cms_PR
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 731 | 731 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 465 | E | GXXQ11 | Based on tests and observations made during the physical environment survey with the facility's Safety Officer (employee #1), it was determined that the facility failed to ensure a safe, functional, sanitary and comfortable environment related to the cover of the air conditioner held in place by tape and no directional vents in resident's room #108, extractor fans in resident's bathrooms #103 and #108 are very loud, broken window shades in resident's rooms #102 and #103, a grab bar is needed behind the toilet at resident's room #109 and an air extractor is needed in the closet with the kitchen's grease trap which could affect six out of fourteen residents (sample selection residents #1, #4 and random sample residents #2, #3, #5, #6). Findings include: 1. The air conditioner cover in resident's room #108 was observed on 6/7/10 at 8:35 am with tape holding it in place. Also, the vent panel used to adjust the air flow was missing which will not allow the resident (random sample resident #5) in this room to direct the air as she desires. 2. The extractor fans at resident's bathrooms #103 and #108 (with resident #1 and random sample residents #3 and #5) were found very noisy on 6/7/10 at 8:30 am and 9:10 am. This does not allow a peaceful environment for residents when they use these bathrooms. 3. The window shades at resident's rooms #102 and #103 (with resident #1 and random sample residents #2 and #3) were found in need of repair as observed on 6/7/10 at 8:15 am and 8:30 am. The condition of the shades will not block out all of the light from the outside if the residents desire. 4. A grab bar is needed behind the toilet at resident's room #109 (with resident #4 and random sample resident #6) as observed on 6/7/10 at 9:10 am. 5. An air extractor is needed in the closet with the kitchen's grease trap as found on 6/8/10 at 10:00 am. | 2014-01-01 | ||
| 730 | 730 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 441 | F | GXXQ11 | Based on observations made during an ulcer care procedure for resident #1 with two licensed practical nurse (LPN) (employee #8 and #9), it was determined that the facility failed to promote sanitary and safe care through its infection control program as evidenced by improper hand washing techniques after touching contaminated material and placing on clean gloves which could affect one out of one admitted residents with ulcer care (sample selection residents #1). Findings include: Observations were made on 6/7/10 from 12:12 pm till 12:24 pm of a grade II sacral ulcer wound care procedure for sample selection resident #1 by a licensed practical nurse (LPN) (employee #8) and LPN (employee #9). LPN #9 removed bandages from the ulcer using clean gloves and after removing the bandages she discarded the gloves and put on a new pair of clean gloves by putting her hands in a box of clean gloves without washing her hands or sanitizer them and then she prepared the items that LPN #8 was going to use to care for the ulcer. The facility failed to follow standards of nursing practice related to hand washing or hand sanitizing during ulcer care procedures by inserting hands into a box of clean gloves without washing or sanitizing them after touching dirty and contaminated bandages. | 2014-01-01 | ||
| 729 | 729 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 428 | D | GXXQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of eight resident's records and interview, it was determined that the facility failed to ensure that a drug regimen review is performed at the moment of admission or more frequently than once a month when the resident's condition, medications or refusal of medications dictates for one out of eight residents (resident #3). Findings include: 1. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed on 6/8/10 at 9:00 am due to her refusal to take prescribed medications and she said that she has had bad reactions with certain medications such as Cipro, Ultracet and Chromagen Forte. She stated that these medications give her diarrhea and make her dizzy and if she has diarrhea and is dizzy she can not perform her physical therapy exercises. She also stated that she is not opposed to taken other medications, just as long as they do not give her diarrhea or make her dizzy because her main goal is to receive all of the programed therapy sessions possible before she is discharged . The resident's record was reviewed on 6/7/10 at 3:00 pm and on 6/8/10 at 9:30 am and provided evidence that she was ordered Cipro 500 mgs, tablet every twelve hours, orally for seven days which was started on 6/4/10, she was ordered Ultracet one or two tablets every four hours, orally which was started on 6/4/10, she was ordered Chromagen Forte every twelve hours for seven days which was started on 6/6/10 and Toradol 30 mgs as needed, every six hours, intramuscularly which was started on 6/4/10. The resident's Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Of ten intramuscular Toradol injections offered to the resident from 6/4/10 through 6/8/10 the resident refused four and accepted six according with the MAR. The MAR indicated [REDACTED]. The resident's record provided evidence on 6/8/10 at 9:45 am that the physician ordered Peptobismol 30 cc sta… | 2014-01-01 | ||
| 728 | 728 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 371 | F | GXXQ11 | Based on the kitchen observational tour with the clinical dietitian (employee #3), review of policies/procedures, food code guidelines, registration temperatures and interview, it was determined that the facility failed to use proper infection control techniques during cold milk temperature registration, maintain and store food in a safe and sanitary manner, defrosting meat, expired bread and failure to completely cover watermelon with plastic, the kitchen is in need of an ice maker that works properly, the ceiling acoustic tiles are not washable, improper procedures used at the three compartment sink and no test strip registration and the dry food storage room is not maintaining proper relative humidity levels and the floor has peeling paint which could affect fourteen out of fourteen admitted residents (sample selection residents #1 through #7 and random sample residents #1 through #7). Findings include: 1. During the kitchen observational tour performed with the clinical dietitian (employee #2) on 6/7/10 from 10:45 am till 12:15 pm, kitchen employee #11 was observed recording temperatures of the lunch time food with a thermometer. She had an alcohol pad that she used to wipe the thermometer after she removed the thermometer from the food trays to obtain the temperatures. When kitchen employee #11 went to the refrigerator to take the temperature of the pre-served milk (in small plastic cups with lids) she introduced the thermometer into the milk and recorded the temperature and left the cup in the refrigerator available for residents. The facility failed to ensure that personnel follow established policies and procedures related with the removal of the milk after using it to measure the temperature to avoid possible cross contamination and flavor changes. 2. The three compartment sink was observed on 6/7/10 at 11:20 am during the kitchen observational tour. The first compartment was observed with water and soap to wash pots, pans and utensils, the second compartment is used to rinse and the third compartment is… | 2014-01-01 | ||
| 727 | 727 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 366 | F | GXXQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of resident's diet cards, observational tour of the kitchen with the clinical dietitian (employee #3) and review of policies and procedures, it was determined that the facility failed to ensure that residents who refuse served food at the facility receive substitutes offered of similar nutritive value related to two out of two residents with lactose intolerance who did not receive lactose free products (sample selection residents #3 and #4). Findings include: 1. During the initial observational tour of the facility on 6/7/10 from 8:00 am till 9:20 am with the nursing supervisor (employee #5), resident #3 (admitted on [DATE]) was interviewed on 6/7/10 at 8:40 am and resident #4 (admitted on [DATE]) was interviewed on 6/7/10 at 9:00 am and they stated that they are lactose intolerant and are avoiding the dairy products served at the facility because they are not lactose free. The following was determined related to residents #3 and #4 and the facility's failure to provide food substitutes: a. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed during the observational tour on 6/7/10 at 8:40 am related to food that she had on her night table and she stated that she is lactose intolerant and she brought the food with her to ensure that she has something to eat that will not make her sick, in the event that the facility does not have lactose free products. The resident stated on 6/7/10 at 8:40 am that she prepared her own oatmeal with lactose free milk since her admission because the facility did not send her lactose free products and they send her meals with food that she can not eat (flour, wheat, gluten, yeast, cheese and butter). The facility failed to ensure that the resident is given a diet based on her food needs and foods that can cause allergies [REDACTED]. b. Resident #4 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES RED… | 2014-01-01 | ||
| 726 | 726 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 363 | F | GXXQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of resident's diet cards, observational of the food line assembly with the clinical dietitian (employee #3) and review of policies and procedures, it was determined that the facility failed to ensure that the food scale is present during resident's food tray assembly, the emergency menus stock was not complete and lactose free products are not maintained in stock at all times which could affect fourteen out of fourteen admitted residents (sample selection residents #1 through #7 and random sample residents #1 through #7). Findings include: 1. During observations of the food line assembly with the clinical dietitian (employee #3) on 6/7/10 from 10:45 am till 12:15 pm, it was determined that the food cooker (employee #2) was serving resident's food for the skilled nursing facility and did not have a food scale available at the food line to ensure that recommended amounts of food as ordered by the dietitian and physician are served. Resident's diet cards include specific amounts of protein for each resident (for example 3 ounces), but employee #2 was placing chicken (the protein) in the resident's food trays for the amount that she thought was correct. When this was brought to her attention a food scale was given to her and she weighed the chicken of the first resident meal, but returned the scale and did not use it for the other thirteen residents. The facility failed to ensure that kitchen personnel following established policies and procedures related to weighing food when residents are ordered specific amounts of food in accordance with their health status. 2. Review of the emergency menus with the administrative dietitian (employee #4) on 6/8/10 at 11:00 am provided evidence that the emergency menus will provide nutritive meals for three days with food that requires minimum amount of preparation time. However, based on food requisition orders it was found that a large portion of the food for this menus was ordered and wa… | 2014-01-01 | ||
| 725 | 725 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 309 | D | GXXQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and eight records reviewed with nursing personnel responsible for residents' care, it was determined that the facility failed to provide necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being for one out of eight residents related with the residents' refusal to take certain medications that made her feel bad based on past experience and actual experience at the facility regarding intestinal discomfort (resident #3). Findings include: 1. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed on 6/8/10 at 9:00 am due to her refusal to take prescribed medications and she said that she has had bad reactions with certain medications such as Cipro, [MEDICATION NAME] and [MEDICATION NAME] Forte. She stated that these medications give her diarrhea and make her dizzy and if she has diarrhea and is dizzy she can not perform her physical therapy exercises. She also stated that she is not opposed to taken other medications, just as long as they do not give her diarrhea because her main goal is to receive all of the programed therapy sessions possible before she is discharged . The resident's record was reviewed on 6/7/10 at 3:00 pm and on 6/8/10 at 9:30 am and provided evidence that she was [MEDICATION NAME] mgs, tablet every twelve hours, orally for seven days which was started on 6/4/10, she was ordered [MEDICATION NAME] one or two tablets every four hours, orally which was started on 6/4/10, she was ordered [MEDICATION NAME] Forte every twelve hours for seven days which was started on 6/6/10 and [MEDICATION NAME] 30 mgs as needed, every six hours, intramuscularly which was started on 6/4/10. The resident's Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Of ten intramuscular [MEDICATION NAME] injections offered to the resident from 6/4/10 through 6/8… | 2014-01-01 | ||
| 724 | 724 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 281 | F | GXXQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed during the observational tour on 6/7/10 at 8:40 am related to food that she had on her night table and she stated that she is lactose intolerant and she brought the food with her to ensure that she has something to eat that will not make her sick and in the event that the facility does not have lactose free products. The resident's record was reviewed on 6/7/10 at 3:00 pm and provided evidence that the pre-admission & admission order sheet from 6/4/10 identified lactose under allergies and under diet "regular". An initial nutritional assessment was not found in the resident's record. A nutritional assessment was found with a date of 6/7/10 at 8:00 am that identified the resident as lactose intolerant. The resident stated on 6/7/10 at 8:40 am that she prepared her own oatmeal with lactose free milk since her admission because the facility did not send her lactose free products and they send her meals with food that she can not eat (flour, wheat, gluten, yeast, cheese and butter). The facility failed to ensure that the resident is given a diet based on her food needs and foods that can cause allergies are avoided. The facility failed to ensure that residents' with lactose intolerance identified during the pre-admission leads to appropriate lactose free and allergy free foods for this resident (please cross reference tag F363 #3). 4. Resident #4 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed during the observational tour on 6/7/10 at 9:00 am related to the food at the facility and she stated that she is lactose intolerant and some of the food that the facility is providing her with is not lactose free and she doesn't eat it. The facility failed to ensure that the resident is given a diet based on her food needs and foods that can cause allergies are avoid… | 2014-01-01 | ||
| 723 | 723 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 279 | E | GXXQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on eight resident's records reviewed, observations and interviews, it was determined that the facility failed to develop a comprehensive plan of care for two out of eight residents in the sample selection (Residents #3 and #4) related to lactose intolerance immediately when admitted to the facility. Findings include 1. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed during the observational tour on 6/7/10 at 8:40 am related to food that she had on her night table and she stated that she is lactose intolerant and she brought the food with her to ensure that she has something to eat that will not make her sick and in the event that the facility does not have lactose free products. The resident's record was reviewed on 6/7/10 at 3:00 pm and provided evidence that the pre-admission & admission order sheet from 6/4/10 identified lactose under allergies and under diet "regular". An initial nutritional assessment was not found in the resident's record. A nutritional assessment was found with a date of 6/7/10 at 8:00 am that identified the resident as lactose intolerant. The resident stated on 6/7/10 at 8:40 am that she prepared her own oatmeal with lactose free milk since her admission because the facility did not send her lactose free products and they send her meals with food that she can not eat (flour, wheat, gluten, yeast, cheese and butter). The resident was admitted on [DATE] and since her admission she was eating her own lactose free food until 6/8/10. The facility failed to ensure that a plan of care related to the resident's lactose intolerance was developed as soon as possible to ensure that the resident is given a diet based on her food needs and foods that can cause allergies are avoided. 2. Resident #4 is a female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed during the observational tour on 6/7/10 at 9:00 am relate… | 2014-01-01 | ||
| 722 | 722 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 250 | D | GXXQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on eight resident's records reviewed, interviews and observations, it was determined that the facility failed to ensure that medically-related social services assess residents' needs (refusal to take prescribed medications) related to taken appropriate medications to improve their health status for one out of eight residents (residents #3). Findings include: 1. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed on 6/8/10 at 9:00 am due to her refusal to take prescribed medications and she said that she has had bad reactions with certain medications such as Cipro, Ultracet and Chromagen Forte. She stated that these medications give her diarrhea and makes her dizzy if she has this she can not perform her physical therapy exercises. She also stated that she is not opposed to taken other medications, just as long as they do not give her these side affects because her main goal is to receive all of the programed therapy sessions possible before she is discharged . The resident's record was reviewed on 6/7/10 at 3:00 pm and on 6/8/10 at 9:30 am and provided evidence that she was ordered Cipro 500 mgs, tablet every twelve hours, orally for seven days which was started on 6/4/10, she was ordered Ultracet one or two tablets every four hours, orally which was started on 6/4/10, she was ordered Chromagen Forte every twelve hours for seven days which was started on 6/6/10 and Toradol 30 mgs as needed, every six hours, intramuscularly which was started on 6/4/10. The resident's medication administration record (MAR) was reviewed on 6/8/10 at 9:40 am and provided evidence that the resident has refused Cipro and Ultracet since its inception. Of ten intramuscular Toradol injections offered to the resident from 6/4/10 through 6/8/10 the resident refused four and accepted six according with the MAR. The MAR also provided evidence that the resident accepted the first dose of Chromag… | 2014-01-01 | ||
| 721 | 721 | CENTRO MEDICO WILMA N VAZQUEZ SNF | 405025 | ROAD 2 KM 39 5 BO ALGARROBO | VEGA BAJA | PR | 693 | 2010-06-08 | 154 | D | GXXQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on eight clinical records reviewed and resident interview, it was determined that the facility failed to ensure that one out of eight residents is fully informed of their total health status and it is transmitted to the resident appropriately related to the residents' refusal to take prescribed medications (Resident #3). Findings include: 1. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was interviewed on 6/8/10 at 9:00 am due to her refusal to take prescribed medications and she said that she has had bad reactions with certain medications such as Cipro, [MEDICATION NAME] and [MEDICATION NAME] Forte. She stated that these medications give her diarrhea and makes her dizzy if she has this she can not perform her physical therapy exercises. She also stated that she is not opposed to taken other medications, just as long as they do not give her these side affects because her main goal is to receive all of the programed therapy sessions possible before she is discharged . The facility failed to provide evidence of the following: a. No evidence was found that the facility informed health consequences related to the refusal of the prescribed medications or inquired about other medications previously used by the resident that were tolerated by her. b. No evidence was found of on-going efforts on the part of facility to keep the resident informed about different medication options after she refused the medications and documenting and acting upon the resident's expressed concerns. | 2014-01-01 | ||
| 720 | 720 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 501 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident's records reviewed, interviews and medication reconciliation, it was determined that the facility failed to implement physician resident policies/procedures in the facility related to countersignatures of physician orders [REDACTED].#2, #4, #6, #7 and random sample residents #2 and #10). Findings include: 1. Resident's records reviewed provided evidence that the medical orders were not countersigned by the primary physician in charge of the resident's care. The orders were placed by medical licensed interns, however according with facility policies/procedures, the primary physician has up to 72 hours to countersign the orders. The following was found for these resident's related to the dates of the intern's orders and lack of the countersignatures by the primary physician: a. Resident #2 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/19/10 at 10:30 am and provided evidence that on 2/8/10 at 12:50 pm the primary physician did not countersign the intern orders within 72 hours. b. Resident #4 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/18/10 at 3:30 pm and provided evidence that on 1/22/10 at 9:40 am the primary physician did not countersign the intern orders within 72 hours. c. Resident #7 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/18/10 at 3:30 pm and provided evidence that for the following dates the primary physician did not countersign the intern orders within 72 hours: date/time-1/22/10 at 10:45 am and 11:30 am, 2/14/10 at 7:35 am and 2/16/10 at 3:00 pm. d. Random sample selection resident #2 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/18/10 at 2:45 pm and provided evidence that on 2/8/10 at 12:30 pm (admission orders [REDA… | 2014-02-01 | ||
