cms_GA
Data source: Big Local News · About: big-local-datasette
38 rows where "inspection_date" is on date 2016-12-10
This data as json, copyable, CSV (advanced)
Suggested facets: filedate, filedate (date)
| Link | rowid ▼ | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4390 | 4390 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 160 | D | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on staff interviews, review of Admission Record, Discharge Instructions, Resident Statement Landscape and Resident Trust Fund policy dated, 12/1/14, the facility failed to establish procedures to ensure that upon the discharge of 1 of 45 sample residents (R) #94 with a personal fund deposited with the facility, the facility conveyed the resident's funds and a final accounting of those funds to the individual within 30 days. Findings include: Review of the facility's policy Resident Trust Accounts effective date 12/1/2014 documented in pertinent part: A reconciliation of all resident accounts recorded in the Resident Trust system to the bank statements must be completed monthly and signed by the facility Administrator. A copy of the completed and signed reconciliation, along with supporting documents must be forwarded to the designated regional staff member each month. If some resident discharges from the facility any funds remaining after financial obligation to the facility shall be refunded to the resident within 30 days after discharging. Review of the Admission Record for R#94 documents R#94 was admitted to the facility on [DATE] under Medicare part A services. R#94 was her own responsible party. Discharge Instructions dated 4/11/16 documented the resident was accompanied by the Administrator and Social Services Director (SSD) and R#94 left the facility using a walker. Review of the Resident Statement Landscape documented that although the resident had discharged on [DATE] the resident had a balance of $770.69 on 6/3/16 when the account was closed. During an interview on 12/08/2016 at 3:42 p.m. the Business Office Manager (BOM) stated that R#94 had a private account and she was not paying the facility. The facility had the resident sign a form to have her social security check deposited into her resident trust fund account. The BOM was asked to provide an accounting of R#94's billing and payment history. This information was not p… | 2019-11-01 |
| 4391 | 4391 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 221 | D | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, medical record review, Restraint Management policy review, and staff interviews, the facility failed to ensure the restraint for one resident (R#88) of 45 sample residents was applied/utilized according to physician's orders [REDACTED]. Findings include: Resident #88 was admitted to the facility on [DATE] with diagnoses, according to the 11/1/16 Admission Data Collection & Evaluation, of [MEDICAL CONDITION] alcoholic [MEDICAL CONDITION], Wernicke's disease (a neurological disease characterized by the clinical triad of confusion, the inability to coordinate voluntary movement (ataxia), and eye (ocular) abnormalities, and [MEDICAL CONDITION]). The Admission Minimum Data Set (MDS - a comprehensive assessment completed by facility staff that drives the care planning process ), with an Assessment Reference Date (ARD) of 11/10/16, documented R#88 had severely impaired cognition (section C1000) and was rarely/never able to make herself understood or understand others (sections B0700 and B0800). R#88 required total assistance by two staff members with bed mobility, dressing, toilet use, and personal hygiene. She required total assistance by one staff member with locomotion in her wheelchair and extensive assistance by two staff members with transfers (section G0110). R#88 used a restraint (chair prevented rising) daily (section P0110G). The (MONTH) (YEAR) physician's orders [REDACTED].*release restraint every 2 hours (for) 15 minutes. A 12/5/16 Care Plan documented, I use a physical restraint (Lap tray on my chair) (related to) impaired safety awareness and high fall risk. The interventions included: (One) person assist for ambulation short distance tolerated daily .Anticipate and intervene for potential causes which have precipitated prior falls or accidents .Discuss and record with the family/caregivers, the risks and benefits of the restraint, when the restrains (sic) should/will be applied, routines while restrained and a… | 2019-11-01 |
| 4392 | 4392 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 223 | J | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, resident and staff interviews, policy review, and medical record review, the facility failed to ensure that one resident's out of 45 sample residents (R#39) physically abusive behaviors were addressed and interventions were implemented to keep residents safe from further potential harm. R#39 threatened R#56 with harm from a wire clothes hanger on 10/23/16. On 12/5/16, R#39 was observed hitting R#56 with a wire clothes hanger. The facility responded with an intervention to remove all wire clothes hangers from R#39's possession. On 12/8/16, a wire clothes hanger was observed in R#39's room. The nursing staff assigned to work with R#39 were unaware of the intervention to remove wire clothes hangers from his possession. The facility's failure to ensure residents were protected from further physical abuse by R#39 was determined to be likely to cause serious injury, harm, impairment, or death to a resident. Immediate Jeopardy was identified on 12/8/16 and determined to first exist on 10/23/16, when R#39 first threatened R#56 with harm using a wire clothes hanger. The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy on 12/8/16 at 2:55 p.m. An acceptable Allegation of Compliance (AoC) was received on 12/10/16 and the surveyors validated the Immediate Jeopardy was removed on 12/10/16 as alleged. The deficient practice remained at a D (isolated potential for more than minimal harm) scope and severity while the facility developed and implemented the Plan of Correction and the facility's Quality Assurance Committee monitored the effectiveness of the systemic changes. Findings include: The facility's (MONTH) (YEAR) Abuse Prevention Program (and) Reporting Policy documented, in pertinent part, .Identify, correct, and intervene in situations where abuse, neglect, and/or mistreatment are most likely to occur. This includes, but is not limited to, identification/analysis of .Residents/pati… | 2019-11-01 |
| 4393 | 4393 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 226 | J | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, resident and staff interviews, policy review including Abuse Prevention Program (and) Reporting Policy, and medical record review, the facility failed to implement the policy related to investigation of resident to resident abuse for one resident (R#56) by (R#39), and; failed to ensure that criminal background check was completed for one Licensed Practical Nurse. R#39 threatened R#56 with harm from a wire clothes hanger on 10/23/16. On 12/5/16, R#39 was observed hitting R#56 with a wire clothes hanger. The facility responded with an intervention to remove all wire clothes hangers from R#39's possession. On 12/8/16, a wire clothes hanger was observed in R#39's room. The nursing staff assigned to work with R#39 were unaware of the intervention to remove wire clothes hangers from his possession. The facility's failure to implement policies to ensure residents were protected from further physical abuse by R#39 was determined to be likely to cause serious injury, harm, impairment, or death to a resident. Immediate Jeopardy was identified on 12/8/16 and determined to first exist on 10/23/16, when R#39 first threatened R#56 with harm using a wire clothes hanger. The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy on 12/8/16 at 2:55 p.m. An acceptable Allegation of Compliance (AoC) was received on 12/10/16 and the surveyors validated the Immediate Jeopardy was removed on 12/10/16 as alleged. The deficient practice remained at a D (isolated potential for more than minimal harm) scope and severity while the facility developed and implemented the Plan of Correction and the facility's Quality Assurance Committee monitored the effectiveness of the systemic changes. Findings include: The facility's (MONTH) (YEAR) Abuse Prevention Program (and) Reporting Policy documented, in pertinent part, to notify the Shift Supervisor immediately if suspected abuse, neglect, mistreatment or misappro… | 2019-11-01 |
| 4394 | 4394 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 241 | E | 1 | 0 | QBL111 | > Based on observations, resident interviews and staff interviews, the facility failed to ensure 2 of 45 sampled residents (R#88 and R#43), 2 supplemental sample residents (R#65 and R#47) and all 79 residents who received nutrition orally were treated with dignity and respect and not in an institutional manner. Specifically: -Residents were called by undignified labels such as feeders and tube feeders by staff. -Staff placed clothing protectors on residents without determining whether they wanted to wear them. -Residents waited extensive time frames, without food or beverage, in the dining room for meals. -Residents were not provided with knives to enable them to cut up foods, such as meat. -R#88, R#43, R#65 and R#47 were not provided with adequate staff assistance and attention to maintain a dignified appearance. Findings include: 1. Undignified reference to residents who required meal assistance or those being fed via tube feeding. The Dietary Manager was interviewed during the initial kitchen inspection on 12/5/16 from 10:00 a.m. - 10:30 a.m. The Dietary Manager was asked about the dining room seating and she stated there were 2 seatings in the dining room. The Dietary Manager stated, Independent residents eat first, and then the feeders eat. The Dietary Manager was interviewed a second time on 12/10/16 at 9:22 a.m. and referred to residents who required meal assistance as feeders and residents who were fed via feeding tube as tube feeders. The Social Service Designee (SSD) was interviewed on 12/9/16 at 10:03 a.m. and stated she did not like the term of feeders when referring to residents and indicated it was not dignified. A copy of the seating assignments for first and second seating were provided to the surveyor. On the second sitting list, the following was documented, Table 1 - Feeders (13 residents' names were listed). 2. Clothing protectors a. Observations On 12/5/16 the second seating of the lunch meal was observed. At 1:07 p.m. 8 out of 10 residents in the dining room were wearing white terry cloth cl… | 2019-11-01 |
