Keser Nursing and Rehabilitation Center, Inc.

Based on observation, and staff interview, it was determined that the facility did not ensure that the kitchen areas and equipment are maintained in good repair and clean, so as to afford food production under sanitary conditions.

Reference is made to the following:
- The black mold like coating of the ceiling metal panel, in the dairy walk-in refrigerator.
-Corroded wall surface, in the meat walk-in refrigerator.
- Loose floor metal panel and accumulation of water under the panel in the meat walk-in refrigerator.
- Broken door gasket and accumulation of black wet dirt between the gasket and the door frame, in the meat walk-in refrigerator.
- Broken/loose ceramic tiles at the perimeter of the kitchen floor, especially the dairy side of the kitchen.

This resulted in no actual harm with potential for greater than minimum harm that is not immediate jeopardy.

The findings include:
On June 1, 2011, at 9:30 AM to 10:30 AM, the following was observed during the kitchen tour :

(1) In the dairy "walk-in " refrigerator, the ceiling metal panel was heavily coated with black mold like spots.

(2) In the meat "walk-in" refrigerator, the floor metal panel was loose and coming off the floor. Accumulation of dirty water was noted beneath the metal panel.

(3) The door gasket was loose and coming off the door frame of the meat walk-in refrigerator. An accumulation of wet black dirt was noted between the door gasket and the door frame.

(4) The front wall metal panel (across from the refrigerator door), within the meat refrigerator was corroded with rust, at the floor/wall junction.

(5) The ceramic tiles, immediately outside of the dairy walk-in" refrigerator were noted broken and loose. The ceramic tiles at the perimeter of the floor, especially in the dairy section of the kitchen, were not sealed to prevent void spaces between the wall and the tiles. Such void spaces had a potential for accumulation of dirt and harborage of insects.

(6) The "Robocoup" brand food blender/mixer located in the meat kitchen had a 3 inches x 1 inch section of metal corner broken/mangled. Old dried food particles were noted wedged between the mangled metal folds.

On June 1, 2011 at approximately 12:00 PM, the facility's director of food services stated that all noted items in the kitchen will be corrected and proper repairs will be performed to maintain sanitary conditions in the kitchen.

415.29 (j)(1); 415.14 (h)

This requirement is not met as evidenced by:
Based on observation, it was determined that the facility did not ensure that the call registering stations installed in the soiled workroom, clean workroom and in the nourishment station of the nursing units on the first and second floors are maintained to display a visible signal when calls are placed from the resident rooms/and toilet rooms.

The findings include:
On June 1, 2011 at 10:30 AM to 2:30 PM, it was observed that the facility installed nurses' call registering stations in the soiled workrooms, in the clean workrooms and in the nourishment stations of the nursing units. The call registering stations are designed to register an audio and visual signal upon placing a call from the resident's rooms or toilet rooms. Nevertheless, during the environmental tour, it was noted that the call registering stations did not display a visible signal in the soiled workrooms, in the clean workroom and in the nourishment stations on the first floor and second floors, when calls were placed from the resident rooms or the resident toilet rooms. On June 1, 2011 at approximately 1:30 PM, the facility's administrator stated that call registering stations will be repaired so as to display a visible signal within the service areas when calls are placed from the resident rooms or from the resident toilet rooms of the nursing units.

713-1.3 (b)

Based on observation, interview and record review the facility did not ensure that professional standards were maintained as evidenced by a medication pass observation in which the label on a bottle of medication had the name of another resident, different from the resident being observed. (Resident # 19).

This was evident for one (1) of twenty-seven (27) sampled residents. Resident # 19.

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

The finding is:

Resident # 19 is a 76 year old re-admitted on 01/12/10 with diagnoses that included: Epilepsy.

The Minimum Data Set (MDS) 3.0 assessment dated 05/10/11 documented that has memory problems and is cognitively impaired.

On 06/02/11 at 9:30AM during a medication pass observation of a bolus feeding the Licensed Practical Nurse (LPN) was observed administering 5 cubic centimeters (cc) of Valproic Acid 250 milligram (mg) per milliliters (ml) liquid medication into a clear plastic medication cup. The name on the label was different from Resident # 19 ( who had the order).

The LPN was interviewed at 10:00AM on 06/02/11 and he stated he felt that because the resident has a history of seizures, he needed to give him the medication. I should have told my supervisor that the resident did not have his own medication. "I know, right label, right resident."

On 06/03/11 at 1:15PM the morning shift (7:00AM - 3:00PM) LPN who administered medication to Resident # 19 on 06/01/11 was interviewed and she stated that on 06/01/11 she had a little bit left in the bottle and that she did not reorder the medication and did not report this to her supervisor. "I did not follow protocol."

