River Bluffs Memory Care Community

Maintain physician order documentation in resident record

87608 Postural Supports (a) Based on… Postural supports may be used under the following conditions.(3) A written order from a physician indicating the need for the postural support shall be maintained...This requirement was not met as evidenced by: Licensee did not ensure there was a written physician's order indicating the resident's need for a postural support (1/2 side rails) for R1's hospital bed. There were 3 1/2 side rails attached to the bed, there should only be 1 per sideThis poses a potential health and safety risk to persons in care.

Resident access to hazardous items with safety review

Based on observation, the licensee did not comply with the section cited above inwhich poses/posed a potential health, safety or personal rights risk to persons in care. During the facility tour, LPA observed the Beauth Shop door unlocked which contained scissors and haircare supplies. Additionally room 13 had accessible hygiene supplies under the bathroom sink. R4's Physician Report states at risk if allowed access to Hygiene supplies. As does R1 and R2's.

Ensure hazardous items are locked and not unattended

Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed sharp knives used for cooking in a drawer in the kitchen. During interview, the Cook confirmed that the lock on the drawer was not in working order. Thhis leaves the knives in an unlocked, accessable drawer when the kitchen is unattended.

Keep bath, laundry and kitchen floors clean

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times..... (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.This requirement was not met as evidenced by: Licensee did not ensure that resident bathrooms are clean, safe, sanitary and in good repair. LPA observed multiple resident toilets that were unsanitary and unclean. 2 toilet seats are broken requiring replacement and a soiled resident brief was found on the floor in a resident bathroom.

Ensure hazardous items are locked and not unattended

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives..., are in locked storage and are not left unattended if outside the locked storage.This requirement was not met as evidenced by: Licensee did not ensure a sharp cooking knife in the kitchen, bottle of bleach in a laundry room and an open housekeeping cart were locked and inaccessible to residents in care.This poses an immediate health and safety risk to residents in care.

Based on Record review and interview, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. The facility has a Hospice Waiver for 8. There are currently 9 residents admitted to and receiving Hospice care.

Record centrally stored prescriptions and refill data

Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 3 medication count audits medication start dates were not accurately recorded which poses/posed a potential health, safety or personal rights risk to persons in care. R1 Pantoprazole start date 4/17/24 and R2 Aspirin start date is not recorded on the centrally stored log.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above. LPAs observed a razor in the shower of room 2 and Shout laundry spray in the bathroom of room 16. This poses a potential health, safety or personal rights risk to persons in care.