cms_GA
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31 rows where "inspection_date" is on date 2017-07-20
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Suggested facets: facility_name, facility_id, address, city, zip, deficiency_tag, scope_severity, eventid, 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 189 | 189 | SIGNATURE HEALTHCARE OF BUCKHEAD | 115110 | 54 PEACHTREE PARK DRIVE N.E. | ATLANTA | GA | 30309 | 2017-07-20 | 371 | F | 0 | 1 | XEII11 | Based on observation, staff interviews, and review of facility policy, it was determined the facility failed to ensure one of three resident refrigerators was maintained at a temperature of 41 degrees Fahrenheit (F) or below. In addition, the facility failed to ensure that resident food and drink items were labeled with a resident's name and dated on two of three resident nourishment refrigerators. There was a total of 113 residents receiving oral feedings. The census was 132 residents on the first day of the survey. Findings include: A review of the policy titled Record of Refrigeration Temperatures revised 7/1/14 revealed the following under the sub-section titled PR[NAME]EDURE: 4: The refrigerator must be clean and temperatures must be 41 degrees F or less. 5. Temperatures greater than these areas are to be reported to the Dietary Manager (DM) immediately. 8. Nursing unit refrigerators and freezers and any other refrigerator/freezers having resident food stored in it must be clean, have Use By Dates on food product. 1. On 7/19/17 at 9:38 a.m. an observation was conducted of the fourth-floor resident nourishment refrigerator. The Unit Manager, Registered Nurse (RN) AA was present. There were two thermometers in the refrigerator and both read 50 degrees F. RN AA confirmed the temperatures of 50 degrees F. On 7/19/17 at 9:54 a.m. an observation was conducted of the third-floor resident nourishment refrigerator with the Unit Manager Licensed Practical Nurse (LPN) BB present. There was a sign on the outside of the refrigerator door that read: Pantry Refrigerators are for resident food only. Please be sure that any items placed inside of fridge are labeled with a name, room number, and a date. (Any unlabeled items will be discarded.) The observation revealed the following - An opened 32-ounce container of thickened liquids. There was no date to indicate when the item was opened. LPN BB confirmed that the container contained thickened liquids for residents, and that it was not dated. - A Kentucky Fried Chicken box da… | 2020-09-01 |
| 327 | 327 | AMARA HEALTHCARE & REHAB | 115150 | 2021 SCOTT ROAD | AUGUSTA | GA | 30906 | 2017-07-20 | 156 | E | 0 | 1 | TDOI11 | Based on record review, and staff interviews, the facility failed to provide complete Advance Beneficiary Notices and Notices of Medicare Non-Coverage letters when changes in services were introduced which affected liability for two of three residents reviewed (R#4 and R#37). Three residents were reviewed for Liability Notices and Beneficiary Appeal Rights. Findings include: 1. Review of the Notice of Medicare Non-Coverage form issued to Resident (R) R#4 on 2/1/17, revealed the resident's services Will end on 2/4/17. Review of the form revealed the type of current services ending section, Insert type was blank. Further review revealed, per the form, Medicare probably will not pay for after the effective date indicated on the form, was blank. Review of the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) issued to R#4 on 2/1/17, revealed the form was not completed revealing the resident/responsible party could not make an informed choice about the services they wished to receive by not knowing what they might have to pay for. The section about cost of the items/services for which Medicare would probably no longer pay for was blank. The section about secondary insurance, and contact information for the Medicare Contractor were also blank. Further review of the SNFABN revealed it contained a section in which the resident/responsible party was to mark whether they wanted to receive the items/services that might no longer be covered, or instead, declined these items/services. Per the form, the resident/responsible party was to Choose one option, check one box, and date and sign this notice. Review of the form revealed it was not signed/dated by the resident/responsible party, but instead, stated that Verbal understanding provided by telephone by a family member. Neither option on the form was marked, and there was no indication as to whether the resident/responsible party wanted non-covered services to continue or end. 2. Review of the SNFABN issued to R#37 on 3/7/17 revealed the form was not completed rev… | 2020-09-01 |
| 328 | 328 | AMARA HEALTHCARE & REHAB | 115150 | 2021 SCOTT ROAD | AUGUSTA | GA | 30906 | 2017-07-20 | 159 | E | 0 | 1 | TDOI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility failed to establish and maintain an accounting system which met generally accepted practices of accounting, which included crediting and dispersing interest earned on resident accounts to the resident, and/or providing quarterly financial statements to 67 current or past residents whose personal funds were handled by the facility since 7/1/16. In addition, the facility failed to notify two of five residents (R#66 and R#69) reviewed for personal funds when the amount of money in their resident account reached $200 less than the resource limit and provide notification that as a result, they could lose their Medicaid eligibility. The sample size was 63. Findings include: 1. Interview with Resident (R) R#66's family member via telephone on 7/17/17 at 3:04 p.m., revealed the facility handled personal funds for the resident, whose [DIAGNOSES REDACTED].#66's family member indicated the facility did not provide financial statements of how much money was in the resident's account. Review of the facility's Trust Fund Trial Balance ledger confirmed that the facility handled R#66's personal financial account. The ledger also included the names and trust fund balances for 66 other current and past residents of the facility who had allowed the facility to handle their personal funds at some time between 7/1/16 -7/1/17. As part of the Personal Funds review, the facility was asked to provide evidence that quarterly financial statements were provided to each resident. Review of the facility's Trust Fund Trial Balance report revealed between 7/1/16 - 6/30/17, 51 current or past residents had a balance of at least $50 upon which interest should have been earned, credited, and dispersed. Interview with the Billing Coordinator on 7/19/17 at 9:18 a.m., revealed the facility had not been sending out quarterly financial statements prior to 7/1/17. She stated the facility had recently identified this problem a… | 2020-09-01 |
| 329 | 329 | AMARA HEALTHCARE & REHAB | 115150 | 2021 SCOTT ROAD | AUGUSTA | GA | 30906 | 2017-07-20 | 247 | D | 0 | 1 | TDOI11 | Based on record review, staff and resident interview, and review of the facility's policy and procedure titled, Room to Room Transfer, revealed the facility failed to ensure notification prior to a room change. The deficient practice was evidenced by one resident (R#128) from a total of 63 sampled residents evaluated for admission/transfer and discharge. (R#128) was moved from one room to another without being informed. The deficient practice had the potential to affect all residents. Findings include: An interview with Resident (R) R#128 on 7/17/17 at 4:46 p.m., revealed he was recently moved from Station I to Station II. R#128 indicated he was not informed of the move prior to his belongings being packed and moved to a different room. Review of R#128's clinical record revealed R#128 had a Significant Change Minimum Data Set (MDS) assessment completed on 4/27/17, in section C he was assessed and coded for a score of a 14 out of 15 on the Brief Interview for Mental Status (BIMS), which indicated he was not cognitively impaired. Review of the Nurse's Notes dated 7/7/17 at 12:05 p.m. for R#128, revealed the following information: new order noted to transfer pt (patient) to Station II room (number) ., .Resident transferred to Station II room (number) with belongings and medications. Will cont (continue) plan of care. The nursing note did not include why R#128 was moved, if it was discussed with him, if he agreed with the move, nor if he was satisfied with the move. An interview with Social Services (SS) BB on 7/19/17 at 2:30 p.m., revealed the facility had a form they used when residents were transferred from one room to another. The form was titled, Notification of Room Change, and included information as to why the resident was moved and if the move was satisfactory to the resident. Further interview revealed, the facility failed to complete the form prior to moving R#128 from one room to another room. Review of the facility's policies and procedures revealed a document titled, Room to Room Transfer, dated 2/2002,… | 2020-09-01 |
