Accel At Longmont Health And Rehab, Llc
ACCEL AT LONGMONT HEALTH AND REHAB, LLC in LONGMONT, CO — inspection on August 29, 2024.
Found 9 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
The tricycle was stolen from behind a locked gate at the facility.
The nursing home administrator
wheelchair the facility had in storage in lieu of his electric tricycle after the facility failed to replace or reimburse the resident.
C.
Staff interviews The SSD was interviewed on 8/28/24 at 3:45 p.m.
The SSD said the previous NHA agreed to store Resident #12's tricycle.
She said since the tricycle was very big, it was stored, not in the main building, but in the nearby building.
The SSD said that at some point, the tricycle was stolen and a police report was filed.
She said, unfortunately, the tricycle was not located.
She said the previous NHA did not reimburse the resident for the tricycle because the corporate managers did not allow the NHA to pay the full cost of the tricycle, which was estimated at $4,000.00.
The SSD said the previous NHA offered Resident #12 a few hundred dollars but the resident never accepted the money.
The current NHA was interviewed on 8/29/24 at 5:30 p.m.
The NHA said he was not aware of the situation with Resident #12's missing property as it had occurred prior to his time. He said the facility did not have a policy for personal property.
The NHA said the admission policy that all residents signed did say that all personal items should be entered into the inventory sheet and updated with any changes.
The RNC was interviewed on 8/29/24 at 4:30 p.m.
The RNC said the facility had no policy for personal property responsibility.
The RNC said a grievance was filed by Resident #12 about his missing tricycle.
The RNC said the resident and the former NHA did not come to an agreement about the missing property.
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Accel at Longmont Health and Rehab, LLC 1960 S Fordham St Longmont, CO 80503
(PRN) if the dressing became compromised.
site.
The WCN said it was important not to miss any doses of an antibiotic because of trough levels or the potential for increase or spread of the infection.
The WCN said any missed dose of an antibiotic should be reported to a physician.
The RNC was interviewed on 8/29/24 at 4:30 p.m.
The RNC said a PICC line should not be removed without a physician's order.
The RNC said if a PICC line was removed prior to the completion of antibiotic therapy it should be reported and replaced as quickly as reasonably possible.
The RNC said a PICC line that was not replaced right away could cause a delay in the resident's antibiotic treatment.
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Accel at Longmont Health and Rehab, LLC 1960 S Fordham St Longmont, CO 80503
jeopardy to resident health or offered to the resident, and staff interviews (see below) indicated it was unclear how frequently it safety was to be done.
See also the resident interview above; Resident #140 said that the staff did not help him move.
- Skin breakdown 8/21/24
On 8/21/24, the WCP documented Resident #140 still had an unstageable DTI to the right great toe that measured at 0.9 by 1.0 dcm, trauma injury to the right second toe, but also a new pressure wound unstageable DTI on the right heel that measured 3.0 x 6.0 cm.
Orders were entered for right heel wound care every three days, cleanse with wound cleanser, and pat dry.
Apply foam dressing and off-load while in bed.
On 8/22/24, the care plan was updated with interventions to off-load heels as allowed and apply boot to the right foot when out of bed. -However, none of the care plan updates after admission indicated staff had considered the resident's height and the footboard on his bed.
See resident interview and observation above.
On 8/25/24, the daily skilled nurses note documented concerns for a right heel wound, right second toe wound, and bruising to the right fourth toe with new right foot swelling (edematous +3 and painful to touch).
- Change of condition 8/27/24
On 8/27/24 (during the survey), the care plan was updated with an intervention to document weekly treatments and to include measurements for every wound.
However, on this date, the resident experienced a change in condition and was transferred to the hospital.
Specifically: On 8/27/24 at 3:19 p.m., LPN #1 documented that during therapy it was observed that Resident #140 was altered from baseline and unable to complete tasks normally.
Vital signs were taken and revealed that Resident #140 had a fever (100.7 F) and hypotension (a low blood pressure of 97/65).
The physician was notified of Resident #140's status and the resident was sent to the emergency department via ambulance.
The hospital emergency room records dated 8/27/24 at 8:24 p.m. read in pertinent part, cellulitis of right lower limb, severe sepsis without septic shock, purulent (pus-like drainage which is a sign of infection) drainage along heel with streaking erythema superiorly. Resident #140 was admitted to the ICU and treated with antibiotics.
D.
Interviews
- The WCN was interviewed on 8/27/24 at 2:29 p.m.
