Belle Care Nursing And Rehabilitation Center
BELLE CARE NURSING AND REHABILITATION CENTER in TRENTON, NJ — inspection on June 26, 2024.
Found 6 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
According to the Admission Record (AR), Resident #147 was admitted to the facility with the diagnoses which included but not limited to chronic respiratory failure and tracheostomy (hole in the windpipe to facilitate breathing).
The most recent comprehensive Minimum Data Set (MDS), an assessment tool dated 4/10/24, reflected that Resident #147 had moderate cognitive deficits and was dependent on staff for hygiene. Resident #147's individualized comprehensive care plan (ICCP) reflected that the resident required total dependence and one-person physical assistance with personal hygiene.
According to the AR, Resident #32 was admitted to the facility with the diagnoses which included but not limited to cerebral infarction (stroke).
The most recent comprehensive MDS dated [DATE], reflected that Resident #32 had severe cognitive deficits and was dependent on staff for hygiene. Resident #32's ICCP reflected that the staff provided incontinent care every two to four hours and that the resident required total dependence and one-person physical assistance with personal hygiene.
On 6/18/24 at 8:02 AM, the surveyor conducted an incontinence tour on the Second Floor nursing unit accompanied by the Unit Manager/Licensed Practical Nurse (Um/LPN #1) and observed the following:
The surveyor and UM/LPN #1 entered Resident #147's room who was observed lying in bed. UM/LPN #1 asked the resident if she could check their incontinent brief and the resident gave UM/LPN #1 permission.
The surveyor observed that the resident's incontinent brief was dry and the chuck (protective bed pad) that was directly under the resident was dry, however the fitted sheet located under the chuck had a large brown/yellow stain that smelled like urine and contained some dry brown stains which UM/LPN #1 identified as bowel movement (bm). UM/LPN #1 was interviewed at that time, and stated that the Certified Nursing Aide (CNA) that was assigned to care for Resident #32 should have changed the resident's sheet when performing incontinence care and should not have left a urine-soaked sheet on the resident's bed. UM/LPN #1 stated that the Agency CNA that cared for the resident on 11:00 PM to 7:00 AM shift must have left the dirty sheet on the resident's bed because the CNA (CNA #1) that came in that morning just got to the unit and had not made rounds yet. UM/LPN #1 stated that incontinence rounds were completed by the CNA every two hours.
The surveyor observed the resident's skin during the tour and the resident's skin was free of skin breakdown.
A review of the CNA Assignment sheet for 6/18/24, revealed that for the resident census of 47, there were five assigned CNAs. CNA #1 had thirteen assigned residents to care for.
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
According to the Admission Record (AR), Resident #147 was admitted to the facility with the diagnoses which included but not limited to chronic respiratory failure and tracheostomy (hole in the windpipe to facilitate breathing).
The comprehensive Minimum Data Set (MDS), an assessment tool dated 4/10/24, reflected that Resident #147 had moderate cognitive deficits and was dependent on staff for hygiene. Resident #147's individualized comprehensive care plan (ICCP) reflected that the resident required total dependence and one-person physical assistance with personal hygiene.
According to the AR, Resident #32 was admitted to the facility with the diagnoses which included but not limited to cerebral infarction (stroke).
The comprehensive MDS dated [DATE], reflected that Resident #32 had severe cognitive deficits and was dependent on staff for hygiene. Resident #32's ICCP reflected that the staff provided the resident incontinent care every two to four hours, and that the resident required total dependence and one-person physical assistance with personal hygiene.
On 6/18/24 at 8:02 AM, the surveyor conducted an incontinence tour on the Second Floor nursing unit accompanied by the Unit Manager/Licensed Practical Nurse (UM/LPN #1) and observed the following:
The surveyor and UM/LPN #1 entered Resident #147's room who was observed lying in bed. UM/LPN #1 asked the resident if she could check their incontinent brief and the resident gave UM/LPN #1 permission.
The surveyor observed that the resident's incontinent brief was dry and the chuck (protective bed pad) that was directly under the resident was dry, however the fitted sheet located under the chuck had a large brown/yellow stain that smelled like urine and contained some dry brown stains which UM/LPN #1 identified as bowel movement (bm). UM/LPN #1 was interviewed at this time and stated that the Certified Nursing Assistant (CNA) that was assigned to care for Resident #32 should have changed the resident's sheet when performing incontinence care and should not have left a urine-soaked sheet on the resident's bed. UM/LPN #1 stated that the agency CNA that cared for the resident on the 11:00 PM to 7:00 AM shift must have left the dirty sheet on the resident's bed, because the CNA (CNA #1) that came in this morning just got to the unit and had not made rounds yet. UM/LPN #1 stated that incontinence rounds should be done by the CNA every two hours.
The surveyor observed the resident's skin during the tour and the resident's skin was free of skin breakdown.
On 6/18/24 at 8:45 AM, the surveyor conducted an incontinence tour on the First Floor nursing unit with a Licensed Practical Nurse (LPN #1) and observed the following:
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
During entrance conference on 6/17/24 at 10:00 AM, the surveyor asked the Licensed Nursing Home Administrator (LNHA) and Director of Nursing (DON) who the facility's Infection Preventionist (IP) was, and the DON stated the facility's previous IP left about two or three months ago and the position was vacant.