On 06/03/11 at 1:30PM the Unit Supervisor was interviewed and he stated that the it is the responsibility of the medication to report if a medication is needed, and that it is not the policy of the facility to borrow another resident's medication.

A review of the Physican's Order dated 05/19/11 documented, " Valproic Acid Syrup 250mg/5ml via Gastric Tube (GT) every 12 hours."

415.11(c)(3)(i)

Section 7.1.10.1, states that means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.

This standard is not met as evidenced by:
Based on observation, it was determined that the facility did not ensure that the exit discharge path, at the exterior of the exit passageway from the basement is maintained substantially level and free of broken surfaces, and puddles.

This resulted in no actual harm with potential for greater than minimal harm that is not immediate je o pardy.

The findings include:
On June 1, 2011, at 10:30 AM to 2:30 PM, it was observed that the travel path at the exterior of the exit passageway, adjacent to the elevator mechanical room, in the basement , is a paved path. The paved surfaces are broken and puddles of water was noted in the path of travel. All exterior exit discharge pathways must be maintained substantially level and free of broken/cracked surfaces which will impede the safe usage of the exit pathways during fire or other emergency. On June 1, 2011 at approximately 1:00 PM, the facility's maintenance consultant stated that the broken surfaces at the exit discharge in the basement will be repaired and maintained free of puddles.

711.2 (a)(1)

This standard is not met as evidenced by:
Based on observation, it was determined that the facility did not ensure that exit stair "Y" enclosures is free from the passage of overhead and vertical drain pipe, as per 7.1.3.2.1 and 7.1.3.2.3.

This resulted in no actual harm with potential for greater than minimal harm that is not immediate je o pardy.

The findings include:
On June 1, 2011 , at 10:30 AM to 2:30 PM, it was observed that the enclosure to exit stair "Y", at the basement level, is penetrated by an overhead and vertical drainage pipe of approximately 4 inch diameter. The drainage pipe is not meant to serve the stair enclosure. The drainage pipe lacks an enclosure of at least 1 hour fire resistance rating. Any accidental water leakage from the drain pipe in the exit stair would interfere with the safe usage of the stairway by the building occupants during fire or other emergency. On June 1, 2011, at approximately 12:30 PM, the facility consultant stated that the drainage pipe penetrating exit stair "Y" enclosure will be enclosed with at least 1 hour fire resistance rating construction.

711.2 (a)(1)

Physical Plant Violation - State Only

The ventilation systems shall be designed and balanced to provide the pressure relationship as shown in Table 8.

This requirement is not met as evidenced by:
Based on observation, and staff interview, it was determined that the facility did not ensur e tha t the laundry area is provided with ventilation system in accordance with Table 8, 713-2.2(d), so to create an equal pressure relationship with the adjacent corridors.

The findings include:
On June 1, 2011, at 10:30 AM to 2:30 PM, it was observed that the facility has in-house central laundry area in the basement. The laundry area lacks ventilation system to create an equal pressure relationship with the adjacent corridors/areas. The wall fan unit and wall louvers provided in the laundry area were noted off. The centralized general laundry area must be provided with equal pressure relationship with adjacent area, with 2 air changes of outdoor air supplied to the room, with 10 total air changes per hour supplied to the room and with all air directly exhausted to the outside, in accordance with Table 8 of 713-2.21(d). On June 1, 2011, at approximately 1:30 PM, the facility's consultant stated that the required ventilation system will be provided in the general laundry area.

713- 2.21(e)(2)(iii):

Backflow preventers (vacuum breakers) shall be installed on hose bibs, janitors' sinks, bedpan flushing attachments, and on all other fixtures to which hoses or tubing can be attached.

This Requirement is NOT MET as evidenced by:
Based on observation, it was determined that the facility did not ensure that the water fixture contained within the janitors' closets, in the basement, to which hoses could be attached, is provided with backflow preventers (vacuum breakers).

The findings include:
On June 1, 2011, at 10:30 AM to 2:30 PM, it was observed that the water fixtures contained within the janitors' closet in the basement are designed for hose attachment. The water fixture lacks backflow preventers (vacuum breakers). On June 1, 2011 at approximately 12:30 PM, the facility's consultant stated that all water fixtures designed for hose attachments will be provided with backflow preventers (vacuum breaker).

42 CFR 483. 70(a):

LSC 13-2.4.1, 711.2(2) (1)
K 32 S/S = B - Exiting from the main storage area in the basement is not acceptable. Only one exit access door leads to the corridor. Two means of egress are required.

NYCRR 711.2(a)(1)