Midway Nursing Home

415.14 - Dietary services

(h) Sanitary conditions. The facility shall store, prepare, distribute and serve food under sanitary conditions; and in accordance with the sanitary requirements of Part 14 (Service Food Establishments) of Chapter I (State Sanitary Code) of this Title.

State Sanitary Code - Subpart 14-1.170

CONSTRUCTION AND MAINTENANCE OF PHYSICAL FACILITIES

14-1.170 Floors.

Floors and floor coverings of food storage, food preparation equipment, utensil washing areas, and floors of walk-in refrigerating units, dressing rooms, locker rooms, toilet rooms and vestibules, are to be maintained clean and in good repair and are to be smooth, durable, and non-absorbent. The use of anti-skid floor covering is acceptable when necessary for safety reasons.

This requirement is not met as evidenced by:

Based on observation and staff interview, it was determined that the facility did not ensure that the dry goods food storage area located in the basement was maintained in good repair. Reference is made to water accumulation on portions of the floor surface and a chipped floor surface in the room.

This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.

The findings are:

During a tour of the dry goods food storage room located in the basement on 04/28/10 at approximately 2:30pm the following was noted:

1. Water accumulation was observed on the floor surface area below the entire length (approximately 20 ft.) of a food storage shelving unit and next to a reach-in ice cream freezer.
2. Large portions of the floor surface area were observed to be chipped and with flaking paint.

In an interview at this time the Food Service Director stated that the water accumulation is a result of the recent heavy rains and that the housekeeping department is responsible for removing the water accumulation from the floor. She further stated that she would cover the dry goods items with plastic to prevent any direct contact with potential water splashes.

In an interview the same day at approximately 2:00 pm, the Administrator stated that the water table is very high in the area and that the sump pump was recently replaced to handle the extra water load during heavy rains. He further stated that the facility is exploring other long term solutions to the high water table issues.

Based on observations, record review and staff interviews, the facility did not ensure that the residents' dignity is maintained as evidenced by a resident wearing socks of another resident and a resident wearing mis-matched socks. This was evident for 2 of 29 sampled residents. (Residents #5 and Resident #9).

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

The findings are:

1.) Resident #5 is a 69 year old male with diagnoses that included Hypothermia, Heart Failure, Acute Renal Failure, and Dementia.

The Minimum Data Set (MDS) 2.0 Assessment dated 04/20/10 documents that the resident is alert, with modified independence in decision making skills and requires extensive assistance with activities of daily living.

The Comprehensive Care Plan (CCP) dated 02/04/10 documents that the resident requires "extensive assistance of 1 one person for "Dressing" related to decreased strength.

The "Resident Profile/Certified Nurse Assignment (CNA)" dated 03/2010 documents "Extensive Assistance for Dressing."

On 04/30/10 at 8:05AM during a dressing change observation and at 11:15AM, the resident was observed wearing socks which were labelled with the initials of a resident in room 313A.

On 04/30/10 at 3:00PM, the Resident was interviewed about his socks and clothing items and he stated that missing socks are a frequent issue and that he feels bad wearing someone else's socks. "I feel its not right, and I want to wear my own socks..." The Resident stated that it's mostly a sock issue here.

On 04/30/10 at 2:00PM the assigned CNA (Certified Nurse Aide) was interviewed and she stated that she placed socks on his feet this morning and did not notice that the socks did not belong to the Resident. She stated that when this happens she is to report this to the nurse on the floor so that the right Resident could get the right socks.

The Registered Nurse Supervisor was interviewed on 04/29/10 and stated that the evening CNA's are responsible for placing the Resident's personal belongings away when the are returned from being laundered. If items are misplaced or mislabeled the CNA are to report these things to nursing.

2.) Resident # 9 is an 86 year old female admitted on 11/24/09 with diagnosis that included Hypertension, Syncope, Anxiety and Altered Mental Status.

The Minimum Data Set (MDS) 2.0 Assessment dated 02/10/10 documents that the Resident has moderately impairment cognition and requires limited to extensive assistance for activities of daily living.

The Comprehensive Care Plan (CCP) dated 02/12/10 documents that for "Dressing" the Resident requires extensive assistance of one person.