| 719 | 719 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 467 | D | OWRV11 | Based on observations made during the physical environment tour and interview, it was determined that the facility failed to ensure that one resident room out of thirteen (room #101) has adequate outside ventilation which affected one out of twenty-five admitted residents (random sample resident #14). Findings include: Thirteen resident's sleeping room windows were observed on 2/17/10 from 8:30 am till 11:30 am and provided evidence that the window in room #101 does not communicate to the outside. The windows in this room opens into the physical therapy department on the ground level of this skilled nursing facility. On 2/17/10 at 8:30 am no residents were found in room #101, however during interview with random sample selection resident #14 on 2/17/10 at 10:50 am provided evidence that the resident was moved from room #101 to room #112 at 8:20 am on 2/17/10. The sun light, night and rain viewed from a window helps keep residents oriented to the time of day, helps their sense of well being and is important for their circadian cycle. | 2014-02-01 | ||
| 718 | 718 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 465 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on tests and observations made during the physical environment survey with the Physical Plant Manager and interview, it was determined that the facility failed to ensure a safe, functional, sanitary and comfortable environment related to sleeping room windows that open to wide, rubber wall/floor molding detached in rooms, the air extractor does not work in the maintenance closet and dirty linen closet, emergency exit door "A" did not have a functional work alarm, resident's rooms are not maintained properly and the facility does not have a self dispensing ice machine to facilitate resident's and family use which could affect twenty-five out of twenty-five residents (sample selection residents #1 through #9 and random sample residents #1 through #16). Findings include: 1. Thirteen resident's sleeping room windows were tested on [DATE] from 8:30 am till 10:45 am and provided evidence that the window in resident's room #104 did not have a handle to open or close it and the window in resident's room #105 could be opened wide. Rooms are located at the ground level of this skilled nursing facility. Minimum requirements of "Guidelines for Design and Construction of Health Care Facilities" (GDCHCF) section 8.2.2.4(1) states if operable windows are provided in resident's rooms operation of such windows shall be restricted to inhibit possible escape or suicide and the missing handle can allow entry from the outside. 2. The maintenance closet and dirty linen closet located near the nursing station were visited on 2/18/10 at 9:25 am and provided evidence that it does not have a working extractor. 3. Emergency exit door "A" located at the end of the hallway was opened on 2/18/10 at 10:00 am and found to not emit and alarm signal. The physical plant manager (#52) was notified and repaired the sensor on 2/18/10 at 10:30 am, however the facility failed to provide evidence that they are periodically checking these doors to ensure that they work. Also, w… | 2014-02-01 | ||
| 717 | 717 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 463 | E | OWRV11 | Based on observations made during the physical environment tour, it was determined that the facility failed to ensure that two out of twenty-five admitted residents have a way to alert staff that they need help from their beds related to the emergency call button out of the reach of the resident lying in bed for sample selection residents #7 and #9. Findings include: The emergency call system push buttons for residents #7 (room #115) and #9 (room #114) were observed out of reach of these residents while lying in bed on 2/17/10 at 11:00 am and 11:15 am. The emergency call system must be placed near the residents to ensure accessibility in the event of an emergency and residents must be instructed on their use and rounds shall be made to verify their placement close to the residents. | 2014-02-01 | ||
| 716 | 716 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 441 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made related to infection control issues, ulcer care, review of policies and procedures and interview, it was determined that the facility failed to promote sanitary and safe care through its infection control program as evidenced by lack of cleaning of the sphygmomanometer and digital thermometer during use between residents, no policies for the cleaning of wheel chairs at the physical therapy area, no cover over the brush used to clean toilets, mops were placed with the mop head up against the wall, no policies and procedures to operational the housekeeping duties, no material data sheet of chemicals used to clean the area, improper hand cleaning and glove techniques, handling of ice and room environment which could affect twenty-five out of twenty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #16). Findings include: 1. Registered Nurses (#16, #17, #21, #24 and #25) were using a sphygmomanometer and digital thermometer between residents without disinfecting the equipment as observed on 2/17/10 from 8:25 am through 10:45 am. Nursing Supervisor (employee #35) was interviewed on 2/18/10 at 2:54 pm regarding policies and products used to disinfect the equipment and she stated that the facility does not have a specific policy in place to disinfect these items. 2. Housekeeping personnel (employee #33) put on a yellow paper gown and gloves to handle the biohazardous garbage in rooms #113 and #114 as observed on 2/17/10 from 9:30 am through 9:45 am, after the handling of the biohazardous material she started to clean the floor and bathroom of these rooms without changing gloves or taken off the gown. After the process of cleaning the bathrooms she put the toilet brush on the top of the housekeeping cart without covering it. A plastic container labeled lemon quest was observed on the top of the housekeeping cart, no documentation of the percent of the dilution of the pr… | 2014-02-01 | ||
| 715 | 715 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 431 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations of the medication storage area and review of manufacturer's recommendations for medications, it was determined that the facility failed to ensure that drugs and biologicals are stored in a proper manner in the medication refrigerator and appropriate parameters of temperatures for medications in the medication refrigerator, medications were available for residents use that were expired which could affect twenty-five out of twenty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #16). Findings include: 1. During observations made of the medication storage refrigerator in the drug storage room with registered nurse (R.N) (employee #4) on [DATE] at 11:15 am, it was found that the refrigerator had a large accumulation of ice. The temperature registration was reviewed and provided evidence that the recorded temperatures were within the range of 37?F to 39?F for the month of February 2010, and the legend on the bottom of the refrigerator form states that the range is to be between 36?F to 40?F. The manufacturer's recommendations for Lantuss suggests a range of 36?F to 46?F, for Humulin ,[DATE] the range should be below 86?F and as cool as possible, for Humalog 100 the range should be between 36?F to 46?F. The thermometer of the refrigerator was examined and provide the temperature of 20?F and a vial of opened Humalog 100 was found frozen. Also eleven (11) vials of multivitamins in a box were found with a layer of ice on a top of the vials and the manufacturer's recommendations states the range to be between 36?F to 46?F. Also, all multi-use vials had dates opened recorded on a label placed by nursing personnel, however the dates exceeded 28 days as recommended by the manufacturer to ensure that medications are safe for use and failed to be aware that multi-use medications are discarded after 28 days. The facility failed to ensure appropriate parameters for all medications … | 2014-02-01 | ||
| 714 | 714 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 428 | D | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and the review of ten resident's records, it was determined that the facility failed to ensure that a drug regimen review is performed at the moment of admission when the resident's condition or medications dictate for one out of ten residents (resident #8). Findings include: The record review for resident #8 was reviewed on 2/18/10 at 2:30 pm and provided evidence that the resident was admitted on [DATE] with a [DIAGNOSES REDACTED]. No evidence was found of the initial drug regimen review in order to verify if any irregularities are present and to ensure appropriate delivery of medications via gastrostomy. | 2014-02-01 | ||
| 713 | 713 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 425 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made during the medication administration, review of clinical records, medication administration records and policies/procedures and interview, it was determined that the facility failed to provide medications as ordered by the physician and failed to ensure that medications are available to comply with physician orders [REDACTED].#1, #8 and random sample resident #2). Findings include: 1. During the drug pass on 2/18/08 from 8:45 am till 10:45 am, it was found that resident sample #1 was admitted with retroviral medications for his HIV positive condition (Norvir 100 mg, Prezista 600 mg, Raltegravir 150 mg (twice a day), Elvitegravir 150 mg and Truvada 1 tablet daily), the facility does not have these drugs on their formulary. During observations made during the medication administration, Registered Nurse (R.N) #8 administered these drugs that were supplied by the resident to the facility. All the small plastic pouches with the medications were observed without the expiration date and lot number and two of them did not have the milligrams (Prezista 600 mg and Truvada 1 tablet). Also, the small plastic pouches were observed with the residents' information that were not clear. The Pharmacy Administrator (employee #55) stated during an interview on 2/19/10 at 9:15 am that these medications are part of a study and they are supplied by the resident because they are not part of our formulary. Occasionally they come in their original containers with the lot numbers and expiration dates, but sometimes they arrive with the resident's name without the dose. These medications are labeled and supplied by the pharmacy department and administered by nursing personnel and excess medications are given to residents when they are discharged , according with pharmacy policies and procedures. 2. The medication reconciliation of the medical record for random sample resident sample #2 on 2/18/10 at 1:30 pm provided evidence that the physician… | 2014-02-01 | ||
| 712 | 712 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 371 | F | OWRV11 | Based on the kitchen observational tour with the administrative dietitian, review of policies/procedures, food code guidelines, registration temperatures, manufacturer's instructions and interview, it was determined that the facility failed to use proper infection control techniques during hot food temperature registration, maintain and prepare food in a safe and sanitary manner related to the steam table, defrosting meat and maintaining food frozen, the kitchen is in need of cleaning and painting, opened food without identification labels, cleaned trays and pots are not placed properly to air dry, the three compartment sink did not have test strip registration, no evidence was found of the annual cleaning and sanitizing of the ice maker which could affect twenty-five out of twenty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #16). Findings include: 1. During the kitchen observational tour performed with the administrative dietitian (employee #54) on 2/17/10 from 11:40 am till 12:45 pm, a kitchen employee (#45) was observed recording temperatures of the lunch time food with a thermometer. She had a paper towel in her left hand and the thermometer in her right hand and when she removed the thermometer from the food trays to obtain the temperature, she wiped it with the paper towel, then introduced it into a plastic cup with sanitizer and then dried it with the same paper towel that she had in her hand. The facility failed to ensure that personnel follow sanitary measures when recording food temperatures to avoid possible cross contamination. 2. The area where the three compartment sinks are located, the area where trays are stacked after they are cleaned and the area where patient's food trays are automatically cleaned were observed on 2/17/10 at 12:30 pm in need of cleaning and paint. Also, the area where trays are stacked after they are cleaned was found with a plastic cover on the floor and a clean knife was found with food particles. 3. Already cleane… | 2014-02-01 | ||
| 711 | 711 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 363 | F | OWRV11 | Based on the review of menus recipes and observational tour of the kitchen with the administrative dietitian, it was determined that the facility failed to ensure that the food scale is present during the food assembly and recipe menus are written which could affect twenty-five out of twenty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #16). Findings include: 1. During the kitchen observational tour of the food line assembly with the administrative dietitian (employee #54) on 2/17/10 from 12:05 pm till 12:30 pm, it was determined that four kitchen employees (#45, #46, #47 and #48) did not have a food scale present at the food line to ensure that recommended amounts of food as ordered by the dietitian and physician are served. 2. Review of menus recipes with the administrative dietitian (employee #54) on 2/19/10 at 11:00 am provided evidence that meals prepared for the menus do not have recipes to follow to ensure that food is prepared consistently by employees regardless of who prepares the food. | 2014-02-01 | ||
| 710 | 710 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 362 | F | OWRV11 | Based on the review of policies/procedures, observations and interview with the administrative dietitian, it was determined that the facility failed to ensure that enough staff are working during different shifts to ensure that food prepared and served on food trays for residents are delivered at appropriate and established times in accordance with facility policies and procedures which could affect twenty-five out of twenty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #16). Findings include: During the observational tour of the kitchen performed on 2/17/10 at 11:40 am, it was found that staff assembled food trays for residents from 12:10 pm till 12:30 pm, then the cart that they were placed on was pushed to the side of the food line preparation area as four kitchen employees (#45, #46, #47 and #48) continued with the food tray assembly for the patients at the hospital. The administrative dietitian (employee #54) was interviewed on 2/17/10 at 12:32 pm related to the reason why the food cart was not sent to the residents for consumption and she stated that one of her employees was sick as of a week ago and when employees #45, #46, #47 and #48 finish serving the hospital patient's trays one of them will bring the food to the residents in the skilled nursing facility. The administrative dietitian then removed employee #48 from the food line assembly and she delivered and served the trays to the residents from 12:40 pm till 12:55 pm. On 2/18/10 at 8:30 am during an observational tour with the physical plant manager (employee #52) it was found that a kitchen employee #48 was delivering the breakfast food trays to resident's rooms from 8:30 am till 8:50 am. According with facility policies/procedures reviewed on 2/19/10 at 10:00 am breakfast is to be sent to the residents starting at 6:45 am and lunch is to be sent starting around 11:30 am. The facility failed to plan ahead to acquire enough staff to ensure that food trays are delivered according with policies… | 2014-02-01 | ||
| 709 | 709 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 353 | F | OWRV11 | Based on observations and interviews, it was determined that the facility failed to provide nursing services to residents in accordance with the patients' plan of care related to assisting residents during meals for fourteen out of twenty-five admitted residents (sample selection #1, #2, #3, #5, #7, #9 and random sample selection #1, #2, #3, #4, #8, #9, #12 and #13). Findings include: 1. Lunch trays were transported to resident's rooms at 12:00 noon by a kitchen employee (#48). The kitchen employee placed the trays with the lunch meals on each resident's food trays. However, it was not until 12:25 pm that nursing personnel began to assist residents who needed assistance (residents #2, #3, #7, #9 and random sample #3, #4, #8, #9, #12 and #13). 2. Residents #2, #3, #7, #9 and random sample #3, #4, #8, #9, #12 and #13 are residents who need assistance to eat, however on 2/18/10 at 12:30 pm, resident #3 and random sample #13 were giving assistance. For the day of 2/18/10, four licensed practice nurses (LPN) were assigned to provide resident care. 3. Residents #1, #5 and random sample residents #1, #2 and #3 stated during an interviews on 2/18/10 from 11:55 am till 12:45 pm that during the lunch time meals, sometimes they need to wait from 20 to 25 minutes to receive assistance and be positioned for lunch. 4. Resident #3 stated during an interview on 2/17/10 at 2:35 pm that she eats very slow and she knows that personnel who assist her, need to be with her for a long time assisting her while she eats. 5. During assistance of the lunch time meal as observed on 2/18/10 from 11:55 am till 12:45 pm, no evidence was found of nursing supervision related to the level of care needed and in the ordered of the care needed for the residents regarding meal assistance. 6. The Director of Nursing (D.O.N) (employee #50) stated during an interview on 2/18/10 at 3:00 pm that the staffing pattern for the unit was complete. He did not provide an explanation of why nursing assistance is delayed up to a half hour after the food trays are … | 2014-02-01 | ||
| 708 | 708 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 332 | E | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made during medication administration, review of clinical records and medication administration records, it was determined that the facility failed to ensure that drugs are given as ordered by the physician for four out of fifty-one doses given for a medication error rate of 7.84% (residents #8). Findings include: 1. During the drug pass on 2/18/10 from 8:30 am till 10:45 am, registered nurse #8 (R.N) failed to follow professional standards of practice based on the following observations: a. During medication administration observations performed on 2/18/10 from 8:30 am till 10:45 am, R.N #8 was observed administering medications to resident #8. He administered 5 ml of [MEDICATION NAME], 5 ml of Hematron and 5 ml of multivitamins supplement by gastrostomy tube. He measured the medications in a measuring cup and did not placed the measuring cup on a level surface at eye level to evaluate if the amount was correct, he held the cup in his hand at eye level. He was asked to extract the medication with a syringe and the amount extracted was not correct, 4.5 mls were extracted instead of 5 mls as ordered by the physician. The technique of lifting the measuring cup in his hand at eye level is not the correct procedure to ensure that specific amounts of medications are administered correctly on a continuos basis. Also R.N #8 was observed crushing 750 mgs [MEDICATION NAME] administer by gastrostomy tube and he diluted it with some water and when he served the medication via gastrostomy, part of [MEDICATION NAME] was left in the cup after he crushed it. Administration standards for medications require specific calibration equipment to ensure that medications are administered according to the physician's orders [REDACTED]. | 2014-02-01 | ||
| 707 | 707 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 323 | D | OWRV11 | Based on observations made during a physical environment tour with the physical plant manager, it was determined that the facility failed to ensure that the physical environment is as free of accident hazards as possible for one out of twenty-five admitted residents (random sample resident #10) related to the placement of containers used for garbage and biohazardous trash. Findings include: The facility has a total of thirteen resident's rooms as observed during a physical environment tour on 2/19/10 from 8:30 am till 10:00 am with the physical plant manager (employee #52). All resident's rooms are double occupancy rooms. Random sample resident #13 was observed in room #110 bed A (closest to the front door) as she was exiting from the bathroom located near bed B. The resident was using a walker (left total knee replacement) and had to turn the walker to the side in order to pass between bed B and the containers used to place regular and biohazardous trash. One foot and seven inches was measured between the foot of bed B and the trash container and two feet were measured between bed A and the biohazardous container. For double occupancy rooms a minimum of four feet clearance is required between the foot of the bed and nearest object to ensure path of movement for staff and residents. The facility failed to ensure that the containers for regular and biohazardous trash were arranged to facilitate movement for this resident, the placement of these containers created an obstacle for this physically compromised resident and a possible tripping hazard. | 2014-02-01 | ||
| 706 | 706 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 309 | D | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, records reviewed and interviews, it was determined that the facility failed to provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for one out of ten residents in the sample selection related to monitoring [MEDICATION NAME] levels (resident #2). Findings include: Resident #2 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident's cognitive pattern on the five-day minimum data set (MDS) performed on 2/8/10 provided evidence that the resident requires extensive assistance for bed mobility, transferring, eating, personal hygiene, toilet use and bathing. The clinical record was reviewed on 2/19/10 at 10:30 am and provided evidence that the resident was ordered [MEDICATION NAME] 100 mg every 8 hours on 2/4/10 at 9:30 am. The laboratory results on 2/7/10 provided evidence that the [MEDICATION NAME] was 2.0 ug/ml, which is not within the normal range of 10.0-20.0 ug/ml. On 2/8/10 the physician's progress note provided evidence to perform a neurological follow-up due to low [MEDICATION NAME] levels. The primary physician #56 stated during an interview on 2/19/10 at 11:20 am that the resident should be evaluated by a neurologist to adjust the dose of [MEDICATION NAME] and the resident has not convulsed since his admission. On 2/19/10 at 1:50 pm the physician ordered to increase the [MEDICATION NAME] to 300 mg initially, then 300 mg after 2 hours, then 300 mg after 4 hours and to take [MEDICATION NAME] levels on 2/20/10. The facility failed to ensure that the resident's [MEDICATION NAME] levels were monitored to ensure proper dosing and that effective levels of [MEDICATION NAME] are achieved. Also, no evidence was found of laboratory results related to the [MEDICATION NAME] levels from 2/7/10 through 2/19/10. | 2014-02-01 | ||