| 330 | 330 | AMARA HEALTHCARE & REHAB | 115150 | 2021 SCOTT ROAD | AUGUSTA | GA | 30906 | 2017-07-20 | 280 | D | 0 | 1 | TDOI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of the facility's policies and procedures, the facility failed to review and revise care plans for two residents (R#77 and R#45) and failed to ensure that one resident (R#66) or their responsible party was included in the preparation, development, and revision of the care plan. R#77's care plan was not revised related to the use of [MEDICAL CONDITION] medications and R#45's care plan was not revised related to a living will. The sample was 63 residents. Findings include: 1. Review of Resident (R) R#45's clinical record, revealed she was readmitted to this facility on 2/13/12 with [DIAGNOSES REDACTED]. Review of the quarterly Minimum Data Set (MDS) assessment, section C dated 5/31/17, revealed R#45 was assessed and coded a score of 9 out of 15 for cognition, which indicated her cognition was moderately impaired. Review of R#45's clinical record document titled, Physicians Orders, revealed a telephone order dated 6/8/17, which included the following information; Consult social worker- daughter to bring copy of living will which states pt (patient) request is DNR (do not resuscitate) status . Review of R#45's care plan dated 3/1/17, revealed the document titled, Advance Directive Plan of Care, had not been reviewed or revised. R#45's care plan was marked as has no advance directives FULL CODE STATUS. An interview with Social Services (SS) BB and the Minimum Data Set (MDS) Coordinator on 7/19/17 at 9:00 a.m., revealed the consult information on the Physicians Orders document was not communicated to either of them, consequently the consult was not completed and the care plan was not reviewed and revised. An interview with the Administrator on 7/19/17 at 9:15 a.m., indicated the facility failed to follow their MDS policies and procedures when they had not consulted either of their social services workers, AA and BB, and the MDS Coordinator, of the physician's telephone order regarding R#45's livin… | 2020-09-01 |
| 331 | 331 | AMARA HEALTHCARE & REHAB | 115150 | 2021 SCOTT ROAD | AUGUSTA | GA | 30906 | 2017-07-20 | 309 | D | 0 | 1 | TDOI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and review of the facility's Long Term Care Facility [MEDICAL TREATMENT] Services Agreement, the facility failed to 1) complete their own [MEDICAL TREATMENT] Communication Form, and 2) routinely communicate with the [MEDICAL TREATMENT] Clinics to ensure they could provide a continuum of care and services for the residents who had a [DIAGNOSES REDACTED]. The deficient practice had the potential to affect two Residents (R#63 and R#127) who were receiving for [MEDICAL TREATMENT] care and services of 63 sampled residents. Findings include: 1. Review of the clinical record for Resident (R) R#63, revealed she was readmitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Further review of the clinical record revealed R#63 received [MEDICATION NAME] (a medication to increase red blood cells), [MEDICATION NAME] (an anticoagulant to prevent blood clotting, and Iron (a medication for [MEDICAL CONDITION]) during her [MEDICAL TREATMENT] treatments. Each of these medications required monitoring due to potential adverse side effects. An interview with the Licensed Practical Nurse (LPN) AA on 7/19/17 at 3:00 p.m., revealed R#63 went to the [MEDICAL TREATMENT] Clinic for treatments three days each week and on 5/1/17 she was hospitalized after her [MEDICAL TREATMENT] treatment. LPN AA indicated after R#63 came back from the [MEDICAL TREATMENT] Clinic on 5/1/17, she experienced some [MEDICAL CONDITION] activity and was confused. When interviewed about how R#63 tolerated her [MEDICAL TREATMENT] treatment that day, LPN AA revealed she was unsure because the [MEDICAL TREATMENT] Communication Form had not been completed. LPN AA added that R#63 was cognitively intact, however on that day she was confused. LPN AA further indicated the facility had a [MEDICAL TREATMENT] Communication Form they and the [MEDICAL TREATMENT] clinic were to complete to ensure a continuum of care between the two facilities, however, LPN AA indic… | 2020-09-01 |
| 332 | 332 | AMARA HEALTHCARE & REHAB | 115150 | 2021 SCOTT ROAD | AUGUSTA | GA | 30906 | 2017-07-20 | 329 | D | 0 | 1 | TDOI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interviews, and record review, the facility failed to assure one of five residents (R#77) reviewed for unnecessary medication use was free from an unnecessary drug. The facility administered an antipsychotic without indication for use of the medication, failed to identify an individualized targeted behavior related to the use of the medication, and failed to attempt non-pharmacological interventions prior to the use of medication. The facility failed to attempt a gradual dose reduction when no evidence was provided such an attempt would be clinically contraindicated. The sample size was 63. Findings include: Review of the policy revealed: Residents will only receive antipsychotic medication when necessary to treat specific conditions for which they are indicated and effective. Nursing staff will document in detail an individual's target symptoms. Antipsychotic medications will not be used if the only symptoms are one or more of the following .verbal expressions or behavior that are not due to conditions listed above under indication and do not represent a danger to the resident or others. The Physician shall respond appropriately by changing or stopping problematic doses or medications or clearly documenting (based on assessing the situation) why the benefits of the medication outweight he risks or suspected or confirmed adverse consequences. Observation on [DATE] at 1:24 p.m., 4:01 p.m., and [DATE] at 10:21 a.m. revealed Resident (R) R#77 was in bed. During each observation, the resident's television was on a Home and Garden television show (HGTV). Interview with R#77 on [DATE] at 10:21 a.m., revealed the resident was pleasant, and had no complaints. Although she displayed some memory loss, she displayed no behaviors, signs of delusions or hallucinations. When asked about her medications, R#77 indicated she did not know the names, but thought she took a medication at night to help her sleep. Review of… | 2020-09-01 |