| 4395 | 4395 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 250 | J | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, resident and staff interviews, the Social Services job description, and medical record review, the facility failed to ensure that two residents (R) (R#39 and R#56) out of 45 sample residents received medically-related social services to address problematic behavioral symptoms, including aggression toward other residents. The facility's failure to provide social services behavioral interventions to ensure residents were protected from further physical abuse by R#39 was determined to be likely to cause serious injury, harm, impairment, or death to a resident. Immediate Jeopardy was identified on 12/8/16 and determined to first exist on 10/23/16, when R#39 first threatened R#56 with harm using a wire clothes hanger. The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy on 12/8/16 at 2:55 p.m. An acceptable Allegation of Compliance (AoC) was received on 12/10/16 and the surveyors validated the Immediate Jeopardy was removed on 12/10/16 as alleged. The deficient practice remained at a D (isolated potential for more than minimal harm) scope and severity while the facility developed and implemented the Plan of Correction and the facility's Quality Assurance Committee monitored the effectiveness of the systemic changes. Findings include: The facility's (MONTH) 2007 Social Services Coordinator job description documented the role was to provide for the psychosocial needs of the patients and families served by the center. An Essential Skill of the position was counsel patients and families including dealing with feelings about death or dying and other emotional, mental, environmental, or physical limitations. R#39 was admitted to the facility on [DATE] (Refer to F223 Background information for pertinent diagnosis) The annual Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 11/16/16. Was reviewed. (Refer to F223 for R#39 ' s cognitive status decision-making skills, be… | 2019-11-01 |
| 4396 | 4396 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 253 | F | 1 | 0 | QBL111 | > Based on observations, staff interviews and record review, the facility failed to have an effective system for providing the housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable resident rooms and communal areas for all residents in the facility. This had the potential to affect all residents in the facility. The facility had a census of 83 residents. Findings include: Observation during initial tour on 12/5/16 at 9:56 a.m., found the 100 hall shower room closest to the living room smelled of urine, had missing floor tiles, chipped floor paint, a missing paper towel dispenser cover, and chipped wall paint. The 100 hall pantry had ketchup splatters on the cabinets and floor. The hand rails down the 100 hall varied in color, some close to the nurse's station had built up dirt and dried debris on them. On the 200 hall nurse's station wall that faced the hallway had dried drips and soiled buildup on it. The resident food refrigerator had red liquid spilled down the outside of the drawer and on the refrigerator base, and the 200 hall oxygen storage room had missing cove base, and debris on the floor. Review of the resident rooms on 12/8/16 9:10 a.m. to 10:00 a.m. revealed the following observations: Room 101: the walls needed painting including the window seal, and the closet had a large cracked area with packaging tape over it. The bathroom sink did not shut completely off and the toilet ran continuously, the room had a strong urine odor, and chipped, moldy tile as well as dirt build-up observed around the floor and cove base. Observation also revealed an unknown brown substance on the wall. Room 102: Dirt build up noted on the cove base, cracked entry door, broken and missing closet drawers, and the bathroom had a dirty call cord. Observation in the room also revealed a dirty two wheel walker, and nails left sticking out of the wall. Room 103: The name holder on the door had separated and started to peel away from the door, the closet had a door that did not fit properly… | 2019-11-01 |
| 4397 | 4397 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 280 | J | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on medical record review, observations, and staff interviews, the facility failed to ensure revision of the comprehensive care plan to adequately reflect the status of four residents (R) R#39, R#81, R#27, and R#51 of 45 sample residents. Specifically, R#39's care plan was not revised to reflect an incident of threatening another resident; R#51's care plan was not revised to reflect the resident's positioning needs; R27's care plan was not revised to reflect the resident's current needs for help with activities of daily living; and R#51's care plan was not reviewed quarterly as required. The facility's failure to revise R#39's care plan after threatening R#56 with harm by a wire clothes hanger was determined to be likely to cause serious injury, harm, impairment, or death to residents. Immediate Jeopardy was identified on 12/8/16 and determined to first exist on 10/23/16, when R#39 first threatened R#56 with harm using a wire clothes hanger. The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy on 12/8/16 at 2:55 p.m. An acceptable Allegation of Compliance (AoC) was received on 12/10/16 and the surveyors validated the Immediate Jeopardy was removed on 12/10/16 as alleged. The deficient practice remained at a [NAME] (pattern of potential for more than minimal harm) scope and severity while the facility developed and implemented the Plan of Correction and the facility's Quality Assurance Committee monitored the effectiveness of the systemic changes. Findings include: 1. R#39 was admitted to the facility on [DATE] (Refer to F223 Background information for pertinent diagnoses). The annual Minimum Data Set (MDS), was reviewed (Refer to F223 for R#39's cognitive status decision-making skills, behaviors and locomotion). Per the 9/15/09 Initial Social Service Assessment and the 8/24/16 and 11/29/16 Social Services Notes R#39 had a history of [REDACTED]. A 10/23/16, 4:30 p.m. Nurse's Note, written by… | 2019-11-01 |
| 4398 | 4398 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 312 | D | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, interview and record review, the facility failed to ensure one of 45 sampled residents (Resident #89) who is unable to carry out activities of daily living received the necessary services to maintain good grooming, personal and oral hygiene. Findings include: Review of Resident (R) #89's Admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had short and long term memory problem and had severely impaired decision making regarding tasks for daily life. The resident had difficulty focusing attention (easily distracted, out of touch, or difficulty following what was said) and disorganized thinking (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject) continuously present. It identified the resident did not reject care during the assessment period. It also identified the resident was independent with no needed set up for bed mobility and transfers and needed supervision but no set up for walking in her room and the corridor/locomotion on and off unit. According to the assessment, the resident needed extensive assistance of one person for dressing, and was totally depended on at least one person for toilet use, personal hygiene, and bathing. Review of the resident's care plan, last revised on 10/4/16, revealed the resident required assistance with ADLs related to an old [MEDICAL CONDITION]. It identified the resident ambulated independently, would refuse care and assistance at times (i.e. bathing, toileting, incontinent care, and grooming tasks). The care plan directed staff to assist with dressing daily and as indicated, bathe the resident per facility protocol and prn, clean and trim fingernails as indicated, and provide assistance with personal hygiene and oral care daily and as needed. The care plan also identified the resident had impaired cognition as evidenced by short/long term memory loss, poor decision making skills, a… | 2019-11-01 |