| 705 | 705 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 281 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations during the drug pass, ulcer care, interview, review of policies/procedures, observational tour and record review, it was determined that the facility failed to ensure that services are provided according to acceptable standards of practices and established policies and procedures, failure to use resident identification wrist bracelets during the drug pass, failure to ensure the correct placement of foley catheters, failure to follow proper infection control procedures and medical orders which could affect twenty-five out of twenty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #16). Findings include: 1. During the drug pass on 2/18/10 from 8:30 am till 10:45 am, registered nurse #8 (R.N) failed to follow professional standards of practice based on the following observations: a. During the drug pass performed on 2/18/10 from 8:30 am till 10:45 am, it was found that the R.N #8 called the residents by their names but failed to verify their name with their wrist bracelets. Policies and procedures related to the use of identification wrist bracelets states that all residents are to be identified by their wrist bracelets before administering medications or performing interventions. b. During the drug pass performed on 2/18/10 from 8:30 am till 10:45 am, it was found that R.N #8 failed to assess the residents for pain. The Nursing Supervisor (employee #51) stated during an interview on 2/18/10 at 11:30 am that nursing staff are to evaluate resident's pain assessment during the medication pass, before administering medications or performing interventions according with the pain management protocol. c. During the drug pass on 2/18/10 from 8:30 am till 10:45 am R.N #8 was observed serving 5 ml of [MEDICATION NAME], 5 ml of Hematron and 5 ml of multivitamins supplement for resident #8, however he failed to shake the three bottles of medications before measuring for administr… | 2014-02-01 | ||
| 704 | 704 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 279 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on eleven (ten sample selection residents and one random sample resident) resident's records reviewed, it was determined that the facility failed to develop a comprehensive plan of care for four out of eleven residents in the sample selection and random sample residents (Residents #4, #6, #7 and random sample resident #10) related to [MEDICAL CONDITION] Drug Use and Diabetes Mellitus. Findings include 1. Resident Sample #4 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/18/10 at 3:30 pm and provided evidence that the resident's 14 day MDS assessment performed on 2/3/10 the RAPs identified concerns with ADL Functional, Mood State, Behavioral Symptoms, Pressure Ulcers and [MEDICAL CONDITION] Drug Use. The physician placed orders for [MEDICATION NAME] coverage with regular insulin subcutaneus as followed by the [MEDICATION NAME] curve. No evidence was found that the facility developed and identified plans of care for Diabetes Mellitus and [MEDICAL CONDITION] Drug Use. 2. Resident #6 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/18/10 at 2:30 pm and provided evidence that the resident's 14 day MDS assessment performed on 2/10/10 the RAPs identified concerns with Visual Function, ADL Functional, Activities, Falls, Nutritional Status and Pressure Ulcers. The physician placed orders [MEDICATION NAME] coverage with regular insulin subcutaneus as followed by the [MEDICATION NAME] curve. No evidence was found that the facility developed and identified plans of care for Diabetes Mellitus. 3. Resident #7 is a [AGE] years old male who was admitted for services on 1/19/10 with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/19/10 at 11:00 am and provided evidence that the resident's 30 day MDS assessment performed on 2/19/10 the RAPs identified concerns with Visual Function, ADL Functional, … | 2014-02-01 | ||
| 703 | 703 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 272 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on eleven (ten sample selection residents and one random sample resident) resident's records reviewed, it was determined that the facility failed to assess resident's needs using the resident assessment instrument (RAI) and the minimum data set (MDS) for residents as required by the statutory and regulatory section 1819 Social Security Act related with the implementation and use of the assessment instrument to identify health problems for six out of eleven sample selection residents and random sample resident (residents #1, #2 #3, #4, #9 and random sample selection resident #10). Findings include: 1. Resident #1 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/17/10 at 1:20 pm. The resident's 5 day Minimum Data Set (MDS) assessment reference date of 2/3/10 section K for Oral Nutritional Status and section L for Oral Dental Status were left in blank. The resident's 14 day Minimum Data Set (MDS) assessment reference date of 2/14/10 section K for Oral Nutritional Status and section L for Oral Dental Status were left in blank. 2. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident's 5 day Minimum Data Set (MDS) section K for Oral Nutritional Status and section L for Oral Dental Status were left in blank. 3. Resident Sample #2 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/19/10 at 10:30 am. The resident's 14 day Minimum Data Set (MDS) section "E" for Mood and Behavior Patterns, section "F" for Psychosocial Well-Being, section "G" for Physical Functioning and Structural Problems parts a, b, c, d, part #3, # 4, #5, #6, #7, #8 and #9 were left in blank, section "K" for Oral/Nutritional Status, section "L" for Oral/Dental Status and section "N" for Activity Pursuit Patterns were left in blank. 4. Resident Sample #4 is a [AGE] years old male who wa… | 2014-02-01 | ||
| 702 | 702 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 257 | G | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made during observational tours and interviews, it was determined that the facility is not promoting care in a manner that enhances each residents' care for five out of twenty-five admitted residents (Residents #1, #5, #7 and random sample #6 and #11) related to uncomfortable and unsafe temperatures in resident's rooms and during bed baths and neglected resident #5 petition for a bed change and warmer room temperature which caused the resident mental anguish and distress. Findings include: 1. Resident #5 was observed during the initial observational tour on 2/17/10 at 10:30 am under three heavy blankets in room [ROOM NUMBER]. She was interviewed on 2/17/10 at 10:35 am related to the services provided at the facility and she stated that she was very cold. She stated that she was so cold that she could not sleep and that her feet were frozen because her bed is next to the air conditioner unit. The room temperatures was measured with a thermometer on 2/17/10 at 10:40 am and gave a reading of 62?F. The temperature finding in this resident's room and her concerns about the temperature were told to the nursing supervisor (employee #51) on 2/17/10 at 12:45 pm for action related to the residents' comfort and care. On 2/18/10 at 8:40 am accompanied by the physical plant manager (employee #52), the resident's room was visited again and the room temperature was measured with a "Tel Fast 2 laser" thermometer and gave a reading of 61?F and the resident was in the same bed next to the air conditioner unit. The resident was interviewed on 2/18/10 at 8:45 am and she was very upset and wanted to leave the facility. The physical plant manager (employee #52) notified the finding to the nursing supervisor (employee #51) and the Director of Nursing (employee #50) on 2/18/10 at 9:00 am to either lower the temperature or move the resident into a room where she can be further away from the air conditioner unit. On 2/19/10 at 9:00 am the residen… | 2014-02-01 | ||
| 701 | 701 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 256 | E | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the observational tour of the physical environment and tests to overhead bed lamps and floor night lights, it was determined that the facility failed to ensure that resident's rooms have overhead lamp pull cords that are long enough to be easily reached (resident's rooms #112A and 113A) and the floor light in resident's room [ROOM NUMBER] did not illuminate which affects three out of twenty-five admitted residents (resident #3 and random sample residents #13 and #14). Findings include: 1. All resident's sleeping rooms were visited during the observational tour on 2/17/10 from 8:45 am till 11:30 am and the following was observed in three out of thirteen resident's rooms related to night lights above resident's beds and floor night lights: a. The pull cords for the night lights above resident's beds in rooms #112A and #113A were not accessible to the residents lying in their beds. b. The floor night light in resident's room [ROOM NUMBER] did not illuminate when turned on. | 2014-02-01 | ||
| 700 | 700 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 241 | G | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made of residents and interviews with personnel and resident, it was determined that the facility failed to ensure that residents receive services necessary to provide dignity related to personal hygiene of facial hair and finger nails and foley bag placement for seven out of twenty-five residents (Resident #3, #7, #8 and random sample residents #1, #7, #9, #13), the failure to provide dignity resulted in resident #7 to lose sleep, be uncomfortable and embarrassed when around other residents. Findings include: 1. Resident #7 is a [AGE] years old male who was admitted for services on 1/19/10 with a [DIAGNOSES REDACTED]. The resident was observed on 2/17/10 at 11:30 am during the initial tour with a registered nurse (employee #4) with a full beard and very long, dirty finger nails. The resident was interviewed on 2/17/10 at 11:35 am and he stated that he felt really bad because the beard was extremely itchy and it did not let him rest. He was asked if he told staff not to shave him or if he knew of a reason why they were not shaving him and he stated "as far as I'm concerned I want them to shave me because I have vision problems and can not do it by myself and I am not aware of a reason why they have not shaved me for such a long time". The resident stated "they bathe me in bed daily but I guess they don't have time to shave me or cut my finger nails". When the resident showed his finger nails they were long and dirty, he was asked if he could see his finger nails and he stated that he could not, but he did not not like his nails long. The resident stated that he felt dirty because of the beard and length of his finger nails and when he goes to different therapies he is embarrassed. The Director of Nursing (D.O.N) (employee #50) was interviewed on 2//17/10 at 2:00 pm related to residents' personal hygiene and he stated that all residents receive a bath daily either in their bed or the shower room and male residents are sha… | 2014-02-01 | ||
| 699 | 699 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 224 | G | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made during observational tours and interviews, it was determined that the facility is not promoting care in a manner that enhances each residents' care for five out of twenty-five admitted residents (Residents #1, #5, #7 and random sample #6 and #11) related to uncomfortable and unsafe temperatures in resident's rooms and neglected resident #5 petition for a bed change and warmer room temperature which caused the resident mental anguish and distress. Findings include: 1. Resident #5 was observed during the initial observational tour on 2/17/10 at 10:30 am under three heavy blankets in room [ROOM NUMBER]. She was interviewed on 2/17/10 at 10:35 am related to the services provided at the facility and she stated that she was very cold. She stated that she was so cold that she could not sleep and that her feet were frozen because her bed is next to the air conditioner unit. The room temperatures was measured with a thermometer on 2/17/10 at 10:40 am and gave a reading of 62?F. The temperature finding in this resident's room and her concerns about the temperature were told to the nursing supervisor (employee #51) on 2/17/10 at 12:45 pm for action related to the residents' comfort and care. On 2/18/10 at 8:40 am accompanied by the physical plant manager (employee #52), the resident's room was visited again and the room temperature was measured with a "Tel Fast 2 laser" thermometer and gave a reading of 61?F and the resident was in the same bed next to the air conditioner unit. The resident was interviewed on 2/18/10 at 8:45 am and she was very upset and wanted to leave the facility. The physical plant manager notified the finding to the nursing supervisor and the Director of Nursing (employee #50) on 2/18/10 at 9:00 am to either lower the temperature or move the resident into a room where she can be further away from the air conditioner unit. On 2/19/10 at 9:00 am the resident's room was visited to verify the temperature and … | 2014-02-01 | ||
| 698 | 698 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 174 | F | OWRV11 | Based on the group interview, interviews with personnel, review of policies/procedures and observations, it was determined that the facility failed to provide telephone services with reasonable accessibility where calls can be made and received without being overheard for twenty-five out of twenty-five admitted residents (sample selection #1 through #9 and random sample selection #1 through #16). Findings include: During observations of the nursing station on 2/17/10 at 8:40 am, it was found that the facility does not have a cordless telephone. The Physical Plant Manager (employee #52) was interviewed on 2/17/10 at 8:40 am related to procedures when residents request phone use or they receive calls at the nursing station and he stated that residents have to come to the nursing counter and they use the phone next to the nursing counter. He was asked if the facility had another area where patients could talk in private without being over heard and he stated that the designated area was next to the nursing station. He was also asked if the facility had a cordless phone and he stated that they did not. The Director of Nursing (employee #50) was interviewed on 2/17/10 at 12:15 pm and he was asked about phone use when residents are bedridden or those who require substantial time to get out of bed to go to the nursing counter and he had no reply. During the group interview on 2/17/10 at 2:00 pm two out of four residents (sample selection resident #4 and random sample resident #8) (the other two residents (random sample residents #1 and #2) did not participate verbally during the group interview) stated that they were not aware that they could receive or make phone calls from the facility. Facility policies/procedures reviewed on 2/17/10 at 3:20 pm provided evidence that residents can use the nursing counter phone if they do not have a phone, however no documentation was found that residents are made aware that they can receive and make calls without paying for them. No evidence was found that the policies and procedures… | 2014-02-01 | ||
| 697 | 697 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 164 | F | OWRV11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made during the drug pass and ulcer care and observational tour, it was determined that the facility failed to promote residents' right for personal privacy during medication administration, ulcer care and while in their rooms for three out of twenty-five admitted residents (resident #3, #8 and random sample resident #9). Findings include: 1. Resident Sample #8 is a [AGE] years old male who was observed on 2/18/10 at 8:50 am during the drug pass for medication administration by gastrostomy tube. Registered nurse #8 failed to run the curtain completely around the resident's beds to provide privacy for this resident from staff and other persons who entered in the resident's room during the procedure. The resident's bed is near the front door which does not ensure residents' privacy during medication administration. Also, when registered nurse #8 finished the medication administration procedure he left the room while the resident was uncovered. 2. Random sample resident #9 is an [AGE] years old female who was observed on 2/19/10 at 12:10 pm during ulcer care. Registered nurse #11 failed to run the curtain completely around the resident's bed to provide privacy for this resident from staff and other persons who were entering in the resident's room during the ulcer care procedure. 3. During an observational round of resident's rooms on 2/19/10 at 9:15 am with the physical plant manager (employee #52) resident #3 was visited in room [ROOM NUMBER]. The resident was observed lying in bed covered with a blanket up to her waist and a yellow gown covering her chest area. Yellow gowns are usually worn by maintenance personnel or staff during ulcer care, but the resident did not like what she was wearing and she requested the yellow gown from the facility. The yellow gown is see through and the resident did not have anything on under the yellow gown, exposing her breasts to persons who entered her room such as the physical plant mana… | 2014-02-01 | ||
| 696 | 696 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 155 | D | OWRV11 | Based on the review of ten medical record and interview, it was determined that the facility failed to promote the right of residents to formulate advance directive for one out of ten sample selection resident (Resident #3). Findings include: The record review of resident #3 was performed on 2/17/10 at 1:23 pm and provided evidence that the advance directive document in order to acquire information for the establishment of advance directives was left in blank. The nursing supervisor (employee #51) stated during an interview on 2/18/10 at 8:43 am that this resident was moderately impaired related to cognitive skills for decision making and the resident's son was the person in charge of the resident. The facility could not contact the relative in order to complete the advance directives and they were waiting for the relative to visit the resident to acquire information. | 2014-02-01 | ||
| 695 | 695 | SAN GERARDO HOSP | 405022 | MSC 250 WINSTON CHURCHIL AVE 138 | RIO PIEDRAS | PR | 926 | 2010-02-19 | 151 | F | OWRV11 | Based on observations and interviews, it was determined that the facility failed to promote the right of each resident to know and distinguish personnel in charge of their direct care which affects twenty-five out of twenty-five admitted residents (residents #1 through #9 and random sample residents #1 through #16). Findings include: 1. Observations made during of the initial tour on 2/17/10 from 8:45 am through 10:45 am provided evidence of the following: a. Facility employees #15 and #16 were observed giving direct care (changing bed sheets and providing resident care) to residents. These employees did not have identification or name tags in order to be identified by the residents, visitors, resident's relatives and other persons at the facility. b. Facility employee #27 was observed escorting residents to the physical therapy area. He did not have an identification or name tag in order to be identified by the residents, visitors, resident's relatives and other persons at the facility. c. Facility employee #29 was observed visiting resident's rooms, she did not have an identification or name tag in order to be identified by the residents, visitors, resident's relatives and other persons at the facility. She was interviewed on 2/17/10 at 10:00 am and she stated that she is the recreational coordinator. d. Facility employee #2 (registered nurse) was observed interacting with residents on various occasions but did not have an identification or name tag in order to be identified by the residents, visitors, resident's relatives and other persons at the facility. 2. The relative of resident #1 was interviewed on 2/18/10 at 2:00 pm and she stated that she did not know who were the registered nurses, licensed practical nurses or therapists because they do not have identification or name tags and they are dressed in a lot of different colors. 3. Resident #5 was interviewed on 2/17/10 at 1:56 pm and she stated that she did not know who were the registered nurses, the licensed practical nurses or the therapists because th… | 2014-02-01 | ||
| 694 | 694 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 520 | F | ET9L11 | Based on observation, interview and record review, it was determined that the Quality Assurance (QA) Committee was not effective in addressing identified resident care issues and in resolving deficiencies pertaining to the Quality of Care and Quality of Life of the facility residents. Previously cited deficiencies were not corrected as alleged by the facility. Plans which the QA Committee developed to bring the facility into compliance were not implemented in a manner which assured ongoing compliance. All required personnel were not present at quarterly QA meetings. This deficient practice had the potential to affect all 30 residents in the facility. The findings include: 1. Review of Quality Assurance (QA) on 08/29/13 at 2:00pm revealed attendance records lacked documented evidence of any QA meetings during 2013. Review of the QA records for the last two quarters of 2012 lacked documented evidence of who attended the meetings on 7/19/12 and 10/16/12. Interview with Registered Nurse (RN) 25, who served as head of the QA committee, revealed that all 2013 QA records were at her home, waiting to be transcribed and she would provide them on 8/30/13. Further interview confirmed that although each department ' s name was listed on the sign-in sheet attached to the 2012 minutes, the sign-in sheet had not been completed and she did not have documentation to verify that the Director of Nursing (DON), Medical Director, and at least three other staff had been present during the meeting. Further review of QA records on 8/30/13 at 9:50am revealed that each of the 2012 QA minutes now contained a completed sign-in sheet, indicating the Medical Director had been present at the meeting. Interview with RN25 confirmed that she had the Medical Director sign these sheets on the morning of 8/30/13, over a year after the 7/19/12 meeting occurred. Review of the 2013 QA attendance records provided on 8/30/13 revealed quarterly meetings were held on 1/12/13 and 4/10/13. Review of the sign-in sheets for these two meetings lacked documented… | 2014-03-01 | ||
