Inspection Reports for
Sunny Ridge

.009.01 Criminal History and Background Check: one of four employees did not have a Department Criminal History and Background Check completed as confirmed by the administrator and human resources director.

.009.06.c Use of Previous Criminal History and Background Check: one employee did not have the Idaho State Police background check completed prior to working alone with residents; the check was still pending at the time of survey.

.215.01 Administrator Responsibility: the administrator did not ensure all facility policies were developed to fulfill IDAPA16.03.22; the abuse/neglect/exploitation policy lacked required definitions, reporting procedures, documentation, investigation steps, and interventions to prevent recurrence; technical assistance was previously given on October 7, 2022.

.250.09 Plumbing: the facility's water temperatures were not consistently maintained between 105 and 120 degrees F; on 7/1/24 and 7/2/24, water temperatures in several resident rooms ranged from 131 to 137 degrees F, and the maintenance person was unaware of the high temperatures.

.260.06 Housekeeping and Maintenance Services: the facility was not maintained in a clean, safe and orderly manner; observed issues included cracked and chipped tile around the shower room door jamb, chipped and missing laminate on nurse's station countertops, separating baseboards, a strong urine odor in a resident's room, and scratched and gouged exit doors.

.319 Comprehensive Assessment Requirements: Resident #2 did not have a comprehensive assessment, including a nursing assessment, completed prior to admission on 3/2/23 as confirmed by the administrator.

.404 Fire and life safety standards: no documented weekly or monthly inspections for dry system and wet system gauges and control valves, and no documented emergency light testing monthly or annually.

.405.03 Medical gases: signs for oxygen use were not placed at rooms 101 and 110 or their entrances as required.

.405.04 Fuel-fired heating: no documented annual inspection for fuel-fired heating.

.260.07 Toxic Chemicals: toxic chemicals were observed to be stored in an unlocked area accessible to cognitively impaired residents on three occasions from 10/5/22 to 10/6/22.

.305.02.b Current Medication Orders and Treatment Orders: the facility did not ensure residents received their diets as ordered; Resident #2 was not provided a mechanical soft diet and Resident #1 was not provided a consistent or controlled carbohydrate diet on 10/5/22 and 10/6/22.

F 0578 Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive: the facility failed to help Resident #18 develop an advance directive, with no documentation of offering information to formulate one.

F 0641 Ensure each resident receives an accurate assessment: the facility failed to ensure MDS assessments accurately reflected residents' status for Residents #3 and #6, including incorrect PASRR coding and erroneous documentation of an indwelling catheter.

F 0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured: Resident #32's care plan did not include care for her toenails despite observed fungal infection and discoloration.

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable: Resident #32, dependent on staff for ADLs, did not receive toenail care and was not referred to the Podiatrist as needed.

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals: Resident #49's psychotropic medication Mirtazapine was not clarified for its indication, with the DON confirming it was for insomnia and depression.

F 0692 Provide enough food/fluids to maintain a resident's health: Resident #32 experienced significant weight loss and was not provided non-dairy nutritional supplements as ordered; dietary preferences were not documented or communicated.

F 0761 Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs: expired medications were found in two medication carts and a storage room; refrigerator temperature logs were not updated for several days.

F 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards: multiple food safety violations were observed including staff not wearing hair nets, serving undercooked eggs, improper food temperature monitoring, improper glove use, dirty cutting boards, inadequate sanitation, contaminated equipment, and damaged cooking skillets.

F 0880 Provide and implement an infection prevention and control program: staff failed to perform hand hygiene and don gloves appropriately during medication administration; Resident #49's graduated cylinder and syringe were not changed and dated as ordered, increasing infection risk.

F 0887 Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status: Resident #32's COVID-19 vaccination was not administered or documented despite consent and risk factors.

F 0578 Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive: the facility failed to help Resident #18 develop an advance directive, with no documentation of offering information to formulate one.

F 0641 Ensure each resident receives an accurate assessment: the facility failed to accurately reflect residents' status in MDS assessments for Residents #3 and #6, including incorrect PASRR Level II coding and erroneous documentation of an indwelling catheter.

F 0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured: Resident #32's care plan did not include care for her toenails despite observed fungal infection and discoloration.