| 4399 | 4399 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 323 | E | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, staff interview and record review, the facility failed to ensure seven of 45 sampled residents (R) (R#3, R#21, R#56, R#87, R#88, R#89, and R#97) received the needed assistance related to transfers and dressing to prevent accidents or injury, and failed to provide supervision to prevent incidents/accidents to include resident to resident altercations. Findings include: 1. R#56, [AGE] years old, was admitted to the facility on [DATE]. Review of the [DIAGNOSES REDACTED]. Review of the 4/1/16 Admission Minimum Data Set (MDS) indicated R#56 did not speak ([DIAGNOSES REDACTED]. R#56 was either independent or required supervision with activities of daily living (ADLs) including bed mobility, transfers, and walking. Review of weight records in the electronic charting system showed the resident was 5'8 tall and weighed 168 pounds on 11/14/16. Review of the reportable incidents since the resident's admission on 3/14/16 showed eight incidents of resident to resident physical altercations were submitted (with a total of seven incidents occurring involving R#56). In four of the incidents, R#56 was the aggressor towards other residents. In three others, the resident was the victim. Different residents were involved in each in each incident. Documentation from the incidents was as follows: 4/11/16, R#56 became excited, hitting himself on the back, and then walked over to a female resident (no longer residing in the facility) and hit her on the left shoulder with his open hand. The residents were separated. There were no injuries to either resident. R#56 was discharged to a psychiatric facility for medication management. A busy box was purchased for R#56, for his entertainment, following this incident. 4/26/16, R#56 was walking down the hall and hit a male resident (no longer residing at the facility) on the head as he walked by. The residents were separated with increased supervision implemented. R#56 was discharged to a psychiatric … | 2019-11-01 |
| 4400 | 4400 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 329 | D | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, clinical record review, and staff interviews, the facility failed to ensure [MEDICAL CONDITION] medications were not used unnecessarily for three of 45 sampled residents (R#88, R#56, and R#40). Specifically, [MEDICAL CONDITION] medications were administered without appropriate diagnoses, without behavior monitoring, without documented evidence of using non-pharmacological interventions prior to administration, without rationale for dual antipsychotic use, and without evidence of gradual dose reductions. Findings include: 1. Resident (R)#88 was admitted to the facility on [DATE] with diagnoses, according to the 11/1/16 Admission Data Collection & Evaluation, of [MEDICAL CONDITION] alcoholic [MEDICAL CONDITION], Wernicke's disease and [MEDICAL CONDITION]. The Admission MDS (Minimum Data Set) assessment, with an ARD (Assessment Reference Date) of 11/10/16, documented R#88 had severely impaired cognition (section C1000), did not experience delusions or hallucinations (section E0100), had no behavioral symptoms (section E0200), and was rarely/ never able to make herself understood or understand others (sections B0700 and B0800). A 12/5/16 Care Plan documented, I take [MEDICAL CONDITION] medications ([MEDICATION NAME] . [MEDICATION NAME]) and am at risk for adverse reactions. I exhibit agitation and will hit others. I am resistive toward care at times. I have (diagnoses) of Wernicke's disease, [MEDICAL CONDITION], dementia, and [MEDICAL CONDITION]. The interventions included: Administer (medications) as ordered . Notify (physician) as indicated. Observe for effectiveness, side effects, or an increase/ change in behaviors . Obtain (psychiatric evaluation) as indicated . (and) Pharmacy Consultant to review and make recommendations as indicated. The (MONTH) (YEAR) physician's orders [REDACTED]. -[MEDICATION NAME] ([MEDICATION NAME], an anti-anxiety medication), 0.5 milliliters (ml) every eight hours as needed (PRN) (no diagnos… | 2019-11-01 |
| 4401 | 4401 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 332 | D | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, interview, and record review, the facility failed to ensure the facility's medication error rate remained below 5% when two of two nurses failed to administer medications as ordered for two of six residents observed during medication pass (Resident (R)#37 and Resident #71). One nurse administered the wrong dose of an ordered medication to R#37, and the second nurse required interruption in insulin administration to R#71 to prevent a medication error from occurring, and then used incorrect injection technique during insulin administration. These 3 errors out of 34 opportunities resulted in an 8.8% medication administration error rate. Findings include: 1. Observation on 12/8/16 at 10:25 a.m. revealed Licensed Practical Nurse (LPN) AD stated she planned to administer R#37's medications. During the pass, LPN AD opened a container of Fiber Powder and stated the physician ordered the resident to receive a dosage of 3.4 grams. The LPN looked at the clear plastic medication cup indented with measurement lines, and stated the cup did not have the proper measurement. LPN AD looked at the container and the cup again, and stated she planned to give a medication cup full of the powder. She filled the 30 milliliter medication cup with the powder, mixed it in two small glasses of water, and provided it to the resident who consumed it. Review of an order clarification, dated 10/4/16, indicated the order directed the staff to discontinue the [MEDICATION NAME] (Fiber Powder) powder 3.4 grams by mouth daily. It then directed the staff to give [MEDICATION NAME] one tablespoon by mouth daily for constipation. Review of the resident's record also revealed a physician's orders [REDACTED]. It directed the staff to give [MEDICATION NAME] 3.4 grams fiber powder daily at 9:00 a.m. During an interview on 12/10/16 at 9:15 a.m., LPN AH stated the staff had the order clarified from grams to make it easier for the staff to administer, but the clarif… | 2019-11-01 |
| 4402 | 4402 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 428 | D | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on staff interview and clinical record review, the facility failed to ensure the Pharmacist's monthly drug regimen reviews were acted upon for 2 of 45 stage 2 sampled residents (R) (R#40 and R#88). The Physician declined the Pharmacist's recommendations without providing rationale. Findings include: 1. R#40 was admitted to the facility on [DATE]. The resident had [DIAGNOSES REDACTED]. Review of the (MONTH) (YEAR) physician's orders [REDACTED]. The resident was observed during the survey from 12/5/16- 12/10/16. Attempts were made to converse with the resident; however, he did not respond coherently to conversation. Observations revealed the resident sat in his wheel chair in the common area with his eyes closed (12/5/16 at 10:35 a.m., at 12:32 p.m.; on 12/6/16 at 10:24 a.m., 12:34 p.m.; on 12/7/16 at 6:16 a.m., 6:39 a.m., 7:33 a.m. and 7:49 a.m.). The Pharmacist's recommendations were reviewed from (MONTH) (YEAR) through the survey exit on 12/10/16: The Consultation Report for the month of (MONTH) (YEAR) included the Pharmacist's recommendation, which read, (Resident's name) has received Quetiapine Fumarate 75 mg q (every) am and hs (bedtime) for behavioral or psychological symptoms of dementia (BPSD): Recommendation: Please consider a gradual dose reduction to 50 mg q (every) am and 75 mg q hs with the end goal of discontinuation of therapy. If therapy is to continue at this dose, the prescriber must document a clinical contraindication, defined as a patient- specific rationale including, 1) documentation that target symptoms returned or worsened during a dose reduction attempted during the most recent facility admission AND 2) why additional attempted dose reduction would be likely to impair the resident function or increase distressed behavior. The Physician's response indicated he both accepted and declined the recommendation (both boxes were checked). The Physician documented in full, No (symbol for change), B>R. There was no clin… | 2019-11-01 |
| 4403 | 4403 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 490 | J | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, record review, and staff interview, the facility failed to ensure it was administered in a manner that enabled it to use its resources effectively and efficiently to ensure new interventions were implemented to address resident-to-resident physical abuse by resident (R) #39 were communicated to all staff and a system was implemented to ensure the interventions were carried out to prevent further incident, residents were safe and received quality care. The facility's failure to ensure interventions were communicated and implemented to safeguard residents from further physical abuse by R#39 was determined to be likely to cause serious injury, harm, impairment, or death to a resident. Immediate Jeopardy was identified on 12/8/16 and determined to first exist on 10/23/16, when R#39 first threatened R#56 with harm using a wire clothes hanger. The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy on 12/8/16 at 2:55 p.m. An acceptable Allegation of Compliance (AoC) was received on 12/10/16 and the surveyors validated the Immediate Jeopardy was removed on 12/10/16 as alleged. The deficient practice remained at a F (widespread potential for more than minimal harm) scope and severity related to additional findings of non-compliance and Substandard Quality of Care. In addition, the facility's failures to protect residents from physical abuse (F223), implement policies that prohibit abuse and neglect (F226), provide medically-related social services to address abusive behaviors (F250), review and revise the care plan addressing abusive behaviors (F280), ensure the responsibilities of the medical director were carried out effectively (F501), and implement effective quality assurance activities (F520) were all assigned a scope and severity of J, indicating an isolated potential for serious injury, harm, impairment, or death to residents. The Immediate Jeopardies at F223 and F226 constitu… | 2019-11-01 |