| 693 | 693 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 514 | F | ET9L12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the clinical record revealed R#4 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Additional [DIAGNOSES REDACTED]. The following was found during the record reviewed: a. The weekly weight chart form revealed that staff nurse (employee #1) weight the resident on admission 1/17/14 and the residents ' weight was 173 pounds. The resident was visited at his room on 1/22/14 at 11:20 am and was observed on his bed because the resident admitted at the facility with multiple body traumas and did not ambulate. The head nurse (employee #6) was interview related to what kind of form the nurse used to take the resident weight because the weight weekly chart form did not provide this information. The head nurse and the surveyor go to the residents ' room and during the residents ' interview he stated: '' I have been here five days. I cannot ambulate because I have fractures on different areas of my body.'' Related to how the nurse takes the weight on admission he stated: '' She take the weight in my bed on scale used for residents that cannot ambulated.'' The License Practical Nurse (LPN) failed to document on the weekly weight chart form the type of scale used to weight the resident when the resident cannot ambulate. b. The daily nurse ' s notes on 1/21/14 lacks of nurse signature on shift 6:00 am from 2:00 pm. c. During the record review on 1/22/14 at 1:40 pm provide evidence that the telephone order was taken by the register nurse (employee # 8) on 1/18/14 at 9:35. The telephone order revealed '' Silver med on necrotic area. [MEDICATION NAME] Ag on depth and cover with Alevyn.'' The telephone order lacks of time if am or pm. The order did not specify the residents ' affected area to provide the local care and lacks how many times a day the nurse provide the local care. The head nurse (employee #6) was interview on 1/22/14 at 1:45 pm. related to the incomplete telephone order and she stated: '' All of nurses were oriented re… | 2014-03-01 | ||
| 692 | 692 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 501 | F | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, it was determined that the Medical Director failed to assure the development and implementation of needed resident care policies, and provide for the coordination of medical care in the facility. The Medical Director ' s failure had the potential to affect all residents of the facility. The findings include: 1. Review of the facility policy titled, " Articulo III - El Director Medico " (Article III - The Medical Director) revealed that the Medical Director was to " desarrollara politica medica " (develop medical policies). However, review of facility policies revealed multiple medical care areas for which no policies had been developed. For example, although the facility was providing care to residents who received [MEDICAL TREATMENT], interview with multiple staff revealed there was no [MEDICAL TREATMENT] policy regarding care of these patients, or how coordination/communication between the facility and the [MEDICAL TREATMENT] center was to be accomplished. (Refer to F309.) The policy also noted that the Medical Director was to " Cooperara con la Directora de enfermeras en la preparacion de programas de educacion en servicio para el personel de enfermeria " (cooperate with the Director of Nursing in preparing educational programs for nursing personnel). However, there was no evidence that this policy was followed. Interview with the Director of Nursing (DON) on 8/30/13 at 8:40am revealed that the Medical Director had not been involved in preparing or providing any education for nursing staff during the four months she had been DON of the facility. 2. Observation revealed that the Medical Director failed to promptly respond to nursing requests for patient care. Observation of R8 on 8/28/13 revealed the resident ' s leg was red and swollen. The resident stated she had been having pain and had requested to be seen by the physician, since she was concerned her surgical wound was infected. Inte… | 2014-03-01 | ||
| 691 | 691 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 490 | F | ET9L11 | Based on observation, interviews, and record review, it was determined that the facility was not administered in a manner that enabled each resident to attain or maintain their highest practicable well-being. Although the facility had been aware of deficiencies in the areas of Resident Behavior and Facility Practices, Quality of Life, Resident Assessments, Quality of Care, Dietary Services, Pharmacy Services, and Administration since March, 2012, the Administrator failed to take effective steps to correct these deficiencies and assure that each resident received the care they needed. The findings of the survey conducted on 8/26 -30/13 revealed that Actual Harm in Quality of Care continued to exist and Substandard Quality of Care was identified. Findings: Observation, interviews, and record review during the survey of 8/26 -30/13 revealed that residents sustained actual harm when care was not provided as needed. Substandard quality of care had the potential to affect all residents relative to the development and implementation of abuse/neglect policies. Deficiencies were identified in the areas of Resident Behavior and Facility Practices, Quality of Life, Resident Assessment, Quality of Care, Dietary Services, Pharmacy Services, Infection Control, Physical Environment, and Administration. Refer to F221, F226, F246, F248, F249, F252, F272, F278, F281, F309, F323, F325, F329, F332, F363, F371, F425, F431, F441, F456, F463, F465, F501, F514 and F520 in this document. Review of facility records revealed that a survey conducted in March, 2012 identified multiple deficiencies, and a Plan of Correction (POC) was submitted in response. However, the findings of the 8/26 - 8/30/13 standard and extended survey revealed that actions which the Administrator had stated would be taken to bring the facility into compliance with federal regulations had not been effectively completed. For example, as part of the POC, abuse training was to be completed for all staff; however, review of personnel records revealed that the facility ha… | 2014-03-01 | ||
| 690 | 690 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 465 | E | ET9L11 | Based on observation and interview, the facility failed to maintain the residents ' environment in a safe, clean and homelike fashion. This had the potential to affect all the residents who resided on the A hall of the facility. Findings include: Observation on 8/26/13 at 12:30 pm revealed the refrigerator and the ice machine in the nutrition pantry on Nursing Unit A had multiple areas of spilled nutritional supplements inside the freezer, and the cold storage areas. The ice machine had a large collection of dust, dirt and debris on the fan air intake toward the top of the machine. Interview on 8/27/13 at 11:30am the Housekeeping Supervisor (utilizing a Spanish speaking interpreter) acknowledged that the refrigerator and the ice machine did require cleaning. | 2014-03-01 | ||
| 689 | 689 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 463 | D | ET9L11 | Based on observation and interview, the facility failed to assure that two restrooms which were accessible to residents were equipped with a functioning call system. Findings: 1. On 8/27/13 at 2:00pm observation of the restroom next to the resident dining room revealed that it was not equipped with a working call system. Although a call light indicator was present over the door to the restroom, a tour of the restroom revealed there was no mechanism present in the room to activate the system. Interview on 8/27/13 at 2:00pm with Registered Nurse (RN) 10 revealed the bathroom next to the dining room was used by residents. She related that she thought that the restroom was connected to the facility call system. However, after observing the restroom, RN10 confirmed there was no mechanism to activate the system as it appeared the old switch with string had been removed. Interview on 8/27/13 at 2:03pm with the Maintenance Supervisor revealed that this restroom had not had a working call system for approximately two months. He related that the call light in this restroom was causing other lights in the system to malfunction, so it was disconnected and had not yet been repaired or replaced. 2. Observation on 8/27/13 at 4:25pm revealed that another common restroom (across the hall from Resident Room #2) also was not equipped with a working call light. Interview with the Maintenance Supervisor confirmed that residents can access this restroom, and that this call light was disconnected at the same time as the one in the restroom next to the dining room. | 2014-03-01 | ||
| 688 | 688 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 456 | F | ET9L11 | Based on observation and interview, the facility failed to ensure that two stand-up weight scales and a crane weight scale (for use by residents) were maintained and in proper working order. This had the potential to affect all residents in the facility. Findings include: 1. On 8/30/13 at 9:00am, due to nutritional concerns (Refer to F325), a weight was requested for R1. The Director of Nursing (DON) reported that the resident ' s weight was 131 pounds when weighed on the crane scale that morning. When the DON was asked how she accounted for the weight of the canvas and poles that accompany the crane scale, she responded " I do not know. " The resident was then weighed on the stand-up scale (balanced to zero prior to resident ' s weight) on 8/30/13 at 9:30am, accompanied by the DON. The resident ' s weight on this scale was noted to be 91 pounds. Observation of the crane scale revealed there was no evidence as to when it was last calibrated. Observation of the two stand-up scales revealed they were last calibrated in January, 2010, and were marked to show the next calibration was due in January, 2011. The DON was then interviewed regarding the discrepancy in the two weights, and she stated she was not sure which scale was accurate. The DON confirmed that the scales had not been calibrated as scheduled, and she was unaware why this had not occurred since 2010. Review of manufacturer ' s instructions provided by the facility revealed the accuracy of a scale should be determined with accurate test weights or the scale should be compared with a scale known to be accurate such as a commercial scale with a weight and measure sticker affixed. | 2014-03-01 | ||
| 687 | 687 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 441 | F | ET9L12 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made during the follow up survey, observational tour to resident's rooms, pantry area, bath room, wheelchair designated area, recreational area, it was determined that the facility failed to promote sanitary and safe environment through its infection control program which could affect 27 out of 27 admitted residents (sample selection residents #1 through #6 and random sample residents # 7 through # 27). Findings include: Deficiency not corrected During the observational tour for infection control on 1/22/14 and 1/23/14 from 9:00 am till 11:55 am of residents rooms, pantry area, visits bath room, wheelchair designated area the following was found: 1. During a visit to the wheelchair designated area located in the corridor near the pantry on 1/22/14 at 11:30 am, two wheelchairs were observed, the area lacks of identification sign. The wall in the interior of the room was observed with peeling paint, dirty and very dusty. No evidence of daily register cleanness. 2. The pantry area was visit on 1/22/14 at 9:45 am. a daily register cleanness worksheet was observed on the left side of the entrance wall, accordance of the daily register worksheet the housekeeper personnel cleaning the area two times daily in am and pm, and written the hour when entrance and when ended and the write the initials of the person on the worksheet, however no evidence of cleanness on January 2, 3, 5, 8, 10, 11, 13, 16, 17, 19, 20, 21 and in pm on 1, 2, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15, 16, 18, 19 and 20 of 2014. 3. During the follow up visit on 1/22/14 at 10:00 am to the Recreational Therapy department area the residents ' and visits ' bathroom was visited and a daily register worksheet was observed behind the door and no evidence of daily cleaning on January 2, 4, 5, 10, 17 and 21 in am and on January 2, 3,4, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and 21 in pm. Strong odor of urine was detected. Appearance of water or urine was ob… | 2014-03-01 | ||
| 686 | 686 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 431 | E | ET9L11 | Based on observation and interview, the facility failed to assure that all drugs and biologicals remained under lock, with one medication cart and the medication room being accessible to residents, staff, and visitors on multiple occasions. In addition, the facility failed to assure that all medications were properly labeled. Findings: 1. During initial tour of the facility on 8/26/13 at 11:00am observation revealed the emergency medication cart, located in the resident sitting area, in front of the nurses ' station was open. This cart contained multiple vials of intravenous medications. Interview with the Nurse Manager on the unit at this time revealed she was not aware the emergency cart was open. She stated " The pharmacy technician was here and left the cart open about 20 minutes ago. " 2. Observation on 8/27/13 at 3:10pm revealed the door to the medication room was ajar. Observation of the unlocked room revealed 10 vials of Vancomycin (antibiotic) sitting on top of the medication cart. In addition, at least 20 vials of insulin, and multiple stock medications were also accessible in the refrigerator in the unlocked medication room. The Director of Nursing (DON) was shown the unlocked room at this time, and stated that the medication room was to be locked at all times. Observation on 8/27/13 at 4:45pm and 5:20pm revealed that although the DON had been notified of the problem, the medication room was ajar, with medications and other medical supplies accessible to unauthorized persons. 3. On 8/27/13 at 5:00pm, observation revealed multiple vials of Vancomycin 1gram in a plastic baggie on the medication cart. Observation of the plastic baggie revealed that it was labeled with R1 ' s name and the name of the medication. However, review of the label revealed there were no instructions for nurses to follow as to how to mix the medication. The following day at 12:40pm, the pharmacist was interviewed about the labeling of medication. The pharmacist stated she was responsible for writing directions for the nurses to pr… | 2014-03-01 | ||
| 685 | 685 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 425 | D | ET9L12 | Based on follow up survey, observations made during the medication administration, review of clinical records, medication administration records, policies/procedures and interview, it was determined that the facility failed to have a mechanism in place to ensure safe and effective use of drugs located on night cabinet. New deficiency Findings include: 1. Medication night cabinet area was reviewed on 1/23/14 from 9:24 am through 10:55 am. with register nurse (employee #5). The failure of the facility to maintain the most accurate inventory of medication storage on night cabinet, in order to promote a safer drug management and administration was determined based on the following findings: a. The quantity of some intravenous medication (Bentyl 20 mgs/ml, Rocephim 2gms, Depomedrol 80 mgs/ml, Vasotec1.25 mgs/ml, Dopamine HCL 200mgs/ml, Benadryl 50 mgs/ml, Haloperdidol 5 mgs/ml and Promethazine 25 mgs/ml) does not correspond with the quantity included in the inventory and medication list. During interview on 1/23/14 at 1:56 pm with the pharmacist (employee #10 ) stated " that pharmacy technicians told her that for some of the medication they increase the quantity to have available the medications that are more frequently ordered and used during the night and when pharmacy was closed " . b. Some oral medications (Plavix 75 mgs, Seroquel 50 mgs, Cymbalta 50 mgs, Lactulose solution 10 g/15 ml, and Metamucil oral powder) were available in the cabinet, but not included in the inventory list. c. Some intravenous mediation (Cefepime 2 gms, Imipenem 500 mgs, Zosyn 3.375 gm Heparin flush 5000 units/5 ml and Enalapril 2.5 mgs/2 ml) were available in the cabinet, but not included in the inventory list. | 2014-03-01 | ||
| 684 | 684 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 371 | F | ET9L11 | Based on observation, interview and record review, the facility failed to ensure food safety when they: 1 ) did not assure proper functioning of the dishwashing machine ; 2) did not assure the freezer remained at 0 degrees or below; 3) did not date and label potentially hazardous food;. 4) created a potential for cross contamination during food and dish storage; 5) did not assure sanitation of hand-washed dishware; and 6) did not assure that potentially hazardous foods were maintained at appropriate temperatures from cooking through serving and delivery. This had the potential to affect all of the 30 residents who resided in this facility. Findings: 1. Dish Machine: Observation on 8/27/13 at 11:05am revealed the wash cycle temperature on the dish machine reached 147 degrees and the rinse cycle revealed that it also registered 147 degrees. Observation of the dish machine revealed it was a " Hobart Viz-A-Tron " system. The machine was labeled to indicate that for the " AM 14 Hot water sanitizing " system, the wash temperature was to be 150 degrees and the rinse temperature 180 degrees. The label also indicated that for the " AM-14 Chemical Sanitizing " system, the wash and rinse temperatures were to be 120 degrees. Observation of this machine revealed it was a hot-water sanitizing dish machine. During this observation, interview with E55 revealed she was a kitchen employee who was familiar with the machine. E55 related that she did not know if the dish machine was a high-temperature machine, or used a chemical agent for sanitizer. Interview with the Maintenance Supervisor, who was also present, revealed he was also unaware if the dish machine used a chemical for sanitizing. However, the Maintenance Supervisor then stated the temperature of the rinse cycle was supposed to be between 175-180 degrees (indicating that it was a hot water sanitizing system.) Interview on 8/27/13 at 12:30 with one of the facility owners revealed the facility did not have manufacturer ' s specifications for the dish machine and the facilit… | 2014-03-01 | ||
| 683 | 683 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 363 | F | ET9L11 | Based on observation, interview, and record review, the facility failed to follow menus to meet specific physician-ordered calorie diets. This failure affected all residents of the facility Findings: During lunch preparation on 8/28/13 a review of the tray cards revealed that each resident in the facility was on a calorie-specific diet. For example: Room 3A - 1800 cal low sodium diet Room 3B - 1600 cal low sodium diet Room 4A - 1500 cal low sodium diet Room 4B - 1400 cal low sodium diet Observation on 8/28/13 during the preparation of meal trays revealed residents received the same amount of food, regardless of their physician-ordered diet. For example, observation of the second food cart, prepared at 11:40am, revealed that Rooms 12C, and 15A who were to receive a 1600 calorie diet received the same amount of food as Room 14A and 16A, who were on a 1500 calorie diet, as well as Room 15B, who was to receive a 1400 calorie diet. Each of these residents was observed to receive one same-sized serving of lasagna, two tongs full of lettuce and two tomato slices. Throughout the meal service, the chef who was preparing the plates was not observed to refer to a spreadsheet, menu, or other document which reflected portion sizes. Interview on 8/28/13 at 1:25pm with the chef revealed that the portion sizes for each specific calorie-diet were documented on the back of the resident ' s tray card. Review of these cards confirmed the chef ' s statement and noted that each diet card listed specific quantities of food which were to be served. For example, review of the 1800 calorie diet revealed that for lunch, the resident was to receive 3 servings of starch, while the 1400 calorie diet was to receive only 2 servings. Review of the cards revealed they did not detail what size constituted a serving. Further interview with the chef revealed that he was supposed to check the diet cards while serving the meals, " but I didn ' t. " The chef related that for meals like lasagna and other casseroles, every resident receives the same size… | 2014-03-01 | ||
| 682 | 682 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 332 | D | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and clinical record review, the facility failed to ensure that the medication error rate was 5% or less during administration of medications. This had the potential to affect two (R11 and R1) of 7 residents who were observed for administration of medication. The medication pass observation error rate was 8% based on 25 opportunities. Findings: 1.During the medication pass observation on 8/28/13 at 9:00am, RN46 administered the following oral medications to R11: [MEDICATION NAME] 20mg (milligrams), [MEDICATION NAME], 10mg, [MEDICATION NAME] 20mg, [MEDICATION NAME], 100mg, [MEDICATION NAME] 4mg, Xarelto 10mg and [MEDICATION NAME] (Cipro)750mg. Review of the clinical record revealed a prescription from the physician dated 8/21/13 [MEDICATION NAME], 1 tablet orally every 12 hours, dispense 10 tablets. An additional physician's order [REDACTED]. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The last dose of this medication should have been on 8/27/13. Interview with RN46 on 8/28/13 at the end of medication pass, revealed she was unaware if the order [MEDICATION NAME] discontinued. 2. During medication pass on 8/28/13 at 9:30am, RN44 was observed to mix intravenous [MEDICATION NAME], in the hallway prior to administering the medication to R1 and the following events took place: 1) Prior to beginning the task, the nurse did not wash/disinfect his hands; 2) The nurse then cleansed the port of a 100ml (milliter) bag of normal saline and withdrew 10ml. 3) The nurse cleansed the [MEDICATION NAME] vial rubber port. 4) Proceeded to mix the normal saline and [MEDICATION NAME] in the vial and transferred the mixed [MEDICATION NAME] into a 250ml bag of normal saline. 5) The nurse then labeled the bag, entered the resident ' s room, and attached the [MEDICATION NAME] diluted onto an intravenous pump. 6) The nurse flushed the resident ' s peripheral line with normal saline, … | 2014-03-01 | ||
