitizer before pouring the medications for Resident #17. Staff F brought the medications, which included several tablets as well as Refresh eye drops, to Resident #17. Staff F administered the tablets and then donned gloves to administer the eye drops. Staff F removed the gloves after administering the eye drops and did not wash hands or apply hand sanitizer when done. Staff F walked over to the medication cart to start pouring medications for the next resident, Resident #18. Resident #18 Observation on 9/22/17 at approximately 7:50 a.m. of the medication pass on Lighthouse Lan… | 2020-09-01 |
| 63 | 63 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 552 | D | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to inform 1 resident in a standard survey sample of 22 residents of the increased risk of mortality in patients with a [DIAGNOSES REDACTED].e. Black Box Warning) in advance of treatment involving an antipsychotic medication (Resident identifier is #50.) Findings include: Resident #50 Review on 4/13/18 at approximately 11:00 am of Resident #50's medical record revealed a physicians order for [MEDICATION NAME] 5 mg tablet (ARIPiprazole) give 5 mg by mouth one time a day for Major [MEDICAL CONDITION], dated 2/23/18. Further review of resident #50's medical record revealed that there was no documentation that Resident #50 was informed of the increased risk of mortality in patients with a [DIAGNOSES REDACTED].e. Black Box Warning) prior to the administration of [MEDICATION NAME]. Interview on 4/13/18 at approximately 11:15 am with Staff H (Unit Manager) confirmed the above findings for the administration of Abilfy. | 2020-09-01 |
| 64 | 64 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 625 | B | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed notify the resident of the facility's bed hold policy for 1 of 1 transferred residents in a sample of 22 residents. (Resident identifier #55) Findings include: Review of Resident #55's progress notes on 4/13/18 at 08:56 am revealed Resident #55 was transferred to the hospital on [DATE]. Further review of the resident's medical record revealed [REDACTED]. Interview with Staff I (Regional Director of Operations) on 4/13/18 03:02 pm confirmed that there was no written evidence of notification of the bed hold policy for Resident #55 on 4/9/18. Interview further revealed that it is the facility notifies residents of the facility's bed hold policy on admission and not at transfer. | 2020-09-01 |
| 65 | 65 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 656 | C | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, it was determined that the facility failed to develop comprehensive care plans that included medical, nursing and psychosocial needs for 6 residents in a standard survey sample of 22 residents. (Resident identifiers are #5, #25, #52, #66, #80 and #185.) Findings include: Resident #66 Observation on 4/11/18 at approximately 10:35 a.m. revealed that Resident #66 was using oxygen that was being administered through a nasal cannula. Review on 4/13/18 of Resident #66's current care plan revealed that there was no care plan for Resident #66's use of oxygen. Interview on 4/13/18 at approximately 11:30 a.m. with Staff [NAME] confirmed that a care plan should be in place for Resident #66's use of oxygen. Resident #80 Interview on 4/12/18 at approximately 9:00 a.m. with Resident #80 revealed that Resident #80 does not feel that they are getting good pain relief with the pain medications being administered. Resident #80 revealed that an acceptable pain level for them after medication would be about a 5 or 6 out of 10. Review on 4/13/18 of Resident #80's current care plan revealed that the goal for Resident #80's acute pain was written as The resident will voice a level of comfort of (SPECIFY residents states range of comfort) out of (SPECIFY) through the review date. Date initiated: 03/30/2018 . Interview on 4/13/18 at approximately 1:20 p.m. with Staff F (Registered Nurse) confirmed that Resident #80's care plan did not specify what the acceptable goal level of pain was for Resident #80. Resident #185 Observation of Resident #185 in their room on 4/11/18 at 8:35 am revealed the resident has extreme swelling in their hands and feet. Review of Resident #185's progress notes on 4/13/18 at approximately 7:45 am revealed a progress note from 3/25/18 stating that Resident #185 was sent to the hospital for [MEDICAL CONDITION]. Review of Resident #185's current care plan on 4/13/18 at approximately 7:45 am rev… | 2020-09-01 |
| 66 | 66 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 658 | B | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to obtain and follow physician orders for 2 residents in a standard survey sample of 22 residents. (Resident identifiers are #66 and #185.) Findings include: Professional reference: Potter, [NAME] [NAME], and Anne Griffin Perry. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Resident #66 Observation on 4/11/18 at approximately 10:35 a.m. revealed that Resident #66 was using oxygen that was being administered through a nasal cannula. Review on 4/13/18 of Resident #66's Active Physician Orders revealed no physician order for [REDACTED].>Review on 4/13/18 of Resident #66's Health Status Progress note, dated 3/17/18, revealed a note which read .O2 (oxygen saturation) 92% 2L (on 2 liters) NC (nasal cannula.) Review on 4/13/18 of Resident #66's Respiratory therapy progress note, dated 3/15/18, revealed a note which read .Patient has required supplemental O2 to normalize O2 saturations . Interview on 4/13/18 at approximately 11:30 a.m. with Staff [NAME] (Respiratory Therapist) confirmed that there should have been a physician order in place for Resident #66's use of oxygen. Resident #55 Review on 4/13/18 at 8:56 am of the physician orders dated 3/28/18 revealed an order for [REDACTED]. Review on 4/13/18 at approximately 9:00 am of Resident #55's progress notes revealed the following: on 4/9/18 the resident was receiving O2 at 3 LPM, on 4/8 the resident was receiving O2 at 4 LPM, on 4/6/18 the resident was receiving O2 at 3 LPM, on 4/5/18 the resident was receiving O2 at 3 LPM, on 4/3/18 the resident was re… | 2020-09-01 |
| 67 | 67 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 690 | D | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure that a resident with an indwelling catheter was assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catheterization is necessary, for 1 of 2 residents reviewed for catheters in a sample of 22 residents (Resident identifier is #185). Findings include: Observation of Resident #185 on 4/11/18 at 8:36 am revealed the resident had a urinary catheter. Review of physician orders [REDACTED].#185 revealed an order dated 4/8/18 for catheter 16 French with 10 cc balloon to straight drainage. Review of Resident #185's list of [DIAGNOSES REDACTED]. Interview with Staff J (Licensed Practical Nurse) on 4/13/18 at 9:37 am revealed that Resident #185 had a catheter when admitted from the hospital on [DATE] and the reason for the catheter was patient request. Interview with Staff A (Director of Nursing) on 4/13/17 at approximately 1:30 am confirmed there was no clinical [DIAGNOSES REDACTED]. | 2020-09-01 |
| 68 | 68 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 695 | B | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to provide and document that they maintained their schedule for changes in oxygen tubing for 4 residents in a standard survey sample of 22 residents. (Resident identifiers are #18, #23, #66 and #68.) Findings include: Resident #18 Observation on 4/11/18 at approximately 9:55 a.m. of Resident #18 revealed that Resident #18, who was on precautions for [MEDICAL CONDITION] ([MEDICAL CONDITION] Resistant Staph Aureus,) had oxygen tubing attached to an oxygen tank that Resident #18 was using and another oxygen tubing attached to an oxygen concentrator that they were not presently using. Neither of the two oxygen tubings had dates on them. Review on 4/13/18 of Resident #18's (MONTH) (YEAR) Treatment Administration Record revealed that there was no documentation that Resident #18's oxygen tubing was changed on 4/6/18, when it was due to be changed. The box for the nurses initials, documenting the change, was blank for 4/6/18. Review on 4/13/18 of Resident #18's (MONTH) (YEAR) Treatment Administration Record revealed that the last documented date that Resident #18's oxygen tubing was changed was on 3/27/18. Resident #23 Observation on 4/11/18 at approximately 9:40 a.m. of Resident #23 revealed an oxygen concentrator that was running next to Resident #23's bed as Resident #23 was laying in bed sleeping. The oxygen tubing had a piece of tape on the tubing that read 3/31/18. Review on 4/13/18 of Resident #23's Active Physician Orders revealed that Resident #23 had an order for [REDACTED]. Review on 4/13/18 of Resident #23's (MONTH) (YEAR) Medication Administration Record and Treatment Administration Record revealed that there was no documentation of changes to Resident #23's oxygen tubing. Resident #66 Observation on 4/11/18 at approximately 10:35 a.m. revealed that Resident #66 was using oxygen that was being administered through a nasal cannula. The oxygen tub… | 2020-09-01 |
