Lake Port Square Health Center

In the surveyor’s words

From the most serious findings on record at Lake Port Square Health Center, in the surveyor’s own words.

• Immediate jeopardy, widespreadF600May 6, 2022

  Based on observation, interview, and record review, the facility failed to ensure residents were free from medical neglect by allowing unqualified agency and/or facility staff to work outside of their scope of practice, administering IV (intravenous) medications via midline catheters for 4 of 4 residents, Residents #2, #56, #138, and #237, without certification of education, training and validation of competency for IV medication infusion to residents who are administered IV medications. IV infusion without IV certification and validation of competency could result in the likelihood of serious harm and/or death for residents who are administered IV medication infusions. […]

• Immediate jeopardy, widespreadF726May 6, 2022

  Based on observation, interview, and record review, the facility failed to ensure licensed nurses had appropriate competencies and skills sets to provide nursing and related services to residents by allowing unqualified agency and/or facility staff to work outside of their scope of practice, administering IV (intravenous) medications via midline catheters for 4 of 4 residents, Residents #2, #56, #138, and #237, without certification of education, training and validation of competency for IV medication infusion to residents who are administered IV medications. IV infusion without IV certification and validation of competency could result in the likelihood of serious harm and/or death for residents who are administered IV medication infusions. […]

• Immediate jeopardy, widespreadF835May 6, 2022

  Based on observation, interview, and record review, the facility administration failed to effectively and efficiently attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident by not assuming full responsibility for the day to day operations of the facility by allowing unqualified agency and/or facility staff to work outside of their scope of practice, administering IV (intravenous) medications via midline catheters for 4 of 4 residents, Residents #2, #56, #138, and #237, without certification of education, training and validation of competency for IV medication infusion to residents who are administered IV medications. […]

• No harm, potential for more than minimal, widespreadF761May 6, 2022

  Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals used in the facility were stored and labeled in accordance with current professional standards for 5 of 5 medication carts reviewed for medication labeling and storage. Findings include: During an observation of medication cart #1 on 5/2/2022 at 9:10 AM with Staff B, Licensed Practical Nurse (LPN), there were two opened [MEDICATION(S)] insulin pens with no date opened or expiration dates, one unlabeled medication cup with a small round yellow pill with no resident identifier and no identification of what the medication was, two opened [MEDICATION(S)] 0.005% ophthalmic solution with no date opened or expiration dates and one unopened [MEDICATION(S)] 0.005% ophthalmic solution with… […]

• No harm, potential for more than minimal, widespreadF812May 6, 2022

  Based on observation, interview, and record review, the facility failed to properly store food in accordance with professional standards for food service safety, store cooking utensils under sanitary conditions, and maintain resident nourishment rooms to prevent the possible foodborne illness. Findings include: During a tour on 05/02/22 beginning at 9:10 AM of the main kitchen with the Food Services Director (FSD) in the walk-in cooler is a stainless-steel square food storage container covered with plastic wrap that held leftover chopped meat that was labeled with a used by date of 05/01/22. […]