Midway Nursing Home

Based on observation and staff interview, it was determined that the facility did not ensure that housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior were provided on 4 out of 6 residential units.

Specifically, the facility did not maintain the residential room windows, dining room windows and day room windows free of dust. Spider webs were observed on the windows on the first floor dining area. Also, it was observed that privacy curtains in resident rooms were torn at various places.

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

The Findings include but not limited to:

During the Annual Recertification Survey conducted on May 13,2011 and May 16,2011 the following observations were made:

It was observed that during the environmental tour with the Maintenance Director window sills in the facility day rooms, dining rooms and resident rooms(401,408,412,419,301,506,514,218,209,201) were observed with blackened dust. These were observed between the hours of 9:30 AM and 2:30 PM.

In addition, two(2) windows on the main dining room located on the first floor were observed with spider webs (back window,side window).On the back window, spider web was observed between the outside and inside window panel. The side window had a spider web located on the inside bottom of the window.

In an interview with the Administrator at approximately 2:45pm on 5/16/11, he stated that all windows in the facility will be cleaned and maintained.

Additionally, privacy curtains were observed torn in various resident rooms (412,317,315,306 ). These issues were pointed brought to the attention of the maintenance director on 5/13/11 at approximately 11:00 am, and he stated that the facility was in the process of changing all window curtains in the facility.

10 NYCRR 415.5(h)(2)

Based on staff interviews and record review, the facility did not ensure that a resident receive the necessary care and services. Specifically, a resident with bronchial asthma did not receive Prednisone in a timely manner. This was evident for one (1) of twenty-nine (29) sampled residents. (Resident #23.)

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

The finding is:

Resident # 23 is an 81 year old readmitted on 03/24/11 diagnoses that include Chronic Obstructive Pulmonary Disease (COPD)and Bronchitis.

The Minimum Data Set (MDS) 3.0 assessment dated 02/10/11 documented long and short term memory problems with moderately impaired cognitive skills.

A review of the Nurses Notes dated 05/17/11 at 7:00PM documented "...return from Emergency (ER) c (with) orders to start on Medrol dose pack by mouth #1 take as directed ..."

The Physican's Order dated 05/17/11 documented "Prednisone 5 milligrams (mg) PO (by mouth) QID (four times a day) times three (3) days. Prednisone 5 mg PO TID (three times a day) times three (3) days. Prednisone 5mg PO BID (twice a day) times three days. Prednisone 5mg PO OD (every day) times ten days."

A review of the Medication Administration Record (MAR) beginning 04/03/11 thru 05/19/11 did not document that Prednisone was administered on 5/18/11, and 5/19/11.

The nurses note dated 5/18/11 at 5:30AM documented "...To start Medrol/Predinsone Therapy as ordered. Endorse to next shift to follow-up..."

The nurses note dated 5/18/11 at 3:30PM documented "Pharmacy called at approximately 9:30am to clarify order of Medrol Pack and Prednisone order that was faxed to them. I told them I will get back to them after I clarify it with MD. I spoke to MD he said give the Prednisone it is same as the SoluMedrol. I called again to the Pharmacist ... and told them to send the prednisone as order by MD. She said she will send it..."

The nurses note dated 5/18/11 at 3:30PM documented "...Resident is stable o (no) resp (respiratory) distress o SOB (Shortness of Breath) Ambulates on unit/off unit c no difficulty neb tx (nebulizer treatment) given To start on Prednisone when arrived from pharmacy... Endorse to 3 - 11 to follow up..."

On 05/19/11 at 10:10AM, the Registered Nurse Supervisor (RN) on duty on the 05/17/11 from 3:00PM - 11:00PM was interviewed and stated that she did not see an order for Prednisone. She stated that it is her role as the Supervisor to pick up orders and fax the orders to pharmacy.

On 05/19/11 at 10:40 AM the night shift RN (11:00PM - 7:00AM) was interviewed and stated that she had an emergency during the night and did not fax the order for Prednisone over to the pharmacy until 05/18/11 at approximately 8:00AM. She stated that she did not report this to the oncoming shift.

On 05/19/11 at 2:00PM the day shift (7:00AM - 3:00PM) RN was interviewed and stated that she did not follow up with pharmacy. She further stated that she relied on her medication nurse to follow up with the pharmacist.

On 05/19/11 at 2:45 PM, the Pharmacist was interviewed and stated that he received a request order for Prednisone on 05/17/11 at 10:47 PM. He stated that he called and spoke to the nurse (Licensed Practical Nurse/LPN) on 05/18/11 at 9:05 AM for further clarification of dosage of Prednisone. He further stated that because his delivery times are: 5:00AM, 9:30AM, and 7:00PM, the Prednisone was not delivered. it delayed the delivery time for this medication.

A review of the Pharmacy delivery of medication list documents that the Prednisone was delivered on 05/19/11 in the AM.
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415.12

Based on observation and interview it was determined that the facility did not secure oxygen tanks properly in the resident floors. This was evidenced by 4 oxygen 'E' cylinders stored directly on the floor without a rack or chained to avoid tipping over.