On 04/29/10 at 11:45AM during a lunch meal observation, the Resident was observed in the dining room wearing mis-matched shoes. The shoe on the right foot was a sneaker type shoe with shoe laces. The left shoe had a Velcro strap.

On 04/29/10, the assigned CNA (Certified Nurse Aide) was interviewed and stated that she was aware that the resident wearing was mis-match shoes but did not report it to the Supervisor.

A search by the staff of the Resident's closet found no other shoes belonging to the Resident.

The Nurse Supervisor was interviewed on 04/29/10 at 9:00AM and immediately removed the shoes and called down to Physical Therapy for evaluation and replacement of footwear. The Supervisor stated that the Resident does not have any order for special foot wear and could not explain why the resident was wearing mis-matched shoes.

415.5(a)

Based on observations, record review and staff interviews, the facility did not ensure that infection control policies and procedures were adhered to as evidenced by: a diaper in direct contact with a wound and not using alcohol gel according to the manufacturer directions. This was evident on 1 of 27 sampled residents (Resident #13) and 1 of 5 units (6th floor).

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

The findings are:

1) Resident #13 is a 61 year old with diagnoses which include sacral decubitus ulcer stage 4, bilateral lower extremities Cellulitis, Diabetes Mellitus, and Anemia.

The Minimum Data Set 2.0 Assessment (MDS) dated 2/3/2010 documented that the Resident's memory and cognition are intact.

The Physician's Order dated 4/8/2010 documented "Derm aginate 4.25 x 4.25 dsg (dressing) ...Cal. Alginate (Calcium Alginate) 4X4 (4 by 4)...after cleanse W/NS (With/ Normal Saline) apply to sacrum buttock ulcers cover with dry dressing twice a day and as needed."

On 4/29 2010 at 1:25 PM, a wound care dressing change observation was done. The resident was positioned on her left lateral side. The CNA (Certified Nursing Assistant) removed the diaper exposing the wound bed. The diaper lining was in direct contact with the wound. The diaper lining was noted with a light reddish color stain. The wound was observed to be light red in color.

The CNA was interviewed after the wound care procedure and stated that she washed the resident this morning a few minutes before the procedure and found a dirty dressing, and informed the Charge Nurse. The CNA stated that she was told that the treatment nurse will come shortly, and so the CNA proceeded to clean the Resident and applied a new diaper.

The LPN (Licensed Practical Nurse) treatment nurse was interviewed and she stated that "she was not aware that the old dressing was dirty."

2) On 04/30/10 from 9:00AM to 10:00AM, the LPN (Licensed Practical Nurse) was observed administering medications on the 6th floor. The LPN was observed cleansing her hands with the alcohol gel and then using tissues to wipe the gel off of her hands. This technique was observed twice during the observation. The LPN stated that she wipes off the alcohol gel because "...sometimes it is sticky and wet."

A review of the Alcohol Hand Cleanser Product use by the facility recommends to "rub the product to the surfaces of the hands and fingers until dry."

415.19(a)(1-3)

During the initial tour of the facility on the 5th floor on 4/28/2010 at 11:50 AM, in the accordion-door enclosed storage section near the nurses station, two large bags were observed on the floor. One of the bags contained various numerous items of resident's clothing and the other bag held bilateral heel-booties. The Covering Registered Nurse Manager was immediately interviewed and stated that the items in bags belong to the resident, who just had a room change, so the labels on clothing and heel booties need to be changed to reflect the current room number. The RN Manager further stated that the bags should not have been placed on the floor as "this is infection control issue."

415.19(a)(1-3)

NYCRR- 710.1(c)(5)(I)(a)(4)
(5) Proposals requiring a prior review limited to architectural and engineering matters.

(I)(a) Proposals where total project cost does not exceed $3,000,000, and for which a certificate of need is not otherwise required under this Part, shall be subject to review under Article 28 of the Public Health Law limited to a determination of whether the proposal is consistent with applicable statutes, codes, rules and regulations relating to the structural, architectural, engineering, environmental, safety and sanitary requirement of licensed medical facilities where the proposal relates to the acquisition, relocation, installation or modification of:

(4) Heating, ventilating, air conditioning, plumbing, electrical, water supply, fixed dietary, solid waste and/or sewage disposal, and fire protection systems, other than routine maintenance and repairs or routine purchases affecting such systems.

