cms_GA
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34 rows where "inspection_date" is on date 2017-08-17
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| Link | rowid ▼ | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 568 | 568 | CHATSWORTH HEALTH CARE CENTER | 115280 | 102 HOSPITAL DRIVE | CHATSWORTH | GA | 30705 | 2017-08-17 | 223 | D | 0 | 1 | NFWB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, a review of resident clinical records, and a review of the facility's abuse policy, the facility failed to ensure that one Resident (R #75) was free from physical abuse. The sample size was 25 residents. Findings included: A review of the demographics revealed that R#75 is a [AGE] year old resident. A review of the Nursing Progress Notes for R#75 dated 8/11/17 (11:29 p.m.) revealed the following: This nurse heard resident yelling get out of here and observed pushing a male residents (wheelchair) from her room. Male resident twisted resident's (right) arm/wrist and punched resident in stomach. Resident was taken into room and removed from male resident. Upon assessment resident had no (signs or symptoms) of redness or injury to areas in altercation. No (complaints of) pain or discomfort. Resident states I'm fine. He needs to stay out of my room. (Responsible Party) .and (Physician) notified. A review of the quarterly Minimum Date Set (MDS) assessment revealed that R#75 presents with a Brief Interview for Mental Status (BIMS) score of 12. A score in the range of 8-12 indicates that the resident presents with moderately impaired cognitive understanding. A review of the demographics revealed that R#133 is a [AGE] year old male admitted to the facility on [DATE] with a relevant active [DIAGNOSES REDACTED]. A review of the Nursing Progress Notes for R#133 dated 8/11/17 (10:55 p.m.) revealed the following: (R#133) was observed going into a female resident's room on 400 hall. Female resident requested for resident to remove himself from room and started pushing resident's (wheelchair) out of door. Resident witnessed by this nurse to twist female resident's right arm and punch her in the stomach. Resident redirected from area. A review of the quarterly MDS assessment revealed that R#133 presents with a BIMS score of 99. A score of 99 indicated that the resident was cognitively unable to answer the interview questions. During an in… | 2020-09-01 |
| 569 | 569 | CHATSWORTH HEALTH CARE CENTER | 115280 | 102 HOSPITAL DRIVE | CHATSWORTH | GA | 30705 | 2017-08-17 | 225 | D | 0 | 1 | NFWB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to investigate and report alleged violation of abuse for one Resident (R #75). The sample size was 25 residents. Findings included: A review of the demographics revealed that R#75 is a [AGE] year old resident. A review of the Nursing Progress Notes dated 8/11/17 (11:29 p.m.) revealed the following: this nurse heard resident (R#75) yelling get out of here and (sic) observed pushing a male resident (wheelchair) from her room. Male resident twisted resident's (right) arm/wrist and punched resident (R#75) in stomach (sic). Resident was taken into room and removed from male resident. Upon assessment resident had no (signs or symptoms) of redness or injury to areas in altercation. No (complaints of) pain or discomfort. Resident states I'm fine. He needs to stay out of my room. (Responsible Party) .and (Physician) notified. A review of the Minimum Date Set quarterly assessment revealed that R#75 presents with a Brief Interview for Mental Status (BIMS) score of 12. A score in the range of 8-12 indicates that the residents presents with moderately impaired cognitive understanding. A review of the demographics revealed that R#133 is a [AGE] year old resident with a relevant active [DIAGNOSES REDACTED]. A review of the Minimum Date Set quarterly assessment revealed that R#133 presents with a BIMS score of 99. This indicated that the residents was cognitively impaired and unable able to answer the interview questions. During an interview with the Nursing Home Administrator (NHA) on 8/16/17 at 2:41 p.m. he provided the abuse policy. He confirmed that the policy was not dated and stated that he was not sure when it was implemented or when it was last revised. He stated that he was informed on Monday, during morning meeting, that an incident occurred on Friday, 8/14/17 between R#133 and R#75 and was that R#133 punched R#75 and twisted her arm. He confirmed that he had not reported the incident to th… | 2020-09-01 |
| 570 | 570 | CHATSWORTH HEALTH CARE CENTER | 115280 | 102 HOSPITAL DRIVE | CHATSWORTH | GA | 30705 | 2017-08-17 | 323 | E | 0 | 1 | NFWB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview, review of product labels and Material Safety Data Sheets (MSDS), the facility failed to ensure that potentially hazardous bath and hygiene products and treatments for head and body lice were kept secured in one of two shower rooms on one of four halls. The facility census was 105 residents. Findings include: Observations conducted on 8/14/17 at 11:00 a.m. revealed the door to the shower room on the 400 hall did not have a lock. No one was in the shower room and residents were ambulating and moving about in wheelchairs in the hallway outside the shower room door. Inside the shower room, the cabinet below the sink had a latch with no lock. The cabinet contained a gallon container of liquid soap with no cover, hair sprays, alcohol based hand gel and various shampoos including an opened 8.5 ounce plastic bottle of Theragel coal tar shampoo, a 2 ounce container of Nix cream rinse, opened and partially used, and an opened, partially used 4 ounce container of Perigo GoodSense Permethrin Lotion 1% Lice treatment. Review of the product label for Perigo GoodSense Permethrin Lotion 1% Lice treatment revealed if the product is ingested medical help should be obtained immediately. Review of product label for Nix Permethrin Lice Treatment indicated medical help should be contacted if swallowed. The MSDS for Theragel coal tar shampoo indicated ingestion could cause nausea, vomiting or diarrhea and a physician should be contacted. Further observations on 8/17/17 at 4:42 p.m. with the Assistant Director of Nursing (ADON) and the Resident Care Coordinator (RCC) revealed the cabinet under the sink in the unlocked shower room contained the gallon bottle of shower soap with no cover, 2 ounce container of Nix cream rinse, 8.5 ounce bottle of Theragel coal tar shampoo and Perigo GoodSense Permethrin Lotion 1% Lice Treatment. Residents were ambulating and moving about in the hallway out side the shower room. Interview 8/17/17 … | 2020-09-01 |
| 960 | 960 | MUSCOGEE MANOR & REHABILITATION CTR | 115351 | 7150 MANOR ROAD | COLUMBUS | GA | 31906 | 2017-08-17 | 280 | D | 0 | 1 | 57JI11 | Based on observation, interview, record review, and review of facility policies, it was determined the facility failed to develop comprehensive care plans for one resident from a sampled 32 residents reviewed for range (Resident #22) Findings include: Policy review of the facility's policy titled Care Planning dated 11/15/16 revealed it is the responsibility of the Care Plan Coordinator to ensure concerns/changes for a resident is updated in the care plan. The policy continues, it is the responsibility of the Director of Nursing (DON), Registered Nurse (RN) Supervisor and Licensed Charge Nurses to assure provisions of care are delivered in accordance with the care plan. Policy review of the facility's document titled Nurse Aide Maintenance Program dated 8/19/13 revealed Range of Motion (ROM) to extremities is provided during the delivery of care by the Certified Nursing Assistant (CNA) assigned to the residents that shift. Interview conducted 8/14/17 3:40 p.m. with Unit Manager (UM) BB at South Wing Nurses' Station revealed Resident (R)#22 had a contracture of her bilateral knees. Observations made on 8/16/17 at 10:43 a.m. revealed R#22 was in the facility's Main Dining Room. R# 22 was seated in a geri -chair. The resident was positioned on her left side with both of her knees bent at a 90-degree angle. No splints were observed in place on the resident's bilateral knees. When an attempt was made to ask R#22 about her contracted knees, the resident was only able to speak a few words. The resident stated my back is hurting. R#22 was not able to respond to any further interview questions. Interview conducted on 8/17/17 at 10:26 a.m. with CNA DD next to the South Wing Nurses' Station revealed the CNA was assigned to R#22 for the current shift. CNA DD stated she was familiar with R#22's care needs and that she had assisted the resident with her bed bath earlier in the shift. The CNA also stated R#22 does not wear splints and that passive range of motion (PROM) is provided to R#22's knees by her assigned CNA when they … | 2020-09-01 |