The DON stated herself, the Assistant Director of Nursing (ADON), and the two unit managers reviewed immunizations, antibiotic stewardship, and infection control issues. At that time the surveyor requested a copy of the infection control certifications as well as the date the IP stopped working.
On 6/18/24 at 11:42 AM, the surveyor requested from the LNHA a copy of the infection control certifications and the last date the IP worked.
On 6/19/24 at 12:55 PM, the surveyor requested from the LNHA a copy of the infection control certifications and the last date the IP worked as well as the antibiotic stewardship tracking and surveillance.
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
The survey team informed the facility that there were repeated concerns from the last standard survey which included MDS assessments, medication
what the facility implemented to ensure sustainability.
The LNHA acknowledged that even though she started at the facility in April 2024, she was present for the April quarterly QAPI meeting as well as reviewed and signed the facility assessment and reviewed the CMS 2567 from last standard survey. At that time the DON stated she was aware of the facility's previous deficiencies and that facility educated staff and completed reports.
No additional information was provided.
A review of the facility provided Administrator job descriptions included the Administrator is responsible for planning and is accountable for all activities and departments at [name redacted] subject to rules and regulations promulgated by government agencies to ensure proper health care services to residents.
The Administrator administers, directs, and coordinates all activities of the facility to assure that the highest degree of care is constantly provided to the residents .
A review of the facility provided Senior Director of Nursing Services job descriptions included in addition to the standard responsibilities of Director of Nursing, Senior Director of Nursing is responsible for providing leadership, training and expert guidance.
Individuals selected for this position and must be knowledgeable in all aspects of long term care nursing and have demonstrated ability in managing a nursing department .
Performs Related Duties: 1. in the absence of the Administrator and/or licensed Assistant Administrator, the DON is responsible carrying out the administrative duties of the nursing facility .
NJAC 8:39-33.1(a)(e); 33.2 (a)(b)(c)(d)
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
During entrance conference on 6/17/24 at 10:00 AM, the surveyor asked the LNHA and Director of Nursing (DON) who the facility's Infection Preventionist (IP) was, and the facility did not have an IP for two or three months, that the Assistant Director of Nursing (ADON), two unit managers, and herself reviewed antibiotic stewardship and inserviced staff on infection control.
The surveyor requested a copy of their infection control certifications.
On 6/19/24 at 1:36 PM, the surveyor interviewed the DON who stated she did not have a certification in infection control; but she reviewed infection control with the ADON who also was not certified.
The DON stated only the Unit Manager/Licensed Practical Nurse (UM/LPN #1) had an infection control certification.
The DON stated the unit managers provided the antibiotic stewardship information to the ADON who reviewed, summarized, and completed the monthly report, and the ADON in-serviced staff on infection control.
On 6/20/24 at 12:36 PM, the surveyor interviewed the ADON who stated the facility had no IP since April of 2024, everyone was pitching in with infection control.
The ADON stated she had just completed May's antibiotic stewardship review yesterday.
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
According to the Admission Record, Resident #87 was admitted to the facility with diagnoses including but not limited to diabetes mellitus (a disease of inadequate control of blood levels of glucose), hypertension (high blood pressure), heart failure (heart muscle does not pump blood as well as it should), and stroke (damage to the brain from interruption of its blood supply).
A review of the most recent Minimum Data Set (MDS), an assessment tool dated 3/18/24, reflected the resident had a brief interview for mental status score of 15 of out of 15, indicating a fully intact cognition. A review of Section O0300 indicated Resident #87's pneumococcal vaccine (immunization) was not up to date; that the resident was offered and declined.
A review of Resident #87's Immunization Record revealed no pneumococcal vaccine was administered, but the resident was administered influenza vaccine on 3/11/24.
A review of Resident #87's Progress Notes did not include documentation that the resident was educated, offered, and declined the vaccination.
On 6/20/24, the surveyor requested the Pneumococcal Immunization Informed Consent declination form from the Director of Nursing (DON).
On 6/24/24, a review of a Pneumococcal Immunization Informed Consent, revealed that Resident #87 was offered the pneumonia vaccine on 6/18/24 and declined.
There was no documentation that the resident was offered or that the resident was offered the pneumococcal vaccine prior to survey.
On 6/24/24 at 10:02 AM, the surveyor interviewed the Assistant Director of Nursing (ADON) who stated upon admission, the nurse reviewed the resident's vaccination status.
The ADON stated if there was no documented immunizations received, the nurse offered the immunization and had the resident signed the consent form or declined the immunization on the same form.
The ADON stated the resident was offered the pneumococcal vaccine on 6/18/24, but declined.
The ADON confirmed the facility did not have the resident's declination form from admission.
On 6/26/24 at 10:35 AM, the DON in the presence of the Licensed Nursing Home Administrator (LNHA), ADON, and survey team stated, the resident was offered on admissions, but the facility could not provide documentation.
2.
According to the Admission Record, Resident #76 was admitted to the facility with diagnoses included hypertension (high blood pressure), stroke (damage to the brain from interruption of its blood supply), and end stage renal disease (kidneys can no longer function on their own).
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618