| 4404 | 4404 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 501 | J | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interviews and record review, the Medical Director failed to assure care was provided that met current standards of practice in areas including resident-to-resident abuse and use of [MEDICAL CONDITION] medications. The facility's failure to ensure residents were protected from further physical abuse by R#39 was determined to be likely to cause serious injury, harm, impairment, or death to a resident. Immediate Jeopardy was identified on 12/8/16 and determined to first exist on 10/23/16, when R#39 first threatened R#56 with harm using a wire clothes hanger. The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy on 12/8/16 at 2:55 p.m. An acceptable AoC was received on 12/10/16 and the surveyors validated the Immediate Jeopardy was removed on 12/10/16 as alleged. The deficient practice remained at a D (isolated potential for more than minimal harm) scope and severity while the facility developed and implemented the Plan of Correction and the facility's Quality Assurance Committee monitored the effectiveness of the systemic changes. Findings include: During the annual recertification survey and complaints investigation from 12/5/16 to 12/10/16, the facility was found out of compliance with regulatory requirements regarding prevention of resident-to-resident abuse and use of [MEDICAL CONDITION] medications. Cross-reference F222: Chemical Restraints - the facility failed to ensure resident (R) #56 and R#83 were not chemically restrained. The facility administered an array of [MEDICAL CONDITION] medications, including PRN (as needed) injections of medications and multiple medications from the same drug class, to manage residents' behaviors for staff convenience. [DIAGNOSES REDACTED]. The rationale and effectiveness of the medications was not consistently documented. Cross-reference F223: Physical Abuse - the facility failed to ensure that R#39's physically abusive behaviors were addressed and i… | 2019-11-01 |
| 4405 | 4405 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 520 | J | 1 | 0 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interviews and record review, the facility failed to maintain an effective Quality Assurance (QA) program that systematically reviewed quality of care related to resident-to-resident abuse and use of [MEDICAL CONDITION] medications. The facility's failure to maintain an effective QA program that implemented a plan to safeguard residents from further physical abuse by R#39 was determined to be likely to cause serious injury, harm, impairment, or death to a resident. Immediate Jeopardy was identified on 12/8/16 and determined to first exist on 10/23/16, when R#39 first threatened R#56 with harm using a wire clothes hanger. The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy on 12/8/16 at 2:55 p.m. An acceptable Allegation of Compliance (AoC) was received on 12/10/16 and the surveyors validated the Immediate Jeopardy was removed on 12/10/16 as alleged. The deficient practice remained at an F (widespread potential for more than minimal harm) scope and severity related to additional findings of non-compliance and Substandard Quality of Care. Findings include: During the annual recertification survey and complaints investigation from 12/5/16 to 12/10/16, the facility was found out of compliance with regulatory requirements regarding prevention of resident-to-resident abuse and use of [MEDICAL CONDITION] medications. Cross-reference F223: Physical Abuse. The facility failed to ensure that R#39's physically abusive behaviors were addressed and interventions were implemented to keep residents safe from further potential harm. R#39 threatened R#56 with harm from a wire clothes hanger on 10/23/16. On 12/5/16, R#39 was observed hitting R#56 with a wire clothes hanger. The facility responded with an intervention to remove all wire clothes hangers from R#39's possession. On 12/8/16, a wire clothes hanger was observed in R#39's room. The nursing staff assigned to work with R#39 were unaware of the in… | 2019-11-01 |
| 4538 | 4538 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 166 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interview, record review, and Customer Satisfaction - Resident Grievance process policy review, the facility failed to ensure 2 of 45 sampled residents' rights to prompt efforts by the facility to resolve grievances. The facility failed to promptly resolve a grievance regarding a guardian for Resident #17 and regarding missing clothing for Resident #83. Findings include: 1. Review of the Admission Record showed Resident #17 admitted to the facility on [DATE]. Review of Resident (R)#17's Quarterly Minimum Data Set (MDS) assessment dated [DATE] identified the resident with a Brief Interview for Mental Status (BIMS) score of 15 (cognitively intact). Review of a social services progress noted dated 12/2/15 included .(Resident) has Guardian who makes all decision for (resident). During an interview on 12/5/16 at 11:33 a.m., R#17 stated, I hate this place. I want to get out. She reported her guardian had never come to visit her, and did not feel like her wishes or requests were taken seriously by her guardian or the staff in the facility. The resident stated she had asked about getting a different guardian , but did not think anyone had looked into trying to make that happen. During an interview with Social Services Director (SSD) on 12/7/16 at 3:30 p.m., she stated the resident was appointed a guardian because the resident had a history of [REDACTED]. The guardian lived in another state, and confirmed the resident had stated at least since (MONTH) of (YEAR) that the resident wanted a different guardian. The SSD stated she did not know how to go about getting guardianship changed, but did not think it would be granted due to who the guardian was and where the guardian worked. The SSD also confirmed she had not taken any steps toward assisting the resident with attempting to change guardians. On 12/10/16 at 4:30 P.M., the Administrator reported she remembered the resident voicing a grievance of wanting a diff… | 2019-09-01 |
| 4539 | 4539 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 167 | C | 0 | 1 | QBL111 | Based on observation and staff interview, the facility failed to have results of the most recent survey of the facility conducted by Federal or State surveyors and any plan of correction in effect with respect to the facility available to residents, their family members or guardians, and visitors. This had the potential to affect all residents in the facility. Findings include: Observation on 12/5/16 at 10:23 a.m., of the main living area, and front entrance of the facility revealed no survey results available for viewing, and no signs directing to their location. Interview on 12/5/16 at 10:28 a.m., Certified Nurse Aide (CNA) AK went to the front desk and asked the Receptionist for the survey results. The Receptionist stated she did not have them, but the Administrator would. In the Administrator ' s office at 10:35, a.m., the Administrator confirmed she had a copy of the results, but stated she thought the front desk also had a copy. At 10:39 a.m. back at the front desk, the Receptionist again stated she did not have them because staff reorganized that area and many things had been taken to storage. CNA AK stated they used to have them out and available but residents kept taking them away and did not bring them back. CNA AK and the Receptionist both confirmed they did not know of any sign to inform people that the office had the results available to be viewed. During an interview on 12/10/16 at 4:30 p.m., the Administrator confirmed the facility had no survey results available for residents, family members or other visitors to view without having to ask for them, and had no signs notifying anyone of their location or that they were available to be viewed. The facility failed to have survey results readily accessible for residents, family members or visitors to review. | 2019-09-01 |
| 4540 | 4540 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 174 | D | 0 | 1 | QBL111 | Based on observations, resident interviews, and staff interviews, the facility failed to ensure residents had access to a telephone where calls could be made without being overheard. Three sample residents (R) (R#54 and R#62) and one supplemental resident (R#46) out of 16 residents interviewed regarding telephone privacy in stage 1 of the survey reported a lack of a private place to talk on the telephone. Findings include: 1. On12/5/16 at 4:03 p.m. R#54 stated she did not have a private place to talk on the telephone. She stated, I have to go to the social worker and use her phone. 2. On 12/5/16 at 3:31 p.m., R#62 stated there was no privacy when on the telephone. The resident stated, If you want privacy, they say to close the curtain (which does not provide auditory privacy). 3. On 12/6/16 at 9:30 a.m., R#46 stated there was no private place to talk on the telephone. He stated the only phone he knew of was the residents' phone at the end of the 100 hallway. 4. On 12/9/16 at 10:29 a.m., the SSD stated there was a resident phone at the end of the 100 hall near her office, though this was in a public location. She stated if a resident would like to make a private phone call, they could use her office, though this was by request and only available when the SSD was in the building during her normal work hours. The SSD stated there was no cordless phone residents could use in a private location of their choosing. 5. A policy on telephone privacy was requested from the facility, but was not provided as of survey exit on 12/10/16 at 6:00 p.m. | 2019-09-01 |