| 69 | 69 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 697 | D | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined that the facility failed to provide sufficient pain management to 2 residents in a standard survey sample of 22 residents. (Resident identifiers are #80 and #329.) Findings include: Resident #80 Observation on 4/12/18 at approximately 9:00 a.m. of Resident #80 revealed that Resident #80's facial expressions looked as though they were uncomfortable while laying in bed. Interview on 4/12/18 at approximately 9:00 a.m. with Resident #80 revealed that Resident #80 stated that they are not getting good pain relief from the medications that are being administered to them by the facility. Resident #80 reported that an acceptable pain level for them would be 5-6 out of 10. Review on 4/12/18 of Resident #80's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review also revealed that Resident #80 had an order for [REDACTED]. Review on 4/12/18 of Resident #80's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review on 4/12/18 of Resident #80's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Interview on 4/13/18 at approximately 10:10 a.m. with Resident #80 revealed that when they complained of pain, the nurses would bring in [MEDICATION NAME], but Resident #80 stated that Resident #80 preferred [MEDICATION NAME]. Interview on 4/13/18 at approximately 1:20 p.m. with Staff F (Registered Nurse) confirmed that documentation revealed that the parameters, put in place for Resident #80's pain medications were not being followed, and that the parameters should be followed. Resident #329 Interview on 4/11/18 at approximately 1:30 p.m. with Resident #329's granddaughter revealed that Resident #329 complains of not getting relief from pain medications administered for Resident #329's back pain. Review on 4/12/18 of Resident #329's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review revealed that Resident #329 also had an order for [REDACTED].#329 h… | 2020-09-01 |
| 70 | 70 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 812 | E | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the facility's policy and procedure, and interview, it was determined that the facility failed to ensure that perishable food was not stored later than use by date and when food appeared to be spoiling. Findings include: Observation on [DATE] at approximately 8:15 a.m. during kitchen tour in the walk in refrigerator revealed the following: 1 box of romaine lettuce that was discolored brown. 1 pan of meatballs with a use by date of [DATE]. 1 container of brown oranges. 1 box of withered apples. Interview on [DATE] at approximately 8:15 a.m. with Staff B (Cook) revealed that the food in the walk-in refrigerator was stored later than use by date and when food appeared to be spoiling. Interview on [DATE] at approximately 9:05 a.m. with Staff C (Dietary Manager) revealed that the expired items were supposed to be removed from the refrigerator the night before. Review on [DATE] of the facility's policy and procedure titled, Food Storage, Revised date ,[DATE] revealed: Policy: It is the policy of this facility that sanitary conditions should be maintained in all storage areas of food. . Proper Food Preparation: 7. Food that is outdated or of questionable quality will be discarded. | 2020-09-01 |
| 71 | 71 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-04-13 | 842 | B | 0 | 1 | WGWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of Resident #76's medical record , and interview it was determined that the facility failed have a baseline assessment for a seat belt for 1 resident in a standard survey sample of 22 residents (Resident identifier is #76.) and it was determined that the facility failed to document the notification of the physician of drug warnings triggered for 2 residents in a standard survey sample of 22 residents. (Resident identifiers are #35 and #329.) Findings include: Resident #76 Interview on 4/11/18 at approximately 9:15 a.m. with Resident #76 revealed that Resident #76 used a seatbelt whenever they are in their wheelchair. Review on 4/13/18 of Resident #76's medical record revealed that on the 24 hour positioning plan there was a seat belt iniated on 3/2/18 for positioning. There was no baseline assessment done for the residents ability to self release the seat belt. Interview on 4/13/18 at approximately 11:45 a.m. with Staff A (Director of Nursing) revealed that there was no assessment for Resident #76's use of a seat belt while in wheelchair. Resident #329 Review on 4/13/18 of Resident #329's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review revealed that Resident #329 also had an order for [REDACTED]. Review revealed that Resident #329 also hadan order for [REDACTED].>Review on 4/13/18 of Resident #329's (MONTH) (YEAR) Medication Administration Record [REDACTED]. Review on 4/13/18 of Resident #329's Progress notes revealed an order note, dated 4/4/18, which was time stamped at 17:34 (5:34 p.m.) and read .The order you have entered [MEDICATION NAME] Tablet 200 mg Give 200 mg by mouth every 6 hours as needed for pain/fever Has (sic) triggered the following drug protocol alerts/warning(s): Drug to Drug Interaction. The system has identified a possible drug interaction with the following orders: [MEDICATION NAME] Sodium Solution 30 mg/0.3 ml Inject 30 mg subcutaneously one time a day for blood thinner Severity: Sever… | 2020-09-01 |
| 72 | 72 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2019-05-13 | 804 | E | 0 | 1 | 5N2V11 | Based on observation, resident interviews and resident council it was determined that the facility failed to provide foods that are palatable, attractive and at an appropriate temperature. (Resident identifiers are: #5, #56, #66, #79, and #244) Findings include: Observation on 5/8/19 at 1:00 p.m. during mealtime observations meal carts on the Glennwood unit arrived over an hour late. The carts were to arrive at 12:00 p.m. but instead arrived at 1:00 p.m. Staff on the unit stated to surveyor that this happens a lot and it's difficult to care for residents and for staff to schedule their lunch breaks when the food cart come to the floor so late. Several residents on the unit during interviews stated that the food is cold lots of time, staff will heat it up but then it gets tough and chewy because it has to be microwaved. Interview on 5/9/19 at 2:04 p.m. with Staff A (Administrator), Staff B (Regional manager), and Staff C (Director of food services from Massachusetts) confirmed that all food products are canned foods and are not cooked to order just poured out of a can and heated. Observation on 5/9/19 at 11:30 a.m. of the Foods prepared were Turkey stew, Diced Pork with Gravy, Mashed potatoes, etc A test tray was performed at this time, the foods that was served were Diced Turkey with Gravy, Mashed potatoes along with a salad and Pear Crisp with Topping. The diced Turkey with gravy was none palatable and looked and tasted like ham. Also the potatoes were bland, and non palatable. These findings were told to Staff C and Staff A at the time of the test tray being performed. Staff C also questioned the looks of the Turkey and the taste along with the potatoes, stating they need to work outside the food menu that is provided by corporate to have these foods taste better. Interview on 05/09/19 8:38 a.m. with three kitchen staff, regarding times the cart gets to the units, and food temperatures, and what may be the cause. One staff member spoke up Staff D (Cook), who revealed that the right side of the main steam tray l… | 2020-09-01 |
