Richfield Health Center - Salem

In the surveyor’s words

From the most serious findings on record at Richfield Health Center - Salem, in the surveyor’s own words.

• Actual harm, isolatedF760Dec 5, 2024

  Based on interviews, clinical record review, and facility document review, the facility staff failed to prevent significant medication errors for one (1) of five (5) sampled residents (Resident #1). The findings included: The facility staff failed to administer Resident #1's diabetic medication according to the medical provider's orders. This resulted in the need to administer an injectable medication to increase Resident #1's blood sugar on the morning of 5/16/24, with a subsequent transfer to a local emergency department. Resident #1's Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 5/8/24, was signed as completed on 5/15/24. Resident #1 was assessed as being able to be understood, and as able to understand others. […]

• No harm, potential for more than minimal, patternF607Feb 8, 2023

  Based on staff interview, employee record review, and facility document review, the facility staff failed to follow their policy and procedure in regard to screening of new hires for 9 of 25 new hires. The findings included: The facility staff failed to obtain reference checks on new hire #1, #2, #3, #6, #7, #9, #10, #16, and #17 and failed to obtain background checks on new hire #3 and #9 until 02/07/23. 02/07/23, the survey team requested employee files from the facility. 02/08/23, the surveyor reviewed 25 new hire records (employee records). New hire #1, #2, #3, #6, #7, #9, #10, #16, and #17 employee records did not include reference checks. For new hires #3 and #9 background checks were not completed until 02/07/23. […]

• No harm, potential for more than minimal, patternF677Feb 8, 2023

  Based on observation, resident interview, staff interview, clinical record review, and facility policy review, the facility staff failed to provide activity of daily living (ADL) care for 4 of 23 current Residents, Residents #3, #4, #8, and #60. The findings included: 1. For Resident #3, the facility staff failed to provide nail care. Resident #3's fingernails were observed to be long. Resident #3's diagnoses included, but were not limited to, cerebral palsy, diabetes, and apraxia. Section C (cognitive patterns) of Resident #3's annual minimum data set (MDS) assessment with an assessment reference date (ARD) of 11/04/22 included a brief interview for mental status (BIMS) summary score of 15. […]

• No harm, potential for more than minimal, patternF812Jul 29, 2021

  Based on observation, staff interview, and facility document review, the facility staff failed to prepare, distribute and serve food in a manner that would prevent foodborne illnesses. The findings included: 1. During initial tour of the facility, the surveyor observed food in the active food supply that was opened and exposed. The dry storage room contained honey that had a best by date of March 2021. 07/27/2021 1:33 p.m., the surveyor entered the dietary kitchen on (TRC) the rehab center. The freezer was observed to have one box of chicken fritters and one box of hamburger patties that had been opened, the plastic bag had been ripped open exposing the items inside. The dry storage was observed to contain one jug of honey dated December 2020 and a best by date of March 2021. […]

• No harm, potential for more than minimal, isolatedF658Dec 5, 2024

  Based on interviews, clinical record review, and facility document review, the facility staff failed to follow professional standards of practice related to assessing a resident's change in condition for one (1) of five (5) sampled residents (Resident #1). The findings include: The facility staff failed to ensure Resident #1 had assessments, including reassessments, completed and/or documented according to professional standards of practice. Resident #1's Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 5/8/24, was signed as completed on 5/15/24. Resident #1 was assessed as able to make self understood and as able to understand others. […]