| 333 | 333 | AMARA HEALTHCARE & REHAB | 115150 | 2021 SCOTT ROAD | AUGUSTA | GA | 30906 | 2017-07-20 | 460 | D | 0 | 1 | TDOI11 | Based on observations and staff interviews, the facility failed to ensure a bedroom was equipped to afford full visual privacy for each resident during personal care, treatment or as necessary for the resident. This deficient practice was noted with one resident (R#66) of 62 sampled residents. Individual ceiling track for privacy curtains and the actual curtains for R#66 were not in place during the initial tour. The sample was 63. Findings are: During observation of Resident (R) R#66's room on 7/17/17 at 3:09 p.m., revealed the area where the bed was positioned lacked privacy as there were no privacy curtains. An interview with a Certified Nursing Assistant (CNA) AA, on 7/19/17 at 9:30 a.m., revealed she was assigned to R#66 on the morning shift and she did not get R#66 up that morning for dressing. CNA AA further revealed she noted that third shift staff gets the resident up prior to her arrival on first shift, however, CNA AA indicated she would provide privacy for R#66 by pulling the privacy curtain if she were to get her up. CNA AA indicated she could not recall if the privacy curtain for R#66 was in place. An interview with the Maintenance Supervisor (MS) on 7/19/17 at 1:50 p.m., revealed he noticed on 7/18/17 the track for a privacy curtain and the actual curtains were not in place for R#66. Further interview with MS revealed that he put a track in place at the ceiling of R#66's bed area around 5:00 p.m. on 7/18/17 and attached new privacy curtains. He stated, the new shiny bolts in place were the ones I secured to the track. An interview with the Administrator on 7/19/17 at 3:45 p.m., revealed she provided a copy of the facility's undated policy titled, Admission Criteria. The policy indicated the following; .residents have the right to privacy regarding accommodations, medical treatment, written and telephone communications, electronic device communication visits, and meeting with family and of resident groups. | 2020-09-01 |
| 662 | 662 | FAIRBURN HEALTH CARE CENTER | 115298 | 178 WEST CAMPBELLTON STREET | FAIRBURN | GA | 30213 | 2017-07-20 | 282 | G | 0 | 1 | JOE811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interview, it was determined that the facility failed to turn and reposition as care planned for the prevention of pressure ulcers for one resident (R) (R#92) which resulted in actual harm to this resident who developed a facility acquired pressure ulcer. The sample size was 20 residents. Findings include: Review of the clinical record for R#92 revealed an admission date of [DATE] to the facility with the following [DIAGNOSES REDACTED]. Nursing Admission assessment dated [DATE] documented R#92 alert and oriented to person and place. The resident was admitted to the facility with one stage 3 pressure ulcer to coccyx. Review of the interim care plan dated 7/13/17 documented R#92 has impaired skin integrity or at risk for impaired skin: unstageable to the sacrum. Interventions included to perform body audit upon admission and as needed; and reposition/assist with turning every 2-3 hours and as needed. Observations, by the surveyor, on 7/19/17 at 8:30 a.m., 9:32 a.m., 10:15 a.m., and 12:10 p.m. revealed R#92 laying directly on his back with the head of bed elevated. Observation on 7/19/17 at 1:15 p.m. revealed R#92 laying directly on his back with the head of bed elevated. During an interview at this time, resident stated that no one has turned him today. Observation on 7/19/17 at 2:15 p.m., R#92 laying directly on his back with head of bed elevated. Resident's lunch tray was untouched on the bedside table. During an interview at this time with R#92 revealed that the resident was pretty hungry and that no one has turned him since the last interview with the resident. Continuous observation, by the surveyor, on 7/19/17 from 2:40 p.m. to 3:35 p.m., revealed that R#92 remained laying directly on his back with head of bed elevated in addition to observation from 2:40 p.m. to 2:53 p.m. of CNA FF feeding the resident and reports that he ate 100%. Observation of Licensed Practical Nurse (LPN) CC entered R#92's ro… | 2020-09-01 |
| 663 | 663 | FAIRBURN HEALTH CARE CENTER | 115298 | 178 WEST CAMPBELLTON STREET | FAIRBURN | GA | 30213 | 2017-07-20 | 314 | G | 0 | 1 | JOE811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to prevent the development of one clinically avoidable pressure ulcers for one residents (R) R#92 of 20 sampled residents and failed to provide necessary treatment and services to promote the healing of the pressure ulcers. Specifically, the facility failed to assist the resident to turn and reposition and failed to use appropriate infection control technique during treatment to promote healing of the pressure ulcers. This resulted in actual harm for R#92. Findings include: Review of the Dressing Changes and Wound Care Policy revised in (MONTH) 2013 revealed that the guideline of this facility is to provide dressing changes as needed using clean technique which includes guideline number 9: clean wound using circular motion from center of wound outward using only one gauze per wipe. The Skin Integrity Protocol dated (MONTH) (YEAR) documented that it is the policy of this facility to accurately assess each resident's condition for prompt recognition of the risk of pressure injuries, to prevent occurrence and to appropriately treat any pressure injury which the resident may experience. Component [NAME] of the Skin Integrity Program indicated the treatment of [REDACTED]. Review of the clinical record revealed R#92 was admitted to the facility on [DATE] and had active [DIAGNOSES REDACTED]. Review of the Nursing Admission assessment dated [DATE] documented R#92 alert and oriented to person and place. The resident was admitted with one stage 3 pressure ulcer to coccyx and incontinent of bowel and bladder. Review of the admission Braden Scale-For Predicting Pressure Sore Risk dated 7/13/17 revealed that R#92 was At Risk for development of pressure sores with a score of 15 (Total score of 15-18 represents AT RISK). The risk assessment reflected that R#92 requires moderate to maximum assistance with moving. Review of the interim care plan dated 7/13/17 documented that R#92 has impa… | 2020-09-01 |
| 1325 | 1325 | PROVIDENCE OF SPARTA HEALTH AND REHAB | 115397 | 60 PROVIDENCE STREET, PO BOX 86 | SPARTA | GA | 31087 | 2017-07-20 | 253 | D | 0 | 1 | 519O11 | Based on observation and interviews with staff the facility failed to assure that hoyer lifts, fans, and resident wheelchairs (Resident # 11, Resident #15, Resident #18, and Resident #43) were without build build-up or torn armrests. The facility census was 57. Findings: Observation on 7/17/17 at 10:05 a.m. Resident #43 observed in main lobby area sitting in wheelchair with build-up noted on spokes of wheelchair and undercarriage. Observation on 7/19/17 at 7:41 a.m. on B Hall revealed one (1) Wheelchair with mat in the seat, the mat has brown substance on it and the edge of the wheelchair seat has brown substance on it on the right side of the seat; Patient lift with item number has dust and grime on the base with 2 small light brown spots on the foot plate; Large black fan with blades, the frame cover, and the back of the fan coated with dust. Observation on 7/19/17 at 7:47 a.m. on A Hall revealed a lift with number 3 has dust and grime at the base and along the side and large black fan blades, the frame cover, and the back of the fan are coated with dust. Observation on 7/19/19 at 8:29 a.m. on C hall of blue geir chair with white build-up in seat. Observation on 7/19/17 at 8:30 a.m. on A Hall revealed build-up on fan on 100 hall, pink geri chair between room 106 and 108 noted to have black build up on right side panel of chair and build up on arm rests and a dusty base. Observation on 7/19/17 at 8:32 a.m. of build-up on spokes of wheel chair for Resident #18, 3 wheelchairs on Hall A between room 112 and 114 noted with build-up in spokes of chairs. Observation on 7/19/17 8:37 a.m. Resident #11 observed sitting in wheelchair in main lobby that was noted to have build-up on wheels and broken leather on arm rests. Observation on 7/19/17 at 6:05 p.m. Resident #43 observed sitting in wheelchair with build-up on wheelchair spokes and undercarriage. Environmental tour began 7/20/17 at 9:50 a.m. with Maintenance Director It is reported that fans are cleaned every two months towards the end of the month. Social Services … | 2020-09-01 |