| 681 | 681 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 329 | E | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to assure that drugs were not used without adequate monitoring and without adequate indications for their use. The facility ' s failure to assure that each resident ' s medication regimen was free of unnecessary drugs affected five of 10 sampled residents (R1, R5, R6, R7, and R8.) Findings: 1. Review of the clinical record revealed R5was admitted to the facility on [DATE] for rehabilitation therapy in response to fractures of the left femur and left humerus, which she sustained in a fall and additional diagnoses that included [MEDICAL CONDITION], hypertension, depression, arthritis, and [MEDICAL CONDITION]. Review of admission orders [REDACTED].) Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Review of the physician orders [REDACTED]. Further review of the clinical record lacked documented evidence of a diagnosis to justify the use of this [MEDICAL CONDITION] medication. Review of the initial assessment ( " Estimado Inicial " ) completed on 8/23/13, revealed that under Section E ( " Condiciones Psiquiatricas/Humor " ), staff documented R5 had no psychiatric diagnoses. Interview with Registered Nurse (RN) 25 on 8/27/13 at 3:05pm revealed R5 was receiving [MEDICATION NAME] as a hypnotic. After review of the clinical record, RN25 confirmed the resident had no diagnosis to justify the use of this medication. Interview with the facility ' s Registered Pharmacist (RPh) on 8/29/13 at 9:25am revealed the use of [MEDICATION NAME] at night was as a hypnotic, while if it was used during the day, it was an anti-anxiety medication. She related the doctor must include the specific indication for the use of the medication when writing the physician's order [REDACTED]. Interview with R5 on 8/30/13 at 10:00am revealed the resident was not aware she was receiving [MEDICATION NAME], and stated she had no problems sleeping at night. 2. Review of the cli… | 2014-03-01 | ||
| 680 | 680 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 323 | E | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide adequate supervision and/or assistance devices to prevent accidents. The failure to provide the care, supervision, and assistance devices needed to prevent accidents affected four of 10 sampled residents (R1, R 4, R5, and R6.) Findings: 1. Review of the clinical record revealed R5 was admitted to the facility on [DATE] for rehabilitation therapy in response to fractures of the left femur and left humerus, which she sustained in a fall and [DIAGNOSES REDACTED]. Review of the form titled, " Estimacio Inicial para Residentes con Potencial a Caidas " (Initial Assessment for Residents at Risk for Falls) revealed the initial falls risk assessment was completed on 8/24/13. The assessment identified R5 at risk for falls, with risk factors including limitations in movement, dependence on staff for assistance in activities of daily living (ADL), medication use, and orthopedic factors. As a result, staff documented that the falls protocol would be activated for this resident. Review of the " Protocolo de Residentes con Potencial a Caidas " (Protocol for Residents at Risk of Falls) revealed multiple interventions which staff were to use for this resident. They included " Mantener iluminacion adecuada y confortable para el residente " (maintain adequate and comfortable light for the resident.) The Protocol also noted that staff was to " mantener cama al nivel mas bajo posible " (maintain bed at the lowest level possible) and while in bed, the resident was to have the " uso de barandas (2) para soporte del residente " (use of two side rails to support the resident.) Observation throughout the survey revealed that these approaches to prevent falls were not consistently implemented. Although the protocol stated the resident was to have only two side rails when in bed, observation of R5 on 8/26/13 at 11:25am, 2:20pm, 3:15pm, and 3:45pm; and 8/27/13 at 8:00am, and 3:15pm, reveal… | 2014-03-01 | ||
| 679 | 679 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 309 | G | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to assure that each resident received the care and services necessary to maintain their highest practicable well-being. The failure to assess resident condition, monitor for pain, provide prompt physician intervention when needed, and follow physician orders [REDACTED]. Findings: 1. a. Observation on 8/28/13 at 2:40pm revealed R8 lying in bed and the resident ' s right knee was red, and swollen in appearance. Interview with the resident at that time, revealed she was in pain, and she stated her knee was " throbbing. " R8 stated that although staff was giving her pain medication, it was not helping. The resident related the pain was so bad that it was interfering with her sleep. Further interview with R8 revealed that she was admitted to the facility on [DATE] after having a total knee replacement the previous week. She stated she had been telling nursing staff for at least two days that she was worried that her knee was " getting infected " and " hurt a lot. " However, she stated, when staff looked at her knee, they told her there was " no problem. " R8 stated that on 8/28/13, the day of the interview, staff had agreed that her knee was red and painful and told her they would contact a doctor. The resident stated that this was at approximately 8:00am; however, she had not yet seen a doctor, even though she also told the second shift nurse when they came on duty at 2:00pm. She stated that although the nurses kept telling her the doctor would come, " he hasn ' t yet. " R8 concluded by stating she was scheduled to be discharged on [DATE], and was concerned about going home without an antibiotic, if she needed one. Review of the clinical record revealed R8 was admitted to the facility on [DATE], following a total right knee replacement (TKR). The record also revealed additional [DIAGNOSES REDACTED]. Review of admission documents revealed the resident was alert, oriented, and … | 2014-03-01 | ||
| 678 | 678 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 281 | E | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure services were provided in accordance with professional standards of practice. The failure to provide services such as completing accurate and timely initial assessments and care plans, obtaining physician orders, notifying physicians of laboratory results, and conducting medication pass within a standardized time frame had the potential to affect seven of 10 sampled residents (R1, R2, R4, R5, R6, R7, and R8), as well as random unsampled residents receiving late medications. Findings: 1. Review of the clinical record revealed R1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident was receiving [MEDICATION NAME] (antibiotic) 1.5 grams intravenously every day. [MEDICATION NAME] peak and trough levels were ordered twice per week, on Mondays and Fridays. The most recent peak level dated on 8/23/12 was elevated at 50.6 (reference 20-40), and the trough level was elevated at 16.1 (reference 5-10). Additional levels dated on 8/20/13 revealed a [MEDICATION NAME] peak level of 40.2 (reference 20-30) and a trough level of 19.3 (reference 5-10). In addition, there was documentation of the resident ' s sedimentation rate (blood test) on 8/22/13 with a value of 5 (reference 0-30). There was no documented evidence the physician had been notified of these normal and abnormal laboratory (lab) values. Interview with the Medical Director on 8/28/13 at 3:05pm revealed that he was not notified of R1 ' s peak, trough and sedimentation rates and had not noticed these values on his last chart review. Interview with the Director of Nursing (DON) on 8/29/13 at 2:00pm revealed that although there is no written document, the facility ' s practice was for the nurse to call the physician with all lab values; the nurse then signs on the lab form that he/she called the physician. The facility failed to provide services that met the Professional Standards Services tha… | 2014-03-01 | ||
| 677 | 677 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 278 | E | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to assure the accuracy of assessments and/or sign and certify their completion by a Registered Nurse (RN) for three of 10 sampled residents (R4, R8, and R10.) Findings: 1. Observation on both 8/29/13 and 8/30/13 revealed R4 was a resident in this facility. Review of the clinical record revealed the R4 was admitted to the facility on [DATE]. Review of the record revealed an admission Minimum Data Set (MDS) was dated as completed on 8/28/13, with an Assessment Reference Date (ARD) of 8/28/13. a. Review of the clinical record on 8/29/13 revealed that although the admission MDS was dated as completed on 8/28/13, Section VB2 was not signed by a Registered Nurse. b. Further review of the MDS revealed that it contained inaccurate information. For example, A310 coded this admission assessment as a discharge assessment, and A2000 documented the resident was discharged from the facility on 8/28/13. 2. Observation on 8/28/13, 8/29/13 and 8/30/13 revealed R8 was a resident in this facility. Review of the clinical record revealed R8 was admitted to the facility on [DATE]. Review of the record revealed an admission MDS was dated as completed on 8/26/13, with an Assessment Reference Date (ARD) of 8/26/13. Further review of the MDS revealed that it contained inaccurate information. For example, A310 coded this admission assessment as a discharge assessment, and A2000 (discharge date ) documented the resident was discharged from the facility on 8/26/13. 3. Record review of the closed record of R10 contained an MDS dated [DATE] that was coded inaccurately. Section A0310 was coded to indicate this admission assessment was a planned discharge. Additionally Section A2000 indicated R10 was discharged on [DATE], although he was not discharged until 7/2/13. Interview on 8/29/13 at 10:20am with the MDS Coordinator revealed she thought that A310 was supposed to be coded as a " Discharge Assessment … | 2014-03-01 | ||
| 676 | 676 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 272 | D | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to complete a comprehensive, accurate, standardized reproducible assessment of each resident ' s functional capacity. The failure to complete the Resident Assessment Instrument (RAI) in accordance with Utilization Guidelines affected two of 10 sampled residents (R4 and R8). Findings: 1. Review of the clinical record of R4 revealed the resident was admitted to the facility on [DATE]. Further review of the record revealed an admission Minimum Data Set (MDS) was completed on 8/28/13, with an Assessment Reference Date (ARD) of 8/28/13. Review of the MDS revealed that although it was documented as completed on 8/28/13, multiple items of data had not been completed. Items G - J were not completed in Section G (Functional Status). Section N (Medications) was also blank. Review of this RAI revealed that it was not completed in accordance with Utilization Guidelines. For example, based on R4 ' s use of hypnotic medications (Refer to F329), the [MEDICAL CONDITION] Care Area Assessment (CAA) should have triggered for further review. The CAA for Dental Care should have also triggered for assessment, due to the coding in Section L of the MDS. However, review of the CAA Assessment Summary revealed that neither area was marked as triggering for assessment. Interview on 8/29/13 at 12:55pm with the MDS Coordinator revealed that although Section V was dated to indicate the assessment was completed on 8/28/13, it was not yet done. She related that therapy staff was responsible for obtaining the information in Section G about the resident ' s physical functioning status, and they had not provided it to her on time. She related that Section N was supposed to be completed by the Pharmacist; however, this section had not been done until 8/29/13. 2 Review of the clinical record revealed the R8 was admitted to the facility on [DATE]. Further review of the record revealed an admission MDS was dated as complete… | 2014-03-01 | ||
| 675 | 675 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 252 | C | ET9L12 | Based on observation, record review and interview during the follow up survey it was determine that the facility failed to ensure that each resident's dining experience was comfortable and homelike. This had the potential to affect all 27 residents in the facility on the day of the survey. Findings include: Deficiencies Not Corrected 1. During the follow up survey 1/22/14 and 1/23/14 at 8:05 am, tour at the facility and observations made during breakfast on of sample selection cases # 1, # 2,# 3, # 4, # 5 and # 6; revealed that residents were eating breakfast utilizing dishware consisting of paper plates, plastic cups and utensils. 2. Interview with the Dietitian (employee #7) on 1/23/14 at 1:00 pm revealed that they had available for use insulated food trays and silverware to be use with residents on breakfast lunch and dinner. She did not know why the facility was using paper plates, paper cups and plastic utensils. | 2014-03-01 | ||
| 674 | 674 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 249 | C | ET9L11 | Based on observation, interview, and record review, the facility failed to provide an activities program which was directed by a qualified professional. The failure to provide this program had the potential to affect all residents of the facility. Findings: Observation during all five days of the survey, 8/26 - 8/30/13, revealed only one recreational/therapeutic activity per day was provided. Residents were not invited to the activity and observation revealed that the activity provided by the Occupational Therapy (OT) student was not the activity scheduled on the facility calendar. Interview with the Occupational Therapist on 8/27/13 at 1:30pm revealed that although she was assisting with completing activity assessments and care plans, this was not her primary function and it could not always be completed on time. (Refer to F248.) Interview on 8/27/13 at 9:40am with the Minimum Data Set (MDS) Coordinator (through a Spanish-speaking interpreter) revealed that the facility did not currently have any recreational /therapeutic activity staff. The MDS Coordinator revealed that the previous staff person had resigned approximately two weeks earlier and had not yet been replaced. She stated that in the interim (while the facility was in the process of hiring a new Activity Director), the facility was using Occupational Therapy staff to offer activities. Further interview confirmed that the facility was only offering one activity per day (at 12:30pm) due to the lack of a qualified activity professional, as the OT staff had their own duties to perform the rest of the day. | 2014-03-01 | ||
| 673 | 673 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 248 | E | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide for an ongoing program of activities designed to meet the interests and the physical, mental, and psychosocial well-being for five of 10 sampled residents (R2, R3, R4, R5, and R8.) Findings: 1 Observation on 8/26/13 at 11:25am, 2:30pm, 3:15pm, 3:45pm; on 8/27/13 at 8:00am, 9:55am, 155pm, 3:15pm ; and on 8/28/13 at 9:00am, revealed R5 was either in bed or a chair in her room, with the door to the hallway closed. The resident was not observed to be engaged in any recreational activity other than watching television throughout all 5 days of the survey. Interview with R5 on 8/27/13 at 3:15pm revealed she liked puzzles, Sudoku and word finder games. She stated she routinely did them at home and would " very much " enjoy doing them while at the facility. Further interview revealed R5 had not been offered or participated in any activities during the time that she was in the facility. Review of the clinical record revealed R5 was admitted to the facility on [DATE] for rehabilitation therapy in response to fractures of the left femur and left humerus, which she sustained in fall. Further review revealed other [DIAGNOSES REDACTED]. Review of the admission assessment, dated 8/23/13, revealed R5 was alert and oriented to person, place, and time, and had no memory loss. Review of the admission orders terapia recreativa " (recreational therapy). However, review of the clinical record revealed no documented evidence that the resident had been evaluated for recreation therapy as of that date. Further review of the record revealed a pre-printed form titled, " Estimado de areas de Cuidado (CAA) Interdisciplinario " for CAA #10 - Actividades " (Interdisciplinary Care Area Assessments (CAA) for CAA #10 - Activities). Review of this initial Activity care plan revealed that although staff had documented the form was initiated on 8/23/13, the form contained no information other than … | 2014-03-01 | ||
| 672 | 672 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 246 | D | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to accommodate the physical needs of one of 10 sampled residents (R4.) Findings: Observation during initial tour on 8/26/13 at 11:25am revealed R4 was in bed and the resident ' s left arm was in a sling. Interview with Registered Nurse (RN) 48 and RN49, who were present during the tour, revealed the resident had recently had a fall with fractures. Further observation revealed the string to the overbed light was behind and to the left of the bed, out of the resident ' s reach. Observation of R4 on 8/26/13 at 2:30pm, 3:55pm; 8/27/13 at 7:55am, 1:10pm; 8/28/13 at 8:50am and on 8/30/13 at 8:30am, revealed that the string to operate the overbed light remained out of the reach of the resident, who was restrained in her bed by the use of side rails. (Refer to F221.) Interview with R4 on 8/26/13 at 2:30pm revealed that because of her left shoulder fracture, she could not use that arm to reach behind her bed and get the string to operate the overbed light. R4 further stated, that although she could use her right arm to operate devices (like her call light), the string to the light was not long enough to reach the right side of her bed and as a result, she was dependent on staff to turn the light on and off in her room. Further interview with R4 on 8/27/13 at 1:10pm revealed that if the string to the light were accessible, she would use it. Additional interview with R4 on 8/30/13 at 8:30am revealed the resident " would be pleased " if she could turn the light on and off when she wanted. Review of the clinical record revealed R4 was admitted to the facility on [DATE], S/P (status [REDACTED]. According to the admission MDS (Minimum Data Set) dated 8/28/13 the resident had no cognitive impairment, required extensive assistance from staff with bed mobility and had impairment in functional range of motion of the upper extremities on one side. During an interview on 8/30/13 at 8:30am, th… | 2014-03-01 | ||
| 671 | 671 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 226 | F | ET9L11 | Based on interview and record review, the facility failed to develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property. The failure to develop and operationalize policies and procedures relative to training employees and making required reports of allegations of abuse, neglect, mistreatment, and misappropriation of property, had the potential to affect all residents of the facility and constituted Substandard Quality of Care. Findings: 1. Reporting: During the entrance conference of the survey on 8/26/13 at 11:00am, interview with the Administrator revealed that that Registered Nurse (RN) 25 served as the Facility Abuse Coordinator and would be able to answer any questions regarding the facility ' s abuse and neglect prevention program. The facility provided an undated policy titled, " Manual de Normas y Procedimients Deteccion y Prevencion de Abuso y Negligencia " (Manual for the Norms and Procedures for Detection and Prevention of Abuse and Neglect) and stated that this was their abuse/neglect policy. Review of this policy revealed that under " Objectivos " (Objectives) the policy stated that it would use the seven components as a guide. However, review of this policy revealed that each of the seven required components was not addressed. Further review revealed the policy failed to provide procedures for reporting of allegations of abuse/neglect, misappropriation of resident property, and injuries of unknown origin which may indicate possible abuse or neglect. This policy failed to describe how and to whom residents, staff, and others should report suspected abuse and neglect. The policy also failed to describe the procedures the facility would use to report both initial allegations and the findings of each investigation to the State Survey Agency (SSA.) The policy did not reference time frames and failed to indicate that allegations of abuse must be reported immediately, while the findings of the investigation mus… | 2014-03-01 | ||
| 670 | 670 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2013-08-30 | 221 | E | ET9L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to ensure that each resident was free from physical restraints, unless needed to treat a medical symptom. Six of 10 sampled residents (R1, R3, R4, R5, R6 and R7) were restrained through the use of side rails for which there were no physician orders, assessments, care plans, or consent. Findings: 1. Observation of R5 during initial tour on 8/26/13 at 11:25am revealed the resident asleep in bed. Observation revealed the bed was equipped with four side rails (two ? rails per side) and three of the four rails (two top and one bottom) were in the up position. Observation of R5 on 8/26/13 at 2:20pm, 3:15pm, and 3:45pm; and 8/27/13 at 8:00am, and 3:15pm, also revealed that three of four side rails on the resident ' s bed were in the up position. Observation on 8/28/13 at 9:00am revealed R5 asleep in bed with all four side rails in the up position. An interview on 8/27/13 at 3:15pm with R5 revealed staff was raising the side rails because she had fallen at home. The resident, who was lying in bed with three of four side rails up, related that with the side rails raised, she could not get up and out of bed without help from staff. Review of the clinical record revealed R5 was admitted to the facility on [DATE] for rehabilitation therapy in response to fractures of the left femur and left humerus, which she sustained in a fall. Further review revealed the resident had additional [DIAGNOSES REDACTED]. According to the admission assessment, dated 8/23/13, R5 was alert and oriented to person, place, and time, and had no cognition issues. Review of admission orders [REDACTED]. There was no documented evidence the facility had assessed or provided a care plan for the use a restraint. Review of the " Protocolo de Residentes con Potencial a Caidas " (Protocol for Residents at Risk for Falls) in the clinical record revealed that it had been marked to indicate R5 was to have " uso de baran… | 2014-03-01 | ||
