North Ridge Health And Rehab
NORTH RIDGE HEALTH AND REHAB in NEW HOPE, MN — inspection on July 11, 2024.
Found 8 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
During an interview on 7/11/24 the administrator confirmed LPN-E had worked each day that week on different units of the facility and provided direct resident care.
Facility policy Abuse Prevention Program last reviewed 9/23, identified the facility administration and staff were committed to protecting residents from abuse.
Comprehensive policies and procedures have been developed to aid the facility administration to prevent abuse, neglect, or mistreatment.
The abuse prevention program provides policies and procedures that govern at minimum various parts of abuse protection which included the protection of residents during abuse investigations.
245183 07/11/2024
North Ridge Health and Rehab 5430 Boone Avenue North New Hope, MN 55428
During interview on 7/11/24 at 11:41 a.m., the director of nursing (DON) stated all residents were
resident would require.
Once admitted to the facility, the residents received a comprehensive admission assessment and from that an individualized care plan was established.
All staff were expected to complete the personal cares and document which cares were completed each shift. If the staff did not complete an identified care, they were to do document why the care was not provided and communicate concerns to the unit manager or appropriate supervisor. If the care was to be provided between two departments such as nursing and therapy, the DON's expectation was to have the two departments to communicate with each other to ensure the resident received all appropriate care.
The DON was unaware R166 had not received personal cares due to a lack of communication between the two departments.
Personal hygiene/bathing was important not only for psychosocial enhancement, but also for monitoring of the resident's skin integrity.
The Quality of Life-Activities of Daily Living F-F676, F 677 policy dated 9/2023, directed the staff to ensure residents who are unable to carry out activities of daily living receive the necessary care and services to maintain good nutrition, grooming, and personal and oral hygiene.
The policy also directed the staff to educate the resident of the benefits and risks of not accepting interventions and to document such in the residents medical record.
245183 07/11/2024
North Ridge Health and Rehab 5430 Boone Avenue North New Hope, MN 55428
During an observation/interview on 7/8/24 at 4:53 p.m., R190 had the outline of a pouch under their shirt on the right side of their torso. R190 touched the area and stated they had to have their bladder removed because of cancer so they had a pouch for urine now.
During a follow-up interview on 7/10/24 at 10:48 a.m., R190 confirmed they did not have a colostomy.
R190 stated they used the toilet to have a bowel movement and had a bag to collect urine [urostomy].
During an interview on 7/10/24 at 1:22 p.m., registered nurse (RN)-B stated they provided urostomy care to R190 and documented that on the TAR.
During an interview on 7/10/24 at 1:33 p.m., RN-A opened R190's EMR for review and stated R190 had both a colostomy and a urostomy. RN-A navigated to the TAR and indicated R190 had orders for the care of both the urostomy and the colostomy. RN-A reviewed the TAR and confirmed colostomy care had been signed off as provided each shift to R190 for several months.
When informed R190 had indicated they did not have a colostomy, RN-A stated they would have to investigate that and report back.
During a follow-up interview on 7/11/24 at 11:01 a.m., RN-A stated they had reviewed R190's medical record and discussed situation with the director of nursing (DON). RN-A indicated they believed the order for colostomy care was a typo because R190 did not have a colostomy but did have a urostomy.
The colostomy order should have been discontinued instead of documented on as completed because R190 did not have a colostomy. RN-A stated it was their expectation that staff would only document on actions and care they had done or provided.
During an interview on 7/11/24 at 2:22 p.m., the DON confirmed R190 did not have a colostomy and indicated the nurse who had entered the order for colostomy care had entered the order in error.
The DON stated they had a double nurse sign off incorporated into their order process and they expected this process and or nurse manager review to catch routing and order entry errors before they were released in the EMR. In this case, nurses should have caught and discontinued the order error right away when it was discovered R190 didn't have a colostomy.
The DON stated they did not have an explanation as to why staff had continued to sign off on colostomy care for 7 months when R190 did not have a colostomy.