| 1326 | 1326 | PROVIDENCE OF SPARTA HEALTH AND REHAB | 115397 | 60 PROVIDENCE STREET, PO BOX 86 | SPARTA | GA | 31087 | 2017-07-20 | 322 | D | 0 | 1 | 519O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of the facility procedural guidelines for Enteral Tube Medication Administration and staff interview, the facility failed to administer water flushes and medications via gravity to prevent potential complications for one (1) resident (R) (#61) of two (2) residents with gastrostomy/enteral feeding tubes from six (6) residents observed during medication administration. The sample was 27 residents and the census was 57 residents. Findings include: Review of the facility procedural guidelines for Enteral Tube Medication Administration revealed that staff should allow medications to flow down the tube via gravity and to give gentle boosts if the medication will not flow by gravity. Review of the medical record for R#61 revealed that she had an enteral/gastrostomy tube ([DEVICE]). Continued review of the resident's medical record revealed [REDACTED].) per 5 milliliters (mls.) suspension, 12 mls. (300 mgs.) via [DEVICE] daily for [MEDICAL CONDITION]; [MEDICATION NAME] 100 mgs. per ml. solution, 7.5 mls. (750 mgs) via [DEVICE] twice a day for [MEDICAL CONDITION]; [MEDICATION NAME] 10 mgs. per ml. solution, 4 teaspoons (200 mgs.) via [DEVICE] twice a day for [MEDICAL CONDITION]; [MEDICATION NAME] 25 mgs. tablet via [DEVICE] daily for depression; [MEDICATION NAME] 10/325 mgs. tablet via [DEVICE] every 12 hours for pain; [MEDICATION NAME] 10 mg. tablet three times daily for muscle spasms; and [MEDICATION NAME] 25 mg. tablet via [DEVICE] three times daily for disorganized behaviors. On 07/19/17 at 8:05 a.m. during observation of medication administration for R#61, Licensed Practical Nurse (LPN) AA mixed approximately 5 ccs. water with each medication in a separate medication cup. LPN AA drew up 30 ccs. of water flush into the syringe, inserted the tip of the syringe into the resident's [DEVICE] and used the plunger to push the 30 mls. of water through the resident's [DEVICE]. LPN AA then inserted the syringe in… | 2020-09-01 |
| 1327 | 1327 | PROVIDENCE OF SPARTA HEALTH AND REHAB | 115397 | 60 PROVIDENCE STREET, PO BOX 86 | SPARTA | GA | 31087 | 2017-07-20 | 332 | D | 0 | 1 | 519O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to maintain a medication error rate of less than 5% when one (1) of two (2) nurses failed to shake the [MEDICATION NAME] bottle as recommended by the manufacturer and failed administer [MEDICAL CONDITION] medications ([MEDICATION NAME] and [MEDICATION NAME]) as ordered by the physician for one (1) resident (#61) of six (6) residents observed during medication administration. There were 25 medication opportunities with four (4) errors which resulted in a 16% medication error rate. The sample was 27 residents. The census was 57 residents. Findings include: Review of the medical record for R#61 revealed that she had a gastrostomy tube ([DEVICE]) and a [DIAGNOSES REDACTED].) per milliliters (mls.) solution, 7.5 mls. (750 mgs.) via [DEVICE] twice a day for [MEDICAL CONDITION]; [MEDICATION NAME] 10 mgs. per ml. solution, 4 teaspoons (or 20 mls.) (200 mgs.) via [DEVICE] twice a day for [MEDICAL CONDITION]; and [MEDICATION NAME] 125 mgs. per 5 mls. suspension, 12 mls. (300 mgs.) via [DEVICE] daily for [MEDICAL CONDITION]. During observation of medication administration on 7/19/17 at 8:05 a.m., Licensed Practical Nurse (LPN) AA removed the bottles of [MEDICATION NAME] and [MEDICATION NAME] from the medication cart and placed them on the over bed table for R#61. The over bed table was noted to be at the LPN's waist level and slant down at one end. Without shaking the [MEDICATION NAME] as recommended on the bottle label, LPN AA used the syringe which was attached to the [MEDICATION NAME] bottle and withdrew 5 mls. of the [MEDICATION NAME] and placed it in a calibrated medication cup. LPN AA then poured [MEDICATION NAME] into a calibrated medication cup and [MEDICATION NAME] into a calibrated medication cup. Prior to the LPN administering the [MEDICATION NAME] and [MEDICATION NAME] to the resident, the surveyor intervened and requested to check the medications on a level surface… | 2020-09-01 |
| 1328 | 1328 | PROVIDENCE OF SPARTA HEALTH AND REHAB | 115397 | 60 PROVIDENCE STREET, PO BOX 86 | SPARTA | GA | 31087 | 2017-07-20 | 333 | D | 0 | 1 | 519O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to ensure that one resident (R) (R#61) of six (6) residents observed during medication administration was free from significant medication errors. The sample size was 27 residents and the census was 57 residents. Findings include: Review of the medical record for R#61 revealed that she had a gastrostomy tube ([DEVICE]) and a [DIAGNOSES REDACTED].) per milliliters (mls.) solution, 7.5 mls. (750 mgs.) via [DEVICE] twice a day for [MEDICAL CONDITION]; [MEDICATION NAME] 10 mgs. per ml. solution, 4 teaspoons (or 20 mls.) (200 mgs.) via [DEVICE] twice a day for [MEDICAL CONDITION]; and [MEDICATION NAME] 125 mgs. per 5 mls. suspension, 12 mls. (300 mgs.) via [DEVICE] daily for [MEDICAL CONDITION]. During observation of medication administration on 7/19/17 at 8:05 a.m., Licensed Practical Nurse (LPN) AA removed the bottles of [MEDICATION NAME] and [MEDICATION NAME] from the medication cart and placed them on the over bed table for R#61. The over bed table was noted to be at the LPN's waist level and slant down at one end. Without shaking the [MEDICATION NAME] as recommended on the bottle label, LPN AA used the syringe which was attached to the [MEDICATION NAME] bottle and withdrew 5 mls. of the [MEDICATION NAME] and placed it in a calibrated medication cup. LPN AA then poured [MEDICATION NAME] into a calibrated medication cup and [MEDICATION NAME] into a calibrated medication cup. Prior to the LPN administering the [MEDICATION NAME] and [MEDICATION NAME] to the resident, the surveyor intervened and requested to check the medications on a level surface and at eye level. Once placed on the top of the medication cart, the [MEDICATION NAME] measured 10 mls. and the [MEDICATION NAME] measured approximately 22 mls. After surveyor intervention, LPN AA poured out the excess [MEDICATION NAME] to obtain a dose of 7.5 mls. and poured out the excess [MEDICATION NAME] to obtain a dose of… | 2020-09-01 |
| 1329 | 1329 | PROVIDENCE OF SPARTA HEALTH AND REHAB | 115397 | 60 PROVIDENCE STREET, PO BOX 86 | SPARTA | GA | 31087 | 2017-07-20 | 371 | E | 0 | 1 | 519O11 | Based on observation, staff interview, and review of facility Food safety Fact Sheet the facility failed to properly label, date, and reseal six (6) food items after opening. One (1) carton of grated parmesan cheese opened and not resealed properly, no open date or expiration date noted, (1) medium bag of green scallion onions noted to have brown slime in the bag with no open date or discard date, (1) unopened large bag of shredded lettuce turning brown and wilting, (1) two (2) pound jar of kosher dill pickles no open date; whipped topping base no expiration date noted; (1) eleven (11) pound jar of [NAME] slaw opened, lid loosely fitted, no open date noted. The facility has a census sample of fifty-seven (57) residents, and a potential of fifty-three (53) residents could be effected. Findings Include: Initial kitchen tour 7/17/17 at 10:15 a.m. with Dietary Manager (DM), observation reach in cooler #1 has whipped topping base opened 7/8/17 no expiration date, dry grated parmesan. cheese opened not covered, no expiration date. Observation of Cooler #3 for produce 42 degrees (1) eleven pound (11) container of [NAME] slaw opened and not labeled with an open date the lid loosely fitted the container, (1) bag (2 lb) unopened shredded lettuce that appeared to be turning brown in color, (1) medium bag of green scallion onions appearing to have a brownish color gel texture, and (1) (2) gallon jar of kosher dill pickles without an open date noted on the jar. Reach in Cooler # 4 contains all milk products obtained by the DM registered the milk temperature at 40.8 degrees. Review of the week four (4) Menu Calendar Report revealed on 7/17/17 residents will have confetti coleslaw as a food item choice for dinner. Further review revealed residents will have a tossed salad with dressing as a food item choice on 7/18/17. Review of Policies and Procedures titled Food Safety Fact Sheet Date Marking revealed food will be dated before stored, and no food will be stored longer the the Use by date. All food containers will be clearly a… | 2020-09-01 |