The WCN said she conducted a skin assessment on newly admitted residents but was not aware of a timeframe for her assessment to occur.
She said Resident #140's heel tissue had been[TRUNCATED]
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Accel at Longmont Health and Rehab, LLC 1960 S Fordham St Longmont, CO 80503
outcome of these reviews for two of five certified nurse aides (CNA) reviewed.
Specifically, the facility did not complete a performance review for CNA #1 and CNA #2.
Findings include: I.
Record review CNA #1 was hired on 2/28/23. A request for a performance review was made on 8/27/24. -The facility was unable to provide documentation indicating a performance review for CNA #1 was completed in the past 12 months.
CNA #2 was hired on 11/29/22. A request for a performance review was made on 8/29/24. -The facility was unable to provide documentation indicating a performance review for CNA #2 was completed in the past 12 months.
II.
Staff interviews The human resources director (HRD) was interviewed on 8/29/24 at 4:28 p.m.
The HRD said each department lead was responsible for completing an annual performance review for their staff.
She said a performance review was not completed for CNA #1 and CNA #2.
The regional nurse consultant (RNC) was interviewed on 8/29/24 at 4:36 p.m.
The RNC said a performance review was not completed for CNA #1 and CNA #2.
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Accel at Longmont Health and Rehab, LLC 1960 S Fordham St Longmont, CO 80503
given.
#15.
The resident had a physician's order for carbidopa ER (extended release) 25 mg-levodopa 100 mg
disease. -The medication was administered to Resident #15 at 9:50 a.m., 50 minutes after the allowed medication administration window.
III.
Staff interviews LPN #2 was interviewed on 8/28/24 at 10:00 a.m. LPN #2 said she had a two hour window to administer medications from their ordered timeframe.
She said Resident #15's carbidopa-levodopa medication was ordered at 8:00 a.m. and could be given between 7:00 a.m. and 9:00 a.m. -However, the medication was administered at 9:50 a.m., outside the two- hour medication administration window (see observation above).
Physician assistant (PA) #1 was interviewed on 8/29/24 at 9:40 a.m. PA #1 said of all medications, Parkinson's medications should be given on time. PA#1 said that it was extremely important to administer carbidopa/levodopa on time. PA #1 said the reason it was important was because of the half-life (the time it takes for the amount of a drug's active substance in your body to reduce by half) of the medication. PA #1 said even small delays could cause a significant increase in Parkinson's disease symptoms, such as tremors or difficulty swallowing. PA #1 said administering the 8:00 a.m. dose at 9:50 a.m. had been a medication error.
PA #1 said if a lidocaine patch was prescribed for the sacral area it should not be applied to a different area. PA #1 said a different physician's order would be required to place a lidocaine patch on a different area of the body. PA #1 said if a medication was refused or not given it should not be documented as given. PA #1 said any medication refusals required notification of a provider.
The RNC was interviewed on 8/29/24 at 4:30 p.m.
The RNC said medication should be administered as it was prescribed.
The RNC said a lidocaine patch should be placed on the part of the body specified in the physician's order, not just anywhere on a resident's body.
The RNC said timed and extended release medications should be administered within a two hour window of the prescribed administration time.
065429 08/29/2024
Accel at Longmont Health and Rehab, LLC 1960 S Fordham St Longmont, CO 80503
was on the dresser with the lid open and a spoon resting in the cup. LPN #1 handed the resident the
On 8/28/24 at 9:50 a.m. medication administration was observed in the presence of LPN #2. LPN #2 prepared medications for Resident #15 without performing hand hygiene. LPN #2 entered Resident #15's room without performing hand hygiene, then proceeded to administer oral medications.
On 8/28/24 at 9:23 a.m. medication cart #2 was observed in the presence of LPN #6.
While LPN #6 was standing at medication cart #2, a staff member walking down the hallway stopped and picked up a pill off the floor near the medication cart. LPN #6 took the pill from the staff member and threw it into a trash can attached to the medication cart. -After disposing of medication from the floor, LPN #6 proceeded to prepare medications for residents without performing hand hygiene.
III.
Staff Interview The wound care nurse (WCN), who was also overseeing the facility's infection control program was interviewed on 8/29/24 at 12:56 p.m.
The WCN said hand hygiene should be used prior to administering resident care.
The WCN said hand hygiene should be used prior to administering medications, especially eye drops, to prevent the spread of infection.
The WCN said hand hygiene should occur after the removal of gloves and prior to providing care for a different resident.
