Vernon Health & Rehabilitation

In the surveyor’s words

From the most serious findings on record at Vernon Health & Rehabilitation, in the surveyor’s own words.

• Actual harm, isolatedF689Oct 4, 2021

  Based on record review and interview, the facility failed to ensure adequate supervision and interventions to prevent a fall for 1 of 3 residents reviewed for accidents. This deficient practice resulted in Resident Y falling from her bed and acquiring a femur fracture. Findings include: Resident Y's clinical record was reviewed on 10/04/21 at 11:04 a.m. Diagnoses included, but were not limited to, spastic quadriplegic [CONDITION(S)], profound intellectual disabilities, [CONDITION(S)], generalized idiopathic [CONDITION(S)] and epileptic syndromes, not intractable, with [CONDITION(S)], and [CONDITION(S)]. An annual Minimum Data Set (MDS) assessment, dated 6/30/2021, indicated the resident was severely cognitively impaired. […]

• No harm, potential for more than minimal, patternF600Oct 22, 2024

  Based on observation, record review, and interview, the facility failed to provide adequate supervision and intervention to prevent physical resident-to-resident abuse for 4 of 4 residents reviewed for resident-to-resident abuse (Resident 19, Resident 21, Resident 43, and Resident 44). Findings include: 1. During an observation, on 10/15/24 at 9:15 a.m., Resident 43 stood up from her wheelchair, grabbed the nurses' desk to steady herself, her foot caught behind the wheelchair pedal, and she continued to lean forward to attempt to ambulate toward facility visitors. CNA 10 attempted to assist the resident to sit down in the wheelchair. Resident 43 declined and continued to ambulate toward the visitors with the assistance of CNA 10. […]

• No harm, potential for more than minimal, patternF847Oct 22, 2024

  Based on record review and interview, the facility failed to provide an arbitration agreement that granted the resident or their representative the right to rescind the agreement within 30 days of signing it for 3 of 3 current residents reviewed who were admitted after 2/1/24 (Resident 26, Resident 44, and Resident 97). Findings include: During an interview conducted in conjunction with the entrance conference on 10/15/24 at 9:37 a.m., the Administrator indicated the facility offered arbitration agreements in the admission agreement packet. The sample admission agreement packet, provided as indicated above, was reviewed on 10/21/24 at 2:39 p.m. […]

• No harm, potential for more than minimal, patternF679Sep 15, 2023

  Based on observation, interview, and record review, the facility failed to develop and implement individualized activities programming to meet individual resident needs for 6 of 7 residents with developmental disabilities reviewed for activities (Residents D, F, H, I, J, and C). Findings include: 1. Resident D's clinical record was reviewed 9/12/23 at 3:12 p.m. Current diagnoses included profound intellectual disabilities, personal history of traumatic brain injury, spastic quadriplegic cerebral palsy, cognitive communication deficit, and mixed receptive-expressive language disorder. The resident had a current physician's order which originated 8/25/16 and was continued as current in September 2023 for may participate in activities and recreations program. […]

• No harm, potential for more than minimal, patternF847Sep 15, 2023

  Based on interview and record review, the facility failed to ensure residents and/or their representatives were not required to sign an agreement for binding arbitration as a requirement for admission to the facility for 6 of 7 current residents admitted after 8/1/22 (Residents 29, 46, 47, 48, 49, and 51). Findings include: During an interview conducted in conjunction with the entrance conference on 9/11/23 at 9:31 a.m., the Administrator indicated the facility offered arbitration agreements in the admission agreement packet. 1. Resident 29's 7/12/23, Admission Agreement document indicated section 8.7 addressed an agreement not to elect a trial by jury of any fact trialable by a jury. The form did not indicate signing the binding arbitration agreement was voluntary. […]