rowid,facility_name,facility_id,address,city,state,zip,inspection_date,deficiency_tag,scope_severity,complaint,standard,eventid,inspection_text,filedate 6780,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,241,E,0,1,NIB111,"Based on random observations, it was determined that the facility failed to promote the dignity of 19 to 20 residents that ate meals in the main dining room and the six to eight residents that were assisted to eat meals in the assisted area of the main dining room. Findings include: 1. On 2/11/13 at 12:30 p.m., there were 24 residents eating in the main dining room and eight residents eating in the assisted area of that dining room. Nursing staff was observed to put clothing protector towels on 20 of the 24 residents in the main dining area without asking if they wanted a clothing protector. The eight residents in the assisted dining area all faced the back wall with the curtains closed on the two windows in that area. The television set in the main area was on a soap opera that none of the residents were watching. 2. On 2/12/13 at 7:33 a.m., nursing staff put clothing protectors on 19 of the 20 residents in the main dining area without asking if they wanted one. The six residents in the assisted area faced the back wall with the curtains closed. 3. On 2/12/13 at 12:45 p.m., the eight residents in the assisted area of the dining room faced the back wall with the curtains closed. In an interview on 2/13/2013 at 12:45 p.m., the Director of Nursing (DON) said that the curtains were closed in the dining room for residents that were fed by staff to reduce the potential for distracting those residents and to prevent glare on the television in the main dining room. However, after surveyor inquiry, when staff had opened the curtains during meals, observations revealed that the residents being assisted to eat, continued to eat without being distracted. There was not a glare on the television screen in the main dining room.",2017-10-01 6781,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,246,D,0,1,NIB111,"Based on observation and staff interview, it was determined that the facility failed to provide reasonable accommodations for positioning three residents (#47, #59, #162) at the table during meals in the dining room from a total sample of 38 residents. Findings include: 1. Resident #47 was observed on 02/12/13 at 12:30 p.m. in the main dining room seated in a wheelchair at a table for four residents. The tabletop was above his/her chest level. Resident #47 had to reach up to eat his/her meal. 2. Resident #162 observed on 02/12/13 at 12:30 p.m. seated in a wheelchair at a table for four residents. The table top was above his/her chest level. Resident #162 had to reach up to eat his/her meal. 3. Resident #59 observed on 02/12/13 at 12:30 p.m. seated in a Broda Chair at a table for four residents. The table top was above his/her chest level. Resident #59 had to reach up to eat his/her meal. In an interview on 2/13/13 at 12:45 p.m., the Director of Nursing (DON) said that the facility could exchange the tables that were too high for residents to lower tables to accommodate the residents or move the residents to other tables.",2017-10-01 6782,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,279,D,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility failed to ensure that a comprehensive care plan that included measurable objectives and timetables and described the services that were supposed to be furnished to meet the medical, mental and psychosocial needs for a resident was completed and available to those direct care staff who were responsible for those services for one resident (#169) from a sample of 38 residents. Findings include: Resident #169 was admitted on [DATE] under Hospice services with [DIAGNOSES REDACTED]. According to the 12/31/12 admission Minimum Data Set (MDS) assessment, the resident had short term and long term memory problems, severely impaired decision making skills, impaired vision, was short tempered/easily annoyed, had trouble falling asleep, was frequently incontinent and had received an anti-anxiety and anti-depressant medication in the last seven days. According to the 12/31/12 Care Area Assessment (CAA) Summary, the resident triggered for cognitive loss/dementia, visual function, communication, urinary incontinence and indwelling catheter, behavioral symptoms, falls, nutritional status, pressure ulcers, [MEDICAL CONDITION] drug use and pain. Licensed nursing staff had documented on the CAA form that those areas would be addressed in the resident's comprehensive care plan. The comprehensive care plan was supposed to be completed and available to direct care staff by 1/04/13. However, review of the resident's clinical record revealed that there was not a comprehensive care plan available for direct care staff to reference that addressed all of the resident's care needs. Review of the resident's clinical record revealed that an Interim Plan of Care that had been placed in the resident's chart on admission continued to be used as of 2/14/13. However, the Interim Care Plan did not address the resident's cognitive loss/dementia, visual function, urinary incontinence, behavioral/mood symptoms and [MEDICAL CONDITION] drug use. On 2/14/13 at 12:40 p.m., licensed MDS nurse AA stated that the resident's comprehensive care plan was completed on 12/31/12 and should have been placed in the resident's clinical record. Nurse AA stated that the licensed MDS nurse was responsible for completing the comprehensive care plans and placing them on the residents' charts timely.",2017-10-01 6783,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,280,D,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview, and record review, it was determined that the facility failed to revise care plan interventions for one resident (#90) to appropriately reflect his/her assessed physical and cognitive status and abilities in a total sample of 38 residents. Findings include: Resident #90 had [DIAGNOSES REDACTED]. Licensed staff coded the resident as sometimes understanding, as having short and long term memory problems, and as having severely impaired decision making skills on the 12/18/12 and 9/25/12 Minimum Data Set (MDS) assessments. Observation of the resident on 2/12/13 at 12:30 p.m. revealed that he/she was seated in a Broda chair. The resident talked repeatedly but, not appropriate to a subject or surroundings. The resident would call the staff his/her mother, would ask that staff talk to him/her when staff was talking to him/her and called out here I am mommy. There was a care plan since 4/30/12 to address the resident's history of falls and confusion and disorientation at times. There was an intervention for all staff to encourage the resident to use his/her cane. There were Acute Care Plans for Falls that were dated 1/26/13 and 1/28/13. Those plans had interventions for nursing staff to encourage the resident to allow assistance with ambulation as needed, and to encourage the resident to keep the call light within reach and use when needing assistance. A review of the February 1 - 13, 2013 CNA-ADL Tracking Form revealed staff documentation that the ambulation activity by the resident did not occur. A review of the Nurse Aide Information Sheet revealed that the area to indicate a walking status was blank and a handwritten note to use a Broda chair was at the locomotion entry line. During an interview on 2/14/13 at 7:30 a.m., licensed practical nurse (LPN) FF said that she had not observed the staff attempting to ambulate the resident. Therefore, those interventions were based on required responses and abilities of the resident of which he/she was not capable based on his/her MDS assessments and demonstrated physical and cognitvie abilities. The plan had not been revised to reflect interventions that were appropriate for the resident's mental and physical status.",2017-10-01 6784,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,281,D,0,1,NIB111,"Based on observation, review of the facility's Procedural Guidelines for the administration of feedings and medications via gastrostomy tube, and staff interview, it was determined that the facility failed to ensure that licensed nursing staff verified placement of a gastrostomy tube prior to the administration of medications for one resident (#80) from a sample of 38 residents. Findings include: According to the facility's Procedural Guidelines for the safe administration of tube feedings and administration of medication via gastrostomy tube, nursing staff were supposed to verify placement of the gastrostomy tube prior to medication administration or feeding by instilling air into the gastric tube and auscultating for the sound of rushing air by placing a stethoscope over the stomach. However, licensed nurse CC failed to verify placement of the gastrostomy tube with air prior to medication administration for resident #80. On 2/14/13 at 8:10 a.m., during observation of medication administration for resident #80, licensed nurse CC inserted the syringe into the resident's gastrostomy tube and pulled back on the plunger to check for residual. There was no residual in the syringe. Nurse CC then removed the plunger and flushed the resident's gastrostomy tube with 50 cubic centimeters (cc) of water followed by the medications. However, CC failed to verify placement of the gastrostomy tube by inserting air into the tube and auscultating for air prior to the administration of the water flush and medications. Nurse CC stated, at that time, that the nurse on the previous shift had checked the resident's gastrostomy tube for placement at 6:00 a.m. and had told her that there were no problems. On 2/14/12 at 9:50 a.m., licensed nurse DD stated that staff were supposed to verify placement of the gastrostomy tube with air prior to the administration of any medications or feedings. Nurse DD' stated that she/he would verify placement herself/himself and not rely on another staff member's verification.",2017-10-01 6785,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,282,G,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and staff interviews, it was determined that the facility failed to address signs of pain and provide pain management as described in the Plan of Care during the provision of pressure sore and wound treatment for one resident (#112) of three residents with pressure ulcers, and to implement interventions for the potential for nutritional impairment for one resident (#37) in a total sample of 38 residents. This failure resulted in actual harm that was not immediate jeopardy for resident #112. Findings include: 1. Resident #112 was admitted into the facility in September of 2011 with [DIAGNOSES REDACTED]. Review of the documentation on the Licensed Nurse Skin Assessments dated September of 2012 revealed that resident #112 had no wounds/pressure ulcers. Licensed nursing staff documented on the October, 2012 skin assessment that the resident had red areas in his/her groin and small open areas. On the November 26, 2012 skin assessment, the licensed nurse documented that there was a black area on the right heel and treatment in progress to the scrotum folds. On January 23, 2013 the nurse documented that resident #112 had deep tissue injury on the right heel. There was a care plan, updated on 11/21/2012, to address his/her alteration in skin integrity/pressure ulcer. Pressure ulcer to right medial heel (Deep Tissue Injury). There was an intervention to observe for pain and treat as ordered. The goal included to reduce pain and discomfort. However, during an observation of pressure ulcer wound care and care to the ulcers in the resident's groin area on 02/12/13 at 2:28 p.m., the resident cried out in pain but, the nurse failed to intervene and treat the pain. See F314 for additional information regarding resident #112. 