The WCN said vital signs monitoring equipment (blood pressure cuffs, pulse oximeters) should be cleaned after each resident with cavi wipes.
065429 08/29/2024
Accel at Longmont Health and Rehab, LLC 1960 S Fordham St Longmont, CO 80503
program in the nursing home.
(ICP) who had completed specialized training in infection prevention and control which had the
Specifically, the facility failed to have a qualified ICP involved with the facility's infection prevention and control program.
Findings include: I.
Professional reference The Centers for Disease Control and Prevention (CDC), Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, (updated 5/8/23) was retrieved on 9/4/24 from https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html-read in pertinent part, Nursing homes should assign one or more individuals with training in infection prevention and control (IPC) to provide on-site management of the IPC program.
Smaller facilities should consider staffing the IPC program based on the resident population and facility service needs identified in the IPC risk assessment.
II.
Record review The infection preventionist's (IP) certification for training specific to infection prevention and control was requested on 8/26/24 from the nursing home administrator (NHA) for the wound care nurse (WCN), who was the acting IP. -The facility was unable to provide documentation that the wound care nurse had completed specialized training in infection prevention and control (see interviews below).
III.
Staff interviews The WCN was interviewed on 8/29/24 at 5:10 p.m.
The WCN said she was the acting IP but she had not yet completed her certification.
She said she was enrolled in a training program but had not completed it yet.
The regional nurse consultant (RNC) was interviewed on 8/29/24 at 5:30 p.m.
The RNC said she was providing assistance in the building since the director of nursing (DON) quit a few days prior.
She said she was not aware that the WCN had not completed her IP training.
According to the Basic Nursing third edition, Treas, L.S., [NAME], K.L., & [NAME], M.H. (2022), page 1214, Healthy people regularly shift position to maintain comfort.
However, many patients are unable to move without assistance.
They require a change of position at least every two hours to prevent skin breakdown, muscle discomfort, damage to superficial nerves and blood vessels, and contractures.
III.
Facility policy
065429
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 065429 B.
Wing 08/29/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Accel at Longmont Health and Rehab, LLC 1960 S Fordham St Longmont, CO 80503
F-F867 (Quality Assurance and Performance Improvement).
RESIDENT #85
Resident #85, who had a diagnosis of diabetes, kidney disease, and generalized muscle weakness, was admitted to the facility on [DATE] for rehabilitation and strengthening. Resident #85 was assessed on admission with intact skin of the lower extremities, feet, and heels, and a stage 2 pressure injury to her coccyx/sacrum.
She was evaluated at moderate risk of developing pressure injuries due to a history of previous pressure injury and stroke.
On 11/16/23, nine days after admission, a weekly skin assessment documented bilateral heel discoloration.
However, the resident's primary care physician (PCP) did not become aware of the resident's skin condition until 11/20/23. In a note that day, the PCP documented the resident had deep tissue injury (DTI) changes to both heels and right lower extremity cellulitis (skin infection), ascending on the right calf.
The resident was sent to the hospital where she was diagnosed with cellulitis and sepsis from cellulitis, as well as a trauma injury to the right big toe, a stage 3 pressure injury on her coccyx/sacrum, and unstageable pressure injuries to her right and left heel.
She was treated with intravenous (IV) antibiotics and spent a week in the hospital, including one day in the intensive care unit (ICU).
Record review revealed the facility failed to provide the resident with timely and necessary services to prevent the development of the resident's heel wounds and to promote the healing of her coccyx/sacral wound.
Specifically:
-While an 11/16/23 assessment revealed discoloration to bilateral heels and a nursing note the same day documented the physician was notified of the resident's DTI injuries, a change of condition assessment was not completed, and a PCP note on 11/20/24, four days later, indicated the physician was unaware of the heel wounds, citing new wounds on feet have not been seen before.
-While the resident's care plan for skin integrity was initiated on 11/7/23, and included interventions to assist the resident in turning and repositioning frequently and to off-load heels, there was insufficient evidence these interventions were implemented.
Further, the discovery of bilateral heel discoloration on 11/16/23 did not trigger the facility to consider new interventions to prevent further skin breakdown despite being noted as a problem on the care plan.
-While a review of the medication and treatment administration records (MAR and TAR) revealed orders for the resident's coccyx/sacral wound, there was no treatment order for the resident's heels in November 2023.
065429
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 065429 B.
Wing 08/29/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Accel at Longmont Health and Rehab, LLC 1960 S Fordham St Longmont, CO 80503
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.