The Findings are:

On 5/13/11 and 5/16/11 during the Annual Life Safety evaluation the following was observed:

Three (3) empty "E" oxygen cylinders on the third floor and one (1) oxygen tank was observed on the sixth floor without being secured. The 'E' cylinder(s) were stored standing directly on the floor without a rack or chained to avoid tipping over.

In an interview on 05/13/11 at 10:40 A.M., the Maintenance Director stated that the tanks were empty and if required they all will be secured to avoid tipping over.
NFPA 99,4.3.1.1.2, 19.3.2.1.

711.2(a)(1)

Based on observation and interview, the facility did not ensure that exit components are enclosed with construction having a fire resistive rating of at least one hour in that cable wires penetrated and passed completely through the firewall in third floor stairwell near resident room 319.

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

The Finding is:

On 5/13/11 and 5/16/11 during the Annual Life Safety evaluation of the third floor, east stairwell near room 319 a "1/4" inch circular penetration was discovered. On Further evaluation it was found that the penetration was visible from both sides of the wall. Facility must make sure that the entire stairwells are fire/smoke protected. All penetrations must be sealed with an approved (UL rated) fire/smoke sealant.

In an interview with the maintenance director on 5/13/11 at approximately 2:00 pm, he stated that the circular hole will be immediately sealed with the appropriate fire/smoke sealant.

[42CFR 483.70(a); 2000 LSC: 19.3.1.1, 8.2.5.2; 10NYCRR 415.29(a)(2), 711.2(a)(1

Based on observations and interview it was determined that the facility did not ensure that hazardous area was maintained smoke/fire resistive. This was evidenced by multiple penetrations/gaps around the door from outside with only one side (outside) provided with sheetrock.

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

Complaint # 101352

The Finding is:

On 05/13/11 , 05/16/11 during the Annual Life Safety evaluation and on 05/18/11 during a complaint investigation it was observed that the facility is fully sprinklered and has six (6) resident floors and basement.

During the environmental tour with the maintenance director an area in the basement was observed for storage. A separate room was observed within this storage room that was not labeled. In a discussion with the maintenance director he stated that the "separate room" was a "dead files room" where old medical files are located and waiting to be discarded. He also stated that the room contained more than "140 cardboard boxes" with records. Many of the documents were observed loose and scattered on the floor.

Evaluation of the door to this "dead files" room revealed that it was not properly installed as evidenced by gaps around the door. Furthermore, only one side of the wall where the door was installed had sheet rock. The other side of the wall was bare.

Evaluation of the fire protection devices included two sprinkler head and a smoke detector in the room. Storage also exceeded the 18 inch clearance from the ceiling.The nearest fire extinguisher is within 25 feet. Egress to the nearest exit (west stairway) to outside area is within 50 feet.

In an interview with the maintenance director on 5/18/11 at 11:00 am, he stated that these files will be destroyed after the the Administrator reviewed the files and gave the approval to discard. In a separate interview with the Administrator on 05/18/11 at approximately 2:00 pm, he stated that all the files have been removed by maintenance from this room.

711.2 (a)(1)

Based on observation and interview, it was determined that the facility did not ensure that laundry tasks (labeling) was performed in a safe manner. This was evidenced by an unattended heat labeling machine in which the temperature exceeded 300 degrees F. The labeling maching was sitting on a wooden table, and the room had combustable materials.

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

The Finding is:

On May 13,2011 and May 16,2011 between the hours of 9:00 am and 3:00 pm,during the evaluation of the basement on the second day at approximately 11:30 am, a room labeled "storage" was observed with a heat labeling machine on a wooden table indicating a temperature of 365 F . Further observations revealed that the area was unattended, and in the immediate vicinity of the labeling machine there were combustible materials such as plastic bags with clothes, and paper labels. The room was observed to be sprinklered and had a smoke detector.

In an interview with the Housekeeping Director on 5/16/11 he stated that the person who was responsible for the labeling machine went to the resident floor and that she usually turns on the machine in the morning when she begins her duties. Furthermore, he stated that the labeling tasks will be performed in a safe manner and that staff will be inserviced.

415.29 (a) (1)

Based on observation, it was determined that the facility did not ensure that the ABC type portable fire extinguisher installed on the 1st floor dietary area (kitchen), was recharged.

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

The Finding include but not limited to:

On May 13,2011 and May 16, 2011 during the Annual Life Safety evaluation it was observed that the facility is fully sprinklered and has six resident floors.

Evaluation of the Kitchen area on the first floor revealed that a single ABC portable fire extinguisher was not recharged as evidenced by the gauge indicator that showed that the fire extinguisher needed to be recharged. Hydrostatic tested was conducted and also, the latest montly inspection was conducted on 5/2/11.

In an interview with the maintenance director on 5/13/11, he stated that the empty fire extinguisher has been replaced with a fully charged portable fire extinguisher. He also stated that he does not know how the ABC fire extinguisher lost its charge since all fire extinguishers have been checked recently.

711.2 (a)(1)