| 1617 | 1617 | PRUITTHEALTH - SHEPHERD HILLS | 115452 | 800 PATTERSON RD | LA FAYETTE | GA | 30728 | 2017-07-20 | 329 | D | 0 | 1 | 82JL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, staff interview and review of facility policy titled Lippincott Procedures - Pain Assessment, the facility failed to consistently assess one (1) resident (R), (R# 55) before and after administration of pain medication, from a sample of thirty-two (32) residents. Findings include: Review of facility policy titled Lippincott Procedures - Pain Assessment, dated 10/2/15, indicated if an intervention is performed the pain level should be assessed before the intervention and within one hour after the intervention to assess the patient's response. Review of R#55's clinical record revealed that she was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of her physician's orders [REDACTED]. Review of her Quarterly Minimum Data Set (MDS), dated [DATE], revealed a Brief Interview for Mental Status (BIMS) score of eight (8), indicating moderate cognitive impairment, and she was administered pain medication as needed (PRN). Review of facility Controlled Drug Record, dated from 4/14/17 through 7/18/17, compared with Pain Flow Sheets, dated May, (YEAR), June, (YEAR) and July, (YEAR), revealed R#55 was administered [MEDICATION NAME]/ APAP 5 - 325 mg at 5:00 a.m. on 5/19/17, at 12:00 a.m. on 5/28/17, and at 9:00 p.m. on 5/28/17, with no pain assessments before or after administration, on the Pain Flow Sheet on the back of the Medication Administration Record's (MAR's) for the month of May,2017. Continued review of the Controlled Drug Record revealed R#55 was administered [MEDICATION NAME]/APAP 5 - 325 mg at 7:00 p.m. on 6/16/17, at 12:00 a.m. on 6/18/17, at 11:00 p.m. on 6/18/17, at 11:00 a.m. on 6/21/17, at 9:00 p.m. on 6/24/17, at 9:00 p.m. on 6/25/17, and at 6:00 p.m. on 6/30/17, with no assessments before and after administrations recorded on the Pain Flow Sheets. Review of the above Controlled Drug Record revealed administration of [MEDICATION NAME]/APAP 5-325 mg to R#55 at 8:00 p.m. on 7/8/17, at 8:00 … | 2020-09-01 |
| 1618 | 1618 | PRUITTHEALTH - SHEPHERD HILLS | 115452 | 800 PATTERSON RD | LA FAYETTE | GA | 30728 | 2017-07-20 | 514 | D | 0 | 1 | 82JL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and review of facility policy titled Medication Administration: General Guidelines the facility failed to consistently document administration of [MEDICATION NAME]/APAP 5-325 mg on the Medication Administration Record (MAR) for one resident (R), (R#55) from a sample of 32 residents. Findings include: Review of facility policy, revised 1/23/15, revealed after medication administration for facilities using paper MAR, the patient/resident's MAR is initialed by the person administering a medication, in the space provided under the date, and on the line for that specific medication dose administration. Review of physician's orders [REDACTED]. Review of the care plans for R#55 revealed a care plan, dated 1/3/17, indicating she required administration of [MEDICATION NAME] medication as ordered. Review of the Controlled Drug Record for administrations of [MEDICATION NAME] 5 - 325 mg, compared with the May, (YEAR) MAR for R#55, revealed the medication was administered on 5/19/17 at 5:00 p.m., and on 5/28/17 at 12:00 a.m. with no documentation on the MAR. Continued review of the Controlled Drug Record compared with the June, (YEAR) MAR revealed no documentation of [MEDICATION NAME] administrations on 6/16/17 at 7:00 p.m., on 6/18/17 at 12:00 a.m., on 6/18/17 at 11:00 p.m., on 6/21/17 at 11:00 a.m., on 6/24/17 at 9:00 p.m., on 6/25/17 at 9:00 p.m. and on 6/30/17 at 6:00 p.m. The Controlled Drug Record was compared with the MAR from July, (YEAR) and the MAR did not include documentation of [MEDICATION NAME] on 7/17/17 at 5:00 p.m. Review of Nurse's Notes for May, (YEAR), June, (YEAR), and July, (YEAR) for R#55 revealed the administrations of [MEDICATION NAME] on the above dates and times had not been documented in the notes. Interview on 7/20/17 at 9:50 a.m. with Licensed Practical Nurse (LPN) AA confirmed any medication should be initialed on the MAR under the corresponding date, to indicate it had been administer… | 2020-09-01 |
| 3335 | 3335 | CHERRY BLOSSOM HEALTH AND REHABILITATION | 115652 | 3520 KENNETH DRIVE | MACON | GA | 31206 | 2017-07-20 | 371 | F | 0 | 1 | 2OMO11 | Based on observation, record review, and staff interview, the facility failed to ensure that all items on the steam table served at one meal observed were held at the appropriate temperature to prevent foodborne illness. In addition, the facility failed to maintain the sanitizer level in the 3-compartment sink in accordance with the manufacturer's recommendations for two of two observations There were a total of 68 residents that consumed an oral diet. Findings include: 1. During the initial tour of the kitchen on 7/17/17 beginning at 8:00 a.m., Dietary Aide BB was observed washing food preparation equipment in the 3- compartment sink. Review of the label on the container of the sanitizer for the third compartment revealed that it was a quaternary solution. Dietary Aide BB was observed to check the concentration of the sanitizer in the third compartment, and the strip appeared dark green after pulled out of the solution. During interview with the Dietary Aide at this time, she stated that she compared the color on the strip to the poster on the wall, and that if the color was dark green the sanitizer level was 500, and if the color was more of a military green, the level was 400. She verified that the sanitizer level was 500, and that was the concentration that she aimed for. Review of the manufacturer's poster on the wall above this sink revealed that the acceptable concentration for the quaternary solution in the sanitizing compartment was between 150 and 400. During interview with Dietary Aide BB on 7/20/17 at 12:25 p.m., she verified that she wanted a concentration in the sanitizing compartment of the 3-compartment sink to be at least 500. During interview with Dietary Aide DD on 7/20/17 at 1:50 p.m., she stated that when she used the 3-compartment sink, she wanted the sanitizer level to be 400 or above, and for the test strip to be dark green in color. On 7/20/17 at 1:55 p.m., the Food Service Manager (FSM) was observed to check the concentration of the sanitizer level in the 3-compartment sink, and the reag… | 2020-09-01 |
| 3336 | 3336 | CHERRY BLOSSOM HEALTH AND REHABILITATION | 115652 | 3520 KENNETH DRIVE | MACON | GA | 31206 | 2017-07-20 | 456 | F | 0 | 1 | 2OMO11 | Based on observation, record review, and staff interview, the facility failed to ensure that their walk-in freezer was maintained at a temperature to keep foods frozen solidly to prevent possible foodborne illness. There were a total of 68 residents that consumed an oral diet. Findings include: During initial tour of the kitchen with Dietary Aide AA on 7/17/17 beginning at 8:00 a.m., the thermometer on the outside of the walk-in freezer was observed to indicate a temperature of 44 degrees (Fahrenheit) (F) on the inside. During interview with Dietary Aide AA at this time, he first stated that the thermometer indicated 4 degrees, but when asked to look at it closer he stated that it read 40 degrees, and that this freezer had been working OK. During observation on the inside of the walk-in freezer, two surveyors and Dietary Aide AA were unable to find a thermometer on the inside to verify the accuracy of the thermometer on the outside. During further observation, a puddle of a dark liquid was seen on the floor of the freezer on the right side, and Dietary Aide AA stated that the blueberries in the freezer had been leaking. Continued observation revealed a clear plastic bag on the freezer shelf dated 5/29, and labeled as chicken livers, that was completely thawed with a large amount of bloody liquid inside the bag. Two ten-pound tubes of sealed ground beef were observed on a bottom shelf of the freezer, and the beef felt soft and could be depressed with a finger. Further observation of cases of vegetables in the walk-in freezer including squash, baby carrots, and mixed vegetables revealed they were soft to the touch when pressed. These observations were verified by Dietary Aide AA, who stated that he was not aware of any concerns with the walk-in freezer. Review of the Storage Temperature Log for the walk-in freezer revealed that the acceptable temperature range was 0 degrees F or below, and that the temperature had been recorded as a 0 every day from 5/1/17 through 7/17/17 at 6:00 a.m. (the morning the foods in the … | 2020-09-01 |
