Swannanoa Valley Health and Rehabilitation

In the surveyor’s words

From the most serious findings on record at Swannanoa Valley Health and Rehabilitation, in the surveyor’s own words.

• Actual harm, isolatedF580Nov 3, 2022

  Based on record review and interviews with the staff and Medical Doctor (MD) the facility failed to notify the physician of a newly identified open area on the right heel resulting in a delay in treatment for [MEDICAL RECORD OR PHYSICIAN ORDER] . The findings included: Resident #3 was admitted to the facility on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Resident #3 was discharged to the community on 08/29/22. Review of the admitting 3-day skin assessments for Resident #3 revealed on 08/09/22 and 08/10/22 Nurse #1 documented a blanchable open area was present on the right posterior heel. On 08/11/22 Nurse #2 documented a blanchable open area was present on right posterior heal. […]

• Actual harm, isolatedF686Nov 3, 2022

  Based on record review and interviews with the staff, the Wound Care Nurse Practitioner, and Medical Doctor the facility failed to provide necessary care and services for a newly identified open area on the right heel and failed to accurately complete the weekly skin assessment and shower audit tool for an existing wound on the right heel that developed signs of infection for 1 of 3 residents reviewed for pressure ulcers (Resident #3). The findings included: Resident #3 was admitted to the facility on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Resident #3 was discharged to the community on 08/29/22. […]

• Actual harm, isolatedF550Nov 23, 2021

  Based on record reviews, observations, staff interviews, and resident interviews, the facility failed to maintain residents' dignity by not providing showers, bathing, and incontinence care resulting in residents feeling like a homeless person, like staff did not like them, dirty and embarrassed, uncomfortable, and dirty. This affected 3 out of 6 (Resident #27, Resident #13, and Resident #50) sampled residents. 1. Resident #27 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of Resident #27's most recent quarterly Minimum Data Set (MDS) dated [DATE] revealed she was cognitively intact for daily decision making, had no behaviors for refusal of care, and required total assistance of 2 staff for bathing and toileting. […]

• Actual harm, isolatedF600Nov 23, 2021

  Based on record review and staff interviews the facility failed to protect a resident right to be free from abuse (Resident #55) from Nurse Aide (NA) #8 for 1 of 3 residents reviewed for abuse. The findings included: Resident #55 was admitted to the facility on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #55 was severely cognitively impaired and was totally dependent for majority of activities of daily living (ADL). […]

• Actual harm, isolatedF677Nov 23, 2021

  Based on record reviews, resident, and staff interviews the facility failed to provide showers or complete bed baths for 6 of 18 residents (Resident #27, Resident #26, Resident #81, Resident #82, Resident #13, and Resident #50) and failed to provide nail care and grooming for 3 of 18 residents (Resident #54, Resident #23, and Resident #45) reviewed for activities of daily living (ADL). Resident #27 stated because of not getting her showers, her hair was matted to her head, and she could smell her own body odor and it made her feel degraded and like a homeless person. The findings included: 1. […]