2. Resident #37 had a care plan since 11/06/12 to address his/her potential for nutritional impairment. There were interventions for staff to determine the resident's food preferences and provide as feasible, and to provide health shakes three times a day with meals. However during an observation of the resident's meals on 2/12/13 at 12:45 p.m., and on 2/13/13 at 8:50 a.m. and 12:50 p.m., the resident was not served a health shake. Review of the Diet History/Food Preference List form revealed that the form was blank. See F325 for additional information regarding resident #37.",2017-10-01 6786,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,287,B,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and review of a list of missing Minimum Data Set (MDS) 3.0 Assessments, it was determined that the facility failed to transmit four MDS assessments and failed to complete and transmit four discharge MDS assessments in a sample of eight residents with (GA) MDS Missing OBRA Assessments. Findings include: During an interview on 2/13/13 at 7:30 a.m., the licensed practical nurse (LPN) MDS staff AA reviewed the list of eight missing OBRA assessments. LPN AA stated that four of those MDS' had been coded incorrectly and so were not transmitted. LPN AA said that four of those MDS' had not been completed for residents who had been discharged on [DATE], 2/28/11, 10/01/12 and 11/06/12. After surveyor inquiry, LPN AA reported that all eight MDS' on the list had been corrected and/or completed and transmitted.",2017-10-01 6787,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,314,G,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and staff interviews, it was determined that the facility failed to address signs of pain and provide pain management during the provision of pressure sore treatment for one resident (#112), to notify the physician about the registered dietician's recommendations to promote healing of a pressure sore for one resident (#140), and failed to follow up with the physician timely about the status of an infected pressure sore for one resident (#133) of two of four active residents with pressure sores and one closed record with a pressure sore from a total sample of 38 residents. This failure resulted in actual harm that was not immediate jeopardy for resident #112. Findings include: 1. Resident #112 was admitted into the facility in September of 2011 with [DIAGNOSES REDACTED]. Review of the documentation on the Licensed Nurse Skin Assessments dated September of 2012 revealed that resident #112 had no wounds/pressure ulcers. Licensed nursing staff documented on the October, 2012 skin assessment that the resident had red areas in his/her groin and small open areas. On the November 26, 2012 skin assessment, the licensed nurse documented that there was a black area on the right heel and treatment in progress to the scrotum folds. On January 23, 2013 the nurse documented that resident #112 had deep tissue injury on the right heel. There was a care plan, updated on 11/21/12, to address his/her alteration in skin integrity/pressure ulcer. Pressure ulcer to right medial heel (Deep Tissue Injury). There was an intervention to observe for pain and treat as ordered. The goal included to reduce pain and discomfort. However, during an observation of pressure ulcer wound care and care to the ulcers in the resident's groin area on 02/12/13 at 2:28 p.m., the resident cried out in pain but, the nurse failed to intervene and treat the pain. During an observation of pressure ulcer wound care and care to ulcers in the resident's groin area on 02/12/13 at 2:28 p.m., when licensed nurse FF touched the resident's right heel pressure ulcer to clean it, the resident cried out in pain and jerked his/her right leg back from her. Resident #112 cried out three times during the heel ulcer measurements and application of the ordered [MEDICATION NAME]. At that time, nurse FF said that Resident #112 usually complained of pain during the procedure but, not after it. The nurse said that resident #112 had a 1.0 x 0.2 centimeter (cm) opening in his/her left groin fold and a 0.2 cm x 0.2 cm opening in the right groin fold. Resident #112 cried out in pain during the treatment procedures. The resident said expletives and told the nurse that she did not know she was doing. Immediately after the pressure sore treatments were done, nurse FF said that resident #112 commonly called out during the wound care procedure and was medicated. Review of the resident's Nurse's Notes and Medication Administration Records (MARs) revealed no documentation that resident #112 was pre-medicated before wound care was performed to his/her heels or groin area. There was no documentation of pain medication having been given related to the pressure ulcer wound care. On 2/13/13 at 9:45 a.m., nurse FF stated that she had asked the medication nurse on 2/12/13 to pre-medicate the resident before wound care was done. However, nurse FF said that she did not check to ensure that the resident had been given medication prior to her doing the wound cares. Nurse FF acknowledged that the resident had cried out in pain and jerked his/her leg during treatment and that she could have stopped the treatment. There was a physician's orders [REDACTED]. However, nurse FF also acknowledged that she had used normal saline to clean the wound bed on resident #112's groin and not soap and water as ordered by the physician. Nurse FF said that she was responsible to update the care plan about the pressure ulcer on the resident's right heel to reflect the current treatment and not the initialed treatment dated November 2012. In an interview on 2/13/13 at 7:47 a.m., medication nurse DD stated that, sometimes resident #112 could tell you when he/she was in pain. Nurse DD said that, if the resident was sitting up at the nurse's station and hollered out, he/she could tell nurse DD if his/her foot was hurting and could be repositioned and express whether that intervention helped. Nurse DD said that resident #112 was not medicated for pain before the wound care was done on him/her on 02/12/13. She said that resident #112 had not complained about pain yesterday before the procedure but, if the resident had complained of pain, nurse DD said that she/he would have given the 'as needed' (prn) medication. Nurse DD said that she did the wound care treatments if the treatment nurse was off. She said that the last time she did the wound care for resident #112, he/she did not cry out in pain. Review of the February 2013 physician's orders [REDACTED]. During an interview on 2/13/13 at 10:55 a.m., the facility's Medical Director said that he did not want resident #112 to be uncomfortable during dressing changes and it sounded like he/she was (uncomfortable) yesterday. The physician said that resident #112 did curse at staff sometimes whether they were touching him/her or not but, it sounded like he/she was having pain during the treatment yesterday. The physician said that he would address resident #112's pain management. The physician said that he was not aware of any correspondence from the facility by phone or fax related to resident #112's pain management yesterday or today. Review of the Message to the Physician that was faxed by the facility on 02/12/13 at 6:30 p.m., and returned to the facility on [DATE] at 7:57 p.m., revealed that the treatment nurse had notified the physician about the open area on the outer edge of the eschar cap on the resident's right heel. However, there was no documentation that the nurse notified the physician about resident #112's level of pain experienced during the dressing change procedure that day. The physician response noted to change the type of dressing from [MEDICATION NAME] open to air to a foam dressing. During an interview on 2/13/13 at 1:00 p.m., the Director of Nursing (DON) stated that the nurse should have stopped the wound care when Resident #112 cried out in pain. 2. Resident #140 was admitted with an unstageable pressure ulcer on his/her sacrum. During a hospitalized from [DATE] to 1/03/13 for pneumonia and [MEDICAL CONDITION], the sacral pressure ulcer was debrided and [DEVICE] treatments begun. On 1/27/13, the facility's Registered Dietician documented a recommendation for restoring MVI (multivitamin) every day, 500 milligrams (mg) of Vitamin C twice a day, and 220 mg of Zinc every day for 30 days, and one packet of Juven in 60 milliliters (ml) of water for 90 days to promote wound healing. However, there was no evidence that the physician was aware of those recommendations. During an interview on 2/14/13 at 8:30 a.m., Registered Nurse BB confirmed that there was no evidence that the 1/27/13 RD recommendations had been communicated to the physician. After surveyor inquiry, the Director of Nursing provided a Physician Communication Form dated 1/27/13 for the physician to consider the RD recommendations. However, the documentation to implement those recommendations was not signed by the Nurse Practitioner until 2/14/13. There was no evidence that the physician had been made aware of those recommendations or that nursing staff had followed up on the 1/27/13 Physician Communication Form until 2/14/13. 