| 961 | 961 | MUSCOGEE MANOR & REHABILITATION CTR | 115351 | 7150 MANOR ROAD | COLUMBUS | GA | 31906 | 2017-08-17 | 318 | D | 0 | 1 | 57JI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, - record review, facility policy review, it was determined the facility failed to provide range of motion services for two residents (Resident (R) #22 and #30 from a sampled, 32 residents reviewed for range of motion. Findings include: 1. Policy review of the facility's Nurse Aide Maintenance Program document dated 8/19/13 revealed it is the policy of Muscogee Manor to provide range of motion (ROM) for residents on a maintenance program by the Certified Nursing Assistant (CNA) assigned to direct care of the resident. Observation on 08/17/17 at 11:13 a.m. revealed R#22 in her assigned room receiving passive range of motion (PROM). CNA II was performing PROM to the resident's bilateral knees. R#22 could not tolerate the movement of her knees. R#22 was observed with a noticeable change in her facial expression from calmness to tense grimacing when CNA II attempted the PROM intervention on left knee. CNA II was not able to move the resident's left knee. CNA II then attempted to perform PROM on the resident's right knee. Again, R#22 grimaced, shook her head back and forth while reaching for CNA II's hands as she attempted to perform PROM on the resident's left knee. CNA II was not able to move R#22's right knee. Review of R#22's Resident Assessment - Activities of daily living - Functional Rehabilitation Potential form dated 3/1/17 revealed the resident had been receiving PROM assistance by the facility's Restorative Technicians. On 3/1/17 PROM assistance for R#22 was transferred to the CNA Maintenance Program. Further review of the document revealed since R#22 was no longer a candidate for licensed therapy services or Restorative Program the resident was transferred to the CNA Maintenance Program. Record review of R#22's Aide Assignment Record from 6/1/17 through 8/171/17 failed to reveal any documentation to indicate ROM assistance had been provided to R#22. Interview conducted 8/14/17 3:40 p.m. with Unit Manager… | 2020-09-01 |
| 1123 | 1123 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 225 | D | 0 | 1 | I6YR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to assure all alleged violations involving abuse and/or injuries of unknown source were reported immediately to the State Survey Agency (SSA) for two of three residents reviewed for abuse (Resident (R)#42 and R#95), from 39 sampled residents. The facility failed to provide evidence R#95's injury of unknown origin was thoroughly investigated. The facility failed to prevent the potential for further abuse after R#42 alleged he was abused by a staff member. Findings include: Review of the facility's policy titled, Detection and Prevention of Resident Abuse and Neglect (undated) indicated it did not address the regulatory requirement for reporting allegations of abuse, neglect, and injuries of unknown origin to the SSA within 2 hours (cross reference to F226). 1. Review of R#42's clinical record revealed he was a long-term resident with [DIAGNOSES REDACTED]. Per the resident's most recent quarterly Minimum Data Set ((MDS) dated [DATE], the resident was cognitively intact (Section C- Cognitive Patterns), as evidenced by a Brief Interview for Mental Status (BIMS) score of 14/15. Per Section G- Functional Status R#42 required extensive assistance of staff with toileting and section H - Bladder and Bowel documented he was always incontinent of urine. Review of facility investigation records revealed on 8/5/17, during the 3:00-11:00 p.m. shift, R#42 reported a Certified Nursing Assistant (CNA) put urine soaked shirt in his face and berated him. Review of facility investigation records revealed this allegation, which the facility categorized as abuse, was not reported to the SSA until 8/7/17. Review of witness statements for this investigation confirmed facility staff were aware of the allegation on 8/5/17, as Licensed Practical Nurse (LPN) CG documented Between the hours of 2130 and 2230 (9:30-10:30 p.m.) R#42 requested to see her because a CNA was upset with him because his urine got onto his … | 2020-09-01 |
| 1124 | 1124 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 226 | E | 0 | 1 | I6YR11 | Based on record review, interview, and review of the facility's Abuse Prevention policy, the facility failed to develop policies and procedures in specific detail to assure allegations of abuse, neglect, injuries of unknown source, misappropriation, and/or exploitation were reported to the State Survey Agency (SSA) within required time frames. The reporting portion of the policy was not developed in sufficient detail to assure compliance with federal regulations regarding reporting for suspicion of a crime. The failure to assure the reporting component was developed impacted two (Resident (R) #42 and R#95) of three residents reviewed for abuse. Findings include: Review of the current Abuse Prevention policy, dated 9/13/16 provided by the Administrator on 8/14/17 revealed the reporting component of the policy failed to include specific information about the required time frames for reporting allegations. The prevention component noted that allegations were to be reported immediately to State Agencies, but failed to define the term immediately or provide the specific timeframes required by regulation (within no more than two hours for allegations of abuse or reports of serious bodily injury, and within no more than 24 hours for all other allegations). The policy failed to denote the specific State Agencies to whom the report was to be made and also did not address reporting suspicions of a crime. Review of this policy revealed it, also, was not developed to include current requirements about reporting abuse and neglect. Review of the policy revealed The report of the Initial Investigation will be telephoned or faxed to the State Complaint Investigation and Referral Unit within 24-hours of the incident. The policy did not address the (YEAR) changes to federal regulation which defined that allegations of abuse, as well as any allegation with serious bodily injury, were to be reported in no more than two hours. The policy also did not address the (YEAR) regulatory changes which required policies and procedures to incl… | 2020-09-01 |
| 1125 | 1125 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 241 | E | 0 | 1 | I6YR11 | Based on observations, interviews, and review of the Resident Dignity and Social Services Policies - Dignity policies, the facility failed to provide meal service to three residents (R#16, R#147, and R#179) of 39 sampled residents. The census was 147. Findings include: Review of the facility policy Resident Dignity, dated (MONTH) 2106, revealed: Policy - The facility will promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individuality. The Procedures of the resident dignity policy revealed, 2. Facility staff will encourage and assist resident's as necessary with daily activities of daily living in a manner to promote psychosocial well-being and the resident's highest level of independence. The Social Services Policies - Dignity revealed, 'Dignity' means that in their interactions with the resident, staff carries out activities which assist the resident to maintain and enhance his/her self-esteem and self-worth. One of the examples listed under dignity revealed, Promoting resident independence and dignity in dining (such as avoidance of day-to-day use of plastic cutlery and paper/plastic dishware, bibs instead of napkins, dining room conducive to pleasant dining). On 8/14/17 observations were made of the lunch meal on the secured dementia unit (Unit 3, Hall 400). The scheduled meal service times for Unit 3 identified the first meal tray cart was to be delivered at 12:30 p.m., the second cart was to be delivered at 12:40 p.m. and the third cart was to be delivered at 12:45 p.m. The first cart was delivered to the unit at 12:35 p.m. After passing trays to the residents eating in their rooms, three trays remained on the cart and the cart was brought to the dining room at 12:52 p.m. The trays were not distributed to the three residents identified on the tray tickets who were seated in the dining room at that time. R#179 was in the dining room at 12:35 p.m., she repeatedly asked for something to drink and eat. He… | 2020-09-01 |