| 4541 | 4541 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 242 | E | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, resident and staff interviews, review of bathing records/schedules, and review of menus and dining seating assignments, the facility failed to offer 3 of 45 stage 2 sampled residents (R) (R#24, R#25 and R#89) choices regarding whether they wanted a bath or shower and how often they wanted to be bathed/showered. In addition, the facility failed to offer 3 of 45 stage 2 sampled residents (R#50, R#54 and R#25) choices about condiments at meals and a choice of entree. Findings include: 1. Residents were not offered a choice of condiments such as salt, pepper and margarine. a. Four meals were observed during the survey: lunch on 12/5/16 from 12:05 p.m. to 1:30 p.m. (both seatings), breakfast on 12/7/16 from 6:48 a.m. to 8:29 a.m. (both seatings), lunch on 12/7/16 from 12:32 p.m. to 1:09 p.m. (first seating) and dinner on 12/8/16 from 4:59 p.m. to 6:25 p.m. (part of both seatings). There were no condiments such as salt, pepper, sugar, or sugar substitute available on the tables during any meals observed. Furthermore, only a few residents were served salt and pepper packets and margarine with rolls or bread during the meals noted above. Examples of meals in which residents were not provided with choices for condiments included: During the 12/5/16 lunch meal starting at 12:05 p.m. and ending at 1:30 p.m. (both seatings) none of the residents who ate lunch in the dining room were offered margarine; the menu indicated margarine was to be served. Review of the menu indicated the meal consisted of ham, yams, peas, dinner rolls, and peaches. There was no salt, pepper or any other condiments available on the tables and it was not offered to residents during the meal. Margarine was not offered to residents during the meal. During breakfast on 12/7/16 from 6:48 a.m. to 8:29 a.m. (both seatings), none of the tables had salt or pepper available. The menu included eggs, hash brown patty, and breakfast sausage, all of which residents were … | 2019-09-01 |
| 4542 | 4542 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 248 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review and staff interview, the facility failed to ensure one of 45 sample residents (R#88) was provided with an adequate program of activities designed to meet the needs of the individual who was dependent on staff for all meaningful activity, stimulation and interaction. Findings include: Resident (R)#88 was admitted to the facility on [DATE] with diagnoses, according to the 11/1/16 Admission Data Collection & Evaluation, of [MEDICAL CONDITION] alcoholic [MEDICAL CONDITION], Wernicke's disease and [MEDICAL CONDITION]. The admission Minimum Data Set (MDS - a comprehensive assessment completed by facility staff that drives the care planning process), with an assessment reference date of 11/10/16, documented R#88 experience little interest in doing things (section D0500). She enjoyed music, group activities, time outdoors and religious activities per staff assessment (section F0800). The corresponding activities Care Area Assessment (CAA) documented, Resident is disoriented and uninterviewabl. Relies on staff to meet all her needs. She mumbles at times but is unable to make needs known or understand others. She is up in (geri)-chair in social areas most of the day for social interaction and stimulation. A 12/5/16 activities Care Plan documented, I am at risk for social and sensory stimulation. I require (one-to-one) visits. The interventions included: (One-to-one) visits to provide social and sensory stimulation as indicated . Assist to group activities that are appropriate as tolerated . Resident up out of bed and place in open areas for social stimulation. The 11/3/16 Activity Data Collection form documented the resident preferred activities in the morning and preferred large group settings. The resident's indicators requiring adaptation included: behaviors, cognitive impairment, physical limitations, and inability to leave her room. She had an interest in going outside. The form documented, Husband stat… | 2019-09-01 |
| 4543 | 4543 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 272 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview, clinical record review, and bowel and bladder program policy review, the facility failed to complete a comprehensive assessment for 1 out of 45 sampled residents (R) (R#87.) R#87's assessment for urinary incontinence was not comprehensive. Findings include: Review of the facility's Bowel and Bladder Continence Program policy, dated 2/2016, provided the following information, A resident is screened upon admission for participation in the Bowel and/or Bladder Continence program. Potential factors or underlying causes that may be contributing to bowel and/or bladder incontinence are identified and addressed by the interdisciplinary team. Under Bowel & Bladder Continence Program, it directed the staff to, .3. Initiate the Elimination Pattern for at least 3-5 days to collect information on elimination pattern .6. Complete and review, with the interdisciplinary team, the Bladder Incontinence data Collection/Evaluation within the first 14 days after initial identification of bladder incontinence. After the comprehensive review with the interdisciplinary team, the policy directed to identify appropriate interventions based on the type of incontinence identified. Review of the Admission Record showed R#87 was admitted to the facility on [DATE]; she was [AGE] years old with [DIAGNOSES REDACTED]. Review of the 7/6/16 Admission Minimum Data Set (MDS) assessment showed the resident was severely impaired in decision making and coded as rarely understanding others or being understood by others. The resident was coded as being dependent on staff for many activities of daily living (ADLs), including toilet use. The resident was coded as being always incontinent of bowel and bladder. The Urinary Incontinence and Indwelling Catheter Care Area Assessment (CAA), dated 7/11/16, was triggered for in depth assessment due to the resident being always incontinent of urine and being totally dependent on staff. Boxes were checked … | 2019-09-01 |
| 4544 | 4544 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 278 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, staff interview, nurses notes, observation, PrevMed Initial Oral Assessment, Minimum Data Set (MDS), Nutritional Data Collection Tool and Admission Data Collection & Evaluation the facility failed to ensure two resident (R) R#27 and R#54 of three residents reviewed out of a sample size of 45 residents had an accurate assessment regarding the resident's dental status and one resident R#23 had accurate assessment regarding his pressure ulcer. Findings include: The 8/15/16 admission MDS section L Oral/Dental Status code R#27 had no dental issues. Review of the Admission Data Collection & Evaluation form dated 8/15/16 under the subheading clinical data section Oral/Hygiene/GI (gastrointestinal) documented that R#27 had natural teeth and that the teeth were intact. Review of the nurses notes 8/15/16 through 12/9/16 revealed that the resident had not been seen by a dentist or oral surgeon for teeth extractions. Review of the dentist exam on 11/21/16 titled, PrevMed Initial Oral Assessment revealed that the resident had 16 missing maxillary teeth and 16 missing mandibular teeth, so R#27 was edentulous. Observation on 12/6/16 at 12:04 p.m. revealed R#27 was observed to have no teeth. On 12/6/16 at 12:02 p.m. the resident discussed that he had no teeth and needed dentures. On 12/10/16 at 1:55 p.m., the MDS Coordinator (MDSC) stated the resident should have coded R#27 as edentulous on the admission MDS; it was probably just a coding error. 2. R#54 was admitted to the facility on [DATE]. The most recent full assessment, an annual MDS with an ARD of 3/9/16, documented R#54 had no cognitive impairments (section C0500) and had no mouth or tooth problems (section L0200). Edentulous (without teeth) was not coded on the assessment (section L0200B); therefore, the dental care area assessment (CAA) was not triggered for further investigation. On 12/5/16 at 4:14 p.m., R#54 was observed without any teeth. She stated, I have no teeth. … | 2019-09-01 |
| 4545 | 4545 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 279 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility failed to ensure a comprehensive plan of care that accurately reflected the status and needs of the resident was created for three residents (R#32, R#42 and R#56) out of 45 sampled residents. Specifically, R#32's care plan did not reflect the services provided by hospice or instruct the facility staff how to coordinate their services with the hospice provider and R#42's care plan did not reflect nutrition interventions to address weight loss. Findings include: 1. R#32 was admitted to the facility on [DATE]. The 12/16/14 Care Plan, reviewed 10/19/16, documented, I have chosen to receive hospice care. The goal was for the resident to remain comfortable throughout hospice care. The approaches included: Contact (hospice service) as indicated .Coordinate care with Hospice Team .Coordinate with the Hospice Team to assure resident experiences as little pain as possible .Provide resident and family with grief and spiritual counseling if desired. The Care Plan did not document what services were provided by hospice, how often the hospice providers visited the resident, and how the facility staff could communicate and coordinate care with the hospice service. The hospice's plan of care was not available in the resident's record, nor were any hospice documents except for the (Name of Hospice) Communication Log. On 12/10/16 at 8:42 a.m., the Director of Nursing (DON) provided all hospice documentation from (MONTH) (YEAR) to present, which had to be faxed over from the hospice service's main office. Cross-reference F309: Care and Services regarding the coordination of hospice services. On 12/10/16 at 8:57 a.m., the MDS Coordinator (MDSC) stated she typically would take the hospice care plan and combine in the facility's 'Care Plan;' I do not typically include details related to what specific services hospice provides, how often they visit, etc. because I think they adjust it based on the individual… | 2019-09-01 |
