Rolling Hills Health and Rehab

In the surveyor’s words

From the most serious findings on record at Rolling Hills Health and Rehab, in the surveyor’s own words.

• Immediate jeopardy, isolatedF584Jan 23, 2024

  The facility reported a census of 69 residents with 13 selected for review. Based on observation, interview, and record review, the facility failed to maintain comfortable and safe temperature levels of 71 degrees Fahrenheit (F) or greater for ten residents, Resident (R)2, R5, R6, R7, R8, R9, R10, R11, R12, R13 when a facility furnace quit working mid-morning on 01/12/24. The furnace supplied heat to one of four wings, covering six resident rooms, with ten residents affected. Following the breakdown, a repairman came to the facility that afternoon and determined the part needed to repair the furnace required ordering. […]

• Immediate jeopardy, isolatedF760Jan 23, 2024

  The facility reported a census of 69 residents, with thirteen sampled, and three reviewed for significant medication errors. Based on observation, record review, and interview, the facility failed to prevent a significant medication error for Resident (R)1 when facility staff prepared and wrongly administered R4's medications, which included high risk medications, to R1 on 12/18/23. Certified Medication Aide (CMA) R prepared R4's medications, then asked R1 if she was ready for her medication and R1 nodded yes, so CMA R administered R4's medications to R1. CMA R thought R1 resembled the picture in the Medication Administration Record (MAR) for R4. […]

• Immediate jeopardy, isolatedF689Jul 7, 2021

  The facility census totaled 61 residents, with four residents reviewed for accidents. Based on observation, interview, and record review, the facility failed to ensure the safety of residents who required lift transfer, when the facility failed to ensure the competency of agency staff in lift transfers with all slings used. The agency staff failed to properly secured all six sling straps when transferring totally dependent Resident (R) 37 in the mechanical lift from the bed to his wheelchair, and the resident fell out of the lift onto his head, in a fall of approximately three feet onto the floor, and required an emergency room (ER) visit due to his injury and potential risk due to blood thinning medications he received. […]

• Actual harm, isolatedF760Nov 20, 2024

  The facility had a census of 64 residents. The sample included 17 residents. Based on observation, record review, and interview, the facility failed to prevent significant medication errors for one resident, Resident (R) 40, who received medications in error. Subsequently, R40 required rehospitalization in the intensive care unit (ICU). This also placed R40 at risk for adverse medication effects and other related complications. Findings included: - The Electronic Medical Record (EMR) for R40 documented diagnoses of bradycardia (low heart rate, less than 60 beats per minute), cerebrovascular accident (CVA-stroke-sudden death of brain cells due to lack of oxygen caused by impaired blood flow to the brain by blockage or rupture of an artery to the brain), chronic kidney disease (longstanding… […]

• Actual harm, isolatedF760Nov 20, 2024

  The facility had a census of 63 residents, with 19 residents included in the sample. Based on observation, record review, and interview, the facility failed to prevent significant medication errors for one resident, Resident (R) 105, who did not receive medications that were ordered to treat high blood pressure. This placed R105 at risk for adverse complications due to high blood pressure. Findings included: - The Electronic Medical Record (EMR) for R105 documented a diagnosis of coronary artery disease (CAD- abnormal condition that may affect the flow of oxygen to the heart), hypertension (HTN-elevated blood pressure), end-stage renal disease (ESRD-a terminal disease of the kidneys), congestive heart failure (CHF-a condition with low heart output and the body becomes congested with… […]