245183 07/11/2024
North Ridge Health and Rehab 5430 Boone Avenue North New Hope, MN 55428
During continuous observation on 7/10/24 from 7:35 a.m. to 11:16 a.m., R138 was observed in her wheelchair in the dining room. At 7:35 a.m., R138 was observed at the dining room table waiting for breakfast. At 9:54 a.m., R138 attended an activity in the dining room. At 11:08 a.m., resident remained in the dining room following the activity and had not been approached by staff.
During interview on 7/10/24 at 11:16 a.m., nursing assistant (NA)-C stated she could not remember if she had brought R138 to the bathroom. NA-C did approach R138 to offer toileting, however R138 refused.
During interview on 7/10/24 at 11:21 a.m., registered nurse (RN)-F stated R138 was incontinent and did have a history of pressure ulcers.
During interview on 7/10/24 at 11:29 a.m., RN-E stated residents were assessed to determine how frequently they were to be toileted. RN-E confirmed R138 had a healed pressure injury. RN-E expected R138 to be toileted every 2-3 hours and if she refused, R138 should be reapproached.
During observation on 7/10/24 at 11:42, RN-E approached R138 to offer toileting and repositioning prior to lunch. R138 agreed and was toileted and repositioned by staff.
During interview at 7/10/24 at 1:48 p.m., director of nursing (DON) confirmed R138 should have been toileted every 2-3 hours. DON stated it was the resident's right to refuse, however residents with memory impairment should have been encouraged and reapproached with refusal. DON stated repositioning and toileting was important to keep skin intact.
Pressure ulcer prevention policy request and not provided.
245183 07/11/2024
North Ridge Health and Rehab 5430 Boone Avenue North New Hope, MN 55428
During interview on 7/11/24, at 10:00 a.m., director of nursing (DON) stated the facility admission nurses were responsible for completing all admission and re-admissions of residents. DON went on to say if a resident returned on an evening or weekend one of the floor nurses would be responsible for completing any necessary admission assessments, and a second nurse would review the admission documents and perform a second check to confirm accuracy of new or changed orders. DON stated this would include a full a head-to-toe assessment.
While reviewing R45's hospital discharge summary documents DON confirmed the summary indicated R45's dialysis shunt had been removed and R45 was no longer receiving dialysis treatments.
Additionally, DON confirmed staff had falsely documented completing dialysis related tasks from 7/1 thru 7/8, and stated she couldn't explain why staff had documented the tasks as completed. DON stated her expectation of staff was to complete assigned tasks and complete all documentation accurately. DON stated this is important for accuracy of the medical record and to prevent any potentially harmful outcomes to the residents.
245183 07/11/2024
North Ridge Health and Rehab 5430 Boone Avenue North New Hope, MN 55428
During interview on 7/11/24 at 8:12 a.m., RN-E confirmed the carpet outside of the dining room felt sticky and described the two light brown spots outside of room [ROOM NUMBER] at a spilled supplement from a medication pass. RN-E stated there is a carpet cleaner on site and she would get them up to clean it.
During interview on 7/11/24 at 8:21 a.m., Direct of housekeeping stated she does spot checks on the units daily.
She stated the staff are instructed to wipe down hand railings daily, flat mop the walls weekly and as needed, vacuum the floor in the dining room after breakfast, whip down tables daily after breakfast and lunch.
Director of housekeeping confirmed there was crumbs and food particles on the floor after breakfast.
Direct of housekeeping confirmed there was a 4-foot piece of wallpaper missing and the exposed wall had both liquid and solid spilled on the wall and stated the wallpaper is old and needs to be replaced.
Director of housekeeping confirmed spots on carpet outside of room [ROOM NUMBER] and that the carpet felt sticky outside of the dining room.
She stated staff should have been able to clean spots off the floor.
Direct of nursing confirmed the handrails needed to be cleaned and should have been done daily.
She stated it was important to clean and disinfect daily because this was their home, and the facility needed to make sure they have a safe clean area to live.
During interview on 7/11/24 at 8:56 a.m., administrator stated the carpet on the unit needed to be replaced and that there had been discussion but no solid timeline.
The administrator confirmed the wallpaper in room [ROOM NUMBER] was not satisfactory or homelike and confirmed the color was not a match.
The administrator stated the facility was working on replacing a few non-functioning exhaust fans which was the cause of the odor on the unit. He stated the facility was still obtaining quotes for the exhaust fans.