| 669 | 669 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 520 | C | OK6U11 | Based on the review of quality reports and interviews with the MDS coordinator (employee #3), it was determined that the facility failed to analyze and track quality issues for cases of residents who fell down while receiving services. Findings include: 1. Quarterly quality assurance committee meeting from the year of 2011 were reviewed on 3/15/12 at 11:55 am with the MDS coordinator (employee #3). The following was identified during the review: a. The facility's quality assurance activities related with the investigation and management of cases where residents fell down while receiving services were reviewed and discussed with the MDS coordinator (employee #3) on 3/15/12 at 11:45 am. Cases were presented and discussed on a trimester meeting four times a year. However patterns, tendencies and information related with the deviation from care processes and current practice standards that could influence the occurrence of falls were not performed, nor included as part of the case discussion. Committee meetings do not include evidence of quality assurance activities developed in order to improve facility resident fall prevention programs. | 2014-03-01 | ||
| 668 | 668 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 501 | G | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of ten resident's records, policies and procedures, interviews and observations, it was determined that the medical director failed to implement resident care policies related to weight, falls, pain, catheter use, respiratory therapy administration, glucose and laboratory monitoring and resident's change of status which could affect six out of twenty-nine admitted residents (residents #1, #2, #6, #7, #8 and random sample resident #11). Findings include: 1. A mechanism to ensure that the facility complies with State law #24 of June 4,1987 related with personnel qualified by law to administer respiratory therapy was not promoted as evidence by the following: a. Resident #2 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The Director of Nursing (employee #2) stated on 3/13/12 at 1:45 pm that respiratory therapy is administered by nursing personnel to the resident. The facility failed to comply with State law #24 of June 4,1987 which establishes that respiratory therapy must be administered by a respiratory therapist and supervised by a physician. 2. The facility failed to ensure that procedures to weigh residents are accurate as evidenced by the following: a. Resident #2 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The Licensed Practical Nurse (LPN) (employee #4) stated during an interview on 3/15/12 at 1:30 pm that residents are weighed in wheelchairs and the weight of the wheelchair is subtracted from the total weight and the resident's weight was 130 pounds as documented. She also stated that she did not remember the exact weight of the wheel chair, because each wheelchair weight is different. Resident #2 was weighed on 3/15/12 at 1:45 pm and the weight with the wheelchair was 174 pounds. When the facility subtracted the weight of the wheelchair, the resident's weight was 121 pounds. LPN (employee #4) and the MDS coordinator (employee #3) were interview… | 2014-03-01 | ||
| 667 | 667 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 465 | D | OK6U11 | Based on observations made during the physical environment survey with the facility's Director of Nursing (D.O.N), it was determined that the facility failed to ensure a safe, functional, sanitary and comfortable environment related to a wheel chair with the right arm rest with tape wrapped around it to keep it in place in resident's room #14 for the resident at bed "B" which could affect one out of twenty-nine affected residents (resident #2). Findings include: During the observational tour of the facility on 3/13/12 at 9:00 am, resident's room #14 was visited and it was found with a wheel chair with the right arm rest with tape wrapped around it to keep it in place for the resident at bed "B" which will not allow for proper disinfecting and is not the proper manner to secure the arm rest. | 2014-03-01 | ||
| 666 | 666 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 431 | F | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations of the medication storage area refrigerator and review of manufacturer's recommendations for medications with the Director of Nursing (employee #2), it was determined that the facility failed to ensure that medications and biologicals are not available for residents use that were expired (mult-dose vials of insulin that were found available for use after 28 days once started) and eye drops that past the date of expiration which could affect twenty-nine out of twenty-nine admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #22). Findings include: 1. One vial of Humulin R was found in the medication storage refrigerator on [DATE] at 9:30 am with a date opened on [DATE] which exceeds the 28 day limit to discard multi-use medications once opened. 2. One vial of Novolin ,[DATE] was found in the medication storage refrigerator on [DATE] at 9:32 am with a date opened on [DATE] which exceeds the 28 day limit to discard multi-use medications once opened. 3. One vial of Novolin R was found in the medication storage refrigerator on [DATE] at 9:34 am with a date opened on [DATE] which exceeds the 28 day limit to discard multi-use medications once opened. 4. One vial of Novolog was found in the medication storage refrigerator on [DATE] at 9:36 am with a date opened on [DATE] which exceeds the 28 day limit to discard multi-use medications once opened. 5. One vial of Humulin ,[DATE] was found in the medication storage refrigerator on [DATE] at 9:38 am with a date opened on [DATE] which exceeds the 28 day limit to discard multi-use medications once opened. 6. The medication refrigerator was found with three small eye drop containers with solution for the resident in room [ROOM NUMBER]B on [DATE] at 9:40 am, however the resident was discharged since [DATE]. | 2014-03-01 | ||
| 665 | 665 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 425 | E | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of ten medical records, observations during the medication pass, medication reconciliation and interview, it was determined that the facility failed to ensure that the medications and nutritional supplements that are available are provided to residents as ordered by the physician to meet the needs of two out of twenty-nine admitted residents (resident #2 and random sample resident #22). Findings include: 1. Resident #2 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. Juven was ordered for this resident due to his actual body weight of 130 pounds and the dietitian estimated that his desired weight should be 153 pounds. However no evidence was found in the resident's MAR that Juven was administered since it was ordered on [DATE]. Interview with the pharmacist (employee #6) on 3/15/12 at 10:00 am provided evidence that Juven is a nutritional supplement that should not have been transcribed in the MAR and should have been requested from the diet department. No evidence was found of the communication between nursing personnel and the pharmacist related to this nutritional supplement ordered for this resident after it was determined that it was not supplied by the pharmacy department. 2. Random sample resident #22 is a female who was admitted on [DATE]. During the medication reconciliation on 3/15/12 at 9:00 am, it was determined that the resident was receiving Xalatan and Mylanta. The medication administration nurse (employee #7) stated during an interview on 3/15/12 at 9:15 am that these medications were not available and the resident gave it to the facility and the leftovers will be given back to the resident when she leaves. The facility failed to ensure that medications that are ordered for the resident that are in the drug formulary are supplied by the facility. | 2014-03-01 | ||
| 664 | 664 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 371 | F | OK6U11 | Based on the kitchen observational tour, review of policies/procedures and interview, it was determined that the facility failed to store, maintain and prepare food in a safe and sanitary manner related to the failure to ensure that all food are labeled with the date of when they are received, storage of left-overs to be use for the slenderized diets, plastic spoons exposed to the environment, failed to operationalize procedures to ensure that relative humidity and temperatures of the enteral feeding room, humidity of dry food storage area are recorded and registered, to ensure that food is served to residents in a manner to enhance the foods appeal and no evidence was found of an emergency supply of food to be used in the event of a natural disaster which could affect twenty-nine out of twenty-nine admitted residents (residents #1 through #9 and random sample residents #1 through #20). Findings include: 1. During the kitchen observational tour performed with the dietitian (employee #5) on 3/14/12 from 9:30 am till 11:00 am, the following was observed: a. Four boxes of pastries located in a refrigerator near the steam table were observed without the date they were received at the kitchen. A mechanism to ensure that kitchen personnel use the "first in first out" rotation based on the date received was not promoted nor followed. b. One pot with cooked chicken, one with cooked rice and one with spaghetti tomato sauce were observed in the refrigerator covered with plastic wrap. The Dietitian (employee #5) stated during an interview on 3/14/12 at 9:39 am that the food in these pots are left-overs from the day before, that they are stored in the refrigerator and then used before 48 hours to prepare slenderized diets. According with chapter 3 of the food code requirements, leftovers must not be used for highly susceptible populations or people who receive food prepared by a health care center. c. A container with a large number of plastic spoons to be used when personnel serve during the food tray line were observed on … | 2014-03-01 | ||
| 663 | 663 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 334 | E | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of ten medical records and interviews with the MDS coordinator (employee #3) and pharmacist (employee #6), it was determined that the facility failed to ensure that residents are offered and receive influenza immunization from October 1 through March 31 annually and pneumococcal immunization unless the immunization is medically contraindicated for two out of ten records review (residents #2 and #9). Findings include: 1. The medical record of resident #2 was reviewed on 3/13/12 at 1:40 pm and it was found that the immunization screening was completed during admission to the facility. On the screening document it referred that the influenza vaccine and pneumococcal vaccine were not available at the facility to be used on the resident. 2. The MDS coordinator (employee #3) stated during an interview on 3/14/12 at 9:34 am that immunization screening is performed for each resident admitted to the facility in order to determine the residents' immunization status as established by facility policies and medicare requirements. However, the facility could not offer the influenza vaccine and pneumococcal vaccine because they did not have the vaccines available. 3. The pharmacist (employee #6) stated during an interview on 3/14/12 at 10:15 am that during the immunization season from October 1, 2011 through March 31, 2012, the facility did not have influenza vaccine available. Pneumococcal vaccines were not available for the year of 2011. She also stated that she did not have information about efforts made by the facility to acquire vaccines. 4. Resident #9 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. On 3/15/12 at 3:00 pm the medical record was reviewed and provided evidence that the immunization screening was completed during admission to the facility. On the screening document it referred that the influenza vaccine and pneumococcal vaccine were not available at the facility to be used on the res… | 2014-03-01 | ||
| 662 | 662 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 332 | E | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made during medication administration, review of clinical records and medication administration records and policies/procedures, it was determined that the facility failed to ensure that drugs are given as ordered by the physician for three out of fifty doses given for a medication error rate of 6% which affected two out of twenty-nine admitted residents (resident #2 and random sample resident #18). Findings include: 1. During the medication pass on 3/14/12 and 3/15/12 from 8:00 am till 9:45 am with two Registered Nurses (employee #7 and #8) (R.N) they failed to follow professional standards of practice based on the following observations: a. Observations were made of Registered Nurse (employee #7) during the medication administration to resident #2 on 3/14/12 at 8:30 am. The resident is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. When the R.N went to administer [MEDICATION NAME] .125 mgs and [MEDICATION NAME] 75 mgs he crushed them and then added them to a bottle of sterile water which contained approximately 100 ml of sterile water and then poured it into the resident's gastrostomy tube all at once. He then placed the bottle that he used to administer the medications on the top of the resident's night table and it was observed on 3/14/12 at 8:35 am with liquid and medication residuals still left in the bottle. According with the facility's policies/procedures, gastrostomy medications are to be dissolved with 30 ml of water and irrigated with 15 to 30 ml of water if it is for more than one medication. The facility failed to ensure that nursing personnel follow established procedures when administering crushed medications to ensure that the complete dose is administered. b. Random sample resident #18 was admitted on [DATE] with Deconditioning Syndrome and during the medication pass on 3/15/12 with RN #8, she administered [MEDICATION NAME] Inhaler. When the R.N administered the inhaler t… | 2014-03-01 | ||
| 661 | 661 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 323 | C | OK6U11 | Based on the review of ten medical records, policies/procedures, incident/accident reports and interview, with the MDS coordinator (employee #3), it was determined that the facility failed to ensure that resident's medical records include complete documentation that indicates the supervision to prevent falls for ten out of ten residents in the sample selection (residents #1 through #10). Findings include: 1. A mechanism to ensure that the facility includes documentation related with supervision to prevent falls was not complete, nor implemented or followed as reviewed on 3/15/12 at 1:45 pm for ten out of ten residents in the sample selection (residents #1 through #10): a. The facility has protocols for fall prevention that is to be used on every resident admitted to the facility in order to identify the potential for falls. Based on the initial assessment for fall risk, if the resident is considered for fall prevention protocol they must be supervised on rounds every two hours. Rounds must be performed by personnel in charge of the resident and documented on a form for fall prevention supervision. However the form used to document fall prevention supervision rounds were not found for cases reviewed where the fall prevention protocols were activated. The facility provided evidence that they are performing the initial fall prevention risk assessment and activating the protocol for fall prevention. However, the facility failed to operationalize the fall prevention protocol in order to improve surveillance performed by the facility to prevent falls. b. The fall prevention protocol is activated after a multi-disciplinary evaluation where various specialized disciplines (nursing, physical therapy, occupation therapy, treating physician recreative personnel and dietitian) assess the risk of the resident for falls. According with an interview with the MDS coordinator (employee #3) on 3/14/12 at 3:00 pm, the facility's fall prevention protocol has a multidisciplinary approach and must be performed in order to ensure that … | 2014-03-01 | ||
| 660 | 660 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 315 | D | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on ten records reviewed and policies/procedures, interview and observations during the initial tour with the Director of Nursing (employee #2), it was determined that facility personnel failed to promote and maintain a proper bladder training program for one out of ten residents (resident #1). Findings include: Resident #1 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The Director of Nursing (employee #2) stated on 3/13/12 at 8:10 am that the resident was catheterized every 4 hours since the admission for [MEDICAL CONDITION] post foley catheter during admission. The physician was interviewed on 3/14/12 at 10:30 am and he stated that the resident is retaining urine but she does not have a foley catheter because he decided to insert a catheter every four hours instead. During the record review performed on 3/14/12 at 11:30 pm it provided evidence that the resident was ordered to be catheterized every 4 hours. On 3/9/12 at 1:00 pm the physician's progress notes provided evidence that the relatives were informed that the resident was treated due to a urinary tract infection during her hospitalization . Also, the resident received [MEDICATION NAME] 5 mgs HS and laboratory results for PT and PTT were both elevated (PT 62.3, PTT 57.0 and INR 17.8 on 3/9/12) (PT 65.4, PTT 64.7, INR 19.4 on 3/12/12). On 3/9/12 and 3/12/12 the physician's progress notes provided evidence that a "hold" for [MEDICATION NAME] was placed for 5 days, observed for bleeding and administered Vitamin K 100 mg stat for 2 dosis. The physician's progress notes on 3/13/12 provided evidence that the resident continued with elevated PT/PTT and the resident was consulted with the primary physician. The nursing vital signs registration also provided evidence that on 3/11/12 the resident was not catheterized and on 3/12/12 the resident was only catheterized once. No evidence was found in the resident's record related of the facility's communic… | 2014-03-01 | ||
| 659 | 659 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 309 | G | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, ten records reviewed and interview, it was determined that the facility failed to provide the necessary care to monitor the residents' pain status and failed to ensure that nursing personnel notify the physician related to medical changes regarding weight gain and swollen extremities so that residents reach their highest practicable well-being for two out of twenty-nine admitted residents (resident #6 and random sample resident #11). Findings include: 1. Random sample resident #11 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED].#7) with discomfort and the pain assessment was performed. When the R.N asked the resident if she was in pain the resident stated on 3/14/12 at 8:15 am that she did not sleep at all the previous night due to the pain that she had. The resident was interviewed on 3/14/12 at 8:15 am and she stated that she continued with pain and from a scale of 1 through 10 with 10 being the worse, she had more than a 5. The resident also stated that she called the nursing counter around 4:00 am or 5:00 am this morning with a pain estimated at a level 10 and they showed up around 7:00 am to give her the pain medication and because the pain was strong it has not been alleviated yet. The Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The facility failed to ensure that pain medications were administered PRN as ordered by the physician to provide comfort for the resident round the clock which will allow the resident to reach attainable goals set for her recovery. 2. Resident #6 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. During the initial tour on 3/13/12 at 7:30 am the resident was observed in her room sitting in her wheel chair next to her bed and she stated that the night before she did not rest properly because s… | 2014-03-01 | ||
| 658 | 658 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 281 | G | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 9. The facility failed to ensure that procedures to weigh residents are accurate as evidenced by the following: a. Resident #2 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The Licensed Practical Nurse (LPN) (employee #4) stated during an interview on 3/15/12 at 1:30 pm that residents are weighed in wheelchairs and the weight of the wheelchair is subtracted from the total weight and the resident's weight was 130 pounds as documented. She also stated that she did not remember the exact weight of the wheel chair, because each wheelchair weight is different. Resident #2 was weighed on 3/15/12 at 1:45 pm and the weight with the wheelchair was 174 pounds. When the facility subtracted the weight of the wheelchair, the resident's weight was 121 pounds. LPN (employee #4) and the MDS coordinator (employee #3) were interviewed on 3/15/12 at 1:50 pm and they stated that the difference between the resident weight on 3/9/12 and on 3/15/12 (9 pounds) must be based on the type of wheelchair that was used to weigh the resident. However this could not verified because when the resident was weighed on 3/9/12 the weight of the wheel chair was not included in the documentation. The facility failed to follow a standardized procedure when weighing residents in order to reduce errors, increase accuracy and track weight changes for the resident overtime. b. Resident #7 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 3/15/12 at 9:00 am and provided evidence that the resident weighed 114 pounds when she was admitted to the facility on [DATE]. On 3/12/12 it was documented in the medical record that resident's weight was 114 pounds, the medical record did not include information of how the resident was weighed on 2/27/12 and on 3/12/12 (if patient was on a wheelchair, with a walker or standing position without any assistive devices). The resident's weight when st… | 2014-03-01 | ||
| 657 | 657 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 279 | E | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on ten resident's records reviewed, it was determined that the facility failed to ensure that the each member of the interdisciplinary team develops quantifiable objectives for the comprehensive plans of care for two out of ten residents in the sample selection (residents #3 and #4) related to Falls, Ulcers, Activities, Pain, Return to Community, [MEDICAL CONDITIONS] Drugs, Nutrition and ADLs. Findings include 1. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. participation of the Physician and Dietitian and the care plan for Nutrition did not include the participation of the Physician. The facility failed to ensure that the entire interdisciplinary team develops quantifiable objectives for the highest level of resident functioning. 2. Resident #4 is an [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 3/14/12 at 2:00 pm and provided evidence that interdisciplinary team plans of care were developed for: Ulcers, ADL, Activities and [MEDICAL CONDITION] Drugs but did not include the participation of the Physician and Dietitian, and for the plans of care developed for Pain, Falls and Nutrition no evidence was found of the participation of the Physician. The facility failed to ensure that the entire interdisciplinary team develops quantifiable objectives for the highest level of resident functioning. | 2014-03-01 | ||