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable: Resident #32, dependent on staff for ADLs, did not receive toenail care and was not referred to the Podiatrist as needed.

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals: Resident #49's psychotropic medication Mirtazapine was not clarified for its indication, with the DON confirming it was for insomnia and depression.

F 0692 Provide enough food/fluids to maintain a resident's health: Resident #32 experienced significant weight loss and was not provided non-dairy nutritional supplements as ordered; dietary preferences were not documented or communicated properly.

F 0761 Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs: expired medications were found in two medication carts and a storage room, and refrigerator temperature logs were not maintained.

F 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards: multiple food safety violations were observed including staff not wearing hair nets, serving undercooked eggs, improper temperature monitoring, cross-contamination risks, improper glove use, damaged cutting boards, inadequate sanitizing solution concentration, dirty ice machine residue, dirty dishes in clean areas, and damaged cooking skillets.

F 0880 Provide and implement an infection prevention and control program: staff failed to perform hand hygiene and don gloves appropriately during medication administration; Resident #49's graduated cylinder and syringe were not changed and dated as ordered, increasing infection risk.

F 0887 Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status: Resident #32's COVID-19 vaccination was not administered or documented despite consent and risk factors.

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals: medications for two residents were not administered as prescribed, including missed doses of Vitamin B12, Lysine, Topiramate, Venclexta, Breztri Inhaler, Methylprednisolone, and Cefdinir, with documentation indicating medications were unavailable.

F 0550 Honor the resident's right to a dignified existence: residents seated at the same table were served meals at different times, with delays up to 38 minutes causing potential psychosocial harm.

F 0623 Provide timely notification to the resident and ombudsman before transfer or discharge: the facility failed to notify the ombudsman of Resident #6's hospital transfers.

F 0625 Notify the resident or representative in writing how long the nursing home will hold the resident’s bed: bed hold notices were not provided to Residents #6 and #40 upon hospital transfer.

F 0641 Ensure each resident receives an accurate assessment: Resident #16's MDS assessments did not correctly reflect the PASARR Level II status, leading to inaccurate documentation.

F 0658 Ensure services meet professional standards: Resident #17's insulin pen was administered without priming, risking incorrect dosing and blood sugar control.

F 0689 Ensure nursing home area is free from accident hazards and provides adequate supervision: Resident #143 fell from a wheelchair without foot pedals, sustaining a head laceration; facility failed to ensure safety measures.

F 0725 Provide enough nursing staff every day to meet resident needs: residents and representatives reported insufficient staffing causing delays in care and response to call lights, contributing to falls and unmet needs.

F 0756 Ensure a licensed pharmacist performs monthly drug regimen review: pharmacist recommendations for Resident #31's antipsychotic use were not addressed by the physician.

F 0760 Ensure residents are free from significant medication errors: medication errors occurred for Residents #4, #16, and #145 including double dosing, missed medications, and missed doses, with corrective actions taken.

F 0812 Procure food from approved sources and store, prepare, distribute, and serve food safely: multiple food safety violations including expired spices, undated opened food items, improper storage, inadequate cleaning, and equipment maintenance issues were observed.

F 0880 Provide and implement an infection prevention and control program: Resident #144 was on enhanced barrier precautions but staff failed to wear protective gown during medication administration, risking infection transmission.

F 0883 Develop and implement policies for flu and pneumonia vaccinations: Resident #39 consented to influenza vaccine but it was not administered, risking influenza transmission and complications.

F 0550 Honor the resident's right to a dignified existence: residents seated at the same table were served meals at different times, causing delays up to 38 minutes and potential decrease in residents' sense of self-worth.

F 0552 Ensure informed consent: the facility failed to obtain signed consent prior to initiation of Trazodone for Resident #144, risking medication without resident knowledge.

F 0623 Provide timely notification of transfers: the facility failed to notify the ombudsman of Resident #6's hospital transfers, potentially affecting resident rights.

F 0625 Notify residents or representatives of bed hold policies: the facility failed to provide bed hold notices to Residents #6 and #40 upon hospital transfer, risking loss of bed rights.

F 0641 Ensure accurate resident assessments: Resident #16's MDS assessments incorrectly documented PASARR Level II status, risking inaccurate care planning.

F 0658 Ensure professional medication administration: LPN #1 failed to prime the insulin pen before injection for Resident #17, risking incorrect insulin dosing.