| 1126 | 1126 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 242 | D | 0 | 1 | I6YR11 | Based on observation, record review, and interview, the facility failed to honor food choices for four of 39 sampled residents (R#124, R#112, R#63, and R#130). Residents made selections between the regular and alternate meal; however, they did not receive the foods they chose. Residents were not offered milk for the noon meal as one of their beverage selections even though it was supposed to be served per the menu. Findings include: 1. Review of the menu for lunch on 8/14/17 showed the regular selection consisted of sliced ham, scalloped potatoes, glazed carrots, corn bread, apple cinnamon cake, and milk. Review of the tray cards showed the alternate selection consisted of barbeque chicken, baked beans, and coleslaw. 2. Meal observations made on 8/14/17 for the lunch meal in the main dining room: a. At 12:25 p.m. R#124 was observed with a meal consisting of the alternate meal of two chicken wings, baked beans, coleslaw, corn bread and a piece of cake. The resident stated, I wanted ham, potatoes, and carrots (the main meal). This happens (not getting what selected) almost daily. The resident's tray card was on the table and she pointed to it showing she selected the regular meal and not the alternate. At 12:48 p.m. the resident got up and left the dining room. She ate less than 25% of the chicken, beans, coleslaw, and cake. At no time during the meal was she offered the regular selection. b. At 12:32 p.m. R#112 was studying her tray card while her meal sat on the table in front of her. She stated she had ordered ham, scalloped potatoes, and carrots for lunch. She was served three chicken wings, baked beans, and coleslaw. She showed the surveyor her tray card which indicated she selected the regular meal and not the alternate. The resident stated, This is terrible. I did not order this. It happens all the time (getting food she did not choose). No one comes around to check on us. When the resident's plate was checked at 1:03 p.m. after she had vacated the dining room, she had consumed less than 25% of her meal. At … | 2020-09-01 |
| 1127 | 1127 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 248 | E | 0 | 1 | I6YR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and facility policy review of Activities Policies - Conducting Activities, the facility failed to provide for an ongoing program of activities designed to meet the needs for two of three cognitively impaired residents (R#61 and R#78) of 39 sampled residents. Activities were not provided in sufficient numbers/types, were not held as scheduled on the dementia unit, and there were no activities on weekends or in the evenings. Findings include: Review of the (MONTH) 2007 facility policy titled, Activities Policies - Conducting Activities revealed its purpose was to provide a well-organized and safe activity program for all residents. The policy did not address 1:1 activities, specialized activity needs of residents with dementia, or weekend and evening activities. Observations on 8/14/17 at 12:20 p.m., 1:15 p.m., 2:12 p.m., 3:10 p.m., 3:35 p.m., 4:35 p.m., and 4:46 p.m.; on 8/15/17 at 9:55 a.m. and 4:42 p.m., and on 8/16/17 at 8:51 a.m., 9:25 a.m., 10:32 a.m., 10:47 a.m., 11:12 a.m. 11:40 a.m., 12:00 - 1:30 p.m., and 3:00 p.m. revealed R#78 and R#61 were in bed in their shared room. There were no activities observed to be provided during any of the above observations for these two residents. A television set was present in the resident's room; however, it was not turned on during any of the above listed observations. There was no radio or other equipment noted in the room to provide R#78 and R#61 with auditory or sensory stimulation. 1. Review of R#78's clinical record revealed the following pertinent Diagnoses: [REDACTED]. Review of her most recent annual comprehensive Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 6/12/17, revealed staff assessed the resident to have severe cognitive impairment, verbal behaviors, as totally dependent on staff for care, and was bedfast. Section F: Preferences for Customary Routine and Activities documented her activity preferences included liste… | 2020-09-01 |
| 1128 | 1128 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 253 | E | 0 | 1 | I6YR11 | Based on observations, interview and record review, the facility failed to ensure the building was adequately clean and maintained in three of four resident units (100, 200, and 400 rooms) and in common areas. The census was 147 residents. Findings include: 1. Environment observations/tour a. 100 Hall Room 101B - on 8/16/17 at 9:49 a.m. and during the environmental tour, on 8/17/17 between 9:45 a.m. and 11:06 a.m., five red splatters or spills were observed low on the bedroom wall and several more on the floor adjacent to the bathroom. During the environmental tour with the Maintenance Director (MD), Maintenance Staff, and Director of Housekeeping (DH) on 8/17/17 between 9:45 a.m. to 11:06 a.m. the same splatters were observed. The MD stated housekeeping staff was responsible to clean the splatters off the walls and floors. Flooring in the hallway - on 8/16/17 at 10:08 a.m. and during the environmental tour, on 8/17/17 between 9:45 a.m. and 11:06 a.m., cracks were observed on all the linoleum floor tiles (linoleum) extending across the hallway at the start of the lower numbered section of the 100 hall. In addition, in the higher numbered sections, across from the oxygen storage room, seven tiles were cracked in a row down the hallway creating a slight edge between the higher and lower part of the tiles. Twelve more tiles were cracked length wise down the hallway outside rooms 109 through room 111. The MD was interviewed during the environmental tour on 8/17/17 between 9:45 a.m. to 11:06 a.m. and stated it was a foundation issue which affected the flooring. He stated there had been a large tree causing the flooring to buckle and tiles to crack on the 100 hall. The MD stated the tree was removed about six months ago, and he was still watching for additional settling. The MD stated the facility planned to build an addition onto the 100 hall and all the flooring in the hallway would be replaced at that time. The MD stated the facility was in the planning phase of this project and it had not yet been approved by gover… | 2020-09-01 |
| 1129 | 1129 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 258 | E | 0 | 1 | I6YR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure sound levels were maintained within acceptable levels for 5 of 39 sampled residents (R#140, R#152, R#124, R#35, and R#40) and residents who attended the resident council meeting. Staff made too much noise in the hallways and equipment was not maintained to minimize sound levels affecting residents' ability to sleep and rest. Findings include: 1. Observations a. 100 Hall - On 8/14/17 at 5:03 p.m., the floor polisher across from the conference room made a very loud noise as a staff member went up and down the hallway polishing the linoleum floor. Surveyors who were in the conference room at the time were unable to carry on a conversation. b. 200 Hall - On 8/16/17 at 10:29 a.m. a housekeeping staff wheeled 2 barrels down the hall (a 55-gallon round barrel and a square one). Noise from the wheels on the round barrel were very loud. The surveyor was unable to carry on a conversation with another surveyor as the staff member pushed the barrels down the hall. This occurred outside room [ROOM NUMBER]. c. 300 Hall - On 8/16/17 at 10:35 a.m. the Assistant Dietary Manager was pushing a dietary department cart (with sandwiches and drinks) down the hall. The wheels squeaked, creating a very loud noise as the cart was pushed from one end to the other end of the hall. Several minutes later, as the Assistant Dietary Manager was pushing the cart back, she stated to the surveyor, It (the cart) is very loud. It is the wheels. We can send it to maintenance and they can fix it. It is like this (loud and squeaky) a lot. The noise from the cart could be heard from one end of the 300 hall to the other end. The door into the locked unit from the 300 hall was loud and squeaky as a staff member came in on 8/16/17 at 10:58 a.m. and again several minutes later as two additional staff members exited the secure unit into the 300 hall. 2. Interviews a. Four residents expressed concerns with th… | 2020-09-01 |