3. Resident #133 (closed record) was admitted on [DATE] with [DIAGNOSES REDACTED]. The resident was admitted with a full length knee extension brace/immobilizer on his/her left leg to prevent knee flexion and had a physician's orders [REDACTED]. According to the 10/18/12 Treatment Record, the resident developed a 3.2 centimeter (cm) by 4 cm., closed, deep tissue injury on the plantar aspect of his/her left foot that was caused by the left leg immobilizer. The physician was notified, the immobilizer was cut to prevent pressure and the pressure sore was treated as ordered. On 11/02/12, a communication was faxed to the resident's physician notifying him that the now open pressure sore on the plantar aspect of the resident's left foot had a moderate amount of greenish drainage and that the surrounding tissue was red and [MEDICAL CONDITION]. On 11/03/12, the physician faxed the facility with a request for the resident's medication list. However, there was no indication that licensed/registered nursing staff had followed up with the physician about the greenish drainage from the resident's pressure sore until 10 days later, on 11/12/12, when the physician's family nurse practitioner (FNP) assessed the resident and noted a thick, yellow purulent drainage coming from the pressure sore with redness and swelling of the surrounding skin. At that time, the FNP ordered a wound culture to be obtained and for licensed nursing staff to administer 500 milligrams of [MEDICATION NAME] (an antibiotic) to the resident every day. The resident was discharged home on[DATE]. The pressure sore at that time had decreased in size, had pink granulation tissue, light non-purulent drainage and the surrounding skin was not red or [MEDICAL CONDITION].",2017-10-01 6788,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,325,D,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and record review, it was determined that the facility failed to implement planned interventions to address a continued weight loss and a potential for nutritional impairment for one resident (#37) in a total sample of 38 residents. Findings include: Resident #37 had [DIAGNOSES REDACTED]. There was a 2/02/13 physician's orders [REDACTED]. There was a care plan since 11/26/12 to address his/her potential for nutritional impairment. There were interventions for staff to determine the resident's food preferences and provide as feasible, and to provide supplements as ordered. Review of the Weight Flow Sheet documentation revealed the resident had a significant weight loss of 17.4% in five months from 9/11/12 at 178 pounds (lbs.) to 147 lbs. on 2/08/13. Staff documented that the resident weighed 178 lbs. on 9/11/12, 170 lbs. on 9/17/12, 168 lbs. on 10/8/12, 161 lbs. on 11/17/12, 153 lbs. on 12/10/12, 152 lbs. on 1/07/13, 150 lbs. on 1/14/13 and 1/25/13, 149 lbs. on 1/31/13, and 147 lbs. on 2/08/13. However, during observations of meals served to the resident on 2/12/13 at 12:45 p.m., and on 2/13/13 at 8:50 a.m. and 12:50 p.m., staff did not serve him/her a Health Shake. A review of the list of residents that received Health Shakes, provided by the dietary manager on 2/13/13, revealed that resident #37 was not on the list to receive Health Shakes. During an interview on 2/13/13 at 1:50 p.m., the Director of Nurses (DON) confirmed that the resident should have received Health Shakes with meals. A review of the Diet History/Food Preference form revealed that it was blank. Staff had not determined the resident's food preferences as planned since 11/26/12. During an interview on 2/13/13 at 1:50 p.m., the DON stated that the resident was last seen by the Registered Dietician (RD) on 9/23/12 and she made no recommendations at that time. She said that the resident was above his/her ideal body weight. There was a 10/27/12 RD evaluation that noted the resident as 117% of his/her ideal body weight. On 12/15/12, the RD evaluation noted that the resident had been placed on [MEDICATION NAME] on 11/10/12 for diverticulitis and GERD. The RD wrote that the nursing staff had reported that the resident could be disruptive at times when encouraged to eat meals. The RD documented that the resident was 106.9% of his/her ideal body weight at that time and that slight weight loss was optimal. She recommended to start the Health Shakes three times a day if the resident's weight fell below 143 lbs. within 3 months. Although the resident had a continued weight loss since September, 2012, there was no evidence that the facility had determined that the resident's clinical condition had demonstrated that it was not possible to avoid the continued weight loss.",2017-10-01 6789,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,328,D,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on random observations and review of the facility's policy, it was determined that the facility failed to maintain clean air filters on oxygen concentrators in four resident rooms (109A, 212A and B, and 104P) for four residents with oxygen therapy in a sample of 16 residents that had respiratory therapy in a total sample of 38 residents. Findings include: The facility's procedure for infection control for oxygen concentrators noted that the equipment was to be visibly clean. The external filter was to be clean. However, staff failed to maintain clean oxygen concentrator filters in four resident rooms for four residents that used oxygen (rooms 109A, 212A and B, and 104P). 1. During the initial tour on 2/11/13 at 12 p.m., the oxygen concentrator filter in room [ROOM NUMBER]A was heavily coated with dust. 2. On 2/12/13 at 1:15 p.m. and 2/13/13 at 10:30 a.m., the oxygen concentrator filter in room [ROOM NUMBER]B was coated with dust. 3. On 2/13/13 at 9:30 a.m. and 2/14/13 at 7:30 a.m., the oxygen concentrator filter in room [ROOM NUMBER]A was coated with dust. 4. On 2/13/13 at 9:30 a.m., 10:37 a.m., 2:18 p.m., and 3:56 p.m., and on 2/14/13 at 7:30 a.m., the oxygen concentrator filter in room [ROOM NUMBER]P was heavily coated with dust.",2017-10-01 6790,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,329,D,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and record review, it was determined that the facility failed to follow the physician's orders for psychoactive medications for one resident (#52) in a total sample of 38 residents. Findings include: Resident #52 was admitted in June of 2011 with [DIAGNOSES REDACTED]. There was a 1/29/13 physician's telephone order for nursing staff to discontinue giving [MEDICATION NAME] to the resident and give 0.5 milligrams (mg) of [MEDICATION NAME] twice a day. That order was on the Physician's Order Form for February, 2013 for agitation and was scheduled to be given at 9 a.m. and 5 p.m However, a review of the January and February Medication Administration Records (MARs) revealed that nursing staff failed to discontinue the [MEDICATION NAME] as ordered on [DATE]. Licensed nursing staff had given the resident both the [MEDICATION NAME] and the Risperdone, until after surveyor inquiry on 2/13/13. During a telephone interview on 2/13/13 at 3:15 p.m., Hospice Nurse HH said that she had been monitoring resident #52 for his/her response to the change in psychoactive medication from [MEDICATION NAME] to [MEDICATION NAME]. The Hospice nurse said that he/she had observed that resident #52 was more sedated and quiet since the [MEDICATION NAME] was started but, did not realize that the facility failed to stop the [MEDICATION NAME]. The Hospice nurse said that the failure to discontinue the Haloperidal could contribute to sedation for resident #52. In an interview on 2/14/13 at 8:30 a.m., the Director of Nurses (DON) stated that, after surveyor inquiry, the Medical director had made rounds last evening (2/13/13) and evaluated resident #52. Review of the 2/13/13 Physician's Progress Note revealed that the physician had documented that there were no adverse effects from the [MEDICATION NAME] and [MEDICATION NAME] both having been given to resident #52 and that the [MEDICATION NAME] was discontinued yesterday (2/13/13).",2017-10-01 6791,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,371,F,0,1,NIB111,"Based on observation, staff interview and record review, it was determined that the facility failed to ensure that two ice makers used for all residents that received iced beverages from the kitchen and one nurse's station ice maker (400 hall) were clean and sanitary. Findings include: 1. During an initial tour of the facility's kitchen with the dietary manager on 02/11/13 at 12:00 p.m., the interior of the ice machine in the kitchen had a large amount of a black mold like substance on the area where the ice would fall from the ice maker into the ice bin. At that time, the dietary manager said that the ice machine was cleaned two weeks ago by the maintenance department. Review of the documentation of the ice machine maintenance indicated that the last cleaning was done on January 17,2013. The maintenance staff designated on the Ice Machine Form that the various tasks were performed by writing OK. On January 17, 2013, the maintenance staff did not indicate that the interior of the ice machine was cleaned. The staff noted on the Ice Machine Form that the ice bin was cleaned and sanitized in August of 2012. The facility form also indicated that the machine was due to be cleaned on January 31, 2013. The facility did not have a record of cleaning the ice machine on January 31, 2013. 