| 73 | 73 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2019-05-13 | 812 | E | 0 | 1 | 5N2V11 | Based on observation and interview it was determined that the facility failed to prepare, distribute and serve food in accordance with professional standards for food serviced safely. Findings include: Observation on 5/8/19 during the initial tour of the kitchens walk in refrigerator at 9:00 a.m. revealed two different jars of pickles one B---- slices 1/8 smooth pickles with multiple use by dates of 11/15, 3/19, 3/17/19, and 4/25/19. The jar itself internally had buildup on the inside of the glass and cover. This finding was shown to Staff A (Administrator) who discarded the product right away. The second jar of (K----- Dill Pickles) with a use by date of 3/22/19 and 4/19/19. This product was also discarded by Staff A at time of finding. Observation on 5/8/19 at 10:25 a.m. revealed a counter mounted can opener that was ready for use covered with food product that was not properly cleaned. Staff A was also shown this who removed it from services. Observation on 5/9/19 11:30 a.m. while observing the tray line for the test tray it seemed very non-functional. The kitchen aide starts the tray set up with pellet warmer, utensils, and meal ticket. Then the tray is slid down on a steel table to the cook who reads the meal ticket off the tray touching the ticket with their gloved hand, then distributes the foods they read off the ticket and then places the plate onto the tray. During this time several items had been missed which were picked up by other staff and corrected. During these observations multiple times kitchen staff are reaching and placing items from different areas to meet the needs of the resident's meal tickets but failing to maintain safe food handling by touching multiple different surface areas and not changing gloves. | 2020-09-01 |
| 74 | 74 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-12-07 | 580 | D | 1 | 1 | 9HC411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview and record review, it was determined that the facility failed to notify resident representatives when a resident made an allegation of abuse and when a resident pulled out a urinary catheter, prior to insertion of another catheter, for 2 residents in a standard survey sample of 22 residents. (Resident identifiers are #41 and #55.) Findings include: Resident #41 Review on 12/4/18 of the Facility Report to the Long Term Care Ombudsman, dated 11/13/18, revealed that Resident #41 reported to therapy staff on 11/13/18 that they were assaulted by the male night staff. Resident #41 reported that .a man came in my room and was touching me inappropriately .Resident reported that he was not alone . The report revealed that staff member, Staff B (Licensed Practical Nurse) .was assisting with rounds on this resident Staff B reported that they had Staff D (Licensed Nursing Assistant) .assisting (pronoun for Staff B) with rounds on this resident. They changed resident (sic) brief at this time . Further review of the Facility Report revealed that there was no documentation indicating that Resident #41's guardian was notified of the allegation. Review on 12/6/18 of Resident #41's current care plan revealed that Resident #41 has a guardian from the Office of Public Guardian. Review on 12/6/18 of the Facility's investigation, and the nurses notes for Resident #41 revealed that there was no documented evidence that Resident #41's guardian was notified of the allegation of abuse made by Resident #41 or of the investigation that followed. Review on 12/7/18 of the Facility's policy, titled Abuse, revised on 3/18, revealed that the Facility's Reporting/Documentation Requirements were that .family or responsible party are to be notified immediately after the incident has occurred . Interview on 12/7/18 at approximately 8:30 a.m. with Staff [NAME] (Director of Nursing) confirmed that there was no documented evidence that Resident #41's guardian w… | 2020-09-01 |
| 75 | 75 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-12-07 | 610 | D | 1 | 1 | 9HC411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interview, record review and facility policy review, it was determined that the facility failed to thoroughly investigate an alleged violation of abuse and to implement appropriate corrective actions to prevent further allegations of abuse for 1 resident in a standard survey sample of 22 residents. (Resident identifier is #41.) Findings include: Interview on 12/4/18 at approximately 11:30 a.m. with Resident #41 revealed that Resident #41 stated that a couple of weeks ago, they were inappropriately touched in their perineal area by a male staff member. Resident #41 stated that this male had also groped them several times since this original incident. While explaining the groping, Resident #41 was rubbing their chest area, indicating that it was their chest area that was groped. Resident #41 stated that this staff member was in their room last night and had groped their chest area again. Review on 12/4/18 of the Facility Report to the Long Term Care Ombudsman, dated 11/13/18, revealed that Resident #41 reported to therapy staff on 11/13/18 that they were assaulted by the male night staff. Resident #41 reported that .a man came in my room and was touching me inappropriately .Resident reported that he was not alone . The report revealed that staff member, Staff B (Licensed Practical Nurse) .was assisting with rounds. Staff B reported that (pronoun) had Staff D (Licensed Nursing Assistant) .assisting (pronoun) with rounds on this resident. They changed resident (sic) brief at this time . The Facility Report also revealed that Resident #41's care plan was reviewed and updated to have only female caregivers and two for ADL's (Activities of Daily Living.) Review on 12/6/18 of the Facility's investigation regarding the allegation made by Resident #41 revealed a statement, dated 11/13/18, which was written by Staff [NAME] (Director of Nursing) and had a verbal explanation given to Staff [NAME] by Staff B, the alleged perpetrator. In the stat… | 2020-09-01 |
| 76 | 76 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-12-07 | 641 | B | 0 | 1 | 9HC411 | Based on record review and and interview, it was determined that the facility incorrectly coded the Minimum Data Set assessment for one resident, in a survey sample of 22 residents. (Resident identifier is #7.) Findings include: Resident #7 Interview with this resident on 12/5/18 p.m. revealed that they had a below knee amputation and a Charcot foot 5 years ago, and since then they have a prosthesis for the right lower extremity and they use a boot for the left lower extremity. Review on 12/6/18 p.m. of Resident #7's medical record revealed that both the 6/13/18 and the 9/8/18 quarterly Minimum Data Set assessments code the resident in Section G as having no Limp prosthesis. However, record review of the 5/9/18 Admission/Readmission Evaluation document reveals at Section F.m. that the resident does have a prosthesis. | 2020-09-01 |
| 77 | 77 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-12-07 | 726 | D | 1 | 1 | 9HC411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, it was determined that the facility failed to ensure an aide in training was properly supervised during the administration of care for one resident in a survey sample of 22 residents. (Resident identifier is #7.) Findings include: Resident #7 Interview on 12/5/18 a.m. with this resident revealed that on 10/2/18 a new male aide put Resident #7 to bed against Resident #7's will and hurt Resident #7 by doing it roughly, and when the resident asked him to stop he didn't until Resident #7 yelled. Then he sponge bathed her peri area but didn't use dry sponge as resident requested; he put on a brief but he made a wound in the area. At next shift the (another) aide said the brief was put on incorrectly and changed it and the resident had pain and is still being treated for [REDACTED].#7 identified the aide, Staff J (LNA), by name and that the resident .was aware that . (Staff J) was a newly licensed nursing assistant and that he had only been working for about a week Review on 12/6/18 a.m. of the wound weekly observation tools for 10/9/18, for Resident #7, revealed right posterior upper thigh superficial abrasion acquired 10/9/18 and left posterior upper thigh superficial abrasion acquired 10/9/18. Record review of the 10/9/18 Skin/Wound Note reveals . skin check was done on resident's buttocs (sic) and upper legs Two superficial skin abrasions observed . right posterior thigh left posterior thigh Wound consult order was also obtained Interview on 12/7/18 a.m. with Staff [NAME] (director of nursing), revealed that Staff J started in the kitchen as a dietary aide, until he was certified as nurse aide. Review on 12/07/18 a.m. of Staff J's employee record revealed a Personnel Action Form for Dietary Aide effective date 5-11-18 lists date employed as 5-11-18. The NH (New Hampshire) State Police Criminal Records Unit check completed 5/8/18 found no record. The BEAS (bureau of elderly and adult services) State Regist… | 2020-09-01 |