| 4546 | 4546 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 282 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview and clinical record review, the facility failed to ensure the care plan was implemented for one of 45 sampled residents (R#87). Findings include: Review of the Admission Record showed Resident (R)#87 was admitted to the facility on [DATE]; she was [AGE] years old with [DIAGNOSES REDACTED]. Review of the 7/6/16 Admission Minimum Data Set (MDS) assessment showed the resident was severely impaired in decision-making. The resident required limited assistance of one person for eating. The current physician's orders [REDACTED]. Review of the dining room seating assignment, entitled Second Sitting, revealed R#87 sat at Table 1, for feeders, (residents who were dependent on staff to be fed - cross refer to F241 for dignity concerns). Observations revealed the resident was capable, at least some of the time, of feeding herself with minimal assistance from staff; however, the resident was customarily fed by staff and not allowed the opportunity to feed herself (cross refer to F311 for specific observations and findings). Certified Nurse Aide (CNA) AN was interviewed on 12/7/16 at 9:57 a.m. and stated, We feed her. She will attempt to feed herself, but she does not get much in . Her hand coordination is not good. She gets food everywhere; she is not steady with her hands. Licensed Practical Nurse (LPN) AL was interviewed on 12/8/16 at 3:29 p.m. and reported R#87 required total care with activities of daily living (ADLs). When asked if the resident could feed herself, she stated, No she can't feed herself. The care plan, dated 7/19/16, identified the problem of R#87's requirement for assistance with activities of daily living (ADLs) with a goal of ADL needs being met with staff assistance. Under interventions, staff were to Assist with meals as needed. Although the care plan directed staff to assist the resident as needed , staff fed the resident and did not provide her the opportunity to feed herself. | 2019-09-01 |
| 4547 | 4547 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 309 | G | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the observation, resident interview, staff interviews, care plan, Admission Record, Nursing Procedure Manual and the Minimum Data Set (MDS) review the facility failed to ensure 1 out of 45 sample residents, resident (R)#81 reviewed for positioning which caused actual harm to R#81 as he was observed crying out, staff failed to reposition and/or assist him and 1 out of 45 sample resident, R#32 reviewed for integration of hospice services received the necessary care and services to attain their highest practical well-being. Findings include: 1. Review of the Admission Record R#81 was admitted to the facility on [DATE] with the following diagnosis; [MEDICAL CONDITION], generalized pain, muscle weakness, pressure ulcers, weight loss and altered mental status. The 7/19/16 annual MDS assessment section C coded the resident as having an 8/15 on the brief interview for mental status (BIMS) indicating that the resident had a moderate cognitive impairment. Section G identified that R#81 required total assistance of two for bed mobility, transfers, bathing, toileting, and dressing. Review of R#81's care plan revealed that there was no care plan specific to R#81's positioning needs. Review of the facility's policy on 12/9/16 dated 7/15 titled, Nursing Procedure Manual, T 9.1 Turning and Positioning. Procedure #8 stated, Support resident/patient with pillows as follows; under upper scapulae, shoulders, neck, and head, beneath both arms, under knees and float heels off bed with use of pillow. Procedure #13 stated, Reposition within every two hours or more frequently if needed. On 12/05/2016 at 11:45 a.m. R#81 was observed in the common area for approximately 5 minutes. He was crying and screaming for someone to help him as his arm hurt. He was positioned to the right side of his geri-chair with his head tilted over the right side of the chair and his right arm bent with his elbow trapped between the arm of the geri-chair and his body, his body was … | 2019-09-01 |
| 4548 | 4548 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 311 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based observation, interview, and record review of the Minimum Data Set (MDS), MDS Kardex Report, and Skin Assessment/Bath Sheets, the facility failed to ensure that two residents (Resident (R) R#27 and R#87) out of 45 sampled residents received assistance with grooming/hygiene and bathing. Findings include: 1. Review of R#27's Admission Record indicated the facility admitted the resident on 8/15/16 with [DIAGNOSES REDACTED]. Review of the resident's admission MDS assessment, dated 8/15/16, indicated that under Section C, the assessment specified the resident had a score of 11 out of 15 on the Brief Interview for Mental Status (BIMS), which indicated the resident had a mild cognitive impairment. Under Section G, the assessment identified that R#27 required extensive assistance of one personal hygiene. Review of R#27's Kardex (a report used by nursing staff to quickly identify the resident 's needs) printed on 12/9/16 indicated R#27 required extensive assistance of one person for personal hygiene tasks, had clear speech, and usually made himself understood. Review of the Skin Assessment/Bath Sheets for the months of (MONTH) (YEAR), (MONTH) (YEAR), and the first part of (MONTH) (YEAR) indicated that with the exception of 11/22/16, the staff failed to assist R#27 with daily shaving although it was a mandatory task on the form. Observations on Tuesday 12/6/16 at 12:04 p.m., Thursday 12/8/16 at 11:51 a.m., Friday 12/9/16 at 5:25 p.m., and on Saturday 12/10/16 at 12:41 p.m. revealed R#27 exhibited unshaven facial hair. More specifically, observation on Monday 12/6/16 revealed the resident had a light beard growth; by Saturday 12/10/16 the resident had a very short beard and mustache. During an interview on 12/6/16 at 12:04 p.m. the resident stated that he liked to be shaved every day, but added that it was okay if he is shaved only on his shower days which are Tuesday's, Thursday's, and Saturday's. R#27 stated that on Saturday they (the staff) were… | 2019-09-01 |
| 4549 | 4549 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 314 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure 1 of 45 sampled resident (R#3) who had a pressure sore was provided the necessary treatment and services to promote healing and prevent infection. R#3 ' s sacral pressure ulcer was left uncovered with no protective dressing for longer than 3 hours on 12/7/16. Findings include: 1. Review of Resident #3's annual Minimum Data Set (MDS) assessment dated [DATE] identified the resident with short and long term memory impairment, and severely impaired cognitive skills for daily decision. According to the assessment, the resident was totally dependent on two people for bed mobility, dressing, personal hygiene and toilet use. It also identified the resident at risk for developing a pressure ulcer, to have one or more unhealed pressure ulcers at stage 1 or higher. The assessment indicated the resident also had one stage 3 pressure ulcer not present on admission, 0.5 centimeters (cm) (length) by 0.5 cm (width) by 0.5 cm (depth) - and identified granulation tissue as the most severe type of tissue present in any pressure ulcer bed. The assessment identified the resident had a pressure reducing device for the chair and bed, a turning/repositioning program, nutrition or hydration interventions to manage skin problems, pressure ulcer care, and application of nonsurgical dressings, ointments/medications other than to feet. Review of the Pressure Ulcer Care Area Assessment (CAA) for the 10/12/16 MDS revealed it identified the resident as totally dependent on staff to meet all the resident's needs, nurses provided treatments as ordered, and the resident had a [DIAGNOSES REDACTED]. Review of the resident' s care plan, last reviewed on 10/19/16, identified the resident at risk for skin break down related to impaired mobility, bowel and bladder incontinence and a history of a pressure ulcer to the resident's sacrum. The care plan directed staff to inspect the skin with daily care and… | 2019-09-01 |
