rowid,facility_name,facility_id,address,city,state,zip,inspection_date,deficiency_tag,scope_severity,complaint,standard,eventid,inspection_text,filedate
7998,MONTEZUMA HEALTH CARE CENTER,115364,506 SUMTER ST,MONTEZUMA,GA,31063,2012-03-29,156,B,0,1,NZ6611,Based on observation and staff interview the facility failed to post the telephone number for the State Survey and Certification Office. Census = 78 Findings include: Observation of posted signs in the facility revealed that there was no posting of the State Survey and Certification phone number. Interview on 03/28/12 at 5:50 p.m. with the Administrator and Registered Nurse Consultant BB concurred that the number was not posted on any board in the facility.,2016-07-01
7999,MONTEZUMA HEALTH CARE CENTER,115364,506 SUMTER ST,MONTEZUMA,GA,31063,2012-03-29,279,D,0,1,NZ6611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to develop a comprehensive plan of care for vision for one (1) resident (#23) of a sample of thirty-five (35) residents. Findings include: Review of the annual Minimum Data Set (MDS) assessment for resident #23 dated 7/08/11 and subsequent quarterly MDS assessments revealed that the resident was assessed with [REDACTED]. Review of the Care Area Assessment (CAA) completed with the annual MDS assessment dated ,[DATE] 11 revealed that the resident was to be care planned for this care area to identify changes in vision. Review of the medical record revealed no evidence that a care plan had been developed related to vision. Interview on 3/28/12 at 2:20 p.m. with the MDS Coordinator revealed she assessed the resident's vision by taking a newspaper in the resident's room and having the resident read what he could of the newspaper. The resident indicated to her that he could only see the large print words and could not read the smaller print. Continued interview revealed that she did not develop a care plan related to vision.",2016-07-01
8000,MONTEZUMA HEALTH CARE CENTER,115364,506 SUMTER ST,MONTEZUMA,GA,31063,2012-03-29,441,D,0,1,NZ6611,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the facility policy for contact precautions and staff interview, the facility failed to maintain infection control measures to prevent the likelihood of the spread of infection related to proper disposal of gloves on one (1) of two (2) halls. Findings include: Observation on 3/28/12 at 9:16 a.m. revealed a Certified Nursing Assistant (CNA) put on gloves outside of room [ROOM NUMBER] and enter the room. At 9:17 a.m. the CNA exited the room with the gloves on, carrying a resident's breakfast tray. The CNA removed the gloves from her hands and held them in her right hand as she entered room [ROOM NUMBER]. When she exited room [ROOM NUMBER], she no longer had the gloves in her hand. Observation on 3/28 12 at 9:20 a.m. in room [ROOM NUMBER] revealed the gloves were in the trash can in that room. Observation on 3/28/12 at 1:48 p.m. revealed a CNA picking up the lunch tray from isolation room [ROOM NUMBER]. She put on gloves after entering the room and carried the tray out of the room to the cart with her gloves on. As she walked up the hall, the CNA threw the gloves away in the open trash receptacle on the Middle medication cart used for the lower two halls. Review of the facility policy for using gloves revealed that used gloves should be discarded into the waste receptacle inside the room. Telephone interview on 4/06/12 at 9:15 a.m. ,during the Quality Assurance process, with the Infection Control Nurse revealed that gloves should be disposed of in the resident's room prior to leaving the room.",2016-07-01
8037,WARM SPRINGS MEDICAL CENTER NURSING HOME,115603,5995 SPRING STREET,WARM SPRINGS,GA,31830,2012-03-29,323,E,0,1,D6G711,"Based on observations, record review, staff interviews and review of facility policy, the facility failed to ensure that resident's environment remained free of accident hazards related to hot water temperature of 120 degrees Fahrenheit (F) in two (2) resident rooms and one (1) common bath; and the inappropriate application of a wheelchair tray for one (1) resident (#82) from a sample of twenty-seven (27) residents. Findings include: 1. Observation of water temperatures during the general environmental tour conducted with the Facility Maintenance Director on 03/28/12 starting at 1:00 pm revealed water temperatures of 120 degrees F. in the following areas: Ground floor: Water temperature in the common shower room was 120 degrees F The facility reported that all twenty (20) ground floor residents were bathed in this shower room. Resident room Water temperature at the hand sink in room 65 was 120 degrees F Two (2) residents in this room that had access to the sink. Interview with the Maintenance Director on 03/28/12 at 1:15pm, revealed that there have been water temperature issues, especially in the rooms next to the boiler on both floors. He further indicated that he is always tweaking the boiler to maintain proper temperatures. Interview with the Chief Nursing Officer on 03/28/12 at 2:30pm, revealed that she is aware of problems related to water temperature, and that the facility has purchased new parts for the boiler to keep temperatures in range. Review of facility policy reveals that the water temperatures for bathing and handwashing shall be maintained between the temperature range of 95 degrees F. and 110 degrees F. 2. Observation of resident (#82) on 03-28-2012 at 10:45am revealed the resident sitting in a wheel chair with a clear, plastic tray attached to both sides of the chair arms with velcro straps that were tied in knots. The resident was unable to release the tray due to straps being tied in knots. A previous observation conducted 3/28/12 at 8:30am revealed the resident was up in the wheelchair with the tray in place and was able to remove the tray when asked. Record review revealed that the resident had been evaluated and assessed by Physical Therapy for the wheelchair tray as a safety device. Documentation in the record revealed the resident was able to remove the tray. Interview with the Director of Nursing (DON) on 03-28-12 at 10:55am revealed the tray was not a restraint. She did not know why the tray was not applied correctly. Interview with the charge nurse AA on 03-26-2012 at 10:56am revealed the resident could not remove the tray if the straps were tied in knots. Interview with Certified Nursing Assistant BB on 03-28-12 at 10:57am revealed the straps for the tray were suppose to be slipped through the slots on the tray and velcroed, not tied in knots.",2016-07-01
8068,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,241,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record review, it was determined that the facility failed to promote care that enhanced one resident's (#45) dignity in a total sample of 36 residents. Findings include: Resident #45 had [DIAGNOSES REDACTED]. He/She was coded on the 1/17/12 quarterly Minimum Data Set (MDS) assessment as cognitively impaired and as needing total assistance with dressing. There was not a plan of care developed to address the resident's personal care needs, including dressing. There was a 1/17/12 social service note that the resident was not able to make his/her wants and needs known or to communicate with others. Resident #45 was observed on 3/27/12 at 8:35 a.m. sitting in a geri-chair. His/Her shirt had not been pulled down so, his/her abdomen and right breast were exposed. The resident was sitting in a geri-chair in the 4th floor activity room at 9:30 a.m. and 9:50 a.m., his/her shirt had not been pulled down so, his/her left breast and nipple were exposed. The resident was reclined in a geri-chair in the day area on the 3rd floor at 2:35 p.m. He/She had constant involuntary movements of his/her head and extremities. His/Her right side of his/her shirt was not pulled down so that the lower part of his/her right breast was exposed.",2016-07-01
8069,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,246,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, it was determined that the facility failed to continue to provide adaptations for one resident's (#113) wheelchair to maintain proper body symmetry and to accommodate the wheelchair positioning needs for two residents (#19 and #45) in a total sample of 36 residents. Findings include: 1. Skilled therapy staff noted on the 10/10/11 physical therapy discharge report at that time, the resident #113 was using a wheelchair with bilateral lateral supports and a pommel cushion to encourage pelvic alignment. However, on 3/28/12 at 8:15 a.m., 10:00 a.m. and at 11:10 a.m., the resident was observed sitting in the wheelchair without bilateral lateral supports. The resident's body was observed to be twisted to the right side of his/her wheelchair. During those observations, the resident's wheelchair did not have footrests and his/her feet were dangling approximately two inches above the floor. In an interview on 3/29/12 at 12:15 p.m., the physical therapist stated that the use of bilateral lateral supports had not been discontinued from therapy. She stated that, from a therapy standpoint, the resident needed the lateral supports for positioning in the wheelchair. 2. Resident #19 had [DIAGNOSES REDACTED]. Licensed nursing staff completed a quarterly MDS assessment on 2/22/12. They coded the resident as needing total assistance with transfer, locomotion on/off unit, dressing, eating, toileting, bathing and hygiene. Resident #19 was observed sitting in a wheelchair without any foot rest supports on 3/26/12 during initial tour between 11:50 a.m. and 12:13 p.m. and at 2:30 p.m., on 3/27/12 at 7:30 a.m., 10:00 a.m., 11:30 a.m., 2:00 p.m., 3:35 p.m., on 3/28/12 at 7:30 a.m., 10:45 a.m., and 1:25 p.m. and on 3/29/12 at 7:50 a.m., 9:34 a.m., 10:45 a.m. and 12:20 p.m. During all of the observations, both of the resident's feet were dangling and not touching the floor. The resident did not make any attempt to propel himself/herself in the wheelchair during any of those observations. During an interview on 3/29/12 at 12 p.m., the occupational and physical therapy aides confirmed that the resident's wheelchair should have had leg/foot rests on it. They stated that not having had foot rests on the resident's wheelchair had been a concern in the past. 3. Resident #45 had [DIAGNOSES REDACTED]. He/She had restorative orders on the March 2012 physician's orders [REDACTED]. Resident #45 was observed on 3/29/12 at 12 p.m. to have been reclined in a geri-chair asleep. The resident's head was hanging off of the lateral support. The lateral support was not long enough to support his/her head. The resident was still asleep in the reclined geri-chair at 12:40 p.m. His/Her neck was hyperextended to the left and hanging over the lateral support that was on the inside of the chair. During an interview at that time, licensed charge nurse XX stated that the resident's position did not not look comfortable. Nurse XX said that resident should have been laid down in bed when he/she fell asleep in that position. Nurse XX stated that she had requested a therapy screen for positioning which was why the resident had the lateral supports but, nothing had been put in place for positioning his/her head and neck.",2016-07-01