This requirement is not met as evidenced by.

Based on observations, record review and staff interviews, it was determined that the facility did not file a limited review and a safety plan with the New York State Department of Health (NYSDOH) for the installation of equipment affecting plumbing, electrical, and fire protection systems in the basement of the building. Reference is made to the following:

1. Installations of two new hot water heaters (boilers) and three hot water storage tanks along with installation of a circuit breaker for the boilers in a new boiler room in the basement.
2. The work further included the projected installation of additional sprinkler protection and heat detection systems in the new boiler room.
3. A safety plan was not filed for the installations that involved areas on a resident use floor.

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

The findings are:

Interviews with the Administrator during the 04/ 28/10 recertification survey at approximately 2:00pm, and observations at approximately 3:00pm revealed that the facility had installed two new hot water heaters (boilers) and three hot water storage tanks in an old storage room in the basement. The Administrator could not provide any records indicating that a limited architectural review was filed with the NYSDOH for the installations. He stated that the architect and the local buildings department are working together on the project. The Administrator further stated that letters of intended shut downs of the domestic hot water during the boiler installations were submitted to the NYSDOH. The shut downs did not affect services to the facility since they took place at night during minimal demand on the domestic hot water.

A visit to the boiler room located in the basement at approximately 2:50pm revealed contractors on site performing ongoing work in the boiler room. The resident beauty parlor was observed to be located in the basement where the installations of the boilers were taking place.

In an interview on the same day, at approximately 3:00pm the contractor stated that the boiler room a new electrical breaker panel was installed and that additional sprinkler coverage and fire detection systems would be installed.

A review of NYSDOH records on 4/22/10 revealed that no limited architectural review along with a safety plan was filed for the ongoing boiler installations. The facility did not provide documentations of a limited review or a safety plan being filed with the NYSDOH. Further record reviews of written communications (letters) between the facility and the NYSDOH, revealed that the facility communicated boiler shut downs as part of " schedule work on the boilers " . The letters did not indicate the installation of new boilers or hot water storage tanks.

I. Section 7.1.10.1 of the Life Safety Code requires that the 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.

Based upon a life safety code inspection conducted during the facility's annual survey, it was determined that the facility did not ensure that exterior exit discharges from the building to the public way was maintained free of water, leaves and debris accumulation.
This resulted in no actual harm with the potential for more than minimum harm that is not immediate jeopardy.

Findings include:
During the life safety code inspection on 4/30/10 between 12:15 p.m. and 12:45 p.m., the emergency exit located on the west side of the facility and exiting from the basement level was observed with a large accumulation of approximately 4 inches of water and a large amount of leaves and debris in the exit landing and on the stairway, thereby rendering this exit way impassable.
In an interview with the Director of Engineering on 4/30/10 at approximately 12:45 p.m. he stated that the emergency pathway would be cleaned immediately. He stated that this must have been an oversight by the housekeeping personnel responsible for maintaining the yard.

NFPA 2000 Life Safety Code 7.1.10.1
NFPA 2000 Life Safety Code 19.2.1

Based on observation and interview it was determined that the facility did not ensure that metal containers with self-closing covers into which ashtrays could be emptied, were provided in the smoking area.

This resulted in no actual harm with potential for minimal harm that is not immediate jeopardy.

The findings are:

During the annual life safety code survey on 04/30/10 between the hours of 9:00am and 3:00 p.m., the two (2) rear patios designated as the smoking areas for the residents, were noted to be equipped with ashtrays of safe design. The locations were lacking metal containers with self-closing cover devices into which ashtrays could be emptied.
In an interview with the Director of Recreational Services on 04/30/10 at approximately 1:00pm, he stated that he was unaware of the requirement for these types of receptacles inside designated smoking areas. He further stated that he would immediately put an order in for the receptacles and put them in place as soon as they are received.

711.2(a)(1)