The administrator confirmed there were rips and missing pieces of wallpaper in the dining room and stated the wallpaper in the whole building needs to be replaced but that was a massive undertaking. He stated it was not a homelike or welcoming environment.
The administrator confirmed a few handrailings were missing endcaps, which caused them to have a blunt edge and could lead to injury. He stated he would have expected a work order to be put in as critical and for the issue to be fixed.
During an interview on 7/11/24 at 4:16 p.m., the director of nursing (DON) reviewed R40's medications and BPs documented and stated the Midodrine should not have been given since the BP was higher than they allowable parameters to give the medication.
The DON expected all nursing staff would follow the provider orders and only given medication when outside the ordered parameters.
Facility policy Documentation of Medication Administration last revised 9/12 lacked documentation of BP's needed to be taken prior to giving BP medication with parameters and what to do if outside the ordered parameters.
49617
R121:
R121's admission Minimum Data Set (MDS) dated [DATE], indicated she had moderate cognitive impairment and was taking antibiotics. MDS indicated R121 had diagnoses including infection following a procedure, wound infection, malnutrition, and chronic pain.
R121's current physician orders included the following:
- amoxicillin oral suspension reconstituted 400 milligrams (mg)/5 milliliters (mL), Give 6.3mL enterally (directly into the digestive tract) three times a day for infection, dated 6/24/24.
R121's medication administration record (MAR) dated 6/2024, revealed an order for a 48-72 hour antibiotic re-assessment dated [DATE] and discontinued 6/24/24.
The MAR also revealed a discontinued antibiotic order for ampicillin-sulbactam sodium (Unasyn) intravenous solution reconstituted 3 (201) gram (GM), to use 2 gram intravenously every 6 hours for sepsis dated 6/2/24 and discontinued 6/18/24.
R121's care plan lacked documentation of antibiotic monitoring.
A progress note dated 6/11/24, indicated R121 left the facility to an infectious disease appointment and was brought to the emergency department and admitted to the hospital.
245183
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 245183 B.
Wing 07/11/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
North Ridge Health and Rehab 5430 Boone Avenue North New Hope, MN 55428
During interview on 7/11/24 at 8:12 a.m., RN-E confirmed the carpet outside of the dining room felt sticky and described the two light brown spots outside of room [ROOM NUMBER] at a spilled supplement from a medication pass. RN-E stated there is a carpet cleaner on site and she would get them up to clean it.
During interview on 7/11/24 at 8:21 a.m., Direct of housekeeping stated she does spot checks on the units daily.
She stated the staff are instructed to wipe down hand railings daily, flat mop the walls weekly and as needed, vacuum the floor in the dining room after breakfast, whip down tables daily after breakfast and lunch.
Director of housekeeping confirmed there was crumbs and food particles on the floor after breakfast.
Direct of housekeeping confirmed there was a 4-foot piece of wallpaper missing and the exposed wall had both liquid and solid spilled on the wall and stated the wallpaper is old and needs to be replaced.
Director of housekeeping confirmed spots on carpet outside of room [ROOM NUMBER] and that the carpet felt sticky outside of the dining room.
She stated staff should have been able to clean spots off the floor.
Direct of nursing confirmed the handrails needed to be cleaned and should have been done daily.
She stated it was important to clean and disinfect daily because this was their home, and the facility needed to make sure they have a safe clean area to live.
During interview on 7/11/24 at 8:56 a.m., administrator stated the carpet on the unit needed to be replaced and that there had been discussion but no solid timeline.
The administrator confirmed the wallpaper in room [ROOM NUMBER] was not satisfactory or homelike and confirmed the color was not a match.
The administrator stated the facility was working on replacing a few non-functioning exhaust fans which was the cause of the odor on the unit. He stated the facility was still obtaining quotes for the exhaust fans.
The administrator confirmed there were rips and missing pieces of wallpaper in the dining room and stated the wallpaper in the whole building needs to be replaced but that was a massive undertaking. He stated it was not a homelike or welcoming environment.
The administrator confirmed a few handrailings were missing endcaps, which caused them to have a blunt edge and could lead to injury. He stated he would have expected a work order to be put in as critical and for the issue to be fixed.
245183
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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.