2. Observations of the pantry ice machine in the 400 hall nurse's station on 02/12/13 at 10:00 a.m., 11:10 a.m. and 4:35 p.m., and on 2/13/13 at 7:20 a.m., revealed a black mold like substance around the rim of the interior of the ice machine. The substance could drip down onto the ice from the condensation inside of the machine. On 2/13/13 at 2:24 p.m., the environmental staff observed the black mold inside the ice machine. The staff turned the machine off and took the ice that was in the machine and filled the ice chest that the staff used to serve the residents. At 2:36 p.m., a resident came to the nurse's station and requested his/her pitcher to be filled with ice. Nursing staff went to the ice chest and filled the pitcher up with the ice that had been removed from the ice machine. During an interview on 2/14/13 at 9:58 a.m., the maintenance director stated that the form provided was a new form implemented in January of 2013. The ice machine was cleaned in December and in January. The new system required a different machine to be checked each week but, all machines were supposed to be checked once monthly. The supervisor assigned the staff to complete the tasks on the ice machines. The black mold substance was unusual in the ice machines. The company was contacted regarding mold growth in the ice machines. The machines were de-limed every three months, and then cleaned with Clorox product every time mold was observed. The maintenance director was to receive a product to prevent mold growth.",2017-10-01 6792,MAGNOLIA MANOR OF ST SIMONS REHAB & NURSING CENTER,115582,2255 FREDERICA ROAD,SAINT SIMONS ISLAND,GA,31522,2013-02-14,441,D,0,1,NIB111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, and random observations, it was determined that the facility failed to maintain infection control procedures to ensure the sanitary storage of oxygen nasal cannulas in five resident rooms (110, 201, 207B, 307B and 312A) for five residents who used oxygen in a sample of 16 residents with respiratory therapy in a total sample of 38 residents. Findings include: According to guidelines published by the US Centers for Disease Control and Prevention, the main principles of good respiratory practice, for preventing infections associated with respiratory therapy, included the cleaning and drying of any reusable equipment and storage in a clean, dry place. However, staff failed to store nasal cannulas for five residents in a clean, dry place when not in use. During the initial tour on 2/11/13 at 12 noon, nasal cannulas were stored uncovered outside room [ROOM NUMBER], and in rooms 307B and 312A. 1. A nasal cannula was not covered and the tubing was wound around the headrest of an electric wheelchair outside room [ROOM NUMBER]. 2. An uncovered nasal cannula was on the top of the small oxygen tank next to the resident's bed in room [ROOM NUMBER]B. 3. The uncovered nasal cannula and tubing were hanging off the bookcase in room [ROOM NUMBER]A. 4. Observations on 2/11/13 at 1:32 p.m. revealed that there was an uncovered nasal cannula on the dresser in room [ROOM NUMBER]. 5. Observations on 2/12/13 at 9 a.m. revealed that there was an uncovered nasal cannula on the top knob of the small oxygen tank in room [ROOM NUMBER]B. 6. Observation on 2/13/13 at 9:30 a.m. revealed that there was an uncovered nasal cannula and tubing draped over the top of the oxygen concentrator in room [ROOM NUMBER]P. At 2:18 p.m., the uncovered nasal cannula was on the floor next to the oxygen concentrator.",2017-10-01 6885,"OAKS - SCENIC VIEW SKILLED NURSING, THE",115393,205 PEACH ORCHARD ROAD,BALDWIN,GA,30511,2013-02-14,157,D,0,1,P02P11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to notify the physician timely for two (2) residents on a sample of thirty-three (33) residents. One resident, (Q) developed a pressure ulcer and one resident, (# 253) had significant weight loss. Findings include: Resident #253 was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. The resident had an admission weigh of 200.8 pounds. Further review of the weight record indicated the resident had a weight of 190.4 pounds on 12/25/13 which indicated a significant weight loss of 5.1% since admission. In addition, the resident had a weight of 179.2 on 1/12/13 which indicated a significant weight loss of 21.6 pounds or 10.7% in one month. The resident had an Admission Minimum Data Set assessment dated [DATE] which indicated the resident had no weight loss or gain prior to admission. Review of the Weight Progress Notes Form revealed an entry dated 12/27/12 which identified a weight loss of 10.4 pounds since admission. A snack at 3:00 p.m. each day of milk and a sandwich was added as an intervention. However, there was no indication the physician was notified of the significant weight loss. During an interview on 2/13/13 at 3:50 p.m. Licensed Practical Nurse AA stated she was aware of the weight loss on 12/25/12 and should have completed the Form for Significant Weight Loss. She further stated this would have reminded her to notify the physician of the significant weight loss. She confirmed she did not notify the physician of the significant weight loss until 2/12/13. Review of resident Q's clinical record revealed they were admitted to the facility with a fractured left hip, and also had [DIAGNOSES REDACTED]. Review of a right foot and ankle x-ray obtained on 02/04/13 revealed that the resident had a [MEDICAL CONDITION] malleolus and distal fibula, with mild lateral subluxation of distal tibia. Review of orthopedic physician's orders [REDACTED]. Review of Nurse's Notes dated 02/09/13 revealed that the resident was noted with a raised blister to the lateral malleolus. Review of physician's orders [REDACTED]. During interview with LPN Treatment Nurse BB on 02/13/13 at 8:55 a.m., she stated that the ankle blister developed from the velcro walking boot. During further interview, she stated that the blister was discovered on a Saturday by the charge nurse, and the weekend treatment nurse used a facility protocol to cover the area with an [MEDICATION NAME] dressing. During interview with LPN CC on 02/13/13 at 9:15 a.m., she stated that when she found the blister on resident Q's ankle on 02/09/13, she did not call the physician because it was a weekend. Upon further interview, she stated that she notified the physician by making an entry of the new wound in the Medical Consultation Log kept at the nurse's station. Review of the facility's policy and procedure entitled Actual Loss of Skin Integrity: Stage II/Partial Thickness Wound Protocol noted to notify the physician and legal representative of any new areas.",2017-09-01 6886,"OAKS - SCENIC VIEW SKILLED NURSING, THE",115393,205 PEACH ORCHARD ROAD,BALDWIN,GA,30511,2013-02-14,281,D,0,1,P02P11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to clarify the parameters for when to administer insulin, and clarify when to use a walking boot for one (1) resident (Q). The facility also failed to clarify a pressure ulcer treatment order and assess a residents skin condition after the removal of a cast for one (1) resident (#270). The sample size was thirty-three (33) residents. Findings include: 1. Review of resident Q's physician's orders [REDACTED]. Further review of the order revealed it did not specify how much insulin to give if the FSBS exceeded 353. Review of resident Q's Medication Administration Records (MAR) revealed that the blood sugar exceeded 353 on 12/19/12; 01/16/13; and 02/09/13. Further review of the MAR indicated [REDACTED]. During interview with Registered Nurse (RN) Unit Manager DD on 02/14/13 at 8:40 a.m., she stated that the nurse that did the FSBS should have contacted the physician when the blood sugar exceeded 353, as there was no order for insulin coverage above that. Cross-refer to F 309. 2. Review of an orthopedic physician's orders [REDACTED]. Walker boot to right lower leg. Diagnosis: [REDACTED]. Further review revealed the order did not specify when the resident was to wear the boot. On 02/13/13 at 8:55 a.m., Licensed Practical Nurse (LPN) Treatment Nurse BB was observed performing a dressing change to an open blister to resident Q's right outer ankle. During interview, LPN BB stated the wound was found on 02/09/13, and was caused by the velcro walking boot. During interview with LPN CC at 9:15 a.m., she stated that they continued to apply the walker boot after the blister was discovered, but that they had covered the wound with a protective dressing. Review of a Grievances/Complaint Form dated 02/09/13 revealed that a complaint was filed by a family member of resident Q which noted that the resident had their boot on all night. Review of the Action Taken section of the complaint noted that when the problem was identified on Saturday (02/09/13) to be causing irritation, it (the boot) was removed. Review of an untimed Nurse's Notes (NN) dated 02/09/13 noted the boot be in place for transferring and when out of bed and that the boot to remain off at night. Review of the 10:00 p.m. NN on this date revealed that the brace to right foot was intact. During interview with LPN BB on 02/13/13 at 3:30 p.m., she stated the order for the walking boot was not very clear as far as when it was supposed to be worn. Upon further interview she added that walking boots were usually worn just for transfers. During interview with Occupational Therapist (OT) EE on 02/14/13 at 8:25 a.m., she verified the order did not specify whether the boot should be worn continuously, or only when out of bed. During interview with Unit Manager DD at 8:30 a.m., she stated there was no documentation in the NN as to when the boot was delivered and/or applied; that they did not even receive the order for the boot until 02/13/13; and that the order should have been clarified as to how often to wear the boot. During interview with LPN CC at 9:03 a.m., she stated that when she came to work on 02/09/13, she received resident Q in bed early that morning, and that the boot was on. Upon further interview, she stated she removed the boot after receiving the family complaint about the boot being left on all night, and discovered the blister on the resident's right ankle at that time. She verified documentation in the NN that the boot was on at 10:00 p.m. later that night. LPN CC further stated that she tried to clarify the order for when to wear the boot on 02/09/13, but that the orthopedic doctor's office was closed. During interview with Physical Therapist (PT) FF on 02/14/13 at 9:35 a.m., she stated that she applied the walking boot on 02/07/13, and instructed the nursing staff to remove it when the resident went to bed. Upon further interview, she verified the order for the walking boot did not specify when to wear it, but felt it was for protection of the resident's fractured ankle during transfers. During interview with the RN Nurse Consultant GG at 10:45 a.m., she stated she would expect for nursing to follow the physician's orders [REDACTED]. Cross-refer to F 314. 