Inspection Reports for Mid Valley Nursing & Rehabilitation

The facility was found deficient in honoring residents' rights to formulate advance directives, specifically due to an unsigned out-of-hospital Do Not Resuscitate (OOH-DNR) form. Additionally, deficiencies were noted in the administration of intravenous fluids, including failure to label IV dressings, and in medication storage, where a Normal Saline flush was improperly stored at a resident's bedside.

The complaint investigation found that CNA A reused wipes during catheter care and provided care with the resident standing, contrary to proper infection control procedures. The complaint was substantiated with observations and interviews confirming improper technique and risk of infection.

The facility failed to ensure proper catheter care for Resident #2, including improper wiping technique by CNA A who reused wipes and provided care while the resident was standing, potentially placing the resident at risk for urinary tract infections. Interviews with staff revealed inconsistent training and practices regarding catheter care.

The facility failed to develop and implement a complete, person-centered care plan for Resident #1 that included measurable objectives and timeframes for pruritus and related behaviors. Additionally, the facility failed to document weekly total body skin assessments as ordered by the physician for Resident #1, with a missed skin assessment on 02/26/25. Interviews with nursing staff and review of policies revealed gaps in care plan updates and skin assessment documentation.

The facility failed to ensure that licensed vocational nurses correctly completed neuro checks for Resident #1 between 05/30/24 and 06/01/24, resulting in incomplete and inaccurate documentation of vital signs. Despite no injuries from the fall, the failure to document accurate vital signs could risk resident health and affect physician's ability to monitor the resident properly.

The facility was found deficient in multiple areas including failure to develop and implement comprehensive care plans (notably oxygen treatment), failure to obtain physician orders for oxygen therapy, failure to post oxygen and contact precaution signs, failure to maintain accurate clinical records especially neuro checks, failure to label and date food items properly, and failure to follow infection prevention protocols such as Enhanced Barrier Precautions and visitor notification for contact precautions.

The complaint investigation was triggered by allegations of neglect and abuse related to Resident #2's Foley catheter care and Resident #1's unsupervised exit from the facility on 03/21/2024. The facility failed to stop the Foley catheter procedure when Resident #2 expressed pain and failed to report Resident #1's exit within the required timeframe.

The facility failed to ensure Resident #2 was free from neglect and abuse during Foley catheter care, as staff did not stop the procedure when the resident expressed pain, resulting in hospitalization. The facility also failed to report a separate incident of Resident #1 exiting the facility in a timely manner and failed to care plan for Resident #1's wandering and exit seeking behaviors prior to the incident. Immediate Jeopardy was identified related to Resident #2's care but was removed after corrective actions and staff training.

The facility failed to ensure Resident #2 had his physician-ordered medication Entresto available on 03/22/24, resulting in a missed dose. Staff did not notify the physician or pharmacy about the medication unavailability, despite training to do so. The medication was delivered the following day. The facility policy requires timely acquisition and administration of medications and reporting of medication errors.

The complaint investigation found that the facility did not obtain the required physician's signature on Resident #54's OOH-DNR form. Staff interviews confirmed the form lacked the physician's signature, and the social worker maintained a list of pending signatures. Despite the missing signature, nursing staff considered the resident DNR based on other documentation. The facility's policy mandates obtaining the physician's signature to implement the advance directive properly.

The facility failed to ensure Resident #54's OOH-DNR form was fully and correctly completed, as the physician's signature was missing on the form dated 09/13/2023. Interviews with staff revealed that although the resident/POA and witnesses signed the form, the physician's signature was not obtained or uploaded, but nursing staff considered the resident DNR based on other documentation. The facility's policy requires obtaining the physician's signature on the OOH-DNR form to meet directives.

The complaint investigation found that the facility improperly administered extended-release Tylenol by dissolving it for PEG tube administration without physician approval, which could reduce effectiveness. The Director of Nursing confirmed this practice was incorrect and discontinued the medication once aware.

The facility failed to properly administer extended-release Tylenol medication to Resident #3 by dissolving it for administration via PEG tube, contrary to manufacturer instructions. Staff did not consult the physician or follow proper medication administration protocols, potentially reducing medication effectiveness.

The facility was found deficient in multiple areas including failure to ensure residents received services with reasonable accommodation of needs, failure to send timely transfer/discharge notices to the Ombudsman, failure to develop and implement comprehensive care plans with measurable objectives, failure to provide appropriate respiratory care by not changing trach collar and tubing as ordered, and failure to limit PRN antipsychotic medication orders to 14 days without physician re-evaluation.