| 78 | 78 | DOVER CENTER FOR HEALTH & REHABILITATION | 305018 | 307 PLAZA DRIVE | DOVER | NH | 3820 | 2018-12-07 | 880 | B | 0 | 1 | 9HC411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure Transmission Based Contact Precautions were maintained with Personal Protective Equipment for two of two residents in a survey sample of 22 residents, failed to ensure a facility wide Infection Control surveillance and documentation was completed. (Resident identifiers are #41 and #292.) Findings include: Resident #292. Review on 12/6/18 of Resident #292's medical record showed that Resident #292 was admitted to the facility on [DATE] with the multiple [DIAGNOSES REDACTED]. Resident #292 was placed on Transmission Based Contact Precautions at the time of admission due to [MEDICAL CONDITION]. Observation 12/4/18 13:28 p.m. showed an individual (non staff member) in Resident #292's room without any gown or gloves (Personnel Protective Equipment) on for Transmission Based Contact Precautions going several times in & out of Resident #292's bathroom. Observation on 12/5/18 at approximately 12:30 P.M. showed two visitors in Resident #292's room with gowns & gloves on. Interview with these two individuals, identified by Resident #292 as son & daughter of Resident #292, revealed that these two individuals reported they know what to wear when visiting due to white index card attached to yellow over the door precaution supply of PPE. The son reported that at the hospital there was a sign posted on . (Resident #292) door indicating See nurse before entering and hospital staff would tell visitors what PPE was needed when visiting in (Resident #292's) room. Interview & observation on 12/6/18 at 1:30 p.m. with Staff A (Licensed Practical Nurse) confirmed that the PPE supplies contained in the yellow multi-pouched over the door hanger with a piece of white paper attached on the front of this yellow PPE supply container indicating STOP was checked off in boxes on this white paper indicating Gown, Gloves and wash hands. Staff A (LPN) confirmed that a gown & gloves would be worn by… | 2020-09-01 |
| 79 | 79 | EDGEWOOD CENTRE (THE) | 305022 | 928 SOUTH STREET | PORTSMOUTH | NH | 3801 | 2019-02-01 | 609 | D | 0 | 1 | XVXH11 | Based on medical record review, and interview, it was determined that the facility failed to report a case of neglect, to the state survey agency for 1 of 1 resident in a final survey sample of 21 residents. (Resident identifier is #33.) Findings include: Review on 1/31/19 at 9:06 a.m. of Resident #33's nurses note dated 6/26/18 revealed Resident heard calling for help from South wing whirlpool room. Staff entered to find resident sliding down in tub filed with water. Tub drain opened and several staff members assisted holding resident while Hoyer pad was placed under (resident). At no time was (resident's) face or head under water. Resident then Hoyer transferred to w/c (wheelchair) and back to bed to get dressed. No pain or apparent injures noted to resident. Facility DON (Director of Nurses) and POA (Power of Attorney) notified of incident. Review on 1/31/19 at 9:59 a.m. of Resident # 33's care plan revealed under (focus) care area for ADLs (Activities of Daily Living): I have an ADL self-care performance deficit r/t (related to) left parietal intraparenchymal hemorrhage, right hemipligia, and decreased strength Date initiated: 7/12/17 Under (interventions) states Bathing/showering: I require extensive assistance by one staff with bathing/showering. Interview on 1/31/19 at 10:04 a.m. with Resident #33, Resident #33 stated I was so scared I almost drowned Resident #33 was asked if anyone was with (Resident #33) at the time of the event Resident #33 stated no. Resident #33 also said since that event I have not had a tub since, and I love having tubs. Maybe if someone stayed with me I could try again. Interview on 1/31/19 at 11:51 a.m. with Staff A (Administrator), Staff B (Director of Nurses). and Staff C (Unit manger) confirmed that the event as written occurred and that the staff member who was caring for Resident #33 was not in the tub room at time of the event. Since this incident, the staff member has quit due to the what had occurred. The Administrator also was asked if the event was sent to the state surv… | 2020-09-01 |
| 80 | 80 | EDGEWOOD CENTRE (THE) | 305022 | 928 SOUTH STREET | PORTSMOUTH | NH | 3801 | 2019-02-01 | 689 | D | 0 | 1 | XVXH11 | Based on medical record review and interview, it was determined that the facility failed to ensure that 1 of 1 resident receives adequate supervision to prevent accidents in a final survey sample of 21 residents. (Resident identifier is #33.) Findings include: Review on 1/31/19 at 9:06 a.m. of Resident #33's nurses note dated 6/26/18 at 11:37 states Resident heard calling for help from South wing whirlpool room. Staff entered to find resident sliding down in tub filed with water. Tub drain opened and several staff members assisted holding resident while Hoyer pad was laced under him. At no time was (residents) face or head under water. Resident they Hoyer transferred to w/c and back to bed to get dressed. No pain or apparent injures noted to resident. Facility DON (Director of Nurses) and POA (Power of Attorney) notified of incident. Review on 1/31/19 at 09:59 a.m. Resident #33's care plan states under (focus) care area for ADLs (Activities of Daily Living): I have an ADL self-care performance deficit r/t (related to) left parietal intraparenchymal hemorrhage, right hemipligia, and decreased strength Date initiated: 7/12/17 Under (interventions) states Bathing/showering: I require extensive assistance by one staff with bathing/showering. Interview on 1/31/19 at 10:04 a.m. Resident #33 stated I was so scared I almost drowned Resident #33 was asked if anyone was with him at the time of the event Resident #33 stated no. Resident #33 also said since that event I have not had a tub since, and I love having tubs. Maybe if someone stayed with me I could try again. Interview on 1/31/19 at 11:51 a.m. with Staff A (Administrator), Staff B (Director of Nurses). and Staff C (Unit manger) confirmed that the event as written occurred and that the staff member who was caring for Resident #33 was not in the tub room at time of the event. Since this incident, the staff member has quit due to the what had occurred. | 2020-09-01 |
| 81 | 81 | EDGEWOOD CENTRE (THE) | 305022 | 928 SOUTH STREET | PORTSMOUTH | NH | 3801 | 2017-02-10 | 329 | D | 0 | 1 | FQ0H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview it was determined that the facility failed to adequately monitor residents with identified target behaviors for the effects and potential adverse consequences of antipsychotic medications for 2 of 2 residents receiving antipsychotic medications in a survey sample of 22 residents. (Resident identifiers are #3 and #5.) Findings include: Resident #5. Record review on 2/7/17 and 2/8/17 of the MEDICATION ADMINISTRATION RECORD (MAR) for Resident #5 dated 1/1/17 and 2/1/17 revealed the following physician orders [REDACTED]. [MEDICATION NAME] 12.5 mg by mouth every morning and at bedtime related to Hallucinations [MEDICATION NAME] 0.5 mg by mouth every 4 hours as needed for [MEDICAL CONDITION]/restlessness PRN (as needed) [MEDICATION NAME] 12.5 mg by mouth every 24 hours as needed for distressing hallucinations PRN. Review of the (MONTH) MAR revealed the following physician orders: [MEDICATION NAME] 0.5 mg by mouth every 4 hours as needed for [MEDICAL CONDITION]/restlessness PRN [MEDICATION NAME] 12.5 mg by mouth every 24 hours as needed for distressing hallucinations PRN. Further record review showed no documented evidence of ongoing monitoring with an identified target behavior for the prescribed antipyschotic medications listed above for Resident #5. During interview on 2/8/17 at approximately 4:45 p.m. with Staff A (Registered Nurse) after Staff A reviewed the above listed physician orders, the (MONTH) and (MONTH) MAR and computer E-MAR (Electronic Medication Administration Record), Staff A stated that there was no documented evidence of ongoing monitoring with an identified target behavior for the prescribed antipsychotic medications for Resident #5 during the months of (MONTH) and (MONTH) (YEAR). Resident #3 Record review on 2/7/17of the MAR dated 2/1/17-2/28/17 revealed the following physician orders [REDACTED]. There was no documented evidence of behavior monitoring in the medical record or the MAR with an… | 2020-09-01 |
