Beauvais Rehab and Healthcare Center

In the surveyor’s words

From the most serious findings on record at Beauvais Rehab and Healthcare Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Jul 18, 2023

  Based on interview and record review, the facility failed to provide protective oversight for one resident who resided on a secured unit and whose diagnoses included dementia, from elopement (Resident #1). The resident left the facility, without staff knowledge on 7/8/23 or 7/9/23. Emergency Medical Services (EMS) took the resident to an emergency roiagnom on [DATE], and he/she was released to his/her family member, who took the resident back to the facility. On 7/9/23, the facility assessed the resident as at high risk to wander. Insufficient measures were implemented to prevent another elopement. On 7/10/23, the resident again left the facility without staff knowledge. […]

• Actual harm, isolatedF686Jul 18, 2023

  Based on observation, interview and record review, the facility failed to ensure residents received care consistent with professional standards and followed their Wound Management-Nursing Care policy to identify, document, monitor, notify physicians and promptly initiate physician's orders to treat pressure injuries/ulcers (injury to the skin and underlying tissue caused by pressure or friction) for two of six residents sampled with actual pressure injuries and/or at risk of developing pressure injuries (Residents #21 and #22). The census was 133. […]

• Actual harm, isolatedF686Jul 18, 2023

  Based on observation, interview and record review, the facility failed to ensure residents received care consistent with professional standards and followed their Wound Management-Nursing Care policy to identify, document, monitor, notify physicians and promptly initiate physician's orders to treat pressure injuries/ulcers (injury to the skin and underlying tissue caused by pressure or friction) for two of six residents sampled with actual pressure injuries and/or at risk of developing pressure injuries (Residents #21 and #22). The census was 133. […]

• Actual harm, isolatedF692Apr 28, 2023

  Based on observation, interview, and record review, the facility failed to adequately support the nutritional status of one resident who experienced a weight loss of 25.70% in four months by not notifying the physician to obtain orders for the Registered Dietician (RD) recommendations and the facility failed to follow their policy by not having the resident re-weighed (Resident #2). The facility also failed to follow physician orders in providing a therapeutic diet and liquids for one resident who experienced a weight loss of 6.5% in two months (Resident #10) and for one resident who experienced a weight loss of 5.6% in two months (Resident #4). The sample size was 14. […]

• Actual harm, isolatedF684Aug 19, 2022

  41151 Based on observation, interview, and record review, the facility failed to conduct a thorough pre-admission assessment to ensure a resident's needs could be met by the facility (Resident #32). Prior to the resident's admission, the facility was aware the resident needed to reside on a secured unit as a condition to receive outpatient dialysis. At admission, the resident was not placed on a secured unit and missed a dialysis appointment as a result. The resident was then placed on the secured unit, which resulted in self-injurious behavior. The resident was sent to the hospital and issued an immediate discharge notice due to the facility's interdisciplinary team (IDT) determining the facility was not an appropriate placement for the resident. The census was 115. […]