| 1130 | 1130 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 275 | D | 0 | 1 | I6YR11 | Based on record review and interview, the facility failed to assure that an annual assessment was completed in required timeframe's for two residents (R#61 and R#78.) of 39 sampled residents. Specially, the facility staff failed to complete and sign the annual Minimum Data Set (MDS) within 14 days of the Assessment Reference Date (ARD.) Findings include: Review of R#78's the clinical record revealed an annual MDS with an ARD of 6/12/17. Further review of this assessment revealed that Section V (Care Area Assessment) and Section Z (Assessment Administration), attesting that the assessment was complete, was not signed until 6/29/17, the 17th day after the ARD. Review of R#61's clinical record revealed an annual MDS with an ARD of 4/6/17. Further review of this assessment revealed that Section V (Care Area Assessment) and Section Z, attesting that the assessment was complete, was not signed until 4/24/17, the 18th day after the ARD. Interview on 8/16/17 at 4:20 p.m. with MDS Coordinators (MDS BB), who was a Licensed Practical Nurse, revealed she was one of the facility's three. She confirmed both R#61 and R##78's annual assessments were not completed in the required timeframe, and should have been finished within 14 days of the ARD. She stated the MDS department was supposed to have three staff but the department had been short staffed as people just up and left. She related that for a period, she was the only staff completing MDS, and as a result, Some MDSs were late. | 2020-09-01 |
| 1131 | 1131 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 279 | D | 0 | 1 | I6YR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, record review, and review of the Careplans and Care Plans policies, the facility failed to revise the care plan to reflect the resident's current status for one of 39 sampled residents (R#78). Specifically, the facility failed to update/revise the care plan regarding a newly developed pressure ulcer and the use of side rails for accidents. Findings include: Review of the facility policy titled, Careplans (sic) revised (MONTH) (YEAR) revealed, Areas of concern or potential concern will be addressed with measurable goals and specific person-centered approaches to promote achievement of the goal(s). An additional policy titled, Care Plans (revised (MONTH) 2010 and provided by the Administrator as current) revealed, Upon change of condition, complete the Change in Condition report and update the care plan. Review of R#78's clinical record revealed the following pertinent Diagnoses: [REDACTED]. Review of her most recent annual comprehensive Minimum Data Set ((MDS) dated [DATE], revealed Section C-Cognitive Patterns identified R#78 had both short and long-term memory problems and was severely impaired regarding daily decision making. Section G-Functional Status revealed she required total assistance for bed mobility, bathing, eating, toilet use, dressing, and personal hygiene. R#78 was bedfast. Section H-Bladder and Bowel identified she was always incontinent of bladder and bowel. Section J1800 documented R#78 had not had any falls since her last assessment. Section M-Skin Conditions documented she was at risk for pressure ulcers, but did not have any pressure ulcers. Section N-Medications revealed the resident did not receive any [MEDICAL CONDITION] medications. Pressure Ulcer: Review of an Initial and Weekly Healing Pressure Record form dated 8/1/17 revealed, on 7/22/17, the resident was identified with an unstageable pressure ulcer to the left buttock that was 3x3 centimeters in size. Review of the care pla… | 2020-09-01 |
| 1132 | 1132 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 314 | D | 0 | 1 | I6YR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and review of the facility policies titled, Wound Management Program, Policy and Procedures for the Prevention and treatment of [REDACTED].#78). The delay in assessing and providing physician-ordered treatments for a newly acquired pressure ulcer, had the potential to delay healing of the wound. Findings include: Review of the (MONTH) 2010 facility policy titled, Wound Management Program revealed, A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing. The policy indicated, A Facility Pressure Ulcer Report is completed weekly. Review of the undated Policy and Procedures for the Prevention and treatment of [REDACTED]. to provide appropriate treatment modalities for wounds according to industry standards of care. The policy indicated, If a resident is admitted with or there is a new development of a pressure ulcer or lower extremity ulcer, the following procedure is to be implemented . Initiate Initial and Weekly Pressure Ulcer Healing while (sic) will include: type of wound, location, date, stage (pressure ulcers only) . length, width, and depth, wound base description and if present drainage, odor, undermining, tunneling and/or pain. Review of the facility's Pressure Ulcer Prevention and Treatment Interventions Guidelines, dated 2013, revealed, Provide pressure ulcer topical treatment as ordered. Review of R#78's electronic clinical record revealed she was receiving hospice care and had [DIAGNOSES REDACTED]. Review of her most recent annual comprehensive Minimum Data Set ((MDS) dated [DATE], revealed Section C-Cognitive Patterns identified R#78 had both short and long-term memory problems and was severely impaired regarding daily decision-making. Section G-Functional Status revealed she required total assistance for bed mobility, bathing, eating, toilet use, dressing and personal hygiene. Resident #7… | 2020-09-01 |
| 1133 | 1133 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 323 | D | 0 | 1 | I6YR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, professional reference, interview, review of the Resident Assessments policy, and record review, the facility failed to provide an environment free of accident hazards for two (Resident (R)#61 and R#78) of three residents reviewed for accidents, from 39 sampled residents. Specifically, side rails were not firmly attached to the bed when a specialty hospice mattresses was used, resulting in gaps which could potentially cause injuries. Findings include: According to the website: https://www.fda.gov/downloads/medicaldevices/productsandmedicalprocedures/generalhospitaldevicesandsupplies/hospitalbeds/ucm 8.pdf the Clinical Guidance For the Assessment and Implementation of Bed Rails In Hospitals, Long Term Care Facilities, and Home Care Settings, The population at risk for entrapment are patients who are frail or elderly or those who have conditions such as . confusion and pain . The risk may also increase due to technical issues such as the mis-sizing of mattresses, bed rails with winged edges, loose bed rails, or design elements such as wide spaces between vertical bars in the rails themselves . Evaluation is needed to assess the relative risk of using the bed rail compared with not using it for an individual patient. Interview on 8/17/17 at 11:45 a.m. with the Director of Nursing (DON) and Assistant Director of Nursing (ADON) revealed the only policy they could provide related to side rails was the (MONTH) (YEAR) Resident Assessments policy that read for staff to complete a side rails assessment as indicated. Review of this policy revealed it did not indicate when or how side rails were to be used, how the staff would determine what configuration, or size rails a resident required, based on their individual needs, and did not identify the need for ongoing monitoring related to safe use of this equipment. 1. Review of R#78's clinical record revealed she was receiving hospice care and had [DIAGNOSES REDACTED].#78 had both sho… | 2020-09-01 |
| 1134 | 1134 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 364 | E | 0 | 1 | I6YR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, record review, and review of the contracted food service provider company recipes, the facility failed to follow recipes for preparation of pureed food items for 14 residents who had physician orders [REDACTED]. The facility census was 147. Findings include: 1. Unit 3 During the initial lunch dining observation on 8/14/17 on Unit 3, the secured dementia unit, began at 12:30 p.m. The first food cart was scheduled to arrive on the unit at 12:20 p.m. The first cart was delivered to the unit at 12:35 p.m. After staff were observed passing trays to the residents eating in their rooms, three trays remained on the cart and the cart was brought to the dining room at 12:52 p.m. The trays were not distributed to the three residents identified on the tray tickets who were seated in the dining room at that time. The insulated plate covers were ajar and it was unlikely palatable temperatures were maintained. The second meal cart was delivered to the unit at 1:03 p.m. It was scheduled to be delivered at 12:40 p.m. Trays were delivered to the remaining residents who ate in their rooms. The cart was then brought to the dining room. Three residents at the same table were served their meal trays at that time, however, the remaining trays were not distributed to the residents. Staff standing by the trays shuffled the trays around on the cart trying to group the trays together for residents seated at the same table. However, all of the trays needed for the residents in the dining room still had not been delivered to the unit. The insulated plate covers were ajar on the plates and it was unlikely palatable temperatures were maintained. At 1:12 p.m. on 8/14/17 Licensed Practical Nurse (LPN) GG confirmed only three of the 19 residents in the dining room had been served lunch. LPN GG explained staff were waiting until trays for all people seated together at one table arrived prior to serving any resident seated at that table. LPN G… | 2020-09-01 |