| 82 | 82 | EDGEWOOD CENTRE (THE) | 305022 | 928 SOUTH STREET | PORTSMOUTH | NH | 3801 | 2017-02-10 | 371 | E | 0 | 1 | FQ0H11 | Based on observation and interview the facility failed to ensure safe sanitation practices, including kitchen personnel wearing hairnet covering all hair and food handling processes. Findings include: During the kitchen tour on 2/7/17 at approximately 9:40 a.m. with Staff [NAME] (Food Service Director) it was observed that the high temp dishwasher rinse cycle only reached 176 degrees Fahrenheit after 4 empty trays were processed through. Review of the facility's temperature logs revealed the following below range entries: 1/27/17 the rinse cycle reached 160 degrees Fahrenheit, 1/29/17 the rinse cycle reached 140 degrees Fahrenheit, 2/1/17 the rinse cycle reached 160 degrees Fahrenheit, 2/2/17 the rinse cycle reached 160 degrees Fahrenheit. During interview with Staff [NAME] on 2/7/17 at approximately 9:50 a.m., Staff [NAME] confirmed the above findings and stated that the rinse cycle did not reach the required temperature of at least 180 degrees Fahrenheit. During tour of the kitchen on 2/7/17 at approximately 9:55 a.m. with Staff E, the meat slicer was observed to be covered with a plastic cover. This surveyor asked Staff [NAME] if the meat slicer was ready for use and Staff [NAME] stated that it was ready for use. The plastic cover was lifted to view the entire surface area of the meat slicer and it was discovered that the back side of the meat slicer blade in the center of the blade had a ring around the blade of a thick, light brown thick, greasy substance that was easily scraped off when touch by this surveyor. Interview at approximately 10:00 a.m. with Staff [NAME] confirmed the above findings. During tour of the kitchen on 2/7/17 at approximately 10:15 a.m. with Staff E, the walk-in cooler/large walk-in refrigerator, observation revealed a small box of take-out Chinese food and a container of what was labeled as Japanese Soy Product that were sitting among other food items in this cooler. These items did not contain a date. Interview on 2/7/17 at approximately 10:20 a.m. with Staff E, Staff [NAME] stated t… | 2020-09-01 |
| 83 | 83 | EDGEWOOD CENTRE (THE) | 305022 | 928 SOUTH STREET | PORTSMOUTH | NH | 3801 | 2017-02-10 | 441 | E | 0 | 1 | FQ0H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview it was determined that the facility failed to ensure an environment that is safe and sanitary by not implementing a facility wide surveillance of infection control practices and investigations throughout the facility that provides a safe, sanitary and comfortable environment. (Resident identifier is #11.) Findings include: Observation on 2/8/17 during a medication pass with Staff B (Licensed Practical Nurse) at approximately 9:20 a.m. showed Staff B entered Resident #11's room with prepared medications. Staff B donned a pair of gloves and proceeded to perform trach suctioning on this ventilated resident. When this procedure was completed Staff B proceeded to assemble items to administer medications through Resident #11's [DEVICE] (gastrostomy). Staff B with the unchanged gloves proceeded to open the top drawer in the resident's storage bureau and retrieved a plastic 30 cc syringe. Staff B was observed numerous times touching her (Staff B) face and her (Staff B) clothing with the gloved hands related to the heat in the room. Staff B was observed flushing and administering the prescribed medications through Resident #11's [DEVICE] and when finished proceeded to assemble and prepare the pump and tubing for the continuous [DEVICE] enteral feed solution. Following this procedure Staff B with the same unchanged gloves proceeded to administer prescribed eye drops to Resident #11's left eye. Staff B then discarded the appropriate used items in the trash along with the pair of gloves worn throughout this observation. Staff B failed to change gloves and perform hand hygiene following each direct resident contact to prevent cross contamination between the trach suctioning, administration of medications through the [DEVICE], the preparation and assembling of the [DEVICE] enteral feed solution, after touching her (Staff B) own face and clothing and after the administration of eye drops to Resident #11. During interview … | 2020-09-01 |
| 84 | 84 | EDGEWOOD CENTRE (THE) | 305022 | 928 SOUTH STREET | PORTSMOUTH | NH | 3801 | 2017-11-15 | 278 | B | 0 | 1 | L8GV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility failed to ensure that the MDS (Minimum Data Set) assessments were accurate with the election of the hospice benefit for 2 residents in a survey sample of 23 residents. (Resident identifiers are #4 and #7.) Findings include: Resident #4 Review on 11/14/17 of Resident #4's Significant Change MDS assessment dated [DATE] it was noted that the MDS section entitled J1400 Prognosis-Life expectancy less than 6 months is answered no. The MDS section O100 special treatments and programs in column 2. is answered with k. Hospice. A prognosis of less than 6 months life expectancy is a general prerequisite of acceptance into a hospice program and these two assessment areas should be in agreement. Interview on 11/ 15/17 at approximately 4:30 p.m. Staff B (Registered Nurse) concurred that the prognosis did not support the election of the Hospice benefit, as written. Resident #7 Review on 11/14/17 of Resident #7's Quarterly MDS assessment dated [DATE] revealed that section entitled J1400 Prognosis-Life expectancy less than 6 months was answered no. The MDS section O100 Special Treatments and Programs column 2, line K was checked the resident receiving Hospice services. A prognosis of less than 6 months life expectancy is a requirement of acceptance into a hospice program and these two assessment areas need to be in agreement. Review of Resident #7's medical record revealed that Resident #7 is receiving the hospice benefit. Interview on 11/15/17 at approximately 1:30 p.m. with Staff C (Director Of Nurses/Registered Nurse) confirmed that the prognosis did not support the election of the hospice benefit. | 2020-09-01 |
| 85 | 85 | EDGEWOOD CENTRE (THE) | 305022 | 928 SOUTH STREET | PORTSMOUTH | NH | 3801 | 2017-11-15 | 281 | B | 0 | 1 | L8GV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined that the facility failed to provide parameters for PRN (as needed) pain medications for 8 resident in a standard survey sample of 24 residents. (Resident identifiers are #2, #6, #8, #9, #11, #12, #17, and #19.) Findings Include: Potter, [NAME] [NAME], and Anne Griffin Perry. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Pages 699 Prescriber must document the diagnosis, condition, or need for use for each medication ordered Page 708 The prescriber often gives specific instructions about when to administer a medication Resident #2 Review of the Medication Administration Record [REDACTED] [MEDICATION NAME] Tablet 400 mg (milligrams). Give 400 mg by mouth every 6 hours as needed for pain/fever. Tylenol tablet 325 mg. Give 2 tablets by mouth every 4 hours as needed for pain or elevated temperature. Resident #12 Review of the MAR indicated [REDACTED] [MEDICATION NAME] Tablet 325 mg. Give 2 tablets by mouth (PO) every 4 hours as needed for pain/elevated temp. [MEDICATION NAME] Solution 20 mg/ml (milliliters). Give 5 mg PO every 4 hours as needed for pain/dyspnea. Interview on 11/14/17 at approximately 3:00 p.m. with Staff C (Director of Nursing), confirmed that the PRN pain orders were missing indications/parameters for administration. Resident #17 Review 11/15/17 of Resident #17's MAR for (MONTH) (YEAR), revealed that this resident had an order for [REDACTED]. Administer 650 mg. PO q4h (every 4 hours) PRN for pain or elevated temperature, per standing order. Review 11/15/17 of Resident #17's MAR for (MONTH) (YEAR), also reveals that this resident has an order for [REDACTED]. should be administered. Interview on 11/15/17 at approximately 4:40 p.m. with Staff A (Registered Nurse/Resource Nurse) acknowledged that this issue has come to their attention and they are working to make sure all residents have parameters for the administration of pain medications. Resident … | 2020-09-01 |
| 86 | 86 | EDGEWOOD CENTRE (THE) | 305022 | 928 SOUTH STREET | PORTSMOUTH | NH | 3801 | 2017-11-15 | 514 | B | 0 | 1 | L8GV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that residents received the black box warning information for antipsychotic medication prescribed for them for 2 residents in a standard survey sample of 25 residents. (Resident identifiers are #6, and #10.) Findings include: Professional reference: Per FDA US Food and Drug Administration (8/15/13) .FDA is requiring the manufacturers of conventional antipsychotic drugs to add a Boxed Warning and Warning to the drugs ' prescribing information about the risk of mortality in elderly patients treated for [REDACTED]. (See https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm 0.htm accessed 11/27/2017.) Resident #6 Review on 11/13/17 of Resident #6's Medication Administration Record [REDACTED]. If ineffective use [MEDICATION NAME] 25 mg by mouth every 6 hours PRN delusions. The start date on this order was 10/19/17 and the discontinue date was 10/25/17. There was no documented evidence that Resident #6 or Resident #6's POA (Power of Attorney) had received the black box warning information for this medication. Interview on 11/14/17 at approximately 11:00 a.m. with Staff G (Registered Nurse) confirmed that there was no documented evidence that Resident #6 or Resident #6's POA had been given the black box warning information for antipsychotic medications. Resident #10 Review on 11/14/17 of Resident #10's Medication Administration Record [REDACTED]. Start date 5/24/17. There was documented evidence that Resident #10 signed the Psychoactive Drug Administration Consent Form on 5/24/14, but there was no documented evidence that Resident #10 had received the black box warning information for this medication. Interview on 11/14/17 at approximately 11:30 a.m. with Staff F (Unit Manager) confirmed that there was no documented evidence that Resident #10 had been given the black box warning information for antipsychotic medication… | 2020-09-01 |
