Devereux Skilled Nursing & Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Devereux Skilled Nursing & Rehabilitation Center, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF656Aug 21, 2024

  Based on observations, record review and interview the facility failed to implement resident centered care plans for seven Residents (#31, #34, #41, #6, #19,#14 and #38) out of a total sample of 15 residents. Specifically, 1a. For Resident #31, the facility failed to ensure his/her Prevalon boots (soft boots that help reduce the risk of pressure ulcers) were applied as per the plan of care, 1b. For Resident #31, the facility failed to ensure nursing staff supervised the Resident during meals as per the plan of care, 2a. For Resident #34, the facility failed to ensure his/her Prevalon boots were applied and offload the Resident's heels as per the plan of care, 2b. […]

• No harm, potential for more than minimal, patternF812Aug 23, 2023

  Based on observation and interview the facility failed to handle ready to eat food in accordance with professional standards for food service safety. Specifically, during an observation of the breakfast tray line the Cook handled ready to eat food with contaminated gloves. Findings include: Review of the facility policy titled Proper Food Preparation, revised August 2022, indicated the following: -Food will be handled as little as possible On 8/21/23 at 7:21 A.M., through 7:35 A.M., the following observations were made on the tray line during breakfast service: -The cook contaminated his gloves by touching the oven handles, serving utensils, and sheet tray, and then with the same contaminated gloves directly grabbed a ready to eat muffin by the top and placed it on a resident plate to be… […]

• No harm, potential for more than minimal, patternF883Aug 23, 2023

  Based on record review, policy review, and interview, the facility failed for three out of five sampled Residents (#3, #26, and #11) to ensure that each Resident was up to date with pneumococcal vaccinations in line with the Centers for Disease Control and Prevention (CDC) recommendations or had documentation in their medical records regarding their pneumococcal vaccination status. Findings include: Review of the facility policy titled Influenza and Pneumococcal Immunization, dated as revised 12/13/18, indicated it is the facility policy to provide immunizations for residents to minimize the risk of acquiring, transmitting or experiencing complications from influenza and pneumococcal pneumonia. […]

• No harm, potential for more than minimal, patternF761Aug 24, 2022

  Based on observation, record review and interview the facility failed to 1). Ensure medications were stored securely. 2). Ensure medications were kept at the recommended temperature. 3). Ensure opened medications were properly labeled. 4). Ensure oral medications were kept separated from topical medications, on 1 of 2 units. 5. Ensure narcotics are stored double locked until administration. Findings include: Review of the facility policy titled Medication Storage In The Facility and dated revised December 2019 indicated that medications and biological's are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. […]

• No harm, potential for more than minimal, patternF880Feb 23, 2021

  Based on observation, policy review and interview, the facility failed to ensure staff wore personal protective equipment (PPE) appropriately to prevent the possible spread of communicable diseases, including COVID-19. Findings include: Review of the facility's Droplet/Contact Precautions COVID-19 policy dated 8/7/20 indicated that full PPE is required to care for the resident on droplet precautions. Review of the facility's document dated 11/19/20, Use of PPE During Various Stages of Covid-19, indicated that eye protection must be worn in any resident care area. During an interview on 2/23/21 at 7:40 A.M., Nurse #1 showed the surveyor which rooms on the 1st floor had residents that were on quarantine and on droplet precautions for potential COVID-19. […]