| 3946 | 3946 | EVERGREEN HEALTH AND REHABILITATION CENTER | 115720 | 139 MORAN LAKE ROAD, NE | ROME | GA | 30161 | 2017-07-20 | 241 | D | 0 | 1 | B2N111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, review of the undated policy Resident Rights and Perineal/Incontinence Care and record review, the facility failed to ensure one of 19 stage 2 sampled residents (R#22) were provided care and services in a manner enhancing their dignity and respect. During an interview, R#22 said sometimes the Certified Nurse Assistant's (CNAs) would not put a brief on him during the day and it embarrassed him. Findings include: 1. R#22's Admission Record dated 5/28/15 indicated he was admitted on [DATE] with [DIAGNOSES REDACTED]. Review of the 5/12/17 quarterly Minimum Data Set (MDS) assessment section H Bladder and Bowel identified under H0300 Urinary Continence and H0400 Bowel Continence indicated the resident was incontinent of bladder and bowel. Section G Functional Status identified G0110 Activities of Daily Living (ADL) assistance coded R#22 as requiring extensive assistance of two staff members for toilet use. Review of R#22's Care Plan, reviewed and revised on 5/10/17, indicated he was incontinent of bowel and bladder and wore adult briefs daily for protection. The goal for R#22 was to remain free from skin breakdown and he would be clean and odor free. His interventions included using a disposable brief and changing and providing incontinent care as needed. During the initial tour on 7/17/17 at 2:31 p.m., R#22 said that a Certified Nursing Assistant (CNA) on the night shift would not put a brief on him after he had an incontinent episode. He said I was having a cramp in my leg and I couldn't lift my leg up for her but she said I could so she said she wasn't going to put one on me. When asked if he thought this was abuse, he said no, it was more a dignity thing. On 7/14/16 at 9:50 a.m. during a second interview, R#22 said most of the staff on first shift do not put a brief on him. He said especially after my shower on Tuesday and Thursday mornings. They say I need to air out. It's embarrassing to not have one on in the day. During … | 2020-09-01 |
| 3947 | 3947 | EVERGREEN HEALTH AND REHABILITATION CENTER | 115720 | 139 MORAN LAKE ROAD, NE | ROME | GA | 30161 | 2017-07-20 | 253 | E | 0 | 1 | B2N111 | Based on observations, staff interviews, and facility records review, the facility failed to ensure housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior were provided. Findings include: 1. On 7/17/17 at 9:30 a.m. and on 7/19/17 at 11:30 a.m. a heavy buildup of black dirt was observed on the floor of the kitchen, especially along the walls around the kitchen and the dishwashing room. The legs of the three food preparation counters were soiled with a black substance. The Dietary Supervisor (DS) was present and verified the observations. 2. On 7/19/17 beginning at 2:50 p.m., the environmental tour of the facility was conducted with the Maintenance Director. The following observations were observed and noted by the facility staff: On the South Hall, there were two Hoyer-lifts that had dark brown and black build-up around the base and feet of the lift. On the North Hall, rooms 208, 210, 217, 219 and 220's drapes were not correctly hung. They were not attached to the traverse rod. On the North Hall, two cloth chairs at the table in the family room were covered in large brown and yellow dried circles. On the North and South Halls, all the resident's entry doors frames at the base board had dark brown and black build-up. On the North Hall, the door going outside onto the patio, had hair, unidentifiable particles, and dark brown and black buildup at the base of the long window sill. On the South Hall, a horizontal blind on the window beside the door going out to the smoke area, had missing and broken slates. 3. On 7/19/17 at 2:50 p.m., the Maintenance Director said he would get with housekeeping about the items above that needed to be cleaned. He also made a note of the environmental issues and said he would address them. 4. On 7/20/17 at 9:08 a.m. the Director of Nurses provided a copy of the untitled and undated cleaning schedule. She said the Certified Nurse Aides are responsible on the night shift for cleaning resident equipment. She said they did not have documenta… | 2020-09-01 |
| 3948 | 3948 | EVERGREEN HEALTH AND REHABILITATION CENTER | 115720 | 139 MORAN LAKE ROAD, NE | ROME | GA | 30161 | 2017-07-20 | 278 | D | 0 | 1 | B2N111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and staff interview the facility failed to ensure three (Residents (R) #88, #12, #22) out of a stage II sample of 28 residents were appropriately assessed for all of their care needs. R#88's assessment failed to reflect his tube feeding status; R#22's assessment failed to reflect splinting and R#12's assessment failed to reflect his dental status. Findings include: 1) Review of R#88's Face Sheet in his medical record revealed he was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of his physician's orders [REDACTED]. through the abdominal wall). Review of a Speech Therapy Discharge Summary, dated 3/14/17, revealed the speech therapist wrote a progress note stating the resident had evidence of signs and symptoms of aspiration on PO (by mouth intake). The note stated R#88 had signed a waiver releasing the facility from responsibility in the event of a medical crisis because of oral intake, as a result of him refusing his tube feeding and eating/drinking by mouth. R#88's Minimum Data Set (MDS) admitted d 4/11/14, his thirty-day MDS assessment dated [DATE], and his quarterly MDS assessment dated [DATE] were each coded, at Section K-710 Percent of Intake by Artificial Route, to indicate the resident was receiving 51% or greater of his nutrition/daily calorie intake from tube feedings. On 7/19/17 at 1:15 p.m. Licensed Practical Nurse (LPN) AA was asked if the resident received tube feedings. She stated she consistently worked on the unit the resident resided on and stated he always refused to take the [MEDICATION NAME] via peg tube and he always drank 100% of the supplement. She stated she had worked on the unit since the time R#88 was admitted and he had always refused the supplement into his peg tube. On 07/19/17 at 2:30 p.m. LPN DD was interviewed about the resident's tube feeding. She stated she worked 12 hours shifts from 7:00 a.m. to 7:00 p.m. and stated the resident had refused to tak… | 2020-09-01 |
| 3949 | 3949 | EVERGREEN HEALTH AND REHABILITATION CENTER | 115720 | 139 MORAN LAKE ROAD, NE | ROME | GA | 30161 | 2017-07-20 | 313 | D | 0 | 1 | B2N111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that two of four (Resident (R) #3 and R#22) sampled residents reviewed for vision received proper assistive devices to maintain vision. Findings include: 1. R#3 Admission Record dated 5/28/15 indicated he was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the quarterly Minimum Data Set (MDS) revealed R#3 was coded under Section B Hearing, Speech, and Vision B1000 Vision: 1. Impaired- sees large print, but not regular print in newspapers/books. R#3 was coded under B1200 Corrective Lenses as No corrective lens (contacts, glasses, or magnifying glass) used. Review of R#3's care plan dated 5/31/17 indicated he had impaired visual function with a goal of no decline. Interventions included arrange consultation with eye care practitioner and to monitor, document and report acute eye problems. During an interview on 7/19/17 at 10:10 a.m. R#3 said that he had told the social worker about 2 months ago, when she came to see him about his dentures, that he needed glasses and she said she would look into it. He said she had not told him anything since then. During an interview on 7/19/17 at 1:45 p.m., the Social Worker (SW) said she did not know R#3 had vision problems. She said usually the residents let her know when they are having problems. She said there was no written communication regarding when a resident was having vision or other problems received or documented from nursing staff. She said a couple months ago when she was visiting with R#3, he told her he needed dentures but did not say anything about glasses. 2. R#22's Admission Record dated 5/28/15 indicated he was admitted on [DATE] with [DIAGNOSES REDACTED]. Review of the quarterly Minimum Data Set (MDS) revealed R#22 was coded under Section B Hearing, Speech, and Vision B1000 Vision: 1. Impaired- sees large print, but not regular print in newspapers/books. R#22 was coded under B1200 Corrective Lenses … | 2020-09-01 |