8070,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,253,E,0,1,LF6S11,"Based on observations, it was determined that the facility failed to maintain an environment that was free from one ill-fitting air conditioning unit, a broken call light cover plate, one chipped wallboard, a torn curtain lining, and an ill-fitting door on a bedside table in four rooms on two (300 and 400) of four halls. Findings include: Observations were made on 3/26/12 between 11:50 a.m. and 12:13 p.m., 2:20 p.m., 2:47 p.m., 3:10 p.m. and 3:25 p.m., on 3/27/12 at 7:35 a.m. and 4:58 p.m., on 3/28/12 at 7:05 a.m. and 2:00 p.m., and/or on 3/29/12 at 9:15 a.m 300 Hall 1. The room air conditioning unit in room 306 had partially pulled out of the wall which left an opening. Sunlight outside of the building could be seen through the opening. There was dust on the wall and the air conditioner. 2. There was a brown build-up on the floor around the base of the toilet in the bathroom for room 302. A soiled urinal was stored on the back of the toilet. A soiled urinal was hanging on the grab bar in bath tub. There were four wash basins and a bedside commode stored in the bath tub. The bathroom had a urine odor. 400 hall 1. The hinge side of the door on the bedside table in room 407A was sagging. 2. There was a hole in the wall behind the B bed in room 407. 3. There were pieces missing from the call light plate in room 412. The wall around that plate was chipped. 4. The curtain lining on the window in room 417 was torn.",2016-07-01
8071,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,276,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility failed to complete a quarterly Minimum Data Set (MDS) assessment at least every 92 days for four residents from a sample of 49 residents. Findings include: A list of 49 residents with late or missing MDS 3.0 Federal OBRA assessments was obtained by the State Survey Agency prior to the survey. On 3/28/12 the facility provided documentation that they had identified a problem with late or missing MDS's in December 2011 and had implemented a plan of correction with a target date of completion for the end of March 2012. However, after a review of the State Survey Agency list with MDS coordinator QQ on 3/29/12 at 10 a.m., and a review of facility audits of lists of residents identified with late or missing MDS's, four residents were identified as not having a quarterly MDS assessment completed. These assessments had not been identified by the facility. 1. One resident had a quarterly MDS completed on 7/1/11. A quarterly assessment should have been completed in October 2011 prior to the resident being discharged from the facility on 11/7/11. However, the facility failed to complete the quarterly MDS. 2. One resident had an admission MDS completed on 8/16/11. A quarterly assessment should have been completed in November 2011 prior to the resident being discharged [DATE]. However, the facility failed to complete the quarterly MDS. 3. One resident had an annual MDS completed on 6/15/11. Quarterly assessments should have been completed in September and December 2011. However, the facility failed to complete the quarterly MDS's. 4. One resident had a quarterly MDS completed on 8/17/11. The facility identified on 3/27/12 that a quarterly MDS was due by 3/7/12. However, the facility failed to complete the quarterly MDS.",2016-07-01
8072,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,278,D,0,1,LF6S11,"Based on observation, interviews with staff and resident, and record review, it was determined that the facility had failed to accurately code one resident's (H) dental status from a sample of 36 residents. Findings include: During the initial interview on 03/26/12 at 2:39 p.m., resident H stated that some of his/her teeth were missing and his/her dental bridge had been broken over a year ago and prior to admission to the facility. The resident did not remember if anyone had assessed his/her teeth since he/she had been in the facility. He/She said that no one had asked him/her if he/she would like to see a dentist. The resident stated chewing was difficult because of his/her missing teeth. However, a review of the 12/27/11 Minimum Data Set (MDS) assessment revealed that licensed nursing staff had inaccurately coded the resident's oral/dental status as having no concerns. See F412 for additional information regarding resident H.",2016-07-01
8073,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,279,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility had failed to ensure that a comprehensive care plan was developed for three residents (#2, H and #45) from a total sample of 36 residents. Findings include: 1. Resident #2 was admitted on [DATE] with [DIAGNOSES REDACTED]. The resident was coded by staff on his/her 1/10/2012 Minimum Data Set (MDS) for his/her significant change assessment as being cognitively impaired, having highly impaired vision and unclear speech, rarely/never understanding staff, totally dependent on staff for bed mobility, transfer, dressing, hygiene, bathing, eating and toileting, incontinent of bowel and bladder, receiving a tube feeding, having limitations in range of motion to bilateral upper and lower extremities, having had a urinary tract infection within the last 30 days, having had a weight loss of 5% in the last month or 10% in the last 6 months, having facial expressions of pain daily and, having received an antipsychotic, antidepressant and antibiotic medication. The resident's current care plan dated 12/2011 addressed the triggered areas for cognitive loss, activities, pressure ulcer, urinary incontinence and pain. According to the 1/23/2012 Care Area Assessment (CAA) Summary, nursing staff had documented that a care plan would be initiated for the resident to also include the triggered areas of visual function, communication, psychological well-being, activities, falls, nutritional status, feeding tubes, dehydration/fluid maintenance, and [MEDICAL CONDITION] drug use. However, staff did not develop a comprehensive care plan after the resident's 1/10/2012 significant change comprehensive assessment which addressed the triggered areas of visual function, communication, psychological well-being, falls, nutritional status, feeding tubes, dehydration/fluid maintenance and [MEDICAL CONDITION] drug use. On 3/28/2012 at 8:10 a.m., MDS coordinator SS stated that nursing staff had failed to develop the comprehensive care plan that was due on 1/23/2012. On 3/28/2012, after surveyor inquiry, a comprehensive care plan was developed to address the resident's specific care needs. 2. Resident #45 had [DIAGNOSES REDACTED]. Licensed staff coded him/her on the 1/17/12 quarterly MDS assessment as cognitively impaired and needing total assistance for dressing and personal hygiene. However, the staff did not develop a comprehensive care plan to address the resident's dressing, personal hygiene and bathing needs. See F312 for additional information regarding resident #45. 3. Resident H had [DIAGNOSES REDACTED]. The documented goal was that the resident's mobility would not decrease. There were interventions for nursing staff to provide support with transfers as needed and for physical therapy and occupational therapy as needed. The resident had received occupational therapy from 1/31/2 through 2/27/12. On the 2/27/12 Functional Program form, the occupational therapist documented that active/assisted range of motion exercises for both of the resident's shoulders, elbows and wrists were to be done daily as tolerated to maintain level of function. The resident had received physical therapy from 1/31/12 through 2/27/12 . On the 2/27/12 Physical Therapy Discharge Note, the therapist documented a plan for the resident to walk in the hallway with a rolling walker and contact guard to stand-by assistance for more than 300 feet or as tolerated, and for strengthening exercises while sitting in the wheelchair to maintain his/her strength and functional abilities. However, the facility had not incorporated and implemented those interventions into the resident's plan of care. See F318 for additional information regarding resident H.",2016-07-01
8074,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,282,E,0,1,LF6S11,"Based on observation, record review and staff interview, it was determined that the facility had failed to ensure that care plan interventions were implemented to address the personal care needs of three (#11, W and #113) residents' with dirty fingernails and one resident (W) with a heavy beard, the provision of range of motion exercises, splints, foot positioning devices and/or braces as planned for five residents ( R, W, #19, #128, and #45), and to prevent falls for one resident (#188) from a total sample of 36 residents. Findings include: 1. Resident #11 had a care plan intervention since 3/22/10 for total care including nail care by nursing staff. However, the resident was observed the have had a thick black substance underneath his/her fingernails on 3/27/12 at 8:15 a.m. and 5:00 p.m., 3/28/12 at 7:55 a.m. and 11:20 a.m. See F312 for additional information regarding resident #11. 2. Resident #113 had a 5/21/11 care plan intervention for staff to provide assistance with activities of daily living. However, the resident had a thick black substance underneath his/her fingernails on 3/28/12 at 8:15 a.m. and 2:00 p.m. and on 3/29/12 at 8:15 a.m. See F312 for additional information regarding resident #113. 3. Resident #128 had a care plan since 10/29/11 to address his/her frequent pain at multiple sites due to arthralgia. There was an intervention for active range of motion exercises to be provided by the restorative nursing staff six (6) days per week to prevent joint contracture. However, the staff had not provided active range of motion exercises to the resident. See F318 for additional information regarding resident #128. 4. Resident R had a care plan since 5/25/11 to address his/her Impaired mobility related to cognitive impairment and dementia. There was an intervention for nursing staff to perform passive range of motion exercises to affected joints as indicated and document, and to assist with positioning and transfers as necessary. There were current restorative orders for the resident to be out of bed in a geri-chair for positioning purposes and safety, and to position him/her in the geri-chair daily with a bilateral step down cushion and foot box. However, during observations on 3/27/12 at 2:35 p.m. and 4:20 p.m., the resident was seated in a geri-chair but, there was not a foot box on it. See F318 for additional information regarding resident R. 5. Resident W had a care plan since 2/16/12 to address his/her need for extensive staff assistance with activities of daily living (ADLs). There were interventions for direct care (nursing ) staff to provide assistance with ADLs, and encourage him/her to assist with ADLs as able. However, it was observed on 3/26/12 at 3:30 p.m., on 3/27/12 at 4:50 p.m. and on 3/29/12 at 8:55 a.m. and 10:30 a.m. that the resident had long dirty nails. In addition, on 3/27/12 at 4:00 p.m., and on 3/28/12 at 8:50 a.m., 1:00 p.m. and 4:50 p.m., the resident was observed to have a heavy growth of facial hair. See F312 for additional information regarding W. Resident W also had a care plan intervention for restorative nursing as indicated. On the 3/10/12 Functional Program form, the occupational therapist had documented that nursing staff were supposed to place a left shoulder brace properly on the resident daily and a left resting hand splint on the resident every day to prevent contractures. However, it was observed on 3/27/12 at 4:00 p.m., on 3/28/12 at 8:50 a.m., 1:00 p.m., 2:15 p.m. and 4:50 p.m. and on 3/29/12 on 8:55 a.m., 10:30 a.m. and 11:30 a.m. that nursing staff had not applied the left resting hand splint. It was observed that they had not applied the left shoulder brace on 3/28/12 and 3/29/12. See F318 for additional information regarding W. 6. Resident #19 had a care plan since 11/30/11 to address his/her need for total care with all ADLs. There was an intervention for nursing staff to apply bilateral hand, elbow splints and ankle splints daily as tolerated. However, it was observed on 3/26/12 between 11:50 a.m. and 12:13 p.m. and 2:30 p.m., on 3/27/12 at 7:30 a.m., 10:00 a.m., 11:30 a.m., 2:00 p.m. and 3:35 p.m., on 3/28/12 at 7:30 a.m. and on 3/29/12 at 7:50 a.m., 9:34 a.m., 10:45 a.m. and 12:20 p.m., that staff had not put any splints on the resident. See F318 for additional information regarding #19. 7. Resident #45 had a care plan intervention since 5/25/11 for staff to assist with positioning as necessary. The current restorative orders printed on the March 2012 orders documented to position the resident in the geri-chair with bilateral support step down cushion and foot box daily. However the resident was observed in the geri-chair without the foot box on 3/27/12 at 2:35 p.m. and 4:20 p.m. The resident was observed to be poorly positioned in the geri-chair on 3/29/12 at 12 p.m. and 12:40 p.m. See F246 for additional information regarding resident #45. 8. According to a hand written note on resident #188's initial initial care plan (dated 3/5/12), he/she was at risk for falls. There were interventions for the use of a bed alarm and a chair alarm for the resident. However, during observations on 3/28/12 at 11:55 a.m. and at 2:55 p.m., the resident was seated in a room chair but, staff had not applied the chair alarm. See F323 for additional information regarding resident #188.",2016-07-01
8075,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,287,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility failed to complete and transmit two residents' discharge assessments in a total sample of 49 residents with late or missing Minimum Data Set (MDS) assessments as of 2/13/12 and one resident's (#132) entry assessment from a total sample of 36 residents. Findings include: A list of 49 residents with late or missing MDS 3.0 Federal OBRA assessments was obtained by the State Survey Agency prior to the survey. On 3/28/12 the facility provided documentation that they had identified a problem with late or missing MDS's in December 2011 and had implemented a plan of correction with a target date of completion of the end of March 2012. However, after a review of the State Survey Agency list with MDS coordinator QQ, and a review of facility audits of lists of residents identified with late or missing MDS's, three residents were identified as not having a discharge or entry MDS assessments completed by the facility. Those assessments had not been identified by the facility as having been late or missing. 1. One resident was discharged from the facility on 9/21/11. However, a discharge assessment was not completed. 2. One resident was admitted to the facility on [DATE]. The resident was no longer at the facility. However, a discharge assessment was not completed. 3. Resident #132 was hospitalized from [DATE] through 1/25/12. However, the facility did not complete an entry MDS assessment when the resident returned to the facility on [DATE].",2016-07-01
8076,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,312,E,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, it was determined that the facility failed to ensure that four residents' (#11, #45, W and #113) fingernails were clean and trimmed, that two residents' (#45 and W) were shaved and that one resident (A) was provided oral care from a total sample of 36 residents. Findings include: 1. Resident #11 was coded by the facility on the 2/10/12 quarterly Minimum Data Set (MDS) assessment as needing total assistance from staff for personal hygiene. The resident had a care plan intervention since 3/22/10 for total care by nursing staff including nail care. However, the resident was observed with a thick black substance underneath his/her fingernails on 3/27/12 at 8:15 a.m. and 5:00 p.m., and on 3/28/12 at 7:55 a.m. and 11:20 a.m. 2. Resident #113 was coded by the facility on the 1/6/12 quarterly MDS assessment as needing total assistance from staff for hygiene. The resident had a 5/21/11 care plan intervention for staff to provide assistance with activities of daily living (ADL). However, the resident was observed with a thick black substance underneath his/her fingernails on 3/28/12 at 8:15 a.m. and 2:00 p.m. and on 3/29/12 at 8:15 a.m. 3. Resident W was coded by the facility on the 2/02/12 MDS for annual comprehensive assessment as needing total assistance from staff for personal hygiene, toilet use, dressing, transfer and bathing. The resident had a care plan intervention since 2/16/12 for direct care staff to provide assistance with all ADLs. However, the resident was observed with long and dirty nails on 3/26/12 at 3:30 p.m., on 3/27/12 at 4:00 p.m., 3/28/12 at 8:50 a.m., 1:00 p.m. and 4:00 p.m. and on 3/29/12 at 8:55 a.m. and 10:30 p.m. In addition, during the observations on 3/27/12 and 3/28/12, the resident had a heavy growth of facial hair. 4. Resident A was admitted on [DATE] with [DIAGNOSES REDACTED]. Licensed staff coded him/her on the 1/10/12 significant change MDS assessment as cognitively impaired and as needing total assistance with activities of daily living (ADLs). There was not a comprehensive care plan developed to address his/her personal care needs. However, according to the ADL Care Plan in the certified nursing assistants (CNAs) assignment book, mouth care was supposed to have been provided to the resident every shift. On 3/26/2012 at 2:05 PM, the resident was seated in a geri-chair in his/her room. He/She had a foul mouth odor and there was gummy spittle in his/her mouth. The resident's lips were dry and peeling. On 3/27/2012 at 11:34 a.m., the family member of resident A stated that she visited the resident almost daily. She stated that the resident's lips were dry 3-4 times a week. She said that she had noticed a mouth odor as recently as yesterday afternoon when she visited. She said that she had not complained to staff because they should know that the resident needed his/her mouth cleaned and it was just easier to do it herself. She stated that, when she had visited yesterday, she cleaned the resident's mouth herself. On 3/28/12 at 10:10 a.m., the resident was seated in a geri-chair in his/her room. When the resident opened his/her mouth to yawn, his/her tongue was exposed. It had a thick, white coating on it. He/She had a slight mouth odor at that time. On 3/28/12 at 4:45 p.m., CNA AA stated that staff provide oral care for the resident every morning. On 3/29/12 at 11:40 a.m., CNA BB returned the resident to his/her room from the shower. BB stated that she had not provided mouth care yet but, it was provided every day on the 7a.m. to 3p.m. shift. CNA BB stated that the resident sometimes resisted opening his/her mouth for mouth care. At that time, BB was able to open the resident's mouth wide enough to see the white substance on his/her tongue. On 3/29/12 at 12:50 p.m., registered nurse CC assessed the resident's mouth. She stated that it was sometimes difficult to provide mouth care for the resident because he/she resisted opening his/her mouth. However, CC was able to open the resident's mouth wide enough to observe the white substance on the resident's tongue. A review of the clinical record revealed no evidence that the resident resisted mouth care. Certified nursing assistants were not aware of the resident's ADL Care Plan to provide mouth care to the resident every shift. There was no evidence that the facility had monitored the resident's mouth care to evaluate if it was being done every shift and the effectiveness, of the provision of mouth care as scheduled, to meet the resident's needs. 5. Resident #45 was coded on the 1/17/12 quarterly MDS assessment as having cognitive impairments and as needing total assistance for personal hygiene. There was not a plan of care to address his/her personal hygiene needs. During observations on 3/27/12 at 2:35 p.m., 3/8/12 at 8:20 a.m., and on 3/29/12 at 12 p.m., the resident was observed with thick, chin hair. Observations on 3/27/12 at 9 a.m. revealed that the resident had unclean and untrimmed fingernails. On 3/28/12 at 8:20 a.m. and 8:45 a.m., the resident's fingernails were clean but, were long. Review of the ADL Care Plan revealed that nail care was to be done daily and as needed. During an interview on 3/29/12 at 8:45 a.m., CNA YY said that the nurses were responsible for cutting residents' fingernails as needed. During an interview on 3/29/12 at 10:35 a.m., licensed nurse XX stated that CNAs were supposed to clip the residents' nails if they noticed that they needed trimming. She said that the nurses were also responsible for observing and clipping residents' nails if needed.",2016-07-01
8077,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,313,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews with resident and staff, and record review, it was determined that the facility failed to provide services to assist one resident (W) to improve his/her vision status from a total sample of 36 residents. Findings include: Resident W had [DIAGNOSES REDACTED]. He/she was coded by staff on the 2/02/12 annual Minimum Data Set (MDS) assessment as having impaired vision without corrective lens. A consult was located in the resident's medical record from Dixon Eye Care dated 11/2/11. The resident's vision was documented as 20/80 in his/her right eye and 20/400 in his/her left eye which required eye glasses. During an interview on 3/28/12 at 2:03 p.m., resident W stated he/she did not have any glasses. He/she stated that he/she thought that the eye care vision place was waiting for the money. During an interview on 3/28/12 at 4:00 p.m., the social service staff stated that they were not aware that the resident required glasses and was also unaware of the consult from Dixon eye care that had been done on 11/02/11. Therefore, the facility had not addressed the resident's need for eye glasses to improve his/her vision.",2016-07-01
8078,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,318,E,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews with residents and staff, and record review, it was determined that the facility failed to provide range of motion exercises, adaptive devices and/or ambulation assistance to maintain function, range of motion abilities and prevent contractures for five residents (W, #19, R, H and S) in a total sample of 36 residents. Findings include: 1. Resident W had [DIAGNOSES REDACTED]. He/She was coded on the 2/02/12 Minimum Data Set (MDS) assessment as needing total assistance for all activities of daily living (ADLs). There was a care plan since 2/16/12 to address his/her need for extensive assistance with activities of daily living (ADLs). There was an intervention for restorative nursing services as indicated. On the 3/10/12 Functional Program form, the occupational therapist documented that nursing staff was to properly place a left shoulder brace on the resident daily and a left resting hand splint daily to prevent further contractures. However, it was observed on 3/27/12 at 4:00 p.m., on 3/28/12 at 8:50 a.m., 1:00 p.m., 2:15 p.m. and 4:50 p.m. and on 3/29/12 on 8:55 a.m., 10:30 a.m. and 11:30 a.m., that staff had failed to apply the left resting hand splint. During the observations on 3/28/12 and 3/29/12, the staff also had failed to apply the left shoulder brace on the resident. During an interview on 3/28/12 at 2:15 p.m., resident W stated that he/she had not worn the hand splint for about two weeks. He/She stated that the shoulder brace had not been put on that morning because the girl said that she did not know how to do it. In an interview on 3/29/12 at 12 p.m., the occupational therapy aide confirmed that the staff should have applied a splint to the resident's left hand and a brace to his/her left shoulder every day. She/He said that this (the application of the splint and brace) had been a concern since the CNAs caring for the resident were made responsible for applying those splints and braces. During an interview on 3/29/12 at 12:30 p.m., licensed nurse XX confirmed that the CNAs caring for the resident should have applied the splint and brace as planned by the occupational therapy staff to address his/her positioning needs and maintain his/her level of function. 2. Resident #19 had [DIAGNOSES REDACTED]. On the 2/22/12 quarterly MDS assessment, licensed staff coded him/her with limitations in range of motion on both sides of his/her upper and lower extremities. He/She was coded as having received passive range of motion exercises six days a week , active range of motion exercises five days a week, and a splint or brace applied six days a week. There was an 11/30/11 Seating Positioning Addendum form with documentation by the physical therapist that the resident had contractures of his/her upper and lower extremities. The therapist noted that bilateral elbow splints were used because of flexion contractures, and the bilateral AFOs were used to maintain joint alignment. There was a care plan since 11/30/11 to address his/her need for total care by nursing staff with all of his/her ADLs. There was an intervention for nursing staff to apply bilateral hand, elbow and ankle splints daily as tolerated. There was an ADL Care Pan with documentation that right and left elbow splints and bilateral ankle foot orthosis (AFO) were to be applied daily as tolerated. There were March 2012 physician's orders [REDACTED]. However despite the physician's orders [REDACTED]. 12:20 p.m., that nursing staff had not applied any splints or AFOs on the resident as ordered and planned. The resident was not wearing splints or AFOs during those observations. 3. Resident R had a care plan since 5/25/11 to address his/her impaired mobility related to his/her cognitive impairment and dementia. There was an intervention for nursing staff to perform passive range of motion exercises to affected joints as indicated and document, and to assist with positioning and transfers as necessary. There were current restorative nursing service orders for the resident to be out of bed in a geri-chair for positioning purposes and safety, and to position him/her in the geri-chair daily with a bilateral step down cushion and foot box. However, during observations of the resident seated in a geri-chair on 3/27/12 at 2:35 p.m. and 4:20 p.m., staff had not provided a foot box for positioning. Resident R received skilled occupational therapy from 10/14/11 until 12/8/11 when he/she was discharged to a functional program to receive active range of motion (ROM) exercises daily to his/her upper extremities for all joints and all planes for 4 sets of 25 repetitions. The resident received skilled physical therapy from 10/14/11 until 12/7/11 when he/she was discharged to a functional program to walk in the hallway with contact guard - stand by assistance with a rolling walker as tolerated and to receive ROM to bilateral lower extremities that included leg kicks while seated, marches and ankle pumps all in a seated position for three (3) sets of 15 repetitions. Review of the Aide Assignment Record revealed documentation by the CNAs that the resident had been provided ROM exercises to his/her upper extremities from 12/8/11 through 12/31/11. However, there was no evidence that nursing staff had provided ROM exercises for the resident's lower extremities in December 2011 or for either the resident's upper or lower extremities in January, February, and March 2012. There was a 1/5/12 request for a skilled therapy screening due to the resident having weakness in his/her lower extremities. According to the comprehensive rehabilitation screen completed on 1/6/12, the physical therapist did not recommend that a skilled evaluation be done because, the resident had recently been discharged from skilled physical therapy services on 12/7/11 and was on a restorative nursing program. However, there was not any evidence that restorative nursing staff was providing a functional program for the resident as planned. During an interview on 3/28/12 at 2:50 p.m., resident R stated that he/she had gone to therapy when he/she was first admitted and could walk with a rolling walker with some help. He/She said that he/she was afraid to do that now because, no one had helped him/her exercise or walk. Resident R said that his/her legs were getting stiff. He/She stated that he/she went to the group exercise program as many mornings as he/she could but, sometimes he/she did not get up early enough to attend. 4. Resident S was admitted on [DATE] with [DIAGNOSES REDACTED]. There was a physician's orders [REDACTED].The resident had a new [DIAGNOSES REDACTED]. Licensed staff coded him/her on the 8/24/11 Minimum Data Set (MDS) for comprehensive assessment on admission and the 11/22/11 and 2/16/12 quarterly MDS assessments as not having limitations with upper and lower extremities range of motion. There was a care plan since 10/29/11 to address the resident having frequent pain in multiple sites because of arthralgia. The interventions included that he/she should receive active range of motion by the restorative program six days a week to prevent joint contracture. During an interview on 3/27/12 at 9:40 a.m., resident S stated that his/her left arm hurt. The resident was in bed being bathed by a Certified Nursing Assistant ( CNA), an agency CNA, who stated that was the first time she had worked with resident and was not aware of his/her shoulder pain. The resident stated that his/her left arm and shoulder had hurt ever since he/she had heart problems while in the hospital. He/She stated that the doctor, who had looked at his/her arm and shoulder the other day, said it was something like arthritis and ordered some pain medicine. The resident stated that staff did not assist him/her to exercise his/her arms and legs or provide therapy. He/She stated that the therapist had looked at him/her for therapy but, he/she guessed because of his/her heart condition that he/she did not qualify. The resident demonstrated that he/she had difficulty raising his/her left arm. When the CNA attempted to take off the resident's gown during care, the resident complained about the pain in his/her shoulder and was unable to raise his/her left arm. The resident assisted with taking off the gown with his/her right arm which he/she said caused him/her no problems. The resident stated that he/she had not received any staff assistance and was to exercise his/her own shoulder. During an interview on 3/27/12 at 4:30 p.m., CNA WW, who was assigned to give care to the resident , stated that the resident complained of pain in his/her left shoulder. She said that the nurse was aware of the pain but, she did not exercise or assist the resident to exercise his/her arms or legs. She said that the resident moved them when he/she turned in bed. A review of the Aide Assignment Record revealed documentation by the CNAs that they were providing care to the resident. However, there was no documented information about the resident having been unable to raise his/her left arm. There was no evidence that the facility had addressed the resident's left arm limitations and need to continue exercises to maintain his/her range of motion abilities. On 3/29/12 at 9:30 a.m., observation with licensed nurse TT revealed that the resident complained of pain when TT attempted to do range of motion with the resident's left shoulder. Nurse TT stated that she had known that the resident had complained of pain but, was not aware that the resident could not move that shoulder. 5. Resident H had [DIAGNOSES REDACTED]. The documented goal was that the resident's mobility would not decrease. There were interventions for nursing staff to provide support with transfers as needed and for physical therapy and occupational therapy as needed. The resident had received occupational therapy from 1/31/2 through 2/27/12. On the 2/27/12 Functional Program form, the occupational therapist documented that active/assisted range of motion exercises for both of the resident's shoulders, elbows and wrists were to be done daily as tolerated to maintain level of function. The resident had received physical therapy from 1/31/12 through 2/27/12 . On the 2/27/12 Physical Therapy Discharge Note, the therapist documented a plan for the resident to walk in the hallway with a rolling walker and contact guard to stand-by assistance for more than 300 feet or as tolerated, and for strengthening exercises while sitting in the wheelchair to maintain his/her strength and functional abilities. However, during an interview on 3/28/10 at 10 a.m., resident H said that no one was assisting him/her to walk in the hall. He/She said that no one had been assisting him/her with any exercises for awhile now. Review of the CNA Care Plan Worksheet revealed no documentation of restorative interventions to be provided for the resident. During an interview on 3/29/12 at 1 p.m., CNA FF said that she did not recall having been instructed on restorative services to provide for resident H. She said that she had not assisted him/her to ambulate and to perform range of motion exercises. During an interview on 3/29/12 at 1:15 p.m., licensed nurse GG said that therapy was supposed to be providing services for resident H.",2016-07-01
8079,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,323,E,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and staff interview, it was determined that the facility failed to maintain safe hot water temperatures in 10 rooms and one common shower on one (2nd floor) of three resident inhabited floors in the facility, and to apply a chair alarm for one resident (#188) with a history of falls from a sample of 36 residents. Findings include: During the initial tour of the facility on 03/26/12 at 12:20 p.m., the hot water temperatures on the second floor were checked by the Maintenance Director with a facility calibrated thermometer on . 1. The hot water temperature in one of two common shower rooms was 125.3 degrees Fahrenheit (F.) 2. The hot water temperature in room 205 was 124.6 degrees F.; in room 206 was 122.4 degrees F.; in room 207 was 124.5 degrees F.; in room 208 was 123.1 degrees F. and; in room 239 was 120.8 degrees F. During an interview on 03/26/12 at 1:00 p.m., the Maintenance Director stated that he had recently been hired by the facility and was unable to find previous hot water temperature log records. He later located water temperature logs which documented water temperature monitoring through 02/06/12 was done once a month in only one room on each floor. There was not any documentation that water temperatures had been monitored by staff after 02/06/12. Subsequent investigation by the facility, following the observation of elevated hot water temperatures on the 2nd floor, revealed that the hot water pump and and mixing valve were defective and required replacing. The facility consistently monitored the water temperatures until the pump and mixing valve were replaced on 3/29/12. 2. Resident #188 had [DIAGNOSES REDACTED]. He/She was coded on the 2/26/12 Minimum Data Set (MDS) assessment as having cognitive impairments and as needing total assistance for care. There were handwritten interventions on the resident's initial care plan to address his/her risk for falls. Those interventions were dated 3/22/12 for nursing staff to apply a bed alarm, a chair alarm, and a fall mat on one side of the resident's bed. Review of the medical record revealed that resident #188 fell out of bed without injury on 03/05/12. He/she fell while transferring independently from the recliner to bed on 03/26/12 with an abrasion above his/her right eyebrow. However, it was observed on 03/28/12 at 11:55 a.m., 2:55 and 2:59 p.m. that the resident was seated in a room chair but the tab for chair alarm was not attached to the resident. The tab was on the floor.",2016-07-01
8080,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,334,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, it was determined the facility failed to ensure that two residents (#110 and #112) were offered the influenza and pneumococcal vaccines from a total sample of thirty-six residents. Findings include: The facility's Influenza and Pneumoccocal vaccination standing orders policy, dated 1/3/12, documented the facility would administer the influenza vaccination to residents who were [AGE] years or older, or who had a need or want to reduce the likelihood of becoming ill with the flu or transmitting it to others, or who had certain medical conditions. according to the policy, the pneumococcal vaccination would be administered to residents who were [AGE] years old or older, or who were younger than 65 but with underlying conditions. The policy was that a record of the immunizations would be maintained yearly to include the residents who received the vaccines, those who did not receive the vaccines, and those who refused the vaccines. Administrative nursing staff provided Infection Control Surveillance documentation dated 2/3/12 that stated the facility had identified it was not in compliance with immunization administration guidelines. However, as of 3/29/12, there was no evidence residents #110 and #112 had been offered the influenza and pneumococcal vaccines. 1. Resident #110 was admitted to the facility on [DATE]. An Admission Minimum Data Set (MDS) assessment was completed on 1/16/12. The assessment documented the influenza vaccine had not been offered and the pneumococcal vaccine had been offered but declined. However, there was no evidence in the clinical record the resident had been offered but declined the pneumococcal vaccine. There was no evidence the resident had been offered the influenza vaccine. 2. Resident #112 was admitted to the facility on [DATE]. An Admission MDS assessment was completed on 11/3/11. On the assessment, staff coded the resident as having had the influenza vaccine outside the facility. The assessment coded his/her pneumococcal vaccination as being up to date. However, there was no evidence in the clinical record that the resident had received or been offered either vaccine.",2016-07-01
8081,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,412,D,0,1,LF6S11,"Based on observation, record review, and resident and staff interview, it was determined that the facility failed to provide or to arrange for dental services for the one resident (H). who had dental problems from a total sample of 36 residents. Findings include: During an interview on 03/26/12 at 2:39 p.m., resident H stated that he/she was missing some teeth and that his/her dental bridge had broken prior to admission to the facility much more than a year ago. The resident did not remember anyone assessing his/her teeth since being in the facility or asking him/her if he/she wanted to see a dentist. The resident stated that chewing was difficult because of the missing teeth. There was a handwritten note dated 10/8/10 on the resident's care plan that he/she had missing teeth and poor dental hygiene. The documented goal was that he/she would be free of any oral/dental problems. However. licensed staff coded the resident on the 12/27/11 Minimum Data Set (MDS) assessment as having had no concerns with oral/dental status. There was a 3/22/12 registered dietician's nutritional assessment of the resident that he/she had problems of chewing. During an interview on 03/28/12 at 3:39 p.m., the social worker VV stated that the nurse was supposed to obtain the information about dental needs and then give it to the designated person in the financial department. On 3/28/12 at 3:50 p.m., the employee from the financial department stated that, upon admission, residents were informed about a plan for dental coverage that allowed the residents to decrease their liability owed to the facility when paying for the plan. She stated that, after admission, residents could be referred to the program for further information by notification to her by the nursing staff. She stated that, after admission, when dental concerns were discovered, she thought the nurse or social worker would communicate the (dental) concerns and follow up on them During interviews with three random LPNs on the second floor on 03/28/12 at 3:50 p.m. and again on 03/29/12 at 9:50 a.m., they stated that they did not know how the residents were included to the list to be seen by the dentist. Resident H was not on the list to be seen by the dentist. There was no evidence that any referrals had been made to address the dental needs for resident H.",2016-07-01
8082,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,428,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility failed to ensure that the consultant pharmacist identified and reported the administration of the incorrect dosage of a medication for one resident (#132) and failed to ensure that a consultant pharmacist's recommendation was reported to the physician and Director of Nursing in a timely manner for one resident (#128) in a total sample of 36 residents. Findings include: 1. According to the 2007 Drug Information Handbook for Nursing, Geriatric Considerations with the use of Levothyroxine included that TSH must be monitored since insufficient thyroid replacement (elevated TSH) is a risk for coronary artery disease. Resident #132 was hospitalized from 2/7 to 2/9/12. During that hospital stay, his/her TSH level was reported to have been elevated to 43.2 on 2/8/2012 so, his/her dosage of Synthroid was adjusted. According to the February physician's orders [REDACTED]. The 2/9/12 readmission orders [REDACTED]. They incorrectly transcribed it as 75mcg on the nursing home's physician order [REDACTED]. Review of the resident's February Medication Administration Record [REDACTED]. There was not evidence that the facility identified the transcription error from 2/9/12 until after the follow up TSH was obtained on 3/16/12. There was a follow-up TSH level done on 3/16/12. The results of that laboratory test were reported as 51.84 which was higher than when he/she was in the hospital. However, nursing staff did not notify the physician about that elevated TSH level until 3/19/12. At that time, the physician ordered a dosage change to 100mcg of Synthroid. There was no evidence that the consultant pharmacist identified and reported the transcription error and the administration of the wrong dosage of Synthroid during his/her drug regimen reviews done on 2/16/12 and 3/19/12. 2. According to the 2007 Drug Information Handbook for Nursing, the risk of bleeding with the use of Lovenox may be increased with concurrent use of oral anticoagulants (warfarin) drugs which affect platelet function. According to the 12/16/11 consultant pharmacist's report, resident #128 was being given both Lovenox and Warfarin. When the resident's INR was obtained on 12/8/11 and was reported as having been above normal range at 3.35 (2.0-3.0). At that time, there was a physician's orders [REDACTED]. On the bottom of the pharmacist's drug regime review from dated The pharmacist questioned if the staff should to go ahead and re-draw the INR right away and make adjustments in an attempt to discontinue the Lovenox. However, the bottom of the recommendation had a print date of 12/22/11. Six days after that recommendation and 12 days after the physician's orders [REDACTED]. However, because the physician was not aware of the 12/16/11 recommendation for the INR to have been drawn right away so, the INR was done as previously ordered on [DATE]. During an interview on 3/29/12 at 1:20 p.m., the Director of Nurses (DON) stated that it took the pharmacist several days to complete the drug regime reviews and then to e-mail the completed reports to the DON. She stated that when the pharmacist had any recommendation that needed to be addressed immediately, then he/she would tell the DON before leaving the facility. She said that in December she had not been told of any concerns by the pharmacist. She stated that the pharmacist reports were e-mailed to her on 12/25/11 but, because that day and the next day were holidays, she did not receive them until 12/27/11 when she gave them to the nurse managers for the physician's review.",2016-07-01
8083,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,441,E,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, it was determined that the facility failed to maintain a complete record of incidents and corrective actions related to infections. Findings include: The Director of Nursing stated on 3/29/12 at 2:40 p.m. that as of January 2012, the Resident Care Coordinators on each resident floor were responsible for maintaining the infection control logs for the residents on that floor. However, a review of the infections control logs for resident floors 2, 3, and 4, revealed the logs were incomplete for residents identified as having infections, the start and end date of antibiotics if ordered, the type of infection, any symptoms present, laboratory tests obtained, and organisms cultured. In addtion, a review of the infection control log for the facility prior to January 2012 revealed incomplete logs of infections for December 2011. During a random observation of the second floor on 3/29/12 at 2:50 p.m. one resident was noted to have isolation precautions posted outside his/her door. A review of the clinical record revealed the resident had been admitted to the facility on [DATE] with MRSA of the right hip wound. However, this resident was not included in the infection control log for the second floor.",2016-07-01
8084,WYNFIELD PARK HEALTH AND REHABILITATION,115625,223 W.THIRD AVENUE,ALBANY,GA,31701,2012-03-29,505,D,0,1,LF6S11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, it was determined the facility failed to ensure the physician was notified timely of an abnormal laboratory test for one resident (#132) from a total sample of 36 residents. Findings include: Resident #132 had a [MEDICAL CONDITION] Stimulating Hormone (TSH) level obtained on 3/16/12. The results were available to the facility on [DATE]. The laboratory reported that the TSH test results were abnormally high at 51.84 from a normal range of 0.27 to 4.2. However, there was no evidence the facility notified the attending physician until 3/19/12 when, the physician ordered an increase in the dose of the medication. The resident's daily dose of [MEDICATION NAME] was increased from 75 mcg to 100 mcg. The physician also ordered that the facility obtain another TSH level for the resident in six weeks.",2016-07-01
8207,"RETREAT, THE",115675,898 COLLEGE ST,MONTICELLO,GA,31064,2012-03-29,441,D,0,1,MV1G11,"Based on observation, staff interviews and record review the facility failed to ensure that appropriate infection control practices were followed related to medication administration for one (1) resident (#31) from a sample of twenty-eight (28) residents. Findings include: Observation on 3/27/12 at 2:34 p.m. during medication administration for resident #31 revealed Licensed Practical Nurse (LPN) BB disconnected the tube feeding and placed the uncovered connector onto the resident's brief while checking placement then reconnected the tubing to the connector. Continued observation revealed that the nurse then prepared the medication and water flushes, disconnected the connector from the feeding tube, allowed the connector to drop onto the resident's brief and the reconnected the feeding tube to the connector after the medication was administered. Interview with LPN BB on 3/27/12 at 11:50 a.m. revealed that the tubing connector should have been covered and not allowed to drop on the resident's brief. Interview with the Director of Nursing (DON) on 3/27/12 at 3:30 p.m. revealed it is poor technique to allow the tubing connector to rest on the resident's brief.",2016-06-01
8208,"RETREAT, THE",115675,898 COLLEGE ST,MONTICELLO,GA,31064,2012-03-29,514,D,0,1,MV1G11,"Based on record review and staff interview, the facility failed to ensure that pressure sore documentation accurately reflected residents current medical condition for one (1) resident (#30) out of a sample of twenty-eight (28) residents Findings include: Review of the Wound/Skin Healing Record for resident #30 dated 12/30/11 revealed that the resident had a stage two (2) sacral and coccyx pressure ulcer with a red wound bed measuring 7 centimeters (cms) by 6.2 (cms). Continued review revealed that on 1/6/12, the wound bed was described as eschar, measured at 8cms by 7cms and was still considered a stage 2 pressure ulcer Review of the Minimum Data Set 3.0 dated 1/10/12 revealed that resident was admitted with an unstageable pressure sore. Interview with Licensed Practical Nurse (LPN) AA, on 3/28/12 at 11:10 a.m.,revealed that a pressure ulcer that has eschar, is an unstageable ulcer and you measure only the eschar. Continued interview revealed that on admission the physician said that the pressure sore was a stage two (2) and believed it was a blood blister; however, according to her training, she would have called the pressure sore unstageable, but did not question the physician. Interview with the Director of Nursing (DON) on 3/28/12 at 11:45 a.m., she concurred that the treatment nurse should have documented the pressure sore on 1/6/12 as unstageable due to the wound bed being eschar.",2016-06-01
8675,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,161,C,0,1,G6KB11,"Based on record review and staff interview the facility failed to ensure that the surety bond acquired to cover the resident trust account adequately covered the amount of monies being held in the resident trust account for four (4) of nine (9) months reviewed. The facility currently manages eighty-six (86) resident accounts of one hundred three (103) residents in the census. Findings include: Review of the resident trust funds revealed that the facility holds two (2) accounts with resident monies. One account is the regular resident trust account and the other is a petty cash account that is funded by monies from the resident trust account. Review of the these resident trust fund bank statements revealed that for the months of July 2011, August 2011, September 2011, and November 2011, the ending balances combined in these two (2) trust fund accounts exceeded the amount of the Surety Bond which was $100,000. In July 2011 the combined ending balance was 100,787.60, August 2011 the combined ending balance was 105,279.24, September 2011 the combined ending balance was $106,683, 69. and in October 2011 the combined ending balance was $101,743. Interview with the Business Office Manager staff EE on 3/29/12 at 9:10 am revealed that she started doing resident accounts in January 2012. She revealed that the corporate office did an audit of resident trust accounts in December 2011 and notified her that the resident trust account balance had been exceeding the amount of the surety bond. The Surety Bond was to be increased in amount to $125, 000.",2015-11-01
8676,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,164,D,0,1,G6KB11,"Based on observation, record review, and staff interview, the facility failed to provide privacy during wound care for one (1) resident (#164). The sample size was thirty-six (36) residents. Findings include: On 03/28/12 at 10:03 a.m., the Treatment Licensed Practical Nurse (LPN) was observed performing wound care for resident #164, and was assisted by Certified Nursing Assistant ( CNA) AA. The privacy curtain between the beds of resident #164 and their roommate had been pulled, but not the privacy curtain across the foot of resident #164's bed. While the sacral dressing was off and the bed covers totally removed from the resident, the resident's roommate ambulated from their bed located on the hallway side of the room, around and past the foot of resident #164's bed on their way into the bathroom. Resident #164's open sacral wound, buttocks, and bare legs were visible to the roommate. On 03/29/12 at 9:30 a.m., the Treatment LPN stated she normally pulled the curtains all the way around the bed, and added that the roommate usually didn't get up and walk to the bathroom. At 9:40 a.m., the Director of Nurses (DON) stated that she would expect staff to close the door and blinds, and pull the privacy curtain all the way around the bed, when providing personal care for a resident. Review of the facility's Clean Dressing Change policy and procedure noted to provide for privacy when performing a dressing change.",2015-11-01
8677,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,280,D,0,1,G6KB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and staff interview the facility failed to ensure that the care plan related to Activities of Daily Living (ADL) for one (1) resident (# 31) on a sample of thirty-six (36) residents was updated to reflect the actual care the resident was assessed for and receiving. Findings include: Review of the most recent Minimal Data Set (MDS) assessment dated [DATE], as well as the previous annual MDS assessment dated [DATE] assessed resident #31 as being totally dependent on the staff for hygiene, tolieting, and eating. Review of the care plan for self care deficit for hygiene, tolieting, eating and bathing documented the resident needed only set up for grooming,hygiene and bathing supplies and was to be encouraged to complete task with assistance as needed. This care plan also documented that the resident only needed set up for the meal tray such as to cut meat, butter bread and remove wrappers. Observation of the resident during the breakfast meal on 3/27/11 at 8:40 a.m. and again on 3/28/11 at 8:26 a.m. revealed the resident was in the day room being fed by a Certified Nursing Assistant (CNA). The resident was in a wheelchair and had a contracture to the right hand which was in a splint. The resident also had limited use of the left hand. Interview with a CNA CC staff on 3/28/12 at 8:26 a.m. revealed the resident was totally fed by staff and had been for some time. This CNA also revealed the resident was dependent on staff for all tolieting and hygiene required as she was incapable of doing for her/himself. Interview with the MDS Nurse Licensed Practical Nurse DD on 3/28/12 at 2:38 p.m. revealed the care plan for ADL's did not reflect the resident at all as the resident required total dependence of all for ADL's.",2015-11-01
8678,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,282,D,0,1,G6KB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed to consistently follow the care plan related to treatments, reporting skin concerns, and skin checks for one (1) resident (# 164) with pressure sores. The sample size was thirty-six (36) residents. Findings include: Review of resident #164's medical record revealed that they had multiple pressure ulcers. A Nursing Home Orders hospital discharge form dated 03/05/12 noted to change the dressing to the resident's sacrum twice a day, and this was scheduled on the Treatment Record to be done on the 7:00 a.m. to 3:00 p.m. (7-3) shift and the 3:00 p.m. to 11:00 p.m. (3-11) shift. Review of the Impaired Skin Integrity care plan included approaches to perform treatments per physician's orders [REDACTED]. Review of the Resident Weekly Skin Check Sheets revealed that after admission to the facility on [DATE], a skin assessment was not performed until 12/12/11. Per the 02/24/12 skin assessment, the nurse noted reddened areas below the right fifth toe, right hip, and left ankle. On 03/28/12 at 10:03 a.m., Treatment Licensed Practical Nurse (LPN) was observed performing wound care for resident #164. The dressing to the sacral area was dated 3/27. At 11:00 a.m., the Treatment LPN stated that the sacral dressing that she just changed was the same dressing she applied yesterday morning. She added the order was to change the dressing twice a day, and there was no documentation on the Treatment Record that the dressing scheduled to be changed on the 3-11 shift was ever done. She stated that the nurses did skin assessments on all residents weekly, and verified there were no skin assessments done on 11/28/11 and 12/05/11. She added that she did not start treatments to the reddened areas of skin noted on the 02/24/12 skin assessment until 02/27/12, because she was not notified until then. On 03/28/12 at 3:15 p.m., the Director of Nurses (DON) stated that the evening nurse was responsible for doing the 3-11 dressing change. On 03/29/12 at 8:40 a.m., she stated the facility protocol was to do weekly skin assessments. Cross-refer to F 314.",2015-11-01
8679,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,287,B,0,1,G6KB11,"Based on record review and staff interview, the facility failed to transmit Minimum Data Set (MDS) assessments to the Centers for Medicare and Medicaid (CMS) system in the required timeframe for forty-seven (47) discharged residents. Findings include: On 03/27/12 at 9:50 a.m., Licensed Practical Nurse (LPN) MDS Case Manager DD and Registered Nurse (RN) MDS Coordinator HH stated that the MDS Automation Coordinator at the Stage Agency (SA) recently notified them that they had many MDS assessments that were late in being transmitted to them. They stated they didn't realize they were missing any until she called them. At 11:10 a.m., RN MDS Coordinator HH provided the MDS 3.0 Missing Omnibus Budget Reconciliation Act (OBRA) Assessment report dated 03/27/12; 47 residents were on this list. The oldest of these missing assessments was dated 10/03/10. She stated all of these residents had been discharged from the facility, and they were working to get caught up with doing the discharge assessments and transmitting them. On 03/29/12 at 8:00 a.m., LPN MDS Case Manager DD provided a Georgia MDS 3.0 OBRA Assessment report dated 03/01/12 that noted that 68 assessments were missing. She stated they had developed a performance improvement plan to address this, and as of 03/28/12, the number of missing MDS was down to three.",2015-11-01
8680,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,309,D,0,1,G6KB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to follow the physician's order for one resident (#92) with blood sugar below sixty milligrams per deciliter (60 mg/dl) on a sample of thirty six (36) residents. Findings include: Review of the Diabetic Flow Sheet for resident #92 revealed a fingerstick blood sugar of forty-eight milligrams per deciliter (48 mg/dl) at 6:00 a.m. on 02/09/12. Review of the February 2012 physician's orders revealed an order for [REDACTED]. Further review of the Diabetic Flow Sheet indicated the resident was given one can of ensure to treat the blood sugar of 48 mg/dl instead of the [MEDICATION NAME] as ordered by the physician. review of the resident's medical record revealed [REDACTED]. In addition, there was no evidence the blood sugar was rechecked after 30 minutes. During an interview on 3/29/12 at 9:45 a.m., Registered Nurse (RN) FF stated the expectation would be that the nurse should have followed the physician orders. She stated the resident should have been given the [MEDICATION NAME] and the blood sugar should have been rechecked after 30 minutes. She confirmed she could find no documentation the blood sugar was rechecked and that physician was notified as ordered.",2015-11-01
8681,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,312,D,0,1,G6KB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure that adequate hygiene care related to fingernails was done for three (3) residents (# 31, # 39 and # 90) on a sample of thirty-six (36) residents. Findings include: 1. Review of the most recent quarterly Minimal Data Set ((MDS) dated [DATE] assessed resident # 39 as needing extensive assistance with personal hygiene that included nail care. Observation on 3/26/12 at 1:05 p.m., 3/27/12 at 8:40 a.m. and 11:23 a.m. and 3:27 p.m. revealed the resident had fingernails that were long and filled with a brown substance underneath. Interview with Registered Nurse (RN) Unit 200 Manager BB on 3/27/12 at 3:07 p.m. confirmed the resident's finger nails were dirty. 2. Review of the most recent MDS assessment dated [DATE] for resident # 31 documented the resident was totally dependent on staff for hygiene that included nail care. During observation of the resident on 3/26/12 at 1:09 p.m., 3/27/12 at 8:44 a.m., 11:25 a.m. and 3:10 p.m. revealed the resident had long fingernails with brown substance underneath. Interview with the RN Unit Manager BB: on Unit 2 on 3/27/12 at 3:15 p.m. confirmed the resident's finger nails needed to be cleaned. 3. Review of the most recent MDS assessment dated [DATE] assessed resident # 90 as needing total assistance with personal hygiene. Observation on 03/26/12 at 2:27 p.m., 3/27/12 at 8:10 a.m., 12:01 p.m. and again at 3:12 p.m. revealed the resident to be in bed with long fingernails and with a brown substance underneath them. Interview with the RN Unit 200 Manager on 3/27/12 at 3:15 p.m. confirmed the resident's finger nails needed to be cleaned.",2015-11-01
8682,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,314,D,0,1,G6KB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed to report that a pressure ulcer dressing was soiled; failed to change a pressure ulcer dressing per physician's orders [REDACTED].#164). The sample size was thirty-six (36) residents. Findings include: Review of resident #164's Significant Change Minimum Data Set ((MDS) dated [DATE] noted that they were totally dependent on staff for activities of daily living. It assessed the resident as having experienced a non-prescribed weight loss, and currently had pressure ulcers. [DIAGNOSES REDACTED]. A Resident Weekly Skin Check Sheet dated 02/24/12 noted new reddened areas below the right fifth toe, right hip, and left ankle. A Patient Nursing Evaluation dated 03/05/12 noted the Braden Scale assessed the resident as high risk for pressure ulcer development, with risk factors of needing staff assist to move; bed or chair bound; dementia; and malnutrition. A [MEDICATION NAME] lab (used to detect protein-calorie malnutrition) done on 03/05/12 was 9 (normal 16-39). physician's orders [REDACTED]. The Treatment Record scheduled these to be done once on the 7:00 a.m. to 3:00 p.m. (7-3) shift, and once on the 3:00 p.m. to 11:00 p.m. (3-11) shift. On 03/28/12 at 10:03 a.m., the Treatment Licensed Practical Nurse (LPN) was observed performing wound care for resident #164, and was assisted by Certified Nursing Assistant (CNA) AA. The dressing to the sacral area was dated 3/27. The bottom third and up the left side of the dressing was soiled with stool. When the sacral dressing was removed, the resident was noted to have a large Stage IV pressure ulcer. On 03/28/12 at 10:56 a.m., CNA AA stated she came to work at 7:00 a.m. that morning, and that the sacral dressing was soiled with stool at that time. At 11:00 a.m., the Treatment LPN stated the medication nurses did skin assessments on all residents weekly. She stated that she was not aware of any reddened areas noted on the 02/24/12 Skin Assessment until 02/27/12, when a CNA told her. In addition, she said that the sacral dressing that she changed that morning was the same dressing she applied yesterday morning. She stated the order was to change the dressing twice a day, and there was no documentation on the Treatment Record that the dressing scheduled to be changed on the 3-11shift on 03/27/12 was ever done. On 03/28/12 at 3:15 p.m., the Director of Nurses (DON) stated they just completed an inservice with staff including reporting when they noted a soiled dressing, and to do treatments as ordered. On 03/29/12 at 10:15 a.m., the DON provided a facility policy on Preventative Skin Care, which noted to report to the charge licensed nurse any signs and symptoms of skin issues, including redness.",2015-11-01
8683,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,441,D,0,1,G6KB11,"Based on observation, record review and staff interview, the facility failed to ensure appropriate hand washing procedure was followed during assistance with feeding one resident (# 209) on a sample of thirty-six (36) residents. Findings include: During an observation of the dining experience on the West Wing on 3/26/12 at 12:45 p.m., Certified Nursing Assistant (CNA) GG was observed preparing to feed resident # 209. The CNA had finished feeding another resident in same the room and proceeded to provide assistance to resident # 209. The CNA did not wash her hands before beginning the care of this resident. She proceeded to turn the resident in bed, adjust the resident's feet on pillows. She adjusted the residents head on a pillow and raised the head of the resident's bed. The CNA did not wash her hands between the two residents. In addition she did not wash her hands after positioning the resident before she began feeing the resident. During an interview on 3/29/12 at 10:05 a.m., Registered Nurse (RN) FF stated the CNA should have washed her hands before feeing the resident and further stated hand sanitizer is provided for the staff to put in their pocket to use. During an interview on 3/29/12 at 10:20 a.m., CNA GG stated she forgot to wash her hands and was aware she should have. She also stated there was hand sanitizer on the medication carts for the nurses, but stated she did not have any in her pocket to use. Review of the facility Hand Hygiene Policy indicated the hands should be washed between resident contact, after touching bare parts of the body, and before and after eating or handling food.",2015-11-01
8684,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,502,D,0,1,G6KB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure that laboratory test were done as ordered by the physician for one (1) resident (# 31)on a sample of thirty-six (36) residents. Findings include: Review of current March 2012 physician order [REDACTED].# 31 was to have a basic medical profile (BMP) done every six (6) months for the [DIAGNOSES REDACTED]. Review of the resident's record revealed there was no evidence that a BMP had been done since 6/05/11, which was nine months before. This resident also had a physician order [REDACTED]. Interview with the Unit 200 Nurse Manager BB on 3/28/12 at 9:31 am confirmed that the BMP laboratory test had not been done every 6 months as ordered by the physician. Furthermore she could not show evidence of when the last lipid panel was done.",2015-11-01
8685,SIGNATURE HEALTHCARE OF SAVANNAH,115120,815 EAST 63 STREET,SAVANNAH,GA,31405,2012-03-29,514,D,0,1,G6KB11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure that all of the current plans of care were kept with the active clinical record for one (1) resident (# 164). The sample size was thirty-six (36) residents. Findings include: Review of resident # 164's clinical record revealed that they were readmitted to the facility after a hospitalized from [DATE]-03/05/12. Prior to the hospitalization and upon readmission, the resident had multiple pressure ulcers, weight loss, and a feeding tube. Review of the resident's current medical record kept at the nurse's station revealed that it only contained care plans for Impaired Breathing Pattern; Altered Cardiac Output; [MEDICAL CONDITION]; and Resuscitation status. When the overflow record was requested from the Medical Records department, it was noted to contain all of the other care plans, including pressure ulcers and nutrition. On 03/28/12 at 3:35 p.m., Licensed Practical Nurse (LPN) MDS (Minimum Data Set) Case Manager DD verified that resident # 164's care plans had been moved to the overflow chart, and since the resident was only gone seven days, all of their records should have been available on the current chart.",2015-11-01
9357,JOE-ANNE BURGIN NURSING HOME,115272,321 RANDOLPH STREET,CUTHBERT,GA,39840,2012-03-29,279,D,1,0,ZZLX11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, the facility failed to develop a comprehensive care plan which included indwelling Foley catheter use for one (1) resident (#2) from a survey sample of eight (8) residents. Findings include: Please cross refer to F315, example 1, for more information regarding Resident #2. Record review for Resident #2 revealed that the Resident Care Plan documented the resident's admitted as 05/02/2011. A May 2011 physician's orders [REDACTED].#2 to have an indwelling Foley catheter to bedside drainage, with catheter care to be provided twice daily. Observation of Resident #2 on March 28, 2012 at 3:15 p.m. revealed that the resident had an indwelling Foley catheter in place. However, further review of the Resident Care Plan for Resident #2 revealed that the facility had failed to develop a plan of care for the indwelling Foley catheter.",2015-07-01
9358,JOE-ANNE BURGIN NURSING HOME,115272,321 RANDOLPH STREET,CUTHBERT,GA,39840,2012-03-29,282,D,1,0,ZZLX11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, the facility failed to follow the plan of care for one (1) resident (#2) regarding fluid restriction, and for one (1) resident (#3) regarding an enteral tube feeding, from a survey sample of eight (8) residents. Findings include: 1. Please refer to F309 for more information regarding Resident #2. Record review for Resident #2 revealed that the resident's March 2012 physician's orders [REDACTED]. A Resident Care Plan entry of 05/15/2011 identified a problem of the resident having the potential for alteration in cardiac output related to [DIAGNOSES REDACTED]. Interventions to address this noted problem included to encourage adequate fluid intake, while observing any ordered fluid restrictions. However, review of Resident #2's Intake and Output sheet revealed that during March 2012, the facility had given Resident #2 fluid in amounts which exceeded the physician's 1000 cc per 24 hour fluid restriction order on twelve (12) days in amounts ranging from 1277 ccs to 2134 ccs per 24 hours. 2. Please cross refer to F328 for more information regarding Resident #3. Record review for Resident #3 revealed a 03/02/2012 Care Plan entry identifying that the resident was dependent on tube feeding for nutrition, with an Approach to administer tube feedings as ordered. A physician's orders [REDACTED]. The resident's March 2012 medication record documented that on 03/02/2012, [MEDICATION NAME] was initiated at 30 mls per hour per gastrostomy tube, and on 03/03/2012, the resident received [MEDICATION NAME] at 35 mils per hour per gastrostomy. Then, on 03/04/2012, the resident began receiving [MEDICATION NAME] at 40 mls per hour. However, this medication record further documented that the formula continued at the rate of 40 mls per hour until 03/28/2012, with no documented additional attempts after 03/04/2012 to increase the resident's formula rate as ordered by the physician on 03/02/2012, even though there was no evidence to indicate that the resident failed to tolerate the last rate increase on 03/04/2012.",2015-07-01
9359,JOE-ANNE BURGIN NURSING HOME,115272,321 RANDOLPH STREET,CUTHBERT,GA,39840,2012-03-29,309,D,1,0,ZZLX11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure that one (1) resident (#2), who was on fluid restriction, received the ordered amount of fluids, from a survey sample of eight (8) residents. Findings include: Record review for Resident #2 revealed an Admission/Readmission Care Plan sheet which documented an admission date of [DATE], and also documented that the resident had [DIAGNOSES REDACTED]. The resident's March 2012 physician's orders [REDACTED]. However, review of Resident #2's Intake and Output sheet revealed that the resident was given over the ordered 1000 ccs. of fluid per twenty-four (24) hour period on the following dates in the following amounts: on 03/01/2012, 2084 ccs; on 03/02/2012, 1912 ccs; on 03/04/2012, 1374 ccs; on 03/05/2012, 2091 ccs; on 03/06/2012, 1297 ccs; on 03/08/2012, 1277 ccs; on 03/09/2012, 1315 ccs; on 03/10/2012, 1677 ccs; on 03/21/2012, 1915 ccs; on 03/22/2012, 2134 ccs; on 03/24/2012, 1320 ccs; and on 03/25/2012, 1320 ccs. Based on the above, during March 2012, the facility had given Resident #2 fluid in amounts which exceeded the physician's 1000 cc per 24 hour fluid restriction order on twelve (12) days in amounts ranging from 1277 ccs to 2134 ccs per 24 hours. During an interview with Nurse ""EE"" conducted on 03/28/2012 at 2:15 p.m., this nurse stated that the certified nursing assistants were responsible for keeping up with resident fluid intake.",2015-07-01
9360,JOE-ANNE BURGIN NURSING HOME,115272,321 RANDOLPH STREET,CUTHBERT,GA,39840,2012-03-29,315,D,1,0,ZZLX11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the facility's policy for indwelling urinary catheter care, and staff interview, the facility failed to provide the appropriate urinary catheter care for two (2) residents (#2 and #3), from four (4) residents with indwelling urinary catheters, on a total survey sample of eight (8) residents. Findings include: 1. During observation of Certified Nursing Assistants (CNAs) ""AA"" and ""BB"" performing Foley catheter care for Resident #2 on March 28, 2012 at 3:15 p.m., these CNAs utilized wipes to wipe downward on either side of the Foley catheter tubing during pericare, and used [MEDICATION NAME] swabs to wipe the peri area on either side of the catheter tubing as well. However, the CNAs failed to clean the Foley catheter tubing at the insertion site at all. 2. During observation of CNAs ""CC"" and ""DD"" performing Foley catheter care for Resident #3 on March 28, 2012 at 3:35 p.m., these CNAs used wipes to wipe downward on either side of the Foley catheter during peri care, and used [MEDICATION NAME] swabs to wipe downward on either side of the peri area, but they failed to clean the Foley catheter tubing from the proximal to the distal end. Rather, the CNAs used a [MEDICATION NAME] swab to wipe one time on the top of the catheter tubing. Also, during the observation referenced above, the resident's Foley catheter tubing was not secured to the leg either prior to or after the completion of catheter care. The facility's policy for the care of indwelling Foley catheters was reviewed, and it was determined that the policy did not include cleansing of the Foley catheter tubing. This was acknowledged by the Director of Nursing during interview on 03/29/2012 at 12:15 p.m..",2015-07-01
9361,JOE-ANNE BURGIN NURSING HOME,115272,321 RANDOLPH STREET,CUTHBERT,GA,39840,2012-03-29,328,D,1,0,ZZLX11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed to follow the physicians' orders for a gastrostomy tube feeding, and failed to clarify the length of administration for an intravenous solution, for one (1) resident (#3) from a total survey sample of eight (8) residents. Findings include: Record review for Resident #3 revealed a Physician's Orders and Progress Notes sheet with a 03/01/2012 entry which documented that the resident had a gastrostomy tube. A 03/02/2012 physician's order on this Physician's Orders and Progress Notes sheet ordered [MEDICATION NAME] at 30 milliliters (mls) per hour per gastrostomy tube, and to advance by 5 ml increments every 24 hours as tolerated. Review of the resident's March 2012 medication record revealed a 03/02/2012 entry indicating that [MEDICATION NAME] was initiated at 30 mls per hour per gastrostomy tube on that date. A Progress Notes entry of 03/02/2012 at 10:24 p.m. which documented that [MEDICATION NAME] was infusing at 30 mls per hour, with no distress noted at that time. A 03/03/2012 notation on the medication record documented that the infusion rate had increased and that the resident received [MEDICATION NAME] at 35 mils per hour per gastrostomy tube on that date. A Progress Notes entry of 03/03/2012 at 10:08 a.m. documented that [MEDICATION NAME] was infusing at 35 mls per hour, and a Progress Notes entry of 03/03/2012 at 6:15 p.m. documented that the gastrostomy tube site was intact and patent, with no distress noted. A 03/04/2012 entry on the medication record documented that Resident #3 began receiving [MEDICATION NAME] at 40 mls per hour per gastrostomy tube, but also documented that the formula continued at that rate until 03/28/2012. Record review revealed no documented attempts after 03/04/2012 to increase the resident's formula rate by 5 mls per hour every 24 hours as tolerated, as originally ordered by the physician on 03/02/2012, even though further record review revealed no evidence to indicate that the resident failed to tolerate the last rate increase to 40 mls per hour on 03/04/2012. Observation of Resident #3 on 03/28/2012 at 3:35 p.m. revealed that the resident was receiving [MEDICATION NAME] at 40 mls per hour. During an interview with Nurse ""FF"" conducted on 03/29/2012 at 4:15 p.m., this nurse acknowledged that nursing staff failed to follow the physician's orders for the tube feeding formula for Resident #3. Additional record review for Resident #3 also revealed a 03/20/2012 physician's order for Normal Saline intravenously at 75 mls per hour. However, the physician's order did not indicate the length of time the resident was to receive this intravenous fluid, nor was there evidence to indicate that facility staff made attempts to clarify the duration of this therapy. The resident's March 2012 medication record documented that the resident had begun receiving Normal Saline at 75 mls per hour on 03/20/2012, and that this intravenous therapy had continued through 03/28/2012. It was not until 03/28/2012, the second day of this complaint survey, that facility staff contacted the physician and received an order to discontinue this intravenous fluid. During an interview with Nurse ""EE"" conducted on 03/29/2012 at 4:15 p.m., this nurse acknowledged that the licensed nursing staff failed to clarify with the physician how long to run the intravenous Normal Saline for Resident #3.",2015-07-01
9362,JOE-ANNE BURGIN NURSING HOME,115272,321 RANDOLPH STREET,CUTHBERT,GA,39840,2012-03-29,502,D,1,0,ZZLX11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to obtain a urine culture and sensitivity laboratory test as ordered by the physician for one (1) resident (#2) from a survey sample of eight (8) residents. Findings include: Record review for Resident #2 revealed a 03/15/2012 physician's orders [REDACTED]. The Laboratory Report for this 03/15/2012 urinalysis revealed two-plus protein, one-plus occult blood, a three (3) to ten (10) white blood cell result, and ""many bacteria"". A 03/16/2012 physician's orders [REDACTED]. However, further record review revealed no evidence of a urine culture and sensitivity done as ordered on [DATE] or thereafter. During interview with the Director of Nursing on 03/28/2012 at 5:25 p.m., the DON acknowledged that the ordered 03/16/2012 urine culture and sensitivity had not been done.",2015-07-01