3. Resident # 270 was admitted to the facility on [DATE] 13 with a [DIAGNOSES REDACTED]. Review of the Daily Nurses Notes indicated the resident went to the physician's office on 2/8/13. Further review indicated the cast on the right foot was removed at the physician's office. The resident returned to the facility with orders to for skin care to the right ankle, foot and calf. There was no evidence in the medical record of an assessment of the right foot and leg upon return from the physician's office on 2/8/13. Review of the Daily Skilled Nurses Notes dated 2/9/13 indicated the resident complained of pain to the ankle. The boot was removed and a reddened area was noted to the inside ankle and outside bone of the right ankle. A dark area was noted to the top of the foot. The note indicated the boot was loosened and notation was made that area was to be monitored. Review of the medical record indicated no evidence of any additional assessment of the areas on the right foot and ankle and no evidence any type of treatment was performed to the area. During an interview on 2/13/13 at 3:00 p.m. Licensed Practical Nurse (LPN) BB Stated she did not remove the boot after the resident returned from the physician on 2/8/13. She further confirmed she did not call the physician to clarify the instructions to perform skin care to the right ankle foot and leg twice a day. Review of the Georgia State Nurse Practice Act, Article II, Chapter two, Section 3.2 revealed the responsibility for Nursing Practice Implementation. The Licensed Practical Nurse [MEDICATION NAME] under the direction of a Registered Nurse, Advanced Practice Registered Nurse, Licensed Physician or other authorized licensed health care provider: A. Conducts a focused nursing assessment, which is an appraisal of the client's status and situation at hand that contributed to ongoing data collection. B. Plans for episodic nursing care. C. Demonstrates attentiveness and provides client surveillance and monitoring. D. Assists in identification of client needs. E. Seeks clarification of orders when needed During an interview on 2/14/13 at 9:15 am the Director of Health Services (DHS) stated the expectation would be for the nurse to notify the physician for verification of the orders for the treatment and the nurse should have assessed the area upon return to the facility after the cast had been removed. Cross Refer: F314",2017-09-01 6887,"OAKS - SCENIC VIEW SKILLED NURSING, THE",115393,205 PEACH ORCHARD ROAD,BALDWIN,GA,30511,2013-02-14,282,D,0,1,P02P11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to follow the care plan related to reviewing recent bowel elimination patterns and reporting any negative findings to the physician for one (1) resident (#265), and failed to follow the care plan related giving diabetes medications as ordered for one (1) resident (Q). The sample size was thirty-three (33) residents. Findings include: 1. Review of resident #265's Potential for Constipation care plan revealed an Approach to review recent bowel elimination patterns, and report any negative findings to the physician. Review of resident #265's physician's orders [REDACTED]. Review of the facility's BM (Bowel Movement) Report 8/12 from 01/29/13 to 02/11/13 revealed that they had eight watery liquid stools, as well as more than one stool on ten days during this time. During interview with CNA HH on 02/13/13 at 2:50 p.m., he stated that resident #265 had frequent loose BM's ever since they were admitted to the facility, and had to be changed several times a shift. During interview with Registered Nurse (RN) Unit Manager DD at 3:45 p.m., she verified the frequency and consistency of the BM's, and that the resident received a nightly laxative. Cross-refer to F 329. 2. Review of resident Q's Diabetes care plan revealed an Approach for meds as ordered. Review of resident Q's physician's orders [REDACTED]. Further review of this sliding scale order revealed it did not specify how much insulin to give for a blood sugar over 353. Review of the MAR between 12/17/12 and 02/14/13 revealed the resident's blood sugar exceeded 353 on 12/19/12, 01/16/13, and 02/09/13, and the resident was given insulin without an order. This was verified during interview with RN Unit Manager DD on 02/14/13 at 8:40 a.m., who stated the nurse should have contacted the physician when the blood sugar exceeded 353, as there was no order for insulin coverage above that. Cross-refer to F 309.",2017-09-01 6888,"OAKS - SCENIC VIEW SKILLED NURSING, THE",115393,205 PEACH ORCHARD ROAD,BALDWIN,GA,30511,2013-02-14,309,D,0,1,P02P11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to obtain an order for [REDACTED]. Findings include: Review of resident Q's physician's orders [REDACTED]. Further review of the order revealed it did not specify for how much insulin to give once the FSBS exceeded 353. Review of resident Q's Medication Administration Records (MAR) revealed the following: -On 12/19/12 at 9:00 p.m., the FSBS result was 398. The nurse administered 7 units of insulin. -On 01/16/13 at 9:00 p.m., the FSBS result was 369. The nurse administered 8 units of insulin. -On 02/09/13 at 4:30 p.m., the FSBS result was 466. The nurse administered 10 units of insulin. During interview with Registered Nurse (RN) Unit Manager DD on 02/14/13 at 8:40 a.m., she verified that there was no documentation in the physician's orders [REDACTED]. Upon further interview, she stated that the nurse that did the FSBS should have contacted the physician when the blood sugar exceeded 353, as there was no order for insulin coverage above that.",2017-09-01 6889,"OAKS - SCENIC VIEW SKILLED NURSING, THE",115393,205 PEACH ORCHARD ROAD,BALDWIN,GA,30511,2013-02-14,314,D,0,1,P02P11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to provide timely assessments to pressure ulcers and provide treatment according to physician orders [REDACTED].#270) and failed to assess the effect of a device which had the potential to cause pressure and conduct timely assessments for a pressure area for one (1) resident (Q) on a sample of thirty-three (33) residents. Findings include: Review of the medical record for Resident #270 revealed the resident was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. The resident was admitted to the facility with a soft non-removable cast in place on the right leg. Review of the Daily Nurses Notes indicated the resident went to the physician's office on 2/8/13. Further review indicated the cast on the right foot was removed at the physician's office and a removable boot was applied. The resident returned to the facility with orders to for skin care to the right ankle, foot and calf to be performed twice daily. There was no evidence in the medical record of an assessment of the right foot and leg upon return from the physician's office on 2/8/13. In addition, there was no evidence skin care or treatment had been performed to the leg as ordered by the physician. Review of the Daily Skilled Nurses Notes dated 2/9/13 indicated the resident complained of pain to the ankle. The boot was removed and a reddened area was noted to the inside ankle and outside bone of the right ankle. A dark area was noted to the top of the foot. The note indicated the boot was loosened and notation was made that area was to be monitored. Review of the medical record indicated no evidence of any additional assessment of the areas on the right foot and ankle and no evidence any type of treatment was performed to the area until 2/11/13. Review of the Skin Notes dated 2/11/13 indicated the boot was removed from the right leg and pressure areas were noted. The lateral area of the fifth toe had an area of suspected Deep Tissue Injury (DTI) measuring 1.5 centimeters by 1.5 centimeters and was dark purple in color The right heel had a Stage 2 Pressure Ulcer measuring 0.6 centimeters by 1.1 centimeters. The top of the right foot had on open blister which measured 3.0 centimeters by 3.8 centimeters by Observation of the on 2/13/12 at 11:00 a.m. with Treatment Nurse BB revealed an open area on top of the right foot presenting as a Stage 2 pressure ulcer, the area around the wound was reddened. A Stage 2 Pressure Ulcer was present on the right heel and an area was noted on the side of the 5th toe and was bluish-purple in color and presented as possible DTI. During an interview on 2/13/14 at 3:30 p.m., Treatment Nurse BB stated when she arrived to the facility on Monday 2/11/13, she was told the resident had a new walking boot on and was having more pain in the foot. She further stated she removed the boot she discovered the wounds. She confirmed she could find no evidence of assessments or treatments to the areas since the resident returned from the physician's office on 2/8/13. She confirmed she did not stage the area on the top of the foot because she was told by the family the area was a Fracture Blister. During an interview on 2/13/13 at 3:00 p.m. Licensed Practical Nurse (LPN) BB Stated she did not remove the boot after the resident returned from the physician on 2/8/13. She further confirmed she did not call the physician to clarify the instructions to perform skin care to the right ankle foot and leg twice a day. During an interview on 2/14/13 at 9:15 am the Director of Health Services (DHS) stated the expectation would be for the nurse to notify the physician for verification of the orders for the treatment and the nurse should have assessed the right leg and foot upon return to the facility after the cast had been removed. Review of resident Q's Admission Minimum Data Set ((MDS) dated [DATE] noted they needed extensive assistance for bed mobility; had one Stage 2 unhealed pressure ulcer on admission; and was at risk for pressure ulcers. Review of the clinical record revealed [DIAGNOSES REDACTED]. Review of labs dated 12/20/12 noted a Total Protein of 5.9 (normal 6.0-8.3), and an [MEDICATION NAME] of 2.6 (normal 3.4-5.0). Review of a right foot and ankle x-ray dated 02/04/13 revealed that the resident had sustained a [MEDICAL CONDITION] malleolus and distal fibula, with mild lateral subluxation of the distal tibia. Review of orthopedic physician's orders [REDACTED]. Review of a Grievances/Complaint Form dated 02/09/13 noted a family member of resident Q had complained that the boot was left on the resident all night. Review of Daily Skilled Nurse's Notes (NN) dated 02/09/13 revealed an untimed entry that the resident was observed with a raised blister to the lateral malleolus (ankle area), approximately 4 X 1.5 centimeters (cm). Further review of these NN at 10:00 p.m. revealed the resident was in bed with the brace to the right foot intact. Review of the Documentation of Wound Observation and Assessment Form dated 02/11/13 noted the resident was assessed as having a Stage II pressure ulcer to the right lateral ankle, measuring 5 cm by 3 cm by less than 0.2 cm. Review of the narrative portion of this form noted that on 02/11/13, the resident was noted with a velcro walking boot in place; the velcro boot was removed and replaced with a floating/soft blue boot. During interview with Licensed Practical Nurse (LPN) Treatment Nurse BB on 02/13/13 at 8:55 a.m., she stated that the blisterwas caused from the velcro walking boot, and on 02/11/13 she got an order to discontinue the walking boot and apply a soft boot. Observation of resident Q's lateral right ankle at this time revealed an L-shaped area that appeared to be a ruptured blister. At 9:15 a.m., LPN CC stated that when she discovered the blister on 02/09/13, she notified the weekend Treatment Nurse who dressed the wound, and that she