| 1135 | 1135 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 368 | E | 0 | 1 | I6YR11 | Based on observation, record review and interview, the facility failed to ensure meals were served at meal times comparable to normal mealtimes in the community. The deficient practice affected 50 residents who ate in the secured unit and nine residents who ate during the second seating in the main dining room out of a total of 147 residents; residents were observed eating lunch as late as 2:25 p.m. Meal service was haphazard for residents eating in the secured unit with a lack of organization of trays, resulting in residents' trays sitting for extended time frames before being served. Findings include: 1. Review of a CQI (Continuous Quality Improvement) Tool for Dietary Services report dated 5/30/17 indicated a concern with dining room meal service as follows: The D/R (dining room) service did not seem to flow smoothly. The dessert was held hostage till after the meal and some left the D/R before getting their dessert or (sic) it was served .Unit 3 D/R - resident's (sic) were not served their trays together by table leaving some resident eating and other waiting and then trying to get the other resident's tray and or food . (Sic) 2. Review of Food Committee Minutes dated 6/11/17 indicated a resident's comment, Evening meals are sitting too long before being served to residents. 3. Review of an all staff Inservice Sign In Sheet dated 6/22/17 showed 93 staff members attended. One of the topics, Delivery of Trays indicated there was a concern with the delivery and timing of meals as follows: Completion of tray pass is taking longer due to trays being sent out to the floor out of order. Is there anyway (sic) trays can be set up on the tray rack in order of the rooms? 4. Planned meal times Review of the Meal Services Times form indicated planned meal times for lunch for the Unit 3 carts, Unit 2 carts, short hall and second seating in the main dining room were: -Unit 3 first cart - 12:30 p.m. -Unit 3 second cart - 12:40 p.m. -Unit 3 third cart - 12:45 p.m. -Unit 2 right cart - 12:50 p.m. -Unit 2 left cart - 1:00 p.m. … | 2020-09-01 |
| 1136 | 1136 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 371 | F | 0 | 1 | I6YR11 | Based on observation, interview, and record review, the facility failed to develop and implement a system to ensure the kitchen was maintained in a clean and sanitary condition for food storage and preparation. This failure had the potential to affect all 147 residents in the facility. Findings include: The initial tour of the facility's kitchen was conducted on 8/14/17 from 8:40 a.m. until 10:13 a.m. Observations during this time included: Kitchen Floor: -Debris was observed under the deep fryer which appeared to be coagulated grease with food particles, including pieces of what appeared to be potatoes. -A pipe behind the stove had been sawed off and capped. It was approximately 4 inches in diameter, and approximately 4 inches high. It was heavily soiled with what appeared to be dried food particles, grease, and dirt on the outer and inner surfaces. The area around the base of the pipe appeared wet. -There was a hole in the floor (where another pipe had been capped off), approximately 4 inches in diameter, near the two-compartment food preparation sink area and stove which was approximately 3/4 of an inch below the level of the floor tiles. There was standing water in the hole which appeared to have food particles and grease floating in the water. The Dietary Manager stated it used to have a cover over it. -There was a missing piece of metal threshold, approximately 8 inches long, between the red floor tiles and the larger linoleum squares near the steam table. The area where the threshold was missing was wet and there was debris, which appeared to be food particles, dirt, and grease. -There was debris which appeared to be food items, dust, and dirt under the work stations for food preparation. The rubber floor mats (which were made with holes in them) in front of the stove and three-compartment sink had a build-up of visible food debris in the holes. The kitchen floor was sticky and greasy. A container of powdered thickener was on the shelf under the food preparation table where pureed food items were prepared.… | 2020-09-01 |
| 1137 | 1137 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 441 | E | 0 | 1 | I6YR11 | Based on observation and interview, the facility failed to handle laundry in a manner to prevent cross-contamination. Specifically, soiled and clean laundry were comingled in an outdoor area unprotected from the elements. The census was 147. Findings include: Observation on 8/17/17 at 10:08 a.m. revealed laundry was processed in a separate building behind the main facility. The doors to both the clean and soiled laundry areas were propped open. The entrance to the soiled laundry area was through a screened-in porch and observation revealed soiled laundry was stored on the porch outside the building. The tour of this area revealed it included a large uncovered cloth bin, half-filled with soiled clothing. A plastic barrel filled with soiled linen was also stored in this area, the cover to the bin had a large open hole for staff to fill the container without touching the cover. Multiple pillows were on a table touching the screening on the back wall of the porch. In the area between the soiled linen tub, barrel, and shelf with pillows, was another large tub containing clean, neatly folded blankets. The cloth bins used to transport clean laundry were stained or worn, and contained paper and plastic waste. During an interview on 8/17/17 at 10:17 a.m. with contract Laundry/Dietary Aide (DA) DD said barrels and bins kept outside on the screened porch were never covered because this was considered part of the soiled area. She stated the pillows observed on the table (as well as additional pillows in plastic bags) were also soiled. She stated the pillows either came from hospitals or another nursing home that was evacuated approximately 3 months earlier due to a bad storm. She confirmed the pillows were all waiting to be thrown away, and she did not know why the pillows had not been immediately disposed of if they were soiled and could not be cleaned/reused. DA DD said because the soiled laundry was stored on the screened porch, Stuff sitting out in this area can get wet when there is rain or a storm. She confirmed the un… | 2020-09-01 |
| 1138 | 1138 | RIVERSIDE HEALTH CARE CENTER | 115375 | 5100 WEST ST NW | COVINGTON | GA | 30014 | 2017-08-17 | 469 | E | 0 | 1 | I6YR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and interview, the facility failed to ensure adequate pest control services were provided to address the presence of cockroaches, flies, spiders and gnats for residents residing on three out of four wings (100 unit, 300 unit, and 400 unit) and in the kitchen. Staff failed to report the presence of bugs/insects to the maintenance department; interventions to eradicate insects were not timely. The census was 147. Findings include: 1. Environmental Observations/Tour a. 100 Unit -Room 115 - On 8/14/17 at 2:08 p.m., several gnats were observed flying above Resident (R)#218's bedside tray. -Room 115 - On 8/14/17 at 2:35 p.m. a gnat was flying between R#219 and the surveyor during the resident interview. b. 300 Unit -Observations were conducted in the Unit 3 dining room beginning at 12:50 p.m. on 8/14/17. R#17 received her lunch tray at 1:04 p.m. CNA ZZZ assisted R#17 by removing the plate cover and by opening the drinks on R#17's tray, then walked away. At 1:06 p.m., three flies were observed to land on R#17's food. During the next five minutes, flies landed and re-landed on R#17's food six times. R#17 did not respond to the presence of the flies and did not receive staff assistance or support to address the flies. The Dietary Manager (DM) was interviewed at 10:30 a.m. on 8/16/17 and confirmed flies were a problem in the kitchen. The DM confirmed, with food deliveries and dietary personnel coming in and out of the back door to perform tasks such as taking out trash, it was very difficult to keep the flies out of the kitchen, especially in the summer. -During the environmental tour with the Maintenance Director (MD) on 8/17/17 between 9:45 a.m. and 11:06 a.m. a fly was observed flying in the 300 Hallway, halfway down the hall. c. 400 Unit -During the environmental tour with the MD on 8/17/17 between 9:45 a.m. - 11:06 a.m., a gnat was observed flying in the hallway adjacent to the dining room. -400 Hall near the … | 2020-09-01 |