| 3950 | 3950 | EVERGREEN HEALTH AND REHABILITATION CENTER | 115720 | 139 MORAN LAKE ROAD, NE | ROME | GA | 30161 | 2017-07-20 | 371 | F | 0 | 1 | B2N111 | Based on observation, interview, and record review, the facility failed to ensure food was prepared, stored, and served in a sanitary manner. This had the potential to affect 87 of 87 residents receiving food from the facility kitchen. Findings include: 1. On 7/17/17 the following observations were made in the facility kitchen: a. At 9:30 a.m. the 22 Multi-Quat Sanitizer in the third compartment of the three-compartment sink was measured using test strips by the Dietary Supervisor (DS). The level of the sanitizer was 100 parts per million (ppm). Review of the manufacture instructions for the 22 Multi-Quat Sanitizer provided by the DS and as posted on the wall above the three-compartment sink revealed the sanitizer level of the sanitizer was supposed to be between 150 and 400 ppm to sanitized cook ware and food contact surfaces. The DS verified the sanitizer was at 100 ppm. During the tour of the kitchen, on 7/17/17 at 9:30 a.m., the shelf over the stove was soiled with dried food substances and a greasy build up; the two gas ovens and the top of the gas six burner stove was soiled with a heavy buildup of food and black substance; the wall behind the oven and behind the three-compartment sink were soiled with a dried substance. At 9:30 a.m. the outside surface of the four 96-gallon containers containing flour, sugar, thickener, and corn meal were each soiled with a build-up of dried sticky food residue on the lids and the sides of the large container. Inside the container of the white thickener was a black round item about 1/8th of an inch long. The DS verified all four containers were each soiled and upon request removed the black 1/8 substance out of the thickener using a measuring cup. He stated he did not know what the substance was but verified it was not part of the thickener. Also observed, during this time, was a fan mounted on the wall that was blowing into the kitchen food preparation area. It had a heavy buildup of dirt and dust. The DS acknowledged that the fan was dirty. b. At 7/17/17 at 9:33 a.m. two… | 2020-09-01 |
| 4126 | 4126 | RIVER BROOK HEALTHCARE CENTER | 115635 | 390 SWEAT STREET | HOMERVILLE | GA | 31634 | 2017-07-20 | 278 | D | 0 | 1 | CSOQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to accurately code the Minimum Data Set (MDS) for one (1) resident's contracture. Findings included: Observations: On 7/18/2017 2:21p.m., resident was observed lying in bed awake. Resident was observed to have a contracture of her upper extremity and did not have a splint device. On 7/19/2017 8:34 a.m., resident was sitting up in a Geri-chair in the solarium. Resident did not have a splint device in place. On 7/19/2017 2:48 p.m., resident was sitting up in a Geri-chair in the solarium. Resident was awake, but no splint device in place. Record Reviews: Review of the care plan, for R#30, revealed that the care plan did not address resident's contracture. Per review of resident's most recent MDS for 6/16/17 which was not coded for hand contracture, but was coded for leg contracture which resident did not have did not have. Interviews: On 07/17/2017 02:31 p.m., staff HH reports that resident has a contracture of her upper extremity and does not have a splint device, and does not receive restorative services due to there not be a restorative nurse. On 07/19/2017 2:48:17 p.m., interviewed staff DD who confirmed that resident does have a contracture of her upper extremity. She also reviewed resident's care plan that was last updated on 5/29/2017, and reported that the care plan did not address resident's contracture. Staff explained that she did not find any information in the care plan to address the resident's contracture. She explained that her expectation was for nursing staff to evaluate residents, make a referral to therapy for an evaluation, and forward that information to the physician. Her expectation is for the resident to be treated according to physician's orders [REDACTED]. On 07/20/2017 9:08 a.m., interviewed MDS Coordinator, who stated that resident is not currently receiving maintenance services. She stated that there was documentation for (MONTH) and (MONTH) … | 2020-04-01 |
| 4127 | 4127 | RIVER BROOK HEALTHCARE CENTER | 115635 | 390 SWEAT STREET | HOMERVILLE | GA | 31634 | 2017-07-20 | 279 | D | 0 | 1 | CSOQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to update care plans to address a contracture to the left hand for one (1) resident and smoking for one (1) resident. The census was fifty-seven (57). Findings included: Observations: On 7/18/2017 2:21p.m., resident was observed lying in bed awake. Resident was observed to have a contracture of her upper extremity and did not have a splint device. On 7/19/2017 8:34 a.m., resident was sitting up in a Geri-chair in the solarium. Resident did not have a splint device in place. On 7/19/2017 2:48 p.m., resident was sitting up in a Geri-chair in the solarium. Resident was awake, but no splint device in place. Record Reviews: Review of resident #30's care plan on 7/19/2017 at 1:07 p.m., resident's care plan did not address resident's contracture. Per review of resident's most recent MDS for 6/16/17, resident is not coded for left upper extremity impairment. MDS was not coded for hand contracture, but was coded for leg contracture which resident did not have did not have. Interviews: On 07/17/2017 02:31 p.m., staff HH reports that resident has a contracture of her upper extremity and does not have a splint device, and does not receive restorative services due to there not be a restorative nurse. On 07/19/2017 2:48:17 p.m., interviewed staff DD who confirmed that resident does have a contracture of her upper extremity. She also reviewed resident's care plan that was last updated on 5/29/2017, and reported that the care plan did not address resident's contracture. Staff explained that she did not find any information in the care plan to address resident's contracture. She explained that her expectation was for nursing staff to evaluate residents, make a referral to therapy for an evaluation, and forward that information to the physician. Her expectation for resident to be treated according to physician's orders [REDACTED]. On 07/20/2017 9:08 a.m., interviewed MDS Coordinator, wh… | 2020-04-01 |
| 4128 | 4128 | RIVER BROOK HEALTHCARE CENTER | 115635 | 390 SWEAT STREET | HOMERVILLE | GA | 31634 | 2017-07-20 | 280 | D | 0 | 1 | CSOQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to revise the plan of care to include pressure ulcers for one resident (#7), from a total sample of 21 residents. Findings include: Resident (R) #7 was admitted to the facility on [DATE] with a stage three pressure ulcer to the sacrum. Treatment was obtained and the pressure ulcer was assessed until healed on 3/31/17. A new pressure ulcer to the left buttock was identified on 2/24/17. A review of the clinical record revealed that the resident was noncompliant with turning and repositioning while in the bed. Treatment was obtained and the pressure ulcer was assessed routinely until the resident discharged to the hospital on [DATE]. A care plan was developed that included that R#7 was a risk for impaired skin integrity and had a healing area to the sacrum. However, the care plan had not been revised to include the development of the pressure ulcer to the left buttock. During an initial review of the resident's closed clinical record, the care plan was not included. During an interview on 7/20/17 at 2:30 p.m. the MDS coordinator stated that she had been unable to locate the original care plan, so she had printed out another copy. She confirmed at that time that the care plan provided did not include the development of the pressure ulcer to the left buttock. | 2020-04-01 |