| 87 | 87 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2017-04-13 | 160 | B | 0 | 1 | K2IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the resident trust fund and interview, it was determined that the facility failed to convey resident funds within 30 days to the individual(s) or probate jurisdiction administering the resident's estates for 5 out of sample residents. (Resident identifiers are #23, #24, #25, #26, and #27.) Findings include: Review of the following accounts revealed the following: Resident #23 had expired on [DATE] with a balance of $18.74 remaining in this resident's account. Probate paperwork for Resident #23 was filed on [DATE]. Resident #24 had expired on [DATE] with a balance of $35.00 remaining in this resident's account. Probate paperwork for Resident #24 has not been filed as of [DATE]. Resident #25 had expired on [DATE] with a balance of $1697.10 remaining in this resident's account. Probate paperwork for Resident #25 has not been filed as of [DATE]. Resident #26 had expired on [DATE] with a balance of $2,129.24 remaining in this resident's account. Probate paperwork for Resident #26 was filed on [DATE]. Resident #27 had expired on [DATE] with a balance of $368.76 remaining in this resident's account. Probate paperwork for Resident #27 was filed on [DATE]. Interview on [DATE] at approximately 11:30 a.m. with Staff A (Business Office Manager) confirmed that probate paperwork wasn't filed in thirty days. | 2020-09-01 |
| 88 | 88 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2017-04-13 | 279 | D | 0 | 1 | K2IK11 | Based on record review and interview, it was determined that the facility failed to develop a coordinated/integrated Plan of Care for 2 of 2 residents receiving Hospice services in a survey sample of 17 residents. (Resident identifier's are #12 and #16.) Findings include: Review on 4/13/17 of Resident #12 and Resident #16 medical record revealed that Resident's #12 and #16 were receiving Hospice services. Record review revealed that the facility failed to show a coordinated Plan of Care as evidenced by not including or documenting the Hospice goals and interventions in order to ensure that facility staff is providing consistent care when Hospice staff are not scheduled in the facility. Resident #16 Review on 4/13/17 of Resident #16's hospice care plan with a start date of 8/25/16 revealed the following disciplines visiting Resident #16: skilled nurses, Medical social worker, Nurses aide, and a chaplain. Review on 4/13/17 of Resident #16's facility's care plan revealed a hospice care plan with a start date of 8/25/16. Under the interventions section it revealed the hospice nursing assistant to compliment ADL (activities of daily living) care, provide comfort and companionship .Provide resident with food & fluids as desired for physical & emotional comfort Hospice nursing along with Center Staff Nurses to assess and manage symptoms, comfort/pain, bowel function. Interview on 4/13/17 at 1:00 p.m. with Staff B (Director of Nurses) after review of Resident's #16's current facility and the hospice care plans Staff B revealed that the care plans did not include the frequency of services provided by the hospice agency for the skilled nurse, licensed nursing aide, social worker, and spiritual. Staff B confirmed that the facility's was unaware of all the services that the hospice was providing via the care plan. Staff B also confirmed that the facility's and the hospice care plans did not coordinated/integrated with each other. Resident #12 Review on 4/13/17 of Resident #12's care plan revealed a hospice care plan with a s… | 2020-09-01 |
| 89 | 89 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2017-04-13 | 280 | D | 0 | 1 | K2IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined that the facility failed to update a care plan for 1 residents in a standard survey sample of 17 residents. (Resident identifier is #1.) Findings include: Resident #1 Review on 4/11/17 of Resident #1's Medication Administration Record [REDACTED]. Review on 4/11/17 of Resident #1's physician orders [REDACTED]. Further review of the medical record revealed a physician order [REDACTED].#1's DPOA and obtain permission for the DNR. Review on 4/11/17 of Resident #1's care plan completed on 3/31/2017 with a focus area of Advance directives is as follows: Resident has an established advanced directive that has been invoked, code status is full code. with a revision on 4/28/16. Interview on 4/11/17 at 3:30 p.m. with Staff B (Director of Nurses) confirmed that Resident #1's Advance directives care plans had not been updated since Resident #1's full code has been changed on 4/4/17 to a DNR. Staff B found the new order written on 4/4/17 to be a DNR. | 2020-09-01 |
| 90 | 90 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2017-04-13 | 364 | E | 0 | 1 | K2IK11 | Based on observation, interview, and resident council review, it was determined that the facility failed to assure that food is palatable, attractive and at the proper temperature to ensure resident's satisfaction. (Resident identifier is Resident #5.) Findings include: Observations on 4/13/17 at 7:37 a.m. of food service performed identified that the holding temperature on the steam table of the oatmeal prior to being served was 178 degrees Fahrenheit. The holding temperature of the scrambled eggs on the steam table prior to being served was 168 degrees Fahrenheit. A test tray was prepared at 7:45 a.m. and left the kitchen at 7:46 a.m. for the B Unit. The last tray was served to a resident at 7:59 a.m. and the test tray was pulled from the tray cart. At that time the oatmeal temperature of 149 degrees Fahrenheit and the scramble eggs had a temperature of 162 degrees Fahrenheit. The hot water for tea had a temperature of of 153 degrees Fahrenheit. The orange juice on the test tray had a temperature of 73 degrees Fahrenheit and did not maintain a cold temperature below 41 degrees Fahrenheit that was palatable, attractive and at the proper temperature to ensure resident's satisfaction. Interview on 4/13/17 at 1:15 p.m. with Resident #5 revealed that Resident #5 indicated the food is always the same chicken or fish, and is always cold. Resident #5 confirmed that for an alternate meal choices you can get peanut butter & jelly or grilled cheese as an alternate when you don't like the main menu, then stated their preference to have soup more. Interview on 4/12/17 at 10:00 a.m. with the resident council members revealed that several of the residents in attendance felt that the meals that they receive are often cold, especially on Unit B. When questioned, the residents responded that breakfast is frequently not hot enough. The residents did state that the staff would heat up a meal, but that it is not the same. Many residents stated that Unit A was always served before Unit B and that the kitchen frequently ran out of th… | 2020-09-01 |
