Casa Real Nursing Facility
In some cases, the violations are so severe that they cause harm or could cause harm to the resident. When this occurs, the investigators and surveyors have the legal responsibility to issue a fine to the facility or designate the nursing home as a Special Focus Facility (SFF) and placed on the Medicare watchlist.
Recently, Casa Real was designated a Special Focus Facility (SFF) and given the opportunity to make immediate corrections to serious violations that prove dangerous or hazardous to its residents. Even after the corrections are made, the state investigators will continue to perform surveys at a greater rate than normal to ensure that the adjustments are permanent. Should Casa Real be unwilling or unable to make corrections, they may be forced to close their doors or lose their contract to provide care and services to Medicare and Medicaid patients.Casa Real (SFF)
This Medicare/Medicaid-participating 118-certified bed facility provides care and services to residents of the city of Santa Fe and Santa Fe County, New Mexico. The Center is located at:
1650 Galisteo Street
Santa Fe, NM 87505
In addition to providing skilled nursing care, the facility also offers memory care, rehabilitative services, and specialty services including hospice care, respite care and wound care to treat pressure ulcers, neuropathic wounds, arterial and venous insufficiency ulcers and draining wounds that require IV antibiotics.Over $200,000 in Penalties
If violations are identified by state investigators working for the Centers for Medicare and Medicaid Services determined the deficiencies are severe and could cause harm to residents, they can issue monetary fines. In addition to making corrections, the facility must pay the fines to continue operation.
Over the last three years, Casa Real (SFF) receive three fines including $80,048 on November 20, 2014, $62,402 on January 29, 2016, and $60,465 on July 12, 2016. In addition to the monetary fines, Medicare denied payment over the last three years on numerous occasions including on November 20, 2014, January 29, 2016, July 12, 2016, and April 5, 2017 for services provided to residents.Current Nursing Home Resident Safety Concerns
Medicare, Medicaid, and the state of New Mexico routinely update information gathered from ongoing surveys and inspections of the nursing facility. This data is posted online on the federal Medicare.gov website and used by families to determine where to place a loved one who requires the highest level of nursing care in their community. This information is based on a star rating summary system to determine what facilities are at, above or below average.
Currently, Casa Real (SFF) maintains an overall to out of five stars compared all other facilities in the United States. This rating includes one out of five stars for health inspections, four out of five stars for staffing, and four out of five stars for quality measures. Some major concerns that reflect the below-average ranking are listed below.
Failure to Provide Every Resident Environment That Builds or Maintains Their Dignity and Respect of Individuality
In a summary statement of deficiencies dated April 5, 2017, the state investigator noted the facility failed “to promote care with dignity and respect for [26 residents] reviewed during random observation.” The surveyor observed the nursing staff “not closing the privacy curtain covering [a resident] after delivering the meal tray, exposing her midsection and brief to [any] passersby in the hallway.”
Another observation involved “lining up [19 residents] in the hallway outside the locked dining room facing the backs of other residents.” Also, it was noted that the staff failed change a resident’s “soiled shirt after meals” and “not acknowledging or asking [6 residents] prior to placing clothing protectors on them. That deficient practice is likely to result in [the] resident feeling embarrassed, ashamed, disrespected as if their feelings are not important to the faculty staff.”
Failure to Accommodate the Needs and Preferences of Each Resident
In a summary statement of deficiencies dated April 5, 2017, the surveyor noted the facility had failed to “provide reasonable accommodations of individual needs and prep is for [18 residents] reviewed for functioning call lights.” The evidence to support this failure included:
“Not providing a call light pull cord in the bathroom that is long enough for residents to reach from the floor.”
“Not ensuring that there is a call light available for [one resident] to access while in the shower.”
This deficient practice is likely to result in the resident being unable to request assistance while in the restroom such as needing help with transferring, after falling, or other acute distress.”
Failure to Provide Medically-Related Social Services to Help Each Resident Achieve the Highest Possible Quality of Life
In a summary statement of deficiencies dated April 5, 2017, The state investigator noted the facility’s failure “to meet the needs of [a resident] who was grieving the loss of her husband. The deficient practice likely resulted in [the resident] not receiving the immediate support she needed to cope with the loss of her husband, resulting in additional psychological distress.”
The State surveyor interviewed the resident who stated that after a long marriage, her husband “just passed away [and stated that] she was supposed to start counseling services, but hadn’t yet. She stated, ‘I just want to close my eyes and go to sleep since [my husband] died.’” The female resident also stated “what the hell am I gonna do here. Now I am alone.”
The state investigator reviewed the facility’s Grievance Decision Report that revealed the resident “was to have grievance counseling started related to her husband’s death.” It also stated that the resident “would like communication when this will be started. Steps taken to investigate the grievance: Spoke with Nursing to obtain an order from Doctor, as one was not in the chart.” An interview with the facility’s Social Services Director stated, “she was aware that [the resident’s] husband had recently passed away before [the resident’s] admission…”
A subsequent interview with the resident revealed that “she stated, ‘it is good that I’m not holding it in (feelings). I’ve lost loved ones before, but those two deaths (husband and daughter) were more than I am able to handle. It’s the worse pain I’ve ever felt my whole life’.” The resident “shared that her husband passed away exactly two years after her daughter passed away, stating that maybe she (daughter) came to get him (husband when he passed). I wish she would come and get me too.”
Failure to Ensure That Every Resident Receives an Accurate Assessment by Qualified Health Professional
In a summary statement of deficiencies dated April 5, 2017, the state investigator noted the facility’s failure “to ensure the Minimum Data Set (MDS) assessment was accurate for pneumococcal immunizations status for [four residents] reviewed for influenza and pneumococcal immunizations.” The surveyor noted that “at the facility is not accurately reflecting each resident status on the MDS, then residents may not receive the appropriate cares and services they need.”