| 1219 | 1219 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2017-08-17 | 252 | D | 0 | 1 | 9N8H11 | Based on observations, interviews, and review of the Housekeeping policy, the facility failed to ensure a consistent home-like odor-free environment for 3 of 3 (100, 200 and 300) halls in which odors were periodically present where residents resided. Findings include: On 8/14/17 at 10:47 a.m., observation of the bathroom in room 204 revealed that it had a strong urine odor. Further observation revealed that there were no visible signs of soilage in the restroom. On 8/14/17 at 11:33 a.m., a strong urine odor was noted in the bathroom of room 208, which was shared by four male residents. Further observation revealed that the toilet appeared clean, and no urinals or other urine collection devices were seen in the bathroom. On 8/15/17 at 9:15 a.m., observation of the restroom in room 204 revealed that it continued to have a strong urine odor present. Observation during a tour on 8/16/17 at 10:20 a.m. -11:00 a.m. of the halls reveals a strong unpleasent odor indicative of urine in rooms 103, 107, 108, 208, 214 307 and 308. Interview with the Housekeeping Supervisor verified that the facility has problems containing odors in these rooms. The Housekeeping Supervisor further revealed that the facility had just changed chemicals and cleaning products to help control odors. | 2020-09-01 |
| 1220 | 1220 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2017-08-17 | 371 | F | 0 | 1 | 9N8H11 | Based on observation, record review, and staff interview, the facility failed to maintain the holding temperature of two hot foods on the steam table above 135 degrees, and failed to ensure that the temperature of one of one walk-in coolers was maintained at or below 41 degrees to prevent the potential for foodborne illness. There were 72 residents who received an oral diet, and the sample size was 35 residents. Findings include: 1. On 8/15/17 at 12:27 p.m., Dietary Aide CC was observed taking steam table temperatures at lunch with the facility's calibrated thermometer. Further observations revealed that the temperature she obtained for a pre-packaged pureed chicken pouch was 128 degrees Fahrenheit (F), and the temperature of a pureed corn pouch was 122 degrees F. This was verified during interview with Dietary Aide CC. Interview with the facility's Registered Dietician (RD) on 8/15/17 at 12:49 p.m., she verified the temperature of the pureed chicken was 128 degrees and the pureed corn was 120 degrees. During observation at this time, the RD had the pureed chicken and pureed corn removed from the tray line and reheated to temperature of 140 degrees F. Interview with the Dietary Manager on 8/16/17 at 11:00 a.m. revealed that there were 72 residents who consumed an oral diet. During further interview, she stated that 15 residents were receiving pureed diets, and five of those 15 residents were receiving double portion sizes. The Dietary Manager further stated that when the tray line temperatures were taken on 8/15/17 at 12:27 p.m., 25 trays had already been sent to the floor for the residents, including six pureed diets, with four of the six receiving large portions. Review of the Hot/Cold Temperature Log dated 8/15/17 at tray line start time of 12:00 p.m., revealed that the temperature for the pureed chicken pouch was 170 degrees F, and the pureed corn was 182 degrees F. 2. During observation of the walk-in cooler temperature on 8/14/17 at 9:22 a.m. revealed that it was 42 degrees F. This was verified during inter… | 2020-09-01 |
| 1221 | 1221 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2017-08-17 | 463 | D | 0 | 1 | 9N8H11 | Based on observations and staff interview, the facility failed to maintain a functioning call light system for two (2) of sixty nine(69) residents in the facility. 1. On 8/14/17 at 1:52 p.m., the bathroom call light for rooms 205 and 206 on the locked unit was pulled, and observed to not light up outside the doorway in the hall, to visually alert staff that assistance may be needed. Further observation revealed that a nursing staff member from outside the locked unit responded to the call light, and stated during interview that a light illuminated on the nurse call system located at the nurse's station (which was located outside of the locked unit). On 8/15/17 at 10:20 a.m., the bathroom call light for rooms 205 and 206 was checked again, and this time it did not light up in the hallway outside the room, nor light up or alarm at the console at the nurse's station. This was verified during interview with Certified Nursing Assistant (CNA) AA, who stated that all four residents in rooms 205 and 206 would be able to use the call light. On 8/15/17 at 10:36 a.m., all of the bathroom call lights on the 200-hall were checked with CNA AA and CNA BB, and all of them were fully functional except for rooms 205 and 206 which did not illuminate in the hallway, but this time alarmed at the console at the nurse's station when activated. 2. On 8/14/17 at 10:47 a.m., observation of the call light for room 204-B revealed that there was no push button mechanism at the end of the call light cord, and the call light was not functional. During interview with the Maintenance Supervisor on 8/15/17 at 10:08 a.m., he stated that he found out about needed maintenance repairs by word of mouth from the nursing staff. He further stated there was also a log book to record needed repair work in, but staff was not good about using it. He stated during further interview that he checked the call lights at least monthly. | 2020-09-01 |
| 1428 | 1428 | HARBORVIEW HEALTH SYSTEMS JESUP | 115414 | 1090 W ORANGE ST | JESUP | GA | 31545 | 2017-08-17 | 161 | B | 0 | 1 | 73MR11 | Based on staff interview, review of the resident trust account bank statements, and the Long Term Care Facility Resident's Fund Bond, the facility failed to have a surety bond to cover the amount of funds in the resident trust account. There were 61 residents in the facilty with personal funds accounts. Findings include: The facility had a Long Term Care Facility Resident's Fund Bond in the amount of $25,347.02. However, a review of the bank statements for the resident trust account from (MONTH) through (MONTH) (YEAR) revealed that the balance in the resident trust account exceeded the amount of the surety bond on the following dates: February (YEAR): 2/3/17 through 2/17/17 (15 days) March (YEAR): 3/3/17 through 3/22/17 (20 days) April (YEAR): 4/3/17-4/7/17 and on 4/19/17 (six days) May (YEAR): 5/3/17 through 5/9/17, 5/10/17, and 5/16/17 through 5/22/17 (15 days) June (YEAR): 6/2/17 through 6/5/17 (four days) July (YEAR): 7/3/17 through 7/10/17 and on 7/20/17 (nine days) During an interview on 8/16/17 at 2:40 p.m., the Administrator stated that the surety bond is overseen by the corporate office and she would contact them. | 2020-09-01 |
| 1628 | 1628 | MADISON HEALTH AND REHAB | 115457 | 2036 SOUTH MAIN STREET | MADISON | GA | 30650 | 2017-08-17 | 225 | D | 0 | 1 | 4L7A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the facility's Abuse Policy and resident and staff interview, the facility failed to ensure that an allegation of neglect was reported to the State Agency (SA) and thoroughly investigated to include written, signed statements from all staff, residents and witnesses involved for one residents (R) (R#61) out of 24 sampled residents. Findings include: Review of the Abuse Prohibition Policy and Procedures revised (MONTH) 2008 documented: once a complaint or situation is identified involving alleged mistreatment, neglect, or abuse, including injuries of unknown origin and misappropriation of resident property the incident will be immediately reported. Reporting 1) The administrator will immediately notify the complaint intake and referral unit and/or interested family member of the incident and the pending investigation. The administrator or designee will direct the investigation. Investigation 2) Interviews will be conducted for all pertinent parties. Written signed statements from any involved parties will be obtained. Statements will be gathered from the suspect, person making accusations, resident involved, reliable residents who may have witnessed the incident, and any other persons who may have information. Review of the Minimum Data Set (MDS) Annual assessment dated [DATE] documented R#61 with a Brief Interview of Mental Status (BIMS) score of 15, which indicated cognition intact; and active [DIAGNOSES REDACTED]. During an interview on 8/14/17 at 4:15 p.m., R#61 stated that she felt that she was abused because she had requested her ordered Tylenol and the nurse refused to give her the medication. She revealed that because she would not leave the nurses station and kept asking for the medication, the nurse turned her wheelchair away from the nurse's station and pushed her down the hallway. R#61 revealed that she receives the medications when other nurses are working and she did not understand why he would no… | 2020-09-01 |