| 91 | 91 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2017-04-13 | 441 | D | 0 | 1 | K2IK11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, it was determined that the facility failed to follow infection control practice while providing care to 1 out of sample resident with a peripherally inserted central catheter in a survey sample of 17 residents. (Resident identifier is out of sample #19.) Findings include: Record review on 4/13/17 of the Medication Administration Record (MAR) for Resident #19 revealed an order for [REDACTED]. Observation on 4/13/17 with Staff C (Registered Nurse) at approximately 10:15 a.m. showed Staff C prepared the physician ordered medication Azireonam 1 GM (gram) intravenously (IV) for Resident #19. Staff C prepared the IV solution and intravenous tubing to attach to the IV pump. The double lumen Peripherally Inserted Central Catheter (PICC) was located on Resident #19's left upper chest. Staff C donned gloves and proceeded to cleanse each of the individual dual lumen ports with a separate alcohol wipe. One port was cleansed with a alcohol wipe and discarded on Resident #19's over the bed table. The second port was cleansed with a alcohol wipe and this was discarded on Resident #19's over the bed table. This over the bed table had multiple books and personal items of Resident #19. Further observation revealed as Staff C was connecting the IV tubing to the IV pump Staff C encountered air in the IV tubing. Staff C proceeded to disconnect the tubing from the pump and prime the tubing more to eliminate the air in the tubing. Staff C proceeded to attach the IV tubing to the pump. Staff C with donned gloves still in place proceeded to cleanse one of the PICC ports with one of the discarded used alcohol wipes. After cleansing Staff C discarded this alcohol wipe on the resident's over the bed table and picked up the second discarded used alcohol wipe and proceeded to cleanse the other PICC port with this used alcohol wipe and again discarded this wipe on the resident's over the bed table. Interview on 4/13/17 wit… | 2020-09-01 |
| 92 | 92 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2017-04-13 | 456 | D | 0 | 1 | K2IK11 | Based on observation, manufacturer's instruction for use and interview, it was determined that the facility failed to follow manufacturer's instructions for dating glucometer testing solutions opened for 2 of 5 medication carts and cleaning of 1 anticoagulation meter. Findings include: Observation on 4/11/17 at approximately 9:30 a.m. of the opened glucometer quality control high and low testing solutions on 2 of the 2 A wing unit medication carts, it was revealed that the high and low quality control testing solutions were not dated with either the open date of the solutions or the discard date of the solutions. Manufacturer's instructions dated 06/01/96, state under section titled, Storage and handling the following directions, Do not use if the expiration date has passed. Discard any unused control solution 90 days after first opening or after the expiration date. Interview on 4/11/17 at approximately 9:45 a.m. with Staff B (Director of Nursing/Registered Nurse) who confirmed the control solutions were not dated when they were opened. Observation on 4/11/17 at approximately 9:35 a.m. of the anticoagulation meter on the A wing, revealed a dried brown substance on the right hand side of the meter and a 1 inch by 2 inch piece of clear plastic tape with the writing in blue pen, Unit A on the back of the meter. Interview on 4/11/17 at approximately 9:37 a.m. with Staff B regarding the cleaning of this meter, Staff B stated that the meter is cleaned with the bleach wipes after each use. Staff B agreed that the meter did have a dried brown substance on the right hand side of the meter. Staff B also agreed that the tape on the back of the meter precluded the machine from being cleaned effectively to ensure no transmission of infection could occur. | 2020-09-01 |
| 93 | 93 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2017-04-13 | 516 | D | 0 | 1 | K2IK11 | Based on observation and interview it was revealed that the facility failed to safeguard resident information on 1 of 7 medication cart computers. Findings include: Observation on 4/12/17 at approximately 11:30 a.m. revealed an unattended medication cart on Unit [NAME] The medication cart had a computer on top of it. The screen on the computer was still open with pictures of residents, as well as their medication information. This information was easily accessible to anyone. After approximately 5 minutes, Staff C (Licensed Practical Nurse) came over to the medication cart and stated that she forgot to lock the screen, and locked it. Observation on 4/12/17 at approximately 11:55 a.m. revealed the same medication cart, again unattended, with the computer screen open with resident information. After approximately 3 minutes, Staff C came over to the medication cart and asked if she had forgotten to lock it again. Staff C stated that she would just log out and that would ensure that it would be locked. Interview on 4/13/17 at approximately 2:00 p.m. with Staff B (Director of Nursing) confirmed that the medication cart computer screens should always be locked when not in attendance. | 2020-09-01 |
| 94 | 94 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2019-07-11 | 580 | D | 0 | 1 | NENQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, it was determined the facility failed to notify the resident's physician and/or representative when treatment has been discontinued or delayed for 2 residents in a final sample of 20 residents (Resident identifiers are #22 and #183). Findings include: Resident #183 Interview on 7/8/19 at 12:38 p.m. with Resident #183 revealed the resident was admitted on [DATE] and had not received all of their prescribed pain medications and the resident was upset because they were having constant moderate to severe pain. Review on 7/10/19 of Resident #183's Medication Administration Record [REDACTED]. There were notes for the first 10 administration times that indicated the medication was not given because it was not available from the pharmacy. There was no documentation of notification of the missed administration to Resident #182's physician. Resident #183 received [MEDICATION NAME] starting on 7/9/19. Interview on 7/10/19 at 12:00 p.m. with Staff A (Director of Nursing) confirmed there was no documentation that the physician was notified in the delay of Resident #183 receiving the above medication. Resident #22 Interview on 7/8/19 at approximately 12:10 p.m. with Resident #22's DPOA (Durable Power of Attorney) revealed that the facility had stopped Resident #22's orders for medications, and that they needed to be restarted as Resident #22 had some health issues, in particular acid reflux, without the medications. Resident #22's DPOA stated that they were not aware that the medications were being discontinued and that when they realized it, they asked to have them restarted. Review on 7/10/19 of Resident #22's Physician order [REDACTED]. Review on 7/10/19 of Resident #22's (MONTH) 2019 Medication Administration Record [REDACTED]. Review on 7/11/19 of the facility policy, titled, Communication of Health Status, last reviewed on 3/1/16, revealed that it was the facility's policy to .Advise patient and /or healt… | 2020-09-01 |
| 95 | 95 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2019-07-11 | 658 | D | 0 | 1 | NENQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, it was determined that the facility failed to follow professional standards to ensure that a resident did not receive 4 times the dose ordered for a medication used to treat CAD ([MEDICAL CONDITION]) for 1 resident in a final survey sample of 30 residents. (Resident identifier is #43.) Findings include: Professional reference: [NAME] [NAME] Potter and Anne Griffin Perry, Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Observation on 7/9/19 at approximately 7:43 a.m. during medication pass revealed that Staff C (Licensed Practical Nurse) popped a [MEDICATION NAME] 40 mg (milligram) tablet from a medication card into a medicine cup. After popping the medication into the cup, Staff C put the medication card back into the medication cart drawer. Review on 7/9/19 at approximately 7:43 a.m. of Resident #43's Medication Administration Record [REDACTED]. The review also revealed that Resident #43 did not have an order for [REDACTED].>Interview on 7/9/19 at approximately 7:50 a.m. with Staff C revealed that they said that they had taken the [MEDICATION NAME] 40 mg from another resident's medication card in error. Observation on 7/9/19 at approximately 7:50 a.m. of Resident #43's medication cup revealed that Staff C, after being interviewed, reached into the medication cup and removed the [MEDICATION NAME] tablet and discarded it. Staff C then went back into the medication cart drawer and removed Resident #43's [MEDICATION NAME] 10 mg from the correct medication card and popped it into the medication cup. Interview on 7/9/19 at approximately 9:20 a.m. … | 2020-09-01 |
