Bishop Rehabilitation And Nursing Center

F-F580):

- Resident #37 did not receive their Lyrica from the day shift (7:00 AM-3:00 PM) of 6/22/2024 until day shift of 6/24/2024 due to the facility not having the resident's ordered medication and the provider was not notified.

This resulted in putting residents who received pain medication, at risk for harm that was Immediate Jeopardy and Substandard Quality of Care.

- Resident #147 refused heparin, insulin, and labs as ordered for a period of 6 months, the medical provider was not notified and there was not an assessment by the provider.

- Resident #153 had a low blood glucose level that was reported to the facility by the lab on 6/22/2024 and the provider was not notified.

This resulted in the likelihood of serious injury, serious harm, or death that was Immediate Jeopardy to resident's health and safety.

- Resident #528 had a change in condition and was not assessed by a qualified professional when the change was noted, the medical provider was not notified, and the resident's representative was not notified.

Subsequently, the resident was hospitalized with severe dehydration.

This resulted in harm to Residents #528 and #37 that was not immediate jeopardy.

Activities of Daily Living (

F-F677):

- Resident #154 did not receive oral hygiene as ordered.

- Resident #226 did not receive assistance with eating as care planned.

Pressure Ulcer Services (

F-F686):

- Resident #826 was readmitted from the hospital with pressure injuries of the sacrum and heel, the areas were not assessed by a qualified professional, and there were no treatments provided for the areas.

The resident was re-hospitalized on two subsequent occasions, had pressure injuries of the sacrum and heels, the areas were not assessed timely by a qualified professional or provided with treatments following readmission.

- Resident # 271 had orders for pressure relief boots to be worn while in bed and the boots were not applied.

Subsequently, the resident developed a deep tissue injury (localized area of purple/maroon discolored intact skin due to damage of underlying tissue) area to their right heel.

Additionally, there were wound care recommendations for a wheelchair cushion evaluation and for the resident's brief to be left open to air that were not implemented.

335338

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 335338 B.

Wing 07/11/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Bishop Rehabilitation and Nursing Center 918 James Street Syracuse, NY 13203

F-F688):

- Resident #64 did not have bilateral hand splints in place as ordered and care planned.

Maintaining Acceptable Parameters of Nutritional Status (

F-F692):

- Resident #133 had a significant weight loss and recommendations for an appetite stimulant were not discussed with the medical provider.

Respiratory Care (

F-F695):

- Resident #64's did not receive the appropriate Bilevel Positive Airway Pressure (mechanical non-invasive ventilator for breathing assistance) mask.

Pain Management (

F-F697)

-Resident #28's physician ordered pain cream was not administered as ordered and was documented as administered.

-Resident #37 did not receive Lyrica (used to treat nerve and muscle pain) as ordered for 3 days;

-Resident #64 was not aware of an as needed order for acetaminophen (pain reliever) and was not offered the medication when in pain.

Subsequently, Residents #28, #37, #64 had unresolved pain that affected their daily functional abilities, psychosocial well-being, and diminished quality of life.

This placed all residents with pain, who received pain medication, at risk for harm that was Immediate Jeopardy and Substandard Quality of Care.

Medically Related Social Services (

F-F745):

- Resident #41 did not have person-centered mental health interventions, licensed psychologist's recommendations were not implemented into the resident's plan of care.

There were no documented social services follow up with the resident following their behaviors.

- Resident #126 did not have person-centered mental health interventions for their behaviors or refusals of care and medications.

There were no documented social services follow up with the resident following their behaviors.

335338

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 335338 B.

Wing 07/11/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Bishop Rehabilitation and Nursing Center 918 James Street Syracuse, NY 13203

During a telephone interview on 6/10/2024 at 10:05 AM, Nurse Practitioner #16 stated if they ordered acute labs for a resident, they typically followed up the next day to review the results. If routine scheduled labs were completed, they expected nursing to notify them as soon as possible of any alterations.

Lab results such as a high white blood cell count and elevated blood urea nitrogen were labs they wanted to be notified about.

They stated they believed they did not work on 2/16/2024 and did not review the resident's labs until after the resident was discharged to the hospital. If they had known the resident's white blood cell count was high, they would have intervened and ordered a chest x-ray and/or urinalysis (often used to check for urinary tract infections).

For the elevated blood urea nitrogen, they would have ordered extra hydration (fluids) by mouth or intravenously (through a vein).

Earlier intervention could have resulted in a different outcome for the resident.

335338

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 335338 B.

Wing 07/11/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Bishop Rehabilitation and Nursing Center 918 James Street Syracuse, NY 13203