While a review of the records from the most recent MDS revealed for resident’s records were up-to-date, additional medical records for another four residents revealed that there was “no documentation regarding resident pneumococcal vaccine the status [and] no documentation the pneumococcal vaccine was offered or declined.”
Failure to Develop, Implement and Enforce a Complete Care Plan That Meets All the Resident’s Needs
In a summary statement of deficiencies dated April 5, 2017, the state investigator noted the facility’s failure “to develop care plans to reflect the current status for [2 residents] reviewed for social services and pain.” The surveyor noted that “at the facility’s not updating the care plans to reflect resident’s current status, then residents are likely not to get the care and services they need.”
Failure to Ensure Services Provided by the Nursing Facility Meet Professional Standards of Quality
In a summary statement of deficiencies dated April 5, 2017, after conducting interviews and reviewing records, the surveyor noted the facility failed “to follow physician’s orders for [seven residents] reviewed during random observations and during medication storage.” The investigator noted specific failures including:
- A failure “to provide a therapeutic diet as ordered for [a resident].”
- A failure “to administer medication daily as ordered for [a second resident].”
- A failure to “have a physician orders medication available for administration for [3 different residents].”
- A failure to “administer medications at the scheduled time for a [sixth resident].”
- A failure to “administer to ordered medication does for a [seventh resident].”
The survey noted that “a physician’s orders are not followed, and residents are likely to experience weight loss, increased behaviors and depression and overdose a medication.”
Failure to Ensure that a resident’s antipsychotic drug Regiment is Free from unnecessary medications
In a summary statement of deficiencies dated April 5, 2017, the state investigator noted the facility failed “to ensure that each resident’s drug regimen is free from unnecessary medications.” This failure involved two residents “reviewed for unnecessary medications and pain by not monitoring for target symptoms and potential side effects for psychoactive medications for a resident.” The failure also included “not assessing [that resident’s] level of pain and anxiety prior to administering a PRN (as needed) medication and then again after the medication had been administered to ensure effectiveness.”
It was also noted the failure of not assessing another resident’s “level of pain post the administration of an as needed pain medication.” The investigator stated that “the facility is not adequately monitoring residents’ symptom of potential side effects of medication use or assessing residents’ pain/anxiety before and after administration of as needed medication, then residents may be receiving these medications unnecessarily and could likely experience adverse side effects or not receive the desired therapeutic effect.”
Failure to Ensure Residents Remained Safe from Serious Medication Errors
In a summary statement of deficiencies dated April 5, 2017, the investigator noted the facility’s failure “to prevent a significant medication error for [a resident] observed during medication a ministration by giving expired insulin. This deficient practice has the potential to place the resident at risk of receiving medications with decreased effectiveness and exposing them to bacterial contamination.”
Failure to Provide Necessary Cares and Services to Ensure That Every Resident Maintains Their Highest Well-Being
The survey team made an unexpected visit to the facility on November 1, 2016, to respond to a complaint regarding urinary catheter care. The complaint involved a resident “unknowingly had an obstructed urinary catheter and was complaining of pain in the morning of October 12, 2016, and the Hospice Nurse arrived in the afternoon and drain 250 mL of urine.”
During an interview, a staff member “confirmed that although they noticed the empty urinary catheter bag during their shift, they had assumed that the urinary catheter bag was recently emptied. During further investigation, the team discovered that another resident also had an obstructed urinary catheter that went unnoticed by staff, until family alerted staff of the urinary bag was empty.” After the problems identified and addressed, the staff “was able to drain two bags of urine from [the second resident].”
The surveyors interviewed staff members who revealed: “inconsistencies without and who provides urinary catheter care when concerns are reported to Nursing staff, and inconsistencies with documenting urinary catheter output.” The investigator’s noted that this failure “resulted in Immediate Jeopardy being identified.”
The investigators immediately notified the Facility Administrator, Acting Director of Nursing and Regional Nurse that an Immediate Jeopardy existed from 3:53 PM on October 27, 2016.
Failure to Maintain Privacy of a Resident’s Clinical Record
After interviewing staff members and based on observations the State surveyor noted on November 1, 2016, that the facility “failed to ensure that resident health protected information was out of hearing range of visitors.” This failure involved one resident at the facility. The deficiency “is likely to result in other residents, visitors and family members being able to hear residents’ protected health information.”
This failure was observed at 5:58 AM on October 27, 2016 “while walking through the facility parking lot, [a Registered Nurse] was talking with a Certified Nursing Assistant.” The Register Nurse stated, “I am glad [the name of the resident] was admitted to the hospital, now I don’t have to deal with another pain in my ass taking my meds.”
An interview was conducted with the Registered Nurse at 8:15 AM that same day who stated “The male [resident] takes meds and everything that is on top of the medication card. I have to chase him down. He is a pain in the ass. Go ahead and cite me, I am used to being cited.”
The investigator reviewed the company’s employee Handbook regarding Health Insurance Portability and Accountability Act (HIPAA) that was “provided by the Medical Records Director on November 3, 2016, that states:
“Do not share resident information with volunteers, or any other individual organization that is not directly involved in the care of the resident, the collection of payment from the resident, or during day-to-day administrative duties. When discussing resident information with the Power of Attorney of the resident, do so quietly. Do not give information about the resident to anyone that does not have the Power of Attorney without specific, written information from the resident. Avoid using the resident’s name and hallways, dining areas, or other areas.”
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