| 656 | 656 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 257 | E | OK6U11 | Based on the observational tour of resident's rooms, temperature measurements and interviews during the survey for the physical environment, it was determined that the facility failed to ensure that eight out of eighteen resident's rooms during the initial tour (resident's rooms #3, #4, #6, #7, #8, #9, #10 and #17) (sample selection residents #3, #6, #8 and random sample residents #2, #4, #6, #7, #8 and #19) have appropriate temperatures for nine out of twenty-nine residents. Findings include: During the observational tour of resident's sleeping rooms performed on 3/13/12 from 7:00 am till 10:45 am and on 3/14/12 and 3/15/12 from 8:00 am till 9:00 am it was found that some resident's sleeping rooms were cold and resident's were lying in their beds with multiple blankets. The temperature of all sleeping rooms were taken with a laser thermometer provided by the facility and provided evidence that the temperatures ranged from 69?F through 73?F. Eight resident's rooms during the initial tour (#3, #4, #6, #7, #8, #9, #10 and #17) had temperatures less than 71? F and the residents in these rooms were interviewed (sample selection residents #3, #6, #8 and random sample residents #2, #4, #6, #7, #8 and #19) on 3/13/12 from 7:00 am till 10:45 am and they stated that they preferred the temperature of the room a little warmer so they did not need so many blankets. The facility failed to verify resident's room temperatures to ensure that the temperature range is between 71?F and 81?F, the facility must ensure this temperature range. The facility failed to verify with residents if they were comfortable in their rooms even when the temperature range is appropriate the resident shall receive a reasonable accomodation whether warmer or cooling the room temperature or room change. Periodic resident room temperatures shall be documented and resident verification of temperature comfort shall also be documented to ensure that residents can recuperate to their fullest potential. | 2014-03-01 | ||
| 655 | 655 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 248 | C | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Resident #6 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The record review was performed on 3/13/12 at 2:15 pm. The resident's 5 day MDS comprehensive assessment provided evidence on Section F Activity Preferences that the residents' response to all questions at F400 and F500 were "Very Important" and "Somewhat Important". Recreational daily progress notes were reviewed on 3/13/12 at 2:15 pm and it was found that the resident received a recreational therapy initial evaluation on 3/8/12 but no other evidence was found in the resident's record that she received activities since the 3/8/12 evaluation, which is not in accordance with the planned activities program. Based on the review of ten resident's medical records, it was determined that the facility failed to ensure that three out of ten records reviewed (residents #3, #4 and #6) received an ongoing activities program designed to meet the interests and the physical, mental and psychosocial well-being of their residents. Findings include: 1. Resident #3 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident's 5 day MDS comprehensive assessment provided evidence on Section F Activity Preferences that the residents' response to all questions at F400 and F500 were "Very Important". Recreational daily progress notes were reviewed on 3/13/12 at 3:00 pm and it was found that the resident did not receive recreational therapy on 3/3/12, 3/4/12, 3/10/12 and 3/11/12 which is not in accordance with the planned activities program. 2. Resident #4 is an [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 3/14/12 at 2:00 pm and describes a resident that needs Extensive Assistance with one to two persons to physically assist. The resident's 5 day MDS comprehensive assessment provided evidence on Section F Activity Preferences that it was not completed at F400 and F… | 2014-03-01 | ||
| 654 | 654 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 241 | G | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the initial observational tour of resident's rooms with the Director of Nursing (D.O.N) (employee #2) and interview, it was determined that the facility failed to ensure that residents receive services in a manner that maintains or enhances residents' dignity related to a resident without clothes lying under a blanket before her bed bath and a resident who did not have her disposable briefs changed when she called, which affected two out of twenty-nine admitted residents (random sample residents #4 and #17). Findings include: 1. Random sample resident #17 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. During the initial tour on 3/13/12 at 10:10 am, it was observed that the resident was resting in bed in a semi-sitting position, she did not have clothes on and was covered by her blanket and the air conditioner was on. The resident stated during an interview on 3/13/12 at 10:15 am that nursing personnel took off her clothes around fifteen minutes ago before preparing items for her bed bath. She also stated that the room felt cold. The facility failed to promote the resident's dignity during the procedure of the bed bath by leaving the resident alone in the room without clothes (under a blanket) and the air conditioner was on. 2. Random sample resident #4 is a [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was observed on 3/13/12 at 7:40 am during the initial tour with the Director of Nursing (D.O.N) (employee #2) when the resident was going to eat her breakfast. She stated that last night she did not rest well and she urinated about 4 or 5 times in the same disposable brief. She also stated that she was admitted yesterday in the afternoon and when she called for assistance last night no one came. Interview with the DON on 3/13/12 at 8:00 am provided evidence that last night there were two Licensed Practical Nurses (LPNs) and a Registered Nurse during the … | 2014-03-01 | ||
| 653 | 653 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 226 | C | OK6U11 | Based on the review of policies and procedures, facility in-service activities, personnel files and interview with the director of nursing (employee #2), it was determined that the facility failed to operationalize policies and procedures for screening and training employees who provide care at the skilled nursing facility. Findings include: 1. Review of policies and procedures related to Abuse and Neglect protocols and resident interventions on 3/15/12 at 9:00 am provided the following evidence: a. Abuse and Neglect in-service activities offered at the facility for the year of 2012 does not include all personnel who offer direct care to residents. b. According with policies and procedures provided by the facility, all personnel who offer direct care at the facility must receive abuse and neglect in-service training. c. Evidence presented by the facility of personnel who participated in the Abuse and Neglect in-service only include the registered nurses and licensed practical nurses. d. The director of nursing (employee #2) was interviewed on 3/15/12 at 9:36 am and she stated that only nursing personnel receive Abuse and Neglect training. | 2014-03-01 | ||
| 652 | 652 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 176 | E | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the initial observational tour and ten resident's medical records review with the MDS Coordinator (employee #3) and Director of Nursing (employee #2) and interview, it was determined that the facility failed to ensure that four out of twenty-nine admitted residents who self administer drugs are evaluated for the need of these drugs and authorized by the interdisciplinary group for the use of these drugs (residents #2, #3 and random sample residents #1 and #4). Findings include: 1. Resident #2 was observed during the initial tour with one bottle of "Miel Rosada" on the night table on 3/13/12 at 9:15 am. Nursing personnel (employee #12) stated during an interview on 3/14/12 at 11:10 am that he uses the "Miel Rosada" on the resident after he provides oral care. No evidence was found in the resident's record on 3/15/12 at 11:00 am during the medication reconciliation of the interdisciplinary groups' authorization of the use of this drug or that they knew the resident was using it. 2. Resident #3 was observed during the initial tour with a small bottle of [MEDICATION NAME] Lubricant Eye Drops on the night table on 3/13/12 at 7:20 am. The resident stated during an interview on 3/13/12 at 7:25 am that she uses the eye drops to help the burning sensation in her eyes. No evidence was found in the resident's record on 3/15/12 at 11:10 am and medication reconciliation, of the interdisciplinary groups' authorization of the use of this drug or that they knew the resident was using it. 3. Random sample resident #1 was observed during the initial tour with a large container of Fiber Therapy on the night table on 3/13/12 at 7:15 am. The resident stated during an interview on 3/15/12 at 11:30 am that she uses the fiber because occasionally she is constipated and it helps her go to the bathroom daily. No evidence was found in the resident's record on 3/15/12 at 11:35 am and medication reconciliation, of the interdisciplinary groups' authorization of t… | 2014-03-01 | ||
| 651 | 651 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 167 | C | OK6U11 | Based on observations during the initial tour of the facility and interview with the administrator (employee #1), it was determined that the facility failed to ensure that residents have the most recent Medicare survey results available which could affect twenty-nine out of twenty-nine admitted residents (residents #1 through #9 and random sample residents #1 through #20). Findings include: Results of the most recent Medicare inspection performed at the facility was not observed available for residents to review on 3/13/12 at 7:30 am. The administrator (employee #1) stated during an interview on 3/13/12 at 7:55 am that the last inspection report was located in a drawer in front of the counter of the nurse's station, however the drawer was found empty. | 2014-03-01 | ||
| 650 | 650 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 164 | E | OK6U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations made during the initial tour, it was determined that the facility failed to promote the residents' right for personal privacy during bathing procedures for two out of twenty-nine admitted residents (resident #2 and random sample resident #6). Findings include: 1. Resident #2 is a [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. During the initial tour on 3/13/12 at 10:00 am, it was observed that the resident was sitting on a wheelchair with disposable briefs on top of an underpad before nursing personnel (employee #10) took the resident into the shower. The resident's room door was in the closed position, however the resident was left exposed to persons entering and leaving the room while the nurse prepared the shower for the resident. The facility failed to provide privacy for this resident from staff and other persons who entered the room while he was waiting to be showered. 2. During the tour of the room of random sample resident #6 (female resident) on 3/13/12 at 10:30 am, nursing personnel were giving her a bed bath. The Licensed Practical Nurse (LPN) (employee #9) closed the door to provide privacy for this resident, however the curtains did not close completely and the resident's back side could be seen from one of the sides of the curtain when staff entered the resident's room. The facility failed to to ensure that the patient was treated with respect and is provided privacy during the bed bath. The resident's bed is near the front door which does not ensure the residents' privacy during the bathing process if the curtain is not drawn properly. | 2014-03-01 | ||
| 649 | 649 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2012-03-15 | 156 | C | OK6U11 | Based on the review of ten medical records with the MDS coordinator (employee #3) and social worker (employee #7) and interview, it was determined that the facility failed to provide medicare recipients the important message from medicare about rights and information related to resident's rights during the stay at the facility as well as the medicare appeal right related to the facility's discharge, this deficient practice was identified for ten out of ten residents of the sample selection (residents #1 through #10). Findings include: 1. The following was identified during the review of ten medical records with the facility's MDS coordinator (employee #3) from 3/13/12 through 3/15/12 from 8:00 am till 3:00 pm: a. The facility has not implemented a mechanism to ensure that the important message from medicare about rights and information related to the resident's rights during the facility stay as well as the medicare appeal right related to the facility's discharge was provided to each medicare resident admitted to the facility to receive services. The Social Worker (employee #7) stated during interview on 3/13/12 at 3:00 pm that this important message from medicare was not provided to residents or relatives during admission. The facility failed to promote the right of each resident to be informed upon admission of their right as a medicare resident and the discharge appeal right. | 2014-03-01 | ||
| 648 | 648 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 520 | F | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the complaint investigation (PR 430), review of quality reports and interviews with the Director of Nursing (employee #2) and Quality Assurance Officer (employee #14), it was determined that the facility failed to analyze and track quality issues for cases of residents who fell down while receiving rehabilitative services which was found for one out of ten records reviewed (closed sample selection resident #10). Also, no evidence was found of quality related to monitoring and evaluating established time frames to evaluate Laboratory results (This finding is not related to the complaint case investigation). Findings include: 1. Facility Quality Assurance Activity Plan and Indicators related with the investigation and management of cases where residents fall down while receiving rehabilitative services were reviewed with the quality assurance officer (employee #14) on 2/17/11 at 9:45 am. These reports revealed that for the year of 2010, four residents fell down in their rooms while receiving assistance from a relative who came to visit. Special provisions in order to deal with the incidents related to a pattern of the occurrence in order to avoid the prevalence of the occurrence were not taken, documented or discussed during the quality assurance committee meetings or evidenced as part of quality assurance activities related with fall prevention. 2. Incident and accidents reports for the month of January of 2011 were reviewed with quality assurance officer (employee #14) on 2/17/11 at 10:15 am. During this month an incident occurred related with an [AGE] years old female resident with a [DIAGNOSES REDACTED]. The incident report was documented by a registered nurse from the shift of the event and she wrote that the Licensed Practical Nurse (LPN) had the resident (sample selection resident #10) in the bathroom assisting her with a shower when the LPN left the resident alone and the resident fell down while picking up a bar of soap from t… | 2014-03-01 | ||
| 647 | 647 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 501 | G | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on initial tour observations, review of records and policies/procedures (P&P) and interview, it was determined that the facility failed to provide the necessary care and monitoring related to glucose levels and the medical director failed to show responsibility for the coordination of medical care in the facility to ensure that resident's reach their highest practicable well-being for one out of nine residents (sample selection resident #7). Findings include: Sample selection resident #7 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/16/11 at 3:15 pm and provided evidence that the resident's cognitive pattern on the five-day minimum data set (MDS) performed on 2/16/11 describes a resident who does not have memory problems, behavior symptoms or change in mood. The MDS also provided evidence that the resident requires partially/limited assistance for bed mobility, transferring, eating, personal hygiene, toilet use and bathing. The resident was observed during the second day of the survey with generalized malaise and shaking. During interview on 2/16/11 at 8:30 am the resident stated that she did not rest well last night and she did not feel well. The RAPs identified concerns with ADL Functional, Nutritional Status, Falls and Pain. The clinical dietitian in the initial assessment on 2/11/11 at 11:30 am recommends a diabetic diet of 1,400 kcal, high fiber, nutritional supplement with bedtime snack. The dietitian also recommends glucose control to help meet her needs, due to poor appetite. The resident is receiving [MEDICATION NAME] 5 mgs orally (PO) daily and [MEDICATION NAME] 4 mg PO daily and the nursing staff performed glucose levels two times a day (6:00 am and 4:00 pm). On 2/14/11 at 6:00 am the resident's "Diabetic Chart" provided evidence that glucose levels were 55 mg/ml at 6:00 am and at 4:00 pm it was 56 mg/ml, on 2/15/11 at 6:00 am it was 74 mg/dl and at … | 2014-03-01 | ||
| 646 | 646 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 465 | F | 5V0111 | Based on tests and observations made during the physical environment survey with the Safety Officer (employee #6) and interview, it was determined that the facility failed to ensure a safe, functional, sanitary and comfortable environment related to a bathroom pull cord tied to the grab bar, a paper dispenser is not appropriate for a resident's room, there is ceiling damage in a resident's room, an air conditioner is noisy, a light is needed in the walk in freezer of the kitchen and electrical circuit breaker panels have empty spaces between breaker switches which could affect thirty-five out of thirty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #26). Findings include: 1. The following was found during the initial observational tour of the facility on 2/15/11 from 7:10 am till 10:00 am: a. The paper towel dispenser located in resident's room #10 is located too close to the hand sink and it does not have a handle to lower the paper. b. The ceiling near resident's bed "B" of room #16 was found with water damage. 2. The air conditioner in resident's room #17A makes a loud noise when the thermostat activates the air conditioner to turn on or off as found on 2/15/11 at 9:25 am. The resident in room #17 (random sample resident #23) was interviewed on 2/15/11 at 9:30 am and he stated that the air conditioner makes a lot of noise but he has not notified this situation to facility personnel. Residents' rooms shall be verified for Air Conditioner units that make excess noise when the thermostat is activated to ensure that residents can rest comfortably during the day or night. 3. The emergency pull cord located near the toilet in resident's room #12 (random sample residents #15, #16 and #17) was found on 2/15/11 at 9:45 am tied to the grab bar and it was activated and it worked. However, if a resident is falls to the floor the cord can not be reached. The cord was immediately released by the Safety Officer (employee #6) and all other rooms were checked, however t… | 2014-03-01 | ||
| 645 | 645 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 441 | F | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. During the observational tour of resident's sleeping rooms performed on 2/15/11 from 7:10 am till 10:00 am, Licensed Practical Nurses (LPNs) were observed changing resident's bed linens and the following was found: a. A LPN (employee #3) was observed in resident's room [ROOM NUMBER] (random sample residents #7 and #8) after she showered the residents and changed the resident's bed linens. She placed the dirty bed linens that she removed from the resident's beds on the biohazardous container and after she helped random sample resident #7 to her bed, the LPN grabbed the dirty linen in her hands without gloves and opened the resident's door and because there wasn't a dirty hamper near the door she walked in the hallway with the dirty linen until the hamper near resident's room [ROOM NUMBER] (approximately 20 to 25 feet). b. A LPN (employee #4) was observed leaving resident's room [ROOM NUMBER] (random sample residents #23 and #24) walking in the hallway with dirty bed linen without gloves on. The LPN was holding the dirty linen against her uniform until she deposited them in the hallway hamper in front of resident's room [ROOM NUMBER] (approximately 25 to 30 feet). When she opened the lid of the hamper she pushed the linen into the hamper because it was full. (The facility failed to ensure that nursing personnel use appropriate hand protection when handling dirty linen, properly transport linen through the facility hallways and have an accessible hamper to dispose of the dirty linen to reduce the possible risk of cross contamination). 3. Resident's ice packs were observed from 2/15/11 through 2/17/11 from 7:00 am through 4:00 pm hanging from window operators, near hand sinks, in bathrooms, on night tables, on food tray stands and over resident's blankets. These ice packs are used exclusively for that particular resident, however the placement of these ice packs exposes them to environmental factors and possible cross contamination and shall b… | 2014-03-01 | ||
| 644 | 644 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 371 | F | 5V0111 | Based on the kitchen observational tour, review of policies/procedures and interview, it was determined that the facility failed to store, maintain and prepare food in a safe and sanitary manner related to trays placed on the steam table, lids of pots and pans without handles, the dish washer employee did not properly use the test strip on the sanitizer of the third sink, dirty containers with spices, dented cans in the dry storage room, the dish washer was not working, the facility is using Styrofoam trays to place resident's food on and the food server did not know the measurements of the spoons and ladles that he was using during food tray assembly which could affect thirty-five out of thirty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #26). Findings include: 1. During the kitchen observational tour performed with the dietitian (employee #5) on 2/15/11 from 10:30 am till 12:00 noon, the following was observed: a. Four containers of spices were observed at 10:40 am under a table near a supply shelf in the kitchen. They were observed without caps and the containers were found dirty (ginger powder, chili powder, curry powder and one with meat tenderizer). These spice containers were discarded by the dietitian (employee #5). b. One container with "adobo criollo" a local spice (16 ounces) was observed with a date when opened of 5/6/2009. c. The three compartment sink was observed after the dish washing process. The first compartment was observed with water and soap, the second compartment had water and the third compartment was observed with sanitizing solution. The sink with the sanitizing solution was tested by employee #7 with a test strip and he was observed introducing the test strip and leaving it in the water for approximately 30-45 seconds. The test strip provided evidence that the sanitizing solution registered 400 ppm and not 200 ppm as required. Review of the test strip vial provided evidence that the test strip is to be placed and removed imme… | 2014-03-01 | ||