| 4550 | 4550 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 315 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and reviews of Minimum Data Set Assessments, admission Collection and Evaluation forms, and the facility's Bowel and Bladder Continence Program policy, the facility failed to ensure the staff provided individualized care, services, and treatment to promote optimal urinary and bowel continence for three residents (Resident (R) #82, R#89, and R#87) out of a sample of 45 residents selected for review. Specifically, the facility failed to thoroughly assess and evaluate urinary and bowel continence status, failed to develop and implement individualized bladder and bowel training programs, and failed to provide timely assistance to the residents with toileting needs in effort to assist the residents to achieve as much normal urinary and bowel function as possible. Findings include: 1. Review of R#82's Annual Minimum Data Set (MDS), dated [DATE], indicated the resident had a Brief Interview for Mental status (BIMS) score of seven (zero to seven indicated severe cognitive impairment). It indicated the resident rejected care on four to six days of the previous seven days, and that the resident required supervision with walking in his room but needed no assistance for walking in the corridor. The resident needed supervision with no set up for locomotion on/off the unit, extensive assistance of one person for dressing, limited assistance of one person for toilet use, and personal hygiene. It indicated the resident was frequently incontinent of urine and occasionally incontinent of bowel, and no trial toileting or bowel program had been attempted. Review of the admission data Collection and Evaluation forms, dated 7/7/16, under Functional & Clinical Data indicated the resident had some bladder control and directed the staff to Complete Elimination Pattern. Under Bowel Incontinence, it indicated the resident had some bowel control, and again directed the staff to complete the Elimination Pattern. It also noted the reside… | 2019-09-01 |
| 4551 | 4551 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 325 | G | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews, review of Dietitian monthly reports and clinical record review, the facility failed to ensure 1 of 45 stage 2 sampled residents (R) (R#42) maintained nutritional parameters. R#42 experienced significant unplanned weight loss. Specifically, The facility failed to monitor nutritional intake and ensure timely Dietitian involvement and assessment for R#42 when he experienced a change in condition and started to lose weight. When the resident's tube feeding regimen was decreased, there was no comparison of what the resident's tube feeding provided to what his nutritional requirements were. The resident's tube feeding amount was decreased after he experienced a significant weight loss; the feeding did not meet his assessed calorie needs which caused actual harm to the resident. Findings include: 1. R#42, [AGE] years old, was admitted to the facility on [DATE]. According to the Admission Record, his [DIAGNOSES REDACTED]. Review of a Nutrition assessment dated [DATE] indicated the resident was 72 or 6' tall. The resident's ideal weight range was from 160-196 lbs. According to the Weights and Vitals Summary, R42's weights over the past 6 months were recorded in pounds (lbs) as follows: -198.4 lbs on 6/6/16 -200.4 lbs on 7/5/16 -200.2 lbs on 8/9/16 -201.5 lbs on 9/8/16 -195.1 lbs on 10/10/16 -193.1 lbs on 10/25/16 -186.5 lbs on 10/30/16 -183.1 lbs on 11/6/16 -182.9 lbs on 11/13/16 -180.7 lbs on 11/20/16 -174.7 lbs on 11/18/16 -177.5 lbs on 12/5/16 Based on review of weight records, the resident experienced a 24 lb, 11.9% unplanned, significant weight loss in 3 months from 201.5 lbs on 9/8/16 to his most current weight of 177.5 lbs on 12/5/16. The resident's BMI was 24.1, normal weight range, at the time of the survey. The resident was observed during the survey; he was tall and lean in appearance. On 12//5/16 at 11:45 a.m. the resident was being pushed by a staff member in his wheelchair down the hall. The surve… | 2019-09-01 |
| 4552 | 4552 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 366 | F | 0 | 1 | QBL111 | Based on observations, menu review, tray card review, and resident and staff interviews, the facility failed to serve alternate selections for five residents (R#24, R#30, R#28, R#51 and R#76) who did not like the main starch and/or vegetable selections and failed to offer alternates to one resident (R#39) who did not eat what was served, which had the potential to affect all residents who received nutrition orally (79 residents). Findings include: Observation of meals included: lunch on 12/5/16 from 12:05 p.m. to 1:30 p.m. (both seatings), and dinner on 12/8/16 from 4:59 p.m. to 6:25 p.m. (first seating). Observation of the lunch meal on 12/5/16 and review of the menu showed the meal consisted of ham, yams, dinner rolls, peas and diced pears. Alternates (pork cutlet and peanut butter and jelly sandwich) were available for the entree. No alternates were available or served during the meal to replace the peas or yams. On 12/8/16 the evening meal was observed to consist of Salisbury steak with gravy, rice, snap peas, roll and Jello. Alternates were available for the entree (meatloaf and ham); however, no alternates were available or served during the meal to replace the rice or peas. Residents were not offered an alternate when they ate less than 25% of the meal. R#24 did not eat any of the rice or peas; no alternate was offered. R#30 did not eat any of the rice; no alternate was offered. R#28, R#51 and R#76 did not eat any of the peas; no alternate was offered. R#39 ate less than 25% of all menu items; no alternate was offered. R#50 was interviewed on 12/5/16 at 1:23 p.m. during the noon meal. R#50 was eating a peanut butter and jelly sandwich and had been served nothing else. R#50 stated she selected the sandwich as she did not want ham that was the main entree. She was asked if she had been offered the rest of the meal (sweet potatoes, peas, roll and diced pears); she stated she had not. R#54 was interviewed on 12/7/16 at 1:05 p.m. When asked if she was offered an alternate if she did not like or eat what was ser… | 2019-09-01 |
| 4553 | 4553 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 371 | F | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of sanitizer product information, and staff interview, the facility failed to ensure the kitchen and dining room were maintained in a sanitary manner for 79 out of 84 residents whose meals were prepared by the facility. Findings include: The initial kitchen Tour was conducted on 12/5/16 from 10:00 a.m. - 10:30 a.m. with the Dietary Manager. A bucket with 4 wiping rags, immersed in a solution, was observed in the pot washing area. The Dietary Manager was asked what the rags were used for and she reported to, wipe things. The Dietary Manager stated the rags were placed in the bucket in between wiping up spills and cleaning counters and other kitchen surfaces. When asked to test the solution with the pertinent test strip the Dietary Manager stated there was no sanitizer in the bucket. When asked what product was used for sanitizing when washing pots for example, she stated pointed to a 5 gallon bucket with product information identifying the product as Quat (quaternary ammonia). The product information was posted on the wall and identified the minimum concentration of 150 parts per million (ppm) to effectively sanitize. The wiping rag solution was tested and no sanitizer was present. A second bucket with wiping rags, stored on a counter in a solution, was observed in the soiled area of the dish machine. Dietary Aide (DA) AB was running dishes through the dish machine and was asked to test the sanitizing solution with the pertinent test strip. DA AB stated there was no sanitizer in the solution, only dish soap. DA AB verified she used the rags to wipe up spills and clean countertops and kitchen surfaces. DA AB stated the only time she put sanitizer in the solution (Quat) was when she wiped down tables in the dining room following meals, but she had emptied the solution from breakfast that contained Quat and replaced it with soapy water. Both the Dietary Manager and DA AB were asked if additional sanitizing was complet… | 2019-09-01 |
| 4554 | 4554 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 412 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, staff interview, observation, PrevMed Initial Oral Assessment and Minimum Data Set (MDS) review, the facility failed to ensure follow-up dental services were obtained for two resident (R) R#27 and R#54 of three residents reviewed for dental services out of a sample size of 45 residents. Findings include: According to the Admission Record R#27 was admitted to the facility on [DATE] with the following pertinent diagnosis; [MEDICAL CONDITION] disorder, [MEDICAL CONDITION] type and dysphagia. The 8/15/16 admission MDS assessment section C coded the resident as having an 11/15 on the brief interview for mental status (BIMS) indicating that the resident had a mild cognitive impairment. Section G identified that R#27 required extensive assistance of one for personal hygiene. Section L Oral/Dental Status code R#27 had no dental issues. Requested the facility Dental Policy on 12/9/16 and 12/10/16. No policy was made available by survey exit on 12/10/16. The resident was interviewed on 12/6/16 at 12:02p.m. R#27 stated that he needed dentures but the house dentist wanted too much for them. He stated he would have to look into other options and was not sure that he could get them. Review of the PrevMed Initial Oral Assessment completed on 11/21/16 revealed that R#27 had no teeth, had a good ridge and was a candidate for dentures. During an interview on 12/09/2016 at 9:54 a.m. the Social Services Director (SSD) stated she recently found a dentist that will come monthly as previously the dentist came quarterly at best. The SSD stated that all residents are Medicaid and the Business Office Manager (BOM) was responsible for contacting the Department of Children and Family Services to sign residents up for the dental insurance which would then adjust their patient liability payment so they would have dental coverage. She further discussed that this process was done during the resident's admission so that they could be seen if they… | 2019-09-01 |