| 4129 | 4129 | RIVER BROOK HEALTHCARE CENTER | 115635 | 390 SWEAT STREET | HOMERVILLE | GA | 31634 | 2017-07-20 | 287 | D | 0 | 1 | CSOQ11 | Based on staff interview and record review, the facility failed to electronically transmit a completed Discharge Minimum Data Set (MDS) assessment to the State database for one resident (#80) from a total sample of 21 residents. Findings include: Resident #80 was discharged to home from the facility on 2/15/17. A review of the clinical record revealed that staff had completed a Discharge MDS assessment on 5/19/17. However, there was no evidence, the assessment had been transmitted to the State database. During interviews on 7/20/17 at 11:04 a.m. and 11:37 a.m., the Administrator stated that she had completed an audit of MDS assessments, upon becoming Administrator at the facility in (MONTH) (2017). She stated that she thought this MDS had been transmitted, but confirmed that although the MDS had been completed, it was not transmitted to the State database. | 2020-04-01 |
| 4130 | 4130 | RIVER BROOK HEALTHCARE CENTER | 115635 | 390 SWEAT STREET | HOMERVILLE | GA | 31634 | 2017-07-20 | 318 | D | 0 | 1 | CSOQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to provide maintenance services for one (1) resident after stopping Range of Motion (ROM) services for one (1) resident with a contracture without a physician's orders [REDACTED]. Findings included: Observations: On 7/18/2017 2:21p.m., resident was observed lying in bed awake. Resident was observed to have a contracture of her upper extremity and did not have a splint device. On 7/19/2017 8:34 a.m., resident was sitting up in a Geri-chair in the solarium. Resident did not have a splint device in place. On 7/19/2017 2:48 p.m., resident was sitting up in a Geri-chair in the solarium. Resident was awake, but no splint device in place. Record Reviews: Review of resident #30's care plan on 7/19/2017 at 1:07 p.m., resident's care plan did not address resident's contracture. Per review of resident's most recent MDS for 6/16/17, resident is not coded for left upper extremity impairment. MDS was not coded for hand contracture, but was coded for leg contracture which resident did not have did not have. Interviews: On 07/17/2017 02:31 p.m., staff HH reports that resident has a contracture of her upper extremity and does not have a splint device, and does not receive restorative services due to there not be a restorative nurse. On 07/19/2017 2:48:17 p.m., interviewed staff DD who confirmed that resident does have a contracture of her upper extremity. She also reviewed resident's care plan that was last updated on 5/29/2017, and reported that the care plan did not address resident's contracture. Staff explained that she did not find any information in the care plan to address resident's contracture. She explained that her expectation was for nursing staff to evaluate residents, make a referral to therapy for an evaluation, and forward that information to the physician. Her expectation for resident to be treated according to physician's orders [REDACTED]. On 07/20/2017 9:08 a.m., in… | 2020-04-01 |
| 4131 | 4131 | RIVER BROOK HEALTHCARE CENTER | 115635 | 390 SWEAT STREET | HOMERVILLE | GA | 31634 | 2017-07-20 | 325 | D | 0 | 1 | CSOQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure 2 residents (R) (R#51 and R#78) of 39 sampled residents were provided with adequate nutritional interventions to maintain their weight. Findings include: R#51 was admitted [DATE] Review of the Admission/Re-Admission Data Collection & Initial Plan of Care form dated 3/3/17 and timed at 6:00 p.m. documents a height of 5 feet (ft) and 7 inches (in) and a weight (wt) of 115 pounds (lbs). Review of Weight Chart dated 3/3/17 notes a wt. of 115 lbs. on 3/3/17 and a wt. of 117 lbs. on 3/16/17. Review of the Nutrition Data Collection Tool signed by the Registered Dietitian (RD) and dated 3/28/17 lists a height of 67 (inches) and a wt of 117 (pounds). It also lists the diet order as Regular, oral intake as good. The RD's notes state that R#51 has good po intake and will continue to monitor. Review of Weight Chart dated 4/18/17 lists a wt. for (MONTH) of 109 lbs,, (MONTH) 107 lbs, and (MONTH) 107 lbs. There were no wts listed for (MONTH) or July. Review of the Admission/Re-Admission Data Collection & Initial Plan of Care form dated 5/29/17 and timed at 3:38 p.m. documents a height of 5 ft and 6 in, and a wt of 108 lbs. The form also lists a Regular diet and Regular liquids. There were no nutritional notes found in the medical record between 3/28/17 and 5/30/17. Review of the Nutrition Progress Note dated 5/30/17 and signed by the DM lists a wt of 108 lbs. A box titled Weight Changes is checked as no. Additional boxes on the form include sections for loss or gain in 30, 90 and 180 days. These three boxes are empty. A narrative notes R#51 had recently returned from a hospital stay, had a regular diet ordered and supplement of Ensure, one can three times a day. The notes also document a one pound weight gain from a weight obtained on (MONTH) 17, (YEAR). No reference is made to the admission weight of 117 pounds or the weight loss of nine pounds over a period of 89 days. Review of the poli… | 2020-04-01 |
| 4132 | 4132 | RIVER BROOK HEALTHCARE CENTER | 115635 | 390 SWEAT STREET | HOMERVILLE | GA | 31634 | 2017-07-20 | 332 | D | 0 | 1 | CSOQ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure the medication error rate was less than 5%. A total of 33 medication opportunities were observed with three errors for three of six residents for a total error rate of 9%. Findings include: 1. During an observation on 7/19/17 at 4:26 p.m. Licensed Practical Nurse (LPN) FF administered four units of Humalog insulin, subcutaneously to the abdomen of Resident (R) #18, for a finger stick blood sugar result of 195. However, a review of the clinical record revealed a physician's orders [REDACTED]. During an interview on 7/20/17 at 9 a.m., LPN FF confirmed that she had administered four units of Humalog insulin for the blood sugar result of 195 on 7/19/17. She stated that was the insulin she had available for the resident and she had followed the sliding scale that was printed on the Humalog insulin box. A review of the Humalog insulin box revealed that the sliding scale printed on the box was different from the sliding scale in the physician's orders [REDACTED]. During an interview on 7/20/17 at 12:30 p.m., Regional Nurse Consultant BB stated that the physician had approved that the [MEDICATION NAME] and humalog were interchangable and the pharmacy maintained the documentation. However, he confirmed that the amount of insulin LPN FF administered was incorrect. 2. R #53 had a physician's orders [REDACTED]. The medication was scheduled to be administered at 8 a.m. However, LPN GG failed to administer the medication on 7/20/17 at 8:32 a.m., during the medication administration observation. LPN GG confirmed that she had forgotten to administer the Therems-M tablet during an interview on 7/20/17 at 8:45 a.m. 3. R#4 had a physician's orders [REDACTED]. The medication was scheduled to be administered at 8 a.m. and 4 p.m. However, LPN FF failed to administer the medication on 7/19/17 at 4:12 p.m., during the 4 p.m. medication administration observation. | 2020-04-01 |
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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 );