F 0689 Prevent accidents and provide supervision: Resident #143 fell from wheelchair without foot pedals in use, sustaining a head laceration; facility failed to ensure safety measures.

F 0725 Provide sufficient nursing staff: residents and representatives reported insufficient staffing causing delays in care and response to call lights, increasing risk of harm.

F 0756 Ensure monthly pharmacist drug regimen review: pharmacist recommendations for Resident #31's antipsychotic use were not addressed by attending physician, risking unnecessary medication use.

F 0760 Ensure residents are free from medication errors: multiple medication errors occurred for Residents #4, #16, and #145 including double dosing and missed medications; nurses involved no longer employed.

F 0812 Procure and store food safely: expired spices, undated opened food items, inadequate cleaning, and equipment maintenance deficiencies were observed, risking food contamination and resident health.

F 0880 Implement infection prevention program: staff failed to wear protective gown when administering medications via enteral tube to Resident #144 despite signage and orders, risking infection transmission.

F 0883 Develop and implement vaccination policies: Resident #39 consented to influenza vaccine but did not receive it, risking influenza transmission and complications.

F 0622 Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged: the facility failed to ensure all pertinent information was provided to the receiving facility when Resident #15 was transferred, and documentation of the transfer information was missing.

F 0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured: care plans for Residents #23 and #33 lacked person-centered details and interventions for depression and PTSD symptoms, placing residents at risk of negative outcomes.

F 0657 Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals: Resident #10's care plan was not reviewed or revised after an unwitnessed fall, missing updated fall risk interventions.

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents: Resident #10 was left unsupervised during meals despite being a fall risk, resulting in a fall and injuries; staff in-service was recommended.

F 0697 Provide safe, appropriate pain management for a resident who requires such services: the facility failed to monitor residents appropriately and offer non-pharmacological interventions prior to administering opioid pain medications for Residents #3, #4, #17, and #32.

F 0760 Ensure that residents are free from significant medication errors: Resident #32 did not receive ordered ABHR cream medication on 2/21/24 due to medication not being available despite being signed out.

F 0806 Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options: Residents #27 and #32 had food preferences that were not honored or documented properly, including Resident #27 receiving eggs despite disliking them and Resident #32 not receiving requested cereal.

F 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards: food items in the kitchen were not dated or labeled properly, and hygiene practices were not consistently followed by dietary staff, risking foodborne illness.

F 0814 Dispose of garbage and refuse properly: one outside dumpster was observed with the lid open and food debris around it, increasing the risk of pest infestation.

F 0880 Provide and implement an infection prevention and control program: staff failed to perform hand hygiene and change gloves appropriately during wound care for Residents #10 and #14, risking cross-contamination and infection.

F 0622 Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged: the facility failed to ensure all pertinent information was provided to the receiving facility when Resident #15 was transferred, and documentation of this communication was missing.

F 0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured: care plans for Residents #23 and #33 lacked person-centered details and interventions for depression and PTSD symptoms, placing residents at risk of inadequate care.

F 0657 Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals: Resident #10's care plan was not reviewed or revised after an unwitnessed fall, missing updated fall risk interventions.

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents: Resident #10 was left unsupervised during meals despite being a fall risk, resulting in a fall and injuries; staff in-service was recommended.

F 0697 Provide safe, appropriate pain management for a resident who requires such services: Residents #3, #4, #17, and #32 were not monitored appropriately for pain nor offered non-pharmacological interventions prior to opioid medication administration.

F 0760 Ensure that residents are free from significant medication errors: Resident #32 did not receive ordered ABHR cream medication due to unavailability despite documentation of administration.

F 0806 Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options: Residents #27 and #32 had food preferences that were not honored or documented properly, including repeated serving of disliked eggs and failure to provide requested cereal.

F 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards: food items in the kitchen were not dated or labeled properly, and staff failed to follow hygiene practices such as hand hygiene and wearing beard restraints.

F 0814 Dispose of garbage and refuse properly: one outside dumpster lid was left open with food debris on the ground, creating potential for pest infestation.

F 0880 Provide and implement an infection prevention and control program: staff failed to change gloves between providing incontinent care and wound care for Residents #10 and #14, risking cross-contamination and infection.