| 1629 | 1629 | MADISON HEALTH AND REHAB | 115457 | 2036 SOUTH MAIN STREET | MADISON | GA | 30650 | 2017-08-17 | 282 | D | 0 | 1 | 4L7A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to follow the care plan related to pain medication administration for one Resident (R) (#61) out of 24 sampled residents. Findings include: During an interview on 8/14/17 at 4:15 p.m., R#61 stated that she felt that she was abused because she had requested her ordered Tylenol and the nurse refused to give her the medication. She revealed that because she would not leave the nurses station and kept asking for the medication, the nurse turned her wheelchair away from the nurse's station and pushed her down the hallway. R#61 revealed that she receives the medications when other nurses are working and she did not understand why he would not give her the medication. Resident stated that she does not feel threatened or scared of the nurse working and has no problem with him being her nurse. She would just like to receive her Tylenol as ordered. Review of the Facility Incident Report dated 1/31/17 documented an allegation of staff to resident neglect. R#61 reported that she asked for pain medication for her ear and the nurse stated that she could get it at 8:30 p.m. Resident stated that she fell asleep and woke up at 11:30 p.m. and requested pain medication again and was told by the nurse that she was not getting any and he pushed her wheelchair down the hallway. Witness statement from Registered Nurse (RN) AA revealed that the resident came to the nurse's station requesting Tylenol for sleep. RN AA advised the resident that he could not give Tylenol for sleep. The resident then complained of ear pain, RN again denied the resident the pain medication. RN instructed resident to attempt to go to sleep on her own. Review of the Minimum Data Set (MDS) Annual assessment dated [DATE] documented R#61 with a Brief Interview of Mental Status (BIMS) score of 15, which indicated cognition intact; and active [DIAGNOSES REDACTED]. The Care Area Assessment (CAA) Summary triggered pain with the option to be… | 2020-09-01 |
| 1630 | 1630 | MADISON HEALTH AND REHAB | 115457 | 2036 SOUTH MAIN STREET | MADISON | GA | 30650 | 2017-08-17 | 309 | D | 0 | 1 | 4L7A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow physician orders [REDACTED].#61) out of 24 sampled residents. Findings include: During an interview on 8/14/17 at 4:15 p.m., R#61 stated that she felt that she was abused because she had requested her ordered Tylenol and the nurse refused to give her the medication. She stated that because she would not leave the nurses station and kept asking for the medication, the nurse turned her wheelchair away from the nurses station and pushed her down the hallway. R#61 revealed that she receives the medications when other nurses are working and she did not understand why he would not give her the medication. Resident stated that she does not feel threatened or scared of the nurse working and has no problem with him being her nurse. She would just like to receive her Tylenol as ordered. Review of the Facility Incident Report dated 1/31/17 documented an allegation of staff to resident neglect. R#61 reported that she asked for pain medication for her ear and nurse stated that she could get it at 8:30 p.m. Resident stated that she fell asleep and woke up at 11:30 p.m. and requested something pain medication again and was told by the nurse that she was not getting any and he pushed her wheelchair down the hallway. Witness statement from Registered Nurse (RN) AA revealed that the resident came to the nurses station requesting Tylenol for sleep. RN AA advised the resident that he could not give Tylenol for sleep. The resident then complained of ear pain, RN again denied the resident the pain medication. RN instructed resident to attempt to go to sleep on her own. Review of the Minimum Data Set (MDS) Annual assessment dated [DATE] documented R#61 with a Brief Interview of Mental Status (BIMS) score of 15, which indicated cognition intact; and active [DIAGNOSES REDACTED]. Review of physician orders [REDACTED]. 1. [MEDICATION NAME] (Tylenol) 500 milligrams (mg) every 6 hours as needed for pain/… | 2020-09-01 |
| 2127 | 2127 | PRUITTHEALTH - SWAINSBORO | 115533 | 856 HIGHWAY 1 SOUTH | SWAINSBORO | GA | 30401 | 2017-08-17 | 242 | D | 0 | 1 | 5KKX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff and resident interview, and review of facility documents, the facility failed to assure that one resident (R#125) was provided showers according to resident's choice and shower schedule. The resident sample was 28. Findings: R#125 was admitted to the facility on [DATE]. Review of the medical record revealed [DIAGNOSES REDACTED].>[MEDICAL CONDITION], Primary Hypertension, [MEDICAL CONDITION], Asthma, [MEDICAL CONDITION], and [MEDICAL CONDITION]. Review of the most recent quarterly Minimal Data Set (MDS) (a standardize screening and assessment tool used for long term care residents), dated 7/28/17, revealed under Section C - Cognitive Patterns that R#125 scored a 15 out of 15 on the Brief Interview for Mental Status (BIMS), indicating the resident was cognitively intact. Section G - Functional Status documented that R#125 required limited assistance with one person physical assist for transfers, walking, locomotion, toilet use, dressing, and personal hygiene, and R#125 is depended on staff for bathing with one person physical assistance needed. Review of the comprehensive care plan for R#125 revealed a care plan for self-care deficit activities of daily living (ADL) related to physical status. Resident requires assistance with ADL's. Approaches for R#125 included bath/shower as scheduled, incontinent care after each episode, and assure adequate rest periods. Interview on 8/15/17 at 9:08 a.m., with R#125 who reported that a shower was offered to her at 10:00 p.m., on 8/14/17 but she did not get it as she wants morning showers. R#125 then reported that she was informed that Tuesday is the men's day for showers. Interview on 8/15/17 at 3:30 p.m. with R#125 who reported that she requested a shower this morning but was told that today is showers for men only. Resident is unsure of who she spoke with but she stated she requested a shower tomorrow morning at 10:00 a.m. Interview on 8/16/17 at 10:38 a.m., with FF Certified Nursing Assist… | 2020-09-01 |
| 2128 | 2128 | PRUITTHEALTH - SWAINSBORO | 115533 | 856 HIGHWAY 1 SOUTH | SWAINSBORO | GA | 30401 | 2017-08-17 | 280 | D | 0 | 1 | 5KKX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review the facility failed to revise the care plan to address treatment for [REDACTED].#60. The sample size was 28. Findings include: Review of the resident's care plan revealed there had been no revision of R#60 plan of care to indicate the resident had interventions to reflect any treatment for [REDACTED]. The Braden Scale assessment revealed that the resident was at high risk for impaired skin integrity. Further review for resident R#60's plan of care dated 3/31/17 title Alteration to skin integrity revealed an update added on 4/6/17 for a pressure ulcer to the left heel. Further review of the care plan did not reveal any interventions to address preventive measures for the heel area.Review of the wound assessment notes and physician order revealed that R#60 was receiving treatment for [REDACTED]. Interview with the Treatment Nurse on 8/16/17 at 1:58 p.m. revealed that she was unaware that R#60's care plan was missing interventions to address the pressure ulcer now categorized as a friction area on the left heel area. She reported that area to left heel is a friction area with an intact crust. She stated a crust means a scab and not considered a pressure sore to the left heel. She reported the heel has never been open and is presently being assessed as a friction area. She described the heel as having a crust with no drainage with a harden discoloration, and crust is about a pea size. She stated the friction area is being treated with skin prep. She further stated that she was not the treatment nurse at the time the heel area was identified as a pressure ulcer. She stated that the Director of Nurses was the former treatment nurse prior to she taking the position in latter part of (MONTH) (YEAR) . Interview with the Assistant Director of Nurses on 8/16/17 at 2:36 p.m. confirmed that the resident has a friction area to the left heel and not a pressure ulcer to the left heel. She verified that the care plan… | 2020-09-01 |
| 2129 | 2129 | PRUITTHEALTH - SWAINSBORO | 115533 | 856 HIGHWAY 1 SOUTH | SWAINSBORO | GA | 30401 | 2017-08-17 | 309 | D | 0 | 1 | 5KKX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interviews, and review of the Lippincott procedures - [MEDICAL TREATMENT] care - pre and post [MEDICAL TREATMENT] the facility failed to obtain pre and post [MEDICAL TREATMENT] blood pressures for one resident (R) #15. The sample size was 28 residents. Findings include: Record review revealed that R#15 was admitted to the facility on [DATE]. Review of the resident's Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the resident had a Brief Interview for Mental Status (BIMS) score of 14 indicating that the resident was cognitively intact. Review of section O, Special Treatment and Programs, revealed the resident receives [MEDICAL TREATMENT]. physician's orders [REDACTED].>B/P & Pulse monitor and record before and after [MEDICAL TREATMENT]. Review of Lippincott procedures - [MEDICAL TREATMENT] care - pre and post [MEDICAL TREATMENT] revealed 1.Pre [MEDICAL TREATMENT] - take and record patient/resident blood pressure and pulse, and observe shunt access (AV shunt or Permacath) prior to patient/resident transport to [MEDICAL TREATMENT]. 2. Post [MEDICAL TREATMENT] - Upon return from [MEDICAL TREATMENT], take and record patient/resident blood pressure, pulse and observations of the dressing at the access site. Review of the Medication Administration Record [REDACTED]. The Medication Administration Record [REDACTED]. The MAR for (MONTH) (YEAR) showed documented blood pressure on 7am to 7pm shift on (MONTH) 7 and 16 and on the 7pm to 7am shift on (MONTH) 7 thru (MONTH) 15. Interview on 8/16/17 at 2:39 p.m. with Registered Nurse (RN) CC who reported that R#15 should have vitals taken prior to going to [MEDICAL TREATMENT]. MAR for (MONTH) reflected that vital signs are not being documented consistently before or after [MEDICAL TREATMENT]. Interview on 8/17/17 at 8:36 a.m. with Senior Care Partner GG reported that blood pressure is taken at the [MEDICAL TREATMENT] center and should be transcribed onto t… | 2020-09-01 |
| 3644 | 3644 | NANCY HART CENTER FOR NURSING AND HEALING LLC | 115686 | 2117 DOCTOR WARD ROAD | ELBERTON | GA | 30635 | 2017-08-17 | 334 | C | 0 | 1 | VPQ811 | Based on record review, review of the policy titled Immunizations: Influenza (FLU) Vaccination of Residents, Staff, and Volunteers and staff interviews, the facility failed to provide education related to the risk and benefits of the flu vaccination or obtain informed consent prior to administration of the flu vaccine for five of five residents (R#12, R#15, R#23, R#34 and R#49). The sample was 17 residents. Findings include: Review of the policy titled Immunizations: Influenza (FLU) Vaccination of Residents, Staff, and Volunteers dated 2012 documented: Guideline: All residents, staff and volunteers of our facility should receive the influenza vaccine annually, unless there is a documented contraindication. These vaccines may be administered by any appropriately qualified personnel who are following facility procedures, without the need for an individual physician evaluation or order. Administration Procedure: Informed consent in the form of a discussion regarding the risks and benefits of vaccination will occur prior to vaccination. (In the case residents, this may be with their authorized representative when appropriate. If signed consent is required according to state law, it would occur at this procedural step). R#12 received the flu vaccination to the left deltoid on 9/12/16. There was no evidence that education was provided or informed consent was obtained prior to administration. R#15 received the flu vaccination to the left deltoid on 9/12/16. There was no evidence that education was provided or informed consent was obtained prior to administration. R#23 received the flu vaccination to the left deltoid on 9/12/16. There was no evidence that education was provided or informed consent was obtained prior to administration. R#34 received the flu vaccination to the left deltoid on 9/12/16. There was no evidence that education was provided or informed consent was obtained prior to administration. R#49 received the flu vaccination to the left deltoid on 9/12/16. There was no evidence that education was provided o… | 2020-09-01 |
| 6734 | 6734 | HARBORVIEW HEALTH SYSTEMS JESUP | 115414 | 1090 W ORANGE ST | JESUP | GA | 31545 | 2017-08-17 | 156 | E | 0 | 1 | 73MR11 | Based on staff interview and record review, the facility to provide accurate information on the Notice of Medicare Non-Coverage (Form CMS- ) for five residents (#3, #5, #2, #108 and #94) and failed to provide the skilled Nursing Facility Advance Beneficiary Notice (SNFABN) (Form CMS- ) for two residents (#108 and #94) being discharged from medicare part A services from a total sample of six residents. Findings include: During an interview on 8/17/17 at 9:40 a.m., the Minimum Data Set (MDS) coordinator stated that Resident (R) #3, R#5 and R#2 were receiving skilled services while on Medicare Part A. 1. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#3 on 5/11/17, for skilled services ending on 5/17/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. 2. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#5 on 5/6/17, for skilled services ending on 5/8/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. 3. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#2 on 4/3/17, for skilled services ending on 4/5/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. During an interview on 8/17/17 at 11 a.m., the Social Service Director stated that R#108 and R#94 received skilled services while under Medicare Part A services. 4. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#108 on 7/24/17, for skilled services ending on 7/26/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. In addition, the facility issued Form CMS-R-131, instead of the required skilled Nursing Facility Advance Beneficiary Notice (SNFABN) (Form CMS- ). 5. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#94 on 8/4/17 for skilled services… | 2017-10-01 |
| 6735 | 6735 | HARBORVIEW HEALTH SYSTEMS JESUP | 115414 | 1090 W ORANGE ST | JESUP | GA | 31545 | 2017-08-17 | 280 | D | 0 | 1 | 73MR11 | Based on interviews and record reviews, the facility failed to include a key member of the interdisciplinary team during the care plan meetings for three of three residents reviewed out of a sample size of 23 residents. R# 31, 82 and 88 had numerous care plan meetings with documented signatures of the different disciplines in attendance. A certified nursing assistant (CNA) was not in attendance at any of the 13 meetings reviewed. Findings include: During an interview on 8/16/17 at 9:45 a.m, the RN/MDS Coordinator, BB was asked about the assessment and care planning process. While she responded that she talks with the staff including the CNAs when she is conducting a resident assessment to assist in gathering information she specifically said the CNAs do not attend the care plan meetings. When asked who attends the meeting and how they document the attendance she said the Social Services Director, the Dietary Services Director, the two Unit Manager RNs, herself and the resident and/or family member if they choose to come to the meeting. She stated they all sign a form that is kept in the chart, the Interdisciplinary Care Plan Team Sign In Sheet. Review of the Interdisciplinary Care Plan Team Sign In Sheet(s) for R#31 includes care plan meetings held on 6/21/16, 8/18/16, 11/28/16, 2/9/17 and 3/29/17 with the signatures of staff disiplines of Nursing (RN), Social Services, Activities, and Dietary in attendance at each of the five meetings. A rehab team member attended two of the meetings. The resident was in attendance at one of the meetings and a family member attended four of the five meetings. There are no signatures from a CNA for any of the dates. There is no evidence of a CNA who had responsiblity for the resident attending the care planning meetings. Review of the Interdisciplinary Care Plan Team Sign Sheet for R#82 includes care plan meetings held on 11/6/16, 2/6/17 and 5/10/17 with the signatures of staff disciplines of Nursing (RN), Social Services, Activities and Dietary in attendance at each of the three… | 2017-10-01 |
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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 );