Sky View Rehabilitation and Health Care Center, LLC

Based on observation and interview, the facility did not ensure that areas occupied or used by residents and staff were well maintained. This was related to walls, doors and a wheelchair, which was evident on 2 of 5 floors (third and fourth floors). This had the potential for more than minimal harm that was not immediate jeopardy.

The findings are:

1. On 7/26/10 during the initial tour and on 7/28/10 in the afternoon the corner walls adjacent to the bathrooms in resident rooms were noted to be ripped at the lower end of the walls. The vinyl baseboard trimming below these areas were also ripped and separating from the walls These rooms included 14 rooms on the third floor (302, 303, 304, 305, 307, 308, 309, 311, 312, 315, 317, 322, 325, and 327) and 4 rooms on the fourth floor (422, 424, 426 and 427).

2. On 7/28/10 It was also noted that the lower portions of the heavy duty vinyl covering on 3 closet doors in resident rooms (315, 318, and 420) were separated from the doors, bent and protruding in the walk way in the room. This condition posed a accident hazard, i.e. skin tears or lacerations.

The above condition was brought to the attention of the Director of Maintenance on 7/2910 in the afternoon. At that time he stated that the condition would be addressed.

3. Resident #14 was observed on 7/26/10 seated in a soiled wheelchair which was encrusted with spilled food materials on both armrest and the frame. On 7/29/10 in the afternoon, during an interview, the Director of Housekeeping stated that resident wheelchairs are cleaned monthly and as necessary if requested by nursing. He further stated that this resident's wheelchair was last cleaned routinely on 7/1/10.

415.29

Based on observation, record review and interviews the facility did not ensure that a resident received services to prevent a potential decline in her ability to ambulate. This was evident for 1 of 7 residents reviewed for Activities of Daily Living (ADL) Resident #3.
This resulted in no actual harm with the potential for more than minimal harm.

The findings are:

Resident #3 is an 89 year old female with diagnoses including Arthritis, Chronic Obstructive Pulmonary Disease and Anxiety Disorder. A review of the resident's record revealed that she was hospitalized in 04/10 with a diagnoses of Pneumonia and returned to the facility on 4/28/10. A Minimum Data Set (an assessment tool) dated 5/5/10 was completed for a Significant Change due to a decline in the Resident's ADLs.

The resident received Physical Therapy on return to the facility and, according to a note in the Comprehensive Care Plan (CCP) dated 5/27/10, her ability to perform ADLs had improved and she started a "Level II" program. The Level II program was implemented by nursing rehab and the goal was for the resident to ambulate 80 feet three times weekly, using a walker and limited assistance. The most recent entry in the Level II Restorative Nursing Flow Sheets revealed that the resident was ambulated 200 feet on July 9 and that she would be referred to "Level III with staff CNAs [certified nurse sides] to continue ambulating.

The resident was described as non-ambulatory in the CNA Care Plan and Accountability Record and instructions for July/10.

The CNA who was caring for the resident was interviewed on 7/28/10 at 11:40AM and stated that the resident did not ambulate.

The Registered Nurse/Charge Nurse was interviewed on 7/26/10 at 10:25AM and was asked to describe the Level III program. The RN responded that this was done with the Activity Program and did not involve ambulation.

The RN/Unit Manager was interviewed again on 7/29 at 12:45PM and at that time she was asked what the expectation was for residents who were no longer receiving Level II services. The RN responded that she was unsure as to what the expectation was. She further stated that she thought that the members of the Activity program would work with the residents.

483.25(a)(2)

Based on observation and interview the facility did not provide reasonable accomodations for residents during dining. Specifically, 1. Nine residents ate lunch in the hallway by the elevators on unit 3. 2. Meals were not replaced, when indicated, in a timely manner for Residents #6 and #19. This resulted in the potential for minimal harm.

The findings are:

1. Nine residents were observed eating lunch in the hallway near the elevators on unit 3 on 7/26/10.

The RN Unit Manager was interviewed at 12:00PM on 7/26/10 and stated that the residents ate in the hallway because there was not enough room in the dining room to include them at mealtime.

Nine residents were further observed eating in the hallway near the elevators in unit 3 during the lunch meal on 7/27/10, 7/28/10 and 7/29/10.

2. a. During the lunch meal observation on unit 3 at 11:40AM on 7/26/10, it was noted that the lunch tray for Resident #6 was delivered without an entree. A unit staff member called the kitchen to request an entree immediately, and again, 10 minutes later. The resident's entree was delivered approximately 30 minutes after it was first requested from the kitchen. At that time, 3 of 4 of the resident's tablemates had already finished eating their lunch.

b. During the lunch meal observation on unit 3 at 11:45AM on 7/26/10, Resident #19 needed to have her food replaced because another resident at her table put some of her own food on top of Resident #19's food. A staff member immediately removed the resident's tray and called the kitchen for a replacement. The replacement food was delivered 30 minutes later.

The kitchen supervisor/cook was interviewed on the afternoon of 7/29/10 and stated that replacement meals should arrive within 10 minutes, unless they are "special orders,"which are expected to be delivered within 20 minutes. The meals described above were not special orders.

415.5(e)(1)

Based on observations and interview it was determined that all corridor doors were not constructed to resist the passage of fire and smoke. This was evidenced by electrical closet and day room doors on resident floors 2 through 5 that were either louvered or that did not positively latch when closed. As a result, a fire or smoke situation originating in these rooms could spread and compromise the means of egress.

This resulted in no actual harm with the potential for minimal harm.

The findings are:

During life safety rounds conducted on 7/26/10 at approximately 11:30 AM the following was observed:

1) The electrical closet on the 5th floor was inspected and it was noted that the corridor door to this closet was louvered. The Director of Maintenance stated at the time that the door was louvered for ventilation. He also indicated that the electrical closets on floors 2-5 were similarly provided with louvers, which was confirmed during a tour of the building.

2) The twin (corridor) doors of the dayrooms on the nursing units were self closing and were provided with magnetic hold open devices. However, upon testing, it was noted that these doors were not positive latching or held closed by an alternate means suitable for keeping the doors closed.
The above conditions noted may allow for the passage of smoke or fire from one area to another.

10NYCRR 711.2(a)(1)
2000 NFPA 101 - 19.3.6.3.6