continued to use the walking boot when the resident was out of bed. Upon further interview, she stated she did not call the physician to clarify continued use of the boot. During interview with Registered Nurse (RN) Unit Manager DD on 02/14/13 at 8:30 a.m., she stated that there was no documentation in the NN as to when the walking boot was delivered and/or applied, and that the order should have been clarified as to when to wear it. During interview with LPN CC on 02/14/13 at 9:03 a.m., she stated that resident Q's family member had told her on 02/09/13 that the boot was to be used for transferring and when out of bed only, but that she was not able to contact the orthopedic doctor to verify this because it was a weekend. LPN CC verified that the 10:00 p.m. NN on 02/09/13 noted that the resident was in bed, and the brace to the right foot was intact. During interview with Physical Therapist FF on 02/14/13 at 9:35 a.m., she stated that she applied the walking boot on 02/07/13, told the nursing staff to take it off when he/she went to bed, and to check the skin every two hours. During interview with LPN Treatment Nurse BB on 02/14/13 at 9:55 a.m., she verified that the weekend treatment nurse did not start a Documentation of Wound Observation and Assessment Form when the blister was discovered on 02/09/13, and that the measurements documented in the 02/09/13 NN were an estimate. Upon further interview, she stated that she would have contacted the physician due to the resident's history of poor wound healing for treatment orders and to see if he wanted to continue use of the walking boot. Review of the facility's Actual Loss of Skin Integrity: Stage II/Partial Thickness Wound Protocol noted to notify Physician and legal representative of any new areas; document area per Documentation of Skin and Wound Care policy; initiate or review care plan and review interventions and update as needed. During interview with RN Nurse Consultant GG on 02/14/13 at 10:45 a.m., she stated that the purpose for the walking boot must have been for stability, as the resident was non-weight bearing. Upon further interview, she stated that skin checks were done every two hours when a resident had a brace, but was only documented if a concern was found. She further stated that there was no facility policy and procedure related to routine skin checks for a resident with a brace/boot.",2017-09-01 6890,"OAKS - SCENIC VIEW SKILLED NURSING, THE",115393,205 PEACH ORCHARD ROAD,BALDWIN,GA,30511,2013-02-14,325,D,0,1,P02P11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide interventions to address a significant weight loss of 10.7 percent (%) in one month for one (1) resident (#270) on a sample of thirty-three (33) residents. Findings include: Review of the medical record for resident #270 revealed the resident was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. The resident had an admission weight of 200.8 pounds. Further review of the weight record indicated the resident had a weight of 190 pounds on 12/25/12 which indicated a significant weight loss of 5.1% since admission. In addition, the resident had a weight of 179.2 pounds on 1/12/13 which indicated the resident with at significant weight loss of 21.6 pounds or 10.7% in one month. The resident had an Admission Minimum Data Set (MDS) assessment dated [DATE] which indicated the resident had no weight loss or gain prior to admission. Review of the Weight Progress Notes Form revealed an entry dated 12/27/12 which identified a weight loss of 10.4 pounds since admission. A snack at 3:00 p.m. each day of milk and a sandwich was added as an intervention. An interview on 2/13/13 at 3:30 p.m. Licensed Practical Nurse AA stated the intervention to address the weight loss was a nursing intervention and confirmed the physician was not notified of the significant weight loss. Review of the facility's policy for the Weight Monitoring Program indicated if significant weight loss is identified the Weight Loss/Gain Checklist is completed, the resident would be added to the Colored Napkin Program and weekly weight team documentation would be performed and the resident would be evaluated for possible interventions to address the weight loss. Further review of the Weight Progress Note Form and the Nutritional Progress Notes revealed no evidence the additional weight loss of 11.2 pounds had been addressed and there was no evidence of additional interventions to address the weight loss. During an interview on 2/13/13 at 3:50 p.m. LPN AA stated she was in charge of the Weight Loss meetings which were held weekly to review residents with significant weight loss. She stated she was aware of the weight loss on 12/25/12 and should have completed the form for Significant Weight Loss. She further stated this would have reminded her to notify the physician of the significant weight loss and add the resident to her list of residents with weight loss which are reviewed in the weekly weight meetings. She further stated after reviewing her meeting notes, the resident was not being followed in the weight meetings and was not on the Colored Napkin Program. She further stated she did not show the resident as having a significant weight loss on the January 2013 weight report. She further stated the admission weight recorded on the weight report was entered incorrectly.",2017-09-01 6891,"OAKS - SCENIC VIEW SKILLED NURSING, THE",115393,205 PEACH ORCHARD ROAD,BALDWIN,GA,30511,2013-02-14,329,D,0,1,P02P11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to consult with the physician regarding continued use of a laxative for one (1) resident (#265), who was having intermittent loose stools. The sample size was thirty-three (33) residents. Findings include: Review of resident #265's physician's orders [REDACTED]. Review of the facility's BM (Bowel Movement) Report 8/12 from 01/29/13 to 02/11/13 revealed the following: 01/29/13: Had one extra-large watery liquid stool, and one large soft-formed stool. 01/30/13: Had two large soft-formed stools. 01/31/13: Had one large soft-formed stool. 02/01/13: Had one large watery liquid stool. 02/03/13: Had an extra-large soft-formed and an extra-large watery liquid stool. 02/04/13: Had a medium and a large soft-formed stool. 02/05/13: Had a small watery liquid stool. 02/06/13: Had a small and a medium soft-formed stool. 02/07/13: Had a large soft-formed and an extra-large watery liquid stool. 02/08/13: Had a medium, large, and extra-large watery liquid stool. 02/09/13: Had two large, soft-formed stools. 02/10/13: Had a medium watery liquid, and one large soft-formed stool. 02/11/13: Had a medium and large watery liquid stool, and one medium soft-formed stool. During interview with the Registered Nurse (RN) Unit Manager DD on 02/13/13 at 2:20 p.m., she stated that the Certified Nursing Assistants (CNA) documented in the computerized system once a shift as to whether or not the resident had a BM. Upon further interview, she stated that if there was more than one type of BM consistency per shift, that meant the resident had more than one stool that shift. RN Unit Manager DD added that she didn't know if the computerized system captured multiple BM's of the same consistency per shift. During interview with CNA HH on 02/13/13 at 2:50 p.m., he stated that resident #265 had frequent loose BM's ever since they were admitted to the facility, and had to be changed several times a shift. Upon further interview, CNA HH stated that the computerized system did not let them put in how many stools a resident had per shift. During interview with RN Unit Manager DD at 2:58 p.m., she stated they had changed the resident's tube feeding in an effort to decrease the number of BM's that the resident had. During further interview at 3:45 p.m., RN Unit Manager DD verified the resident received Senna-S daily from admission through 02/11/13, and that the resident had received two doses of [MEDICATION NAME] (an anti-diarrheal) on 02/09/13 for loose stools. Review of the facility's Geriatric Dosage Handbook, 11th Edition, noted that Senna-S was a stimulant laxative and stool softener, and used for short-term treatment of [REDACTED].",2017-09-01 6971,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,225,D,0,1,YKS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and review of facility policy and procedure, it was determined the facility failed to ensure that an allegation of neglect was immediately reported to the administrator and to the State survey and certification agency, and was thoroughly investigated for one resident (D) in a total sample of 29 residents. Findings include: The facility failed to ensure that resident D's allegation of a CNA refusing to provide requested care was reported immediately to the administrator of the facility and to state survey and certification agency. Although a licensed nurse was aware of the resident's allegation, there was no evidence that the facility had investigated the allegation and reported the results of the investigations to the administrator or his designated representative and to the state survey agency within 5 working days of the incident. However, the facility failed to identify an allegation of neglect made by resident D about CNAKK and immediately report it to the state survey and certification agency, and to thoroughly investigate to determine the validity of that allegation and to implement any corrective actions if needed. Resident D was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. During an interview on 2/11/13 at 1:11 p.m., resident D said that, 2 to 3 weeks ago when he/she was sitting in the hallway outside the bathroom door, Certified Nursing Assistant (CNA) KK walked by and he/she asked that CNA to help him/her onto the toilet. The resident said that CNA KK replied no but, licensed practical nurse (LPN) JJ walked by and offered to help him/her. The resident stated CNA KK told LPN JJ that she would not help resident D. The resident described the incident as having made him/her feel pretty rough, like nobody cared. The resident said that he/she was able to stand but it took one person to help get him/her from the wheelchair to the toilet. Resident D said that nurse JJ told him/her that she was going to report the incident. During an interview on 2/13/13 at 2:45 p.m., the Director of Nurses (DON) said that the Activity Director had told her about that incident involving resident D and CNA KK after it was discussed at the February Resident Council meeting. Resident D had brought the incident up at that meeting. The DON said that she talked to the resident the day of the February meeting and also