| 4555 | 4555 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 431 | E | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the Clinical Program Manual dated 3/16 Medication Management 3F-2.2, In-service titled, Survey Preparedness, observations and staff interviews the facility failed to properly store , label and dispose of medications. Specifically, the facility failed to ensure timely removal of discontinued or expired medications in 1 out of 1 medication rooms observed and failed to label insulin and eye drops, and dispose of expired medication in 2 out of 2 medication carts assigned to the West unit. Findings include: Review of the medication management policy on 12/9/16 titled, the Clinical Program Manual dated 3/16, Medication Management section 3F- 2.2, stated, 12. Removed discontinued medications from the medication supply during the shift the medication is discontinued on. Store in a locked location, as identified by the facility, for disposition according to state and federal requirements. Manufacturing Guidelines: Novolog: Opened at room temperature or Refrigerator temperature good for 28 days Humalog: Opened at room temperature or Refrigerator temperature good for 28 days Humulin R: Opened at room temperature or Refrigerator temperature good for 28 days Humulin 70/30: Opened at room temperature or Refrigerator temperature good for 28 days Humulin N: Opened at room temperature or Refrigerator temperature good for 28 days Novolin N: Humulin N: Opened at room temperature or Refrigerator temperature good for 28 days Novolin 70/30: Opened at room temperature or Refrigerator temperature good for 28 days Novolog 70/30: Opened at room temperature or Refrigerator temperature good for 28 days Lantus: Opened at room temperature or Refrigerator temperature good for 28 days Levemir: Opened at room temperature or Refrigerator temperature good for 42 days An in-service dated 12/2/16 titled, Survey Preparedness given by the Director of Nursing (DON) which stated in pertinent parts: .2. Medication management-all nurses are expected to administer medications … | 2019-09-01 |
| 4556 | 4556 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 441 | D | 0 | 1 | QBL111 | Based on observations, staff interview and policy review including Infection Prevention and Control Program the facility failed to ensure handwashing was completed after providing care and prior to leaving resident rooms for one of two halls (200 hall). Findings include: Observation in Resident (R) R#3's room on 12/07/16 at 2:58 p.m. revealed Licensed Practical Nurse (LPN) AH cleansed and dressed a wound. Afterward, LPN AH removed her gloves, picked up the trash, and took the trash bag from the room without washing her hands. LPN AH walked to the shower room and opened the door with her potentially soiled hands, threw away the trash and then walked to the clean utility room and washed her hands. Observation on 12/8/16 at 4:47 p.m. revealed Certified Nursing Assistant (CNA) AS and CNA AO provided incontinent care for R#3 in the resident' s room. After applying a new incontinent brief, CNA AO removed her gloves, picked up the bag of trash with the soiled brief in it, opened the door and walked out of the resident's room without washing her hands. CNA AO walked down the 200 hall, opened the storage room door with contaminated hands and pulled out some wipes from the shelf, then walked to the shower room where she opened the door with her unwashed hands and discarded the bag of trash. She then walked to the utility room and washed her hands. During an interview on 12/10/16 at 1:25 p.m., the Director of Nursing confirmed staff needed to wash hands before leaving resident rooms to help prevent the spread of infection. Review of the facility's Infection Prevention & Control Program policy dated 06/2016 identified it's overview as, The facility strives to prevent transmission of infections and communicable disease, development of nosocomial infection and effectively treat and manage nosocomial and community acquired infections. The goal of the program is to identify and reduce the risks of acquiring and transmitting infections among residents, employees, volunteers, and visitors The policy did not specifically address ha… | 2019-09-01 |
| 4557 | 4557 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 467 | F | 0 | 1 | QBL111 | Based on observation and staff interview, the facility failed to ensure all residents in the facility had sufficient ventilation. The facility had two wings where residents lived, and 4 shower rooms available for resident bathing. The ventilation system failed to function properly in 4 of 4 shower rooms used by residents. Finding include: Observation during initial tour of the facility on 12/5/16 at 10:00 a.m. revealed strong, stale odors in the hall near both nurses station, down resident halls on East and West Wing, and in the sun room near the dining room. The 100 hall shower room closest to the living room had a strong urine odor. Observation on 12/6/16 at 7:30 a.m. again revealed a strong stale odor down the resident halls of East and West Wing and a sewer gas smell near the 200 Hall nurses station. An environmental tour of the building took place on 12/09/16 at 8:50 a.m. During the tour, observation revealed the Maintenance Director tested ceiling vents in resident bathrooms and confirmed the bathrooms for resident rooms 201-218 and 107 through 119 had no working ventilation. Observation also revealed the facility's beauty shop had no working ventilation, and had 4 shower rooms available for all residents in the facility to use, all without working ventilation. During an interview on 12/10/16 at 2:31 p.m. a.m., the Maintenance Supervisor reported he looked into the issue and found a seized motor and a busted belt that needed replaced for the facility's ventilation system. On 12/10/16, the Maintenance Director reported the facility did not have a policy regarding the ventilation, but following their monthly preventative maintenance check. The facility failed to ensure adequate ventilation throughout the building to maintain air quality and reduce odors in the resident living spaces. | 2019-09-01 |
| 4558 | 4558 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 497 | D | 0 | 1 | QBL111 | Based on review of personnel files and staff interviews, the facility failed to ensure Certified Nurse Aides (CNAs), employed by the facility for at least a year, had performance appraisals completed. Two of two CNA files reviewed (CNA AR and CNA AC) failed to have had a performance appraisal completed in the last year. Findings include: Nine CNA files were requested for review of performance appraisal completion (CNAs: AC,AU, AX, AL, BC, AZ, AY, AR, and BD). Review ofthe files showed two (CNA AR and CNA AC) of the nine CNAs had been employed by the facility for over a year; performance appraisals had not been completed for either employee. The Director of Nursing (DON) was interviewed on 12/10/16 at 2:15 p.m. and verified neither CNA AC nor CNA AR, employed in excess of a year, had appraisals completed. The DON stated she had not checked into the requirement for CNA performance appraisals since coming on board as DON a month prior. The Administrator was interviewed on 12/10/16 at 3:45 p.m. and stated the facility had conducted some of the CNA performance appraisals due over the past year; however, administration had no money available for employee raises. The Administrator stated that conducting the appraisals without being able to award staff monetarily had created problems. A decision was made to forgo the appraisals until money was available to compensate employees for good performance. | 2019-09-01 |
| 4559 | 4559 | PIONEER HEALTH OF CENTRAL GEORGIA | 115564 | 712 PATTERSON STREET | BYROMVILLE | GA | 31007 | 2016-12-10 | 514 | D | 0 | 1 | QBL111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, clinical record review, and review of summarized data from monthly drug regimen reviews, the facility failed to ensure the Pharmacist's monthly drug regimen reviews were maintained as part of the resident's record for 1 of 45 stage 2 sampled residents (R) (R#40). Three of R#40's drug regimen reviews were missing and could not be located. Findings include: 1. R#40 was admitted to the facility on [DATE]. The resident had [DIAGNOSES REDACTED]. The Pharmacist's recommendations were reviewed from (MONTH) (YEAR) through the survey exit on 12/10/16. The Consultation Reports for (MONTH) (YEAR), (MONTH) (YEAR), and (MONTH) (YEAR) were missing from R#40's current and overflow medical record. No copies of the reports were available. A log with a compilation of all the residents' recommendations from the Pharmacist on a monthly basis was available; the report also titled Consultation Report demonstrated the Pharmacist completed the drug regimen reviews for the months of (MONTH) (YEAR), (MONTH) (YEAR), and (MONTH) (YEAR) with recommendations being made during these months as follows: -January (YEAR), The Pharmacist recommended [MEDICATION NAME] (hormone) ordered every 3 months be accurately documented. There was no evidence of the Physician's response to this recommendation found in the record. The monthly drug regimen review form for R#40, titled, Consultation Report for (MONTH) (YEAR) was missing. According to the 12/16 physician's orders [REDACTED]. -March (YEAR), The Pharmacist recommended identifying the specific months the [MEDICATION NAME] (hormone) was to be administered. The order was for every 3 months. There was no evidence of the Physician's response to this recommendation found in the record. The monthly drug regimen review form for R#40, titled, Consultation Report for (MONTH) (YEAR) was missing. According to the 12/16 physician's orders [REDACTED]. -July (YEAR), The Pharmacist recommended a gradual dose reduction o… | 2019-09-01 |
Advanced export
JSON shape: default, array, newline-delimited
CREATE TABLE [cms_GA] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );