cms_TN
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39 rows where "inspection_date" is on date 2014-05-21
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7247 | 7247 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 157 | G | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, it was determined the facility failed to notify the physician or family of a significant unplanned weight loss for 1 of 3 (Resident #62) sampled residents of the 3 residents reviewed with weight loss. The failure of the facility to notify the physician of Resident #62' significant weight loss of 13.91 percent (%) in one month resulted in actual harm when the resident continued to loss weight. The findings included: Review of the facility's Change in Medical Condition Of Residents policy documented, .Notification of the physician, legal representative, or interested family member, should occur promptly, according to federal regulations, when there is a change in the resident's condition . Loss of appetite/unplanned weight loss . Nurses notes should include documentation of the symptoms and observations associated with the change in condition, the date and time of contact with the physician and family . Medical record review for Resident #62 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of Resident #62's weight records documented the following: a. 4/8/14 - 194 pounds (#). b. 5/8/14 - 167#. c. 5/14/14 - 166#. d. 5/19/14 - 161#. The weight loss from 194 to 167, indicated a significant weight loss of 13.91 percent (%) in one month. The weight loss from 194 to 161 # resulted in a significant weight loss of 17.01% in 6 weeks. The facility was unable to provide documentation of the physician or the family being notified of Resident #62's significant weight loss. Review of the physician progress notes [REDACTED].#62's weight loss. Review of the nurses' notes dated 4/8/14 through 5/12/14 did not document notification to the physician or family of Resident #62's weight loss. During an interview at the 2 west hall nurses' station on 5/20/14 at 10:00 AM, Resident #62's wife stated, They called me last night (5/19/14) and told me he (Resident #62) wasn't eating. Residen… | 2018-02-01 |
| 7248 | 7248 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 164 | E | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, observation and interview, it was determined the facility failed to ensure 3 of 7 (Nurses #2, 3 and 4) nurses provided privacy for residents during medication administration. The findings included: 1. Review of the facility's nursing procedures manual documented, .Policy Name: Administering Medications via Nasogastric / Gastrostomy Tube . screen the resident for privacy . 2. Observations in Resident #131's room on 5/19/14 at 8:20 AM, Nurse #2 did not close the door or the privacy curtains during administration of a topical medication patch onto Resident #131's back. 3. Observations in Resident #137's room on 5/19/14 at 5:10 PM, Nurse #3 did not close the door or the privacy curtains during an accucheck and then administered an insulin injection to Resident #137. 4. Observations in Resident #5's room on 5/19/14 at 6:00 PM, Nurse #4 did not close the door or the privacy curtains during administration of medications via feeding tube. 5. During an interview in room [ROOM NUMBER] on 5/21/14 at 8:45 AM, the Director of Nursing (DON) was asked what she expected the nursing staff to do when administering medications such as insulin injections, topical patches or medications through a feeding tube. The DON stated, .close the door, the curtains. | 2018-02-01 |
| 7249 | 7249 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 241 | D | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review and observation, it was determined the facility failed to ensure 2 of 20 staff members (Certified Nursing Assistants (CNA) #2 and 3) maintained residents' dignity and respect when the staff referred to residents requiring assistance with feeding as feeders. The findings included: 1. Review of the facility's Dignity policy documented, The facility must promote care for the 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 . 2. Observations on the 1st floor on 5/18/14 at 12:26 PM, CNA #2 stated, He's a feeder. 3. Observations on the 1st floor outside room [ROOM NUMBER] on 5/18/14 at 12:30 PM, while serving meal trays CNA #3 referred to residents as feeders. CNA #3 stated, All that's left is feeders Observations on the 1st floor outside room [ROOM NUMBER] on 5/18/14 at 12:35 PM, CNA #3 stated, Those are all feeders. | 2018-02-01 |
| 7250 | 7250 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 253 | E | 0 | 1 | LQD711 | Based on policy review, observation and interview, it was determined the facility failed to provide a clean environment as evidenced by scuffed walls, dirty floors along the baseboards, crumbling window sill, peeling paint over the air conditioning unit, a large area of white putty-like material that was not finished beside the sink, dried spilled areas on the floor and/or ants on the window sill in 7 of 73 (rooms 104, 204, 205, 209, 216, 217 and 230) resident rooms. The findings included: 1. Review of the facility's housekeeping policy documented, .The environment of the facility will be kept clean . through the daily housekeeping . PR(NAME)EDURE . Two housekeepers on each floor will clean resident rooms . The floor technician is responsible for the stripping, waxing and mopping of the common floor areas in . halls and all carpet cleaning . 2. Observations on 5/19/14 beginning at 2:25 PM revealed the following: a. Room 104 - walls were scuffed, dirty and cracked above the baseboard. b. Room 204 - walls were scuffed and the floor was dirty along the baseboards. c. Room 205 - walls were scuffed, window sill was crumbling and paint was peeling over the air conditioning unit. d. Room 209 - walls were scuffed. e. Room 216 - walls were scuffed and the floor was dirty along the baseboards. f. Room 217 - a large area of white putty-like material that was not finished beside the sink; window sill was dirty and the floor was dirty along the baseboards. 3. Observations in room 230 on 5/18/14 at 2:55 PM, revealed dirt on the floor along the baseboards and in front of the closet. There was a brown and a pink dried spilled area, each about an inch in diameter, on the floor beside the bed. The window sill was crumbling and there were ants on the window sill and on the air conditioning unit. 4. During an interview on the second floor 200 hall on 5/19/14 at 3:15 PM, the administrator and the maintenance director were asked about the dirty floors and walls. The administrator stated, We are in the process of stripping the floors c… | 2018-02-01 |
| 7251 | 7251 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 280 | G | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review and interview, it was determined the facility failed to ensure care plans were revised to reflect the current status for unplanned weight loss or the risk for emergency bleeding care related to [MEDICAL TREATMENT] shunt site for 3 of 35 (Residents #14, 25 and 62) sampled residents reviewed of the 19 included in the stage 2 review. The failure to put care plan interventions in place for unplanned signficant weight loss resulted in actual harm for Residents #25 and 62. The findings included: 1. Review of the facility's care plan policy documented, .Plans of care are developed by the interdisciplinary team, to coordinate and communicate care approaches and goals for the resident . The team . should present findings from assessments . Existing goals and approaches should be reviewed and revised, as needed . When a new approach or goal is identified, the entry should be dated using the date the goal / approach is entered on the care plan . 2. Medical record review for Resident #25 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of dietary progress notes documented the following: a. 12/6/13 - .Quarterly Review - Current wt. (weight) 166# (pounds). b. 2/10/13 (typo should be 14) - .RD (Registered Dietitian) Review Jan (January) 2014 wgt (weight) 150# (arrow for down) 16# 9.% (percent) Significant loss. No Feb (February) wgt Available . 3. Care Plan . Review of the care plan dated 9/12/13 documented, .PROBLEMS / STRENGTHS . AT NUTRITIONAL RISK . MECHANICALLY ALTERED DIET . GOALS . RESIDENT WILL TOLERATE DIET CONSUMING 75%- (to) 100% OF MEALS WITH NO UNPLANNED WEIGHT CHANGES . The care plan did not address Resident #25's significant weight loss. During an interview in the 2nd floor restorative dining room on 5/19/14 at 6:35 PM, the Registered Dietician (RD) was asked if Resident #25 ever received any interventions to prevent unplanned weight loss during November 2013 to January 201… | 2018-02-01 |
| 7252 | 7252 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 282 | D | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, review of incident log, observation and interview, it was determined the facility failed to ensure a care plan intervention for a fall was followed for 1 of 19 (Resident #62) sampled residents reviewed of the 35 residents included in the stage 2 review. The findings included: Review of the facility's care plan policy documented, .Plans of care are developed by the interdisciplinary team, to coordinate and communicate care approaches and goals for the resident . Medical record review for Resident #62 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of an Incident Without Details and Interventions log documented, a fall on 4/3/14 with injury going to the bathroom and a fall 5/7/14 without injury. Review of a nurse's note dated 4/3/14 documented, .Pt (patient) found on floor near bathroom . skin tears to right arm and right knee . Review of a nurse's note dated 5/7/14 documented, .pt found in floor laying in front of BR (bathroom) door . Review of the care plan dated 5/31/13 documented, .4/3/14 . pull tab personal alarm placed . Observations in Resident #62's room on 5/18/14 at 2:45 PM, revealed Resident #62 in the bed with the call light underneath the bed and there was no pull tab personal alarm in place as care planned. Observations in Resident #62's room on 5/19/14 at 8:00 AM and on 5/19/14 at 10:40 AM, revealed there was no pull tab personal alarm in place for Resident #62 as care planned. Observations in Resident #62's room on 5/19/14 at 2:50 PM, revealed there was no pull tab personal alarm in place for Resident #62 as care planned. The clip alarm was across the room behind the recliner. During an interview in Resident #62's room on 5/19/14 at 2:50 PM, Nurse #2 was asked if the resident had a pull tab alarm clipped to him. Nurse #2 stated, Yes, he does. Upon entering the room with Nurse #2 the surveyor informed Nurse #2 the clip alarm was across the room behind the recliner. During an interv… | 2018-02-01 |
| 7253 | 7253 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 312 | D | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, observation and interview, it was determined the facility failed to provide the necessary services for personal hygiene during bathing for 1 of 19 (Resident #19) sampled residents observed. The findings included: Review of the facility's nursing procedures manual documented, .Policy Name: Bath - Bed . PURPOSE . Bed baths promote cleanliness and comfort for the resident who is unable to tub or shower bathe . Residents who are unable to tub or shower bathe should receive a complete bed bath as needed . PR(NAME)ESS . Wash, rinse, and pat dry the back . then wash, rinse and dry the buttocks . Empty the basin; rinse well and refill with clean warm water . Wash, rinse, and dry the genital area . Observation in Resident #19's room on 5/20/14 at 10:30 AM, Certified Nursing Assistant #2 performed a complete bed bath for Resident #19. CNA #2 washed Resident #19's face, trunk, arms, axillary and genital area. Then CNA #2 proceeded to wash the resident's legs and feet. CNA #2 then washed the resident's buttocks, washing off a moderate amount of fecal material from the area. CNA #2 then proceeded to wash the resident's back, and assisted the resident with positioning and donning a clean shirt and heel boots. CNA #2 wiped the resident's hair with a wash cloth dampened in the dirty bath water. CNA #2 did not wash her hands or change her gloves or the bath water during the bed bath. CNA #2 removed her gloves and donned a clean pair without washing her hands. CNA #2 removed Resident #19's top dentures from the resident's mouth, took them to the sink and cleaned them with a toothbrush and toothpaste. CNA #2 then removed the gloves and washed her hands. During an interview in room [ROOM NUMBER] on 5/21/14 at 8:45 AM, the Director of Nursing (DON) was asked when should staff perform pericare during a bedbath. The DON stated, After the feet and legs. If they do it before, they should change the water first. The DON was asked if she expecte… | 2018-02-01 |
| 7254 | 7254 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 314 | D | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed medical record review and interview, it was determined the facility failed to ensure treatment was provided for pressure ulcers for 1 of 3 (Resident #127) sampled residents with pressure ulcers of the 35 included in the stage 2 review. The findings included: Closed medical record review for Resident #127 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a nurse's note dated 2/15/14 documented, .2 open blisters to L (left) buttocks area and 1 open blister to R (right) buttocks . Review of a physician's progress note dated 2/20/14 documented, .Buttocks (sign for with) Stage II Decubitus (pressure sore) . During a telephone interview on 5/21/14 at 11:15 AM and 11:30 AM the physician was asked if he remembered ordering a treatment for [REDACTED]. There are no orders to treat the stage 2 pressure ulcer nor was there evidence treatment was provided for the ulcer. | 2018-02-01 |
| 7255 | 7255 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 322 | D | 0 | 1 | LQD711 | Based on the review of the Geriatric medication handbook, observation and interview, it was determined the facility failed to properly administer medications for 1 of 1 (Resident #5) residents receiving medications via feeding tube, as evidenced by the nursing staff forced dissolved medications through the tube using the syringe plunger, instead of allowing the medications to flow into the tube by gravity. The findings included: Review of the Geriatric medication handbook, tenth edition, documented, .ENTERAL TUBE ADMINISTRATION . Remove plunger from the 60mL (milliliter) syringe and connect syringe to clamped tubing . flush tubing using gravity flow . Pour dissolved/diluted medication in syringe and unclamp tubing, allowing medication to flow by gravity . Observations in Resident #5's room on 5/19/14 at 6:00 PM, Nurse #4 administered medications via Resident #5's feeding tube. Nurse #4 crushed two medications and dissolved them in approximately 5 cubic centimeters (cc) water, each in a separate medication cup. Nurse #4 then drew up the medications separately with a 60 cc piston syringe and pushed the medication through the feeding tube using the syringe plunger. Nurse #4 flushed the feeding tube with 30 cc water using the same technique. Nurse #4 did not allow the diluted medications or the water flushes to flow into the feeding tube by gravity. During an interview in in Resident #5's room on 5/21/14 at 8:45 AM, the Director of Nursing (DON) was asked how she expected nursing staff to administer medications per a feeding tube and if they are supposed to push the medications using the syringe plunger. The DON stated, It should really go in by gravity. They (nurses) should put it (medication) in and pour the water in. | 2018-02-01 |
| 7256 | 7256 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 325 | H | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to adequately address and maintain the nutritional status for 2 of 4 (Residents #25 and 62) sampled residents of the 3 residents reviewed who experienced weight loss. The facility's failure to implement interventions resulted in a significant weight loss causing actual harm and substandard quality of care to Residents #25 and 62. The extended survey for substandard quality of care was done on 5/21/14. The findings included: 1. Review of the facility's Weight Loss and Malnutrition policy documented, .Maintenance of adequate nutrition and hydration is necessary for the resident to maintain health, and prevent complications such as malnutrition and pressure sores . If intake is less than 50% (percent) alternate foods should be offered. Additional supplements may be provided. Consultation with the Registered Dietician (RD) may be obtained, and coordination with the nursing department should occur, to inform the physician of findings and to implement appropriate nutritional interventions . Severe weight loss is defined as: .1 month > (greater than) 5% . 3 months > 7.5% . 6 months >10% . Consult with the Registered Dietitian to determine calorie, protein, vitamin and mineral requirements. Supplement intake as needed. Make recommendations and obtain orders for nutritional interventions as needed . Review of the facility's Nutritional Assessments policy documented, .A comprehensive nutritional assessment is completed to determine the resident's need for nutritional interventions, for the maintenance of acceptable parameters of body weight . The comprehensive assessment should be utilized to assist the interdisciplinary team with the development of care for each resident . The Registered Dietitian should be consulted for additional assessment in the presence of . weight loss . 2. Medical record review for Resident #25 documented an admission… | 2018-02-01 |
| 7257 | 7257 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 332 | D | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the Geriatric medication handbook, medical record review, observation and interview, it was determined the facility failed to ensure 2 of 7 (Nurses #2 and #3) medication nurses administered medications with a medication error rate of less than 5 percent (%). There were two medication errors made out of 25 opportunities for errors, which resulted in a medication error rate of 8%. The findings included: 1. Review of the Geriatric medication handbook, tenth edition, documented, .EYEDROP ADMINISTRATION . If additional drops of the same or different medication are required in the same eye, wait 3- (to) 10 minutes . Medical record review for Resident #78 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician orders [REDACTED].[MEDICATION NAME] 2 drops to (right) eye qid (four times per day) x (times) 7 d (days) . Observations in Resident #78's room on 5/19/14 at 1:55 PM, Nurse #2 administered 2 drops of [MEDICATION NAME] ophthalmic solution to Resident #78's right eye. Nurse #2 did not allow any time to lapse between the two drops, which resulted in a medication error #1. During an interview in room [ROOM NUMBER] on 5/21/14 at 8:45 AM, the Director of Nursing (DON) was asked how long should a nurse wait between 2 drops of the same ophthalmic solution. The DON stated, Two to three minutes. 2. Review of the Geriatric medication handbook, tenth edition, documented, .DIABETES: INJECTABLE MEDICATIONS .[MEDICATION NAME] R (Regular) . TYPICAL ADMINISTRATION / COMMENTS . 30 minutes prior to meals . Medical record review for Resident #137 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED].[MEDICATION NAME] R . Inject Unit(s) BY INJECTION 4 Times Daily . SLIDING SCALE . 201-250 Give: 4 units . Observations in Resident #137's room on 5/19/14 at 5:10 PM, Nurse #3 performed an accucheck on Resident #137. Resident #137's glucose level was 227. At 5:15 PM,… | 2018-02-01 |
| 7258 | 7258 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 333 | D | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and interview, it was determined the facility failed to ensure 1 of 7 (Nurse #3) medication nurses administered insulin timely in relation to meals which resulted in a significant medication error. The findings included: Review of the Geriatric medication handbook, tenth edition, documented, .DIABETES: INJECTABLE MEDICATIONS .[MEDICATION NAME] R (Regular) . TYPICAL ADMINISTRATION / COMMENTS . 30 minutes prior to meals . Medical record review for Resident #137 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED].[MEDICATION NAME] R . Inject Unit(s) BY INJECTION 4 Times Daily . SLIDING SCALE . 201- (to) 250 Give: 4 units . Observations in Resident #137's room on 5/19/14 at 5:10 PM, Nurse #3 performed an accucheck on Resident #137. Resident #137's glucose level was 227. At 5:15 PM, Nurse #3 administered [MEDICATION NAME] R 4 units subcutaneous (SQ) to Resident #137. Resident #137 did not receive a meal tray until 5:53 PM, 38 minutes after the insulin was administered. During an interview at the nurse's station on 5/19/14 at 5:55 PM, Nurse #3 was asked when should the resident be fed after an injection of [MEDICATION NAME] R. Nurse #3 stated, I think it's within 30 minutes. During an interview in room [ROOM NUMBER] on 5/21/14 at 8:45 AM, the DON was asked what is the timeframe for feeding a resident after a [MEDICATION NAME] R injection. The DON stated, Thirty minutes. Resident #137 did not receive a meal for 38 minutes after the administration of [MEDICATION NAME] R insulin which resulted in a significant medication error. | 2018-02-01 |
| 7259 | 7259 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 371 | E | 0 | 1 | LQD711 | Based on policy review, observation and interview, it was determined the facility failed to ensure kitchen equipment was cleaned after use, food was not left in the drain of the sink, there was proper sanitizer in the 3 compartment sink and the dish machine and frozen food was stored in an air tight container on 2 of 4 (5/18/14 and 5/19/14) days of the survey. The findings included: 1. Review of the facility's SANITIZER USE CONCENTRATIONS FOR FOOD SERVICE AND FOOD PRODUCTION FACILITIES policy documented, .MEAT SLICER . Scrub, rinse, and sanitize parts in pot and pan sink . Wash blade . Use detergent and triple-thick cloths . Rinse, using clean hot water and triple-thick cloths . Sanitize blade . Observations in kitchen on 5/18/14 at 10:22 AM, revealed the meat slicer had a brown dried substance and pieces of meat on the blade and machine shell. During an interview in kitchen on 5/19/14 at 3:18 PM, the Certified Dietary Manager (CDM) stated, It (film stain on the meat slicer) was where they (dietary staff) wiped it off. 2. Review of the facility's Food Storage policy documented, .Sanitation of Equipment . 3-compartment sink . Add sanitizing agent to third tank . 200 ppm (parts per million) . is the required concentration of sanitizer to water ratio . Observations in the kitchen on 5/18/14 at 10:25 AM, dietary staff member #1 checked the 3 compartment sink for accurate sanitizer concentration 3 times with no results visualized. Observations in the kitchen on 5/18/14 at 10:27 AM, revealed a piece of meat in the drain section of the second compartment of the three compartment sink. During an interview in kitchen on 5/18/14 at 10:37 AM, dietary staff member #1 stated, It (sanitizer level in the 3 compartment sink) is not registering . suppose to be 200 (PPM). During an interview in the kitchen on 5/19/14 at 3:23 PM, when asked what was in the drain of the second compartment of the sink. The CDM pulled out a piece of old sausage. The CDM was asked how often the sinks are cleaned. The CDM stated, Every night. The CDM wa… | 2018-02-01 |
| 7260 | 7260 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 441 | E | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, observation and interview, it was determined the facility failed to ensure practices to prevent the spread of infection and cross contamination were maintained when laundry failed to use the proper detergent on 3 of 3 (5/19/14, 5/20/14 and 5/21/14) days of the survey and a certified nursing assistant practiced good hygiene during personal care for 1 of 19 (Resident #19) sampled residents observed. The findings included: 1. Observations in the laundry room revealed the following: a. On 5/19/14 at 9:05 AM - 2 residential type washers running with no detergent in the dispensers. b. On 5/20/14 at 8:30 AM and 2:33 PM - 2 residential type washers running on the cold wash setting with no detergent in the dispensers. c. On 5/21/14 at 10:10 AM - a residential type washer running on the cold wash setting with no detergent in the dispensers. During an interview in the laundry room on 5/19/14 at 9:05 AM, Laundry Technician #1 was asked what is washed in the two residential type washers. Laundry Technician #1 stated, We use 2 regular size washers for clothing protectors and residents clothing. We are using regular detergent and no sanitizer. Maintenance checks the temperature. Laundry technician #1 was then asked what her method was for handling dirty clothing. Laundry technician #1 stated, I wear a clothing protector and gloves but have been out of clothing protectors for approximately 2 weeks. During an interview in the laundry room [ROOM NUMBER]/20/14 at 8:45 AM, Laundry Technician #2 was asked about the residential type washers. Laundry Technician #2 stated, We use cold water and no bleach in these washers During an interview in the laundry room on 5/20/14 at 10:45 AM, the Housekeeping Director stated, The detergent supplier was in this morning and told me . you are out of detergent for the residential type washers. 2. Review of the facility's nursing procedures manual documented, .Policy Name: Bath - Bed . PURPOSE . Bed baths … | 2018-02-01 |
| 7261 | 7261 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 465 | D | 0 | 1 | LQD711 | Based on policy review, observation and interview, it was determined the facility failed to ensure the common areas were clean and sanitary on 1 of 4 (200 hall) halls and 1 of 3 (bathroom across from room 202) bathrooms on the second floor of the facility. The findings included: 1. Review of the facility's Housekeeping Policy documented, .The environment of the facility will be kept clean and environmentally safe through the daily housekeeping staff . PR(NAME)EDURE . Two housekeepers on each floor will clean resident rooms . The floor technician is responsible for the stripping, waxing and mopping of the common floor areas in . 2. Observations on the 200 hall on the second floor on 5/19/14 at 2:25 PM, revealed the hall between rooms 206 and the dining room had large amounts of dirt built up along the baseboard and in the corners on both sides of the hall. The wall outside of room 227 had a brown substance dried on it in a splash pattern. The floor in the hallway outside room 218 had dirt build-up, especially in the corners and along the baseboard. There was no cover over the light fixture in the hall between rooms 205 and 209. There was insufficient lighting in the patient bathroom across from room 202 due to a burned out bulb in the light fixture over the sink. The shower floor had brown stains in the grout and along the edges of the walls. There were white droplet stains on the bathroom floor. During an interview in the 200 hall on the second floor on 5/19/14 at 3:15 PM, the administrator and the maintenance director were asked about the dirty floors and walls. The administrator stated, The wax was so thick on the floors, he (Maintenance Director) had to use a scraper. The administrator was asked about the dirty wall outside room 227. The administrator stated, .Oh. Yes. It looks like a spill from a feeding. The maintenance director was asked when the project with the floors would be finished. The maintenance director stated, Don't know, only have (named 2 other maintenance staff) to help, have other things goin… | 2018-02-01 |
| 7262 | 7262 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 468 | E | 0 | 1 | LQD711 | Based on policy review, observation and interview, it was determined the facility failed to provide firmly secured handrails on 2 of 8 (100 hall and 200 hall) halls. The findings included: 1. Review of the facility's HANDRAILS policy documented, .PR(NAME)EDURE . When handrails are loose or have become unsafe, staff should make maintenance requests listing the exact location of the handrail issue . Maintenance staff will round daily to observe for any handrail issue and work to have them repaired within 48 hours . 2. Observations of the 100 hall on 5/19/14 at 2:25 PM revealed loose handrails in the following locations: a. Outside the nurse's station across from bathroom. b. Outside the patient bath and linen closet. c. Outside the patient bath and across from room 125. d. Between rooms 126 and 127. e. Outside room 128. f. Outside room 131 and across from the east nurse's station. g. Beside the computer room and outside rooms 133 and 134. 3. Observations of the 200 hall on 5/19/14 at 2:25 PM revealed loose handrails in the following locations: a. Outside the bathroom and across from the med supply room. b. Between the clean and soiled utility rooms. c. Outside the nurse's station. d. Outside the nursing supervisor's office and room 204. e. Across from room 229. f . Outside room 237. g. Between the dining room and room 238. During an interview on the second floor outside the dining room on 5/21/14 at 7:30 AM, the maintenance director was asked about the loose handrails. The maintenance director stated, We're working on it. | 2018-02-01 |
| 7263 | 7263 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 469 | D | 0 | 1 | LQD711 | Based on policy review, observation and interview, it was determined the facility failed to provide an environment free of insects as evidenced by ants in a residents room on 2 of 3 (5/18/14 and 5/19/14) days of the survey. The findings included: 1. Review of the facility's Insect and Rodent Control policy documented, .PURPOSE . To prevent the spread of bacteria . PR(NAME)ESS . Windows to the outside should be protected from the entrance of rodents and insects . 2. Observations in room 230 on 5/18/14 at 2:55 PM, revealed ants in the windowsill and on the air conditioning unit. 3. Observations in room 230 on 5/19/14 at 8:00 AM, revealed ants in the windowsill. 4. During an interview on the 200 hall on 5/19/14 at 3:15 PM, the administrator and the maintenance director were asked about the ants seen in room 230. The maintenance director stated, I think they (ants) are climbing up the outside wall. I will get them (named the contract pest control company) to spray the outside wall. | 2018-02-01 |
| 7264 | 7264 | CLAIBORNE AND HUGHES HLTH CNTR | 445157 | 200 STRAHL STREET | FRANKLIN | TN | 37064 | 2014-05-21 | 498 | D | 0 | 1 | LQD711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to ensure 1 of 3 certified nursing assistants (CNA #1) demonstrated competency in bathing of Resident #19. The findings included: Review of the facility's nursing procedures manual documented, .Policy Name: Bath - Bed . PURPOSE . Bed baths promote cleanliness and comfort for the resident . PR(NAME)ESS . Wash, rinse, and pat dry the back . then wash, rinse and dry the buttocks . Empty the basin; rinse well and refill with clean warm water . Wash, rinse, and dry the genital area . Observation in Resident #19's room on 5/20/14 at 10:30 AM, Certified Nursing Assistant #2 performed a complete bed bath for Resident #19. CNA #2 washed Resident #19's face, trunk, arms, axillary and genital area. Then CNA #2 proceeded to wash the resident's legs and feet. CNA #2 then washed the resident's buttocks, washing off a moderate amount of fecal material from the area. CNA #2 then proceeded to wash the resident's back, and assisted the resident with positioning and donning a clean shirt and heel boots. CNA #2 wiped the resident's hair with a wash cloth dampened in the dirty bath water. CNA #2 did not wash her hands or change her gloves or the bath water during the bed bath. CNA #2 removed her gloves and donned a clean pair without washing her hands. CNA #2 removed Resident #19's top dentures from the resident's mouth, took them to the sink and cleaned them with a toothbrush and toothpaste. CNA #2 then removed the gloves and washed her hands. During an interview in room [ROOM NUMBER] on 5/21/14 at 8:45 AM, the Director of Nursing (DON) was asked when should staff perform pericare during a bedbath. The DON stated, After the feet and legs. If they do it before, they should change the water first. The DON was asked if she expected nursing staff to wash their hands and change their gloves after pericare or after cleaning fecal material during a bedbath, a… | 2018-02-01 |
| 8056 | 8056 | FORT SANDERS SEVIER NURSING HOME | 445129 | 731 MIDDLE CREEK RD | SEVIERVILLE | TN | 37862 | 2014-05-21 | 241 | D | 0 | 1 | ZE6K11 | Based on observation and interview, the facility failed to promote care in a manner and environment that maintained dignity for one resident (#44) of twenty-five residents reviewed. The finding included: Observation of the resident on May 19, 2014, at 1:20 p.m., in the resident's room revealed the resident had a urinary catheter bag exposed and visible from the hallway, with no privacy cover in place. Interview with Registered Nurse #1, in the west hall, outside the resident's room on May 19, 2014, at 1:25 p.m., confirmed the facility had failed to maintain the resident's dignity by ensuring the urinary catheter bag had a privacy cover in place. foley bag uncovered , visible from hall, comfirmed by(NAME)troutman RN 5/19/14 11:03am in room based on | 2017-08-01 |
| 8057 | 8057 | FORT SANDERS SEVIER NURSING HOME | 445129 | 731 MIDDLE CREEK RD | SEVIERVILLE | TN | 37862 | 2014-05-21 | 279 | D | 0 | 1 | ZE6K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to develop a comprehensive care plan for [MEDICAL CONDITION] medication usage for one resident (#3) of twenty-five residents reviewed. The finding included: Resident #3 was admitted on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the comprehensive care plan revealed no plan for [MEDICAL CONDITION] medications had been initiated. Interview with the Director of Nursing on May 21, 2014, at 9:17 a.m., at the west wing nurses' station confirmed the care plan for [MEDICAL CONDITION] medications had not been initiated. | 2017-08-01 |
| 8058 | 8058 | FORT SANDERS SEVIER NURSING HOME | 445129 | 731 MIDDLE CREEK RD | SEVIERVILLE | TN | 37862 | 2014-05-21 | 282 | D | 0 | 1 | ZE6K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to follow the care plan for one (#25) of twenty-five residents reviewed. The findings included: Resident #25 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Quarterly Minimum Data Set (MDS) dated [DATE], revealed the resident had impaired short and long term memory, and required total assistance with personal hygiene and bathing. Review of the ADL (Activities Daily Living) Flow Sheet dated May 18 and 19, 2014, revealed on May 19, 2014, the resident received a partial bath in the morning and a shower in the evening. Continued review revealed the resident also received oral care and nail care in the evenings. Medical record review of the current care plan dated August 8, 2011, and last revised on April 18, 2014, revealed .Provide with grooming daily and prn (as needed) nail care weekly and prn . Observation on May 20, 2014, at 1:45 p.m., in the dining area revealed the resident sitting at a table with the Certified Occupational Therapy Assistant, Environmental Services Employee #1, and the Food Services Manager. Continued observation revealed all were encouraging the resident to eat lunch. Further observation revealed the resident using a spoon to eat the food, and handled the straw to drink the chocolate milk. Observation revealed eight of ten finger tips had dark blackish-brown debris under the fingernail tips. Observation of the resident's fingertips and interview with the Director of Nursing Services, Environmental Services Employee #1 (assisting the resident to eat), and Licensed Practical Nurse #1, on May 20, 2014, at 2:05 p.m., in the dining area confirmed eight of ten fingertips were soiled with blackish-brown debris. Observation on May 21, 2014, at 8:45 a.m., in the resident's room revealed the resident would only allow the left hand to be observed and the nail tips still had blackish-brown debris. Observation… | 2017-08-01 |
| 8059 | 8059 | FORT SANDERS SEVIER NURSING HOME | 445129 | 731 MIDDLE CREEK RD | SEVIERVILLE | TN | 37862 | 2014-05-21 | 309 | D | 0 | 1 | ZE6K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to document a daily blood pressure for three of twenty days in May 2014 for one resident (#29) of twenty-five residents reviewed. The findings included: Resident #29 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Physician's Recapitulation Orders dated May 1, 2014 through May 31, 2014, revealed, Obtain BP (blood pressure) and HR (heart rate) every day. Medical record review of the Vital Sign Flow Sheet revealed no blood pressure was documented for May 1, 5, and 6, 2014. Interview with the Assistant Director of Nursing on May 21, 2014, at 9:45 a.m., in the activity room confirmed the physician's orders [REDACTED]. | 2017-08-01 |
| 8060 | 8060 | FORT SANDERS SEVIER NURSING HOME | 445129 | 731 MIDDLE CREEK RD | SEVIERVILLE | TN | 37862 | 2014-05-21 | 312 | D | 0 | 1 | ZE6K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to provide nail care for one (#25) of twenty-five residents reviewed. The findings included: Resident #25 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Quarterly Minimum Data Set, dated dated dated [DATE], revealed the resident had impaired short and long term memory and required total assistance with personal hygiene and bathing. Review of the ADL Flow Sheet dated May 18 and 19, 2014, revealed on May 19, 2014, the resident received a partial bath in the morning and a shower in the evening. Continued review revealed the resident also received oral care and nail care in the evenings. Observation on May 20, 2014, at 1:45 p.m., in the dining area revealed the resident sitting at a table with the Certified Occupational Therapy Assistant, Environmental Services Employee #1, and the Food Services Manager. Continued observation revealed all were encouraging the resident to eat lunch. Further observation revealed the resident using a spoon to eat the food, and handled the straw to drink the chocolate milk. Observation revealed eight of ten finger tips had dark blackish-brown debris under the fingernail tips. Observation of the resident's fingertips and interview with the Director of Nursing Services, Environmental Services Employee #1 (assisting the resident to eat), and Licensed Practical Nurse #1, on May 20, 2014, at 2:05 p.m., in the dining area confirmed eight of ten fingertips were soiled with blackish-brown debris. Observation on May 21, 2014, at 8:45 a.m., in the resident's room revealed the resident would only allow the left hand to be observed and the nail tips still had blackish-brown debris. Observation on May 21, 2014, at 1:15 p.m., in the dining area revealed the resident feeding self a popsicle and eight of ten finger tips had blackish-brown debris (increased amount) under eight of ten fingernail tips. | 2017-08-01 |
| 8061 | 8061 | FORT SANDERS SEVIER NURSING HOME | 445129 | 731 MIDDLE CREEK RD | SEVIERVILLE | TN | 37862 | 2014-05-21 | 371 | F | 0 | 1 | ZE6K11 | Based on observation and interview, the facility failed to ensure employees wore hairnets to prevent contamination of the resident's food. The findings included: Observation on May 19, 2014, at 11:30 a.m., in the kitchen in the food preparation area revealed the Lead Food Service Team Member had bangs protruding from the front of the hairnet. Observation on May 21, 2014, at 6:55 a.m., in the kitchen revealed the Lead Food Service Team Member had bangs protruding from the front of the hairnet, and was in the food preparation area. Continued observation revealed two food service workers with beards preparing food and no covering for the beards. Interview with the Lead Food Service Team Member on May 21, 2014, at 6:55 a.m., confirmed the bangs were not secured in the hairnet. Interview with the Dietary Manager on May 21, 2014, at 7:30 a.m., in the facility dining room confirmed staff with beards do not wear covering for the beards and bangs should be covered with a hairnet. | 2017-08-01 |
| 8062 | 8062 | FORT SANDERS SEVIER NURSING HOME | 445129 | 731 MIDDLE CREEK RD | SEVIERVILLE | TN | 37862 | 2014-05-21 | 441 | D | 0 | 1 | ZE6K11 | Based on observation, facility policy review, and interview, the facility failed to serve food in a sanitary manner for two of three meals observed. The findings included: Observation on May 19, 2014, at 12:30 p.m., in the dining area revealed Certified Nurse Assistant (CNA) #1 with bare hands served a resident the food tray, picked up the dinner roll and sliced it with the butter knife, applied butter to the roll and placed it on the resident's plate. Observation on May 21, 2014, at 8:20 a.m., in the dining room revealed CNA #2 with bare hands served a resident the food tray, used the bare finger to hold the toast in place, and applied butter and jelly to two pieces of toast. Review of facility policy, Sanitation and Infection Control, revised on January 10, 2014, revealed .Use proper hand hygiene, use a spatula or tongs, or wear disposable gloves when handling food; do not touch food with bare hand . Interview with the Food Services Manager on May 19, 2014, at 12:47 p.m., in the dining area confirmed resident food is not to be touched with the bare hands. rolls Based on | 2017-08-01 |
| 8063 | 8063 | FORT SANDERS SEVIER NURSING HOME | 445129 | 731 MIDDLE CREEK RD | SEVIERVILLE | TN | 37862 | 2014-05-21 | 514 | D | 0 | 1 | ZE6K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure a complete medical record was maintained for one resident (#43) of twenty-five residents reviewed. The findings included: Resident #43 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a physician's orders [REDACTED]. Medical Record review of the resident's hospice record, revealed there was no hospice care plan in the chart. Interview with Registered Nurse #2, in the Prayer room on May 20, 2014, at 2:15 p.m., confirmed there was no care plan for hospice care present in the resident's chart. | 2017-08-01 |
| 8488 | 8488 | LIFE CARE CENTER OF TULLAHOMA | 445238 | 1715 N JACKSON ST | TULLAHOMA | TN | 37388 | 2014-05-21 | 203 | D | 0 | 1 | RUH711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to issue a thirty day notice prior to discharge for one resident (#221) of three residents reviewed for admission, transfer, and discharge rights. The findings included: Resident #221 was admitted to the facility on [DATE], and readmitted on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a Certificate of Need for Involuntary admitted d November 7, 2013, revealed .I am a licensed physician .In my professional opinion, based on the examination and the information provided, I certify that this person is subject to Involuntary care and treatment .has a mental illness or serious emotional disturbance .antisocial behavior, Paranoia .roomate fears for life and had to be removed .intoxication - refused blood tests, refused psychiatric evaluations .violent outbreaks + (plus) actions to staff & employee. Inappropriate letters to staff. Paranoid ideations .threat to self and others .help refused multiple times .Requires direct transportation to an admitting psychiatric facility for a second certificate of need (CON) examination . Interview on May 20, 2014, at 3:00 p.m., with the Administrator, in the Administrator's office, confirmed the facility had refused to readmit the resident and did not issue a thirty day letter of discharge to the resident. Telephone interview on May 21, 2014, at 3:15 p.m., with the psychiatric hospital's Social Worker, revealed the Social Worker had contacted the facility on November 15, 2013, as the resident was stabilized, and the facility had refused to readmit the resident to the facility. c/o # | 2017-06-01 |
| 8489 | 8489 | LIFE CARE CENTER OF TULLAHOMA | 445238 | 1715 N JACKSON ST | TULLAHOMA | TN | 37388 | 2014-05-21 | 205 | D | 0 | 1 | RUH711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to issue the facility's Bed Hold Policy, upon hospital transfer, for one resident (#221), of three residents reviewed for admission, transfer, and discharge rights. The findings included: Resident #221 was admitted to the facility on [DATE], and readmitted on [DATE], with [DIAGNOSES REDACTED]. Medical record review of a physician's orders [REDACTED]. Medical record review revealed no documentation the resident had been issued a copy of the facility's Bed Hold Policy. Review of the facility's Bed Hold Policy revealed .At the time the Resident is to leave the Facility for a temporary stay in a hospital .the Resident/Legal Representative will be given a written copy of the Bed Hold Policy and may elect to hold open the Resident's room and bed until the Resident returns . Interview on May 20, 2014, at 3:00 p.m., with the Administrator, in the Administrator's office, confirmed the facility did not issue the bed hold policy to the resident, at the time of discharge on November 7, 2013. c/o # | 2017-06-01 |
| 8490 | 8490 | LIFE CARE CENTER OF TULLAHOMA | 445238 | 1715 N JACKSON ST | TULLAHOMA | TN | 37388 | 2014-05-21 | 241 | D | 0 | 1 | RUH711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, facility policy review, observation, and interview, the facility failed to ensure dignity was maintained by a staff member standing, not sitting beside, while assisting a resident to eat, for one resident (#162) of thirty-seven residents reviewed. The findings included: Resident #162 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the Quarterly Minimum Data Set, dated dated dated [DATE], revealed the resident required extensive assistance of one person for eating. Review of the policy, Feeding A Resident, revealed, .Sit to feed the resident . Observation on May 19, 2014, at 11:55 a.m., revealed the resident seated in a gerichair at the nursing station. Continued interview revealed Certified Nursing Assistant (CNA) #1 standing beside the resident feeding the resident lunch. Interview on May 19, 2014, at 1:10 p.m., with Licensed Practical Nurse (LPN) #1, at the nursing station, confirmed the CNA was not to feed the resident while standing over the resident. | 2017-06-01 |
| 8491 | 8491 | LIFE CARE CENTER OF TULLAHOMA | 445238 | 1715 N JACKSON ST | TULLAHOMA | TN | 37388 | 2014-05-21 | 279 | D | 0 | 1 | RUH711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, facility policy review, observation and interview, the facility failed to develop a care plan to address the fluid restriction for one resident (#36) of thirty-seven residents reviewed. The findings included: Resident #36 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of the Nutrition Data Collection/Assessment, dated April 19, 2014, revealed the resident received a regular consistency, concentrated carbohydrate diet, with a 1200 milliliters (ml) fluid restriction. Review of the physician's orders [REDACTED]. Observation on May 20, 2014, at 3:30 p.m., in the resident's room revealed a thirty-two ounce water pitcher, half-full, on the over-bed table near the bed, and two six ounce cups partially filled with clear liquid. Review of the facility's policy, Fluid Restriction, revealed, Fluid restrictions are coordinated between Nursing Services and Food and Nutrition Services. Diets are adjusted to comply with fluid restrictions . Interview with the Director of Nursing on May 20, 2014, at 3:40 p.m., in the day room on the East Wing confirmed the fluid restriction should have been divided between shifts, including the fluids provided by dietary. Interview with the Registered Dietician via telephone on May 21, 2014, at 8:45 a.m., from the Human Resources office, confirmed the resident had been reviewed in the Resident At Risk meeting for non-compliance with fluid restriction. Continued interview confirmed the 1200 ml fluid restriction should have been on the care plan for guidance of who should have provided what amount of fluid in a specific timeframe. Continued interview confirmed the facility failed to develop a care plan to address the fluid restriction for resident #36. | 2017-06-01 |
| 8492 | 8492 | LIFE CARE CENTER OF TULLAHOMA | 445238 | 1715 N JACKSON ST | TULLAHOMA | TN | 37388 | 2014-05-21 | 323 | E | 0 | 1 | RUH711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the Material Safety Data Sheet (MSDS), facility policy review and interview, the facility failed to ensure potentially hazardous chemicals were stored in a safe, secure manner; and failed to ensure equipment was safe for one resident (#96) of thirty-seven residents reviewed. The findings included: Observation of the Biohazard Room on the North Wing on May 19, 2014, at 10:20 a.m., revealed the door was unlocked, and a quart-size spray bottle labeled MPC Flashback Spray Buff, one-third full of clear liquid, was hanging on the handle of the floor buffer, stored in the Bio-Hazard Room. Review of the MSDS for Flashback FS revealed, the product was classified as a cleaning compound that could pose an immediate (acute) health hazard. Continued review revealed storage and handling information included, .Keep out of reach of children .Avoid contact with eyes, skin, and clothing. Avoid breathing vapors . Review of the facility's policy, Hazardous Materials Management Plan, revealed, .The purpose and objectives of the Hazardous Materials and Waste Management Program are: .Minimizing risks to patients, visitors, personnel and the environment . Interview on May 19, 2014, at 10:25 a.m., with the Housekeeping/Floor Technician, who came to retrieve the buffer, confirmed the Bio-Hazard Room had been left unlocked, and the chemical spray had been left unsecured. Resident #96 was readmitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Observation on May 19, 2014, at 1:50 p.m. revealed the resident seated in a wheelchair in the resident's room. Continued observation revealed the left side of the wheelchair skirt guard below the arm rest was loose with duct tape applied and a sharp edge was present on the top of the wheelchair skirt guard, and the right side of the wheelchair skirt below the arm rest was loose. Interview and observation on May 19, 2014, at 1:55 p.m., with Licensed Practical Nurse #2 (LPN) Unit Manager, in … | 2017-06-01 |
| 8493 | 8493 | LIFE CARE CENTER OF TULLAHOMA | 445238 | 1715 N JACKSON ST | TULLAHOMA | TN | 37388 | 2014-05-21 | 441 | D | 0 | 1 | RUH711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, facility policy review, observation and interview, the facility failed to provide signage for isolation for one resident (#109), of thirty-seven residents reviewed. The findings included: Resident #109 was readmitted to the facility on [DATE], with [DIAGNOSES REDACTED]. diff - A bacteria that causes inflammation of the colon; can live for long periods on surfaces; highly infectious; and spread by contact with contaminated materials.) Medical record review of the laboratory test dated May 16, 2014, revealed the resident had a positive result for [DIAGNOSES REDACTED]. Observation of the doorway outside the resident's room on May 20, 2014, at 7:28 a.m., revealed no indication the resident was on isolation precautions. Observation during the resident interview on May 20, 2014, at 7:28 a.m., in the resident's room revealed two large containers, one designated for linen with a red biohazard bag, and the other designated for garbage. Continued observation in the resident's room revealed a multi-drawer container near the door in the resident's room with personal protective equipment (gowns, masks, gloves). Review of the facility's policy, Standard and Transmission-based Precautions; Isolation Procedure, revealed, .Transmission-based precautions are used in addition to standard precautions for residents with suspected or confirmed infectious conditions. Residents are place on appropriate transmission-based precautions until the condition has been ruled out or the criteria for removal from isolation have been met . Continued policy review revealed requirements for Contact Isolation included, Stop sign on door. Interview with Licensed Practical Nurse #3 on May 20, 2014, at 7:30 a.m., confirmed the resident was in Contact Isolation for C.diff, and should have had a Stop sign posted on the resident's door. | 2017-06-01 |
| 8494 | 8494 | LIFE CARE CENTER OF RED BANK | 445240 | 1020 RUNYAN DR | CHATTANOOGA | TN | 37405 | 2014-05-21 | 241 | D | 0 | 1 | FL2P11 | Based on observation and interview, the facility failed to maintain dignity during dining for one resident (#9) of thirteen residents observed in the main dining room. The findings included: Observation on May 19, 2014, at 11:55 a.m., in the main dining room, revealed thirteen residents waiting on lunch to be served. Twelve residents had clothing protectors on. Resident #9 entered the dining room and the Dietary Manager went to the resident, while speaking to a different resident across the room, and placed the clothing protector on resident #9 without speaking to resident #9. Interview with the Dietary Manager on May 19, 2014, at 12:04 p.m., in the dining room, confirmed the Dietary Manager did not ask the resident if the resident wanted a clothing protector and did not address the resident while placing the clothing protector. | 2017-06-01 |
| 8495 | 8495 | LIFE CARE CENTER OF RED BANK | 445240 | 1020 RUNYAN DR | CHATTANOOGA | TN | 37405 | 2014-05-21 | 281 | D | 0 | 1 | FL2P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to follow physician's orders for administration of medication for one (#72) of thirty-seven sampled residents. The findings included: Resident #72 was readmitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the physician's orders dated May 2014, revealed, Saline Nasal 0.65% Spray bid (twice daily) two sprays both nostrils. Observation of the medication pass and interview on May 20, 2014, at 8:45 a.m., revealed the Licensed Practical Nurse (LPN) #1 did not administer Saline Nasal 0.65% Spray, ordered by the physician and listed on the Medication Administration Record (MAR). Interview with LPN #1 outside of the resident's room, confirmed the nasal spray was not administered because the medication was not on the cart and was usually kept in the resident's room. Further interview revealed the resident was alert and had been assessed to self administer medications. Continued interview confirmed the nurse had given medication to the resident on May 11, 2014. Further interview confirmed the LPN had documented on the MAR the medication was given May 11, 2014, but had not observed the resident administer the drug. Medical record review of the Medication Administration Record (MAR) for May 2014, revealed the medication had been documented as given twice daily for the month of May. Interview with the resident, on May 20, 2014, at 9:00 a.m., in the resident's room, with the Assistant Director of Nursing (ADON), revealed the resident had not received the medication for some while and had not received the medication for the month of May 2014. Interview with LPN #2 on May 20, 2014, at 9:15 a.m., at the South/West Nursing Station, confirmed when the LPN had worked the hall, the nurse had documented the medication as being given without observing the medication administered. Interview with RN Supervisor #1, at the South/West Nursing Station, on Ma… | 2017-06-01 |
| 8496 | 8496 | LIFE CARE CENTER OF RED BANK | 445240 | 1020 RUNYAN DR | CHATTANOOGA | TN | 37405 | 2014-05-21 | 371 | F | 0 | 1 | FL2P11 | Based on observation, review of facility policy, and interview, the facility failed to contain the hair of one of seven staff members observed; failed to maintain sanitary equipment in the food preparation area; and failed to label food in one of one walk-in coolers in the dietary department; and failed to cover food during tray service for four of four wings. The findings included: Observation on May 19, 2014, at 10:15 a.m., in the dietary department, revealed one employee in the dishwashing area wearing a visor, but no hair net. Observation on May 19, 2014, from 10:15 a.m. to 10:44 a.m., revealed the can opener blade and gears soiled with black debris, a water pan in the base of the bread warmer with a thick coating of light brown film and debris in the base of the pan, and a scoop stored inside the bulk flour storage container atop the flour. Continued observation revealed the stand-up mixer splash plate and upper grill soiled with hard white and brown debris. Continued observation in the walk in cooler revealed a full pan containing fifteen uncooked rib eye steaks, unlabeled and undated, available for use; and two trays containing twenty seven fruit cups uncovered, unlabeled and undated, and available for use. Continued observation revealed a five pound plastic bag of shredded cheese opened, undated, and available for use. Review of the facility policy Associate Conduct revised January 2007, revealed, .Food and Nutrition Services Associates wear a hair covering .at all times .cleaning schedule to include all equipment and areas to be cleaned .director of .nutrition services .monitors the .schedule .to ensure tasks are completed . Interview with the Dietary Manager on May 19, 2014, at 10:50 a.m., in the dietary department, confirmed all foods were to be labeled and dated; hair coverings were to be worn at all times; all food preparation equipment including can openers, mixers, and water pans in the bread warmer were to be kept clean; scoops were not to be stored inside the bulk storage bins; and the facility f… | 2017-06-01 |
| 8497 | 8497 | LIFE CARE CENTER OF RED BANK | 445240 | 1020 RUNYAN DR | CHATTANOOGA | TN | 37405 | 2014-05-21 | 372 | C | 0 | 1 | FL2P11 | Based on observation and interview, the facility failed to maintain sanitary conditions for two of two dumpsters in the garbage dumpster area. The findings included: Observation on May 19, 2014, at 2:30 p.m., in the dumpster area, revealed the doors to the facility dumpsters closed. Continued observation revealed multiple used latex gloves and medication dispensing cups scattered on the ground throughout the dumpster area. Continued observation revealed a plastic urinal on the ground beside the dumpster. Interview with the Dietary Manager on May 19, 2014, at 2:35 p.m., in the dumpster area, confirmed the waste was to have been contained inside the dumpsters and the facility failed to maintain sanitary conditions in the dumpster area. | 2017-06-01 |
| 8498 | 8498 | LIFE CARE CENTER OF RED BANK | 445240 | 1020 RUNYAN DR | CHATTANOOGA | TN | 37405 | 2014-05-21 | 441 | F | 0 | 1 | FL2P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, review of facility policy, and review of personnel files, the facility failed to sanitize the hands while passing the meal trays for three of three hallways; failed to ensure isolation procedures were followed for one room with two residents (#30 and #80) of thirteen isolation rooms observed; failed to properly store clean linen on four of four halls; failed to provide sanitary storage of linens in one of two linen storage closets; failed to ensure one of two bed scales were clean; and failed to ensure one of one ice chest was not contaminated in the main dining room. The findings included: Observation on May 19, 2014, at 12:30 p.m., in the North hallway, revealed the following: Certified Nursing Assistant (CNA) #1 was passing meal trays to the residents in their rooms. Continued observation revealed CNA #1 removed a meal tray from the food cart and entered room [ROOM NUMBER]. Continued observation revealed CNA #1 took the tray into the room and placed it on the overbed table, assisted with the meal set-up, and exited the room without cleansing or washing the hands. Continued observation revealed CNA #1 removed a meal tray from the food cart, gathered a clothing protector, and entered room [ROOM NUMBER] with the food tray. Continued observation revealed CNA #1 placed the clothing protector on the resident who was lying in the bed, and secured it at the back of the resident's neck. CNA #1 continued to provide tray set up to include taking the lids off the food items, picked up the utensils, and used the knife to spread the butter on the bread on the meal tray. Continued observation revealed CNA #1 did not cleanse or sanitize the hands after leaving room [ROOM NUMBER]. Continued observation revealed CNA #1 removed a food tray from the food cart and took it into room [ROOM NUMBER]. Observation revealed CNA #1 entered the room without cleansing or sanitizing the hands; removed the call light… | 2017-06-01 |
| 8499 | 8499 | LIFE CARE CENTER OF RED BANK | 445240 | 1020 RUNYAN DR | CHATTANOOGA | TN | 37405 | 2014-05-21 | 514 | D | 0 | 1 | FL2P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to ensure a clinical record was accurately documented for medication administration for one (#72) of thirty-seven sampled residents. The findings included: Resident #72 was readmitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the physician's orders [REDACTED]. Observation of the medication pass and interview on May 20, 2014, at 8:45 a.m., revealed Licensed Practical Nurse (LPN) #1 did not administer Saline Nasal 0.65% Spray, ordered by the physician and listed on the Medication Administration Record (MAR). Interview with LPN #1 outside of the resident's room, confirmed the nasal spray was not administered because the medication was not on the cart and was usually kept in the resident's room. Further interview revealed the resident was alert and had been assessed to self administer medications. Continued interview confirmed the nurse had given medication to the resident on May 11, 2014. Further interview confirmed the LPN had documented on the MAR the medication was given May 11, 2014, but had not observed the resident administer the drug. Medical record review of the Medication Administration Record (MAR) for May 2014, revealed the medication had been documented as given twice daily for the month of May. Interview with the resident on May 20, 2014, at 9:00 a.m., in the resident's room, with the Assistant Director of Nursing (ADON), revealed the resident had not received the medication for some while and had not received the medication for the month of May 2014. Interview with LPN #2 on May 20, 2014, at 9:15 a.m., at the South/West Nursing Station, confirmed when the LPN had worked the hall, the nurse had documented the medication as being given without observing the medication administered. Interview with RN Supervisor #1, at the South/West Nursing Station, on May 21, 2014, at 8:30 a.m., revealed the resident was alert and had … | 2017-06-01 |
| 8500 | 8500 | LIFE CARE CENTER OF RED BANK | 445240 | 1020 RUNYAN DR | CHATTANOOGA | TN | 37405 | 2014-05-21 | 515 | D | 0 | 1 | FL2P11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to maintain a medical electronic record for one (#266) of thirty-seven sampled residents. The findings included: Resident #266 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review revealed the resident was issued a thirty day discharge notice on December 18, 2013, due to non-coverage of services, and discharged home from the facility on December 20, 2013. Medical record review of the electronic health record revealed the nursing notes, facility discharge notes, and all daily social services notes from December 12, 2013, to December 20, 2013, were absent. Interview with the Social Services Director on May 21, 2014, at 10:00 a.m., in the social services office, confirmed the documents were entered into the electronic health record, but those records had been lost, and per the facility information technology department's report, were not recoverable. Continued interview confirmed the resident's electronic health record was not complete and readily accessible. | 2017-06-01 |
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CREATE TABLE [cms_TN] ( [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 );