| 96 | 96 | ROCHESTER MANOR | 305024 | 40 WHITEHALL ROAD | ROCHESTER | NH | 3867 | 2018-10-16 | 641 | B | 1 | 0 | 4FNO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review, and interview, it was determined that the facility failed to accurately reflect the resident's status using the Resident Assessment Instrument (RAI) for 2 residents reviewed with wander alarms in a survey sample of 6 residents. (Resident identifiers are #4 and #5.) Findings include: Resident #4 Record review on 10/16/18 at approximately 11:30 a.m. revealed Resident #4 had a physician order [REDACTED]. Review on 10/16/18 of Resident #4's Minimum Data Set (MDS) Annual assessment on 8/17/18 and Quarterly assessments on 5/18/18, 3/6/18, and 12/14/17 revealed in Section P (Restraints and Alarms) that wander/elopement alarms were not used. Interview on 10/16/18 at approximately 11:45 a.m. with Staff B (Director of Nursing) confirmed the above findings and revealed that the MDS should have reflected that wander/elopement alarms were used daily. Observation on 10/16/18 at approximately 1:00 p.m. revealed that Resident #4 had a wander alarm on their right ankle. Review of the medical record of Resident #5 on 10/16/18 at approximately 10:45 am revealed an order dated 9/14/18 for placement of a Wander-Guard wander/elopment device (a device used to protect residents from elopment/leaving the building unattended) on the ankle of Resident #5 due to poor safety awareness. Interview with Staff B, (DON) on 10/16/18 at approximately 11:00 am revealed that the Wander-Guard security device was placed on Resident #5's ankle on 9/14/18. Further record review on 10/16/18 at 11:15 am revealed that the last quarterly MDS (Minimum Data Set)comprehensive assessment was performed on 9/18/18. The MDS dated [DATE] under Section P (Restraints and Alarms); Item E: (Wandering/elopment Alarm): stated that there was no wandering/elopment alarm in use for Resident #5. An interview on 10/16/18 with Staff B at approximately 11:30 am revealed that the MDS assessment was not coded correctly and should have reflected that Resident #5 was wearin… | 2020-09-01 |
| 97 | 97 | MAPLE LEAF HEALTH CARE CENTER | 305030 | 198 PEARL STREET | MANCHESTER | NH | 3104 | 2018-03-16 | 880 | B | 0 | 1 | OZ7411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to implement an infection prevention practice to prevent the potential transmission of influenza for 1 out of 2 residents who received nasal swabs for influenza during the standard survey. (Resident identifier is #61.) Findings include: Observation on 3/14/18 at approximately 10:00 a.m. of Resident #61 revealed that Resident #61 was short of breath and had frequent coughing. Review on 3/15/18 of Resident #61's nurses notes, dated 3/14/18, revealed that Resident #61 .complained of 'not feeling well' .non prod (non productive) cough .had a temperature of 100.2. Review on 3/15/18 of Resident #61's Physician Telephone Orders, dated 3/14/18, revealed an order for [REDACTED].>Review on 3/15/18 of Resident #61's nurses notes, dated 3/14/18, revealed a note which documented .Flu Swab A & B collected. Observation on 3/15/18 at approximately 3:00 p.m. of Resident #61's room revealed that there was nothing indicating that Resident #61 was placed on precautions. Interview on 3/15/18 at approximately 3:00 p.m. with Staff A (Registered Nurse, Unit Manager) confirmed that Resident #61 had not been placed on precautions. Review on 3/16/18 of the facility's Infection Control Manual, dated 12-98, revised 10-1-08, revealed that In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a patient known or suspected to be infected with microorganisms transmitted by droplets .that can be generated by the patient during coughing, sneezing, talking, or the performance of procedures . Interview on 3/16/18 at approximately 12:00 p.m. with Staff B (Licensed Practical Nurse, Infection Control) confirmed that Resident #61 should have been placed on Droplet Precautions when Resident #61 was suspected of having influenza. | 2020-09-01 |
| 98 | 98 | MAPLE LEAF HEALTH CARE CENTER | 305030 | 198 PEARL STREET | MANCHESTER | NH | 3104 | 2019-05-03 | 658 | D | 0 | 1 | 2O0511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, review of physicians orders, manufacturers instructions and it was determined that the facility failed to follow physicians orders for 1 out of 4 residents observed during medication administration and 1 of 3 residents reviewed for pain in a final sample of 23. (Resident identifier is #17 and #57.) Findings include: Potter, [NAME] [NAME], and Anne Griffin Perry. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336-Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physicians' orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Resident #57 Observation on 5/1/19 at approximately 8:20 a.m. with Staff A, Licensed Practical Nurse (LPN) during medication pass with Resident #57 revealed that Resident #57 had a [MEDICATION NAME] adhered to the lower back dated 4/30. Review on 5/1/19 of Resident #57's physicians orders revealed the following: (pronoun omitted) [MEDICATION NAME] 4% adhesive patch. Apply 1 patch topically to low back (remove after 8 hours). Apply 8 a.m. and remove 4 p.m. Interview on 5/1/19 at approximately 8:25 a.m. with Staff A revealed that the [MEDICATION NAME] should have been removed at 4:00 p.m. on 4/30. Review on 5/2/19 of the manufacturer's instructions for (pronoun omitted) [MEDICATION NAME] 4% adhesive patch revealed: . Directions . Remove patch from the skin at most 8-hour application Resident #17 Review on 5/3/19 of Resident #17's physician orders [REDACTED]. Review on 5/3/19 of Resident #17's Medication Administration Record [REDACTED]. Interview on 5/3/19 at 12:48 p.m. with Staff B (Unit Manager) confirmed the it was not documented that Resident #17's patch was removed on 4/10/19 and 4/24/19. | 2020-09-01 |
| 99 | 99 | MAPLE LEAF HEALTH CARE CENTER | 305030 | 198 PEARL STREET | MANCHESTER | NH | 3104 | 2019-05-03 | 880 | E | 0 | 1 | 2O0511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed establish and follow written policies and procedures for standard and transmission-based precautions and when and how isolations should be used for a resident for 4 of 4 residents observed on precautions. (Resident identifiers are #18, #53, #99, #205.) Findings include: Resident #18 Observation on 4/30/19 at 9:40 a.m. revealed a precaution sign outside of room [ROOM NUMBER]. Interview on 4/30/19 at approximately 9:45 a.m. with Staff B (Unit Manager) revealed that Resident #18 in room [ROOM NUMBER] was on precautions for [MEDICAL CONDITION]. Observation on 4/30/19 at 10:20 a.m. revealed a staff changing Resident #18's bed with gown hanging off of the staff's shoulders. Observation on 4/30/19 at 10:50 a.m. revealed housekeeping cleaning room and mopping floor around Resident #18's bed not wearing a gown or gloves. Observation on 4/30/19 at 1:50 p.m. revealed two Licensed Nursing Assistants (LNA) in Resident #18's room not wearing a gown or gloves. Staff C (LNA) removed the garbage bag from the trash container that contained used gowns and took it down the hallway to the soiled utility room. Observation on 5/1/19 at 8:30 a.m. revealed staff went to deliver food to Resident #18. Staff put food on top of the precaution cart in the hallway and put on a mask and brought the tray into Resident #18 who was in bed. Review on 5/3/19 of Resident #18's care plan dated 4/29/19 revealed that the resident is on contact precautions. Review on 5/3/19 of Resident #18's physician orders [REDACTED]. Interview 5/3/19 at 12:50 p.m. with Staff D (Infection Preventionist) revealed that for some residents on contact precautions, staff only need wear gloves and gowns during direct care, that residents can attend activities and dining and some residents would need to stay in their room and require staff to wear gloves and gowns whenever they enter the resident's room. Staff D … | 2020-09-01 |
| 100 | 100 | COURVILLE AT NASHUA | 305037 | 22 HUNT STREET | NASHUA | NH | 3060 | 2017-03-02 | 225 | D | 0 | 1 | O8XB11 | Based on resident group interview, and review of facility generated reports, it was determined that the facility failed to report misappropriation of property to the state agency as required by regulation. Findings include: Interview on 3/1/17 at 10:30 a.m. with the resident group, revealed residents had complaints regarding items going missing such as jewelry, and money. Review of the grievance log from 5/20/16 to 3/2/17 revealed that there were no reports of jewelry or money missing. There was Resident #21's cell phone that was recorded as missing on the grievance log on 2/12/17. Interview on 3/2/17 at approximately 9:30 a.m. with Staff A (Social Worker) confirmed that missing items on the grievance log had not been reported to the state. Interview on 3/2/17 at approximately 10:45 a.m. Staff A stated, We ask the resident if they want us to call the police department. If they do not want us to call the police, then we don't. If we don't call the police then we don't notify the State(of NH). Staff A further stated: If the resident is alert and oriented and making their own decisions we do not continue to search if the resident says they misplaced it (the object). | 2020-09-01 |
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CREATE TABLE [cms_NH] ( [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 );