to a CNA with the same first name to determine if she was the CNA who had been involved in the incident. The DON stated that she had told the administrator about the incident. However since neither of them had felt that it was not valid, the DON said that she did not write it up as a grievance. She said that she was unaware that the week-end charge nurse (LPN JJ) had been involved. The DON said that, normally if she felt that a reported incident was valid or if she was not sure if it was valid then, she filed a grievance form. She said that she always followed-up with any staff member and resident who were involved. In an interview on 2/13/13 at 2:55 p.m., the Administrator said that anyone who came to him could file a grievance unless they felt that the issue had been immediately resolved. If not, then there should be a written grievance. He reiterated the DON's statement that they did not believe the resident's allegation was valid. During an interview on 2/13/13 at 3:34 p.m., the Activities Director stated that after having discussed residents' rights at the end of the Resident Council meeting held on 2/5/13, she had asked the residents if their rights had been violated. The Activities Director confirmed that resident D had reported his incident with a CNA having refused to take him/her to the bathroom. She said that when she had talked to the resident one-to-one at the end of the meeting, the resident called the CNA by name. The Activities Director said that she had reported the incident to the DON. Review of the 2/5/13 Resident Council meeting attendance sheet revealed that resident D had attended that meeting. There was a 2/5/13 memo signed by 18 CNAs and/or LPNs that listed specific complaints from residents. One of the listed complaints had documentation for staff not to tell a resident no if they asked to be taken to the bathroom. After surveyor inquiry, the DON provided a Grievance Investigation form dated 2/14/13 however, there was no evidence that the resident's allegation that a CNA had refused to provide requested assistance had been promptly reported to the state survey agency or thoroughly investigated.",2017-09-01 6972,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,278,D,0,1,YKS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility failed to accurately code the section on vision impairment on a Minimum Data Set (MDS) assessment for one resident (#46) in a total sample of 29 residents. Findings include: Review of the 8/09/12 vision consultation report revealed that the physician had diagnosed resident #46 as having moderate to severe [MEDICAL CONDITION] that required removal as soon as possible, and mild [MEDICATION NAME] degeneration. However, a review of the 9/15/12 annual MDS assessment revealed that licensed staff had inaccurately coded the resident as having had no visual impairment. Review of the 10/11/12 consultation report revealed that the physician diagnosed the resident with visually significant [MEDICAL CONDITION]. However, a review of the 11/28/122 quarterly MDS assessment revealed that licensed staff had inaccurately coded the resident with no visual impairment. During an interview on 2/13/13 at 12:25 p.m., the MDS Coordinator and Director of Nurses (DON) said that they were not aware that the resident had had a vision consultation and that vision problems had been diagnosed . However, the annual and the quarterly assessments should have identified the resident as having had a vision impairment. The MDS Coordinator admitted that her assessment of a resident's vision was based on whether or not the resident could see the television. However that process did not follow the guidelines in the MDS manual for the assessment of residents' vision.",2017-09-01 6973,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,279,D,0,1,YKS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview and record review, it was determined that the facility failed to develop a comprehensive plan of care to address the range of motion and positioning needs of one resident (#13) and the vision needs of one resident (#46) in a total sample of 29 residents. Findings include: 1. Licensed staff coded resident #13, on the 9/19/12 and 12/12/12 Mimimum Data Set (MDS) assessments, as having decreased range of motion and limited mobility, chronic pain due to limited mobility and contractures in his/her upper and lower extremities. It was observed on 2/13/13 at 11:11 a.m., that first finger on the resident's right hand was contracted. There were not splinting devices in use. On 2/13/13 at 1:22 p.m., licensed practical nurse (LPN) PP said that three people had to assist the resident to get dressed because the resident's legs would not bend. She said that since the resident was on hospice services, they did not use splints. During an interview on 2/13/13 at 4:00 p.m., the Director of Rehabilitation services provided therapist reports dated 12/07/11 and 12/14/12 which noted that the resident was to continue to wear Prevalon heel floating boots. There was a recommendation for an abduction wedge to keep the resident's legs separated. There was documentation on the 3/06/12 interdisciplinary team collection form about the resident's decreased mobility and hospice status. Documentation on the form noted that the resident would benefit from an abduction wedge and floating heel boots. The team documented at that time that the resident's legs were scissored. However, staff did not develop a plan of care to address the resident's range of motion and positioning needs See F318 for additional information regarding resident # 13. 2. Review of an 8/09/12 vision consultation report revealed that the physician diagnosed resident #46 as having moderate to severe [MEDICAL CONDITION] that required removal as soon as possible, and mild [MEDICATION NAME] degeneration. However, a review of the 9/15/12 annual MDS assessment revealed that licensed staff had inaccurately coded the resident as having had no visual impairment. Review of the 10/11/12 vision consultation report revealed that the physician diagnosed the resident with visually significant catracts. However, a review of the 11/28/122 quarterly MDS assessment revealed that licensed staff had inaccurately coded the resident with no visual impairment. During an interview on 2/13/13 at 12:25 p.m., the MDS Coordinator and DON said that they were not aware that the resident had had a vision consultation and that vision problems had been diagnosed . Therefore, a care plan had not been deveoped to address the resident's visual impairment and visual needs.",2017-09-01 6974,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,282,D,0,1,YKS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview and record review, it was determined that the facility failed to implement planned interventions to promote skin integrity for one resident (#46) and to arrange for needed dental services for one resident (C) in a total sample of 29 residents. Findings include: 1. Resident #46 had [DIAGNOSES REDACTED]. There was a care plan since 10/22/10 to address his/her risk for alteration in skin integrity due to incontinence and a history of frequent skin tears and bruising due to involuntary movements. There were interventions to keep the resident's bed side rails padded and to encourage him/her to reposition frequently. However, staff failed to pad the resident's side rails as planned. See F323 for additional information regarding resident #46. 2. Resident C had a care plan which had been reviewed on 12/12/12 to address his/her need for assistance with all activities-of-daily living (ADLs). There were interventions for staff to provide dental care after each meal and at bedtime, to report loose or ill-fitting dentures, and to offer dental services as needed. During an interview on 2/13/13 at 8:30 a.m., resident C stated that his/her gums and mouth were sore along the bottom on the right side. Although the resident stated that she had not reported the problem to nursing staff, documentation in the 1/05/13 Resident Council meeting minutes revealed that resident C had complained about his/her gums hurting. There was a note that Social Service staff would follow up, however, there was no evidence of any follow up having been done. Staff failed to implement their planned intervention. See F411 for additional information regarding resident C.",2017-09-01 6975,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,309,D,0,1,YKS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review, it was determined that the facility failed to implement the facility's protocol for one resident (#6) that was constipated in a total sample of 29 residents. Findings include: The facility's BM (bowel movement) protocol, provided by the Director of Nurses (DON) on 2/14/13. The protocol was that if a resident had not had a bowel movement in 3 days then, the nursing staff was supposed to start with 30 mililters (ml) of Milk of Magnesia (MOM) suspension or 30 ml of [MEDICATION NAME] by mouth or gastrostomy tube. During and interview on 2/14/13 at 12 p.m., the DON stated that if nursing staff initiated the facility's BM protocol then, it would be documented on the resident's Medication Administration Record [REDACTED] Resident #6 was admitted on [DATE] with [DIAGNOSES REDACTED]. A review of the resident's Medication Administration Records (MARs) revealed that there was no documentation that the resident had had a bowel movement from 11/29/12 - 12/04/12 (6 days), from 10/22/12 - 10/26/12 (5 days), 10/12/12 - 10/15/12 (4 days), and from 9/18/12 - 9/21/12 (4 days). However, there was no documentation on the MAR indicated [REDACTED].",2017-09-01 6976,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,318,D,0,1,YKS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and record review, it was determined that the facility failed to provide treatment and services to address the range of motion and positioning needs for one resident (#13) from a total sample of 29 residents. Findings include: Resident #13 had [DIAGNOSES REDACTED]. Licensed staff coded resident #13, on the 9/19/12 and 12/12/12 Minimum Data Set (MDS) assessments, as having decreased range of motion and limited mobility, chronic pain due to limited mobility and contractures in his/her upper and lower extremities. During an interview on2/11/13 at 1:16 p.m., licensed practical nurse (LPN) PP stated that the resident had contractures of his/her left hand and starting contractures of his/her right hand. During an observation on 2/13/13 at 11:11 a.m., the resident's first finger on his/her right hand was observed to be contracted. There