River Valley Rehabilitation and Healthcare Center

In the surveyor’s words

From the most serious findings on record at River Valley Rehabilitation and Healthcare Center, in the surveyor’s own words.

• Actual harm, isolatedF689Jul 13, 2023

  Based on record review, observations and staff interviews, the facility failed to ensure three (#4, #45 and #43) of eight residents reviewed for accident hazards out of 21 sample residents, were provided adequate supervision and a safe environment to prevent accidents and the re-occurrence of falls. Specifically, the facility failed to implement effective fall precautions to prevent the re-occurrence of falls for Resident #45 and Resident #43, contributing to major injuries: On 3/31/23 with a third fall within a week, Resident #43 fell suffering a laceration to her forehead and was sent to the emergency room for sutures; and On 7/7/23 with a fifth fall within two months, Resident #45 fell suffering a fractured hip. […]

• No harm, potential for more than minimal, widespreadF812Apr 2, 2025

  Based on observations and interviews, the facility failed to store, prepare, distribute and serve food in a sanitary manner in the main kitchen and the main dining room. Specifically, the facility failed to: -Ensure food was labeled, dated and discarded in a timely manner; and -Ensure the refrigerator and hot cocoa machine was cleaned regularly. I. Failed to ensure food was labeled, dated and disposed of timely A. Professional reference The Colorado Retail Food Establishment Rules and Regulations, ([DATE]), retrieved on [DATE] read. […]

• No harm, potential for more than minimal, widespreadF726Jul 13, 2023

  Based on record review and interviews, the facility failed to ensure licensed nurses were able to demonstrate competencies in skills and techniques necessary to care for residents' needs, as identified through resident assessments, facility assessments, and described in the plan of care for three of five certified nurse aides (CNAs), two of two licensed practical nurses (LPNs) and two of two registered nurses (RNs). Specifically, the facility: -Failed to complete competencies as identified in the facility assessment for CNA #2, #4, and #6; -Failed to complete competencies as identified in the facility assessment for LPN #1 and #2; and -Failed to complete competencies as identified in the facility assessment for RN #1 and #2. I. […]

• No harm, potential for more than minimal, patternF550Dec 19, 2024

  Based on observations, record review and interviews, the facility failed to promote and maintain the resident's dignity for four (#3, #39, #49 and #51) of five residents reviewed for dignity and respect out of 41 sample residents. Specifically, the facility failed to ensure Resident #3, Resident #39, Resident #51 and Resident #49's call lights were in reach. Findings include: I. Facility policy and procedure The Call System policy, dated September 2022, was provided by the nursing home administrator (NHA) on 12/19/24 at 2:07 p.m. […]

• No harm, potential for more than minimal, patternF659Dec 19, 2024

  Based on record review and interviews, the facility failed to ensure residents received care from qualified employees for 11 (#15, #5, #46, #49, #34, #6, #19, #262, #45, #47 and #24) of 11 residents out of 41 sample residents. Specifically, the facility failed to ensure qualified and credentialed staff received, entered, confirmed and revised verbal and written physician's orders for Residents #15, #5, #46, #49, #34, #6, #19, #262, #45, #47 and #24. Findings include: I. Record review A. Resident #15 Review of Resident #15's December 2024 computerized physician orders (CPO) revealed the following physician's orders: Tylenol, give as needed every eight hours, not to exceed three grams of tylenol in 24 hours, ordered 2/1/23. […]