| 643 | 643 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 309 | G | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on initial tour observations, review of records and policies/procedures (P&P) and interview, it was determined that the facility failed to provide necessary care monitoring and documenting glucose levels to ensure that resident's reach their highest practicable well-being for one out of ten residents in the sample selection (sample selection resident #7). Findings include: Sample selection resident #7 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The clinical record was reviewed on 2/16/11 at 3:15 pm and provided evidence that the resident's cognitive pattern on the five-day minimum data set (MDS) performed on 2/16/11 describes a resident who does not have memory problems, behavior symptoms or change in mood. The MDS also provided evidence that the resident requires partially/limited assistance for bed mobility, transferring, eating, personal hygiene, toilet use and bathing. The resident was observed during the second day of the survey with generalized malaise and shaking. During interview on 2/16/11 at 8:30 am the resident stated that she did not rest well last night and she did not feel well. The RAPs identified concerns with ADL Functional, Nutritional Status, Falls and Pain. The clinical dietitian in the initial assessment on 2/11/11 at 11:30 am recommends a diabetic diet of 1,400 kcal, high fiber, nutritional supplement with bedtime snack. The dietitian also recommends glucose control to help meet her needs, due to poor appetite. The resident is receiving [MEDICATION NAME] 5 mgs orally (PO) daily and [MEDICATION NAME] 4 mg PO daily and the nursing staff performed glucose levels two times a day (6:00 am and 4:00 pm). On 2/14/11 at 6:00 am the resident's "Diabetic Chart" provided evidence that glucose levels were 55 mg/ml at 6:00 am and at 4:00 pm it was 56 mg/ml, on 2/15/11 at 6:00 am it was 74 mg/dl and at 4:00 pm it was 58 mg/ml and on 2/16/11 at 6:00 am it was 48 mg/dl and at 4:00 pm it was … | 2014-03-01 | ||
| 642 | 642 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 281 | F | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. A mechanism to ensure that nursing re-assessments are performed in cases where the nurse has interventions with the resident based on the initial assessment of needs according with standards of practice was not followed nor performed. a. Sample selection resident #2 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was admitted for rehabilitation to receive Occupational Therapy, Physical Therapy and Recreational Therapy. On 2/9/11 at 10:50 am while was receiving physical therapy the resident complained of nausea and dizziness and was sent to the ward to be evaluated by the physician. The resident was evaluated by the physician who ordered a CBC and diff sample and [MEDICATION NAME] 10 mgs intramuscular for one dose. Treatment was offered, however no evidence was found of nursing progress notes from the 6-2 shift describing the status of the resident after the administration of the medication on 2/9/11 at 10:45 am. The results of the resident's CBC & Diff blood sample were evaluated and discussed with the resident. No evidence was found of nursing progress notes from the 6-2 shift describing the status of the resident and the dizzy episode that she had in the physical therapy area. On 2/11/11 at 10:20 am while she was receiving physical therapy the resident complained of dizziness and was sent to the ward to be evaluated by the physician. The resident was evaluated and the physician discontinued [MEDICATION NAME] PO (orally) and ordered [MEDICATION NAME] 10 mgs intramuscular stat, [MEDICATION NAME] 10 mgs PO every eight hours and [MEDICATION NAME] 50 mgs every six hours for pain. Treatment was offered however, no evidence was found of nursing progress notes from the 6-2 shift which describes the status of the resident after the administration of the medications. On 2/16/11 at 5:30 pm the resident presented nausea and the nurse called the physician to inform the residents' status. The physician… | 2014-03-01 | ||
| 641 | 641 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 257 | C | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the observational tour of resident's rooms, temperature measurements and interviews during the survey for the physical environment, it was determined that the facility failed to ensure that four out of eighteen resident's rooms during the initial tour (resident's rooms #4, #6, #11 and #16) (sample selection resident #9 and random sample residents #4, #5, #7, #8, #13, #14, #21 and #22) have appropriate temperatures and one out of thirty-five residents was not comfortable related to the room being too cold (sample selection resident #5). Findings include: During the observational tour of resident's sleeping rooms performed on 2/15/11 from 7:10 am till 10:00 am and on 2/16/11 and 2/17/11 from 8:00 am till 9:00 am it was found that some resident's sleeping rooms were cold and resident's were lying in their beds with multiple blankets. The temperature of all sleeping rooms were taken with a laser thermometer ("Tel Fast 2 laser") and provided evidence that the temperatures ranged from 70?F through 75?F. Four resident's rooms had a temperature of 70? F (rooms #4, #6, #11 and #16) and the residents in these rooms were interviewed (sample selection resident #9 and random sample residents #4, #5, #7, #8, #13, #14, #21 and #22) on 2/15/11 from 7:30 am till 8:15 am and on 2/16/11 from 8:00 am till 8:30 am and they stated that they preferred the temperature of the room like it was because they like to sleep covered in blankets. On 2/15/11 at 8:00 am the temperature of resident's room [ROOM NUMBER] was recorded at 71?F with the laser thermometer and the resident at bed "B" (random sample resident #10) was lying in bed uncovered and she had on a pair of short pants and a short sleeve shirt and she stated on 2/15/11 at 8:05 am that she was very comfortable, however the resident at bed "A" (sample selection resident #5) stated that she felt very cold and she did not like the temperature of the room. This was brought to the attention of the Director o… | 2014-03-01 | ||
| 640 | 640 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 241 | D | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the initial observational tour of resident's rooms with a Registered Nurse (RN) (employee #1) and interview, it was determined that the facility failed to ensure that residents receive services in a manner that maintains or enhances the residents' dignity related to verbally announcing that they were going to change the resident's "Pampers" which could be heard by the resident's roommate for one out of thirty-five admitted residents (Random Sample resident #25). Findings include: During the observational tour of resident's room [ROOM NUMBER] on 2/15/11 at 9:10 am with Registered Nurse (R.N) (employee #1), random sample resident #25 was observed lying on her bed and she was asked if everything was all right and she stated on 2/15/11 at 9:10 am that she was waiting for someone to change her disposable briefs. The resident stated that she can not control her bladder but staff come quickly to change the disposable briefs as soon as she calls. After the interview with the resident, the surveyors started walking out of the room and in a voice that could easily be heard by the resident in bed "A" (random sample resident #26) the R.N stated that she would send in a Licensed Practical Nurse (LPN) "to change her Pampers". The facility failed to ensure that personnel promote care in a manner that maintains or enhanced the resident's dignity and respect related to her self-esteem and self-worth. | 2014-03-01 | ||
| 639 | 639 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 226 | D | 5V0111 | Based on the review of policies and procedures and interviews with nursing personnel related to the abuse and neglect protocol of the facility, it was determined that the facility failed to ensure that personnel are aware of policies and procedures on how to channel situations related with abuse and neglect (nursing personnel employee #21). Findings include: Review of policies and procedures related to Abuse and Neglect and interviews with nursing personnel related to the abuse and neglect protocol at the facility, it was found that one licensed practical nurse (employee #21) stated during an interview on 2/17/11 at 9:00 am that she did not remember how to channel situations related with abuse and neglect. | 2014-03-01 | ||
| 638 | 638 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 224 | G | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the complaint investigation (PR 430), review of policies and procedures and review of ten resident's medical records with the Director of Nursing (D.O.N) (employee #2), it was determined that the facility failed to operationalize and implement policies and procedures to promote a safe environment for one out of ten residents who receive care at the facility in order to avoid physical harm (sample selection resident #10-closed record). Findings include: Resident #10 is an [AGE] years old female who was admitted on [DATE] with a [DIAGNOSES REDACTED]. During the record review on 2/17/11 at 9:00 am, the functional status and activities of daily living (ADL) assistance on the 14 days Minimum Data Set (MDS) assessment was identified that the resident had improved since her admission to the facility, needs physical help in part of bathing activity and the ADL support must be provided by one person. On 1/30/11 at 11:00 am the resident was receiving a bath in the shower with the assistance of a Licensed Practical Nurse (LPN) when she fell down to the floor, after the fall the resident complained of a severe pain of the right leg. The resident was evaluated by the physician on 1/30/11 at 11:25 am and ordered [MEDICATION NAME] 30 mgs intramuscular and transfer to a hospital to receive an evaluation and treatment. A registered nurse (employee #20) in charge of documenting the incident report writes that the LPN was with the resident in the bathroom assisting during a shower, when the LPN left the room and left the resident alone and that the resident fell down while picking up a bar soap from the floor (but does not sign her name under this statement). The same report has written evidence that the LPN (employee #13) involved in the incident did not admit that she left the resident alone in the bathroom. The resident was transferred to another facility for evaluation and treatment on 1/30/11. According with information given by the ombudsman offi… | 2014-03-01 | ||
| 637 | 637 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 164 | F | 5V0111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. During the medication drug pass on 2/16/11 from 8:45 am till 10:23 am, it was found that the RN (employee #11) was preparing medications for the resident in room [ROOM NUMBER]A (random sample resident #1). When the RN went to administer the [MEDICATION NAME] 30 mgs subcutaneously, she exposed the resident's abdominal area and closed the curtain but left a side of the bed uncovered by the curtain leaving the resident exposed while she administered the medication. 3. During the medication drug pass on 2/16/11 from 8:45 am till 10:23 am, it was found that the RN (employee #11) was preparing medications for the resident in room [ROOM NUMBER]A (sample selection resident #7). When the RN went to administer the [MEDICATION NAME] 30 mgs subcutaneously, she exposed the resident's abdominal area and closed the curtain but left a side of the bed uncovered by the curtain leaving the resident exposed while she administered the medication. Based on observations made during the initial tour with a Registered Nurse (RN) (employee #1), it was determined that the facility failed to promote residents' right for personal privacy before entering resident's rooms to ensure that they were willing to receive visitors which was observed at eighteen out of eighteen resident's rooms which could affect thirty-five out of thirty-five admitted residents (sample selection residents #1 through #9 and random sample residents #1 through #26) and failed to draw the curtains in resident's rooms #2A and #3A during [MEDICATION NAME] injection administrations for sample selection resident #7 and random sample resident #1. Findings include: 1. During the initial tour observational tour of resident's rooms on 2/15/11 from 7:10 am through 10:00 am the registered nurse (RN) (employee #1) failed to knock on resident's doors before entering. When the RN failed to knock before entering resident's rooms, she could not verify if the residents were willing to receiving a visit or if they… | 2014-03-01 | ||
| 636 | 636 | THE MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE | 405028 | CALLE COSME REPARTO SAN LUCAS SECTOR CANEJAS | RIO PIEDRAS | PR | 926 | 2011-02-17 | 151 | C | 5V0111 | Based on observations and interviews, it was determined that the facility failed to promote the right of residents to know and distinguish personnel in charge of their direct care which could affect thirty-five out of thirty-five admitted residents (residents #1 through #9 and random sample residents #1 through #26). Findings include: 1. Observations made during of the initial tour on 2/15/11 from 7:25 am through 10:00 am provided evidence of the following: a. Facility employees #3, #12 and #13 were observed dressed in light violet scrub uniforms giving direct care (changing bed sheets and providing resident care) to residents. These employees did not have identification or name tags in order to be identified by the residents, visitors, resident's relatives and other persons at the facility. The facility's Director of Nursing (D.O.N) (employee #2) stated during an interview on 2/16/11 at 2:23 pm that these personnel were licensed practical nurses (LPNs). b. Facility employee #4 was observed dressed in a pink scrub uniform giving direct care (changing bed sheets and providing resident care) to residents. This employee did not have identification or name tag in order to be identified by the residents, visitors, resident's relatives and other persons at the facility. The facility's Director of Nursing (D.O.N) (employee #2) stated during an interview on 2/16/11 at 2:27 pm that this person is a new licensed practical nurse (LPN), who does not have a light violet scrub uniform that are used by the LPNs at this facility. 2. Observations made during the observational tour on 2/16/11 from 8:12 am through 10:00 am provided evidence of the following: a. A facility registered nurse (RN) (employee #11) was observed preparing the medication cart in order to begin the medication pass. She was observed dress in a white nurse's uniform without a name tag or identification. The facility's nursing supervisor (employee #2) stated during an interview on 2/16/11 at 8:15 am that she is a registered nurse. b. Facility employee #10 was o… | 2014-03-01 | ||
| 635 | 635 | SAN JUAN AGING CENTER | 405021 | 65 INF AVE K3 H4 | RIO PIEDRAS | PR | 924 | 2013-08-23 | 371 | F | ROUJ12 | Based on observation, interview and facility records, policies and procedures, it was determined that the facility failed to ensure that food temperatures were taken accurately, failed to ensure that the internal temperature of the freezer was accurate and failed to ensure that the temperature and humidity in the dry storage room were within acceptable ranges. The facility failed to maintain a system of labeling and dating food items in all storage areas to ensure that food items were not outdated. The facility failed to ensure that the pots were sanitized effectively and that the test to determine the concentration of the sanitizer was performed accurately. The facility failed to ensure that ceilings were maintained in sanitary condition over the food preparation area and in the food storage areas and failed to ensure that the hand washing area and sinks were equipped to prevent cross contamination of food for consumption. Findings include: Deficiencies not corrected An initial tour of the kitchen was conducted on 1/31/14, from 9:35 A.M. until approximately 11:00 A.M., on the follow up survey in the presence of the kitchen supervisor and facility administrator. An interview was conducted with the supervisor at the tour. He explained that he works for the FAZAA Food Service that is contracted by the facility and that the FAZAA Food Service Director for the facility is on site from 5:00 A.M. to 7:00 A.M., two days a week. 1.As we toured the dishwasher area, missing ceiling tiles and tiles with holes and with brown and black stains were observed over the area where clean trays were stacked. Three of six lights were observed to be missing over the food tray line area. 2. Rust was observed on the bottom of the urn. The gauge meter holder on the urn was observed to be peeling and in disrepair. The supervisor stated that it was broken. Rust was noted on the edge of the stem table and below the ignition buttons and the glass was unclean. 3.Upon entering the enteral feeding storage and preparation room, dust was observed… | 2014-03-01 | ||
| 634 | 634 | SAN JUAN AGING CENTER | 405021 | 65 INF AVE K3 H4 | RIO PIEDRAS | PR | 924 | 2013-08-23 | 441 | D | ROUJ11 | Based on observation and interview, the facility failed to ensure that dressing changes were done in a manner which would not spread infection between staff and patients. Findings are: A dressing change of a recent surgurical procedure was observed for Resident #3 on 8/23/13 starting at 9 A.M. The wound care nurse performed the dressing change. Before the dressing change began, one surveyor asked her if she required assistance and she replied that she did not. Several times during the course of the dressing change, the wound care nurse's glasses fell down onto her nose where she was unable to see. She asked the surveyors who were observing the dressing change to move her glasses up to the bridge of her nose several times. At one point in the dressing change, the nurse's glasses fell off her face entirely and onto the bed where the patient was laying. She picked the glasses up with a gloved hand and placed them on the bedside cabinet. She then wiped the glasses with an alcohol gauze and replaced them to her face. She, therefore, may have contaminated the patient's bed who had an open wound with her personal glasses and may have placed contaminated glasses on her face after they were only quickly wiped with the alcohol swab. | 2014-03-01 | ||
| 633 | 633 | SAN JUAN AGING CENTER | 405021 | 65 INF AVE K3 H4 | RIO PIEDRAS | PR | 924 | 2013-08-23 | 520 | F | ROUJ11 | This requirement is not met. Based on interviews, record reviews, the facility did not have a Quality Assurance Committee which addressed problems/issues in the nursing home, did not address problems on an ongoing basis changing their indicators as necessary and including staff in the QA committee meetings to bring attention to problems which could be addressed. Findings are: Based on interviews with the Medical Director of Utilization Review and the Quality Assurance Coordinator on 8/22/2013, all 7 facilities administered by the Municipal County of San Juan used the same QA forms. These were checked off as met or not met. The same forms have been used as required by the County Administrator with no attempt to individualize indicators to San Juan Aging as described by the Director of Utilization Review. The QA Coordinator and the Director of Utilization Review stated that the committee did meet quarterly and only these forms were presented. They indicated that the four members of the committee were the Administrator, the Director of QA, the Director of Utilization Review and the Director of Nursing Services. No other disciplines or professionals were represented. Among the staff who did not attend were Physical Therapy, Housekeeping and Maintenance, Social Work, the Medical Director, Dietary Services and a representative from the kitchen or the contractor providing food service. At a meeting with the Administrator held on 8/23/2013, the absence of a QA Committee meeting the requirements required by the federal regulations was brought to his attention. He agreed that the above-mentioned professionals or their representatives were not represented. | 2014-03-01 | ||
| 632 | 632 | SAN JUAN AGING CENTER | 405021 | 65 INF AVE K3 H4 | RIO PIEDRAS | PR | 924 | 2013-08-23 | 465 | F | ROUJ11 | Based on observation and interview, the facility failed to provide a safe and comfortable environment for the patients. Findings are: On a tour of the residential rooms on 8/19/2013 with the nursing supervisor, multiple areas of poor maintenance and failure to repair the physical plant were observed. These included broken ceiling tiles, caused by leakage from the ceiling, broken door handles on closets, warped and broken wood on the edges of doors and door frames, peeling paint, broken Venetian blinds. Several doors to rooms had holes in the door where door handles had been removed. and the holes not repaired. Specifics for rooms include: Room 514 - Due to broken and warped wood on the bathroom door frame, the door to the bathroom was hard to open and close. Room 515 - Peeling paint on the wall near the bathroom; cracked and peeling paint on the bathroom doorframe. Room 516 - Broken handle on the closet door, chipped paint on the closet door. Room 517 - Open tiles in the ceiling. (The tiles had been moved and not set back in place.) Room 518 -Wood chipped off on doorframe to room, broken handle on closet door, chipped paint on the closet door. Room 519 - Rusted drain cover in the sink, wooden chips broken off on door to room, handle on closet door broken. Room 520 - Broken drawer in cabinet by the sink, broken Venetian blinds, door to room had multiple areas of wood chipped away, holes through door where a previous door handle had been replaced. Room 523 - loose ceiling tiles. Room 524 - Broken Venetian blinds. Room 525 - Broken handle on closet door with missing pieces, sharp edges on which someone could cut himself, hot water comes out of sink slowly and leaks, | 2014-03-01 |
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CREATE TABLE [cms_PR] ( [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 );