were no visible positioning devices in use. On 2/13/13 at 1:22 p.m., LPN PP said that it took three people to assist the resident to get dressed and it was very hard because the resident's legs would not bend. She said that since the resident was on hospice services, they did not use splints. During an interview on 2/13/13 at 4:00 p.m., the Director of Rehab RR provided therapist reports dated 12/07/11 and 12/14/12 that noted the resident was to continue to wear Prevalon heel floating boots. There was a recommendation for an abduction wedge to keep the resident's legs separated. There was a 3/06/12 interdisciplinary team collection form that documented the resident's decreased mobility and hospice status. The form documentation noted that the resident would benefit from an abduction wedge and floating heel boots. The team documented that the resident had scissored legs at that time. However, staff had not developed care plan interventions to address preventive care related to the resident's limited range of motion and positioning needs. Although the interdisciplinary team had noted that the resident would benefit from the use of floating heel boots and an abduction wedge to assist the resident with positioning, there was no evidence of their use.",2017-09-01 6977,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,323,D,0,1,YKS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview and record review, it was determined that the facility failed to implement interventions to address a potentially hazardous assistive device for one resident (#46) who had a history of [REDACTED]. Findings include: Resident #46 had [DIAGNOSES REDACTED]. Licensed staff coded him/her on the 11/28/12 Minimum Data Set (MDS) assessment as needing limited assistance for bed mobility. There was a care plan since 10/22/10 to address the resident's risk for alteration in skin integrity due to a history of having frequent skin tears and bruising because of his/her involuntary movements. There was an intervention for staff to keep the three side rails padded. However, during observations of the resident in bed on 2/11/13 at 2:00 p.m. and 2:55 p.m., and on 2/13/13 at 11:30 a.m., and 11:55 a.m., staff had not padded the three side rails. On 2/11/13 at 2:00 p.m., the resident's head was positioned against the metal side rail. During an interview on 2/13/13 at 12:25 p.m., the Director of Nurses (DON) and MDS Coordinator stated that the use of side rails was assessed on admission and then quarterly. They said that the staff just reviewed verbally and looked at the use of side rails. However, there was no documentation to verify that the side rails for the resident had been evaluated to assess the potential hazard from continued use. There was no evidence that staff had monitored the effectiveness of the side rails and the intervention for the use of the padding on those rails to prevent skin tears and bruising on the resident.",2017-09-01 6978,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,328,E,0,1,YKS711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and staff interview, it was determined that the facility failed to ensure that respiratory care equipment was stored in a sanitary manner and failed to ensure the equipment was properly maintained in five resident rooms (11, 17B, 21A, 4C and 23B) in use for three residents in three rooms (11B, 17B and 21A) in a total sample of 29 sampled residents. Findings include: 1. During observations on 2/11/13 at 11:35 a.m. and on 2/12/13 at 10:00 a.m., the nasal cannula at the 11B bed location was uncovered and wrapped around the handle of the oxygen concentrator. The filter on the right side of the concentrator was dirty, with the bottom half covered in a white lint-looking material. There was not a filter on the left side of the concentrator. The mask for the Continuous Positive Airway Pressure ([MEDICAL CONDITION]) machine on the bedside table of bed B was uncovered. Resident #24 was observed lying in bed (11A) on 2/13/13 at 7:50 a.m. with oxygen being administered through a nasal cannula from an oxygen concentrator. The oxygen concentrator that had previously been at his/her roommate's bedside on 2/11/13 and 2/12/13 had been moved to his/her bedside. The right air filter on the oxygen concentrator was dirty and the left filter was missing. The [MEDICAL CONDITION] mask was uncovered on the bedside table. 2. Resident #9 was observed lying in bed on 2/13/13 at 3:50 p.m. and 2/14/13 at 3:36 p.m. with a nasal cannula infusing oxygen from an oxygen concentrator. However, there was not an air filter on either side of the concentrator. 3. On 2/14/13 at 11:55 a.m., the oxygen concentrator in room [ROOM NUMBER]A was observed to have only one dirty air filter instead of the two filters that it was supposed to have. One air filter was missing. On 2/14/13 between 1:10 p.m. and 1:20 p.m., the following observations were made: 4. There was an uncovered nasal cannula draped over the oxygen concentrator in room [ROOM NUMBER]B. The front panel of the concentrator was dusty. One of two air filters was dusty and one was missing. 5. Although the oxygen concentrators in rooms 4C and 23B were not in use, staff had failed to maintain them in a clean and intact condition. a. There were not any air filters on the dusty oxygen concentrator in room [ROOM NUMBER]C. b. The dusty humidifier bottle attached to the dusty oxygen concentrator in room [ROOM NUMBER]B was not dated. There was a dusty air filter on the machine. During an interview on 2/14/13 at 2:09 p.m., the ward clerk stated that the treatment nurse was responsible for routinely cleaning and checking oxygen concentrators. On 2/14/13 at 2:14 p.m., the Director of Nurses (DON) said that oxygen concentrators and tubing were supposed to be cleaned every Sunday by the treatment nurse. She said that the cleaning and tubing changes were documented on the treatment sheets. However, a review of the treatment sheets revealed no staff documentation that the oxygen concentrators had been routinely cleaned.",2017-09-01 6979,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,411,D,0,1,YKS711,"Based on record review, interviews with staff and a resident, and observations, it was determined that the facility had failed to provide timely routine dental services for one resident (C) in a total sample of 29 residents. Findings include: Resident C had a care plan which had been reviewed on 12/12/12 to address his/her need for staff assistance with all of his/her activities-of-daily living (ADLs). The interventions included that staff would provide dental care after each meal and at bedtime, report loose or ill-fitting dentures, and offer dental services as needed. During an interview on 2/13/13 at 8:30 a.m., resident C stated that his/her gums and mouth were sore along the bottom on the right side. Although the resident said that he/she had not reported the problem to nursing staff, a review of the 1/02/13 Resident Council meeting minutes revealed staff documentation that Social Service would follow up on resident C's complaint about his/her gums hurting. However, there was no evidence that the staff had followed up on the resident's complaint. Staff failed to implement their planned intervention to offer dental services as needed. During an interview on 2/13/13 at 10:51 a.m., the Social Service Director (SSD) stated that the facility was in the process of getting a mobile dentist to come to the facility. She stated that, for now, if a resident complained of mouth or tooth pain then, the staff would report it to nursing or her. She said that then she called the doctor to see if it might could be a medical problem or if the resident needed an appointment with a dentist. She stated that the facility would then send the resident out to a dentist. On 2/13/13 at 11:06 a.m., the SSD said that she was unaware the resident C had ever complained about any dental problems. The SSD said that the nurses examined the resident's mouths on admission and assessed their dental needs and then the CNAs assessed the residents' mouths when they provided mouth care. On 2/13/13 at 11:35 a.m., the SSD stated that, when resident C was admitted , a family member took the resident for dental appointments but, the resident had not been to the dentist for the past two years. The SSD did not know when the resident had last been examined by a dentist. After the surveyor's inquiry, on 2/13/13 at 11:21 a.m., the SSD stated that the resident's physician had referred the resident to a dentist.",2017-09-01 6980,SGMC LAKELAND VILLA,115707,138 WEST THIGPEN AVE,LAKELAND,GA,31635,2013-02-14,431,E,0,1,YKS711,"Based on observations and review of the facility's policy, it was determined that the facility failed to discard opened insulin timely to maintain viability and to discard expired medications in two medication carts (North and South halls) and/or in the medication room. Findings include: The facility's policy identified insulin as a medication with a shortened expiration date. The policy noted that the expiration date for an opened vial of insulin was 28 days. Vials would expire 28 days after being opened (or punctured) or having been removed from the refrigerator, whichever came first. However, observations in the medication carts and medication rooms revealed that nursing staff had not implemented that policy for insulin. Observations were made of the South hall medication cart and the medication room on 2/14/13 between 10:45 a.m.and11a.m. South hall medication cart with licensed pratical nurse (LPN) XX 1. There was documentation on a bottle of Lantus insulin that it had been opened on 12/24/12 with an expiration date of 1/22/13. 2. There was a bottle of Lantus insulin opened 12/26/12 with an expiration date of 1/24/13. 3. There was a bottle of Humalog insulin opened 12/26/12 with an expiration date of 1/24/12 and a reorder date of 2/12/13. The new bottle was observed to be unopened in the medication room refrigerator but, the opened vial was still on the cart. Per licensed nurse - all nurses on the medication cart try to keep check of medication expiration dates so can they can be reordered The Medication room and Stock medication cabinet with LPN XX 1. There was one bottle of Rugby brand chlorophyll tablets (100 count) that had expired 03/09. 2. There was one bottle of Major brand Banophen caplets (1000 count) that had expired 10/12. Observations of the North hall medication cart with LPN PP were done on 2/14/13 between 11:10 a.m. and 11:20 a.m. There was one bottle of Novolin R insulin with an opened date of 1/4/13 and an end date of 2/02/13.",2017-09-01